Neurology residency competitiveness

[ciestar]

I mean, is this borderline inappropriate/unethical/illegal? If a student-physician applies w better board scores, publications, letters, and whatever else - and has their app thrown in the trash because of the school they went to - and you admit to participating in this systematic form of discrimination... I don’t know...

Not really my concern, if that’s their approach to shaping the future of medicine, then so be it, but it smells like somehow, esp after the merger, this could present itself as a future lawsuit if programs admit to it

Then say they do interview DOs, the solution would be? Easy. They don’t rank them.

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[anotherro]

Then say they do interview DOs, the solution would be? Easy. They don’t rank them.

Tbh this PD has shot them selves in the foot by creating a numerical score for each applicant


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[ciestar]

Tbh this PD has shot them selves in the foot by creating a numerical score for each applicant


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Why? A lot of programs do it.

 

[anotherro]

Why? A lot of programs do it.

Absolutely, of course. But... if some sort of review (legal) was done and it was found that a DO applicant actually scored highly using the program’s own algorithm based score (this PD put their program’s applicant selection process out there), higher than an MD applicant who was ultimately ranked higher, it would contradict the programs statement...”but we interview DOs!” demonstrating a disingenuous act in their part to only appear impartial, and clearly show that they discriminate based on a student’s school. Not only is it a waste of the D.O. applicant’s time and money, but it is a systematic bias that (what do I know?) is probably not legal.

Either that... or the DO is penalized in the algorithm for being a DO, and I am not sure that is legal? Like I said, what do I know.

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[Chibucks15]

Absolutely, of course. But... if some sort of review (legal) was done and it was found that a DO applicant actually scored highly using the program’s own algorithm based score (this PD put their program’s applicant selection process out there), higher than an MD applicant who was ultimately ranked higher, it would contradict the programs statement...”but we interview DOs!” demonstrating a disingenuous act in their part to only appear impartial, and clearly show that they discriminate based on a student’s school. Not only is it a waste of the D.O. applicant’s time and money, but it is a systematic bias that (what do I know?) is probably not legal.


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Its completely legal and there are 1000 other excuses somebody could use if you ever actually tried to bring a lawsuit. "fit of program" is one that comes to mind. You could just say you like the personality of one person better and felt it would augment the program in a more productive way. Life isn't about numbers and it could literally just be 'holistic review' that leads to one candidate over another

 

[ciestar]

Its completely legal and there are 1000 other excuses somebody could use if you ever actually tried to bring a lawsuit. "fit of program" is one that comes to mind. You could just say you like the personality of one person better and felt it would augment the program in a more productive way. Life isn't about numbers and it could literally just be 'holistic review' that leads to one candidate over another

Which programs also do. My step 1 sucks and it will penalize me with a number system.. but if i interviewed well, that could propel me up more.

And what you said.. any program can use whatever excuse they want. Fit is usually a great one.

 

[anotherro]

Its completely legal and there are 1000 other excuses somebody could use if you ever actually tried to bring a lawsuit. "fit of program" is one that comes to mind. You could just say you like the personality of one person better and felt it would augment the program in a more productive way. Life isn't about numbers and it could literally just be 'holistic review' that leads to one candidate over another

the only attachment I have to this whole discussion is that, if I get through the next four years of school I will be a DO, so I’ll leave it at that. But... I do think it would be difficult for a program to argue that, alongside a numeric score that shows qualification, that they have never found a single DO student that “fit” with the program. In fact, it would clearly demonstrate that the consistent quality that didn’t “fit”, was the DO title.

But like I said, what do I know. I will be starting a DO program next fall, and if all goes well, I will be a DO. That is my only tie to any of this -

Cheers


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[Chibucks15]

the only attachment I have to this whole discussion is that, if I get through the next four years of school I will be a DO, so I’ll leave it at that. But... I do think it would be difficult for a program to argue that, alongside a numeric score that shows qualification, that they have never found a single DO student that “fit” with the program. In fact, it would clearly demonstrate that the consistent quality that didn’t “fit”, was the DO title.

