Pathway to neurology advice

[zaben]

MDPHD student here looking for some advice concerning how to get to neurology after potentially not matching this year in neurosurgery. Just a little background: I was on the fence between Neurosurg and neurology and Ultimately went neurosurg after feeling like I enjoyed the OR more, but at the same time I enjoyed my neuro rotation and working with many neurologists in my PhD.
In terms of numbers and such, I am a competitive applicant: I got 270+ step1, 280+ step2, AOA and top quartile grades, published 20+ papers etc I am a good candidate on paper and I have a ton of neurosurgery interviews because of it. Unfortunately, in my chairman’s clinic on my subI I got a lot of questions wrong on vascular trials and he wrote extensively about that in my letter of rec (I wouldn’t have even applied Neurosurg if he told me this was going to be my letter) which has come up in almost all of my interviews and I just think it’s so bizarre in this day and age to have any negativity at all in a letter of rec that I don’t think I’m going to match and am trying to plan ahead.
I spoke with the neurology PD at my school and they said I should have no problems matching to neurology if I do a research year and they will write me a good letter as I worked with them on my neuro rotation, but I’m terrified at the prospect of being “out of the system” for a year and spent most of my PhD working across from a lab with IMGs who applied neuro every year and never matched and it just seems like it doesn’t actually work out most of the time? I’m of course going to try to SOAP into any limited neuro spots, but if that fails I’m just wondering if anyone has advice on next steps to realistically find a path to neurology whether it be through a prelim year or trying to delay graduation etc. I feel like I’m in a living nightmare tbh and the only reason I am able to stay sane through this is for my wife and kid and I would give anything to go back in time and just apply neurology from the start but this is where I am and just looking for options or stories of reapplications etc

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[confused_doc]

If neurosurgery is your passion can't you do a research year in neurosurgery and get a letter from that? You shouldn't have to settle with such insane stats. Neurology isn't even competitive so there's absolutely no doubt that you'll get it if you want it. But you've clearly worked so hard to get neurosurgery and I don't think your dream should be derailed because of the evil chairman. I honestly think you should report him as they're not even allowed to send out negative recommendation letters.

But anyway I just reread again and you don't yet know if you've matched or not. Chances are you absolutely have matched, it's hard not to be neurotic and good to have a plan B, but also don't be too defeatist. If you want neurosurgery definitely don't settle for less, you've got this.

 

[Neurogeneral]

You could still match to NSG with your top
levels stats and background. If you don’t though I wouldn’t scramble and settle for an unmatched neuro spot. I would probably do a research year and figure out what you want to do next. If you truly want to do neurosurgery, I would apply again next year while continuously beefing up your application with more research or maybe even deferring your graduation and doing more clinical electives. Don’t let this chairman crush your dreams! Don’t sell your self short by going to a third rate residency position that no one really wanted.

Now, if you really want to do neuro, apply to top 20 programs next year. If you are someone who is more procedure-inclined, consider anesthesia or interventional radiology. If you are someone who loves procedures, those are good options. Our neurosurgery program was cut throat and had a reputation for terminating their residents and those were the programs that they tended to parachute into instead of neurology.

 

[drg123]

MDPHD student here looking for some advice concerning how to get to neurology after potentially not matching this year in neurosurgery. Just a little background: I was on the fence between Neurosurg and neurology and Ultimately went neurosurg after feeling like I enjoyed the OR more, but at the same time I enjoyed my neuro rotation and working with many neurologists in my PhD.
In terms of numbers and such, I am a competitive applicant: I got 270+ step1, 280+ step2, AOA and top quartile grades, published 20+ papers etc I am a good candidate on paper and I have a ton of neurosurgery interviews because of it. Unfortunately, in my chairman’s clinic on my subI I got a lot of questions wrong on vascular trials and he wrote extensively about that in my letter of rec (I wouldn’t have even applied Neurosurg if he told me this was going to be my letter) which has come up in almost all of my interviews and I just think it’s so bizarre in this day and age to have any negativity at all in a letter of rec that I don’t think I’m going to match and am trying to plan ahead.
I spoke with the neurology PD at my school and they said I should have no problems matching to neurology if I do a research year and they will write me a good letter as I worked with them on my neuro rotation, but I’m terrified at the prospect of being “out of the system” for a year and spent most of my PhD working across from a lab with IMGs who applied neuro every year and never matched and it just seems like it doesn’t actually work out most of the time? I’m of course going to try to SOAP into any limited neuro spots, but if that fails I’m just wondering if anyone has advice on next steps to realistically find a path to neurology whether it be through a prelim year or trying to delay graduation etc. I feel like I’m in a living nightmare tbh and the only reason I am able to stay sane through this is for my wife and kid and I would give anything to go back in time and just apply neurology from the start but this is where I am and just looking for options or stories of reapplications etc

