PGY-2 Fellowship Decision - Movement vs Others?

[DrAtheist]

Hi all,

I'm finishing up my PGY-2 year right now and as such am starting to seriously consider different fellowships. At this point I'm starting to lean towards Movement Disorders, but have some reservations about. My top priority is lifestyle at this point as I have small kids and want to be around to see them grow up. Money would be nice but is a distant second priority.

Movement
Pros: Ataxia is probably the most interesting group of disorders to me and Parkinson's/Parkinson's plus are a close second behind Ataxia in terms of interest. DBS is also incredibly cool and rewarding to program. Good mix of bread and butter treatable pathologies and rare disorders. Good outpatient lifestyle. The exam is extremely important in guiding therapies. Long term relationships with patients. Also the rotation that was the most fun and interesting to do.

Cons: In a word, Botox. I really hate hands-on procedures in general and the idea of having to do Botox to be financially competitive is not appealing. I'm willing to suck it up if I need to learn it to finish fellowship, but I would ideally not do it at all in my eventual practice. Additionally, I'm not 100% sure that I want to be in academics for the rest of my life and it seems like DBS programming is hard to come by in the community.

MS/Neuroimmunology:
Pros: Lots of strange and rare conditions that are really interesting. Improving treatment options with lots of growth in the future. Good outpatient lifestyle. Don't have to do any procedures to be competitive. Lots of interesting neuroimaging analysis. Long term relationships with patients.

Cons: The patient population can be really needy and difficult to work with in my experience. Significant risk of causing serious adverse events with medications. Lower end of the pay scale.

Epilepsy
Pros: Have an interesting and billable procedure with EEGs. Long term relationships with patients. Some low stress inpatient to add some variety to the practice. Good treatment options for large portion of patients and interesting neuromodulation. Outpatient lifestyle.

Cons: Pseudoseizure patients are really hard to deal with. While functional patient's are a mainstay of almost every subspeciality, pseudoseizures take a lot of work to disprove and can be incredibly frustrating. The neurological exam is not very important. Could see myself quickly becoming bored with the work.

Any insight anyone has into any of these fields or advice would be much appreciated!

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[Thama]

Not all movement docs do BTX. There are several in our group who do not. However, what I'll say is you should stay open to it - I went into fellowship focused on DBS and completely ambivalent toward BTX, but ended up really enjoying BTX. It's very different than the procedures you're exposed to as a resident - you're problem-solving with dystonia/spasticity biomechanics rather than doing anything technically challenging. It's also very different than BTX for migraine, which is rudimentary by comparison.

Re: DBS in the community - you can build that yourself to some degree, either establishing a relationship with a neurosurgery practice that does DBS implantation or the local academic center. Most of the time, either of those will be happy to do the fun part (implant and initial programming sessions) and send the long-term management back to you. It will take some initiative, however.

 

[DrSatan]

What's your gripe with Botox? It' such a simple procedure & pays well. All programs I researched had Botox. I'm not sure if you could request not to do any of it, but you certainly would not be obligated to after graduating. I believe 2 to 3 movement faculty at my current institution do not regularly do Botox. I'd wager DBS would be near impossible in the community, but I could simply be ignorant to it.

I felt the same way about neuroimmunology. It is also likely going to bloom given all the antibodies & disease modifying agents being creating.

I see the appeal of EEG, but I do not like epilepsy. But, seizure semiology is & neurologic examination may be useful for localization of seizure focus for considerations on surgical resection.

 

[Telamir]

It's almost like every job and subspecialty has pros and cons, and there's a pretty long recent thread that discusses this very topic.

 

[astrobean]

I chose movement and I love it. I find the patient population great and rewarding. There are always functional and needy patients, but compared to what I experienced in residency I would say less needy than epilepsy and MS. I like the botox aspect because it's just something different to do and patients really appreciate it. Agree with what others have said about DBS. Dude if you set up shop 2-3 hours outside an academic center that does the DBS but you referred and can take the patient back for programming? The academic center would be ALL ABOUT THAT. If you worked DBS in to your practice like that I don't think you would miss the reimbursement bump from botox.

 

[Maria30900]

Hi all, Does it matter when a fellowship PD emails you prior to the rank deadline and says you are among the top candidates they interviewed this year? If they have 2 spots, to how many applicants do they usually send such emails? Thank you.