US neurologists in the 1990s - Trends in practice characteristics

Background: The American Academy of Neurology (AAN) conducts periodic surve ys of its members to profile and monitor changes in the characteristics of US neurologists and their practices. Objective: To assess neurologists' cha racteristics, geographic distribution, practice arrangements, professional activities, practice volume, procedures performed, sources of revenue, invo lvement with managed care and capitation, and other selected topics. Method s: The AAN Member Census survey was sent to US neurologists in the fall of 1996 (response rate = 89%), and the Practice Profile survey was sent to a r andom sample of 1,986 US neurologists in the summer of 1997 (response rate = 55%) who had completed a Member Census survey. The results of the Practic e Profile survey were compared with those of two prior surveys conducted in 1991 to 1992 and 1993 to 1994. Results: The mean age of US neurologists is 48 years, 18% are women, 93% are US citizens, and 24% are international me dical graduates. The proportion of neurologists in solo practices, group pr actices, and medical schools/universities has not changed. The weekly hours worked has remained stable (58 hours), but the time spent in administrativ e activities has increased (p < 0.001). The average number of patient visit s per week to neurologists appears to have increased (p < 0.001), as has th e proportion of neurologists performing procedures (p < 0.05). The majority of neurologists have contracts with managed care organizations (82%), and a minority (32%) have capitated payment arrangements. Medicare continues to be the largest source of clinical revenue. Nearly 50% of all respondents h ave experience in developing clinical practice guidelines or critical pathw ays, and >20% of respondents employed physician extenders to assist in thei r practices. Conclusion: Neurologists are spending more time in administrat ive activities, are performing or interpreting more procedures, and are see ing more patients. Neurologists' involvement with capitation is comparable with that in a nationally representative sample of physicians, and they are exploring innovative ways, such as developing practice guidelines and usin g physician extenders, to improve the quality and efficiency of providing n eurologic care.