How competitive are the various neuro fellowships?

[ariwax]

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This one's for the residents:

Those of you who are thinking about fellowships, which ones are harder to get than others? And how hard to get are the harder ones?

ariwax

 

[undecided3yr]

I would be interested in what thoughts could be provided on this topic as well

 

[bustbones26]

I do not think that most fellowships are not all that competitive; however, I would follow that with the statement that fellowships at well known institutions are competitive.

Here is the scoop:

Clinical Neurophysiology: Not entirely competitive, a number of neurologist will do this fellowship

Epilepsy, sleep, neuromuscular, etc.: Pretty much the same training you'd get as a clinical neurophysiology fellow, just more focused toward one particular area of electrodiagnostics.

Neuro-opthalmology: Wide open! Completely non-surgical field of ophthalmology, hence, opthalmologist don't want to do it. Programs are begging neurologist to take these spots.

Stroke, Vascular, call it what you want: Becoming competitive. Many people are interested doing a fellowship in this specialty so that they can move on and perhaps do further fellowship in neuro-intervention hoping to cash out.

Neuro-ICU: Competitive and a ball buster of a fellowship! Pretty much running an ICU: vent management, lines, codes, etc. Its just that this particular ICU is full of neuro and neurosurgery cases. Again, some programs tied into a stroke fellowship and people do it hoping to move onto neurointervention.

Neuroimmunology, Neurooncology: Do you really need to do a fellowship to see all MS patients? No. But if you do a fellowship in any of these two areas, the difference between you and a general neurologist is that you'd be highly engaged in research in these areas. Not competitive.

Movement Disorders: Up and coming. Again, like neuroimmunology and neurooncology, more focused patient population and research. However, the big thing now is EMG guided injections to treat dystonias.

Headache Medicine: not competitive right now at all. Some recent increase in interest from some as some pain management techniques are being used in this branch.

Pain management: traditionally done my anesthesia or PM&R. Not excluded from this if you are a neurologist, but perhaps at a bit of a disadvantage when applying. Now becoming quite competitive. Many people are starting to see how much money pain specialist are raking in.

Behaviorial neurology, Cognitive neurology, Neuropsychiatry, call it what you want, all the same. Not competitive. Lots of fascinating patients to see and really neat stuff to learn about. But again, a research oriented fellowship.

Neuro-AIDS: Again, research oriented. Was a big deal back when HIV was hitting the brain hard. Now that those ID guys have better antivirals, neuro complications of AIDS are dwindling significantly.

 

[kapMD/PhD]

Hey - that's quite a list - thanks for your efforts!

 

[neurologist]

I do not think that most fellowships are not all that competitive; however, I would follow that with the statement that fellowships at well known institutions are competitive.

Here is the scoop:

Clinical Neurophysiology: Not entirely competitive, a number of neurologist will do this fellowship

Epilepsy, sleep, neuromuscular, etc.: Pretty much the same training you'd get as a clinical neurophysiology fellow, just more focused toward one particular area of electrodiagnostics.

Neuro-opthalmology: Wide open! Completely non-surgical field of ophthalmology, hence, opthalmologist don't want to do it. Programs are begging neurologist to take these spots.

Stroke, Vascular, call it what you want: Becoming competitive. Many people are interested doing a fellowship in this specialty so that they can move on and perhaps do further fellowship in neuro-intervention hoping to cash out.

Neuro-ICU: Competitive and a ball buster of a fellowship! Pretty much running an ICU: vent management, lines, codes, etc. Its just that this particular ICU is full of neuro and neurosurgery cases. Again, some programs tied into a stroke fellowship and people do it hoping to move onto neurointervention.

Neuroimmunology, Neurooncology: Do you really need to do a fellowship to see all MS patients? No. But if you do a fellowship in any of these two areas, the difference between you and a general neurologist is that you'd be highly engaged in research in these areas. Not competitive.

Movement Disorders: Up and coming. Again, like neuroimmunology and neurooncology, more focused patient population and research. However, the big thing now is EMG guided injections to treat dystonias.

Headache Medicine: not competitive right now at all. Some recent increase in interest from some as some pain management techniques are being used in this branch.

Pain management: traditionally done my anesthesia or PM&R. Not excluded from this if you are a neurologist, but perhaps at a bit of a disadvantage when applying. Now becoming quite competitive. Many people are starting to see how much money pain specialist are raking in.

Behaviorial neurology, Cognitive neurology, Neuropsychiatry, call it what you want, all the same. Not competitive. Lots of fascinating patients to see and really neat stuff to learn about. But again, a research oriented fellowship.

Neuro-AIDS: Again, research oriented. Was a big deal back when HIV was hitting the brain hard. Now that those ID guys have better antivirals, neuro complications of AIDS are dwindling significantly.

