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SCOPE OF NEUROLOGIC PRACTICE: DIFFERENT PLACES, DIFFERENT MODELS
The scope of practice in neurology is in a constant state of flux. Like the arboreal tree line in circumpolar locations, the frontiers of neurology advance and recede in consonance with ambient temperatures, predominant winds, and periodical cyclic variations. But unlike the line of transition from forest to tundra, the borders of neurology are very much influenced by human intervention.
A bird’s eye view of the world perspective on the scope of practice shows a ragged landscape with extremely irregular borders and a surprising variety of positive and negative forces. What is state-of-the-art neurology practice in one country may be considered a different specialty in another. In the United Kingdom and Spain (and many other countries), neurology and clinical neurophysiology are separate specialties. In Central America, neurosurgeons regularly practice neurology. World Health Organization publications portray stroke as a cardiovascular disease rather than a neurologic one.
One scope of practice issue recently came to my attention. Child neurology is the province of neurologists in many countries. Moreover, in some countries child neurology has not yet achieved the recognition taken for granted in the United States. Italy is an example.
In 2000, the Italian University Committee transferred child neurology from a subspecialty of pediatrics to child neuropsychiatry. The Committee based its action on the international and academic stature acquired by Italian child neuropsychiatry over decades of growth. Although limited to the academic setting, the move complicated a situation that was already unclear. Historically, child neurology in Italy had its roots mainly in pediatrics. With a population of 10 million under the age of 18 years, the specialty of pediatrics and its subspecialties are important to the nation.
Modern Italian child neurology was founded by Alberto Fois along with other pediatricians in the 1960s. The event occurred in the …
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