I'm really sorry. This sounds completely ridiculous. But I guess the silver lining is, you're still getting interviews, which means the programs still liked you enough to take a look. So you have a chance to control their impression. Not to mention, your stats on paper should give no doubt that you are super intelligent and your chairman was grumpy and totally unreasonable. Some of your interviewers must know how strange his gripe is, and wouldn't pass on a stellar candidate because you didn't know some small sliver of info as an M4. I know that's not your question, but I think the other posters here have assured you, you'd get whatever you want in Neurology. The question is, is that what you really want? If NSGY is what you want, pursue it. I hope you'll match. Keep us posted.

 

[xenotype]

MDPHD student here looking for some advice concerning how to get to neurology after potentially not matching this year in neurosurgery. Just a little background: I was on the fence between Neurosurg and neurology and Ultimately went neurosurg after feeling like I enjoyed the OR more, but at the same time I enjoyed my neuro rotation and working with many neurologists in my PhD.
In terms of numbers and such, I am a competitive applicant: I got 270+ step1, 280+ step2, AOA and top quartile grades, published 20+ papers etc I am a good candidate on paper and I have a ton of neurosurgery interviews because of it. Unfortunately, in my chairman’s clinic on my subI I got a lot of questions wrong on vascular trials and he wrote extensively about that in my letter of rec (I wouldn’t have even applied Neurosurg if he told me this was going to be my letter) which has come up in almost all of my interviews and I just think it’s so bizarre in this day and age to have any negativity at all in a letter of rec that I don’t think I’m going to match and am trying to plan ahead.
I spoke with the neurology PD at my school and they said I should have no problems matching to neurology if I do a research year and they will write me a good letter as I worked with them on my neuro rotation, but I’m terrified at the prospect of being “out of the system” for a year and spent most of my PhD working across from a lab with IMGs who applied neuro every year and never matched and it just seems like it doesn’t actually work out most of the time? I’m of course going to try to SOAP into any limited neuro spots, but if that fails I’m just wondering if anyone has advice on next steps to realistically find a path to neurology whether it be through a prelim year or trying to delay graduation etc. I feel like I’m in a living nightmare tbh and the only reason I am able to stay sane through this is for my wife and kid and I would give anything to go back in time and just apply neurology from the start but this is where I am and just looking for options or stories of reapplications etc

I think your options are many and you have no need to be afraid of being stuck/being in a nightmare. The hard part for you is actually just deciding what you want if the 'worst' happens as the options are vast with your excellent background.

1) This is assuming you don't match NSGY as you absolutely may still match- I think this is the likeliest outcome. Who cares if you got some questions on trials wrong? You are smart enough they'll be certain you pass the boards and a knowledge deficit is the easiest thing to fix in a resident that is obviously smart with a good background medical knowledge as your stats indicate. Personality problems/professionalism issues are hard to fix and the major thing in a letter that would sink a person.
2) You could try again for NSGY and you may well match the second time around.
3) There will be some SOAP spots and you'd be an absolute top contender anywhere to get one, and a top contender even if you got a prelim IM at a place with a neuro residency to match into an advanced position later.
4) You could potentially get an out of match neurology spot somewhere with those stats anytime. We had an out of match person join a class in my residency partway through the year (and they were excellent). However, you won't get a lot of choice on where you go if you want something out of the match. You'd be an obvious top contender for an out of match spot at pretty much any program that had one. They won't care if you aren't good at neurovascular disease, they'll know you are teachable.
5) You'd 100% certainly match neurology next year and quite possibly would match at a top program of your choice.

