Why did you go into Neurology?

[HealthE]

I have been thinking about becoming a Neurologist for awhile. I am wondering...what motivated people here to go into Neurology?

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[danielmd06]

I have been thinking about becoming a Neurologist for awhile. I am wondering...what motivated people here to go into Neurology?

For the money, the power, and the women. Mostly the women.

 

[95439]

Daniel....totally beat me to it. Neurologists are like the "Scarface" of the medical world.

 

[neurologist]

Temporary insanity. Been paying for it ever since . . .

 

[typhoonegator]

My research. Besides, you have to do something with your life. Might as well be awesome.

 

[21CentSouldier]

Pretty much to study zombies and why they like to eat only brains. Heavy duty NIH funding going into this. True story.

 

[Barry Otter]

Temporary insanity. Been paying for it ever since . . .

Can you expound on this? What drew you to neurology, and what has since disillusioned you about it?

 

[neurologist]

Can you expound on this? What drew you to neurology, and what has since disillusioned you about it?

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.

 

[typhoonegator]

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.

 

[Jorje286]

My research. Besides, you have to do something with your life. Might as well be awesome

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.

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)?

 

[PETRAN]

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.

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





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?
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)

 

[Leukocyte]

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.

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.

 

[Leukocyte]

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





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?
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)

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.

 

[VL2000]

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

 

[danielmd06]

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

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...

 

[typhoonegator]

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

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.

 

[neurologist]

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





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?
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)

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!

 

[MossPoh]

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.

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.

 

[typhoonegator]

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.

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.

 

[Suncrusher]

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

 

[neurologist]

. . .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

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.

 

[dwdrums2112]

For the money, the power, and the women. Mostly the women.

Thank god for this post.

 

[dwdrums2112]

@neurologist I thought neurology was one of the most lucrative specialties in medicine?

 

[PETRAN]

Thank god for this post.

Not to destroy your dream but i think he was ironic

 

[PETRAN]

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!

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 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 )

 

[dwdrums2112]

Damn.

 

[bustbones26]

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!

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.

 

[Dr. Bruce Banner]

I was talking to one of the fellows in neurology and she basically said everything that has been said here. She also told me if I like neuro, PM&R is a great field to go into with a lot of potential. Granted, she said PM&R focuses more on the PNS than the CNS. Although she wouldn't change her specialty if she had to choose again, she thought she would be very happy as a PM&R physician. Anybody else think that way? Any thoughts and recommendations for this clueless 3rd year medical student would be much appreciated

 

[neglect]

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.

That’s exactly right. OB/GYN doctors HATE psych. And their clinics are full of chronic pelvic pain with no etiology.

The paradox here is that the only doctors who see ONLY psych patients with enough insight to recognize their mental illness are psychiatrists! The rest of us get to manage somatiform and conversion disorders, which entails profound loss of insight and absolute resistance to the diagnosis. The tomato can’t cut itself.

I’m going to steal the one about the brain and mind having power to make one ill. I think that is a good formulation that perhaps some of these folks could appreciate.

And FWIW, once you tell a conversion disorder patient that they have conversion disorder, they tend to never seek out your advice again. They either get better (totally happens, some conversion DO advocates think this is incorrect but they are wrong) or stay chronic. There’s a movie on Netflix called Unrest - unwatchable, but shows what happens when they forsake the diagnosis, leave the neurologist, and wallow in their disorder (and to be entirely fair, the subject also has chronic fatigue, which may have somatic underpinnings, it is just poorly understood at this point).

I was talking to one of the fellows in neurology and she basically said everything that has been said here. She also told me if I like neuro, PM&R is a great field to go into with a lot of potential. Granted, she said PM&R focuses more on the PNS than the CNS. Although she wouldn't change her specialty if she had to choose again, she thought she would be very happy as a PM&R physician. Anybody else think that way? Any thoughts and recommendations for this clueless 3rd year medical student would be much appreciated

I’m not rehab, but here’s my take: PM&R, like neurology, is broad. It seems to me that the key distinguishing feature is diagnosis. Neurology is all diagnosis all the time. You’re constantly calling it, on the front lines, taking data and synthesizing diagnoses. Rehab docs are on the back lines, after the diagnosis, dealing with the recovery process that takes weeks, months, years. Most inpatient PMR docs seem to have very little purpose: arrange rehab and social aspect of care after someone gets a hip replacement, has a stroke, trauma, etc. There are some medicine-light requirements to make sure they don’t get a DVT, pain is addressed and so on. IMO nature is helping these folks heal, PT might offer minor help, unsure about the role of the inpatient rehab doc. Perhaps some will come into the thread and help me understand.

