Read monthly updates from AAN President Ralph L. Sacco, MD, MS, FAHA, FAAN, to learn about Academy news and action on issues important to the neurology profession and patients.
Growing Our Workforce to Meet the Rising Demands for Neurological Care
One in six people have some neurological condition, and as our population ages the number of people who need neurological care is rising. There are too few neurologists to meet these growing demands. For a number of years, and through several AAN presidencies, the Academy has been confronting the growing deficit of neurologists in the workforce with direct action. The AAN's Workforce Task Force found that the United States is currently experiencing an 11-percent shortfall in the number of neurologists needed for patient care that will grow to 19 percent by 2025. We need to act quickly to fill this gap and ensure that our populations have access to high-quality patient-centered neurological care. I would like to take a moment to update you on two major initiatives to help strengthen and grow our profession.
We need to more effectively engage advanced practice providers (APPs) as essential members of our neurology workforce and fully embrace the concept of the interdisciplinary patient care team. Whether in academic departments, subspecialty clinics, or in community practice, APPs are greatly helping to provide neurological care. The growing employment of APPs collaborating with neurologists and helping to alleviate workload prompted the AAN to establish two APP membership categories. In just four years, I'm happy to report that we have crossed the 1,000-member threshold and APPs are the fastest growing segment of our organization. A high priority for the Academy is to do everything we can to increase APP participation both within the organization and in the field of neurology generally.
Collaborating across its committees and work groups, the AAN is committed to addressing the unique professional and educational needs of APPs in neurology to ensure high-quality patient care; member career satisfaction; and efficient, cost-effective practices. The AAN is working to meet four goals:
- Increase APP membership and engagement of APPs in the AAN
- Ensure standardized, quality clinical education for APPs
- Ensure standardized, quality online practice education for APPs
- Improve neurology environment to one that is receptive to APPs in practice
The Academy recently created the Consortium of Neurology APPs (CNAPP) to provide a highly visible home for APPs within our organization. AAN leadership has made it a priority to appoint a number of APPs on our major committees, such as the Member Engagement Committee, the Practice Committee, and the newly created Drug Pricing Task Force. We are pleased with the high engagement of APPs at our conferences, in-person meetings, and through our Synapse online communities. And every day, we are focused on making sure they're valued, and that our programs, products, and services keep the APP in mind. Our strategic plan addresses the AAN vision, “to be indispensable to our members,” both for physician members and new APP members. APPs are essential members of our workforce who will enable us to fully address the AAN mission, “to promote the highest quality patient-centered neurologic care and enhance member career satisfaction.” Neurologist-led interdisciplinary teams will allow all health care professionals to practice together and more efficiently serve the growing number of neurology patients.
While APPs can help alleviate the “here and now” pressures on our neurology workforce, the second major initiative for our Academy is to enhance the pipeline of medical students choosing careers in neurology. We need to grow the number of future neurologists to reduce that projected 19-percent shortage we face. For too long, the proportion of US medical school graduates has remained stable at 2.5 percent annually choosing to enter a neurology residency. With a goal of increasing this number, we received a grant from the Conrad N. Hilton Foundation and created a special work group under our Education Committee. Our Medical Student Pipeline/Hilton Grant Work Group is diligently working to explore, develop, and enhance opportunities to engage medical students and increase their interest in choosing a career in neurology.
Like everything we do as an organization, we are generating data to provide evidence-informed approaches to address this issue. To better understand the challenges we face engaging students to go into neurology, the Exploration Sub Group has focused on analyzing survey and interview data. The Implementation Sub Group is focused on identifying and implementing activities and programs to raise awareness about neurology at the medical school level and attract high-quality medical students into neurology. At the 2017 Annual Meeting, we held focus groups of Year 1 and Year 2 medical students, a group of Year 4 medical students planning to enter neurology, a group of Year 4 medical students not entering neurology, and a group of adult and child neurology trainees. In addition, AAN staff has been conducting phone interviews with medical students at institutions from a variety of locations and with varying demographics. There are three interview subjects at each institution: a student who chose neurology, a student who considered neurology but chose another specialty, and a student who never considered neurology.
All of this data will be incredibly helpful as we design better ways to excite medical students about our field and grow the neurology professional pipeline. Remember that the Academy is home for our neurology clerkship directors and the Student Interest Group in Neurology (SIGN) that are a medical student's “first contact” with neurology. We plan to capitalize on that moment and provide our ambassadors with enhanced tools to bend the curve and increase the proportion of students choosing careers in neurology.
Furthermore, at the 2017 Annual Meeting:
- Eight talks in the Navigating Your Career Area were about SIGN or geared toward medical students.
- Of the 92 talks in the Navigating Your Career Area, 66 contained content applicable to medical student attendees.
- There were 65 one-on-one mentoring sessions with medical students, with neurology faculty and practitioner volunteers serving as mentors.
- Four neurologist-led poster hall tours were offered to medical students on three days, and 22 students participated.
- A digital scavenger hunt was piloted to help improve medical student engagement. Held Saturday to Wednesday, the hunt drew medical students to different areas and talks at the meeting, with up to three winners each day.
- The meetings of our Consortium of Program Directors and Consortium of Neurology Clerkship Directors hosted presentations about the medical student pipeline work. The consortiums were asked for feedback as well as interest in piloting our new, reformed SIGN program at institutions.
Growing our neurology workforce of APPs and neurologists is of paramount importance to AAN leadership and remains a top strategic priority. I am confident that our strategy and these, and other, tactics will be successful. Our “Neuroscience Is...™” campaigns and even our yearly Brain Health Fair held in our Annual Meeting host cities have the potential to inspire young minds to join us in our work to prevent, treat and cure neurological diseases.
You can help, too. Think back to what sparked your interest in neurology, and if you have the opportunity, share that spark with a child or a fresh-faced med student. You may help launch the career of a practitioner who brings tremendous skill and compassion to his or her patients, or a researcher who makes a great discovery or cure. Let's all be part of the solution to growing the workforce to meet the rising demands for neurology care.
ARCHIVES: AAN President Ralph L. Sacco, MD, MS, FAHA, FAAN
- September 2017: AAN Task Force Takes on High Drug Costs
I think it is safe to say that many of our members who treat patients are aware of the high cost of many of the neurologic drugs in the United States. We understand that these costs-even with insurance-can have a severe economic impact on our patients and certainly drive up the expense of health care in this country. Many of us have heard our patients and their families express dire concerns about whether they could continue to take an effective medication that is controlling their condition and helping them maintain a high quality of life. Other patients do not take medicines as prescribed because of the high cost of a prescription. This is particularly true for patients with chronic neurological conditions that often require life-long therapy.
Your Academy has been aware of this, too. Earlier this year, the AAN approved a position statement on Prescription Drug Prices. As the document points out, many therapies for neurologic disease are among the most expensive in the US.
Neurologists also are limited by few, if any, therapies available in a particular class of medications. For example, the recently approved therapies for Duchenne muscular dystrophy and spinal muscular atrophy are expected to cost $300,000 and $750,000 in the first year of treatment, respectively. These medications likely will require many years of therapy starting at a very young age. There are very few families who can afford such drugs. Additionally, some drugs that have even been approved for many years, are available as generics, or have multiple options available have greatly increased in price. Setting aside the financial enormity of such a burden, stratospheric price tags for these and other medications can be emotionally devastating to patients and family caregivers just as they need to have a laser-beam focus on treating the physical aspects of their disorder. Then, add insult to injury when patients learn that their medications-if available in Canada or overseas-may be considerably less expensive and they are unable to access this cheaper cost.
A couple decades ago in Washington, politicians aligned with the pharmaceutical industry ensured that the federal government would be unable to negotiate drug pricing under Medicare's Part D coverage. Rather than being able to bring the weight of its purchasing power to bear on these unchecked prices, Medicare, the country's largest single-payer health care system, has seen its costs balloon to unsustainable levels. The Centers for Medicare & Medicaid Services has projected that drug costs in the US will rise to $406 billion at the end of this decade from $272 billion in 2013, driven in part by higher priced “specialty” drugs.
In Congress, the AAN has advocated for several pieces of legislation that are consistent with our position, including the Improving Access to Affordable Prescription Drugs Act introduced by Minnesota Sen. Al Franken to address the main areas of concern outlined in the AAN's position statement: price negotiation, transparency, and importation. We also have been working with the National MS Society on their transparency goals regarding drug pricing. But we must do more for our patients and our profession to address the ongoing issue of high drug costs.
This summer, I appointed a new Neurology Drug Pricing Task Force, led by Nicholas E. Johnson, MD, our able chair of the AAN Government Relations Committee. Its charge is to study the environment of drugs for neurologic disease and propose ways for the AAN to proactively address the challenges associated with ultra-high drug costs, including implications at the governmental, institutional, physician, and patient levels. Evaluation of other professional and patient-advocacy organization positions and opportunities for collaborations with other organizations will also be considered. We must work with our partners and address this major problem together.
The task force held the first of its bimonthly conference calls in July, and will produce recommendations to the AAN Board of Directors in the coming months. We will communicate the results of their work to you, and we will call on you through email AAN Action Alerts to support legislation that accomplishes the goals outlined by the Academy in our Prescription Drug Prices position statement. Stay tuned and thanks for your continued efforts to promote the highest quality patient-centered neurologic care.
