Neurology vs. EM

[FictionalGirl]

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Hello everybody, I'm having a problem deciding what to do with the limited time we've been given: I really enjoyed neurology, but i do incredibly poorly with overnight call and just get exhausted. I think I'd be good at neurology, I'm interested in the material, the patients, the creativity..... but I'm afraid. I don't ever want to be as unhappy as I was in medical school. I know that residency is tough no matter what, but I worry, because sleeplessness actually makes some medical problems i have get much much worse, and makes me depressed. I'm not afraid of working hard, which is what I know some people will say, but it's not true. I just know my limitations. I'm looking for a life where I have time to write (i'm a science fiction writer, at least i was before medical school and want to be again) and have a family and work half time hopefully when my kids are little. But I also want to do something I'm good at and enjoy it. What I don't really know is what life is like in neurology -- our residency program at my school is pretty hard-core. The residents are overworked, exhausted and the attendings are too. I don't really understand what I'd be getting myself into (and does anyone know what programs have night float?? perhaps thats an option) and I don't know what life is like after residency either.

My other option is Emergency. I also enjoy it, the hours in residency seem to be more reasonable, and i'm a bit more familiar with the options and what the career is like. But I can't shake neurology. it seems like a career that would have staying power for me. If anybody could comment on my concerns and their experiences in neurology it would be great. It's so hard to base a decision on a 6 week rotation done in the third year that's a very artificial environment (At least the third years role)

Also, I may not have the chance to do an additional rotation in neurology until after the applications are already due, but i can get recommendations from my core rotation.... will this be a problem?

Thanks for the input

 

[omgwtfbbq?]

Hi Fictional.... I think we may have gone to grad school together.... but back on topic, I also went through the process of deciding between EM and Neurology, which a lot of people thought was a strange two to whittle it down to. PM me if you want to chat.

 

[PhakeDoc]

Well, I think with the new work hours regulations likely to be put in place by next summer, overnight call seems to be a dying entity.

 

[medsRus]

Well, I think with the new work hours regulations likely to be put in place by next summer, overnight call seems to be a dying entity.

I'm glad to hear that. Is there a nice sheet that shows the proposed regulations???

 

[chite85]

Here's a link to a very recent article outlining the proposed ACGME recommendations and views from about 500 surveyed program directors.

http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/21559

 

[Head]

I think there are already quite a few neurology programs that have implemented the night float system, so you could potentially apply only to those. This would probably work well for you because you would have a couple of months each year that were strictly nights and then the rest would be daytime. I think ER would actually be worse in this regard because they often switch between shifts at various times of day and night even in the same month.

You could taylor your job after residency to your needs. Many jobs will require you to take overnight call roughly once a week. The good news is that this is usually home call and you are very rarely called in the middle of the night. Alternatively you could stay in academics where residents field all the calls and you almost never get called at night.

I don't know of any programs off hand that are strictly night float, but many others on this forum could probably name a few.

 

[neurolddoc]

Some thoughts from a point of view a bit down the road:

The issues about hours in training loom large in your immediate future but residency is 3 years; you will be practicing for 30. You sound like you would eventually like to have a part time practice with fairly predictable hours. An office based neurology practice could potentially be a fit. Some practices are limiting the amount of inpatient work they do and I think that a part-timer could find a place, particularly if you have electrodiagnostic skills. I will defer to the academic types about the part-time possibilities in academia.

ER work will always be shift work. What I have observed in various size hospitals is that the full-time senior people have the weekday 8-5 shifts and the part-timers are on for off-shifts. To my mind that would be a problem but I suppose it depends on what type of schedule would work for you.

 

[danielmd06]

I think both specialties would fit the long-term, private practice lifestyle you want, but I believe neurology would offer you a lot more flexibility in the post-residency world. As pointed out above, most ER docs are pulling shifts, and this means you're gonna get some wacky hours as part of your responsibilities at some point in your career. You would definitely have more of a 9-5 life as a neurologist in private practice than what alot of neurology residencies are structured like, too.

Furthermore, neurologists are in relatively high demand right now (and only getting moreso according to projected needs and an aging US population), and I think that post-residency you could literally find any reasonable fit you would want. You could work strictly inpatient (on ER-type hours) as a neurohospitalist, or you could work in a strictly outpatient practice.

I think most ER residencies are much easier than most neurology residencies right now in the terms you are speaking of...but remember that residency is temporary and the permanent job you are really going to have is something potentially very different from your residency experience as a neurologist.

Also, as mentioned above, the forthcoming work hour restrictions will really level the playing field between different specialty-specific resident hours.

Whatever your decision, good luck!

 

[Curious Tom]

Without hijacking the OP's immediate concern, does anyone have an insight as to why so many of us that have always loved neurology also have a peculiar attraction to EM?

I, too, considered EM as my second option till few months ago.

 

[AznTrojan]

if you like EM and neurology.. check out neurocritical care

 

[Arcan57]

Neuro and EM both interested me, but I came it choosing from the opposite perspective. If the circardian shifts of EM were intolerable during my student rotation, I was going to apply to neuro. EM residencies have a significant number of on-call months on off-service rotations (traditionally being heavily weighted towards ICU and surgical subspecialties). Of the ten off-service rotations I did, 9 of them had overnight call. Also, while you are in the emergency department approx 2/3 of your shifts will be evenings, nights and weekends. This distribution will likely continue for the rest of your career.
There are excellent reasons to choose EM, but wanting to avoid overnight call in residency is not one.

Neurocritical care does combine a lot of the procedural aspects of EM with less of the troll/drug-seeking population and more time to actually think about a patient's disease process. I loved my month in the NSICU, and having it at the beginning of my second year really solidified my central and arterial line skills. 15-20% of my program's graduating class have stayed for a neuro critcare fellowship. That being said, it seemed like the neuro intensivists worked longer hours than either neuro or EM.

 

[AOX4]

bump..

anyone care of add more to this thread? What specality can give you a better lifestyle neuro or EM?

 

[danielmd06]

bump..

anyone care of add more to this thread? What specality can give you a better lifestyle neuro or EM?

You may want to re-read my posts. I specifically answer this question.

If anyone else has more to offer though...I'd love to hear also.

 

[AOX4]

I think both specialties would fit the long-term, private practice lifestyle you want, but I believe neurology would offer you a lot more flexibility in the post-residency world. As pointed out above, most ER docs are pulling shifts, and this means you're gonna get some wacky hours as part of your responsibilities at some point in your career. You would definitely have more of a 9-5 life as a neurologist in private practice than what alot of neurology residencies are structured like, too.

Furthermore, neurologists are in relatively high demand right now (and only getting moreso according to projected needs and an aging US population), and I think that post-residency you could literally find any reasonable fit you would want. You could work strictly inpatient (on ER-type hours) as a neurohospitalist, or you could work in a strictly outpatient practice.

I think most ER residencies are much easier than most neurology residencies right now in the terms you are speaking of...but remember that residency is temporary and the permanent job you are really going to have is something potentially very different from your residency experience as a neurologist.

Also, as mentioned above, the forthcoming work hour restrictions will really level the playing field between different specialty-specific resident hours.

Whatever your decision, good luck!

excellent post. another good way to think of EM is that 2/3 of your shifts will be nights or weekends. what is neuro call like?