Neurology ----- Thoughts?!?!?!?

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IJL

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So far, it seems like a pretty badass field IMO.

I have some questions:

1. How long is the residency?
2. Is it a separate residency from IM?
3. Is there a neuroradiology fellowship stemming from neurology?
3.a. How is this different than going the radiology route to begin with?
4. What are the downsides to neurology?
5. Are they well paid?




THANKS!!!!!!!!!!!!
 
So far, it seems like a pretty badass field IMO.

I have some questions:

1. How long is the residency?
2. Is it a separate residency from IM?
3. Is there a neuroradiology fellowship stemming from neurology?
3.a. How is this different than going the radiology route to begin with?
4. What are the downsides to neurology?
5. Are they well paid?

(1) Neurology, itself, is three years after internship. Some programs have the internship year built in. Others don't. For the ones that don't, you have to apply for the internship year as well.

(2) Yes.

(3) Don't know. As to how it's different than going into radiology, well, it's neurology. An entirely different field. lol

(4) There are none.

(5) Compared to what? No doctor is going to go hungry. If you like the field, do it.
 
There is a 1-yr fellowship called Neuroimaging, which allows you to stand-alone bill neuroradiology reads as a neurologist. The job market for this is probably small because few people know the possibility of hiring these instead of rads-trained neuroradiologists (who can read all scans, not just brain and PNS MRI/CT - takes 6 yrs total). Maybe only in a private neuro-only group, you could pitch yourself for this position.

6. Excellent job market from what I understand, which is supposedly growing. There's a current shortage of general neurologists, as well as some sub-specialties to a lesser extent. In the south, peds neurologists average 405k/yr because they only exist every few hundred miles in large cities. I've seen ads for gen neuro for 400k, but those were in undesirable locations.

7. Procedures in gen neuro: Not many; lumbar puncture and EMG. Interventional pain (1 yr fellowship): Spinal steroid injections, etc. Neurointerventional (3 yr fellowship): overplayed field from what I've read (people who actually know what they're talking about, feel free to chime in), but this is endovascular neurosurgery and is all procedure. Neurointensivist (2 yr fellowship): probably one of the most badass subspecialties period, and is just as procedural as ICU + ventriculostomies, etc.

8. Low (25th Percentile) / Median / High (75th Percentile)

Starting Salaries $170,000 / $200,000 / $240,000
1 - 2 Years in Specialty N/A / $254,836 / N/A
All Physicians $208,665 / $254,836 / $316,892

(most recent non-academic salary data from AAMC, which is from the 2012 survey)

Most of the people viewing are aware that salary is a major selection criteria for a job. I recommend checking out AAMC Careers in Medicine and getting a login. Also tells you sweet stats on "Most common diagnoses", "Types of patient encounters by %" (i.e. chronic illness vs. acute illness, relative % of terminal patients, patient ages, etc)
 
According to this, dermatology is said to be intermediate competitiveness and radiology is supposed to be not competitive.

That is, indeed, what it says... "Competitiveness" is a soft/subjective measure. In the case of WUSTL, they have blatantly listed their criterion for the competitiveness measure (e.g. percent of us seniors matching in said specialty).

It doesn't mention the self-selecting nature of that applicant pool to begin with...and therein lies the conflict with your beliefs.
 
I'll start by saying that I'm only an M2 and these answers are from what I've learned working a group on neuroradiologists and neurologists since my gap year.

3. Is there a neuroradiology fellowship stemming from neurology?
Yes there is. The feeling that I've heard from talking with several radiology trained neuroradiologists is you are better prepared and easier to hire if you come from a radiology background.
3.a. How is this different than going the radiology route to begin with?
You are focused on clinical management of patients with neurological condiations as a neurologist vs. mostly diagnosis as a radiologist. Most neuroradiologist who don't go on to a neurointerventional fellowship do not manage patients, so there is little benefit to the clinical management that you get from a neurology background.

5. Are they well paid?
Depends on the city you work in.

7. Procedures?
Also EMGs and are in the OR when placing ECOG strips go ensure they are placed in the necessary locations as well as ensure that the strips are transmitting adequate signals.
MEG is also sometimes part of Neurology.
Neurointerventional is neuroangiography, stenting, localized drug delivery (there is some awesome Retnoblastoma treatment that some neurointerventionalists are doing right now), gluing AVM, etc.
 
There is a 1-yr fellowship called Neuroimaging, which allows you to stand-alone bill neuroradiology reads as a neurologist. The job market for this is probably small because few people know the possibility of hiring these instead of rads-trained neuroradiologists (who can read all scans, not just brain and PNS MRI/CT - takes 6 yrs total). Maybe only in a private neuro-only group, you could pitch yourself for this position.

