IM vs. Neurology, what about combined?

[bigdreamer#1]

Hey all...so I'm one of those who is having a tough time deciding between Neuro and internal med. However, I did discover that there are some combined residencies for both for 5 years. My question is what niche or where do you work then? Could you be a hospitalist or a neurologist or would you be more the hospitalist or IM primary care who provides for the neurological patient as well? Anyone have any thoughts? Just curious. I guess i'm wondering if it would be a waste to do a combined?

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[neurologist]

Wow. I had nooooooooooooooooooooo problem making the IM vs neuro decision!

Well, a lot of visits to primary internists are arguably neuro-related (primarily headache, back pain and other chronic pain issues, vertigo/balance issues, etc). Granted, you don't need to be a neurologist to be good at taking care of those (it's really not rocket science), but the added neuro exposure wouldn't hurt, and might save your patient and their insurance company the time and cost of an outside consult. On the inpatient side you could take care of your own stroke and other acute neuro issues. And certainly you'd probably be better than the average neurologist at taking care of in-hospital complications (PEs, infections, decubiti, etc).

It think it comes down to how much of the rest of IM you really want to keep seeing. If you like treating DM, HTN, lipids, URIs, pneumonia, asthma, etc, and want to keep doing it, I'd suggest you not bother with the neuro. And if you are even remotely thinking of an IM subspecialty down the road (cards, pulm, etc), skip the neuro as well.

 

[buckley]

I had the same dilemma myself, but I decided I love Neuro more than IM. What I like about IM is the "generalist" part, where nothing seems to faaaaze you, and you are actually comfortable putting your patients in double digit medications. But in terms of subject matter (dementias, MS, movement disorders), neuro wins my interest hands down. I did contemplate on the combined programs IM-Neuro and Neuro-Psych. Fortunately or unfortunately (I really don't know which), I kept hitting blank walls while I was doing my research on them. Nobody could tell me (or maybe the PCs just weren't into answering emails) what the clear cut requirements were, how the training would be structured, do I apply via eras, etc. So it left me feeling, maybe the combined programs are still feeling their way through. This is just from MY experience last year. So for my love for IM, i'll have a year to make the most out of it. Hopefully learn to decently manage pneumonia, MI, PTE, DM, etc. on my own. After that, it's neuro all the waaaaay! But according to APD, I have until January to change my mind. I don't think I will, but who knows?
Good luck!

 

[bustbones26]

Hey all...so I'm one of those who is having a tough time deciding between Neuro and internal med. However, I did discover that there are some combined residencies for both for 5 years. My question is what niche or where do you work then? Could you be a hospitalist or a neurologist or would you be more the hospitalist or IM primary care who provides for the neurological patient as well? Anyone have any thoughts? Just curious. I guess i'm wondering if it would be a waste to do a combined?

I suppose if you had the IM background you'd be a tremendous neurohospitalist.

As some have stated before, I had to choose between IM and Neuro.

What I liked about IM was the inpatient aspects of it. I was not really into the outpatient management of old people with diabetes who swear they religiously check their blood sugar (once per week) and swear that they only eat one meal at day (At McDonalds) and want to know why YOU can't control their BP or blood sugar.

On the neuro side, I did not find outpatient clinic as boring as IM clinic and their is plently of inpatient fun with neuro as well so I suppose this is why I pursued this over IM. Of course, their are the difficult personalities of patients to deal with in Neuro. Sometimes I laugh and think that for some of my patients for every one real disease they have they have three unreal ones. But dealing with these people is an art and can be fun too. Not to mention that it generates so many fun and amusing stories to share with your colleagues.

 

[Haemulon]

Your not alone in this whole IM/Neuro decision. The combined programs seem really attractive because for just one more year, you can get that extra training to become more proficient in a broader range of disease and care. I like the idea of becoming an IM/Neuro doc because of the ability to take on more of the general care for patients with neurological disease and other comorbidities. After all, Neuro patients in general also have all of the same health problems as the rest of the population. ALso, in the hospital setting I am hoping that it will make me more competant in a neuro-ICU or stroke unit setting, being more on top of managing ventilators and monitoring electrolytes and such in addition to the neuro stuff.

