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LETTERS TO THE EDITOR: More Clinical Skills, Less Reliance on MRI; Keeping Private Practice Alive

doi: 10.1097/01.NT.0000435594.46901.88
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More Clinical Skills, Less Reliance on MRI

Regarding “Migraine Patients Often Misdiagnosed with MS Based on Evidence of White Matter Hyperintensities,” (Aug. 15,, the concern about multiple sclerosis in a neurologically healthy person too often begins when a neuroradiologist reports white matter hyperintensities as “consistent with” or “highly suspicious for...demyelinating disease.”

We have all seen scan reports of septuagenarians containing these pronouncements. Patients frequently get to read their reports. Primary care physicians and neurologists are then compelled to explain or explain-away the possibility of multiple sclerosis.

Non-specific symptoms become potential exacerbations, and a house of cards can be constructed in the minds of the unsophisticated. Unless the neuroimaging specialist has detailed personal knowledge of a patient's history and physical findings, any MRI reference to possible “demyelinating disease” should be incorporated into a statement such as “demyelinating disease can only be a consideration if there is compelling clinical evidence to support that diagnosis.” Patients would be better served if they relied on the clinical skills of their physicians, rather than focusing on whether or not to treat their MRI scans.

David E. Hoffman, MD

Buffalo Medical Group

Buffalo, NY

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Keeping Private Practice Alive

Regarding “What Neurologists Who Left Private Practices Have Gained — and Lost” (Aug. 15:, the model that we have found to be exceedingly successful since going in the opposite direction 10 years ago (leaving the hospital/university bureaucracy behind) is to develop a large autonomous comprehensive private practice in which the neurologist take-home pay is entirely their fair share of the revenue pie after all the expenses are paid.

This model creates an exciting environment — and based on recent AAN surveys on compensation — yields an average pay that is 50–100 percent greater than the average neurologist.

Yes, everyone works hard, but their subspecialty expertise is put to use, they have no frustrations from hospital management, contribute to cost-effective care by avoiding hospitalization in a big way — where even the simplest testing has been two-to-three times more costly — and offer patients near immediate access rather than long wait times seen in very small practices and large bureaucratic institutions that seem to struggle with operations.

There are other ways to survive — beyond the “bookends” presented in the article — small and dying or employed and underpaid/over-managed. Thanks for your insights.

Joseph V. Fritz, PhD

Chief Executive Officer

Dent Neurologic Institute

Amherst, NY 14226

I just read your story, “What Neurologists Who Left Private Practices Have Gained — and Lost,” about neurologists transitioning to employed practice. It was very well done and I'm glad you wrote it. This is an important trend that doesn't get enough attention. Thanks for putting it on the front page (literally and figuratively).

Lyell K. Jones Jr., MD

Neurology Residency Program Director

Associate Chair for Hospital Practice

Mayo Clinic College of Medicine

Rochester, MN

© 2013 American Academy of Neurology