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

Structural issues for neurohospitalists

By Ira Chang

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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 ().,-MN.html2010
American Academy of Neurology2010
Amin ALikosky D.The role of hospitalists in the acute care of stroke patientsCurr Treat Options Cardiovasc Med201012240
AnonNew report highlights crisis with on-call panelsED Manag20051727
AnonOIG advisory opinion clarifies some call issuesED Manag200719128
Archambault D.Despite advantages, perks, fewer physicians work as employeesMich Med20041039
Aurbach ADAronson MDHow physicians perceive hospitalist services after implementation: anticipation vs realityArch Intern Med20031632330
Avitzur O.Neurohospitalists: a new term for a new breed of neurologistNeurol Today2005544
Baerlocher MONoble JDetsky AS.Impact of physician income source on productivityClin Invest Med20073042
Chang CWTorbey MTDiringer MNNeurointensivists: part of the problem or part of the solution?Crit Care Med2008361350
Collier VU.Use of pay for performance in a community hospital private hospitalist group: a preliminary reportTrans Am Clin Climatol Assoc2007118263
Cors WKRohr R.The ‘ist'explosion:driving forces, current trends and future directions for hospitalistsPhysician Exec20103610
Everett GUddin NComparison of hospital costs and length of stay for community internists, hospitalists, and academiciansJ Gen Intern Med200722662
Foa R.Reflections on the end of a practice: lessons learnedNeurol Today2010104
Freeman WDGronseth GEidelman BH.Invited article: is it time for neurohospitalists?Neurology2008701282
Gipe B.The cost and quality of hospitalists: a detailed analysis of creating and managing a hospitalist serviceMed Group Manag J19994640
Gregory DBaigelman WWilson IB.Hospital economics of the hospitalist. Health Serv Res2003Jun38905
Henry K2004AAN member demographic and practice characteristicsAAN Publications
Josephson SAEngstrom JWWachter RM.Neurohospitalists: an emerging model for inpatient neurological careAnn Neurol200863135
Khaliq AAGanti AKLetters to the EditorJ Gen Intern Med200520377
Kralovec PDMiller JAThe status of hospital medicine groups in the United StatesJ Hosp Med2006175
Levine JK.Compensation models and issues for a multispecialty group practiceJ Ambul Care Manag19961950
Likosky DJ.Is it time for neurohospitalists?Neurology200972859
Likosky DJShulman SRestrepo LFreeman WD.Survey of neurohospitalists: subspecialty definition and practice characteristicsFront Neurol201019
Lindenauer PKRothberg MBOutcomes of care by hospitalists, general internists, and family physiciansNew Engl J Med20073572589
McConnell KJJohnson LAArab NThe on-call crisis: a statewide assessment of the costs of providing on-call specialist coverageAnn Emerg Med200749727
McGinn TCentor R.Where should hospitalist programs be housed?J Gen Intern Med2008231288
McMahon Jr LF.The hospitalist movement – time to move onNew Engl J Med20073572627
McMahon LF JrThe hospitalist movement – time to move onNew Engl J Med20073572627
Mitchell DM.Editorial: the expanding or shrinking universe of the hospitalistJ Hosp Med20083288
Moulin TSablot DVidry EImpact of emergency room patients on patient management and outcomeEur Neurol200350207
Murin S.Hospitalists in the intensive care unit: an intensivist perspectiveHospitalist199935
Nelson JRWhitcomb WF.Organizing a hospitalist program: an overview of fundamental conceptsMed Clin N Am200286887
Peterson, MC.A systematic review of outcomes and quality measures in adult patients cared for by hospitalists vs nonhospitalistsMayo Clin Proc200984248
Pham HHDevers KJHealth care market trends and the evolution of hospitalist use and rolesJ Gen Intern Med200520101
Rogove H.The intensivist and the hospitalist: defining responsibilityHospitalist199934
Sehgal NLWachter RM.The expanding role of hospitalists in the United StatesSwiss Med Wkly2006136591
Shaw DV.Practice efficiency and physician compensation: a case studyJ Med Pract Manag200219138
Threlkeld RC.Opportunities and challenges in physician employment at a hospital or its affiliatesJ Med Assoc Ga20089733
Wachter RM.The hospitalist movement 10 years later: life as a swiss army knifeMed Gen Med2006830
Ward CReckewey KSilbaugh BFinancial benchmarks for hospitalist programsPhysician Exec20022843
Zakaria AProvencio JJLopez GA.Emerging subspecialties in neurology: neurocritical careNeurology2008701282