Chapter 17 - Structural issues for neurohospitalists  pp. 213-223

Structural issues for neurohospitalists

By Ira Chang

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Introduction

Since the term was introduced in 1996 by Bob Wachter and Lee Goldman in The New England Journal of Medicine, the hospitalist field has become the fastest growing specialty in medicine. The definition of hospitalist has also broadened to include “any physician whose primary professional focus is the care of hospitalized patients”. More recently as a result of pressures similar to those felt by primary care providers, hospitalist subspecialist models have emerged [,]. Factors contributing to increased demand for inpatient neurology expertise are:

  • the increasing age and longevity of the patient population resulting in a rise in acute stroke and dementia care with more complex medical co-morbidities;
  • inadequate neurology exposure and experience in internal medicine training programs that results in medical hospitalists requesting neurological consultations more frequently;
  • the increasing importance of timely neurological evaluation and decision-making.

Evidence of growth analogous to that of internal medicine hospitalists is occurring in the neurohospitalist field. The Neurohospitalist Section, since its formation in 2009, has been the fastest growing section of the American Academy of Neurology (AAN) and an increasing number of neurohospitalist positions are being filled nationally. As neurohospitalist models emerge to provide timely inpatient neurological care and relieve the stress of acute neurological evaluation on an outpatient practice, many structural and organizational issues need to be considered. A neurohospitalist program will experience the organizational difficulties felt by internal medicine hospitalists in addition to those specific to a neurohospitalist practice ().

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