Subspecialization in neurology: the role of the United Council for Neurologic Subspecialties.

SUBSPECIALIZATION IN NEUROLOGY: THE ROLE OF THE UNITED COUNCIL FOR NEUROLOGIC SUBSPECIALTIES Lynne P. Taylor, Seattle: I read with interest the debate about general neurology vs subspecialization in neurology and wanted to share my perspective as someone who has recently relocated to a hematologyoncology section at Tufts Cancer Center. For 20 years, I have practiced as both a general neurologist seeing all aspects of neurology and now as a neurooncologist and palliative care physician. Neurooncology is notable among the subspecialties for involving all aspects of neurology, both upper and lower motor neuron. I also think we are in an excellent position to teach general neurology—albeit through a cancer perspective—to a whole new generation of students. Because of my training and exposure to cancer patients, I have also become interested in palliative care and increasing the number of neurologists who become board certified in palliative care is my advocacy project for the Palatucci Advocacy Leadership program of the American Academy of Neurology (AAN). There are now 46 neurologists in the United States and Canada who are board certified in palliative care. Given the unique aspects of neurodegenerative diseases, brain death, persistent vegetative state, and catastrophic events such as intraparenchymal brain hemorrhage and traumatic brain injury, we should be at the forefront of palliative care education and research. Many of these 46 boardcertified neurologists are now practicing full-time palliative care outside of the traditional framework of neurology. In the end, the debate seems unnecessary. Generalist, subspecialist, or neurologically trained but practicing outside of the field, we are all united by a love of “localizing the lesion,” neuroanatomy, and our respect for our patients as they struggle with their own difficult set of symptoms.