By Cyndi Port, RosmanSearch, Inc.
If you have been trying to recruit a neurologist in the past few years, you have probably noticed that filling these positions is neither quick nor easy. You are not alone. A quick search of the American Academy of Neurology (AAN) website shows that there are currently over 500 open neurology positions. There are some recent trends in the neurology job market that might explain why hiring a neurologist has become so challenging.
The overwhelming need for many programs is a general neurologist, someone who can see a headache in the morning and a Parkinson’s patient in the afternoon. Neurology training programs, however, are by and large producing specialists. Whether it’s the physician’s desire to delve deeper into a specific area of neurology, or the residency programs encouraging residents to specialize, the fact is that according to the 2011 American Academy of Neurology Resident Survey, 86 percent of neurology residents intended to complete a fellowship, up from 78 percent percent in 2008.¹ It is becoming increasingly rare to find a neurologist looking to go into practice right out of residency.
The increase in neurological conditions with the aging population and the explosion of innovation in neurology created a situation where specialization became de riguer. There is so much more a neurologist can do now than even 20 years ago. Interventions are more common, more involved, and most importantly, more effective. For many of the neurologists just coming out of training, it may seem that residency just scratches the surface. This problem is compounded when the neurologist comes out of fellowship, because at that point it may have been 3 or 4 years since the last time she evaluated a condition outside of her specialty area.
This poses a problem for the practice looking for a general neurologist. The retiring neurologist who once saw patients with every type of neurological condition now has to be replaced by several neurologists, all of whom specialize in one or two specific areas. The good news is, the demand for neurological services is on the rise as well—due to increased population growth, aging population, and the increase in insured patients through the Patient Protection and Affordable Care Act.² So while the cost to fully-staff the neurosciences department might be more than planned, the patient base will increase as well, as your practice can provide services to patients who would otherwise seek treatment elsewhere.
Out-patient/in-patient split, or lack thereof
Once upon a time a neurologist in practice would round at the hospitals in the morning, see patients in his office during the day, and then go back to the hospital in the early evening. Today, medical staff privileges are no longer seen as core to a practice, and as a result, many neurologists have stopped participating in hospital care.³ Outpatient practice provides a stable patient flow and predictable lifestyle for doctors seeking to spend less time traveling to the hospital or multiple hospitals, and more time with their families or pursuing other interests. Procedures once performed in the hospital can now be done at their own facilities. In addition, this subspecialization may make the physician feel uneasy or unprepared to take general emergency department call in their general specialty. In our practice we are seeing more physicians seeking a work/life balance than ever before, and it has become increasingly difficult to recruit a neurologist who is willing to split time between the office and the hospital.
Of course, there remain patients with acute neurological issues who need a neurologist to care for them. Furthermore, some procedures, like t-PA for stroke, require rapid evaluation and intervention by a certified neurologist. Increasingly, hospitals are employing inpatient neurologists, or neurohospitalists, to attend to a variety of inpatient neurology needs that just did not exist 20 or 30 years ago. The “increasing complexity of in-patient medicine” combined with “diminished internal medicine training in neurology” creates a perfect scenario for this new breed of neurologist who finds the hospital setting more rewarding than outpatient practice⁴ and an opportunity for hospitals to provide the community with improved continuity of care.
Having a telemedicine program in place is another way to deal with the problem of hospital call. Having tele-neurology in place means that the doctor covering the ER can get the stroke patient immediate neurological attention without having a stroke neurologist in the hospital. Tele-neurology programs are becoming increasingly common. The American Stroke Association has said that having a telemedicine program in place will help solve the problem of shortage of inpatient neurologists and allow hospitals to become acute stroke ready.
The compensation for neurologists is increasing at a rapid rate. The latest MGMA compensation survey shows an increase in neurologists’ salaries of over 5 percent from 2014-2015. There is no reason to think this trend will slow down anytime soon and in fact we find that salaries are increasing so rapidly, that data collectors, like MGMA, cannot always keep up. This creates a situation where community hospitals, which may be beholden to legal or compensation committee rules for salary caps, are not able to stay competitive or the process for getting the salary approved is far too slow or the desire candidate has moved on. Either way, they lose their competitive edge. Loan reimbursement, relocation expenses, coverage for CME, and vacation time all factor in to the compensation package, and is something experienced neurologists, and those coming right out of training have come to expect.
Hiring a neurologist in today’s tough job market requires a position that appeals to someone’s desire to subspecialize and significant compensation (and, as always, a bit of luck!).
1. www.aan.com/uploadedFiles/Website_Library_Assets/Documents/8.Membership/1.Your_Membership/2. Member_Benefits/3.Residents_and_Fellows/2011%20AAN%20Resident%20Survey%20Final%20Report.pdf
2. https://www.aan.com/PressRoom/home/PressRelease/1178, http://www.rscdiagnosticservices.com/blog/the-neurologist-shortage-in-the-united-states
3. If Not Neurohospitalists, Who? If Not Now, When? David J. Likosky, MD, SFHM, Neurohospitalist. 2011 Apr; 1(2): 64–66
4. IN PRACTICE: Modern Neurohospitalists at the Crossroads of an Existential Crisis, Avitzur, Orly MD, MBA, Neurology Today: 16 May 2013 - Volume 13 - Issue 10 - p 32–33