Is a fellowship necessary in Neurology?

[Captain DO]

To have the best opportunities/knowledge/etc?

Or is it more or less the same without a fellowship?

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[kchan99]

A fellowship is necessary if you are interested in academic neurology... Check out the posts in http://forums.studentdoctor.net/threads/jobs-in-academic-institutions.1170550/

At my residency program, about 90% of recent graduates have done fellowships. In the last two years only a couple of residents didn't go into fellowships. One resident did neurology as a second residency after internal medicine. He is now a neurohospitalist. The other resident had family and financial reasons. There are quite a few residents who have planned for two fellowships over last few years, e.g. movement disorders and neuroimmunology, epilepsy and behavioral neurology, epilepsy and neuro-oncology, vascular neurology and neurocritical care, vascular neurology and interventional neuroradiology, etc.

Clinical neurophysiology (EEG, EMG) has been common fellowship for neurologists seeking employment in private practice groups and community hospitals. Many neurology residencies don't provide sufficient exposure to EMG and EEG. The reimbursement for EMG back in the day... (before recent cuts) was quite good, but I still see ads for neurologists trained in EMG and EEG in this era of lower reimbursement. Vascular neurology is also popular.

I suggest that you speak with both academic and community neurologists regarding career options. Are there any particular aspects of neurology that you have more interest in?

 

[MasterStroke]

Is a stroke fellowship useful?

 

[freelow_per7]

I am assuming you are interested in working as a general neurologist.
Otherwise, it makes sense to pursue fellowship if you plan to subspecialize as most universities require board certification (ie, fellowship training)
I am currently a clinical neurophysiology fellow halfway through my training.
I have already landed a job working as a general neurologist at a private hospital after training.
Like Kchan99 everyone in my class pursued additional training.
What I can tell you is that you absolutely do not NEED any additional training after residency to land a decent job and be a competent neurologist.
That being said, the experiences I have gained thus far performing NCS/EMG and reading EEG/EP have been second to none.
I strongly recommend pursuing a clinical neurophysiology fellowship if you plan to work as a clinician and can afford the year off.
Most programs do a decent job training residents to manage stroke. Neuromuscular is a different story.
However, if you feel comfortable enough dx bread and butter cases such as CTS/Radiculopathy/FLDN/SFN, you may be able to get by referring all the complicated stuff like MND/MMN/CIDP/MG out to a neuromuscular specialist.
Most private neurologist in the area were I train refer their complicated cases to the university for me to see.

 

[Dreamangel3587]

Agree with freelow. It all depends on what you plan on doing post residency. I am also a CNP fellow and have not really decided if I want to pursue academia or private practice. I do know that if I work in a private neurology clinic, I would be more than ready to do EMG/NCS and read EEGs.

 

[Hank Rearden]

Stroke fellowship can be very helpful if you want to pursue a neurohospitalist or academic position. People hiring neurohospitalists prefer those that are stroke or NCC trained. It also allows you to be competitive for stroke director positions, which typically pay a bit more than a regular neurohospitalist. If you goal is to see patients in clinic and do no inpatient work, stroke fellowship is probably a waste of time. If you have no desire to be a stroke director and don't need to compete for a job in a major market, stroke fellowship may also be a waste of time. There is a real shortage of vascular neurologists in the U.S., so it does provide you a lot of job security.

 

[neurochica]

Stroke fellowship can be very helpful if you want to pursue a neurohospitalist or academic position. People hiring neurohospitalists prefer those that are stroke or NCC trained. It also allows you to be competitive for stroke director positions, which typically pay a bit more than a regular neurohospitalist. If you goal is to see patients in clinic and do no inpatient work, stroke fellowship is probably a waste of time. If you have no desire to be a stroke director and don't need to compete for a job in a major market, stroke fellowship may also be a waste of time. There is a real shortage of vascular neurologists in the U.S., so it does provide you a lot of job security.

I will wholeheartedly disagree with this statement. I turned down 2-stroke fellowship for the opportunity to be a neurohospitalist. I interviewed all over the country and once I realized that the stroke fellowship was not going to get me more income or even a leg up, I drop the fellowship like a hot potato.
I am a true dedicated neurohospitalist in a mid size academic institution and was offered the job over a vascular stroke doc. I have also turned being the stroke director (at two different institutions) even with a $50k stipend- I just hate admin work.
You will need a fellowship to practice certain sub-specialties in neurology i.e neurooncology, neurooptho etc. While in residency, I made sure to spend a lot of times reading EEGs and thus I read my own. Bottom line is that you don't need to a stroke fellowship to be a neurohospitalist or to make $300k, practice/group fit, in my experience, is the most important thing in a job search.

