Creating Efficient, Well-Rounded Neurology Departments

The Association of University Professors of Neurology (AUPN) began back in 1968 as an organization of neurology department chairs to inform and curate neurological education, clinical practice and research, and to be a combined voice for neurology leaders to influence policy. That year, the organization had its first formal meeting, where Maynard Cohen was selected as president. Since its formalization, the AUPN has supported department chairs through its educational offerings that are geared toward the leaders in neurology departments including program directors and clerkship directors.

Over time, there have been dramatic changes in all aspects of neurologic care, and along with this, neurology education has transformed. These changes have affected all aspects of education across the educational continuum, including learners, teachers, educators, content, delivery methods, assessments, and outcomes. Several in the field believe that unification of educations across professions and specialties will allow for increased leverage of resources, meta-data, skillsets, and perspectives to develop a core foundation for all health professions so that students in different professions learn with and from each other.

To gain a greater understanding about the changes in neurology, how its taught, and the impact the AUPN has had in neurology departments, NeurologyLive^® hosted a Roundtable Discussion featuring former AUPN presidents Robert Griggs, MD; Clifton Gooch, MD; and Henry Kaminski, MD. In this episode, the group discussed the ways in which neurology education has changed throughout the years, going from a diagnostic to a therapeutic specialty, and how neurology departments can get the most out of the resources and clinicians available.

Marco Meglio: Let's move on to the next question, shifting our focus away from education and delving deeper into the realm of neurology departments. We've discussed how these departments have evolved over the past two decades, the available resources, and the challenges they face. So, how can we establish efficient neurology departments that make the best use of resources and medical professionals' expertise?

Clifton Gooch, MD: That's the $100,000, or perhaps even $1 million question. I believe it's a collective effort. Neurologists can only carry a certain load. In our department, and likely in many others, neurologists work diligently in clinics, yet we bear the common burden of an expanding list of unfunded mandates. These include dealing with the demands of electronic medical record systems, which often force us to input data that might not be directly relevant to our skill set or the patient's immediate needs. Progress is being made, and I am optimistic that AI will eventually alleviate this issue by automating much of the administrative workload that has accumulated over the past two decades with the widespread adoption of EMRs. Furthermore, the system should develop sustainable revenue-sharing models to support the breadth of tasks neurologists perform. Neurology holds one of the highest tasking volumes among medical specialties. Patients come to us, and their cases are among the most intricate, yet often the coordination of care isn't financially compensated. This responsibility frequently falls on the shoulders of the physician.

The organization needs to acknowledge, distribute, and absorb these tasks so that physicians can focus on their medical roles and function seamlessly within the team-based care model we now operate under. This prevents physicians from being bogged down by non-physician duties that can be overwhelming. Without proper implementation, this situation can lead to burnout. Unfortunately, neurology ranks among the specialties with the highest rates of burnout. This is due to our relatively lower compensation and the longer working hours. Our patient load requires significant support, and it's essential for institutions to recognize the necessity of hiring additional staff, such as nurses. However, this is often met with concerns about increased costs. Nevertheless, these expenses are fundamental to patient care. As AI solutions emerge, they will alleviate some bureaucratic burdens.

As we develop group health management systems, organizations will likely become more proactive in addressing aspects of patient care that may not directly generate revenue but are crucial. I envision this will help resolve some of the existing issues. In the interim, we, as department chairs, do our best. We negotiate with administration and strive to communicate the challenges we face. At USF, we're fortunate to have excellent leadership, and while they understand the situation, we still confront the same obstacles as others. Therefore, achieving maximum efficiency requires the organization to provide comprehensive support across the board. Physicians need the freedom to fulfill their roles without resorting to "pajama time," where they work on medical records late into the night after a long day in the clinic. This unsustainable approach needs to change. Ultimately, I believe this is the path to optimizing efficiency – securing proper support for research, evaluating funded versus unfunded research, ensuring funding for educational endeavors, and establishing leadership that acknowledges the costs and identifies the necessary sources of revenue. With clinical revenues largely insufficient to fund other missions, these steps are essential from my perspective.

Robert Griggs, MD: A profound shift we're witnessing is neurology's transformation from a diagnostic to a therapeutic specialty. In my early days in neurology, most conditions we encountered were untreatable. However, the landscape has changed, with the majority of diseases now being treatable, or at least having a discernible path toward treatment. For instance, spinal muscular atrophy, once fatal in infants, can now be treated with gene therapy. Neurologists are poised to administer these gene therapies. This trend will extend to numerous other neuromuscular and medical domains. As we progress, the infusion of treatments and our understanding of age-related diseases will place neurologists in a prime position. This shift might also affect specialties like cardiology, as advances in preventing atherosclerosis redirect attention toward neurology. Collaboration between neurologists and neurosurgeons will be instrumental, particularly in the realm of intervention. While neurosurgeons possess certain expertise, conversations often reveal that neurologists maintain the upper hand in understanding the brain.

Henry Kaminski, MD: To underscore these points, education and collaborative efforts with leadership are paramount. Let's consider the Stroke Program as an example. Stroke is a significant public health concern, and we have interventions in place. Our approach involves a collaborative center, bringing together neurologists and neuro radiologists. This model showcases the evolution from diagnosing to actively treating conditions, allowing patients to recover and leave the hospital. This model will likely repeat across numerous specialties. It's about educating leadership and fostering collaboration with colleagues from different specialties, all working together. This, in turn, should lead to improved reimbursement rates and heightened appreciation across the board.