AAN July 2020 Career Compass

2020

LOOK INSIDE! Video Interviewing: The New—and Necessary—Tool for Landing Your Next Job . . . . . . . . . . . . . . . .

P3

Elevate Your Career with the Axon Registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P 6 Teleneurology—Welcome to the Newest Old Way of Practicing Medicine . . . . . . . . . . . . . . . . . . . P 10

July Issue • Job Listings • Career Articles

TOWER HEALTH IS HIRING NEUROLOGISTS Due to extensive growth, expanding volume, and community need, we are seeking talented Neurologists in the following specialties: n n n

Hospitalist General Sleep Medicine

n n

Stroke Medical Director Vascular

Drexel University and Tower Health have partnered to open a four-year School of Medicine in West Reading, near the Reading Hospital campus, which is scheduled to open in 2021 and will train 200 medical school students.

What We Offer: n

Tower Health Neuroscience Center is a multisubspecialty clinical service line addressing the needs in the seven Tower Health hospitals in four counties of Southeast PA. The expanding Neuroscience Center has hired 20+ Neurologists and an additional four Fellowshiptrained Neurosurgeons, in the past five years, for a total of seven. Tower Health will also be starting a Neurology Residency Program in the near future.

n n n n n

Competitive Compensation Exceptional Health Insurance and Benefits Educational Loan Assistance Relocation Assistance 403b (matching) and 457b Retirement Plans Spousal/Domestic Partner Job Search Support

For more information, contact: Kenneth (Nick) Nichols, Senior Physician Recruiter 484-628-6581 • Kenneth.Nichols@towerhealth.org

Careers.TowerHealth.org At Tower Health, we are an Equal Opportunity Employer who is committed to creating a diverse and inclusive environment that is reflective of the communities we serve.

Weill Cornell Medicine in partnership with NewYork-Presbyterian/Brooklyn Methodist Hospital is looking for a Board Certified/Board Eligible Neurologist with fellowship training in Epilepsy, to join our growing team in Park Slope, Brooklyn.

NewYork-Presbyterian/ Brooklyn Methodist Hospital is a 651- bed academic institution, academically affiliated with Weil Cornell Medicine, caring for residents throughout Brooklyn and the surrounding areas. Our hospital boasts various neuroscience services, which includes: the Carolyn E. Czap and Eugene A. Czap Alzheimer’s Program; the Multiple Sclerosis Center; the Comprehensive Epilepsy Center; the Center for Parkinson’s Disease & Movement Disorders; a renowned Stroke Center, and Brooklyn’s first Mobile Stroke Treatment Unit. Our academic programs include nine graduate medical education residency programs and six fellowship programs.

Located in Park Slope, one of the most popular neighborhoods in Brooklyn, known for its’ excellent public schools, Prospect Park, the Brooklyn Botanical Gardens and trending restaurants and bars. The neighborhood attracts artists, professionals, singles and families, as well as visitors from all over NYC and around the world.

We offer a competitive salary and benefits package. The selected candidate will be an employee of Weill Cornell Medicine and hold an academic appointment at Weill Cornell Medical College. Salary and academic rank at Weill Cornell Medical College will be commensurate with experience and credentials.

Please forward CV to: Laura Screeney, FASPR, Director, Physician Recruitment, NewYork-Presbyterian, las9150@nyp.org NewYork-Presbyterian/Weill Cornell Medicine are an affirmative action/equal opportunity employer with a strong institutional commitment to diversity among faculty and staff.

2

Video Interviewing: The New—and Necessary—Tool for Landing Your Next Job When states and cities around the country initiated shelter-in-place procedures to help fight the coronavirus, the impact was felt on every aspect of daily life—including the process of securing work. Suddenly, candidates and employers who were anticipating site visits to help them finalize decisions found themselves scrambling to substitute video and phone “meetings” instead.

The “new normal” is working well According to Marissa Whalen, neurology recruiter with Rosman Search, Inc., the transition to virtual hiring has gone fairly smoothly, all things considered. One reason, she says, is that most organizations were already conducting phone interviews for at least the initial stages of their hiring processes, so the “new normal” merely extends the remote aspect. “Typically, we would see employers start with a phone interview and then invite the candidate for an in-person interview or site visit,” she explains.

“Now, it’s going to stay with virtual interviewing for the next stage, where they might do a more in-depth phone interview or perhaps a video interview in place of the site visit.”

