Neurology, can it be IT for me?

[Duon89]

So before my neuro rotation, I have never even considered neuro.

I am currently on Neuro rotation as a 3rd year. it's just 2 wks of outpt and 2 wks of inpt (no neuro icu, no ped neuro)
I really enjoyed outpatient setting. I was enthralled by the movement disorders especially. I had a chance to follow movement disorder specialist few days and I like how I can see different movements on pt and the fact that it can manifest in many different organ systems as well. And the fact that it is a lifelong management is just great . It sucks that most of these diseases are not curable. But, if there is no cure now, it is likely that there is room for improvements and growth in the field and I like that idea too. And I really like the idea of sub-specializing in neurology. I do understand I would probably have to see migraine and seizure pts still after doing subspecialty. I would not mind that at all. So, I thought to myself "Maybe this is it!"

Now I am on inpatient setting where I would see pt with mostly stroke, seizure, and here and there rare disease cases. And I am just not enjoying the stroke/seizure pts as much. And it is more challenging to examine them too, more due to my lack of examining skills etc. And I guess I am just not a big fan of inpt medicine, mainly because I suck lol.

But now I am in the dilemma where I am not sure the feelings that I had during oupt setting is good enough to make the decision of going into neuro.

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[TUGM]

It seems that you are genuinely fascinated with a certain subspecialty of neurology, and can see yourself practicing it in the future. Know that this can be accomplished. You can tailor your practice to see a certain subset, though it is much more feasible to do this in an academic setting. In private practice, you'll have to see some general stuff, but you could always try to market yourself to a niche practice.

In residency training, across pretty much all specialities, you'll have to do a mix of outpatient and inpatient stuff. Literally every field has these two dichotomies, so you'll never really find a specialty where you won't have inpatient things to do, except maybe in dermatology, but even they have to see consults every once in a while.

Know that neurology training is only inpatient heavy in the first year. Though program structures can vary, most of them seem to be front loaded. Your PGY-2 year (N1), you'll be doing quite a bit of inpatient training - you'll learn how to strokes, status epilepticus, bleeds, ICU stuff, myasthenic crises, etc. But usually after that, there is a lot of time to pursue outpatient work, and you can tailor your rotations towards your interests.

Also, once you start residency, you realize you didn't know a patient's face from their ass, and start to learn the actual application of medicine at a rapid pace. Don't let your current lack of knowledge or clinical exam skills hold you back from something you find yourself truly interested in. Those movement disorder specialists are usually master clinicians who are experts of functional neuroanatomy. There's seriously nothing cooler than doing a physical exam to diagnose your patient and know where you'll find the lesion before you even order the imaging to confirm. And if you're wrong, then chances are you've got a rare and enigmatic disease process to learn from/about. You get to learn those skills during training!