Questions about neurology from a medical student

[farmaka]

I am an MS3 that has very little exposure to the practical aspect of neurology. I am very interested in what I have studied in neuro, especially stroke, imaging, CSF, spinal cord injuries.

Due to the fact that I will have very little neurology experience before I apply to residency I was hoping you could tell me about your experience in neuro residency/practice if you would be so kind.

What is your typical day like?
What are the boring aspects?
What are the most exciting aspects?
What kind of person in your belief thrives in this specialty?
Do you have ample time to contemplate patient issues?
How do you feel you fit into the healthcare team?
What makes neurology unique?

Please feel free to add anything else about your experience!
Thanks in advance

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[DrStephenStrange]

I am an MS3 that has very little exposure to the practical aspect of neurology. I am very interested in what I have studied in neuro, especially stroke, imaging, CSF, spinal cord injuries.

Due to the fact that I will have very little neurology experience before I apply to residency I was hoping you could tell me about your experience in neuro residency/practice if you would be so kind.

What is your typical day like?
What are the boring aspects?
What are the most exciting aspects?
What kind of person in your belief thrives in this specialty?
Do you have ample time to contemplate patient issues?
How do you feel you fit into the healthcare team?
What makes neurology unique?

Please feel free to add anything else about your experience!
Thanks in advance

Also an MS3 interested in neurology, but definitely do a couple rotations and sub-Is in neurology before applying to residency. Don't just go into it blind because it's actually one of the most grueling residency programs, and if you don't find out if you like the clinical aspect of it before hand, you can burn out.

 

[farmaka]

Also an MS3 interested in neurology, but definitely do a couple rotations and sub-Is in neurology before applying to residency. Don't just go into it blind because it's actually one of the most grueling residency programs, and if you don't find out if you like the clinical aspect of it before hand, you can burn out.

Going in blind is certainly not good, which is why I am trying to gather as much information I can from people in residency or attending.

 

[DrStephenStrange]

Going in blind is certainly not good, which is why I am trying to gather as much information I can from people in residency or attending.

I know. I was just saying that because you said you will have very little experience in neurology before you apply to residency. Even if you get some insights from people here, the best way to actually get the experience and know if you really like it is to dive into it and see things for yourself.

 

[Telamir]

I am an MS3 that has very little exposure to the practical aspect of neurology. I am very interested in what I have studied in neuro, especially stroke, imaging, CSF, spinal cord injuries.

Due to the fact that I will have very little neurology experience before I apply to residency I was hoping you could tell me about your experience in neuro residency/practice if you would be so kind.

What is your typical day like?
What are the boring aspects?
What are the most exciting aspects?
What kind of person in your belief thrives in this specialty?
Do you have ample time to contemplate patient issues?
How do you feel you fit into the healthcare team?
What makes neurology unique?

Please feel free to add anything else about your experience!
Thanks in advance

I'm an inpatient neurologist only, so take my answers from that regard.

1) Typical day: Depends if I'm on day shift or night shift. Night shift I take from home until I'm called in, and after midnight I just take phone calls. It's not a bad schedule but being woken up for minutiae or a "FYI this person is being admitted" type calls can be annoying. When I'm on day shift I'm in house from 7am-7pm. It can be quite busy (~800 bed ish hospital). I have an NP with me +/- 1 medicine resident and 1-2 med students (which I don't have the students round/see patients/whatever. I just have them shadow since it's more efficient). My census is anywhere from 10-20 patients with a lot of turn over since I'm consult only. I cover stroke, transfer from a bunch of neighboring hospitals, phone consults from a satellite hospital/rehab hospital (I don't see those in person). I might be on EEG call, but that varies.

2) Boring aspects: Doing inpatient you're pretty much just seeing strokes and seizures. Lacunar strokes are boring, and "seizure like activity" is a dump of a consult that means next to nothing. A good majority of the time consults are "one and done" such as drug reactions, metabolic encephalopathies, antiseizure drug modification (I'm more comfortable with this than most since I'm an epilepsy subspecialist). That sort of stuff.

3) Most exciting aspects: Getting a good stroke alert. Meaning an actual stroke patient within the window that you can do something for and see them get better. Every now and then I like seeing some general neuro I don't typically see often such as movement disorders or transient global amnesia, etc. A good case of status epilepticus also gets me going.

