Menu Icon Search
Close Search

About the ads

Why did you go into Neurology?

Discussion in 'Neurology' started by HealthE, 11.16.11.

  1. HealthE

    HealthE

    Joined:
    04.26.10
    Messages:
    158
    Status:
    Pre-Health (Field Undecided)
    SDN 2+ Year Member

    SDN Members don't see this ad. (About Ads)
    I have been thinking about becoming a Neurologist for awhile. I am wondering...what motivated people here to go into Neurology?
  2. danielmd06

    danielmd06 Neurosomnologist

    Joined:
    09.09.06
    Messages:
    939
    Location:
    Florida
    Status:
    Attending Physician
    Physician SDN 7+ Year Member
    For the money, the power, and the women. Mostly the women.
  3. bblue

    bblue Member

    Joined:
    04.09.06
    Messages:
    451
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    Daniel....totally beat me to it. Neurologists are like the "Scarface" of the medical world.
  4. neurologist

    neurologist En garde Moderator

    Joined:
    08.26.03
    Messages:
    5,082
    Status:
    Attending Physician
    Physician Faculty SDN 10+ Year Member
    Temporary insanity. Been paying for it ever since . . .
  5. typhoonegator

    typhoonegator Neurointensivist Moderator

    Joined:
    12.22.06
    Messages:
    1,249
    Location:
    Boston
    Status:
    Attending Physician
    Physician SDN 7+ Year Member
    My research. Besides, you have to do something with your life. Might as well be awesome.
  6. 21CentSouldier

    21CentSouldier

    Joined:
    10.04.10
    Messages:
    64
    Status:
    Medical Student
    SDN 2+ Year Member
    Pretty much to study zombies and why they like to eat only brains. Heavy duty NIH funding going into this. True story.
  7. Barry Otter

    Barry Otter Seeking Fortoona

    Joined:
    09.02.03
    Messages:
    141
    Location:
    Hooters
    SDN 7+ Year Member
    Can you expound on this? What drew you to neurology, and what has since disillusioned you about it?
  8. neurologist

    neurologist En garde Moderator

    Joined:
    08.26.03
    Messages:
    5,082
    Status:
    Attending Physician
    Physician Faculty SDN 10+ Year Member
    In med school, I really liked the "basic sciences" of neurology -- neurophysiology, neuropath, imaging, pharmacology, etc. I found the logic of neuroanatomy and the "localize the lesion" approach to be very elegant and appealing. During med school neuro rotations, where most of one's time was spent on the inpatient service and you saw strokes all the time, that worked out fine.

    Unfortunately, when you get out into "real world" neurology and find that 75% of your patient population is chronic pain and/or unexplainable somatic symptoms that never get better, that all falls apart.

    I suspect that if I had more outpatient exposure to outpatient "community neurology" as a med student I would have realized this and done something else. I've tried to minimize my exposure to the general neurology population via fellowship training and trying to tailor my subsequent practice to subpecialty referrals as much as possible. But I'll tell ya, I get a knot in my stomach every time I look at my schedule and it says "reason for referral: headaches and dizziness," which still, in my opinion, occurs way more than I would like.
  9. typhoonegator

    typhoonegator Neurointensivist Moderator

    Joined:
    12.22.06
    Messages:
    1,249
    Location:
    Boston
    Status:
    Attending Physician
    Physician SDN 7+ Year Member
    Neurologist is absolutely right (as per usual) -- if you want to go into neurology you need to do it with both eyes open. Because we deal with what the rest of the medical world considers a "black box", many things that are hard to (or impossible to) explain end up getting rammed down our throats. The ability of the brain/mind to make the body sick is greatly, greatly under-appreciated by both healthcare providers and patients. It's like a really painful game of hot potato.

    No matter how much you try to insulate yourself, it is really impossible to completely separate yourself from chronic pain, dysphoria, dizziness, headaches, forgetfulness, etc. Some of these people will have definable diagnoses, and you can have an enormous impact on their lives. Many will not, and you will follow them until they find someone else they think will treat them better.

    I'm a neurocritical care physician, and you would think that would raise the bar enough to protect me from this population. Wrong. I have intubated and placed central lines in patients with pseudoseizures. I have watched as "Chiari" patients spent 10 days in the ICU trying to wean off a PCA pump because they desatted so often the floor would not take them. I have seen grids and strips placed in the brains of patients who don't actually have epilepsy, and DBS placed in the brains of people who don't actually have movement disorders. The list goes on and on.