If you like procedures/the OR and NSGY ends up not working out I think you could be quite happy in neurointerventional neurology/NIR with a neurocritical care background. It gets very close to neurosurgery on pretty much every aspect, so much so that most NIR neurologists have neurosurgery personalities, dispositions, and awful call schedules. Interventional pain is also doable with enough hard work which you have already proven yourself capable of. If you enjoyed your neuro rotation in med school you'll probably do just fine in neurology residency.

One thing that may not be impossible right now would be to ask for a big favor and apply to your home neurology residency as a backup. They might do it and give you a special interview spot, then include you into their match- I don't think it is technically too late. You might be able to add a few more programs that either have very late interviews or if any neuro faculty at your program would be willing to pull a favor for you with a friend somewhere else.

 

[Spinothalamic]

MDPHD student here looking for some advice concerning how to get to neurology after potentially not matching this year in neurosurgery. Just a little background: I was on the fence between Neurosurg and neurology and Ultimately went neurosurg after feeling like I enjoyed the OR more, but at the same time I enjoyed my neuro rotation and working with many neurologists in my PhD.
In terms of numbers and such, I am a competitive applicant: I got 270+ step1, 280+ step2, AOA and top quartile grades, published 20+ papers etc I am a good candidate on paper and I have a ton of neurosurgery interviews because of it. Unfortunately, in my chairman’s clinic on my subI I got a lot of questions wrong on vascular trials and he wrote extensively about that in my letter of rec (I wouldn’t have even applied Neurosurg if he told me this was going to be my letter) which has come up in almost all of my interviews and I just think it’s so bizarre in this day and age to have any negativity at all in a letter of rec that I don’t think I’m going to match and am trying to plan ahead.
I spoke with the neurology PD at my school and they said I should have no problems matching to neurology if I do a research year and they will write me a good letter as I worked with them on my neuro rotation, but I’m terrified at the prospect of being “out of the system” for a year and spent most of my PhD working across from a lab with IMGs who applied neuro every year and never matched and it just seems like it doesn’t actually work out most of the time? I’m of course going to try to SOAP into any limited neuro spots, but if that fails I’m just wondering if anyone has advice on next steps to realistically find a path to neurology whether it be through a prelim year or trying to delay graduation etc. I feel like I’m in a living nightmare tbh and the only reason I am able to stay sane through this is for my wife and kid and I would give anything to go back in time and just apply neurology from the start but this is where I am and just looking for options or stories of reapplications etc

The main question I have is whether or not you truly want to do neurosurgery. If you are starting to have second thoughts and would prefer neurology that is one thing. One of the best pieces of advice that I ever heard was from a neurosurgery chief resident who said something along the lines of “if you can picture yourself enjoying anything else in medicine, do that instead of neurosurgery”. Followed by anecdotes about how his two year old barely knew who he was. Like many people in neurology I was totally down the rabbit hole of neurosurgery with pubs, a master’s year, etc prior to ultimately deciding that I didn’t like the idea of being called when someone else figured something out and just needed a procedure done. (Of course I have tremendous respect for our NSG colleagues but ultimately it wasn’t the right fit for me.)

However if you are set on NSG, excited for it, etc then I agree to definitely not give up hope! Honestly as long as there is not a personality problem you would likely match this year or next year despite the letter. Most people with the type of personality problems that are troublesome during the match don’t actually realize they have a personality problem, but it probably would have come up on some other letters throughout your education in some way.

The only thing I would add is that I would not be discussing any possible neurology match with any program that has also NSG department including your home program. People talk, especially in NSG, and you could become a pariah very quickly!

