Choosing neurology residency

[ehel27]

I`m an intern physician in Europe, soon having to make a residency choice. My first choice always was neurology, but I`m growing increasingly ambivalent about it. I always found neurology very interesting and already thought about this field when going into med school. I studied physiotherapy before and had already some contact with neurological patients and found it quite fascinating. I did a longer elective rotation in neurology in 6th year of med school and found it still very interesting. Honestly I find neurology the only subject in medicine that I can read with some joy. I like the delicate details of the neurological exam, the logic involved and the neuroscience and neuroanatomy that lies behind everything. I also like that there is so much still to discover scientifically in this field. Additionally I`m a bit of a philosophical type and find the interfaces between neurology/psychiatry and physical/mental fascinating. However, I`m very introverted and therefore has also considered the more para-clinical specialties like radiology.

My choice is really between neuro and radiology. I feel the latter fits my personality well, but at the same time it`s not as interesting. On the contrary neuro is interesting, but not as fitting to my personality. The main problem is that I get very depressed and emotionally drained from dealing directly with seriously ill patients and incurable conditions. Somehow I almost feel over-empathetic towards patients and the work ends up feeling absurd and useless. I have the impression that my colleagues are much better at distancing themselves. Secondly, I`m worried about the work pressure and the burnout rate in the field. My impression so far, is that the amount of hours and stress is quite similar to internal medicine. I`m not really the most energetic type and when rotating in IM I always felt like those guys were not my kind of people.

Does anyone have any advice? Should I follow my interest in neuro or maybe chose a field that fits an introvert better? Is it a real red flag that I quite often get emotionally drained from seeing seriously ill patients? I always thought that I could always go outpatient after residency and deal with sleep, headaches or other "light" neuro if I get too burned out from inpatient heavy stuff. Don`t know how easy that is in practice though.

Sorry for the horribly long rant

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[Thama]

IMO the first decision you need to make in specialty selection is the type of work you want to do: outpatient clinic, inpatient care, surgical, acute care, etc. Only then will picking the subject matter of your work make sense.

If you're someone who enjoys the work of a radiologist but not that of a clinician (inpatient or outpatient), you aren't going to be happy in neurology no matter how much you find the subject matter interesting. Outpatient work really isn't any lighter than inpatient in most senses - it's far more direct personal interaction, just with a different level of acuity. The interesting cases do not make up for the day to day doing something you don't like, particularly once you have some experience and most of what you see becomes fairly routine to you. As a radiologist you can also further specialize in neuroradiology and thus continue to engage with your interests while doing the kind of work you want to do.