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May 24, 2021

Advanced Practice Clinicians—Neurology’s Underused Resource

Author Affiliations
  • 1School of Nursing, Emory University, Atlanta, Georgia
  • 2Department of Neurology, University of Rochester Medical Center, Rochester, New York
JAMA Neurol. 2021;78(8):903-904. doi:10.1001/jamaneurol.2021.1416

We have a supply-and-demand issue in neurology. Currently, the supply of neurology clinicians is inadequate to meet the demands of patients,1 and the distribution of neurologists in the US highlights inequitable access to care.2 This is not news to neurologists, where the mean wait time for a new patient visit is 32 to 35 days according to a 2013 survey by the American Academy of Neurology (AAN)1 and 2016 data from Athena Health.3 Future predictions suggest that access issues will worsen, given the aging US population, including neurologists (mean age in the US, 52 years),4 and new treatments that drive increased demand. Advanced practice clinicians (APCs) offer a resource that could help address the issue of access as well as further optimize care.

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    2 Comments for this article
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    Inequitable Care?
    Phillip Shaffer |
    The authors cite a concern for inequitable care yet the entire article is a call to supply care to some of their patients that many would consider lower quality than that a board certified physician would provide. Important to note is that the practice can charge the same or nearly the same for this less adequate care.

    There could be nothing less equitable. I might ask if the self-pay patients are shuttled off to the midlevels.

    They can't hide the fact this is entirely about money.

    There are thousands of medical school graduates who
    do not match yearly. They could be brought into practice in a helping role, and some could be more qualified than people the authors acknowledge have no training whatever in Neurology.
    CONFLICT OF INTEREST: None Reported
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    Standard of Care
    Brian Wilhelmi, MD, JD | Creighton University School of Medicine
    As a practicing physician-attorney I have seen a large rise in the amount of malpractice claims against nurse practitioners and physician assistants that are now practicing independently across my state and others. These providers frequently cannot explain the science behind their decisions at a deposition after alleged injury to a patient. This has profound implications for the practice of neurology. If there is no evidence understood by these professions, there is no standard of care based upon the evidence. In short, the increased access comes at a direct cost to the standard of professional care provided by neurologists on a daily basis. In addition, the author of this article seems unaware of the campaign supporting title misappropriation happening across the United States. Chiropractors are calling themselves "functional physicians." Nurse anesthetists are calling themselves "anesthesiologists." Naturopaths are calling themselves naturopathic physicians. Training programs as short as a month are calling themselves "residencies." The ultimate loser in this equation is the patient who is left trying to navigate who is and who is not a physician. Many are left confused and injured in the process. The standard of care in the courtroom for these providers is not the physician standard. In Arizona, for example, a neurologist cannot testify as to the standard of care for a NP or PA working under them. I cannot imagine publishing this article without a counterpoint article regarding these trends and the damage done to the physician profession by allowing non-physician "neurologists" to practice clinical neurology and the damage it would do to the term "neurologist" in the eyes of the public. The phrase "top of their degree" is a market-tested masterpiece of deception. If you are not properly trained in a field, a point conceded by the authors, and not properly tested to prove you have mastered a body of knowledge, you should not be able to practice in the field and provide inaccurate diagnosis and treatments.
    CONFLICT OF INTEREST: None Reported
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