Neurology Question?

[chrslbrt]

---

Members do not see this ad.

I wanted to asks this question in the Neurology forum, but I figured why needlessly bother them when I can might be able to find the answer here.

Why is Neurology a relatively uncompetitive specialty? I dont get it.

-All the 'hours worked per week' surveys are around 50
-The average salary is around 200K, more than FM and IM on average
-The subject field is very interesting: A lot of stuff with the brain, neurophysiology, etc.
-There is a chance for highly paid specialties(Neurophysiology, Pain Medicine, Sleep Medicine, Neuroradiology if you're lucky)

Can someone shed some light as to why this specialty isn't ultra-competitive/popular?

 

[indianjatt]

I can only think of two reasons
1.) don't neuro specialties usually have about 5-7 years in residency ?
2.) maybe others aren't interested in it as they are in other specialties

 

[MilkmanAl]

All the 'hours worked per week' surveys are around 50

meh. That isn't terribly special.

The average salary is around 200K, more than FM and IM on average

Also not special.

The subject field is very interesting: A lot of stuff with the brain, neurophysiology, etc.

Unfortunately, "interesting" is about as far as it goes. Most of the things you'll be diagnosing have no cure, and many don't even have particularly good treatments. If it's your thing, fire away, but the specialty's lack of popularity speaks for itself.

There is a chance for highly paid specialties(Neurophysiology, Pain Medicine, Sleep Medicine, Neuroradiology if you're lucky)

The same can be said for just about every other specialty. Also, those specialties you noted are teeny, tiny fields, with the possible exception of pain management, and pain practitioners are more likely to come from anesthesia or PM&R, as far as I'm aware.

 

[chrslbrt]

meh. That isn't terribly special.

Also not special.

Unfortunately, "interesting" is about as far as it goes. Most of the things you'll be diagnosing have no cure, and many don't even have particularly good treatments. If it's your thing, fire away, but the specialty's lack of popularity speaks for itself.

The same can be said for just about every other specialty. Also, those specialties you noted are teeny, tiny fields, with the possible exception of pain management, and pain practitioners are more likely to come from anesthesia or PM&R, as far as I'm aware.

I guess that all makes sense.

 

[DrYoda]

Can someone shed some light as to why this specialty isn't ultra-competitive/popular?

There are a lot of chronic pain patients in neuro, which is a patient population most don't like dealing with. There are also many patients with incurable conditions, again something many see as a negative.

And like Milkman said, there's really nothing stand out about it in terms of lifestyle/money (which is what drives most competative specialities to be competative).

1.) don't neuro specialties usually have about 5-7 years in residency ?

Neuro residencies are four years (intern year+3 neuro). Possibly followed by additional fellowship training if you want to.

 

[docB]

-There is a chance for highly paid specialties(Neurophysiology, Pain Medicine, Sleep Medicine, Neuroradiology if you're lucky)

Can someone shed some light as to why this specialty isn't ultra-competitive/popular?

Neurophysiology isn't really a subspecialty and the experts in that are often non-physician PhDs. There are neurology trained physicians who use their knowledge of neurophysiology working for drug companies and they do pretty well but all the academics make less.

Neuroradiology isn't a subspecialty of neurology. If you want to do neurorads you have to be a radiologist.

Here's a link to the American Board of Psychiatry and Neurology site and a page that discusses neurology subspecialties.

 

[ICCONFETTI]

It's true that neurology is CURRENTLY a relatively less competitive specialty compared to internal medicine/surgery (although not necessarily compared with family, psych), it is definitely becoming a more popular and competitive specialty.

One of my theories behind it is that it is still a relatively newer specialty (similar to pm+r, emergency med). Years ago, anesthesiology used to be a very non-competitive field when it first came out before people realized the attractiveness of the pay/hours. I predict that neurology will become an increasingly more competitive/popular specialty as more and more of the population grows older, and people experience more neurological diseases (stroke, dementia, movement disorders, etc.)

 

[typhoonegator]

I feel qualified to speak on this as a neurocritical care fellow and moderator of the neuro forum.

Neurology is as old as the hills, but was previously reached as a career via internal medicine. Neuro used to be a division of medicine at most hospitals, before branching out in the middle of the last century. Neurologists, as a whole, make just-OK money, and usually have to do a lot of procedures like EMGs, botox, etc. if they want to earn well. The hours aren't that bad overall, but again the big earners work a lot of hours. Specialties like neuroIR, neurocritical care, and stroke are on call a lot.

