THE CASE FOR NEUROLOGY

“Neurologists are the best professionals to diagnose and treat neurological disorders”-AON

Neurologists are specially trained physicians whose skill lies in their ability to diagnose diseases of the central (brain and spinal cord) and peripheral nervous systems. Neurologists do not perform surgery but often work closely with neurosurgeons.  Diseases affecting the nervous system number nearly 600 or more and will usually include entities such as Parkinson's disease, Alzheimer's disease epilepsy, migraine, stroke, Lou Gehrig's disease, myasthenia gravis and diseases of the peripheral nerves.  Some of these diseases are present both in children and adults and an increasing number of these problems now plague an expanding elderly population. Diagnosis of most of these entities require careful history taking interviews with the patient, relatives and caregivers and a detailed physical examination of the nervous system.  Although tests such as blood work CT and MRI scanning, electroencephalography (EEG) and electromyography (EMG) are important tools, the most important aspect of diagnosis is the time spent in a one-to-one interview and examination of the patient. Diagnosis is often difficult and sometimes elusive and the impact on the patient and his or her family is often devastating.

Canada has had a long and distinguished history of involvement in the neurosciences producing many world leaders in the field.  The major medical schools all have highly organized neurology training programs. Those wishing to specialize in neurology will spend an extra four years or more following graduation of rigorous and intensive training followed by a grueling examination leading to the FRCP (Fellow of the Royal College of Physicians) in neurology.  Our standards remain extremely high and are recognized throughout the world.  The early pioneers who helped to develop the specialty of trained in the most prestigious centers in Europe. Neurologists are the best professionals to diagnose and treat neurological disorders.

It has almost been traditional up to the 1960s to have most of our graduates in neurology concentrated in the teaching hospitals, now often referred to as centers of excellence, in the larger metropolitan areas. In the 1960s there was a steady migration of neurologists to outlying communities with populations of well over 50,000 people in Ontario.  This has happened in Ontario as well as in other jurisdictions across Canada.  The services provided in these locations by neurologists have been invaluable by providing timely diagnosis and treatment as well as relatively easy access for patients with disabling neurological problems.  Many of these communities have grown in size such that the ratio of neurologist to community is now reaching one neurologist per hundred thousand people or more. The work load in this situation is steadily increasing as nearly one quarter of the 225 neurologists in the province reach retirement age.

The expertise of neurologists is also of crucial importance in the management of patients with acute stroke and diseases such as meningitis, encephalitis, acute inflammation of nerves, diseases such as myasthenia gravis, botulism and also various forms of coma.  These often present as dire emergencies in emergency departments and intensive care units.  Our colleagues in other specialties value of our services when these are available as management of these problems can be particularly difficult and stressful for all concerned.

Since it takes a significant time to train as a neurologist, urgent steps need to be taken by the Government of Ontario to see that the numbers needed to service the province are maintained.  This means creating attractive working conditions for existing personnel to remain in the province and to attract many of those who moved to other provinces or abroad to return home. At the moment Ontario could use another 40 neurologists in clinical practice.

To achieve this goal, there must be a carefully organized strategy to see that the service levels are maintained in all affected communities while at the same time providing staff for the teaching hospitals for both service and teaching as well as research.  The population of Ontario has grown nearly 5% since the year 2000.  This has brought with it many new problems which have been discussed at length in other scenarios.  At the same time we are witnessing a growing elderly population and with it increasingly challenging problems of degenerative diseases affecting the central and peripheral nervous systems.  There will be no time in history where neurology services will be required more than in the next 20 years.

These developments and the attendant difficulties are apparent to those of us on the front line and it is for this reason that the Association of Ontario Neurologists (AON) has chosen this time to speak out.  We are the best and most highly qualified people to diagnose and treat neurological diseases.  We are also in the best position to advise on the appropriate strategies for dealing with these problems in the future taking full advantage of the newer therapeutic options available.  It is essential that a dialogue be established at the highest level between the Government of Ontario, the Ontario Medical Association and the AON, together with other stakeholders such as patient advocacy groups, to see that neurology is carefully nurtured as a viable and vigorously maintained specialty in the province.

This will mean immediate attention to the neurological needs not only of the teaching hospitals and centers of excellence but also to community facilities in large communities of over 50,000 people usually with even larger catchment area populations.  Hospitals in such communities must be given the resources to service neurological professionals which will include not only specialized equipment (such as electroencephalography EEG) electromyography (EMG), CT and MRI scanning) but ancillary trained personnel to help run multidisciplinary clinics to meet the needs of patients.  Steps must also be taken to redress unfair relativity imbalances in the remuneration of neurologists to make the province of Ontario more competitive. Conditions must be created to enable neurologists to do what they do best which is to spend more time with their patients.

There are many competing demands for funds in healthcare but just as significant changes have been made in the allocation of funds for cardiologic, geriatric, orthopedic, and cancer services, so too neurology must now be added to those specialties requiring urgent attention.  It is hoped that those reading this who have loved ones with neurological diseases will fully understand the arguments put forward and may even take the time to contact their local politicians and hospitals to help raise the profile of neurology ands make the case. Meanwhile the Association of Ontario neurologists stands ready to engage in a productive dialogue with all other stakeholders involved in the care of patients with neurological diseases.

For further information please visit our website at http://www.aoneuro.on.ca/.

Dr. Ranjit Singh is a practicing neurologist in Guelph Ontario and is the current president of the Association of Ontario neurologists.