Center of Excellence Series: Toronto Western Hospital’s Parkinson’s Fellowship Program

There are approximately 3,000 movement disorder specialists in the world. While they are all neurologists, not all of them have experience treating Parkinson’s disease (PD). For every person with Parkinson’s to receive treatment from a specialist, each one of these doctors would have to treat more than 3,000 people with PD. Parkinson’s Foundation estimates that the average movement disorder specialist sees a total of 350 patients. That’s more than 8.9 million people with PD who are not being treated by a specialist.

“Increasing the number of available movement disorders specialists will expedite proper diagnosis and best management practices for patients with Parkinson’s and will almost certainly translate into better patient outcomes and improved quality of life for not only patients, but their families,” said Anthony Lang, MD, and fellowship program mentor, at the Toronto Western Hospital (TWH) Movement Disorders Clinic.

For this Parkinson’s Foundation Center of Excellence, being a leader in Parkinson’s expert care means training and increasing the numbers of practicing movement disorder specialists through their competitive and specialized fellowship program. TWH has become internationally recognized for its fellowship program, which teaches fellows how to care for a Parkinson’s patient and conduct groundbreaking research at the same time.  

Since 1985, the Toronto center has trained more than 85 fellows in movement disorders. The international program has hosted fellows from 21 countries, all of whom go back home as Parkinson’s experts, sometimes opening specialized Parkinson’s centers in extremely underserved areas.

“Fellows have gone back to South Africa, Saudi Arabia, Malaysia, Thailand and India to become faculty in their local hospitals or Centers of Excellence, providing care to their Parkinson’s community,” said Susan Fox, MD, Movement Disorder Specialist, a fellowship program mentor. “At this moment, we have fellows from Ireland, Switzerland, the United States, Israel and Iran who are getting first-hand experience in managing Parkinson’s care.”

Neurologist Julien Bally, MD, completed the fellowship. “If I had to highlight only one aspect of my fellowship, it would be the marvelous national diversity of the fellows, which is an excellent opportunity to exchange different points of views, talk about different medical systems and cultures,” Dr. Bally said.  

With an estimated 10 million living around the world with Parkinson’s and an aging global population, the need for more movement disorder specialists is high, so securing a spot in the international fellowship program is competitive. “The most common feedback I receive from almost every Center of Excellence is that there is a shortage in movement disorder specialists,” said Director of Research and Centers Program, Clarissa Martinez-Rubio, PhD. “Given the opportunity, I feel almost every center would hire more specialists, allowing them to treat more patients. This fellowship program is addressing an urgent need.”

Toronto Western Hospital has already completed its 2018 fellowship application round, evaluating more than 30 applicants for three fellowship positions. The next round, for the July 1, 2019, application process, began in January 2017, 18 months before the fellowship start date. To apply, applicants must submit their resume and reference letters, then interview with the center. Once fellows are chosen, the center helps international fellows secure work visas.

Over the course of the two-year fellowship, fellows are fully integrated into the center’s daily operations, learning and experiencing every aspect of managing Parkinson’s — from diagnosis to advanced therapy. There are separate fellows, who have already done a general movement disorder fellowship, for the center’s deep brain stimulation surgery team.

“Toronto’s outstanding fellowship program has an enormous impact on all aspects of the work of our program,” Dr. Lang said. “Fellows provide outstanding patient care, permitting us to follow larger numbers of patients and maintain closer support for patients through more regular telephone contact.”

In addition to Parkinson’s, the center also specializes in many other movement disorders. Fellows predominantly do clinical work, working directly with patients. “Every patient seen by a fellow is reviewed with a staff member, so all fellows get one-on-one mentorship and training,” Dr. Fox said. They also better understand when to recommend complementary therapies, like physical, speech or occupational, instilling the interdisciplinary care mindset.

“We have met a wealth of people who have taught us the craft and nuances of taking care of Parkinson’s patients, allowing us to nurture many projects that foster professional and personal development,” fellow Ariel Levy, MD, LMCC, FRCPC, said.

Fellows are not only taught the integral basics of Parkinson’s care, but are also encouraged to conduct their own Parkinson’s research. With data, labs and an entire center at their fingertips, every fellow completes at least one cutting-edge Parkinson’s or movement disorder-related research project as part of their clinical experience.

“Fellows are deeply embedded in our research program; they participate in clinical trials of new medications and conduct research projects that they have conceived and developed themselves with the supervision and mentorship of our faculty,” Dr. Lang said. By the end of the two-year program, most fellows get at least one research paper published in a medical journal.

“Fellows come with diverse backgrounds and research interests, various levels of training and knowledge,” Dr. Fox said. The movement disorders clinic is a leader in PD research. The center consistently participates in clinical trials. Currently, Dr. Fox is conducting a study on IV-administered levodopa, which is used to help with PD-related dyskinesia. Dr. Fox has worked with fellows to conduct the center’s most recent clinical trials on PD medications, drooling and visual hallucinations in Parkinson’s patients.

For more than two decades, the fellowship program has met its ambitious goal to find fellows who can help underserved PD communities by providing expert Parkinson’s care. However, the center also exceeds in helping fellows become better doctors. “My fellowship allowed me to develop as a physician, arming me with new knowledge,” neurologist Sean Jeremy Udow, MD, FRCP(C), said. “Managing movement disorders requires the giving and taking of time, along with the ability to listen, to communicate and to form the important relationship between doctor and patient.”

Center of Excellence Series

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