Advice needed

[Itsarainbow]

-redacted per request

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[Thama]

By scores, you'd be reasonably competitive for a mid-tier neurology program. But there's a lot more to competitiveness than scores.

If your love is procedures then neurology is not for you. The last thing neurology programs want is people using it as a backup for failed matches in procedural specialties, as the residency is very demanding and the only thing attracting most of us to it over IM or similar is enjoying the subject matter. If you want a backdoor to doing profitable procedures after not matching gas, then IM -> cards/CCM/etc is your path.

 

[Itsarainbow]

By scores, you'd be reasonably competitive for a mid-tier neurology program. But there's a lot more to competitiveness than scores.

If your love is procedures then neurology is not for you. The last thing neurology programs want is people using it as a backup for failed matches in procedural specialties, as the residency is very demanding and the only thing attracting most of us to it over IM or similar is enjoying the subject matter. If you want a backdoor to doing profitable procedures after not matching gas, then IM -> cards/CCM/etc is your path.

Thanks for the response. I am interested in the subject matter because I think its the new frontier in medicine. Do you a future/fellowships where maybe you can do procedures?

 

[Thama]

What kind of procedures are you talking about exactly? Yes, there are procedures in neurology. No, very few neurologists spend a majority of their time doing procedures, and even most of those procedures aren't what an anesthesiologist or surgeon would recognize as a procedure - it's EMG or botox injections, that sort of thing. Interventional neuroradiology is an exception but it's still dominated by other specialties and very competitive for neurologists to enter.

 

[xenotype]

Thanks for the response. I am interested in the subject matter because I think its the new frontier in medicine. Do you a future/fellowships where maybe you can do procedures?

Few comments for you.
1) If you do decide neuro you need your TY structured carefully to meet neuro program requirements for intern year, and a lot of it is IM ward months that you need.
2) Neurology residency is 3 years of stroke alerts, seizures, and headaches all night. You'll do 1-2 LP a day maybe, and if you are lucky to be in the right program maybe a few simple headache injections once a week. There's no procedures for residents past that really in most programs. You need to love the stroke alerts and the weird stuff that people come in with to have any happiness in neurology. A portion of it also is reading EEGs, which is basically just staring at wavy lines on a screen like radiology. Of course you don't have to love neuro residency to like neurology, but inpatient neurology is basically just what you do in residency.
3) Procedures from neurology- EMG and EMG guided botox. It isn't nearly as invasive as placing a line, you just jab the needle in different muscles and look at wavy lines/listen to snap/crackle/pops. Otherwise you are looking at neurocritical care, NIR, or interventional pain for more procedures. NIR and pain are hard to get spots.

With all of that said, there are a few neuro residencies that own interventional pain fellowships. I've trained with neuro people who prefer procedures and the ICU environment. They still like neurology and gravitate to pain or neurocritical care, or end up liking EMG and botox well enough on the outpatient side. The key aspect is whether you can enjoy stroke, status etc on the hospital side because that is a lot of residency, and if you do neurocritical care a lot of the business. Thama's comments are broadly correct and you need to be careful about ending up in a very cerebral field that rarely breaks out more than a syringe.

Programs are going to want to really hear why neurology from you, especially since you are coming from major disadvantage being passed over one cycle already. I will say plenty of programs can be DO friendly, and PG2 spots do open up here and there for various reasons in categorical programs as well.

 

[Itsarainbow]

Few comments for you.
1) If you do decide neuro you need your TY structured carefully to meet neuro program requirements for intern year, and a lot of it is IM ward months that you need.
2) Neurology residency is 3 years of stroke alerts, seizures, and headaches all night. You'll do 1-2 LP a day maybe, and if you are lucky to be in the right program maybe a few simple headache injections once a week. There's no procedures for residents past that really in most programs. You need to love the stroke alerts and the weird stuff that people come in with to have any happiness in neurology. A portion of it also is reading EEGs, which is basically just staring at wavy lines on a screen like radiology. Of course you don't have to love neuro residency to like neurology, but inpatient neurology is basically just what you do in residency.
3) Procedures from neurology- EMG and EMG guided botox. It isn't nearly as invasive as placing a line, you just jab the needle in different muscles and look at wavy lines/listen to snap/crackle/pops. Otherwise you are looking at neurocritical care, NIR, or interventional pain for more procedures. NIR and pain are hard to get spots.

With all of that said, there are a few neuro residencies that own interventional pain fellowships. I've trained with neuro people who prefer procedures and the ICU environment. They still like neurology and gravitate to pain or neurocritical care, or end up liking EMG and botox well enough on the outpatient side. The key aspect is whether you can enjoy stroke, status etc on the hospital side because that is a lot of residency, and if you do neurocritical care a lot of the business. Thama's comments are broadly correct and you need to be careful about ending up in a very cerebral field that rarely breaks out more than a syringe.

