Neurologists are physician specialists who diagnose and treat patients with diseases and disorders affecting such areas as the brain, spinal cord, peripheral nerves, muscles, and autonomic nervous system.
Neurologist Career History
The development of modern neurology began in the 18th and 19th centuries. Studies were performed on animals in order to understand how the human brain functioned. Although these early studies produced some useful information, major research in the field of neurology did not begin until the end of the 19th century. Aphasia, epilepsy, and motor problems were targeted and researched. Techniques for brain mapping were also introduced in an effort to determine the locations of functional areas.
In the early 1920s, Hans Berger invented the electroencephalograph, which records the electrical activity in the brain. This achievement led to greater capabilities in diagnosis, treatment, and rehabilitation. During the late 20th century, neurology was further advanced by computerized axial tomography (CAT scans), nuclear magnetic resonance, and neurosurgery.
By the 21st century, continued research led to better drug therapies and a clearer understanding of brain function. Results of this research have given neurologists such resources as new surgical techniques and treatments, including implanted “pacemakers” for certain types of epilepsy; they have also increased their understanding of the causes of neuropathic pain, provided new drug treatments for migraines, and resulted in the discovery of genetic links for certain conditions. As the field of neurology continues to grow, treatments and—in some cases—cures are being found for diseases that previously had not even been identified with a name.
Neurologist Career Description
A neurologist evaluates, diagnoses, and treats patients with diseases and disorders impairing the function of the brain, spinal cord, peripheral nerves, muscles, and autonomic nervous system, as well as the supporting structures and vascular supply to these areas. A neurologist conducts and evaluates specific tests relating to the analysis of the central or peripheral nervous system.
In addition to treating such neurological disorders as epilepsy, neuritis, brain and spinal cord tumors, multiple sclerosis, Parkinson’s disease, and stroke, neurologists treat muscle disorders and pain, especially headache. Illnesses, injuries, or diseases that can adversely affect the nervous system, such as diabetes, hypertension, and cancers, are also treated by neurologists.
Neurologists see patients in two capacities—as a consulting physician or as the patient’s principal physician. A neurologist works as a consulting physician when asked by a patient’s primary care physician to consult on a case. For example, when a patient has a stroke or shows signs of mental confusion, that patient’s primary care doctor may ask a neurologist to consult on the case so that they can determine exactly what is wrong with the patient. In this circumstance, as a consulting physician, the neurologist conducts a neurological examination and evaluates the patient’s mental, emotional, and behavioral problems to assess whether these conditions are treatable. To do the exam, the neurologist may interview the patient, give vision, balance, and strength tests, and order a magnetic resonance imaging scan (MRI) of the person’s brain. After the neurologist has gathered information from such a variety of sources, he or she will discuss the findings with the primary care doctor and make a diagnosis. Treatment plans are then made.
A neurologist is often the principal physician for people with such illnesses as Parkinson’s disease, epilepsy, or multiple sclerosis. Because these are chronic and sometimes progressive conditions, the neurologist monitors the development of the illness and works to treat the patient’s symptoms, which may include muscle spasms, seizures, or loss of coordination. The neurologist may prescribe medications (such as an anticonvulsant), physical therapy (to maintain strength or coordination), or new tests (such as a CAT scan). Depending on the patient’s condition, the neurologist may see the patient anywhere from every few months to once a year.
The neurologist also works with psychiatrists, psychologists, and other mental health professionals as necessary, because a patient’s social condition and emotional issues are closely tied to neurological health. Patients with dementia, for example, often also suffer from depression. When a neurologist notices that a patient being treated seems withdrawn and unusually down, the neurologist may call in a psychiatrist to determine if anything can be done to help with the patient’s emotional needs.
Neurologist Career Requirements
Neurologists first earn an M.D. degree and become licensed to practice medicine. If you are interested in pursuing a medical degree, a high school education emphasizing college preparatory classes is a must. Science courses, such as biology, chemistry, and physics, are necessary, as are math courses. These classes will not only provide you with an introduction to basic science and math concepts but also allow you to determine your own aptitude in these areas. Since college will be your next educational step, it is also important to take English courses to develop your research and writing skills. Foreign language and social science classes will also help make you an appealing candidate for college admission as well as prepare you for your future undergraduate and graduate education. Courses in computer science are a must, as well, since the computer is changing the way medicine is communicated and shared by busy medical professionals.
