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Neurology or PM&R

Discussion in 'Neurology' started by Cassowary, Mar 14, 2019 at 3:55 AM.

  1. Cassowary

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    MD student. Cannot decide between neurology and PM&R. The work of both appeals to me. Anyone have anything to weigh in?

    How about when it comes to practice models, compensation, and lifestyle?
    Ultimately the deciding factor will probably be compensation and lifestyle.

    Any ideas on how the work will be 10 years from now?

    I have a entrepreneurial bug, so any idea on which has better entrepreneurial opportunities?

    Am interested in private practice. Ideally open my own practice with multiple ancillaries and midlevel extenders. NIR, teleneuro, and locums stroke interest me for neruology, and pain medicine and sports/spine interest me on the PMR side. Admittedly I'm swayed by the lifestyle of PMR residency.
     
    #1 Cassowary, Mar 14, 2019 at 3:55 AM
    Last edited: Mar 14, 2019 at 4:04 AM
  2. Spodermin

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    You're interested in lifestyle?
    Yet you're interested in NIR and stroke? Forget the fact that NIR would be an uphill battle for the next 6-7 years of your life, but really? NIR and lifestyle don't fit together.
    Unless you want to do outpatient neurology, go for PM&R.
     
  3. OP
    OP
    Cassowary

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    Lifestyle isn’t THAT important to be honest, if comensation makes up for it and if I enjoy what I’m doing.

    I admit NIR interests deviate from my desire for lifestyle. The way I see it, at the attending level though, I don’t think it would be much worse than anything else if I set up my own practice and rent a surgery center; I could pick my own hours

    My idea was 4 years of moderate intensity neuro residency, and 2 years of high intensity endovascuar fellowship isnt too much worse than 4 yrs neuro/PMR residency + 1 yr moderate intensity fellowship
     
    #3 Cassowary, Mar 14, 2019 at 5:09 AM
    Last edited: Mar 14, 2019 at 6:00 AM
  4. Spodermin

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    I think you're trolling
     
  5. OP
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    Cassowary

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    Uhh ok *shrugs*
     
  6. Thama

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    This is spectacularly inaccurate. Acute stroke care is at the core of modern NIR and is the main reason why neurologists are considered to have a valid role in the subspecialty at all. NIR means that you are on call 24 hours a day for acute strokes q #partners in your practice.
     
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  7. BronxBomber

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    As someone interested in NIR, what do you mean by uphill battle? Is it really hard to convince programs to let you into their NIR/ENR fellowship? Is it hard to get hired after fellowship if you're not IR or NS?
     
  8. OP
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    Cassowary

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    I have no experience but what ive seen is yes, neurosurgeons and radiologists have a much easier time getting in. What I’ve also seen however is there is a trend in more neurologists being accepted to endovascular programs
     
  9. OP
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    Cassowary

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    I wasn’t aware, thank u for correcting. They customarily work 7 on 7 off schedules then?
     
  10. Spodermin

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    NIR fellowships are controlled by radiology and neurosurgery. They don't like/want neurology expanding into their field.
    The way I see it, there's two parts as to why neurologists aren't being allowed to expand into this field.

    #1
    Neurosurgeons can do whatever they want inside the brain because when **** hits the fan, they can operate.
    Neuroradiologists have extensive experience in all imaging modalities related to the nervous system. There's a reason they spend 5-6 years reading images after all.
    Neurologists aren't trained in any procedures during residency (maybe LPs) and they aren't trained at reading images per se.

    #2
    Neurosurgery/radiology will not allow neurology to do to them what cardiology did to the their surgeon buddies.
     
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  11. Thama

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    Point 2 is far more valid than point 1. Radiologists also typically have zero patient care experience outside of a minimal intern year and are as suited to clinically evaluate a stroke patient as I am suited to perform a C-section.
     
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  12. Thama

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    Call schedules vary, but the ones I'm most familiar with are q3 or q4, etc depending on how large the practice is.
     
  13. NITRAS

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    To say that neurologist aren’t trained in images isn’t exactly accurate, but the OP sounds like they appreciate lifestyle.....and neuro-IR isn’t a lifestyle I’d want.
     
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  14. deathmerchant

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    Other than neurology being the most fascinating field in medicine (obviously we are all biased here) and being able to take care of some of the sickest people in the hospital ; PMR is better in every other way you can think of.

    NIR might be an exception in that it is more like Interventional cardiology or IR for comparisons rather than Neuro.
     
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  15. Ibn Alnafis MD

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    Beg to differ.

    Job market and demand: Neuro wins
    Diversity of pathologies: Neuro wins
    Types of practice settings: Neuro wins
    Salary: Neuro wins
    Ownership and mastery of an organ system: Neuro wins


    Lifestyle in residency and after: PMR wins
     
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  16. deathmerchant

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    Some valid points!
     
