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Can somebody comment on which Neurology fellowship will be in demand in 5-10 years.
I am interested in Headache and MS.
I am interested in Headache and MS.
Neurology fellowship in demand
- Thread starter Epic786
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If you're interested in headache and MS, I think both of those will still exist as medical diagnoses in 10 years. Outside of a few really big and desirable locales, fellowship-trained neurologists are in demand. Do what interests you the most.
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Pretty much any of them. You should know that ms is a rare disease and that outside an established ms center you'll be doing general neuro for a good long while. And if you do headache, you'll probably have the reverse problem and see only migraine.
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I've been interested in Neurology for a while, mainly stroke but many other aspects. Could you please elaborate on what "general neuro" entails. I know that could end up being a hefty question but just some bullets or a general description would be greatly appreciated.
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General neuro: you pretty much see anything that comes your way. I consider myself subspecialized in two areas, but I feel it is important for any neurologist to diagnose and manage things outside their subspecialization zone. It informs your approach and it helps more patients. And it isn't like neurology is so vast that you can't start TCA/triptan on a migraine patient at 8:30, diagnose memory loss as AD, then adjust sinemet on PD, then reduce BP on a stroke FU, then discuss new oral MS therapies.
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The compensation for MS or Headache is not much more than general neurology.
I am a headache specialist and my pay has never been much more than that of a general neurologist. Just a few things from my own career pathway.
I first was a military neurologist, so I got paid by rank and time, nothing more. I did not have my UCNS certificate in headache medicine at the time, but I can tell you that if I did, it would have earned me a pat on the back and something to put on my OER, certainly no additional salary!
After I got out of the military, I went into my own private practice. I still really did not make more than my colleagues, even though I marketed myself as a headache specialist and did things that the other guys were not doing (e.g. certain craniofacial nerve blocks, in-office infusions with rescue therapies, etc). I had been doing sphenopalatine ganglion blocks the old fashioned way for some time (i.e. Q-tip method). These were great for say a cluster headache patient with 10/10 pain! But, some yahoos developed a few catheter devices to make SPG blocks simple, made it so simple that a monkey could be trained to do one, bragged about how much money you would make in reimbursement for such a simple procedure, so on and so forth. Well, it was only a matter of time before the insurance companies and Medicare caught onto this. In-office infusions and IV pushes DO NOT add much in revenue.
As I decided to get out of private practice, I did investigate academic jobs with university based headache centers. Salary offers were LOW but the trade off was very light call and schedule compared to that of a private neurologist. Let's face it, in general, no matter what specialty you practice, we all sacrifice pay for quality of life.
Now that I am employed by a large hospital group, well, they like that I am a headache specialist but still expect me to take my turn on call. Call is typically stroke/pseudostroke, seizure-like events or the real deal, or altered mental status. So yes, I still have to do Neurology 101! That being stated, these are the same things you dealt with as a resident. Only difference is, now you are the consultant, not the inpatient admitting physician, so a little easier now that you are dealing with just the stroke end of the admission and not having to write for tylenol at 3AM.
As for MS? Again, you could seek an academic job, but again, the pay will likely be lower than the private world. I have noticed that a number of MS specialists enjoy the science side of the job.
I always liked MS as well. Yeah, sometimes those patients can be intense and exhausting, but at least those patients have real neurological lesions. There are a few neurologists out there that do both! Think of it this way, if you have a specialty headache clinic set up with staff that can run infusions and rescue therapies for headache, well, that same staff can also run Tysabri infusions and do Gilenya start ups.