I flagrantly disagree with the opinion that neurologists "diagnose but can't do anything". This is an antiquated opinion, promulgated by old attendings and perpetuated by ignorant people who don't know anything about the specialty or it's advances in the last 50 years. It is worth pointing out that IM docs don't "cure" heart failure, or MI, or rheumatoid arthritis, or cirrhosis, or any of the other myriad chronic disease processes they take care of. I can't "cure" a stroke any more than they can "cure" dead heart tissue from an MI.

Neurology is a complicated and poorly understood field, and one that a lot of people don't find very exciting. Our exam takes a long time. Our patients can be very weird, hard to communicate with, or otherwise difficult to manage. Not all medical schools have required neurology clerkships, as strange as that may sound, so people aren't even necessarily exposed to it. Also, many neuro inpatient departments are not particularly large, so it can look like a bit of a backward specialty if you don't see all the stuff going on in the outpatient side. All of these things make it a little more difficult to attract people to the specialty.

Neuroradiology is traditionally reached through radiology, but two of my best friends from neuro residency are doing neuroradiology fellowships at Harvard/BWH right now, so it certainly is possible. Neurointerventional radiology is now populated by neurosurgeons, neurologists with vascular neurology fellowships, and radiologists with neuroradiology fellowships. Neurointerventionalists are highly sought after, make excellent money, and get to do very exciting and cutting-edge procedures. Neurocritical care is a burgeoning field, taking care of the sickest of the sick neuro patients with traumatic injury, aneurysmal rupture, huge strokes, bleeds, myasthenia, etc.

While overall neuro might not be competitive, the top programs are very difficult to get into. High board scores, AOA, and numerous publications are the norm. My residency class was over half MD/PhD.

It's a rewarding specialty, the research is well-funded by the NIH, and a relative dearth of attendings makes job opportunities widely available. If you are into it, don't blow it off because it seems "uncompetitive".

 

[neurologist]

I wanted to asks this question in the Neurology forum, but I figured why needlessly bother them when I can might be able to find the answer here.

Why is Neurology a relatively uncompetitive specialty? I dont get it.

-All the 'hours worked per week' surveys are around 50
-The average salary is around 200K, more than FM and IM on average
-The subject field is very interesting: A lot of stuff with the brain, neurophysiology, etc.
-There is a chance for highly paid specialties(Neurophysiology, Pain Medicine, Sleep Medicine, Neuroradiology if you're lucky)

Can someone shed some light as to why this specialty isn't ultra-competitive/popular?

Neurology is "relatively uncompetitive" for a variety of reasons:

First and foremost, neuroscience is generally poorly taught at the med school level, where most student's introduction to the field in years 1 and 2 consists of being forced to listen to droning lectures and memorize obscure brain parts and neuroanatomic pathways. I think if more schools adopted a case-based or patient-based teaching model, it would increase student interest.

Second, during the clinical years, most med students are sent off to do inpatient neurology, which for the most part at most places consists of seeing lots and lots of stroke. (Recall the old saying that neurology is like golf -- you play it one stroke at a time . . . ). I know that the vascular mavens will disagree with me here, but, while stroke can be a good neuroanatomic teaching too, clinically it's just not all that interesting to many people, and can often seem to boil down to "cookbook neurology" (+/-TPA, off to physical therapy, manage risk factors). While the "adrenalin rush" of a three hour TPA window may appeal to a handful of interventionalist wanna-be's, that's a small population. If more exposure to outpatient practice was stressed in med school, I think student would see much more variety and more of the neurologist's ability to affect outcome and long-term quality of life than they see in the hospital setting.

As noted above, there is the "neurologists can't fix anything" reputation. I agree that this is true to some extent, but frankly, I "fix" quite a few people with chronic problems by reducing symptoms to a more tolerable or controllable level.

Another down side it that many neuro patients do have chronic "annoying" problems like psych issues and chronic pain. I can't deny this, but in real life practice, you often have options of tailoring your practice to avoid these as much as possible if you want.

Lifestyle-wise, it's not bad, especially if you're in a large call group. Salary is OK, not as much as a plastic surgeon, but we're not starving.

Overall, it's not a bad choice for a specialty, as long as you're not trying to make big bank and don't mind dealing with chronic problems.

 

[neurologist]

Neurophysiology isn't really a subspecialty and the experts in that are often non-physician PhDs. There are neurology trained physicians who use their knowledge of neurophysiology working for drug companies and they do pretty well but all the academics make less.

Huh???? "Neurophysiology isn't really a subspecialty"? 😕

Then how did I get to do a fellowship and get board certified in it? Every time I do an EEG, EMG, evoked potential, orpolysomnogram, I am "doing neurophysiology."

 

[docB]

I stand corrected.