Neuroimaging is an integral and indispensable part of every neurologist's practice. As neuroimaging now becomes a formal neurological subspecialty, through the United Council of Neurologic Subspecialties, the entire concept of "neurologist as neuroimager" is undergoing a detailed examination and emphasis at all levels of neurological training and endeavor. This article summarizes historical aspects and current trends involved with the political, academic, and practical neuroimaging issues encountered by the clinical neurologist. Reference is made to rationale for organ system specialty imaging; support organizations; imaging utilization and appropriateness guidelines; medical specialist competition, self-referral and turf matters; practice domain prerogatives; legislative challenges; and educational and advocacy concerns.