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Lifestyle of a *General Neurologist*

Discussion in 'Clinical Rotations' started by bigfrank, Mar 2, 2002.

  1. bigfrank

    bigfrank SDN Donor
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    Hello everyone.

    I know that, for some some strange reason, very few US-MDs are going into Neurology at the present time. Can anyone answer me a few questions about the field?

    1. What kind of LIFESTYLE does a General Neurolgist who is in a group have? What is the average call frequency? Weekends? Hours per week?

    2. Is Neurology vs. PM&R a growing turf war? If so, what do you think will be the outcome for Neurologists? Does a neurologist have to deal primarily with inpatient neurology?

    3. What is the average salary of a neurologist? I have talked to people from "www.emedhire.com," and a lady named "Laura" claimed that for the most recent year, the new residents that she got jobs averaged $180K/year as a STARTING salary. I know this seems a tad high, but does anyone else have any comments?

    Thanks, Frank :D
     
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  3. Voxel

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    A general neurologist will spend time in their clinic 8-6ish. Call depends on how many people are in your group. If there are 6 people in your group then you will be on Q6 (every sixth day) and you will see patients in the hospital before 8AM and after hours if the ER and hospitalist cannot handle these patients until the AM. There is also the issue of who hangs the TPA and such. Most of the time it is the ER and sometimes the neurointerventional radiologist (if there is one in your area) comes in to do direct TPA injection and interventional procedures. It also depends on if you have residents on call to take care of patients. That is you are a private neurologists who admits to a hospital with neurology residents. That is probably the best senario as you will not have to come in to admit patients. You can see them in the morning and let the neurology sla..err residents take care of them overnight.
     
  4. bigfrank

    bigfrank SDN Donor
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    Voxel,

    Are you saying that a neurologist will have to go in early to the hospital EVERY DAY and go to the ER after work EVERY DAY?

    Please let me know. I appreciate your response very much but am a little confused by it.

    Best wishes,

    Frank
     
  5. Voxel

    Moderator Emeritus 7+ Year Member

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    If you are the sole neurologist in town, then you will go in every day before work to see patients. If the ER/hospitalist/medicine service cannot stabilize the patient and begin treatment overnight, then you will come into the hospital while being on call every night if there is a patient for you to see that night. That is the disadvantage of being the only neurologist in town. If you are solo, but there are other neurologists in town then at least you can split/share the call responsibilities amongst your selves. If there are six of you, you will be on call Q6 (every sixth day/night).
     
  6. Voxel

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    Call mainly applies to thrombotic stroke as there are therapeutic options. Otherwise, neurologists do not get to treat many diseases. This may chance in the future, but as of today neurologists mostly diagnose, educate, and refer patients for rehab. Their is little in the way of treatment, except for seizures and supportive care. For things they can treat, such as primary seizures, this can be treated/stabilized by the ER doc and patient can be discharged to see you first thing in the AM.
     
  7. Neurogirl

    Neurogirl Resident Extraordinaire
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    Neurologists do MUCH more than what the above poster implied. In the PAST, neurology was primarily a field of diagnosis (which is why it's never been that popular) but that is changing. Although many illnesses still lack definative cure, MOST of the more common neurological diseases have treatments which slow progression and/or reduce/eliminate symptoms. In addition to stroke and epilepsy, neurologists evaluate and treat pain syndromes (headache, CRPS, cranial and peripheral neuropathies), demyelinating diseases of the CNS (MS) and PNS (Guillain Barre), parkinsons disease and other movement disorders, myasthenia gravis, CNS infections, toxic and metabolic encephalopathies (as well as other neurological complications of systemic diseases and medications), dizziness (vertigo/syncope) and sleep disorders.

