Is subspecialty fellowship required if pursuing academic neurology on a clinician-scientist track?

[Dormouse]

It seems that subspecialty training have become very common in neurology. I'm very interested in those NIH/NINDS R25 funded ~6-year neurology research track residencies that provide a "research fellowship" in the last two years, with the goal of preparing fellows for early career grant applications, but I'm unclear as to when subspecialty training occurs if one is on a research track, and could not find any good explanation on this...

Is subspecialty fellowship essentially required if going into academic neurology, or do people forgo that when pursuing a "research" fellowship? Or is it built into a research track residency?

Thank you in advance!

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[Thama]

Plenty of academic centers, including some pretty high-end ones on most people's rankings (for whatever those are worth), have hired and continue to hire general neurologists. Many of them actually struggle to keep general neurologists because the salary can't match a near-identical job description at the private practice across town.

If you want a research career, many of the fellowships set up to put you on that path are subspecialty fellowships but often non-ACGME as the clinical requirements are comparatively light in order to provide plenty of research time. You still come out as a dementia/movement/MS/etc subspecialist, however.

 

[sharkbaitwhohaha]

A word of caution (not personal experience, but knowledge of such); general neurologist clinics at academic centers are FILLED with predominately functional/nonneurological issues. It makes sense too. A tremor case will promptly be filters to the movement clinic, a neuropathy case to the neuromuscular clinic, demyelinating disease to the neuroimmunology clinic, etc.

You know what will be sent to the general clinic? All the non specific vision issues, non neurological paresthesias, cognitive slowing, generalized fatigue, clearly non seizure spells. Sure there are some regular neurology in a general neuro clinic, but not enough to satisfy the interested neurologist.

There is a reason they have a hard time findings general neurologists at academic center.

 

[Dormouse]

All these advices are really helpful, thanks so much to you both.

 

[Hank Rearden]

I agree with most of what the above posters are saying but will add some flavor based on personal experience. I went through a fellowship much like what you describe - essentially 2 years of research fellowship after neurology residency in the hopes of pursuing an academic career with a research focus. During the research fellowship I continued to do clinical work as a general neurologist attending on the inpatient wards and seeing clinic patients. The above poster is right in that your clinic will be full of headache patients and functional disorders. While I grew to enjoy taking care of headache patients, the functional disorders got old pretty quick. At the end of the fellowship my studies were somewhat equivocal and I could not secure further grant funding. As much as I wanted to stay in academics, my chairman didn't really have a place for me without grant funding or subspecialty clinical training. I interviewed at other academic centers as a general neurologist, but the packages I was offered were not great.

Ultimately I decided to go back and do a stroke fellowship that included a year of research. After that I was much more competitive for an academic job and essentially had my pick along with a startup package. My studies produced better results and I was eventually able to secure my own grant funding.

I would steer clear of the type of research fellowship program you describe with no subspecialty clinical training. Many like me have fallen on their face afterwards and I would guess less than half end up staying in academics. Instead I recommend excelling in your residency program, then getting into the best subspecialty fellowship program you can that has combined clinical and research training.

 

[Dormouse]

I would steer clear of the type of research fellowship program you describe with no subspecialty clinical training. Many like me have fallen on their face afterwards and I would guess less than half end up staying in academics. Instead I recommend excelling in your residency program, then getting into the best subspecialty fellowship program you can that has combined clinical and research training.

This is exactly the kind of information I was trying to find out, thank you so much.

If you have subspecialty training, how common is it these days to find a position with a startup package and sufficient protected time from clinical work to launch an independent research program? Are some subspecialties easier than others? If you don't mind me asking, did you have significant publication record from your research fellowship or before that helped? That's awesome that you essentially had your pick with multiple good offers.

 

[xenotype]

This is exactly the kind of information I was trying to find out, thank you so much.

If you have subspecialty training, how common is it these days to find a position with a startup package and sufficient protected time from clinical work to launch an independent research program? Are some subspecialties easier than others? If you don't mind me asking, did you have significant publication record from your research fellowship or before that helped? That's awesome that you essentially had your pick with multiple good offers.

