Dr. David Likosky is helping to shape the future for neurologists who practice primarily in the hospital.
Dr. Likosky, director of the stroke program at Evergreen Hospital Medical Center in Kirkland, Wash., was the founding chair of the neurohospitalist section of the American Academy of Neurology and cofounder of the Neurohospitalist Society. As a leader in these organizations, he is helping to define the role of the "neurohospitalist."
Dr. David Likosky
In an interview with Mary Ellen Schneider, Dr. Likosky shared his thoughts on the growing field and how neurohospitalists can help their medicine hospitalist colleagues.
Mary Ellen Schneider: Who is the typical neurohospitalist and how does he or she get into the field?
DR. LIKOSKY: The field is still young so the typical neurohospitalist remains to be defined. I’d say overall, neurohospitalists skew younger. They are people who are more likely to be new in practice or just out of residency, and are more familiar with the internal medicine hospitalist model and comfortable with that model of care. A number of neurohospitalists are trained in vascular neurology as well, and there’s a lot of overlap between neurohospitalists and vascular neurologists.
MES: What attracted you to hospital medicine?
DR. LIKOSKY: I’ve never practiced in an office. I’ve always enjoyed the inpatient population. Some people see neurohospitalist work as an escape from having to run a practice. In some ways, that’s true. But, at the same time, you still have to manage your practice, there’s just a different set of issues, politics, and dynamics. For me, it was mostly about having a chance to practice internal medicine and neurology in the hospital with patients who are sick or very sick. The other great thing about working in the hospital is the opportunity to work on systems of care and quality metrics in a more controlled environment.
MES: Are more hospitals paying for so-called stroke call, and how does call compensation help or harm the development of the neurohospitalist field?
DR. LIKOSKY: More hospitals are paying for stroke call. Much of that is due to the pressure for hospitals to become certified as stroke centers by the Joint Commission. Some of it is as a result of medicine hospitalists pressuring hospitals to make sure that they have neurology backup. But no matter what the pressures are, it does seem to be an increasing trend overall. One of the things that paying for a stroke call does is to foster an environment in which the hospital administration is willing to pay for a neurohospitalist program or to subsidize a neurohospitalist program.
MES: You teach neurology courses to internal medicine–trained hospitalists, what’s their comfort level with neurology, and how can neurohospitalists assist them?
DR. LIKOSKY: Internal medicine hospitalists, when they leave residency and go into practice, are frequently uncomfortable with the amount of neurology that they’re seeing and feel inadequately prepared. They look for help from their neurologist colleagues. But even with a neurologist working in a nearby clinic, a hospitalist may not always feel comfortable interrupting them or asking for assistance. A neurohospitalist, who is in the hospital and dedicated to inpatient care, is available and is a great help to your average medicine hospitalist. It’s a great partnership.
MES: What has been the reaction of your community-based neurology colleagues to the emergence of neurohospitalists?
DR. LIKOSKY: Most are very happy to have a neurohospitalist in the community. It lightens up the call schedule, particularly during the day. So when their office is busy, there’s less of a need to reschedule patients or cancel parts of the day. Few see it as competition and, if set up well, a program can benefit all. By and large, your average community-based neurologist is very happy to have a neurohospitalist program around whether as a part of their practice or not. It’s a good source of referrals for them and may remove the type of work with which they are either uncomfortable, unhappy, or just don’t have the time to do.
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