The status of neurology fellowships in the United States: clinical needs, educational barriers, and future outlooks

Abstract

The need for subspecialty-trained neurologists is growing in parallel with increasing disease burden. However, despite the immense burden of neurological diseases, like headache and neurodegenerative disorders, recruitment into these subspecialties remains insufficient in the United States. In this manuscript, a group of educators from the American Academy of Neurology’s A.B. Baker Section on Neurological Education sought to review and discuss the current landscape of neurology fellowships in the United States, the factors driving fellowship recruitment and the educational barriers. Moreover, suggestions to potentially improve recruitment for under-selected fellowships, which can contribute towards an alignment between neurological education and neurological needs, and future educational scenarios are discussed.

The Neurology Fellowship Application Conundrum

“…The national trend to have more categorical programs puts neurology program directors in a stronger position to influence the PGY1 curriculum for their trainees. 15…”

“…The national trend to have more categorical programs puts neurology program directors in a stronger position to influence the PGY1 curriculum for their trainees. 15 Similarly, child neurology programs should seek opportunities to broaden the spectrum of educational experiences as early as possible. The majority of child neurology program directors favor reducing the ACGME requirement that child neurology residents spend 12 months in adult neurology.…”

Shaping neurology subspecialty training in Europe

“…Additionally, the discrepancy between neurological conditions and trained subspecialty providers might become even more evident over time, given that certain subspecialties with low attractiveness such as cognitive disorders [4,5] do not match the growing demand [3]; therefore, dedicated strategies are necessary to potentially improve recruitment for underselected fellowships [6].…”

Finding Fellowship in Neurology Fellowship Recruitment

“…Fellowship programs that are inpatient based also have a recruitment advantage because half of adult neurology residents have not had adequate outpatient exposure by the time they apply for fellowship, and this may lead to a mismatch between subspecialties chosen by residents and those where there is a need for more specialists given the relative burden of disease. 1 The lack of outpatient exposure is one reason why most residents would prefer a later fellowship application process. 2 More than three-fourths of program directors feel similarly.…”

“…The national trend to increase the number of categorical adult neurology residency positions that include PGY1, from 66% (552 of 839) in 2018 to 77% (772 of 1,005) in 2022, provides an opportunity to offer more outpatient neurology experiences, exposure, and mentorship built into that first residency year. 1,9 Adding balanced residency elective time earlier in PGY2 could also provide formative experiences important for fellowship choice and career development. In addition to a balanced curriculum, ensuring that a wide variety of faculty supervise neurology residents in the inpatient and outpatient settings can bring subspecialty expertise and exposure into general neurology settings.…”