neurophysiology fellowships

[hyperdense]

When do most neurophysiology fellowship programs start interviewing? Have any programs started already? Also other than a interest in neurophysiology what are fellowship programs looking for in applicants?

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[Claymore]

I went through the process last year and applied to a handful of programs in the midwest. I received offers to interview anywhere from May to August, more towards the beginning of that range (May-early July). Unfortunately there is little standardization and programs that interview later are probably at a disadvantage as applicants accept positions on a rolling basis. My suggestion is to get your applications out there by March-early April, and especially apply to your top choice(s) early.

 

[Fencer]

Most program directors for CN (Consortium of PD) want to start interviews in August and offers in September. A PD can offer a slot during the interview, but PDs should allow you a few days to decide (once you are back to your program). I personally do not want to see applications until at least May or June. It is my experience that those who take early slots are either brilliant (top 5-10% of residents) or in the bottom quartile. Most of the solid residents will be interviewing between July and September. However, it is like Early Decision, you might be able to lock a slot in a program that is desirable to you, but not top choice. If you wait until early May, then apply to a broader group of programs and you often have a wider net.

At the present time, there is no standard and no matching program. There is talk to get into a match, the problem is the timing of the current system doesn't help. A March (-1.25 yrs) match would be too early (Jan/Feb vs Aug/Sept interviews).

By 2011, we will begin with ABPN Epilepsy certification, and in 2013, ACGME accredited Epilepsy programs. When ABPN Neuromuscular started, the number of CN fellowship slots was about 240, now is ~190. I will predict that we will have about ~150 CN by 2014, with 50 for Epilepsy and 50 for Neuromuscular.

The Epilepsy/Neuromuscular programs will be geared towards academicians, while CN continue to be program of choice for residents considering a career as private practitioners.

 

[hyperdense]

Thank you for the input--very helpful. I only applied to a handful of programs. Its comforting to know that I still have an option to apply to more if things don't work out.

 

[Flail Chest]

Hi all I had a quick question about neurophys. If I pursue this fellowship after Neuro residency will I be board eligible for sleep medicine, Neuromuscular, and epilepsy (providing I could pass all three exams) or are you only board eligible for Neurophysiology? I'd like to have a sleep center at night but do general Neuro with emg and/EEG during the day. Thanks in advance for any input!

 

[danielmd06]

Hi all I had a quick question about neurophys. If I pursue this fellowship after Neuro residency will I be board eligible for sleep medicine, Neuromuscular, and epilepsy (providing I could pass all three exams) or are you only board eligible for Neurophysiology? I'd like to have a sleep center at night but do general Neuro with emg and/EEG during the day. Thanks in advance for any input!

Clinical neurophysiology can qualify you for board certification in neurophysiology (both EEG and EMG). You actually do not need board certification in anything beyond adult neurology to actually bill for EEG's and EMG's, though. I suppose this could change in the future. Clinical neurophys fellowships do indeed often include a couple of months dedicated to sleep or intraoperative monitoring depending on the institution and your own wishes.

Sleep medicine is now a separate issue altogether (wasn't always this way in the past). You can read sleep studies without board certification, but your study must be overread by a board certified sleep doctor for any laboratory that is accredited by the AASM. It's not a small deal. And this is definitely the way of the future for sleep. To obtain board certification for sleep medicine, you must first complete an ACGME-accredited sleep medicine fellowship. This qualifies you to take the board exam in sleep (which you must obviously pass). The fellowships are one year long (with some two year exceptions for extra research time at some institutions).

Bottom line? If you want to do sleep, you need to do a sleep fellowship. If you want to do EMG/EEG, you don't have to do a clinical neurophys fellowship (but it's often advisable).

 

[Flail Chest]

Thanks! Very helpful!

 

[RedNeuro]

Clinical neurophysiology can qualify you for board certification in neurophysiology (both EEG and EMG). You actually do not need board certification in anything beyond adult neurology to actually bill for EEG's and EMG's, though. I suppose this could change in the future. Clinical neurophys fellowships do indeed often include a couple of months dedicated to sleep or intraoperative monitoring depending on the institution and your own wishes.

Sleep medicine is now a separate issue altogether (wasn't always this way in the past). You can read sleep studies without board certification, but your study must be overread by a board certified sleep doctor for any laboratory that is accredited by the AASM. It's not a small deal. And this is definitely the way of the future for sleep. To obtain board certification for sleep medicine, you must first complete an ACGME-accredited sleep medicine fellowship. This qualifies you to take the board exam in sleep (which you must obviously pass). The fellowships are one year long (with some two year exceptions for extra research time at some institutions).

Bottom line? If you want to do sleep, you need to do a sleep fellowship. If you want to do EMG/EEG, you don't have to do a clinical neurophys fellowship (but it's often advisable).

On the same lines, I am doing a sleep fellowship and have a neurophys fellowship lined up for next year. Do you (or anyone else) think it is worth it to the second fellowship (neurophys)?

