Academic Neurology Departments Research Articles

An Approach to Successful Development of Clinician-Scientists in Neurology: The NINDS R25 Experience.

Training clinician-scientists is a primary objective of many academic neurology departments, as these individuals are uniquely positioned to perform insightful clinical or laboratory-based research informed both by clinical knowledge and their own experiences caring for patients. Despite its importance, training clinician-scientists has perhaps never been so challenging. The National Institute of Neurologic Disorders and Stroke (NINDS) R25 program was designed in an attempt to support these individuals, decrease the time needed to obtain National Institutes of Health K awards, and to help educate a cohort of trainees preparing for a career in academic neurology. We endeavored to describe the structure and features of the program while examining its outcomes. R25 outcome data from 2009 to 2024 were reviewed. Statistical comparisons were made using 2-sided Mann-Whitney U testing. A total of 67% of adult neurologists who received an R25 had a successful application for a National Institutes of Health K award compared with 45% of adult neurologists who had not received R25 support (p < 0.0001). Among child neurologists, 73% who applied went on to receive K funding after R25 support, compared with 45% who had not been part of the R25 program (p < 0.001). The average time between completion of residency and obtaining a K award for R25 participants was decreased by 26 months among those with an MD/PhD degree, and 32 months for those with an MD degree compared with non-R25 individuals. The R25 program has been successful in achieving its training goals, but stands as only one component of support for aspiring clinician-scientists. Investments and commitments made by academic neurology departments are key to supporting this success. ANN NEUROL 2024.

Cerebrospinal fluid biomarkers for cerebral amyloid angiopathy.

Integrating cerebrospinal fluid-biomarkers into diagnostic workup of patients with sporadic cerebral amyloid angiopathy may support early and correct identification. We aimed to identify and validate clinical- and cerebrospinal fluid-biomarkers for in vivo diagnosis of cerebral amyloid angiopathy. This observational cohort study screened 2795 consecutive patients admitted for cognitive complaints to the academic departments of neurology and psychiatry over a 10-year period (2009-2018). We included 372 patients with available hemosiderin-sensitive MR imaging and cerebrospinal fluid-based neurochemical dementia diagnostics, i.e. Aβ40, Aβ42, t-tau, p-tau. We investigated the association of clinical- and cerebrospinal fluid-biomarkers with the MRI-based diagnosis of cerebral amyloid angiopathy, applying confounder-adjusted modelling, receiver operating characteristic and unsupervised cluster analyses. We identified 67 patients with cerebral amyloid angiopathy, 76 patients with Alzheimer's disease, 75 patients with mild cognitive impairment due to Alzheimer's disease, 76 patients with mild cognitive impairment with unlikely Alzheimer's disease and 78 healthy controls. Patients with cerebral amyloid angiopathy showed a specific cerebrospinal fluid pattern: average concentration of Aß40 [13 792 pg/ml (10 081-18 063)] was decreased compared to all controls (P < 0.05); Aß42 [634 pg/ml (492-834)] was comparable to Alzheimer's disease and mild cognitive impairment due to Alzheimer's disease (P = 0.10, P = 0.93) but decreased compared to mild cognitive impairment and healthy controls (both P < 0.001); p-tau [67.3 pg/ml (42.9-91.9)] and t-tau [468 pg/ml (275-698)] were decreased compared to Alzheimer's disease (P < 0.001, P = 0.001) and mild cognitive impairment due to Alzheimer's disease (P = 0.001, P = 0.07), but elevated compared to mild cognitive impairment and healthy controls (both P < 0.001). Multivariate modelling validated independent clinical association of cerebral amyloid angiopathy with older age [odds-ratio: 1.06, 95% confidence interval (1.02-1.10), P < 0.01], prior lobar intracerebral haemorrhage [14.00 (2.64-74.19), P < 0.01], prior ischaemic stroke [3.36 (1.58-7.11), P < 0.01], transient focal neurologic episodes (TFNEs) [4.19 (1.06-16.64), P = 0.04] and gait disturbance [2.82 (1.11-7.15), P = 0.03]. For cerebrospinal fluid-biomarkers per 1 pg/ml, both lower Aß40 [0.9999 (0.9998-1.0000), P < 0.01] and lower Aß42 levels [0.9989 (0.9980-0.9998), P = 0.01] provided an independent association with cerebral amyloid angiopathy controlled for all aforementioned clinical confounders. Both amyloid biomarkers showed good discrimination for diagnosis of cerebral amyloid angiopathy among adjusted receiver operating characteristic analyses (area under the receiver operating characteristic curves, Aß40: 0.80 (0.73-0.86), P < 0.001; Aß42: 0.81 (0.75-0.88), P < 0.001). Unsupervised Euclidian clustering of all cerebrospinal fluid-biomarker-profiles resulted in distinct segregation of cerebral amyloid angiopathy patients from all controls. Together, we demonstrate that a distinctive set of cerebrospinal fluid-biomarkers effectively differentiate cerebral amyloid angiopathy patients from patients with Alzheimer's disease, mild cognitive impairment with or without underlying Alzheimer's disease, and healthy controls. Integrating our findings into a multiparametric approach may facilitate diagnosing cerebral amyloid angiopathy, and may aid clinical decision-making, but warrants future prospective validation.

