If I hate working nights, what sort of subspecialties/practice arrangements in neurology should I look into?

[chick_fil_eyyy]

Interested in hearing about people's day-to-day practice and satisfaction/gripes! Right now I like most everything I've seen in neuro, and I totally understand that residency is residency - you'll be on call a lot and super busy. However, for long-term career, I think waking up at 3am every few weeks to go see patients at the hospital would burn me out. I know headache and movement disorder docs generally have a more "chill" lifestyle, but would like to hear people's opinions on minimizing working overnight regularly as a neurologist.

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[GuillainMollaret]

There is a degree of variability. Some practices utilize neurohospitalists for overnight hospital coverage while the clinic docs either have no call or outpatient call (i.e. clinic patients calling in with questions, much easier than being on call for a hospital/ED). This is possible with larger practices.

Other groups may have no neurohospitalists and there is a rotating inpatient call schedule. Or the group may not be affiliated with a hospital at all thereby negating the need for inpatient call.

 

[Hank_Hill_MD]

The concussion specialist (idk what the official title is... sports neurologist? neurotrauma?) had by far the most chill schedule of all the physicians on my rotations. 9-5, 5 days a week with no call. Had at least 30 minutes for every patient whether new or established, usually an hour for new ones. Patients generally skewed younger as athletes, with some worker's comp here and there. Had it written into their contract that they were outpatient only. Probably not bringing in a ton of income that way, but if you don't mind that, it seems like a pretty sweet gig.

Fair bit of competition between that clinic and the sports med docs in the same network, though. Weird vibe there, but they were appreciative having neuro backup for the few concussions that didn't go by the book, so I think the two can coexist under the right circumstances/clinic setup.

 

[Postictal Raiden]

Many neurology subspecialties are outpatient focused (movement, neuromuscular, epilepsy, neurodegenertive, MS, headache, sleep, neurophysiology, neuro-ophth, and others). As an outpatient neurologist, you can choose to not set a foot in the hospital or work nights/weekends for the rest of your career. However, as mentioned above, many groups have rotating inpatient coverage (ie 3 weeks of outpatient and 1 week of inpatient), but you don't need to join a group. You can have your own practice and design your schedule the way you please.

On the other hand, stroke and NCC are obviously hospital based specialties and require night/weekend coverage to some degree.

 

[popopopop]

The local neuroicu attending by me works 7 on 7 off, no nights. He's a young guy too, so it wasn't a seniority thing.

 

[neglect]

Rehab.

 

[typhoonegator]

There's waking up and going in a couple nights a week, and then there's multiple calls per night that you field from home...every night you're on call. The stress associated with each is different, but I can assure you that both eventually add up to be pretty awful. These days, it's not hard to find jobs where you "take all your call from home" but that consists of a bunch of teleneurology sites that want to "run it by you" for every TIA/UTI that rolls in, or telestroke where you're doing video and massive hand-holding, etc. I guess what I'm trying to say is not to underestimate the effect of these cumulative micro-aggressions on your sleep and well-being.

 

[neurochica]

I agree with typhoon- one thing that I do when I get to each hospital is to train th ED docs and nurses on what’s acceptable to call. It usually takes a few week (of intensive nagging) but I get those call down very quickly.

 

[Algor]

This is just my opinion, not legal advice or recommendation.
I would avoid calls from home, often you need a very detailed exam to make a decision. E.g. peripheral vertigo vs basilar artery occlusion? Spinal cord compression or GBS? The outcome is very different and such case may change your entire future. So, here are the options:
1) Pure outpatient practice, no calls from the hospital.
2) Neurohospitalist with teleneurology back up after hours (you should not be the one who takes teleneurology calls after hours)
3) Neurohospitalist with night hospitalist backs up after hours.
4) Pure neurophysiology, doing outpatient EMG and reading remote EEG/Long term video EEG
5) Intraoperative monitoring
6) Administrative work, e.g. working for insurance companies, disability application evaluation.
7) Combination of outpatient practice and hospital coverage with teleneurology/stroke neurologist back up (again, you should not be one doing teleneurology).
8) Rehab
9) No - fault/work comp work
10) Return to play evaluation after a concussion
11) Pain management/medical marijuana
12) Full-time teleneurology job
Due to advances in endovascular treatment "tPA or not tPA" or "give 1g of Keppra for status" will not be enough anymore. All stroke cases from now will require very complex evaluation for large vessel occlusion and determination if such occlusion or stenosis is symptomatic. In my opinion, all night calls in neurology will become miserable pretty soon (most likely, you will not have enough people who are willing to take calls, you will get more calls due to extended stroke window up to 24 hours and stroke calls will be more complex, you will be called for all encephalopathies presenting within 24 hours). I believe such phenomena as "an outpatient neurologist taking night calls" will disappear VERY soon. Most of the stroke calls will be handled through telemedicine. If you take stroke calls, you want to make sure you have very reliable neuroradiology/know how to read CTA and CT perfusion. This will make neurology shortage even worse. So, many hospital/group leadership are in complete denial, "looking for a neurologist who will do outpatient work, inpatient consult and administer tPA". This comes from a very poor understanding of the current market situation. So, those who understand it better will be able to build a strong neuroscience program, those who are in denial will get in trouble/get sued for not administering tPA/missing large artery stenosis/occlusion and other treatable neurological diseases (e.g. myasthenia gravis, GBS, etc).