- August 2017: AAN Fights for Research Funding, Provides Support to Researchers
Promoting neurology and neuroscience research and training is fundamental to the AAN mission and a key part of our 2017 goals. Our patients are depending on us to accelerate cures for neurological conditions and translate the breakthroughs in neuroscience research to the clinic. As we move closer to the October 1 application deadline for a host of AAN Research Program awards and scholarships provided by your Academy and its partners, I'd like to share some concerns and opportunities regarding neurologic research.
We have fought hard to preserve and improve funding for the National Institutes of Health (NIH) and the BRAIN Initiative. NIH funding was among our key asks in the 2017 Neurology on the Hill and we continued to push our advocacy messages throughout the budget process. We worked across party lines for two years to ensure the inclusion of strong research funding in last year's 21st Century Cures Act, which included an increase of $4.8 billion for NIH, a 6.1 percent increase for NIH. Besides increasing the overall NIH budget, NINDS funding increased by 5.3 percent to $1.78 billion and NIA to a little over $2 billion, with $400 million more in funding for Alzheimer's disease and related dementias, which we know have a major toll on our patients and their families. We also were successful in getting a $110 million increase for the BRAIN Initiative in 2017. This represents a 73 percent increase to $260 million, which was the largest bump for any NIH program. But those successes are now in danger of being undone.
You've likely heard that President Trump has proposed a draconian $5.9 billion cut to the 2018 budget for NIH, a 21 percent reduction from 2017 funding levels. The president's budget threatens millions in funding for the BRAIN Initiative that was authorized by the 21st Century Cures Act. These cuts could be crippling. Many of us remember the havoc that researchers and their valuable work endured when Congress enacted the budget “sequester” several years ago and NIH funds were cut back. Moreover, our patients and their families are the ones most threatened by this potential downward spiral in NIH funding as their hopes for faster cures are obliterated. We cannot and will not let this occur! Both Republicans and Democrats have voiced their opposition to the president's proposed budget, and with the urging of AAN advocates, 64 representatives and 10 senators have signed letters of support for the BRAIN Initiative. Our Government Relations Committee and advocacy staff are hard at work to defend against this devastating cut. The AAN will continue to strongly oppose the research cuts in the Trump budget proposal and will include research in our requests during Neurology “off” the Hill visits during the August congressional recess.
Fortunately, what is proposed by the president can be changed or ignored by Congress-where we have the strongest influence due to the AAN's acceptance as THE experts when it comes to neurology. Our political action committee, BrainPAC, has enabled us to educate members of Congress and helped us elect lawmakers who are allies in our work. While some congressional leaders have voiced support for research funding and opposition to the president's budget, we can't take it for granted we will win this round. I strongly urge you to stay fully engaged, read the Capitol Hill Report, and watch your email inbox over the coming weeks for action alert emails from the AAN. We will need all of our members to help in countering this assault on research funding. If we ask you to contact your representative and senators to preserve federal funding for scientific research-and brain research in particular-I hope you will respond swiftly. Grassroots advocacy across interest groups throughout the country helped stymie the administration's initial American Health Care Act last spring, and we need that same passion applied to any research funding cuts.
In this uncertain time, you can be very proud of the leadership your Academy is providing regarding research funding, not only in Washington, DC, but directly within the neurology community. We are expanding our own commitments to fund the best and brightest and increase the future translational workforce for neurology research. The AAN has again teamed with the American Brain Foundation and five new partners- the McKnight Brain Research Foundation, Society of Vascular and Interventional Neurology, International Headache Society, Muscle Study Group, and The Mary E. Groff Charitable Trust- to add new scholarship awards to the 2018 AAN Research Program. Working with these and other organizations, the AAN is making good on its commitment to help support young researchers who will grow to shape the future of neurology and neuroscience, just as many of you have in your careers.
And the AAN has gone further by establishing two larger-scale career development awards that fulfill its pledge to support all types of research across all career levels and discovery stages. These three-year awards will support junior investigators interested in an academic career in neurology and provide support of $150,000 per year for a total of $450,000. Learn more about the 2018 AAN Research Program and apply for scholarships by October 1.
We are also delighted to celebrate the 25th anniversary of the American Brain Foundation that we have helped develop, support, and expand. Over that time, it has distributed more than $24 million in funding to 233 recipients. The overwhelming majority of these young researchers have gone on to secure NIH grants and academic positions, and I firmly believe the endorsement of the Academy and Foundation of their skills and potential was a valuable boost to their success. The new energized American Brain Foundation Board, with more public, high-profile members, is taking bold steps to bring researchers and donors together to defeat brain disease.
The Foundation recently launched a crowdfunding platform to raise up to $100,000 for individual researcher campaigns. This platform is available to the public, and we are eager to see how we can connect people who have a passionate desire for a cure with those who have a passionate desire to discover the cure. You can learn more, and donate or apply for inclusion as a researcher, at AmericanBrainFoundation.org.
The AAN is working at all angles to expand research that is so vital to the future brain health of our population. We need to fight together to halt any cuts to NIH and, if anything, expand funding for neurological research. While the government is at odds as to how much support it should provide to medical research, the AAN and the American Brain Foundation are doing everything we can to ensure that we continue to accelerate our progress toward discoveries, treatments, and cures for neurological conditions. I urge our members to join us and make the future much brighter for our patients and families.
- July 2017: Neurology Must Address Gender Disparity Issues
According to the 2016 data in our most recent AAN Insights Report, women now comprise 36.8 percent of the AAN membership; among US neurologists, 31.5 percent are women. This is significant growth since 2008, when women were only 29 percent of all AAN members and 24.7 percent of US neurologists. Residency programs are training increasing numbers of women in our profession. Despite the increasing women among our neurology work force, some alarming statistics were published last year demonstrating gender disparities particularly among neurology.
We evaluated the evidence in this article very seriously and acted swiftly. Last November, then-President Terrence Cascino reported to members that the Academy had formed a Gender Disparity Task Force, chaired by Board member Elaine C. Jones, MD, FAAN. The charge to the task force was to gather information and statistics on disparities in pay and other types of discrimination that women face in our profession and make recommendations to the AAN Board of how to address these issues. The 11-person task force convened four times in as many months to examine gender disparities as they play out in compensation, professional advancement, leadership opportunities, and work/life balance. I want to personally acknowledge their hard work in rapidly addressing this important problem.
These are the causes the Gender Disparity Task Force identified for disparities:
- Lack of salary transparency, leading to female neurologists not being aware of their colleagues' salaries and not having relevant data for negotiation.
- Absence of negotiating and networking by women, rooted in a difference in how the genders approach both tasks.
- Bias and, in particular, implicit bias which can color major decisions without being detected.
- Penalty for work/life balance and family responsibility, based on the higher likelihood that women will assume caretaking roles in their personal lives.
The Task force made these recommendations for the AAN to consider implementing as we address these issues:
- Lead by example by reporting percentages of women involved in AAN leadership, and by continuing to promote gender-friendly work practices. Currently, 42 percent of the members on the AAN and AAN Institute Boards of Directors are women. Among the six AAN and AAN Institute officers, three are women. Of the seven members of the Academy's executive staff, three are women.
- Continue to enhance leadership education options for female AAN members, such as the new Women Leading in Neurology Program that begins Fall of 2017.
- Improve transparency by sharing neurology compensation and productivity data and developing resources that explain requirements for various career stages, while also leveraging relationships to encourage similar transparency from other medical associations and public institutions.
- Address bias by making available survey tools that reveal implicit biases, as well as by writing articles or AAN publications on the topic.
- Develop mentors by training men and women leaders to mentor women, by creating networking opportunities for women, and by highlighting female neurologists who have achieved leadership roles or professional success.
- Promote different practice options to support work/life balance.
- Offer a scholarship or research fund to support relevant scholarship on the subject.
- Explore legislative options that have been successful elsewhere while also updating the Code of Professional Conduct to reflect the AAN's stance on gender disparity.
- Conduct further investigation and publish the results.
As the AAN works to implement the recommendations above, we ask that you take action and participate in these programs and resources to address disparity and bias in your workplace. It's typically easier to spot the foibles of others than our own. But each of us should give some thought about how we may casually accept these disparities and perhaps even, consciously or subconsciously, perpetuate them. Our profession needs to attract and retain the best and brightest minds and we can't afford to deter or lose good people-whether because of their gender, ethnicity, sexual orientation, religion, or nationality-simply because of archaic thinking rooted in a prejudicial culture of the past.
We must continue to be guided by the core values of our AAN that include leadership, integrity, professionalism, commitment, respect, and compassion. Last year, we added a new and critical core value: diversity and equality. We commit to building and sustaining an inclusive organization that respects and values the diversity of our membership and the communities we serve, and promotes equality in professional advancement and compensation.
I hope you will join me in helping ensure our profession is open, welcoming, and provides equal opportunities on a level playing field where we all are judged solely by our skills, experience, and performance of our duties in service to our patients and all humanity. Let's all work together to address and eliminate gender disparities.
- June 2017: We Must All Hang Together
Over the last few years, the AAN has strengthened our advocacy efforts, expanded our Government Relations Committee, and leveraged our BrainPAC. Now more than ever, we need to work together for the betterment of our patients and our profession. We are proud of our efforts to remain evidence-based, consensus-driven, and guided by our mission and core values as we articulate well-developed advocacy positions. The Academy recently published Health Care Delivery Principles, a list of criteria by which we will gauge any proposed changes to the Affordable Care Act. These principles were published in the May AANnews and you can find them online. Considerable effort by leadership and staff went into preparing this document, which focuses specifically on the needs of neurologists and our patients.
