US neurologists: attitudes on the US health care system.

Because the American Academy of Neurology (AAN) exists to represent the views and needs of neurologists, a mailed survey to a randomly selected sample of 520 US-based, board-certified or board-eligible neurologist members was conducted in early 1995 to determine their attitudes in four key changing areas of the US health care system: (1) provision of neurologic care, (2) neurology workforce, (3) academic research, industry sponsorship, and pharmaceutical issues, and (4) health care delivery systems issues. Frequency distributions of degree of agreement and disagreement with 40 statements regarding issues in these four areas were tabulated for the entire group of 430 respondents (response rate = 83%). Associations between these attitudes and six demographic and practice variables (age, gender, board certification, practice type, degree of managed care, and geographical region) were evaluated in an exploratory analysis. The high response rate to the survey and the similarity in demographic and practice characteristics of respondents to the entire US-based, board-certified or -eligible AAN membership support that the attitudes that were measured are likely to be representative of US neurologists, excluding resident trainees. The survey results show that neurologists are deeply concerned that patients with chronic neurologic disorders are not receiving all the neurologic services they need. Respondent show uncertainty about whether there is a current oversupply of neurologists but generally agree that there are too many neurology residency positions. Neurologists support industry sponsorship of academic medical center research and new drug development. With respect to many of the current mechanisms for health care cost containment, respondents indicate they have little confidence that these strategies are in the best interests of patients or physicians. The survey results confirm that there is no consensus among US neurologists on how to improve today's health care delivery system, and the results suggest that certain attitudes are related to neurologists' demographic and practice characteristics. Since today's health care market is volatile, regular assessments of neurologists' attitudes will be needed to assure that their views are understood and clearly represented by the AAN.