The question Icelandic neurologists get asked most frequently by colleagues visiting our island of 300 000 inhabitants in the North Atlantic is: “How many neurologists are practicing in Iceland?” The answer always raises an eyebrow. There are 13 more or less full-time neurologists, including 10 working at the only university hospital. This relative abundance of neurologists of one for every 25 000 contrasts with one for every 170 000 in the UK, for example.¹ The principal hospital in Iceland, the Landspitali University Hospital in the capital Reykjavik, serves as the primary hospital for at least two thirds of the population and as the referral hospital for the rest of the population.

During the last decade neurologists have been taking on the responsibility of providing primary in-hospital care for most patients with acute stroke—around 400 admissions to the Landspitali stroke unit annually. This has been a challenge for us because it has required …