Summit Examined Issues in Academic Neurology, How the AAN Can Help
Academic neurology departments, like many other constituents of the AAN, are facing many challenges today to support the under-funded missions of clinical care, education, and research. As the birthplace of many neurologists, neurology departments are the place where students get their first exposure to the field, residents begin their training, fellows differentiate into subspecialists, and faculty careers develop. The challenges that are facing all of us include the ever-changing health care reforms, research funding cuts, neurology work force issues, graduate medical education funding cuts, reduced reimbursement for services, and increasing regulatory burden. As a sitting chair of a neurology department, I have personally felt the pressures and sometimes felt alone in coming up with solutions to respond to these challenges.
We believe the time is right to come together to discuss the state of neurology and academic medicine, and to develop tangible solutions in support of the future of academic neurology. The AAN has developed an Academic Medicine Initiative and been actively seeking new ways to maximize the effectiveness of our ongoing support for academic neurology. Paramount to this initiative is strengthening the AAN’s relationship with chairs, understanding the needs of academic neurology departments, and efficiently identifying unmet needs of chairs and their departments and effectively addressing them.
I am delighted to report that on March 5 in Chicago, the AAN hosted the first-ever Neurology Department Chair Summit, in collaboration with our colleagues at the American Neurological Association (ANA) and the Association of University Professors of Neurology (AUPN). Attendees included more than 100 chairs from across the country as well as the chairs and vice chairs of the AAN’s Education and Science Committees.
Simply put, many attendees didn’t know what’s already being done by our organizations. Others were aware of what’s not being done, and many had ideas on what should be done. The sense was that there have been gaps in what we provide department chairs, and that we—the AAN, ANA, and AUPN—need to do more.
The goal of this summit was to identify the current gaps, share best practices, and create a roadmap for moving forward.
The desired outcome of the summit was to have fresh, focused ideas that the AAN and our colleagues can create programming around.
Current Academic Department Support from AAN, ANA, and AUPN
Barbara Vickrey, MD, MPH, immediate past-president of ANA; Karen Johnston, MD, president of AUPN; and I were pleased to discuss current support provided by our organizations to neurology academic departments and medical students, and answer questions about these current offerings. Among the valuable AAN resources I shared was the Axon Registry®; the number of academic departments enrolled in Axon is small and I called for all academic departments to participate. I also shared how advanced practice providers (APPs) are now the fastest growing group of AAN members and we are developing resources to help fully integrate them into the neurology care team. I also provided background on the AAN Academic Medicine Initiative.
Issues Facing Academic Departments
This discussion focused on the outcomes of a survey that was sent to the chairs to ask what issues they are facing. It came as no surprise that revenue to support the mission of academic departments came up as the number one concern for chairs. Moreover, we worked to identify gaps and opportunities where the ANA, AUPN, and AAN can provide solutions in areas including: funding the education mission, pipeline and recruitment, research, and institutional change/integration. There is a concern that we need to focus on undergraduates and excite them about neurology before they are captivated by another specialty
Models for Revenue Generation for Departments: Making the Case to Hospital Administrators
We discussed the data and analyses that would be instrumental in making the case to hospital administrators and other health system leaders for transfer of resources to neurology, based on the hospital-based downstream revenue driven by neurologists and neurologic care. We also looked at ways to maximize billing and the growing impact of therapeutics, including infusion, procedures such as endovascular neurology, and comprehensive stroke centers.
Discussion and Prioritization
Toward the end of the day, we discussed the gaps and opportunities identified by the breakout groups during the meeting. There were ideas on what the AUPN, ANA, and AAN could possibly do on these topics. We heard that we need more data, toolkits, and greater participation in the AAN’s Neurology Compensation and Productivity Survey. If we could get more data on faculty compensation for certain subspecialties that could be very helpful in making the case to administrators. More education was requested on coding, models where neurologists could get reimbursed for reading images, and more education and resources for APPs to help optimize their participation in the neurology practice. There were requests for new models for growing revenue and providing support for K programs for young investigators. And we need to continue advocating for our workforce pipeline and moving neurology training to the third year of medical school for all, not fourth year. We also discussed the importance of continuing to advocate for more funding for neurology research at the NIH and encouraging policies that support the continued investment into novel therapeutics by industry.
The Chair Summit was a definite success and is only the beginning of our on-going efforts to support all aspects of academic medicine. The recommendations that came from this meeting and more will be summarized and prioritized to consider next steps. I am so grateful to the chairs, volunteers, and staff who helped develop a responsive agenda, led a number of panel discussions, and contributed greatly to the lively discussions in the breakout groups. I am very happy to have seen the amazing engagement, collegiality, and willingness to collaborate and learn from each other. We will build on our momentum to revitalize academic neurology, and I’m proud that the AAN is helping to lead the way.