Fellowship to complement epilepsy training

[DiscoReinhardt]

My main interest is inpatient epilepsy and will be doing a 2 year fellowship. However, I am also interested in picking up teleneurology shifts on the side which I’ve heard becomes easier to get with a stroke fellowship, plus epilepsy alone might become a bit boring after a while.

On the other hand stroke really gives you no experience with extra billable procedures like EMG, Botox, so I’m a bit hesitant. Not sure how much one gains clinically either after residency. Feel Neuromuscular would be more useful clinically and EMG would be a boost (although I’m unsure how I’ll fit that in- doesn’t help in teleneuro and I won’t have the typical patient base).

Should I stick with epilepsy only, or bite the bullet and go for stroke/neuromuscular/any other fellowship after that?

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[Thama]

Sleep is the obvious addition to epilepsy: you can read full montage sleep studies if you have both sets of training, and both can fit neatly together in a fairly relaxed, high-RVU outpatient practice.

 

[xenotype]

My main interest is inpatient epilepsy and will be doing a 2 year fellowship. However, I am also interested in picking up teleneurology shifts on the side which I’ve heard becomes easier to get with a stroke fellowship, plus epilepsy alone might become a bit boring after a while.

On the other hand stroke really gives you no experience with extra billable procedures like EMG, Botox, so I’m a bit hesitant. Not sure how much one gains clinically either after residency. Feel Neuromuscular would be more useful clinically and EMG would be a boost (although I’m unsure how I’ll fit that in- doesn’t help in teleneuro and I won’t have the typical patient base).

Should I stick with epilepsy only, or bite the bullet and go for stroke/neuromuscular/any other fellowship after that?

It seems like you are signing yourself up for training forever with no discernible benefit at a great, great cost to yourself. Plenty of people do teleneurology or neurohospitalist gigs off of 1 year epilepsy fellowships including stroke coverage. The further out you get from recent stroke experience (residency in your case), the more you'll absolutely need a stroke fellowship year to do any of it. This is an overall point about why 2 year fellowships like this are bad for many people. It is just free money to the people training you unless you are getting organized for a high powered, funded research position or an exceptionally specialized role. Will you be clinically better than the guy that only did 1 year? Maybe for the first 6 months of attending-hood, then who knows? At some point you need to start seeing patients on your own and take the training wheels off- neurology residency should have already been a lot of stroke and inpatient neurology. You'd be far better off doing 1 year of epilepsy and either 1 year of stroke or just stopping there and working as a neurohospitalist like most people. The only exception to this would be some super specialized large level IV center with MEG, etc in which case you won't get paid that well, and won't be doing any stroke anyways.

If you want to do outpatient that changes things quite a bit depending on what procedures you want to be able to do as Thama alludes to. It is also really hard to be both a great EEGer and a great EMGer simultaneously. Most people end up being quite mediocre at one or the other and trying to brush it under the rug.

 

[Postictal Raiden]

It seems like you are signing yourself up for training forever with no discernible benefit at a great, great cost to yourself. Plenty of people do teleneurology or neurohospitalist gigs off of 1 year epilepsy fellowships including stroke coverage. The further out you get from recent stroke experience (residency in your case), the more you'll absolutely need a stroke fellowship year to do any of it. This is an overall point about why 2 year fellowships like this are bad for many people. It is just free money to the people training you unless you are getting organized for a high powered, funded research position or an exceptionally specialized role. Will you be clinically better than the guy that only did 1 year? Maybe for the first 6 months of attending-hood, then who knows? At some point you need to start seeing patients on your own and take the training wheels off- neurology residency should have already been a lot of stroke and inpatient neurology. You'd be far better off doing 1 year of epilepsy and either 1 year of stroke or just stopping there and working as a neurohospitalist like most people. The only exception to this would be some super specialized large level IV center with MEG, etc in which case you won't get paid that well, and won't be doing any stroke anyways.

If you want to do outpatient that changes things quite a bit depending on what procedures you want to be able to do as Thama alludes to. It is also really hard to be both a great EEGer and a great EMGer simultaneously. Most people end up being quite mediocre at one or the other and trying to brush it under the rug.

Very well said.
As a PGY-4 I always feel rusty coming on to the stroke service after a month or two of electives/consult service. I can’t imagine managing stroke after not doing it for a year, much less two.

This will trigger many people here, but I’ll say it anyways because I am not here to make friends. Fellowships are largely a scam. Just like the entire higher education system. It is in the best interests of academicians to keep pushing people into more training. It’s an illusion. What are you going to experience in a year of stroke fellowship that you didn’t in your 4 years of neuro residency? Similarly, what is the gain of doing a two year epilepsy fellowship as opposed to one? Or movement or neuroimmunology?

Like Xenotype mentioned, the father you’re removed from residency, the less comfortable and competent you’ll be managing conditions not in your area of fellowship.

I stand by what I always have been writing on this forum (and I know that I have my own biases, who doesn’t?). Needing to do a fellowship in order to do neurohospitalist work is an insult to your residency training since every neurology residency should be competent in managing all types o stroke and their complications, seizures, NM emergencies, and other neuro emergencies. Moreover, just like every neurology graduate is comfortable with neuro imaging, a basic level of competence in reading EEGs is a must. No one should need a fellowship to be able to recognize an electrographic seizure and epileptiform discharges.

I agree that EMG is a different beast and may require a fellowship unless your residency program goes out of its way to ensure sufficient exposure to EMG.

 

[elanmorin]

Agree with Ibn and xenotype above; your entire residency is an enfolded neurohospitalist fellowship.

If your goal is to work in the inpatient setting, you should be well prepared for this by the end of your residency. A two-year epilepsy fellowship where you are spending 80%+ of your time looking at EEGs will not be helpful and may even hurt your overall General Neurology background by the time you finish (not saying you can't pick it up again, but you will lose what you aren't using regularly).

Do a fellowship to pick up knowledge or skills that you want to apply but didn't get enough of in residency: sleep, EMG, movement, neuroimmunology (depending on your residency exposure and interests) if you plan on doing any outpatient work on the side, as you can create a subspecialty niche for yourself. Otherwise, a one year epilepsy/neurophys/stroke fellowship at most if doing inpatient work.