Her inspiration for child neurology are the “kids,” even on a difficult day. And yet Ann H. Tilton, MD, the president of the Child Neurology Society (CNS), came this close to missing out on what became her career — and passion.
“I had placed pediatrics as one of my last rotations because I was convinced that I would not do pediatrics as I entered into medical school,” she said. “But I found it to be enjoyable, energizing, and challenging. The days on my rotation flew by.”
Dr. Tilton became interested in subspecialty care and child neurology during her rotation. “I distinctly remember one day in the clinic where behind every door was a patient with a diagnosis I had never seen. Additionally, the clinical care could range from consulting on critically ill children in the Intensive Care Unit to a clinic where learning disabilities are addressed.”
She credits her involvement as a fellow and faculty member at Scottish Rite Hospital in Dallas (part of the University of Texas Health Sciences Center), a predominantly orthopedic hospital that treats patients with cerebral palsy, neuromuscular disorders, and rehabilitation needs, for spurring her interests in neurorehabilitation, spasticity, and neuromuscular disorders.
Her specific research interests are spasticity, cerebral palsy, and the use of new therapeutic modalities such as botulinum toxin and intrathecal baclofen.
Today, Dr. Tilton juggles multiple responsibilities. She was elected to the four-year term as CNS president in 2004, and is the section chair of Child Neurology and clinical professor of neurology and pediatrics at Louisiana State University Health Sciences Center. She is also the co-director of the Rehabilitation Center at the Children's Hospital in New Orleans, an ad-hoc member of the executive committee at the Child Neurology Foundation, the outreach and philanthropic arm of the CNS, and a liaison to the CNS, which means she reports back to the CNS on Foundation meetings.
In an interview with Neurology Today, she discussed the challenges facing child neurologists and the Child Neurology Society.
HOW IS THE ROLE OF THE CHILD NEUROLOGIST CHANGING?
In the past, the child neurologist classically had a role in diagnosing a disorder, but now there are new interventions to help these children. One in ten children have a neurological disorder, and I firmly believe that child neurologists are an appropriate specialty to provide this care. I see children with autism, neuromuscular disorders, headache, epilepsy, and metabolic disorders.
YOU ARE AMONG THE FEW WOMEN LEADERS OF A NEUROLOGY ORGANIZATION. HAS THAT BEEN CHALLENGING FOR YOU?
I have found the membership to be very supportive. We have 1,186 active members, and at least one-third of them are women, which is quite a change from when I entered the field. Women have a solid presence in the specialty, and so I think gender is much less an issue compared to the past.
WHAT WOULD YOU IDENTIFY AS A PRIORITY CHALLENGE FOR THE CNS?
I don't think there's a single member of the CNS who doesn't see the growing shortage of child neurologists as the dominant issue that needs to be addressed. We're not alone in this regard, of course; many pediatric subspecialties are confronting similar challenges, as is neurology in general, if not quite so acutely.
We're a small subspecialty and have a small professional organization with relatively limited resources in numbers and dollars, so we really need to focus our efforts. So the key issues for us are recruitment, reimbursement, and the role of child neurology in the larger medical and public community.
WHAT IS THE CNS DOING ABOUT THESE WORKFORCE ISSUES?
The Society's initial efforts in addressing workforce issues began around 2000, when University of Pennsylvania health economists surveyed child neurologists to get a more accurate sense of the changes they were experiencing on the ground. In follow-up surveys of child neurologists and on-line surveys of pediatricians, their primary referral source, earlier estimates suggesting a 20 percent shortfall of child neurologists nationwide were corroborated.
DO YOU SEE THAT SHORTFALL AS A SIGN OF THINGS TO COME?
The first sizable wave of child neurologists is beginning to retire — the founding and charter CNS members who started the organization in 1972. Their strong mentorship and the development of more than 60 child neurology training programs have guaranteed a successful and outstanding “second generation” of neurologists.
WHAT IS THE CNS DOING TO IMPROVE THE PIPELINE OF CHILD NEUROLOGISTS?
