I'd like to interview a neurologist :)

[qqw]

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1) What is the most common procedure you do?

2) What are the most common issues you manage?

3) What do you like LEAST about neurology? Most?

4) How is the job market for you?


Thanks 🙂

 

[typhoonegator]

Heh, OK. This miiiiight not be representative.

1. Central line insertion. I don't really count radial arterial lines.

2. Cerebral edema, respiratory failure, status epilepticus.

3. Outpatient clinic. My research lab.

4. Excellent, but my grants would be hard to move.

 

[Hank Rearden]

Similar boat

1) Tell my resident to do an LP
2) Ischemic stroke, ICH, TIA
3) ER docs who play cover your ass medicine and admit people with perioral numbness to the stroke service. Most like working with residents / med students, doing research.
4) Excellent

 

[bustbones26]

Similar boat

1) Tell my resident to do an LP
2) Ischemic stroke, ICH, TIA
3) ER docs who play cover your ass medicine and admit people with perioral numbness to the stroke service. Most like working with residents / med students, doing research.
4) Excellent

Okay, no to explain the joke.
In this clip, Lois just says "9/11" for every campaign question and had the crowd cheering for her. Sometimes, I feel that so long as we call every vague neurological symptoms a stroke or TIA, the docs are happy and don't really care. Hence, whenever I round, I call every vague neurological case my "9/11 theory".

Anyways, to answer the questions

1) Peripheral Nerve Blocks, EMG/NCS, Botox
2) Headache, stroke, BS that the FP/IM docs dump on me
3) Getting dumped on. as I referenced in my last response, there are a number of cases of vague BS that primary care docs just love to defer to neurology.
4) Job market is wide open

 

[tirral]

Context: PGY-2 resident, mostly on the inpatient wards/consult side of things

1) Lumbar puncture
2) Stroke, status epilepticus, pseudoseizure, and the daily why-is-my-patient-encephalopathic-from-his-fulminant-sepsis consult
3) Least - Not getting to see my daughter as much as I'd like. Most - every day, I get paid to think for a living.
4) I am tied to my current job for 2.5 more years, and probably fellowship afterwards. After that, wide open.

 

[neglect]

OK, I'll play.

1. LPs, then ever fewer EMGs, and I consider the administering of tPA to be highly procedural - so then that.

2. Alzheimer's disease and clinical trials and, lately, human resources.

3. Least: we have to work harder than ever to maintain our salaries after overhead. Not fond of phone calls. I like some of the business aspects, but they also tend to suck at your soul (if you believe in such a thing) when you realize it is about the bottom line. I hate the fact that doctors are under attack from all sides: lawsuits, codes, documenting, patient ratings on the internet, money. I hate stupid uncaring residents who want me to think for them. I dislike jerk patients and jerk family members. I don't like testing overutilization, medical cowards. Hate me-too meds, XR patent extensions, most pharm sales people. I'm neutral but generally averse to the diffuse emotional/muddy/psychosocial aspects. I hate the slow pace and unpredictable nature of neurologic advances. I hate insurance company idiocy and I always fight and waste their time as much as I can.

Most: I love making elegant diagnoses in an hour long history and physical, which have defied all the fancy tests. And even when it's obvious, I love making solid neurologic diagnoses and giving it to them straight. I love seeing the inside of the way humans work when the brain breaks down. I love getting people into trials and advancing medical treatments against the most feared diseases. I love making a >10 point reduction in the NIHSS after giving tPA in 30 minutes. I love seeing a med student or resident get some added value, a new appreciation, rarely gain a new passion, and a chance to grow up a little. I love spending my day well, in a way that's a good fit for the way my brain works.

4. Stupid question. Neurologic illnesses are huge, neurologists are few.

 

[qqw]

Thanks for the insight guys 🙂

OK, I'll play.


3. Least: we have to work harder than ever to maintain our salaries after overhead.


4. Stupid question. Neurologic illnesses are huge, neurologists are few.

???
If job opportunities are so plentiful, one would think you wouldn't have to struggle to maintain your salary.

You seem unhappy/agitated. I'm glad this thread gave you an opportunity to vent.

 

[typhoonegator]

Thanks for the insight guys 🙂



???
If job opportunities are so plentiful, one would think you wouldn't have to struggle to maintain your salary.