    Night call usually involves evaluation/management of altered mental status/coma, stroke and trauma (nonsurgical hematomas, cerebral edema, spinal shock). If you're in a group, and can share call, the lifestyle isn't bad. Most neurologists split their time between hospital and clinic patients. They usually see inpatients in the morning (7-9am-old patients) and afternoon (4-6pm-new patients) and clinic patients inbetween. Depending on location and type of practice, the money can be very good. Finally, I don't see much of a turf war between neuro and PM&R (except maybe for pain management). There may be some turf issues with EMG and NCS, but it doesn't seem to be a problem. In general, if the patient has been referred to neuro then the neurologist does the studies. If the patient is referred to PM&R (usually later on...after evaluation and initial management) then the physiatrist does the studies. Hope this info helps. :D
     
  8. Voxel

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    I don't want to get into a fight with you, but neurology continues to be a specialty that diagnosis and supportive care. There will be more treatment options on the horizon, but until then it will remain a specialty that mostly diagnoses. Yes, you do deal with headaches and different pain syndromes, but this is not exclusive to neurology as PMR and Anesthesia treat this in their own pain clinics.
     
  9. Neurogirl

    Neurogirl Resident Extraordinaire
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    Huh? Maybe you should reread my post. As a soon-to-be PGY-2 in Neurology, I should know what my field has to offer. If you want to dispute somthing I've said, then do so, but don't make blanket statements without providing supportive information.
     
  10. Voxel

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    1) Treat MS? yeah with what.
    2) Treat GB? supportive care
    3) Treat Parkinsons? symptoms but not cure
    4) Pain not exclusive to neurology and in fact is done mainly by anesthesia.
    5) Sleep disorders are usually treated by pulmonary docs outside of academia.
    6) Toxic and metabolic encephalopathies are treated in the ED by ER Docs.
    7) CNS infections, Yes, but also treated by the medicine/ID people.

    I don't care if you are the chairman of neurology at Harvard. Give neurology another twenty years and we'll have some cures/real therapy (hopefully).
     
  11. neutropeniaboy

    neutropeniaboy Blasted ENT Attending
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    As much as I find the two of you amusing right now, I have to side with Neurogirl. Besides, Voxel, your claim was that there wasn't much neurologist "treat" (i.e., you didn't say "cure.") Much could be said of many fields in medicine when a cure isn't available. Treatment of patients includes many facets.

    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Voxel:
    <strong>1) Treat MS? yeah with what.
    2) Treat GB? supportive care
    3) Treat Parkinsons? symptoms but not cure
    4) Pain not exclusive to neurology and in fact is done mainly by anesthesia.
    5) Sleep disorders are usually treated by pulmonary docs outside of academia.
    6) Toxic and metabolic encephalopathies are treated in the ED by ER Docs.
    7) CNS infections, Yes, but also treated by the medicine/ID people.

    I don't care if you are the chairman of neurology at Harvard. Give neurology another twenty years and we'll have some cures/real therapy (hopefully).</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">
     
  12. Voxel

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    Well cure maybe a strong word. I agree with you. But attempting to treat symptoms with no hope of improvement is not really treatment (ie Parkinsons). What I really want to see is the day that people can completely recover/regain function from strokes and spinal cord injuries, unlike what happens for the most part today. If you like neurology so be it. You and I have different views on what it means to offer treatment to patients. Including my friend's mother who is dying from MS and patients with ALS.
     
  13. gatormed

    gatormed Member
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    I've seen treatment result in some pretty dramatic improvements in MS patients in spite of your single case anecdotal evidence.
     
  14. Voxel

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    They were probably of the relapsing-remitting type. What about patients with the primary or secondary progressive type which suffer progressive disability? Where's there therapy? Even the interfonB-1b and Glatiramer trials produces just a relative risk reduction, but what about the other 60% who continue to deteroriate clinically? You don't need my single anecodatal evidence. Gatormed, any word on ALS?
     
  15. racerx

    racerx ASA Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Voxel:
    <strong>Well cure maybe a strong word. I agree with you. But attempting to treat symptoms with no hope of improvement is not really treatment (ie Parkinsons). What I really want to see is the day that people can completely recover/regain function from strokes and spinal cord injuries, unlike what happens for the most part today. If you like neurology so be it. You and I have different views on what it means to offer treatment to patients. Including my friend's mother who is dying from MS and patients with ALS.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">So by your definition, improving the quality of life of those that are suffering (currently) incurable illness can't be defined as treatment? By your tone, it seems that unless there is a "cure" for a given neurological illness, it is a waste of time to even attempt a course of treatment.

    Although wanting to find a cure for the illness is admirable, we shouldn't discount the benefits of controlling the symptoms in an attempt to improve the lives of the patients. Some will not live to see their particular disease cured. However, if they are given more quality time on this earth, isn't it just a little bit worth it?

