Page 75 - Read Online

Williams et al. Neurology fellowship

increased its programs by only 10.6% in 13 years, with number of clinical neurologists in the USA. [13,14] The
Clinical Neurophysiology increasing at 443% in 9 years, changes occurring in neurology residents and fellows
and Vascular Neurology. This most likely represents a over the past decade have been gradual and unique to
maturation of the subspecialty and the slowed growth each subspecialty. In addition to the well-established
[15]
rate one would expect with this. subspecialties there are residents seeking additional
training in less codified, but still important fields such
The existence of gender differences amongst as therapeutic development. [15]
Neurology subspecialty trainees can be noted.
Neurodevelopmental Disabilities (89%) and to a Viewed broadly, there is an evident steady increase
lesser degree Child Neurology (65%) demonstrate in the number of Neurology susbspecialty training
a disproportionate number of female trainees while programs and fellows. When looked at on a
Endovascular Surgical Neuroradiology (0%) and subspecialty by subspecialty basis the trends become
Vascular Neurology (26%) have a disproportionate more complicated. Some subspecialties such as
number of male trainees. While in some subspecialties Endovascular Surgical Neuroradiology have a limited
the proportion of female trainees remains relatively number of accredited programs and fellows that
stable, Neurodevelopmental Disabilities (89%), Child interpretation of trends is not feasible. The situation for
Neurology (65%), and Clinical Neurophysiology (51%) Endovascular Surgical Neuroradiology is particularly
all have a growing percentage of female trainees. It complicated as there are multiple training paths which
is unclear what exact effect the initial growth in the can be followed to reach this endpoint and there are
proportion of female Neurology residents peaking in a number of subspecialists, often situated in separate
2009-2010 at ~47%, and the subsequent decline will departments, including neurology, neurosurgery,
have on subspecialty career choices [Figure 1]. and neuroradiology who care for these patients
and have overlapping skill sets. The effects of the
DISCUSSION training background on patient outcomes have not
been thoroughly studied. Other recently accredited
The number of physicians in the United States subspecialties such as Neurovascular and Clinical
becomes larger and more diverse with each new Neuromuscular have demonstrated robust growth
class of graduating medical students. This influx of rates since inception (650% per year and 344.4%
new physicians benefits the medical community with per year, respectively). Other subspecialties, such
the supplementation of new physicians to an aging as Neurodevelopmental have shown little growth in
society and growing healthcare needs. Additionally the number of training programs (growth rate of 75%
these trainees will replace physicians lost to attrition per year) and a steady number of new fellows. These
via retirement or death. With over 120 specializations trends are most likely substantially affected by real or
for new medical graduates to choose from, medical perceived work-force demand, as has been previously
[12]
trainees have a broad range of potential career implied for some subspecialties. [16,17] Other factors
choices. With a predicted growth in the shortage of which likely influence career choice in neurologic
clinical neurologists, understanding the current career subspecialties include, but are not limited to, lifestyle
training choices made by Neurology trainees and factors such as salary, work hours, and duration and
the trends which these choices are following will be rigor of training as well as the factors which can influence
[18]
important for addressing the shortfalls predicted in the success in an academic career. Our study does not
address the underlying factors which influence these
trends, but merely describes them. This knowledge
helps facilitate strategic planning on how to best assist
supply meeting demand. While the details of how to
do so are beyond the scope of this study, they can
include various incentives to increased recruitment in
subspecialties facing deficits in clinicians.

Authors’ contributions
Developed the concept of the study: T.S. Hodgson,
R.V. Lukas
Analyzed the data: J.S.A. Williams, T.S. Hodgson, R.V.
Lukas
Figure 1: Trend in percentage of female neurology residents over Composed the manuscript: J.S.A. Williams, R.V.
time Lukas, T.S. Hodgson
Neuroimmunology and Neuroinflammation ¦ Volume 4 ¦ April 18, 2017 67