WEDNESDAY, April 17, 2013 — By 2025, the demand for neurologists will far outnumber the supply, which could create longer wait times for multiple sclerosis patients to see doctors for diagnostics and treatment.
Medical students are not specializing in neurology, creating an 11 percent disparity in the number of doctors available and the number needed to adequately care for all patients. By 2025, the gap in supply and demand will increase to 19 percent, according to a study published today by the American Academy of Neurology (AAN) in the journal Neurology. This means patients with neurodegenerative diseases like multiple sclerosis (MS), Parkinson's, and Alzheimer's will have to wait longer to see a specialist. Right now patients wait an average of 30 business days for a follow-up visit. While one month doesn't seem like much, even a short amount of time can be difficult, especially for those with MS.
"People are frightened," said Nicholas LaRocca, PhD, a policy analyst at the National Multiple Sclerosis Society. "People don't have a disease that sits there. They have flare ups. If you go to bed at night, you wake up, and you can't walk, 10 days can seem like an eternity."
The AAN study looks at statistics including data from the United States Census Bureau, the Centers for Disease Control and the National Nursing Home Survey to estimate the number of patients who will need specialist neurological care in 2025. It also estimates the number of available neurologists, taking into account currently practicing U.S. neurologists, doctors' retirement probabilities, incoming students graduating from medical school and patient care hours worked.
The results show that the number of practicing neurologists will grow from 16,366 in 2012 to more than 18,000 by 2025. However, demand for these doctors is much higher — about 21,000. Though a 3,000-doctor disparity doesn't seem like much, it will have a significant impact on the health care industry, according to Thomas Vidic, MD, a neurologist at American Academy of Neurology who was a co-author on the study.
"We realized that the problem is going to be compounded, and in the short-term future, we will not have enough physicians to provide appropriate care for the neurological conditions in our aging population," Dr. Vidic said.
California will bear the brunt of the burden, with an estimated 498-doctor gap by 2025. Texas follows with about a 400-doctor need, and Florida is a close third with a projected 309-doctor gap. Multiple sclerosis patients in New York will have the least trouble making appointments as the state is projected to have a surplus of 431 neurologists.
It's difficult to pinpoint the exact cause of the disparity among states, but Dr. Vidic suggests it could be due to an expanding population in certain states.
"California is a state that has grown in the last few years, and, traditionally, there's been more of a concentration in terms of neurology workforce in the northeast of our country," Vidic said. "I would suspect that the population growth has probably outstripped the growth in the neurology workforce."
The National Multiple Sclerosis Society says they have been dealing with the shortage for years, and have tried to address it with academic and professional programs targeted at prospective doctors.
"We saw the trend several years ago and have been trying to bring fresh minds and talent to the MS scene," said Arney Rosenblat, a spokeswoman for the National Multiple Sclerosis Society. "We have clinical fellowships and a slew of other programs that we hope that will entice people to become neurologists."
But multiple sclerosis-centered care is time consuming and complicated due to the varied nature of the disease, meaning prospective doctors may choose to specialize in more lucrative fields. Students graduating medical school often shoulder between $150,000 and $200,000 worth of debt with little hope of paying it off quickly. Because MS care is mainly composed of cognitive assessments with very few actual procedures or operations, neurologists don't tend to make the kind of money that surgeons can demand.
"Without those additional procedures and given the complexity of MS, it's difficult for neurologists who are seeing people with MS to earn enough to really cover the costs of operating a practice," Dr. LaRocca said. "It provides a disincentive for people to go into neurology."
The neurologist shortage could affect wait time for patients to get appointments. In 2010, it took a new patient about 28 business days to see a doctor. In 2012, that number rose to 35 business days. For children, the statistics are more disappointing. Almost 40 percent of children's hospitals reported a lack of neurologists, and the wait time for an appointment was 45 business days.
"In my town (Hackensack, NJ) there is an MS center, and there's only one neurologist there," said Shanene Muldrow, who works as a customer service representative and has MS. "I love the neurologist there. She has such a huge volume of patients so it is hard to see her. That's mainly because she's the only one who specializes in MS."
On April 23, Vidic and his colleagues will go to Capitol Hill to encourage Congress to discuss the problem — and possible solutions. It's a move he hopes will be a game-changer for his field.
"There's only so much time in the day for all of us to see patients," he said. "It's very difficult, and it'll get worse in the future."