I like neurology, but...

[Lupescu Ioan]

Hi everyone! My name is John and I am a first year resident in Neurology.
I always loved reading about the brain(it's anatomy and physiology), and also it's pathology, so I chose neurology after finishing college. But the problem is that in my city(Bucharest), the best hospital in neurology is an emergency hospital. Ok, you will say neurology is from many points of view an emergency specialty, so it was predictable.
But I am a pretty anxious guy(and introvert too), and I don't like the idea of lots of emergencies, especially when I will be on call. From what I hear, at that hospital there are 4 neurologists on call every night, and aprox. 100 consultations, and I don't think I will be up to it.

I also don't know how much I will really enjoy neurology, even if I will practice in a "chronic disease" hospital(e.g with Parkinson, Alzheimer, MS, etc).
I guess I would have been more satisfied perhaps as a researcher in neuroscience, but unfortunately that isn't possible in my country.

I forgot to mention that I have been offered the possibility to work at the Oncology Institute at a project on cerebral tumors(research). This can be done in parallel with my residency, because it won't be so time consuming. But I was thinking if it's not maybe a good idea to move to oncology.

Has anyone been in similar situations(not necessarily with neurology, but with any other specialty)? If so, what did you do? I would like to hear other stories.

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[deathmerchant]

That is little surprising because neurology is still considered an outpatient speciality. A lot of Neuro emergencies have been managed by ER, IM, Neuroanesthesia etc ( seizures/ Status), subacute strokes. Most of the interesting neuro stuff is outpatient ; like -MS/Movt Disorders/Cognition/Epilepsy/neurophys and these are no longer "untreatable chronic diseases" and there is lot of exciting stuff happening and changing every day. So I think you are in a good specialty from that standpoint. I think you need to see more outpatient neuro and give it time.
Regarding that research- it s a good idea to do it, if u can do it simultaneously and if thats what u like doing(research)

 

[Lupescu Ioan]

Well, not here in my country. Almost all Neuro emergencies are done by neurologists. Internal Medicine is pretty "quiet", in contrast to other countries, in which I hear it's one of the hardest. Even in "chronic disease" hospitals, Neurology is said to have tough on-call nights. It would be nice if I could practice Neurology in an outpatient setting, or in my own medical office. But during residency, I must practice it in a hospital.

 

[lymphocyte]

That is little surprising because neurology is still considered an outpatient speciality. A lot of Neuro emergencies have been managed by ER, IM, Neuroanesthesia etc ( seizures/ Status), subacute strokes. Most of the interesting neuro stuff is outpatient ; like -MS/Movt Disorders/Cognition/Epilepsy/neurophys and these are no longer "untreatable chronic diseases" and there is lot of exciting stuff happening and changing every day. So I think you are in a good specialty from that standpoint. I think you need to see more outpatient neuro and give it time.
Regarding that research- it s a good idea to do it, if u can do it simultaneously and if thats what u like doing(research)

That's interesting. Surely that's institution dependent? Where I did my Sub-I (a large academic university), we took stroke call, managed status, rounded in ICU, had dedicated neurointensivists, etc. Very active inpatient unit with a consult-happy ED.

But what struck me about neurology is the variety. If you want ward work, you can be a neurohospitalist. Emergency? Stroke. Sick patients? Neuro-ICU. Procedures? Interventional or even pain. 9-5? EEG/EMG. But yes, outpatient neurology can be soooooo rewarding, with many emerging treatment modalities and a stable, no-call lifestyle (if you so choose). Your residency won't even let you do outpatient electives? Who manages the outpatients? How do you get training for that?

 

[deathmerchant]

Well I think I should have been more clear. I agree with all above. All neuro emergencies Are managed by Neurology. Although it used to be managed by ER/IM in the past and in a lot of smaller places still. But my point was - majority of Clinical Neurology practice is still outpatient. Obviously early on in residency our experience is skewed towards more inpatient.

 

[Mad Jack]

Well, not here in my country. Almost all Neuro emergencies are done by neurologists. Internal Medicine is pretty "quiet", in contrast to other countries, in which I hear it's one of the hardest. Even in "chronic disease" hospitals, Neurology is said to have tough on-call nights. It would be nice if I could practice Neurology in an outpatient setting, or in my own medical office. But during residency, I must practice it in a hospital.

That's interesting. Do internists manage epilepsy, movement disorders, etc once these patients are discharged in your country?

 

[ProfMD]

That is little surprising because neurology is still considered an outpatient speciality. A lot of Neuro emergencies have been managed by ER, IM, Neuroanesthesia etc ( seizures/ Status), subacute strokes. Most of the interesting neuro stuff is outpatient ; like -MS/Movt Disorders/Cognition/Epilepsy/neurophys and these are no longer "untreatable chronic diseases" and there is lot of exciting stuff happening and changing every day. So I think you are in a good specialty from that standpoint. I think you need to see more outpatient neuro and give it time.
Regarding that research- it s a good idea to do it, if u can do it simultaneously and if thats what u like doing(research)

This is definitely institution specific. When I was doing my med school neurology clerkship, the hospital I was at had a strong neuro presence. They handled all neuro emergencies (stroke, status), ran the neuro-ICU, and followed all the neurosurgery patients since the was no neurosurgery resident, only a general surgery intern assigned to the neurosurgery service.

When I was a resident at a larger hospital, the neuro residents did not cover neurosurgery, but they did see plenty of emergencies in the ED.

 

[Lupescu Ioan]

That's interesting. Do internists manage epilepsy, movement disorders, etc once these patients are discharged in your country?

No. I'm doing right now an IM internship (the neuro residency starts with 6 months of IM) and the clinial unit in which I have been assigned, is specialized in liver disease(chronic hepatitis, liver cirrhosis, etc). In other clinical units, the IM doctors are specialized in Cardiology, Nephrology or Rheumatology.
After a neuro patient is discharged, I guess the GP is the one that manages him. And if it is necessary, sends him to an outpatient neurologist.

 

[lymphocyte]

But I am a pretty anxious guy(and introvert too), and I don't like the idea of lots of emergencies, especially when I will be on call. From what I hear, at that hospital there are 4 neurologists on call every night, and aprox. 100 consultations, and I don't think I will be up to it.

To get to your original point:

If you're on call and your programme requires you to manage emergencies, well.. sorry, I guess you'll be stuck doing that. But many neurologists are introverts (to put it lightly) and confidence comes naturally with time and experience. You're not going to be managing status or pushing tPA without a lot of training--that's what residency is for.

You're worried and anxious about how challenging inpatient medicine might be. I get that. Plenty of neurologists I've met hate inpatient medicine. But they suffer through it and end up with great, stable, no-call, emergency-free lives in outpatient clinics. Only you can decide if it might be worth it.

I wish you the best of luck.