neuro vs cardio

[khaled salah]

Hi guys, iam a final year med student, I need a help deciding betw card/neuro
i have rotated in both here are my impressions
neuro cons for me
1) hate dealing with dementia patiens
2) don't feel comfortable w psychiatry as a subject and practice
3) have zero interest in psych,behav, sleep,headache
4) jobs almost neurohospitalist / outp neuro / peds ,very few jobs for interv neurology / neuro onco
5) INR has a practice scope limited to neurovascular dx ,unlike full range of structural heart manipulations (coronaries ,valves epicardial ablation, neochord , heart failure interventions ,devices implantation,pulmonary denervation , all pvd interventions)
6) i have enjoyed studying cardio as a subject much more , and almost all subspecialities read in it in my free time
pros
1) i like the complexity of neuroanatomy
2) have a huge interest in neuro oncology / ophtalmol / immuno , vascular neuro
3) neuro research is exploding and there are a lot of unmet clinical needs (thomas oxley endovascular bci , intra arterial biologic / chemo therapy for 1ry and recurrent brain tumors , endovascualr embolic hemispherectomy , gene therapies etc,) unlike cardio ( feel like has reached platue) and i want to be engaged in lab research in one of these topics .

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[deathmerchant]

Hi guys, iam a final year med student, I need a help deciding betw card/neuro
i have rotated in both here are my impressions
neuro cons for me
1) hate dealing with dementia patiens
2) don't feel comfortable w psychiatry as a subject and practice
3) have zero interest in psych,behav, sleep,headache
4) jobs almost neurohospitalist / outp neuro / peds ,very few jobs for interv neurology / neuro onco
5) INR has a practice scope limited to neurovascular dx ,unlike full range of structural heart manipulations (coronaries ,valves epicardial ablation, neochord , heart failure interventions ,devices implantation,pulmonary denervation , all pvd interventions)
6) i have enjoyed studying cardio as a subject much more , and almost all subspecialities read in it in my free time
pros
1) i like the complexity of neuroanatomy
2) have a huge interest in neuro oncology / ophtalmol / immuno , vascular neuro
3) neuro research is exploding and there are a lot of unmet clinical needs (thomas oxley endovascular bci , intra arterial biologic / chemo therapy for 1ry and recurrent brain tumors , endovascualr embolic hemispherectomy , gene therapies etc,) unlike cardio ( feel like has reached platue) and i want to be engaged in lab research in one of these topics .

Sounds like cards might be a better fit for you. Reading your pros and cons list you should definitely not consider Neurology in my opinion. All those cons of neuro and the "complexity of neuroanatomy" mostly goes away in few years. There is definitely much to learn in neuro, so unless you want to dedicate yourself to research in a specific condition/niche in neuro, the day to day of neuro will be very frustrating for you.

 

[khaled salah]

Sounds like cards might be a better fit for you. Reading your pros and cons list you should definitely not consider Neurology in my opinion. All those cons of neuro and the "complexity of neuroanatomy" mostly goes away in few years. There is definitely much to learn in neuro, so unless you want to dedicate yourself to research in a specific condition/niche in neuro, the day to day of neuro will be very frustrating for you.

how dedication to specific dx research influence the decision , i mean is it possible to choose a speciality based on it ?

 

[Captain_Falcon]

Hi guys, iam a final year med student, I need a help deciding betw card/neuro
i have rotated in both here are my impressions
neuro cons for me
1) hate dealing with dementia patiens
2) don't feel comfortable w psychiatry as a subject and practice
3) have zero interest in psych,behav, sleep,headache
4) jobs almost neurohospitalist / outp neuro / peds ,very few jobs for interv neurology / neuro onco
5) INR has a practice scope limited to neurovascular dx ,unlike full range of structural heart manipulations (coronaries ,valves epicardial ablation, neochord , heart failure interventions ,devices implantation,pulmonary denervation , all pvd interventions)
6) i have enjoyed studying cardio as a subject much more , and almost all subspecialities read in it in my free time
pros
1) i like the complexity of neuroanatomy
2) have a huge interest in neuro oncology / ophtalmol / immuno , vascular neuro
3) neuro research is exploding and there are a lot of unmet clinical needs (thomas oxley endovascular bci , intra arterial biologic / chemo therapy for 1ry and recurrent brain tumors , endovascualr embolic hemispherectomy , gene therapies etc,) unlike cardio ( feel like has reached platue) and i want to be engaged in lab research in one of these topics .