Why a more in-depth phone interview instead of advancing directly to video? As Whalen notes, some of the interviewers might now be even busier than usual, with less ability to head back to their offices at a scheduled time. “If a chief of neurology couldn’t easily sit in

front of a computer for the meeting, the phone would be a good alternative,” she says. Even so, she doesn’t expect candidates to be hired without being “seen” at all. Whether by video or in-person, neither party in a hiring situation will likely feel comfortable making a commitment without the visual cues that come from seeing each other in real time.

From virtual tours to daylong video-thons Indeed, some organizations are so eager to provide those extra cues, they’re including “bonus material” in the conversation, like a walk-around tour of the candidate’s prospective office or clinic.

While these are fun experiences, Whalen warns that other interview processes hew more closely to the traditional in-person model, with back-to-back video meetings that can run an hour or more, or which segue directly into the next meeting. “With a series of people interviewing you,” she says, “you could be sitting in front of your

View more jobs online at careers.AAN.com

3

laptop from 8 to 5, with just short breaks to use the bathroom or get something to eat.”

Given how tiring it is to be “on” for a full day in front of the camera, candidates might be glad to learn that some organizations have moved to splitting up the video interviews. “Now we’re also seeing where they’ll schedule one or two interviews on one day of the week, and another couple of interviews later in the week,” Whalen explains.

However the remote sessions are conducted, Whalen advises candidates who are serious about a position to extend their outreach beyond the formal interview process to help make up for some of the input they’d normally receive from the site visit. For example, speaking or emailing with nurses or doctors not involved in the recruitment process can provide the opportunity to ask questions such as, “What is a typical day like for you?”

Offers follow interviews—as usual Although Whalen says that Rosman Search has seen a “small percentage” of employers place their hiring process on hold, for the most part they’ve been moving forward. “In a few months, I think we’ll see more movement than ever before, as we get through the backlog on any interviews that were delayed,” she predicts. In the meantime, candidates receiving offers are needing to balance the desire to sign a contract with any discomfort they may feel about not seeing their future workplace in person.

“We’re definitely seeing offers extended on virtual,” she says.

“How the candidate responds comes down to their comfort and priorities. The ones who don’t want to do that are going to be the people who want to see the community or their workplace first.

But there are others who are anxious to get things wrapped up, or perhaps they already know the community and they’re ready to get this done. People with J-1 visa concerns are already watching the clock, so they may be more inclined to accept a virtual offer.”

Will the “new normal” become…normal?

Here’s an interesting question: If candidates or organizations could choose between virtual interviewing and the traditional on-site process, which would they request? Whalen can see advantages for both methods. On the one hand, she says, “Virtual interviewing isn’t anybody’s ideal. Everybody likes to meet people in person and pick up on the vibes to see how they get along with each other.” But on the other hand? Virtual interviewing may help cash-strapped organizations to “see” more candidates, while letting time-starved candidates consider more employers. At the very least, Whalen anticipates that candidates might slip a virtual visit into future hiring processes, to help them clarify their thinking before accepting an offer.

As for the current crop of candidates, Whalen suspects many or most will find themselves participating in a virtual interview process before landing their offers. And when that happens, she has this advice to share: “Remember that we’re all experiencing this together. If anything goes wrong with the process, take a deep breath, because it won’t reflect on you. We all just have to learn how to do this.”

4

Seven Tips for Acing the Video Interview 1. Prepare for the interview as usual. Although the format is different, the content of the conversation is likely to be the same as if you were meeting in person. “It’s still an interview process,” Whalen says. “Learn about the job, research the program, prepare your questions, and look up the interviewers online to understand more about their backgrounds.”

2. Post notes where you can see them. If your workspace includes a vertical surface where you can pin a shortened version of your notes, you won’t have to rattle through papers or spend as much time looking down while you’re on camera.

3. Control your environment. A quiet room with no distractions is the ideal for video conferencing. Whalen recommends putting your light source in front of you and using a simple backdrop such as a blank wall or uncluttered bookcase. These steps will help ensure you show up well on your interviewers’ screens.

4. Manage your equipment. Of course you were planning to turn off the notifications on your laptop or cell phone (right?). But did you also have “practice with the microphone and camera” on your to-do list? Even if you’ve been using these tools regularly, it’s smart to confirm that everything’s working as it should.

5. Consider an upgrade. If you’re scheduled for an interview tomorrow, now is probably not the time to experiment. But if you have the extra time to try new equipment, you’ll likely find that external cameras and microphones provide notably better video and audio than their built-in counterparts.

6. Dress nicely—top to bottom. Even though the interviewer will never know what you’re wearing below camera level, you will.

Taking care with your clothing, hair, and makeup is part of what makes a meeting special, while giving you an extra edge mentally.