4) What kind of person thrives in this specialty: Honestly whoever wants to do it. People who like to think generally go into the specialty but I've met both introverted neurologists and party animal neurologists. We're all a little weird.

5) Do you have ample time to contemplate patient issues: Eh. I guess? Thing is pretty much everyone sees more or less the same thing over and over once you set up a practice. The guy who does mostly MS doesn't "contemplate patient issues" so much because he does MS so often he becomes efficient. Same for stroke, same for an epileptologist, etc. Every now and then you get a case that stumps you but those are not the majority. Still, I guess I have enough time to browse up to date or do a brief lit search when I get home if I needed to.

6) How do I fit into the healthcare team: Just another cog in the murder machine. I don't know what you want me to say. People have brain questions, I answer brain questions.

7) What makes neurology unique: Brains, man. It's like...cool, yo. Like...no one knows the brain, you know? Like...how does it work? What you do must be so interesting.

 

[sharkbaitwhohaha]

I'll bite too. From residency perspective (but currently a fellow in neuromuscular)

1) Typical day:
Residency:
If in patient: different services (EMU, stroke, general, neuroICU: Seeing acute patients and managing floor related neurological stuff.
Examples
- General neurology team myasthenia patient admitted for worsening speech and double vision-> management of acute NMJ issues and respiratory stuff. 6 days/week 7am to 3-6 pm depending.
-Stroke team:: basically a check list (somewhat joking) and making sure their stroke work up is complete and they are on the write preventative (ASA?, PLavix plus aspirin, anticoagulant?)hours typically 6d/w 7-6pm or so (earlier depending on census)
-EMU-> just semiology learning and discussing medication management and surgical approach to epilepsy. hours typically 6d/w 7-5pm

Call is mixed in during certain rotations (general, stroke, other) and this is typically 24 hour overnight call covering the ED and hospital.

Outpatient: M-F 8-5. seeing all the interesting stuff in neurology (multiple sclerosis, dementias, parkinsonisms, epilepsies, neuromuscular stuff- neuropathies, myopathies, ALS, myasthenia gravis).

Fellow:
Now all outpatient and awesome. Going EMG/NCS and learning the nitty gritty of the neurological exam

2) Boring aspects: Most of the day to day hospital stuff (following up with social work, disposal, awaiting patients to complete their acute immunotherapy (IVIG or plasmapheresis)

3) Most exciting aspects: being a master of the Neuro exam and when deficits happen, being able to localize-> differential-> +/-scan and labs and then diagnosis and then treat (even if supportive treatment).
Non neurologists are deathly afraid of the nervous system, so we have some job security.

4) What kind of person thrives in this specialty: inquisitive, detail oriented. But there are tons of neurological sub specialities to fit a lot of different personalities (an epileptologic is very different from a neuroICU attending). A headache specialist is very different from a neuromuscular specialist.

5) Do you have ample time to contemplate patient issues: most of the time. But depends on the volume of patients

6) How do I fit into the healthcare team: Just like everyone else

7) What makes neurology unique: still very physical exam heavy. And thats not going away anytime soon. Even with technological advances with imaging and genetic testing. There are TONS of neurological disease with no know genetic source and MRI/Labs are negative. We frequently make clinical diagnosis. Think of primary lateral sclerosis (everything you test will be negative, even EMG/NCS)

in summary: its awesome, but keep an open mind.

 

[farmaka]

Thanks for the replies! Had fun reading both of your perspectives

 

[NEApplicant]

Don't just go into it blind because it's actually one of the most grueling residency programs, and if you don't find out if you like the clinical aspect of it before hand, you can burn out.

Can you expand on this? What makes you say it's "one of the most grueling"?

 

[DrStephenStrange]

Can you expand on this? What makes you say it's "one of the most grueling"?

From talking to many residents in the past, it's been brought up many times that neurology residents work the longest hours (really close if not more than IM residents) and have the steepest learning curve from the beginning because the brain/nervous system is a difficult subject for everybody whether you like it or not. This can lead to burning out if you don't actually like it. Usually though, I hear if you get through PGY 1 and 2, it gets easier in the last 2 years.

 

[Prehealth1011]

Can you expand on this? What makes you say it's "one of the most grueling"?