Of course, I also received good advice froma mentor of mine that emphasized medicine as a team effort. As a neurologist, you can usually pick up the phone or page an IM doc or other specialist to consult or take over management for particular aspects of your patient that are outside of your area of expertise. There will be plenty of neuro out there to keep you busy without having to also be jack of all trades in medicine. And on the business end, most neuro practices will likely prefer to hire partners that stay focused on the neuro-side of the practice. There just may not be but so much time to dabble in general medicine by itsself once emmersed in a neuro practice. Rural settings an exception of course.

We'll see what happens though. I am just finishing 1st year, so have a long way to go. Either way, my own interests are more in neuro, but I like medicine for its management of severe or difficult inpatient populations.

 

[exgatr]

I was considering IM & Neuro too, but I figured the following things out:

IM: See a lot of patients in clinic for 30 bucks a pop

Neuro: See fewer patients in clinic for 60 bucks a pop (dunno if thats the real number, but you get a specialist level reimbursement)

IM/Neuro: Why would I see a patient for 30 bucks when I can see one for 60? (However I'll say that if you want to do neurocritical care, you'll be at the top of the pile of fellowship applicants with this degree)

IM vs. Neuro: Both very interesting specialties, but for me, it's too hard to be a great internist. You have to keep track of all the latest developments in between seeing 80 patients a day. I'd rather concentrate on a more focused specialty that's just as interesting, but I can get a handle on more easily and be a better doctor for my patients.

 

[bigdreamer#1]

I was considering IM & Neuro too, but I figured the following things out:

IM: See a lot of patients in clinic for 30 bucks a pop

Neuro: See fewer patients in clinic for 60 bucks a pop (dunno if thats the real number, but you get a specialist level reimbursement)

IM/Neuro: Why would I see a patient for 30 bucks when I can see one for 60? (However I'll say that if you want to do neurocritical care, you'll be at the top of the pile of fellowship applicants with this degree)

IM vs. Neuro: Both very interesting specialties, but for me, it's too hard to be a great internist. You have to keep track of all the latest developments in between seeing 80 patients a day. I'd rather concentrate on a more focused specialty that's just as interesting, but I can get a handle on more easily and be a better doctor for my patients.

Yeah, I can appreciate this logic. Although, my dilema is that I was thinking more hospitalist as Internist and don't mind clinic with neuro. Those are my options in my mind. I still haven't made any headway in making a decision, i find positives and negs for both, one pulls ahead only to be deminished the next week....I do like your reasoning.

 

[exgatr]

Here's some more practical thinking:

In the end, I don't think I like neuro MORE than anything else. What I do like is that it has a controllable lifestyle and is a short-cut to a specialty (4 vs 6 years). Obviously, I do find it extremely interesting, but I also liked rheum, cards, ophtho, psych, surgery, family, etc...

There is also a SERIOUS shortage of young docs going into neurology, which combined with the aging population should translate into serious bank.

(Boy am I gonna get flamed for this)

Yeah, I can appreciate this logic. Although, my dilema is that I was thinking more hospitalist as Internist and don't mind clinic with neuro. Those are my options in my mind. I still haven't made any headway in making a decision, i find positives and negs for both, one pulls ahead only to be deminished the next week....I do like your reasoning.

 

[neurologist]

There is also a SERIOUS shortage of young docs going into neurology, which combined with the aging population should translate into serious bank.

(Boy am I gonna get flamed for this)

No flaming, just a reality check: "aging population" means "Medicare or other less-than-maximal insurance payments".

If you plan on making any "serious bank" it's gonna have to be via seeing "serious numbers of patients." Bottom line will be a volume game, like peds . . .

 

[AlternateSome1]

Unless you plan on going into cosmetic neurology...oh...wait...
Guess it is back to seeing lots of patients.