7. Smile. As Whalen notes, “We always say that you can hear a smile over the phone. When you’re face to face in a video interview, they can actually see you smile. This is a situation where a positive attitude is just invaluable.” n

Exceptional Adult Neurologist Opportunity Northern Light Eastern Maine Medical Center’s Neuroscience Center, located in Bangor, Maine, seeks to expand its Neurology Department of currently 10 neurologists. A BC/BE neurologist with or without subspecialty interests (including vascular and neurohospitalist subspecialties) will be considered.

•Collegial professional environment •Competitive salary •Generous benefit package, including medical, dental, and paid time off •CME allowance •Relocation assistance •Education loan reimbursement •J‐1 waiver opportunity for 2021

Northern Light Eastern Maine Medical Center is a 411‐bed tertiary care center, Joint Commission‐accredited Stroke Center and ACS‐verified Level II Trauma Center that offers a full spectrum of inpatient and outpatient services, including the support of a 50+‐physician hospitalist service.

Bangor, a regional center for arts and commerce, offers access to Maine’s spectacular coast, lakes and mountains, including Acadia National Park. Schools rank among New England’s best. The University of Maine with its cultural and sports amenities is located in neighboring Orono. Bangor International Airport offers direct and one‐stop nationwide connections.

For more information contact: Amanda Klausing, FASPR, Physician Recruiter ProviderJobs@northernlight.org or 207‐973‐5358

Neurology Opportunity in the Beautiful Berkshires~Western Massachusetts

We understand the importance of balancing work with a healthy personal lifestyle.

• Berkshires, a 4-season resort community • Endless cultural opportunities, • World renowned music, art, theater, and museums • Year round recreational activities from skiing to kayaking.

• Excellent public and private schools make this an ideal family location, • Just 2 ½ hours from both Boston and New York City.

Berkshire Health Systems Opportunity • Full and Part Time opportunities.

• Subspecialty or General Neurology interests welcome.

• 1 in 7call arrangement gives you the 'perfect' position to balance both your professional interests and personal commitments.

• Flexible balance of inpatient/outpatient coverage • Competitive compensation and benefits package, including sign on, productivity option and relocation.

Berkshire Medical Center, BHS's 302-bed community teaching hospital and Trauma Center, is a major teaching affiliate of the University of Massachusetts Medical School. With the latest technology and a system-wide electronic health record, BHS is the region's leading provider of comprehensive healthcare services.

This is a great opportunity to practice in a beautiful and culturally rich area while being Interested candidates are invited to contact: affiliated with a health system with award winning programs, nationally recognized Shelly Sweet, Physician Recruitment Specialist physicians, and world class technology. msweet@bhs1.org or Apply online at: www.berkshirehealthsystems.org www.berkshirehealthsystems.org

The NewYork-Presbyterian Medical Group is looking for a full time Board Certified/Board Eligible General Neurologist to provide clinical care for a growing and well-established practice in Cortlandt Manor located in Northern Westchester County, New York. Subspecialty training is welcome but not required.

NewYork-Presbyterian/Hudson Valley Hospital is a fully accredited general, 128-bed hospital providing care to residents of Westchester, Putnam and Lower Dutchess Counties. We offer a wide range of ambulatory care and inpatient services, with 450 medical staff members in 62 specialties. The hospital is a New York State designated stroke center and home to the region’s only state-of-the-art, 24-hour "no wait" emergency department, which sees more than 40,000 visits per year.

Cortlandt Manor, New York is located in the northwestern corner of Westchester County. With easy access to major parkways, the hospital is easy to reach from Yorktown, Peekskill and Putnam Valley, Croton and other areas. Cortlandt Manor is an hour’s drive to New York City.

NewYork-Presbyterian Medical Groups is part of the physician division of NewYork-Presbyterian, recently named one of the top 5 academic facilities in the nation. NewYork-Presbyterian is affiliated with two renowned medical schools, Columbia University Vagelos College of Physicians and Surgeons and Weill Cornell Medicine. In collaboration with ColumbiaDoctors and Weill Cornell Physicians, NewYork-Presbyterian Medical Groups provide coordinated care delivery throughout the region and access to leading healthcare services and world-renowned specialists.

We offer a competitive salary and comprehensive benefits package.

Please forward your CV to: Lynne Zeman, Physician Recruiter, NewYork-Presbyterian: LMK9015@nyp.org NewYork-Presbyterian Hospital is an equal opportunity employer.

View more jobs online at careers.AAN.com

5

Elevate Your Career with the Axon Registry Question: At a time when health care practitioners are more strained than ever before, which tasks would they certainly like to do less frequently—or never? If your answer included mandated reporting to Centers for Medicare & Medicaid Services (CMS) and other insurers to maximize appropriate reimbursement, there’s good news. The Academy’s Axon Registry ® has been helping to relieve that burden since 2016, with the number of practices reaping the benefits more than doubling in that short time.

