The American Academy of Neurology has prioritized brain health through prevention, early detection, and longitudinal care. However, these goals depend on a stable and engaged neurology workforce. This article examines professional fulfillment as a structural determinant of workforce stability, continuity of care, and system performance. Emerging evidence demonstrates that burnout and professional fulfillment are related but distinct constructs. While burnout reflects occupational distress, fulfillment is associated with meaningful work, recognition, supportive leadership, and alignment between professional values and daily practice. Structural factors including work design, administrative burden, leadership quality, and psychological safety influence both outcomes. Approximately one-third of neurologists report intent to leave their organization within 2 years, raising concerns about workforce sustainability. Efforts to improve neurologic care must therefore extend beyond burnout mitigation to actively promote fulfillment. Measuring and improving professional fulfillment may strengthen retention, preserve continuity of care, and support long-term brain health initiatives in neurology.
BACKGROUND AND OBJECTIVES:The aim of this study was to quantify the relative percentage of patients with neurosarcoidosis who demonstrate persistent gadolinium enhancement on MRI, despite apparent clinical remission. METHODS:Data from 39 patients with neurosarcoidosis were collected retrospectively for use in electronic chart analysis. Data were anonymized, and patient data (demographics, clinical presentation, radiographic characteristics, and treatment profile) were collected. Standard descriptive statistics were performed, comparing populations with and without persistent gadolinium enhancement. RESULTS:There was no significant difference in disease and treatment data between patient groups with and without persistent gadolinium enhancement. Persistent gadolinium enhancement was common and not associated with clinical disease activity in patients with neurosarcoidosis. There was no correlation between radiographic and clinical improvements. DISCUSSION:Our study demonstrates that persistent gadolinium enhancement is common and does not necessarily correspond to active disease. Given that neurosarcoidosis is commonly monitored with serial MR imaging, these data suggest that persistent enhancement alone should not be used to guide treatment and needs to be taken in the context of the patients' clinical status, previous imaging findings, and examination.
BACKGROUND:Neurologic disorders are a leading cause of disability worldwide, yet US specialty care remains fragmented and reactive. Integrated population-health models that embed neurology within coordinated systems can improve access, efficiency, and outcomes. RECENT FINDINGS:We reviewed case studies from 5 diverse academic health systems-Cleveland Clinic, Mayo Clinic, Mass General Brigham, Kaiser Permanente, and Vanderbilt University Medical Center. Strategies included embedding neurologists in primary care, deploying low-cost telehealth networks, and aligning incentives for value-based care. These programs demonstrated improved timeliness, patient satisfaction, and resource utilization, while highlighting persistent challenges such as reimbursement uncertainty, workforce burnout, and digital inequities. IMPLICATIONS FOR PRACTICE:Key elements-team-based care, telehealth, and shared governance-are adaptable beyond large academic centers. Transparent cost analyses, alternative payment models, and policies addressing licensure and equity will be essential to scale integrated neurology and sustain innovation across community and rural settings.