LOTS of hours. Their PGY-2 is essentially another intern year. People also get burnt out from the long physical exams and nonsense consults.

It's a very diverse field though if you can get through it. Great job market. You can be a neurohospitalist, outpatient AND you can apply to pain.

 

[Thama]

LOTS of hours. Their PGY-2 is essentially another intern year. People also get burnt out from the long physical exams and nonsense consults.

It's a very diverse field though if you can get through it. Great job market. You can be a neurohospitalist, outpatient AND you can apply to pain.

PGY2 year in neuro makes the IM intern year look like a joke.

If you want to do pain, apply to anesthesia. Getting there from neuro is not only more difficult but a waste of your neurological training.

 

[Postictal Raiden]

The residency day-to-day description of @sharkbaitwhohaha is pretty spot on except that many programs now have converted from call system (24hr to 36hr shifts) to the night float system (12 to 14 hour shifts). My program was one that underwent this transition prior to the start of my training. From talking to upperclassmates, the call system was one of the main causes of burnt out. This, however, has come at the cost of losing the cushy lifestyle of PGY-4 as now seniors are expected to do a good number of night shifts in order to have a resident in-house every night.

 

[mrbreakfast]

Can you expand on this? What makes you say it's "one of the most grueling"?

Neurology residents work more hours than IM even during PGY1 year, but the main difference isn't the hours, it's what happens in them. You are much busier during the day, primarily because, in general, you see more acuity. Strokes come in all the time, you have relatively low manpower compared to other specialties, and, unlike most medicine programs, neuro services typically don't have a cap (e.g. you can have a service with 30+ patients) and don't have protected non-admitting days (e.g. your service might admit 4-5 patients for several days straight).

The other major difference is how nights are covered, which is usually 24-hour call. I've had a number of night where I personally saw 10+ consults, admitted 5+ patients, and answered 80+ pages - with the other night resident was seeing the other half of the consults - and that's after working a full days shift. It's good training, but tiring.

Outside of academic OBGYN/surgical programs, neurology is probably the busiest specialty in terms of residency. Still, not a reason to avoid it.

 

[Telamir]

^^^^

Pretty accurate. PGY-2 was horrendous and burned me out on life/the specialty until half-way through PGY-4.

Like explained above, medicine will typically admit every 3 days or so (at least where I trained) and they had a cap. Neurology does not/cannot cap, and we also have a lot of turnover with admissions/discharges and consults especially with stroke/seizures. If you have a primary service crank the misery up to 11.

I echo the above sentiment with call. I used to take 18 hour call (not 24) and that was still rough. I'd be the only resident/neurologist in the hospital and I would do on a rough night 5-10 admissions +/- a few ER consults that got to leave all the while handling asinine nursing pages and medical complications of floor patients.

All in all, yes...it's worse than IM at least where I trained.

 

[BlueBleck]

7) What makes neurology unique: Brains, man. It's like...cool, yo. Like...no one knows the brain, you know? Like...how does it work? What you do must be so interesting.

How'd you get a copy of my personal statement?

When I'm on day shift I'm in house from 7am-7pm. It can be quite busy (~800 bed ish hospital). I have an NP with me +/- 1 medicine resident and 1-2 med students (which I don't have the students round/see patients/whatever. I just have them shadow since it's more efficient). My census is anywhere from 10-20 patients with a lot of turn over since I'm consult only.

Quick followup question: Are you charting after you're off, or is it typically truly 7 to 7?

 

[Telamir]

I make an absolute point to not be in house a second longer than I need to. I've gotten very efficient charting, and in the two years I've been working here I think I've been in house later than 7pm maybe twice. Some colleagues will stay charting but I get it done throughout the day.

Usually I will come in the morning and divvy up the patients between me and the NP. He gets the easy followups, or people whose workup is mostly complete and just need a "goodbye note". He will usually see maybe 5-6 per day depending, all followups which he will staff with me at some point during the day. I will then go and see all my patients (typically ~10) which are mostly followups +/- 1-2 consults I might get while rounding to knock them out quickly. I'll then write notes from say 10am through 11:30am or so and if I get a new consult during that time it will go to the resident or the NP if they are urgent. If not, they wait.

Basically this method lets me be done with the majority of my documentation before 1pm. After that time it's just a note here and there from consults/strokes/EEG reports (If I'm reading that particular week) and note attestations as they trickle in.