Academic Vascular Neurology - Lingering Effect of Gender Inequity on Compensation, Career and Burnout (P5-2.005)

<h3>Objective:</h3> NA <h3>Background:</h3> Despite rising numbers of women physicians, gender inequity in salary, promotion and leadership roles persist, resulting in disempowerment and limited career advancement. Little is known about disparity characteristics among academic vascular neurology (AVN) faculty. This study explores the disparity among AVN faculty in compensation, career development and burnout. <h3>Design/Methods:</h3> Nineteen academic neurology departments in the US were sent a standardized survey in 2021–2022 on demographics, career, compensation, equity, domestic circumstances, parental leave, and burnout as part of the Women in Neurology Collaborative Study. This study analyzed AVN faculty and used descriptive characteristics to identify disparities. <h3>Results:</h3> A total of 47 AVN faculty (29 women) responded. Most respondents were Caucasian (68%, n=32) and associate professors (44%, n=21). 51% (n=24) were satisfied with their current compensation, with 54% (n=13) being men. The majority of respondents dissatisfied with compensation were women (75%, n=15). The most common reason for dissatisfaction was compensation being below national benchmark or compared to colleagues. 60% of AVN faculty, majority of whom were females, perceived lack of gender equity in pay. 23% of respondents reported that implicit gender bias negatively affected career development. Moderate to severe burnout was reported by 26% (n=12) respondents, with 75% (n=9) being females. Those who reported burnout have been AVN faculty for 5.9±3.3 years, of which half were dissatisfied with compensation and gender bias, while 67% indicated absence of career sponsorship and 42% had no mentorship. <h3>Conclusions:</h3> In summary, majority of female vascular neurologists in early-career stage reported gender bias affecting compensation, career dissatisfaction, lack of mentorship or sponsorship and burnout. This offers preliminary information for AVN programs to determine areas of improvement in faculty pipeline development, recruitment, and retention to align with diversity, equity and inclusion efforts of academic institutions, national and international stroke organizations. Future studies should analyze how interventions can improve these disparities. <b>Disclosure:</b> Ms. He has nothing to disclose. Dr. Nobleza has nothing to disclose. Ms. Zheng has nothing to disclose. The institution of Dr. Patel has received research support from Ucb. Dr. Alick-Lindstrom has nothing to disclose. The institution of Dr. Ayub has received research support from Brown Physicians Incorporated. Dr. Grewal has nothing to disclose.

