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4 Reasons for the Nationwide Increase of Neurohospitalists

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Did you know there are 1,500 neurohospitalists across the United States? And that number is only rising, reports Cheryl Clark in HealthLeaders Magazine.

As we covered in our last post, “‘Hyphenated-hospitalists’ are cropping up in orthopedics, dermatology, surgery, otolaryngology, oncology, neurology, psychiatry, and gastroenterology,” and this phenomenon is perfectly illustrated by the number of neurohospitalists that are being employed by such healthcare organizations as the 274-bed Evergreen Hospital in Kirkland, Wash.

The question is, Why are neurologists attracted to subspecialty hospitalist positions? Clark talked with David Likosky, MD, who works at Evergreen as a neurohospitalist and is the president of the Neurohospitalist Society. He gave four reasons for this trend:

1. The nationwide shortage of neurologists.

Likosky told Clark this shortage has motivated “many community neurologists to decide ‘they don’t want to go in the hospital anymore. There are economic forces, concerns about liability, and the need to maintain a viable outpatient practice.’” This obviously leaves hospitals with a serious gap in care.

2. The emerging subspecialties in neurology.

The entire specialty was caught off-guard, Likosky said, by the numerous subspecialties that arose in neurology, subspecialties “that are complex and rapidly evolving, such as focuses on seizures, headaches, or neuromuscular diseases…” Therefore, many neurologists “may not feel qualified to respond to a hospitalized patient with symptoms that don’t fit in their wheelhouse.”

3. The evolution of time-critical treatments.

High-acuity care wasn’t prevalent in neurology when most of the current crop of specialists entered the field, Likosky told Clark. “For stroke, it really was the stereotypical thing to say, ‘Give them two aspirin and I’ll see them tomorrow.’” Now, there are such treatments as the “well-accepted clot-busting drug tPA,” he said, which give neurologists an important role to fill on the care team.

4. The pivotal role neurohospitalists play in general medicine and surgery.

Whenever a general medicine or surgery patient develops neurology problems, Clark writes, a neurohospitalist is needed. She gives the example of hospital delirium, “an emerging issue for some patients…which can be provoked by too many medications combined with long lengths of stay.”

The neurohospitalist is responsible for reviewing the patient’s medications, she continues, and collaborating “with the surgeons and others to ‘set up systems that avoid giving certain medications in the first place,’” Likosky told her.

Evergreen Hospital has seen positive outcomes from its two employed neurohospitalists. “On seven of the eight CMS stroke measures, the hospital fares far better than the state and nation averages, and is equal on the eighth,” Clark reports.

In our next post, we’ll look at the downsides of the subspecialist hospitalist model. Until then, as physicians who are looking for jobs, what are your thoughts on hyphenated-hospitalists? What factors are currently confronting your specialty that would motivate you to explore this career move?

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