I agree that seeing a Movement Disorders Specialist is probably the best possible route, at least in most cases. Take the case of a friend of my daughter (33) who was diagnosed by the local neurologist with PD and put immediately of 600mg of Sinemet a day. She got to the MDS I go to and he doesn't think she has PD at all.

The real problem is much more elementary. Most of the people in my poor rural southern state do not have access to a neurologist much less a MDS. Entire swaths of the state have practically no specialty medical care. There is only one MDS in the state that i am aware of and he is in the far NW corner making it at least a 6 hour drive for many. I see an MDS in another state. I have to fly up once or twice a year, spend the day and fly back. It's expensive and tiring but there is no reasonable choice that I can find.

Until we begin to compensate physicians based on some measure besides procedures we will not see any dramatic increases in the numbers of these guys. They have to train for years, incurring huge student loan debt but not the income to pay it off. There will have to be an incentive to locate in areas that are severely underserved and the simple betterment of humanity has not worked so far. Health care in this country and possibly in all the world is in a mess and will require a more complete overhaul to right it than, I think, any of our political representatives has the fortitude to take on.

So what is the answer? Choose your parents well. Rich is better than poor, because so far if you have enough money you can get pretty good care, if you don't, good luck.

***One more thought... While MDSs are not board certified most of the ones at University Hospitals have done a fellowship in Movement disorders and passed an examination. It is usually only retained by the schoold but it does show a level of post residential skill and training. By looking at their training (listed on the University's website) you can determine the quality or reputation of the institution.

Doctors are like people, some are nice and some aren't. If you get a bad one, move on. Because of their extra training they can be of great value to you.