Alzheimer's disease and the modified role of the neurologist in today's healthcare environment

Alzheimer's disease (AD) is a global priority public health problem, such that health ministries worldwide and medical education sectors alike need to prioritize resources for dementia research, education, and treatment. Many American opinion leaders in neurology hold to the maxim that the rising incidence and prevalence of AD in an aging population will create an increasing demand for the services of neurologists. With managed care on the march, however, a declining workload for practicing neurologists is far more likely, because until 2010 the number of neurologists will continue to expand more rapidly than the increasing burden of illness. Reform of medical education in support of the World Health Organization "Health for All" initiative can provide all physicians with a population-based perspective and a sense of social mission that encourages appropriate utilization of specialized resources and personnel. In the era of managed care, neurologic education should be broadened into the domain of mental illness to increase practice opportunities for graduating residents as behavioral neuroscientists. The capacity of AD referral centers to thrive in a cost-conscious managed care environment is crucially dependent on the ability and willingness of office-based neurologists with managed care contracts to make appropriate patient referrals to such centers. Neurologists who question the capacity of primary care physicians to provide the full range of specialized services should likewise question the quality of tertiary care carried out in a community framework of service provision.