, news that comes as no revelation to Thomas Vidic, MD, clinical associate professor of neurology at Indiana University, South Bend.
In 2013, Dr. Vidic and other members of an American Academy of Neurology Workforce Task Force coauthored a report that predicted the demand for neurologists would outstrip supply by 2025. A decade later, it appears the situation is even more dire than anticipated.
While a nationwide physician shortage is affecting all specialties, neurology is facing a particularly difficult confluence of events. Advances in treatments for migraine, epilepsy, multiple sclerosis, and other neurological disorders have created a growing demand for care of pediatric and adult patients.
Over the next 7-27 years, as the number of Americans over age 65 increases, the incidences of Parkinson’s and dementia are set to double, and stroke cases are expected to rise by 20%.
At the same time, physician retirement and burnout are siphoning off neurologists from a workforce that isn’t growing fast enough. The American Medical Association reports the number of neurologists who treat patients in the United States grew by only 598 over the last decade, from 12,761 to 13,359.
This perfect storm has created what another AAN report calls a “grave threat” to patient care. The neurologist shortage “reduces access to care, worsens patient outcomes, and erodes career satisfaction and quality of life for neurologists as they face increasingly insurmountable demands,” write the authors of that 2019 report.
“We’re in trouble,” said Dr. Vidic. “We have a tremendous need for neurologists that we’re just not supporting.”
How did we get here?
Some of the challenges related to neurologist recruitment and retention are similar to those in other specialties. Compensation is certainly a factor, Dr. Vidic said.
Although neurologists’ incomes have increased significantly over the past decade, they still rank in the lower half of all medical specialties. In addition, only 50% of neurologists believe they are fairly compensated.
Burnout is another significant challenge. In 2019, before the pandemic, 53% of neurologists surveyed in Medscape’s National Physician Burnout, Depression, and Suicide Report indicated they were burned out. That percentage increased slightly in 2023, to 55%, with most respondents reporting a strong to severe impact on their lives.
The most common reason for burnout was administration and paperwork that cuts into neurologists’ time with patients. Charting and completing prior authorization and step therapy forms required by most insurers take an average of 17.6 hours a week for neurologists – much longer than the overall physician average and higher than almost all other specialties.
But perhaps the biggest contributor to the nationwide neurologist shortage is a 26-year cap on Medicare funding for medical residency. Enacted as part of the 1997 Balanced Budget Act, the legislation limits Medicare funding for medical residency training at 1996 levels. Most medical residencies are funded by the federal government and Medicare is the largest participating program.
As a result of the cap, the number of total residents in the United States – which grew by 20.6% between 1987 and 1997 – increased by only 8% from 1997 to 2007.
A new study on patients’ long travel times to neurology clinics, published in Neurology, is the latest to illustrate the real-world impact of too few neurologists amid growing caseloads.
Researchers found that 17% of the 563,216 Medicare beneficiaries who visited a neurologist in 2018 had to travel an average of 81 miles one way. Those long distances were endured most often by patients with brain and spinal cord cancers, amyotrophic lateral sclerosis, and multiple sclerosis.
While the neurologist shortage affects every state, a 2020 study suggests rural areas are most affected. This analysis of Medicare recipients showed that just 21% of rural residents with a neurological condition had access to a nearby specialist, compared with 27% of urban dwellers. The findings are similar to those of a 2017 report that identified “neurology deserts” in a number of states across the country.
Wait times for new neurology patients are reported to be among the longest of all specialties, with an average of 30 days for adult patients and 5-6 months for pediatric patients.