    OK, I'm off my idealistic, preachy soapbox. :D

    racerx
     
  16. bigfrank

    bigfrank SDN Donor
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    Hello everyone.

    Is call taken from home usually?

    Thanks, Frank :confused:
     
  17. neutropeniaboy

    neutropeniaboy Blasted ENT Attending
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by bigfrank:
    <strong>Hello everyone.

    Is call taken from home usually?

    Thanks, Frank :confused: </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">For whom? This is institution-dependent and if present, may be dependent upon seniority in residency. For attendings? Most likely home...
     
  18. bigfrank

    bigfrank SDN Donor
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    Hi, I appreciate your response. I was actually referring to a neurologist in the "real world," after residency (pvt. practice).

    Thanks, Frank.
     
  19. gatormed

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    All fields of medicine are full of diseases with no "cure." When's the last time you saw a diabetic cured. If you are looking for sure cures you'd better go into surgery. Even in that field, transplant surgery only creates a permanent state of immunosuppression. By the way, as a diagnostic radiologyist you don't treat anyone much less cure. As an interventionalist you are often treating sequelae of the ongoing disease process of atherosclerosis.
    You got me on ALS.
     
  20. Goofy

    Goofy Senior Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Voxel:
    <strong>Well cure maybe a strong word. I agree with you. But attempting to treat symptoms with no hope of improvement is not really treatment (ie Parkinsons). What I really want to see is the day that people can completely recover/regain function from strokes and spinal cord injuries, unlike what happens for the most part today. If you like neurology so be it. You and I have different views on what it means to offer treatment to patients. Including my friend's mother who is dying from MS and patients with ALS.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I would tend to agree with voxel in this regard. While many treatments exist in Neurology, they produce very little in the way of meaningful results. Epilepsy, one of the few syndromes that does have a meaningful treatment is often treated by any number of physicians. Many of the diseases Neurogirl listed, don't offer treatments that produce meaningful improvements.

    Another example of this is Alzheimer's disease. A piece of chewing gum would probably produce more of a theraupeutic option than aricept.

    I would add that this is not an attack on a highly respected and perhaps one of the most cognitive professions. It is a lot of things, but it aint a discipline for those who want to treat aggressively with meaningful results. The treatments that are available, as a whole do little to reduce morbidity/mortality in parkinsons alzheimers, ALS, etc....

    The real draw for Neurology, as I see it, is it's inherent cognitive core, and future outlook. This field is poised to become a real watershed profession. Because so there are so many terrible neurological diseases without meaningful treatments, there is a lot that WILL be done in the future. There are many exciting therapeutic modalities to look forward to. Claiming they exist now seems quite silly to me. This doesn't mean Neurologists aren't important or needed. They are highly respected and integral members of the diagnostic team. And you don't need to be a pgy2 to know that. Nor does being a pgy2 provide unique insight into intricacies of the profession. One year of neurology, in my opinion, hardly qualifies anyone as the gatekeeper of knowledge on this profession.
     
  21. Goofy

    Goofy Senior Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by gatormed:
    <strong>All fields of medicine are full of diseases with no "cure." When's the last time you saw a diabetic cured. If you are looking for sure cures you'd better go into surgery. Even in that field, transplant surgery only creates a permanent state of immunosuppression. By the way, as a diagnostic radiologyist you don't treat anyone much less cure. As an interventionalist you are often treating sequelae of the ongoing disease process of atherosclerosis.
    You got me on ALS.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Gatormed,

    I don't believe the guist of the argument is 'cure'. The point is that neurology offers little in the way of meaningful therapeutic modalities. We have excellent treatments for diabetes with most people capable of living a full life expectancy if they adhere to a strict therapeutic regimen. As you know diet and exercise are the cornerstone of treatment, followed by oral meds and insulin if necessary. These are very effective treatments that can produce a normal life expectancy if adhered to religiously. The same cannot be said for diseases like alzheimers or ALS.
     
  22. Goofy

    Goofy Senior Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by racerx:
    <strong>Although wanting to find a cure for the illness is admirable, we shouldn't discount the benefits of controlling the symptoms in an attempt to improve the lives of the patients. Some will not live to see their particular disease cured. However, if they are given more quality time on this earth, isn't it just a little bit worth it?