    I will defend our specialty by saying that we are not entirely unique in the psychosomiasis we endeavor to treat. Gastroenterology has their nonspecific abdominal pain, derm has their chronic itch and things like Morgellons, neurosurgery has refractory back pain (as does ortho), cardiology and pulmonology have nonspecific chest pain and shortness of breath, psychiatry has a large amount of things to deal with, endocrine deals with chronic fatigue, etc.

    The bottom line is that you need to be aware about these things from the ground floor, or you will be in for a very rude awakening. Neurology is an amazing field, filled with uncertainty, wonder, and the hope of ameliorating the burdens placed on our patients by diseases that change the very way we interpret and interact with the world. I'm happy, and I know many neurologists who could never imagine themselves doing anything else. But when you're down in the trenches, living the day-to-day, it can be difficult to appreciate the upside.
  10. Jorje286

    Jorje286 Member

    Joined:
    07.19.04
    Messages:
    561
    SDN 10+ Year Member
    Hi typhoonegator,

    Can you please expand on this? What do you research and what do you think is so awesome about neurology? Just trying to get the more positive spin out of this thread. :p

    I would like to ask more specific questions too if you don't mind: how much intellectual enjoyment do you get out of your daily practice? Do you feel like you're constantly challenged or does it ever feel like routine "scut" work? Are there realistic research options for IMGs (preferably in theoretical neuroscience)?
  11. PETRAN

    PETRAN

    Joined:
    12.28.10
    Messages:
    187
    Status:
    Psychology Student
    SDN 2+ Year Member


    I bet that your other favorite choice was consult-liaison psychiatry-psychosomatic medicine

    :eek:



    Aren't unexpleined symptoms interesting to deal with? That detective-type of work that we all watch in the tv, house m.d. etc. I guess that it is not like that in the real-world is it? :p
    Anyway, in the end it depends on the person. Some like it black-white others more gray. Chronic pain patients are tiresome though for sure. Despite that, pain can be a very interesting research area IMO (i've worked a bit on the neuroscience behind it and there are lots of interesting stuff)
  12. Leukocyte

    Leukocyte Senior Member

    Joined:
    07.03.03
    Messages:
    1,579
    SDN 10+ Year Member
    Thank you for your honesty...and VERY insightful post. Few are brave enough to say what you have said and be honest about the true reality of "everyday" practice. Neurology is a medical professional job and not a basic science. The job of a Neuroscientist or a Neurobiologist is not the job of a Neorologist. I like you went into medicine thinking it is a science.....I was very wrong. As a Family Med doc, I completely understand where you are coming from. I see my fare share of "headaches and dizziness" and other vague / psychosomatic symptoms every day....and I hate it when I have to refer my patients to the neurologist because I feel that they (the neurologists) would now have to deal with this difficult patient.

    Most of us discover the day-to-day "reality" of Medicine as a job very late. Trying to get out of Medicine then is not easy. Having huge student loans and mouths to feed makes leaving clinical medicine very difficult and not practical. HOWEVER we all must do what we like. If one wants to be a Neuroscientist (a scientist) as opposed to a Neurologist (a day-to-day job professional) then they should be able to do what they like. Again the transition from clinical medicine to non-clinical medicine or science is not easy...but people have to do what they love in their life.

    Again, thank you for your refreshing honesty and bravery.
  13. Leukocyte

    Leukocyte Senior Member

    Joined:
    07.03.03
    Messages:
    1,579
    SDN 10+ Year Member
    When the doctor is in the "trenches" dealing with people on a day-to day basis, with heavy responsibility on their shoulders, and where he/she is UNDER PRESSURE because they are EXPECTED to make them feel better and have QUICK answers to their problems.....naaaaaa it is not fun anymore. The reality of medicine as a job is that the doctor is expected to be knowlegable, quick, and efficient...to make the doctor's bosses (the Administrators who are not even doctors) happy. In reality, there is little room or time for what they do on fantasy TV shows you mention.