Abstract WP93: Academic Vascular Neurology - Lingering Effect Of Gender Inequity On Compensation, Career And Burnout

Introduction: Despite rising numbers of women physicians in medical schools and the workforce, gender inequity persist. This cumulates in disempowerment, burnout, limited career advancement and devaluation of women. The aim of this study was to explore the disparity among academic vascular neurologists in terms of compensation, career development and burn-out. Methods: A total of 19 academic neurology departments in the United States were sent a survey in 2021-2022 on demographics, career, compensation, equity, and burnout. There were 425 academic neurology faculty members who responded. This study analyzed the cohort of academic vascular neurology (AVN) faculty. Results: A total 47 AVN faculty were included, of which 62% (29) were women. Majority of the respondents were Caucasian (68%, n=32) and were instructors or assistant professors (55%, n=26). Among the AVN faculty, only 51% (n=24) were satisfied with their current compensation. Majority of those who were satisfied were men (54%, n=13). Majority of those who were dissatisfied were women (75%, n=15). The most common reason for dissatisfaction was compensation being below national benchmark or compared to colleagues. 59.5% of AVN faculty members, majority of whom are females, perceived lack of gender equity in pay. Implicit gender bias was reported to have a negative effect on career development by 23% of AVN faculty. Moderate to severe burn out was reported by 26% (n=12) AVN faculty, among which majority (75%, n=9) were females. Those who reported burnout have been AVN faculty for 5.9±3.3 years. Half of those who reported burn out was dissatisfied with compensation and have felt that gender bias affected their careers, while 67% indicated absence of career sponsorship and 42% had no mentorship. Conclusions: This study described specific disparities in compensation, burn-out and career development among academic vascular neurology faculty. This information offers preliminary information for academic vascular neurology programs to explore areas of improvement when it comes to AVN faculty pipeline development, recruitment and retention as it aligns with DEI efforts. Future studies should be done to explore how interventions can improve the disparities noted.

Neurology Morbidity and Mortality Conferences and Quality Improvement: Single-Center Experience and National Survey.

Morbidity and Mortality (M&M) conferences are widespread but vary in goals and methodology. Some focus on clinical enigmas while an increasing number utilize quality improvement (QI) tools to effect systems change. Little is known about the current state of US Neurology M&Ms. We surveyed 56 US academic neurology departments regarding their M&Ms to understand the use of QI tools and assess variability. Additionally, we reviewed the evolution of M&Ms in our department. The survey was completed by 44 (80%) departments; 68% reported quarterly frequency with 61% discussing 1-2 safety events per conference. The number of written guidelines or protocols resulting from M&Ms in 2years varied from 0 (14% of departments), 1-2 (45%), to >5 (5%). Institutional culture regarding quality and safety and conference timing were cited by 71% as important in improving participation. In our own department, the M&M format changed in 2014 based on a sentinel patient event combined with improving safety culture across the hospital: neurology M&Ms transformed into thematic quarterly conferences utilizing QI tools. Attendance increased 3-fold, and in 7years, we have generated 26 guidelines or pathways with corresponding decision-support tools, among other improvement efforts, resulting in specific systems changes. Based on survey results and our experience, suggested M&M "best practices" include the use of just culture, peer review protection, safety event analysis with QI methodology, trainee involvement, and logistical optimization. Structured M&Ms incorporating suggested QI-informed "best practices" can be highly effective in driving system change within neurology.

Grand rounds education in neurology, with a focus on headache medicine.