What is the registry, and what does it do?

In a nutshell, the Axon Registry is a neurology-focused clinical quality data registry. That’s one of those definitions in which every word matters, but perhaps none so much as “neurology-focused.”

The registry helps alleviate the fundamental imbalance experienced by neurologists trying to meet reimbursement standards implemented under the Affordable Care Act that have been based on the general practice of medicine rather than specialty areas.

At the same time, focus on measures important to neurologists also ensures that their quality improvement efforts are rooted in data relevant to their specific practices and sub-specialties. As an example, the list of metrics measured by the registry includes such neurology-specific concerns as the staging of dementia, counseling for appropriate exercise for patients with MS, and counseling on how epilepsy treatment affects contraception.

6

The registry is free for Academy members, but to participate, their practices must invest some upfront time in syncing their electronic health record (EHR) systems to allow automated retrieval of (anonymous) patient data by the Academy’s technology vendor.

The setup process is relatively simple, requiring a few hours spread out over a series of phone calls with the vendor. Other than this, the only other effort involves the actual input of the data, which most practitioners are already doing. In a few cases, where the practice’s electronic health records system does not integrate well, the information needs to be uploaded each day by someone at the practice.

Once the information has been uploaded, it can serve a number of functions. In addition to meeting insurers’ reporting requirements, the data becomes part of the practice’s dashboard. Here it can help the group’s practitioners to identify trends or gaps in services, as

well as issues revealed by the quality metrics. But the data serves a larger purpose as well. When it joins a broader data set (it’s important to note that the data collected is aggregate, with no way to identify individual patients), the information helps demonstrate larger trends and issues, of use to all the neurologists participating in the registry.

What has happened since the 2016 launch?

Sarah Benish, MD, FAAN, has been involved with the registry since joining the AAN work group in 2014 where the decision was made to recommend that the Board of Directors endorse its creation. Having participated in every stage of the registry’s development and launch, she now chairs the Registry Subcommittee, which manages its ongoing maintenance and improvement. From this vantage, she’s able to see the current strengths of the registry and the areas that need further development. For example, she says, “We’ve been successful in the launch and in recruiting, and we’re filling in the gaps where information is being collected. We’ve also been very successful in meeting MIPS criteria for CMS.” (MIPS stands for Merit-based Incentive Payments System, which has been part of the CMS program for reimbursing on a quality-of-care basis rather than fee-for-service.)

The recruiting numbers Benish refers to are impressive. In January 2020, the number of enrolled practices was 173, up from 70 in mid2016, with nearly 1,300 practitioners currently participating. In that time, information from an astonishing 2.4 million patient visits has been recorded, up from just 291,000, providing a veritable treasure trove of data. The measures being reported have also more than doubled, from 22 at the registry’s launch to 50 today. Indeed, on this last growth point, Benish notes that the registry has now matured to the level of needing further analysis on the measures themselves. “Once you launch quality measures,” she says, “you have to constantly update them or they lose their usefulness. Now, our monitoring includes the question of which new measures to add, and whether we should retire any if they’re not useful, or if they’re past their prime in our scientific knowledge.”

Benish also acknowledges that the measures have now expanded to the point that individual practitioners would not be able to use them all. “That would be too cumbersome,” she says.

“We’re expecting that people would, at maximum, sign on for 10 measures.” Having too many useful measures to choose from?

That’s a good problem for neurologists to have.

Another development since the registry’s launch has been the creation of its first validation study—a point of some pride for the Academy. Although other specialty medical associations have also launched registries, Benish notes that AAN is the first to take this next step to validate the program and its data. So far, she says, their work has uncovered gaps in data collection that have prompted more robust onboarding processes for new practices and corrections for current practices. “Generally, we found that if people were entering information in discrete fields, the accuracy improved,” she notes. “The free-form text was where we found issues.

We would never tell providers they have to provide the information in a certain way, but now we can help them see other ways to be more accurate.”

A user’s perspective The Axon Registry has been integral to the work of Neeta Garg, MD, at the University of Miami. In addition to serving as associate professor of clinical neurology and director of quality for the neurology department, she is also the Axon Registry liaison, charged with ensuring the quality and timeliness of data submitted to the registry. As one could expect, all her duties have changed somewhat in the wake of COVID-19 requirements for sheltering in place. For example, the outpatient session she leads each week at the University of Miami MS clinic are now conducted remotely as are the weekly clinic sessions at Jackson Memorial Hospital.

