Do I need to do a fellowship?

[DerpyNeuroMD]

Kind of dreading spending another year in training. Just want to do general / private practice, locums, or hospitalist. Don't want to be at a big center. Do I need a fellowship these days? Am I really limiting myself if I forego one? If so how much and in what ways? If I regret it in a year or two can I still go back and do one?

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[Telamir]

No but yes but no but yes but maybe but yes but no.

You don't need it. You're more competitive with it if you want to work somewhere other than boonieville, USA. Yeah you can go back and do it but it's more painful to go back to fellow lifestyle/pay after being an attending. I've seen people regret not doing fellowship, I've seen people not care. I wouldn't do more than 1, and I wouldn't do a 2 year one unless you want to do neuro ICU.

I did one where I acquired a skill (EEG). While I'm an inpatient neurologist currently I can always do epilepsy (spells clinic) if I wanted to, I guess.

Also this has been discussed before, I'm sure you can some of those forum posts.

 

[Postictal Raiden]

Obviously having a fellowship helps and opens more doors. Also it depends on what career path you chose. Outpatient general neuro, mixed neurophys is hands down most bang for your buck, with neuromuscular is close second. For inpatient, epilepsy or EEG heavy neurophys. Stroke is also valuable if you work at busy stroke centers or if you want to become a stroke director at some community hospital (more $$$).

Otherwise it’s really based on what you really want. Some people do fellowship to escape having to see mundane general neuro consults and instead they would like to focus on their area of interest. Others do it because you most likely going to need one if you gonna do academia.

Regardless, plenty of jobs to go around. You don’t need a fellowship to find a job if you’re not too fixated on a specific location.

With that said, I’m a fresh grad and I’m very familiar with the current market. Just this week I was approached by two recruiters for outpatient gen neuro jobs in SoCal. I don’t have a fellowship. I don’t do EMG. They didn’t care.

 

[Neurogeneral]

The majority of neurologists do a fellowship for a variety of reasons….

Many have a particular interest that they want to focus on and residency often provides inadequate training for outpatient-centric subspecialty care…..neuro-immunology pmovement disorders, headache, neuromuscular/autonomics, epilepsy, etc.

Some just want to do more procedures and diagnostics like EEG, EMG, sleep, pain, etc. Many of those that fall into this category don’t want to spend everyday just seein clinic visits or inpatient consultations….this is where I fall into btw…..

And then are those that love acute neurology or even intensive care. If you love stroke and want access to as many opportunities as possible, you should at least do a vascular neurology fellowship. Otherwise, you are going to limit yourself on some level. And obviously you can’t practice NCC or NIR without doing fellowships.

 

[Dantes]

Obviously having a fellowship helps and opens more doors. Also it depends on what career path you chose. Outpatient general neuro, mixed neurophys is hands down most bang for your buck, with neuromuscular is close second. For inpatient, epilepsy or EEG heavy neurophys. Stroke is also valuable if you work at busy stroke centers or if you want to become a stroke director at some community hospital (more $$$).

Otherwise it’s really based on what you really want. Some people do fellowship to escape having to see mundane general neuro consults and instead they would like to focus on their area of interest. Others do it because you most likely going to need one if you gonna do academia.

Regardless, plenty of jobs to go around. You don’t need a fellowship to find a job if you’re not too fixated on a specific location.

With that said, I’m a fresh grad and I’m very familiar with the current market. Just this week I was approached by two recruiters for outpatient gen neuro jobs in SoCal. I don’t have a fellowship. I don’t do EMG. They didn’t care.

If you don't mind sharing, what's the general salary range for starting offers you're getting in that area?

 

[Postictal Raiden]

If you don't mind sharing, what's the general salary range for starting offers you're getting in that area?

PM your questions

 

[Cere-berus]

Obviously having a fellowship helps and opens more doors. Also it depends on what career path you chose. Outpatient general neuro, mixed neurophys is hands down most bang for your buck, with neuromuscular is close second. For inpatient, epilepsy or EEG heavy neurophys. Stroke is also valuable if you work at busy stroke centers or if you want to become a stroke director at some community hospital (more $$$).

Otherwise it’s really based on what you really want. Some people do fellowship to escape having to see mundane general neuro consults and instead they would like to focus on their area of interest. Others do it because you most likely going to need one if you gonna do academia.

Regardless, plenty of jobs to go around. You don’t need a fellowship to find a job if you’re not too fixated on a specific location.

