Thoughts on neurophysiology fellowship for community practice?

[DerpyNeuroMD]

PGY2 -- I'm seriously considering CNP right now. It looks like it hasn't been discussed in a little while.

My plans are to go out into the community, likely join a practice at first or do locums for a minute. EMG and EEG both seem like sort of fun ways to break up the monotony of pure clinic. There are some programs in my area that are 50/50 EMG/EEG.

I know people are saying CNP is sort of dying out in favor of choosing one or the other, but in the long term if I'm one of only a handful of neurologists serving rural areas, would one year be sufficient to know enough to be dangerous with both of these skills? At least for bread and butter, and to the degree where I could refer to an academic center if I felt out of my comfort zone?

Also, in your opinion, would it be worth the extra year? I.e. would it pay for itself? And for that matter how are reimbursements looking for these procedures?

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[Telamir]

If you are doing rural, or if you are opening up a practice; absolutely CNP is a good choice. Yes it's currently skewing more towards one than the other but this is in academic places mostly where true "general neurologists" are not common.

As someone who does locums full time though, I would not recommend doing locums straight out of training. Get a job with some mentorship as the first 2-3 years out of training are the hardest/most formative as an attending.

 

[Neurogeneral]

A dual track EMG/EEG CNP is still a very solid fellowship - well worth the investment of one extra year of training.

This fellowship is best suited for a community-based general neurologist. So you should be able to do EMG and EEG in non academic practices -whether you are in a bigger city/metro or rural areas. Some employers may even prefer someone who can do both.

Doing EMGs also gives one a break/reprieve from doing daily non-stop clinic, which helps prevent burnout IMO…..

 

[Postictal Raiden]

Well worth it. Best bang for your bucks in the community/private world.

If you attend one of the rare programs that provide very immersive and abundant exposure to electrodiagnostics (LLU comes to mind where residents graduate with 100+ EMG logged), then probably you wouldn’t need the fellowship to be comfortable with EEGs and EMGs.

 

[deleted1139416]

If you are doing rural, or if you are opening up a practice; absolutely CNP is a good choice. Yes it's currently skewing more towards one than the other but this is in academic places mostly where true "general neurologists" are not common.

As someone who does locums full time though, I would not recommend doing locums straight out of training. Get a job with some mentorship as the first 2-3 years out of training are the hardest/most formative as an attending.

A dual track EMG/EEG CNP is still a very solid fellowship - well worth the investment of one extra year of training.

This fellowship is best suited for a community-based general neurologist. So you should be able to do EMG and EEG in non academic practices -whether you are in a bigger city/metro or rural areas. Some employers may even prefer someone who can do both.

Doing EMGs also gives one a break/reprieve from doing daily non-stop clinic, which helps prevent burnout IMO…..

Well worth it. Best bang for your bucks in the community/private world.

If you attend one of the rare programs that provide very immersive and abundant exposure to electrodiagnostics (LLU comes to mind where residents graduate with 100+ EMG logged), then probably you wouldn’t need the fellowship to be comfortable with EEGs and EMGs.

What areas in neuro would you all say are getting saturated?

 

[Postictal Raiden]

What areas in neuro would you all say are getting saturated?

Epilepsy for sure. That’s if you want to do pure epilepsy. Couple of my friends did 2-year epilepsy fellowship and had to accept jobs in areas they didn’t want to move to in order to do EMU/epilepsy only work

 

[neophyte2008]

I agree that it is the best fellowship for a generalist and is the best bang for buck.

 

[deleted1139416]

@Ibn Alnafis MD @neophyte2008

Is the job market for generalists who don’t do fellowships good? Or do with the rapid rise in new neurologists being trained, do you think fellowship is necessary?

 

[Postictal Raiden]

@Ibn Alnafis MD @neophyte2008

Is the job market for generalists who don’t do fellowships good? Or do with the rapid rise in new neurologists being trained, do you think fellowship is necessary?

I live in a desirable non-coastal city on the West Coast. There’s a big demand for general neuro in the outpatient world. Ofc they “prefer” someone with formal training in EMG/EEG, but they’d take any BC/BE neurologist with a pulse. I know that because some of these jobs have been advertised for 2+ years now.

Until now, I get tons of recruitment emails for outpatient neuro work. The need is dire and it’s getting worse. In my area, it takes 3-6 months to see a neurologist. I can only imagine how bad it is in less fortunate regions of the country

 

[Postictal Raiden]

@Ibn Alnafis MD @neophyte2008

Is the job market for generalists who don’t do fellowships good? Or do with the rapid rise in new neurologists being trained, do you think fellowship is necessary?

I didn’t do a fellowship, so definitely I have my biases.

About 90% of all neuro grads do a fellowship of some kind. But unlike pathology, the decision of pursuing additional training is mainly due desire to subsidize rather than for the sake of employability. Like IM, Neuro is vast, and most people prefer to focus on one area of it. Others simply want to avoid seeing certain parts of neurology (like my NCC friend who says he doesn’t want to see patients with GCS above 7).

With that said, this is subspecialization is adding to the demand for general neurologists who see every type of consult. Keep in mind, general neurology also entails a person who is capable of doing routine electrodiagnostics (EEGs and EMGs). Nearly every group in my area is looking to hire general neurologists.

As you see, sometimes doing a fellowship can also limit your options if you strictly want to practice your subspecialty. Like I mentioned before, my friends who did epilepsy fellowship and only want to do epilepsy related work had to relocate from the West Coast to Ohio and Kentucky for jobs.

 

[Postictal Raiden]

 

[Postictal Raiden]

As you see above, neurology is one of the most in-demand specialties per PracticeLink, the largest physician job search engine.

In fact if you look at their previous issues, neurology always made the list, most times one of the top 5 and few times the very top specialty in terms of demand.

This is something to keep in mind when looking for jobs. Don’t allow employers to lowball you. They NEED you and they KNOW it.

 

[DrStephenStrange]

@Ibn Alnafis MD @neophyte2008

Is the job market for generalists who don’t do fellowships good? Or do with the rapid rise in new neurologists being trained, do you think fellowship is necessary?

One of my seniors, who is about to graduate in < 3 months and who does want to do a fellowship, has had job offers as high as 450K base salary. They plan on going back home to a neurohospitalist 7 on 7 off gig in Indianapolis for 400K base salary. Even as a PGY-1 Neuro resident, I also get emails about job offers all the time. Sometimes, it pays a lot more to be a general neurologist. The job market is actually pretty good even fresh out of residency, but of course after a fellowship, you can still practice general neurology if you want.