Are General Neurologists a Dying Breed?

Europe is grappling with general neurology workforce shortages that could have serious consequences for patient care. The European Academy of Neurology (EAN) warned in a recently released white paper of “an increasing burden of neurological disorders” in the face of an insufficient neurological workforce in most countries and decreasing numbers of general neurologists.

The shortages are pervasive, patients are suffering, and neurological societies are alerting stakeholders. The white paper points to potential solutions that will require support from health authorities and policymakers and greater recognition of the value of general neurologists in the medical community.

“We need this workforce to be the first point of contact to get a broader understanding of the patient, to provide the best follow-up and support, and get the patient on the right diagnostic pathway,” said Astri Arnesen, president of the European Federation of Neurological Associations and an author of the white paper. “Without an accurate initial diagnosis, a patient can end up going to specialist after specialist for different tests, which are costly for the patient and for society. It then takes such a long time to get the right diagnosis — and many patients never do.”

‘Significant Burdens’

Arnesen emphasized that staffing shortages in general neurology could have far-reaching effects, imposing significant financial and social burdens on patients, their families, and healthcare systems.

The reason: General neurologists play a key role in providing timely, accessible, and comprehensive care for patients with neurological disorders. They ensure coordinated care within the community by collaborating with specialist neurologists and other health professionals and are instrumental in diagnosing and managing many common neurological disorders. They also play an important role in delivering pre- and postgraduate education and promoting brain health.

Current estimates show there are 0.1 neurologists per 100,000 people in low‐income countries compared with 7.1 neurologists in high‐income countries and 9.2 in Europe, according to the report. While European countries fare better than many other countries, the number of general neurologists may still be insufficient to handle the increasing burden of neurological disorders.

A case in point is Poland, where the Polish Neurological Society urged that neurological diseases become a “strategic priority” for the healthcare system. The society highlighted staff shortages in both specialist care and in hospitals, noting that every third working neurologist is of retirement age. It called for investments in medical, nursing, and auxiliary staff in neurology to attract more professionals into the field.

The Association of British Neurologists saw early on that a crisis was emerging and that the UK’s workforce of consultant neurologists was “significantly lower” than expected — particularly in comparison with France and Germany.

Mihai Radu Ionescu, MD, a neurology specialist at the Neuroaxis Neurology Clinic in Bucharest, Romania, said a shortage of general neurologists could leave large numbers of patients with neurological disorders without a diagnosis and access to the right treatment. Romania also has been experiencing multiple healthcare system challenges, including insufficient funding and shortages of medical personnel.

“Unfortunately, the reality in the field is that you need general neurologists who have a broad knowledge base to be able to treat most patients and then send the truly rare and atypical cases to a specialty center or subspecialist in the field,” he said. “The strength of a general neurologist lies in being able to treat most neurological disorders or at least the most frequent ones.” 

A Brighter Future?

Workforce shortages in general neurology may stem from its lack of appeal compared with specialized neurology — salaries are lower, workloads are higher, and general neurologists tend to get little academic recognition, according to the EAN report. High burnout rates as well as the complexity surrounding modern neurotherapeutic approaches, which require knowledge of a variety of diagnostic and treatment technologies, may also contribute to the shortages.

Ionescu believes that increasing the recognition of general neurology’s importance and offering financial incentives could encourage more professionals to pursue careers in the field.

“I think young doctors wishing to choose a career in general neurology would be better incentivized to pursue such a path if they would receive more academic recognition, perhaps through local general neurological societies,” he said. Financial incentives could include allowing more procedures to be undertaken by general neurologists without further subspecialty training and ensuring that they have sufficient training to be able to refer patients to specialist centers “when findings are truly atypical.”

Arnesen agreed. “We need a highly specialized neurology workforce, but we [also] need more general, broader expertise” to bring value to more patients.

“I think we’re at a time where society, decision makers, politicians, and healthcare providers are opening their eyes to how big the field of neurology is and how many people are affected by neurological diseases and the consequences they bring,” she said. “There is a growing understanding that this is a field we need to prioritize and improve, as we’re losing a lot of people too early.”

The EAN task force made several recommendations to promote the development of general neurology at both academic and community levels. These include recognizing general neurology role models with clinical distinction pathways and awards, integrating general neurology into mentorship and leadership programs, and ensuring adequate training in medical schools and neurology programs with exposure to community-based neurological care.

The task force also advocated for promoting academic career opportunities in general neurology, including research and teaching, and incorporating general neurology roles into brain-health promotion efforts like the intersectoral global action plan on epilepsy and other neurological disorders.

Joint initiatives among neurological societies and support from health authorities and policymakers are encouraged to assess care needs, enhance general neurology roles, and improve reimbursement to reflect the complexity of neurological care.

The task force recognized that to succeed, these initiatives will require collaboration from national, regional, and global neurological societies, as well as input from patients and their caregivers.

“We need better coverage of general neurologists within the healthcare system,” Arnesen said. “I hope that by working together — both medical societies and patient communities — through advocacy and helping people understand the importance of neurology services, we can solve an important piece of the puzzle. Then we just need to believe that improvements are possible.”

Arnesen and Ionescu have disclosed no relevant financial relationships.

Charlotte Waterworth is a UK-based freelance medical writer and editor with more than two decades of experience working across a variety of health-related disciplines.