IM/Neuro is an extra year, right? Is is worth the extra year, to have the IM certification?

How about Neuro/Psyc.?

What do you mean by "worth it"? Neither neuro/IM or neuro/psych are likely to be "worth it" in terms of $$$ in the job market. However, since a large number of neurology patients have concurrent medical and psychiatric problems as well, it may well be "worth it" in terms of being better trained to treat the "whole patient" and their comorbidities rather than just the neuro aspect. But I doubt it will make you any more money.

Thanks neurologist (btw, are you a practicing neurologist?). Yeah, I should've clarified. I meant "worth it" mainly in the sense of being able to be a better neurologist, better able to consult, etc., but also in $$$$$/time/lifestyle sense.

I guess it depends on what type of lifestyle/practice someone wants.

................ comments, anyone else???

...Just a hunch though...I bet if you subspecialized in IM then you would be making more $$...right? Can one even do this? What subspecialty would go well with neurology - neuroendocrinology?

care

Careofme:

Sure, if you go into a procedure-driven IM subspecialty like cards or nephrology or GI you would make more money than in general IM or neuro. Less invasive fields like endocrine or rheumatology actually make LESS on average than neuro (check out the salary tables at www.physicianssearch.com if you haven't done so already)

Now, it's true that there are a handful of people (usually at large, research oriented academic centers) who have carved out little niches for themselves as "neuroendocrinologists" "neurourologists" or "neuro-" something else, but they are rare and if you are a "neuro-whatever" supersubspecialist, you can probably be pretty sure you will be doing either 95% bread-and-butter neuro or 95% bread-and-butter "whatever" and very little overlap work. Also, a lot of overlap subspecialties just don't make much sense. I've never heard of anyone making a living as a "neuropulmonologist."

Given the comorbidities seen in neurology patients, the best combo would be neuro-IM or neuro-psych. Reasons: 1) lots of systemic medical illnesses cause neurologic symptoms (lupus, sarcoid, thyroid disease, vascular disease, various infections, etc; 2) like it or not, you may well become the de facto primary care provider for lots of your neuro patients; 3) many, many, many neuro patients have psychiatric issues (I think someone once called psychiatry "neurology without physical signs"). They can be particularly hard to deal with and the psych background can help a lot. But again, don't expect to make a whole lot more money for your services in these specialties.

Carpe Diem:
Yes, I am a practicing neurologist.

Thanks for the input Neurologist.

What do you feel is on the forefront for neurology practice in next 10 to 15 years? and would you pick Neurology again as a specialty? thanks for any feedback

1. Sorry, but in my last post I overlooked one very obvious medicine/neurology subspecialty overlap: neuro-oncology is a field where you can be kept pretty busy doing just that.

2. The forefront of neurology? Good question. Neurology is kind of interesting in that our knowledge of basic science and pathophysiology has, in the last decade, far outstripped our ability to translate that knowledge into meaningful treatment. The biggest example of this is in the genetics arena. Pick up any neuro journal and you will be flooded with papers about new developments in identifying genes, cloning proteins, etc, but little of this has led to anything meaningful to our patients other than "genetic counseling." We've now got over a dozen different genetic flavors of spinocerebellar ataxia, but we still can't reverse or halt the pathologic process. I suspect this will change, slowly, but I am frankly not optimistic that there will be any slam-dunk "genetic treatments" available in my professional lifetime. I think in the short term (10-15 years) a lot of progress will be made in the immunologic side (vaccines for Alzheimers, treatments for immune-mediated processes like MS and myesthenia). I'm not talking cures, but possibly more effective disease-modifying agents. I also think surgical and biomechanical treatments will continue to advance as well (think deep brain stim for Parkinsons, vagal nerve stim for epilepsy and perhaps a bunch of other indications, visual and hearing prostheses). And by the way, don't worry about being unemployed. Barring any incredibly drastic changes in the health care environment, the aging population is going to need more neurologists to deal with all those strokes, dementias and peripheral neuropathies.

3. Yes, I would probably still pick neurology. But to be fair I have to admit I am still pretty "fresh" and not yet old and burned out and cynical. Ask me again in 10-15 years.

Hi,

I notice that some programs are combining Neuro with Radiology, presumably so that Neurologists can read their own brain MRIs and CTs. I would think that this could provide a very nice boost to your income--right??