6. Excellent job market from what I understand, which is supposedly growing. There's a current shortage of general neurologists, as well as some sub-specialties to a lesser extent. In the south, peds neurologists average 405k/yr because they only exist every few hundred miles in large cities. I've seen ads for gen neuro for 400k, but those were in undesirable locations.

7. Procedures in gen neuro: Not many; lumbar puncture and EMG. Interventional pain (1 yr fellowship): Spinal steroid injections, etc. Neurointerventional (3 yr fellowship): overplayed field from what I've read (people who actually know what they're talking about, feel free to chime in), but this is endovascular neurosurgery and is all procedure. Neurointensivist (2 yr fellowship): probably one of the most badass subspecialties period, and is just as procedural as ICU + ventriculostomies, etc.

8. Low (25th Percentile) / Median / High (75th Percentile)

Starting Salaries $170,000 / $200,000 / $240,000
1 - 2 Years in Specialty N/A / $254,836 / N/A
All Physicians $208,665 / $254,836 / $316,892

(most recent non-academic salary data from AAMC, which is from the 2012 survey)

Most of the people viewing are aware that salary is a major selection criteria for a job. I recommend checking out AAMC Careers in Medicine and getting a login. Also tells you sweet stats on "Most common diagnoses", "Types of patient encounters by %" (i.e. chronic illness vs. acute illness, relative % of terminal patients, patient ages, etc)

I thought that child neurology is among the most underpaid specialties in medicine. Few months ago there was a thread in the neurology section that had some salary details. Besides, based on the recently released Medicare Physician Fee Schedule, neurology and RadOnc are going to receive the biggest pay cuts (scroll down to page 1269).

http://www.ofr.gov/OFRUpload/OFRDat...w.ofr.gov/OFRUpload/OFRData/2012-26900_PI.pdf

P.S. with respect to you OP, I highly doubt you are a med student. You don't even know that neurology and IM are separate specialties?
 
Like many specialties, how much you make depends on location and how much you work. If you want to take q3 call and book a lot of patients in clinic you will make more money than someone in a group taking q8 or 9 call and seeing like 6 or 8 patients a day

One set of procedures you missed is chemical denervation- this can be phenol for neuropathic pain like with neuromas (not as big) or management of spasticity/dystonia with botox. Botox-able conditions include MS, stroke, CP, SCI, TBI for spasticity or blepharospasm, cervical dystonia, the action specific dystonias like writer's cramp or musician's cramp.

There are some other cool non-procedure procedures you can do like interoperative monitoring for epilepsy surgery or implantation of DBS- basically the neurosurgeon cracks the skull but you go into the OR to tell the neurosurgeon where to place the electrodes and help test the positioning with the patient to make sure they are where you want them. I call these non-procedure procedures because you're not really doing the full procedure but it's not exactly your run of the mill clinic/floor medicine practice.

You can also interpret and bill for interpreting EEGs, not really a procedure in the sense that someone else is placing and removing the electrodes etc, but it bills like a procedure.

Some drawbacks of the field which may be more or less depending on who you are as a person
-lots of old people
-lots of palliating conditions as there aren't cures for a decent # of conditions. For me this is rewarding because you can take someone who is totally not functional and give them back some function or return them to independent living which I think is rewarding
-a number of conditions that degenerate and the patient dies from it like huntington's, Alzheimer's, ALS etc
-lots of people with conversion will present to you because clinically whatever is happening looks neurologic but in your workup everything is normal, then you have to try to sell seeing a psychiatrist for conversion to the patient which some neurologists do really well and some do extremely poorly
-I think we do deal with more psych issues than your average practitioner however anyone doing clinical medicine will have to deal with comorbid psych issues (you can escape this only by doing path or rads....then you have to deal with your coworkers' psych issues)
 
That is, indeed, what it says... "Competitiveness" is a soft/subjective measure. In the case of WUSTL, they have blatantly listed their criterion for the competitiveness measure (e.g. percent of us seniors matching in said specialty).

It doesn't mention the self-selecting nature of that applicant pool to begin with...and therein lies the conflict with your beliefs.

Oh I'm not trying to argue that they aren't highly competitive. I actually meant that it's kinda misleading to say that, regardless of whatever criterion they use.
 
I thought that child neurology is among the most underpaid specialties in medicine. Few months ago there was a thread in the neurology section that had some salary details. Besides, based on the recently released Medicare Physician Fee Schedule, neurology and RadOnc are going to receive the biggest pay cuts (scroll down to page 1269).

You're right, the average, I think, is around 150-180k. For the 2010 AMA survey it was 405k in their "Region 6" (South/Southeast), purely due to a massive shortage. These guys probably see a patient every ten minutes, which is horrible to need to do for that field, but I can vouch that there are only about five of those to treat all the kid neuro cases within a few hundred miles of me (and that distance includes some major cities).
 
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