Pros and cons of neuro being it's own speciality and not IM fellowship

[Raygun77]

Howdy,

As you may know, in some/many? countries- atleast in Australia where I hail from- neurology is actually an IM subspeciality, much like cards, gastro, etc. I'm curious to hear what you guys think are the advantages and disadvantages of such a set up.

Obvious disadvantage would be the duration- 4 year standalone vs 5 years (2 years basic physician and 3 years neurology fellowship here)

I'd think doing the IM part first would lend itself well to being an inpatient neurologist, though. Not to mention the closer relationship you'd share with cardiologists who then maybe we/you could model our practices on in terms of interventional neurology/angiography/neuroimaging (in your first 2 IM years you'd do some cards rotation(s) which would involve the cards equivalents of these...I can imagine some form of a relationship emerging)

Anyone have thoughts?

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[neurologist]

Howdy,

As you may know, in some/many? countries- atleast in Australia where I hail from- neurology is actually an IM subspeciality, much like cards, gastro, etc. I'm curious to hear what you guys think are the advantages and disadvantages of such a set up.

Obvious disadvantage would be the duration- 4 year standalone vs 5 years (2 years basic physician and 3 years neurology fellowship here)

I'd think doing the IM part first would lend itself well to being an inpatient neurologist, though. Not to mention the closer relationship you'd share with cardiologists who then maybe we/you could model our practices on in terms of interventional neurology/angiography/neuroimaging (in your first 2 IM years you'd do some cards rotation(s) which would involve the cards equivalents of these...I can imagine some form of a relationship emerging)

Anyone have thoughts?

Actually, if done like that here in the states, the length would probably actually be 6 years, as full IM training is usually 3 years prior to doing a fellowship.

From the perspective of resident/fellow/med student wanting to finish training and get a "real job," I'd think that prospect would be a real minus, especially given the relatively low salary for neuro compared to, say cardiology. Plus, neuro is not all that popular a choice to begin with, so anything that makes it "harder or longer" would probably reduce the number of people interested in doing it at all.

From the point of view of "would it make you a better overall physician," I don't know. I don't see the need for a neurologist (particularly if they further subspecialize) to be "complete internist." Look at the flip side: we don't expect internists to be "complete neurologists," do we? I think it's important for neurologists to have an understanding of the interplay between medical issues and neuro, but I don't think adding another year or two of residency will really make a big difference.

 

[bonran]

Having trained in other countries & in the US, I have found pros & cons in both approaches.

IM-Neuro is longer training. The neurologist has a more holistic approach to the patient & attempts to deal witht the medical issues on his own instead of consulting medicine. However there is less exposure to neurological subspecialties which unlike other specialties (cardiology/ID/Endo/Rheum etc) is important. What other specialties dont realize is that neurology is vast & covers very unrelated fields-epilepsy/stroke/sleep/neuromuscular/NICU/pain/sleep/neuroradiology/neuroimmunology/behavioral-functional/neuropsychiatry/pediatric neurology/neuroinfections & HIV/movement disorders. Granted some of these specialties are not as extensive as cardiology or ID; but neither are endocrine or rheumatology. The important thing is that there is not much overlap in the basic concepts of stroke-sleep-pain-EMG-EEG although they are all covered by neurology. Hence, time is needed during training to understand these concepts to be a complete & competent neurologist. Even neuroICU is very different form doing medical ICU. There is a completely different set of mechanics in the brain that need to be thoroughly understood. All this makes a 3-4 yr training in general neurology imperative.

After all, all other organ systems have just one goal in life "to keep the brain alive". All other specialties have no meaning if this vital organ is lost. It is the most delicate & least understood organ. Once part of it is lost, it doesnt effectually recover well.

In the US there are a few (now rare & dying out) IM-Neuro programs consisting of 2.5yrs of IM & 2.5yrs of Neuro with certification in both.