Expansion of Residency Positions

[sallyhasanidea]

As many of you have noticed, it didn't take much for EM to go from a very lucrative field with abundance of job opportunities to situation where grads are not able to find jobs. This is mainly an unprecedented expansion rate of their residency programs/position combined with a competing force of midlevels invasion.

So I looked at the latest NRMP data and realized that neurology is undergoing a very fast rate of expansion as well.

View attachment 334889
View attachment 334890

As you see, the number of categorical spots has grown by 33 positions and the advanced positions by 10 positions from 2020 to 2021. That's a total of 43 positions, or about 4% growth in a single year. In a five year period, the expansion is 183 positions or 23%.

How concerning is this trend?

Can you please link where you got this data?

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[Postictal Raiden]

Can you please link where you got this data?

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2021/03/Advance-Data-Tables-2021_Final.pdf

Table 7A

 

[sallyhasanidea]

Oh, I absolutely agree with the need for an increase in neurology residency spots in the immediate future.
I'm just worried the specialty will overcorrect like RO did and leave a rough job market.

This is the AAN estimate from 2013: Supply and demand analysis of the current and future US neurology workforce
View attachment 335018

We'd essentially need to output a net 3,380 increase between 2012 and 2025 to meet demand. The report used a figure of 729 new neurologists per year between 2012 and 2025 as their supply model or a total of 13*729 = 9,477 new neurologists.

Assuming a 4 year neurology residency, we'd need to look at positions from 2008 to 2021 to estimate 2012 and 2025.
Here's the number of positions offered in the NRMP match from 2008 to 2021:

2009- 581
2010- 585
2011- 605
2012- 638
2013- 670
2014- 700
2015- 717
2016- 747
2017- 786
2018- 839
2019- 898
2020- 926
2021- 969

Which gives a total of 9,661. Based on a 2.8% rate of attrition from 2005-2009, we'd have 9,390 neurologists entering which results in a net shortage of 3,380 + 87 = 3,467. So they were fairly accurate with this model.

If we extrapolate the supply and demand from AAN's projection (it looks like they estimated a 0.76% increase in supply and a 1.28% increase in demand per year) for another 10 years we would get a supply of 19,480 and a demand of 24,348 or a gap of 4,868. If we assume a consistent 4.4% increase in residency positions we would end up with a total 22,031 positions or 21,414 after attrition.

2022- 1,011
2023- 1,056
2024- 1,102
2025- 1,151
2026- 1,201
2027- 1,254
2028- 1,309
2029- 1,367
2030- 1,427
2031- 1,490

Their supply model for this period would be 729*23 = 16,767 which is a difference of 21,414-16,767 = 4,647 which narrows the gap to 221. So the gap will disappear by 2036 if this model stays consistent. In summary, it looks like we're able to absorb a 4.4% per year increase for the next 2 decades or so before it becomes a problem.

Can you please share where you got data all the way back from 2008?

 

[BoneWizard]

Can you please share where you got data all the way back from 2008?

Archives: Report Archives - The Match, National Resident Matching Program

 

[sallyhasanidea]

Archives: Report Archives - The Match, National Resident Matching Program

very cool, thanks. Do you know if there's similar fellowship match data available?

 

[BoneWizard]

very cool, thanks. Do you know if there's similar fellowship match data available?

It's on the same page under Specialties Matching Service. General stats are under Results and Data.

 

[sharkbaitwhohaha]

Mostly agree with caveats which I suspect you'll agree with. My center has experienced midlevels in movement and NM that are somewhat autonomous- the midlevels involved have years of experience and only see patients with those problems. They also are quick to involve attendings when it isn't clear what is going on, which is frequent in NM and movement for obvious reasons. Agree that headache is very formulaic and very hard to harm a patient in. Sleep clinic is easy, and sleep studies are easy but I doubt midlevels have an easy way in to reading sleep studies. Epilepsy clinic is easy and very formulaic. Reading EEGs well is not easy at a level IV center. Deciding on surgical plans and really knowing seizure semiology, taking a careful enough history and EEG video review to find the onset zone is not easy at all. A miss on the high end of level IV epilepsy practice is an easy lawsuit when the family is incredibly devastated they still have seizures, and now have some new memory deficits too post-op. The clinic part a midlevel can easily do, but most epileptologists don't like clinic anyways. There's no real route into reading EEGs other than doing an neurology residency and either having the appropriate fellowship training or just making stuff up which plenty of neurologists get away with but very doubtful a midlevel could get paneled or credentialed to do.

