A new era of neurologic practice, the need to shift the residency training paradigm, and the importance of hospitalist neurology.

Neurologists are a small (∼3%) highly subspecialized segment of the US physician workforce providing added value to care of patients with routine and complex neurological conditions. Over time, we have grown from providing mainly cognitive and electrophysiology diagnostic services to providing patients with sophisticated diagnostic, management, and preventive options. We are faced with new challenges with the Affordable Care Act (ACA). The ACA emphasizes primary care-based approaches and encourages preventive services, but neurology is not recognized as a primary home for patients with neurological disease. Furthermore, ACA will result in declines in volume-driven care in favor of “value-added care,” and we anticipate that specialty consultations and diagnostic testing will be major targets for cost savings. The US physicians are being challenged to make adaptive changes as reimbursements diminish. In this new medical practice era, paradigm shifts in residency training, and subsequent practice patterns, are necessary. Consequently, we advocate for residency training in primary care and hospitalist neurology and other complementary changes to secure the future of Neurology.