now the answer to your question is NO, neurologists should not be allowed to "FORMALLY" interpret their "own" imaging, much like neurologists wouldn't want PMR docs (no knock on them) doing acute stroke and administering tPA, though in my experience with them clinically PMR is quite skilled at the neuro exam and diagnosing strokes and pushing a syringe into an IV, the reason is scope of practice, just like acute stroke is not something PMR deals with on a regular enough basis to gain the same kind of proficiency that a vascular neurologist has, neurologists do not have nearly enough experience, even in practice as attendings to interpret their own scans. neurology residency is 3+1 years, of which imaging to make a diagnosis is only a portion of what you learn, you may see several hundred scans, radiology is 4 + 1 years, of which neuroradiology is approximately 4-6 months, and with the shift in training can be up to 18 months, add to that fellowship of 2 years (1000s of scans, an order of magnitude higher), and you're comparing a physician trained in not only anatomy, pathophysiology of disease, but also in the physics of how said anatomy, pathophys produces an imaging finding, to a physician who is no where near that caliber of training, though they are "clinically better", the 1 year "neuro-imaging" fellowships do not aid you much in gaining the same expertise.
Hahahahaha!!!!!
PMNR treating stroke!!!! & using that as logic for neurologists not being allowed to read their own films.
What brilliant "surgical" logic!!! Completely unscientific & unethical as usual. The more I hear these arguements here in the US, the more I feel I am listening to business managers & bean counters in the guise of scientists & physicians.
If PMNR do EMGs & botox & it is clinically indicated, they should do it by all means. They should be taught to do it the right way. At my old residency program, which had a top-of-the-line EMG fellowship, I never saw the NM specialists ever complain about it. What I did see were some PMNR residents rotating with them for 6 months so that they could learn to do EMGs properly if they were going to do it in practice (reason given to me by one of the NM specialists when I asked him why there were PMNR residents on that day doing EMGs). I completely agree with him. God hasn't ordained the EMG for neurologists & no rule of human decency is being broken if another specialty does it, if it is clinically indicated.
I am a stroke neurologist. I would welcome PMNR treating stroke patients. I know it will be a self-defeating exercise. For PMNR never sees an acute stroke. Heck they even round on their patients once a week. Pushing tPA!!! I wonder if they even remember that IV injections should be followed by a flush!! And a PMNR's neurological exam may seem "complete" to your surgical eyes, but have you ever seen them do a speech, cranial nerves or a "neuroophthalmologic" exam (do they even know what neuroophthalmology is??!!)? Without these "underrated clinical skills", I can assure you of several vertebrobasilar/posterior cerebral artery strokes being missed between them & neuroradiologists. I would certainly support ER physicians being trained in identifying stroke patients & thrombolyzing them if it does good for the patients & improves outcomes. Again, God hasn't ordained stroke thrombolysis for vascular neurologists or neurologists. It is a tool developed to help acute stroke patients.....PERIOD.
Where as a neurologist is seeing his/her brain scans daily & sometimes making decisions even before the neuroradiologist gets to them, a PMNR only sees stroke patients 2 weeks after acute therapy (if you ever want to see how different the 2 look you are welcome to spend some time in my stroke unit & then stroll down to the PMNR floors). If I waited for my neuroradiologists to read my acute stroke scans, I would never thrombolyse 1 stroke patient in time (infact in the few stroke patients I paged them to get an opinion on, ie someone in the thrombolytic window with a possible intracranial tumor, they proved non-commital & completely unhelpful like true radiologists-it could be a tumor or a cavernoma or an abscess or everything under the Sun). I read my own scans (just like a cardiologist reads their own angios, cardiac echos, cardiac NM scans, cardiac MRIs & cardiac CT scans without 5 yrs of radiology training but with 1 year of Cardiac Imaging fellowship or sometimes even less-no one is scaring them of missing a lung tumor while reading their cardiac CT or a small pericardial sarcoma-something that may be clinically completely irrelevant).
