Current incoming MS3 - need advice

[deleted1139416]

Hi ya’ll! So I’m about to start my MS3 year next week and just want some advice about going into neuro! I think at this point I really have to think about what kind of specialty I want to do and neuro is at the top of the list.

I know that neuro can be very time consuming and is often regarded as the most difficult non-surgical residency/field to go into. To be completely honest, I don’t mind the hours. I’ve always regarded myself as somewhat of a workaholic, but that’s mostly cause my mind loves being preoccupied and if I don’t have much do to, I tend to get a little angsty.

I would say that the most important thing for me is problem solving. Medicine is actually my second career - I worked in database software engineering for about 8 years before starting med school. The thing I miss the most about it is solving problems and logic. Will I get this in neuro? Any specific field within neuro?

Regarding money and salary, as long as I can make a comfortable living, I really don’t care. I won’t graduate with too much debt because I have enough saved up and invested from my software career to take care of my living expenses in medical school and my father will be paying off my tuition as an agreement with my family on early inheritance (given how high the interest rates are). The only reason I would chase a super high (300K+) salary is if the position came with problem solving and mentally stimulating responsibilities.

I know this post makes me sound like an apathetic robot that stumbled into medicine. But I have a lot of deeper reasons for wanting to go into medicine, specifically neuro. I love interacting with people and patients, and I want to make a difference in someone’s life (which was why I left software).

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[xenotype]

I wouldn't say it is the most difficult non-surgical field to go into. Cardiology can be rough, often worse in practice than neurology in total hours and call burden. The average neurology attending overall is going to work very similar to IM in terms of hours. With that said neurology residency on the whole tends to be much more intense than IM residencies. Where I trained the IM residents were truly coddled in comparison to neurology where we were expected to balance multiple emergent cases alone simultaneously, had painful 'home call' that was rarely ever actually at home, and had to learn to deal with much higher sheer volume, often at very high acuity as well (eg flight medics dumping an intubated patient in front of you with literally no information about them, while one is in the midst of 3 other stroke alerts in the past 20 minutes).

Based on what you are saying I think you'd likely much prefer neurology over most other fields. It truly is problem solving most of the day and while most cases out in the community are straightforward you'll get a couple cases a day that are very interesting or are complex. It requires a very logical approach compared to other fields of medicine in terms of localization, and can be rewarding when exam findings alone can make the diagnosis. There are also a lot of different ways to practice neurology from outpatient subspecialty, inpatient, teleneurology, critical care/interventional etc so very likely one will find a niche they enjoy. As for salary, at least for now the average PP neurology salary is about $325k and we are able to be slightly above IM and subspecialties in terms of pay, but no guarantees for what the future will be for phyisicians in general. Rare for a neurologist to end up rich versus GI, cards, subspecialty surgery, etc but we really get paid close to what general surgery and OBGYN make anyways, and their lifestyles are almost always worse.

 

[deleted1139416]

I wouldn't say it is the most difficult non-surgical field to go into. Cardiology can be rough, often worse in practice than neurology in total hours and call burden. The average neurology attending overall is going to work very similar to IM in terms of hours. With that said neurology residency on the whole tends to be much more intense than IM residencies. Where I trained the IM residents were truly coddled in comparison to neurology where we were expected to balance multiple emergent cases alone simultaneously, had painful 'home call' that was rarely ever actually at home, and had to learn to deal with much higher sheer volume, often at very high acuity as well (eg flight medics dumping an intubated patient in front of you with literally no information about them, while one is in the midst of 3 other stroke alerts in the past 20 minutes).

