Read monthly updates from AAN President Ralph L. Sacco, MD, MS, FAHA, FAAN, to learn about Academy news and action on issues important to the neurology profession and patients.

December 2017

AAN Is Working Hard to Modify ABPN Maintenance of Certification (MOC)

As neurologists, we strive to provide the highest quality patient-centered care for all of our patients. We believe and take an oath that basically pledges that we can provide this care to all patients regardless of their backgrounds. Despite our best intentions, disparities in outcomes and health care exist across sex, race, ethnicity, culture, religion, region, gender identity, and other communities for many medical conditions-including neurologic disorders.

In my own professional career, I have focused much of my research on addressing health care disparities for stroke and helping to identify differences across race, ethnicity, sex, and region. Stroke disparity is just one example, and there are numerous others in our neurological profession. Identifying the difference is often the initial step, but explanations for these inequities are complex. Disparities in the incidence and outcomes for neurologic conditions are likely driven by socioeconomic and educational differences, geographic access to care, implicit and explicit biases, and other factors. Regardless of cause, much more difficult work is needed to develop interventions and correct these disparities.

We hold dear the physician-patient relationship. It is among the most intimate and trusting relationships one can have. In our busy work day, we may lose sight of this crucial dynamic. And we may forget that, along with the burden of illness, our patients may also carry into the exam room social issues that impact their ability to engage in their care. An inability to comprehend a diagnosis and course of treatment may lead a patient to neglect a doctor's recommendation; having inadequate access or no insurance may delay necessary care or put prescribed curative, preventative, or disease-modifying drugs out of reach; cultural fears and mistrusts, worries over financial hardships, or barriers of language and understanding can impact our ability to produce positive health outcomes. Added to that, our personal social biases-real or perceived, explicit or implicit-can further alter this relationship. These issues can have a direct bearing on whether the patient has a successful outcome and lead to disparities.

Addressing these disparities is critical as we seek to promote high-quality patient-centered neurologic care for an increasingly diverse and aging population. We need to develop programs and resources to help our membership better handle the specific needs of our diverse patient populations. To begin to better understand and address the issue of disparities in patient outcomes in neurologic care, I have created a presidential task force. The first meeting of our new Neurology Health Care Disparities Task Force kicked off in October. AAN Board members Brett M. Kissela, MD, FAAN, and Charlene Gamaldo, MD, FAAN, are committee chair and vice chair, respectively. The goals of this Health Care Disparities Task Force are to:

  1. Develop strategic approach to further our understanding of the current state of health care disparities among individuals suffering with neurological conditions
  2. Identify an approach for the AAN to develop interventions to reduce these health care disparities
  3. Develop methods to improve our awareness of the impact of implicit bias in the health outcomes of the neurological patient

The AAN recognizes the importance of having leaders that reflect the demographics of its members and the patients they serve. We have already invested in enriching our talent pool and training our members of diverse backgrounds through our Diversity Leadership Program. I am happy to report that the third graduating class this October has already helped kick-start this task force by presenting their collective thoughts and recommendations on ways that the AAN can help address neurological disparities. With this excellent foundation, we are confident that our task force will provide some important recommendations and strategies to help move the AAN forward and be a leader in this area.

We anticipate that the creation and implementation of these strategies will require input and involvement across the AAN, from science, education, and practice, to member engagement, government relations, and even our Axon Registry®. The Neurology Health Care Disparities Task Force will present its final report to the board in June 2018. We look forward to helping our members and our patients tackle this critical issue with a goal of achieving equity for all with neurological conditions. 

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