Best kept secret

[greymatters]

---

Members do not see this ad.

OK, so I've read a few of the threads on similar topics...and seen the replies but I still don't get why neuro is not far, far, FAR more competitive. Sorry if its getting repetitive but have yet to see a good, logical answer.

How I see it, realistically, 3 factors determine the competitiveness of specialties...despite people giving their personal opinions on why they like this or that.

1. Money (no competitive specialties are low pay)
2. Hours ( aka lifestyle)

3. Prestige ( far and away behind nr 2...see derm for proof)

Do a scatter graph of specialties, money v hours and see where the top competitive specialties end up!

I live in a major city on the west coast. Looking at offers new attendees get to work in the suburbs, even without fellowships, it adds up to about 300k. Least in PP I've seen is 220k but this had very good hours and minimal call. That's base (usually mid to low 200k) + incentives...not pension etc. This is up by quite a lot compared to just a few years back. I honestly don't know how much they would make as partners. Academia, can start mid 100k however. This is just from people I know. I don't trust those surveys online much...I can only tell from personal experience. People aren't getting much better offers for cardio which is far more competitive and doesn't enjoy the same lifestyle. Hospitalist would have to work like a dog for that kind of pay...and that is probably way out in the boonies. Optho, start on less and is seriously competitive ( big outlier as a specialty). GS... if you got that kind of money for neuro hours in a major city, 1st year out, you'd consider yourself lucky, Rads and even derm are massively more competitive but do they earn significantly more first year out? Yet neuro is NOT that competitive, probably on a par with IM.

Its a highly cerebral field, way more complex than many others. You get to have a life and treat some very interesting patients. Get fellowships and things get even better. So many things can be treated now that couldn't before...huge future for the field. Also its quite risk free, not dependent on 1 thing for income (GI), likely to ever be outsourced or come under mid-level pressure. Few turf wars too.

Am I missing something? Is this going to change massively in the next few years?

 

[Jubears09]

My observation is that a lot of people don't go into it is because they came to medical school to help people and neurology is still largely seen as a diagnostic specialty. A lot of people still wonder what a neurologist actually does.

If they value lifestyle, radiology is much more lucrative and they have defined roles in the system. Even derm is a very therapeutic specialty, you can say what you want about the relative importance of their patients' problems, but you can't argue that patients don't walk away happy.

IMO, the lifestyle, hours, pay, prestige are all factors, but the inherent medical parts are still the most important factor in career decisions. It's the same reason family med has such a large problem attracting people - the job description nowadays is largely different than what people came in to do. Albiet for very different reasons than neurology.

 

[greymatters]

Very good answer

However, almost all of the other specialties show an almost linear correlation between competitiveness and money, neuro should by all acounts be more competitive. Not hard finding a neuro job after 4 years, same can't be said about radiology job after 5 years...a job which looks like it will be a lot less lucrative soon...and is hard work...very high volume. Neuro can't be covered overnight by someone far away either.

I agree with most of what you say but it doesn't explain the discrepancy to me.

 

[Rock13]

A lot of the specialties you listed probably have a higher income ceiling than neuro. In neurology you start at a good level, but wouldn't reasonably expect to double your salary by the time you've become more senior - like ophtho, or maybe surgery. Just my observation.

 

[bustbones26]

OK, so I've read a few of the threads on similar topics...and seen the replies but I still don't get why neuro is not far, far, FAR more competitive. Sorry if its getting repetitive but have yet to see a good, logical answer.

How I see it, realistically, 3 factors determine the competitiveness of specialties...despite people giving their personal opinions on why they like this or that.

1. Money (no competitive specialties are low pay)
2. Hours ( aka lifestyle)

3. Prestige ( far and away behind nr 2...see derm for proof)

Do a scatter graph of specialties, money v hours and see where the top competitive specialties end up!

I live in a major city on the west coast. Looking at offers new attendees get to work in the suburbs, even without fellowships, it adds up to about 300k. Least in PP I've seen is 220k but this had very good hours and minimal call. That's base (usually mid to low 200k) + incentives...not pension etc. This is up by quite a lot compared to just a few years back. I honestly don't know how much they would make as partners. Academia, can start mid 100k however. This is just from people I know. I don't trust those surveys online much...I can only tell from personal experience. People aren't getting much better offers for cardio which is far more competitive and doesn't enjoy the same lifestyle. Hospitalist would have to work like a dog for that kind of pay...and that is probably way out in the boonies. Optho, start on less and is seriously competitive ( big outlier as a specialty). GS... if you got that kind of money for neuro hours in a major city, 1st year out, you'd consider yourself lucky, Rads and even derm are massively more competitive but do they earn significantly more first year out? Yet neuro is NOT that competitive, probably on a par with IM.

Its a highly cerebral field, way more complex than many others. You get to have a life and treat some very interesting patients. Get fellowships and things get even better. So many things can be treated now that couldn't before...huge future for the field. Also its quite risk free, not dependent on 1 thing for income (GI), likely to ever be outsourced or come under mid-level pressure. Few turf wars too.

Am I missing something? Is this going to change massively in the next few years?

Simply put, neuro is not competitive due to lower pay in comparison to other specialties. Many other docs steer away from neuro, claim "its too hard". There is no doubt in my mind that if tomorrow, neurologists were averaging 400-500K per year, we'd suddenly see a flocking of patients to our clinic.

Neurology is fascinating, but keep in mind that we are dumped on frequently:
-- I see way too many fibromyalgia patients with vague body sensory disturbances, some of which demand that they have MS despite a perfectly clean brain MRI.
--Psychogenic tremor/movement disorders
--Passing out spells are dumped onto neuro frequently
--I recently saw a case of "whole body pain". Push comes to show, he had pain in every JOINT, sounds like a rheumatology referral to me.

My experience in neurology so far has been that numerous consults are inappropriate and if you ask one or two questions that a primary care physician assistant failed to ask, you can guide the patient into the right direction.


We just took a major slaying on EMG reimbursements last year. What's next? EEG? Sleep studies?

