Neurohospitalist fellowship?

[mrbreakfast]

Hey SDN, I'm a PGY3 who is interested in being a neurohospitalist and who previously got good advice here about the necessity/utility of having fellowship training in getting a good neurohospitalist job. I've also been talking to our fellows and attendings at my program. Overall, it's my understanding that a stroke fellowship is probably the most useful fellowship one can do; I'd rather not do one, though, unless I have to. I've been looking into neurophysiology fellowships and have an upcoming elective to potentially help secure letters, but am also not particularly passionate about that.

One person mentioned neurohospitalist fellowships. There aren't many, and I previously had thought this fellowship was primarily for residents in outpatient-focused residencies who wanted more stroke/inpatient exposure (of which we have plenty in my residency). That being said, in terms of personal interests I'd rather do this fellowship than either stroke or EEG-focused neurophysiology. I'm wondering if my view of this fellowship as "supplemental residency" is incorrect. I don't feel as though I need this fellowship for competency purposes, and as a PGY3 already feel decently confident in EEG, stroke, and neurocritical care. The fellowship looks interesting, and I don't want to be a stroke director or anything, but also don't want to do a fellowship I don't "need."


tl;dr I'd like to be a general neurohospitalist at either an academic center or a larger urban private hospital. Does SDN think a neurohospitalist fellowship would be useful for employment/resume purposes in making that happen? Any insight into how either the private practice or academic world view this relatively new fellowship?

Thanks.

---

Members don't see this ad.

 

[Hockeyfan23]

Being a non-fellowship trained neurohospitalist, I'm quite biased. In my opinion, a neurohospitalist fellowship is a huge scam and just another way for the system to pay you slave wages for another year of hard work without getting much out of it. Most neurology residencies (especially mine) are extremely inpatient and stroke focused that I don't think stroke fellowship is truly necessary either. During residency I was pretty much giving tPA and running endovascular alerts every night on call. I think most residents should feel pretty comfortable with these processes by the time they hit PGY-3/4. Now, if you want to work at a large academic center, or become a stroke director then I agree fellowship may be needed. If you plan on reading cEEG or feel that you did not get adequate enough training on reading routine EEG, then neurophys fellowship is not a bad idea either. I will just say on my interview trail, not one person cared that I wasn't fellowship trained and I do not feel it affected my opportunities or offers.

Just my $0.02

 

[Telamir]

Don't do a neurohospitalist fellowship. I feel the same as above. If you want to do inpatient do a stroke fellowship or neurophys or epilepsy or something that'll help with your skills as an inpatient neurologist.

I'm a neurohospitalist with an epilepsy fellowship.

 

[Postictal Raiden]

I came here to say the things that the above poster said. NH fellowship is a scam. It is an insult to our neurology residency training. Imagine if IM residents had to do a hospitalist fellowship after completing their residency.

Like mentioned above, stroke, epilepsy or neurophys can be very helpful if you’re looking to stay in academia or geographically restricted to coastal cities. Not at all necessary for 90% of the jobs posted.

FYI, I was offered NH jobs straight out of residency in both FL and SoCal.

 

[xenotype]

Being a non-fellowship trained neurohospitalist, I'm quite biased. In my opinion, a neurohospitalist fellowship is a huge scam and just another way for the system to pay you slave wages for another year of hard work without getting much out of it. Most neurology residencies (especially mine) are extremely inpatient and stroke focused that I don't think stroke fellowship is truly necessary either. During residency I was pretty much giving tPA and running endovascular alerts every night on call. I think most residents should feel pretty comfortable with these processes by the time they hit PGY-3/4. Now, if you want to work at a large academic center, or become a stroke director then I agree fellowship may be needed. If you plan on reading cEEG or feel that you did not get adequate enough training on reading routine EEG, then neurophys fellowship is not a bad idea either. I will just say on my interview trail, not one person cared that I wasn't fellowship trained and I do not feel it affected my opportunities or offers.

Just my $0.02

Agree completely on all points and couldn't have said it better. Residency is the training for neurohospitalist work. Any argument that X or Y fellowship is required to do inpatient neurology including stroke coverage etc is just arguing that residency isn't long enough. Especially NH fellowship is egregious and just academic departments taking advantage of the low pay for extra coverage. They could easily hire a midlevel for the same coverage but they know you'll be more productive. Want to know the best part? Your legal liability probably isn't a whole lot lower for being an NH 'fellow' than working on your own especially if you aren't protected by qualified immunity or a low cap on reimbursement (only certain states, certain hospitals).

