I need advice: Neuro or Internal Med?

[kr371]

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hi! I am trying to figure out what to apply in! I am deciding between Neuro and Medicine. Any advice on how to make this decision???
please,

 

[GopherBrain]

You aren't giving us much to work with... What is drawing you to each choice? Personally, I would recommend that you go into IM (just so I have less competition in neuro). 🙂

 

[kr371]

thanks for the reply. I guess I am trying to figure out why some of you chose neurology. For me, I really enjoyed the clerkship in Neuro. I like the neuro exam more than the regular medicine exam because you know what you are looking for. However, I feel like doing the IM residency would make you into a REAL doctor. They seem to know everything and can take care of people in an emergency. In the future, I am looking for an outpatient practice and reasonably good hours. So how did you guys make the choice?

 

[tofurious]

I had a similar dilemma, but you will also have to make a choice whether to specialize in a medical subspecialty or do general internal medicine. If you specialize in cards, chest, or GI, you also "know what you are looking for". What I like about neurology is the uncertainty even when you get the diagnostic test results back, as the sensitivity and specificty of many neurological tests are not as high as we would like them to be. You get to do one year of medicine in your pre-lim year, so you can get a boatload of medicine as you and your program see fit. Plus, you will be frequently tempted and recruited to go into medicine instead in that year. If by the end of your prelim year you still want to go into categorical medicine, I am sure there will be a spot for you.

 

[kinetic]

If you like localizing lesions and the brain, choose Neuro. If you give a flying rat's ass about where the spinothalamics run or what they do, choose Medicine.

(Don't bother telling me that people in Medicine need to know this, too. They don't.)

[Edit: Sorry this post was so blunt. I was tired. I can gussy it up for you if you want later.]

 

[IMGforNeuro]

I will try to sum up things different people think about non surgical specialities and subspecialities.
If you like providing long term care for chronic disease: Neuro, Endocrine, Rheumat, Hemeonc, Nephro even pulm sometimes.
If you like quick results - Cardio, GI, Pulm/Critical care
Of course- primary care int med is an option for people who want to be 'complete doctors'.
INCOME - we know about cardio and GI. Heme/Onc and Pulm/Critical care is good.
Endo, Rheumat is slightly on the low end , but more than primary care.
Neuro income (from AAMC website) ranges from 159,000 to 220,000
http://www.aamc.org/students/cim/pub_neurology.htm
In my opinion neuro income is not bad, infact good because neurologists earn more than the average physicians (if you consider that most physicians are primary care). If we compare incomes of specialists , neuro incomes are in the mid range.
LIFESTYLE- Primary care is good life style (depends on how you make it)Cards, GI, Pulm/critical care are very busy
Rheumat, Endo , Hemeonc, Allergy/Immunology, Nephro- good lifestyle with decent working hours.
WHERE DOES NEURO FIT IN? Depends-
General neurology has flexible working hours, you can be busy if you want (and then make more money)
In neuro subspecialities- neuromuscular/clinical neurophysiology same as gen neuro. Epilepsy, movement disorders, behavioral neuro, Multiple sclerosis also good lifestyle because they also practice lot of gen neuro.
Stroke and Neurocritical care are more busy- also because they take calls.
So majority neurologists have flexible working hours.
WHY NEURO?
It is difficult to say. If you have a genuine fascination for the brain, go for it.
Neurosurgeons are very busy, lot of malpractice, but more income compared to neurology.
If you really like to think and investigate, neurology is the field.
I would also say that neurology in the 21st century is NOT JUST a thinking speciality. You can do stuff and make a difference in patients' lives.
Neurology is NOT a lethargic speciality. This notion crept in because of the situation before the nineties when so many of the advancements available now were not present. If you want adrenaline rush, go for vascular neuro or neuro critical care. I have come to know about different neuro subspecialities after speaking to fellows and some faculty members and working with them for a year so you can take my word on this.
Best of luck.

 

[impatiently waiting]

I don't know if this will help or not. i am currently an IM categorical intern and will be doing neurology starting July (I switched out). I think you mainly have to look at what you see yourself liking more say 5 or 10 years from now. I wouldn't look at the bottom line (i.e. $$$) since that can change a lot. As a student i wanted to do cardiology. As an intern I realized there wasn't a chance in hell that would happen, not because of competitiveness, but because I hated the lifestyle and the way other organ systems were ignored. Kind of a wham, bam, thank you maam approach where the chest pain patient comes in, gets their stress/echo/cath and then goes home as soon as possible. Anyway, my point is just didn't like CArds anymore, and though I wanted to find another IM specialty to go into I couldn't do that either and found myself choosing a new specialty every day. On top of that I burned out of medicine. As a primary care doc (which i respect more and more each day) you really mop a lot of messes, chasing labs and studies and non-compliant patients. This really hit me when i was in the specialty clinics when I saw how the specialist physician would address the main problem then say in the dictating letter "I refer so and so back to you to find out why this lab is high or work up the hemoptysis or work up this lesion seen in the liver". before i would hate that because it didn't feel like the patient was being completely cared for but then in my primary clinics where i was basically the PCP getting all this stuff dumped on me i didn't like it at all. now most of the IM specialties will allow you to an extent to avoid chasing labs and studies like non-IM specialties, but you will still deal with a good degree of general medicine (nephro, cards, pulmo). Not so much so for GI, rheum, etc.
So on to Neurology which was my second love anyway, and also i won't have to worry about a bunch of details from each field of IM, at least nowhere near as before. I also am interested in some of the fellowships you can do afterwards and i think there are some cools ones to choose from (besides just pain). Sorry to ramble, just giving my insight as someone who chose IM and now is doing neuro. I actually like the idea someone gave earlier, which is you will always be able to get an IM spot after intern year, but not always the same vice versa for neuro

