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Neuro residency

GhostOfCharcott

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So, I just matched to a neurology residency just this year. I will be starting my intern year after about a month. Neurology have always been my number one choice of specialty since MS1. I have never had any doubt about it until I matched to it. Internal medicine was a very distant second choice.

Is it usual that I am having this buyers remorse type of feeling right after matching? Has anyone have gone through the same situation?


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GhostOfCharcott

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It's common to be apprehensive before intern year. What are your concerns about neurology residency?

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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dodobirddh

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the landscape of neurology is changing..

1. Many diseases hitherto untreatable are eminently treatable now... eg stroke, multiple sclerosis, dystrophies

2. The cognitive challenge to reach a diagnosis is unlike many other specialities thus giving you a edge over other specialities.

3. Mobile apps/AI are changing the way we learn and interact with new developments in neurology... some notable ones are listed below..

UpToDate - for current literature

Neurology Pro - for quick list of differential diagnosis

Software tools on mobile eg OKN strip

Calculators eg NIHSS

AI applications for detecting papilledema/ diabetic retinopathy are already available.

This century is certain to see major advances in the field of Neurology. Be where the action will unfold... follow your passion, rest will fall in place!
 
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Thama

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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.
 
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deathmerchant

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So, I just matched to a neurology residency just this year. I will be starting my intern year after about a month. Neurology have always been my number one choice of specialty since MS1. I have never had any doubt about it until I matched to it. Internal medicine was a very distant second choice.

Is it usual that I am having this buyers remorse type of feeling right after matching? Has anyone have gone through the same situation?


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stages of Neurology commonly seen

1. It’s a fascinating specialty (Pre med- pre-Match)
2. Its not that good..etc etc (R1-R3)
3. It’s not that bad (R4-Fellowship/first few years of practice)
4. It’s perfect for me ( Hopefully after 2-3 years into practice)

After that it depends on your personality
 
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neglect

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So, I just matched to a neurology residency just this year. I will be starting my intern year after about a month. Neurology have always been my number one choice of specialty since MS1. I have never had any doubt about it until I matched to it. Internal medicine was a very distant second choice.

Is it usual that I am having this buyers remorse type of feeling right after matching? Has anyone have gone through the same situation?
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.

Perhaps neurology is not for you. We can't answer that for you.

I think what others CAN help you with is the process by which you find out what's good for you. There's a lot of danger in asking a doctor who specializes in X, "I like X, should I go into X?" Because there's a tendency to validate oneself by encouraging others to do the same. Obviously the same is true for a med student who just matched in IM. "This is great, I'm going to be the master of really sick people!" Hey, that's fine for them. I was the same. But at my current level I actually discourage med students from going into neuro unless they really love it. There are so many great options and a student might find a better fit with another specialty.

So I'd urge you to NOT look outward. You'll find plenty of reasons to do it or not do it from external factors: every specialty is burned out, ER is the worst IMO. Your friends zigged and you zagged. You need to look inward. Are you interested in the brain, do you think like neurologists tend to think? Do you like brain or nerve diseases? How do you feel about seeing neurologically messed up people? Is making a lot of money critical to you? Would you be satisfied doing something that barely needs an MD, like rehab (I'm constantly confused: why is that a thing)? Do you love surgery? How do you get along with people who are stereotypical neurologists? Looking at the wide variety of neurologic subspecialties, is there something there that's interesting to you? Most importantly, is there a better fit in other areas, from rheum to ID to cards to ICU to oncology?

Life is too short to do something you hate. Best luck.
 
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Telamir

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I take half and half call for a large (~800 bed) hospital when I'm on night shift (half shift in hospital, half at home) however now due to COVID I'm taking it all from home. Truthfully with telestroke there is very little you have to go in for unless there is a patient in the ICU or the floor with stroke like symptoms that are convincing/serious since we don't have telestroke capability for inpatients (yeah....I know). Often times you just get called so the ED can "run something by you", get outpatient followup scheduled for dispo, or questions which can usually be answered with "I'll see him in the morning". Of course, all of this depends on your ED. If your ED docs are good then you might not get called often at all; patients will get admitted and you'll be consulted in the morning. If they're quick to call you then it might be a miserable time.
 
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EmilKraepelin55

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Perhaps neurology is not for you. We can't answer that for you.

I think what others CAN help you with is the process by which you find out what's good for you. There's a lot of danger in asking a doctor who specializes in X, "I like X, should I go into X?" Because there's a tendency to validate oneself by encouraging others to do the same. Obviously the same is true for a med student who just matched in IM. "This is great, I'm going to be the master of really sick people!" Hey, that's fine for them. I was the same. But at my current level I actually discourage med students from going into neuro unless they really love it. There are so many great options and a student might find a better fit with another specialty.