Based on what you are saying I think you'd likely much prefer neurology over most other fields. It truly is problem solving most of the day and while most cases out in the community are straightforward you'll get a couple cases a day that are very interesting or are complex. It requires a very logical approach compared to other fields of medicine in terms of localization, and can be rewarding when exam findings alone can make the diagnosis. There are also a lot of different ways to practice neurology from outpatient subspecialty, inpatient, teleneurology, critical care/interventional etc so very likely one will find a niche they enjoy. As for salary, at least for now the average PP neurology salary is about $325k and we are able to be slightly above IM and subspecialties in terms of pay, but no guarantees for what the future will be for phyisicians in general. Rare for a neurologist to end up rich versus GI, cards, subspecialty surgery, etc but we really get paid close to what general surgery and OBGYN make anyways, and their lifestyles are almost always worse.

Thank you for the response!! Yes, money isn’t really that big of a problem for me given my current savings and plan in place to graduate pretty much debt free. Also I’m married and my wife is in a well paying job.

Funny you mentioned cardiology. One of my closest friends wants to go into cardiology and we always have friendly banter about neuro vs. cardio!!

I’m very glad you mentioned the problem solving aspect! Another question I had - does going into neuro have opportunities to blend into other fields such as tech/business etc? I wouldn’t mind getting a part time MBA once I’m an attending. And I’m pretty sure my software background would help me in a biotech position. I just love the idea of having a job that combines medicine with something else.

 

[confused_doc]

I heard neuromuscular, stroke (not really in practice) and neuropthalmology were the most logical neurology sub specialties.

 

[deleted1139416]

I heard neuromuscular, stroke (not really in practice) and neuropthalmology were the most logical neurology sub specialties.

How about epilepsy? Although I’d worry about AI takeover in EEG readings.

 

[Aldertonghen]

Thank you for the response!! Yes, money isn’t really that big of a problem for me given my current savings and plan in place to graduate pretty much debt free. Also I’m married and my wife is in a well paying job.

Funny you mentioned cardiology. One of my closest friends wants to go into cardiology and we always have friendly banter about neuro vs. cardio!!

I’m very glad you mentioned the problem solving aspect! Another question I had - does going into neuro have opportunities to blend into other fields such as tech/business etc? I wouldn’t mind getting a part time MBA once I’m an attending. And I’m pretty sure my software background would help me in a biotech position. I just love the idea of having a job that combines medicine with something else.

I just started my residency so I don’t know the specifics but yes you can absolutely do an MBA and get involved in tech (and you can start an MBA during fellowship itself if it’s not an ACGME accredited one- I’ve seen an example of this). Almost all the endovascular attendings I know are involved in biotech in atleast a supervisory role (new stents/coils etc)- and there are some cool (so far not established) startups in this field (Synchron). Certain sub specialties- like neuromuscular- lean towards genetics/biology based startups while others like movement, epilepsy and pain can have a ton of software engineering going on. Movement would probably be an amazing mix of complex, thought provoking patients and your software background might be great for improving on existing DBS programming.

 

[chexmyx]

How about epilepsy? Although I’d worry about AI takeover in EEG readings.

To me, logical part of neurology is the localization. Stereo EEG planning is probably the most high-stakes, fascinating example of localization in neurology in my opinion. If you end up in a center that aggressively pursues extra-temporal resections you will start naming gyri of the brain other neurologists haven’t even heard of. This tends to be a somewhat niche pathway (although it shouldn’t be - these resections are far more effective than a third Med), and the ones that I know work hard.

Reading eeg itself tends to be more subjective than you would think. That is, the interpretation can vary widely among epileptologists.

 

[deathmerchant]

Hi ya’ll! So I’m about to start my MS3 year next week and just want some advice about going into neuro! I think at this point I really have to think about what kind of specialty I want to do and neuro is at the top of the list.

I know that neuro can be very time consuming and is often regarded as the most difficult non-surgical residency/field to go into. To be completely honest, I don’t mind the hours. I’ve always regarded myself as somewhat of a workaholic, but that’s mostly cause my mind loves being preoccupied and if I don’t have much do to, I tend to get a little angsty.

I would say that the most important thing for me is problem solving. Medicine is actually my second career - I worked in database software engineering for about 8 years before starting med school. The thing I miss the most about it is solving problems and logic. Will I get this in neuro? Any specific field within neuro?