    OK, I'm off my idealistic, preachy soapbox. :D

    racerx</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Again, I don't dispute that there are therapeutic treatments available for virtually all Neurological diseases. That argument is moot. My argument is that these drugs produce very little in the way of meaningful improvement. Obviously a lot can be done for the epileptic, but the overwhelming majority of neurological disease has little in the way of meaningful improvements. These modalities offer little in the way of improving morbidity. I could list any number of diseases including ALS, Alzheimers, MS, MG, MD, Parkinsons, PIcks disease, Friedreich's Ataxia, huntingtons, Polio. These diseases, for the most part, have some sort of treatment associated with them. Sadly, therapeutics do little in the way of curbing morbidity and mortality.
     
  23. Vader

    Vader Dark Lord of the Sith
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    It is suprising to see such a traditionalist view espoused on this board regarding neurology and neurological disease/treatments. Part of the draw to the field is its cognitive nature, but also the extensive opportunities for basic and clinical research, and the exciting new therapies that have been developed recently or that are on the horizon.

    I'm not sure why certain people here seem to devalue symptomatic, palliative, and supportive care. Physicians have the responsibility not simply to reduce morbidity and mortality, but also to improve quality of life. A physician can make "meaningful improvements" in a patient's life without necessarily extending life. For example, Deep Brain Stimulation has the potential to help certain patients with control of their motor symptoms. It is really quite astounding how a simple device can lead to dramatic lifestyle improvements. There are loads of other examples of treatments or therapies that improve quality of life. Treatment of depression in Huntington's patients is a great example. HD is associated with an increased risk of suicide, so it's important to treat the depression. Who are you to say that this isn't significant? Many neurologists find this to be a rewarding aspect of the profession.

    Of course, the ultimate goal is to find a complete cure (or really primary prevention). Not many specialities in medicine actually attain this ideal, however. There is an unfortunate tendency to devalue symptomatic and supportive care. Fortunately, many have realized this and are leading the charge to assess quality of life outcomes in clinical trials.

    By the way, to my knowledge drug treatments for epilepsy are usually made in consultation with a neurologist. Even though other specialities may be able to prescribe certain drugs, that does not mean they necessarily have the clinical expertise to determine the proper course of treatment. Hence the idea of teamwork.

    For cerebrovascular and auto-neuroimmune disease, there are definitive procedural treatments (i.e. thrombolytics, plasmapheresis, etc). These also are usually done in consultation with a neurology team.

    Traditionally, neurology has been viewed as a diagnostic specialty that could do little, if anything to help patients. This is no longer the case. Our ever-increasing knowledge of the nervous system has led to the development of innovative new preventions or therapies that have the potential to dramatically affect patient care.
     
  24. Voxel

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    A distinction must be made between what is possible today vs what may be possible in the future. There are no guarantees that certain breakthoughs will happen (within our lifetime) nor how long it will take for those breakthroughs to take place.

    Many believe that the future treatment options for neurologic disease to be much brighter in this century than the previous one. This includes, clinicians, researchers, NIH resource allocators, and private investors.
     
  25. Neurogirl

    Neurogirl Resident Extraordinaire
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    Who says we haven't made that distinction? Also, one of the above posters stated that one year of residency didn't qualify me as the "gatekeeper of knowledge about the profession". That much is true. However, it has provided me with enough knowledge to see that some of you should be reading more and criticizing less. Some of the outdated/inaccurate info on this thread is just embarrassing.
     
  26. Voxel

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    What are you talking about?

    What should we be reading? What specific mis-information is embarrassing to you? Since many people have posted different ideas and information, it's hard to say what you mean by mis-information. Should we be reading about a wonder drug that cures most MS patients in the NEJM? Journal of Neurology? Please do tell.
     
