Editors' Note: Hodgson and Lukas and Freeman et al. discuss subspecialization in neurology and its potential impact on the future neurology workforces. Alfahad questions the diagnosis of amyotrophic lateral sclerosis (ALS) in the Teaching NeuroImage by Sharma et al. He argues that, because of the young age and lack of convincing upper motor neuron involvement in the patient reported, other potential ALS mimickers should be considered. The authors respond. —Chafic Karam, MD, and Robert C. Griggs, MD
Dall et al.1 noted that the future supply of neurologists will be affected by the increasing subspecialization of younger neurologists. The decision to subspecialize is a highly personal decision that may not be driven by patient demand.2 This, in addition to the geographic distribution of neurologists demonstrated by Dall et al., could lead to an oversupply in a few subspecialties and a shortfall in others. All of this will be in the context of upcoming economic challenges described in the recent report by the American Academy of Neurology Workforce Task Force.3 Given the potentially large impact of increasing subspecialization, it is important to monitor the effects of new accreditations that are being created for neurology fellowship programs by the American Board of Psychiatry and Neurology and United Council for Neurologic Subspecialties.4
Author Response
We appreciate the comments by Drs. Hodgson and Lukas concerning factors that affect decisions trainees make about choice of subspecialties and the potential impact of those decisions on the composition of future neurology workforces. The unsettled economics of health care makes it unclear whether the number and types of neurology subspecialty fellowships, especially those associated with cuts in graduate medical education (GME) funding, will increase or decrease over time.
Significant reduction in GME funding could lead to decreased residency/fellowship slots due to the medical school/residency “mismatch.”5 Hodgson and Lukas correctly pointed out that the accreditation process itself may have resulted in increased subspecialization in neurology independent of the patient demand or medical need for these subspecialties.6 Much, however, will still depend on economic priorities as determined by policymakers, especially with regard to GME funding.
Ultimately, optimizing specialty and subspecialty allocations will likely require a restructuring of both the medical school experience as is already being done at many centers and GME, as well as the development of new models of financing both medical school and GME.
- © 2014 American Academy of Neurology
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Cutaneous α-Synuclein Signatures in Patients With Multiple System Atrophy and Parkinson Disease
Dr. Rizwan S. Akhtar and Dr. Sarah Brooker