Profile The following information reflects responses from 53 neurologists who completed the 2003 Pathway Physician's Survey.

Transcription

1 NEUROLOGY Neurology is a board-certified specialty of internal medicine that offers an exciting and intellectual avenue for those interested in the brain, spinal cord, peripheral nerves, and muscles in both adults and children. Recent advances now allow the accurate diagnosis and treatment of many severely disabling disorders considered unapproachable 20 years ago. Neurologists treat patients who have a variety of disorders, including headaches, strokes, seizure disorders, multiple sclerosis, dystonia, muscular dystrophy, peripheral nerve disease, learning disorders, traumatic injuries to the nervous system, Parkinson s, Huntington s, and Alzheimer s disease. Some are also engaged in neurological rehabilitation. Many neurological problems are characterized by pain and can be chronic, debilitating, and difficult to treat. A large portion of the practice of neurology is consultative, but the neurologist may also be the primary physician. The specialty has close links with psychiatry, with which it maintains a combined certification board. Clinical neurophysiology is a subspecialty in the diagnosis and management of central and peripheral nervous system disorders using electrophysiological techniques.

2 Profile The following information reflects responses from 53 neurologists who completed the 2003 Pathway Physician's Survey. A. Respondents by types of areas Other 4.65% Small City 34.88% Large City 11.63% B. Respondents by gender Female 11.54% Metropolitan City 48.84% Male 88.46% C. Respondents by years in practice Number of Responses yrs 6-10 yrs yrs yrs yrs More than 30 yrs Perspectives A. Respondents' satisfaction with current specialty/area of work Number of Responses satisfied Somewhat satisfied Neither satisfied nor Somewhat

3 B. Would you choose this specialty again? Not Sure 9.62% No 5.77% Yes 84.62% C. Respondents by practice environment Number of Responses Academic instution Affiliated w/group Business/industry Hospital Community Acdemic med ctr Hospital other Managed care HMO IPA PPO Mgr care other Solo practitioner Practice other D. Respondents' satisfaction with practice environment Number of Responses satisfied Somewhat satisfied Neither statisfied nor Somewhat

4 and of Critical Factors Critical Factors represent significant aspects of physicians experiences in their practices. The rating represents their assessment of their current practice characteristics, while the weighting represents the importance of each factor to physicians. A. Caring for patients: How much time do you spend directly seeing and caring for patients? 7.8 σ = 1.95 No time at all Most of my time σ = B. Continuity of care: How much continuity of care do you have with patients, (i.e., the length of patient relationships)? σ = Short Term Long Term σ = C. Autonomy: To what extent do you have the final word on the treatment of your patients? σ = limited autonomy Great deal of autonomy σ =

5 D. Diversity: How much routine (similar work) or diversity (different tasks/activities) is involved in your work? σ = Great deal of routine Great deal of diversity σ = E. Personal time: Does your work allow you to control the scheduling and amount of time you spend on personal activities, (i.e., family, leisure)? σ = little flexibility A great deal of flexibility σ = F. Expertise: How broad is the scope of your work? σ = Narrow expertise Broad Expertise σ =

6 G. Income satisfaction: Compared to all physicians, do you feel you are fairly compensated for the amount of time and effort you spend? σ = Highly satisfied σ = H. Creativity: To what extent does your work provide opportunity for creativity? σ = Little opportunity Great deal of opportunity σ = I. Certainty of outcomes: How much certainty of clinical outcomes does your work provide? σ = little, often "wait and see" A great deal, outcomes usually clear σ =

7 J. Clinical decision-making: On what basis are your clinical decisions made? σ = Application of theory to a situation Based on prior evidence of clinical outcomes σ = K. Patient decision-making: To what extent do your patients have input into decisions about their health care? σ = Little opportunity Great deal of opportunity σ = L. Interacting with other physicians/members of health-care team: To what extent does your work provide opportunities for you to interact with other physicians/ members of a health-care team? σ = little A great deal σ =

8 M. Manual/mechanical activities: How often do you use manual/mechanical activities for highly skilled tasks (i.e., following procedures, performing operations)? σ = Never Most of the time σ = N. Pressure: How much pressure do you have in your work (i.e., dealing with clinical crises, need for immediate decisions about patients, dealing with multiple patients simultaneously). σ = Minimal pressure High pressure σ = O. Responsibility: How much responsibility do you assume for patient outcomes in your work? σ = Limited responsibility Sole responsibility σ =

