Did my neurology rotation in an outpatient setting, and not sure anymore if I want to pursue neurology anymore.

[Doctor_Strange]

At the end of my preclinical years, I reflected on the various subjects and found that I did indeed enjoy my neurology block and decided to look into neurology as a specialty to pursue. As a DO student, my third year rotations have not been the greatest to put it mildly. But, I was able to find a local neurologist in my hometown to do a 4 week rotation with him in an outpatient office where he does mainly TBI. Long story short, I kind of enjoyed it. It was not just glorified shadowing, as the doc let me do H&P of patients with him coming into the room and doing a more focused H&P. Anyways, at the end of the rotation I did not fall head over heels for the specialty as I thought I would, but I just liked it, but without any great enthusiasm. I could see myself in other fields still. I did think the outpatient setting was a bit of a boring routine, which was not exactly my cup of tea and I was not particularly fond of headache complaints, it felt too subjective when hearing the pts complaints which sounds ridiculous I know but I was not expecting to feel that way towards the end (eg if pt had a headache complaint, I would not be as enthused during the H&P). Movement disorders or the like were interesting. I would place my level of interest at the end of the rotation at a 6/10 (10/10 = want to be a neurologist). I had envisioned that if I were to pursue neurology that I would do a vascular fellowship and even do an interventional neurology one as well (I am actually doing an IR rotation in a few weeks, 2 week rotation only). Anyways, was just wondering what are the signs for someone to realize that they enjoy neurology? What made you choose neurology? I will try to get some more inpatient exposure later this year to see if neurohospital medicine is more to my liking as well.

I would be disingenuous if I were to ignore the fact that my relatively high Step 1 score (243) has not recently played a factor into my decision making process as I have read on these forums that neurology is not the most lucrative field in medicine due to lack of procedures, etc. But OTOH, I have been told since neurology is such a sub-specialized field of medicine, that mid-level encroachment is less prevalent meaning docs have more availability to generate income. This is not a primary factor, but it is one for me to consider nonetheless. That is likely why the idea of IR is interesting to me (I have some mild interest in diagnostic radiology and anesthesiology as well, but I think I like speaking with patients enough to keep neurology on my ddx).

Any advice, insight, or criticisms on my outlook are welcome!

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[Telamir]

Hey, man. I'll be honest. If you don't like it you don't like it. That being said, you did outpatient neurology, and a very focused type of clinic at that (mostly TBI) while you seem to be interested more in inpatient type of setting. In that regard I think the experience you got was inadequate for the interests you have. If you had made me do TBI clinic I'd want to jump off a bridge.

Income is fine. Don't base your decision solely or primarily on that or you will be very unhappy doing something you hate cause it pays better.

Procedure wise you're correct. The most "procedure heavy" sub-specialties are neurophys based (epilepsy, neuromuscular) and movement disorders with some botox injections and the like. That being said, there's few of us and generally we're in pretty high demand.

 

[Doctor_Strange]

Thanks for the reply. I think when I rotate with the IR doc, I will ask him what he thinks of his career. He is chief of the stroke center at the community hospital I am rotating at. Maybe I will do some shifts with him and see if that is up my alley. I worry that if I fall in love with his IR practice, that my desire for that will be complicated since most IRs come from DR background, not neurology (he did come from neurology though).

 

[liquidshadow22]

Apply to neurosurgery. It's more active, less passive note writing and history taking. Yawn.

 

[Tman507]

Still a medstudent.... Very interested in neurology and rads. The neuroscience and localisation in neurology is too complex for midlevels to understand, half of the specialists at your hospital don't even know what you're speaking about, practically suuper safe from midlevels. The pay apparently isn't as bad as seen on medscape, it is also made up by the huge number of patients you see, doing an emg/ncs fellowship helps and is usefull for general practise and some neurologists do pain medicine and use those procedures as part of their neurology practice, i know of a neurologist that does botox treatments as well...i hear you can do a fellowship in imaging to read and be compensated for your own mri/ct etc, but don't know anyone who does this. I'd say neurology is one of the safest non-surgical specialty out there at the moment.
If you want patient recognition and stable career then neurology is a good choice. Vascular and interventional wont help if you have interests in movement disorders, its just asking for permanent stroke call but depends on your job description too....in neurology its easy to find a job compared to other specialties. I heard of some neurologists that had pretty decent hrs...
Personally if I'd go into neuro, I'd practice ''general neurology'' along with a neurophysiology fellowship and pain as well.
Outpatient isn't that bad if its general neuro or neurophys....less burn out too apparently.
Although due to the demand for neurologists you could possibly make a killing doing contract work.