 

[MasterStroke]

What a great post!

 

[Postictal Raiden]

I will wholeheartedly disagree with this statement. I turned down 2-stroke fellowship for the opportunity to be a neurohospitalist. I interviewed all over the country and once I realized that the stroke fellowship was not going to get me more income or even a leg up, I drop the fellowship like a hot potato.
I am a true dedicated neurohospitalist in a mid size academic institution and was offered the job over a vascular stroke doc. I have also turned being the stroke director (at two different institutions) even with a $50k stipend- I just hate admin work.
You will need a fellowship to practice certain sub-specialties in neurology i.e neurooncology, neurooptho etc. While in residency, I made sure to spend a lot of times reading EEGs and thus I read my own. Bottom line is that you don't need to a stroke fellowship to be a neurohospitalist or to make $300k, practice/group fit, in my experience, is the most important thing in a job search.

Thank you for sharing this valuable information.

How's the demand for neurohospitalists? I'm strongly considering this career path.

 

[neurochica]

Thank you for sharing this valuable information.

How's the demand for neurohospitalists? I'm strongly considering this career path.

There is more demand than applicants. Also, just because an institution is not advertising for a neurohospitalist doesn't mean they won't hire one. I been approached by several institutions asking me to a. start a program b. take over all inpatient responsibilities. (remember that most practicing neurologist are older than 55 and hate clinic). I love my 7/on 7/off schedule and really not ready( i love my time off with my family) to take on starting a new program.

Like I said before, when looking for a job, have a list of things that you won't compromise and go from there. for example, when i was interviewing, things in my list that were not negotiable were: salary (i wanted at least $300k), schedule ( i wanted 7/7) size of the city and crime rate.

 

[Postictal Raiden]

There is more demand than applicants. Also, just because an institution is not advertising for a neurohospitalist doesn't mean they won't hire one. I been approached by several institutions asking me to a. start a program b. take over all inpatient responsibilities. (remember that most practicing neurologist are older than 55 and hate clinic). I love my 7/on 7/off schedule and really not ready( i love my time off with my family) to take on starting a new program.

Like I said before, when looking for a job, have a list of things that you won't compromise and go from there. for example, when i was interviewing, things in my list that were not negotiable were: salary (i wanted at least $300k), schedule ( i wanted 7/7) size of the city and crime rate.

Thank you very much for the valuable advice.

 

[cerebral edema]

I will wholeheartedly disagree with this statement. I turned down 2-stroke fellowship for the opportunity to be a neurohospitalist. I interviewed all over the country and once I realized that the stroke fellowship was not going to get me more income or even a leg up, I drop the fellowship like a hot potato.
I am a true dedicated neurohospitalist in a mid size academic institution and was offered the job over a vascular stroke doc. I have also turned being the stroke director (at two different institutions) even with a $50k stipend- I just hate admin work.
You will need a fellowship to practice certain sub-specialties in neurology i.e neurooncology, neurooptho etc. While in residency, I made sure to spend a lot of times reading EEGs and thus I read my own. Bottom line is that you don't need to a stroke fellowship to be a neurohospitalist or to make $300k, practice/group fit, in my experience, is the most important thing in a job search.

Thanks for your post. I'm at a crossroads. Applying to stroke fellowships this month but only want to be a hospitalist....

 

[neurochica]

Thanks for your post. I'm at a crossroads. Applying to stroke fellowships this month but only want to be a hospitalist....

I was in the same position 3 years ago. I was offered and accepted a stroke fellowship at one of the best stroke centers in the country with the opportunity to be mentored by one of the godfathers of stroke. When I decided to skip fellowship, my home institution offered me to stay as a neurohospitalist. However, because they have 2 different services, an inpatient unit and a stroke unit, I would have never been able to practice vascular neurology ( the stroke doctors, residents and fellows run that unit).

Thus, I declined the position and accepted a position where I am able to practice vascular neurology. In fact, 85% percent of what I do is stroke (TIA, ischemic, etc) and the rest is general inpatient neurology.

