Postpone and think

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mm78

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Hey all,
I think I'm going to postpone starting residency for a year. Hopefully figure out what to do for a lifetime or 20 years whatever feels better down the road.

Neurology looks pretty cool but not really dead set on it. Even know a gas resident who was thinking about it and may still think about switching over. Anyway what are the pros and cons about neurology including the bread and butter, typical lifestyle, compensation, and degree of autonomy/admin hassles?

Sincere answers from private practice attendings would be awesome.
 

neurologist

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Hey all,
I think I'm going to postpone starting residency for a year. Hopefully figure out what to do for a lifetime or 20 years whatever feels better down the road.

Neurology looks pretty cool but not really dead set on it. Even know a gas resident who was thinking about it and may still think about switching over. Anyway what are the pros and cons about neurology including the bread and butter, typical lifestyle, compensation, and degree of autonomy/admin hassles?

Sincere answers from private practice attendings would be awesome.

I think you have a very good plan. Rushing into a specialty is not a good idea.

Bread and butter outpatient neurology is headache and other chronic pain disorders, people with "memory problems" (both true dementia and those with simply too much going on in their lives to focus), seizure vs syncope, and a smattering of people with vague symptoms that really can't be blamed on anything truly neurologic. Those categories will make up probably about 75% of your practice as a general neurologist. If you subspecialize (EMG, epilepsy, sleep, movement disorders, etc), you can reduce the general neuro aspects but in most practices it is highly unlikely you will ever have a 100% subspecialty practice, especially in private practice.

Inpatient is stroke, seizure, and altered mental status.

"Lifestyle" is highly dependent on location and nature of practice. Big groups generally equals less frequent call. Busy urban hospital setting means very busy call. Hours are generally not too bad, but vary from practice to practice and are to an extent going to be dependent on your salary structure. I've encountered some groups where a large part of your pay is performance based -- as long as you cover your basic overhead, you can work as much or as little as you want beyond that, but it will be directly reflected in your paycheck. Some people like that freedom. Others prefer a guaranteed salary like a hospital employed model, but then you lose a lot of freedom with regard to structuring your schedule and environment.

Salary is generally at the lower end of medical specialties, but can be bumped up if you do lots of EMG or sleep studies. Also highly dependent on geography and practice type. $200K is probably a good average ballpark number. A dinky hospital in some remote area may pay top dollar, but it's a dinky hospital in the middle of nowhere. Big famous medical centers in popular urban areas generally pay less, especially once local cost of living is factored in.

"Admin hassles" occur anywhere, but you will have less direct control over them in a hospital practice setting vs a private practice.
 
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