Forsaking a personal chair in an internationally renowned university and medical school to become a “community neurologist” attached to a non-teaching hospital in a far off city: an epiphany, or an act of frank foolishness? After 27 years of being embedded in a medical school, and at the age of 60, I made the move. After all, a change is as good as a rest, goes the old proverb.

In writing such an article as this, one runs the risk of creating a whining critique of all that is maddening about universities and faculties of medicine. Instead I will try to compare my two very different medical careers. Let’s start with the present: the Lions Gate Hospital is in North Vancouver which lies between the sea and the dramatic Coastal Mountain range. It is certainly one of the loveliest areas in which to live and work in Canada. The hospital is no backwater. All important specialties are present. Neuro-wise, there are three neurologists, four neurosurgeons, and several of the radiologists are trained in “neuro”. The hospital has state-of-the-art CT and MR scanners, an excellent intensive care unit staffed by intensivists, a neurosciences ward and a neurocritical care unit for postoperative patients and those with acute and/or complicated disorders. Patients are usually looked after by both a specialist and a hospitalist (in-hospital general practitioner). The university teaching hospital is a short distance away for help with ultra-complex patients. We have monthly “neuro rounds” and I find these to be more interdisciplinary, lively, humorous and educational than those I left behind.

Like the other specialists, most of my time is spent in my office, …