  27. Goofy

    Goofy Senior Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Neurogirl:
    <strong>Who says we haven't made that distinction? Also, one of the above posters stated that one year of residency didn't qualify me as the "gatekeeper of knowledge about the profession". That much is true. However, it has provided me with enough knowledge to see that some of you should be reading more and criticizing less. Some of the outdated/inaccurate info on this thread is just embarrassing.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Neurogirl,

    I believe you have taken remarks on this thread by voxel, myself and others a bit too personal. I would hesitate to unilaterally categorized any differing opinion as 'mis-information.' We are all sharing our viewpoints with well reasoned substantiation. Just because we don't agree with you hardly makes us rumor mongers of misinformation. Branding our viewpoints this way is offensive. I hope you can appreciate more than one point of view, even if it differs from your own.
     
  28. Vader

    Vader Dark Lord of the Sith
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Klebsiella:
    <strong> </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Neurogirl:
    <strong>Who says we haven't made that distinction? Also, one of the above posters stated that one year of residency didn't qualify me as the "gatekeeper of knowledge about the profession". That much is true. However, it has provided me with enough knowledge to see that some of you should be reading more and criticizing less. Some of the outdated/inaccurate info on this thread is just embarrassing.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Neurogirl,

    I believe you have taken remarks on this thread by voxel, myself and others a bit too personal. I would hesitate to unilaterally categorized any differing opinion as 'mis-information.' We are all sharing our viewpoints with well reasoned substantiation. Just because we don't agree with you hardly makes us rumor mongers of misinformation. Branding our viewpoints this way is offensive. I hope you can appreciate more than one point of view, even if it differs from your own.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Examples of misinformation:

    Klebsiella: A piece of chewing gum would probably produce more of a theraupeutic option than aricept.

    Voxel: But attempting to treat symptoms with no hope of improvement is not really treatment (ie Parkinsons).

    These statements are simply not true. Aricept, while by no means a wonder drug, has shown clinical benefit for patients. Symptomatic treatment, though unsatisfying, still is an important part of caring for patients. These and other statements by you two represent a highly-skewed viewpoint on neurology by non-neurologists who don't really know the details of what they're talking about. Neurogirl never claimed to be the ultimate source on what neurology is all about (it's doubtful anyone really knows this), so quit ganging up and berating her.

    There is a difference between friendly disagreement and OVERSTATING YOUR POSITION... Jeesh! :rolleyes:
     
  29. Goofy

    Goofy Senior Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Vader:
    <strong> </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Klebsiella:
    <strong> </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Neurogirl:
    <strong>Who says we haven't made that distinction? Also, one of the above posters stated that one year of residency didn't qualify me as the "gatekeeper of knowledge about the profession". That much is true. However, it has provided me with enough knowledge to see that some of you should be reading more and criticizing less. Some of the outdated/inaccurate info on this thread is just embarrassing.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Neurogirl,

    I believe you have taken remarks on this thread by voxel, myself and others a bit too personal. I would hesitate to unilaterally categorized any differing opinion as 'mis-information.' We are all sharing our viewpoints with well reasoned substantiation. Just because we don't agree with you hardly makes us rumor mongers of misinformation. Branding our viewpoints this way is offensive. I hope you can appreciate more than one point of view, even if it differs from your own.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Examples of misinformation:

    Klebsiella: A piece of chewing gum would probably produce more of a theraupeutic option than aricept.

    Voxel: But attempting to treat symptoms with no hope of improvement is not really treatment (ie Parkinsons).

    These statements are simply not true. Aricept, while by no means a wonder drug, has shown clinical benefit for patients. Symptomatic treatment, though unsatisfying, still is an important part of caring for patients. These and other statements by you two represent a highly-skewed viewpoint on neurology by non-neurologists who don't really know the details of what they're talking about. Neurogirl never claimed to be the ultimate source on what neurology is all about (it's doubtful anyone really knows this), so quit ganging up and berating her.

    There is a difference between friendly disagreement and OVERSTATING YOUR POSITION... Jeesh! :rolleyes: </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Vader,

    I believe you take yourself entirely too seriously. I wont stop 'ganging up' on someone if I feel a need to express myself. Other's on this forum have felt the urge to censor my viewpoints without success. I doubt you will be able to silence my insatiable need to speak out.

    In all seriousness, my comments were obviously not a scientific examination of literature on the use of aricept. My comment was meant as a humerous jibe at what is largely considered a useless drug, BY NEUROLOGISTS. It might surprise you to learn that I do in fact have a very rich connection to, and experience in this particular discipline, although I am admittedly not a neurologist. But it doesn't take a neurologist to realize that Aricept is almost worthless.