 

[Postictal Raiden]

[QUOTE="xenotype, post: 22965471, Your legal liability probably isn't a whole lot lower for being an NH 'fellow' than working on your own especially if you aren't protected by qualified immunity or a low cap on reimbursement (only certain states, certain hospitals).
[/QUOTE]

Can you elaborate on the above?

 

[xenotype]

Can you elaborate on the above?

I believed a lot of naive things in training about malpractice like 'you can't get sued at the VA, you can't be sued as a resident- they'll just drop you and name the attending'. None of these things are true. You can get sued at the VA- while your personal assets aren't at risk you will be subject to VA peer review and reported to NPDB which can seriously affect your future job prospects/state licensing depending on the circumstances. As for being a resident/fellow, you will be sued in a bad outcome. If the attending merely cosigned the note or put a boilerplate attestation and never saw the patient or saw the patient in a very cursory manner you can still be primarily responsible in a suit for the bad outcome. The lawsuit can still drag on for years, will still be in your NPDB, and you will still have to talk about it in job interviews/state license applications/hospital credentialing. One of the suits where a resident was named primarily responsible on MedMalReviewer was at a VA where the attending cosigned a note a week later after a patient was sent home from the ED. One of my attendings in residency told me of a PGY2 that was haunted by a lawsuit that hit him PG4 and as a fellow, and they were not merely 'dropped' from the suit in lieu of the attending. Residency would have been a lot scarier if I had known all of this. The reality is lawsuits aren't that common and are primarily a function of how many patients one sees plus randomness, outside of factors that really reduce lawsuits like caps on compensation in many states.

My point that doing more training just because one is afraid of liability- sure it offers some protection but there are no guarantees in life. Being in training is not a magic shield against lawyers in some of the really bad outcomes we all fear.

 

[Telamir]

I've gotten deposed on a case where they were suing a neurosurgeon even though I was the senior resident at the time who wrote the initial consult note and I did not follow the patient whatsoever during their hospitalization. The chart also had a separate consult note by an attending neurologist, and progress notes from other residents, attestations by the attending on service. They were not deposed, only I was. In other words sometimes there's no rhyme or reason to this crap.

While I wasn't sued whatsoever I'm actually kinda thankful it happened. I got a feel for what a deposition is like, what to do and not to do, and I got paid for my time cause I was a fact witness.

 

[deathmerchant]

Hey SDN, I'm a PGY3 who is interested in being a neurohospitalist and who previously got good advice here about the necessity/utility of having fellowship training in getting a good neurohospitalist job. I've also been talking to our fellows and attendings at my program. Overall, it's my understanding that a stroke fellowship is probably the most useful fellowship one can do; I'd rather not do one, though, unless I have to. I've been looking into neurophysiology fellowships and have an upcoming elective to potentially help secure letters, but am also not particularly passionate about that.

One person mentioned neurohospitalist fellowships. There aren't many, and I previously had thought this fellowship was primarily for residents in outpatient-focused residencies who wanted more stroke/inpatient exposure (of which we have plenty in my residency). That being said, in terms of personal interests I'd rather do this fellowship than either stroke or EEG-focused neurophysiology. I'm wondering if my view of this fellowship as "supplemental residency" is incorrect. I don't feel as though I need this fellowship for competency purposes, and as a PGY3 already feel decently confident in EEG, stroke, and neurocritical care. The fellowship looks interesting, and I don't want to be a stroke director or anything, but also don't want to do a fellowship I don't "need."


tl;dr I'd like to be a general neurohospitalist at either an academic center or a larger urban private hospital. Does SDN think a neurohospitalist fellowship would be useful for employment/resume purposes in making that happen? Any insight into how either the private practice or academic world view this relatively new fellowship?

Thanks.

Yes like everyone mentioned, please don't waste time with a NH fellowship. On a side note, as much as you feel you want to be a NH for the rest of your life, things change. There is a reason a lot of neurologists want to only work outpatient and not take stroke call. Or you might want to go to academics, 5-10 years later. Doing fellowship is not a bad idea overall, but definitely not a NH fellowship.