At the end of the day, this does not mean that neurology is not a lucrative field or that you cannot make a nice living as a neurologist, but certainly your pay will pale in comparison to more competitive specialties.

 

[Jubears09]

Very good answer

However, almost all of the other specialties show an almost linear correlation between competitiveness and money, neuro should by all acounts be more competitive. Not hard finding a neuro job after 4 years, same can't be said about radiology job after 5 years...a job which looks like it will be a lot less lucrative soon...and is hard work...very high volume. Neuro can't be covered overnight by someone far away either.

I agree with most of what you say but it doesn't explain the discrepancy to me.

I think its important to distinguish competitiveness from demand. The factors mentioned in your initial post affect how many students want to go into a specialty whereas competitiveness is also large affected by the number of spots available. Medicine and Peds, for instance, have much more interested students every year than derm, but there are just so many more spots available. I mean, it's easy to turn neuro into a "competitive" specialty, just cut the residency spots in half and per last years data we'll right there with Rad Onc. I'm sure the pay will go up in a few years too if that happened.

The real questions in my head are 1) why aren't more students trying to do neuro? and 2) What can we do as a specialty to make it more lucrative? More people are willing to do peds for lower pay and I'd argue less prestige than we get. More people choose IM/surgery with worse hours.

 

[Plecopotamus]

I've asked a few older neurologists about this (people in their late 70s who've had the opportunity to watch the field change over many years). They felt that to some extent those really excited by the complexity were drawn increasingly to PhD programs during periods when the bench research was looking so promising for funding and advancing neuroscience faster than clinical advancements were made by MD counterparts (and as has been mentioned above many people see neuro as diagnostic and impotent in the realm of treatment). They also suggested that there is a big discrepancy between the didactic and clinical years with regards to neuro during which neuroanatomy and neurochemistry are taught in in such a way that they feel so overwhelming & daunting that students aren't excited for neuro & de-prioritize the rotation...often placing it so late in their clinical years (or not taking it at all at some schools) that they don't experience clinical neurology until they're already applying to other residencies.

No idea how valid it is, but that's the $.02 I've been offered. I think the latter certainly is contributory at my school where we can't rotate in neurology until fourth year (and the other nearby school only offers neuro as an elective). I'm curious to see if a few of my friends pursuing psychiatry will wish they'd applied to neuro after they take the rotation.

 

[Yoyomama88]

Is it possible to tailor your practice strictly to CNS problems? If i do an MS or epilepsy fellowship, can I see 80 percent of those cases?

I don't want to see back pain or my foot hurts.

 

[danielmd06]

Is it possible to tailor your practice strictly to CNS problems? If i do an MS or epilepsy fellowship, can I see 80 percent of those cases?

I don't want to see back pain or my foot hurts.

Depending on how flexible you are willing to be for salary and location...yes.

 

[danielmd06]

I've asked a few older neurologists about this (people in their late 70s who've had the opportunity to watch the field change over many years). They felt that to some extent those really excited by the complexity were drawn increasingly to PhD programs during periods when the bench research was looking so promising for funding and advancing neuroscience faster than clinical advancements were made by MD counterparts (and as has been mentioned above many people see neuro as diagnostic and impotent in the realm of treatment). They also suggested that there is a big discrepancy between the didactic and clinical years with regards to neuro during which neuroanatomy and neurochemistry are taught in in such a way that they feel so overwhelming & daunting that students aren't excited for neuro & de-prioritize the rotation...often placing it so late in their clinical years (or not taking it at all at some schools) that they don't experience clinical neurology until they're already applying to other residencies.

Agree this is part of the problem. For me this subject was nephrology. The kidney is *still* a black box to me and it made it hard for me to enjoy or become interested in renal problems in my clinical rotations.

 

[danielmd06]

The real questions in my head are 1) why aren't more students trying to do neuro? and 2) What can we do as a specialty to make it more lucrative? More people are willing to do peds for lower pay and I'd argue less prestige than we get. More people choose IM/surgery with worse hours.

Well, IM has a multiplicity of lucrative fellowship options available after completion of the residency, plus the Affordable Care Act has incentivized primary care a bit more.

The topic of why more people don't pick neurology has been chatted about here more than once. In my (brief) opinion, it boils down to lack of good teaching/understanding of the nervous system, perceived lack of competitiveness with larger numbers of foreign grads filling spots (perception is not a small deal among medical students), not-so-charismatic attendings and residents who don't do a good job "selling" themselves or the specialty, lower reimbursements compared to other medical specialties, a potentially brutal residency and call schedule, and a patient population that can include difficult/psychosomatic/pain problems (that many doctors are frustrated with and are not good at managing) or diseases that don't necessarily get "fixed" in a rapid timeframe.

I agree that neurology was (and is) a hidden gem. We have an elegant organ system with a fun physical exam. We have awesome subject matter to study. We have cool overlap with specialties like ophthalmology, radiology, neurosurgery, orthopaedic surgery, IM, and PM&R. We have a multiplicity of variable fellowship options. We make fair money. We can tailor our practices with surprising flexibility. We are certainly in demand and only projected to be in greater demand as the American population ages (which leverages the salary back into competitive ranges), etc...

If it paid $400k per year then I guarantee you people would be lining up telling you how they were fascinated by it and would love to practice it...

As far as making it more competitive and lucrative, there are always new technologies coming forth. I hope that neurology can get on the imaging bandwagon for some of the studies done for the ever-growing population of neurodegenerative diseaes. Things like SPECT and/or PET. The number of resident positions is also tightly controlled. In my opinion, this is taking a page from the neurosurgeons. Part of the reason their salaries are higher is because of the supply/demand ratio. Of course, their residencies are infamously difficult at some institutions. Same principle for neurology, I think.

 

[greymatters]

The replies have been great, thanks guys

If these guys are starting on around 300k, wont they be making 400k if they work hard a few years in?

Now, how many jobs other than ortho/plastics/rad onc/derm can give you this? Honestly, all other IM specialties than GI would love that kind of pay/hours, yet neuro is only 4 years and not much more competitive than IM. Even obgyn is more competitive...and they are the most miserable doctors that I have ever seen.