Supervising, teaching, and training trainees (residents and post-doctoral fellows) through these remote clinic sessions has been an interesting and learning experience for her. Technology has really been an invaluable tool both for delivery of health care for the patients and education and training for the students via Zoom and other video conferencing platforms.

Even with all of the changes that needed to happen in rapid order, data submission for the registry has gone smoothly. “The documentation for the televisit is the same as for an in-person visit for the most part,” she explains. “All the historic data points, everything that’s part of a note, are documented the same way.

It’s only the physical exam that’s either not happening or is very limited given the constraints of the visit being done through video communication.”

Leadership on quality improvement and optimal use of the registry were both new roles for Garg when she came to the University of Miami from Massachusetts in 2018. Needing a way to ramp up

View more jobs online at careers.AAN.com

7

quickly, she decided to create a poster presentation on the registry experience at University of Miami, which she presented at the 2019 Annual Meeting, with the subtitle, “Limitations and Barriers to Optimal Participation and Performance.” From that exercise, she learned that the process of data collection and submission for the system was somewhat cumbersome and could be made smoother for their practice and others. On the other hand, she also identified many advantages, including an easily navigable dashboard, good technical support from the Academy and its vendor, and the fact that participating doesn’t require any special resources to set up. She envisions future improvements that might include visuals and quarterly reports to make the information more quickly accessible to time-strapped neurologists.

For now, Garg has this recommendation for practitioners who use the registry: “Your quality team should do a monthly random chart review to ensure accuracy of the data. We were doing this at Miami periodically until last year but now we’ve fallen away from it. I think it’s good practice and I want to get back to it when we’re able to get our team together again.”

What does the future look like?

Not surprisingly, Benish and her subcommittee also have ideas for the future of the registry. For one thing, she expects what she calls exponential growth in the data volume when larger practices begin signing on in greater numbers. To date, that enrollment has been slowed by the longer decision processes used by universities and large health systems—a fact Benish knows well. As an associate professor of neurology at the University of Minnesota, she’s had to wait until just recently for the M Health Fairview system to get up and running on the registry. She’s now looking forward to having more hands-on experience with the registry inside her own practice.

In the meantime, her goals for the system remain steadfast: “What I’m hoping is that the registry will show us areas where we can learn how to improve our care, and then we can provide tools for our membership for improving care for those populations that aren’t served well now. Our ultimate goal is to carry information about the entire spectrum of neurology care that’s out there, including small and large practices and individual providers.”

One barrier Benish believes the registry can help to reduce is the tendency for some doctors to shy away from metrics. “I think a lot of doctors get scared of quality metrics,” she says. “They look at their score and if it’s 90 percent on a migraine treatment, they think ‘Oh gosh, that’s negative.’ Doctors are over-achievers and they see it as bad to be less than 100 percent on something.”

Rather than focusing on the negative aspect of a number, Benish wants to accentuate the opportunity for improvement. “The role of the Academy is to offer solutions,” she notes. “Everyone went into medicine to help people and we want to support that. As doctors, we all have to get over our fear of not being perfect. We need to recognize that if we don’t measure, we don’t know where we stand and we can’t improve.” n

KINDNESS AT WORK.

Neurology Opportunities

Northeast and Central Pennsylvania

What you do at Geisinger shapes the future of health and improves lives – for our patients, communities and you. Our commitment to caring runs deep as we go the extra step to provide cutting-edge tools like the MyCode Community Health Initiative, our groundbreaking genomics program, to ensure patients get the best diagnosis possible. Wherever your future takes you at Geisinger, our commitment to you is what differentiates us.

As part of our expanding practice, Geisinger has opportunities for specialty neurologists, residents, and fellows throughout Pennsylvania.

Interested candidates, please reach out to Lori Surak at ljsurak@geisinger.edu.

The future of health is in you. geisinger.org/careers AA/EOE: disability/vet.

8

N eurologists o pportuNities Located in Beautiful Northern California Sutter Medical Group is currently seeking BE/BC adult neurologists, neurointensivists, neurohospitalists, and advanced practice clinicians to join established practices throughout the Sacramento-Sierra region of California.

Sutter Medical Group is a successful, 1000+ member multi-specialty group offering physicians the opportunity to build their practices within a progressive, financially sound and collaborative organization. SMG is recognized as a Top Performing Physician Group by the Integrated Healthcare Association. Our members are dedicated to providing the highest quality and most complete health care possible to the people in the communities we serve in the greater Sacramento Sierra Region of Amador, Placer, Sacramento, Solano and Yolo Counties.

