Elipsis

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Nov 21, 2010
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I'm planning on applying for a few local neurohospitalist openings in the area over the winter. I 've looked through a lot of the prior forum posts and have answered a lot of my questions about different models, range of compensation, etc. I'm wondering if there are any current neurohospitalists willing to comment on their experience and offer any advice either in what to look for or in how to approach the work itself.

I'm leaning towards this career path for a few different reasons. First I really enjoy acute and emergency neurology, and I feel like it's one of my main strengths as a resident. Because of this I think I have a lot to offer patients in this role. I enjoy the general neurology clinic as well, and would appreciate developing a relationship with patients over time, as well as the predictability of the clinic day; it's just that the problems in hospital neurology are more interesting to me. Second, I have a spouse in the middle of her education who wants to change locations in a few years, and I would feel weird about joining a practice or clinic and leaving all the patients to be passed on to another person after a few years. If we moved at some point I might consider more for a private practice general neurology opportunity, but even then I would be more intellectually interested in inpatient work.

One of our rotations is at a privademic hospital on a neurohospitalist service that does general neurology consults and stroke consults. A lot of the consults are nonsults, with a fair amount of legit stuff sprinkled in. Residents cover a few of the calls per week from home (come in for TPA/possible ELVO patients) so I have some experience with that, and I'm starting to moonlight covering some weekend calls. Overall I enjoy the rotation. The challenge with the overnight calls is that the information you get over the phone is a joke and you have no idea whether what you're getting is serious or not, so it seems like your choice is to either be comfortable missing some things or just MRI almost anybody. In general at this hospital we are overworking up just about all the consults which bothers me because I feel like it is economically irresponsible and intellectually inelegant. I'm wondering for current neurohospitalists have you found a way to work without MRI ing the **** out of everything or are you comfortable assessing with your history and exam during the day, and then what do you do during the night when all you have is the ED assessment. Even with my own history and exam I feel like there have been a ton of patients in residency with strokes with odd presentations and nothing impressive on exam. I'm wondering how people approach this because I feel like CYA hospital neurology would really burn you out after a while. In general burnout is one major concern I have with this career path because of the number of scutty consults, although I don't mind easy consults per se, just when you do 10 of them in one day and you feel like you're just generating income for the hospital without providing any benefit to any patient.

For anyone willing to comment on this thread, a couple of questions.

1. Why inpatient only work? How long have you been doing it. Do you still like it?
2. 7 on 7 off or 8-5 with shared call? Hospital employed or private? Any big frustrations with hospital administration? How many other neurohospitalists and how do you divide the schedule/vacation time? How many NPs? The NP we have here is awesome and indispensable and makes the job doable.
3. Can you comment on the issues I mentioned about unnecessary MRI's? How do you approach stroke "rule outs" overnight and weak consults during the day?
4. Daily census? How many new per day, how many follow ups, how many general vs. stroke?
5. Burn out? Do you feel like this is pretty sustainable for you still both in terms of intellectual interest and fatigue or frustration?

Thanks for anyone willing to read and comment
 
Jun 22, 2015
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Great thread! Im very interested in the answers as an MS3 interested in neurology and as someone who preferred acute/inpatient neurology settings. I don't think I would do neuro if I couldn't do neurohospitalist, vascular, or NCC.

I would like to add another question. How much general internal medicine do you practice? What level or "medicine" problem will you treat and manage for your patients that you are primary on?
 
Last edited:
Jun 22, 2015
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What size of hospital/community typically has a role for a neurohospitalist? Do you need to be in a very large metro area or would something like Sacramento, Indianapolis, Kansas City, Orlando, Pittsburg etc. (~ 2 mill metro pop) sized cities have a need for this in their larger community hospitals?

I'm interest in neurohospitalist but I don't really want to live in a place like LA, SF, Boston, NYC, etc. The sweet spot for me is a midsized city like I listed above.


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Elipsis

5+ Year Member
Nov 21, 2010
55
18
Status
Resident [Any Field]
You can check the aan career center or practice link listings yourself but based on those cities of all sizes are looking for neurohospitalists. In general you would have a tough time finding a job in a major metro and a very easy time looking in the larger community hospitals you're thinking about. In fact those are the areas that are going to want you badly and offer a lot of money to get you.
 
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