Would there be enough work to do only brain imaging? I think that radiologists with fellowships in neuro imaging typically only do it as part of an overall diagnostic radiology practice. Is there any conflict between the fellowship trained rads and neurologists who do rads?

Are these programs as competitive as a Diagnostic Rads residency? (I would bet that a lot of Rads hopefuls would try to use them as a "back door" into diagnostic rads).

Also, is there any ability to combine Neurology with pain management? Are the fellowships that Gas and PM&R folks do open to Neurologists?

Sorry for so many questions at once.


Neurologist--thanks for your informative responses.

Programs combining radiology, neurology and neuroradiology fellowship are far and few between. They are very impractical as are most combined programs (psych/im, fp/im). In other words dont think you will get a better job or make more money. How many radiologists in their right mind would want to practice neurology anyway?!!@

I am not aware of any imaging fellowships for neurologists. This would be a very impractical fellowship anyways as most neuroradiologists in private practice and even in academics do a good deal of general radiology. Sure, I guess you could buy a magnet for your office and charge for the technical and professional fee, but I doubt a typical neurologist has the volume to make that venture worthwhile.

There are, as O&T notes in his (her?) post, a handful of combined neuro/rad residencies. There are also neuroimaging fellowships available for neurologists who have completed residency. I will be honest and say I know next to nothing about them, and I don't personally know any neurologists who have done any of those programs.

Theoretically, if you worked for a large single-specialty neuro group practice, you probably could get by just reading all the CT's, MRI's, PET's etc that the practice generates. If the group has it's own equipment, it could be a money-maker. But if reading pictures is your goal, why even bother to be a neurologist? Just be a radiologist.

The real problem with this is not the issue of "can or should" you have radiology training (every neurologist should have some ability to interpret films -- and I've found that a good general neurologist can often outread a general radiologist when it comes to neuroimaging), but rather "does the state I'm practicing in (or, more importantly, the HMO/insurance companies who reimburse me) even ALLOW neurologists to be reimbursed for reading films. Again, I'm not anywhere near an expert on this, but in a lot of places, I believe radiologists have a monopoly on this. And they are not going to be happy to share with neurologists. (BTW, this goes both ways; neurologists, for their part, are actively trying in several states to prevent physical therapists from being allowed to do EMG.)

As for Pain, there are many opportunities for neurologists to do pain fellowships,and they can be quite useful (after all, probably the biggest reason people get sent to a neurologist is for pain -- headache, back pain, neck pain, painful neuropathy, etc). While most pain related specialties (neuro, anesthesia, PMR) seem to operate their own fellowships, there is a lot of cross training and for the most part you'll learn the same stuff. My only question is: can you really stand being a pain doc and spending your entire day listening to patients complain about pain? Pain that never ends. Pain that just won't go away. Pain that nothing ever helps. Pain that is occupying every single waking moment of my existence. Pain. Pain. Pain. Not that pain medicine isn't necessary, but I just couldn't handle it -- ugh!!! Way too depressing and frustrating.

O&T:

Check out UCLA neuroimaging fellowship. With Mazziota, a neurologist who studies brain imaging. Pretty cool stuff. With a fellowship like that, and its directed only at academics, people go off and study the progression of MS with and without treatment. Pharm companies love it because they prefer the clear cut end points of lesion and atrophy prevention over softer clinical outcomes, even though those clinical outcomes matter more.

In terms of private practice, there is a neurology group in my area that have their OWN MRI scanner - one of my friends joined their group. They use it jointly with ortho, not neurosurg so far. They pay a neuro-radiologist to come by 3 afternoons a week and read. Soon they will probably send the images over to India for readings. And they are making $$$$.

Remember, old and tired, you old goat, that you image where we want you to, and we use the infomation you provide to make clinical decisions before you toss neurology away as a silly field. Patients do not present with a high T2 intensity lesion in their right caudate. Think of all the scans you are NOT seeing: all peripheral cases, most movement disorders, most primary headache disorders.

But everyone wants to think of themselves as the most important person in the world and doctors are hardly an exception.

With regards to combined residency. Let me give you some advice: decrease your suffering, get out of residency as soon as you possibly can. The longer you stay, the worse it is. In other words, pain is bad. Residency is pain. Thus residency is bad. These combined residencies look good on paper, but what looks good on paper is seldom the same in reality. For support of this, look at California's politics.

Later.