    In fact if you had done even the smallest bit of research, you might learn that there are several clinical trials that have shown NO benefit of this useless and meaningless drug. It's affects are largely placebo. But your a self proclaimed neurologist, and I'm not, so you obviously know this already.

    Voxel and myself obviously have very high standards when it comes to patient care. Meaningful treatment equally obviously means different things to different people. A tiny incremental improvement in a patient with locked in syndrome just doesn't cut it for me. While this might be gratifying to you, don't expect others, especially non-neurologists to agree. And certainly don't take offense or deliberately become offensive if others don't see eye to eye with you.

    I applaud your valiant defense of Neurogirl, it is truly admirable. But I wont be censored if I feel I have something worthwhile to share. Even if my opinions are unilaterally branded 'uninformed' by obviously 'uninformed' neurologists.
     
  30. Vader

    Vader Dark Lord of the Sith
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    Hey Kleb,

    You're absoultely right--it's your prerogative as an SDN poster to express your views (as long as they are in accord with the user agreement). I wouldn't even imagine myself trying to suppress your "insatiable need to speak out" or to convince you that neurology is a great field (how these things would even be possible is beyond me).

    I'm sure that Neurogirl and other neurologists have high standards of patient care and are quite informed of the current data. There is no need to question her qualifications or expertise and it is fairly rude of you to do so. I'm not suprised that she seemed somewhat taken aback and offended in her reply.
     
  31. Voxel

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    Vader,

    What I stated was not "misinformation", but rather my opinion. You sound like the drug companies. While Aricept does alleviate some of the symptoms in some patients, it does not avert the end point of parkinsons. It may however slow the natural progression of the disease.

    I think people on this forum should do at least a month of "real" clinical neurology and get exposed to all the different areas of neurology to make up their own mind about the true nature of this evolving field.
     
  32. Dr JPH

    Dr JPH Membership Revoked
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    I like the way Vader talks. He/She says some good stuff.
     
  33. imajin78

    imajin78 Junior Member
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    What I stated was not "misinformation", but rather my opinion. You sound like the drug companies. While Aricept does alleviate some of the symptoms in some patients, it does not avert the end point of parkinsons. It may however slow the natural progression of the disease.

    I dont know Voxel, it sounds like some "misinformation" to me, when you think Aricept will help with Parkinsons. No wonder the drug doesn't work. :D
     
  34. Jay Shoaps

    Jay Shoaps Junior Member
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    I think that its interesting that in this discussion regarding the perceived weaknesses of the current state of neurology, no one has discussed neurosurgery in relation. How many people interested in neuroscience are considering neurosurgery? Personally I am very interested in neuroscience but am not sure that I would like neurology, for some of the reasons discussed above. It seems that neurosurg offers many of the same enticements, e.g. working with the brain, expanding new horizons for research, and in addition offers the chance for dramatic improvement through therapy.

    Just curious how many of the neuro interested have considered entering this field
     
  35. Voxel

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    Sorry about that, lol it must be my Alzheimer's getting to me. Anyway, I ment to say Aricept used to treat Alzheimer's not parkinsons.
     
  36. Vader

    Vader Dark Lord of the Sith
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Jay Shoaps:
    <strong>I think that its interesting that in this discussion regarding the perceived weaknesses of the current state of neurology, no one has discussed neurosurgery in relation. How many people interested in neuroscience are considering neurosurgery? Personally I am very interested in neuroscience but am not sure that I would like neurology, for some of the reasons discussed above. It seems that neurosurg offers many of the same enticements, e.g. working with the brain, expanding new horizons for research, and in addition offers the chance for dramatic improvement through therapy.
    </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">We just had the chief of neurosurgery here at UCSF speak to us about the field, residency programs, etc. It definitely is a more "hands-on" field and one does get the sense of having accomplished something very tangible for the patient. In addition, there are great opportunities for research and collaboration with other fields (i.e. neurology, psychiatry, etc).

    Neurosurgery is an intense field with a demanding lifestyle. The hours are long and the training takes many years. On the other hand, some people feed off of that intensity and find reward in the extremely interesting and stimulating nature of their work.