    Basically, the reality in medicine is that every doc has to "hold their own"...and make the non-doctor Administrators happy. If a doc cannot "hold their own" or see the number of patients they are expected to see as seen by the Administrators (beacuse they are being creative and spending too much time with each patient looking for answers)...then that doc, in reality, will not be able to feed himself or his family.
  14. VL2000

    VL2000

    Joined:
    01.22.11
    Messages:
    4
    Status:
    Medical Student
    How would you guys compare Neurology to Radiology? As a third year student, I loved both of these rotations, and decided to apply to both Neurology and Radiology. As I am going thru interviews currently, I am having a very difficult time deciding if I should choose Neuro vs Rads. Just looking for any advise that I can get.
    Thanks everyone
  15. danielmd06

    danielmd06 Neurosomnologist

    Joined:
    09.09.06
    Messages:
    939
    Location:
    Florida
    Status:
    Attending Physician
    Physician SDN 7+ Year Member
    I love neurology, and would make the same choice I have already made career-wise if offered a second chance.

    However, my own advice would be to carefully consider what you value out of each of these options, and decide based on your future aspirations. Radiologists make alot of money...
  16. typhoonegator

    typhoonegator Neurointensivist Moderator

    Joined:
    12.22.06
    Messages:
    1,249
    Location:
    Boston
    Status:
    Attending Physician
    Physician SDN 7+ Year Member
    Neuro--- Rads
    Work in light--- Work in dark
    Look at images some of the day--- Look at images almost all day
    Frequent patient contact--- Little patient contact
    Rarely thinks about physics--- Frequently thinks about physics
    Diagnosis and treatment--- Diagnosis
    Makes good money--- Makes great money
    Body fluids--- No body fluids

    This is glib, and ignores interventional radiology, but my point is that radiology is very different from almost every other specialty. If you were thinking rads vs. path, I think I would understand better.

    Do you want to take care of patients or not? If you do, then only a small wedge of radiology would satisfy you. If you want to see patients every day, then you need to pick a field, and neurology is one of them, but beyond that it is hard to help.
  17. neurologist

    neurologist En garde Moderator

    Joined:
    08.26.03
    Messages:
    5,082
    Status:
    Attending Physician
    Physician Faculty SDN 10+ Year Member
    LOL, consult liaison psych (and inpatient psych in general) was actually my favorite rotation as a med student! Almost made me want to become a shrink, but I realized that the outpatient chronic depression patients would irk me too much in the long run.

    As for pschosomatic stuff, look, it's really interesting and cool and intellectually satisfying when you can do a history, exam, testing, etc and come up with the conclusion that "this just isn't a 'real' problem." Makes for great stories with your colleagues too. Most of us gradually develop a 6th sense about this kind of thing and can spot the "non-organic" stuff intuitively right away (although you should always leave some room for allowing you might be wrong. . . ). Problem is, you then have to explain it to the patient, and actually the treatments for these kinds of things (i.e., cognitive behavioral therapy) is often not all that successful. The patients with such disorders usually aren't the most high-functioning and insightful individuals.

    As for "unexplained symptoms" in general, yeah, they're fascinating -- IF you eventually come up with an explanation. But I'll tell you, a lot of times you just don't, and then they just become frustrating for both doctor and patient. Example: the textbook explanation of a Horner's syndrome is an apical lung tumor. Know how many times I've found that in patients who have Horner's syndrome? ZERO. Know how many times I've found ANY explanation for Horner's syndrome in a patient? Yup, ZERO. Despite zillions of dollars in imaging tests etc.

    Even fairly readily explainable things can get frustrating when the patient "just doesn't get it." A lot of my migraine patients, despite being told over and over what migraine is all about, keep asking "I don't understand why I get these . . . why can't someone explain it?"

    Interesting to note that we have the same outlook on pain -- VERY interesting from the biologic standpoint with lots of cool reseach, but god I hate dealing with it clinically!
  18. MossPoh

    MossPoh Textures intrigue me

    Joined:
    04.24.06
    Messages:
    8,007
    Location:
    Tally/Willkillya County
    Status:
    Medical Student
    SDN 7+ Year Member
    People can be interested in multiple specialties, even if they have different things. Even non-interventional has procedures and does have to meet with patients. It isn't as much as other specialties, but it is still there. My dad struggled between Ob/gyn and radiology back in his day, another friend between neuro and rads and another between EM and rads. It isn't THAT unusual of a question as a third year student.
  19. typhoonegator

    typhoonegator Neurointensivist Moderator

    Joined:
    12.22.06
    Messages:
    1,249
    Location:
    Boston
    Status:
    Attending Physician
    Physician SDN 7+ Year Member
    My point isn't that it is unusual to be interested in rads and something else (it's not). My point is that it should be pretty easy to figure out which one you like more. They're incredibly different in day to day practice.
  20. Suncrusher

