Is fellowship an absolute necessity?

[Neurologo]

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I'm not interested in an academic career at all. I just want to start practicing privately post residency due to my age and financial responsibility. Currently interested in EMG/EEG/Sleep. I'm trying to learn as much as I can during residency in these rotations.

Is fellowship a must for these skills in your opinion? Or can I continue to learn more post-residency while working? I think I can for the following reasons: I see old timers who learned to read EEG/EMG w/o fellowships. I see job postings that say they will train on the job if interested in sleep. What is your experience? Am I wrong? Greatly appreciate sharing your thoughts.

 

[danielmd06]

I'm not interested in an academic career at all. I just want to start practicing privately post residency due to my age and financial responsibility. Currently interested in EMG/EEG/Sleep. I'm trying to learn as much as I can during residency in these rotations.

Is fellowship a must for these skills in your opinion? Or can I continue to learn more post-residency while working? I think I can for the following reasons: I see old timers who learned to read EEG/EMG w/o fellowships. I see job postings that say they will train on the job if interested in sleep. What is your experience? Am I wrong? Greatly appreciate sharing your thoughts.

EEG is something that most of us seemed to pick up in residency out of necessity, but I don't think most folks truly become comfortable with it without a fellowship. EMG was definitely a weak point for me (you don't do much neuromuscular in an inpatient setting), and doing EMG's takes some time to learn properly.

Basically, I suspect that you could become passably competent at both without a fellowship if you made these two areas a high priority during your residency and were prepared to put some hard work into what might otherwise have been a cushy elective month. No doubt that you are going to become much, much more comfortable with the one year fellowship, though.

Case in point, many consider sleep medicine to be simple. After two to four months in an honest to goodness fellowship, I realized how precious little I actually knew about the subspecialty even after alot of independent reading, and about four month-long electives in sleep as a resident. It's just different when you actually immerse yourself in something. And to be fair, my home residency location had no sleep fellowship and minimal sleep exposure and the neurology attendings I had in residency treated sleep medicine as something of a quaint, fluffy expenditure of time. I got lots of jokes about Rip Van Winkle and "never waking up again."

Sleep medicine can be picked up as a hobby during residency just like EEG/EMG, but if you actually want to read PSG's for an AASM accredited laboratory, you have to be board certified. The only way to sit for the sleep boards now is to complete an ACGME fellowship in sleep medicine. So your plan to pick up sleep in residency would definitely have some drawbacks to it.

 

[eviorr]

I'm not interested in an academic career at all. I just want to start practicing privately post residency due to my age and financial responsibility. Currently interested in EMG/EEG/Sleep. I'm trying to learn as much as I can during residency in these rotations.

Is fellowship a must for these skills in your opinion? Or can I continue to learn more post-residency while working? I think I can for the following reasons: I see old timers who learned to read EEG/EMG w/o fellowships. I see job postings that say they will train on the job if interested in sleep. What is your experience? Am I wrong? Greatly appreciate sharing your thoughts.

I would second that in regards to sleep. If you want to get paid to read PSG's, you must be boarded, which means you must do a fellowship. With the current sleep board requirements, you also pretty much need an entire year of clinical sleep medicine, so any fellowship that would allow you to sit for the ABPN neurophys board and the ABPN sleep board would be two years long.

- Erick

 

[bustbones26]

I'm not interested in an academic career at all. I just want to start practicing privately post residency due to my age and financial responsibility. Currently interested in EMG/EEG/Sleep. I'm trying to learn as much as I can during residency in these rotations.

Is fellowship a must for these skills in your opinion? Or can I continue to learn more post-residency while working? I think I can for the following reasons: I see old timers who learned to read EEG/EMG w/o fellowships. I see job postings that say they will train on the job if interested in sleep. What is your experience? Am I wrong? Greatly appreciate sharing your thoughts.

In agreeance with other, fellowship is a nessecity if you want to do sleep.