With that said, I’m a fresh grad and I’m very familiar with the current market. Just this week I was approached by two recruiters for outpatient gen neuro jobs in SoCal. I don’t have a fellowship. I don’t do EMG. They didn’t care.

For outpatient general neuro you recommend mixed neurophys and neuromuscular. For inpatient, epilepsy and stroke. Do you think movement would be good for outpatient general neuro?

 

[Postictal Raiden]

For outpatient general neuro you recommend mixed neurophys and neuromuscular. For inpatient, epilepsy and stroke. Do you think movement would be good for outpatient general neuro?

Absolutely but from a financial prospective not as RVU generating specialty as neurophys

 

[Cere-berus]

Absolutely but from a financial prospective not as RVU generating specialty as neurophys

is there a reason why you wouldn't want to do EMGs other than not having a fellowship?

 

[Postictal Raiden]

is there a reason why you wouldn't want to do EMGs other than not having a fellowship?

I’m not sure if I understand the question.

EMG is dense in in RVUs in comparison to regular encounters (although it is not as lucrative as it once was). Without a fellowship (NM or EMG neurophys) it is really hard to have a sufficient residency exposure to master this skill. With that said, many general neurologists still perform EMG despite not having done a dedicated fellowship. Their qualify is questionable for most of the time. However, some residency programs really go out of their way to ensure their graduates have enough exposure.

 

[Cere-berus]

I’m not sure if I understand the question.

EMG is dense in in RVUs in comparison to regular encounters (although it is not as lucrative as it once was). Without a fellowship (NM or EMG neurophys) it is really hard to have a sufficient residency exposure to master this skill. With that said, many general neurologists still perform EMG despite not having done a dedicated fellowship. Their qualify is questionable for most of the time. However, some residency programs really go out of their way to ensure their graduates have enough exposure.

I was talking to movement person, and they find EMGs to be annoying. Said its burdensome to deal with the patient population, takes up alot of time, memorizing spinal levels, have to sort through tons routine stuff most of which is neuropathy to find anything interesting like the muscle disease since its so rare.

 

[Postictal Raiden]

Ah. No idea. My movement docs in residency liked doing EMG guided Botox for spasticity.

I’ll let the movement guys here comment

 

[Sage of Pale Bones]

Obviously having a fellowship helps and opens more doors. Also it depends on what career path you chose. Outpatient general neuro, mixed neurophys is hands down most bang for your buck, with neuromuscular is close second. For inpatient, epilepsy or EEG heavy neurophys. Stroke is also valuable if you work at busy stroke centers or if you want to become a stroke director at some community hospital (more $$$).

Otherwise it’s really based on what you really want. Some people do fellowship to escape having to see mundane general neuro consults and instead they would like to focus on their area of interest. Others do it because you most likely going to need one if you gonna do academia.

Regardless, plenty of jobs to go around. You don’t need a fellowship to find a job if you’re not too fixated on a specific location.

With that said, I’m a fresh grad and I’m very familiar with the current market. Just this week I was approached by two recruiters for outpatient gen neuro jobs in SoCal. I don’t have a fellowship. I don’t do EMG. They didn’t care.

Sorry to bring up an old thread; I was wondering about CNP vs NM or Epilespy.

I figured the consensus was that it is better to train in either NM/ EMG or Epilepsy/ EEG and really master one as nowadays you don't really get much from a mixed CNP program. Do you feel there is still merit in an EMG/ EEG CNP program in 2023?

 

[Postictal Raiden]

Sorry to bring up an old thread; I was wondering about CNP vs NM or Epilespy.

I figured the consensus was that it is better to train in either NM/ EMG or Epilepsy/ EEG and really master one as nowadays you don't really get much from a mixed CNP program. Do you feel there is still merit in an EMG/ EEG CNP program in 2023?

From a community based and purely financial prospective, mixed CNP is the best fellowship for outpatient neurology

 

[Sage of Pale Bones]

From a community based and purely financial prospective, mixed CNP is the best fellowship for outpatient neurology

If, say, your residency training did a good job covering EEG but you feel woefully unprepared for EMG would the end result of NM be similar to mixed CNP for outpatient Neuro?

(thanks for the advice btw)

 

[Postictal Raiden]

If, say, your residency training did a good job covering EEG but you feel woefully unprepared for EMG would the end result of NM be similar to mixed CNP for outpatient Neuro?

(thanks for the advice btw)

Yes

If you feel very comfortable with EEGs, then yeah doing an NM fellowship, as opposed to CNP, would make sense.