9 P. Schedule: What type of schedule do you have in your work? σ = Regular hours Irregular and unpredictable hours σ = Q. Security: How much professional security do you have in your position, (i.e., know where you stand and are certain of your future professionally, will there be a need for your services in the future)? σ = Little security Great deal of security σ = R. Sense of accomplishment: To what extent does your work provide the opportunity to see end results? σ = Little opportunity Great deal of opportunity σ =

10 Weekly distribution of time According to the survey, neurologists spend their week as follows: Activity Patient care activities On-call(in contact) On-call(available) Administrative Professional travel Continuing education Community service Research Other professional Average Hours per week (may overlap) Patient profile A. Patient encounters per week Number of Patients Ambulatory Inpatient Nursing Home Telelphone Terminally Ill Other Encounters B. Patient characteristics By age Infants(0-2 yrs) Children(3-18 yrs) Adults(19-64 yrs) Older adults(65+ yrs) By race Underrepresented minority (URM) Non-URM % % By type of insurance % Medicaid/Medicare Uninsured Other Percentage of patient encounters that deal with: % Routine check-ups Acute illness Chronic illness Terminal illness 5.69 Percentage of time per patient encounter devoted to: Acute conditions Chronic conditions Preventitive health % C. Five types of illnesses/conditions most frequently encountered Number of responses Headache 47 Epilepsy/seizures 36 Stroke 35 Dementia 24 Parkinson's disease 20

11 Specialty: Neurology Total survey responses: 53 Summary of comments for question: List up to three other factors, if any, you would advise students to consider carefully before selecting your specialty? Physicians who completed the Pathway Physician s Survey, 2003, submitted the following comments. The majority of comments are categorized by the Critical Factors that are rated and weighted in another section. Numbers in parentheses indicate the total number of responses for a particular comment. 1. Caring for Patients Taking care of chronic patients Interaction with patients 2. Continuity of Care 3. Autonomy 4. Diversity 5. Personal Time Can control time (2) Family (2) Childcare Hobbies Balance your life, you are more than just a doctor 6. Expertise 7. Income Satisfaction Financial satisfaction (4) Is money very? Procedures performance (EEG, EMG, etc) apparently can be sources of substantial income 8. Creativity 9. Certainty of Outcomes 10. Clinical Decision Making Clinical diagnosis Problem solving Lots of opportunity to experiment with different medications 11. Patient Decision Making

12 12. Interacting with Other Physicians/Members of Health-care Team Quality of support services/specialties 13. Manual /Mechanical Activities 14. Pressure Still low pressure compared to some other specialties 15. Responsibility 16. Schedule Able to control schedule to a high degree 17. Security Job security (2) 18. Sense of Accomplishment 19. Patient Characteristics Age of patients Type of patients 20. Types of Illnesses Poor prognosis in many disorders Must like treating chronic diseases Chronic pain issues Genetic diseases 21. Practice Environment Relatively low overhead Practice in a group Academic or private Avoid non-owner positions Academic opportunity Insurance problems 22. Health Care Environment 23. Personality/Temperament Intellectual curiosity/intrigue (3) Desire to keep learning/advance knowledge (2) Interest in decision-making Somewhat compulsive Like physiology

13 Commitment of caring Able to deal with uncertain, untreatable, or bad outcomes 24. Miscellaneous Comments Rapidly changing specialty, be prepared to read/learn more about things that are new (5) Dependency for referrals Lack of treatment in certain areas Interest in/enjoy neurological health and diseases (3) A lot of emergency referrals from other physicians Freedom to practice as you wish Diagnosis Spouse interaction Tradition is big Academic vs. patient care New research Some neurological disorders are still in the early process of therapeutic development Expectations Choose the field that interests you Satisfaction Erosion of the specialty by other specialties Need for extensive continuing education This specialty is in short supply, therefore considerable flexibility in location, hours, etc. (2) Can be very complex and interesting Challenge Become the best, referrals will come New drugs Independent Rapid advances in basic science and treatment in the field (2) Share call broadly Time Can you get good training Interview skills Medication Fascination Future developments Location of practice (3)