    Residency programs look for people who are extremely dedicated, who have done well academically, and who have demonstrated aptitude for research. Dr. Berger mentioned that eight out of the thirteen or so residents at UCSF's program have MD/PhDs, but this was by no means a requirement. I think it also depends on the program to which you apply--UCSF's is very intent on training the residents for academic careers (although some ultimately choose to go into practice).

    Increasingly, interplay between different specialties is becoming necessary. For example, with deep brain stimulation there is quite a bit of collaboration between neurologists, neurosurgeons, and other members of the health care team. It is great to see this happening, because this has the potential to break down traditional barriers to enable better patient care.
     
  37. ckent

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    One of my parent's friend is a neurologist and he told me he was frustrated with the field because of many of the reasons people are arguing about here. He has a private practice, and he told me that I should not go into neurology because the only type of patients he gets referred are
    1. the patients that the internist cannot manage (and therefore he cannot manage either, because he has the same arsenal of drugs that an internist has at his disposal)
    2. when the internist is worried about being sued by the patient
    3. and patients that the internists do not like.
    I'm not going to presume anything about his competence as a neurologist, I don't know enough (I haven't done a neurology rotation yet), but that's just what he said.

    Also, a question to some of what was being said about Aricept, my understanding of the drug was that even though patient's do not live any longer on the drug, trials have shown that Aricept keeps patients out of nursing home for longer periods of time (ie improve symptoms). Therefore, even though Aricept does not decrease mortality end points, it does benefit the patient and it was also deemed to be economically beneficial for insurance companies and patient's families because the cost of the drug was significantly less then the cost of the extra time spent in the assisted living unit. Again, I'm not pretending to be neurologist, so go easy on me <img border="0" title="" alt="[Wink]" src="wink.gif" /> . This discussion has been interesting to read so far, I hope that you guys keep arguing <img border="0" title="" alt="[Wink]" src="wink.gif" /> .
     
  38. Goofy

    Goofy Senior Member
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    Ckent,

    You have listed some rather excellent reasons why Neurology is unappealing to many. I realize I state this at risk of being called a 'misinformer' by vader and his/her minions.

    Regarding Aricept, your point is well taken. The drug has been shown to have very mild delay in cognitive decline for early dementia patients. This really is only pertinent within the first 6 months of treatment. I had the pleasure of working on a rather large clinical trial involving aricept. I can also tell you that in other trials the benefit was questionable at best. The drug offers extremely little in the way of improvement in morbidity, and certainly nothing in the way of mortality. Think of it as giving you one extra day of memory over years of treatment. Thats how little it does. A piece of bubble gum might offer more, but such a study hasn't been conducted yet.

    I realize that any attacks against one's chosen profession immediately elicits passionate defense. What people have to realize is that not everyone loves neurology, and there are concrete reasons for this. I certainly realize that most people don't like my chosen specialty, but I find my work so gratifying that I could care less. It would be nice to see the pre-neurologists of our group better understand this.
     
  39. Neurogirl

    Neurogirl Resident Extraordinaire
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    Ok...here are a few examples:

    1. MS-For patients with RRMS (85% of all MS pts) ABC therapy (avonex, betaserone, copaxone) has been shown to produce good results. Copaxone is especially impressive. In the longest study yet (6 years) it has been shown to significantly decrease relapses (to less than one every 4 years) and to stop the progression of disability in 70% of those taking it. Of that 70%, 15-20% even showed a DECREASE in disability.

    2. AD-Aricept IS slightly better than chewing gum. It has been shown to modestly decrease cognitive decline and to significantly decrease behavioral problems (wandering, emotional outbursts, etc.)

    3. GB-Plasmapheresis and IVIg are routinely used to decrease disease severity, hasten recovery and shorten hospital stays.

    4. PD-Selegline, dopamine agonists, COMT inhibitors and levadopa allow pts to live relatively symptom free lives for many years and when the meds no longer work, stereotactic surgery and deep brain stimulation can, for the majority of patients, provide many more years of symptomatic relief.

