The child neurology clinical workforce in 2015

Abstract

Objectives: More than a decade has passed since the last major workforce survey of child neurologists in the United States; thus, a reassessment of the child neurology workforce is needed, along with an inaugural assessment of a new related field, neurodevelopmental disabilities. Methods:The American Academy of Pediatrics and the Child Neurology Society conducted an electronic survey in 2015 of child neurologists and neurodevelopmental disabilities specialists.Results: The majority of respondents participate in maintenance of certification, practice in academic medical centers, and offer subspecialty care. EEG reading and epilepsy care are common subspecialty practice areas, although many child neurologists have not had formal training in this field. In keeping with broader trends, medical school debts are substantially higher than in the past and will often take many years to pay off. Although a broad majority would choose these fields again, there are widespread dissatisfactions with compensation and benefits given the length of training and the complexity of care provided, and frustrations with mounting regulatory and administrative stresses that interfere with clinical practice. Conclusions:Although not unique to child neurology and neurodevelopmental disabilities, such issues may present barriers for the recruitment of trainees into these fields. Creative approaches to enhance the recruitment of the next generation of child neurologists and neurodevelopmental disabilities specialists will benefit society, especially in light of all the exciting new treatments under development for an array of chronic childhood neurologic disorders. In the past 2 decades, child neurology has undergone a remarkable transformation, and has been joined by an important companion field, neurodevelopmental disabilities. In the past, large academic child neurology groups were rarities in the United States. Now groups of a dozen or more child neurologists are becoming increasingly common in major metropolitan areas, as expectations regarding access to appointments and availability of specialty services have increased. More child neurologists now undergo subspecialty training in pediatric epilepsy/neurophysiology, behavioral neurology, neuromuscular diseases/neurophysiology, neuroimmunology, movement disorders, and other fields. The accurate diagnosis and treatment of childhood neurologic diseases has acquired a new urgency, as standards of care are advancing rapidly and novel molecular therapies for a range of these disorders are emerging. Thus, the need for a well-trained, highly motivated child neurology workforce is more important than ever.Natural questions to ask are whether the workforce is equipped to handle this bounty and open new frontiers, and what challenges these specialists are currently encountering in their careers. The last child neurology workforce survey in the United States was conducted more than a decade ago

Integrating quality improvement into the ECHO model to improve care for children and youth with epilepsy

“…Since 2009, several studies and surveys of the child neurology workforce have demonstrated shortages of pediatric neurologists. 7,19 Therefore, innovative models of health care delivery must have a strong emphasis on real-time physician education in a coordinated team-based approach. Integration of QI into such models makes them more meaningful and clinically relevant for physicians and can translate into sustainable practice change over time.…”

“…Epilepsy remains one of the most common reasons for referral to a pediatric neurologist. 7 Unfortunately, there is an existing deficiency in the number of pediatric neurologists (estimated to be at least 20% below the national need), often resulting in limited access to care for CYE, especially in rural and underserved communities. 8,9 Health care delivery system use of telemedicine technology is one way to improve subspecialty care access.…”

Child Neurology Applicants Place Increasing Emphasis on Quality of Life Factors

“…This paralleled our institutional data that identified an increasing emphasis on interpersonal relationships and applicants perceived “personality fit” with residents based on their interview day experience. Our survey respondents were generally representative of the child neurology workforce with an increasing representation of females 10 , 11 , 12 and number of DO degrees over time. 12 Our respondents had a higher representation of MD/PhD degrees than recent workforce numbers, which have demonstrated an overall decrease in MD/PhD degrees over time.…”

“…There was a higher predominance of physicians with MD/PhD degrees (5.9%) in the practicing physicians than trainees and trend for increasing representation of trainees with DO degrees (1.7% practicing physicians and 12.6% trainees). 12 Given the changes in applicant demographics and educational backgrounds, we questioned whether this his created a shift in training priorities.…”

Child neurology services for children with epilepsy in Finland

“…The prospects for more child neurologists in the United States seemed ominous in 2005 11 and appear to have been realized 12 . In contrast, a certain oversupply was reported from Canada 13 .…”