 

[DrSatan]

Neurology kind of sucks, but at least it's fairly interesting from time-to-time.

 

[Postictal Raiden]

Neurology kind of sucks, but at least it's fairly interesting from time-to-time.

Very accurate statement

 

[Clockdoc89]

Neurology kind of sucks, but at least it's fairly interesting from time-to-time.

NGL This is pretty discouraging to read as an M4 applying to neuro

 

[Chibucks15]

NGL This is pretty discouraging to read as an M4 applying to neuro

Eh just get through residency. Cuz the docs I’ve worked with outpatient are cushy as hell

 

[DrSatan]

NGL This is pretty discouraging to read as an M4 applying to neuro

Neurology is hard, but keep in mind I'm also just venting as a new PGY-3. It gets better & I find reward in neurology. Don't let it totally discourage you, if you like neurology, it really is the best. Imagine going into something you didn't find fascinating...

 

[sharkbaitwhohaha]

Don't let others discourage you from neurology if you're interested in it. Some of my co residents/fellows complain about neurology, but I've loved it. The stuff we complain about is common among medicine in general.

Yes, neurologist and neuroresidents get dumped on with stupid consults...but thats not special for us (cardiology and "non cardiac chest pain", GI with "negative exam abdominal pain"..etc).

 

[liquidshadow22]

If you are wonk, do neurology. If you are not, potentially might be a bad fit. Just my 2 cents. Headaches, dizziness, neuropathy etc isn't THAT interesting after a while.

 

[DocMom1]

If you are wonk, do neurology. If you are not, potentially might be a bad fit. Just my 2 cents. Headaches, dizziness, neuropathy etc isn't THAT interesting after a while.

Headache and neuropathy are conditions where a neurologist can do a great deal to diagnose and help patients, including several treatments just released in the last several years, which is why we all went into medicine. The research angle should not be neglected either if you're investigation minded. Also remember that ANYTHING that is done repeatedly over years loses its original mystique, whether it is an ENT putting in cochlear implants, a general surgeon doing a lap chole, an OBgyn delivering a baby, etc. If pain is not your thing but you are interested in the nervous system, there are other subfields like movement, dementia, neuropsych, neurorehab, epilepsy, neuro-onc, neuromuscular, neuro-ophtho, neuro-interventional, behavioral neurology, neuroimmunology, neuro-ID, and others may be more in line with your interests.

 

[Chibucks15]

If you are wonk, do neurology. If you are not, potentially might be a bad fit. Just my 2 cents. Headaches, dizziness, neuropathy etc isn't THAT interesting after a while.

That's true in literally every field. I will never understand this argument.

 

[liquidshadow22]

That's true in literally every field. I will never understand this argument.

Yes that's true. I knew someone who switched from neurology to internal medicine and I simply could not understand why. He thought that internal medicine would be so much more interesting than seeing stroke after stroke.

I just think that procedural fields provide a little more challenge and a break from the monotony of clinical care and I would call this more "interesting". Obviously it's a subjective matter, but I personally would call most primary care fields and nonprocedural specialties pretty boring.

 

[mrbreakfast]

NGL This is pretty discouraging to read as an M4 applying to neuro

Neurology residency sucks, but so does residency for the vast majority of other specialties. It comes with the medical territory, and keep in mind half of this thread is residents complaining about more residency-specific issues (e.g. deluge of functional patients in resident clinic, consults from teams that put zero thought into the question before paging you, social work nightmares on the primary service) which are less prevalent in the actual working world. But overall, residency isn't that bad. You get intellectual stimulation every day, and as a neurologist, there's kind of a rewarding challenge in helping patients literally no one else has been able to help. Don't be discouraged.

 

[Thama]

Yes that's true. I knew someone who switched from neurology to internal medicine and I simply could not understand why. He thought that internal medicine would be so much more interesting than seeing stroke after stroke.

I just think that procedural fields provide a little more challenge and a break from the monotony of clinical care and I would call this more "interesting". Obviously it's a subjective matter, but I personally would call most primary care fields and nonprocedural specialties pretty boring.