So I'd urge you to NOT look outward. You'll find plenty of reasons to do it or not do it from external factors: every specialty is burned out, ER is the worst IMO. Your friends zigged and you zagged. You need to look inward. Are you interested in the brain, do you think like neurologists tend to think? Do you like brain or nerve diseases? How do you feel about seeing neurologically messed up people? Is making a lot of money critical to you? Would you be satisfied doing something that barely needs an MD, like rehab (I'm constantly confused: why is that a thing)? Do you love surgery? How do you get along with people who are stereotypical neurologists? Looking at the wide variety of neurologic subspecialties, is there something there that's interesting to you? Most importantly, is there a better fit in other areas, from rheum to ID to cards to ICU to oncology?

Life is too short to do something you hate. Best luck.

What is a stereotypical neurologist, from your perspective? The neurologist at my school seems to be what I would consider the “stereotype.” This includes being a stickler for minor details and definitions, tangential during conversations/lectures providing overly verbose and eclectic information regarding pathophysiology, is philosophically minded, and has a slight air of intellectual superiority. Lol I don’t know, it’s probably just him.
 

Thama

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What is a stereotypical neurologist, from your perspective? The neurologist at my school seems to be what I would consider the “stereotype.” This includes being a stickler for minor details and definitions, tangential during conversations/lectures providing overly verbose and eclectic information regarding pathophysiology, is philosophically minded, and has a slight air of intellectual superiority. Lol I don’t know, it’s probably just him.

This kind of person is more commonly found in neurology than, say, ortho, but isn't really what most neurologists are like. There were a few like that in my residency program, and everyone else found them pretty annoying.
 
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deathmerchant

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What is home call like for neurologists? What percentage of time/how often do they have to go into the hospitals for home call shifts? How does call compare to internal medicine specialties?

Pretty much what Telamir said. Depends a lot on your comfort level and your ED/IM guys. If you develop a good rapport with them and the nursing staff and also make sure you talk to the nurse (or if possible the primary) once after seeing a consult; you would rarely have to come in. I go in once or twice a week. (Although my hospital is much smaller and less busy- 350 bed)
 
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neglect

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What is a stereotypical neurologist, from your perspective? The neurologist at my school seems to be what I would consider the “stereotype.” This includes being a stickler for minor details and definitions, tangential during conversations/lectures providing overly verbose and eclectic information regarding pathophysiology, is philosophically minded, and has a slight air of intellectual superiority. Lol I don’t know, it’s probably just him.

The stereotype is very smart, nerdy, mild mannered on the surface but can be passive aggressive. A bit aspie/spectrum. Thoughtful, likes deliberating, thinking deep. Wary of rushing in and easy fixes. Speaks in sentences and paragraphs. Not very money hungry. Familiar with libraries. Intersection of biology, electrical engineering, philosophy/logic.

I think this is changing. Neurology is seen as a good lifestyle profession. I believe neurology is now majority female in terms of residents. Also, with tPA and endovascular, I think it is attracting 'atypical' folks who want to get things done.
 
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EmilKraepelin55

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The stereotype is very smart, nerdy, mild mannered on the surface but can be passive aggressive. A bit aspie/spectrum. Thoughtful, likes deliberating, thinking deep. Wary of rushing in and easy fixes. Speaks in sentences and paragraphs. Not very money hungry. Familiar with libraries. Intersection of biology, electrical engineering, philosophy/logic.

I think this is changing. Neurology is seen as a good lifestyle profession. I believe neurology is not majority female in terms of residents. Also, with tPA and endovascular, I think it is attracting 'atypical' folks who want to get things done.
You basically described all of my best friends in a nutshell with your definition of the "stereotype," which lends more minor credence to the idea that perhaps I should pursue this field. Definitely looking forward to my neurology rotation!
 
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Telamir

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Personalities vary tremendously nowadays. In my residency class at a "brand name" academic center there was:
1) A super extroverted guy who went into academia and was always partying
2) A mid 30's lady who had done a previous residency in Spain and she was a pretty normal/social person.
3) A more socially isolated guy who spent all his time working out, was jacked, and extremely disciplined.
4) Me, a very pragmatic not super detail oriented guy, middle of the road with socializatio who likes fast cars, video games, and occasionally wears bowties.

Like I said...varied.
 
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Ibn Alnafis MD

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In my residency, third of residents fit the neuro “stereotypical” phenotype (intelligent, introverted, mildly socially awkward, very well read). Most of the rest is your average DGAF type personality. Then there’s me, extroverted, loud, opinionated, financially driven, and easily excitable.
 
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