Neurologists are seeing about 13 more patients per week than they were in 1991. On average, they're a few years older and the number of women in the ranks of the specialty has grown modestly. Electroencephalography and CT procedures are down, while MRI and positron emission tomography procedures are up. Neurologists are giving 22 more botulinum toxin injections a year than they were 13 years ago when they were first asked, according to the sixth census survey of neurologists released by the American Academy of Neurology (AAN) in July.1
Katherine Henry, MD, MEd, has left her mark on the census process since she was appointed by the Academy in 2003 for her first 2-year term as chair of the AAN member demographics subcommittee. The committee is charged with creating the survey tool and directing the collection and analysis process. Her academic background in data collection and analysis, interest in data pertaining to special interest groups in neurology such as international members and women in neurology (she's a mentor to women neurology residents and junior faculty), and the addition of an epidemiologist to her committee of like-minded information enthusiasts have made the census assume a broader and more scientific approach.
Henry hopes this approach will yield more and better data for its growing audience. "It helps us understand who and what we are," she said. "Understanding the trends in demographics of membership and in neurological practice gained through the census helps the community within the specialty make informed decisions as far as education and other areas of focus are concerned."
The AAN determined that 78.9% (12,498) of all US neurologists (15,831) are members of the AAN by matching its membership with the AMA's Masterfile of 1,025,324 physicians. Of these, just under 60% (8638) returned their survey questionnaires. The AAN had 17,872 total members at the time of the report, including 14,708 US members and 3164 international members.
US, INTERNATIONAL PRACTICE VARIATIONS
This is the first year the census broke out information on international neurologists to learn more about their preferences. "The international data was highlighted because we are interested in attracting international members. We want to encourage more dialogue and cross-fertilization," said Henry.
The international members had only a slightly lower response rate (54%, or 1708 responses) than did US members. Some of the more significant differences Henry noted between the US and international respondents were in practice settings and size and the types and scale of patient visits.
Whereas the majority of US neurologists are in group (29.5%) or solo practices (24.8%), the majority of international members work in a university research setting (32.8%), followed by solo practice (18.7%) and government hospital or clinic (18.3%). The international members also are slightly more often involved with clinical research (93.8%) than their American counterparts (91.5%).
Henry said the reason for the preference for university-based careers and research among international respondents is not clear and is an area that warrants further study. "The difference may be due to many varying factors. We will not have a better sense of the specific reasons until we look at the data further," she said. "This highlights the importance of collecting these data and then taking it a step further through more statistical analyses to get a better understanding of what it all means."
Patient focus areas differ between the 2 groups. International respondents' primary focus areas are cerebrovascular disease (49.9%), movement disorders (41.1%), epilepsy (39.6%), aging/dementia (38.9%), and headache (37.5%). US neurol- ogists named headache (46.3%), epilepsy (42.9), electromyography (40.8%), and cerebrovascular disease (40%) as at least 1 of their practice focuses.
USE OF computer TECHNOLOGY
In addition to the census, a randomly selected 2000 members were asked to complete the Practice Profile Form. This survey addresses practice issues and is administered concurrently with the census. Questions regarding use of technology were additions to the latest survey.
A DEMOGRAPHIC SNAPSHOT OF US NEUROLOGISTS
Location of practices
The South is favored as a practice setting by US neurologists (32.7%), followed by the Northeast (25.5%), Midwest (21.5%), and West (20.2%). The highest concentration of neurologists per 100,000 population is in Washington, DC, at 11.02, followed by Massachusetts at 7.32 and Maryland at 6.85. The lowest concentrations are in Wyoming at 1.78 and Idaho at 1.94.
Of all US neurologists, 23.3% are women, up from 21.6% in 2000.
International members are represented by fewer women neurologists (19.5%).
Adult neurologists account for 83.3% of all US neurologists, and 9.4% of respondents said they are child neurologists. The remaining 7.3% includes neurosurgeons, neuroradiologists, emergency medicine physicians, and neuro-ophthalmologists.
Hours worked per week
US neurologists work 55 hours a week on average. That includes patient care, medical research, administration, and teaching.
More than 83% of the 2000-member sample indicated that they used computer technology; 75.9% of those respondents said that they used computers for medical claims/billing. Respondents said they also used computer technology for communication with other physicians (49.9%), patient medical records (46.3%), communication with patients (25.6%), prescription medication (23.7%), and tracking medical errors (9.5%).
Indeed, of those physicians who reported using computerized systems, 46% said they used electronic medical records (EMRs) and 44% said they used personal digital assistants (PDAs) or other handheld devices. Solo practitioners were the least likely to use a PDA (34.3%), and physicians practicing in university-based groups were the most likely (55%).
For what were PDAs and other handhelds most relied on? Seventy-one percent of the survey respondents who reported using computerized systems relied on them to obtain information about drug re- sources. About 43% reported using them to access medical formularies, calculators, and/or conversion tables, and 37% reported using them to access medical reference information.
Future surveys will be able to measure neurologists' interest in adapting to new technologies. Adaptation to EMRs may depend on standardization within the EMR industry as well as future federal government investment in health care information technology (see also, "The March Toward Paperless Health Care," Applied Neurology, March 2005, pages D1, D6-D8).
ROLE OF PHYSICIAN EXTENDERS
The number of physician extenders (physician assistants or nurse practitioners) has increased only slightly since the 1998 census, when 21.8% of neurologists reported having physician extenders on staff. In 2000, 28% reported physician extenders on staff. By 2003, the number had declined slightly to 23.6%.
Although the number of physician extenders employed by a practice has remained fairly consistent, the type of work they perform has shifted substantially. The role of these professionals has shifted away from solely patient education and triage to a greater focus on direct patient care and performing billable procedures.
More than a quarter (27.7%) of physician extenders in neurology practices see new patients independently, and nearly three quarters (71.4%) of physician extenders in neurology practices are seeing follow-up patients independently.
"This makes financial sense," said Henry. "As designated mid-level providers, physician extenders are billable for 80% of physician reimbursement," said Henry, adding that patients often view extenders as professionals with whom they can develop strong relationships. Physician extenders are performing more billable procedures (31.9% presently compared with 26.2% in 2000), dictate more patient notes (51.2% compared with 42.8% in 2000), manage less patient triage (33.3% compared with 42.4%), and manage fewer group medical appointments (4.7% compared with 8.3%).
MEDICAL ERROR TRACKING ON THE RISE
Fewer than half (38.5%) of US practices surveyed systematically track medical errors, but that's a slight increase from the 31.3% who said they tracked medical errors in 2000. Since 2000, neurologists have grown less willing to track medical errors to minimize them. Nearly 63% said they were willing in 2004, down from 75% in 2000, and 30.8% of respondents were unsure of their willingness to track errors, up from 22.5% in 2000. These findings may reflect a hesitation to take on more paperwork and tracking functions as opposed to a true unwillingness to track medical errors, said Henry. *
1. Henry K, Lawyer BL, Member Demographics Subcommittee of AAN. Neurologists 2004. St Paul: American Academy of Neurology; 2005.