The field is enticing some truly impressive young doctors, including a growing number of young MDs and PhDs, but the problem is we're not drawing enough of them. The CNS is trying to remedy that through outreach work to medical school students, SIGN groups, and residency match programs like the San Francisco match, which have made a large difference.
Expanding education programs at all levels is a top priority. For example, we are co-sponsoring an upcoming workshop, in conjunction with professors of child neurology, to provide mentors to young faculty members.
WHAT HAS THE CNS DONE WITH THE MATCH PROGRAM?
The CNS began to coordinate the national match program for child neurology about two years ago. Prior to that time the match had been based on offers by the programs following the interviews. The new approach has given more programs visibility and allows the candidates to explore several programs without immediate pressure to sign up. There also seems to have been an increased general interest in the field.
HAS THIS PROGRAM MADE A DIFFERENCE?
More needs to be done to convince prospective child neurologists as undergraduates and medical students of the field's potential for growth and career satisfaction. Reimbursement is one of the top concerns for some medical students and residents who know that the cognitive specialties are not compensated as well as those that are procedurally based. The issue, which also affects CNS members directly, needs to be addressed on a national level.
HOW IS THE CNS ADVOCATING FOR HIGHER REIMBURSEMENT?
The CNS is working with other organizations such as the American Academy of Pediatrics (AAP) and the AAN to advocate nationally for better reimbursement, so that the very high expenses for medical school will not deter prospective child neurologists.
By addressing two issues — loan forgiveness and proper funding for reimbursement for cognitive skills — with meaningful policy initiatives, Congress could turn the situation in child neurology around by reducing the financial anxieties prospective trainees encounter when weighing their career options. Financial considerations are not, of course, the only factors that come into play — child neurologists always register an extraordinarily high level of satisfaction with their careers in surveys taken over the past several years, but for a young doctor faced with major debt and a minimum five-year deferral of full-time employment for training, it looms large.
SO IT SOUNDS LIKE ADVOCACY IS A TOP PRIORITY FOR THE CNS. DO YOU PLAY A ROLE IN ADVOCATING FOR YOUNG PATIENTS AND THEIR FAMILIES?
Advocacy for children with neurological disorders is a central focus of the CNS mission. We team up with families, and a wide range of family support and disease-specific research associations, as well as professional associations like the AAN, the American Neurological Association, and the AAP. The CNS has benefited greatly over the years from the generosity of these larger “sister” organizations, which share their resources to influence policy changes affecting issues related to reimbursement and recruitment.
In conjunction with the Child Neurology Foundation, we host an advocacy workshop at our annual meeting for families with children with neurological disorders. The first was on respite care.
HOW DOES THE CHILD NEUROLOGY FOUNDATION WORK WITH THE CNS?
Each organization has created a greater focus and the CNS Long Range Planning committee has been revitalized, thanks to immense effort on the part of both boards. One of my initial goals when I became CNS president was to clarify the evolving relationship between the CNS and the Child Neurology Foundation. Foundation money is used for research in both clinical and basic sciences, multi-center grants, young investigators, high school neuroscience awards, and support for the annual meeting. Awards that were funded through the CNS are now funded though the Foundation, and the research committee that reviews the rewards is now a combined committee of the CNS and the Foundation.
HOW WOULD YOU CHARACTERIZE YOUR TENURE AS CNS PRESIDENT?
The opportunity to be the president of the CNS is an incredible privilege. Time goes by very quickly because of the constant challenges and rewards and the exceptional people I work with, including a group of committed physicians who truly love what they do, and dedicated national staff members such as Mary Currey, the CNS Executive Director, and Roger Larson, the Associate Director.
THE CNS ANNUAL MEETING
This year the CNS is hosting its 36th annual meeting in Quebec City, October 10–13. The four-day annual meeting is a major focus of the Society, providing an educational venue as well as important networking opportunities. For more information about the CNS and this year's preliminary annual meeting program, see www.childneurologysociety.org.