Best kept secret

[bustbones26]

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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.

quote]

Yah know, you'd think those ASA/AHA Guidelines would just turn stroke care into cookbook medicine and are fairly easy to follow? That being stated, if I had a dollar for every stroke/TIA that was either misdiagnosed by FM/IM/EM, I'd have a lot of dollars!! I am not bashing on these individuals per se, just pointing out that they are more than happy to just do a reflex neurology consult and have no interest in managing the case otherwise.

 

[neurochica]

I agree that we need to do a better job selling our specialty. It starts by telling Med students our current income—It seems that disclosing our income is taboo: not cool.


I recently completed residency and all of the places I interviewed for employment offered me $300k or above. Three of my residency mates accepted jobs for $250K, $350K and $390K starting. Mostly Midwest although one accepted a job in the southeast. None of us work crazy hours or are located in the boonies.


I think neurology tends to attract a certain type of people, just like pathology. If you don’t fit the mold, you will not be happy. I don’t care how much money you offered me to be a surgeon—it is just not my cup of tea. So my advise to you MS4 students, find a field that you really enjoy and go with that.

 

[greymatters]

My response to you came across as rude, wasn't the intention...my point is that the way in which to attract better candidates is not to go on about how fascinating the nervous system is, instead just point out facts about the lifestyle/income as the last poster has done, this seems to attract the best students to the most popular specialties.

 

[fleshwound]

I think neurology tends to attract a certain type of people, just like pathology. If you don’t fit the mold, you will not be happy.

...what kind of people? or should this be a separate thread?

 

[typhoonegator]

...what kind of people? or should this be a separate thread?

There are threads on this already. At any rate, I disagree. There are neurology archetypes just as there are orthopedic surgeon archetypes, but not everyone fits these molds. Neurology should attract people interested in neuroscience. I don't think your life will be sad and unfulfilled if you simultaneously love neurology and hate bowties and dandruff. There's room for jocks and mods and punks and nerds and goths in our speciality. I certainly don't fit any sort of neurology mold, and I'm absurdly happy with my profession.

 

[danielmd06]

My response to you came across as rude, wasn't the intention...my point is that the way in which to attract better candidates is not to go on about how fascinating the nervous system is, instead just point out facts about the lifestyle/income as the last poster has done, this seems to attract the best students to the most popular specialties.

No worries (if you were indeed speaking to me). As the song goes, I'm easy like Sunday morning.

 

[Dharma]

No worries (if you were indeed speaking to me). As the song goes, I'm easy like Sunday morning.

The Commodores original or the Faith No More cover?

 

[danielmd06]

The Commodores original or the Faith No More cover?

Commodores. The original.

Well done.

 

[neurodoc]

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...

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

Your number 1 student (and probably general) criticism that neurologists don't do anything is, IMHO, at the heart of the unpopularity of neurology. The pay issue is certainly important, but seems to me to a bit exaggerated. Board Certified Neurologists are not starving and most can find salaried jobs or other practice opportunities in the big cities and the Boonies. Having subspecialty training and certification in EMG/EEG, stroke, sleep, etc., expands the opportunities. Specializing in Pain Management is another much-in-demand option.

Neurologists are now able to do quite a lot for a host of diseases. Think about the new MS, migraine, and epilepsy meds. Think about Botox. Think about thrombolytic treatment for stroke.

As regards the last-mentioned item (stroke thrombolytic Tx), this is something for which the expert diagnostic skills of a neurologist (or at least of a non-neurologist physician who really knows neurology) are absolutely essential. I know of quite a few patients who were subjected to thrombolysis when they presented to the ER with things like Bell's Palsy, acute MS attacks, cervical radiculopathy, and even migraine.... Since the current ACLS criteria require only that the patient present with "stroke symptoms" with onset of < 4 hours+/- and a "negative CT" (mainly to r/o bleed or large infarct), it's clear that someone has to decide what constitutes "stroke" symptoms... Who better to do so than a neurologist?

 

[Neurologo]

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.".

Same thing can be said of any other specialties and their practices. This is precisely something we need to prevent from happening if we do care about our specialty. I would avoid training anyone other than neurology residents. If anything would cheapen our specialty, it would be opening the doors wide to anyone from practicing neurology without a full residency. In our program when gen med PGY3s rotate through neurology, we don't let them see any ED or stroke consults mainly because we do not trust their skills and knowledge in neurology. We teach them to become a better referrers to neuro consult and not to become a semi-neurologist.

 

[Jubears09]

Same thing can be said of any other specialties and their practices. This is precisely something we need to prevent from happening if we do care about our specialty. I would avoid training anyone other than neurology residents. If anything would cheapen our specialty, it would be opening the doors wide to anyone from practicing neurology without a full residency. In our program when gen med PGY3s rotate through neurology, we don't let them see any ED or stroke consults mainly because we do not trust their skills and knowledge in neurology. We teach them to become a better referrers to neuro consult and not to become a semi-neurologist.

We rely on radiologists to teach us to how to interpret imaging, neurosurgeons to show us how to deal with DBS, pulm to show us how to do bronchs, etc; because we're all in this together to take care of the same patients. It's the patients that suffer when those "trained" internists are their primary providers in a hospital without a neuro consult (the majority in my state). If neurology residency adds so little that the residents can be replaced by people who rotate for a month, that part of the residency needs to be seriously revamped.

 

[neurodoc]

We rely on radiologists to teach us to how to interpret imaging, neurosurgeons to show us how to deal with DBS, pulm to show us how to do bronchs, etc; because we're all in this together to take care of the same patients. It's the patients that suffer when those "trained" internists are their primary providers in a hospital without a neuro consult (the majority in my state). If neurology residency adds so little that the residents can be replaced by people who rotate for a month, that part of the residency needs to be seriously revamped.

That's a big "if." What a good neurology residency "adds" to the medical field is training a neurology resident to understand how the nervous system works, and how it doesn't work when there is disease. A well trained neurologist will be able to "help" all those other non-neurologist physicians (the radiologists, internists, orthopedists, ER "stroke interventionialists, and yes, even neurosurgeons, manage their patients.