If you want to do rads but interested in neuro then you could do a fellowship in msk(has some spine and joint procedures, peripheral nerve US etc) and neurorads. Money is more in rads and hours good.
IR and INR has worse lifestyle.
Only issues here should be AI in far future(rad groups would just be a bit smaller due to faster workflow) and patient recognition for DR(if you're looking for that), Only thing for IR is recognition of IR to the general public and PCP as an essential service...INR is cool but many IRs are trained in stroke. Not sure how easy finding a job is, IR is hot at the moment so it could be easier..... Overall very cool, safe, good hours(if not IR/INR), high compensation...PAs do some 'IR' scutwork(very basic things like ports). Turf issue isn't that bad, there's many things that IR can do that cardio and vascular don't do.

Anesthesiology has good pay, manageable hours and easy to find a job(essential service, joining a group gives good lifestyle, can lit travel the country just doing contract work), but if you're in America midlevels will be an issue...however, many people say that burnout is very common amongst anaesthesiologists.

Edit..if you want neuro with procedures for movement disorders then, you could look into functional neurosurgery, very interesting field, lots of cool tech too....No midlevels can take neurosurgery lol...but its a different ballgame from neurology with limited diagnosis and pathology when compared to neurology.

 

[Doctor_Strange]

Apply to neurosurgery. It's more active, less passive note writing and history taking. Yawn.

Don't have the scores for that, plus I am a DO student lol

 

[Telamir]

Still a medstudent.... Very interested in neurology and rads. The neuroscience and localisation in neurology is too complex for midlevels to understand, half of the specialists at your hospital don't even know what you're speaking about, practically suuper safe from midlevels. The pay apparently isn't as bad as seen on medscape, it is also made up by the huge number of patients you see, doing an emg/ncs fellowship helps and is usefull for general practise and some neurologists do pain medicine and use those procedures as part of their neurology practice, i know of a neurologist that does botox treatments as well...i hear you can do a fellowship in imaging to read and be compensated for your own mri/ct etc, but don't know anyone who does this. I'd say neurology is one of the safest non-surgical specialty out there at the moment.
If you want patient recognition and stable career then neurology is a good choice. Vascular and interventional wont help if you have interests in movement disorders, its just asking for permanent stroke call but depends on your job description too....in neurology its easy to find a job compared to other specialties. I heard of some neurologists that had pretty decent hrs...
Personally if I'd go into neuro, I'd practice ''general neurology'' along with a neurophysiology fellowship and pain as well.
Outpatient isn't that bad if its general neuro or neurophys....less burn out too apparently.
Although due to the demand for neurologists you could possibly make a killing doing contract work.

If you want to do rads but interested in neuro then you could do a fellowship in msk(has some spine and joint procedures, peripheral nerve US etc) and neurorads. Money is more in rads and hours good.
IR and INR has worse lifestyle.
Only issues here should be AI in far future(rad groups would just be a bit smaller due to faster workflow) and patient recognition for DR(if you're looking for that), Only thing for IR is recognition of IR to the general public and PCP as an essential service...INR is cool but many IRs are trained in stroke. Not sure how easy finding a job is, IR is hot at the moment so it could be easier..... Overall very cool, safe, good hours(if not IR/INR), high compensation...PAs do some 'IR' scutwork(very basic things like ports). Turf issue isn't that bad, there's many things that IR can do that cardio and vascular don't do.

Anesthesiology has good pay, manageable hours and easy to find a job(essential service, joining a group gives good lifestyle, can lit travel the country just doing contract work), but if you're in America midlevels will be an issue...however, many people say that burnout is very common amongst anaesthesiologists.

