do most neurologists subspecialize?

[trollwitchdoctr]

Do most neurologists end up pursuing a fellowship? If so, why is it so much more attractive than general neurology? What can a subspecialist do that a general neurologist can't?

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[danielmd06]

Do most neurologists end up pursuing a fellowship? If so, why is it so much more attractive than general neurology? What can a subspecialist do that a general neurologist can't?

I have no idea what absolute numbers show, but anecdotally, the majority of neurologists go into fellowships. When I was in residency, I recall that the most commonly selected fellowship was clinical neurophysiology.

Why do so many of us do fellowship? Well, it's multifactorial. I had a personality that drove me toward super-subspecialization from the first year of medical school. The more subspecialized I got, the more I liked it. Fellowship was a way to formally do this for me. So that's one reason.

Also, general neurology is extremely broad, and it's difficult to cover all of your bases in a three year residency. Most of us admit that there are certain areas that we are less comfortable in than others (MS and movement disorders are examples of two common areas of neurology that non-fellowship trained people may feel a bit inadequate dabbling in after residency). Completing a fellowship allows one to learn certain areas that you may have felt deficient in, better learn subject matter you already like but wanted to dedicate more time to, or even to prepare for an academic or private practice career. Most academic programs expect fellowship training at a minimum unless you are going to be a neurohospitalist or run a general neurology clinic etc.

Subspecialists offer exactly what you would think they offer. Namely, more expertise in the far reaches of the specialty that hopefully complement some academic or private practice group. Certain fellowships allow you particular ability to bill for particular procedures. For instance, to interpret sleep studies (and bill for them) for an accredited sleep lab, you need to have completed a fellowship in sleep medicine. Other areas of neurology, such as EEG and EMG, are billable just by viture of completing a residency in neurology.

This is a very broad question. You should research neurology at your home institution and observe what the various fellowship-trained people offer to your program and then proceed to learning more about the fellowships that interest you in particular.

 

[0nsp]

I think this also depends where you are training. In Canada, Neurology is 5 years of residency rather than 4 as it is in the States. Thus, the generalists here are a lot more comfortable with all of neurology and I think the number pursuing fellowship drops accordingly. At my institution , it seems to be about 50/50 with younger graduates more likely to pursue fellowship training. It really depends what you want to do and if you find a field that really captivates you. I plan on pursuing a fellowship, but I hope to have a general neurology clinic at least part time because I don't want to lose those skills and want to see all of the other interesting cases that neurology brings. I think most of us chose this field for the fun/intellectual challenge of localising and diagnosing.

 

[trollwitchdoctr]

Really appreciating all the feedback. This is very helpful!

 

[typhoonegator]

It varies a lot by institution as well, and the job climate in the region. There is concern that insurance companies will continue to further restrict payments only to people who are "boarded" in certain subspecialties. Since general neurology has very few procedures left in it, there is a natural desire to subspecialize in order to stake a claim to a procedural aspect of the field.

As an example, if you were joining a regional hospital-based practice, you'd have a much better chance to cut a slice of EEG interpretation if you had an epilepsy fellowship under your belt than if you were "just" a generalist. Obviously practices can be managed in many ways, but in an eat-what-you-kill model you can see how a subspecialty identity can have a real impact on your bottom line, even if in reality you end up seeing 80% general neurology in your practice.

 

[GalenWoman]

Anyone going into Sleep Medicine, any sleep fellow?