To quantify the proportion of headache-related grand rounds in academic neurology programs and to compare this with adult neurology residency director views on the need for an increase in headache-related grand rounds. Although headache are among the most prevalent and most burdensome neurologic conditions, headache medicine is often considered underrepresented in neurology departments. Additionally, prior studies have shown that many neurology residency directors feel that training programs do not include an adequate amount of exposure to headache clinics or headache-related didactics. One important aspect of didactic education in neurology departments is adult neurology grand rounds. Previous publications have evaluated neither the proportion of headache-related grand rounds in academic neurology departments nor the residency program directors' views on appropriate amount of headache-related grand rounds. Our study has attempted to quantify this information to elucidate opportunities to improve practice educational gaps. In this cross-sectional study, we surveyed adult neurology residency directors (from the Accreditation Council for Graduate Medical Education [ACGME] listing of academic adult neurology residency programs) between October 2018 and September 2019. In addition, we used two methods to obtain the proportion of headache-related grand rounds in neurology: (1) emailing residency directors a questionnaire asking for a list of prior grand rounds topics and (2) an online search for each academic neurology program. First, for our grand rounds analysis, headache medicine consisted of 3.7% of the lectures in 2017-2018 and 6.3% of the lectures in 2018-2019 (average of each institution; 17 institutions and 411 total lectures in 2017-2018, 21 institutions and 463 total lectures in 2018-2019). The most common number of lectures on headache medicine for each grand rounds series was zero (for 7 of 17 grand rounds series in 2017-2018 and 7 of 21 in 2018-2019), followed closely by one lecture (for 6 of 17 grand rounds series in 2017-2018 and 6 of 21 in 2018-2019). Second, for our survey, the response rate was 19.3% (29/150). No residency director thought their institution had too many grand rounds dedicated to headache medicine, and 62.1% (18/29) thought they had an adequate amount of headache grand rounds. Within the survey responders, 75.9% (22/29) of adult neurology residency programs have a board-certified headache specialist at their institution. Although most adult neurology residency directors believe that headache is adequately represented in adult neurology grand rounds, headache medicine makes up 4%-6% of all neurology grand rounds. Compared with other neurology subspecialties and the other core ACGME milestones, headache makes up the fewest grand rounds lectures that were assessed in this study.

Academic Neurology Departments: Structure, Diversity, and Financial Pressures in 2019 vs 2002.

This article provides an overview and update on the current status of academic neurology based on structured insights from departmental leaders across the United States. Academic neurology, at a time when and leaders in academic medicine in general, are facing protean administrative, structural, and financial challenges that threaten all academic missions.1,2 In 2002, the Association of University Professors of Neurology (AUPN) and American Neurologic Association (ANA) jointly surveyed US neurology department chairs on the health of US academic neurology.1 The results showed troublesome findings related to adverse financial pressures on education, research, faculty development, and growth of new programs. In 2016, the AUPN surveyed neurology department chairs to better understand the organization and operations of neurology departments under contemporary health care reform. Results highlight that most neurology departments had fewer than 60 faculty members, a minority of whom were tenured or on a tenure track. Over a third had faculty members on a purely clinical track, with no education or research responsibilities.2 In early 2019, the AUPN partnered with the American Academy of Neurology (AAN) to resurvey academic neurology chairs using most of the 2002 AAN/AUPN survey questions. Survey responses from 2019 were compared with the earlier findings.

Developing the Neurology Diversity Officer: A Roadmap for Academic Neurology Departments.

Academic neurology departments must confront the challenges of developing a diverse workforce, reducing inequity and discrimination within academia, and providing neurologic care for an increasingly diverse society. A neurology diversity officer should have a specific role and associated title within a neurology department as well as a mandate to focus their efforts on issues of equity, diversity, and inclusion that affect staff, trainees, and faculty. This role is expansive and works across departmental missions, but it has many challenges related to structural intolerance and cultural gaps. In this review, we describe the many challenges that diversity officers face and how they might confront them. We delineate the role and duties of the neurology diversity officer and provide a guide to departmental leaders on how to assess qualifications and evaluate progress. Finally, we describe the elements necessary for success. A neurology diversity officer should have the financial, administrative, and emotional support of leadership in order for them to carry out their mission and to truly have a positive influence.

