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January 14, 2020; 94 (2) Views & Reviews

Child neurology in the 21st century

More than the sum of our RVUs

Mary L. Zupanc, Bruce H. Cohen, Peter B. Kang, David E. Mandelbaum, Jonathan Mink, Mark Mintz, Ann Tilton, William Trescher
First published December 24, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008784
Mary L. Zupanc
From the Department of Pediatrics and Neurology (M.L.Z.), Division of Pediatric Neurology, Children's Hospital of Orange County, Orange, CA; Neurodevelopmental Science Center (B.H.C.), Akron Children's Hospital, OH; Department of Pediatrics, Neurology, and Molecular Genetics and Microbiology (P.B.K.), University of Florida, Gainesville; Department of Pediatrics and Neurology (D.E.M.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (J.M.), University of Rochester Medical Center (J.M.), NY; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center (M.M.), Voorhees Township, NJ; Department of Neurology and Pediatrics (A.T.), Louisiana State University, Baton Rouge; and Department of Pediatrics and Neurology (W.T.), Penn State University, Milton S. Hershey Medical Center.
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Bruce H. Cohen
From the Department of Pediatrics and Neurology (M.L.Z.), Division of Pediatric Neurology, Children's Hospital of Orange County, Orange, CA; Neurodevelopmental Science Center (B.H.C.), Akron Children's Hospital, OH; Department of Pediatrics, Neurology, and Molecular Genetics and Microbiology (P.B.K.), University of Florida, Gainesville; Department of Pediatrics and Neurology (D.E.M.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (J.M.), University of Rochester Medical Center (J.M.), NY; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center (M.M.), Voorhees Township, NJ; Department of Neurology and Pediatrics (A.T.), Louisiana State University, Baton Rouge; and Department of Pediatrics and Neurology (W.T.), Penn State University, Milton S. Hershey Medical Center.
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Peter B. Kang
From the Department of Pediatrics and Neurology (M.L.Z.), Division of Pediatric Neurology, Children's Hospital of Orange County, Orange, CA; Neurodevelopmental Science Center (B.H.C.), Akron Children's Hospital, OH; Department of Pediatrics, Neurology, and Molecular Genetics and Microbiology (P.B.K.), University of Florida, Gainesville; Department of Pediatrics and Neurology (D.E.M.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (J.M.), University of Rochester Medical Center (J.M.), NY; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center (M.M.), Voorhees Township, NJ; Department of Neurology and Pediatrics (A.T.), Louisiana State University, Baton Rouge; and Department of Pediatrics and Neurology (W.T.), Penn State University, Milton S. Hershey Medical Center.
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David E. Mandelbaum
From the Department of Pediatrics and Neurology (M.L.Z.), Division of Pediatric Neurology, Children's Hospital of Orange County, Orange, CA; Neurodevelopmental Science Center (B.H.C.), Akron Children's Hospital, OH; Department of Pediatrics, Neurology, and Molecular Genetics and Microbiology (P.B.K.), University of Florida, Gainesville; Department of Pediatrics and Neurology (D.E.M.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (J.M.), University of Rochester Medical Center (J.M.), NY; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center (M.M.), Voorhees Township, NJ; Department of Neurology and Pediatrics (A.T.), Louisiana State University, Baton Rouge; and Department of Pediatrics and Neurology (W.T.), Penn State University, Milton S. Hershey Medical Center.
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Jonathan Mink
From the Department of Pediatrics and Neurology (M.L.Z.), Division of Pediatric Neurology, Children's Hospital of Orange County, Orange, CA; Neurodevelopmental Science Center (B.H.C.), Akron Children's Hospital, OH; Department of Pediatrics, Neurology, and Molecular Genetics and Microbiology (P.B.K.), University of Florida, Gainesville; Department of Pediatrics and Neurology (D.E.M.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (J.M.), University of Rochester Medical Center (J.M.), NY; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center (M.M.), Voorhees Township, NJ; Department of Neurology and Pediatrics (A.T.), Louisiana State University, Baton Rouge; and Department of Pediatrics and Neurology (W.T.), Penn State University, Milton S. Hershey Medical Center.
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Mark Mintz
From the Department of Pediatrics and Neurology (M.L.Z.), Division of Pediatric Neurology, Children's Hospital of Orange County, Orange, CA; Neurodevelopmental Science Center (B.H.C.), Akron Children's Hospital, OH; Department of Pediatrics, Neurology, and Molecular Genetics and Microbiology (P.B.K.), University of Florida, Gainesville; Department of Pediatrics and Neurology (D.E.M.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (J.M.), University of Rochester Medical Center (J.M.), NY; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center (M.M.), Voorhees Township, NJ; Department of Neurology and Pediatrics (A.T.), Louisiana State University, Baton Rouge; and Department of Pediatrics and Neurology (W.T.), Penn State University, Milton S. Hershey Medical Center.
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Ann Tilton
From the Department of Pediatrics and Neurology (M.L.Z.), Division of Pediatric Neurology, Children's Hospital of Orange County, Orange, CA; Neurodevelopmental Science Center (B.H.C.), Akron Children's Hospital, OH; Department of Pediatrics, Neurology, and Molecular Genetics and Microbiology (P.B.K.), University of Florida, Gainesville; Department of Pediatrics and Neurology (D.E.M.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (J.M.), University of Rochester Medical Center (J.M.), NY; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center (M.M.), Voorhees Township, NJ; Department of Neurology and Pediatrics (A.T.), Louisiana State University, Baton Rouge; and Department of Pediatrics and Neurology (W.T.), Penn State University, Milton S. Hershey Medical Center.
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William Trescher
From the Department of Pediatrics and Neurology (M.L.Z.), Division of Pediatric Neurology, Children's Hospital of Orange County, Orange, CA; Neurodevelopmental Science Center (B.H.C.), Akron Children's Hospital, OH; Department of Pediatrics, Neurology, and Molecular Genetics and Microbiology (P.B.K.), University of Florida, Gainesville; Department of Pediatrics and Neurology (D.E.M.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (J.M.), University of Rochester Medical Center (J.M.), NY; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center (M.M.), Voorhees Township, NJ; Department of Neurology and Pediatrics (A.T.), Louisiana State University, Baton Rouge; and Department of Pediatrics and Neurology (W.T.), Penn State University, Milton S. Hershey Medical Center.
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Citation
Child neurology in the 21st century
More than the sum of our RVUs
Mary L. Zupanc, Bruce H. Cohen, Peter B. Kang, David E. Mandelbaum, Jonathan Mink, Mark Mintz, Ann Tilton, William Trescher
Neurology Jan 2020, 94 (2) 75-82; DOI: 10.1212/WNL.0000000000008784