I don't argue that a handful of specialties mentioned above shouldn't be more competitive but neuro is basically the least competitive specialty outside PC and that to me seems really weird.

 

[neglect]

Yeah, it's a hidden gem - but only if you actually like neurology. Neurology consistently attracts about 1% of med students. They see a fit. For 99% of all our peers, neurology has vastly different connotations.

Personally I'm fine with this. I'm not eager to practice with a glut of bad neurologists.

 

[neglect]

Is it possible to tailor your practice strictly to CNS problems? If i do an MS or epilepsy fellowship, can I see 80 percent of those cases?

I don't want to see back pain or my foot hurts.

After a few years you can. And then you can see all the pseudoseizures and nonspecific white dots on MRI.

If these guys are starting on around 300k, wont they be making 400k if they work hard a few years in?

Only if they live in Texas. Honestly, if you work pretty hard you can easily get into the 200s on the coasts. You'd have to be working very hard, with very hard working partners, to make in the 300s. And that's the difference with other specialties. Because if you're rads, anesthesiology, interventional medicine like cards or GI, or surgical sub specialty, then you're def into the 300s and above and above (I know, you can be surprised).

 

[danielmd06]

The replies have been great, thanks guys

If these guys are starting on around 300k, wont they be making 400k if they work hard a few years in?

Now, how many jobs other than ortho/plastics/rad onc/derm can give you this? Honestly, all other IM specialties than GI would love that kind of pay/hours, yet neuro is only 4 years and not much more competitive than IM. Even obgyn is more competitive...and they are the most miserable doctors that I have ever seen.

I don't argue that a handful of specialties mentioned above shouldn't be more competitive but neuro is basically the least competitive specialty outside PC and that to me seems really weird.

Agree with neglect that $400k in neurology is an extreme rarity. Neurologists just don't make that much money. As we have said, this is part of the reason for the relative lack of competitiveness of our specialty compared to others.

I guess that some neurologists must have indeed made this much in the past because the data is shown via MGMA (disclaimer is that the last time I saw an updated version of these numbers was 3 years ago), but you're talking about roughly the tippy top percentile of all neurologists. And that is certain to drop, with the recent 50% cuts to EMG services.

 

[IonClaws]

Yeah, it's a hidden gem - but only if you actually like neurology. Neurology consistently attracts about 1% of med students. They see a fit. For 99% of all our peers, neurology has vastly different connotations.

My curiosity is stricken with neurology and its cerebral nature. I like the idea of having to think about which nerve tracts are damaged and why based on what muscles are hypo- or hyperactive and what story the patient tells. However, it seems that some symptoms are difficult if not impossible to diagnose and even if they are, there is often nothing neurologists can do for the patients, although this has changed quite a bit in the last decade (?) and treatments are likely to improve as the importance of neurological care increases in an aging baby-boomer population as neurodegenerative diseases are more prevalent in older patients. Furthermore, the brain is really the base of the human soul - it largely defines who were are as individuals and separates us from the rest of animals. Diseases of the nervous system can really strike at the core of our beings - losing memories, being unable to speak or even move have devastating consequences for interactions with family, friends, and really the world in general. In losing control of our nervous systems, we lose a big part of who we are.

ANYWAY, following my tirade of why neurology interests me, I must ask - why is the field such a turnoff for medical students? Are non-specific headache/dizziness/etc. symptoms really less interesting than, say, telling patients that I can't do anything about their cold because it's a virus and because it constantly changes so there is no treatment for it? Do medical students just want simple, easy problems to fix that don't require much thought?

 

[danielmd06]

My curiosity is stricken with neurology and its cerebral nature. I like the idea of having to think about which nerve tracts are damaged and why based on what muscles are hypo- or hyperactive and what story the patient tells. However, it seems that some symptoms are difficult if not impossible to diagnose and even if they are, there is often nothing neurologists can do for the patients, although this has changed quite a bit in the last decade (?) and treatments are likely to improve as the importance of neurological care increases in an aging baby-boomer population as neurodegenerative diseases are more prevalent in older patients. Furthermore, the brain is really the base of the human soul - it largely defines who were are as individuals and separates us from the rest of animals. Diseases of the nervous system can really strike at the core of our beings - losing memories, being unable to speak or even move have devastating consequences for interactions with family, friends, and really the world in general. In losing control of our nervous systems, we lose a big part of who we are.

ANYWAY, following my tirade of why neurology interests me, I must ask - why is the field such a turnoff for medical students? Are non-specific headache/dizziness/etc. symptoms really less interesting than, say, telling patients that I can't do anything about their cold because it's a virus and because it constantly changes so there is no treatment for it? Do medical students just want simple, easy problems to fix that don't require much thought?

Did you read my posts? I think I answer your question. At least according to my own opinion. Also, this topic has been discussed a fair bit on this forum. You should be able to locate various answers pretty quickly if you do a search.

 

[Dharma]

ANYWAY, following my tirade of why neurology interests me, I must ask - why is the field such a turnoff for medical students? Are non-specific headache/dizziness/etc. symptoms really less interesting than, say, telling patients that I can't do anything about their cold because it's a virus and because it constantly changes so there is no treatment for it? Do medical students just want simple, easy problems to fix that don't require much thought?

The common reasons I hear (mostly implied by their reactions and comments) amongst fellows students:

1. "Neurologists don't do anything!" - I'm not sure the role(s) of the neurologist is/are demonstrated well to students, besides the clinical scenarios thrown at them during systems. Couple this with late rotation exposure and some schools not even requiring a rotation and/or having limited access to one often leaves neuro out in the cold. I've yet to meet one other student who says they are interested in neurology.

2. Prestige and perception- Immaturity still leaves one chasing the gain of approval of some outside force, coupled with the yearning to satisfy some "cool" factor that they can brag about at their high school reunion or on FakeBook. Still, neuro sounds pretty darn cool, so no worries if you have nerdy friends!