As Dr. Cascino mentioned in his final column in this space, the political views of our members run across the spectrum. We all have our personal political philosophies and our heterogeneity as an organization makes us stronger. But it is not for the Academy to assign praise or blame to any particular political party. While our members and staff who are deeply involved in advocating for neurology on Capitol Hill may be knowledgeable of the tug-of-war that is involved in moving legislation through Congress, the Academy itself must keep focused on furthering the art and science of neurology, no matter who is in power and whatever our personal affiliations. When we advocate as an organization, we need to do our best to speak in one voice for what is best for our patients and profession.
At the time of this writing, the House of Representatives has passed a revised version of the American Health Care Act (AHCA), which still fails to meet several of our principles for health care. The bill has moved to the Senate, where Republicans have indicated they will work on their own version. Consequently, we will remain focused in applying our principles to any proposals, today and tomorrow. Future breakthroughs for curing, preventing, and treating neurological disorders require us to speak loudly for increased funding of NIH research. As you can see in this month's Capitol Hill Report, we were successful in our fight to preserve the gains we have made for federal funding of neurologic research in Congress's final budget for the remainder of the 2017 fiscal year. Our members and staff worked very hard last year to increase the budgets for the NIH and BRAIN Initiative. The 21st Century Cures Act was a monumental step forward, had strong bipartisan support, and needs the proper appropriations to be successful. And we will continue to make the case that the health of our citizens and the economic future of our country are in peril as long as 50+ million Americans are living with chronic and costly neurologic disease.
Cuts in research funding are not just suffered by our neuroscientists, they damage our ability to discover treatments and cures our practicing neurologists can prescribe to their patients. As Benjamin Franklin said, “We must, indeed, all hang together or, most assuredly, we shall all hang separately.”
Regulatory hassle that provides no value remains an issue that we need to convince Congress to address. Burdensome regulations and job burnout do not impact just practicing neurologists-they can dissuade medical students from entering our specialty, which affects our academic programs across the country at the very time we need to increase our work force.
We must turn up the heat on Congress, each and every one of us. Because what happens to one area of neurology can affect us all. So, when you get an Action Alert email in your inbox, this is when you must hang together with your colleagues. If the topic is health care reform, we need the support of our neuroscience and academic community. Likewise, when it regards funding for research, we need to have every practicing neurologist involved. It takes just seconds to open these alerts, click a button or two, and send your representative or senator a message of support for neurology. As these emails build up in their inbox, they will begin to feel the heat. Believe me, this is not an insignificant action. These are the voices of their constituents, aka “voters.” Your voice, and your vote, count. It appears the midterm elections will be hotly contested, and you can make a difference.
If you have a little more time to give, consider applying to attend Neurology on the Hill, which broke attendance records last winter with 216 of your colleagues advocating on Capitol Hill. I have been to DC numerous times and I know how important it is to educate lawmakers face-to-face about the issues affecting us, especially when we speak as constituents in their voting district. We really can enlighten and change minds in these discussions. It is empowering to be a citizen lobbyist. It is even more effective if we bring our patients with us. We are also working across organizations and bringing patient advocacy groups together to join forces as we did with the American Stroke Association/American Heart Association in 2016. We need to bring groups together to unify our positions and speak loudly in larger numbers. I hope you will consider applying for the 2018 event when applications open. We welcome new participants, experienced in advocacy or not, especially from underrepresented parts of the country. You might have a story to tell that can turn a skeptic into a believer. Yes, it can happen, even in Washington!
When Congress is on recess in August, you can experience this power by attending town halls, visiting your lawmakers' offices, or even inviting them to your clinic or laboratory. Again, this grassroots education can have a very strong impact when powered by your passion for neurology. Our advocacy efforts extend throughout the year and do not just involve our federal government, but also are aimed at state legislators. Contact our terrific advocacy staff to learn more about these events.
The AAN has worked hard to develop our advocacy expertise. I want to thank the 29 members who participated in the Palatucci Advocacy Leadership Forum last month. After 15 forums, we have graduated 439 members through this intensive training. The graduates will tell you the experience has changed their lives, and they have gone on to change the lives of patients and colleagues in their communities. We call upon these PALF graduates to use their talents and help the AAN move forward.
Finally, we need to thank the many members who have generously supported our BrainPAC. We have gained an entry to some very influential Congressional members that would never have been possible in our pre-PAC days. I witnessed this myself at the 2017 Congressional Open House, when I saw so many of our elected officials recognizing and calling across the hall to our AAN staff on a first name basis. They know our name, who we are, and what we stand for. This kind of relationship building can go a long way to get our advocacy positions heard and acted upon.
So, you can see, advocacy is at the heart of moving neurology forward, whether it is patient care, research, or improving our work lives. Even if you don't aspire to lead the Academy, we need you to be a leader in advocating for neurology.
We must all hang together.
- MAY 2017: The Goals and Priorities for My Term as President
In writing my first President's Column for AANnews, I cannot help but reflect on how far we have come as a professional organization and how much work we still need to do. The last two years as president elect have zipped by so quickly, and I am grateful for the experience and time to learn, listen, and work with the many volunteers and outstanding staff of the AAN. Working closely with our Past President Terry Cascino, the AAN Board, and the executive team over the last two years, I can fully vouch for the great team we have in place to help guide us. As we get ready to celebrate our 70th year, I am humbled to start my term as the 35th president of the AAN and plan to emphasize teamwork, distributed leadership, and strategic continuity, as we chart a course for a brighter future.
The founders of the AAN had the wisdom to create a two-year position of president elect so that the person in this role would be intimately familiar with the wide range of issues faced by neurologists and how the Academy was addressing them. Gone are the days when the new president would chart a new path sometimes in different directions. Transitions are so critical and the AAN Board has helped ensure that we have strategic continuity between leadership teams. The recommendations from a variety of taskforces are just getting started, including Solo and Small Practices, International, Wellness and Burnout, and Gender Disparities. Terry Cascino's presidential priorities will continue to be emphasized as we move some of these initiatives into the implementation phase and develop next steps in other priorities.
For 2017, the goals of the AAN remain:
- Ensure the ongoing health of the profession and the organization to support the unique needs of all members
- Personalize member communication and the member experience
- Educate and assist members in providing high-value, quality clinical care in the evolving health care environment
- Advocate for members and their patients on issues of importance to neurology, including access to high-quality, cost-effective care; research; and fair payment
- Enhance member satisfaction, well-being, and resiliency with resources that support members throughout their careers
- Promote neurology and neuroscience research and training
We made great strides in 2016 accomplishing objectives for many of these goals, and they remain very relevant. They will continue to be part of our strategic plan, but the tactics to fulfill them will likely evolve.
We also are continuing our “Wildly Important Goal,” designed to execute a critical Academy-wide strategy during the day-to-day functions or “whirlwind” of what needs to be done:
To demonstrate the value of neurology, neurologists, and neuroscientists.
At the same time, each new president has brought to the table issues he or she strongly believes deserve attention for the good of our members and profession. So, I wish to take this opportunity to share my platform for the next two years.
Meeting the Future Demands for High-quality Neurologic Care
Over many years and AAN presidencies, the Academy has recognized the growing chasm between the supply and demand for neurological care and has taken significant steps to address this. I, too, deeply share this concern. One in six has some neurological issue and this is likely to rise as our population ages. The supply of neurologists will fall 20 percent below demand by 2020. The urgency to expand the neurology workforce pipeline will continue as one of my top priorities. It is a massive and complex task to not only encourage medical students to enter the profession of neurology, but to reach down to our nation's youth and excite them to pursue careers in neurology and neuroscience. We seek to spark in them the same inspiration that led us to become engaged in neurology and neuroscience. We are being helped in this effort by a generous grant from the Conrad N. Hilton Foundation to study this specific issue.
The goal of the grant is to increase the number of medical students entering neurology by 25 percent over three years. We also need to increase the diversity of our neurology workforce and leadership to more adequately address health care disparities. The AAN will also continue to invest in leadership training through our Leadership University across a variety of constituents. At the same time, we will continue to enhance the multi-disciplinary neurology patient care team of tomorrow, building on our successful campaign to bring advanced practice providers into our membership so they can improve their skills and working relationships with neurologists and provide high-quality patient care. They are essential to helping to meet the future neurological care demands. Moreover, our advocacy team will continue its efforts to increase patient access through innovative technologies including reducing the barriers to teleneurology.
Enhancing Value and Quality of Neurologic Care
One of the AAN's largest and most ambitious undertakings has been the Axon Registry®, which successfully completed its pilot phase last year. With nearly 1,000 providers from clinics and hospitals now participating, and more being added on a quarterly basis, the Axon Registry will move into phase two and evolve to an essential quality improvement tool. What has been classified as the learning health system, we need to harness the power of this registry to improve the lives of our patients. The registry makes it possible to harness and analyze patient data that neurologists can then use to measure, track and benchmark performance, share best practices and efficiencies, and improve the quality of care. The Axon Registry also provides members an easy way to submit quality data to the Centers for Medicare & Medicaid Services for quality reporting, and it is approved by the American Board of Psychiatry and Neurology as an MOC Part IV PIP Clinical Module activity. The AAN will continue to grow its quality improvement programs and neurology-specific measurement sets.
