The fill rate for neurology positions appears to have risen slightly in this year's resident match, and experts in the field say that interest in the specialty is growing among medical students.
This year, a total of 539 neurology resident positions were offered for both 4-year categorical programs and advanced programs that begin after a year of prerequisite training. Of those, 520 positions (96%) were filled.
This year's rate appears to be up from 2006, when the match was split between two programs—the National Resident Matching Program (NRMP) and the San Francisco Matching Service. In 2006, a total of 578 residency positions were offered in neurology between the two match programs with 534 students matching for a 92.3% fill rate among all applicants.
This year, all neurology residency candidates applied through the NRMP. Most of the positions offered this year were for advanced programs. Of the 379 positions available in advanced programs, 96% were filled, with 58% filled by U.S. medical graduates. There were 160 positions offered for categorical programs, with a 98% fill rate and a 52% fill rate among U.S. medical graduates.
“We continue to see greater interest in neurology,” said Dr. Brett Kissela, program director in neurology at the University of Cincinnati and the chair of the Consortium of Neurology Program Directors, part of the American Academy of Neurology.
However, residency training programs will have to be ramped up at some point to meet predicted shortages in the specialty, he said.
In 2006, the Association of American Medical Colleges (AAMC) issued a statement predicting a physician shortage within the next few decades and calling for increases in medical school and graduate medical education capacity. Specifically, the AAMC has called for a 30% increase in medical school enrollment by 2015, compared with 2002 levels. The group is also seeking expansion in the aggregate number of graduate medical education positions to keep up with the additional medical school graduates.
If there is a shortage of physicians, neurology will be significantly affected, Dr. Kissela said. The need for neurologists has already increased as therapeutics have improved, particularly in the area of stroke care. “Supply is not keeping up with demand,” he said (CLINICAL NEUROLOGY NEWS, December 2006, p. 9).
But in the meantime, other efforts aimed at increasing medical student interest in neurology seem to be paying off, experts said.
Among the efforts to increase awareness of neurology during medical school is the American Academy of Neurology's SIGN program—Student Interest Group in Neurology.
As part of this effort, academic institutions can register and receive a small stipend to support lectures and other activities with medical students.
“I think neurology is still a specialty that suffers from being underrepresented in the medical school curriculum,” Dr. Kissela said.
In addition, some medical schools have created specialized “pathways” for those students interested in neuroscience. These students take a slightly different curriculum that may include extra lectures on the neurosciences and a research project. A small pathway program for neurology was recently started at the University of Cincinnati. However, because the program is new, it is not known how it will pan out in terms of those students choosing residencies in neurology, Dr. Kissela said.
A career in neurology should be attractive to many students both because of the reasonable hours and the ability to earn more money than in some other cognitive specialties like family medicine, said Dr. Ralph Jozefowicz, director of the neurology residency training program at the University of Rochester (N.Y.) and chair of the AAN education committee.
But overall, the decision to choose neurology is highly individualized, he said. “It's really the material. Some people like it. Some people don't.”
4-Year Programs on the Rise
One trend in this year's match data was an increase in the number of positions offered in 4-year categorical programs.
This year, there were 160 positions offered for categorical residencies compared with 40 positions offered in 2006.
While opinions are still mixed on which type of structure is best, for some programs the categorical approach may offer a competitive advantage, Dr. Jozefowicz said. For academic medical centers that are somewhat geographically isolated from other training programs, such as his institution in Rochester, having a 4-year residency may be more appealing to candidates who don't want to have to move again after their preliminary year of internship.
But for programs in places like New York City, where there are several academic medical centers in close proximity, having a categorical program might not offer an edge. “It depends on where you are,” Dr. Jozefowicz said.
Choosing a categorical residency may also appeal to medical students because it allows them to get to know their medicine colleagues better, said Dr. Kissela, whose own institution recently became an integrated 4-year neurology residency.
Dr. Kissela said that when he talks to medical student candidates in neurology, they overwhelmingly support the idea of a categorical residency.
Consolidating the Match
The decision to consolidate both the categorical and advanced residency match into the NRMP was a few years in the making, said Dr. Joel Morgenlander, professor of medicine at Duke University in Durham, N.C., and chair of the Association of University Professors of Neurology's graduate education subcommittee.
The change was something that the neurology program directors had been pushing for and was ultimately voted on by the Association of University Professors of Neurology.
As a result of the change, applicants who were interested in matching to a preliminary year in internal medicine and an advanced residency in neurology were able to submit a single application to the NRMP. The NRMP was able to match applicants to both programs at the same time, Dr. Morgenlander said.
Previously, applicants had to submit an application to the San Francisco match for the advanced residency and an application to NRMP for their preliminary year of internship. Applicants received the results of their advanced residency match in January, ahead of the NRMP match.
So far, the switch has been popular with medical students who viewed it as a simpler process, Dr. Morgenlander said. While it's too early to fully judge the transition, so far comments have been positive, he said.
“The early word is that we did the right thing,” Dr. Morgenlander said.
In addition to easing the application process, the NRMP held other advantages, Dr. Jozefowicz said. For example, using the NRMP process allows applicants to participate in the couples match.
Previously, if one spouse was participating in the San Francisco match and the other in the NRMP, they couldn't match as a couple.
Interest in the couples match has grown significantly during the last 20 years.
In 1987, 347 couples participated in the match together, compared with 621 in 2007. “I really think the switch was beneficial,” Dr. Jozefowicz said.
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