Those physicians who choose to specialize in adult neurology must first complete an internship (with a minimum of eight months spent in internal medicine) and a three-year residency in neurology. Both the internship and residency must be accredited by the Accreditation Council for Graduate Medical Education (ACGME). Those wanting to work in child neurology have several training pathways to choose from, including completing two years of a pediatrics residency or one-year residencies in internal medicine and pediatrics. Again, these must be ACGME accredited. In addition, the ACGME notes there are a growing number of programs that combine fields and prepare graduates to be eligible for certification in two areas, such as neurology/internal medicine or neurology/psychiatry. The residency programs provide supervised neurology experience in both hospital and ambulatory (outpatient) settings. Educational conferences and research training are also part of a neurology residency.
Certification or Licensing
Upon completion of residency training, neurologists may seek certification in neurology or child neurology from the American Board of Psychiatry and Neurology (ABPN). To be eligible for certification, qualified applicants must have an unrestricted state license to practice medicine; have the required years of residency training; and must pass both a written and oral examination as administered by the ABPN.
All physicians must be licensed to practice in the United States. To become licensed, physicians must pass a state exam, which is administered by their state’s board of medical examiners.
Because they treat patients who may have suffered injuries to the head, neurologists need to have a calm and soothing presence with patients who may be experiencing alternating emotions, including confusion and anger. In addition to compassion, neurologists need to be capable of sifting through a lot of data for specific details.
Exploring Neurologist Career
One of the best introductions to a career in health care is to volunteer at a local hospital, clinic, or nursing home. In this way it is possible to get a feel for what it’s like to work around other health care professionals and patients and possibly determine exactly where your interests lie. As in any career, reading as much as possible about the profession, talking with a high school counselor, and interviewing those working in the field are other important ways to explore your interest.
Neurologists are employed by hospitals, research institutes, managed-care offices, trauma centers, and colleges and universities. Some are self-employed in their own or group practices.
Neurologists interested in teaching may find employment at medical schools or university hospitals. There are also positions available in government agencies such as the Centers for Disease Control, the National Institutes of Health, and the Food and Drug Administration.
Pharmaceutical companies and chemical companies hire physicians to research and develop new drugs, instruments, and procedures.
There are no shortcuts to entering the medical profession. Requirements are an M.D. degree, a licensing examination, a one- or two-year internship, and a three-year residency. Upon completing this program, neurologists are then ready to enter practice. They may choose to open a solo private practice, enter a partnership practice, enter a group practice, or take a salaried job with a managed-care facility or hospital. Salaried positions are also available with federal and state agencies, the military, including the Department of Veterans Affairs, and private companies. Teaching and research jobs are usually obtained after other experience is acquired.
Neurologists who work in a managed-care setting or for a large group or corporation can advance by opening a private practice. Some physicians may become directors of a laboratory, managed-care facility, hospital department, or medical school program. Some may move into hospital administration positions. A neurologist can also achieve recognition by conducting research in new medicines, treatments, and cures, and publishing their findings in medical journals. Participation in professional organizations can also bring prestige.
With further training, a neurologist may become a neurological surgeon. Neurological surgeons, also known as neurosurgeons, diagnose, evaluate, and treat patients with disorders or injuries affecting the central, peripheral, and autonomic nervous systems. This specialist provides both nonsurgical and surgical care, depending on the nature of the injury or illness.
Individual salaries for neurologists vary depending on such factors as type and size of practice, geographic area, and professional reputation. According to Physicians Search.com, neurologists receive starting salaries that range from $100,000 to $190,000. Those with three years of experience had an average salary of $196,563. Salaries ranged from $130,872 to $252,765.Because of the variety of factors influencing earnings, these figures should only be thought of as a guide.
