Neurology vs IM + fellowship

[scoopdaboop]

I'm assuming people that are interested in neuro were also interested in IM? How do you go about making this decision?

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[Chibucks15]

I'm assuming people that are interested in neuro were also interested in IM? How do you go about making this decision?

Dealing with endless discharge summaries and paperwork BS was the defining factor as to why NOT to do IM. It's soul sucking. With neuro you can sign off at least in most cases

 

[kazill]

Dealing with endless discharge summaries and paperwork BS was the defining factor as to why NOT to do IM. It's soul sucking. With neuro you can sign off at least in most cases

Specialists who do a post-IM fellowship also get the same benefit of being able to sign off. It’s just a 3 year period where that would be the issue (is my impression, with the caveat that getting a fellowship isn’t guaranteed). I’m currently also dealing with the decision to go for neuro or IM with the intention to specialize, learning how others came around to that decision considering their long term career would be helpful!

 

[NITRAS]

It amazes me the amount of people that go through great pains to avoid actually taking care of patients.

You don’t think that neurology doesn’t have their paperwork BS? Who do you think does the prior authorization for their endless expensive and niche medications? Or you are stuck in the hospital doing a stroke eval at 3am.

Go to neurology if you want to practice neurology.

Do IM if you want to do anything related to IM.

 

[mrbreakfast]

Dealing with endless discharge summaries and paperwork BS was the defining factor as to why NOT to do IM.

You will also have to do a lot of paperwork as a neurologist, even as inpatient. I would estimate the average neurohospitalist writes more chart documentation than an IM hospitalist (depends on setting). In outpatient, neurologists prescribe lot of expensive meds (like botox) and deal with a lot of disability/FMLA paperwork, which is much worse than discharge summaries.

I'm assuming people that are interested in neuro were also interested in IM

I would say this is actually probably less common than you might think. A lot of the neurologists I know were also interested in surgery (particularly ortho) or emergency medicine - a neurohospitalist may log more hours in the ED than an actual ED physician. A lot of people like the emphasis on the exam and (generally speaking) not on labwork, which is kind of the opposite of IM. The idea of restoring physical function is attractive to some. All of those were true for me. My med school IM experience was a few minutes of putting stethoscopes on patients and hours talking about numbers every day; I hated it.

Another question is asking yourself what kind of patients and diagnoses you like seeing, and compare that to the "bread and butter" of different specialties/subspecialties, as well as the patient population those illnesses generally affect.

Really, just do what you're interested in.

 

[deathmerchant]

I'm assuming people that are interested in neuro were also interested in IM? How do you go about making this decision?

When I was a med student, I was interested in Neurosurgery, Neurology and IM.

Comparing Neuro to IM is not fair because Neuro is technically a subspecialty/consult service. In fact, in most other countries neuro is a fellowship after IM residency.

First decide if you want to specialize and be a consult only type person and deal with just one organ system or want to do a primary care type of work. If you want to specialize, then pick some IM fellowships that you might be interested in and then you/we can compare Neurology to those.

 

[90sportsfan]

I'm assuming people that are interested in neuro were also interested in IM? How do you go about making this decision?

I disagree with this. I am interested in Neuro and knew (and confirmed) that I don’t want to do IM. I would guess that there are not many who are torn between Neuro vs IM. Neuro attracts people who are interested in Neurology. IM attracts people who have a more broad Medicine interest and they may have an interest in a single organ/system at some point. If you go into Neuro, you are interested in the brain/CNS.

 

[Drrrrrr. Celty]

I disagree with this. I am interested in Neuro and knew (and confirmed) that I don’t want to do IM. I would guess that there are not many who are torn between Neuro vs IM. Neuro attracts people who are interested in Neurology. IM attracts people who have a more broad Medicine interest and they may have an interest in a single organ/system at some point. If you go into Neuro, you are interested in the brain/CNS.

A lot of people go into IM exclusively because they are interested in subspecialization. I know I personally didn't do FM because I didn't want to be limited to primary care if I decided I wanted a subspecialty.

