Leading the way to attract and retain the specialists Kentucky needs

Education, opportunities and environment are key players in solving the state’s shortage of neurological specialists.

There were so few neurologists and neurosurgeons in the state in 1976, that the specialties weren’t even mentioned in the following year’s 88-page Physician Manpower in Kentucky’s report from the state’s Legislative Research Commission.

Nearly 50 years later, some counties in the Commonwealth still lack a single physician — let alone a specialist. While the physician shortage is a complex national problem, the impact on Kentucky is disproportionate.

“Residents of Kentucky should not have to leave the Commonwealth for complex neurological issues, and that means having the specialists right here to care for them,” said Larry Goldstein, MD, codirector of the UK Kentucky Neuroscience Institute and chair of the UK Department of Neurology. “A lack of neurologists and neurosurgeons at a time when the rate of stroke and other neurological conditions are on the rise is disconcerting.”

At the center of the issue are education, recruitment and retention. KNI and UK continue to tackle the problem together, employing strategies such as expanding residency and fellowship programs; giving faculty the opportunity to focus on their interests that can combine clinical care, research, education and community involvement or service; and offering structured professional development programs.

“It’s really about providing a welcoming and collaborative environment where trainees and faculty are valued, their contributions are noticed and where high-quality clinical programs are grown,” Dr. Goldstein said.

In 2024, Dr. Goldstein was named co-chair of the Kentucky Heart Disease and Stroke Prevention Task Force to advance stroke prevention and stroke care throughout the state. With his experience in clinical care and research, he has his finger directly on the pulse of the state’s needs and is in a unique position to address the shortage of neurologists and neurosurgeons.

“We’d love our medical students, residents, and fellows to stay here or to come back if they decide to get a different perspective elsewhere, which is perfectly fine,” he said. “And while our faculty retention is extraordinarily good, we must continue to evolve as needs such as work/life balance and learning styles change. This begins with listening and communicating.”

A few of the projects that are helping to address the shortage are:

• The growth of the residency programs in both adult and child neurology, expanding the adult program from seven to eight residents and moving from two to three residents in child neurology beginning this July.

• Growth of UK’s Pipeline program for premedical UK and Kentucky high school students and summer fellowships for undergraduate students.

• Further development of the already close and integrated relationship between the Neurology and Neurosurgery Departments. “Many of our programs are joined at the hip,” Dr. Goldstein said. “Being seamlessly integrated provides a strong infrastructure for clinical care, research and education.”

• The PA neurology residency program, which now has two positions a year for physician assistants who receive a yearlong experience in neurology subspecialties.

• A structured and clear program to help faculty track their progress up the academic ladder to promotion. “We review the statements of evidence, a guide for accomplishments supporting academic promotion, every five years and modify them accordingly,” Dr. Goldstein said. “While others may have something similar, our program, which includes faculty mentoring, is very structured.”

“UK is a place where there is a sense of belonging and collegiality, where we work to provide opportunities for our faculty to pursue their interests and where we support each other across departments,” said Dr. Goldstein, who came to Kentucky in 2015 after a 30-year career at Duke University. “UK is a sweet spot for me, and I hope it will become one for many others.”