Expanding Neurologic Research
Understanding the complexity of the brain and the hundreds of disorders that can affect it requires a herculean research effort. While we had great success last year advocating for increases for the National Institutes of Health, the 21st Century Cures Act, and the BRAIN Initiative, those efforts are endangered as Congress wrestles with drastic cuts in the new administration's proposed budget. We will fight those cuts, working in tandem with other associations when suitable. We must unify the many voices of neurology and speak loudly to continue the investment in neurological research. Our annual Neurology on the Hill will continue to be a highlight, but our members must be willing to advocate daily for causes that are important to our profession and patients. We will continue to leverage the power of our political action committee BrainPAC to access members of Congress and educate them on our issues.
The AAN continues to support the growth of the American Brain Foundation with a mission of bringing researchers and donors together to defeat brain disease. We have and will continue to invest our own funds into the best and brightest among our colleagues to develop the Clinical Research Training Scholars and our new Translational Research awards. We need to accelerate cures for neurological disorders and more rapidly translate advances in research from the bench to the bedside.
Expand the Scope of Neurology Practice to Enhance Brain Health Across the Lifespan
Over the last decade, we have made many strides in our mission to treat and prevent neurological disorders. The time is right for us to more effectively expand the scope of neurology practice to include interventional, preventative, and regenerative neurology. The “new neurologist” of the 21st century has many more opportunities to improve the health of individual patients, those at-risk, and take a leading role in caring for populations. We need to inspire young people to enter the field to intervene, treat, and prevent neurologic disease. This neurologist should be equipped with cures for stroke and epilepsy; the ability to modify disease with interventions like deep brain stimulation for Parkinson's; and use of early aggressive treatments that could prevent advancement of such progressive diseases like Alzheimer's disease and multiple sclerosis. And we must emphasize regeneration and recovery following intervention, so our patients can resume a life as normal as is possible.
We must promote preventive neurology that may help keep chronic, debilitating diseases like stroke, traumatic brain injury, migraine, Alzheimer's and Parkinson's at bay. The new neurologist would care for those who are “at-risk” of neurological conditions across the lifespan. If we can detect conditions earlier, we may be able to modify transitions from wellness to illness, delaying the disease and even compressing morbidity. Our role should emphasize successful aging, quality of life, and maintenance of brain health.
This is an ambitious platform, but I believe our reach should always exceed our grasp. I will revisit these topics as we make progress over the next two years. Your input is always welcome and you can feel free to email me with your thoughts and concerns. We can only advance as a profession if we work together, openly communicate, and take control of our future. I look forward to working with you, the countless colleagues that volunteer in leadership capacities, and our terrific AAN staff to strengthen our profession and the value that we provide to our patients.
ARCHIVES: AAN Past President Terrence L. Cascino, MD, FAAN
- APRIL 2017: Thank You for the Honor of Serving as Your President
The Academy's leadership, from the Board of Directors to committee participants to executive staff, must strive to represent all members-adult and child neurologists, community neurologists, academics, those in small and solo practices, researchers, and international members-as much as possible. In my travels across the country and the world as the Academy's president, I've had the chance to hear a very wide range of views and opinions from our members working in these diverse practice settings. Many have offered their perspectives about the type of health care system we should have. For example, there are members who feel a single-payer, government run system would be best. There are others who feel just as passionately that government should not interfere with health care. And there are supporters for all possible combinations in between. What I have grown to realize is that the vast majority of members all want the same core things: fair reimbursement for the value we provide, reduced regulatory hassles that produce no value to our patients, appropriate funding for neuroscience research, patient access to neurologists, and preservation of a rich neurologist-patient relationship. In the past few weeks the Board of Directors approved Health Care Delivery Principles which incorporates these member views.
The AAN continues to be strong in delivering excellent innovative education, superb science, and first-rate scientific publications. This must continue and become even better as we answer current and upcoming challenges. However, in order to provide our members the fullest support essential to practicing the highest quality neurology, the Academy has been active in additional areas.
To help neurologists get fair reimbursement for the value we deliver, we have increased our advocacy efforts with Congress and stepped up our communications and direct meetings with CMS. No matter how we try though, this can go only so far. We must now demonstrate value with data we don't have. For this reason, we started the Axon Registry® to help us improve patient care and at the same time collect and produce the data to demonstrate to payers something we already know: We add great value to the care of neurologic patients. The roll out of the registry is going very well and I encourage all US members to learn more about getting involved with it. Not only does your practice data help us make the case for neurology when we advocate for you, it also provides an easy way for you to submit data to CMS for quality reporting and help satisfy the MOC Part IV PIP Clinical Module activity requirement.
As I said, our practice settings are quite diverse. Yet, we need to do what we can to help all types. We began by concentrating on small and solo practices as this group was under the most intense pressure from external forces. An Academy task force made up of individuals from this demographic has developed a number of recommendations, many of which are being implemented now.
Reduction of Regulatory Burden
Regulations that make patients safe and improve quality are necessary. Unfortunately, many regulations don't do that and are simply hassles that get in the way of patient care and deeply frustrate physicians. The AAN's task force on burnout published the first in a series of member survey results in the February 21, 2017, issue of Neurology®, also available online. The task force discovered that 60 percent of neurologists surveyed are experiencing some form of burnout. A key driver is the regulatory burden affecting all physicians. This must be changed or we will face a burned-out work force, which will not be in This trend also is occurring in many areas internationally.
The AAN is working to improve the situation. Our message and those of other medical societies to Congress, CMS, third-party payers, certification and licensure agencies is clear: We must reduce regulatory hassles which produce no value where possible. We hope they are listening. In the meantime, burnout can be mitigated by making our practices more efficient in areas such as more effective EHR usage and other ideas. Our committees are working on ways we might help members who are interested in using best practices to mitigate some of the causes of burnout. Finally, helping people become more “resilient” in dealing with burnout issues has been shown to help selected individuals. We are offering a menu of tools for members who are interested to try, with an eye to expanding these in the future.
Support for Research
Without robust investment in neuroscience research funding, we may not have the type of innovative treatments we all want for our patients. An important focus of our advocacy efforts has been to increase funding for the National Institutes of Health (NIH) and the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, which seeks to accelerate the development and application of innovative technologies for brain research. Our hard work in 2016 helped persuade Congress to pass the 21st Century Cures Act, which contains a $4.8 billion increase in funding over 10 years for NIH, of which $1.51 billion will go toward the BRAIN Initiative, subject to annual appropriations.
We also continue to look to the American Brain Foundation to enjoy increased success in raising dollars toward its mission to “cure brain disease.”
So, the issues we face are complicated and the challenges are numerous as an aging population, and society at large, confronts the increasing physical and financial burden of neurologic diseases. Even as our services and skills are needed now more than ever, it has never been more necessary to justify them to skeptical or unaware policymakers and regulators. Despite this, I remain optimistic about our future. My advice is to concentrate on doing what is best for our patients and this will aid us in providing high-quality care. These are things the vast majority of our members can agree. It is quite obvious we have a love for neurology and great compassion for our patients. This will serve us well as we move forward, but it won't be enough. We need to take control of our futures. The AAN is doing what we can, but it will take work from all of us to assure a bright future for our profession.
It has been a high point in my career to serve as AAN president. Any kudos that come my way were earned by my colleagues on the Board of Directors, the hundreds of volunteer members who have participated on committees and task forces, those who have given their time and energies to educating us at the Annual Meeting and conferences, our impassioned advocates who champion neurology in their communities and throughout the world, and our amazing staff led by Executive Director Cathy Rydell. Thank you all for the privilege of serving as president of this great association.
- MARCH 2017: Annual Meeting Science Program Presents Innovations to Entice Clinicians
One of the exciting things about holding this April's Annual Meeting in Boston is that this city has long been a major hub of science and research, of tradition and change. This challenges us to be better than our best when we present the latest cutting-edge research in neurology. I think we will accomplish this thanks to the leadership of AAN Board Member Dr. Lisa M. DeAngelis, who chairs the Science Committee, and the great efforts of hundreds of volunteer members and our staff.
I presume you have plenty of new features for this year's Science Program.
We certainly do. We're constantly thinking about not only how we can attract the best abstracts-we have over 2,700-but how can we present them in a way that enhances the attendees' experience. We strive to have the broadest array of neurology topics and still enable attendees to have a personal experience interacting with presenters and colleagues. For example, our poster sessions have always been very popular, but this year we are grouping topic-related posters together in “neighborhoods.” Not only will this be more convenient, but it will help spur discussions and exchange of ideas. And the chance for interaction with leading researchers continues in our “Best of” sessions, which are four abstract presentations followed by a panel discussion, and ending with a “meet the investigator” breakout.
The Experiential Learning Area was a hit last year in Vancouver, and it will be bigger and better in Boston. How will science be represented?
At the Research Corner: Moving Neurology Forward, attendees can enjoy informative presentations and helpful mentoring sessions on research careers, grant proposals, funding, and more. The platform sessions in the Research Corner on History, Autonomic Disorders, Pain, Neurorehabilitation, and Global Health will be appreciated by those seeking more insights on those topics. This will also be an exciting new venue for award recipients. The 2017 Scientific Award recipients will be recognized and celebrated in the Research Corner, which will feature a display wall with recipient names and photos, and a private lounge space for award winners to enjoy.
I understand there are new neuroscience programs directed at clinicians.
