Child neurology: past, present, and future.

The emergence of child neurology as an independent discipline was enhanced by pediatricians developing an organ system approach to the study of illnesses of children and indirectly by their interest in normal psychomotor development, a function of maturation of the nervous system. Technological innovations, advances in neuroimaging, and the development of therapeutic agents directly benefited patients with neurologic disorders and enhanced the role of the neurologist. The American Board of Psychiatry and Neurology was founded in 1934. It formally recognized child neurology as a special area of expertise in 1959 when Sidney Carter was appointed as a director and the clinical examination was changed to include an hour devoted specifically to child neurology. In 1969, special certificates in child neurology were issued. Thirty candidates, or more, have successfully passed the examination each year since then. As of Spring 1995, there had been 1007 certificates issued to child neurologists. In 1991 and 1992, alternative pathways to training in child neurology were developed. These substituted a year of internal medicine or a year of basic neuroscience research for 1 year of pediatrics. Relatively few child neurologists have chosen these alternative pathways. The performance of child neurologists, on Board examinations has generally been comparable to that of adult neurologists with the latter holding a slight edge. In 1990, a study of first-time takers of the certification examination was begun. In child neurology, 54% of the cohort passed both parts I and II on their first attempts, and as of July 1995, 81% of the original cohort was certified. In adult neurology, the comparable rates are 56% and 84%. Accreditation of child neurology training programs began in 1987. As of November 1995, there were 75 accredited child neurology training programs, which offered slightly over 200 total positions. Changes in health care delivery are currently taking place and have placed greater emphasis on primary care physicians. Proposals have been put forth that, if enacted, will reduce the current number of medical students and also reduce the total number of residents being trained. Reductions as great as 40% of current resident number have been proposed. Child neurology will need to reassess our current work force and training needs and re-evaluate our role in the training of primary care physicians. There appears to be a paradox. Explosions of information in both the basic and clinical neurosciences have directly benefited our patients, but yet our continued growth as a subspecialty is being challenged.