Are you in the US? Typically you don't decide Cards vs Neuro but instead IM (with plans for cards) vs Neuro. You also focus on either adult or child neurology, almost never both (closest would be if you go epileptology and only read EEGs all day)

Psychiatry is not Neurology. There are some psychiatric components that leak their way into neurology (eg depression with Huntington's/MS, mood disturbances in dementia patients). You can avoid neurocognitive/behavioral/dementia patients if you subspecialize and work in academics, but if you don't subspecialize or even if you do subspecialize but go private practice you cannot avoid these.

Neuro-IR is incredibly competitive.



Do NOT do neurology based off this post.

 

[voxveritatisetlucis]

The only thing with cardio is that it’s a relatively difficult fellowship match, so you need to be okay with being a hospitalist or pcp if you do IM

 

[Telamir]

Yeah. You don't like neuro.

 

[khaled salah]

Yeah. You don't like neuro.

*I too don't have a lot of interest in headache or sleep and find psych/dementia patients difficult to treat. After residency I will likely never encounter them again in my subspecialty (this can be said for basically all of the subspecialties- except of course cognitive).
I would also say that there isn't a much overlap between neuro and psych. The training programs used to be different and there was a lot of overlap. Just like how neuro actually used to be a subspecialty of IM. So when the change was made to separate them they kept some psych on the boards and made neuro residents do an intern year in IM. More of a formality.
Based on your list, it seems like you may not have a good idea of what neurology really is. If there are residents or attendings at your current institution I would encourage you to reach out and have these convos with them!*

this is a response i quote from a neurology resident on reddit , would be happy to know your view!

 

[Telamir]

I too don't have a lot of interest in headache, sleep, and find psych/dementia patients difficult.

While you can insulate yourself a bit from the things you don't find as interesting there's 1) No way to be completely isolated outside of being mainly a research type person and 2) You will have to learn how to deal with those conditions and be somewhat proficient at it. My personal slant is that I think folks who become so focused on their niche (say dementia) to the point where they become unable to see anything else (say stroke) are kinda ****ty neurologists but that's my opinion and probably somewhat unpopular. I'm an "epileptologist" but I work inpatient pretty much exclusively and therefore am quite comfortable with pretty much the entire gamut of neurology. I am not implying I know it all though...but you know what I'm saying.

The "psych overlap" I find is something that's told to neurology and psychiatry med students/early residents to make them feel good. In truth the overlap is only in our direction (pseudoseizures, conversion disorder, etc) and rarely ever in theirs (maybe behavioral management of dementia, though I haven't met a psychiatrist willing to do this).

Your list of cons for neuro is much bigger than your list of pros. Therefore, you don't like neuro. You say you're more interested in cards--so why is this even a conundrum?

 

[khaled salah]

Your list of cons for neuro is much bigger than your list of pros. Therefore, you don't like neuro. You say you're more interested in cards--so why is this even a conundrum?

because there are certain subspecialities super interesting for me as a subject and research (INR , neuro onco) and subsx somewhat interesting for me (neuroimmun, ophth, vascul ) . have no problem w epilepsy, movement , but the other topics as i said have zero interest in it , do you see it unrealistic to pursue a career in neurology with these early reservations ?!

 

[khaled salah]

I'm an "epileptologist

can i take the chance and ask you about these two new therapies , will these thx be that impactful in near future?

Definitive treatment of seizures due to hemimegalencephaly in neonates and young infants by transarterial embolization: technical considerations for ‘endovascular embolic hemispherectomy’ | Journal of NeuroInterventional Surgery

New UC San Diego Health among First in Nation to Perform Regenerative Brain Cell Procedure for Epilepsy

UC San Diego Health is among the first in the nation to perform an experimental regenerative brain cell therapy for epilepsy aimed at eliminating seizures.

health.ucsd.edu

 

[Telamir]

Wouldn't know--I don't see kids.

It seems like a different method of doing a hemispherectomy. Perhaps less invasive but it seems to accomplish the same thing. Hemispherectomies aren't really done in adults.

I'm not saying you CAN'T do neuro. I'm just saying be realistic. It seemed to me on your first post you liked cardiology more.

