The Growing Shortage of Vascular Neurologists in The Era of Health Reform

Leira, Enrique C.; Kaskie, Brian; Froehler, Michael T.; Adams, Harold P.

doi:10.1161/strokeaha.111.000466

Cited by 45 publications

(36 citation statements)

References 32 publications

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“…8 This does not compare favorably to other countries, because the ratio is ≈1 per 160 000 in Germany, 1 per 137 000 in Denmark, and 1 per 177 000 in Australia (personal communications from Drs Grete Andersen, Geoffrey Donnan, and Wolf Schaebetz). Only 77 vascular neurology fellowships were available in 2012, and all of them focused primarily on clinical training.…”

Section: Clinical Manpower Needsmentioning

confidence: 98%

Ensuring the Future of Clinical and Basic Stroke Research

Fisher

2014

Stroke

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Section: Clinical Manpower Needsmentioning

confidence: 98%

Ensuring the Future of Clinical and Basic Stroke Research

Fisher

2014

Stroke

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“…The shortage of neurovascular specialists is well recognized with only about 1,100 physicians currently available, and stroke incidence projected to outstrip supply [2]. Since 2012, only 10 new ACGME-Recognized Vascular Neurology fellowships have been inaugurated, which totals 82 at the time of this manuscript.…”

Section: Overview Of Strategies and Tools (Fig 3)mentioning

confidence: 99%

“…Nearly 800,000 strokes occur annually in the United States [2], with the total cost of stroke burden projected from 2005 to 2050 to be USD 2.2 trillion [3]. As the goal for acute stroke treatment is to reperfuse and salvage brain parenchyma, mechanical thrombectomy was developed as a treatment modality for patients unable to undergo the standard intervention of fibrinolysis [4].…”

Section: Introductionmentioning

confidence: 99%

Mandatory Neuroendovascular Evolution: Meeting the New Demands

et al. 2018

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Background: Traditionally, patients undergoing acute ischemic strokes were candidates for mechanical thrombectomy if they were within the 6-h window from onset of symptoms. This timeframe would exclude many patient populations, such as wake-up strokes. However, the most recent clinical trials, DAWN and DEFUSE3, have expanded the window of endovascular treatment for acute ischemic stroke patients to within 24 h from symptom onset. This expanded window increases the number of potential candidates for endovascular intervention for emergent large vessel occlusions and raises the question of how to efficiently screen and triage this increase of patients. Summary: Abbreviated pre-hospital stroke scales can be used to guide EMS personnel in quickly deciding if a patient is undergoing a stroke. Telestroke networks connect remote hospitals to stroke specialists to improve the transportation time of the patient to a comprehensive stroke center for the appropriate level of care. Mobile stroke units, mobile interventional units, and helistroke reverse the traditional hub-and-spoke model by bringing imaging, tPA, and expertise to the patient. Smartphone applications and social media aid in educating patients and the public regarding acute and long-term stroke care. Key Messages: The DAWN and DEFUSE3 trials have expanded the treatment window for certain acute ischemic stroke patients with mechanical thrombectomy and subsequently have increased the number of potential candidates for endovascular intervention. This expansion brings patient screening and triaging to greater importance, as reducing the time from symptom onset to decision-to-treat and groin puncture can better stroke patient outcomes. Several strategies have been employed to address this issue by reducing the time of symptom onset to decision-to-treat time.

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“…Young physicians will not enter a fellowship program in vascular neurology unless they plan to pursue a career in the field. While some young physicians are willing to enter a labor-intensive and demanding specialty like vascular neurology for altruistic reasons or personal satisfaction, others may not be willing to do so for the reasons discussed by Leira et al 6 Some solutions have been proposed. For example, a program that would help mitigate vascular neurology trainee's debts similar to that for colleagues that go to rural primary care settings or research has considerable appeal.…”

Section: Other Factors That Affect Recruitment Of Physicians Into Vasmentioning

confidence: 99%

“…The situation is even more severe in vascular neurology, a situation in which delays are inherently life-threatening. 6 From 2005 to 2012, 1169 physicians were certified by the ABPN. Of these, only 269 were graduates of training programs approved by the Accreditation Council for Graduate Medical Education (ACGME).…”

mentioning

confidence: 99%

Future of Subspecialty Training in Vascular Neurology

Adams

Biller

2014

Stroke

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Medical Specialties (ABMS) to recognize the expertise of those board-certified neurologists who were providing specialized care of patients with a broad spectrum of cerebrovascular diseases (vascular neurology.) This designation reflected the growth in knowledge about stroke as reflected by dedicated meetings and focused journals. The expansion in knowledge in vascular diseases of the brain and spinal cord, which was the result of advances in experimental, epidemiological, and clinical research, also served as an impetus. In 2005, the ABPN started the process of awarding 10-year time-limited certificates in vascular neurology. Now, ≈10 years later, it is reasonable to review the progress in the field of vascular neurology and to look at the future of the subspecialty.Because of their demonstrated special expertise and experience in the diagnosis and treatment of patients with a broad spectrum of vascular diseases of the central nervous system, vascular neurologists are and will continue to be at the forefront of stroke management. Patients, third-party payers, and colleagues will continue to seek the advice and care of vascular neurologists. With the advent of specialized training and resultant certification, many general neurologists now refer their problematic cases to vascular neurologists. This trend likely will continue and probably will accelerate. In addition, vascular neurologists are well-suited for leadership positions within hospital quality improvement programs and clinical initiatives. As of January 2013, the Centers for Medicare and Medicaid Services began mandatory hospital reporting of 7 stroke quality metrics known as core measures. Performance on these measures may become incorporated in determining reimbursement incentives and penalties in the future. The Joint Commission also is certifying primary and comprehensive stroke centers based on the recommendations of the Brain Attack Coalition. Certification standards include a well-defined leadership team that includes a medical director with expertise in cerebrovascular disease to help the program achieve its mission. Thus, vascular neurologists will continue to be the leaders of stroke-related research initiatives, professional and public educational programs, and advocacy efforts to the public and governmental bodies. 1-5The American Academy of Neurology (AAN) has emphasized the increasing shortage of neurologists in the United States, particularly in rural areas. 5 As a surrogate, they have used increasing waiting times for an outpatient clinic visit. The situation is even more severe in vascular neurology, a situation in which delays are inherently life-threatening.6 From 2005 to 2012, 1169 physicians were certified by the ABPN. Of these, only 269 were graduates of training programs approved by the Accreditation Council for Graduate Medical Education (ACGME). This figure represents an average of 38 new physicians entering the specialty each year. More than one-half of the board-certified vascular neurologists trained before the creation of t...

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The Growing Shortage of Vascular Neurologists in The Era of Health Reform

Cited by 45 publications

References 32 publications

Ensuring the Future of Clinical and Basic Stroke Research

Ensuring the Future of Clinical and Basic Stroke Research

Mandatory Neuroendovascular Evolution: Meeting the New Demands

Future of Subspecialty Training in Vascular Neurology

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