I completed my undergraduate studies at the University of Michigan in 1999 and graduated with high honors in Cellular and Molecular Biology. I graduated from the University of Pennsylvania Medical School in 2004. After an internship in Internal Medicine, I entered the Neurology residency program at the University of Pennsylvania. I then joined the University of Michigan as a clinical neuromuscular fellow in July of 2008, and completed a two-year research fellowship on a NIH T32 training grant. Michigan. In April 2011, I completed a Master’s of Science program in Clinical Research Design and Statistical Analysis. This program provides physicians with rigorous course work in biostatistics, epidemiology, clinical trial design, SAS programming, cost effectiveness, research ethics, and survey design. I was also part of the Clinical Research Mentoring Program which provides the structure needed for young investigators to learn how to write grants, establish a scientific advisory committee, obtain IRB approval for studies, and execute a research proposal. In July 2011, I became an Assistant Professor at the University of Michigan.
My research focus is on improving the efficiency of neurologic diagnostic testing. I am specifically interested in neuroimaging for headache, which is one of the most common reasons for a patient to seek medical care. I have also studied where our country spends money in regards to neurologic care, which has potential policy ramifications. I was involved in a project that determined that we spend more money on neurologist ordered MRIs than we do on neurologists’ office visits. Electrodiagnostic tests and electroencephalograms accounted for the next highest aggregate costs from testing. I also contributed to work that investigated the proportion of a neurologist salary that comes from procedures versus evaluation and management of patients. We found that most neurologists receive greater than 60% of their revenue from evaluation and management, but neurologists are not included in Medicare and Medicaid reimbursement programs to encourage these services. My work has also led to one Choosing Wisely recommendation to not perform MRIs for patients with distal symmetric polyneuropathy. I have a second Choosing Wisely recommendation relating to electrodiagnostic testing in patients with diabetes and distal symmetric polyneuropathy that is under consideration as well. I have identified over 70 Choosing Wisely recommendations that pertain to neurologists, and proposed the best way to prioritize these targets.
I have investigated the appropriateness of diagnostic testing in patients with distal symmetric polyneuropathy. To date, I have found that despite guidelines, both general practitioners and neurologists order a large number of tests, with great variation in the type of tests ordered. Even with a high number of tests ordered, the guideline recommended tests are often not performed. These simple, inexpensive blood tests frequently lead to a change in management of DSP patients. In contrast, electrodiagnostic tests and MRI of the brain and/or spine rarely change management of these patients despite being frequently performed and contributing to most of the cost associated with the evaluation of DSP. I have contributed to the understanding of the causes of neuropathy for patients with and without diabetes. I completed a Cochrane review that demonstrated that glycemic control prevented neuropathy robustly in patients with type 1 diabetes, but much less so in those with type 2 diabetes. This result indicated that there are key differences between type 1 and type 2 diabetes, which may include metabolic syndrome components. I am currently investigating these relationships in my K23 funded project