You seem unhappy/agitated. I'm glad this thread gave you an opportunity to vent.

Physicians in general have to work harder than ever, that's what he meant. There are plenty of jobs out there, essentially all of which require a lot of work due to zero-sum mission creep.

 

[neglect]

???
If job opportunities are so plentiful, one would think you wouldn't have to struggle to maintain your salary.

You seem unhappy/agitated. I'm glad this thread gave you an opportunity to vent.

I honestly gave you upsides and downsides.

I don't know how you went from my post to your delusional health care economics (hint: regulated system), knowing my mood, or assuming venting. I suspect if I were to start venting, for example about your obvious naivety, you would know it.

 

[qqw]

I honestly gave you upsides and downsides.

I don't know how you went from my post to your delusional health care economics (hint: regulated system), knowing my mood, or assuming venting. I suspect if I were to start venting, for example about your obvious naivety, you would know it.

I know it was honest. I was not kidding when I said I was glad you started venting.

You had a hard day at work, got dumped on, people were mean to you, etc...so you come online and blow off steam with some passive aggressive posts. Twas good insight into the field. Posts from unhappy people in any field are good for those considering the career.

I'm only a 3rd year, I have no clue how things work at this stage. That's why I'm asking questions. You're welcome to vent about my naivety whenever, more stress relieve for you and I'll use it to extract info I need. Win-win 😉

 

[TUGM]

MS3s are getting cheekier every year. May wanna tone it down for residency 😉.
PGY-2 here:
1) LPs, putting in Dobhoffs (if you consider this a procedure - it's really more of an annoyance, and not sure why our nurses can't put these in...) for dysphagic patients; but hopefully one day diagnostic angios
2) Stroke, stroke mimics, seizures, pseudo seizures, altered mental status/"metabolic encephalopathy"
3) Not specific to neurology, but dealing with hospital bureaucracy and politics is super annoying when you're just trying to do good by your patient. Specific to neurology - the slower pace in the outpatient setting. Best - super cool diagnoses, localizing the lesion - no MRI needed.
4) From what I understand, great for most specialties.

 

[neglect]

I know it was honest. I was not kidding when I said I was glad you started venting.

You had a hard day at work, got dumped on, people were mean to you, etc...so you come online and blow off steam with some passive aggressive posts. Twas good insight into the field. Posts from unhappy people in any field are good for those considering the career.

I'm only a 3rd year, I have no clue how things work at this stage. That's why I'm asking questions. You're welcome to vent about my naivety whenever, more stress relieve for you and I'll use it to extract info I need. Win-win 😉

I love making elegant diagnoses in an hour long history and physical, which have defied all the fancy tests. And even when it's obvious, I love making solid neurologic diagnoses and giving it to them straight. I love seeing the inside of the way humans work when the brain breaks down. I love getting people into trials and advancing medical treatments against the most feared diseases. I love making a >10 point reduction in the NIHSS after giving tPA in 30 minutes. I love seeing a med student or resident get some added value, a new appreciation, rarely gain a new passion, and a chance to grow up a little. I love spending my day well, in a way that's a good fit for the way my brain works.

 

[bustbones26]

Thanks for the insight guys 🙂



???
If job opportunities are so plentiful, one would think you wouldn't have to struggle to maintain your salary.

You seem unhappy/agitated. I'm glad this thread gave you an opportunity to vent.

So far, I have worked in three different models: Government, private practice, hospital-owned/group setting.

Here is the deal. Neurologist are not paid to think, which for the most part, is what we do. Simply speaking, fitting in patients with multiple complaints and potentially complex disorders, requiring lengthy appointments means less patients per day than colleagues in other specialties. So, while you can make a valid argument that you work just as hard as say a family doctor, even though you see a third as many patients as they do per day, it does not equal more revenue.

The private practice model is dying due to ever changing rules, regulations, and laws. So, you have be very business savvy and find ways to cut your overhead while generating more revenue. It takes planning and time that does cut into your patient care and personal life. The average reimbursement for a new patient consult from a Medicaid patient is anywhere from $90 to $120. If you laugh and say "I won't see Medicaid patients in my practice" well good luck with that in Neurology. Operating costs are outrageous! In my local area, I can probably rent a 2000 square foot home for $1000/month or less but for the same amount of commercial office space, you're talking well over $4000 per month!! Consider how many patients you can see per hour, with little remibursement versus your overhead and operating costs. If you do the math, its a juggling act and some do not want the aggravation.