Conversely, I would find most procedural specialties incredibly boring, especially since most proceduralists work themselves into a very narrow niche. One guy is the LASIK surgeon and does nothing but LASIK all day. The other guy is the cataract guy and does nothing but cataracts all day. One orthopod is the shoulder guy and does nothing but rotator cuffs all day, but if you need a hip that's a different guy or a knee is yet another guy who only does the same knee replacement day after day.

I see a wide variety of pathologies in my clinic and offer a few different procedures in my practice which is enough to break up any monotony from figuring out a fairly diverse set of problems. Neurology isn't the glamorous specialty and we may not have the cushy lifestyle with the big money, but the kind of person who would get bored with neurology quite simply isn't the kind of person I'd ever find much interest in conversing with.

 

[liquidshadow22]

Conversely, I would find most procedural specialties incredibly boring, especially since most proceduralists work themselves into a very narrow niche. One guy is the LASIK surgeon and does nothing but LASIK all day. The other guy is the cataract guy and does nothing but cataracts all day. One orthopod is the shoulder guy and does nothing but rotator cuffs all day, but if you need a hip that's a different guy or a knee is yet another guy who only does the same knee replacement day after day.

I see a wide variety of pathologies in my clinic and offer a few different procedures in my practice which is enough to break up any monotony from figuring out a fairly diverse set of problems. Neurology isn't the glamorous specialty and we may not have the cushy lifestyle with the big money, but the kind of person who would get bored with neurology quite simply isn't the kind of person I'd ever find much interest in conversing with.

Fair enough you're entitled to your opinion. Surely the surgeons who perform the same procedure day in and day out and intentionally restrict themselves, must suffer from boredom as well. We all have different tolerance levels for repetition and how that translates into fulfillment.

I just think that having someone's chest or brain open in front of you on an operating table would become less stale than discussing someone's stroke or headache hx for hours on end even after years of performing said task. To each their own.

 

[Chibucks15]

Fair enough you're entitled to your opinion. Surely the surgeons who perform the same procedure day in and day out and intentionally restrict themselves, must suffer from boredom as well. We all have different tolerance levels for repetition and how that translates into fulfillment.

I just think that having someone's chest or brain open in front of you on an operating table would become less stale than discussing someone's stroke or headache hx for hours on end even after years of performing said task. To each their own.

Weird hill to die on in a neurology subforum but as you say, to each their own. Surgery is the worst (to me and many others) that’s why many of us like neurology in the first place

 

[GuillainMollaret]

I enjoy having dedicated EMG time each week (about 1/3 of my week is EMG). It definitely adds variety to my schedule and breaks up the monotony of seeing clinic patients.

I think a nice mix of office visits and procedures is the way to go. Between Botox, nerve blocks, and EMG, this is possible for most outpatient neurologists.

 

[Clockdoc89]

I enjoy having dedicated EMG time each week (about 1/3 of my week is EMG). It definitely adds variety to my schedule and breaks up the monotony of seeing clinic patients.

I think a nice mix of office visits and procedures is the way to go. Between Botox, nerve blocks, and EMG, this is possible for most outpatient neurologists.

Is there a sub specialty that encompasses all of those procedures? I would guess neuromuscular? Maybe movement? I am ideally looking for a primarily outpt career with a mix of procedures for the very reason you mentioned. Is it possible to learn more procedures through CME and add that to your repertoire? Perhaps getting into some PMR territory with US guided procedures in office?

 

[Chibucks15]

Is there a sub specialty that encompasses all of those procedures? I would guess neuromuscular? Maybe movement? I am ideally looking for a primarily outpt career with a mix of procedures for the very reason you mentioned. Is it possible to learn more procedures through CME and add that to your repertoire? Perhaps getting into some PMR territory with US guided procedures in office?

The docs I worked with did a little bit of everything as general neurologists in the Midwest, may be harder on the coasts. Botox you can pick up through CME, if your residency trains you to feel comfortable in EMG/EEG/sleep you can do it regardless of subspecialty too if the need is great enough. My mentor is sleep trained and he does EMGs regularly in clinic. Didn't see much US techniques but I don't see why not

 

[Thama]

discussing someone's stroke or headache hx for hours on end even after years of performing said task. To each their own.

Nobody actually does this. Did they replace clinical neurological education with memes about neurology at your medical school?

 

[Postictal Raiden]

In my humble opinion, the field is becoming too broad to think one can be proficient at reading EEGs, performing EMGs, and treat other specialized areas of neurology (MS, Movement, etc) coming out of residency. That is specially true when you realize that your residency experience is heavily shifted towards inpatient neurology.