The fields you mention (oncology, ophthalmology, neuroimmunology) are pretty research heavy, particularly onco and immunology. If you're into that and want to do a lot of research then maybe it's worth looking into. Keep in mind: when you say you don't like psych make sure you mean you don't like the psychopathology and not mean a dislike of dealing with people. You WILL deal with people and emotions all the time in neurology, perhaps more than in cardiology and especially so in oncology.

INR is cool--but it's the only fellowship that makes your life worse (in terms of call, procedures, etc.) While interesting, you should go into it eyes wide open in terms of what the day to day of these fields are.

 

[khaled salah]

The fields you mention (oncology, ophthalmology, neuroimmunology) are pretty research heavy, particularly onco and immunology. If you're into that and want to do a lot of research then maybe it's worth looking into

1) so Will it be realistic if i pursue neurointervention to do impactful research in one of these topics or call duties will not give me a chance !?

2) i know that inr call is the worst , but is there a chance in near future to slightly improve with expanding indications / workforce ?

3) i have recently seen an (endovascular neuro onco) fellow position on X , (intra arterial chemo for RB , preop emboliz ,recurrent gbm , head& neck) ,can it be an emerging research& practice area , or we are faraway from finding an effective thx for these recurrent , unresectable brain tumors and these procedures are just palliative and adjunctive ?

4) are there any low hanging fruits for gene therapies / neuroprotection (MRI unidentifiable epilepsy/ bilat generalized resistant , metabolic degenerative dx ,retinal dystroph,TBI ) or we are still in early preclinical stage ?!

 

[Spinothalamic]

Based on your responses above, it sounds like any outpatient neurology job probably wouldn’t be a great fit for you as there is so much clinical overlap between many subspecialties and also functional neurologic disorders. Outside of a super specialized center, you will be treating all of the neurologic symptoms regardless of if you only “specialize” in a certain part of neurology. In training many people don’t realize this and intentionally shield themselves from these things—then later they find out they aren’t comfortable or aren’t capable of practicing full spectrum neurology which limits job prospects/geography/compensation.

While it is possible to do bench research and do endovascular, it is statistically extremely unlikely. Try not to base your career choice on a very unlikely practice setting but rather what would be considered the norm. If you want to do NIR you should expect about 7 years of pure inpatient stroke training with bad hours during and after training, with the likelihood of not doing a lot of research unless you want even less of a life outside of medicine.

Finally, I don’t think anything that is said on this forum is going to really change your mind. You have a very strong inclination to consider a wide variety of possibilities/opportunities in life and dwell on them (which I did a lot at that stage in training) which leads you to ask questions in rapid succession, but you really just need to give it some time and actual clinical experience because you will probably have another extreme interest in a couple of weeks.

 

[khaled salah]

Based on your responses above, it sounds like any outpatient neurology job probably wouldn’t be a great fit for you as there is so much clinical overlap between many subspecialties and also functional neurologic disorders. Outside of a super specialized center, you will be treating all of the neurologic symptoms regardless of if you only “specialize” in a certain part of neurology. In training many people don’t realize this and intentionally shield themselves from these things—then later they find out they aren’t comfortable or aren’t capable of practicing full spectrum neurology which limits job prospects/geography/compensation.

While it is possible to do bench research and do endovascular, it is statistically extremely unlikely. Try not to base your career choice on a very unlikely practice setting but rather what would be considered the norm. If you want to do NIR you should expect about 7 years of pure inpatient stroke training with bad hours during and after training, with the likelihood of not doing a lot of research unless you want even less of a life outside of medicine.

Finally, I don’t think anything that is said on this forum is going to really change your mind. You have a very strong inclination to consider a wide variety of possibilities/opportunities in life and dwell on them (which I did a lot at that stage in training) which leads you to ask questions in rapid succession, but you really just need to give it some time and actual clinical experience because you will probably have another extreme interest in a couple of weeks.

you enlightened me ,I am so grateful for your response

 

[Aldertonghen]

Based on your responses above, it sounds like any outpatient neurology job probably wouldn’t be a great fit for you as there is so much clinical overlap between many subspecialties and also functional neurologic disorders. Outside of a super specialized center, you will be treating all of the neurologic symptoms regardless of if you only “specialize” in a certain part of neurology. In training many people don’t realize this and intentionally shield themselves from these things—then later they find out they aren’t comfortable or aren’t capable of practicing full spectrum neurology which limits job prospects/geography/compensation.

