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Media Release
ASSOCIATION OF ONTARIO
NEUROLOGISTS CALL ON HEALTH
TO ESTABLISH A DIALOGUE TO DEAL WITH GROWING CRISIS IN NEUROLOGY
(April 30, 2008, Toronto, Ontario) – Dr. Ranjit Singh, President of the Association of Ontario Neurologists (AON), held a media conference today to call on the Minister of Health and Long-Term Care to establish a dialogue between the Government of Ontario, the Ontario Medical Association and the Association of Ontario Neurologists – together with other stakeholders – to deal with the growing crisis in neurology. Joining Dr. Singh at the media conference was the Association’s Vice President, Dr. Keith Meloff.
“Neurologists are specially trained physicians whose skill lies in their ability to diagnose diseases of the central (brain and spinal cord) and peripheral nervous systems,” said Dr. Singh. “Neurologists do not perform surgery, but often work closely with neurosurgeons. Diseases affecting the nervous system number nearly 600 or more, and include Parkinson's disease, Alzheimer's disease epilepsy, migraine, stroke, Lou Gehrig's disease, myasthenia gravis and diseases of the peripheral nerves. Some of these diseases are present both in children and adults, and an increasing number of these problems now plague an expanding elderly population.”
Diagnosis of most of these diseases requires careful history-taking interviews with the patient, relatives and caregivers, and a detailed physical examination of the nervous system. Although blood work, CT and MRI scanning, electroencephalography (EEG) and electromyography (EMG) are important diagnostic tools, the most important aspect of diagnosis is the time spent in a one-to-one interview and examination of the patient. Diagnosis is often difficult and sometimes elusive, and the impact on the patient and his or her family is often devastating in the more serious cases. In other cases, a patient’s life can be vastly improved – and sometimes even saved – by the timely intervention of a neurologist.
“The expertise of neurologists is also of crucial importance in the management of patients with acute stroke and diseases such as meningitis, encephalitis, acute inflammation of nerves, myasthenia gravis and botulism, as well as various forms of coma,” said Dr. Singh. “These often present as dire emergencies in emergency departments and intensive care units. Our colleagues in other specialties value our services when these are available, as management of these problems can be particularly difficult and stressful for all concerned.”
It had almost been traditional up until the 1960s to have most of our graduates in neurology concentrated in the teaching hospitals – usually referred to as centers of excellence – in the larger metropolitan areas. In the 1960s, however, there was a steady migration of neurologists to outlying communities in Ontario with populations of well over 50,000. Those neurologists practicing in these locations have proven invaluable by providing timely diagnosis and treatment, as well as relatively easy access for patients with disabling neurological problems. Unfortunately, many of these communities have grown in size so that the ratio of neurologist to community is now reaching one neurologist per 100,000 people or more.
“It doesn’t take a rocket scientist to figure out the problem here,” said Dr. Meloff. “While the work load is steadily increasing, nearly one quarter of the 225 neurologists in the province have reached or are about to reach retirement age. At the same time, we are witnessing a growing elderly population, and with it, increasingly challenging problems of degenerative diseases affecting the central and peripheral nervous systems. One also needs to keep in mind that the population of Ontario has grown nearly 5% since the year 2000. Clearly, there is no time in history where neurology services will be required more than in the next 20 years.”
Since it takes a significant time to train as a neurologist, urgent steps need to be taken by the Government of Ontario to see that the numbers needed to service the province are maintained. This means creating attractive working conditions for existing neurologists to remain in the province, as well as convincing those who moved to other provinces or abroad to return home. To achieve this goal, there must be a carefully organized strategy to see that the service levels are maintained in all affected communities, while at the same time providing staff for the teaching hospitals.
“That there is a crisis in neurology is only too apparent to those of us on the front line,” said Dr. Meloff. “It is for this reason that the Association of Ontario Neurologists has chosen at this time to speak out. Neurologists are the best and most highly qualified professionals to diagnose and treat neurological diseases. We are also in the best position to advise on appropriate strategies for dealing with these problems in the future, taking full advantage of the newer therapeutic options available. It is therefore essential that a dialogue be established at the highest level between the Government of Ontario, the Ontario Medical Association and the Association of Ontario Neurologists – together with other stakeholders, such as patient advocacy groups – to ensure that neurology is carefully nurtured as a viable and vigorously maintained specialty in the province.”