 

[atlas_shrugged]

hi! I am trying to figure out what to apply in! I am deciding between Neuro and Medicine. Any advice on how to make this decision???
please,

Neurology is a very interesting field...and with so many ongoing researches & developments in treatment , it is going to be very exciting in the coming decade....no more is it going to be a just a diagnostic branch as is the general belief....

You will be an expert on Brain if you do neuro whereas in IM you will again deal with all systems and mostly primary care unless u plan to go for fellowship which again is 3 long years..so you gotta decide for urself whether u wanna go for primary care/ or be an expert in something..

Another advise...take Neurology only if you like thinking & analysing & are more of a problem solver..if you like procedures more ,then take IM & do cardio/GI later on..(of course there are other procedure based branches like surgery /anesth but you are deciding btw Neuro & IM..right🙂

Hope it helps.

 

[GopherBrain]

Just do a combined program, it is only 6 years. 😀

Who wants to get a real job anyhow?

Seriously thought, some of the best neurologists I have ever met are double boarded.

 

[mandimd]

Hi guys,

I am currently in the last month of my 3rd year, and I am totally torn between Medicine and Neurology. The thing is I really like Neuro Critical Care and I think that is why I am interested in neuro. I liked neuro though because the doctors i worked with were all very compassionate and sensitive and took a lot of time with their patients, but i just worry that treating chronic debilitating diseases could get depressing. I like neuro ICU because of the excitement and adrenaline rush. I like medicine because of the intellectual challenges and the long term relationships people have with their patients, another reason why i like neuro. If any neurologists or medicine docs out there had a similar dilemma lemme know how you narrowed it down.

Thanx,
Mandi

 

[mrmed]

Which program did you switch into for july?

 

[jimdo]

word of advice...

run as far away from medicine as you possibly can. Couldnt imagine ANYTHING is a career more depressing than managing long term social issues and organ systems that have nothing to do with your area of interest. Could you imagine managing COPD for the rest of your career? Now, you could say the same for CVA, but at least it is an organ system you are interested in and theres a process for localizing the damage in a cerbrovascular accident.

 

[Hard24Get]

bump!?

 

[mysophobe]

Raisin the dead today, huh?

 

[Hard24Get]

Raisin the dead today, huh?

oh, come on, gimme a break 😳 . Can't we discuss this? 🙁

 

[mysophobe]

We could, but what's been said is good advice. Basically, you have to think about what you want to be dealing with for the rest of your career. You might be able to tolerate COPD, DM, CAD, etc. for a few months during your IM rotation, but do you want to be managing that all day, everyday, for 30 years? Likewise, if you're only mildly interested in the brain/neurology, think about whether or not you think it will sustain you for 10 years, let alone 20 or 30. Picking a specialty is all about thinking ahead--what will you be happy doing in 10 years? Whatever it is, do that.

 

[architbhatt]

Hey I am Board cert in im and doing neuro(yes second resi). Had a chance to switch after first year IM. I decided rather to complete IM and do neuro. Why? because I like both. If you are interested in NEURO , take neuro. You won`t enjoy IM.

 

[neuroluv]

Hey I am Board cert in im and doing neuro(yes second resi). Had a chance to switch after first year IM. I decided rather to complete IM and do neuro. Why? because I like both. If you are interested in NEURO , take neuro. You won`t enjoy IM.

can you expand on this. i am also tyring to do the same thing. i really hate IM, but i was allready 2/3's done, so i figured the extra experience would help.
does this you an edge on getting a spot, since you i will have finished 3 years of IM?

 

[Bonobo]

I went through a similar dilemma, and in the end went with neuro. I remember my advisor simply asking me why the decision was so hard. It occurred to me that it was hard because there appears to be so many different factors at stake: interest, adrenaline, lifestyle, money, scope, ability to change a patient's life, painful patients (no pun intended), competitiveness, etc. Then he said do what you think you are meant to do.

The advisor was a neuroscientist (who had left medical school half-way through) and he brought up an interesting point. These hard decisions which require so many factors to be in balance cannot be resolved with hard logic. Rather, a more dynamic optimization process is needed (much like simulated annealing for producing perfect glass--but that is for another topic). Intuition likely uses this process, so let intuition guide your hard decisions.