The funny thing is that both programs get about the same amount of strokes,~800---they are just run differently. one is run by stroke docs and fellows and ours is run by 2 neurohospitalist which brings business to our neuro-interventionist.

I guess what i am trying to say is that you won't be doing vascular neurology at Stanford as a neurohospitalist but you will be doing all other aspects of inpatient neurology. Vascular neurology is what I love to do so I looked for an academic institution who essentially letting me run my own ship. Also, there are kinds of different models out there. Consult only, admit and let the hospitalist manage, consult admit and manage. Etc.

Working as a Neurohospitalist is actually not bad. I have 2 NPs, residents (non neuro) and students who do the rounding. I show up at 10;30 to round and wrap things up by 5pm. Do it for a week and travel for the other week.

Please don't take this as neurohospitalist work is easy, rainbows, and unicorns. It is the opposite. But when you really love what you do, it is really fun. It sure beats drug seeking headache patients in the clinic.

 

[Postictal Raiden]

Which neurology residency programs provide heavy hospital training that would be adequate for someone considering a neurohospitalist career but not interested in pursuing a fellowship?

Thank you,

 

[postbacpremed87]

Which neurology residency programs provide heavy hospital training that would be adequate for someone considering a neurohospitalist career but not interested in pursuing a fellowship?

Thank you,

Also interested in this. Being a neurohospitalist in a smaller community with just the 4 year residency would be desirable.

 

[Hockeyfan23]

Bump; looking for more opinions into this as well. Current PGY-2 here looking to go into neurohospitalist field

 

[Thama]

Being a neurohospitalist with just residency is absolutely doable, especially in smaller towns and less competitive metro areas. Some fellowships can make you more competitive for jobs in academic centers and more competitive metro areas, and can improve your billing. The really attractive thing about most neurology fellowships is that, as opposed to the 2-3+ years of residency-like effort that medicine people do, our fellowships are usually just 1 year and are not particularly competitive. It's a small price to pay to gain billable skills and make yourself a more in-demand commodity.

 

[Postictal Raiden]

Being a neurohospitalist with just residency is absolutely doable, especially in smaller towns and less competitive metro areas. Some fellowships can make you more competitive for jobs in academic centers and more competitive metro areas, and can improve your billing. The really attractive thing about most neurology fellowships is that, as opposed to the 2-3+ years of residency-like effort that medicine people do, our fellowships are usually just 1 year and are not particularly competitive. It's a small price to pay to gain billable skills and make yourself a more in-demand commodity.

Follow up question: Are hours in fellowship similar to residency hours? Or is the schedule during fellowship more like 8-5 with weekends off, allowing the opportunity to do moonlight and make up for some of the financial loss?

 

[Thama]

Follow up question: Are hours in fellowship similar to residency hours? Or is the schedule during fellowship more like 8-5 with weekends off, allowing the opportunity to do moonlight and make up for some of the financial loss?

Depends on what you do. For NNICU fellowships you might think residency was easy by comparison. But mostly the hours are far less than residency hours and are more on the order of 8-5 with some call.

 

[jd1031]

To have the best opportunities/knowledge/etc?

Or is it more or less the same without a fellowship?

If you want to practice general neurology and don't care about location, then no it doesn't matter. Otherwise, getting fellowship training does matter, even for non-academic practice esp in major cities. There's a reason why the vast majority of neurology residents now go through fellowship training. Extra tools in your tool box means more billable procedures and a wider breadth of patients due to handling more complex neurological cases in your subspecialty that would have otherwise been referred out to other centers. Thus, it makes you more marketable to future partners/hospital systems. Plus, if you have a certain area of interest within neurology, becoming a subspecialitst allows you to see a higher proportion of patients you think are "interesting" (and less of the patients you think are less interesting), which can boost morale in the long run.

 

[Epic786]

Which neurology residency programs provide heavy hospital training that would be adequate for someone considering a neurohospitalist career but not interested in pursuing a fellowship?