 

[bigdreamer#1]

Here's some more practical thinking:

In the end, I don't think I like neuro MORE than anything else. What I do like is that it has a controllable lifestyle and is a short-cut to a specialty (4 vs 6 years). Obviously, I do find it extremely interesting, but I also liked rheum, cards, ophtho, psych, surgery, family, etc...

There is also a SERIOUS shortage of young docs going into neurology, which combined with the aging population should translate into serious bank.

(Boy am I gonna get flamed for this)

Actually, I just caught up with the thread here, and I have been more impressed with my Neurology rotationin this last week. I've determined Neurology to be the way to go for me, for the lifestyle reasons, as well as the fact I've always loved the brain, so much more than the other organs. Not to mention, in neurology, academia is always an option while doing some practice on the side if you chose. I like that due to the current noncompetitive nature of few applying for neurology residency, it is reasonable to match at a very good residency program. It's all to good to pass up.

I also agree with you about the shortage and demand for neurologist, I heard this yesterday that in my state we rank dead last of all US states, with regard to demand/shortage in neurology. I'm optimistic that the field will be very exciting in the future on several fronts.

 

[buckley]

Cosmetic Neurology?! Awwwrrrriiiight! I wonder what the field would entail, neurofibromas and shagreen patches? Who knows, in the future, maybe you can do gyri sculpturing or something...teeheehee

 

[JaSam]

IM vs. Neuro: Both very interesting specialties, but for me, it's too hard to be a great internist. You have to keep track of all the latest developments in between seeing 80 patients a day. I'd rather concentrate on a more focused specialty that's just as interesting, but I can get a handle on more easily and be a better doctor for my patients.

This was the same dilemma I had. Gotta say, I couldn't have said it any better. Love them both, but I really don't wanna memorize and have to understand everything about internal medicine and keep up with all the latest developments.

 

[NRAI2001]

Your not alone in this whole IM/Neuro decision. The combined programs seem really attractive because for just one more year, you can get that extra training to become more proficient in a broader range of disease and care. I like the idea of becoming an IM/Neuro doc because of the ability to take on more of the general care for patients with neurological disease and other comorbidities. After all, Neuro patients in general also have all of the same health problems as the rest of the population. ALso, in the hospital setting I am hoping that it will make me more competant in a neuro-ICU or stroke unit setting, being more on top of managing ventilators and monitoring electrolytes and such in addition to the neuro stuff.

Of course, I also received good advice froma mentor of mine that emphasized medicine as a team effort. As a neurologist, you can usually pick up the phone or page an IM doc or other specialist to consult or take over management for particular aspects of your patient that are outside of your area of expertise. There will be plenty of neuro out there to keep you busy without having to also be jack of all trades in medicine. And on the business end, most neuro practices will likely prefer to hire partners that stay focused on the neuro-side of the practice. There just may not be but so much time to dabble in general medicine by itsself once emmersed in a neuro practice. Rural settings an exception of course.

We'll see what happens though. I am just finishing 1st year, so have a long way to go. Either way, my own interests are more in neuro, but I like medicine for its management of severe or difficult inpatient populations.

My dads (an amazing IM doc) prespective on "combined residencies" = being a "jack of all trades" never works... if as a neurologist you start to treat the primary care problems of your patients --> primary care docs stop referring patients to you..simple as that.

True for any specialty really; a doc my dad knows who is a multiple fellowship trained cardiologist started taking care of the IM/FP problems of his patients --> big surprise hes basically working as at the level of a primary care doc now bc no PCP wants to send him patients anymore bc he never sends the patients back to the PCP.. no referals = can not survive as a specialist.. practicing as a neurocritical doc maybe different, but mixing an IM practice + Neuro practice not as likely to work.

 

[OliverTwist]

Be careful. Many if not most of the Combined programs are being discontinued in all specialties, including Med-Neuro.

 

[trp2006]

Be careful. Many if not most of the Combined programs are being discontinued in all specialties, including Med-Neuro.

Not that I am going to pursue a Med-Neuro program, but what is the source or proof for the above claim?

 

[PhakeDoc]

From my classmates who went through the match this past year, Med-Peds seems to be as in high demand as ever, at least on the East Coast.