    5. MG-One of the easiest neuro diseases to treat using AChE inhibitors, steriods and Imuran (for steroid failures).

    Regarding other physicians treating neuro problems, I'm sure it happens, but I just don't ever see it. Although they may be comfortable writing medication refills (or treating previously diagnosed conditions), I've never met an internist or FP who was interested in diagnosing and treating anything with a neuro component (with the exception of uncomplicated meningitis). ER docs are even worse! The ones I've known get a CT, labs, stabilize, call neuro and move on! <img border="0" title="" alt="[Eek!]" src="eek.gif" />

    To Vader: Thanks for your help...I obviously needed it! :D

    To ckent: I'm sorry your friend is so dissatisfied with the field, but that's not the way most neurologists feel (at least the one's I've worked with...probably a dozen).
     
  40. Vader

    Vader Dark Lord of the Sith
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    Neurogirl: Nah, you didn't need my help, but I got yo' back anyway because you're one of my Dark Side "minions" (according to Klebsiella). :D

    Klebsiella: I think we all understand that neurology (like any field) isn't for everyone. That's why we need neurosurgeons. :p In all seriousness though, I think the overriding principle here is that any specialty warrants a certain degree of professional courtesy. To each his/her own. :D
     
  41. gatormed

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    Regarding referrals from GP's. I know that the wait for a new patient to be seen in neuro clinic runs around 3-4 months in my institution. They couldn't all be dumps.
     
  42. Neurogirl

    Neurogirl Resident Extraordinaire
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    That is the case in my area as well. In some areas of the country, the demand for neurologists is so great that people are being recruited while still in the middle of residency! Recruitment efforts in most specialties usually begin midway through the last year of training, but I have a friend who is currently a pgy-3 (still has TWO full years to go (with fellowship)) and he's already being actively recruited! One group even flew he and his wife out to their area to meet with the group and see the facilities. <img border="0" title="" alt="[Eek!]" src="eek.gif" />
     
  43. Goofy

    Goofy Senior Member
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    Neurogirl,

    I'm certain that you might even come up with an even more exhaustive list if you really tried. My point is that Neuro offers a lot less on the treatment side than other disciplines. While your chosen specialty is gratifying to you, it isn't necessarily to others. I can certainly understand why others would enjoy this highly cognitive, albeit less treatment oriented discipline.
     
  44. Neurogirl

    Neurogirl Resident Extraordinaire
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    Kleb,

    You are correct! I could supply a more exhaustive list. That was not my purpose. I only supplied the information because I was asked to do so. Good grief! :rolleyes: All I ever intended to do was show that the field is not the barren waste land of treatment options you portrayed it to be. I only asked that you not make gross generalizations.

    Neurology is obviously not for everyone, but it's certainly not the only field that focuses less on cure and more on disease management. I don't know why so many think that neurological illnesses are necessarily more devastating than other types of disease. When it comes to quality of life, I think it would be just as horrible to have advanced COPD or heart failure or renal failure or liver failure (yes, I know, some get organ transplants, but we both know that most don't) or schizophrenia or cancer.

    The point is, there are many areas of medicine that can't offer cure for the more serious diseases. While I don't have that much experience with the IM subspecialists, it does seem that most of them spend a good portion of their time dealing with debilitated and/or terminal patients. :(

    BTW, I'm curious...what field are you in?
     
  45. rad

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    "it does seem that most of them (im subspecialists) spend a good portion of their time dealing with debilitated and/or terminal patients."

    that is very true. probably more so than neurologists
     
  46. Neurogirl

    Neurogirl Resident Extraordinaire
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    Sorry for the shameless bump, but I'm still waiting for a reply. Tell me Klebsiella, what field are you in?
     
  47. Sanman

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    Thought I'd bump this up cause there weren't many responses to original poster's questions. How about the lifestyle of a private practice neurologist?
     
  48. bigfrank

    bigfrank SDN Donor
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    Thanks, I am still waiting for my original question to be answered. Best wishes, Frank
     
  49. Neurogirl

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    Frank,

    Not sure what else I can tell you. I discussed hours, call, and duties in my first post. Regarding compensation, it varies depending on region and type of practice. For example, a private practice neurologist in the midwest or south can expect to start at $150,000 to $180,000 (not including the production bonus, which, if provided, can increase income by as much as 30-40%). After partnership, income should increase substantially...at least $250,000+.
     

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