Join us and enjoy:    

Income guarantee with shareholder track Generous compensation and benefits, including 401(k) Advanced practice technology, including Electronic Medical Records A positive work-life balance and Northern California’s natural beauty and lifestyle

The Sacramento Sierra Region offers all the advantages of living in Northern California. The region offers cultural diversity, as well as ample outdoor activities including river rafting, skiing, and biking. Centrally located, you are just an hour and a half from the mountains of Lake Tahoe or the bay of San Francisco. For the wine connoisseur, scenic Napa Valley is just a short drive away.

Michelle Pedler, Physician Recruiter Sutter Health Sacramento Sierra Region,2750 Gateway Oaks, Sacramento, CA 95833, (800) 650-0625, CareerCenter: 20 NCC Ad, halfpage develops@sutterhealth.org, www.checksutterfirst.org Placed in AANnews, Brain&Life 8.25 x 5.25 +0.125 bleed, 4C

The American Academy of Neurology is proud to offer

THE #1 CAREER CENTER FOR NEUROLOGISTS

FIND A JOB

RECRUIT TOP TALENT

Learn more! Careers.AAN.com

Teleneurology—Welcome to the Newest Old Way of Practicing Medicine Just in time for the safe distancing requirements of the COVID-19 response: Teleneurology is ready and able to deliver remote health care to some of medicine’s most fragile patients.

Do you remember the old punchline, “Take two aspirin and call me in the morning?” While that trope may have been over-used by 1960s-era comics in their standup routines, it was rooted in a reallife experience: Doctors who would consult with their patients on the phone, sometimes eliminating the need for an in-office visit.

So, what happened to the old-fashioned telephone consult? It took some turns on the way, but it’s definitely back, more robust than ever. Now the communication tool is video, and the virtual consults have evolved light years past the services offered by the general practitioner of yore.

Neurology is one medical specialty that is especially well-suited to remote delivery of services. Not only can some of medicine’s least mobile patients be treated without leaving their homes, but some of the most urgent cases—those in the so-called “golden hour” of stroke treatment—can be immediately evaluated in hospital settings with no stroke specialist on site.

Teleneurology has other, more routine benefits as well, ranging from a lower cost of service delivery (because less overhead or

10

infrastructure is needed) to shorter wait times for patients seeking their first meeting with a neurologist.

And, just when virtual services are needed more than ever, remote delivery of neurology care is poised for exponential growth, thanks to the 2018 FAST Act (Furthering Access to Stroke Telemedicine), which opened the door to an equalized reimbursement process for telestroke care, regardless of where the patient is located.

While the kinks are still being worked out, the bottom line from this development is that hospitals can better afford to enter a market that in the past had been sustainable only for private companies.

Two teleneurologists, on two different paths Although telestroke and teleneurology are not new, the range of related career paths are more varied than ever before. Take the examples of Eric Anderson, MD, PhD, and Elaine C. Jones, MD, FAAN, both AAN members who have been active in furthering teleneurology, but with strikingly different career paths.

Eric Anderson, MD, PhD—teleneurology as the basis for a career Anderson, who attended Emory University for his residency and epilepsy fellowship, has the distinction of pioneering the use of an iPhone 4 for in-hospital teleneurology trials when he was still

an intern in 2010. As he tells it, “When I was a student, I was infatuated with the idea of telemedicine. If you believe that every minute counts with telestroke, then the idea of bringing someone instantly to the bedside with tele-technology was fascinating.

When I was interning at Emory, the iPhone 4 was just coming out.

It had this feature called FaceTime, that had audio and video—but both people on the call had to have the same setup for it to work.

My wife was kind enough to let me buy two iPhones, so I could experiment with other doctors using FaceTime to provide neurology services at the hospital. That got a lot of press at the time, and the attention of the Academy.”

Having seen the potential first-hand for teleneurology, Anderson started his own telemedicine service three years later, while completing his fellowship. Intensive Neuromonitoring, which he still operates, provides tele-EEG services to clinical practices in Georgia, and the surrounding area. From there, he added roles as a teleneurologist for CortiCare, Inc. in California—for which he is now the medical director—and as a teleneurologist for SOC Telemed—for which he is now the chair of neurology, in charge of 70 teleneurologists who handle up to 8,000 tele-visits each month.

In other words, Anderson leads the teleneurology or telemedicine functions for three distinct companies simultaneously, while also providing direct teleneurology services himself.

When asked about his biggest challenge in this work, Anderson’s answer isn’t surprising: the schedule. “I balance three or four calendars,” he explains, “so I need to schedule several months in advance to minimize conflict and ensure a basic level of time off.”