Many here are far more knowledgeable than me, but you should consider focusing on clinical trials. MS, NM, and headache are red hot with new drugs that actually work, and industry funding can obviate the need for government grants. Can even be done in a well set up private practice. It's one thing to churn out equivocal low impact studies, and quite different to be working on a drug for a bad disease with few treatments that actually makes it to FDA approval. That's been happening a lot lately and you can be a big part of it in a subspecialty with a practice well set up for being a big trial site. My residency program was trial focused rather than bench/translational research focused, and as a result had more clinical trials in progress than any other department in the university, and more research dollars invested as a result. Several diseases with limited treatment options my program was the #1 or #2 center, with the best enrollment and best data from experience in avoiding pitfalls on compliance/reporting problems. As I've stated in other threads, not a brand name program. Faculty better paid as a result, and medium cost of living location.

 

[Hank Rearden]

Having subspecialty clinical training alone will not convince a program to give you a startup package unless you have some research productivity as well. There are programs out there that will combine the year of subspecialty clinical training with 1-2 additional years of research usually through a T32 mechanism, but there may be other funding mechanisms. I did not have a lot of publications, I think just a few from my original research fellowship and then 1 or 2 more during the research I performed as a stroke fellow. I think the key was that I excelled clinically and latched on to a mentor who was fairly well known in the field and put in a good word for me at other programs.

I don't know whether certain subspecialties offer more of these combined clinical/research opportunities. I would not look at it that way, instead you should focus on what you are most interested in studying for the rest of your career - both the type of patients you want to take care of and what interests you from a research perspective. Your interest will drive you to achieve more and then you will have a better chance to land a fellowship spot at a well-regarded program.

To the other poster talking about industry-sponsored trials - yes, you can engage in research by participating in industry-sponsored trials and the revenue can sometimes lighten your clinical load. I think industry-sponsored research is important, and am currently a site PI on one such trial. The issue, however, is that you are never the one designing the studies. Not that I'm in the game just for the glory, but I feel leading investigator-initiated studies is much more fulfilling both personally and professionally. Many investigator-initiated studies do start small, but they can eventually have a huge impact that rivals that of industry-sponsored trials.

 

[xenotype]

To the other poster talking about industry-sponsored trials - yes, you can engage in research by participating in industry-sponsored trials and the revenue can sometimes lighten your clinical load. I think industry-sponsored research is important, and am currently a site PI on one such trial. The issue, however, is that you are never the one designing the studies. Not that I'm in the game just for the glory, but I feel leading investigator-initiated studies is much more fulfilling both personally and professionally. Many investigator-initiated studies do start small, but they can eventually have a huge impact that rivals that of industry-sponsored trials.

If you get big enough and experienced enough in the game, you are the one designing the trials. My mentor is a go to for industry in planning trials and dealing with the FDA, and gets compensated time for it. If the trials fail, industry eats the cost. If your grant funded study goes nowhere, you might be out on the street or back moving meat in clinic. Instant academic career death sentence. You are never free in the highly competitive game of getting your grants renewed, and it is getting worse on the R01 side bit by bit, some years massively when the NIH gets a budget cut. Also, the pay for many of these 'start up package' research jobs is just insulting for a neurologist. Research jobs with industry backing come with fair (for academics) salaries.

 

[sharkbaitwhohaha]

If you get big enough and experienced enough in the game, you are the one designing the trials. My mentor is a go to for industry in planning trials and dealing with the FDA, and gets compensated time for it. If the trials fail, industry eats the cost. If your grant funded study goes nowhere, you might be out on the street or back moving meat in clinic. Instant academic career death sentence. You are never free in the highly competitive game of getting your grants renewed, and it is getting worse on the R01 side bit by bit, some years massively when the NIH gets a budget cut. Also, the pay for many of these 'start up package' research jobs is just insulting for a neurologist. Research jobs with industry backing come with fair (for academics) salaries.

I know you didnt mean it that way, but this mentality is insulting to clinical neurologists.

Most people go to medical school to "move meat" and not to sit at a desk writing papers like it's English class begging for money in a grant proposal.

 

[xenotype]

I know you didnt mean it that way, but this mentality is insulting to clinical neurologists.

Most people go to medical school to "move meat" and not to sit at a desk writing papers like it's English class begging for money in a grant proposal.

I don't do any research and didn't mean any offense. Clinic feels like a treadmill to me and I prefer inpatient. I actually hate research, but I think if you choose to do it, you should get paid fairly compared to clinical work, and shouldn't have your grant being denied hanging over you like the grim reaper.