Neurophysiology fellowship: do or don't

[lakeplacid]

Hi all,

I'm a PGY-3 debating whether I should do a Neurophysiology fellowship
(already applied to a few programs) or just become a general
neurologist after residency.

I'm not interested in an academic career- at least not right now.
With the direction healthcare is headed in this country, I'm thinking
a salaried job at a hospital (like as a neurohospitalist seeing
consults or doing clinic or some reasonable combination thereof) would
be fine. I've been informally looking for jobs as well, and I've
noticed that many of them seem to be looking for general neurologists
or neurohospitalists with stroke training. In other words, doing a
neurophys fellowship wouldn't be beneficial or necessary at all.

Now, I originally wanted to do a fellowship b/c I happen to like
epilepsy and reading EEGs. The EMG stuff is just part of the package-
I don't particularly care one way or the other, esp. since the
reimbursement is down. However, do I really like epilepsy/EEGs enough
to do a whole addtl year of it? I don't know.

I kind of just want to get started on my neurology career and make
real money. I feel like the practical thing would be to just do
general neurology and forget about the fellowship, b/c it doesn't seem
like there is that much demand out there for neurophysiologists. I
have a feeling I would end up accepting a general neurology job even
with the fellowship, and one of my fears is that the addtl fellowship
training might even make people not want to hire me as much b/c they
think I will have certain expectations ( e.g. want higher compensation
or want to work in a facility with an EMU, etc.).

For those of you who have done a fellowship or are out in the real
world, do you have any tips on how I should make my decision? On one
hand, I want to get started with my career b/c I wonder if the
compensation is just going to decline with the new healthcare
legislation, but I also don't want to regret not doing a fellowship.
However, it is a whole year and I'm not getting any younger!

Thanks for any input!

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[NeuroDocDO]

If you are interested in being a neurohospitalist, I believe that a neurophys fellowship with emphasis on EEG or a vascular fellowship is helpful. I feel that general outpatient neurology is dead and most neurologists are joining large hospitals as large health organizations are what will survive the helathcare overhaul. EMG/NC is unfortunately no longer going to help the outpatient neurology offices sustain themselves financially. As a neurohospitalist who received very good general neurology training and vascular neurology training in residency, I decided to pursue a neurophys fellowship to beef up my EEG skills. I read EEG very frequently in the hospital setting and I feel that additional training certainly gave me the confidence to read on my own. You certainly do not need a fellowship and I could have been hired without and could even read the EEG's without the training. I still feel that it was worth it and sub-specialty training does make you stand out more from the crowd. These are just my thoughts.

 

[DD214]

"I kind of just want to get started on my neurology career and make
real money."

I feel for you, but the train has left the station.

 

[bustbones26]

"I kind of just want to get started on my neurology career and make
real money."

I feel for you, but the train has left the station.

Today, I struggled performing NCS on the legs of a fatty, which I hate to do, but eventually knocked out a good quality study. It just took me longer than expected. This is sickening whenever I see the pain guys next door run every patient into a flouroscopy suite, shove needle into their back, and collect 8 times what I make on an EMG/NCS in 1/4 of the time.

Then again, it also sickens me that I have to jump through hoops to get botox for a patient with chronic migraine that has failed everything, and whenver I do get it approved, the reimbursement is minimal. Yet, I see the pain doctors do injections on people with normal L-spine MRIs and somewhat collect four figures in cash?

&$&%, I went into the wrong speciality. They got it figured out! They inject a patient, the patient follows up with a PA-C and dumps their whining and complaints onto the PA-C.

But then again, let's see how long their gravy train lasts?

 

[bustbones26]

Hi all,

I'm a PGY-3 debating whether I should do a Neurophysiology fellowship
(already applied to a few programs) or just become a general
neurologist after residency.

I'm not interested in an academic career- at least not right now.
With the direction healthcare is headed in this country, I'm thinking
a salaried job at a hospital (like as a neurohospitalist seeing
consults or doing clinic or some reasonable combination thereof) would
be fine. I've been informally looking for jobs as well, and I've
noticed that many of them seem to be looking for general neurologists
or neurohospitalists with stroke training. In other words, doing a
neurophys fellowship wouldn't be beneficial or necessary at all.

Now, I originally wanted to do a fellowship b/c I happen to like
epilepsy and reading EEGs. The EMG stuff is just part of the package-
I don't particularly care one way or the other, esp. since the
reimbursement is down. However, do I really like epilepsy/EEGs enough
to do a whole addtl year of it? I don't know.

I kind of just want to get started on my neurology career and make
real money. I feel like the practical thing would be to just do
general neurology and forget about the fellowship, b/c it doesn't seem
like there is that much demand out there for neurophysiologists. I
have a feeling I would end up accepting a general neurology job even
with the fellowship, and one of my fears is that the addtl fellowship
training might even make people not want to hire me as much b/c they
think I will have certain expectations ( e.g. want higher compensation
or want to work in a facility with an EMU, etc.).

For those of you who have done a fellowship or are out in the real
world, do you have any tips on how I should make my decision? On one
hand, I want to get started with my career b/c I wonder if the
compensation is just going to decline with the new healthcare
legislation, but I also don't want to regret not doing a fellowship.
However, it is a whole year and I'm not getting any younger!

Thanks for any input!

Sorry to get distracted earlier.

I agree with others that good EEG training would likely help you be a good neurohospitalist. Yeah, its another year of not making money, but my suggestion would be to find a cushy program that will let you read and learn EEG well. You might find that year a break. I have to say, I wish I had a break before I went out into the "real world".

 

[GalenWoman]

I do not think you make good money with EEGs, unless you do continous or extended, reimbursenet is otherwise very little