Expanding the Scope of Neurology: An Interview with Ralph L. Sacco, MD

When Ralph L. Sacco, MD, MS, FAHA, FAAN, assumed his role as President of the American Academy of Neurology (AAN) at the recent AAN Annual Meeting in Boston, he had both a clear vision for the future of neurology and a plan for how to get there. “It's all about teamwork and collaboration across organizations and national boundaries, as well as bringing many constituencies and subspecialties of neurology together,” said Dr. Sacco in an interview with Practical Neurology® magazine. As the first neurologist to serve as president of the American Heart Association (from 2010 to 2011), Dr. Sacco knows something about the importance collaborative and multidisciplinary care, and he is making it a focus of his platform as incoming AAN President: “To provide state of the art care of complex neurological patients, we have to work in teams. Providing integrated and multidisciplinary care requires neurologists to work with a number of different specialists, including rehab physicians, neuropsychologists, neurosurgeons, and multiple professional groups.”

According to Dr. Sacco, this collaborative mindset should extend beyond clinical care and also encompass organizational aspects of the specialty. “The AAN is the largest professional society for neurologists in the world, and we are trying to work across specialties and constituencies to both coordinate and collaborate with the multiple voices of neurology.” That means expanding the reach of the Academy to more fully engage international collaborators, patient-centered organizations, and particularly advance practice providers, he observed. “Advance practice providers are growing fast in our organization, and we want to make sure we can engage them fully in our multidisciplinary team care required for neurological patients,” he said.

Another point of emphasis in Dr. Sacco's tenure will be personal and professional wellness. One of the most significant challenges facing neurologists and the specialty as a whole is burnout, according to Dr. Sacco. “One of the biggest drivers of burnout is regulatory burden that doesn't have specific value to the care of patients. Our last President, Dr. Terrence L. Cascino had created a task force to address burnout among neurologists,” he noted. “We are continuing that task force activity and turning it into a wellness task force to begin to think about ways to mitigate and reduce burnout and improve the lives of our neurology members.”

At the last two AAN Annual Meetings, many features have been added to modernize educational formats, said Dr. Sacco. Among these is a collection of wellness programs directed at individual members to enhance resilience, such as yoga and tips for handling stress. The AAN has also created more experiential learning sessions, including “Ask the Expert” panels, difficult cases, and special debate formats. “We've incorporated a lot of different approaches to bring education to our members in a more contemporary fashion for both individual and educational enrichment,” Dr. Sacco explained.

The AAN is also addressing wellness and burnout through their Government Relationships Committee to coordinate with CMS and federal regulators in an effort to improve the practice of neurology and reduce regulatory hassle. Telemedicine is also a major part of this platform. “We're trying to expand access through better reimbursements for telemedicine, which will improve our ability to care for the growing number of patients with neurological conditions,” according to Dr. Sacco.

Another challenge facing the specialty that Dr. Sacco intends to address in his tenure is the workforce shortage. Roughly 2.6 percent of US medical students choose neurology as a profession, which has remained stable for too long, according to Dr. Sacco. “To meet the demand for neurological care by an aging population, we are actively working on programs to stimulate more students to get excited about careers in neurology,” he says.

Dr. Sacco is hopeful that the Academy's strategies to improve wellness and collaboration at various levels will expand the scope of neurology practice and encourage greater participation in the field. “Neurology needs to be thought of as interventional, preventive, and also as a regenerative specialty. If we can get more people thinking about how we can cure, treat, prevent, and hopefully even regenerate neurological conditions, in the future we can also get more medical students interested in our profession,” he noted. “We've made a lot of strides, and the research discoveries in the last few years are putting us at a great point to bring some of these strides much more into the clinic.”