Common questions about Neurology

[carter]

---

Members don't see this ad.

Hello everyone,

I am about at that point in my med school career where a decision has to be made about which field to go into. I have truly been that person who has considered just about everything up till this point. I was once set on radiology but found the rotation very boring. Then I fell in love with EM, but did not appreciate the lack of continuity of care in that field. I have always considered myself as having a "medicine" personality, who likes to interpret the data to come up with the differentials. I enjoyed the diagnostic part of my medicine rotation, but honestly, I am more interested in the fellowships it has to offer (such as heme/onc and cards). And I feel very uneasy about the fact that I have to go through 3 years of IM to get to that point.

So this brings me to neurology. It was one of my favorite subjects in basic sciences and it truly just made sense to me at that time. I was strongly considering it as an MS II but did not give it much thought based on the common notions about the field (lack of treatments, complexity of the nervous system, below average compensation etc). However, recently I am beginning to think it might be the perfect field for me. It contains the diagnostic part that I enjoy about internal medicine. It has the acute care aspect of it, which I enjoyed about EM. And it has the interpretation of images that I enjoyed about radiology.

So the reason for this rant is just to get some ideas about where this field is headed in the future. I know there has been tremendous research that is going on in the field and the future looks bright in terms of improvement of treatment. But where do you see a neurologist in, lets say, 10-15 years? Will this field ever be able to sort of take over "the brain" as cardiology has with the heart? Why can't neurologist interpret their own images and bill for them while cardiology can with their echoes and other cardiac images? Why can't they get more involved in the interventional part of it? Are there soon to be advances in treatments that will make this field hot? Will this translate to better reimbursement for neurologists and thus make it more attractive?

I apologize for the long post, but I'm sure a lot of med students considering this field have similar questions and concerns and there just don't seem to be that many answers available in this field compared with others. Thanks.

 

[BrianUM]

http://www.svineuro.org/

 

[Terpskins99]

http://www.svineuro.org/

Its a nice idea, except that its near impossible for a neurologist to obtain an interventional fellowship. INR fellowships are almost the exclusive domain of neurosurgeons and radiologists.

 

[minstral]

Terps your statement is about 3-5 years out of date.
Highly competitive field regardless though

 

[Terpskins99]

Terps your statement is about 3-5 years out of date.

No it isn't, minst.

Highly competitive field regardless though

I didn't say it was impossible. Its nearly impossible. "Highly competitive" for a neurologist getting into INR is a HUGE understatement. There are almost none out there.

 

[Sir Elroy]

No it isn't, minst.

I didn't say it was impossible. Its nearly impossible. "Highly competitive" for a neurologist getting into INR is a HUGE understatement. There are almost none out there.

From what I've seen of my program's neurointerventional program (which has a number of neurology-trained fellows in it), I've got to side with minstral on this one. Highly competitive, sure. Nearly impossible, no. Where are you getting your information?

 

[Terpskins99]

From what I've seen of my program's neurointerventional program (which has a number of neurology-trained fellows in it), I've got to side with minstral on this one. Highly competitive, sure. Nearly impossible, no. Where are you getting your information?

Radiologists at my hospital for the most part.

 

[hans19]

Radiologists at my hospital for the most part.

Agree with terpskins.
INR is extremely difficult for neurologists to attain. Its much easier for radiologists and neurosurgeons.

 

[Sir Elroy]

Agree with terpskins.
INR is extremely difficult for neurologists to attain. Its much easier for radiologists and neurosurgeons.

I don't think anyone would disagree that radiologists/neurosurgeons have it easier. As has been noted in a number of other threads, there are plenty of programs that will not accept people from neurology. However, in the last few years, a number of other programs have become more open.

The key for neurology residents is to find out which are which, and apply accordingly. Easy, no. But there are now enough friendly programs to make it quite doable.