Dr. Singh agreed. “While we fully understand there are many competing demands for funds in healthcare, we feel that just as significant progress has been made in the allocation of funds for cardiologic, geriatric, orthopedic, and cancer services, so too must neurology now be added to those specialties requiring immediate attention.”
The Association of Ontario Neurologists represents the majority of neurologists in the province. Its mandate is to ensure the best possible neurological care for the citizens of Ontario and to represent the interests of its members. To learn more, please visit the Association’s Web site at www.aoneuro.on.ca.
Backgrounder
v Here are 10 things the Government of Ontario and the Ontario Medical Association could do right now to help alleviate the growing crisis in neurology:
1. Increase Consultation Fee from the current $147.00 to $175.00
The purpose of this would be to:
a. Recognize the increasing complexity of the neurological encounter; b. Provide economic catch up for the shortfall of the previous agreement; c. Achieve parity with other provinces (e.g. Alberta); and d. Retain and attract more manpower to the Province.
2. Expand the Chronic Disease Premium (E078) to include the following Neurological Disorders
- Motor Neuron Disorders (including ALS); - Complex Peripheral polyneuropathy e.g. CIDP, hereditary neuropathies (Charcot Marie Tooth);
- Myasthenia Gravis and LEMS; - Chronic myopathies (acquired and hereditary) e.g. myotonic dystrophy; - Chronic Movement Disorders; - Traumatic Brain Injury; - Chronic Daily Headache (CDH); - Stroke Care; - Cerebral Tumors; and - Congenital Malformations of the nervous system.
3. Implement all outstanding OMA Central Tariff Committee (CTC) recommendations
The OMA has approved fair and relevant fees for the funding of professional and technical fees for EEG (electroencephalography) and EMG (electromyography). The survival of many laboratories providing these vital services to patients throughout the Province will depend on this.
4. Add Complex Modifier of 25% of the consultation fee to consultations exceeding 45 minutes
This is meant to recognize the additional complexity of examination of patients with cognitive and/or language impairments as well as contentious or arcane diagnoses.
5. Introduce a Detention Fee of 25% of the consultation fee, billed at 15 minute increments, for purely administrative duties, such as
a. Seeking transfers and services for patients particularly in emergency situations (this has become particularly relevant to our specialty as we arrange urgent neurosurgical services in and out of country); b. Reviewing complex investigative results on behalf of a patient (e.g. MRI, CT Films, EMG and other results); and c. Giving telephone advice on behalf of patients who have not been seen to fellow medical practitioners.
6. Increase funding in hospitals (with suitably qualified neurologists on staff) for Electrophysiology Laboratories across the Province
The OMA Negotiating Committee must convince Government to provide increased funding to hospitals for fully staffed and equipped EMG and EEG laboratories as essential components to good neurological care, equivalent to MRI and CT scanning. This will have the additional benefit of attracting neurologists to work in these settings (community-based and academic). At the moment hospitals will not fund these facilities adequately as they do not generate a profit. This must change.
7. Establish a single code Follow-up Fee for neurology of $75.00
The purpose of this request is to remove confusion regarding how to bill follow-up of patients with neurological diseases. This is based on the following:
a. The majority of neurological cases require either extensive examination and/or extensive discussion with the patient and relatives. Most neurological disorders requiring follow-up (e.g. Parkinson’s disease, dementia, etc.) become increasingly complex over time, and this is not reflected in the present schedule of decreasing compensation per follow-up; b. Following the MRC Debacle, neurologists have been under-billing for follow-ups; and c. This fee would provide an incentive for neurologists to provide follow up for complex cases, thus removing some of the burden from others.
8. Provide a Continuing Medical Education (CME) stipend of $2,600.00 per annum for neurologists
The negotiating committee should convince the government to provide a CME stipend similar to that available to FHN/FHO groups of $2,600.00 per annum per neurologist.
9. Increase funding for chronic neurological diseases clinics
Clinics for Epilepsy, Multiple Sclerosis, Stroke Prevention, ALS, Parkinson’s disease and other disabling neurological conditions are urgently needed in community and academic settings. Disabled patients have long wait times and have to travel long distances to get support services. This should be addressed. Clinic staffing should include Physician Assistants to provide interim care more effectively. The Ontario Government must be encouraged to fund these clinics which will operate under the supervision of neurologists in a multidisciplinary setting.
10. Provide financial support/incentives for Electronic Medical Record (EMR) implementation in Neurologists’ Offices
Contact:
Stephen Skyvington President PoliTrain Inc. Phone: (416) 985-2239 E-Mail: politrain@sympatico.ca
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