Even so, he admits that he is prone to adding more things to the calendar, such as his work on committees to improve telemedicine, and presenting or publishing on the topic. While the packed calendar challenges Anderson, it also demonstrates one of teleneurology’s benefits to medical professionals: The added availability of work time when you strip away non-medical processes, such as commuting to a clinic. As a bonus, working from home lets Anderson maximize downtime to interact with his family.

Perhaps the most surprising aspect of Anderson’s career path is this one fact: His entire medical practice since finishing his fellowship in 2014 has been conducted virtually. If there are other neurologists who can make the same claim, it would be a small cohort—but that situation could change with each new class of graduating residents and fellows.

Elaine Jones, MD, FAAN—teleneurology as the antidote to burnout If Anderson is the model for using teleneurology to serve as many patients as possible, Jones might be the model for leveraging it to achieve an enviable work-life balance. Although she has been working in telemedicine almost as long as Anderson (she has been with SOC Telemed for six years now), she entered the field at an entirely different point in her career. For Jones, teleneurology is more of a capstone than a launch pad, coming as it does after decades of private practice. In her words, “I started working with SOC while I was still in solo practice in Rhode Island. When I decided to close my practice three years ago and move to South Carolina where my parents are, I decided to go with SOC exclusively. I take the night shift, which means that I can have my

days free to help my parents or go to the beach. Even if I’m on shift and I hear a big crash downstairs, I can run down and check. Just being home is a huge advantage with telemedicine.”

Although Jones doesn’t count herself as a night person, she has found that the schedule suits her workstyle as well as it does her home life. “The work at night is a little less hectic, a little more focused,” she says. “It tends to be more emergencies, but everyone is a little calmer.” To start her 10:00 p.m. shift, Jones can be ready at her computer in as little as 15 minutes after her postdinner nap. Eventually, the call center will send a message alerting her to a new consult, after they’ve confirmed which neurologist is both available and licensed for the state where the patient is located.

By 6:00 a.m., once she has finished with the last notes, Jones is done with her shift and ready to sleep—with no concerns about being needed for call or other work duties.

The night schedule also provides a good backdrop for Jones’ professional service, including her second term on the Academy’s board, and the three committees she serves on for SOC. In addition, Jones has done significant work for the Academy on such issues as physician burnout, which brings her to this observation: “I think telemedicine provides one of the best opportunities there is for work-life balance for doctors. When your shift ends, you’re completely free for the other things in your life.”

When asked about down sides or challenges of being a teleneurologist, Jones doesn’t cite a lack of collegial interaction. That’s because she can use the chat feature on Zoom to send an image to other doctors on shift if she wants another viewpoint. When she was a solo practitioner, she says, “It was just me and Google.”

Indeed, Jones has found that impromptu conversations with colleagues have helped keep her on the cutting edge—such as the recent look at hemorrhagic encephalitis from a patient with COVID-19 that was shared by an SOC teleneurologist for others doctors to see.

On the other hand, Jones does miss the face-to-face interaction with patients and the opportunity to keep up her “live skills.” As a remedy, she takes on-site locums jobs in different locations, sometimes filling her teleneurology shifts in the hotel at the end of the day. Or, she may separate the two activities, giving her the chance to enjoy the locums location more fully. That’s the plan she’s making for two weeks in Alaska later this year, where she hopes to get in some fishing and hiking when she’s off shift. To complete her customary 100 hours for SOC that month, she’ll simply compress her workdays together in one chunk— an accommodation she says the company is able to make because of the flexibility afforded by telemedicine. This adaptability, along with the other advantages, has made Jones reconsider her earlier career vision. “When I started, I always said that this was a temporary gig for me and I would be going back to private practice.

But now I’m not so sure about that,” she says.

Is teleneurology right for you?

Whether you’re just starting out in your medical career, or you’ve been practicing for decades, teleneurology could be a good fit. To find out, you’ll want to consider some of these aspects of the work.

Equipment and space For the moment, teleneurology is primarily conducted from the practitioner’s home space, although that could change if

View more jobs online at careers.AAN.com

11

organizations in the future opt to provide the services from bricksand-mortar locations. To be ready for home-based consults, you’ll need enough privacy to ensure patient confidentiality and uninterrupted sessions, as well as adequate broadband and the corresponding computer equipment. Having tried a number of configurations—including an ill-fated treadmill desk—Anderson has found his best setup includes a large 42” video screen that gives better visual acuity when working with patients.

Solo or employed?

Are you hanging out a shingle, or sending out a resume? Both options are available to you, but the details will matter. As a solo practitioner, you’ll be responsible for the billing, for example, and for ensuring credentialing with client hospitals. But you’ll also have full authority over your schedule and work. On the other hand, as the employee of a telemedicine company, you’ll trade some of that autonomy, and possibly some of your income, for the benefit of having someone else mind the administrative details.