    Suncrusher ☣ ☣ ☣ ☣ ☣ Lifetime Donor

    Joined:
    06.28.10
    Messages:
    6,391
    Location:
    Florida
    Status:
    Medical Student
    SDN 2+ Year Member
    I'm an M1 thinking about Neurology as a possible future interest, especially since I need to choose an area in which to do summer research. I've read the threads in this subforum and I'm wondering if anyone would be willing to expound on any cons (and pros) of Neurology besides dealing with a lot of chronic, non-specific problems that don't give you a lot of job satisfaction; for example, other specialties often complain about changes to insurance reimbursements that are making it impossible for them to make ends meet, mid-level practitioner encroachment, etc. Is Neurology facing any of these problems (or any other problems)? And what does the future of Neurology look like, both good and bad? I'm interested in the field, but I want to have a fair understanding of what I'd be getting into :xf:
  21. neurologist

    neurologist En garde Moderator

    Joined:
    08.26.03
    Messages:
    5,082
    Status:
    Attending Physician
    Physician Faculty SDN 10+ Year Member

    Every specialty is facing the challenges of the shifting healthcare reimbursement system; neurology is not immune to this. If medicare/medicaid cuts payments (which is always followed by private insurers doing the same), we will lose a lot of money, probably to some extent even disproportionately so relative to some other specialties since a lot of neuro patients are old (medicare) or disabled or of low socioeconomic status (medicaid).

    Neuro will be particularly hard hit if payment for EMG, EEG and sleep studies is significantly cut (or, in the case of sleep studies, if the bulk of them convert to home study systems.)

    I suppose that if you are entrepreneurial you could try to do an "end run" around this by trying a cash-based "conceige" practice, but again, due to the economic status of many neuro patients I suspect this wouldn't be feasible. The exception to this (as I have posted elsewhere) might be to open a "cash only" headache or other pain practice.

    As for "midlevel encroachment," it's not as great as in some other areas. While an increasing number of neuro practices use them, I don't think they'll ever be as prominent as they are in primary care.

    To me, the future of neurology looks like pretty much "more of the same." Our diagnostic ability will continue to far outstrip our ability to treat, and we will continue to make less money than most other specialties.
  22. dwdrums2112

    dwdrums2112

    Joined:
    01.12.12
    Messages:
    39
    Status:
    Pre-Medical
    Thank god for this post.
  23. dwdrums2112

    dwdrums2112

    Joined:
    01.12.12
    Messages:
    39
    Status:
    Pre-Medical
    @neurologist I thought neurology was one of the most lucrative specialties in medicine?
  24. PETRAN

    PETRAN

    Joined:
    12.28.10
    Messages:
    187
    Status:
    Psychology Student
    SDN 2+ Year Member


    Not to destroy your dream but i think he was ironic :smuggrin:
  25. PETRAN

    PETRAN

    Joined:
    12.28.10
    Messages:
    187
    Status:
    Psychology Student
    SDN 2+ Year Member


    nice post neurologist. Would you prefer to work as a neurohospitalist or in an inpatient stroke ward then? I had some experience with a rehabilitation unit with stroke patients and i (personally) felt a bit miserable after a while :oops: Maybe the more acute units are more interesting (the time constraints of administering TPA), the rush of adrenaline and stuff, but it is surely not for everyone.


    So would you choose psychiatry today? Or maybe choose something completely different? (maybe something that has nothing to do with the nervous system :laugh:)
  26. dwdrums2112

    dwdrums2112

    Joined:
    01.12.12
    Messages:
    39
    Status:
    Pre-Medical
  27. bustbones26

    bustbones26 Senior Member

    Joined:
    07.26.03
    Messages:
    930
    Status:
    Attending Physician
    SDN 10+ Year Member
    I did it becauseI wasn't smart enough to get into a competitive specialty and didn't feel like doing primary care.

    Anyways, as for psychosomatic stuff, I just love the headache patients wearing sunglasses in the clinic. I have YET to ever have success with any of these patient. Also, my patients should turn around after they leave the clinic, I might be behind them in the hallway noting that they are no longer demonstrating antalgic gait and no longer using a cane. If I keep following them, I might even catch them driving away (whenever they are on a revoked license).

    I agree with neurologist, these all make great stories.

// Share //

Style: SDN Universal