Edit..if you want neuro with procedures for movement disorders then, you could look into functional neurosurgery, very interesting field, lots of cool tech too....No midlevels can take neurosurgery lol...but its a different ballgame from neurology with limited diagnosis and pathology when compared to neurology.

Several things:

1) Relatively safe from midlevels. There are some midlevels doing stuff like headache clinic etc, where it's all very flowchart based. The field is complex however. You're right most people don't know a lot about neuro, or they don't care to know about it. It can be a blessing and a curse; good job security, but **** consults abound cause "anything can be neuro".

2) Pay is fine. Neurology as a field is very academic and these numbers influence the "average". If you go to academics inpatient neuro (I interviewed for a few jobs in academia) pay is ~225-250 ish depending on location and institution. Private practice neurology is ~300-400 essentially, depending on what you do, and if you want to moonlight for additional income or not. I know people making more doing locums. I personally do a mix; I do some teaching, but essentially it's "private practice".

3) Botox is mostly in the realm of headache and movement disorders for dystonia/spasticity etc. That being said, if you get some training during residency I don't see why you can't do it. I can do botox for migraine but as I said, I do inpatient so I don't bother.

4) Imaging fellowships are rare, and I know a guy with a fellowship/board certification but he does not bill for his own imaging. It's rife with controversy (MRI Brain has other structures in the head you don't pay attention to as a neurologist) and you may miss some incidentalomas. Also, finding a radiology group who is willing to let you cut into their business is not easy.

5) Patient recognition.....eh. Stable career, sure. Vascular neurology is very geared towards inpatient neurology for sure, but it's also common for them to run a stroke clinic as well. Neurointerventional ehh....you want people to share call burden with for sure. Your lifestyle can definitely be affected doing this field IF you're doing acute stroke. There are other "neurointerventional" procedures that aren't quite so urgent (carotid stenting, aneurysm coiling, etc).

6) Yes, it's easy to find a job. We're in very high demand and hours are not bad for purely outpatient gigs.

7) I'd NEVER do pain, honestly...but that's just me.

8) Honestly this whole thing about recognition and prestige fades real ****in' quick.

9) As far as doing neurosurgery instead....completely different animal and a completely different discussion in and of itself.

That's all I can think of for now. Hope it helps.

 

[Tman507]

Several things:

1) Relatively safe from midlevels. There are some midlevels doing stuff like headache clinic etc, where it's all very flowchart based. The field is complex however. You're right most people don't know a lot about neuro, or they don't care to know about it. It can be a blessing and a curse; good job security, but **** consults abound cause "anything can be neuro".

2) Pay is fine. Neurology as a field is very academic and these numbers influence the "average". If you go to academics inpatient neuro (I interviewed for a few jobs in academia) pay is ~225-250 ish depending on location and institution. Private practice neurology is ~300-400 essentially, depending on what you do, and if you want to moonlight for additional income or not. I know people making more doing locums. I personally do a mix; I do some teaching, but essentially it's "private practice".

3) Botox is mostly in the realm of headache and movement disorders for dystonia/spasticity etc. That being said, if you get some training during residency I don't see why you can't do it. I can do botox for migraine but as I said, I do inpatient so I don't bother.

4) Imaging fellowships are rare, and I know a guy with a fellowship/board certification but he does not bill for his own imaging. It's rife with controversy (MRI Brain has other structures in the head you don't pay attention to as a neurologist) and you may miss some incidentalomas. Also, finding a radiology group who is willing to let you cut into their business is not easy.

5) Patient recognition.....eh. Stable career, sure. Vascular neurology is very geared towards inpatient neurology for sure, but it's also common for them to run a stroke clinic as well. Neurointerventional ehh....you want people to share call burden with for sure. Your lifestyle can definitely be affected doing this field IF you're doing acute stroke. There are other "neurointerventional" procedures that aren't quite so urgent (carotid stenting, aneurysm coiling, etc).

6) Yes, it's easy to find a job. We're in very high demand and hours are not bad for purely outpatient gigs.

7) I'd NEVER do pain, honestly...but that's just me.

8) Honestly this whole thing about recognition and prestige fades real ****in' quick.

9) As far as doing neurosurgery instead....completely different animal and a completely different discussion in and of itself.

