My feeling is that there are 4 reasons why people don't go into neurology:
1. It's true that cures or near cures are not easy to find in this field (not counting interventional neurology). Occasionally, one can use IVIG or plasmapheresis to treat certain rare acute autoimmune diseases. Certain neuro-infectious diseases are often diagnosed and then cured by neurologists. Epilepsy can be essentially cured often times, as well as certain sleep disorders. And, yes, the stroke neurologist can cure about 2% of their acute stroke patients with tPA (assuming a tPA rate of about 15% and a NNT around 7). But compare this to cardiology, oncology, GI, general surgery, orthopedics, etc. where cures are the common goal. This is the single most clear deterrent to going into neurology.
2. Average income statistics for neurologists are not that great ($170k/yr). Making $200k/yr straight out of residency isn't hard, but only if one is willing to do EMG's, sleep and/or botox injections 50% of the time. To do the real interesting stuff, you get paid less (except in stroke and critical care... and of course interventional...)
3. There aren't many "cool" procedures in the field, again except for interventional and neurocritical care (where one can do bedside intracranial procedures fairly frequently).
4. Exposure in medical school is to a complicated messy course in neuroanatomy, a poorly inpatient run rotation often in the fourth year, and a bad reputation.
Keeping stroke/critical care/interventional aside, there are equally 4 reasons to choose neurology over every other field in my opinion:
1. While you may not be to do the miraculous neurosurgical cure of a brain tumor, the neurologist (especially those that love the field) has the opportunity to make a remarkable diagnosis for patient that has eluded many doctors prior. Sherlock Holmes, I believe is modelled after a neurologist in London. I have seen patients who have gotten spinal surgery, multiple painful procedures of various sorts, been tossed around from doctor to doctor, only to finally see a neurologist who makes the diagnosis of MS and stops the unnecessary harm.
2. Neuroscience is obviously the most intersting topic in the world. It cross-sections philosophy, economics, ethics, art, biology, evolution, etc, and gives great opportunities to physician-scientists, physician-ethicists, etc.
3. It is the fastest growing specialty and has more funding from the government than any other specialty (including basic science awards). The rate of advance is accelerating, and is exhilirating to watch and be a part of. While it is financially rewarding to be in a field at its peak (cards), I and other neurology residents are betting that neurology will pay off nicely in the long run.
4. As a neurologist, you can make immense difference in patients lives, particularly for those who are "watching their own funerals". MS patients, relieved from simply being properly diagnosed, can now take treatment that delays further attacks by an average of 2 years, and lessen the impact of each attack thereafter by proper further treatment. A new additional treatment has just been announced in the NEJM, and other await. The choice of treatment is complex as is the diagnosis and the long-term management making it difficult to simply apply an algorithm that is taught to the GP. Epilepsy is more obvious. So are movement disorders. Just wait for the same thing to happen for stroke, neurological tumors, and maybe even neurodegenerative diseases...
B