Great list; I would just add the following comments:

1. Any fellowship will be more competitive at a "big name" place (i.e, the same "top programs" that everyone thinks of in terms of residencies). Also, many of them give preference to their own residents when it comes to fellowship applications, so you may be at a relative disadvantage if for instance you did your residency at Podunk State Hospital and Grille and want to do a neuro-ICU residency at Mass General.

2. With regard to neurophysiology and sleep fellowships: Most neurophys fellowships require that you have a "major focus" in either EEG/epilepsy or EMG/neuromuscular. You would do 9 or 10 months of one and 2 or 3 months of the other. This is important when it comes to taking board certification exams because the boards for EEG and EMG have specific requirements as to how much time you have to spend doing each.

3. Sleep medicine is a whole different ballgame. While there is some overlap between neurophys fellowships and sleep (specifically, you will learn how to read polysomnograms during a neurophys fellowship), you CANNOT sit for the sleep boards having done a general neurophysiology fellowship; you have to have done a sleep medicine program. This is soon to become the only way to get sleep boarded, so if you are looking for a job that wants a "sleep board certified" physician, you won't meet that requirement with a general neurophys fellowship (even though you will probably know how to read polysomnograms as well as a sleep fellowship trained doctor).

4. Neuro-ophth and behavioral: You can't make a living doing just these subspecs. Every neuro-ophth doc I've met also does either general neurology or general or other subspecialty ophtho. Same for behavioral: the evaluations take so long that they are not worth the reimbursement money you get.

5. Vascular and Neuro-ICU: These are the big up-and-coming fields, because neurology is starting to go the way of internal medicine and is developing "hospitalist" neurologists to focus on the inpatient side. I'm betting on lots of openings for these fields in the near future.

6. Headache/pain: This will probably be another big-growth subspeciality because of the possibility of opting out of insurance and starting "cash-only" pain programs.

 

[Happy613]

Neurology is a complelty diffrent field than it was two decades ago. I think that in general, fellowships spots in neuro are going to greatly increase as the field forges new inroads into the specialized treatments of previously untreatable conditions.

For instance: I would think that there is going to be a huge need for Interventional Neurologists in the future as the standard of care for stroke shifts towards endovascular treatments.

I believe that rads is slowly backing off from the field b/c the lifestyle is not so great as compared with other IR procedures that are primarily elective (ie. no hemiparetic pateints presenting at 3am on a tuesday morning, needing intra-arterial thrombolysis). And I think neurosurgery is progressing so rapidly as a field that endovascular is rather low on the list of "prize" fellowships.

In any case I think the future of neurology subspecialization is very exciting, and well trained neurologists will be in high demand.

 

[bustbones26]

I believe that rads is slowly backing off from the field b/c the lifestyle is not so great as compared with other IR procedures that are primarily elective (ie. no hemiparetic pateints presenting at 3am on a tuesday morning, needing intra-arterial thrombolysis). And I think neurosurgery is progressing so rapidly as a field that endovascular is rather low on the list of "prize" fellowships.

In any case I think the future of neurology subspecialization is very exciting, and well trained neurologists will be in high demand.

What I am about to say is nothing official or documented anywhere, just some thought from talking to some of my colleagues. Right now, believe it or not, many radiology fellowships are begging for applicants, especially IR, I almost can't believe this. But from what I have been told, the reason for this is that a general radiologist makes so much money, most don't want to go onto a fellowship, especially since they won't make that much more money than they would if they stayed a generalist. From what I have been told, there are some IR programs out there that are wining and dining applicants, almost handing them fellowship. Note sure what the scene is for neurorads right now.

 

[PainDr]

Pain is VERY competitive. Also, there are only a handful of programs that recognize the value of multidisciplinary training and are eager to have neurologists. The majority still don't get it and greatly prefer anesthesia. A somewhat larger (but still relatively small) number of programs will consider PM&R. As might be expected, most of the multidisciplinary programs are at big name institutions, which is great. In spite of the limited number of options, I had no problem getting enough interviews (all really great programs) and matched at my top choice. Of course, I had a long standing interest in pain which was even documented in my Deans' Letter. Believe it or not, many programs actually require the Deans' Letter as part of the application...I guess they're trying to weed out those who are only interested in the $$$$$ 😱

 

[ariwax]

Thanks for the replies. You've all been very helpful.

 

[Happy613]

What I am about to say is nothing official or documented anywhere, just some thought from talking to some of my colleagues. Right now, believe it or not, many radiology fellowships are begging for applicants, especially IR, I almost can't believe this. But from what I have been told, the reason for this is that a general radiologist makes so much money, most don't want to go onto a fellowship, especially since they won't make that much more money than they would if they stayed a generalist. From what I have been told, there are some IR programs out there that are wining and dining applicants, almost handing them fellowship. Note sure what the scene is for neurorads right now.

I have heard similar stories. I know one person who did a prelim year of surgery and is doing an IR fellowship next year; then applying for general rads. He said that IR programs are not filling up and many programs he knew of had this option.