 

[bustbones26]

Hello everyone,

I am about at that point in my med school career where a decision has to be made about which field to go into. I have truly been that person who has considered just about everything up till this point. I was once set on radiology but found the rotation very boring. Then I fell in love with EM, but did not appreciate the lack of continuity of care in that field. I have always considered myself as having a "medicine" personality, who likes to interpret the data to come up with the differentials. I enjoyed the diagnostic part of my medicine rotation, but honestly, I am more interested in the fellowships it has to offer (such as heme/onc and cards). And I feel very uneasy about the fact that I have to go through 3 years of IM to get to that point.

So this brings me to neurology. It was one of my favorite subjects in basic sciences and it truly just made sense to me at that time. I was strongly considering it as an MS II but did not give it much thought based on the common notions about the field (lack of treatments, complexity of the nervous system, below average compensation etc). However, recently I am beginning to think it might be the perfect field for me. It contains the diagnostic part that I enjoy about internal medicine. It has the acute care aspect of it, which I enjoyed about EM. And it has the interpretation of images that I enjoyed about radiology.

So the reason for this rant is just to get some ideas about where this field is headed in the future. I know there has been tremendous research that is going on in the field and the future looks bright in terms of improvement of treatment. But where do you see a neurologist in, lets say, 10-15 years? Will this field ever be able to sort of take over "the brain" as cardiology has with the heart? Why can't neurologist interpret their own images and bill for them while cardiology can with their echoes and other cardiac images? Why can't they get more involved in the interventional part of it? Are there soon to be advances in treatments that will make this field hot? Will this translate to better reimbursement for neurologists and thus make it more attractive?

I apologize for the long post, but I'm sure a lot of med students considering this field have similar questions and concerns and there just don't seem to be that many answers available in this field compared with others. Thanks.

Let's get back on track. Neurology is still much of a "frontier" specialty which is what makes it fun. There is so much yet to be done. New advances are on the horizon constantly. I remember having a second grade teacher with MS who was wheelchair bound, had tenotomies to relieve her spasticity, and self cathed everyday. THIS WOULD NEVER HAPPEN TODAY!! New and better therapies are always in research. It won't be long that we will be seeing newer and better therapies for alzheimers on the horizon as well. Same goes for headache managment, new therapies are always being investigated.

Neurology is becoming procedural in many ways. Some neurologist are doing interventional pain managment fellowships (at places that let them do it, now that I have stated it, there will be 15 more post on "no they won't" versus "yes they will"). As well, botulinum toxin is the best thing to hit neurology since sliced bread. The woman I talked about above, NEVER would have had tenotomies to relieve spasticity, baclofen pumps, botox, all much better therapies that we use today. Many movement disorders specialist are making good bank by using this stuff for treating dystonia (FDA approved for this) and so are other general neurologist, neurophysiologist, etc. that feel comfortable doing the injections. As well movement disorder specialist are also becoming skilled at managing deep brain stimulators. I have to tell you, I for one would not find a clinic filled with parkinsons, etc. all that exciting but the procedures that these movement disorders guys do are kind of fun.

As far as neurointervention. Its a long path and possible. Yes, we can debate on places that would never take neurologist versus those that do, but it is possible. If that is what makes you happy. Requires a preliminary fellowship in neurocritical care, vascular neurology, stroke, etc. It seems exciting but keep in mind that it is competetitive and just like interventional cardiology, long hours and endless "coming in after hours". But ultimately, kind of cool that we have procedures for these things now.

Sleep medicine is becoming a known as a multidisciplinary specialty and neurologist are certainly qualified to apply for these fellowship. Look around these boards and what you will mostly find are inquires about money. Unfortunately, a number of people I talk to on a day to day basis think about pursuing sleep because they feel that reading a sleep study is easy and why not do it if you can make lots and lots of money?? My understanding from several sleep specialist with different backgrounds is that the sleep medicine boards are a killer!! But, hey, I do find sleep neurophysiology kind of fascinating myself.

Epilepsy seems to be a promising fields as this is an area where to get to help assess patients for epilepsy surgery and see some things that quite simply a general neurologist does not.

