Thursday, May 9, 2013

The looming neurologist shortage

Jennifer LaRue Huget

I have on occasion thought about moving away from Connecticut, where I have lived for 30 years, and returning to my home state, Maryland.

But whenever I start reviewing all the things I love about Maryland, I remember all the things – the people, places and experiences – I would miss if I left my current home.

Near the top of that long list is the set of doctors I have access to here, the ones who cared for me from my young adulthood to my middle age, seen me through the birth of my children, my gallbladder surgery – and my diagnosis with multiple sclerosis. And while I feel grateful to all of my physicians, I am most attached to my wonderful neurologist. He handled the process of diagnosing me with calm, empathy and good humor, which might sound strange to some but which has helped me maintain perspective and my own good cheer through the past 12 years. He helped me find the right medication for me and he’s offered good counsel at every checkup.

So I find the news recently reported in the journal Neurology chilling: A study published there on April 17 finds that the U.S. will face a shortage of neurologists by 2025. Specifically, the study, led by Thomas R. Vidic, MD, of the Elkhart Clinic in Elkhart, Ind., projects that the demand for neurologists will grow quite a bit faster than supply: While in 2012 there were about 16,366 neurologists practicing in the U.S., there was demand for about 18,180. By 2025, there’ll be need for 21,440 neurologists, the study projects, but only 18,060 neurologists will be practicing at that time.

That will mean longer wait times to see a neurologist, the authors note, and will make it more difficult for some patients to connect with a neurologist in the first place.

That’s all bad news, given that, as the study points out, 1 in 6 people in the U.S. currently have conditions warranting a neurologist’s care, and that number is expected to grow as baby boomers age and conditions such as Alzheimer’s disease, Parkinson’s disease, and MS continue to become more prevalent. A big part of the problem, the study suggests, is that Medicare doesn’t reimburse neurology care at the same rate it pays for other healthcare services, making neurology a less lucrative, and therefore likely less attractive, field for medical school students to pursue.

The National MS Society is concerned about the growing shortage of neurologists, too—especially those who are specifically trained and qualified to care for people with MS. The Society worked with a research firm to conduct a study about why residents and young physicians choose to specialize in MS as a career choice (and why not).  They have also held discussions with MS researchers and clinicians to get their ideas about how to attract more talent to the field – and are in the process of developing new strategies and activities to address the problem, including advocacy, providing more MS fellowships and reaching out to medical schools.

A physicians’ group also recently presented the findings of the Neurology study on Capitol Hill to draw attention to the impending neurologist shortfall and ask Congress to protect patients’ access to these important medical specialists. Here’s more on the study and likely impacts in the MS world from Everyday Health.

Are you in the care of a neurologist? How do you think that care (or lack thereof) may have affected your experience with MS?

You can Sign up to receive advocacy alerts from the Society in order to add your voice to this conversation when the opportunity for action arises.

Jennifer LaRue Huget was diagnosed with MS in 2001. A freelance writer and children's book author, she lives in Connecticut with her husband, two teenage kids, and two brown dogs. Her website is www.jenniferlaruehuget.com.

5 comments:

  1. I feel like I have experienced the whole spectrum of neurologist care: The first neurologist I saw (at UCLA) was a nightmare. He gave a flippant, unfeeling diagnosis and berated me for not coming in sooner (it took 5 months for his office to get my paperwork right and another two months for me to be seen). After him I had a wonderful gal (also at UCLA). Unfortunately soon after, UCLA stopped accepting my insurance. The next neuro I was assigned to ought to be in prison. I saw him once and my primary care dr asked if he seemed "ok" to me. I told her that beyond a handshake he never touched me and spent the entire meeting with his back to me typing on the computer. She said he'd given her a very detailed report on me. I saw it and it was a COMPLETE fabrication. Talk about chilling. The next year my Medicare kicked in and I started going to Kaiser. I got the most wonderful neurologist. She was so patient and kind. We really connected. Once, I was expressing my distress after someone close to me had commented,"Gee waddya know, you went from being a contributing member of society to being a drain on society just like that (snap)!" -- this neuro just about exploded. I thought she was going to cry! She went on and on about how wonderful she thought I was and that that was so not true and I shouldn't have anything to do with that person, etc. It was heartwarming. But now I have moved to Wyoming and I have to find a new neurologist. I have been procrastinating for 10 months but now my Baclofen is running out. I found an MS center in Billings, MT and I absolutely must call ASAP... maybe tomorrow?

