Holloway R G, Vickrey B G, Keran C M, Lesser E, Iverson D, Larson W, Swarztrauber K
Department of Neurology and Community and Preventive Medicine, University of Rochester, NY 14642, USA.
Neurology. 1999 Apr 22;52(7):1353-61. doi: 10.1212/wnl.52.7.1353.
The American Academy of Neurology (AAN) conducts periodic surveys of its members to profile and monitor changes in the characteristics of US neurologists and their practices.
To assess neurologists' characteristics, geographic distribution, practice arrangements, professional activities, practice volume, procedures performed, sources of revenue, involvement with managed care and capitation, and other selected topics.
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 random 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 Practice Profile survey were compared with those of two prior surveys conducted in 1991 to 1992 and 1993 to 1994.
The mean age of US neurologists is 48 years, 18% are women, 93% are US citizens, and 24% are international medical graduates. The proportion of neurologists in solo practices, group practices, and medical schools/universities has not changed. The weekly hours worked has remained stable (58 hours), but the time spent in administrative activities has increased (p < 0.001). The average number of patient visits per week to neurologists appears to have increased (p < 0.001), as has the 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 have experience in developing clinical practice guidelines or critical pathways, and >20% of respondents employed physician extenders to assist in their practices.
Neurologists are spending more time in administrative activities, are performing or interpreting more procedures, and are seeing 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 using physician extenders, to improve the quality and efficiency of providing neurologic care.
美国神经病学学会（AAN）定期对其成员进行调查，以描述和监测美国神经科医生的特征及其执业情况的变化。
评估神经科医生的特征、地理分布、执业安排、专业活动、工作量、所实施的诊疗操作、收入来源、参与管理式医疗和按人头付费的情况，以及其他选定主题。
1996年秋季向美国神经科医生发送了AAN成员普查调查问卷（回复率 = 89%），1997年夏季向完成成员普查调查问卷的1986名美国神经科医生随机样本发送了执业概况调查问卷（回复率 = 55%）。将执业概况调查问卷的结果与1991年至1992年以及1993年至1994年进行的两项先前调查的结果进行比较。
美国神经科医生的平均年龄为48岁，18%为女性，93%为美国公民，24%为国际医学毕业生。个体执业、团体执业以及医学院校/大学中神经科医生的比例没有变化。每周工作时长保持稳定（58小时），但用于行政活动的时间有所增加（p < 0.001）。神经科医生每周的平均门诊量似乎有所增加（p < 0.001），实施诊疗操作的神经科医生比例也有所增加（p < 0.05）。大多数神经科医生与管理式医疗组织签订了合同（82%），少数（32%）有按人头付费的支付安排。医疗保险仍然是临床收入的最大来源。近50%的受访者有制定临床实践指南或关键路径的经验，超过20%的受访者雇佣医生助理协助其执业。
神经科医生在行政活动上花费的时间更多，实施或解读的诊疗操作更多，看诊的患者也更多。神经科医生参与按人头付费的情况与全国具有代表性的医生样本相当，他们正在探索创新方式，如制定实践指南和使用医生助理，以提高提供神经科护理的质量和效率。
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