The stereotype of the general neurologist is a neurologist in private practice who addresses everything that comes through the door. While there is some validity to the stereotype, as with most stereotypes, it is too simplistic. For a while, academic departments often represented a collection of subspecialty groups. However, many departments recognize that patients are referred without diagnoses and there was no mechanism to identify the appropriate group to see the patients. General neurology is being rapidly expanded in many academic departments. Often they manage disorders such as MS with the support of the subspecialty group. The private practice neurologist, while often not fellowship-trained, often has strong subspecialty interests. It is often stated that subspecialists still at heart remain generalists and wish to stay abreast of developments in other areas of neurology and at times, such as when they are ward attending, are confronted by a broad spectrum of neurologic disease.
The AAN has in the past few years made a concerted effort to remain relevant to the subspecialists including providing education and science that complements the annual meeting of the subspecialty with the expressed goal that there is no intent to compete with the alternative meetings. There is a view by subspecialists that the education and science at the Annual Meeting is for the generalist and there is an attempt to address the program with integrated neuroscience and specialties in focus educational efforts. Has this initiative resulted in a reduced usefulness for the generalist? Perhaps so. However, many generalists do want in-depth coverage of areas of interest such as MS, movement disorders, stroke, etc. Some subspecialists also want the ability to efficiently update knowledge in a variety of areas in neurology.
During his term as president, Dr. Robert Griggs appointed a task force to look at the needs of the general neurologist. That task force has completed its work and reported to the AAN Board in June. The recommendations will address many AAN activities.
One of the major goals of the AAN is education. Many local hospital "grand rounds," while providing CME credit, are irrelevant to neurologic practice. On the other hand, to attend a week-long AAN Annual Meeting is not realistic or efficient. One recommendation is that specific update tracks be identified at the Annual Meeting so that one can go for a few days and efficiently attend courses that provide wide review. Further, the Fall Conference should be designed specifically to provide effective updates of numerous subspecialties that not only include current evidenced-based patient care but also some of the new insights provided by science and potential new treatments.
It is worth specifically mentioning the Maintenance of Certification requirement. There is a lot of confusion surrounding this initiative of the ABPN. In fact, it is the ABMS that has directed the member boards to develop a Maintenance of Certification initiative that not only tests knowledge but also assesses professionalism, appropriate CME, and practice improvement activities. The AAN has developed a number of products to make this effort as painless as possible. The ABPN requirements are being refined and the AAN is trying to perfect its support of MOC activities.Another responsibility of the AAN is practice support through coding and billing advice, health information technology information, and guidance on changing regulations, among other efforts. Courses and articles are directed at this goal. However, for example, it is hard to find the material in a central location on the website. Another recommendation of the task force is to bring this material into a single area of the website. Additionally, the task force is advising the AAN to provide more meaningful career advice, including those wishing to pursue a career in general neurology and to provide information to those wishing to integrate research studies into their practice.
It is critical that the AAN get this effort right. General neurologists do not have another organization looking out for their interests on the national level. The role of the general neurologists is rapidly getting more difficult with the ever-evolving knowledge in different subspecialties such as the treatment for MS. With the changing economic environment, the economics of practice are much more challenging. The AAN can do a better job and the commitment to that goal must extend beyond just the task force report to integrating this goal into the day-to-day function of the AAN.