Subspecialty According to Jones, some specialties, such as headache and stroke, might be especially adaptable to teleneurology processes, while others requiring in-person procedures or evaluations might be less amenable. Anderson notes that most of the aspects of in-person care valued by neurologists will still be possible online, regardless of the discipline. “When we think of neurologists, in our minds, there’s been kind of a schism between emergency neurology and outpatient neurology,” he says. “We didn’t used to have treatment for stroke but now, with all the emergency treatments we can provide, there’s this branch that’s all go-go-go instead of let’s cerebrate on this. I think that what’s satisfying for neurologists— being a bit of a detective and coming up with an answer for the patient—that’s not missing with teleneurology, as much as people think it will be.”

The business of teleneurology Although the tele- aspect of this service delivery model gets most of the attention, virtual health care can’t happen if the administrative side isn’t managed. Chief among the issues are billing, licensing, and liability.

Billing The conversation about billing can be complex in any aspect of medicine, and especially when you add an entirely new mode of service delivery. From their professional service committees, both Anderson and Jones have delved into the issue of billing as it relates to telemedicine. Their conclusion might be summed up with “Not quite there yet.” On the one hand, the 2018 FAST Act represented a tremendous leap forward by ensuring equity in reimbursement for telestroke, which removed the main barrier to hospitals providing the service. On the other hand, after more than a year, Jones notes that the unique aspects of telemedicine create equally unique problems—such as the confusion caused by some insurers billing from where the doctor is located while others bill from the patient’s location, while none of them seem to be using the same codes for the work.

Licensing It’s possible that future physicians will see the licensure issue as one of the growing pains for telemedicine. How else would you describe the result of Elaine Jones’ work—licensure in an eyepopping 21 states, and counting? Since physicians in the United

1 2

States must currently hold licensure for the state in which their patient is “seen,” telemedicine practitioners have little choice but to pile on the licensures—and the attendant fees and CME requirements. Hospital credentialing adds to the paperwork tangle, with most systems requiring annual renewals that the physician must either initiate or at least review and corroborate, depending on whether they work for an agency or for themselves. In Jones’ case, licensure in 21 states translates to 150 credentialing organizations, none of which is on the same annual schedule for processing renewals. Perhaps it’s no wonder that one of the groups she’s chosen to help with at SOC Telemed is the credentialing committee, which she chairs.

Malpractice In some ways, this might be the easiest of the administrative balls to juggle since the physician’s carrier or broker usually takes the lead on the process. Even so, Anderson warns that the teleneurologist should still pay attention to the details. For example, he ended up altering his practice when his broker advised him that carrying malpractice in some states was significantly more expensive than in others. He also learned that not every carrier will cover every state, which may create another set of decisions for the practitioner.

What does the future hold for teleneurology?

After taking decades to reach its current level of acceptance, teleneurology finally seems poised for a major leap forward. The new burst is fueled by a perfect storm of circumstance: the near universal access to high-quality electronics for practitioners and at least a smartphone for patients; the breakthrough in billing opportunities represented by the FAST Act; and the unprecedented need for home-based services demanded by the COVID-19 crisis.

It’s the moment that Anderson, Jones, and so many of their colleagues have been building towards as they perfect the process of delivering health care remotely.

“I keep thinking there might be a return to doctor-controlled medicine and solo practices with the COVID-19 impact,” Anderson says. “The virtual doctor has a lot more in common with the country doctor than with the employed doctor.”

Even if this genie could be put back in the bottle, Jones, for one, doesn’t believe that would happen. “I don’t think it will ever go back to where it was,” she says. “I think doctors and patients have realized the convenience of it and won’t want to go back. But the problem will be, how will things shift when this (the pandemic) is over? What’s going to lag behind is the payment system and that’s going to impact everything else.”

Unless, that is, the payment system doesn’t matter anymore. With the current prevalence of high-deductible insurance plans, Anderson anticipates that some doctors might revert to direct-to-the-patient billing that benefits both parties by cutting out insurance altogether.

“If you don’t have a brick-and-mortar operation to finance, why wouldn’t you just charge the patient their co-pay amount, instead of going through the insurance? It’s the same cost for the patient and you can afford to charge less if you don’t have overhead.”

Billing issues aside, both Jones and Anderson are optimistic about the future of teleneurology. “It’s an exciting time to be a neurologist,” Jones says. “Neurology has really led the way with telemedicine anyway, even before this. I think if we continue to innovate, we will be a great boon to our patients, and to medicine.

We’re going to be out there fighting hard for it to remain.” n