International Issues: An international survey of young neurologists' perceptions of future health care and neurology

Details on the Methods are in appendix e-1 on the Neurology® Web site at Neurology.org. The questionnaire is provided in appendix e-2.

The data presented are an effort to unveil the current visions of residents and young neurologists about the future of health care and neurology. The main finding was common optimism about health care as well as neurology. This enthusiasm is confirmed by the predominant plans to practice as a neurologist in 10 years. Interestingly, cross-border mobility might be considered, which corroborates the current interests in international relocation. The interest to relocate was prevailing and an increment of insufficient provision for neurologic service in certain areas can be anticipated. Hence, national bodies need to be aware of this mindset and counteract by raising the attractiveness for remaining in less attractive regions and countries.

Overall, young neurologists share the concerns of insufficient income and fear the subsequent impaired quality of life. The latter is viewed central in career decisions for the current generation of neurologists.⁷

Bradley⁸ proposed a rise in the number of medical graduates entering neurology residency between 2000 and 2020. The estimation was supported by the explosion of knowledge in neuroscience and potential insights into previously unclear disorders.⁹ There were differences among the demographic cohorts. The level of optimism was particularly high in Africans/Middle Easterners.

Regardless of the level of optimism, we inquired for potential reasons leading to constraints. An expected worsening of the health system was more important for colleagues from the European Union/EEA (43%) compared to Eastern Europe (10%) and Africa/Middle East (0%). Furthermore, there were differences in the expected consequences of the clinical and nonclinical workload, which were important reasons for skepticism in the European Union and Eastern Europe but not in Africa/Middle East.

The results of our survey highlighted that the upcoming generation of neurologists are aware of challenges related to demographic trends. The perception of subspecialties that will gain further importance included dementia, cerebrovascular diseases, cognitive neurology, and neurodegenerative diseases. Other relevant fields were movement disorders, sleep disorders, and multiple sclerosis, where bench to bedside approaches have been able to change diagnosis and treatment of disease over recent decades. Gene-based therapies and stem cell technology are predicted to have rapid development to delay or repair the progression of brain degeneration disease, as well as deep brain stimulation devices to treat the most serious cases of movement disorders.⁸ The respondents of this survey did not indicate neuroinfectious diseases to gain importance in the future, although the WHO rates infectious diseases as major issue that will gain further importance within the next years.¹⁰ This may be related to the recent development in many European countries that other disciplines have taken over the care of patients with neuroinfections (e.g., internal medicine, critical care medicine).

We assume a couple of biases and limitations of this study. First, a selection bias is likely, as participants of this international neurology course were self-nominated and mainly originating from academic departments, and more updated on the progress and demands in the wide spectrum of neurologic subspecialties. This recruitment bias may also support the tendency to consider relocation.

Our survey confirms neurology in the 21st century being a dynamic area of medicine, with constant advances and transitions.

Our data suggest that talented junior colleagues continue to be attracted to neurology and acknowledge ever-changing demands and upcoming challenges.

Three tables and two appendices; two Microsoft Word files and one PDF file.