Regarding money and salary, as long as I can make a comfortable living, I really don’t care. I won’t graduate with too much debt because I have enough saved up and invested from my software career to take care of my living expenses in medical school and my father will be paying off my tuition as an agreement with my family on early inheritance (given how high the interest rates are). The only reason I would chase a super high (300K+) salary is if the position came with problem solving and mentally stimulating responsibilities.

I know this post makes me sound like an apathetic robot that stumbled into medicine. But I have a lot of deeper reasons for wanting to go into medicine, specifically neuro. I love interacting with people and patients, and I want to make a difference in someone’s life (which was why I left software).

All of medicine in general is "problem solving" by its nature IMO. Its just different types of problems and different approaches. Neuro is a bit more abstract and honestly frustrating at times due to relative lack of definitive testing and treatment compared to other surgical and non surgical fields. Although neuro is probably still the most reliant on a good history and examination which is one of the biggest reasons most people choose neurology.

Regards to money, if you don't mind staying busy and don't go in academia- you can easily get to 350k-500k.

Finally I would say neuro is still probably backwards ( compared to other fields) in regards to how much we know about it and hence has the biggest scope for new tech/business/treatment ideas. Neuromodulation and Neuro-interventions are still very early and really just started getting common in the past 10-15 years. And Neurophysiology could also use a good overhaul with their tech/softwares.

We have had a previously heated thread/debate in this forum about AI taking over EEG. Seems pretty far-away to me. (Please don't come after me lol)

 

[Aldertonghen]

All of medicine in general is "problem solving" by its nature IMO. Its just different types of problems and different approaches. Neuro is a bit more abstract and honestly frustrating at times due to relative lack of definitive testing and treatment compared to other surgical and non surgical fields. Although neuro is probably still the most reliant on a good history and examination which is one of the biggest reasons most people choose neurology.

Regards to money, if you don't mind staying busy and don't go in academia- you can easily get to 350k-500k.

Finally I would say neuro is still probably backwards ( compared to other fields) in regards to how much we know about it and hence has the biggest scope for new tech/business/treatment ideas. Neuromodulation and Neuro-interventions are still very early and really just started getting common in the past 10-15 years. And Neurophysiology could also use a good overhaul with their tech/softwares.

We have had a previously heated thread/debate in this forum about AI taking over EEG. Seems pretty far-away to me. (Please don't come after me lol)

One of my attendings said going into neurology right now is like buying stocks at an all time low- it really seems like the field will explode soon.

 

[deleted1139416]

One of my attendings said going into neurology right now is like buying stocks at an all time low- it really seems like the field will explode soon.

What’s the timeline on this? Sometime in the next couple years or next couple decades?

Also - how worried should I be on the expansion of neuro residency spots? I’m just worried about having an EM situation on our hands.

 

[xenotype]

What’s the timeline on this? Sometime in the next couple years or next couple decades?

Also - how worried should I be on the expansion of neuro residency spots? I’m just worried about having an EM situation on our hands.

Hard to predict the future but as a neurologist you have a major thing EM docs will never have. You can literally just hang a shingle, hustle, and start creating demand on the outpatient side. I do inpatient work presently but if it becomes unpalatable/pay drops I'll go outpatient. Inpatient pays a bit better right now for the amount of effort put in than outpatient in my opinion, but an efficient private practice for those that like to hustle will overcome this. As a neurologist you can literally just charge cash for office visits outside the entire system if you want, and it's probably workable even if the entire insurance/medicare system collapses. This option is seldom used in our field these days but it is becoming a big thing in primary care and will spread elsewhere if govt/insurers continue to cut reimbursements aggressively, especially under an environment of heavy inflation.

 

[confused_doc]

One of my attendings said going into neurology right now is like buying stocks at an all time low- it really seems like the field will explode soon.

But don't people say this about neurology every 20 years or so and it doesn't seem to materialise? Would love if it did though.