NeuroVoices: John Greenfield, MD, PhD, on the Growth of Neurology and the Budding Young Community of Neurologists

John Greenfield, MD, PhD

Founded in 1967, the Association of University Professors of Neurology (AUPN) has been dedicated to supporting neurology department chairs through educational offerings geared towards leaders such as program directors and clerkship directors. In particular, the organization has been focused on legislative issues that affect research grant fundings, representation of neurology in the workforce, and the neurological curriculum in medical education at all levels, among many others.

At the 2023 American Academy of Neurology (AAN) Annual Meeting, held April 22-27, in Boston, Massachusetts, NeurologyLive® sat down with John Greenfield, MD, PhD, president elect of the AUPN, to discuss the notable strides in neurology and the importance of sound education. As part of a new iteration of NeuroVoices, Greenfield provided perspective on the change in approach to patients with neurological disorders, and the reasons for why young medical professionals should join the space.

NeurologyLive®: What are some research areas that catch your eye?

John Greenfield, MD, PhD: There are a couple of things. I think some major trends that I've seen are the emerging role of biologics in a variety of different fields. Over the past 10 years in multiple sclerosis, it's transformed the care of patients with MS. Now we're starting to see potential in Alzheimer disease, but it's still unclear. And in fact, that's a very hot topic. I tried to get into the lecture on latest treatments, and you couldn't get in that room because it was packed full.

I ended up going to a different talk at that time about another hot topic in artificial intelligence. That’s been brought to the forefront with the emergence of chatGPT in the Microsoft browser, and everybody's very interested in that. But the role of artificial intelligence in decisions, support, teaching, helping write and organize research, and looking at large datasets, there's just a huge potential. There are downsides and risks, as there are with any research, but I think those are among the major things.

One other area that I'd want to talk about is the molecular genetics, because that has revolutionized the treatment of a few diseases so far, and probably will in other diseases in the near future. If somebody 15 years ago said, we will have a potential cure for spinal muscular atrophy, it's going to be expensive, but we can have these kids grow up and lead pretty normal lives, that would have been amazing. And yet, this is what we're seeing with nusinersen. The kicker for that is the cost is high. For the first year, it's 3 quarters of a million dollars and half of that for every year after. There are some actual gene modification, with one approved therapy that costs even more than that. But if it's a one-time deal, and if it works, then you have a cure. We're seeing it's an exciting time for neurology, we're seeing a lot of cool things happening, and a lot of them are represented at this meeting.

How can we attract young medical professionals to neurology? Similarly, how can we keep those currently in the field?

I don't think it's going to be that hard. In fact, I walked past a sign on the way here that said, the AAN membership is now more than 40,000 people, which is pretty respectable. More and more medical students are going into it. Neuroscience is a hot major in college and its our job as neurology educators to try to latch on to those people and focus them into doing neuroscience as a career and stay in neurology. Some of them end up going to the dark side into the neuroradiology or psychiatry, and that's okay. We just want to grab some of the good ones for ourselves! But at least at our medical school, we've had increasing numbers of medical students opting for neurology as a career.

The more that we stress that this is a growing career, that we're able to do more for people in a variety of different diseases. Back when I was training, the idea was that neurologists gave you the diagnosis, and then that was it. It couldn't be further from the truth. These days, we have treatments for most of the conditions that we see, so it's an exciting time. I don't think that's going to be a problem in terms of keeping people in the field.

Burnout is a real thing. And I think it's important to make sure that we keep the career rewarding. Part of that is what we do with these meetings, to keep refreshing our knowledge base, meeting up with colleagues, and having the time that we need to work with patients to talk with them. There's a lot of pressure to see more patients in smaller increments of time, and I think we need to push back against that a little bit so that we are not just churning patients through, and that we're developing relationships and taking the time we need to make important diagnoses.

Transcript edited for clarity. Click here for more NeuroVoices.