There are going to be a lot of different opinions on this topic for sure, but I think it's an important conversation.
I believe the competent "general neurologist" is on its way to extinction. That being said, I am referring to general neurologists in the sense that they have been historically--primary outpatient general neurologists who can perhaps take care of 95% of patients that walk through the door throughout the course of their disease, whether it be MG, MS, PD, JME, IIH, ALS, DLB, etc. while being able to perform EMG, EEG, and Botox.
It is my opinion that the increasing complexity of hospital/emergency neurology along with "neurophobia" of hospital-based providers (along with increase in APPs) has led to a great need for around-the-clock inpatient neurology coverage. This has in turn led to limiting neurology resident exposure to outpatient neurology--even much of what has typically been considered "bread and butter". Unfortunately many residencies in existence today have severely limited outpatient neurology exposure, and you can graduate from many without any significant experience interpreting EMG/EEG. In tandem with severe limitation of outpatient exposure, the expansion of the range of diagnosable conditions and therapeutic options has worsened the problem. Most neurologists know about NMDA, but what about mGluR1 or KLHL11? Those are just a few of a ton of new antibody-associated disorders. Previously graduating neurologists could be competent with Copaxone, interferons, and a handful of AEDs, but now there are about 50 different medications for MS and epilepsy alone, most with unique side effects and varying degrees of required monitoring. Even the headache world has exploded with a wide array of therapeutic options.
That being said, I do believe it is still possible to be a competent "general neurologist" in the classical sense of the phrase (notice I am referring to a competent general neurologist rather than simply a practicing general neurologist that makes good money). I think there are some important prerequisites and required actions. I think you have to be adaptable, hard-working, and intelligent. I think you have to work hard in residency beyond what is required. If you don't complete residency at a place where you graduate with solid experience in EMG/EEG, you will need to do a fellowship or make the decision to refer out for EMG or EEG. With rare exceptions, I think that topping off residency training with additional fellowship training will best equip you to be a good outpatient general neurologist.