Neurologists working for hospitals, research institutes, and universities receive typical benefits such as paid vacation time, health insurance, and retirement plans. Those who run their own practices must pay for such extras themselves.
Neurologists, like many physicians, must divide their time between patient consultations, study and publishing, and office or departmental administration. Most neurologists work far more than 40 hours a week. A neurologist may see anywhere between 10 and 30 patients each day. They perform medical histories, diagnose problems, and explain treatment and rehabilitation options.
Neurologist Career Outlook
While the U.S. Department of Labor projects occupations in the health care field to grow faster than the average through 2014.The USDL reports that patient demand should create a substantial number of jobs for specialists. The future for neurologists, therefore, should be bright as the need for their expertise increases. One reason for this increased need is the country’s growing senior population. Older people are often affected by neurological problems, including a wide variety of dementias. As research continues and treatments become available there should be more resources neurologists can drawn on to help patients manage such diseases as Alzheimer’s. Additionally, research should provide answers to questions about what causes certain diseases and why and how these diseases progress. When doctors know these answers, they will be able to provide increasingly accurate treatments for such illnesses as amyotrophic lateral sclerosis (Lou Gehrig’s disease), multiple sclerosis, and Parkinson’s disease. For these reasons, neurologists should experience strong job growth.
For More Information:
For the journal, see Neurology (journal). For the scientific study of the nervous system, see Neuroscience.
"Neurological sciences" redirects here. For the journal, see Neurological Sciences (journal).
A network of dendrites from neurons in the hippocampus.
|Significant diseases||Radiculopathy, neuropathy, visual snow, stroke, dementia, seizures and epilepsy, Alzheimer's disease, Attention deficit/hyperactivity disorder|
|Significant tests||Computed axial tomography, MRI scan, lumbar puncture|
Neurology (Noun) (from Greek: νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine dealing with disorders of the nervous system. Neurology deals with the diagnosis and treatment of all categories of conditions and disease involving the central and peripheral nervous systems (and their subdivisions, the autonomic and somatic nervous systems), including their coverings, blood vessels, and all effector tissue, such as muscle. Neurological practice relies heavily on the field of neuroscience, which is the scientific study of the nervous system.
A neurologist is a physician specializing in neurology and trained to investigate, or diagnose and treat neurological disorders. Neurologists may also be involved in clinical research, clinical trials, and basic or translational research. While neurology is a nonsurgical specialty, its corresponding surgical specialty is neurosurgery.
Significant overlap occurs between the fields of neurology and psychiatry, with the boundary between the two disciplines and the conditions they treat being somewhat nebulous.
Main article: List of neurological disorders
A large number of neurological disorders have been described as listed. These can affect the central nervous system (brain and spinal cord), the peripheral nervous system, the autonomic nervous system, and the muscular system.
Main article: History of neurology
The academic discipline began between the 16th and 19th centuries with the work and research of many neurologists such as Thomas Willis, Robert Whytt, Matthew Baillie, Charles Bell, Moritz Heinrich Romberg, Duchenne de Boulogne, William A. Hammond, Jean-Martin Charcot, and John Hughlings Jackson.
|Names||Physician, Medical Practitioner|
|MD or DO (US), M.B.B.S. (UK), M.B. B.Ch. B.A.O. (Republic of Ireland)|
Many neurologists also have additional training or interest in one area of neurology, such as stroke, epilepsy, neuromuscular, sleep medicine, pain management, or movement disorders.
In the United States and Canada, neurologists are physicians having completed postgraduate training in neurology after graduation from medical school. Neurologists complete, on average, about 8 years of medical college education and clinical training,which includes obtaining a four-year undergraduate degree, a medical degree (DO or MD), which comprises an additional four years of study, then completing one year of basic clinical training and four years of residency. The four-year residency consists of one year of internal medicine internship training followed by three years of training in neurology.