Of course, get all the info you can first. Realize also that no matter what path you take now, you can likely tailor it to the specifications that you need, and probably to the ones that you want also.

That said, I like neuro, because while IM might be trained in every system of the body, they have very little training in anything regarding the nervous system making neurologists truly important. IM however provides well-tread paths to procedural specialties, intensive care, and hospitalist medicine, while neurology is still growing in those areas.

B

 

[AznTrojan]

lets put it this way.. i only 4 more days left in my intern year before i start neurology.. if i had to do 3 years of IM to do neuro.. i wouldn't be doing neurology.. not because i don't love neurology.. it's because my hatred for internal medicine runs that deep 😉

 

[GopherBrain]

lets put it this way.. i only 4 more days left in my intern year before i start neurology.. if i had to do 3 years of IM to do neuro.. i wouldn't be doing neurology.. not because i don't love neurology.. it's because my hatred for internal medicine runs that deep 😉

I would swim in a pool full of shards of broken glass before I would complete 2 more years of medicine... I would leave medicine and try to get my old job working behind the counter of a gas station...

 

[Methyldopa]

I would swim in a pool full of shards of broken glass before I would complete 2 more years of medicine... I would leave medicine and try to get my old job working behind the counter of a gas station...

Wow! And here I am just about to start my PGY-I Prelim year. Just shoot me now!!

 

[ChillDoc]

Anyone else struggling on IM vs Neuro? What are your guys' thoughts on the decision 6 years after the OP? Which is easier: start Neuro and have a change of heart to IM categorical or start IM categorical and then switch Neuro?

 

[typhoonegator]

Congratulations on finding and commenting on a thread from 2006. The zombie has risen from the dead.

 

[EdLongshanks]

Congratulations on finding and commenting on a thread from 2006. The zombie has risen from the dead.

Well, as a moderator, you must appreciate that the poster followed the instructions to "use the search function and don't post redundant threads" 🙂

 

[HNR.75]

Hi,
Any more thoughts and insights about this topic now in 2020? 🙂

Sent from my LDN-L21 using SDN mobile

 

[Postictal Raiden]

You’ll get very biased opinions here. You tell us the pros and cons of each from your prospective.

Good job on the necrobump. If this thread is a person, it would be legally driving now.

 

[HNR.75]

Haha [emoji23]
Well I like neurology a lot but my concern is its reputation of more diagnosing than treating.
Also I probably get bored easily, I don't know whether I would enjoy the long-term relationships with patients.
For internal medicine, the only reason I'm thinking of it is having many options to choose from later on, and not having to decide now 🙂

Sent from my LDN-L21 using SDN mobile

 

[NITRAS]

When I graduated medical school in 2012, there was very limited treatments for stroke. I remember being on the stroke unit for two weeks and we didn’t tPa anyone. I was tempted but chose IM instead.

It’s a lot better now. More people get treated for actue stroke. There are new drugs coming out for some of their other diseases. I really love general medicine, but I think I would have enjoyed neurology a bunch.

You could look at inpatient neurology at see that everything they do can be predicated on an MRI. This isn’t entirely true, but it isn’t entirely false either. Neurology, at least inpatient, has a lot more overnight call than they used to. Our stroke neurologist now see every TIA and Stroke admission in ED via telemedicine (thanks to COVID19) and I kinda hope it stays that way.

Not sure if that helps. I love general medicine, but there are times I think I would have loved being a stroke neurohospitalist.

PS: and neuro-critical care is a back-door, non-boarded way of being a CC doc.

 

[Telamir]

It's actually boarded.

 

[Thama]

It's actually boarded.

And not at all a back door. It's a very difficult fellowship.

 

[Thama]

Haha [emoji23]
Well I like neurology a lot but my concern is its reputation of more diagnosing than treating.
Also I probably get bored easily, I don't know whether I would enjoy the long-term relationships with patients.
For internal medicine, the only reason I'm thinking of it is having many options to choose from later on, and not having to decide now 🙂

Sent from my LDN-L21 using SDN mobile

"More diagnosing than treating" may have been true several decades ago, but it's wildly detached from reality now. Neurology is about as treatment-oriented as any IM subspeciality at this point. The one exception is in dementia, but every field has its disease that you can't do much for (whether the field admits that to themselves or not).

Neurology is hard. If you don't know whether you really want to do it or not, probably better not. It's a substantially more challenging residency than IM both in subject matter and in work hours without any real financial or lifestyle payoff above that of your average IM track.

 

[NITRAS]

It's actually boarded.

it’s been a few years, but can you sit for critical care boards with it? I thought not. Correct me if I’m wrong.

 

[Thama]

it’s been a few years, but can you sit for critical care boards with it? I thought not. Correct me if I’m wrong.

You can sit for neurocritical care boards.