I am contemplating it based on:

1) I want to read EEGs in the daytime. See epilepsy and sleep pts and read sleep studies.
2) Want to do private practice


-Wanted to also do IOM but due to severe reimbursement cuts this is likely not feasible anymore

From a referral standpoint will it make a difference? Is an EEG and sleep practice feasible and better than either alone?

Thanks for any input.

 

[danielmd06]

On the same lines, I am doing a sleep fellowship and have a neurophys fellowship lined up for next year. Do you (or anyone else) think it is worth it to the second fellowship (neurophys)?

I am contemplating it based on:

1) I want to read EEGs in the daytime. See epilepsy and sleep pts and read sleep studies.
2) Want to do private practice


-Wanted to also do IOM but due to severe reimbursement cuts this is likely not feasible anymore

From a referral standpoint will it make a difference? Is an EEG and sleep practice feasible and better than either alone?

Thanks for any input.

If you want to do sleep plus general neurology and specifically see some epilepsy patients, then the neurophysiology fellowship makes sense (particularly if you feel your residency didn't prepare you that well for private practice...which is not uncommon these days).

The downside is that you are now spending an extra year (of 200-300k lost income) as a fellow once again.

You'll definitely be well rounded and could still do pure sleep if you wanted. Based on the literature, I think it is reasonable to check for sleep disordered breathing in most patients with epilepsy. It's almost fair to ask why you *shouldn't* send an epileptic for a sleep study if they're overweight, complaining of hypersomnolence, snore, have nocturnal seizures, or have uncontrolled seizures. Beth Malow at Vanderbilt has written alot about this topic. And Nancy Foldvary Schaefer has some good book chapters and articles on this, too.

 

[danielmd06]

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[RedNeuro]

If you want to do sleep plus general neurology and specifically see some epilepsy patients, then the neurophysiology fellowship makes sense (particularly if you feel your residency didn't prepare you that well for private practice...which is not uncommon these days).

The downside is that you are now spending an extra year (of 200-300k lost income) as a fellow once again.

You'll definitely be well rounded and could still do pure sleep if you wanted. Based on the literature, I think it is reasonable to check for sleep disordered breathing in most patients with epilepsy. It's almost fair to ask why you *shouldn't* send an epileptic for a sleep study if they're overweight, complaining of hypersomnolence, snore, have nocturnal seizures, or have uncontrolled seizures. Beth Malow at Vanderbilt has written alot about this topic. And Nancy Foldvary Schaefer has some good book chapters and articles on this, too.

Thanks for the info. I have to look at all aspects, so realistically, how much more income would a neurophys fellowship add to sleep/neuro practice? 50k? 75k?

I think my EEG component is pretty solid (had 6 mo of EEG in residency - pedi + adult). EMG is something I am not too interested in, so won't be doing too much of that anyways.

Appreciate your input and comments.

 

[danielmd06]

Thanks for the info. I have to look at all aspects, so realistically, how much more income would a neurophys fellowship add to sleep/neuro practice? 50k? 75k?

I think my EEG component is pretty solid (had 6 mo of EEG in residency - pedi + adult). EMG is something I am not too interested in, so won't be doing too much of that anyways.

Appreciate your input and comments.

Well, in most respects it would add zero. You can do an EEG or EMG and bill for the interpretation without the fellowship and board certification (unlike sleep). So, unless you have academic interests, research interests, or a reason to spend an extra year of your life in one place...I would just go straight to work.

EMGers are fairly commonplace in private practice, so if you were in most group situations there would be someone able to do them if you didn't want to.

 

[RedNeuro]

Well, in most respects it would add zero. You can do an EEG or EMG and bill for the interpretation without the fellowship and board certification (unlike sleep). So, unless you have academic interests, research interests, or a reason to spend an extra year of your life in one place...I would just go straight to work.

EMGers are fairly commonplace in private practice, so if you were in most group situations there would be someone able to do them if you didn't want to.

Thank you, that makes sense. What about IOM? Do I need the fellowship for this? Also based on the state of medicare reimbursements fir IOM, is it even worthwhile to get training in it?

 

[danielmd06]

Thank you, that makes sense. What about IOM? Do I need the fellowship for this? Also based on the state of medicare reimbursements fir IOM, is it even worthwhile to get training in it?

Sorry, IOM is more than I know about. I'm sure you can get more information on the ACGME and AAN websites, and there are a few IOM-specific people on the forum from time to time. Perhaps a quick search?

 

[RedNeuro]

Sorry, IOM is more than I know about. I'm sure you can get more information on the ACGME and AAN websites, and there are a few IOM-specific people on the forum from time to time. Perhaps a quick search?

Will do. Thanks very much for your input. From what I gather from you and others, there truly is no benefit to the second fellowship. I am not interested in an academic career. And my EEG skills are pretty good. Much thanks.

 

[chiming_in]

I made a comment in the other forum about the IOM program at Stanford

http://neurology.stanford.edu/neuromonitoring/fellowship.html

Hope that is of help (if you are considering an ACGME-accredited program dedicated to intraoperative monitoring).