Now for a group model, they may not be looking at your revenue but will look at your RVUs. Hence, why seeing that extra consult for a dizzy patient that is re-admitted every three months for a "stroke" with the same exact complaints, is worth your time. It beefs up your RVUs and makes you look productive to your employer. But, at the end of the day, seeing 100+ dizzy consults per month will not earn your group big money.

 

[neglect]

So far, I have worked in three different models: Government, private practice, hospital-owned/group setting.

Here is the deal. Neurologist are not paid to think, which for the most part, is what we do. Simply speaking, fitting in patients with multiple complaints and potentially complex disorders, requiring lengthy appointments means less patients per day than colleagues in other specialties. So, while you can make a valid argument that you work just as hard as say a family doctor, even though you see a third as many patients as they do per day, it does not equal more revenue.

The private practice model is dying due to ever changing rules, regulations, and laws. So, you have be very business savvy and find ways to cut your overhead while generating more revenue. It takes planning and time that does cut into your patient care and personal life. The average reimbursement for a new patient consult from a Medicaid patient is anywhere from $90 to $120. If you laugh and say "I won't see Medicaid patients in my practice" well good luck with that in Neurology. Operating costs are outrageous! In my local area, I can probably rent a 2000 square foot home for $1000/month or less but for the same amount of commercial office space, you're talking well over $4000 per month!! Consider how many patients you can see per hour, with little remibursement versus your overhead and operating costs. If you do the math, its a juggling act and some do not want the aggravation.

Now for a group model, they may not be looking at your revenue but will look at your RVUs. Hence, why seeing that extra consult for a dizzy patient that is re-admitted every three months for a "stroke" with the same exact complaints, is worth your time. It beefs up your RVUs and makes you look productive to your employer. But, at the end of the day, seeing 100+ dizzy consults per month will not earn your group big money.

1. Regulations prevent neurologists from charging more for our services, unless you want to entirely ditch Medicare and insurances companies. Then charge patients out of pocket. Otherwise you have to be efficient. Thankfully a 30 year old with migraines who is triptan naive does not take up much time.

2. In practice, you have to think about overhead. The difference between 53% over head and 55% percent is huge to what you bring home! So if you're spending too much money for rent, consider buying commercial property and pay rent to yourself. Medical practices are highly stable. You will get a loan and in time you'll make money and diversify your interests.

3. More on overhead: salaries take more off your overhead than rent. Be careful. Want to make life easier with an MA? Great, you have to pay her with 2 extra people per day. EMRs were a failed promise: they are fairly expensive to maintain and do not reduce the need for secretaries. You have to pay overhead with multiple streams of income. Do not refer things out: we are doing well with EEGs, inpatient EEG, home sleep studies, clinical trials, and cognitive computerized test code 96120. An EMG/NCV pays about the same as a new patient and are boring, so I've dumped them. Botox sucks, but trigger points are still OK from what I gather. MRIs do not make financial sense.

4. In a hospital owned practice, you nearly have to be equally savy. I'm not in that system, but from what I've seen those who think they are not worth $ are right. Those who know what they're worth, work hard, make money for their hospital admins (remember, hospital admins are utterly replacable, they do not see patients so they spend all day scheming how to get more money out of the system. You have to deal with them between patients and after work and don't have time or inclination to understand RVUs properly), and get paid accordingly. In fields like neurology, with a shortage of talent, you can drive a great bargin in a hospital system and could end up with more money than you bring in (because the hospital admins know about downstream revenue, even if they pretend otherwise). But you'll have to be devoted and efficient.

5. You cannot see medicaid patients. I mean, wonderful to do charity work, but don't confuse charity cases for the activites that keeps the lights on and food on the table. There are so few neurologists that I can't imagine not filling with actual paying customers unless you're in Montana. Of course, doing hospital work, you have to take all comers and that's a bit of charity (an aside: recently saw a first seizure in the ER on Medicaid with tens of thousands of cosmetic work).