Neurology is a specialized field of medicine dealing with disorders of the nervous system. Neurologists diagnose and treat diseases such as Alzheimer’s, Parkinson’s, stroke, multiple sclerosis, epilepsy, migraines, and more. However, there is a shortage of neurologists in many parts of the world. This article will explore the reasons for the relatively small number of neurologists.
High barriers to entry
Becoming a neurologist requires a long and rigorous education and training pathway. After finishing a 4-year undergraduate degree, aspiring neurologists must complete 4 years of medical school to earn their MD. Then they embark on a 4-year neurology residency where they gain hands-on clinical training under the supervision of experienced neurologists. Many then go on to pursue 1-2 years of additional subspecialty fellowship training in an area like stroke, epilepsy, or neuromuscular disorders. In total, it takes approximately 12-14 years of post-high school education and training to become a practicing neurologist. This lengthy process deters many from pursuing the specialty.
Competitive residency positions
There are a limited number of neurology residency positions available. In 2020, there were only 1,299 neurology residency positions offered in the United States for U.S. medical school graduates. Yet the number of applicants was 1,868, meaning there were almost 600 more applicants than available positions, making neurology a very competitive specialty to match into. Many medical students interested in neurology end up matching into other specialties instead due to the lack of neurology residency spots.
Demanding training
The neurology residency consists of long hours and intense training in the diagnosis and management of complex neurological conditions. The hours and stress cause some trainees to drop out of the neurology pathway and switch into less demanding specialties. A 2014 study found the neurology residency has one of the highest burnout rates among medical residents.
Lower salaries
Neurologists earn modest salaries compared to other medical specialists. In 2020, the median salary for neurologists in the U.S. was only $237,000. By comparison, dermatologists earned a median of $381,000 and orthopedists earned $497,000. The lower earning potential makes neurology financially less appealing compared to other medical careers. Medical students with large student loan debts may be deterred from neurology for this reason.
Specialty | Median Salary |
---|---|
Neurology | $237,000 |
Dermatology | $381,000 |
Orthopedics | $497,000 |
High cost of malpractice insurance
The cost of malpractice insurance is very high for neurologists due to the high risks associated with treating brain, spine, and nerve disorders. Premiums can exceed $100,000 per year in some states. This further reduces take-home pay, making neurology less financially viable.
Challenging working conditions
Neurological disorders like dementia, stroke, and Parkinson’s present complex diagnostic and treatment challenges. The work is intellectually demanding and requires excellent critical thinking and problem-solving skills. Patients often have progressive incurable diseases and poor prognoses, which can be emotionally taxing for neurologists. The specialty also typically involves being on-call nights and weekends to handle emergencies like strokes or seizures. These difficult working conditions lead some medical residents to pick other specialties.
High burnout rates
A 2018 survey found that 46% of neurologists experience symptoms of burnout. The demanding workload coupled with the difficulties of managing chronic neurologic diseases contribute to high rates of exhaustion and career dissatisfaction. Some neurologists decide to retire early or leave the specialty mid-career due to burnout.
Inadequate exposure to neurology in medical school
Medical students often have minimal clinical rotations in neurology compared to higher-profile specialties like internal medicine and surgery. A lack of exposure during medical school years means students fail to gain an adequate understanding of neurology. Without opportunities to get first-hand experience in the diagnosis and treatment of neurological disorders, medical students are less likely to choose neurology for residency. Expanding neurology rotations in medical school could help address this pipeline problem.
Lack of neurology research funding
Governmental and private research funding for neurology pales in comparison to other disease areas like cancer and cardiovascular disease. Inadequate funding slows advancements in understanding neurological disorders. With less money to support research, fewer academic neurology positions become available for physicians who want to split time between research and clinical care. This can deter prospective neurologists who have a strong interest in research.
Declining interest in the brain
Compared to fields like cardiology and oncology, there seems to be declining medical student interest in the nervous system. Applications to neurology residencies have decreased by 20% over the past decade. With fewer medical graduates specializing in neurology each year, the workforce supply is reduced. Causes for declining interest may include lack of exposure in medical school, lower salaries, and perceived difficulty of the specialty.
Shortage of neurologic subspecialists
There are shortages of neurologists in subspecialties like neurosurgery, neuromuscular medicine, neurocritical care, and child neurology. These areas require additional fellowship training beyond the neurology residency. Few neurology graduates want to prolong training with lengthy fellowships due to large opportunity costs. Loan repayment programs could incentivize neurologists to pursue extra subspecialty training.
Inadequate access in rural areas
Neurologists tend to cluster in urban academic medical centers and hospitals. Neurologists are far less prevalent in rural areas where patients must travel long distances to seek care. Incentive programs like loan repayment could attract more neurology graduates to practice in rural underserved regions. Telemedicine can also help expand access to neurologic expertise in remote areas.
Conclusion
The road to becoming a neurologist is long and challenging. Modest pay, high stress, burdensome training requirements, and lack of research funding discourage many from entering the specialty. Exposure to neurology in medical school is often inadequate. Interest in neurology as a career seems to be waning among students compared to other specialties. Additionally, neurologic subspecialists and neurologists in rural areas are especially scarce. Addressing these multifaceted issues will be critical for attracting more talent to the field of neurology and reducing shortages.