3. "I hated neuroanatomy!" - Which leaves me scratching my head, because it was easily the most interesting of systems thus far (albeit one of the toughest), and plays such a crucial -often central- role in all the others. It also seems to have the most potential for new discoveries and understandings, and maybe this "unknown" factor scares people away. Regardless, it is one of the toughest basic science courses and I think that also drives many away. Maybe this could be improved with better teaching/courses during the first two years.

4. Compensation- Most students have absolutely no idea about compensation in medicine besides the average numbers that are commonly tossed around, and neuro is on the lower end of the spectrum during such tossings.

But... I'm only a student as well, so I'm sure my perception is a bit skewed also...

 

[BlackFrancis33]

Don't underestimate the influence of neurologists themselves. I know that everyone on SDN is one of the 'cool' neurologists, who doesn't 'fit the mold' but the fact is that many neurologists come off as weird, obtuse, or worse. We aren't exactly the warmest bunch and our class photos don't necessarily stack up well next to the Derm and Ortho folks. Those of us that are actually cool neurologists (of course I am one of them!) need to do a much better job of selling our specialty.

 

[Jubears09]

Don't underestimate the influence of neurologists themselves. I know that everyone on SDN is one of the 'cool' neurologists, who doesn't 'fit the mold' but the fact is that many neurologists come off as weird, obtuse, or worse. We aren't exactly the warmest bunch and our class photos don't necessarily stack up well next to the Derm and Ortho folks. Those of us that are actually cool neurologists (of course I am one of them!) need to do a much better job of selling our specialty.

Definitely agree with this. When my school had our "residency fair" the first thing the neurology resident told me was that the guys in neurology are WEIRD while the girls were fairly normal. Considering that was a male resident, I'd have to agree with him.

That is one of the thing I like about this field though, everyone who go into it by choice do it for the right reasons.

 

[FutureDO2016]

So a general neurologist will probably make around $200-250 grand a year but what about a neurologist with 1 or 2 fellowships in lets say vascular stroke, pain, neuroradiology, or sleep? Would those fellowship trained neurologists make over $300 grand?

But then again there are other specialties without fellowship training that make $400 grand and more including Anesthesia, Radiology, and Dermatology and all the surgeries + GI + cardio but those require more years/fellowship.

Plus, I think a lot of people avoid neuro because of their unpleasant neuroanatomy course during pre-clinical years...hence people avoid neuro and aren't big fans due to the complex nature of the brain.

 

[neurologist]

So a general neurologist will probably make around $200-250 grand a year but what about a neurologist with 1 or 2 fellowships in lets say vascular stroke, pain, neuroradiology, or sleep? Would those fellowship trained neurologists make over $300 grand?

But then again there are other specialties without fellowship training that make $400 grand and more including Anesthesia, Radiology, and Dermatology and all the surgeries + GI + cardio but those require more years/fellowship.

I have 2 fellowships and make $200-250K (approximately 50% of which disappears into taxes and other payroll deductions before I ever get to hold it in my hot little hands). And I consider myself reasonably well paid for my location and practice environment.

My take is that over $300 K in neuro is possible in 4 circumstances; like everything else in life, we all make our compromises and trade-offs:

1. Like every specialty, sure you can make megabucks if you want to go practice in Podunk where they have to pay big to attract anyone and you will be the only neurologist for 500 miles of corn and soybean fields. The financial benefit is often magnified even more by the probable low cost of living in such places, but again, you get what you pay for . . . Opportunities like this are probably a great deal for a select group of certain people (i.e, you're originally from a place like that, you're a crazy hermit/survivalist, you've had your license pulled in the other 49 states, etc,) but most folks aren't jumping at those opportunities.

2. A really well run, efficient, large neuro group private practice in a big market where you are big enough to have negotiating clout with the local insurance companies. You'll mostly find practices like this in moderate-sized to large urban areas of the midwest and south, where managed care hasn't quite yet beaten everyone into submission.

3. Solo or small group practice where you work 24/7/365. You can do this pretty much anywhere, as long as you're OK with the 24/7/365 aspect . . .

4. Busy private practice in certain sub-sub-specialty areas (i.e, pain procedure mill, used to include sleep but that's going away fast).

Plus, I think a lot of people avoid neuro because of their unpleasant neuroanatomy course during pre-clinical years...hence people avoid neuro and aren't big fans due to the complex nature of the brain

Man, I never understood this . . . neuroanatomy was what attracted me to neuro in the first place -- I love that shizz -- it's the patient care aspect that I can't stand . . .

 

[Leukocyte]

Plus, I think a lot of people avoid neuro because of their unpleasant neuroanatomy course during pre-clinical years...hence people avoid neuro and aren't big fans due to the complex nature of the brain.

I respectfully disagree. Many people are facinated with the brain, neuro-anatomay....... I think most people avoid Neurology as a specialty because the actual practice of Neurology is NOTHING like the facinating neuro-science class that they teach in medical schools. My experience with clinical neurology is that of a love-hate relationship. I love the neuro-science, but dealing with the neurology patient population is a huge challenge. In my opinion, Neurology see the toughest, most chronic, most demanding, most unpleasant, most mean patient population in all of medicine...chronic pain and headache patients who never ever get better no matter what you do for them.

I can only speak from my experience with clinical neurology as a family medicine physician.....I always feel sorry for the Neurologist(s) who I refer my patients to. The patients I refer to Neurology are usually the most meanist and dissatisfied patients with chronic pain and headaches who are often grumpy, and often rude.

So I think most people like the science of neurology, but do not go into the medical prcatice of neurology because of the current state of general clinical neurology prcatice. They do not want to deal with vague, whinny, mean, rude, chronic pain and headache patients.

 

[FutureDO2016]

I should clarify at my med school the neuroanatomy professor got fired and students in my class hated it because he wasn't really trained to teach it as his lectures were straight verbatim from the BRS Neuro book and he's gone this year. He was an IM foreign trained doc with prior teaching experience...

I thought it was fascinating and challenging at the same time because the decussations in a lesion going through several layers is confusing especially with a bad professor...