Learning the basics of EEG is essential for private practice. If you want to do video or long term monitoring, well, then you have to do a fellowship.

EMG, well, depends on your program. Back in my day, we had lots of hands on experience doing EMGs and learned how to perform and adequate study. On the flip side, I did a military residency, thus, 99% of the patients that I did an EMG on did not have any significant pathology. They were mostly guys getting medically discharged that had some vague pain issue that some PA-C somewhere decided that they needed an EMG on the way out. As my attendings at the time argued, well, that was good practice. I did not get to do many EMGs on ALS, muscular dystrophy, myasthenia, etc.

If I may use myself as an example. I rarely see the "slam dunk" that is the person that gives a crisp clear description of a seizure event and has textbook EEG findings. I have an extensive pseudoseizure population 🙁 My typical approach is to do a simple sleep deprived 30 minute EEG. If normal or equiovocal, then I do not mess around, referral to an Epilepsy center for a 96 hour study is next.

I work in close association with pain medicine, so I do EMG/NCS for pain related complaints, radiculopathy, carpal tunnel etc. As I mentioned earlier, that was the bulk of my training experience anyways. If I think a person has a funky rare zebra neuropathy or a real neuromuscular illness, then I am referring them to an expert.

There are some clinical neurophysiology fellowships out there that offer a good mix of EEG/EMG. In my opinion, if you want to go into private practice and then that is probably your best option if you do consider any fellowship training.

 

[Mattchiavelli]

there is also the option of doing a few years of private practice as a general neurologist and deciding what areas you really want to get better trained on before deciding what to do for fellowship- it's not a requirement that you do fellowship immediately after residency.

 

[Neurologo]

Your answers give me more clear view of options. I greatly appreciate it.

If any fellowship is done, it will be sleep for me since it intrigues me the most intellectually (why we dream; why do we sleep at all? Role of Hypnosis, etc.). I figure EMG/EEG skills can be further honed by ongoing private study and sitting in those labs whenever I get a chance while doing sleep.

I also like the idea of doing fellowship if needed after a few years of working in the trenches.

I love clinic works and have limited tolerance for inpatient works - although I manage well, am trying to avoid hectic acute settings like critical care. I enjoy seeing routine items (headaches, chronic pains, vertigo, seizures, tremors, movements, and any random neurologic complaints in need of analysis). I love my clinic days of the week. But I also enjoy analyzing graphs and finding hidden patterns. I feel that I can get really good at them by figuring out the underlying mechanism of these recording machines.

 

[michaelrack]

If any fellowship is done, it will be sleep for me since it intrigues me the most intellectually (why we dream; why do we sleep at all? Role of Hypnosis, etc.s.

1. why we dream- if you are lucky, you might spend 15 minutes during a one year fellowhship discussing this.

2. Why do we sleep at all? You will probably spend 15 minutes to several hours on this during fellowship (there are several experiments on total sleep deprivation, sleep is important for memory, etic)

3. hypnosis- not a part of most sleep fellowships.

If you are intrigued by repiratory physiology, the mechanism of central sleep apnea, advanced Positive airway pressure modalities, etc... then a sleep fellowship is for you

 

[Neurologo]

Thanks for all your responses.
Since I enjoy general neurology "bread and butter" topics and do not want to limit myself to doing primarily one thing (EMG/NCS, EEG, etc.), will it make a significant difference in term of productivity/earnings whether I do a fellowship or not? I do hear private practices are looking more for general neurologists. Is that true?

Again, greatly appreciate your responses. None of my attendings can answer these questions with confidence since they have no experience of private practices.

 

[neurolddoc]

We have neurologists with and without fellowships. For EEG and EMG a fellowship is nice and makes one more comfortable at the onset. Non fellowship trained neurologists have successfully gotten themselves up to speed after being in practice.

I agree that if you want to do inpatient monitoring, a fellowship is needed.