Different types of neurologist.

Most neurologists in the United Kingdom work in regional neurological and neurosurgical centres in or linked to university teaching hospitals. Such centres usually have two or more neurologists and neurosurgeons and at least one neuroradiologist, clinical neurophysiologist, and neuropathologist; they also provide scanning facilities and other neuroradiological and neurophysiological equipment. This concentration of skill, usually in large conurbations, means that many people live many miles from their nearest neurologist. Although many neurologists visit their neighbouring district general hospitals to run outpatient clinics and advise on inpatients, some hospitals are too far away from the main centres to make this practicable, and then their only contact is by telephone and transfer of patients. This set up is far from ideal and is aggravated by the small number of neurologists and their uneven geographical distribu? tion. My own, admittedly rough, calculations suggest that there are 158 consultant neurologists and about 18 honorary consultants in the United Kingdom and that the provision of consultant sessions varies from about 3-6 per 100 000 population in the four Thames health regions to only 1-6-1-9 in Wales, Wessex, and Trent. Understandably, therefore, some physicians have considered that their patients, and their hospitals, might be better served by the creation of posts for physicians with an interest in neurology. These physicians would be based at the district general hospital and would take a full share in the acute general admissions as well as providing a neurological opinion, referring more unusual cases, when necessary, to regional centres for more complex investigations and neurosurgical treatment. Advertisements for general physicians often indicate that an interest in a medical specialty such as gastroenterology or diabetes would be an advantage. An interest in neurology is never specified, for the simple reason that the policy of the specialty is to train pure neurologists, a policy that was reaffirmed in 1979 and 1982 by the committee on neurology of the Royal College of Physicians.