 

[neglect]

Those of us that are actually cool neurologists (of course I am one of them!) need to do a much better job of selling our specialty.

Why sell it? Neurology attracts very bright people who see what others don't: it is the practical extension of neuroscience and neuroanatomy. I fear the day when this field gets overrun by greedy jerks, in it for the money or prestige, instead of devoted and smart people who want to challenge themselves to better these terrible conditions.

I can only speak from my experience with clinical neurology as a family medicine physician.....I always feel sorry for the Neurologist(s) who I refer my patients to. The patients I refer to Neurology are usually the most meanist and dissatisfied patients with chronic pain and headaches who are often grumpy, and often rude.

So I think most people like the science of neurology, but do not go into the medical prcatice of neurology because of the current state of general clinical neurology prcatice. They do not want to deal with vague, whinny, mean, rude, chronic pain and headache patients.

Recall bias. You remember those terrible, mean, stupid pain patients who are rude to you and are unmanageable. How about your stroke, MS, seizure, PD, and AD patients? They don't make a fuss, so you forget about them. But that's what keeps the lights on - and the mean people get injections into their faces, so that could be a plus.

 

[Leukocyte]

You remember those terrible, mean, stupid pain patients who are rude to you and are unmanageable........But that's what keeps the lights on...

That is my point exactly. Chronic pain patients (who are never happy, no matter what you do to help them) "keep the lights on" in most Neurology offices....., but unfortunately make the practice experience more difficult to enjoy.

Recall bias? Yes. Most people tend to remember the bad (painful) experiences more. Not all chronic pain patients are mean and rude, but unfortunately some are. It only takes one mean and rude patient to ruin the whole work day.

 

[Leukocyte]

3. Prestige ( far and away behind nr 2...see derm for proof)

"Prestige" is very subjective. A specialty might be prestigious to you, but it might not be prestigious at all to the person next to you.

I think it is immature to think that a specialty will bring prestige to a person. Respect is earned, not granted. IMHO, being an excellent, smart, and successful chef is more "prestigious" than being an average neurosurgeon. Prestige/respect = How good you are in what you do.

I have to be very careful with what I say here, since I am in a Neurology forum.....but I hate to break it to you....not ALL people think Neurology is "prestigious". DISCLAIMER: This is NOT my opinion (I think Neurology is just absolutely lovely 😀), but just relaying what I heard others say about Neurology (Do not shoot the massenger ).

Advice from a "older" collegue: Please young medical students....do not go into any medical specialty because YOU ASSUME/THINK it is "prestigious". Your assumed Prestige of the specialty should not even be a factor in you decision...go into a specialty only because you LOVE it. If you love your specialty, you will be good at what you do...and only then you will get your "prestige".

 

[neglect]

That is my point exactly. Chronic pain patients (who are never happy, no matter what you do to help them) "keep the lights on" in most Neurology offices....., but unfortunately make the practice experience more difficult to enjoy.

Recall bias? Yes. Most people tend to remember the bad (painful) experiences more. Not all chronic pain patients are mean and rude, but unfortunately some are. It only takes one mean and rude patient to ruin the whole work day.

Here's what I said.

Recall bias. You remember those terrible, mean, stupid pain patients who are rude to you and are unmanageable. How about your stroke, MS, seizure, PD, and AD patients? They don't make a fuss, so you forget about them. But that's what keeps the lights on.

I mean that all the easy to forget stroke, MS, seizure, PD and AD patients keep the lights on.

I have exactly zero tolerance for any patient that disrupts the doctor-patient relationship. They get fired pronto. I recommend this to anyone. Doctors are far too accommodating and nice. If you don't fire them they could do more than ruin your day - they are med mal liabilities. If you'd like a sample letter, PM me.

In a way I've started to like it when a personality disorder manifests, and they lie or act out or whatever. Because now I know their true colors and I'll never see them again and they will never affect me. And I also don't let one bad experience color the day. Focus on the good, move forward from the bad. We aren't the crazy/mean/narcissist/borderline people - they are, and by being affected by them, you give them the power they seemingly want.

 

[bustbones26]

Dear all, interesting read in the latest Practical Neurology. At this past Annual Texas Neurology Society Conference, they surveyed attendees. If you pull this up, just go to table. 3

Here is what is striking. Only 17% stated that if they could go back in time to their MS-4 year, that they would choose neurology as a career again.

Let's play devils advocate for a moment. Basically, 83% of neurologist in Texas would NOT go into neurology again if they were had a Hot Tub Time Machine.

 

[Jubears09]

Dear all, interesting read in the latest Practical Neurology. At this past Annual Texas Neurology Society Conference, they surveyed attendees. If you pull this up, just go to table. 3

Here is what is striking. Only 17% stated that if they could go back in time to their MS-4 year, that they would choose neurology as a career again.

Let's play devils advocate for a moment. Basically, 83% of neurologist in Texas would NOT go into neurology again if they were had a Hot Tub Time Machine.

That information doesn't seem very helpful without the same data re physicians in general and physicians in TX. Last years medscape data surverying all specialties put neuro right in the middle of the pack at 50% would do this again with the highest being derm/optho at ~60% ish.

Also the timing and location of this matters considering TX is one of the most conservative states and this is the year ACA is being implemented and neurology being a target of cuts. I'd imagine similar numbers across the board in the state

 

[BlackFrancis33]

Why sell it? C'mon Neglect, are you telling me we couldn't do a little better? I'm not saying sell it on a street corner, I talking about selling it amongst the top 25% of med school classes to try to attract a few more of the best and brightest. I have met multiple people who have said, 'I liked neurology a lot but when I met Dr. X, I couldn't imagine doing it.' We have a lot of Dr. X's in Neurology who shouldn't be let anywhere near medical students.

Bbones26- If I get a hot tub time machine, I'm not going back to the day I made my medical school decision. I'm going back to the day I almost had a 3 way with those two cheerleaders...OK that never actually happened. But you get the idea.

