I strongly agree with "15. Neurology organizations
are dominated by academic neurologists who don't seem
to be too worried about the concerns of private
practice." I believe that the AAN has let all of us
down when it comes to preservation of procedural
revenue in a time when the Radiology lobby has done an
excellent job in obtaining protection for their
interpretation of imaging.


--- Robert E McMichael <mcmichael@prodigy.net> wrote:
> Message From: Robert E McMichael MD JD
> <mcmichael@prodigy.net>
>
> Is neurology a dying profession? I ask this
> question for a number of reasons that seem to bode
> ill for American neurology. I will compare us to a
> similar specialty (Cardiology) that seems to be more
> popular and doing better.
>
> 1. Neurology is an increasingly unpopular
> specialty. Last I read in JAMA, more than 60% of
> neurology residency positions were being filled by
> foreign medical graduates, a sign that neurology is
> less popular with American medical students than in
> the past.
> 2. I have been told by some faculty that the pool
> of applicants seems go have gone down in quality.
> 3. Medicare payment for patient care (E&M services)
> has not kept pace with the consumer price index. In
> 2001 it went down 2.1%.
> 4. From 2002-2005 Medicare is cutting all fees by a
> total of 20%.
> 5. Private insurance fee schedules are tied to
> Medicare.
> 6. We have lost cerebral angiography to radiology.
> Cardiology kept coronary angiography.
> 7. We have lost carotid ultrasound and
> transcranial doppler to radiology (except to a
> limited extent in our offices). Cardiology kept
> echocardiography.
> 8. We have lost MRI and CT to radiology.
> Cardiology kept cardiac imaging as part of the
> nuclear stress test.
> 9. We have seen fees for evoked potentials fall
> below cost.
> 10. We are too geriatrically oriented. This
> results in patients who are more time-consuming but
> who pay less.
> 11. We are losing EMG. We have always competed
> less successfully than physical medicine for the
> orthopedic, neurosurgery, and primary care EMG
> referrals. I think these referral patterns go back
> to poor customer service by neurology EMG labs in
> training programs. Neurology faculty are too
> preoccupied with research and their own speciality
> interests. PM&R gives better service. Now, we have
> independent physical therapy EMG practitioners and
> chiropractic neurologists doing EMG. In Texas, this
> is promoted by their licensing boards. The TMA and
> the Texas State Board of Medical Examiners have done
> nothing.
> 12. We are losing sleep medicine and
> polysomnography to pulmonary. I do not object to
> pulmonologists practicing sleep medicine, but sleep
> disorders are inherently neurologic conditions. We
> should be operating sleep labs and treating the
> patients. These are less geriatric oriented and
> less vulnerable the gutting of Medicare Part B that
> is going on now. Even for Medicare, interpretation
> of a polysomnogram is paid nearly double what a new
> patient visit is paid.
> 13. We are being slowly pushed into seeing only
> those labor-intensive, time-consuming patients for
> whom we provide no procedures. We get lots of
> telephone calls, requests for prescription refills,
> and problems that other doctors refuse to treat
> because they are so unrewarding to treat.
> 14. Pediatric neurologists are covered with
> Medicaid patients and Medicaid is a terrible payor
> in most states.
> 15. Neurology organizations are dominated by
> academic neurologists who don't seem to be too
> worried about the concerns of private practice.
>
> Is this real, or do I just need to "get a grip?"
>
> Bob
>
> Robert E. McMichael, M.D., J.D.
> Neurology Associates of Arlington, P.A.
> 1001 North Waldrop Drive, Suite 816
> Arlington, TX 76012
> 817-795-5566
> Fax 817-261-7315