The predicated future shortfall of neurologists to care for our aging population is well-documented.  This has spurned new residency programs and efforts to increase student interest in pursuing neurology training.  Pipeline processes are needed to add new neurologists to the work-force.  However, burnout amongst existing neurologists is driving turnover and contributing to the shortage through early retirement, “specialty regret” and deterring future trainees.  Working long hours trying to manage out-patient practices while covering the hospital and call is a known driver of burnout. 

In 2014 all employed neurologists at Geisinger Medical Center maintained out-patient practices, rotated on the neurology in-patient service and took call (including stroke call).   We faced escalating turnover rates and had difficulties recruiting.  Our wait list for out-patient care was increasing and we were barely able to cover the call schedule.  During 2015-6 we instituted a neuro-hospitalist program to cover the in-patient services and call using two 12 hour shifts every day and working a 7 on 7 off schedule.  We retrospectively reviewed staffing levels, turnover, out-patient productivity and patient satisfaction scores before and after this intervention.

By 2019 we had 6.75 FTE neuro-hospitalists.  We had been able to recruit and retain new subspecialty out-patient neurology providers without weekend or call responsibilities.  The department had grown by over 60% with increased out-patient productivity and patient satisfaction scores (see table).

Instituting a neuro-hospitalist program and allowing subspecialty neurologists to develop out-patient practices without weekend or call responsibilities facilitates recruitment, reduces turnover and increases individual out-patient productivity and patient satisfaction scores.