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	𝑃 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	𝑃 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	𝑃 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.”