I think Neuro is just the same as someone wanting to do Cardio off the bat. You're interested in an organ system or a set of diseases.

 

[kazill]

First decide if you want to specialize and be a consult only type person and deal with just one organ system or want to do a primary care type of work. If you want to specialize, then pick some IM fellowships that you might be interested in and then you/we can compare Neurology to those.

Not to hijack the OP’s thread but I personally am split between pursuing neuro or pursuing heme/onc. Both allow for long term relationships with patients, both also have interesting inpatient work, both have lots of opportunity for research and have emerging treatments, both are subject material I find fascinating, and both are super employable in the areas I want to live.

Basically I have no idea what to consider to choose between the two other than salary (which from my understanding is higher in heme/onc) and general gut feeling.

I know neuro-oncology is a field I can pursue but based off of the thread recently on this forum I get somewhat lukewarm vibes from that as a subfield.

 

[sharkbaitwhohaha]

Not to hijack the OP’s thread but I personally am split between pursuing neuro or pursuing heme/onc. Both allow for long term relationships with patients, both also have interesting inpatient work, both have lots of opportunity for research and have emerging treatments, both are subject material I find fascinating, and both are super employable in the areas I want to live.

Basically I have no idea what to consider to choose between the two other than salary (which from my understanding is higher in heme/onc) and general gut feeling.

I know neuro-oncology is a field I can pursue but based off of the thread recently on this forum I get somewhat lukewarm vibes from that as a subfield.

Obviously "long term" is relative

 

[scoopdaboop]

Yeah I prefer IM fellowships over neurology for sure. Cardiology is more interesting + pays better, GI is eh, Heme onc is definetly interesting. Problem is, I would hate to add extra stress by worrying about matching into these somewhat competitive fellowships, and instead neurology is just match and you're set.

 

[NITRAS]

Most people can match into a sub speciality with a year or two of research and brown nosing, but lots of people who plan on subspecialty training. . .don’t. IM is a very broad field and most people can find a job that they like for money that works for them.

Outside of GI (and I bet that changes in the next decade) and cardiology, there isn’t a whole lot of financial benefit to sub speciality training. Also, the sub specialists GI and Cards that make the real big bucks don’t usually have lifestyles that most would envy. It isn’t even that hard to find internists that break $400k-$500k.

I was interested in neurology as a medical student. I probably would have gone Neuro because I loved stroke. . . But realized that at the institution I was at, they never gave tPa because it took too long to get through the ED, and the best therapy for stroke was. . . Aspirin/statin. Things have changed a LOT since then. Neurology actually has lots of cool stuff going for it right now. I have a pinch of regret every now and again, but I really enjoy what i do and the variety. The old time neurologists are some of my favorite consultants.

 

[scoopdaboop]

Most people can match into a sub speciality with a year or two of research and brown nosing, but lots of people who plan on subspecialty training. . .don’t. IM is a very broad field and most people can find a job that they like for money that works for them.

Outside of GI (and I bet that changes in the next decade) and cardiology, there isn’t a whole lot of financial benefit to sub speciality training. Also, the sub specialists GI and Cards that make the real big bucks don’t usually have lifestyles that most would envy. It isn’t even that hard to find internists that break $400k-$500k.

I was interested in neurology as a medical student. I probably would have gone Neuro because I loved stroke. . . But realized that at the institution I was at, they never gave tPa because it took too long to get through the ED, and the best therapy for stroke was. . . Aspirin/statin. Things have changed a LOT since then. Neurology actually has lots of cool stuff going for it right now. I have a pinch of regret every now and again, but I really enjoy what i do and the variety. The old time neurologists are some of my favorite consultants.

I mean heme onc has a lot of money to be made in that field. Also, people said GI will get cut cuz colonoscopy changes like 10 years ago too. But you are right, neurology is cool and always changing, has money to be made with infusions and new drugs coming out etc.

 

[Thama]

Yeah I prefer IM fellowships over neurology for sure. Cardiology is more interesting

If this is how you feel then definitely go IM. If neurology isn't the most interesting thing to you then the pay/lifestyle/prestige factors don't have much to recommend them over other clinical specialties.

