Objective: 1. Identify factors leading to lower number of residents interested in movement disorders fellowship.
2. Propose strategies to increase recruitment.

Background: The prevalence of Parkinson’s Disease (PD) approaches one million persons in the US. Paradoxically, there remain unfilled movement disorders fellowship positions in the US.

Method: We review the current state of movement disorders fellowships, reasons for insufficient applications, and potential opportunities for growth. Available statistics on fellowship applicants and positions were assessed with review by an interdisciplinary team of movement disorder and other neurology subspecialists and educators.

Results: Movement Disorders entered a match system in 2012 using the San Francisco Match, with 29 registered programs totaling 43 positions, of which 34 were filled (79%). By 2020, there were 52 programs with 72 positions, with 54 positions filled (75%). When compared to the more popular neurocritical care fellowship, also through the SF match since 2010, greater than 90% of positions have been filled every year except for 2012 when 81% of positions were filled. Barriers to choosing movement disorders as a fellowship include lack of exposure during residency including PGY1, difficulty in pursuing scholarly projects, fellowship application timing (later than nearly all other subspecialties), and lack of centralized, comprehensive, and updated movement disorder fellowship program information through the American Academy of Neurology, American Neurological Association, and International Parkinson’s Disease and Movement Disorders Society.

Conclusion: Despite the high prevalence of a burdensome movement disorder such as PD, one-fourth of movement fellowship positions remain unfilled. Providing neurology residents early in their career more consistent exposure to movement disorder patients through their continuity clinics and during earlier years of residency training, inviting them to divisional lectures and case presentations, providing them the opportunity to attend MDS sponsored courses, and exposing them to available procedures and clinical trials are all potential means of increasing exposure, interest, and growth in fellowship recruitment. Studying educational strategies of neurology residency programs will allow better ascertainment of priorities in movement disorders recruitment and implement stronger strategies to expand the pool of subspecialists.

References: Sarva, H., Patino, G.A., Rashid, M. et al. The status of neurology fellowships in the United States: clinical needs, educational barriers, and future outlooks. BMC Med Educ 21, 108 (2021). https://sfmatch.org/SpecialtyInsideAll.aspx?id=23&typ=1&name=Movement%20Disorders# Shih, L. C., Tarsy, D., & Okun, M. S. (2013). The current state and needs of North American movement disorders fellowship programs. Parkinson’s disease, 2013, 701426.

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