Changing minds from Neurocritical care to Pulmonary/Critical Care

[Iliopsoas]

Did anyone else consider staying in internal medicine after their intern year? I am 3/4 done with my intern year and am supposed to start neurology in a few months, but am second guessing my choice. Before matching into neurology I only wanted to do Stroke/NCC; I matched at an institution that has both and have researched the field extensively. Now I find myself loving the idea of being a Pulmonary/CC physician.

First, Pulm/CC physicians can care for neuro patients. At hospitals without neurointensivists, these patients generally go to the MICU for medical management. Second, they seem to do more procedures on the whole than the neurointensivists I talk to. For example, there are not many neurologists I know that can perform bronchs. And while I've thought about doing interventional neurology, I honestly don't think I could tolerate wearing lead for the rest of my career (why doesn't this deter more people from wanting to pursue interventional neurology?). Finally, with Pulm/CC, there are more opportunities to join larger groups and share the call burden, compared with NCC docs who are highly sought after and often overworked.

When I was in medical school my mentor told me to pick the field that I would most prefer to practice after my critical care career was over. In other words, which would I rather do when I'm 60 - neuro clinic or pulmonary clinic? While I thought that the answer for me was neurology, I'm just not sure anymore.

For now, I'm in very good standing with my internal medicine preliminary program. I have had multiple attendings ask me to reconsider neurology and stay to finish internal medicine training there, which is encouraging.

Is this a common problem? Did anyone else second guess themselves after their intern year?

Sincerely,
Confused SDN'er

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[typhoonegator]

Pulmonary critical care is great, and I don't want to dissuade you from a very viable career option, but there is a wide spectrum of neurocritical care training and plenty of opportunities for procedures if you go to the right program. I do intubations, bronchs, thoras, paras, bolts, all forms of CVL and a-lines, LPs, lumbar drains, diagnostic chest/abd ultrasound, etc in my fellowship program. We run the bronch and anesthesia for bedside T&G placement as well.

After fellowship, you have a lot of options for your call structure. You can be on a 1 in 2 schedule and make more money, or take a more sane gig at a larger center with 1 in 4 or even less coverage time, supplemented by research or administrative pursuits.

While general critical care physicians certainly can treat neurologic disease, there is good data showing superior outcomes from a dedicated neurocritical care unit for several major neurologic diseases. This probably has to do with expert nursing care just as much as physicians.

It doesn't matter to me what you decide, but I would recommend exploring all of your options before making a decision.

 

[danielmd06]

Did anyone else consider staying in internal medicine after their intern year? I am 3/4 done with my intern year and am supposed to start neurology in a few months, but am second guessing my choice. Before matching into neurology I only wanted to do Stroke/NCC; I matched at an institution that has both and have researched the field extensively. Now I find myself loving the idea of being a Pulmonary/CC physician.

First, Pulm/CC physicians can care for neuro patients. At hospitals without neurointensivists, these patients generally go to the MICU for medical management. Second, they seem to do more procedures on the whole than the neurointensivists I talk to. For example, there are not many neurologists I know that can perform bronchs. And while I've thought about doing interventional neurology, I honestly don't think I could tolerate wearing lead for the rest of my career (why doesn't this deter more people from wanting to pursue interventional neurology?). Finally, with Pulm/CC, there are more opportunities to join larger groups and share the call burden, compared with NCC docs who are highly sought after and often overworked.

When I was in medical school my mentor told me to pick the field that I would most prefer to practice after my critical care career was over. In other words, which would I rather do when I'm 60 - neuro clinic or pulmonary clinic? While I thought that the answer for me was neurology, I'm just not sure anymore.

For now, I'm in very good standing with my internal medicine preliminary program. I have had multiple attendings ask me to reconsider neurology and stay to finish internal medicine training there, which is encouraging.

Is this a common problem? Did anyone else second guess themselves after their intern year?

Sincerely,
Confused SDN'er

Man, you're taking me back about four years and reminding me of myself.

I had exactly the same questions, and I believe this second guessing is more common in neurology than many would care to admit. My choice was between internal medicine and emergency medicine...both of which played on my original neurologic interests - stroke (EM), interventional (IM - cards), neurocritical care (IM -pulm), and...sleep disorders (IM - pulm).

EM seemed like a great lifestyle choice during residency with many career options afterwards, and IM seemed like a better overall career move with more fellowship options. Obviously, both seemed selfishly smarter in terms of the PGY-2 schedule. Both seemed to have attendings and residents that were more "like me" in terms of life goals and personalities when compared to neurology. I also felt a strong moral obligation to neurology because of the contract I had signed (debatable here on SDN, but this is my personality and how I viewed the situation).

Basically, my choice ultimately boiled down to whether or not to do Pulm/CCM (like you) or stick with neurology. The EM decision was harder than you might think, too.

I chose neurology because I really felt that the final job description was truer to my personal academic interests, desires, and goals - regardless of fellowship. The outpatient and inpatient casework just seemed much more interesting in neurology than IM or EM, and I felt that the average workday was better for a neurologist in private practice than an EM or IM doc (debatable I know, but this is my opinion).

This isn't an easy choice for you I'm sure. It certainly wasn't for me, and I even felt that the decision became more complicated the more I researched it! The advice you got actually wasn't bad. When push comes to shove..do you want to read about and care for neurologic disease or pulmonary disease?

And if you love both too much to make an easy choice, then there is actually a third option. You can decide to "cheat" and do both neurology and pulmonary. How? There is always a fellowship in Sleep Disorders out there from either specialty.

It's what I'm doing. You should think about it.