The Evolution and Geographic Distribution of Headache Medicine Fellowship Programs and Graduates: An Observational Study

Abstract

The number of fellowship programs has increased dramatically since 2007, but their geographic distribution is uneven and so are the subsequent practice locations of fellow graduates. At present, the distribution of training programs and headache specialists is not well matched to the US population as a whole or to the location of important racial and ethnic minorities. Increasing the overall supply of headache specialists is important, but geographic inequalities in specialist distribution must also be addressed or disparities will increase.

Trends in neurology fellowship training

“…[16,17] Other factors which likely influence career choice in neurologic subspecialties include, but are not limited to, lifestyle factors such as salary, work hours, and duration and rigor of training as well as the factors which can influence success in an academic career. [18] Our study does not address the underlying factors which influence these trends, but merely describes them. This knowledge helps facilitate strategic planning on how to best assist supply meeting demand.…”

Workforce Gap Analysis in the Field of Headache Medicine in the United States

“…There are currently 564 United Council of Neurological Subspecialties (UCNS)‐certified headache medicine specialists in the United States . One‐third of states have two or fewer headache medicine specialists . The overt disparity between the number of certified headache medicine specialists and the 47 million Americans living with migraine indicates a vast shortage of headache medicine specialists.…”

New Investigator and Trainee Task Force Survey on the Recruitment and Retention of Headache Specialists

“…The authors developed a survey of 10 multistep questions focusing on the following areas: (1) demographics; (2) exposure to a headache center during any part of the training experience; (3) reason for becoming interested in headache medicine; (4) sources used to inform them about headache management; (5) perceptions of goals, strengths, and weaknesses of working in the field of headache medicine; (6) preferences for treating certain diseases and symptoms; (7) barriers for headache education during training and ideas for improving headache education; and (8) ideas for improving mentorship and recruitment into the field. Several questions utilized either true/false or a typical 5-level Likert item scale with strongly agree, agree, neutral, disagree, and strongly disagree (Appendix).…”

“…6 As of the beginning of 2014, 32 states (63%) did not have a headache fellowship program and 24 states (47%) did not have a practicing United Council of Neurologic Subspecialty (UCNS) fellowship graduate. 7 We conducted a survey of new investigators, trainees, and headache attendings of the New Investigators and Trainees (NITS) Section of the American Headache Society (AHS) to gain a better understanding of their prior experience in headache medicine and what role that played in their decision to pursue a headache medicine specialty. We also sought to determine their perceptions about the field and the future of the headache medicine specialty.…”