Stroke care imperiled by impending shortage of vascular neurologists

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A talent void is pending among stroke specialists, according to a study published in the December issue of Stroke. The question posed by the authors is how to increase the number of young vascular neurologists entering the pipeline to compensate for losses.

According to Harold P. Adams Jr., MD, from Carver College of Medicine at the University of Iowa in Iowa City, and José Biller, MD, from Loyola University Chicago and the Stritch School of Medicine in Maywood, Ill., only 38 new physicians enter the specialty every year. This number derives from the 269 American Board of Psychiatry and Neurology-certified physicians who graduated from programs approved by the Accreditation Council for Graduate Medical Education between 2005 and 2012.

Meanwhile, they noted that of vascular neurologists currently practicing, around 5 percent are older than 65 years with a mean age in the field of 48 years. They expressed concerns that attrition will begin in the next few years due to death, retirement and changes in practice.

Much like concerns in recent years about pending nurse shortages, this dearth of cerebrovascular specialists could have a critical impact on healthcare.

They projected that the more than 800,000 strokes per year in the U.S. will grow in number along with an increasingly aging population. They wrote that not only is this a slow-growth field of medicine that is in high and growing demand, many areas, especially rural ones, already experience the pinch. Also, while underserved populations trend toward greater prevalence for stroke, few trainees are from diverse and underserved backgrounds.

Adams and Biller recommended changes to training programs and fellowships; increased colleague contact among trainees to allow them a greater support network in the field; increased availability of fellowships and stroke-care training to non-North American physicians and nonstroke specialists; and instituting changes that would provide increased compensation, debt remuneration and incentives for specialists and trainees to entice more physicians into the field.

They suggested incentives to improve coverage in underserved areas and rural areas. They noted that while telestroke and telemedicine may cover some of these concerns, incentives would help to bring more physicians to train in these areas as well.

Adams and Biller emphasized that whichever direction and form these changes take, “These efforts need to be started immediately. Time is short.”