I'm a neurology PGY-2 resident. I'll give my $0.02.
1. Like said above, the hours, the stress, and the learning curve in neurology residency is higher than most specialties. Only surgical and OB residents work more hours than we do. When on days, expect to work 10-12hrs 6 days a week. When on nights, 12-15 6 nights a week. Some programs still have the traditional call system where you do a 28hr shift Q4-7 depending on the program, but from what I'm hearing, most programs are moving towards the nightfloat system. Most programs are front loaded; PGY-2 is nearly all spent inpatient pushing 80hrs/week. PGY-3 tends to be 50/50 inpatient/electives. PGY-4 is similar to 4th year med school; third of it is hard work and the rest is electives and "research".
2. Also like mentioned above, neurology is love or hate type of field. It's not one that you could stomach or easy your way into. You NEED to love it or you'll be miserable doing it. Therefore, it's very self-selective. It draws those who are fascinated by complexity and intrigued by ambiguity, not necessarily those who have urge to fix every patient they encounter.
3. Life after residency is significantly better. Even in inpatient heavy specialties like stroke and neurocritical care, everyone now does shift work where you cover the service 1-2 weeks in the month while having the rest of the month either off or chill clinic.
4. Money is good. Not cards or GI good but better than general IM or other nonprocedural IM specialties. Surveys have us towards the bottom third of the list in terms of salaries but this is skewed by a significantly large portion of neurologists who work academia or those who see less than 15 pts a day. Nowadays, starting salary for neurohospitalist is ~300k. Outpatient is 250K+ but much higher ceiling than neurohospitalist. Academic salaries are pathetic (high 100's-low 200's starting salary).
5. Similar to IM, the field is vast and has multiple subspecialties (Stroke, Epilepsy, NCC, Movement, Neuromuscular, MS, Neurodegenerative, Headache, Neurophys, etc...). Most neurologists subspecialize not because they have to, but again, most who go into neurology are genuinely in love with the field and want to become experts and contribute to a specific subfield.
6. Prestige is nice. We get tons of that from laypersons but not so much from our colleagues in other fields, haha.
7. Job market is great. There's shortage and it's growing. I don't think there will be issues finding a job anywhere in the country, at least not in the foreseeable future.
In regards to OP's question, neuro is not a competitive specialty. Your numbers look good. You are still a third year student have plenty of time to show interest in the field. Do a couple rotations, one being an away, and attend a conference.
IMO EM and neurology lay on the opposite ends of the spectrum: Doer vs thinker, generalist vs specialist, service vs brand. $/hr is better in EM no argument and EM is undoubtedly "sexier" than neurology. However, neurology is a more stable career and allows you the opportunity to advance and grow through it. You are an expert of an organ system and have "ownership" of your patients. Also, your shelf life as a neurologists is also longer than that of an EM physician.
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