The Workforce Task Force Report
Clinical implications for neurology
Abstract
The American Academy of Neurology Workforce Task Force (WFTF) report predicts a future shortfall of neurologists in the United States. The WFTF data also suggest that for most states, the current demand for neurologist services already exceeds the supply, and by 2025 the demand for neurologists will be even higher. This future demand is fueled by the aging of the US population, the higher health care utilization rates of neurologic services, and by a greater number of patients gaining access to the health care system due to the Patient Protection and Affordable Care Act. Uncertainties in health care delivery and patient access exist due to looming concerns about further Medicare reimbursement cuts. This uncertainty is set against a backdrop of Congressional volatility on a variety of issues, including the repeal of the sustainable growth rate for physician reimbursement. The impact of these US health care changes on the neurology workforce, future increasing demands, reimbursement, and alternative health care delivery models including accountable care organizations, nonphysician providers such as nurse practitioners and physician assistants, and teleneurology for both stroke and general neurology are discussed. The data lead to the conclusion that neurologists will need to play an even larger role in caring for the aging US population by 2025. We propose solutions to increase the availability of neurologic services in the future and provide other ways of meeting the anticipated increased demand for neurologic care.
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Information & Authors
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© 2013 American Academy of Neurology.
Publication History
Received: February 27, 2013
Accepted: April 16, 2013
Published online: June 19, 2013
Published in print: July 30, 2013
Disclosure
W. Freeman has no conflicts of interest or pertinent financial disclosures. K. Vatz has no conflicts of interest or pertinent financial disclosures. R. Griggs is past-President of the American Academy of Neurology and has no conflict of interest or pertinent financial disclosures. T. Pedley receives a stipend from the AAN as President and royalties from UpToDate and 3 textbooks that he has edited. Go to Neurology.org for full disclosures.
Study Funding
No targeted funding reported.
Authors
Author Contributions
Dr. Freeman: drafting/revising the manuscript for content. Dr. Vatz: drafting/revising the manuscript for content. Dr. Griggs: drafting/revising the manuscript for content. Dr. Pedley: initial discussions and objectives, drafting/revising the manuscript for content.
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We appreciate the comments by Drs. Hodgson and Lukas concerning factors that affect decisions trainees make about choice of subspecialties, and the potential impact of those decisions on the composition of future neurology workforces. We are uncertain if the number and types of neurology subspecialty fellowships will increase or decrease over time, due to future economic pressures in health care, especially those associated with cuts in graduate medical education (GME) funding. Significant reduction in GME funding could lead to decreased residency/fellowship slots due to the medical school-residency "mismatch" recently described by Iglehart in an opinion piece in the New England Journal of Medicine. [1] Hodgson and Lukas correctly point out the accreditation process itself may have resulted in increased subspecialization in neurology independent of the patient demand or medical need for these subspecialties. [2] Much, however, will still depend upon economic priorities as determined by policymakers, especially with regard to graduate medical education (GME) funding. Ultimately, optimizing specialty and subspecialty allocations will likely require a restructuring of both the medical school experience (as is already being done at many centers) and graduate medical education, as well as the development of new models of financing both medical school and GME. /p>
1. Iglehart JK. The Residency Mismatch. N Engl J Med 2013; 369:297- 299. /p>
2. Hodgson TS, Brorson JR, Ardelt AA, Lukas RV. Accrediting neurology fellowships accelerates subspecialization. Front Neurol 2013;4:94.
For disclosures, contact the editorial office at [email protected].
Dall et al. noted that the future supply of neurologists will be affected by the increasing subspecialization of younger neurologists. The decision to subspecialize is a highly personal decision that may not be driven by patient demand. [2] This, in addition to the geographic distribution of neurologists demonstrated by Dall et al., could lead to an oversupply in a few subspecialties and a shortfall in others. All of this will be in the context of upcoming economic challenges described in the recent report by the AAN Workforce Task Force. [3] Given the potentially large impact of increasing subspecialization, it is important to monitor the effects of new accreditations that are being created for neurology fellowship programs by the American Board of Psychiatry and Neurology and United Council for Neurologic Subspecialties. [4]
1. Dall TM, Storm MC, Chakrabarti R, et al. Supply and demand analysis of the current and future US neurology workforce. Neurology 2013;81:470-478.
2. American Academy of Neurology. 2011 AAN Resident ?Survey Final Report. St. Paul: American Academy of Neu- rology; 2011. Available at http://www.aan.com/globals/ axon/assets/9124.pdf. Accessed June 15, 2012.
3. Freeman WD, Vatz KA, Griggs RC, Pedley T. The Workforce Task Force Report: Clinical implications for neurology. Neurology;2013: 81:479- 486
4. Hodgson TS, Brorson JR, Ardelt AA, Lukas RV. Accrediting neurology fellowships accelerates subspecialization. Front Neurol 2013;4:94. Available at http://www.frontiersin.org/Neurology_Education/10.3389/fneur.2013.00094/full
For disclosures, please contact the editorial office at [email protected].