Movement disorders vs General Neurology

[DrStephenStrange]

Hello guys, it’s me again seeking advice on career paths moving forward.

PGY-3 is already close to its midway point, and I’m still kind of undecided. I have a movement elective rotation coming up, and I’m hoping I can make up my mind at the end before applications go out in March. I’m currently 70% leaning towards applying.

With that said I had a few questions:

For those of you who went into movement (or those that have insider info), what is your practice set up like? Do you only do Movement or do you still practice some general neurology? If both, how feasible is this? Do you do any inpatient? What is your schedule like?

You see, I’ve found that I need variety in order to stay sane, and having a mix of inpatient and outpatient with some inpatient general neurology will probably be my ideal practice setup in the future.

Does being a fellowship trained movement specialist give you additional leverage when negotiating your contracts and salary?

Part of the reason I’m still hesitant now is the fact that I am married with no kids yet, and I’m just dreading putting our lives on hold any longer and seeking additional training when I could be making attending salary and have a life.

I also have to say, I have zero interest in research and would only be seeking the 1 year clinical fellowships. I’m telling myself, if I decide to do it, I can survive another year after coming this far. However, just wondering, is not being interested in research looked down upon in the field at all (since a lot of programs are 2 years with research)? Or does it even matter?

Additionally, if you were to go back would you still do a movement disorders fellowship?

Are there any additional advice you would give someone seeking to go into movement in the current market?

Thanks everyone,
Excited to read what all any of you have to say.

All the best!

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[Spinothalamic]

For reference, I did not do movement but I did neuro-ophthalmology and also practice general neurology. My residency provided great general neurology training and I do EMG/EEG, nerve blocks, Botox for migraine/HFS/bleph/spasticity as well as a few patients with cervical dystonia. That being said, if you want to do general outpatient neurology, I would highly recommend you do a one-year clinical fellowship. Movement would be great, especially if you can learn skills to be able to offer DBS to patients (might be highly needed depending on your desired practice location) It will give you a “bread and butter” subspecialty for your practice and give you a lot of experience with Botox particularly. The one year of deferred salary isn’t that big of deal if it helps to prevent long-term burnout. Also, it will help to be embedded in a clinic setting for one year as you will be exposed to how an efficient clinic runs, odd cases, difficult patients, etc. Vast majority of neurology residents don’t get enough clinic experience. Consider 6 months of intermittent Locums after fellowship and you will be doing very well. Also, you mention “no kids yet”, obviously this involves many different variables, but going into 4th year of residency and then a fellowship year is a great time to have kids. Probably better than during attending life, at least for an outpatient fellowship year. This is a completely different topic but figured I would throw that in there. There will never be a perfect time.

 

[clinicmd]

On contracts and salary—I saw this salary spreadsheet with data across a bunch of specialties. Honestly, don't see a huge difference between general neuro and sub-specialties, but it could benefit from more people adding their info to make it more complete. Might help answer some of these questions better

 

[DrSatan]

For those of you who went into movement (or those that have insider info), what is your practice set up like? Do you only do Movement or do you still practice some general neurology? If both, how feasible is this? Do you do any inpatient? What is your schedule like?

Non-academic outpatient only movement disorders specialist. I work 8am to 430pm Monday to Friday. I see a mix of all patients (though I have set patient populations I will not see -- MS, dementia, headache) but have dedicated time to slowly build my movement practice. I take every other night home call every 4-5 months for 2 weeks.

Does being a fellowship trained movement specialist give you additional leverage when negotiating your contracts and salary?

I did not personally feel like it gave me any leverage. Most places I looked at did not particularly care, and if anything preferred against movement disorders. There were not many academic center job prospects in locations I was interested in living in.

I also have to say, I have zero interest in research and would only be seeking the 1 year clinical fellowships. I’m telling myself, if I decide to do it, I can survive another year after coming this far. However, just wondering, is not being interested in research looked down upon in the field at all (since a lot of programs are 2 years with research)? Or does it even matter?

I did a 1 year clinical fellowship. 2 years is nice because movement disorders are very broad and DBS exposure can be limited in 1 year, but you will always have a learning curve out on your own no matter what. Research is a waste if you are not going into academics.

Additionally, if you were to go back would you still do a movement disorders fellowship?

Yes, I would probably still do a movement disorders fellowship. I learned a lot and honed my skills in ways that simply practicing without guidance would not have allowed. I think movement disorders is the most fascinating neurologic subspecialty. Also, it was the easiest year of work I have had since college.

Are there any additional advice you would give someone seeking to go into movement in the current market?

Consider neurophysiology fellowship because your salary can be exorbitant and you will be in high demand. You may have more control over your schedule as well.

 

[Captain_Falcon]

Non-academic outpatient only movement disorders specialist. I work 8am to 430pm Monday to Friday. I see a mix of all patients (though I have set patient populations I will not see -- MS, dementia, headache) but have dedicated time to slowly build my movement practice. I take every other night home call every 4-5 months for 2 weeks.


I did not personally feel like it gave me any leverage. Most places I looked at did not particularly care, and if anything preferred against movement disorders. There were not many academic center job prospects in locations I was interested in living in.


I did a 1 year clinical fellowship. 2 years is nice because movement disorders are very broad and DBS exposure can be limited in 1 year, but you will always have a learning curve out on your own no matter what. Research is a waste if you are not going into academics.


Yes, I would probably still do a movement disorders fellowship. I learned a lot and honed my skills in ways that simply practicing without guidance would not have allowed. I think movement disorders is the most fascinating neurologic subspecialty. Also, it was the easiest year of work I have had since college.


Consider neurophysiology fellowship because your salary can be exorbitant and you will be in high demand. You may have more control over your schedule as well.

What part(s) of the country were you looking at for jobs?

 

[DrSatan]

What part(s) of the country were you looking at for jobs?

I'm not going to disclose that. Why do you ask? You can readily see what jobs are available via AAN and recruiter websites if you are curious about the movement disorders job market.