That's all I can think of for now. Hope it helps.

Thanks for the insight, much appreciated

 

[Thama]

Realistically, nobody in their right mind is actually considering "neurology vs neurosurgery". The whole "but I love the brain soooooo much" garbage fades after the 22nd consecutive left MCA you admit in a 36 hour period whose family thought it would be a good idea to wait a day or two just to see if they got better on their own before bringing them to the ER. Neurosurgeons are people that would have done other surgical fields if not neurosurgery. Neurologists are people that would have done other clinical fields if not neurology.

If you are telling yourself that you don't know whether you want to go into neurology or neurosurgery, then you need to check yourself and the quality of your medical education because you clearly have no idea what one or both of those specialties is actually like on a day to day basis.

 

[neglect]

Realistically, nobody in their right mind is actually considering "neurology vs neurosurgery". The whole "but I love the brain soooooo much" garbage fades after the 22nd consecutive left MCA you admit in a 36 hour period whose family thought it would be a good idea to wait a day or two just to see if they got better on their own before bringing them to the ER. Neurosurgeons are people that would have done other surgical fields if not neurosurgery. Neurologists are people that would have done other clinical fields if not neurology.

If you are telling yourself that you don't know whether you want to go into neurology or neurosurgery, then you need to check yourself and the quality of your medical education because you clearly have no idea what one or both of those specialties is actually like on a day to day basis.

I TOTALLY agree with this post, but I will say that I've met several people who wanted to do neurosurg, but literally said "I didn't want to get a divorce to do it," so they became neurologists. I've always been struck with the fact that this made no sense to me, but they must be very different.

For me, it was pretty much always going to be neurology. If it hadn't been neuro, then one of the medical specialties. I kinda liked rheum (but didn't like the process of shotgunning tests). I hated interventional cards, but liked clinical cards and reading EKGs.

For whatever reason, I also rocked Step 1 and 2 (didn't do so well on MCAT BTW). I pretty much could have gone into anything, so I went into neurology!

 

[Thama]

I TOTALLY agree with this post, but I will say that I've met several people who wanted to do neurosurg, but literally said "I didn't want to get a divorce to do it," so they became neurologists. I've always been struck with the fact that this made no sense to me, but they must be very different.

For me, it was pretty much always going to be neurology. If it hadn't been neuro, then one of the medical specialties. I kinda liked rheum (but didn't like the process of shotgunning tests). I hated interventional cards, but liked clinical cards and reading EKGs.

For whatever reason, I also rocked Step 1 and 2 (didn't do so well on MCAT BTW). I pretty much could have gone into anything, so I went into neurology!

This is me in a nutshell. I could have been happy as an internist, likely going into rheum or ID from there. I liked neurology better. My surgery faculty that worked with me kept trying to get me to go into a surgical field, but despite being good with my hands and mostly liking the OR (and having a more than adequate application to match into any surgical specialty) I said hell no to that bundle of toxicity.

My neurosurgery friends would 100% have been orthopods. Not one of them would have been happy as a neurologist. If it takes more than 5 minutes to make a diagnosis then they want a scan, biopsy, or neurology consult to figure it out for them.

 

[neglect]

This is me in a nutshell. I could have been happy as an internist, likely going into rheum or ID from there. I liked neurology better. My surgery faculty that worked with me kept trying to get me to go into a surgical field, but despite being good with my hands and mostly liking the OR (and having a more than adequate application to match into any surgical specialty) I said hell no to that bundle of toxicity.

My neurosurgery friends would 100% have been orthopods. Not one of them would have been happy as a neurologist. If it takes more than 5 minutes to make a diagnosis then they want a scan, biopsy, or neurology consult to figure it out for them.

It is still so weird to me that neurosurgeons spend years and years to be able to operate on the brain and then do spinal fellowships to do (mostly useless) spine surgeries.

 

[Postictal Raiden]

Similar to what been said above, I can’t imagine a brain that is equally interested in neurology and neurosurgery (unless you sever the corpus collosum ).

Things that draw people to neurology are very very different from things that draw people to surgery. Thinker vs doer type of thing.