 

[Jubears09]

Why sell it? C'mon Neglect, are you telling me we couldn't do a little better? I'm not saying sell it on a street corner, I talking about selling it amongst the top 25% of med school classes to try to attract a few more of the best and brightest. I have met multiple people who have said, 'I liked neurology a lot but when I met Dr. X, I couldn't imagine doing it.' We have a lot of Dr. X's in Neurology who shouldn't be let anywhere near medical students.

Exactly this. What's impressed me about the ROAD specialties isn't just that they have natural advantages, but they also have fantastic outreach and put much effort into making sure students have a great experiences when rotating/have a presence at conferences like AMA. My school's derm dept can fill with their eyes closed, but they still take the time to individualize every rotating student's schedule to their interests and make sure everything is set up to optimize advising/etc even if they're not going into derm. 10 years down the line even those who don't end up in derm have a great impression of the specialty and that's part of what makes it so strong/desirable.

Don't get me wrong, I love neuro because of the community as well, but we're still a backup specialty to a lot of people and at the very least we want ALL the people who match into our specialty to be here because it's their first choice, not because they couldn't get into ortho.

 

[neglect]

"Prestige" is very subjective. A specialty might be prestigious to you, but it might not be prestigious at all to the person next to you.

I think it is immature to think that a specialty will bring prestige to a person. Respect is earned, not granted. IMHO, being an excellent, smart, and successful chef is more "prestigious" than being an average neurosurgeon. Prestige/respect = How good you are in what you do.

I have to be very careful with what I say here, since I am in a Neurology forum.....but I hate to break it to you....not ALL people think Neurology is "prestigious". DISCLAIMER: This is NOT my opinion (I think Neurology is just absolutely lovely 😀), but just relaying what I heard others say about Neurology (Do not shoot the massenger ).

Advice from a "older" collegue: Please young medical students....do not go into any medical specialty because YOU ASSUME/THINK it is "prestigious". Your assumed Prestige of the specialty should not even be a factor in you decision...go into a specialty only because you LOVE it. If you love your specialty, you will be good at what you do...and only then you will get your "prestige".

I'd just like to second this. There's a lot of wisdom here. You earn prestige and the way to do it is through internal processes - not external labels. And you can hold your head up high in any bit of medicine, even derm, if you offer good care and act in accordance with the dignity of our field.

 

[danielmd06]

Why sell it? Neurology attracts very bright people who see what others don't: it is the practical extension of neuroscience and neuroanatomy. I fear the day when this field gets overrun by greedy jerks, in it for the money or prestige, instead of devoted and smart people who want to challenge themselves to better these terrible conditions.

I don't think it hurts us to try and "sell" ourselves or our specialty. It's a reasonable method to attract increased numbers of bright applicants. Just like certain hospitals or residency programs, certain specialties do a better job of this than others and reap the benefits of doing so. Note that I am not advocating trickery or false advertising.

Like Dante, many medical students are lost in that metaphorical Dark Wood of Error. They know what their friends, senior students, residents, rotational experiences, and Google tell them. A bad or weak experience can be a powerful motivator. Likewise a positive one.

I don't think we need to worry so much about the field being overrun by those seeking prestige or money. In my opinion, those individual are likely to self-select out of neurology no matter how much we try and point out the good attributes of what this specialty can offer.

 

[danielmd06]

...a Hot Tub Time Machine.

I could see this having some benefits over a DeLorean...

 

[danielmd06]

"Prestige" is very subjective. A specialty might be prestigious to you, but it might not be prestigious at all to the person next to you.

I think it is immature to think that a specialty will bring prestige to a person. Respect is earned, not granted.

Advice from a "older" collegue: Please young medical students....do not go into any medical specialty because YOU ASSUME/THINK it is "prestigious". Your assumed Prestige of the specialty should not even be a factor in you decision...go into a specialty only because you LOVE it. If you love your specialty, you will be good at what you do...and only then you will get your "prestige".

Correct.

I have been asked to sometimes advise medical and college students about this and I use words and sentences very, very similar to these. I actually further include paycheck (to a degree). The money that currently can be earned in one specialty can grow or shrink based on what an insurance company starts covering, new technology, or cuts. No one has a crystal ball, and it seems like a recipe for misery if you select a specialty mostly due to reimbursement. I would say that it's fine to have expectations of a certain lifestyle and to hunt accordingly, and I most definitely wouldn't advocate blatantly ignoring a job's reimbursements, either. Just try and keep it in the middle to low end of that priority list.

 

[greymatters]

Having to sell something demeans it, this basically means you need to convince people in the first place.


Derm doesn't need to sell itself


Question is surely, how can neuro become more attractive? Maybe it can't. No matter how good you rotation as MS4 etc was doesn't really matter since the factors I mentioned in the first post are what really create demand.

Can you get derm money with derm pay, if not, no amount of convincing will make a the specialty as competitive... see IM specialty pay...then see IM specialty competitiveness...then tell me that I'm wrong.

 

[Jubears09]

Having to sell something demeans it, this basically means you need to convince people in the first place.


Derm doesn't need to sell itself


Question is surely, how can neuro become more attractive? Maybe it can't. No matter how good you rotation as MS4 etc was doesn't really matter since the factors I mentioned in the first post are what really create demand.

Can you get derm money with derm pay, if not, no amount of convincing will make a the specialty as competitive... see IM specialty pay...then see IM specialty competitiveness...then tell me that I'm wrong.

Derm absolutely needs to sell itself, or else there would be no academic derm at all. Like neurology, most people entering med school don't know anything about the Derm. Medicine and surgery that the two default paths that don't need to do any selling, I'd argue every other specialty needs to "flip" a student at some point in med school. Derm recruits surgically inclined students by selling itself as a procedural specialty with fantastic hours. It sells itself to medicine inclined students as a specialty involving a lot of Rhem and ID without the rounding.