Some neurologists receive additional subspecialty training focusing on a particular area of the field. These training programs are called fellowships, and are one to two years in duration. Subspecialties include brain injury medicine, clinical neurophysiology, epilepsy, hospice and palliative medicine, neurodevelopmental disabilities, neuromuscular medicine, pain medicine, sleep medicine, neurocritical care, vascular neurology (stroke),behavioral neurology, child neurology, headache, multiple sclerosis, neuroimaging, neurorehabilitation, and interventional neurology.
In Germany, a compulsory year of psychiatry must be done to complete a residency of neurology.
In the United Kingdom and Ireland, neurology is a subspecialty of general (internal) medicine. After five to nine years of medical school and a year as a preregistration house officer (or two years on the Foundation Programme), a neurologist must pass the examination for Membership of the Royal College of Physicians (or the Irish equivalent) before completing two years of core medical training and then entering specialist training in neurology. A generation ago, some neurologists would have also spent a couple of years working in psychiatric units and obtain a diploma in psychological medicine. However, this requirement has become uncommon, and, now that a basic psychiatric qualification takes three years to obtain, the requirement is no longer practical. A period of research is essential, and obtaining a higher degree aids career progression. Many found it was eased after an attachment to the Institute of Neurology at Queen Square, London. Some neurologists enter the field of rehabilitation medicine (known as physiatry in the US) to specialise in neurological rehabilitation, which may include stroke medicine, as well as brain injuries.
Main article: Neurological examination
During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the cranial nerves (including vision), strength, coordination, reflexes, and sensation. This information helps the neurologist determine whether the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management.
Neurologists examine patients who are referred to them by other physicians in both the inpatient and outpatient settings. Neurologists begin their interactions with patients by taking a comprehensive medical history, and then performing a physical examination focusing on evaluating the nervous system. Components of the neurological examination include assessment of the patient's cognitive function, cranial nerves, motor strength, sensation, reflexes, coordination, and gait.
In some instances, neurologists may order additional diagnostic tests as part of the evaluation. Commonly employed tests in neurology include imaging studies such as computed axial tomography (CAT) scans, magnetic resonance imaging (MRI), and ultrasound of major blood vessels of the head and neck. Neurophysiologic studies, including electroencephalography (EEG), needle electromyography (EMG), nerve conduction studies (NCSs) and evoked potentials are also commonly ordered. Neurologists frequently perform lumbar punctures to assess characteristics of a patient's cerebrospinal fluid. Advances in genetic testing have made genetic testing an important tool in the classification of inherited neuromuscular disease and diagnosis of many other neurogenetic diseases. The role of genetic influences on the development of acquired neurologic diseases is an active area of research.
Some of the commonly encountered conditions treated by neurologists include headaches, radiculopathy, neuropathy, stroke, dementia, seizures and epilepsy, Alzheimer's disease, attention deficit/hyperactivity disorder,Parkinson's disease, Tourette's syndrome, multiple sclerosis, head trauma, sleep disorders, neuromuscular diseases, and various infections and tumors of the nervous system. Neurologists are also asked to evaluate unresponsive patients on life support to confirm brain death.
Treatment options vary depending on the neurological problem. They can include referring the patient to a physiotherapist, prescribing medications, or recommending a surgical procedure.
Some neurologists specialize in certain parts of the nervous system or in specific procedures. For example, clinical neurophysiologists specialize in the use of EEG and intraoperative monitoring to diagnose certain neurological disorders. Other neurologists specialize in the use of electrodiagnostic medicine studies – needle EMG and NCSs. In the US, physicians do not typically specialize in all the aspects of clinical neurophysiology – i.e. sleep, EEG, EMG, and NCSs. The American Board of Clinical Neurophysiology certifies US physicians in general clinical neurophysiology, epilepsy, and intraoperative monitoring. The American Board of Electrodiagnostic Medicine certifies US physicians in electrodiagnostic medicine and certifies technologists in nerve-conduction studies. Sleep medicine is a subspecialty field in the US under several medical specialties including anesthesiology, internal medicine, family medicine, and neurology. Neurosurgery is a distinct specialty that involves a different training path, and emphasizes the surgical treatment of neurological disorders.