I too had your dilemma when I was an M3. I had amazing boards and could have pursued any field. This caused me to explore radiology, which is largely a cerebral field, but I ultimately couldn’t make myself love it enough to pursue it.

Don’t allow your success to become your enemy. I realize that neurology is not a competitive field and someone with a competitive application may feel he/she is “too good” for it. However, you also need to follow your heart and choose the field that best fits your desires and personality. Don’t go into a field just because you can.

In regards to inpatient vs outpatient, the experience can be very different. TBI is not the most exciting thing to experience in neurology. I’d probably swallow a cyanide pill if I had to spend a week in a TBI clinic. On the other hand, outpatient general neurology can be very diverse. In fact, I chose to pursue this field based off my outpatient general neuro experience. I saw 20+ patients a day, and almost every single case was different.

I echo what has been recommended above. You need to do an inpatient rotation to experience the acute cases, namely strokes and seizures. These are much more exciting than seeing nothing but TBI all day.

A side note, I also was drawn to rheum and ID, but more ID. But the idea of having to do IM first was a deal breaker.

 

[Telamir]

I echo the above. Many students (myself included at one point) look at their board scores with a "What can I buy with this?" mentality. If you have good board scores think of it as the freedom to choose. Even if a field that isn't super competitive (neuro, psych, FM, IM, whatever) your good scores can help you get into an awesome program. Choose what you like and try to not let FOMO make your decisions for you.

I personally liked gen-surg but I didn't pursue it due to toxic culture + back pain when standing long periods of time due to non existent arches on my feet haha.

 

[Doctor_Strange]

Similar to what been said above, I can’t imagine a brain that is equally interested in neurology and neurosurgery (unless you sever the corpus collosum ).

Things that draw people to neurology are very very different from things that draw people to surgery. Thinker vs doer type of thing.

I too had your dilemma when I was an M3. I had amazing boards and could have pursued any field. This caused me to explore radiology, which is largely a cerebral field, but I ultimately couldn’t make myself love it enough to pursue it.

Don’t allow your success to become your enemy. I realize that neurology is not a competitive field and someone with a competitive application may feel he/she is “too good” for it. However, you also need to follow your heart and choose the field that best fits your desires and personality. Don’t go into a field just because you can.

In regards to inpatient vs outpatient, the experience can be very different. TBI is not the most exciting thing to experience in neurology. I’d probably swallow a cyanide pill if I had to spend a week in a TBI clinic. On the other hand, outpatient general neurology can be very diverse. In fact, I chose to pursue this field based off my outpatient general neuro experience. I saw 20+ patients a day, and almost every single case was different.

I echo what has been recommended above. You need to do an inpatient rotation to experience the acute cases, namely strokes and seizures. These are much more exciting than seeing nothing but TBI all day.

A side note, I also was drawn to rheum and ID, but more ID. But the idea of having to do IM first was a deal breaker.

I echo the above. Many students (myself included at one point) look at their board scores with a "What can I buy with this?" mentality. If you have good board scores think of it as the freedom to choose. Even if a field that isn't super competitive (neuro, psych, FM, IM, whatever) your good scores can help you get into an awesome program. Choose what you like and try to not let FOMO make your decisions for you.

I personally liked gen-surg but I didn't pursue it due to toxic culture + back pain when standing long periods of time due to non existent arches on my feet haha.

I appreciate both of these replies. It's been several weeks since I got my score back, and I have sort of settled down as far as my perspective on what specialty to pursue. I think, though, that my interest in neurology remains tepid after my rotation -- which admittedly was only 2 weeks, so it is not fair to say that I even have a good understanding of the scope of the field. I don't have anymore electives available to me, so I would need to spend extra time outside of my core rotations to go to the hospital and see how inpatient neurology functions. I am about to do an interventional neuroradiologist rotation next week, so I think that may help me focus in on the acute cases that are presented even though it is a hyper-specialized field. All that being said, I'm still extremely unsure of how to proceed, and I don't want to be a victim of the "what specialty can I buy" attitude that I admittedly probably hold, but it is more now of I-want-to-pick-the-right-specialty mentality now! If anything, my recent anesthesiology rotation has revealed to me that I do like procedures, and outside of Botox injections, I really don't know what neurology has to offer (other than the IR route).