Programs are going to want to really hear why neurology from you, especially since you are coming from major disadvantage being passed over one cycle already. I will say plenty of programs can be DO friendly, and PG2 spots do open up here and there for various reasons in categorical programs as well.

Thanks for the reply. I guess the reason why I like procedures is that I can directly affect the status of my patients and I find that satisfying. As noted, I know it's difficult to get into those competitive fellowships but how can a person maximize their chances, and exactly how difficult are they to get? Neurology is such a broad field and it is difficult to find a footing in what exactly I want to do. I feel like it has much more potential and as technology improves, I hope that down the line there will be more procedures that neurologists can implement. Is that wishful thinking?

 

[Thama]

I feel like it has much more potential and as technology improves, I hope that down the line there will be more procedures that neurologists can implement. Is that wishful thinking?

I'm not really sure why you would think this way. Neurology isn't a procedural field at its core, and those that select for neurology training generally don't prioritize doing procedures at all costs. The advances in procedural aspects of neuroscience are much more likely to be taken by those in overlapping procedural specialties. On the neurology side, we're likely to see more effective medications and even disease-modifying agents and gene therapies available for our patients with difficult to treat neurodegenerative diseases, but I see little reason to think that neurology will magically convert itself into a procedural field once a certain technological threshold is reached.

 

[Postictal Raiden]

You better off doing PMR, OP. They do many in-office procedures and the field has a well-established pathway towards interventional pain.

Neurology is not a procedural specialty. EEG and EMG are not procedures in the classical sense. They are merely diagnostic modalities, or an extension of the physical exam.

Like mentioned above, neurology draw people who enjoy neuroscience, detailed history taking and meticulous physical exam. It’s a field for thinkers not doers.

Another option is to do IM then try to match into CC, cardiology or GI.

 

[scoopdaboop]

Im sorry but you had NO interviews? your board scores are run of the mill average... Did you have any other possible red flags? Scaring me for the future, as i too am DO.

 

[Itsarainbow]

No, no red flags
My personal statement might have been an issue but otherwise my app was normal

 

[scoopdaboop]

No, no red flags
My personal statement might have been an issue but otherwise my app was normal

Odd. You know others that got interviews around your scores? Anesthesia is not very competitive even for DO's with a 220+

 

[Itsarainbow]

Odd. You know others that got interviews around your scores? Anesthesia is not very competitive even for DO's with a 220+

Apparently it's gotten really competitive these past 2 years.

 

[Prehealth1011]

Odd. You know others that got interviews around your scores? Anesthesia is not very competitive even for DO's with a 220+

Not true anymore. I know everyone says every speciality is more competitive every year, but I had multiple classmates not match with 230s this year (one of them even had 240s)

 

[Always_Eating]

I would touch-base with some Anesthesia PDs to see where there may be gaps in your application, as I am surprised you did not at least get interviews. Then I would reapply during your Transitional year to Anesthesia or try and fill any open spot left lingering. If your first-choice was Anesthesia, I really do not see you being happy in Neurology unfortunately. The day-to-day and personalities in the two specialties could not be any more distinct from each other. As a Neurointensivist, I've spent a lot of time in the OR with Anesthesia intubating and doing cases with them (in training). If that is what makes you happy, then there really is not much that Neurology has to offer you. The closest thing would be Neurocritical Care, and most Anesthesiologists I know would not take a NCC gig for $1,000,000 a year.

 

[xenotype]

I would touch-base with some Anesthesia PDs to see where there may be gaps in your application, as I am surprised you did not at least get interviews. Then I would reapply during your Transitional year to Anesthesia or try and fill any open spot left lingering. If your first-choice was Anesthesia, I really do not see you being happy in Neurology unfortunately. The day-to-day and personalities in the two specialties could not be any more distinct from each other. As a Neurointensivist, I've spent a lot of time in the OR with Anesthesia intubating and doing cases with them (in training). If that is what makes you happy, then there really is not much that Neurology has to offer you. The closest thing would be Neurocritical Care, and most Anesthesiologists I know would not take a NCC gig for $1,000,000 a year.

Yes- OP this is the biggest thing for you to realize. The anesthesiologists typically do not like the NeuroICU. That should tell you a lot about personalities in the different fields- neurology is very cerebral and personal interest in it is a lot of the satisfaction. Otherwise the outcomes in neuroICUs are crap compared to almost every other ICU for obvious reasons, and CCM tends to see it as 'babysitting' a bunch of patients that don't have a great chance of doing well. You have to love neuroscience to get over seeing the bad, sometimes unfixable injuries we have to deal with daily.

 

[IMGASMD]

Op doesn’t want anesthesia anymore. Op probably doesn’t really know what they want to do anymore.
Good luck. Op.

 

[gyngyn]

This thread can be followed here: Failed to match a advance spot. Not sure what to do. Need advice