Neurology - a dying field?

[Pinky]

Having finished my third year rotations and radiology, I'm getting the sense that neurology is a dying field. It seems that many of the problems of the CNS are now in the realm of neurosurgery, neurointerventional radiology, or internal medicine. Is this an accurate assessment of this field? The internists are able to treat Parkinsons, Seizures, Headache, and vertigo. Much of the spinal cord pathology is taken care of by the neurosurgeons. AVMs and stenosed carotids, are treated by the neurointervetionalists.

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[together]

Medicine in its entirety is becoming super-sub-specialized. What were once broad medical fields (i.e., neurology) are now becoming multi-interdisciplinary enterprises (i.e., pediatric neuropsychiatry). With the surge of neuroscience research developments popping up all over the world, neuro-specialists of every stripe will be in great demand in the years ahead. As it is, neurologists require fellowship training in a particular sub-field of neurology before entering into private or group practice.

I also heard that neurology and psychiatry departments will be merging together in the near future insofar as psychiatry is becoming more biologically-based rather than psychoanalytic. There are many books and papers on the topic. Andreasen (MD/PhD and Editor-in-Chief of the DSM) has a new book called "Brave New Brain (Oxford U.P.)" that captures the current state of psychiatry very well.

Feel free to e-mail me.

Together

 

[Rusty]

Originally posted by Pinky:
•Having finished my third year rotations and radiology, I'm getting the sense that neurology is a dying field. It seems that many of the problems of the CNS are now in the realm of neurosurgery, neurointerventional radiology, or internal medicine. Is this an accurate assessment of this field? The internists are able to treat Parkinsons, Seizures, Headache, and vertigo. Much of the spinal cord pathology is taken care of by the neurosurgeons. AVMs and stenosed carotids, are treated by the neurointervetionalists.

•

Neurology is a broad specialty of medicine. Over the last 2 decades, neurology has evolved into a more subspecialized field and shifted to an outpatient vs. inpatient focus for many conditions. Internists are probably less comfortable treating MS, Parkinsons, stroke, ALS, vertigo, headaches, or any of the other areas of neurology than they are in treating hyperthyroidism, osteomyelitis, unstable angina, renal failure or any other common treatable medical conditions. Neuroradiologists have a niche in treating a limited number of neurological conditions. Neurosurgeons are surgeons and limit themselves to conditions that require surgery, which is a very very small portion of spinal cord pathology or neurological problems in general.

None of the other specialties of medicine which are involed in the treatment of neurological problems have the time, experience, training or knowledge of the intricacies of the nervous system to act as primary care physicians in the diagnosis and treatment of most neurological problems. Many students views of neurology are tainted by the false belief held by many internists that most neurological problems are chronic in nature and untreatable. Neurology is an ever evolving specialty field of medicine which is only likely to increase in its importance as the population ages.

 

[Neurogirl]

I agree with Dr. Rusty. The internists I work with are MORE than happy to consult neurology for almost all neuro problems. They might be comfortable caring for neuro patients AFTER the neurologist has diagnosed the condition and formulated a plan of action, but most are NOT eager to diagnose or initiate treatment. Also, as previously stated, neurosurgeons care for only a small percentage of patients and they are always consulted by the neurolgist...not the internist.

 

[MikeS 78]

ya since when did internists, or any generalist for that matter, start taking on responsibilities of formerly relegated to specialists....if anything those guys try to refer off anything outside of the realm of very common and easily treated conditions to someone to who deals with it all the time.......its a lil thing called liability guys

and since when did medicine start losing specialties.....usually its much more likely to pick up about 10 sub-specialties long before it loses 1