While it is possible to do bench research and do endovascular, it is statistically extremely unlikely. Try not to base your career choice on a very unlikely practice setting but rather what would be considered the norm. If you want to do NIR you should expect about 7 years of pure inpatient stroke training with bad hours during and after training, with the likelihood of not doing a lot of research unless you want even less of a life outside of medicine.

Finally, I don’t think anything that is said on this forum is going to really change your mind. You have a very strong inclination to consider a wide variety of possibilities/opportunities in life and dwell on them (which I did a lot at that stage in training) which leads you to ask questions in rapid succession, but you really just need to give it some time and actual clinical experience because you will probably have another extreme interest in a couple of weeks.

Unrelated- but what if all you get to decide on fellowship is 2 weeks of exposure of multiple specialties until mid PGY3? It’s just not enough, and most specialties have you apply early to mid PGY3.

 

[Thama]

Don't do neurology. You aren't going to be happy outside of a few very specific niches that are often difficult to access even for those coming from competitive residencies.

A lot of IMGs have this absurd idea of neurology as a less competitive route to an interventional/procedural career. That's not real life.

 

[khaled salah]

Don't do neurology. You aren't going to be happy outside of a few very specific niches that are often difficult to access even for those coming from competitive residencies.

A lot of IMGs have this absurd idea of neurology as a less competitive route to an interventional/procedural career. That's not real life.

so only pursue neuro if iam ok with the majority of outp neuro daily practice !

 

[Thama]

so only pursue neuro if iam ok with the majority of outp neuro dialy practice !

Exactly. This is a good rule of thumb at every stage of medical training. Only go to med school if you would be happy as a PCP. Only go into neurology if you would be happy as a general neurologist - and so on.

 

[Thama]

Unrelated- but what if all you get to decide on fellowship is 2 weeks of exposure of multiple specialties until mid PGY3? It’s just not enough, and most specialties have you apply early to mid PGY3.

That sounds like a major deficiency in the structure of your residency that should feature prominently on your ACGME surveys. We had to fight for these things when I was a resident and it wasn't until we got the ACGME hanging over the head of our department that the department cared even a little what we thought about anything.

 

[WhereMyLiberalsAt]

Your list of cons for neuro is much bigger than your list of pros. Therefore, you don't like neuro. You say you're more interested in cards--so why is this even a conundrum?

It really is the bolded… There is a reason there are multiple paths to NIR. From a current applicant and my rose colored glasses, you really should like or at least stomach the bread and butter of neuro; at least start out that way.

so only pursue neuro if iam ok with the majority of outp neuro daily practice !

Without a doubt! You’re making out to be that one faculty member in NCC/vascular that hates their life.

I mean F me mate, I’d hate to see you answer the “why neurology” interview question. The best NIR applicants I’ve met were the ones that were “neurologist first.” They were painfully smart, kind, and a joy to be around because they loved the entire topic of neuro. They knew HA, NM, cognitive, and movement so well. You share their zeal for research but I wouldn’t confuse that for what makes them good.

A lot of IMGs have this absurd idea of neurology as a less competitive route to an interventional/procedural career. That's not real life.

Every NIR person I know is an IMG. Every qualified applicant I know is an IMG. I’m hesitantly forming the opinion that NIR via neuro is almost exclusively an IMG game. My hypothesis is it creates a dichotomy 1) IMGs with previous pubs making their CV competitive 2) an American grade with an equivalent “thick cv” are true nerds and will go into epilepsy or something. Other personalities get to NIR through other self selecting routes. *working hypothesis that can change any minute*

 

[Telamir]

Hey c'mon I'm an AMG, I didn't like research/publishing, and I'm epilepsy boarded.

Granted....I work inpatient only so maybe I'm not AS nerdy but still.

I also agree with wanting to be a neurologist first. I've had an INR/stroke guy consult me cause a stroke patient had a headache when I was covering the general neuro service. Not even Tylenol ordered. It's like c'mon man.

 

[khaled salah]

at least stomach the bread and butter of neuro

And this is my situation , i mean , i think it is very rare to be fully interseted in the whole subject of a speciality , one of the surgical specialities i was super interseted in was ct surgery , despite that there were procedures and topics also have zero interset in it . I have rotated inp/outp neuro , and almost didn't get bothered by the bread and butter cases, but to be honest that dosn't mean that i will be satisfied w general neurology as a lifelong career . I know there is a risk to get unmatched to desired subspeciality , but this risk is everywhere, even if pursue IM i may unmatch to cardio

 

[Captain_Falcon]

Hey c'mon I'm an AMG, I didn't like research/publishing, and I'm epilepsy boarded.