  17. OP
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    Cassowary

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    Neuro really wins salary? I know statistics are veeery general, but I thought they are about equal with maybe PMR coming out on top.
     
  18. Spodermin

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    Have you ever seen how a stroke code runs? The neurologist evaluates the patient. The radiologist interprets the images and plans the procedure. Who said anything about radiologists evaluating stroke patients clinically? You don't need patient contact during residency to interpret an MRI/CT/angio and plan a thrombectomy.

    Neurologists spend what, 2 or 3 months on neuroradiology during residency? You really think that's enough to claim that you are "trained" at interpreting images? I've seen neurologists who call up the radiologist to argue about their report, and I've also seen neurologists who couldn't care less about opening the images and rely entirely on the report. So yeah I don't think neurologists are trained to read images, I think its an interest that some choose to develop during their career while others focus on developing their clinical skills.
     
  19. Asklepian

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    I think this sounds a bit naive.
    Yes, it does depend on your institution and your level of dedication to your career, but as a rule, neurologists read their own films. As a resident, I've outcalled our radiology residents (and sometimes attendings) many times, oftentimes totally changing the treatment plan for the patient. Last time this happened was, let me think...two days ago. And I would say the same for my colleagues, as well. Neuroimaging also highly tested on the RITE exam and even has Continua entirely dedicated to it. So it's a bit disingenuous to poo-poo the training neurologists have in reading our own films just because we aren't in a rads residency.
     
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  20. Thama

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    Actually, I've personally run hundreds of stroke codes over the course of residency. None of them involved a radiologist in any way unless we asked for their help for a thrombectomy. In that case they relied 100% on our clinical assessment and were there purely to suck out a clot and return the patient immediately to our care. That model works at large academic institutions with 24 hour in house neurology residents. It doesn't work in the private world when they are calling you as "the stroke guy" and there is neither time nor patience to call 2 other consults because you never trained sufficiently to assess and treat patients outside of the cath lab.

    Neurologists at my program got 4 years of neuroradiology, as we use imaging daily and interpret 100% of it ourselves. From talking to people at other good programs, that's pretty standard. It was more common for us to go to neuroradiology and ask them to change a read that is absurd and may interfere with insurance coverage of ongoing treatment than for us to rely on their read over our own.
     
  21. Ibn Alnafis MD

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    At my program (newish university program), we almost never look at the radiology report. We read images ourselves, specially during the evaluation of code stroke.

    With that said, from time to time, we visit the radiology department to discuss with neuroradiologists the ddx of atypical MRI findings.
     
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  22. Ibn Alnafis MD

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    I don't have data to support this, but from what I have seen and told, nearly every neurology new grad is getting offers 250K+, vast majority 300K+ in private sector. PMR grads on the other hand are getting offers of low 200's.

    Surveys do show that PMR makes high 200's on average, but keep in mind that this maybe due to the fact that a good number of them go into pain.

    All in all, I agree with you, I'll retract what I said about salary. It's equivocal at best.
     
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  23. deathmerchant

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    I think if you look closely, PMR wins salary. The average reported salary of PMR is about 10% higher. And in fact, neuro salaries are falsely driven up right now (as I had mentioned in a previous post) because of very high demand. Neuro is indeed one of the highest in demand specialty with many type of practice settings open. As a neurologist you can pretty much get a pretty good salary if you go to small and medium sized places.

    On the other hand, PMR jobs are mostly in big cities. If you compare salaries of PMR and Neuro in medium and big sized metro academics- PMR will be much better.
     
  24. deathmerchant

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    Like others, I would disagree too. Everywhere I have personally worked or talked to any of my colleagues- we do not have time to wait for radiologist to look at images before planning emergent stroke care. Most neuro residents are well trained in imaging by 6-12 months of residency.
    It is a vital backup for sure. Because in haste, I have missed things that radiologist catches. This is esp true of non CNS things on head imaging. I once missed a nasopharyngeal mass on an CTH in an acute stroke patient that the radiology PGY2 caught.
    For Gen neuro cases, I Very frequently disagree with radiologist's report. No hate, but radiologists really just give a large differential diagnosis and then we have to figure out what that exactly is. Half the time I could use radiopedia for that differential. I personally suck at CNS tumors.

    That being said, I would not work in a setting where there is no radiologist or preferably neuro radiologist in the hospital, helping us out and to discuss complex cases with. And obviously radiologists are the ones driving new research in imaging. I highly appreciate their input.
     
  25. OP
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    Interesting; i read neuro salaries are falsely driven down bc of the high number of neuro people in academic vs private practice
     

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