Hi,
I just got accepted to medical school after working in a neuroscience lab for 5 years. I'm really interested in epilepsy, especially in children and have co-authored 15 papers. I was just wondering why child neurology is not as popular and whether its a good field to pursue. Also, why is the salary so bad?
thanks
The first part of your posts indicates that you might find Child Neurology interesting, or you might not, remember a lot of people change their minds during medical school and fortunately you will gain exposure to a broad range of disciplines, some during the first two years i.e. perhaps an internal medicine clinic half a day a week. But really during your third year you might decide that ob/gyn or surgery is for you, or you may take a peds neurology elective and find out that you love it.
1. Why is child neurology not so popular?
Child neurology is a pediatric specialty, and as such will draw only from those who find that they like working with children. Many medical students find that dealing with screaming children and very worried parents is not for them after having planned on a doing a pediatric subspecialty as a career. So, at a get-go child neurology draws from a limited slice of the medical student pie.
The work of a child neurologist is very different from other fields of medicine. You may often times spend huge amounts of time filling out paperwork for getting services for children and doing other work which appears non-medical in nature to a novice, such as talking with parents at length about problems a child is having relating with siblings at home.
There are not a lot of procedures in child neurology, which means lower salary, and that to do a good ethical job you may need to spend more time with patients than an internist or pediatrician would be able to. So it is hard to bill and quantify what a child neurologist does. Most epilepsy in children is not treated by child neurologists and is treated by pediatricians, child neurologists are consulted with atypical or difficult to treat epilepsy which takes more time. While there may be a shortage, or actually severe shortage of child neurologists in an area, many of the functions of a child neurologist can be performed by pediatricians or adult neurologists who may have a fellowship in child neurology. So, no, not even a high demand for child neurologists has driven up salary as you really need to take your time when seeing these patients. Most pediatric subspecialties don't pay a whole lot more than general pediatrics, very different from adult subspecialties which have a lot of procedures.
The length of training is a real consideration. For a combined program, a resident does 2 years of Pediatrics (or 1 year of peds and research, or one year of internal medicine and one year of pediatrics) and then 3 years of child neurology. This is five years total, so it takes a committed person who can delay paying back loans to do this. Many peds people opt to do a general pediatrics residency and then decide to do a fellowship from there, which you could do for child neurology, but then the length of the training would be 6 years.
While there are other residencies that are long, like neurosurgery and general surgery (5 years plus fellowship . . . ) child neurology is not seen as glamorous as these perhaps and many medical students have no exposure to the field.
2. Is Child Neurology a good field?
Demand is good, outside of a few metropolitan areas, but this has not translated to a relatively higher salary than other physicians. Of course you can earn a good living as any type of physician and the issue might be how well respected are child neurologists? Neurologists have in the past enjoyed a large amount of respect, being able to localize lesions and as master diagnosticians, but with MRI and Head CT, these days have largely passed, and the golden age of Neurology being held in a very high esteem has passed. At least when I did a neurology elective, the general peds service wasn't especially impressed with neurology and most residents were interested in critical care, neonatology and peds cardiology. There is a perception that neurologists can't cure anything also, perhaps more so for child neurologists as no can cure as yet the multitude of developmental disorders or epilepsy, though I am sure you know more about gene therapy and channelopathies than I, so you know there is a lot of interesting bench neuroscience research. Most neurologists view their work as important and their input important, and caring for children with epilepsy IS important even if they can't be cured. I was surprised in medical school that the most sought after/respected specialties were surgical specialties such as ENT/Ortho, and other fields such as radiology even, these students seemed to have a real passion for entering these fields as well, or at least were desperate in waiting to get a position in these fields.
You would have to decide if Child Neurology is for you after having done third year clerkships, ideally take pediatrics clerkship first, and if you like it then sign up for a child neurology elective. Of note, many child neurologists feel satisified with their career regardless of the longer training and pay, although I haven't seen them specifically singled out on the list of top 5 careers in medicine that have the most satisfaction. The average Step 1 for child neurology residency matriculants was around 222 or so this, year, which is almost identical for the vastly larger number of people going into internal medicine, however, there are a lot of people with research background in child neurology.
My advice would be to study hard during the first two years, and do something fun during the summer, you already have a lot of research, and give Child Neurology a look, and if you are still interested in neuroscience research and really see yourself enjoying child neurology despite what others say about the field then perhaps it is for you, but definitely keep your options open.
There is website for the Child Neurology Society:
http://www.childneurologysociety.org
