Neurohospitalists: Challenges for the Integration of a New Field: A Neurointensivist's Perspective

Is fellowship training necessary for neurohospitalists?

Neurohospitalists are an emerging subspecialty group in neurology.(1) A recent survey of neurohospitalists found 75% of respondents had completed general neurology residency plus additional fellowship training (54% vascular neurology, 13% neurocritical care, and 33% other).(2) A limited number of neurohospitalist fellowship positions(3,4) are offered in the United States, however, a standardized curriculum or subspecialty certification examination does not currently exist. Given the recent dialogue surrounding the utility of neurohospitalist fellowship training, the purpose of this article is to provide 2 contrasting perspectives on the perceived need for neurohospitalist fellowship training.

Neurohospitalists: an emerging subspecialty

Akin to the rapid growth in hospitalist medicine seen in the prior decade, there has been a recent explosion in the need for neurohospitalists. Factors driving this demand include nationally mandated quality and safety measures, the increasing complexity and age of the hospitalized patient, and diminished training in diagnosis and management of neurological illnesses for internal medicine residents. The role of the neurohospitalist is varied and may include not only providing neurological care to hospitalized patients but also serving as a leader in an institution's push to meet quality and safety measures. Close collaboration with intensivists, vascular neurologists, and outpatient neurologists is both a challenge and essential for successful delivery of care both during hospitalization and after discharge. Future challenges facing neurohospitalists include defining its relationship to other fields, instituting a pathway for certification, and conducting research to guide the development of evidence-based practice and quality measures.