Granted....I work inpatient only so maybe I'm not AS nerdy but still.

I also agree with wanting to be a neurologist first. I've had an INR/stroke guy consult me cause a stroke patient had a headache when I was covering the general neuro service. Not even Tylenol ordered. It's like c'mon man.

Yo that's outright embarrassing

 

[ProReduction]

1) so Will it be realistic if i pursue neurointervention to do impactful research in one of these topics or call duties will not give me a chance !?

2) i know that inr call is the worst , but is there a chance in near future to slightly improve with expanding indications / workforce ?

3) i have recently seen an (endovascular neuro onco) fellow position on X , (intra arterial chemo for RB , preop emboliz ,recurrent gbm , head& neck) ,can it be an emerging research& practice area , or we are faraway from finding an effective thx for these recurrent , unresectable brain tumors and these procedures are just palliative and adjunctive ?

4) are there any low hanging fruits for gene therapies / neuroprotection (MRI unidentifiable epilepsy/ bilat generalized resistant , metabolic degenerative dx ,retinal dystroph,TBI ) or we are still in early preclinical stage ?!

You can be a proceduralist or a researcher, but you can't be both, especially in Neurointervention. You might say "but what about Tom Oxley or Edward Chang?" Oxley is not a clinician anymore. He is a CEO. Securing funding and promoting a product is a more than full-time job. He is likely never on thrombectomy call at Sinai and the appointment is simply to make his company more legit and for Sinai to also look more legit as they try to become a biotech center. Chang publishes in Nature every other week as last author but his trainees place electrodes and he has full-time PhDs in EECS doing all of the real research stuff. Typically a Neurointerventionist's role in any research study is simply placing a device. If you are fine with this role then that is perfect. But the MBA Admin monsters will keep you too busy with scheduled cases and thrombectomy call to run your own lab or be the driving force in any research.

 

[khaled salah]

You can be a proceduralist or a researcher, but you can't be both

any exceptions ? i understant your point but i mean there are few examples doing both in heavy procedural specialities like surgical oncology / kidney/pancr transplant surgeons. so if i want to do both which procedural speciality you find to be more realistic choice ?! i may say card electrophys / structural

 

[Aldertonghen]

That sounds like a major deficiency in the structure of your residency that should feature prominently on your ACGME surveys. We had to fight for these things when I was a resident and it wasn't until we got the ACGME hanging over the head of our department that the department cared even a little what we thought about anything.

I’ve been told PGY-2 is extremely heavy inpatient and it’s normal to not have subspecialty exposure at this stage. Outside of 4 weeks of epilepsy exposure, everything else is 2 weeks- movement, neuromuscular, MS, sleep, headache. The trouble is we can only take vacations during these rotations (not inpatient ones)- so very often half of these become 1 week long rotations- which is essentially 3-4 days given continuity clinic and didactic requirements. Very hard to decide if one is interested in movement after spending 2 days in Parkinson clinic+ 0.5day in Huntingtons clinic+ 1 day in OR + 0.5 day in Botox/procedures.

 

[Thama]

I’ve been told PGY-2 is extremely heavy inpatient and it’s normal to not have subspecialty exposure at this stage. Outside of 4 weeks of epilepsy exposure, everything else is 2 weeks- movement, neuromuscular, MS, sleep, headache. The trouble is we can only take vacations during these rotations (not inpatient ones)- so very often half of these become 1 week long rotations- which is essentially 3-4 days given continuity clinic and didactic requirements. Very hard to decide if one is interested in movement after spending 2 days in Parkinson clinic+ 0.5day in Huntingtons clinic+ 1 day in OR + 0.5 day in Botox/procedures.

Sorry, I took your original post as meaning 2 weeks total of subspecialty exposure, not 2 weeks for each subspecialty. We had a grand total of 2 weeks that werent straight up inpatient during our entire PGY2 year, which was a disaster when it came time to apply for fellowships. What you're describing is pretty generous. You'll need to take those tastes of exposure in PGY2 and use them to decide how to pursue longer electives for the 2-3 major interests early in PGY3. This doesn't sound like too much of an ask - after all, neurology clerkships during med school are rarely more than 4 weeks, and if you're doing a sub-I then you've probably already decided on neurology.