The future...

[NewmansOwn]

Good morning all-

I notice that despite the relatively large number of people viewing this forum, it doesn't seem to be particularly high-traffic. I hope, thus, you welcome questions from outsiders, but please correct me if I'm wrong...

I won't bore you with tired questions regarding salaries, lifestyle, etc...there are no hard answers to those, anyway. My question is regarding the future and evolution of neurology as a field: With the advent of more advanced radiographic imaging techniques, as well as interventional subspecialization of radiology in general, do you feel neurology is in any danger of becoming obsolete? For instance, the neurological exam, unchaged for the last 100 years...will it be useless in the face of advanced topographic brain images, etc?

Alarmingly few students in medical school talk about neurology these days. While everyone seems to want to know every detail about practice in every specialty, neurology seems somehow largely ignored. The salaries are considerably above those of primary care and the lifestyle is widely agreed to be controllable. So, in an age of self-interest in medicine where dermatology is king, why is neurology overlooked?

Thanks for reading; any insight from experienced persons is greatly appreciated. Also, I know from experience that these forums tend to be very sensitive, especially when one questions, however lightly, an individual specialty. If my post in any way offends a reader, please remember I am very interested in neurology for myself, and am in no way a troll. I offer a preemptive apology to anyone who I may rub the wrong way.

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[neurologist]

Neurology is just not (and never really has been) a wildly popular field. There are any number of reasons for this ranging from the tedious way that neuroanatomy is taught in most 1st year med schools, to the perception that neurologists can't do much in the way of treatment, to the fact that although (as you point out) the salary is generally better than FP or general IM, it's still near the bottom of specialty salaries.

Nevertheless, I don't think neuro is in any danger of dying out, for a varieity of reasons.

First, the bottom line is that nobody other than neurologists knows a damn thing worthwile about neurology. Most FPs and IMs are pretty adept at treating hypertension, diabetes, even some basic depression, but as soon as anything remotely neurologic comes their way, 95% of them immediately raise the white flag and fire off a consult to the nearest neurologist. And that's OK by me, since it keeps me in business.

Second, as far as imaging goes, well, images are just images. Someone's gotta translate imaging findings into a diagnostic and therapeutic framework. And unless radiologists are planning to start seeing and treating patients laugh, my job is safe. And remember the famous saying: "The neurologist's job starts when the MRI comes back normal."

The neurologic exam is unchanged in 100 years because it's an effective screening tool. You can actually go into far, far, more detail on the neuro exam (testing individual muscles, dermatomes, etc, and especially with cognitive tests) but 95% of the time it's unnecessary to go beyond the basic exam to get a good sense of what's going on. Subsequent imaging is a useful and often necessary followup, but it's not the be all and end all.

Basically, neurology is a highly self-selected group of people who tend to be very cerebral (pun semi-intended) and detail oriented. Most of us (wanna-be interventional-IR people aside) like being "thinkers" rather than "doers" and don't mind if it takes 12 months of trial and error to get a handle on some patient's chronic problem.

While I won't say that money is unimportant (I frankly wouldn't be doing this job for $30,000 a year), it's not what really drives most of us. We like the general logic of the nervous system. As a neurophysiologist, I also get a kick out of being able to do an EEG or EMG and see clear objective correlation of symptoms with test abnormality.

So, basically, neuro is not going away any time soon. It will change (as will much of medicine) over the next 50 years as genetics becomes a bigger and bigger slice of medicine (IMHO, this is going to bump rads as the real "specialty of the future") but it will always be around.

 

[sonicgirl]

eloquently put, neurologist.
i couldn't agree more, especially about the fact that when a complaint sounds even remotely neurologic in origin, physicians of other specialites run screaming into the night. that's where we come in.

 

[minstral]

Well put, as a neuro resident to be, I tend to agree with you.

I want one random sampling. Neuro, can you gvie me your profile:

Fellowship training
Years in practice
Starting Salary and Current Salary
Univeristy or community affiliated
Malpractice insurance costs
and State or region you practice?

Its hard to get real answers unless you are in the game.

thanks