Attendees have asked for more integration of scientific research with clinical application, so we have responded with two fresh programs that should provide real value. Our innovative Neuroscience in the Clinic and Clinical Discussions sessions will offer entirely new ways of engaging scientists and clinicians in important discussions about scientific application to the clinical setting. These sessions will offer a new twist by merging scientists, who will provide abstracts and discussion regarding the underlying research and how it applies to our clinical problems followed by a Q&A with the audience. The new Clinical Discussions will incorporate invited discussants at the platform sessions to provide clinical context for the research that was presented.
A highlight for me each year are the plenary sessions.
Perhaps more so this year since you will be presenting the Presidential Lecture?
No, in spite of that! I'm excited and pleased to see my colleague from the Mayo Clinic, Dr. Ronald Petersen, will be the keynote speaker on Sunday.
Dr. Petersen is one of the leading research experts on dementia and Alzheimer's disease and I'm sure his talk will be heavily attended like all of the others. We are presenting plenary sessions daily, beginning on Saturday evening. But again, we have a new approach. Immediately preceding each plenary session will be a scientific platform session that will bring together the top four abstracts in each discipline that were rated as being the most important research by our reviewers; these are our new Best of Science Sessions.
It sounds like you and your team have really come up with a very engaging science program this year and I want to thank you all for the tremendous effort you've put into it.
It's not that difficult when neuroscience is our passion. We hope that attendees will share our enthusiasm and that clinicians, in particular, enjoy a week of “Aha!” moments as we strengthen the connection between the laboratory bench and the exam room.
If you've been on the fence about attending this year's Annual Meeting, I hope these tantalizing changes will nudge you closer to registration. Be aware that the big savings for early registration end on March 30. Even earlier than that is the March 8 hotel reservation deadline to take advantage of discounted rates in the 28 Boston hotels with which the AAN has arrangements. Learn more about the meeting and how to book your travel and hotel accommodations.
- FEBRUARY 2017: 2016 Annual Report Highlights Major Accomplishments for Members
One of the best ways to get a comprehensive view of all the ways the AAN serves you, our member, is by reading our Annual Report for 2016.
The AAN exists for the benefit of members like you, to do the things collectively that would be nearly, if not completely, impossible to do individually. With the dogged commitment and passion of thousands of volunteer members and leaders working in tandem with our professional staff, we had your back in 2016, and we're happy to highlight some of our most significant successes of the year in this annual report. But there are a few efforts we wish to call out in this message because of their profound importance to the specialty of neurology.
Strengthening Practices. Some 30 percent of our US members are in solo and small practices (with five or fewer neurologists), balancing heavy patient loads with increasingly distracting reporting requirements and regulatory hassles. To ensure the Academy is providing the best value to these members, the Solo and Small Practice Task Force identified major issues affecting these members and reviewed existing AAN products and services. The task force made more than two dozen recommendations that the Board of Directors and staff have examined and will be acting upon in the months to come to strengthen our members' practices and alleviate the pressures of regulatory burdens. The AAN is doing everything it can on the health policy front to decrease these burdens and limit the impact of new policy changes, and we had success with the final rules for MACRA and the Medicare physician fee schedule for 2017.
Rebalancing Lives. Neurology is the only medical specialty that has both one of the highest rates of burnout and the lowest rates of work-life balance. We know there are many external factors contributing to physician burnout including the myriad regulatory hassles that you face daily. Your health matters to the AAN and we're here to help. The Burnout Task Force we launched in 2015 to research the issue of physician burnout reported its findings and recommendations to the Board in 2016. Consequently, we launched our new Live Well campaign and webpage with a range of resources to help address regulatory, workplace, and individual frictions that spark burnout and to help cultivate well-being and resiliency in your life. Rest assured that the AAN is fighting for you in Washington, DC, to decrease regulatory hassles and limit the impact of new policies, reporting requirements, and reimbursement changes.
Increasing Research Support. Research into neurologic diseases, treatments, and cures is of the highest importance. For 2016, the Academy expanded our investment in research via the AAN Research Program to $2,800,000, an increase of $400,000 over 2015, and new awards were offered.
Reinventing Learning. We reinvented the AAN Annual Meeting with seismic shifts, from a new one-rate registration fee to novel Experiential Learning Areas unchained from didactic classroom presentations. The result was a meeting imbued with new energy, variety, and enthusiasm that we will build upon in our planning for the 2017 Annual Meeting in Boston. We hope to see you there.
Investing in Quality Improvement. The AAN successfully piloted the Axon Registry® with four cohorts involving nearly 900 neurologists and more than 1 million patient records. The Centers for Medicare & Medicaid Services approved the Axon Registry as a Qualified Clinical Data Registry, meaning AAN members will be able to easily submit quality data to CMS and participate in future Medicare value-based payment programs under MACRA. In addition, the American Board of Psychiatry and Neurology stated participating in Axon Registry will meet Maintenance of Certification Performance in Practice requirements. The Axon Registry demonstrates our commitment to improving the quality and value of neurologic care.
Inspiring Tomorrow's Neurologists. The Conrad N. Hilton Foundation awarded a grant to the AAN to help increase the percentage of medical students entering neurology by 25 percent over a three-year period. This will help us determine what factors lead medical students to choose neurology as a career and develop materials to inspire more students to go into our specialty.
Nurturing Tomorrow's Neurology Leaders. Future success depends on tomorrow's leaders. We evaluated and rebranded our Leadership Programs, launched the Transforming Leaders Program for mid-career neurologists, and developed the Women Leading Neurology Program for implementation in 2017.
Collaborating with Child Neurology. The AAN developed a Child Neurology Work Group in late 2015 with representation from the AAN and the Child Neurology Society to collaborate and identify ways that the two organizations can work together to improve care for patients across the life span. This collaboration has led to initiatives such as new programming at the Annual Meeting including scientific presentations, networking opportunities, and panel discussions, as well as new scholarships to the Annual Meeting for five child neurology residents. In addition, more child neurologists have been integrated into AAN leadership opportunities such as committees and subcommittees, science and education program groups for Annual Meeting programs, and as participants in AAN Leadership Programs.
Committing to Innovation. As leaders, we are committed to advancing the AAN through innovation. Last year, we started work on redesigning all of our publications and their websites, including AAN.com, which receives more than 1 million visitors each year. We've engaged some of the top design agencies from around the world to deliver a highly attractive, easy-to-digest user experience. In addition, we started work on a new powerful search engine across all of our websites to make finding AAN content easier and more relevant. Furthermore, we're embarking on new personalization strategies to help deliver relevant and timely content when and how you like to learn. Even more exciting, we have begun to develop a new website for patients, caregivers, and the public that will serve as a new tool for members looking to provide their patients content from the most trusted authority on managing neurologic disease, the AAN.
Addressing Gender Disparity in Neurology. Appointed in October 2016 in response to startling salary data that shows neurology has one of the widest discrepancies between genders, the Gender Disparity Task Force is studying compensation, professional advancement, leadership opportunities, and work/life balance. It will make recommendations for strategies to improve the identified disparities.
Please know that each day, AAN member volunteers and our staff are fighting on your behalf to make it easier to be a successful neurologist. We've got your back.
- January 2017: 2017 Boston Annual Meeting Builds on 2016 Innovations
Every year, the AAN's Annual Meeting provides the worldwide neurology community with the latest and greatest in science and education. But 2016's meeting was something else altogether. The innovations planned and carried out by hundreds of volunteer members and the Academy staff infused the meeting with new energy and excitement and generated multitudes of positive comments from satisfied attendees.
For the 2017 Annual Meeting, the event again has been structured to deliver tremendous value, choice, customization, and innovation to attendees. I've asked Stefan M. Pulst, MD, FAAN, chair of our Meeting Management Committee, to share some of the highlights that our members can expect when they come to Boston in April.
What do we have in store for this year's Annual Meeting?
Our tagline this year is “Advancing Neurology. Advancing You.” And that really says it all. The meeting will bring forward the latest neurology science and education that advances our understanding of the brain and the disorders that affect it and the central nervous system. With more than 3,000 abstracts, 200+ expert-led courses, and exclusive programming for advocacy, practice, and medical economics, attendees will enjoy a wealth of opportunities to advance their knowledge and skills-as well as their enjoyment of their careers in neurology.
What facets of last year's meeting are being carried over to this one?
Value is always an attribute of the Annual Meeting, but last year was a real game-changer with our all-inclusive registration fee that eliminates pre-registration for individual courses. This gives people the flexibility to choose sessions and move between them as they wish. Attendees can customize their schedule specifically to suit their interests and needs by choosing from 20 subspecialty topics and career-development options.
What about innovation?
We were very happy with how attendees of the 2016 Vancouver meeting embraced the innovative experiential learning formats we introduced. We all acquire information in highly individualized ways. Some like the traditional didactic presentation, and others prefer more dynamic and interactive delivery. So we will continue to break down some walls and have numerous out-of-classroom experiences for learners to enjoy.
We continue to break new ground from a programming standpoint, including the introduction of new Neuroscience in the Clinic sessions. These will feature a mix of scientists and clinicians sharing case discussions and poster and panel presentations to integrate scientific research with clinical application. The topics will include concussion, neuroendocrine, critical care, vision and neurodegeneration, the Zika virus, functional recovery, and language and neurobiology.
Boston is a marvelous site for our Annual Meeting, isn't it?
Definitely. Along with being integral to America's history, Boston has been a vibrant hub for neurology, with top universities and legendary hospitals. It has proven to be a popular destination for past AAN Annual Meetings, offering unique character, charm, and cultural activities you can't experience elsewhere. And with no Annual Meeting programming scheduled in the evenings, you'll have more opportunity to explore this great city-on your own, with colleagues, or with family.