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Abstract

In September 2017, the Child Neurology Society (CNS) convened a special task force to review the practice of child neurology in the United States. This was deemed a necessity by our membership, as our colleagues expressed discouragement and burnout by the increase in workload without additional resources; reliance on work relative value units (wRVUs) as the sole basis of compensation; a push by administrators for providers to see more patients with less allotted time; and lack of administrative, educational, and research support. The CNS Task Force designed and distributed a survey to multiple academic divisions of various sizes, as well as to private practices. Our findings were strikingly similar across different practices, demonstrating high workloads, lack of resources, poor electronic medical record support, and high provider symptoms of fatigue and burnout. From the results, the CNS Task Force has concluded that wRVUs cannot be the sole basis of compensation for child neurology. We have also made several specific recommendations for alleviating the current situation, including innovative ways to fund child neurology as well as ways to enhance job satisfaction.

Glossary

CNS=
Child Neurology Society;
FTE=
full-time employees;
IPOP=
independent private organizations and practices;
NP=
nurse practitioners;
RVU=
relative value unit;
wRVU=
work relative value unit

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 57

  • Received March 20, 2019.
  • Accepted in final form October 29, 2019.
  • © 2019 American Academy of Neurology
View Full Text

Disputes & Debates: Rapid online correspondence

  • Author response: Child neurology in the 21st century: More than the sum of our RVUs
    • Mary Zupanc, Pediatric Neurologist and Epilepsy Specialist, & Professor, Dept of Neurology and Pediatrics, Co-Medical Director, CHOC-Children’s Neuroscience Institute; Division Chief, UCI Pediatric Neurology (Irvine, CA)
    Submitted September 15, 2020
  • Author response: Child neurology in the 21st century: More than the sum of our RVUs
    • Mary Zupanc, MD, Pediatric Neurologist and Epilepsy Specialist, & Professor, Dept of Neurology and Pediatrics, Co-Medical Director, CHOC-Children’s Neuroscience Institute; Division Chief, UCI Pediatric Neurology (Irvine, CA)
    Submitted September 15, 2020
  • Reader response: Child neurology in the 21st century: More than the sum of our RVUs
    • Kendall B. Nash, Child Neurologist, UCSF Benioff Children's Hospital
    • Nicholas S. Abend, Child Neurologist, Children's Hospital of Philadelphia
    • Melissa L. Hutchinson, Child Neurologist, Nationwide Children’s Hospital
    • Ricka D. Messer, Child Neurologist, Children’s Hospital Colorado
    • Elizabeth M. Wells, Child Neurologist, Children's National
    Submitted February 07, 2020
  • Reader response: Child neurology in the 21st century: More than the sum of our RVUs
    • Jan B. Wollack, Child Neurologist, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center
    Submitted February 02, 2020
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  • Article
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