Help re fellowship options

[guj]

I am a 3rd yr Neuro resident and am interested in almost everything. I have narrowed down to stroke or neuro-muscular for fellowship options. I understand some differences that one is predominantly inpatient and other is outpatient.

But I need some guidance re
1. Which fellowship will get me a better paying job (I don't want academic, not interested in research)?
2. I am planning to settle in Portland or San Diego; which fellowship ill help me find a job in the city (not 50 min out of city)?

Thank you all for your help.

P.S: I still don't understand all the fuss about medicare cuts to EMG, I still hear, people making good money (maybe not outrageous money anymore)

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[OasisMan]

well which would you rather do? in- or out-patient? mixture?

the 2 priorities you listed were financial and geographical. because of that, if I were you, I would contact recruiters just to test the waters and see what options are available for those fields in those areas.

 

[typhoonegator]

Salary depends more on the situation than anything else, but I would say that in general you'd have more procedural options and flexibility with neuromuscular training. That said, if you read a ton of neurosonology you can do well with stroke. Depends also on whether you want to do hospitalist/acute stroke work, which can pay well depending on the situation.

 

[deathmerchant]

Clearly, the best option for u would be Neurophys fellowship- a lot of job opportunities, u can work for more than one hospital/practice and do both EEGs and EMGs,hence make good money. Later on u can only focus on either, if u want. Also its just 1yr. Esp Good for u since u are nt particularly interested in academics and research.

 

[danielmd06]

Agree with neurophysiology if you are undecided. It gives you good flexibility and buttresses general neurology knowledge while sharpening your EEG and EMG skill set. A strong all around choice for the average resident.

 

[Hank Rearden]

It seems you are being steered toward neuromuscular by the posters above, but I don't think your choice is that simple. I too was interested in either stroke or neuromuscular, but ended up choosing stroke. My situation is a bit different because I'm academic, but I think some of the same principles apply.

Regarding the issue of salary, the salaries of private docs doing neuromuscular and stroke is probably comparable so that should not be your deciding factor. As one of the posters mentioned, the biggest question is whether you prefer inpatient or outpatient work and the lifestyles that go along with these. If you choose neuromuscular, you are choosing an outpatient lifestyle, doing EMGs and seeing pts in clinic during the week likely with your nights and weekends off with the exception of some shared call every now and then. Your days may be long, but your schedule will be more predictable. Stroke on the other hand is mostly inpatient work, and I think most of these folks turn into neurohospitalists in the private world. It's nice in the sense that you can do interesting schedules like 1 week on 1 week off, but those weeks on are typically 12 hours / day for 7 or more days straight. In addition, for stroke you will likely be going in frequently in the middle of the night for stroke codes. Of course there are probably some stroke docs in private practice who do nothing but clinic, but I think they are rare. Most of us find clinic rather drab.

Regarding your desire to live in Portland or San Diego, your ability to land a job there depends more on how good you are and what jobs happen to be open than which of these specialties you choose. I know there is a huge shortage of stroke docs around the country and that is only likely to grow, not sure if the same is true for neuromuscular.

 

[guj]

Thank you all for your responses and guidance.

I want to do both inpatient and outpatient, doing just one seems very boring and monotonous. I like both stroke and neuromuscular almost equally and being in certain geographical city is important to me. At our institution, our neuromuscular faculty rarely do any inpatient and mostly are research funded.
At this point, it seems stroke will give me more flexibility.

I think biggest trouble as a resident trying to decide about fellowship is that residency doesn't give real world experience of neurology. But I really appreciate all your input.

Thanks.

 

[guj]

Hi all, I have changed my mind and decided to pursue academic practice. Would appreciate input re jobs in academic places for stroke vs Neuro muscular.
Thanks again.

 

[Hank Rearden]

That was a quick switch to academics. If you're really serious about academics the best advice is to go to the strongest fellowship you can get into.