To take advantage of this Annual Meeting's fabulous value, choice, customization, and innovation-and your best savings as an AAN member-be sure to visit AAN.com to learn more and reserve your hotel accommodations by March 8 and register for the meeting before the March 30 early registration deadline.
I hope to see you in Boston!
- December 2016: Registry Success Is Good News for AAN Members
Here at the AAN, we're not afraid to take on large projects. But the biggest task I've been aware of is our Axon Registry®. And while I would love to take credit for the very successful recent conclusion of its pilot phase, I have to say I am merely the messenger of this good news. The kudos belong to my predecessor, Past President Timothy A. Pedley, MD, FAAN, who launched the registry in 2014; former President Bruce Sigsbee, MD, FAAN, and the members of the Registry Committee that he chairs; and our remarkable Academy staff.
I also need to thank the nearly 1,000 AAN member neurologists who volunteered their practices as test beds to actively engage in “real world” use of the registry. They effectively proved the concept and demonstrated the robust execution of this ambitious project. Furthermore, we reached one million patient records faster than any other registry that FIGMD, our vendor, has developed.
After Dr. Sigsbee made his recent report to the Board of Directors on conclusion of the pilot phase, the Board agreed it was successful and voted to begin to expand the program. Our new goal is to have 2,000 members participating in the registry in 2017, and 4,000 member participants by the end of 2018. We also will conduct a quality assessment on the beta data to ensure it meets certain quality reporting requirements. You can read more about this on page 9 in the December issue of AANnews®.
The AAN has made a significant investment of dollars and resources to create the Axon Registry. We are doing this for several reasons. First and foremost, the registry is focused on clinical quality improvement. The Centers for Medicare & Medicaid Services and other policy makers have taken a very positive view of specialty societies that demonstrate their commitment to improving the quality and value of care by creating clinical data registries. CMS considers collecting and analyzing quality data and interventions based on these data as essential to a high-value health care system as we all seek to improve quality and reduce costs.
Second, the registry enables AAN members across the US to use clinical data to improve care delivery and patient outcomes. You will be able to track your performance and really understand important aspects of your individual practice and compare each of these against your peers.
Third, the Axon Registry will enable you to save time and energy while complying with requirements and demonstrate quality care. It will help you:
- Meet the MOC Part IV PIP Clinical Module requirement
- Submit data for PQRS and/or Meaningful Use
- Submit data that will be required under MACRA
In most instances, the registry software will discreetly “pull” the necessary records from your EHR with little or no effort on your part. For larger clinics secured by firewalls that disallow third-party vendor access, it will be necessary to periodically “push” the required data to FIGMD. Still, this is a virtually effortless way to fulfill key reporting requirements.
Currently, the Axon Registry is a free benefit only to AAN members, and we anticipate it will be very popular with members based on our experience with the pilot cohorts. So I want to encourage you to look into participating in 2017 and enjoy the efficiencies the registry provides for the data reporting you need to do. Read the latest updates and watch the brief videos featuring Dr. Sigsbee's explanation of the registry. Send in questions or submit your name to participate.
Again, my thanks to all who have had a hand in the successful launch of the Axon Registry, and I trust we can look forward to a glowing report from our future President Ralph L. Sacco, MD, MS, FAHA, FAAN, after the 2017 results are evaluated.
- November 2016: Fighting for You on Several Fronts
This past summer, AAN Board member Elaine C. Jones, MD, FAAN, who also chairs our Payment Policy Subcommittee, brought up an issue that had not been on our radar: the gender disparity gap in physician pay. “I know pay gaps are becoming a national issue,” she told us, “and I have had several female neurologists approach me about this issue for themselves and asking if the AAN is aware of it and what can be done.”
As Dr. Jones began to look into this, what she learned alarmed her-including this information from a July 12, 2016, article in the New York Times that cited a JAMA Internal Medicine study: A broad analysis of salary information from public medical schools found that women made almost $20,000 less a year than comparable male doctors. Neurology suffers not only from being the lowest paid of the cited specialties, but also has one of the widest discrepancies between genders.
“I would like to request that the AAN make this a priority for our profession,” Dr. Jones asked of the board. “I think a lot could be done within our own field, from educating women on negotiating, educating department chairs on the discrepancies and the need for transparency in their own departments, to mining the data we get from our surveys, etc.”
Thanks to Dr. Jones and Board member Orly Avitzur, MD, MBA, FAAN, chair of our Medical Economics and Management Committee, we have looked into this and what we have discovered is indeed shocking. Our 2016 Neurology Productivity and Compensation Survey, based on 2015 data, shows compensation reported by the female members who took the survey to average $200,000 compared to $250,000 for male members surveyed. In the AAN's August 18, 2016, issue of Neurology Today®, these disparities were discussed by Dr. Jones and other neurology leaders, including Ann H. Tilton, MD, FAAN, secretary/treasurer of the AAN Institute Board of Directors; and Cynthia L. Comella, MD, FAAN, chair of the AAN Women's Leadership Group.
Many of the female neurologists interviewed recognized such salary disparities from their own experiences and suggested the reasons are numerous, including greater acceptance of initial salary offers, lack of aggressiveness in negotiating salaries, perceptions of self-worth, and responsibilities at home. Literature shows females are at higher risk for burnout than males, and the Neurology Today article mentions that the salary issue may contribute to that problem.
Other non-AAN studies and articles confirm that gender-and racial-disparities in salaries exist throughout the medical profession, whether practicing physicians, academic faculty, nurses, or researchers.
Clearly, both to me and the other members of the AAN Board, this is unacceptable and demands immediate action and correction. I have appointed a task force to dig deeper into the causes of this problem and recommend steps that the AAN can take to advocate on behalf of our members and promote equal pay for equal work.
I want to commend Dr. Jones for bringing this to our attention and advocating for action. Indeed, this demonstrates why a diverse board of directors-inclusive of gender, race, and work focus-is paramount to successfully leading an organization where all members are prized, all work skills are respected, and all voices are heard. I look forward to sharing with you the results of the task force's investigation and recommendations as to what the Academy can do to help advocate for equal pay. Stay tuned.
Empowering our members to become confident leaders is at the core of our new suite of AAN Leadership Programs, and the oldest is the Palatucci Advocacy Leadership Forum, launched in 2003. Many of you might be in a position similar to Dr. Gurdesh Bedi, a 2014 graduate of the forum, who shares his remarkable story on page 12. Maybe you have seen deficiencies-or outright failures-in the delivery of quality care to patients, and have ideas about how to change the system in your workplace or community, but haven't been able to figure out how to go about it successfully. Perhaps these conditions have eroded your zest for practicing neurology and you're feeling marginalized. If so, I urge you to take the first step that Dr. Bedi took to become an agent of change and reinvigorate his passion for neurology: apply to participate in the 2017 Palatucci Forum, which will be held next May. You will be trained by experts and your peers, mentored by successful graduates, and reinvigorated by a new mission that is achievable and consequential.
Building sustained relationships with members of Congress is a vital component of successful advocacy. As you can read on page 14, some of our members have met with lawmakers when they returned home, either in the district office or at the neurologist's clinic, during the recent congressional recess. Both settings eliminate the chance of distractions of roll call votes or committee meetings, and clinic visits provide a show-and-tell opportunity that more vividly presents the perspectives of doctor and patient.
I hope these examples will inspire you to take advantage of the opportunity to participate in our Neurology on the Hill visit to Washington next February 27 and 28. I want to emphasize that you do not need any experience to join us. Our staff will present an overview of the issues we will address with members of Congress. You also will hear from some key players in health care policy who will share their insights and experiences. You'll have the chance to meet and network with fellow Academy members-a great way to share common interests, concerns, and solutions that have been successful elsewhere. And that's just the first day! On the second day, you'll don your complimentary Academy green necktie or scarf and meet with your senator and/or representative to help educate them on these issues and make our case on behalf of our patients. While our political system may be far from perfect, we citizens do have the right to have our voices heard, to be grassroots lobbyists, to speak truth to power. If we neglect this responsibility, if we fail to speak up and educate those who make the decisions that affect us, it diminishes our authority to complain about the outcome.
You can learn more about Neurology on the Hill and submit your application by November 20, 2016. The deadline for the Palatucci Forum is January 9, 2017. To host a congressional visit at your practice, please contact Becky Horton.
The AAN's mission includes supporting your career satisfaction. On many different fronts, in a variety of ways, your Academy is fighting for you. I hope you will keep this in mind when you receive your membership renewal notice for 2017 in the mail. The AAN has your back.
- October 2016: New Help for Solo and Small Practices
About a year ago, we launched the Solo and Small Practice Task Force, chaired by Board Vice President and practicing neurologist James C. Stevens, MD, FAAN. The group was charged with reviewing existing AAN products and services and identifying major issues affecting solo and small practices, whose neurologists make up 30 percent of our current AAN membership in the US.
The Task Force members reviewed current data and AAN resources available to assist this group of members, identified gaps in programs and services, and this summer they made their final report to the Board of Directors. In total, the Task Force made 25 recommendations to the Board that spanned eight important topic areas:
- Running Your Practice
- New Payment Models
- Practice Management Education
- Coding and Reimbursement
- Recruiting and Hiring
- Representation in AAN Activities
The Task Force prioritized the recommendations in order of importance. The number one suggestion to the AAN leadership was to consider the development of a toll-free practice help hotline and/or email address with a rapid response. Among other recommendations, the AAN will continue to strengthen existing efforts in these areas:
- Advocating for reduced administrative burdens on physicians (e.g., MOC, Prior Authorization, and Meaningful Use of Electronic Health Records) should remain a top priority for the AAN.
