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Changing Landscape of Child Neurology Practice
Pediatric Neurology 52 (2015) e15
Contents lists available at ScienceDirect
Pediatric Neurology journal homepage: www.elsevier.com/locate/pnu
Letter to the Editor
Changing Landscape of Child Neurology Practice To the Editor:
I read with interest the article by Desai et al.1 I want to congratulate Pediatric Neurology and the authors to bring up this important issue. However, I want to raise two other points related to the rising interest in subspecialty training: disproportionate exposure to epilepsy during fellowship training and changes of referral pattern. Because epilepsy is the most common disorder seen in inpatient pediatric neurology practice, pediatric neurology residents, especially those who are not trained in larger academic centers, have disproportionate exposure to epilepsy and subsequent interest in this subspecialty. Most general pediatric neurologists read routine electroencephalography (EEG) studies, but additional training for 12 years in clinical neurophysiology allows trainees to interpret long-term video EEG in epilepsy monitoring and critical care units. The Future of Pediatric Education II survey showed that 82% of the pediatric neurologists had a special area of expertise within the field of child neurology with nearly two thirds (65%) in epilepsy and more than half (51%) in EEG.2 As the child neurology curriculum continues to evolve, more subspecialty focused training and less adult neurology time may be more justifiable, rather than taking time away from the stipulated 24 months of child neurology. Even with dedicated training in epilepsy, full competency may not be acquired during residency. Moreover, presently the exposure to subspecialty areas such as epilepsy does not count toward the training requirement of subspecialty boards. Another concern of many general child neurologists is that, because of a shortage of pediatricians and less time for primary care providers to deal with complicated patients, they are seeing many patients who could be cared for by pediatricians. A low threshold for referral and an
0887-8994/$ e see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pediatrneurol.2015.03.004
ever-increasing referral of complex patients to pediatric neurologists, is significantly higher compared with other pediatric or adult subspecialties.3 Subspecialty training may provide opportunity for the physician to practice more efficiently in a focused field. Other than in large academic centers, most pediatric epilepsy specialists still need to practice a certain amount of general child neurology. For example, in our pediatric hospital-based practice, three of 11 child neurologists have additional training in clinical neurophysiology and share similar inpatient responsibilities with the general child neurologists. Although a procedure-based relative value unit system may disproportionately benefit physicians engaged in procedural tasks, the net monetary gain for additional training is minimal and likely similar to the monetary gain achieved after most fellowships following general pediatrics training. It is my belief that the rising interest in focused training results from a desire to provide exceptional care to the children with neurological disease rather than from any reimbursement-related concern.
References 1. Desai J, Sadrieh K. Is the quintessential general child neurologist an endangered species? Pediatr Neurol. 2015 Mar;52:261-262. 2. The Future of Pediatric Education II: Pediatric Neurology. Available at: www.aap.org. Accessed February 26, 2015. 3. Child Neurology: Workforce and Practice Characteristics. Available at: www.upenn.edu/ldi/issuebrief10_6.pdf. Accessed February 26, 2015.
Debopam Samanta, MD Neurology Section, Department of Pediatrics University of Arkansas for Medical Sciences Little Rock, Arkansas E-mail address: [email protected]
Contents lists available at ScienceDirect
Pediatric Neurology journal homepage: www.elsevier.com/locate/pnu
Letter to the Editor
Changing Landscape of Child Neurology Practice To the Editor:
I read with interest the article by Desai et al.1 I want to congratulate Pediatric Neurology and the authors to bring up this important issue. However, I want to raise two other points related to the rising interest in subspecialty training: disproportionate exposure to epilepsy during fellowship training and changes of referral pattern. Because epilepsy is the most common disorder seen in inpatient pediatric neurology practice, pediatric neurology residents, especially those who are not trained in larger academic centers, have disproportionate exposure to epilepsy and subsequent interest in this subspecialty. Most general pediatric neurologists read routine electroencephalography (EEG) studies, but additional training for 12 years in clinical neurophysiology allows trainees to interpret long-term video EEG in epilepsy monitoring and critical care units. The Future of Pediatric Education II survey showed that 82% of the pediatric neurologists had a special area of expertise within the field of child neurology with nearly two thirds (65%) in epilepsy and more than half (51%) in EEG.2 As the child neurology curriculum continues to evolve, more subspecialty focused training and less adult neurology time may be more justifiable, rather than taking time away from the stipulated 24 months of child neurology. Even with dedicated training in epilepsy, full competency may not be acquired during residency. Moreover, presently the exposure to subspecialty areas such as epilepsy does not count toward the training requirement of subspecialty boards. Another concern of many general child neurologists is that, because of a shortage of pediatricians and less time for primary care providers to deal with complicated patients, they are seeing many patients who could be cared for by pediatricians. A low threshold for referral and an
0887-8994/$ e see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pediatrneurol.2015.03.004
ever-increasing referral of complex patients to pediatric neurologists, is significantly higher compared with other pediatric or adult subspecialties.3 Subspecialty training may provide opportunity for the physician to practice more efficiently in a focused field. Other than in large academic centers, most pediatric epilepsy specialists still need to practice a certain amount of general child neurology. For example, in our pediatric hospital-based practice, three of 11 child neurologists have additional training in clinical neurophysiology and share similar inpatient responsibilities with the general child neurologists. Although a procedure-based relative value unit system may disproportionately benefit physicians engaged in procedural tasks, the net monetary gain for additional training is minimal and likely similar to the monetary gain achieved after most fellowships following general pediatrics training. It is my belief that the rising interest in focused training results from a desire to provide exceptional care to the children with neurological disease rather than from any reimbursement-related concern.
References 1. Desai J, Sadrieh K. Is the quintessential general child neurologist an endangered species? Pediatr Neurol. 2015 Mar;52:261-262. 2. The Future of Pediatric Education II: Pediatric Neurology. Available at: www.aap.org. Accessed February 26, 2015. 3. Child Neurology: Workforce and Practice Characteristics. Available at: www.upenn.edu/ldi/issuebrief10_6.pdf. Accessed February 26, 2015.
Debopam Samanta, MD Neurology Section, Department of Pediatrics University of Arkansas for Medical Sciences Little Rock, Arkansas E-mail address: [email protected]