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    1. sallyeaux- call now! Please let me just encourage you to call right now! I am a huge procrastinator about doctoring and have been searching for a new neurologist myself after my neurologist of 13 years recently retired. I miss her so... I went to see her colleague yesterday, and tried so hard not to compare, but when the words, "So, you have only had MS for a short time then. Just 13 years?" -came out of her mouth, I could only stare at her. I looked over at my husband with my eyes bugging out. His eyebrows were lifted. It went downhill from there. I will be searching some more... I have been hesitating driving further to the MS clinics in Seattle, but if you are willing to go from WY to Billings, I will quit my whining!!! I support you all the way!! All the best to you, K

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  2. I've been a mover, too, sallyeaux. I was first diagnosed in Los Angeles at Kaiser. I wonder if we both had the same amazing neuro? Being diagnosed by a great neurologist seems to make a difference in the way one moves through the experience and perhaps, what to expect and look for in care. I moved from a large city like Los Angeles to a very small community where I had to drive 80 miles one way to see a decent neurologist. There was one neurologist in the small town where I was living who I decided would not be a good fit after our first visit together. My next move took me to Seattle, WA, which seems to be the mecca for Muliple Sclerosis resources and docs, and once again I felt my care was being well handled by finding a neurologist who understood MS. One more move has taken me to an area of the country where, while MS is not as prevalent, resources are stretched thin. Good MS neuros in this area take over a year to get an appointment with if you're a new patient. Several of the care facilities for MS here also do not accept Medicare at 100%. I've been lucky to have been able to advocate for myself and quickly identify what (and who) works for me and who doesn't when it comes to my MS care. Sometimes I breathe a sigh of relief knowing this will be the last time I have to move. I hope I can still continue to build a strong MS team. Being certain that you're in good hands when it comes to MS is a hugely important part of dealing with this disease.

    It's distressing for me to read the statistics in this article regarding a shortage of neurologists in the coming years. Coupling that fact with cuts to Medicare and Medicaid, I wonder what the future holds for patients who need this specific care? It's even more important now for us to keep advocating for better health care so that those diagnosed with MS and other neurological conditions will have timely and good access to specialists for help when needed.

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  3. My husband bounced around neurologists for several years (some good - some so so) before I stepped in. I thought living between Boston and Providence there was the "perfect neurologist" waiting for him. It took me a while but we found him in Foxboro, MA. It is a 20 minute, back road trip. He is always on time, very knowledgeable, up to date on the greatest and latest stuff - and the icing on the cake is he specializes in MS. How lucky are we? Now after reading this article- I will have to start following Dr. Napoli around with
    a pillow. :)

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  4. OH KATE & TURNING HEART! Your encouragement and kind words really made my day. I actually did call the clinic in Billings yesterday... the person I need wasn't there and she hasn't called me back yet... sigh. But I'm still optimistic, I think I've seen the worst back in L.A.. And not to take the wind out of your sails Kate, but I'm in northern WY and Billings is the closest "big" city to me - it's about 100 mi. About an hour drive - comparable to the 15 miles I used to drive to the doc in L.A. both take about an hour! I'm not very willing (or able) to travel very far. And Turning Heart, it was Dr. Langer at Kaiser Sunset. Other neuros there told me she is the #1 MS doc at Kaiser -- and she's such a great person to boot.

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