 

[Telamir]

Like I said, if you don't like it you don't like it. My perspective is different than others. I do only inpatient and so all I see/deal with is acute and acute on chronic when it comes to neuro. It's not everyone's cup of tea. I'm sure some neurologists here would HATE to do what I do, and I would really dislike doing primarily clinic. I think unfortunately your 2 week rotation was in something you weren't interested in and it might have skewed your thoughts on the field as a whole. Who knows, you might like neuro IR and decide to go the IR route, that's perfectly fine so long as at the end of it you can be happy with what you chose and that you chose it for the right reasons.

 

[Doctor_Strange]

So, I just finished a really interesting 2 week rotation with an interventional neurologist and the neurosurgery group (even spent a day with a neuroradiologist) -- and I immensely enjoyed it. I think it reaffirmed my interest in the specialty -- incredibly different from outpatient neurology. When I looked closer though at the length of training, 4 year neurology residency + 1 year vascular stroke + 2 year neuroradiology specialty, it is daunting. I have to ask, considering the length of training, what are the salary implications of going into such a sub-specialized field? It is a genuine factor to consider, not one I think will dissuade me so hope it would be kosher to ask!

 

[Postictal Raiden]

So, I just finished a really interesting 2 week rotation with an interventional neurologist and the neurosurgery group (even spent a day with a neuroradiologist) -- and I immensely enjoyed it. I think it reaffirmed my interest in the specialty -- incredibly different from outpatient neurology. When I looked closer though at the length of training, 4 year neurology residency + 1 year vascular stroke + 2 year neuroradiology specialty, it is daunting. I have to ask, considering the length of training, what are the salary implications of going into such a sub-specialized field? It is a genuine factor to consider, not one I think will dissuade me so hope it would be kosher to ask!

All of the NIR guys I know make 500k+. One makes seven figures.

 

[Doctor_Strange]

All of the NIR guys I know make 500k+. One makes seven figures.

Ok thank you, that's all I wanted to know and frankly I assumed as much. I still need to figure this out, but at least I can answer the question that I like inpatient neurology, especially stroke. So even if no IR for me, I can be happy with that as a compromise if I end up pursuing neurology!

 

[Postictal Raiden]

Ok thank you, that's all I wanted to know and frankly I assumed as much. I still need to figure this out, but at least I can answer the question that I like inpatient neurology, especially stroke. So even if no IR for me, I can be happy with that as a compromise if I end up pursuing neurology!

Stroke pays very well nowadays. Tons of jobs. Every hospital wants to become a stroke center, and this in turn will only increase the demand and pay. The latest MGMA report I saw quoted stroke salary average at 410k. Pretty good deal for a year fellowship.

 

[Thama]

Isn't NIR hard to match from Neurology? I was under the impression that pain and NIR are both really hard to match, with anes/pmr taking the former and radiology/neurosurgery taking the latter.

Dunno about pain, but yes NIR is difficult from neurology. Helps a lot if you go to one of the residencies where NIR is neurology run, but most are NSGY or rads run.

 

[Tman507]

All of the NIR guys I know make 500k+. One makes seven figures.

-Does an interventional neurologist still practise inpatient neurology? Or is it practically just stroke call and intervention?
-And does an interventional neuroradiologist still practise general radiology or neurorads?

 

[Postictal Raiden]

-Does an interventional neurologist still practise inpatient neurology? Or is it practically just stroke call and intervention?
-And does an interventional neuroradiologist still practise general radiology or neurorads?

The ones I know see stroke patients during acute settings and in clinic, just like stroke neurologists. I don’t know any that does purely interventional stuff.

The two radiologists that do NIR at my facility also do DR for 50%+ of their time.

 

[Tman507]

The ones I know see stroke patients during acute settings and in clinic, just like stroke neurologists. I don’t know any that does purely interventional stuff.

The two radiologists that do NIR at my facility also do DR for 50%+ of their time.

-Oh I see, makes sense, so typically a "super-specialist" stroke neurologist...I'm a fan of general clinical neuro tho, so sticking to only stroke isn't very appealing.
-Do the rads do follow ups or is it purely procedural?

Thanks