Neurologist Interview

Started by Alaisha Barber
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Alaisha Barber

New Member
5+ Year Member
1. Main tasks?
2. Education?
3. Most common procedure?
4. How did you get into this career?
5. Likes and dislikes?
6. Advice?
7. Personal characteristics needed to be successful as a neurologist?
8. Changes you see in the future?
9. How often you see patients?
 
1. Research
2. Yes, please.
3. Logistic regression, central lines
4. By thoughtlessly applying to medical school without any real idea of what I was getting into
5. Like: intellectually stimulating, Dislike: hours
6. Have kids, travel, engage in hobbies
7. For every characteristic I think of I know someone who doesn't have it, so nothing.
8. More overt care rationing
9. 15% of my work time per year
 
typhoonegator said:
1. Research
2. Yes, please.
3. Logistic regression, central lines
4. By thoughtlessly applying to medical school without any real idea of what I was getting into
5. Like: intellectually stimulating, Dislike: hours
6. Have kids, travel, engage in hobbies
7. For every characteristic I think of I know someone who doesn't have it, so nothing.
8. More overt care rationing
9. 15% of my work time per year
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What is your main field of research within neurocritical care? Do you sometimes get frustrated with poor outcomes in the neuroICU? What other fields of neurology did you consider following? By the way, I'm a big fan, I've followed your answers for years and they have helped in my decision to go into neurology. You are the neurology forum hero, we need more people in your position that take the time to inform the newbies.
 
typhoonegator said:
1. I do cerebrovascular disease research mostly.
2. Not really, there are plenty of good outcomes if you adjust your expectations to be realistic.
3. I thought about stroke briefly, but the on/off nature of the ICU works best for my lifestyle and lab work.
4. Thanks, I'm here to help.
Click to expand...
There's still a couple of things I wanted to ask you. My second choice of specialty is internal medicine. I have the feeling that neurocritical care is the one field of neurology that has the most overlap with internal medicine, albeit the critical care aspect. Is that accurate, do you get to treat more medical problems than other neurologists? how much general intensive care is involved in the neuroicu? Do you often treat sepsis or renal/heart failure for example? Do you feel like more of a generalist than other neurologists, in the sense that you treat other organ systems too? Maybe my questions are a bit naive, but I still never rotated in a neuroicu, they don't even exist where I studied, even though there are many in Germany where I will train. What's your opinion on German neurocritical care? Is it on your radar at all, in terms of producing quality research? Again, excuse my ignorance.
 
typhoonegator said:
1. I do cerebrovascular disease research mostly.
2. Not really, there are plenty of good outcomes if you adjust your expectations to be realistic.
3. I thought about stroke briefly, but the on/off nature of the ICU works best for my lifestyle and lab work.
4. Thanks, I'm here to help.
Click to expand...
Oh, also, how often do you get consulted to see non-neurological/neurosurgical patients in the micu?
 
1. Different neuroICUs vary considerably. We treat a lot of general critical care issues in ours. ARDS, ARF on CVVH, sepsis, cardiogenic shock, yada yada. But it isn't a MICU, and I rarely start ECMO or use ventricular assist devices on my service, and only would ever do those things with a lot of support. It's just not what we're there for. German NCC is good, multiple groups publish in Neurocrit Care on a regular basis. I definitely feel like more of a generalist than most neurologists, because I rarely need to actually make diagnoses and the physical neurologic examination is much more rudimentary in the ICU population.

2. There are other neurologic specialties that deal with other medical issues as well. Vascular neurologists often have to manage multiple comorbidities, although rarely in a critical care situation. ALS docs are typically very involved in all aspects of care. Neuro-oncologists as well. I'm sure the list goes on from there.

3. We don't do neuroICU consults, and I only see patients that are physically in my ICU. The neuroICU attendings will consult for neurotrauma only. Outside of that, there is a separate neurology consult service that sees consults in the MICU and SICU, and if they think the patient needs neuroICU help then we discuss transferring the patient to the neuroICU. Again, practice varies considerably, and there are several neuroICU services at prominent places that function much more in a consultative role than we do.
 
Hey, TN, can I also ask you how is the working relationship between neurointensivists and neurosurgeons in your experience? Do they fight over control of the patients in the icu? Also, is it feasable to practice NCC and another subspecialty like neurophys or autoimmune neurology when you are not on? Or is it impossible to keep up with both? Are you limited to general outpatient clinic? These examples weren't random, by the way, they are the other fields within neurology the interest me.
 
NeuroICU and neurosurgery relationships are highly institution-dependent. I have a great working relationship with the surgeons in my institution and I think most of my colleagues do to, but that doesn't mean we always agree. People are often dying and things can get testy at times given the stakes, but a culture of respect keeps things from getting out of hand. I know NCC people who do endovascular and EEG, having done separate fellowships. That's all I'm familiar with.
 
typhoonegator said:
NeuroICU and neurosurgery relationships are highly institution-dependent. I have a great working relationship with the surgeons in my institution and I think most of my colleagues do to, but that doesn't mean we always agree. People are often dying and things can get testy at times given the stakes, but a culture of respect keeps things from getting out of hand. I know NCC people who do endovascular and EEG, having done separate fellowships. That's all I'm familiar with.
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So they practice three subspecialties? Damn. Didn't know that was still possible with the current degree of subspecialization in medicine.
 
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