 

[90sportsfan]

Yeah I prefer IM fellowships over neurology for sure. Cardiology is more interesting + pays better, GI is eh, Heme onc is definetly interesting. Problem is, I would hate to add extra stress by worrying about matching into these somewhat competitive fellowships, and instead neurology is just match and you're set.

I don’t know....Rheumatology and Allergy are constantly 2 of the highest rated QOL specialties with decent money, little stress/emergencies, and very light hours.

So even if you don’t get into Cardiology, GI, or Heme Onc, you’ve got some pretty good fallback options if you want to specialize after IM (maybe minus the payout). Although you have to enjoy the specialty first and foremost.

 

[Drrrrrr. Celty]

Yeah I prefer IM fellowships over neurology for sure. Cardiology is more interesting + pays better, GI is eh, Heme onc is definetly interesting. Problem is, I would hate to add extra stress by worrying about matching into these somewhat competitive fellowships, and instead neurology is just match and you're set.

I mean it's not like any of this is unidimensional and simple. It's about choosing the path that leads you to where you'll be happy in 10 years. Sure you're working harder to do another match. But you have to ask yourself whether you think it's worth it.


Also you're literally a MS2 who hasn't even done any clinicals. You'll figure it out.

 

[deathmerchant]

Yeah I prefer IM fellowships over neurology for sure. Cardiology is more interesting + pays better, GI is eh, Heme onc is definetly interesting. Problem is, I would hate to add extra stress by worrying about matching into these somewhat competitive fellowships, and instead neurology is just match and you're set.

Yea then you should pick IM. The best part about Neurology is that its the most interesting field, studying the most mysterious and fascinating organ; but only to some people. If you are not in that group of people, then there's nothing in Neuro that is better than various IM fellowships including salary.

 

[xenotype]

Yeah I prefer IM fellowships over neurology for sure. Cardiology is more interesting + pays better, GI is eh, Heme onc is definetly interesting. Problem is, I would hate to add extra stress by worrying about matching into these somewhat competitive fellowships, and instead neurology is just match and you're set.

There are a lot of long, hard nights in neurology residency and long days in clinic after you are done training. You need to love the neurology to get over the level of hate of the pagers and your clinic schedule you are going to have. Pay is highly misleading and always changing- you can make money in neurology if you hustle, and will need to hustle in most IM subspecialties to make money as well. Hustling is not great for burnout, sanity, and sometimes even patient care quality. The fringe benefits in neuro like being able to DC from the ED, being a consultant on most patients, and easy/no fellowship match needed aren't enough to sustain the parts that are draining on their own. You need to love the brain, spinal cord, peripheral nerves and all the weird problems they develop.

When I got to third year and did IM wards for a few weeks that was all I needed to permanently take IM out of consideration, about the fourth 'COPD exacerbation' admitted for social issues I saw. You also couldn't pay me enough to stick cameras up butts or prescribe zyrtec and patch tests all day long- my job is way, way cooler than that.

 

[Chibucks15]

You will also have to do a lot of paperwork as a neurologist, even as inpatient. I would estimate the average neurohospitalist writes more chart documentation than an IM hospitalist (depends on setting). In outpatient, neurologists prescribe lot of expensive meds (like botox) and deal with a lot of disability/FMLA paperwork, which is much worse than discharge summaries.


I would say this is actually probably less common than you might think. A lot of the neurologists I know were also interested in surgery (particularly ortho) or emergency medicine - a neurohospitalist may log more hours in the ED than an actual ED physician. A lot of people like the emphasis on the exam and (generally speaking) not on labwork, which is kind of the opposite of IM. The idea of restoring physical function is attractive to some. All of those were true for me. My med school IM experience was a few minutes of putting stethoscopes on patients and hours talking about numbers every day; I hated it.

Another question is asking yourself what kind of patients and diagnoses you like seeing, and compare that to the "bread and butter" of different specialties/subspecialties, as well as the patient population those illnesses generally affect.

Really, just do what you're interested in.

I mean obviously you have paperwork everywhere but its a different kind of paperwork in my experience. But to each their own