Factors Associated with Neurologists’ Provision of MS Patient Care
Table 2
MS patients seen per week for MS subspecialists versus Non-MS subspecialists/general neurologists.
MS subspecialists†
Non-MS subspecialists and general neurologists
Mean number of MS patients seen per week
Standard deviation
value for difference in means for number of MS patients seen by IV if MS subspecialist*
Mean number of MS patients seen per week
Standard deviation
value for difference in means for number of MS patients seen by IV if non-MS subspecialist or general neurologist*
% seeing zero MS patients per week
value for difference in %**
Total study population
25.33
16.51
—
3.47
3.30
—
20.99
—
Subspecialty status
Non-MS subspecialist
—
—
—
3.16
3.17
0.0003
23.90
0.003
General neurologists
—
—
—
4.43
3.42
11.21
Practice arrangement
Solo practice
23.19
10.55
0.5788
3.92
3.35
0.0001
12.20
0.000
Neurology group
25.86
19.15
4.59
3.46
11.57
Multispecialty group
28.82
15.70
4.40
3.60
16.67
University based group
24.88
18.87
1.52
2.12
54.10
Other‡
15.50
10.21
2.94
2.93
16.07
Unknown
28.33
16.04
2.28
2.71
29.87
Demographic characteristics
Age
44 years or less
28.27
19.25
0.2289
2.79
3.24
0.0047
29.03
0.026
45 to 53 years
24.74
15.80
3.64
3.23
19.01
54 to 59 years
22.12
14.58
4.17
3.46
15.25
60 years or more
30.14
18.55
3.56
3.17
15.93
Sex
Male
25.42
17.46
0.9281
3.72
3.33
0.0042
18.60
0.055
Female
25.12
14.39
2.86
3.16
26.43
White
Yes
24.67
16.39
0.7982
3.78
3.44
0.3742
20.00
0.714
No
24.44
19.11
3.36
3.22
18.28
Asian
Yes
24.44
19.11
0.7982
3.37
3.14
0.4811
18.07
0.694
No
24.67
16.39
3.77
3.45
20.00
Other race
Yes
—
—
—
3.50
4.15
0.5701
23.08
0.725
No
24.64
16.59
3.69
3.37
19.48
Hispanic or Latino
Yes
27.50
10.41
0.3782
2.61
2.69
0.1598
25.00
0.485
No
25.41
17.19
3.68
3.34
19.17
Year began medical practice after completing medical training
1972 to 1985
33.00
18.84
0.0816
3.85
3.49
0.0020
16.26
0.071
1986 to 1993
22.25
13.63
3.51
3.33
22.33
1994 to 2001
25.73
16.04
3.92
3.26
18.25
2002 to 2011
23.23
19.89
2.55
2.99
29.03
Negative attitudes towards providing MS patient care
Care for MS patients takes too much time
Yes
26.50
19.34
0.8910
3.64
3.26
0.3922
14.94
0.126
No
24.48
14.27
3.43
3.32
22.31
Insufficient reimbursement for time involved
Yes
28.82
19.13
0.1157
4.15
3.33
0.0051
11.21
0.003
No
22.43
13.49
3.26
3.27
24.05
Lack of sufficient knowledge to feel comfortable caring for this patient population
Yes
—
—
—
0.90
1.47
0.0000
56.25
0.000
No
25.33
16.51
3.66
3.32
18.50
Lack of sufficient knowledge regarding newer disease-modifying drugs
Yes
25.00
—
0.5968
1.76
2.19
0.0000
33.90
0.009
No
25.33
16.60
3.70
3.36
19.20
Lack of special personnel (nurses, social workers, etc.)
Yes
25.50
19.47
0.4365
3.23
3.04
0.6404
16.52
0.178
No
25.26
15.38
3.55
3.38
22.37
Little can be done to improve MS patients’ outcomes
Yes
—
—
—
1.00
—
0.3370
0.00
1.000
No
25.33
16.51
3.48
3.31
21.07
Seldom encounter MS patients
Yes
—
—
—
1.06
1.88
0.0000
48.57
0.000
No
25.33
16.51
3.87
3.32
16.35
MS patients are often difficult to treat
Yes
32.50
19.94
0.3290
3.04
2.87
0.5750
16.67
0.439
No
24.79
16.24
3.52
3.35
21.46
MS patients often have multiple comorbidities
Yes
25.85
14.34
0.6909
3.47
2.82
0.4041
10.00
0.015
No
25.17
17.21
3.47
3.38
22.84
Providing care to MS patients is not sustainable in my practice environment due to time or reimbursement constraints
Yes
28.75
13.02
0.1764
3.60
3.30
0.7362
18.37
0.635
No
24.97
16.85
3.46
3.31
21.28
Positive attitudes towards providing MS patient care
Ability to improve patient outcomes and quality of life
Yes
25.13
16.55
0.6074
3.94
3.26
0.0000
12.57
0.000
No
28.00
17.15
1.73
2.88
51.92
Dynamic area with evolving treatment options
Yes
25.95
16.76
0.1779
4.40
3.37
0.0000
10.74
0.000
No
20.60
14.32
2.30
2.81
33.80
Care involving a multidisciplinary approach
Yes
27.96
18.29
0.0952
4.02
3.43
0.0286
13.79
0.029
No
21.29
12.53
3.30
3.25
23.24
Research opportunities
Yes
27.45
18.67
0.1364
4.11
3.23
0.0621
16.67
0.380
No
21.91
11.74
3.38
3.31
21.60
Personal connection to individuals with MS who are not your patients
Yes
30.69
17.51
0.0676
4.16
3.22
0.1402
15.15
0.394
No
24.10
16.15
3.42
3.31
21.41
Enjoy interacting with MS patients
Yes
28.92
17.98
0.0010
4.79
3.36
0.0000
6.94
0.000
No
16.56
6.64
2.71
3.03
28.75
Community of dedicated professional colleagues with which to interact
Yes
25.63
17.73
0.8752
3.59
3.29
0.5766
20.00
0.786
No
25.02
15.39
3.44
3.31
21.24
Practice characteristics
Area in which you are practicing
Within a major city (population greater than 250,000)
27.20
18.36
0.5061
2.92
3.07
0.0017
28.63
0.000
Suburban or moderate-sized city (population 50,000 to 250,000)
22.86
14.01
3.91
3.49
15.47
Rural area or small city (population less than 50,000)
22.86
12.20
4.06
3.24
10.29
Note: The sample excludes neurologists who have limited patient care responsibilities. Specifically, the sample excludes neurologists who provide direct patient care for less than 40 weeks per year and neurologists who do not have a clinical practice. Wilcoxon-Mann-Whitney tests were calculated for independent variables with two categories. Kruskal Wallis tests were calculated for independent variables with three or more categories. Chi-square tests or, as necessary due to small cell sizes, Fisher’s exact tests were performed. MS subspecialists answered “Yes, and I chose a fellowship in MS” to question “Did you consider a fellowship in MS as subspecialty training?” and, on average, saw at least one MS patient per week. Respondents who did not complete an MS fellowship were categorized as MS subspecialists if indicated that they saw, on average, more than 12 MS patient seen per week. The “other” category includes neurologists who responded “staff-model HMO,” “government hospital or clinic,” or “other public or private hospital or clinic setting” to question “Indicate in which practice arrangement you spend the majority of your clinical time.”