But like I said, what do I know. I will be starting a DO program next fall, and if all goes well, I will be a DO. That is my only tie to any of this -

Cheers


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You're fine. Eventually this will all fade and be reserved for the ivory tower types. And those people love prestige in any field. Its the same with lawyers, finance, I banking, etc. If you don't want to be a surgeon or super specialist at Harvard or places like that then you'll be fine. Don't let it affect you much and try to ignore the 'its not fair' whiners on here

 

[Butters Stotch]

No way you will win a lawsuit against PDs. Hence why colleges can take under par URMs over better applicants who aren’t URM. At the end who cares? If someone doesn’t want you, move on that’s life. Not everyone is going to bend over for you

 

[Splenda88]

Many US students (MD/DO) frown upon programs that have a lot IMG/FMG, so we should not be surprised when some US MD students try to stay away from programs that have a lot of DOs...


My friend who was an average student (with average step 1/2) from a mid tier MD in FL did that when he was applying to IM.

 

[sab3156]

Many US students (MD/DO) frown upon programs that have a lot IMG/FMG, so we should not be surprised when some US MD students try to stay away from programs that have a lot of DOs...


My friend who was an average student (with average step 1/2) from a mid tier MD in FL did that when he was applying to IM.

lol it's pretty funny when people try to deny this reality.

I mean, is this borderline inappropriate/unethical/illegal? If a student-physician applies w better board scores, publications, letters, and whatever else - and has their app thrown in the trash because of the school they went to - and you admit to participating in this systematic form of discrimination... I don’t know...

Not really my concern, if that’s their approach to shaping the future of medicine, then so be it, but it smells like somehow, esp after the merger, this could present itself as a future lawsuit if programs admit to it

They have no legal reason to take applicants from DO schools. Some of them are even blatant about it, and they have every right to say say any of the following:

1) No osteopathic students can rotate at our program (example - HSS orthopedics)
2) No osteopathic students are eligible to apply to our program (example - WashU ophthalmology)

It's not like they're saying "people from a certain religion cannot apply" or "women cannot apply"... those things are protected explicitly by federal and state laws. Those laws don't apply to osteopathic students applying for residency.

 

[Neurality]

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.

Thank you for the honest input. Can't say I'm looking forward to the residency workload but the perks of an attending seem to make up for it. I'm thinking those long PGY 2 hours will at least stay interesting with some cool pathology, considering most of the residents in the ED agonize about "non-emergent" patient complaint.

 

[Postictal Raiden]

Thank you for the honest input. Can't say I'm looking forward to the residency workload but the perks of an attending seem to make up for it. I'm thinking those long PGY 2 hours will at least stay interesting with some cool pathology, considering most of the residents in the ED agonize about "non-emergent" patient complaint.

We get our fair share of non-neurologic neurologic consults. Encephalopathy due to polypharmacy in ESRD, stroke alerts on undetectably low blood sugar levels, seizure rule out on patients who drop 30 points systolic seated to standing, etc. but yes, overall, the neurological work up is much more interesting imo

 

[deleted831695]

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.

1. How much sleep do you get on average?

2. How's midlevel encroachment and/or long-term (10+ years) job outlook?

 

[Postictal Raiden]

1. How much sleep do you get on average?

2. How's midlevel encroachment and/or long-term (10+ years) job outlook?

7 hours

Midlevel are everywhere. Even in surgery. For every one neurosurgeon there are2-3 NPs. Sure they dont operate but they write notes, see pts, and even drill holes in pts heads and place drains, autonomously.
They also exist in neurology, to a lesser extent than other fields. From observation, the only non surgical fields where midlevels exist in less numbers than neurology is nephrology.
Nothing we can change about that. This will continue. Therefore, focus on choosing a field that truly suits you and become an expert of it. Doctors still and will always be the leaders of the healthcare ship.