From my take there’s a financial aspect: PMR skims the lucrative procedures from each specialty: injections for pain, diagnostic joint taps, Botox, EMG/NCV, owning/operating imaging (although all are getting hammered these days, so much less lucrative). The ones who are great essentially do non-surgical ortho and keep people out of the OR for a bit, see 40-50 knees/shoulders/elbows/fingers a day.

 

[Dr. Bruce Banner]

To be honest, I came into medical school set on neurology... neuro is my favorite system to learn, I did well on the tests, I have 260 on my step 1, I have close to 10 publications in neuro most of which I am the 1st author, and I did really well on my neuro rotation... but lately I've been more confused... especially after one of the residents I worked closely with committed suicide. And then it hit me... burnout is real, depression is real, suicide is real. I have had depression before, but never suicidal ideations. I know that I can get stressed out easily because of the way that I am. And as much as I love neuro, all the talk by AAN about neuro being one of the highest burnt out specialties and with the lowest work/life balance, I am having serious second thoughts about neurology. I know some people might say that "if you love the field and the subject, you will be okay". But will I though? The resident I worked with LOVED his field and couldn't see himself do anything else... but that didn't stop depression from getting in his life. I am not even considering neurosurg because that's a whole other level of insanity...

 

[Postictal Raiden]

I fail to understand the basis behind this so-called burn out among neurologists. I could understand it being a thing in residency due to the hours, but why would an attending in neurology be more prone to burnout compared to, say, a surgeon/EM doc/anesthesiologist/internist/etc...?

 

[neglect]

To be honest, I came into medical school set on neurology... neuro is my favorite system to learn, I did well on the tests, I have 260 on my step 1, I have close to 10 publications in neuro most of which I am the 1st author, and I did really well on my neuro rotation... but lately I've been more confused... especially after one of the residents I worked closely with committed suicide. And then it hit me... burnout is real, depression is real, suicide is real. I have had depression before, but never suicidal ideations. I know that I can get stressed out easily because of the way that I am. And as much as I love neuro, all the talk by AAN about neuro being one of the highest burnt out specialties and with the lowest work/life balance, I am having serious second thoughts about neurology. I know some people might say that "if you love the field and the subject, you will be okay". But will I though? The resident I worked with LOVED his field and couldn't see himself do anything else... but that didn't stop depression from getting in his life. I am not even considering neurosurg because that's a whole other level of insanity...

No matter what you go into, you will not be OK. You’re going to have terrible days and nights. You’re going to see suffering in others and even aside from empathy, you will also suffer. You’re going to be abused and betrayed by malevolent people above, around, and below you, including patients and students. You’re going to be overworked, never appreciated, and bossed around.

But you’re going to have help. You’re going to have friends and peers. You’re going to develop mentors. You’re going to recognize the benign indifference most people have towards you. You’re going to lose a bit of yourself, but you’ll gain other parts. You’ll eventually gain competence and pleasure in a job well done. You’ll eventually learn to find the humor, even gallows.

I’m so sorry for your friend. He or she sounds like a tragic loss. You have to find the best fit in medicine for you - and no-one else can do this. You can decrease a whole bunch of horrible things that residency offers by choosing a cush place and a cush specialty. No-one knows you better than yourself and your friends and family. Seek their advice and your own. Best luck.

I fail to understand the basis behind this so-called burn out among neurologists. I could understand it being a thing in residency due to the hours, but why would an attending in neurology be more prone to burnout compared to, say, a surgeon/EM doc/anesthesiologist/internist/etc...?

This is easy to understand to me. I no longer follow the so called ‘hateful patient’ because I fire them or make them dissatisfied right away, but they exist. These are the people with personality disorders presenting with migraines, chronic pain, unexplained symptoms that border on conversion disorder. They are the conversion disorders who refuse to believe you and refuse to move on. The MS patient who refuses DMTs, but want you to take on their care anyway. Some neurologists do not recognize a fundamental bit of medicine: you cannot help those who do not really want it.

I believe this is the biggest reason for burnout, Although there are others. To name a few: layers of administration, insurances, hospital ownership, increased patients per unit of time, EMRs, consult as commodity (neuro box check), use and abuse of neurology to get a history.