I can help you narrow down the options on the stroke side - it would help greatly if you knew which aspect of stroke you were most interested in - acute, endovascular, epidemiology, secondary prevention, imaging, rehab? Overall Cincinnati is regarded as the strongest program. You would be well trained at any of the 25 StrokeNet sites:

http://www.nihstrokenet.org/the-network/about-us

Some other strong programs not in StrokeNet: Wash U, Hopkins, and I'm sure others

Happy to help narrow this list down if you tell me which aspects of stroke you're most interested in.

 

[guj]

Thanks for the reply. I was thinking of private practice but after elective I don't think it is for me. I am ok with less salary but more concerned about finding an academic job.
I don't want to do bench research and have been told that most research in neuromuscular is bench research and also academic jobs are hard to find.

 

[Notch3]

So I am in a similar dilemma as the OP and wanted to ask your guys' opinion. I really enjoy stroke care and wanted to do a stroke fellowship. However, my program is big on stroke and is very inpatient heavy, so we see a lot of stroke pts. Since we haven't had a stroke fellow for the last 2 yrs, the residents run the code strokes, inpatient stroke service, and enroll pts into studies. I just got back from my first set of vascular fellowship interviews at some top programs and am now questioning if I will really gain much further knowledge with pursing a stroke fellowship. I understand it can be helpful for a job as a neurohospitalist or a stroke center director or academics.

So my question is, should I do a fellowship in something that I am weaker at but will more marketable such as neurophysiology? Or pursue my interest and do stroke? Right now I am open to academics and private but am swinging more towards private practice as a neurohospitalist but we'll see, as long as I can land a gig where call is not ridiculous. I'm not a fan of outpatient unless its split 50/50.

 

[Acherona]

Why would you do a fellowship in something you aren't interested in? If you do inpatient hospitalist or strokologist, I don't see how doing EMGs fits into that. I would also think a stroke fellowship is just as marketable. If you go to a good program, I'm sure you'll learn some stuff and can get into research which will help your resume etc.

 

[Notch3]

Agreed! I am sure if I did neurophys, it would be a drag for me. Well at our program, we also have inpatient EMG capability but then again, we only use them when we have those unclear nmsk cases which is rare. I assume majority of hospitals don't even have EMG capability. Anyway, planning to load up on EEG electives my 4th yr so I can be comfortable with that. Thanks for the reply

 

[reticularmonkey]

I'm having difficulty ranking between University of Washington (Seattle), UT Southwestern, UCSD and my small stroke fellowship program at my hospital. They have an interventional fellowship here, but I'm not 100% set on it...I really liked Uni of Washington but they aren't ranked as high as UT Southwestern. I actually didn't like UCSD much in terms of faculty, but they are ranked really high?!

1. UT Southwestern - Possible IR?, Faculty ok but growing dept, not Stroke NET site
2. University of Washington - Great faculty, no IR, Stroke NET
3. My Program - IR + Faculty, no Stroke NET
4. UCSD - Good ranking, Stroke NET

How does this seem to you guys for a stroke fellowship? I would really appreciate any feedback!!

 

[DocMom1]

ReticularMonkey: where is pay greatest and cost of living lowest? this might not be something on the forefront of your mind now, but quality of life will be a tremendous determinant of your comparative satisfaction.

 

[DocMom1]

Salary depends more on the situation than anything else, but I would say that in general you'd have more procedural options and flexibility with neuromuscular training. That said, if you read a ton of neurosonology you can do well with stroke. Depends also on whether you want to do hospitalist/acute stroke work, which can pay well depending on the situation.

in what settings will one be reading neurosonology and getting paid well for it?

 

[typhoonegator]

The per-study reimbursements for carotids and TCD/HITS/CVRS aren't typically very high, so volume is important if you expect that reading neurovascular ultrasound studies are going to make up a substantial portion of your salary. So something like a regional stroke service with a large catchment and a small vascular neurology team would help you maximize the volume of reads you'd be eligible to do. I personally wouldn't want to do something like that, because reimbursements for things like that could change, and probably not for the better. You're probably better off looking at ancillary procedural charges like that as icing on the cake, rather than trying to optimize your system around something that can dry up.