For years, it's been said that the graying of the baby boomers will bring an explosion in the need for neurologists. That time is here now, and there is little doubt that over the next decade, job opportunities for general and specialty-trained neurologists will increase.
But not all neurology jobs — and not all neurologists — are created equal. Even in a growing specialty, there are areas of training where more neurologists are in demand, and areas where the demand is much smaller.
In conjunction with the Academy's first-ever Neurology Career Week— an exclusive AAN event taking place Oct. 10-14 that is the only virtual career fair specific to neurologists and neurology related positions —Neurology Today spoke to some of the participating recruiters and other experts about growth areas in neurology — where neurology residents should consider subspecializing, for example, and what fellowship training are most in demand?
These days, when it comes to subspecialization, less is more in neurology, said Kira Fleshman, a physician recruiter with HCA Healthcare, who said that at any given time she is recruiting for 30 or more neurology positions in HCA's 160-plus hospitals and affiliated private practices.
“Many residents and fellows that I've been talking to want to get into the very subspecialized areas, such as interventional neurology, but they're actually struggling for positions,” she said.
AVOID AREAS OF OVERLAP
That's because it's a field where neurologists “compete” with other specialists who have related expertise, such as neurosurgeons and radiologists. “It's a very competitive field, and there aren't a lot of positions,” Fleshman said. Sleep neurology has similar drawbacks, she noted. “There aren't a lot of openings in our system for sleep neurologists, and that's another area that other specialists can do, such as pulmonologists. Stay away from areas of overlap with other specialties.”
So where is the need greatest? General neurology, she said. “There is a huge need for general neurologists. We have a lot of those positions available, and that's a trend that I think will continue. Even if you get a position as a subspecialist, you need to know that you will probably be doing some general neurology as well.”
Another area of enormous growth, where Fleshman is constantly recruiting, is stroke neurology. “If a resident wanted to go into stroke neurology, via a vascular fellowship, that's something I would highly recommend. There is a great demand for stroke neurologists. A lot of hospitals are trying to become stroke certified, and that's a trend that's going to continue since people really want that gold seal of approval as a stroke center from the Joint Commission, so the demand for neurologists with this training will continue.”
Jennifer McCalla, a physician recruiter with Valley Baptist Health System in Texas, agrees that general neurology and stroke neurology are the two areas of greatest demand in the field.
“I understand that many neurologists are drawn to a field like sleep, where the hours are great, you don't have weekend call and you're compensated well,” she said. “But if everybody's doing sleep, who's going to do general neurology? If you're fresh out of school, you should want to take call so you can get that practical experience and build your patient base. You're eliminating a lot of opportunities if you don't want to take call or work weekends.”
Two other areas in which both McCalla and Fleshman see growing demand for neurologists are neurophysiology and neurocritical care. And two emerging subspecialty fields are also likely to -provide rich prospects for neurologists with the proper training: neuro-oncology and the neurohospitalist field.
“The practice of neuro-oncology has been around for decades, but in the last ten years, the specialty has taken off as more evidence-based practice is integrated into the field,” said John de Groot, MD, associate professor and director of the neuro-oncology fellowship program at MD Anderson Cancer Center in Houston. “I know of multiple places that are looking for fellowship trained neuro-oncologists.” The United Council of Neurologic Subspecialties held its first subspecialty examination in the field in 2008.
Most neuro-oncologist positions are currently found in large medical centers in major cities such as MD Anderson in Houston, Memorial Sloan-Kettering in New York, and hospitals in Boston, Los Angeles, and San Francisco. “But the trend I've been seeing more and more is that people who are graduating from fellowships in neuro-oncology are getting jobs in academic centers that are looking to build a neuro-oncology program,”
Dr. de Groot said. “Academic institutions across the country are looking to grow a program and need neuro-oncologists to take that on. I get e-mails all the time from such places, and our fellows have been in high demand. Some of our recent graduates are setting up programs in Texas, North Carolina, and Nebraska.”
It's an exciting field to get into, said Dr. de Groot. “There are a lot of research opportunities, and the chance to really make your mark in the field. For example, neuro-oncology is not nearly as advanced as breast cancer when it comes to targeted therapies but that's an area where we are looking to make significant progress in the near future. Neuro-oncologists also treat neurologic complications of systemic cancers, which could appeal to people with other subspecialty interests such as pain management, epilepsy, neuromuscular disease, and specialized imaging. It's really a wide open field.”
If you're drawn to acute neurology and the neurologic problems that accompany patients who are hospitalized for other general medical or surgical conditions, you might consider pursuing a career as a neurohospitalist. This growing area is still defining itself as a subspecialty; unlike neuro-oncology, there is not yet a subspecialty certification for neurohospitalists. There are a handful of fellowship programs; one of the first was established about five years ago at the University of California, San Francisco. Another such program at the Mayo Clinic's Jacksonville, FL, facility, began training its first fellow this year. Neurohospitalists who haven't been through one of the handful of specific fellowship programs still usually have some other type of post-residency training, often in vascular neurology.
“We know through talking with colleagues who share this interest that more and more centers, especially academic medical centers, are adopting the neurohospitalist model, which is a departure from the traditional academic model in which each staff neurologist spends a month or two weeks each year attending on the inpatient services,” said Kevin Barrett, MD, assistant professor of neurology and one of Mayo's neurohospitalists.
“Here, we have five neurohospitalists among a larger neurology department, and this group is responsible for coverage of the inpatient neurology service, the consultative service, the emergency department, and neurointensive care unit. We find that this model of practice improves continuity of care for our patients, and promotes resident and fellow education with regard to hospital-based neurology.”
For an article published January 2010 in Neurology, Dr. Barrett and his colleague William Freeman, MD, surveyed neurohospitalist position postings to the AAN's classified service the AAN Career Center. Just one position was posted in 2005; by 2009, there were 13 neurohospitalist posts listed.
“For those who have an interest in research, the field of neurohospitalist medicine, particularly as it relates to quality improvement, resource utilization, and outcome metrics, is very open to systematic study at this point. There's a dearth of systematic or prospectively collected data addressing non-stroke neurologic care in the hospital itself,” Dr. Barrett said. “And the employment opportunities are very diverse, from offering your services as a neurohospitalist to an institution that may not yet have adopted that model, to joining an established group of neurohospitalists.”
When interviewing for a position at an academic center or in a practice, how can you make yourself stand out from the pack? In some cases, it's easy. For general and stroke neurologists, said Fleshman, you might not even be facing off against any other candidates for the position you want. “There's a huge need for neurologists in those fields. Honestly, hospitals and practices can't afford to be quite as picky because there just isn't a ton of competition in those areas,” she said.
But for more specialized fields, there will be several candidates interviewing for the same position. “You do want to make sure that you particularly stand out,” Fleshman said. “That means solid training, of course. And even if you're going into a fellowship, I would recommend taking your boards sooner rather than later — we look for that. We also like to see no breaks in between trainings — a year or two to do a master's in public health or pursue specialized research is one thing, but a year off to travel? No.”
And, it shouldn't have to be said, but Fleshman laments that sometimes it does: don't ignore the fundamentals. Make sure that your documentation, whether online or print — such as your CV and cover note — are well written and proofread. (Don't rely on spellcheck alone!) Whether virtually or in person, be where you are supposed to be on time. And don't bring up money at the first opportunity! “Yes, compensation plays into your decision, but if that's the first thing you mention, you don't give the best impression to the practice or the hospital,” she said.•