- One of the guiding principles of the AAN's efforts around health care payment reform (MACRA) and alternative payment model frameworks should be to consider ease of implementation by members in solo and small practices.
- The AAN should encourage advocacy activities (e.g., email action alerts), leadership programs, and other micro-volunteerism opportunities as first steps for getting involved to members in this segment who are less likely to be able to take large amounts of time away from their practice.
- The leadership of the AAN should be cognizant of the percentage of AAN members in solo and small practice and seek to achieve a goal of proportionate representation on committees as well as the Board of Directors to reflect this segment of the membership.
We are currently evaluating these thoughtful recommendations as part of our consideration of developing an enduring strategy for engaging with members in solo and small practices. We have more control over internal changes than we do over Congress or the Centers for Medicare & Medicaid Services (CMS), of course. Legislative and regulatory advocacy takes time and considerable effort. But we have built a strong foundation and our influence has grown because we are passionate about being proactive and asserting the views and needs of our practicing members. For example, a July 13, 2016, article on the widely read “Policy & Medicine” website lauded our in-depth response-just one of nearly 4,000 comments-to CMS's proposed MACRA rules: “The American Academy of Neurology's (AAN) comment letter was one of the most substantial and included a thorough legal and policy rationale for the inclusion of quality-related CME as a CPIA [Clinical Practice Improvement Activity].” The article quoted heavily from our response to CMS, attesting to the strength of our voice and respect for our views as we continue to fight for members in practice and protect the neurology profession.
Members have a role to play, too: Stay informed and speak up. Often, after answering a “Why doesn't the AAN…?” question from a member, the member's response is “Great, I didn't know the Academy was doing that” or “Thanks, I wasn't aware of those resources.” Time is precious for all of us, but if you don't take a few minutes to regularly visit AAN.com or read AAN emails, AANe-news™, or AANnews®, or join in the conversations on our Synapse online communities, you may miss out on significant information, tools, and programs that can help you regain time with your patients, make your practice more efficient, and ensure you will be properly reimbursed for your work. And please make your voice heard by responding to our advocacy action alert emails, because your participation adds credence to our efforts. If you have issues or concerns you want to relay to the Academy, please contact me or Member Services.
The goals of the Solo and Small Practice Task Force's recommendations are to recommit the AAN to being indispensable to its members in solo and small practice by supporting them to remain in the practice of their choosing. We want to ensure that all of our members-in every type of practice arrangement-recognize the Academy's commitment to them. Watch for more news on progress around implementing the recommendations of the Task Force in the weeks and months ahead.
- SEPTEMBER 2016: We Want YOU to Live Well
How can the AAN help more neurologists be satisfied in their jobs?
That has been a nagging question among Academy leaders for several years. We are the preeminent organization for neurologists and serve our members with an array of programs, services, and products that help you do your job better today than yesterday-and better tomorrow than today. And while these benefits may help make your job easier and enable you to be more effective in treating your patients, they don't necessarily help you be more satisfied with your work. We know all too well that the myriad regulatory hassles that practicing neurologists face daily take valuable time away from the reason you became a neurologist in the first place- to treat your patients. The constantly changing reporting requirements, introduction of new payment policies, and requirements for maintenance of certification can make one feel overwhelmed, frustrated, and angry. The burden of these feelings, whether conscious or subconscious, can extinguish one's passion for our profession, and help lead to burnout.
In 2015, we launched a task force to research the issue of physician burnout-what it is, how it happens, and what can be done to deal with it effectively and improve work-life balance for our members.
Burnout is common in all practice settings and all subspecialties, but neurologists are more highly susceptible to burnout. Neurology is the only medical specialty that has both one of the highest rates of burnout and the lowest rate of work-life balance.
Burnout is described as lack of well-being due to a poor work-life balance. A sense of low personal accomplishment. A feeling of emotional exhaustion and depersonalization that can lead to the loss of interest and enthusiasm for practicing medicine. Burnout is a significant problem in neurology, and it's getting worse over time. Practicing neurologists experiencing burnout may not meet their potential in their jobs and their private lives. This may cause suboptimal clinical judgment, lack of empathy with patients, lack of career satisfaction, and health problems, and exacerbate work-life conflicts.
This problem impacts the health of our overall specialty, too, as more neurologists may leave practice early, fewer may enter neurology as a career choice. And since we already are facing a shortage of neurologists, this affects access to care.
We divided our task force into two groups. One, co-chaired by AAN Board member Neil A. Busis, MD, FAAN, a former chair and current member of the AAN's Medical Economics and Management Committee, and Kerry H. Levin, MD, member of the Education Committee, studied this burnout issue intensively. The Academy randomly surveyed 5,000 US members this past winter and had a very high participation rate of 40 percent-which suggested this issue struck a chord among our members. The results of the survey are still in the process of being prepared for publication and we will use this data as leverage in our policy and advocacy discussions.
The other group of task force members led by Jennifer R. Molano, MD, FAAN, a member of the Member Engagement Committee, and Board member and Practice Committee Chair Heidi B. Schwarz, MD, FAAN, addressed how to mitigate burnout. They identified the three main sources of burnout: regulatory, workplace, and the individual. Then they set about to research and gather tools, strategies, and resources to help members prevent and mitigate burnout.
Your health matters to the AAN and we're here to help.
First, I hope you recognize that we are doing everything we can on the health policy front to decrease your regulatory hassles and limit the impact of new policy issues, reporting requirements, and reimbursement changes. We also have had some success in advocating to decrease the burden of maintenance of certification and we made related education programs free for members to lessen the financial hardship. Please know that each day, AAN staff and member volunteers are fighting on your behalf to make it easier to be a successful neurologist. Change may be slow and incremental, but we do not give up.
In the meantime, we want you to be aware that it is possible to prevent burnout as well as restore well-being. Today, I'm happy to report that we have launched our new webpage at AAN.com/LiveWell with a range of resources to provide you with tips, tools, and strategies for cultivating well-being and resiliency in your life.
We know that one size does not fit all, so we have compiled a variety of didactic and interactive resources to help address regulatory, workplace, and individual frictions that spark burnout. We are planning to offer programs through our Leadership University at the 2017 Annual Meeting that will help you become a resilient leader and recapture the joy of practicing neurology. And we're looking into convening a conference dedicated to mitigating burnout and promoting a stronger sense of well-being.
I'm also pleased to tell you that the AAN is far ahead of many other specialties and organizations in recognizing that burnout is a crisis in our midst that must be understood and addressed if we are going to be the best we can be for our patients, our families and colleagues, and our selves. This happened because the AAN listens to its members. We exist to serve you and we care about you. And even though we already are fighting against these regulatory hassles that contribute to burnout, we knew we had to take more direct action in this area for more immediate solutions. The fact that there was more member interest for participating on our task force than there were spaces available assured us that this focus is necessary. There is tremendous determination and passion among the members on the task force to understand this problem and take the necessary steps to help solve it.
While the Academy continues to tackle the overarching regulatory issues, each of us has a personal and professional responsibility to be true to the ancient proverb, “Physician, heal thyself.” Because only when we are more whole and fully engaged and satisfied-at work, at home, and in our communities-can we have the best assurance that we will, indeed, be able to fully take care of others.
Please look into the resources we are providing at AAN.com/LiveWell. We also want you to share your experiences and suggestions on how deal with stress and refresh yourself. Whether it's a success story about resiliency or an idea you wish to share, we want to hear it! Your feedback is invaluable as we strive to make our well-being resources meaningful and relevant to you. Let me know if there are policy changes we should fight for-or against-to make your jobs easier, if there are other effective programs and tools that we should add, and if there are more ways the AAN can help you be more satisfied in your job.
We want to help you Live Well!
- AUGUST 2016: Increased Support of Research Continues AAN’s Long Commitment to Treatments and Cures
The AAN's commitment to research stretches back to the earliest days of the Academy, when our founder A.B. Baker advocated to Congress for the creation of what was then known as the National Institute for Neurological Diseases and Blindness and helped install Dr. Pearce Bailey as its first director. Now, it's known as the National Institute of Neurological Disorders and Stroke and AAN member Walter J. Koroshetz, MD, FAAN, is its chief.
Recently, the Academy's board and staff put into place a significant expansion of our investment in research. In 2015, the AAN research program funded $2,400,000 to recipients. In 2016, the amount is $2,800,000-an increase of $400,000-and in 2017, the plans are to add $1.1 million in additional funds. The AAN research programs include money from the AAN Institute, the American Brain Foundation, association partners, the pharmaceutical industry, and AAN members.
I'd like to highlight four awards-two of them new-that underscore the AAN's pledge to support all types of research across all career levels and discovery stages:
- New $450,000 Career Development Award
This prestigious three-year award provides $150,000 per year for a total of $450,000. Eligible applicants will have completed residency within five to 10 years of the July 1, 2017, award start date.
- New $130,000 Neurology Research Training Scholarship
This premier two-year award provides $65,000 over two years for a total of $130,000. The award is designed for basic and translational research proposals in neurology. Eligible applicants will have completed residency no more than five years prior to the July 1, 2017, award start date.
- $130,000 Clinical Research Training Scholarship
Formerly categorized as a fellowship, this scholarship provides $55,000 per year for two years, plus a $10,000 per year stipend to support education and research-related costs. It is nondisease-specific, and recognizes the importance of good clinical research and encourages young investigators in clinical studies.