Funds flow in academic neurology

Funds flow arrangements define the financial relationships between departments, medical centers, and university entities within a coordinated academic health system. Although these funds flow frameworks differ, common themes emerge including those that are unique in their influence on academic departments of neurology. Here, we review various funds flow models and their application. Four typical models are described, highlighting the advantages and disadvantages of each for neurology, keeping in mind that most academic health systems use a hybrid model. Several considerations are important when neurology departmental leadership participates in crafting or revising of these funds flow agreements, including choice of benchmarking targets, planning and funding for future growth, demonstrating value, and supporting nonclinical missions including education and research. The American Academy of Neurology Academic Initiative aims to continue to help academic departments nationally understand these issues and define funds flow arrangements that incorporate the unique characteristics of our specialty and allow us to provide outstanding care for patients while supporting the broad missions of neurology departments.

Are researchers moving away from animal models as a result of poor clinical translation in the field of stroke? An analysis of opinion papers

ObjectivesDespite decades of research using animals to develop pharmaceutical treatments for patients who had a stroke, few therapeutic options exist. The vast majority of interventions successful in preclinical animal studies...

Francis Forster, the last Horseman: A career in academic neurology

ABSTRACTAmerican neurologist and epileptologist Francis M. Forster (1912–2006) was the last survivor of the “Four Horsemen,” a nickname given to the four neurologists—Forster, Abe Baker, Russell DeJong, and Adolph Sahs—who were most instrumental in founding the American Academy of Neurology under Baker’s leadership in 1948. Forster was a consulting physician for many high-profile patients, including President Dwight Eisenhower, President Quirino and Archbishop Reyes of the Philippines, Provisional President Lonardi of Argentina, and Cardinal Albert Meyer of Chicago. Forster was also an expert witness for the prosecution in the trial of Jack Ruby, who killed Lee Harvey Oswald. Forster’s greatest legacy, though, was as a teacher: During his career as chairman of two robust academic neurology departments, he trained more than 100 residents, at least 17 of whom went on to become chairmen of neurology departments in the United States, Europe, Asia, and South America.

Editors' note: The state of academic neurology departments in the United States, 2016: A national survey

In the special editorial “The state of academic neurology departments in the United States, 2016: A national survey,” author Gooch highlighted how most neurology faculty members are not on a tenure track and that almost 40% of academic neurology departments have purely clinical faculty with no educational or research responsibilities. Dr. Meador adds data from other surveys indicating that time spent by academic neurologists on research and education has sharply declined over the last 30 years and questions whether this new balance is appropriate. Author Gooch responds that cuts to research funding and clinical reimbursement will likely make the situation worse and that academic leaders and faculty should engage at the institutional and national levels in order to have input into what the future of academic neurology looks like. In “Sleep architecture and the risk of incident dementia in the community,” the authors found an association between dementia risk and lower percentage of REM sleep. They hypothesized that changes in REM sleep may be protective against cognitive decline.

Reader response: The state of academic neurology departments in the United States, 2016: A national survey.

Dr. Gooch's review of a 2016 national survey of neurology department chairs revealed that most neurology faculty members are not on tenure track, and 38% of neurology departments have some clinical service faculty with no assigned educational or research duties.1 Further, a separate 2016 survey of US neurologists, conducted by the American Academy of Neurology, showed that the overall effort by academic neurologists toward education and research has markedly dropped, with an average of 16.4% of their time on research and 11.3% on teaching; the medians for both research and education are 10%.2 In contrast, academic physicians spent 58% of their time on educational and research activities in 1984 compared to 27.7% in 2016.3

Author response: The state of academic neurology departments in the United States, 2016: A national survey.

Dr. Meador highlights a growing national problem, which the data in my editorial1 only briefly touched upon: How can the academic missions of teaching and research be adequately met when the clinical workload of our evolving system has grown to monopolize the vast majority of faculty effort? Dedicated academic funding to support student and resident education is used in some institutions, but is often insufficient to cover faculty effort. Research has become ever more dependent on large and uninterrupted grant support for individual researchers, with NIH funding (and its attached larger indirect cost support funds) becoming the mark of success and often the absolute requirement for career survival at many institutions. The health care revolution radically cut clinical reimbursement (a former source of support to all academic missions); in the future, medical education will likely be radically altered to reduce cost and the research enterprise will likely become even more of an “eat-what-you-kill” endeavor. Academic leaders and faculty should start to deeply engage with their own institutions, government, and national organizations to make their voices heard and to secure a seat at the table to help guide how this new order is structured.

