The Role of Organizations and Individuals in Addressing the Neurologist Shortage

Jennifer Majersik, MD, MS

This is a 2-part interview. To view part 1, click here.

The need for more neurologists remains a glaring issue within the medical community, as an aging population that is growing presents more patients who may be at risk of developing neurologic diseases and conditions. Although there are more neurologists in the field than have been historically, stigmas surrounding the field and questions regarding fair compensation present obstacles when it comes to attracting recent medical school graduates seeking debt relief. Jennifer Majersik, MD, MS, spoke with NeurologyLive on the shortage, which she and colleagues addressed in a report from the American Academy of Neurology (AAN) 2019 Transforming Leaders Program. 

The report, entitled “A Shortage of Neurologists – We Must Act Now,” calls attention to the issue, further presenting strategies for improvement, namely shaping the demand, enhancing the workforce, and advocating for neurologist value. According to Majersik, who is chief of the division of vascular neurology and professor of neurology at the University of Utah, during research efforts, investigators became more aware of small steps that individuals can take, emphasizing the importance of getting “some boots on the ground” outside of organizational efforts. 

Majersik further addressed the role of advanced practice providers and the potential to integrate their skill sets into the neurology field. Individual neurologists also play a key role in increasing interest in neuroscience, with strategies as simple as talking positively about experiences to students or as far-reaching as taking on legislative advocacy to address salary in neurology and other cognitive fields. 

NeurologyLive: What is the American Academy of Neurology’s role, and how can other similar organizations get involved in a concerted effort to address this shortage?

Jennifer Majersik, MD, MS: The AAN is really the main professional organization in the United States that looks out for the interest and needs of neurologists, and so this is critical to their mission. The AAN wants to be integral to all the neurologists and as such, they've taken this issue very seriously. In fact, it was them who commissioned this question for us to write this paper. Years ago, they received funding to conduct a study on why medical students go into certain fields, and we would like to see that work continued now, in terms of how to get people to stay in neurology. We think there's many different areas that they can help in, and one of them is just having…neurologists become aware of this issue so that they can make individual changes in their own areas, but we had several other things that we thought that could be done.

The AAN has a huge advocacy arm that is done primarily through BrainPAC, but also through their advocacy arm that's not within BrainPAC, and so making and trying to enact changes in law, both at state and federal levels, for things such as compensation, or for attracting international medical graduates, to be able to stay in our country, or increasing telemedicine, so that our reach as neurologists can be farther—all of those things are really important.

There's another area [such as] integrating advanced practice providers. Those would be nurse practitioners and physician's assistants, having training programs for them, which they actually did this year—they have a whole separate section, just on training physician's assistants in the field of neurology. Maybe integrating persons who are APCs [advanced practice clinicians] into our teams can help us meet the needs as well, even if they aren’t a traditional MD pathway. 

It’s almost as if the more we looked, the more we saw that the AAN could do, but we also think that this is an effort that individual neurologists should play a role in, even outside of those organizational efforts, because some boots on the ground are really necessary.

What can current neurologists and specialists do to help achieve these goals?

That’s a great question, and it's something that we thought about a lot. The 10 neurologists who wrote this paper, all of us were [only] a little unaware of how bad the problem was, until we started digging into the data. And then, through this program we were in, we would meet every month, and we started sharing stories about what we were doing individually to help improve it. That’s when we became aware that there are the small steps that each of us can make. 

Some of it is as simple as, if you work in an academic institution and you have medical students, putting on your best face for that medical student really talking about why you love your field. Or if you get invited to do something at the high school about neuroscience, taking that opportunity to talk about how great and fulfilling a career in the neurosciences can be, so you start early and young. Others are things like talking to your administration about making sure that neurologists are compensated fairly, or [taking initiative] like one of my colleagues, [who] got his administration to pay for his APCs and his group to go to the American Academy of Neurology meeting. So, saying, “Hey, these are integral members of our team, we should be paying for educational opportunities for them.”

In my clinic now, when patients come in and say, “It took me forever to get in to see you,” and they're really upset, I actually talk about the national shortage of neurologists now. I think that blends into the other thing, [which] is that patients can have a role to play. I know this isn't a patient forum, but there are patient advocacy groups. When patients go to Capitol Hill and say, “We need we need x, y, z,” they often listen. So, to say, “We need more neurologist in our community. My husband has Parkinson [disease], and he can't see somebody for 3 months, and he's fallen,” or whatever the case may be, those stories are very powerful. On the neurology side, if we can match up with patients, I think we can make an even bigger difference. We want to multiply our efforts.

Transcript edited for clarity.

REFERENCE

Majersik JJ, Ahmed A, Chen IA, et al. A shortage of neurologists – we must act now: A report from the AAN 2019 transforming leaders program. Neurology. Published online April 30, 2021. doi:10.1212/WNL.0000000000012111