As we enter the second year of the COVID-19 pandemic, hospitals face increasing demand for neurology care against a backdrop of high costs and provider shortages. However, the experiences of the past year have opened minds to a broader role for virtual neurology care. In this article, we share some of the challenges facing acute neurology as well as new directions and opportunities open to providers.
Lasting Impacts of the Pandemic on Neurohospitalist Care
As the pandemic slowly winds down, the need for neurology services is more urgent than ever. Besides their usual load of neurological emergencies, neurologists are treating an epidemic of COVID-19-related strokes in relatively young people. This leads to a strain in neurology services at many EDs and hospitals, as care teams struggle without the appropriate level of neurology coverage given the increasing demand and constant need for specialist services. This is especially true for practice locations in more rural communities.
Neurohospitalists have been the “boots on the ground” rounding with colleagues on inpatient floors, ICUs, and in the emergency department. But even before the pandemic, we piloted and launched an innovative model – the first of its kind – in which neurologists round virtually with onsite advanced providers or other hospital staff. The goal was to make high quality specialty care available to hospitals without the traditional volume to sustain such a practice. During the pandemic, we were able to expand this model to virtual consults even when neurologists were located within the hospital.
We expect to see virtual neurohospitalist practices like this open more hospitals to high quality neurological care – and allow individual neurologists to care for more patients across a wider geographic area. The pandemic has driven home the idea that virtual care can successfully augment in-person services and permit neurologists to examine patients, make clear recommendations, support in-person providers, and be integral parts of care teams—even while being 100% remote.
“The pandemic has driven home the idea that neurologists don’t need to be physically present to examine patients, make clear recommendations, support in-person providers, and be integral parts of care teams.”
Yafa Minazad, DO
Vice President of Acute Neurology Operations
Telestroke as a Gold Standard
Today, with a pandemic swirling around us, it’s hard to believe that teleneurology services were once a hard sell to hospitals. A few years ago, when we would pitch telestroke services to hospital leaders, they would resist. Many believed virtual care was only for “second-rate” or extremely isolated hospitals.
Fortunately, we were able to win many executives over by appealing to logic. Yes, each of the 6,000 hospitals in the U.S. would love to be covered full time by a vascular neurologist (also known as a stroke doctor). However, with only 1,478 vascular neurologists practicing in the country, that’s mathematically impossible. The best way to promote equitable access is for vascular neurologists to cover multiple hospitals virtually. So thanks in large part to workforce shortages, neurologists became early adopters of telehealth.
As teleneurology programs proliferated, we made a surprising discovery. When it comes to stroke care, telehealth is as effective as in-person care and has several key advantages that may benefit patients, particularly in more rural communities. The time it takes for the on-call neurologist to drive to the ED (or even walk over from the hospital cafeteria) can result in a lifetime of disability for the patient. By contrast, on-demand teleneurology results in more timely treatments that preserve patients’ functioning at near-normal levels.
For these reasons, demand for telestroke services has skyrocketed in recent years. Most comprehensive stroke centers leverage some form of virtual care. And for community hospitals that see only a few stroke patients a month, an on-demand telestroke program is far more cost-effective than paying for in-person neurology coverage (assuming it’s even available).
While these are positive developments, we still see plenty of room for growth. We frequently hear from acute care physicians (particularly hospitalists) who are desperate for more neurology support. The same goes for critical care teams that would like to offer such services as continuous EEG monitoring in the ICU and NICU but lack the neurology expertise to implement. For providers, teleneurology affords lifestyle benefits such as convenient schedules with competitive pay. Also, it allows stroke neurologists and neurocritical care neurologists to leverage their expertise more extensively than if they were in a classic neurology practice.
A Growth Opportunity for Neurologists
Demand for neurologists in 2025 is estimated to exceed supply by 19%. Given this anticipated shortage, hospitals and health systems need to cultivate environments and programs to attract top neurologists and give them the means to practice their specialty in ways that empower them to deliver the best quality patient care.
As a physician-owned and -managed Partnership, Vituity provides neurologists with the opportunity to treat complex neurological conditions in an engaged culture that focuses on the joy of improving health. We have built an expert care team in close collaboration across the Acute Care Continuum with advanced providers, technicians, and ancillary staff to fuel our passion for patient care and embrace the latest care delivery models.
Neurologists benefit from our systems of support and best practices, including medical director training, data and analytics, and time-tested tools for process improvements that give you the freedom to innovate and care for your patients in practice locations throughout the country.
If you’re interested in growing your career, developing new skills, and pioneering new care models—all while having a voice in your practice—Vituity is the perfect opportunity, and we welcome the conversation for you to learn more.