What is neurology?
Neurology is the branch of medicine that deals with disorders of the nervous system, including the brain, spinal cord, peripheral nerves, and muscles.
This covers a range of conditions such as acute neurological emergencies (e.g. stroke, meningitis, encephalitis, or Guillain-Barré syndrome), disorders that can be managed almost entirely in the community (e.g. epilepsy and migraine) and chronic disabling conditions (e.g. multiple sclerosis and Parkinson's disease), where multidisciplinary care is essential.
About one in eight of all GP consultations are for neurological symptoms, and approximately 20% of acute medical admissions are for a neurological problem. Changes in the age structure of the UK population will lead to increasing numbers of people with degenerative conditions of the brain such as dementia and Parkinson's disease.
Changes in neurology
The speciality of neurology is changing rapidly. Traditionally neurology had been thought of as an intellectual pursuit, concerned with diagnosis of rare conditions of the nervous system. However, this is changing with the advent of accessible imaging, the emergence of new therapies, and a multidisciplinary approach. Neurology today is concerned with the on-going care of common disorders such as stroke, epilepsy, multiple sclerosis and Parkinson’s disease, though there are some fascinating rare conditions too.
More neurologists are needed in the United Kingdom. There has recently been a rapid increase in numbers of consultant neurologists and it is likely that new posts will continue to be developed, particularly in district general hospitals (DGH). Most neurologists have sessions at regional neurosciences centres, where they have access to inpatient beds, specialist investigational services (neuroimaging, neurophysiology, pathology) and onward referral to neurosurgical services. Some will develop regional subspecialty services in stroke, epilepsy, neuromuscular disease, dementia, genetics and movement disorders.
Entry to ST3 Neurology is following a period of general professional training (CMT) usually with completion of MRCP. Entry to neurology training remains very competitive in many parts of the country: try to build a CV demonstrating your commitment to speciality.
Higher specialist training
Higher specialist training in neurology is a five year programme, one of which may be relevant research. Usually the training is based around regional neurosciences centres with rotation to other units, including at least one year in a DGH setting. Flexible training is a realistic option: 3 of the 8 current members of our trainees committee are training less than full time.
Pros and cons of a career in neurology
Exposure to fascinating conditions
Variety of clinical disorders
New treatments constantly being developed
Many research opportunities
Retention of links with academic centres
Many district general hospitals want more neurology input
Well structured training programmes
Low intensity of on-call work, although this is changing
Large number of untreatable or poorly treated disorders
Rationing of new, expensive treatments
Despite the small size of the specialty, neurology in the UK has a very strong academic tradition. Research experience is encouraged and can count for up to a year towards the CCT. Ideally, it should be relevant to neurology and undertaken in a department with some clinical commitment—for example, one general neurology clinic a week and participation in the registrar on-call rota. Some trainees may spend two or three years in research usually by taking out-of-programme experience after entering a programme.
Some trainees may seek dual CCTs, commonly with clinical neurophysiology, stroke medicine or rehabilitation.
After satisfactory completion of a training programme, the trainee will be able to apply for his or her CCT. Employment in the ST grade will normally continue for six months after completion of training in order to give time for application and appointment to a consultant post.
The United Kingdom has too few consultant neurologists. The Association of British Neurologists has emphasised the importance and clinical benefits of all such patients being under the care of a consultant neurologist. To meet this target the numbers of consultant posts are being increased, with particular recent expansion in stroke neurology. Acute neurology and community based neurology may be areas of growth in future.
Opportunities for academic posts are also available, both in laboratory and clinical research. Most academic neurologists continue to have some clinical commitment.
Most neurologists maintain a subspecialty interest, often stemming from their days in training or research, and provide a regional expert service for particular diseases or disease groupings—for example, neuroinflammatory disease, muscle disease, peripheral neuropathy and epilepsy.
Neurology is often seen as a difficult speciality populated by dry academics. This is a complete myth. It is a specialty that combines clinical acumen, communication skills, and multidisciplinary management, though there is still plenty of opportunity for those wanting to develop an academic interest.