This is the age of specialization & every clinical specialty reads its own imaging. Ortho, Rheumatology, Pulmonary Med, Ob/GYN, GI, Cards, Ophthalmology, Vascular Surgery, Epilepsy etc do it all the time. Why not neurologists who are always trained to look at the scans themselves & have a complete section on neuroradiology in their boards? Eventually specialist radiology is going to die anyway, with clinical imagers reading scans in each specialty & general radiologist reading the general stuff.
It is all about money & politics. Specializing in radiology is rubbish. Clinicians are quite capable of reading scans (as proven in cardiology & OB/GYN) & applying them appropriately in clinical situations instead of fudging about everything under the Sun because of lack of clinical experience a la radiology. Because Cardiology & Ortho have enough money to buy their own scanners & train cardiologists/Ortho residents to read them, they can get away with taking the Cardiac Imaging boards (held by the American College of Radiology). At the same time, Neurology cannot raise enough funds to install their own CT scanners or MRIs so cannot formally train their residents & fellows (who by the way also train in Neuroanatomy+Neurophysiology+Clinical Neurology & see >1000 scans per yr of their residency & >1000 specialized scans per yr of their fellowship{be it in epilepsy/pediatric neuro/stroke} compared to a 1yr {not 2 yr as you quote} fellowship trained neuroradiologist) in Neuroradiology. Even those neurologists who have been able to train in formal Neuroradiology fellowships (run by Radiologists) are not allowed to sit for the Certification of Added Qualifications in Neuroradiology examinations held by ABR because "they havent gone through a formal radiology residency"..........where is the logic.........what about radiology residency training for the
IM-Cardiology trained Cardiac Imaging Fellows???
By the time a neurologist is done with with his/her residency they have easily gone through 3000-5000 scans & do another 1000-2000 in their fellowship. Compare that to a radiology resident with 6 months of NR training with maybe another 1-2 months (shift in training getting 12 months of additional NR would not be approved by the ABR as the resident would do all his electives in NR-impossible for any board to allow) of NR electives maybe having seen 500 scans, seeing an additional 1000-1500 scans in fellowship. If formally trained, neurologist will give a better & more clinically pertinent read than any neuroradiologist. As reported by other members here, general radiologists are poorly trained in interpreting neuroradiology studies & many ER & IM docs depend on neurologists or neurosurgeons to interpret them properly-a reflection of their NR training during residency which frankly is very poor. It is another thing to read neuroanatomy/neurophysiology/neuropathology & look at scans in the basement of a building. That is completely different from learning neuroanatomy/neurophysiology/neuropathology then standing besides a patient who is having a clinical problem followed by looking at a scan to figure out what is going on. There is no replacement for clinical experience which unfortunately is not for sale in dark rooms.
As far as turfs & reimbursements are concerned, I trained for an year in the UK, spending 3 months as a neurology resident with a Queen's Square neurologist. There were no reimbursements involved when he pulled up each CT/MR after examining every patient he was consulted on. He would interpret each scan himself, then look at the report by the radiologists to confirm findings or make note of any discrepancies. May be you dont understand it because you are a surgeon, but looking at a brain scan is a natural extension of a clinical examination in neurology. This neurologist in UK, after completing his rounds would go to the neuro reading room & give a few pointers to the radiologists there about specifics of brain scan findings and have them correct their reports- all for free of course, as this is the NHS we are talking about-socialized medicine. This is pretty much what I saw the American neurologists do at my residency training program & in fellowship training. These guys are not getting paid for looking at scans. Nor at 50-60 yrs of age do they plan to go back to a neuroimaging/neuroradiology fellowships & "snatch the bread from the radiologists children". They do it because they interpret the scan in light of a clinical exam unlike a neuroradiologist.
By your "surgical" logic, I should wait for the clinical pathologist to interpret every CBC, BMP, LFT, TFT & UA for me before I make a clinical decision because I havent done a fellowship in Clinical Pathology/Laboratory Medicine. May be I should stop farting because I dont have certificate in Fartology.
Please refrain from commenting about specialties you dont have any idea about & stick to the OR.