Collaborative Comanagement Between Neurohospitalists and Internal Medicine Hospitalists Decreases Provider Costs and Enhances Satisfaction With Neurology Care at an Academic Medical Center.

The majority of academic medical centers are moving to a neurohospitalist model of care for hospital neurology coverage. Potential benefits over a more traditional academic model of patient care include greater expertise in acute neurologic disease, increased efficiency, and improved availability to patients, providers, and learners. Despite these perceived advantages, switching to a neurohospitalist model can come at substantial financial cost, so finding ways to maximize the positive impact of a limited number of neurohospitalists is very important to the future health of academic neurology departments. Over the past 7 years, we have implemented a model for inpatient neurological care based on an intimate collaborative relationship between the neurology and hospital medicine services at our main academic hospital. Our goal was to optimize the value of care by decreasing cost while improving quality. Cost and revenue associated with professional services was evaluated on a yearly basis. As part of ongoing quality improvement efforts, yearly surveys were administered to referring providers during the transition to a collaborative care model in which NHs and medicine hospitalists comanage neurology inpatients. Net operating loss was dramatically decreased upon transition to the new care model. Concomitantly, there was a robust positive impact on perception of overall quality, timeliness, and communication skills of neurology services. Collaborative comanagement is an effective strategy to improve overall satisfaction with neurology services at a tertiary academic medical center while maintaining financial viability.

Developing a Stroke Center.

See related article, p 1715 Stroke neurologists are in high demand as increasing numbers of hospitals develop new or expand existing stroke programs. A growing number of recent neurology graduates are hired as neurohospitalists by hospital networks, with the goal of improving stroke care.1 Although stroke subspecialty training is not required to be a stroke director, it is highly valued; in a survey of academic neurology departments, 73% of respondents ranked clinical expertise in stroke as the most important requirement for a neurohospitalist.2 Charged with leading a stroke program, these early career physicians are expected not only to provide clinical stroke care but also to assume major administrative responsibilities. These may include guiding a community hospital (with or without an academic affiliation) to Primary Stroke Center status, expanding a larger hospital’s program to become Comprehensive Stroke Center certified, or simply maintaining the stringent quality measures required by the Joint Commission and other regulatory bodies.3 Stroke fellows typically train in large academic centers with established stroke programs, and recent graduates may encounter significant challenges when transitioning to a leadership role in a less developed program. Faced with a new set of colleagues, new systems of care, and often a new geographical location, newly minted stroke neurologists may initially feel overwhelmed. We outline 7 strategies that may prove …

Survey of the Professors of Child Neurology: Neurology Versus Pediatrics Home for Child Neurology

BackgroundThe optimal academic home for child neurology programs between adult neurology versus pediatric departments remains an open question. The Professors of Child Neurology, the national organization of child neurology department chairs, division chiefs, and training program directors, was surveyed to evaluate the placement of child neurology programs. MethodsProfessors of Child Neurology members were surveyed regarding the placement of child neurology programs within adult neurology versus pediatric departments. Questions explored academic versus clinical lines of reporting and factors that may be advantages and disadvantages of these affiliations. Issues also addressed were the current status of board certification and number of clinics expected in academic child neurology departments. ResultsOf 120 surveys sent, 95 responses were received (79% response rate). The primary academic affiliation is in neurology in 54% of programs versus 46% in pediatrics, and the primary clinical affiliation is 45% neurology and 55% pediatrics. Advantages versus disadvantages of one's primary affiliation were similar whether the primary affiliation was in neurology or pediatrics. While 61% of respondents are presently board certified in pediatrics, only 2% of those with time-limited certification in general pediatrics plan to be recertified going forward. Typically six to eight half-day clinics per week are anticipated for child neurologists in academic departments without additional funding sources. ConclusionsOverall, leaders of child neurology departments and training programs would not change their affiliation if given the opportunity. Advantages and disadvantages associated with current affiliations did not change whether child neurology was located in neurology or pediatrics. Board certification by the American Board of Psychiatry and Neurology in child neurology is virtually universal, whereas pediatric board certification by the American Board of Pediatrics is being maintained by very few. Most academic child neurology programs expect 3-4 days of full-time clinics by full-time faculty.