- $130,000 Practice Research Training Scholarship
Also previously known as a fellowship, this scholarship provides $55,000 per year for two years, plus a $10,000 per year stipend to support education and research-related costs to support training in clinical practice research.
The application deadline for these awards is October 1, 2016. We also have awards specifically for research in ALS, Alzheimer's, ataxia, epilepsy, multiple sclerosis, muscular dystrophy, Parkinson's disease, stroke, and Tourette syndrome with varying application deadlines. I encourage eligible researchers to learn more about these and other Academy research grants.
The brain remains the least-understood-and arguably the most important-organ of the human body, and the human and financial cost of neurologic disease is so tremendously high. These Academy programs, as modest as they may be in the overall funding of brain research, play a vital role in our profession's ongoing search for answers and the nurturing of the next generations of investigators. We always will strive to do more, and we always will be proud of doing as much as we can.
- New $450,000 Career Development Award
- July 2016: Seeking Greater Inclusion, Broader Perspectives in New Board Nominees
As you know, the AAN has more than 30,000 members. That translates into 30,000 sets of viewpoints, needs, challenges, and successes. We come together in this association to be strengthened in our skills, to learn from one another, so we can be better in our jobs today than we were yesterday. And be better tomorrow than we are today.
To help the AAN carry forward its mission and sustain its vision, I'm inviting you to apply to join in leading the world's largest association of neurologists. Never has it been more important to the future of the Academy to increase inclusion from under-represented members-specifically those in solo and small practice, female members, neurologists of various ethnic backgrounds, and those early in their career.
I encourage you to nominate yourself or a colleague you respect by September 1 for the open positions on the Board of Directors for the upcoming 2017-2019 term. The Academy's Nominations Committee will review candidates for president elect, secretary, treasurer, and director positions. You can find more information and make nominations at AAN.com/view/nominations.
To qualify for nomination, one must be a Fellow (FAAN) physician of the Academy, and any member may recommend a Fellow for consideration. If you are not yet a Fellow, you can easily apply for your FAAN credentials today at AAN.com/view/FAAN. I am pleased that we have seen a significant rise over the past year in the number of members successfully elevating their status to Fellow through recognition of their accomplishments, which opens the door to this unique opportunity to lead the AAN.
The Nominations Committee strives for balance and diversity, including geography, gender, subspecialty, professional setting, time in the profession, and ethnic origin. But the committee can only consider from the range of nominations received. I strongly encourage Physician Fellows in these demographics to not let modesty stand in the way of making a significant contribution to the future of the Academy-and further enhance your professional standing and member experience. Whether you are nominated by yourself or your peers, you have particular experiences, insights, and concerns that need to be part of the Board's collective consciousness and contribute to our continued success.
Through the years, the Academy has been fortunate to have experienced, perceptive members step forward to qualify for consideration, and our selections-voted on by members at the business meeting during the Annual Meeting-have been exceptional. Over the past decade in particular, the board has taken on a more sophisticated strategic role, working with information and data provided by our executive staff and input from our 30,000 members to help us define our strategic goals and objectives to support our mission and vision. We then charge Executive Director and CEO Catherine M. Rydell, CAE, and her greatly talented staff to do the necessary work to make it all happen. This approach has been very successful, both for the organization and for meeting the needs of the members we serve.
I think I can speak for my colleagues on the Board in saying that serving in such a leadership role will not leave you unchanged. While the responsibilities are significant, and the issues faced are often complex, you will gain a broader understanding of our profession and appreciation of the AAN's critical role within it. You will be challenged to lift our accomplished association to an even higher level of achievement. Also, you will be asked to be a mentor and provide guidance to participants in our AAN Leadership Program. And you will be able to apply this experience, with newfound knowledge, skills, and perspectives, to your daily work in your practice or institution and to future leadership opportunities beyond the AAN.
Expand Your AAN Experience
Looking for ways to get involved in the AAN? The Academy offers numerous ways for you to help shape the future of the neurology profession and extend your network of colleagues through closer participation, networking, and peer recognition.
- Apply for a leadership role by participating on committees, work groups, or task forces
- Review drafts of AAN guidelines
- Apply for one of the AAN Leadership Programs
- Participate in advocacy programs such as Neurology on the Hill and respond to AAN Action Alerts
- Network and learn from your peers in Synapse, our new online communities
Learn more at AAN.com/membership.
- June 2016: New Grant Will Help Increase Number of Medical Students Going into Neurology
I have some exciting news to share with you, but first I want to provide some background about the future of our neurology workforce, which has long been a concern of the Academy's leadership. This was an issue when I was chair of the Education Committee in the late 1990s, and also for Dr. Ralph Józefowicz when he helmed the committee. In fact, more than 20 years ago, Dr. Józefowicz coined the term “neurophobia” to describe students' negative perception of neurology, that the “neural sciences are overly complex.” He suggested that a lack of integration of basic and clinical information was a potential driver of neurophobia. There is recent evidence that neurophobia may, indeed, be driven by weak basic neuroscience and neuroanatomy courses during the preclinical years. We hypothesize that neurophobia is a common barrier to entering neurology. But we also know that lower reimbursement for evaluation and management services compared to procedures is a factor as well.
In 2011, then-President Dr. Robert C. Griggs established the Workforce Task Force to determine both the magnitude of the current and projected neurologist shortage, as well as the likely consequences. Past President Dr. Timothy A. Pedley and Dr. William D. Freeman co-chaired the task force. As Dr. Pedley reported to members in June 2013, what our Workforce Task Force discovered was alarming: The United States was experiencing an 11-percent shortfall in neurologists that will grow to 19 percent by 2025. Indicators pointing to an inadequate supply of neurologists included the number of days it takes to see a neurologist (35) compared to a family practitioner (20) or a cardiologist (15). Another is the number of unfilled positions due to the difficulty in hiring neurologists. There are also geographic disparities. While there is a relative abundance of neurologists in most of the New England area and Minnesota, demand in nearly all remaining states is-or, by 2025 will grow to be-much greater than the available supply.
Among the recommendations from the Workforce Task Force was to increase the number of neurologists in the clinical workforce by making neurology a more attractive choice of specialty for medical students. This will require addressing a significant income gap between procedural and nonprocedural specialties, and we have been working on this from many different angles, from fighting for fair reimbursement on Capitol Hill and at the Centers for Medicare & Medicaid Services to championing telestroke legislation in Congress. Also, to bolster patient access to neurologic care, we are bringing in nurse practitioners and physician assistants as AAN members and providing distinct neurology training suitable for their roles.
The critical gap in the professional development of neurologists is the transition from medical school to neurology residency. Despite the growing demand and exciting developments in our field, the percentage of medical students entering neurology is persistently inadequate at approximately 2.6 percent per year. In 2015, 412 allopathic medical graduates matched into neurology residency programs. Clearly, a dedicated effort is required to address this problem and the AAN is just the organization to tackle it. And we found a unique partner to assist us: the Conrad N. Hilton Foundation.
The Conrad N. Hilton Foundation invests in seeking a cure and improving quality of life for those who live with multiple sclerosis. A priority of the foundation is ensuring that those with MS have access to the care they need to live full and happy lives. The foundation believes that increasing interest in the field of neurology is essential, not just for patients who will receive care, but for continued advancement in MS research.
The AAN has received a significant three-year grant from the Conrad N. Hilton Foundation that will run until April 30, 2019. The objective of this program is to increase the percentage of medical students entering neurology by 25 percent over the program's duration (for a total of 515 allopathic graduates in 2019). Achieving this goal will substantially address the current 11-percent shortfall and 80 percent of the projected shortfall in 2025. Because much of the focus is on establishing enduring programs, we anticipate further growth in future years.
This grant will help the AAN:
- Determine factors that lead medical students to choose neurology as a career; we will survey medical school programs, study the issues, and examine high-performing programs and learn their tactics
- Develop engaging multimedia resources to inspire medical students to maintain interest in neurology as a field
- Expand and enhance the AAN's Student Interest Group in Neurology (SIGN) program, which provides opportunities to participate in clinical, research, and service activities in neurology at more than 150 chapters in US and Canadian medical schools
Along with Dr. A. Gordon Smith, now our Education Committee chair, President Elect Dr. Ralph L. Sacco is driving this initiative and shared these comments. “We are thrilled to receive this three-year grant from the Conrad N. Hilton Foundation to help jump-start our new AAN initiatives to expand the neurology workforce pipeline. There are dire predictions of the expanding shortage of neurologists who will be readily accessible to care for our aging populations. Despite all of the exciting advances in our field to intervene, treat, and prevent neurological diseases, the proportion of medical students choosing a neurological career has remained disappointingly low. The AAN has taken up the challenge and is designing some really innovative programs and invigorating others, such as the SIGN program, to excite more students to enter the field of neurology. I look forward to working with the AAN Education Committee and subcommittees to make this one of my strategic priorities during my presidency."
The AAN received strong letters of endorsement from our colleagues at the Alzheimer's Association, the American Brain Foundation, the American Heart Association/American Stroke Association, the National Multiple Sclerosis Society, and the Foundation for Peripheral Neuropathy. I'd like to thank them for their support.
And I hope you will join me in thanking the Conrad N. Hilton Foundation for their forward-thinking generosity. We will update you on our progress over the next three years as we work toward successfully meeting our ambitious goal.