Tiago Villanueva: What is a neurohospitalist?

Tiago_Villanueva When I first met Andrew Wilner, an American physician, a few years ago, it was the first time I had heard of the word “neurohospitalist.” I obviously knew what a neurologist or a neurosurgeon are, but a neurohospitalist was an absolute novelty, and I have a feeling it is not a well known role in Europe, if it exists at all.

But Dr Wilner works as a neurohospitalist in the New England area of the United States. So, some time ago, I had a chat with him to learn the ropes of the job (and he gave me permission to reproduce some of his comments). According to him, “a neurohospitalist is a neurologist who sees patients exclusively in the hospital.” Meschia defines a neurohospitalist as a doctor providing care “to patients with neurological abnormalities that either lead to hospitalisation or complicate their stay in hospital.”

This is apparently not a new concept, as Wilner explains: “Most teaching hospitals effectively practice “hospitalist” medicine, with the interns, residents, and fellows performing the duties of an in-house physician. What is new is the creation of a job for ‘private practice’ physicians who work exclusively in the hospital.”

There are currently more than 20 000 hospitalists (mostly internists) practising in the United States, and only a small fraction are neurohospitalists, according to some authors. There are even two academic journals now dedicated to neurohospitalist medicine, namely “The Neurohospitalist” and “Frontiers in Hospitalist Neurology.” There are also fellowships programmes in neurohospitalist medicine at the University of California San Francisco, University of Washington in Seattle, and Mayo Clinic Florida. And there is even a section on neurohospitalist medicine in the American Academy of Neurology, and its annual meeting has included a course on neurohospitalist medicine.

But what is exactly fuelling the development of neurohospitalist medicine? There are several contributing factors, according to Dr Wilner. One of them is the change in the way American doctors work. Whereas previously many doctors used to see patients in their offices and perhaps do hospital rounds in the end of the day, nowadays the outpatient workload has increased, thus allowing less time for doctors to go to the hospital. Moreover, patient workups that would entail several days of ordering tests have nowadays been cut short to just a few hours. Therefore, “an onsite physician is better equipped to assess the patient’s progress and order new tests or treatments than a doctor in office practice who might be running an hour behind and has a full waiting room,” says Dr Wilner.

Another factor driving the growth of neurohospitalist medicine is a change in the way American hospitals are reimbursed. Before, hospitals used to be reimbursed for each hospital day, as if it was a hotel, and hospital stays were long. Wilner adds that “With the change to hospital reimbursement by diagnosis related groups, hospitals now receive a flat fee per diagnosis, creating an incentive for short hospital stays.”

Finally, neurohospitalist medicine is flourishing in part because the new generations of doctors are looking for a better work-life balance than their older counterparts, where many would dedicate all their time to patient care, with significant impacts on personal and family life.

Wilner explains: “Younger physicians and those currently in training, many of whom are women, are less apt to adopt this archaic model and more likely to embrace the ‘shift work’ scheduling of hospitalist work that favors a different kind of ‘quality of life.’”

Neurohospitalist medicine is an interesting example of how medicine, in this case in the United States, evolves and adapts to a relentless changing world. If you’re based in the UK, Europe or other parts of the world, and would like to learn more about neurohospitalist medicine as a career path, I’m sure Dr Andrew Wilner would be delighted to hear from you. He also works as a medical journalist, and his articles appear regularly on Medscape.com and other online publications, and you can follow him on Twitter.

Tiago Villanueva is a locum GP based in Portugal, and former BMJ Clegg Scholar and editor, StudentBMJ.