Defining the role of the academic neurohospitalist in residency education.

We sought to better understand the potential impact of the burgeoning neurohospitalist model of inpatient care on education of neurology residents and to better define possible roles for "neurohospitalists" in residency education. We designed a brief qualitative open-ended survey directed toward academic leaders in neurology and distributed it by e-mail to every academic neurology department in the United States and Canada. Of 83 respondents, 36 (43%) had an active neurohospitalist program and only 10% felt certain they would not have 1 within the next 5 years. All respondents expected to have residents continue to be involved with inpatient care. The main perceived advantage for resident education associated with neurohospitalists was inpatient care expertise, and the main expected disadvantage was decreased exposure to subspecialty attendings. The majority anticipated positive impact on all Accreditation Council for Graduate Medical Education core competencies predominantly based on neurohospitalists' expertise in the inpatient setting. The majority of academic neurology departments are expected to have a neurohospitalist program within the next 5 years. There are several perceived advantages and disadvantages to such a program for education of neurology residents. In general, the impact of these programs is expected to improve resident education. Regardless of expectations, neurohospitalists will likely play a prominent role in the education of the next generation of neurologists.

Neurohospitalists: perceived need and training requirements in academic neurology.

We sought to determine the current practices and plans for departmental hiring of neurohospitalists at academic medical centers and to identify the core features of a neurohospitalist training program. We surveyed department chairs or residency program directors at 123 Accreditation Council for Graduate Medical Education (ACGME)-accredited US adult neurology training programs. Sixty-three(51% response rate) responded, 76% of whom were program directors. In all, 24 (38%) academic neurology departments reported employing neurohospitalists, and an additional 10 departments have plans to hire neurohospitalists in the next year. In all, 4 academic neurology departments have created a neurohospitalist training program, and 10 have plans to create a training program within the next 2 years. Hospitals were the most frequent source of funding for established and planned programs (93% of those reporting). Most (n = 39; 65%) respondents felt that neurohospitalist neurology should be an ACGME-accredited fellowship. The highest priority neurohospitalist training elements among respondents included stroke, epilepsy, and consult neurology as well as patient safety and cost-effective inpatient care. The most important procedural skills for a neurohospitalist, as identified by respondents, include performance of brain death evaluations, lumbar punctures, and electroencephalogram interpretation. Neurohospitalists have emerged as subspecialists within neurology, growing both in number and in scope of responsibilities in practice. Neurohospitalists are in demand among academic departments, with many departments developing their existing presence or establishing a new presence in the field. A neurohospitalist training program may encompass training in stroke, epilepsy, and consult neurology with additional focus on patient safety and cost-effective care.

Getting to value in neurological care: A roadmap for academic neurology

Academic neurology is undergoing transformational changes. The public investment in biomedical research and clinical care is enormous and there is a growing perception that the return on this huge investment is insufficient. Hospitals, departments, and individual neurologists should expect more scrutiny as information about their quality of care and financial relationships with industry are increasingly reported to the public. There are unprecedented changes occurring in the financing and delivery of health care and research that will have profound impact on the mission and operation of academic departments of neurology. With the passage of the Patient Protection and Affordable Care Act (PPACA) there will be increasing emphasis on research that demonstrates value and includes the patient's perspective. Here we review neurological investigations of our clinical and research enterprises that focus on quality of care and comparative effectiveness, including cost-effectiveness. By highlighting progress made and the challenges that lie ahead, we hope to create a clinical, educational, and research roadmap for academic departments of neurology to thrive in today's increasingly regulated environment.