ARTICLE IN BRIEF
AAN President-elect James Stevens, MD, FAAN, discusses how he balanced his professional career with long years as an Academy volunteer, how his private practice has thrived through tumultuous changes in health care, and what he hopes for the next generation of neurologists.
When James C. Stevens, MD, went to the AAN Annual Meeting in San Diego in 1992, he didn't know many people there. So when he saw an invitation on a large scrolling message board advertising a free meal to members under the age of 35, he signed right up. Francis Kittredge Jr., MD, who had sponsored the lunch to elicit opinions concerning the newly-formed AAN Foundation (now known as the American Brain Foundation), saw potential in young Stevens. As Practice Committee chair at the time, Dr. Kittredge invited him to a dinner meeting that night and by the end of the evening, offered him a position on the Quality Standards Subcommittee.
That's how Dr. Stevens started, and by 2007, he himself was chair of the Practice Committee. He has served in a variety of role over the years, most recently as vice-president of the AAN board of directors from 2015-2017, during which time he led the Board's strategic planning process. He has done all this while running an extraordinarily successful and innovative private practice and, along with his wife, Laurel, raising two children who were inspired to choose careers in medicine.
This August marks 30 years for Dr. Stevens at the Fort Wayne Neurological Center in Indiana. Two-thirds of his practice is focused on general neurology and one-third to sleep disorders medicine, in which he is board-certified.
Neurology Today spoke with Dr. Stevens to find out how he balanced his professional career with long years as an Academy volunteer, how his private practice has thrived through tumultuous changes in health care, and what he hopes for the next generation of neurologists.
AS A NEUROLOGIST IN PRIVATE PRACTICE, WHAT DO YOU SEE AS THE TOP THREE CHALLENGES FACING NEUROLOGISTS TODAY?
The number one challenge today is maintaining financial viability through a volatile period of changes: the loss of consult and nerve conduction codes and other reimbursement reductions, as well as increased practice expenses resulting from regulatory requirements. In our office, for example, the number of full-time employees has risen from 1.5 to five staff per physician over the past 20 years to meet regulatory demands.
The second greatest challenge is dealing with that very same over-regulation. Those tasks take time away from what neurologists love to do — see and care for patients. Yet, 50 percent of our time is now spent on administrative tasks that do nothing to improve clinical outcomes.
The third largest problem is that of patient access. There are simply too few neurologists to meet the demands of our aging population.
These problems are accentuated tenfold for solo and small neurologist practices. They have less negotiating power, and it's more difficult for them to set up other revenue centers. That worries me because many of them work in underserved areas and play a vital role in the provision of care.
WHAT IS THE AAN DOING TO ADDRESS THESE THREATS?
Advocacy is one of our highest priorities, and the AAN is working both on both legislative and regulatory responses to decrease the burden. The AAN has joined forces with other cognitive specialty societies to advocate for this, and is also working diligently to increase funding for our research colleagues. It has created the Axon Registry, which currently has 171 participant groups, 51 of which are solo practitioners, and anticipates broader expansion to help more members fulfil regulatory requirements. It provides a variety of tools, programs and resources to educate our members on how to succeed and it has formed a health services research subcommittee to demonstrate the value of neurology.
YOUR PRACTICE HAS BEEN VERY PROACTIVE IN ITS BUSINESS PLAN OVER THE YEARS. CAN YOU DESCRIBE SOME OF THE REVENUE SOLUTIONS THAT HAVE HELPED IT THRIVE?
As a group of eight neurologists, five neuropsychologists, five neurosurgeons, and six nurse practitioners we have been very progressive in creating various service lines over the past 20 years. We have centers for sleep, imaging, electrodiagnostic testing, and infusion, as well as a robust clinical trials program (having engaged in over 150 trials since the nineties). We developed the first telestroke network in our area with two hubs and 24 spoke hospitals. (The latter was the result of my AAN Palatucci Advocacy Leadership Forum project in 2007.) We also have created several specialty clinics: movement disorders; concussion; multiple sclerosis; and clinics to address falls. In addition, we contracted with hospitals to provide neurologic care for inpatient services.
CAN YOU TELL US MORE ABOUT YOUR MEDICAL MALPRACTICE PROGRAM?
Ten years ago, when we saw our medical malpractice insurance premiums were going up and up we decided to create our own risk-retention program. We established insurance through the state of Arizona and offered it to colleagues in other specialties. We have grown to more than 300 physician members and work hard to educate them to keep our risk low. The cost runs around $7,000 to $8,000 annually. We also purchased real estate attached to one of the hospitals we serve, which has proven to have been a lucrative decision.
WHAT WAS YOUR REACTION WHEN YOUR DAUGHTER, KAIT, TOLD YOU SHE WANTED TO GO INTO NEUROLOGY?
It's not anything that I would have expected. Although she used to hang out in my office when she was young, she went to Tulane as an anthropology major. She kept neuroscience as a minor (I felt to placate her father) and surprised me when she announced she was pursuing a career in medicine and at a later date, neurology. I can't begin to describe the pleasure of getting a phone call at two or three in the morning to discuss a patient when your child is on-call and cannot find her resident. My son is a physician assistant. and I'm proud to say that both my children chose their paths for all the right reasons.
WHAT ARE YOUR HOPES FOR THE NEXT GENERATION OF NEUROLOGISTS?
It's good to witness the attitude of people coming out of training with their emphasis on better work-life balance. Compared to my generation, many finishing their training today have a very high debt load, adding importance to our advocacy efforts on behalf of our profession. I hope that the world of neurology will continue the pace of scientific and therapeutic discoveries that will transform the care we deliver our patients. What I hope doesn't happen is that they fall victim to “burnout” and lose their joy of practice. I feel so fortunate to have chosen a career in this profession and to have met so many wonderful people through the AAN. Being in a room with a patient is certainly where I find my greatest professional fulfillment. My wish would be that young neurologists have the opportunity to experience the same passion and rewards that I've had.
WHAT DO YOU LIKE TO DO IN YOUR FREE TIME?
I like to hike and bike and do a variety of outdoor activities. I'm an avid tennis player and have had a weekly singles match for the past 25 years with a dentist in our town who attended college with me. I've also been a wine collector for the past 30 years and have a large wine cellar at my house. My favorites are Tuscan Italian reds, particularly Brunello di Montalcino.