You could probably get away with skipping on fellowship if your program provides with ample opportunity to rotate through neurophysiology AND end up working in a place that is 200+ miles away from any major city. However, in large cities, there’s no shortage of fellowship trained neurologists.

 

[Postictal Raiden]

FWIW, in my residency continuity clinic, I see more diverse cases than my colleagues in FM.

 

[liquidshadow22]

Nobody actually does this. Did they replace clinical neurological education with memes about neurology at your medical school?

Was not meant to be literal. You talk to patients for extended periods of time. That's integral to good clinical care. History taking is paramount.

 

[deathmerchant]

I am an MS3 that has very little exposure to the practical aspect of neurology. I am very interested in what I have studied in neuro, especially stroke, imaging, CSF, spinal cord injuries.

Due to the fact that I will have very little neurology experience before I apply to residency I was hoping you could tell me about your experience in neuro residency/practice if you would be so kind.

What is your typical day like?
What are the boring aspects?
What are the most exciting aspects?
What kind of person in your belief thrives in this specialty?
Do you have ample time to contemplate patient issues?
How do you feel you fit into the healthcare team?
What makes neurology unique?

Please feel free to add anything else about your experience!
Thanks in advance

Just like every field there are pros and cons. I personally love it.

I have a slightly atypical schedule. 7on/7off. About 5 patients and 1-2 EEGs/day. So spend 3-4 hours/day at work. Probably get 1 or 2 calls after that. Probably had to go back in 3 times in the past year. Super chill lifestyle. Recently started few half days of clinic/month recently. Might do locums in my off weeks to make more bucks in the future.

Boring part is the nonsults, which is a part of every field. I think neurologists are biased because we want every case to be a cool mystery. Every other field sees the same boring **** every day but don't complain as much. I also just work alone mostly, which can get boring. In neuro I think it is good to have colleagues/residents/students to bounce ideas off and may be brag a bit!

Exciting is the fact you are working on the most complex organ/machine that ever existed. Neuroscience is just coming out of infancy, so there is a lot to still figure out about it. Also I personally love Functional/psychogenic symptoms. It requires a lot of neurological skill and confidence and doctor-patient rapport to manage them.

A person who can accept not being able to find answers/diagnoses/treatment all the time. You and the patient don't get closure every time in neuro. Someone who is ok with saying " Im sorry i don't know what you have" or " I don't think I can treat you medically". I think people who are patient do well in neuro. Obviously, you also need to go through the grueling 2-3 years of residency.
Good thing is there is a wide variety of subspecialties after neuro residency as mentioned above, from procedure heavy to clinical to philosophical!

And, I personally have all the time I need to contemplate.

 

[deathmerchant]

Fair enough you're entitled to your opinion. Surely the surgeons who perform the same procedure day in and day out and intentionally restrict themselves, must suffer from boredom as well. We all have different tolerance levels for repetition and how that translates into fulfillment.

I just think that having someone's chest or brain open in front of you on an operating table would become less stale than discussing someone's stroke or headache hx for hours on end even after years of performing said task. To each their own.

I personally went from starting residency in Orthopedics to Radiology (in another country) to Neurology just because the former fields were extremely boring to me. Surgery esp was good for few months, after that I felt like a robot.

 

[liquidshadow22]

I personally went from starting residency in Orthopedics to Radiology (in another country) to Neurology just because the former fields were extremely boring to me. Surgery esp was good for few months, after that I felt like a robot.

Interesting. Must say though I found orthopedic surgery to be incredibly boring with respect to other surgical fields. Those surgeries are definitely very repetitive. A good CT surg or Neurosurg case was always very exciting to me as a med student. The anatomy you are working on I think definitely plays a role in what I found to be intriguing.

 

[Clockdoc89]

I personally went from starting residency in Orthopedics to Radiology (in another country) to Neurology just because the former fields were extremely boring to me. Surgery esp was good for few months, after that I felt like a robot.

I have to ask, have you found Neurology to be less monotonous? This is extremely important to me as I think I'm the type that gets bored easily and I think I will need atypical cases to keep me on my toes.

