Recommended by a colleague
Dall TM, Storm MV, Chakrabarti R, Drogan O, Keran CM,
Donofrio PD, Henderson
VW, Kaminski HJ, Stevens JC, Vidic TR. Supply and demand
analysis of the current
and future US neurology workforce. Neurology. 2013 Jul
30;81(5):470-8.
Abstract
OBJECTIVE:
This study estimates current and projects future neurologist
supply and demand under alternative scenarios nationally and by state from 2012
through 2025.
METHODS:
A microsimulation supply model simulates likely career
choices of individual neurologists, taking into account the number of new
neurologists trained each year and changing demographics of the neurology
workforce. A microsimulation demand model simulates utilization of neurology
services for each individual in a representative sample of the population in
each state and for the United States as a whole. Demand projections reflect
increased prevalence of neurologic conditions associated with population growth
and aging, and expanded coverage under health care reform.
RESULTS:
The estimated active supply of 16,366 neurologists in 2012
is projected to increase to 18,060 by 2025. Long wait times for patients to see
a neurologist, difficulty hiring new neurologists, and large numbers of
neurologists who do not accept new Medicaid patients are consistent with a current
national shortfall of neurologists. Demand for neurologists is projected to
increase from ∼18,180 in 2012 (11% shortfall) to 21,440 by 2025 (19%
shortfall). This includes an increased demand of 520 full-time equivalent
neurologists starting in 2014 from expanded medical insurance coverage
associated with the Patient Protection and Affordable Care Act.
CONCLUSIONS:
In the absence of efforts to increase the number of
neurology professionals and retain the existing workforce, current national and
geographic shortfalls of neurologists are likely to worsen, exacerbating long
wait times and reducing access to care for Medicaid beneficiaries. Current
geographic differences in adequacy of supply likely will persist into the
future.
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From the article
The average wait in 2012 for new patients to see a
neurologist (34.8 business days) and for follow-up visits (30.0 days) was
higher than in 2010 (28.1 days for new and 25.6 for follow-up visits).1,2 Other
studies report average wait for new patient visits of 24.1 days for
neurosurgery, 20.3 for family practice, 16.8 for orthopedic surgery, and 15.5
for cardiology.3,4 In 2012, 39% of children's hospitals reported vacancies of
12 months or longer for child neurologists, and child neurology ranked as one
of the most short-handed specialties, with average wait times of 45 business
days….
The Medical Group Management Association's (MGMA) 2010
Physician Compensation and Production Survey reports that adult neurologists in
group practices average 2,205 ambulatory encounters annually (n = 383
neurologists in 118 practices).22 MGMA also reports an annual average 515
hospital encounters. Child neurologists average 1,851 ambulatory encounters per
year (n = 38 neurologists in 19 practices) and 380 hospital encounters per year
(n = 29 neurologists in 16 practices)…
Taking into account changing demographics and associated
increase in prevalence of neurologic conditions, the national shortfall rises
from 11% (the overall shortfall reflecting 10% for adult and 20% for child
neurologists) in 2012 to 16% in 2025. With the impact of PPACA, the shortfall
rises to 19% by 2025. Even if one assumed that supply and demand currently were
in equilibrium at the national level, demand is projected to grow faster than
supply.
The above findings suggest the nation could readily use an
additional 10% adult neurologists, and based on average wait time the current
shortfall of child neurologists is substantially greater. For modeling
purposes, we assume a 10% shortfall of adult neurologists and a 20% shortfall
of child neurologists…
A comparison of the various supply and demand scenarios
projected suggests that even under the most optimistic supply scenario national
provider shortfalls are likely to persist. For adult neurology under the
baseline scenarios, the national shortfall is projected to grow. While supply
of child neurologists is growing at a slightly faster rate than is demand, a
shortfall is projected to persist through 2025. State-level shortages are
projected to persist and grow more severe over time...
This study highlights a current substantial national
shortfall of neurologists, especially pediatric neurologists, and even greater
shortfalls in select states.
[Comment and response] Racette BA, Holtzman DM, Dall TM,
Drogan O. Supply and demand analysis of the current and future US neurology workforce. Neurology. 2014
Jun 17;82(24):2254-5.
While Dall et al. understand US neurology workforce needs,
we contend that the estimates of the current neurology workforce may be overly
optimistic due to the research, education, and administrative commitments of
neurology faculty in academic medical centers. For example, the authors
estimated that Missouri has 365.9 neurologist providers and an estimated need
of 379.6 neurologist providers. Washington University School of Medicine has
122 of the neurology providers in Missouri. However, these 122 faculty
represent only 34.7 clinical neurology full-time employee (FTE) providers.
These revised figures, likely an underestimate, demonstrate that Missouri
actually has 26% fewer neurology provider FTEs than are needed to meet the
estimated current demand. Adjusting for actual neurology provider FTEs across
the United States, particularly in academic medical centers, would demonstrate
a more desperate picture of the state of the US neurology clinical workforce in
2013…
[Response] When projecting state-level supply and demand, we
made the simple assumption that the proportion of professional time spent in
nonpatient activities is constant across states. To the extent that
neurologists in a particular state average more (less) than the national
average time spent in non–patient care activities, our supply estimates will
overstate (understate) total supply in that state…
While our estimates of supply and demand for each state are
best estimates given the data available from national sources, the comments by
Drs. Racette and Holtzman highlight that workforce analysts and neurologists in
a particular state or community are best positioned to have a clear understanding
of the workforce situation in the state or community in which they work.
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