Thank you,[/QUO

Every neurology residency program is focused on being inpatient heavy and you get adequate training. One of our attending's also turned down an NIH stroke fellowship for a neurohospitalist position. I feel if you have a good residency program with good exposure to all sub specialties there is no role of doing a fellowship

 

[Epic786]

Every neurology residency program is focused on being inpatient heavy and you get adequate training. One of our attending's also turned down an NIH stroke fellowship for a neurohospitalist position. I feel if you have a good residency program with good exposure to all sub specialties there is no role of doing a fellowship

 

[Re-Evolution]

As many here have said, you can certainly be a hospitalist coming out of 4 years of residency, but a year of fellowship makes you an "expert" amongst your neurologist peers and if you learn some procedures such as EMG or EEG, it gives you a marketable skill that puts you a head of the competition.

FYI, University of Washington (Seattle) has one more spot for neuromuscular/neurophys for 2020.
depts.washington.edu/neurolog/divisions/neuromuscular-diseases

 

[IonClaws]

Bump for current Neuro PGY2 with a similar question

I was interested in a Clinical Neurophysiology fellowship to work in a private practice, but...I am growing tired of being in training.

I have zero interest in academics, don't care about being in a big city, and have a strong desire to grow and support a family. Small towns and rural areas are actually what I grew up with and prefer.

Do I REALLY need that CNP fellowship?

 

[deathmerchant]

Bump for current Neuro PGY2 with a similar question

I was interested in a Clinical Neurophysiology fellowship to work in a private practice, but...I am growing tired of being in training.

I have zero interest in academics, don't care about being in a big city, and have a strong desire to grow and support a family. Small towns and rural areas are actually what I grew up with and prefer.

Do I REALLY need that CNP fellowship?

Actually I think a CNP fellowship might be more handy in a small town where you could/might have to do everything including EEG, EMG, Botox etc. it’s not required by any means, but will be very useful. Now if you can learn EEG and EMG in residency, you don’t need to be board certified to practice.

Also, if you just want to do Hospitalist gig, then all you need is a working knowledge of EEG, in addition to the usual inpatient stuff for which I don’t think you need a fellowship.

 

[GuillainMollaret]

Fellowship is necessary if you want to do academics or work in a popular/urban area where there are already a good number of neurologists. In those cases, picking either an epilepsy or neuromuscular fellowship rather than CNP and marketing yourself as an expert in one of those areas makes the most sense to me. This is because you will likely be joining a large practice where the epileptologists do the EEGs and the neuromuscular folks do the EMGs rather than people doing both. For neurohospitalist in that setting, a stroke fellowship will be preferred if not required.

For outpatient in a small town or rural setting where they are clawing for neurologists, a fellowship is not necessary unless you need more experience in electrodiagnostics which in that case a CNP fellowship makes perfect sense.

So in your case, no you absolutely don't need a fellowship if you feel comfortable with the training you got during residency.

 

[Algor]

Bump for current Neuro PGY2 with a similar question

I was interested in a Clinical Neurophysiology fellowship to work in a private practice, but...I am growing tired of being in training.

I have zero interest in academics, don't care about being in a big city, and have a strong desire to grow and support a family. Small towns and rural areas are actually what I grew up with and prefer.

Do I REALLY need that CNP fellowship?

If you feel comfortable doing EMG and reading EEGs, you do not need a fellowship. Now, I think if you spend several month in EMU reading continuous EEGs and seeing very weird epilepsy cases, it helps a lot. In terms of stroke fellowship, I feel like the entire neurology residency if vascular fellowship. I am no sure why would you do a vascular fellowship to give tPA, give aspirin or aspirin + Plavix or call your endovascular colleagues? It will roughly cost you 250K. You can invest those money or even buy a small house.

 

[neurochica]

A fellowship will be required at top academic institutions, especially if you are interested in perusing research. However, you can also be hired as a general neurologist without a fellowship at such institutions.

Please know that when applying for a job in the real world, partners will be looking at “fit” in addition to credentials. I believe I told the story once- when I was in academics, We interviewed a gentleman who was an MD/PhD, Triple Boarded (2 fellowships), well published and chief resident. He was pompous, conceited, and Just self centered...qualities that the group was not looking for. They did not extended him an offer. At the end, they settled for a general neurologist with a strong clinical background and personality qualities that were best aligned with the group. You will probably spend more time with your colleagues than with your family and thus, for some practices, fit is extremely important.

Side note-a few years ago I did a locum gig were the 2 neurologist in the group literally hated each other. It was very unpleasant working there as the energy in that group was BAD.

 

[michaelrack]

A fellowship will be required at top academic institutions, especially if you are interested in perusing research

Every doctor should peruse research