Derm got to where they are today - a few generations ago they were just a subgroup of ID - by figuring out how to monetize their specialty, identifying the value the add to the healthcare system and focusing on doing those things really really well (and stripping themselves of what they don't do well by leaving the dept of medicine), and by focusing on getting the best people (which at the end of the day is what makes any specialty strong). And it's not like people sit around figuring out how to give money to dermatologists, as a field they've put an emphasis on the lobbying and recruiting necessary - even as part of training, the entire derm dept at my institution visits the state capital annually - so that they are always a player in the policies that shape pay structures and scope of practice.

I'm not saying neuro needs to go as far as derm did, but it's a self fulfilling prophecy to say we shouldn't be actively trying to promote our specialty both to improve our potential talent pool (students) and to policy makers and administrators. It's easy to look at where the ROAD specialties are now, but I think as a field we're making a huge mistake if we take the state of things for granted and don't look at how Derm, ENT, etc got to where they are and try to apply those lessons towards making neurology stronger.

 

[bustbones26]

1. Like every specialty, sure you can make megabucks if you want to go practice in Podunk where they have to pay big to attract anyone and you will be the only neurologist for 500 miles of corn and soybean fields. The financial benefit is often magnified even more by the probable low cost of living in such places, but again, you get what you pay for . . . Opportunities like this are probably a great deal for a select group of certain people (i.e, you're originally from a place like that, you're a crazy hermit/survivalist, you've had your license pulled in the other 49 states, etc,) but most folks aren't jumping at those opportunities.

:

Not sure what you are talking about? I receive post cards in the mail for jobs every day. EVERY ONE of them is in a university town with groomed golf courses or lakes chock full of trophy bass Okay, that was sarcasm. But those recruitment mailings to get annoying after a while.

 

[typhoonegator]

Not sure what you are talking about? I receive post cards in the mail for jobs every day. EVERY ONE of them is in a university town with groomed golf courses or lakes chock full of trophy bass Okay, that was sarcasm. But those recruitment mailings to get annoying after a while.

All with "vibrant, multi-ethnic communities" and "easy access to major metropolitan areas". Tell me more about this "clear path to full partnership".

 

[danielmd06]

Having to sell something demeans it, this basically means you need to convince people in the first place.


Derm doesn't need to sell itself


Question is surely, how can neuro become more attractive? Maybe it can't. No matter how good you rotation as MS4 etc was doesn't really matter since the factors I mentioned in the first post are what really create demand.

Can you get derm money with derm pay, if not, no amount of convincing will make a the specialty as competitive... see IM specialty pay...then see IM specialty competitiveness...then tell me that I'm wrong.

No. I disagree.

This is part of the real world. It's not cheapening - it's being competitive. For instance, programs in Rochester, MN or Cleveland, OH may have an excellent reputation, but you can bet they might have to try and point out the positive attributes of their locales. Programs in San Francisco or Boston may not have that precise same problem. This applies to virtually any trait. Specialties, residency programs, hospitals, your future employers, medical schools, colleges, and cities all do this. We all do it, to a degree. When you interviewed for med school you "sold yourself." When you apply to residency you "sell yourself." This is part of being competitive. It is not demeaning from my point of view.

To give you another more pragmatic example:

When I went on a date in high school, I shaved, dressed sharp, cleaned my Explorer to perfection, and picked up a girl who had styled her hair, was wearing contact lenses, makeup, and attractive clothes. I wouldn't say we were demeaning ourselves. Rather, we were showing that we cared what each other thought and were striving to impress each other.

 

[greymatters]

Cute example but in high school, as in life since, it isn't the guys who made the most effort who get all the girls. But we are digressing; personally I think neuro wont need to do much. Increasing number of treatment options, relatively good hours and limited number of neurologist graduating every year will cause an increase in demand and income (as already seen in the past 5 years or so). Unlike most other, as I've already mentioned, we aren't dependant on one single modality for our income nor are NPs or any other middle grade capable of doing most of what we do. FPs can remove skin lesions but would you trust them with a CVA? Competition will increase once this happens...in my opinion this will happen soon.

 

[Dharma]

When I went on a date in high school, I shaved, dressed sharp, cleaned my Explorer to perfection, and picked up a girl who had styled her hair, was wearing contact lenses, makeup, and attractive clothes. I wouldn't say we were demeaning ourselves. Rather, we were showing that we cared what each other thought and were striving to impress each other.

Damn SnakeEyes... facial hair AND Explorer already in high school? P-I-M-P!

But wait... you said "a date." There was more than 1 right? 😉

 

[Jubears09]

Cute example but in high school, as in life since, it isn't the guys who made the most effort who get all the girls. But we are digressing; personally I think neuro wont need to do much. Increasing number of treatment options, relatively good hours and limited number of neurologist graduating every year will cause an increase in demand and income (as already seen in the past 5 years or so). Unlike most other, as I've already mentioned, we aren't dependant on one single modality for our income nor are NPs or any other middle grade capable of doing most of what we do. FPs can remove skin lesions but would you trust them with a CVA? Competition will increase once this happens...in my opinion this will happen soon.

It amazes me how much hubris I'm seeing on this forum. The reality is right now our specialty can't even fill a relatively small number of spots with AMGs and people who want rads and derm apply as a backup. You mentioned a lot of great reasons these problems are fixable, but that doesn't mean they're going to fix themselves. As with all things, those who make an effort will end up doing better than those who don't.

No one is going to give you more money if you don't figure out how to monetize and add value that can't be replaced. An FP with a few months on stroke service during residency can care for 90% of CVAs. Same goes for an NP after several years of experience in a neuro dept. They can read the guidelines and follow them as well as we can. Plus, I think the goal is to make treatments so effective that FPs can do it, when it "happens" there's nothing keeping FM programs from letting their residents spend a few months on a neuro rotation to care for the uncomplicated cases.

More importantly, at the end of the day it's the people in any specialty that makes it strong. It's the people who drives the innovations that will move the treatments you mentioned forward, and there's no denying that actively recruiting the best and brightest medical students - even those who have other options and aren't born to be neurologists - will speed up the evolution of our specialty moreso than taking the attitude of "things will fix themselves" or "if you don't like me, I don't want you anyway".

