Attracting More Medical Students to Neurology

April 09, 2019

Including a mandatory clinical neurology experience in the medical school curriculum is one of the key actions necessary to attract more medical students into the neurology specialty and help address the shortage of neurologists in the United States, results of a new study suggest.

The study, which analyzed questions to medical students on their intended area of practice, was published online in Neurology on March 29.

An accompanying editorial adds that more funded neurology residencies are also needed, along with better neurology education and training for primary care doctors and other specialists.

The study authors, led by Laurie Gutmann, MD, University of Iowa, Iowa City, point out that there is a large unmet need for neurologic care, with 50 million Americans diagnosed with a new neurologic disorder each year, but only 16,000 neurologists practicing, giving a workforce deficit of 11% that is projected to increase to 19% by 2025.

Despite this, the percentage of medical students entering neurology has been persistently inadequate (at 2.6%/year), with only 421 graduates of US allopathic (MD-granting) medical schools expressing an intent to specialize in neurology in 2017.

The current study aimed to explore the factors that influence medical students to choose neurology or nonneurologic specialties as a career based on Association of American Medical Colleges (AAMC) questionnaires completed at the end of the first year of medical school and at the time of graduation for the graduation years 2013 to 2014 through 2016 to 2017.

"The AAMC sponsors the Liaison Committee on Medical Education, which is the accrediting body for US MD-granting medical colleges, limiting the dataset to US allopathic medical students," the authors note.

Results showed that of the 51,816 students with complete data, 1456 (2.8%) indicated an intent to enter a neurology residency.

Factors associated with an increased likelihood of entering neurology included a student's rating of excellent for their basic neuroscience course and neurology clerkship, participation in an MD/PhD program, and majoring in neuroscience or psychology as an undergraduate.

Factors associated with a decreased likelihood of entering neurology were a higher-priority response for salary, work/life balance, and personal fit of the specialty.

The researchers say that the data suggests "several approaches to increase the number of medical students entering neurology, including a focus on the student-reported quality of the basic neuroscience course and neurology clerkships, targeted engagement with MD/PhD students, and mentoring programs for students interested in neurology."

"Efforts to improve salaries for neurologists, to reduce medical school debt, and to improve work/life balance may also help to attract more students."

They conclude: "We hope that the finding from this study will help guide changes in the medical school curriculum and garner support for other measures proposed to increase students' interest of neurology as a medical specialty."

More Residency Places Needed

In their accompanying editorial, Zachary N. London, MD, University of Michigan, Ann Arbor, and Robert Greenwood, MD, University of North Carolina, Chapel Hill, agree that improving the neurology content of the medical degree will help the situation but say other moves are also needed, including more funded neurology residencies and better neurology education and training for primary care doctors and other specialists.

They point out that the current study only focused on students from US allopathic medical schools and did not take into account the large number of foreign students entering the neurology field.

"More than half those matched into neurology this year did not come from US allopathic medical schools. They are also coming from osteopathic medical schools and from overseas," London told Medscape Medical News.

He noted that funded neurology residency places this year increased slightly from 839 in 2018 to 883 in 2019.

"In spite of that, the number of US senior medical students choosing neurology dropped, and more residency places went to non-US applicants," London said.

While some of these non-US applicants will end up going back to their home countries to practice, often they are allowed to stay in the United States with the condition that they practice in an underserved community, he explained. "These individuals fulfill a large unmet need."

"Yes, we need to do better in encouraging students into neurology, but we need to do that with both allopathic and osteopathic US medical students and with those from outside the US," he stressed.

"At the end of the day we need to provide more neurology residency places," London stated. He noted that while most residency places are government funded, some are paid for by the individual institutions. "We have to convince our hospitals they want to spend their money on neurology residencies rather than other disciplines. This can be difficult as neurology generally isn't a large income-generator for hospitals."

He believes the decision to go onto neurology is driven mainly by personality. "Historically neurology has attracted cerebral individuals who enjoy the diagnostic process and using the physical exam to make decisions — which is almost unique now among medical specialties. It's also a great field for research, so it attracts many PhD students," he noted.

But — most importantly in London's view — better efforts are needed to train doctors and healthcare professionals outside the neurology specialty in the care of patients with neurological conditions.

"A large percentage of patients are cared for by family doctors, nurse practitioners, and internal medicine doctors. Better neurology training and continuing medical education for these disciplines is essential," he said.

This study was funded by a grant from the Conrad N. Hilton Foundation to the American Academy of Neurology (AAN). Gutmann has received research funding from National Institute of Neurological Disorders and Stroke (NINDS)/NIH. London and Greenwood have disclosed no relevant financial relationships.

Neurology. Published online March 29, 2019. Abstract, Editorial

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