The burnout rate for neurology is comparatively very high. From my experience through the years I loved neurology and I dont think I would get tired of it easily yet I am a very young physician and have a long path ahead of me. I get scared not to become victim to my youthful aspirations and decisions.
There is also the peer pressuring from my friends in Internal medicine that Neurology is a low income field and I will be working Twice as hard to match my Int Med colleagues.
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Let's discuss these points individually, because some are valid and others completely detached from reality.
Burnout in neurology is an issue. I see it particularly in general neurologists in private practice, because let's be honest, migraine and neuropathy are frustrating and not very satisfying to treat for multiple reasons. But more than that, I see it from people that go into neurology because it sounds cool or prestigious or because they think it's an easy back door into some procedural subspecialty like pain or IR. Those people usually end up with a rude awakening on multiple levels: neurology isn't so easy to get into anymore, particularly the level of program that will set you up for a competitive fellowship, and neurology residency is usually among the most difficult non-surgical residencies in any particular institution, and much more difficult than an average IM residency. What carries most of us through is genuine enjoyment of the subject matter and type of patient we see, and this is only amplified by the ability to subspecialize and define your practice by what you most enjoy.
Neurology isn't the only speciality that deals with burnout, by the way. IM has plenty, and some of the most rapidly jaded MDs I know are IM hospitalists. Nothing destroys the desire to care faster than admitting an endless stream of obese diabetic smokers to temporize and discharge for a week or two until they show up again with the same issues. Remember that next time your IM buddies talk about how neurologists don't cure - neither do internists.
As far as income, a general neurologist in private practice can expect to start at a higher salary than a general internist, whether PCP or hospitalist. Salaries of 300K starting are common in private practice, and even academics average around 190-200K starting, which is similar to academic IM if not a little higher. IM can obviously make more by subspecializing, but so can neuro, and our fellowships are much shorter and less competitive than theirs. A higher percentage of neurologists stay in academia thus lowering the overall average, but this is more a matter of personality differences between specialties resulting in different career choices rather than lack of opportunity in PP for neurologists.
As far as work: neurology is a more difficult residency than IM. At my home institution, IM residents were absolutely coddled and tended to throw little fits if not allowed to sign out by 3 PM while we worked q4 28 hour shifts and I stopped bothering to fill out duty hours because I got tired of the paperwork that came with reporting violations. But that's residency - in the real world lifestyles are similar between specialties, and at the end of the day a general neurologist can still refer anything he doesn't think is primarily neurological right back to the IM-trained PCP. It's good to be a specialist.