 

[neurologist]

Derm absolutely needs to sell itself, or else there would be no academic derm at all. Like neurology, most people entering med school don't know anything about the Derm. Medicine and surgery that the two default paths that don't need to do any selling, I'd argue every other specialty needs to "flip" a student at some point in med school. Derm recruits surgically inclined students by selling itself as a procedural specialty with fantastic hours. It sells itself to medicine inclined students as a specialty involving a lot of Rhem and ID without the rounding.

Derm got to where they are today - a few generations ago they were just a subgroup of ID - by figuring out how to monetize their specialty, identifying the value the add to the healthcare system and focusing on doing those things really really well (and stripping themselves of what they don't do well by leaving the dept of medicine), and by focusing on getting the best people (which at the end of the day is what makes any specialty strong). And it's not like people sit around figuring out how to give money to dermatologists, as a field they've put an emphasis on the lobbying and recruiting necessary - even as part of training, the entire derm dept at my institution visits the state capital annually - so that they are always a player in the policies that shape pay structures and scope of practice.

I'm not saying neuro needs to go as far as derm did, but it's a self fulfilling prophecy to say we shouldn't be actively trying to promote our specialty both to improve our potential talent pool (students) and to policy makers and administrators. It's easy to look at where the ROAD specialties are now, but I think as a field we're making a huge mistake if we take the state of things for granted and don't look at how Derm, ENT, etc got to where they are and try to apply those lessons towards making neurology stronger.

Derm can monetize itself because of the large # of derm patients who are generally otherwise well-functioning individuals who have an annoying/unsightly skin problem. Thus, they more likely to be still functioning in society, working, and/or have decent paying insurance or can even pay out of pocket for non-insurance-covered "cosmetic" services.

A significant chunk, if not most, of neurology patients are elderly and/or moderately to very impaired by chronic, incurable, minimally treatable illnesses that reduce their functional ability (MS, parkinsons, dementia, chronic pain, epilepsy, often all with comorbid psychiatric/behavioral problems). These people tend not to have great insurance or a lot of discretionary cash lying around to pay lots of money to their doctors. You can't get blood from a turnip, or more money out of Medicaid.

 

[Jubears09]

Derm can monetize itself because of the large # of derm patients who are generally otherwise well-functioning individuals who have an annoying/unsightly skin problem. Thus, they more likely to be still functioning in society, working, and/or have decent paying insurance or can even pay out of pocket for non-insurance-covered "cosmetic" services.

A significant chunk, if not most, of neurology patients are elderly and/or moderately to very impaired by chronic, incurable, minimally treatable illnesses that reduce their functional ability (MS, parkinsons, dementia, chronic pain, epilepsy, often all with comorbid psychiatric/behavioral problems). These people tend not to have great insurance or a lot of discretionary cash lying around to pay lots of money to their doctors. You can't get blood from a turnip, or more money out of Medicaid.

I completely agree with what you said and those are all valid reasons why I don't think neuro will ever be as much of a lifestyle/pay specialty as derm.

My point was that derm still made/ makes an effort to build/maintain what they have and as neurologists we should be actively trying to make our specialty more desirable and " selling" our specialty because regardless of what the inherent limitations are, we ARE relatively deficient in prestige, lifestyle, and pay right now. I suspect all three aspects can be improved ( as OP pointed out in the first post) but not if we have the attitude that "selling" our specialty somehow makes it worse.

 

[BlackFrancis33]

[It amazes me how much hubris I'm seeing on this forum. The reality is right now our specialty can't even fill a relatively small number of spots with AMGs and people who want rads and derm apply as a backup... ]

Exactly. We don't fill, and we fill up with some questionable applicants (doesn't apply to only FMGs). By no coincidence, the med student, Derm experience was oustanding compared to Neurology at my med school. I have met far too many bizarre personalities in our speciatly, we aren't alone here of course. But, in far too many situations these individuals are the ones interacting with medical students. It only takes 1 weird interaction with Dr. Bowtie with Bad Breath (and no social skills), to turn off the completely uninitiated.

 

[danielmd06]

Cute example but in high school, as in life since, it isn't the guys who made the most effort who get all the girls. But we are digressing; personally I think neuro wont need to do much. Increasing number of treatment options, relatively good hours and limited number of neurologist graduating every year will cause an increase in demand and income (as already seen in the past 5 years or so). Unlike most other, as I've already mentioned, we aren't dependant on one single modality for our income nor are NPs or any other middle grade capable of doing most of what we do. FPs can remove skin lesions but would you trust them with a CVA? Competition will increase once this happens...in my opinion this will happen soon.

Well, my intention was not to give you a road map for perpetual dating success, but rather to answer your comment that "selling" is demeaning. So I gave a few examples, which I think clarify my point over yours. If you don't even try because you're afraid of failure, you guarantee yourself of failure. No worries, though, if you don't see things my way. People are allowed to disagree.

I think neurology (as a very general rule) can do better at recruiting folks. But it means being realistic about practical ways to improve. I think striving to help medical students have a better and more enjoyable experience on our rotations would be quite helpful.

 

[danielmd06]

Damn SnakeEyes... facial hair AND Explorer already in high school? P-I-M-P!

But wait... you said "a date." There was more than 1 right? 😉

Thank goodness. Someone who finally, at long last, caught the reference of my avatar. Well done!

And your post reminds me that for Halloween I need a cane, fur-lined hat, and furry cape. All in green and gold, of course. For the uninitiated, the green is for the money, and the gold is for the honeys. I guess I better find a fake jewel-encrusted goblet to complete my ensemble, too.

 

[Dharma]

Thank goodness. Someone who finally, at long last, caught the reference of my avatar. Well done!

And your post reminds me that for Halloween I need a cane, fur-lined hat, and furry cape. All in green and gold, of course. For the uninitiated, the green is for the money, and the gold is for the honeys. I guess I better find a fake jewel-encrusted goblet to complete my ensemble, too.

Wait, no one recognized the most bada$$ of all Joes? Must be a generation gap!

Don't forget about adding the waist-long pimp hand to the attire.