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Limited resources, competition and health care reform: witnessing the evolution of academic neurology.

Although the 1990s have been designated the decade of the brain by the US Congress, 1 1965 to 1975 was de facto the decade of academic neurology. Fed and sheltered by the life-giving infusion of federal support for undergraduate and graduate medical training during that decade, academic programs in neurology blossomed and flourished. 2,3 When that fiscal infusion slowed to a trickle, academic programs in neurology learned to sustain themselves with dollars derived from research and clinical services. As research funds became lean (there are no longer substantial amounts of fiscal fat in research grants), increasingly little excess from these sources could be diverted to support academic programs. Consequently, the majority of academic neurology programs in the United States now sustain themselves with funds derived from clinical practice. Over the last four decades, the US health care system evolved in an environment that lacked marketplace constraints. 4 The unforeseen result