If EEG reimbursements were any higher, I'd guarentee that academic centers ( Duke and JHU specifically) would be having writing papers about EEG extenders.

 

[Thama]

If EEG reimbursements were any higher, I'd guarentee that academic centers ( Duke and JHU specifically) would be having writing papers about EEG extenders.

Just create 2 templates: normal and mod-gen-slow. Have an AI calculate the baseline frequency and assign the corresponding template to be signed by the midlevel. Any epileptiform activity identified by the AI just routes the EEG to the MD. Worried about missing subtle stuff? Admin isn't.

 

[Splenda88]

Anyone in medicine right now should have a 10-yr plan to be financially independent post residency. Even hospitalist jobs are not that easy to get, especially in desirable places.

 

[GatsbysBatman]

I'm wrapping up a PhD in neuroscience this year. Very much considering neurology med school in two years (taking pre reqs). This thread post is scaring me lol. I don't think the demand for neurologist will drop but it seems like I would graduate just as the gap for jobs starts getting filled. I'm seeing very worthwhile salary figures at the moment to justify med school loans but this thread makes me wonder if I'll be in trouble.

 

[deleted941485]

I'm wrapping up a PhD in neuroscience this year. Very much considering neurology med school in two years (taking pre reqs). This thread post is scaring me lol. I don't think the demand for neurologist will drop but it seems like I would graduate just as the gap for jobs starts getting filled. I'm seeing very worthwhile salary figures at the moment to justify med school loans but this thread makes me wonder if I'll be in trouble.

Isn’t there anything else you can do with a PhD in neuroscience?

 

[GatsbysBatman]

Isn’t there anything else you can do with a PhD in neuroscience?

No.

 

[90sportsfan]

I'm wrapping up a PhD in neuroscience this year. Very much considering neurology med school in two years (taking pre reqs). This thread post is scaring me lol. I don't think the demand for neurologist will drop but it seems like I would graduate just as the gap for jobs starts getting filled. I'm seeing very worthwhile salary figures at the moment to justify med school loans but this thread makes me wonder if I'll be in trouble.

If you have a PhD in neuroscience and do well in medical school, you would be an extremely attractive candidate for the top residency programs, and an academic clinician-science career (assuming you are interested in this route). So any angst about jobs in the future should not scare you. Also, many people go back and forth between what they want to specialize in, so if you really do end up going to med school, your desired specialty could always change, especially since your research background would make you a strong candidate for any specialty; so the future around neurology jobs could be moot.

 

[deleted1129181]

Hey everyone - it has been great reading this thread! Since ya'll know a lot about the field, I had a couple quick questions. Did the rapid expansion of EM residencies have something to do with the rapid expansion of private Emergency Room Departments in general? I remember reading something about how profitable emergency rooms and urgent cares are, so HCA and other organizations started opening them everywhere. The reason I mention this is because I would imagine that the expansion of neurology residencies would have more pushback compared to the expansion of em residencies, would it not?

 

[scoopdaboop]

Hey everyone - it has been great reading this thread! Since ya'll know a lot about the field, I had a couple quick questions. Did the rapid expansion of EM residencies have something to do with the rapid expansion of private Emergency Room Departments in general? I remember reading something about how profitable emergency rooms and urgent cares are, so HCA and other organizations started opening them everywhere. The reason I mention this is because I would imagine that the expansion of neurology residencies would have more pushback compared to the expansion of em residencies, would it not?

neurology residency expansion isnt a big deal. the demand there even if 10 new ones opened today would still be there. if you open 10 over 4 years, then it becomes less of an issue because the demand will go up every year to compensate.

 

[mafiacat8]

Hi sorry this is a bit off topic! I was an applicant this year for neurology and didn't match. if anyone knows of any upcoming pgy1 coming in august, or programs looking for a pgy2 to start for 2023 please message me!