Background

The specialty of neurology has long sought a way to expand accreditation and certification for neurology subspecialties. This is an issue that has been discussed by most of the major organizations in the specialty. Although there are abundant opportunities for neurology fellowships, training requirements vary considerably. Many fellowships are not accredited nor are their graduates certified.

The trend across all medical specialties has been toward subspecialization. In part, this trend is driven by new science and technology, which expand both the need and options for subspecialization. Neurologists appear to be responding to this trend. In 2000, 75 percent of graduating neurology residents sought to enter fellowship programs to develop subspecialty expertise.*

Though clinically related neurosciences and neurotechnology have exploded in the past decade, formal recognition of subspecialties in neurology has not. In fact, neurology?s scope of practice has been reduced as larger, strategically organized groups have adopted subspecialties in overlapping areas of interest.

The certification system of the American Board of Medical Specialties (ABMS) has been structured in a way that makes the approval of new subspecialties difficult. Its requirements include numeric goals that are very difficult for smaller subspecialties to meet, and the approval of a new subspecialty through the ABMS requires the support of a majority of the other ABMS boards. That can become a very political process.

In August 2001, in reaction to these many subspecialty issues, the American Academy of Neurology (AAN) Commission on Subspecialty Certification brought together a group of major neurology organizations that had an interest in collaborating on a process for supporting and nurturing neurology subspecialties.

This meeting developed substantial agreement on a proposal to establish the United Council for Neurologic Subspecialties (UCNS). This is an independent, non-profit professional medical organization whose mission is to provide for accreditation and certification with the goal of enhancing the quality of training for physicians in neurological subspecialties and the quality of patient care.

The parent organizations for the UCNS include the AAN, the American Neurological Association (ANA), the Association of University Professors of Neurology (AUPN), the Child Neurology Society (CNS), and the Professors of Child Neurology (PCN).

In April 2002, the parent organizations agreed in principle to proceed with the establishment of the UCNS and its proposed structure and function. They approved a six-month budget to be used by the UCNS parent representatives to further develop UCNS procedures and membership criteria, and perform the systematic collection of information regarding the interest of potential subspecialty customers. The data collection was accomplished from July through November 2002, using a survey instrument developed by a consultant and implemented by the AAN. A report of the survey findings and a business plan based on that information was part of a package submitted to the five parent boards of directors. Each board was asked to approve the UCNS Business Plan and three-year budget as the final prerequisite for the incorporation of the UCNS. In February 2003, the parent organizations gave their approval, and the UCNS was incorporated in March 2003.

The UCNS Board of Directors held its first Board meeting on May 1, 2003. The UCNS Board designees elected the UCNS officers at the May 1 meeting and adopted the Bylaws and operating procedures. Stephen M. Sergay, MB BCh, was elected the first Chair of the UCNS. Subsequent to the meeting, the membership criteria and the accreditation process and policies were finalized.

The UCNS Board of Directors is made up of five voting directors and seven non-voting ex officio members. The five voting directors include the three officers. The seven non-voting ex officio members include the five parent organizations? Executive Directors, a representative from the American Board of Psychiatry and Neurology, and a representative from the Accreditation Council for Graduate Medical Education. In addition, up to four seats are granted on the UCNS Board for representatives from approved NSAs or IBs.

In the fall of 2003, the UCNS established its Accreditation Council and held its first meeting on September 10, 2003. The Accreditation Council is made up of five members, one nominee from each parent organization.

The UCNS Certification Council was established by the UCNS Board in the summer of 2004, and held its first meeting on September 28, 2004. The Certification Council is made up of five members, one nominee from each parent organization.

In June 2004, the UCNS approved its first subspecialty membership. The neurological subspecialty area of Behavioral Neurology & Neuropsychiatry was approved for membership by the UCNS Board. Several more subspecialties were approved in 2005: Clinical Neuromuscular Pathology (February 2005), Headache (March 2005), Neuro-Oncology (May 2005), and Neurocritical Care (October 2005).

Accreditation and certification activities are underway for all approved subspecialties.

*Source: American Academy of Neurology and Association of University Professors of Neurology, Graduating Neurology Residency Survey, 2000.