MS/Neuroimmunology is a hot specialty simply because there is not that many fellowship trained people around. Most are not attracted to this specialty as they don't feel do hours of exams on people for little reimbursement. When I have attended MS conference, from overhearing these people, they make their money by foreign consultations from countries that will shell out the cash for their expertise. Also, they do some cool research and it is a very laboratory based specialty for research if this is what you like.

Neurobehavior/Neuropsychiatry: Well, I suppose if you like doing neuropsychiatric batteries and perhaps couldn't decide between neurology and psychiatry, then this is a specialty for you. On a bright note, many advances in Alzheimers down the pike from these guys.

 

[carter]

Thank you all for replying. So the consensus is that neurology is rapidly evolving and newer modalities for treatment are always on the horizon. I guess there is more "procedural" stuff in neuro then I originally thought, and I am hoping this will continue in the future.

Based on the previous posts, its safe to say that neurologists have a more difficult time obtaining fellowships in INR, pain and sleep. However, just to be able to have those vastly different options in the future sounds very appealing. I am curious as to how doing a fellowship in certain fields changes your marketability. Based on job postings, it is almost a requirement for most jobs to be able to interpret EEGs and EMGs. Do I need to have a fellowship in this to apply for these jobs or will be residency training be sufficient? I know that probably depends on the residency training I get but I am assuming most residencies have similar standards in their training.

Also, what about something like Neuro-onc? Will I be able to work solely as a neuro-oncologist or will I still have to do general neurology along with it?
I spoke to one medical oncologist who said that he treats neurological tumors, but openly admits that he is not an "expert". How common is it for medical oncologists to treat brain tumors and what's the future like in terms of a neurologists role in solely managing these conditions?

Thanks

 

[salmonella]

In most hospitals, medical oncologists routinely treat primary brain malignancies or brain mets with chemo. If the facility has a neuro-oncology program (which is usually just a neurosurgery team plus neuro-radiologist, but sometimes also a neurologist) then they will be involved and provide consultation (surgical resection, omaya device placement, if indicated). Ultimately the hem/onc team has the primary patient care responsibility, writes chemo, manages side effects, updates for family, etc, as most of these patients are being admitted to either medicine or med onc service.

 

[204534]

A related question- can a neurologist get a fellowship in Neuroradiology?

 

[rgerwin]

A related question- can a neurologist get a fellowship in Neuroradiology?

I don't believe so. That's a radiology sub-specialty, and doesn't really go the other way, from what i understand.

 

[minstral]

rgerwin understands wrong. there are neurorad fellowships available to neurologists. I know someone who is now an nterventionalist who had a neurorad fellowship in arizona.

 

[rgerwin]

I just poked around and Interventionalist fellowships are definitely out there. The one at UCLA requires a prior fellowship in stroke or Neuro critical care. However, the majority of neurorad fellowships are preceded by radiology residencies.

 

[Nerdoscience]

I hate how everyone thinks they know everything about an entire field, then people jump all over them, then everyone gets all pissy.

As for the Neuro-IR/Interventional Neuro/Intravascular Neurosurg thing, this has been discussed to death on a semi-regular basis. The trend is AWAY from Radiology and toward the other specialties, mirroring what happened with interventional Cardiology, and what is happening with Vascular Surgery/IR. This is region and program specific, and IR is still competitive overall, but it is getting easier for Neurologists to get into this field. My med school has a Neuro-run Interventional fellowship. The place I am doing my residency has a Neuro-IR (Radiology-run) fellowship whose last 6 fellows have been 5 Neurologists and a Neurosurgeon.

 

[darksideone]

Its a nice idea, except that its near impossible for a neurologist to obtain an interventional fellowship. INR fellowships are almost the exclusive domain of neurosurgeons and radiologists.

I will have to disagree with you. My mentor is faculty at a INR program and for the past 4 yrs, 5 of their 8 fellows have been trained through neurology. He thinks that is the direction the field is heading with fewer rads residents interested in the field. I believe there are about a dozen interventional neuro programs administered through a neurology dept. or a joint neurology/other department.

Terp, what teaching hospital are you at? I am curious who is giving you that information, are they reliable? Is there a neuro interventional program at your hospital?