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(Stroke. 2005;36:1113.)
© 2005 American Heart Association, Inc.

Letters to the Editor

Who Will Care for Our Hospitalized Patients?

David J. Likosky, MD

Evergreen Hospital Medical Center, Kirkland, Wash

Alpesh N. Amin, MD

University of California, Irvine, Irvine, Calif

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

Much debate has recently focused on who is best qualified to care for stroke patients.^1,2 Arguments have been made for the certification of a neurology subspecialist—the "strokologist."³ Care for the stroke patient is complicated now and only becoming more so. However, in an era when subspecialty coverage for emergency and inpatient care is scarce, the more appropriate question seems not who should care for these patients but rather, who will shoulder this responsibility. Neurologists have been accused of being "asleep at the wheel" in stroke prevention—the same may be true for stroke treatment.⁴

Even specialties that have traditionally provided after-hours emergency coverage are demanding payment or refusing to provide this service altogether. Now that stroke treatment involves emergent evaluation and treatment, there has been a significant change in what is expected. Low remuneration for a late night neurologic evaluation is not a great motivator, and neurologists are not used to canceling clinic appointments for emergencies. Neurologists perform few procedures and other sources of funding are few and far between. Cardiologists, nephrologists and gastroenterologists have developed rotations within their groups for 1 physician to perform the inpatient work for a period of time. The inpatient volumes for these specialties tend to be fairly high and are associated with well-reimbursed procedures.

As a result, others have stepped in to care for stroke patients. Hospitalists have come to the assistance of primary care physicians and have helped alleviate some of the workload for specialists. Internal medicine training is obviously an . . . [Full Text of this Article]

This article has been cited by other articles:

				D. J. Likosky, W. D. Freeman, B. L. Mitchell, G. Gronseth, and B.H. Eidelman IS IT TIME FOR NEUROHOSPITALISTS? Neurology, March 3, 2009; 72(9): 859 - 860. [Full Text] [PDF]