Neurologist Shortage Projected to Worsen by 2025

As the incidence of Alzheimer's disease, Parkinson's disease, and other neurologic diseases linked to aging soars, the number of neurologists available to manage them is not growing apace.

A new study looking at the current number of neurologists and projecting future demand based on alternative scenarios suggests the current significant shortfall of neurologists, estimated at about 11%, will grow to 19% by 2025. The result will be longer wait times, difficulty in hiring new neurologists, and more neurologists declining Medicaid patients, the authors suggest.

"With the rapidly rising rates of brain diseases such as dementia and stroke at the same time as the number of US medical residents choosing neurology over other specialties is clearly declining, the US could face a crisis," senior author Thomas R. Vidic, MD, from Elkhart Clinic in Elkhart, Indiana, said in a statement. "Our study found that long wait times for patients to see a neurologist and difficulty finding neurologists to fill vacant positions are adding to the current national shortfall. In addition, the demand for neurologists is expected to grow as people gain coverage through health care reform."

The report is published online April 17 in Neurology.

Worsening Problem

Previous studies have already shown that wait times to see a neurologist are increasing, the researchers write. The average wait time for a new patient in 2010, for example, was 28.1 days vs 34.8 days in 2012, and 25.6 days for follow-up visits vs 30 days in 2012. In contrast, wait times for a new patient in neurosurgery is 24.1 days, 20.3 days for family practice, 16.8 for orthopedic surgery, and 15.5 days for cardiology.

Child neurology is one of the most short-handed specialties, the authors add; in 2012, 39% of children's hospitals reported having vacancies longer than 12 months for child neurologists, and wait times for new patients here are about 45 days.

For this study, the authors used a microsimulation supply model that simulates the likely career choices of individual neurologists, taking into account the number of new neurologists that are trained each year and changing demographics of the neurology workforce, they write.

On the other side of the equation, they used a microsimulation demand model that simulates the use of neurology services for each individual in a representative sample of the population state by state, and then for the country overall. These demand projections considered the increased prevalence of neurologic conditions associated with population growth and aging, as well as expanded insurance coverage for many patients under the Patient Protection and Affordable Care Act (PPACA).

Using these methods, they projected that the active supply of 16,366 neurologists practicing in 2012 will increase to 18,060 by 2025. However, the demand will outstrip this growth; demand for neurologists was already 18,180 in 2012, an 11% shortfall, and is projected in this study to grow to 21,440 by 2025, increasing that shortfall to 19%.

This includes an increased demand of 520 full-time equivalent neurologists starting in 2014 from expanded medical insurance coverage associated with institution of the PPACA, they note.

"In the absence of efforts to increase the number of neurology professionals and retain the existing workforce, current national and geographic shortfalls of neurologists are likely to worsen, exacerbating long wait times and reducing access to care for Medicaid beneficiaries," the authors conclude. "Current geographic differences in adequacy of supply likely will persist into the future."

Neurology on the Hill

The release of this new study coincides with the annual trip for neurologists to Capitol Hill to protect patient access to neurology services and to advocate for fair reimbursement for the cognitive care offered by neurologists. About 150 neurologists will participate in Neurology on the Hill, taking place next Tuesday, April 23, to encourage Congress to increase reimbursement for face-to-face time with neurologists, which they say is undervalued in the current Medicare system.

"Without fair and stable reimbursement, medical students and residents who have substantial education debt often are forced to seek more financially rewarding specialties than neurology," a statement from the American Academy of Neurology (AAN) says.

"We want Congress to act now to help alleviate this shortage at a time when baby boomers are aging and the number of people with Alzheimer's disease is expected to triple by 2050," said Timothy A. Pedley, MD, AAN president, in that release. "Neurologists are the physicians best suited to care for the 1 in 6 people currently affected by neurological disease. It is therefore vital that they have access to neurologists who are specially trained in treating brain diseases."

The study was supported by the AAN and an educational grant from Lilly, USA, LLC.

Neurology. Published online April 17, 2013. Abstract