 

[liquidshadow22]

Do a year of gen surg prelim if needed. High attrition rate you can look for a pgy 2 spot potentially

Don't go neurology, you eliminate the possibility of transferring into neurosurg

 

[slavicman]

I feel like neurosurgery isn't one of the fields you can go in being "on the fence", given the extraordinary time commitment. The situation with the chairman is horrible but not shocking as I have found the surgery culture overall to be less kind to one's individual needs during my rotations, something to consider down the line.

I would consider doing neurology with sub-specializing in neuro-critical care and/or neuro-interventional where you get to be a procedural neurologist and get a mix of both worlds. Can't imagine having any difficulty getting into a top notch neurology program with those stats even with applying off-cycle.

 

[Dr Meow]

Omg your amazing stats and I am reading your post and imagining all the hard work you must have put into this in addition to your natural talent with my jaw dropped to the floor. I'm just a OMS1 but to get this far just to be backstabbed by your boss.....you must continue just to spite his sorry ass (if neurosurgery is what you want). 10 years later, invite him to diner and make him cover the bill

You are an inspiration.

 

[scoopdaboop]

MDPHD student here looking for some advice concerning how to get to neurology after potentially not matching this year in neurosurgery. Just a little background: I was on the fence between Neurosurg and neurology and Ultimately went neurosurg after feeling like I enjoyed the OR more, but at the same time I enjoyed my neuro rotation and working with many neurologists in my PhD.
In terms of numbers and such, I am a competitive applicant: I got 270+ step1, 280+ step2, AOA and top quartile grades, published 20+ papers etc I am a good candidate on paper and I have a ton of neurosurgery interviews because of it. Unfortunately, in my chairman’s clinic on my subI I got a lot of questions wrong on vascular trials and he wrote extensively about that in my letter of rec (I wouldn’t have even applied Neurosurg if he told me this was going to be my letter) which has come up in almost all of my interviews and I just think it’s so bizarre in this day and age to have any negativity at all in a letter of rec that I don’t think I’m going to match and am trying to plan ahead.
I spoke with the neurology PD at my school and they said I should have no problems matching to neurology if I do a research year and they will write me a good letter as I worked with them on my neuro rotation, but I’m terrified at the prospect of being “out of the system” for a year and spent most of my PhD working across from a lab with IMGs who applied neuro every year and never matched and it just seems like it doesn’t actually work out most of the time? I’m of course going to try to SOAP into any limited neuro spots, but if that fails I’m just wondering if anyone has advice on next steps to realistically find a path to neurology whether it be through a prelim year or trying to delay graduation etc. I feel like I’m in a living nightmare tbh and the only reason I am able to stay sane through this is for my wife and kid and I would give anything to go back in time and just apply neurology from the start but this is where I am and just looking for options or stories of reapplications etc

damn dude. I mean you don't know if you haven't matched yet, but i imagine someone with these stats and pubs will match...how many interviews did you get?

 

[mrbreakfast]

Unfortunately, in my chairman’s clinic on my subI I got a lot of questions wrong on vascular trials and he wrote extensively about that in my letter of rec (I wouldn’t have even applied Neurosurg if he told me this was going to be my letter) which has come up in almost all of my interviews and I just think it’s so bizarre in this day and age to have any negativity at all in a letter of rec that I don’t think I’m going to match and am trying to plan ahead.

This is absolutely insane. I'm sorry this happened to you.

I feel that you would match easily into neurology at my program (top-20) even if you had to reapply. If I were you, I'd probably try to SOAP into a neurosurgery program, but I think your chances of matching into a good neurology program are higher than you think. I might just consider reapplying and trying to match somewhere you really want to be rather than SOAPing into a place you don't.

 

[StrokedocUNM]

I am sorry to hear about your experience. Unfortunately, having graduated several years ago or being an IMG is a perceived barrier for many program directors. I would consider applying for a neurology pre-residency training program to work one year in a supervised clinical environment. The goal would be to demonstrate that you are not only book smart but also able to function within the US healthcare system and in a hospital environment. Ideally, you could bolster your clinical skills and find faculty to write you strong letters of recommendation when the time comes. University of New Mexico offers such a pre-residency program. Check it out. Hope this helps. Best of luck.