Also, many nonmedical doctors, those with doctoral degrees(usually PhDs) in subjects such as biology and chemistry, study and research the nervous system. Working in laboratories in universities, hospitals, and private companies, these neuroscientists perform clinical and laboratory experiments and tests to learn more about the nervous system and find cures or new treatments for diseases and disorders.
A great deal of overlap occurs between neuroscience and neurology. Many neurologists work in academic training hospitals, where they conduct research as neuroscientists in addition to treating patients and teaching neurology to medical students.
Neurologists are responsible for the diagnosis, treatment, and management of all the conditions mentioned above. When surgical intervention is required, the neurologist may refer the patient to a neurosurgeon. In some countries, additional legal responsibilities of a neurologist may include making a finding of brain death when it is suspected that a patient has died. Neurologists frequently care for people with hereditary (genetic) diseases when the major manifestations are neurological, as is frequently the case. Lumbar punctures are frequently performed by neurologists. Some neurologists may develop an interest in particular subfields, such as stroke, dementia, movement disorders, neurointensive care, headaches, epilepsy, sleep disorders, chronic pain management, multiple sclerosis, or neuromuscular diseases.
Some overlap also occurs with other specialties, varying from country to country and even within a local geographic area. Acute head trauma is most often treated by neurosurgeons, whereas sequelae of head trauma may be treated by neurologists or specialists in rehabilitation medicine. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and interventional neurologists has created a demand for stroke specialists. The establishment of Joint Commission-certified stroke centers has increased the role of neurologists in stroke care in many primary, as well as tertiary, hospitals. Some cases of nervous system infectious diseases are treated by infectious disease specialists. Most cases of headache are diagnosed and treated primarily by general practitioners, at least the less severe cases. Likewise, most cases of sciatica and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or surgeons (neurosurgeons or orthopedic surgeons). Sleep disorders are also treated by pulmonologists and psychiatrists. Cerebral palsy is initially treated by pediatricians, but care may be transferred to an adult neurologist after the patient reaches a certain age. Physical medicine and rehabilitation physicians also in the US diagnosis and treat patients with neuromuscular diseases through the use of electrodiagnostic studies (needle EMG and nerve-conduction studies) and other diagnostic tools. In the United Kingdom and other countries, many of the conditions encountered by older patients such as movement disorders, including Parkinson's disease, stroke, dementia, or gait disorders, are managed predominantly by specialists in geriatric medicine.
Clinical neuropsychologists are often called upon to evaluate brain-behavior relationships for the purpose of assisting with differential diagnosis, planning rehabilitation strategies, documenting cognitive strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal aging or tracking the progression of a dementia).
Relationship to clinical neurophysiology
In some countries, e.g. US and Germany, neurologists may subspecialize in clinical neurophysiology, the field responsible for EEG and intraoperative monitoring, or in electrodiagnostic medicine nerve conduction studies, EMG,and evoked potentials. In other countries, this is an autonomous specialty (e.g., United Kingdom, Sweden, Spain).
Overlap with psychiatry
Further information: Psychoneuroimmunology and Neuropsychiatry
Although mental illnesses are believed by many to be neurological disorders affecting the central nervous system, traditionally they are classified separately, and treated by psychiatrists. In a 2002 review article in the American Journal of Psychiatry, Professor Joseph B. Martin, Dean of Harvard Medical School and a neurologist by training, wrote, "the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway".
Neurological disorders often have psychiatric manifestations, such as poststroke depression, depression and dementia associated with Parkinson's disease, mood and cognitive dysfunctions in Alzheimer's disease, and Huntington disease, to name a few. Hence, the sharp distinction between neurology and psychiatry is not always on a biological basis. The dominance of psychoanalytic theory in the first three-quarters of the 20th century has since then been largely replaced by a focus on pharmacology. Despite the shift to a medical model, brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder.
The emerging field of neurological enhancement highlights the potential of therapies to improve such things as workplace efficacy, attention in school, and overall happiness in personal lives. However, this field has also given rise to questions about neuroethics and the psychopharmacology of lifestyle drugs.