 

[Clockdoc89]

In my humble opinion, the field is becoming too broad to think one can be proficient at reading EEGs, performing EMGs, and treat other specialized areas of neurology (MS, Movement, etc) coming out of residency. That is specially true when you realize that your residency experience is heavily shifted towards inpatient neurology.

You could probably get away with skipping on fellowship if your program provides with ample opportunity to rotate through neurophysiology AND end up working in a place that is 200+ miles away from any major city. However, in large cities, there’s no shortage of fellowship trained neurologists.

In your opinion what fellowship lends itself to clinic and having a day or two for procedures or even nonclinical work that still generates income? For me what comes to mind is EEG but I'm a bit concerned that it's susceptible to AI because it seems to be pattern recognition but this is obviously an uneducated opinion.

 

[Postictal Raiden]

In your opinion what fellowship lends itself to clinic and having a day or two for procedures or even nonclinical work that still generates income? For me what comes to mind is EEG but I'm a bit concerned that it's susceptible to AI because it seems to be pattern recognition but this is obviously an uneducated opinion.

Neurophysiology. You get to learn EEGs/EMGs and even how to read sleep studies.
I don't see AI tapping into EEGs anytime soon. Simply because seizure/epilepsy remains a clinical diagnosis. EEGs simply a tool to help make/rule out the diagnosis and see the epileptic foci. EEGs have nowhere near the diagnostic sensitivity/specificity of MRI/CT.

 

[Clockdoc89]

Neurophysiology. You get to learn EEGs/EMGs and even how to read sleep studies.
I don't see AI tapping into EEGs anytime soon. Simply because seizure/epilepsy remains a clinical diagnosis. EEGs simply a tool to help make/rule out the diagnosis and see the epileptic foci. EEGs have nowhere near the diagnostic sensitivity/specificity of MRI/CT.

Yeah that seems like a good option but i've read on this forum, that fellowship may be dying out and it's getting to the point that you need to choose one or the other...I guess I will have the next 4 years in residency to see how it pans out.

 

[Postictal Raiden]

True, but this will take time to happen. I’m in middle of applying to fellowship programs and have noticed that a good number of mixed (EEG/EMG) is still around. Not sure how far you are from applying, but I think the option of pursuing this path will be available for the next few years

 

[Telamir]

In all honesty you will get responses here from people who love their job, and folks who are burned out. I think I may be approaching the burnout category.

First, what I like about neurology:

I think it's an interesting field. In the inpatient world it's mostly stroke and seizures but you do see something interesting from time to time, and the occasional diagnostic challenge that sometimes unfortunately won't be solved (autoimmune stuff, mostly). I also like that with a history and a clever physical (imagine that, talking to your patients and examining them) you can often obtain a diagnosis. It'll make you look like a rockstar and other physician colleagues will marvel at your wizardry. I like that you become proficient in other non neuro things, such as radiology. If you look at your own images and you get comfortable with it you may even call your radiology colleagues with things they may have missed! It's pretty fulfilling to me when I can have a discussion with my neuro-rads colleagues and speak the same language. In the same vein, you sort of become a budget psychiatrist and a budget ophthalmologist. A perk of being a specialist is being able to answer a specific question and sign off once that's done.

Also not strictly neurology related but the job market is great because there just aren't that many of us, and it's a field that I think is quite hard to do well. If you do it well you will earn the respect of your colleagues fairly quickly. Job market being good means money is good too.

Now what I don't like about neuro:

Nonsults. I disagree that it's because I expect everything to be interesting. Rather, I'd expect people to know the basics; and you'll notice quickly...no one knows anything about neuro. The mildest of possibly neurologic symptoms or findings will bring the average internist/ER doc to a state of panic only solved by calling the nearest neurologist in the most frantic manner and ordering as many "neurologic" tests as possible. By this I mean: CT, CTA head/neck, CT perfusion, MRI Brain, EEG, +/- an LP for a patient who is "twitching" in the setting of a florid UTI (asterixis). You will also get a fair number of CYA calls, where an internist or ERP will call you knowing what the answer is just to write your name down and say you spoke so in the unlikely event of a lawsuit you go down too. Every now and then you'll get a call meant for Urology which is kinda funny, though. In some cases, you may also have to play captain obvious.

