As nonprocedural specialists, with a lot of their reimbursements coming from management and evaluation codes, neurologists are now paid less than primary care docs for that management of a patient, since the primary care docs get a bonus for such care under the Affordable Care Act. The AAN is lobbying to get neurologists included as primary care docs and get those bonuses.
"A major concern is that designating a sub-specialist as a primary care provider because she or he evaluates and manages that single condition or disease for which that subspecialist has been trained will fragment care at the time we need to break down such silos of care," AAFP President Reid Blackwelder, MD, told MedPage Today in an email. "If an Alzheimer's patient has a heart condition, a skin disease and diabetes, who is the primary care provider: the neurologist, the cardiologist, the dermatologist or the endocrinologist?"
Or if an multiple sclerosis patient has, oh say, hmmmmm, a jugular outflow obstruction, who is the primary care provider?
I think we've experienced what it would be like if our neurologists were our primary care docs, and I am opposed.