Neurologists on the Shortage of Stroke Specialists | Loyola Medicine
Wednesday, December 17, 2014

Neurologists' call to action: Relieve the growing shortage of stroke specialists

Plan would help address leading cause of death and disability

MAYWOOD, Ill. –  Although stroke is the No. 4 cause of death and a leading cause of disability in the United States, there’s an increasing shortage of neurologists who specialize in stroke care.

In the December issue of the journal Stroke, two prominent neurologists propose a bold program to increase the number of stroke specialists. Their proposals include encouraging more young physicians to specialize in stroke, increasing stroke specialists’ pay and  opening the subspecialty to physicians who are not neurologists.

The authors are Harold P. Adams, Jr., MD, University of Iowa Carver College of Medicine and Jose Biller, MD, Loyola University Chicago Stritch School of Medicine.

More than 800,000 strokes–one every 40 seconds–occur in the United States each year. The number of strokes is expected to grow substantially due to the growing elderly population.

The American Academy of Neurology has documented the increasing shortage of neurologists, especially in rural areas. The problem is especially severe in vascular neurology, the subspecialty that deals with strokes. From 2005 to 2012, an average of only 38 new vascular neurologists entered the subspecialty each year. The average age of vascular neurologists is 48, and 5 percent are older than 65. And attrition in the pool of board-certified vascular neurologists is expected through death, retirement or changes in practice, Drs. Adams and Biller write.

Although stroke is especially prevalent in underserved populations, few African American or Latino physicians are entering vascular neurology training programs.

These are among the measures Drs. Adams and Biller propose to increase the number of stroke specialists:

  • Open up fellowship programs in vascular neurology to physicians who are graduates of residency programs outside the United States and Canada.
  • Allow non-neurologists to train in subspecialty stroke care. These could include physicians trained in emergency medicine, internal medicine, neurosurgery and physical medicine and rehabilitation. Indeed, it may be time to change the name of the subspecialty from vascular neurology to cerebrovascular medicine. “Although we would prefer that stroke care continue to be directed by experts in brain disease (neurologists), if the neurology community does not meet the healthcare needs, alternative strategies to meet the future needs of stroke care are needed,” Drs. Adams and Biller write.
  • Institute a program to help pay medical school debts of physicians who become stroke specialists, similar to incentive programs for physicians who practice primary care in rural areas.
  • Increase the pay of vascular neurologists, commensurate with their long hours, availability on weekends and holidays and expertise.

“Unless the number of neurologists focusing their careers on the diagnosis and treatment of patients with cerebrovascular diseases increases, a professional void will develop,” Drs. Adams and Biller write. Leaders of professional neurology associations “need to develop and vigorously support a broad range of initiatives to encourage residents to enter vascular neurology. These efforts need to be started immediately. Time is short.”

Dr. Adams is a professor in the Department of Neurology of University of Iowa Carver College of Medicine and Dr. Biller is chair of the Department of Neurology at Stritch.

Their article is titled “Future of Subspecialty Training in Vascular Neurology.”

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.