A lot of your consults may also be undifferentiated messes. "Seizure like activity" can mean anything from actual seizure to a tic disorder to pseudoseizures or coreoathetosis. Chances are you'll never see the event in question either. Same goes for strokes in that "anything can be a TIA or a stroke". I've also gotten consults where the patient was already going to hospice (talk about completely pointless).

I also despise psych, and I get more of it than I'd like (although to be fair I'd like zero). This is more circumstantial to my job but every now and then I will get a psychiatrist tell me a patient has epilepsy AFTER an EEG with a pseudoseizure has been captured. You also will see a fair amount of conversion/somatization.

The middle ground:

Training is hard, no doubts about it. Residency was some of the worst years of my life (as I've mentioned in this forum before) but I think this is standard of many fields (except derm and psych?). That being said, it is an interesting field of practice and I think you make a difference in your patient's lives. I am much happier as an attending than I was as a resident since you finally get some time to have a life and interests outside of work. I have learned a lot in these couple years of practice and I do look forward to continuing to work although perhaps a change in practice might be indicated in the next year or two.

 

[Clockdoc89]

True, but this will take time to happen. I’m in middle of applying to fellowship programs and have noticed that a good number of mixed (EEG/EMG) is still around. Not sure how far you are from applying, but I think the option of pursuing this path will be available for the next few years

I will be applying this cycle so assuming the option is still there could I potentially be grandfathered in? That makes me wonder why it is destined to get phased out in the first place? This implies that further training is needed to be proficient in it but i'm not aware of all of the outside forces causing this.

 

[Postictal Raiden]

I will be applying this cycle so assuming the option is still there could I potentially be grandfathered in? That makes me wonder why it is destined to get phased out in the first place? This implies that further training is needed to be proficient in it but i'm not aware of all of the outside forces causing this.

Ok then, you’ll have the chance to apply to these programs as I doubt they’ll all phase out in the next 3 years.

reason is that coming out of neurophys, you won’t be an “expert” at treating anything. You’re basically a general neurologist who can read and do EEGs/EMGs and maybe sleep studies very well but lack the tertiary level understanding/training of epilepsy/NM/sleep compared to someone who did a dedicated fellowship in these fields.

Nothing wrong with that. Just need to know what you want in your career.

 

[Clockdoc89]

Nonsults. I disagree that it's because I expect everything to be interesting. Rather, I'd expect people to know the basics; and you'll notice quickly...no one knows anything about neuro. The mildest of possibly neurologic symptoms or findings will bring the average internist/ER doc to a state of panic only solved by calling the nearest neurologist in the most frantic manner and ordering as many "neurologic" tests as possible. By this I mean: CT, CTA head/neck, CT perfusion, MRI Brain, EEG, +/- an LP for a patient who is "twitching" in the setting of a florid UTI (asterixis). You will also get a fair number of CYA calls, where an internist or ERP will call you knowing what the answer is just to write your name down and say you spoke so in the unlikely event of a lawsuit you go down too. Every now and then you'll get a call meant for Urology which is kinda funny, though. In some cases, you may also have to play captain obvious.

A lot of your consults may also be undifferentiated messes. "Seizure like activity" can mean anything from actual seizure to a tic disorder to pseudoseizures or coreoathetosis. Chances are you'll never see the event in question either. Same goes for strokes in that "anything can be a TIA or a stroke". I've also gotten consults where the patient was already going to hospice (talk about completely pointless).

I'm sorry, ignorant medical student here lol but is it possible to just say a neurological consult is not indicated based on the information provided, or is that just bad consult etiquette? Or do you get paid per consult and it's better to see that patient anyways even though it's BS from a Neurological stand point?

Do you still run into this problem in the outpatient setting? Like getting referrals to your office that dont need a Neurologist and just end up wasting your time and the patients time? Or can you screen these patients before the visit?

Sorry I don't know how any of this really works lol, I just know I'm interested in Neurology since undergrad and I will figure out the rest as I go hopefully without regretting my decision. The entire process of picking a specialty in med school is such bull**** -.-

 

[Postictal Raiden]

Btw the “grandfathering” thing for being dually boarded in epilepsy AND EEG neurophysiology has already phased out couple of years ago.

now in order to be dually boarded you need to do a 2 year fellowship, one year in EEGs and one in epilepsy. This route is meant to prepare you for being an expert in reading every type of EEG and treat intractable epilepsy syndromes