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I appreciate Dr. Sethi's comments on my article.1 There is no question that an advance practice clinician (even with years of neurology experience) is not equivalent to a board certified neurologist. The neurology physician has a much greater depth and breadth of training and experience. The dilemma society (and the field of neurology) faces is that there is a grossly inadequate physician workforce to meet anticipated future healthcare needs (let alone present ones). There is potential to train additional neurologists but not a system whereby you can guarantee those new physicians enter the most needed neurologic subspecialty and geographic region. There is also the potential to redesign health systems whereby you partner with primary care physicians to manage less complex neurologic disorders thus increasing the capacity of existing neurologists to see new patients. These latter two options, however, would take a considerable amount of time and advocacy to achieve. In the mean time we still have many communities where a patient must wait months before they can have their neurologic concern evaluated. This is where use of a team-based physician neurologist with advance practice clinicians can potentially improve access and quality of care.Reference
1. Ross SC. An option for improving access to outpatient general neurology. Neurol Clin Pract 2014;4:435-440.
Disclosures: S.C. Ross has received travel reimbursement from Penn State University, the American Academy of Neurology, and the Pennsylvania Neurological Society; served as a consultant for Impact Network; and has provided independent medical review for Horizon Healthcare Consultants.
While the use of non-physician providers may certainly shorten the wait period and lead to more timely evaluation of new patients, caution needs to be exercised as this practice gains more widespread acceptance.1 It costs less to hire a non-physician clinician than to hire a fully trained neurologist, even one just out of residency training. While non-physician clinicians may improve productivity and efficiency of a neurology practice, one must not forget that their knowledge and clinical skills are limited and not comparable to that of a physician. So while they may take on some of the diagnostic and therapeutic functions of a neurologist, task shifting needs to be limited and clinical encounters closely supervised.
1. Ross SC. An option for improving access to outpatient general neurology. Neurol Clin Pract 2014;4:435-440.Disclosures: N. Sethi serves as Associate Editor for The Eastern Journal of Medicine.
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