Research career in neurology

[MyelinatedPotato]

I'm a MD-PhD student who really enjoyed my PhD and want to focus on basic science research in my career (maybe occasionally seeing some patients after residency). I noticed that compared to specialties like psychiatry or internal medicine, there seems to be less of a well established research track in neurology, and fewer faculty members who run their own labs. Is this an accurate perception? Is neurology a research friendly specialty?

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[Thama]

Just the opposite - neurology tends to attract a disproportionate number of people interested in research and academics compared with IM and most of its subspecialties. If you're seeing something very different in your institution then you may be somewhere with a neurology department that isn't very strong relative to IM or other specialties.

 

[90sportsfan]

Less of a well-established research track in neurology compared to internal medicine or psychiatry???? Have you researched Neurology closely? Many Neurology programs have R25 funding from NIH, so there is a structured pathway for clinician-scientists in neurology. It’s not easy and is super competitive, but those who have a strong research background and train at one of those programs, have a decent chance at getting NIH funding and having a clinician-scientist career.

 

[MyelinatedPotato]

I see people proclaiming to be interested in research... but all the attendings are doing case reports or clinical trials, not running basic science research labs/groups funded federally or by foundations. In contrast I see a lot more successful PIs in psychiatry and internal medicine. Is this from lack of interest from academic neurologists, lack of opportunities, or less investment from neurology departments so doing research requires too much of a pay cut?

If you're seeing something very different in your institution then you may be somewhere with a neurology department that isn't very strong relative to IM or other specialties.

I think that may be the case. However, American Physician Scientist Association has these annual career events and I have seen representation there from literally every specialty for the past couple of years except neurology. Even dermatology sends people there to talk about their research tracks. It's very strange.

Less of a well-established research track in neurology compared to internal medicine or psychiatry????

Absolutely. There are extremely few programs with R25 funding. ABIM specifically has a research short track for board certification that lets you switch out a year of clinical medicine with more research. Psychiatry gives a ton of time off for research if you're on a research track. Neurology only gives 6 months, plus two years only if you're at a R25 funded institution. The last time I checked, there were less than 20 neurology programs with R25 in the whole country.

 

[Aldertonghen]

I see people proclaiming to be interested in research... but all the attendings are doing case reports or clinical trials, not running basic science research labs/groups funded federally or by foundations. In contrast I see a lot more successful PIs in psychiatry and internal medicine. Is this from lack of interest from academic neurologists, lack of opportunities, or less investment from neurology departments so doing research requires too much of a pay cut?


I think that may be the case. However, American Physician Scientist Association has these annual career events and I have seen representation there from literally every specialty for the past couple of years except neurology. Even dermatology sends people there to talk about their research tracks. It's very strange.


Absolutely. There are extremely few programs with R25 funding. ABIM specifically has a research short track for board certification that lets you switch out a year of clinical medicine with more research. Psychiatry gives a ton of time off for research if you're on a research track. Neurology only gives 6 months, plus two years only if you're at a R25 funded institution. The last time I checked, there were less than 20 neurology programs with R25 in the whole country.

It's possible you may be searching the wrong places. The place with the highest NIH-funded neurology department isn't your usual Ivy leaguer, its WashU at St. Louis. Many Ivy league places do not have a presence in neurology.

In general, neurology has a lot fewer residency programs- 160 compared to 300 for psych and 600 for Internal medicine (4x compared to neuro) - and the number of residents/faculty per program is way, way lower, so of course the number of funded PIs will be much much lower than what one would see in IM. There are 6 times as many faculty and residents in IM as compared to my neuro department, so a rough calculation is that there's 24x as many faculty in IM than in neuro (6 times per program*4). This reduces our absolute presence.

My residency program is firmly a mid-tier program in the midwest- yet we have a higher NIH funding/faculty ratio than the IM department at the same place. And this is what you should look at, funding/research adjusted to the number of faculty, because the absolute for neurology is very, very low. Even on a resident level, there are 6 of us in my batch, compared to 36 in IM- so there's no way we are competing in absolute research stats. Psychiatry will give more time than neurology for research for sure, as neurology in 4 years is one of the busiest residencies around- there's so much to learn. Fellowships are where neurologists pump out research- with great determination and effort, I have seen a guy completing a movement disorders fellowship+ a Ph.D. in 3 years flat post-residency.

 

[Thama]

I see people proclaiming to be interested in research... but all the attendings are doing case reports or clinical trials, not running basic science research labs/groups funded federally or by foundations. In contrast I see a lot more successful PIs in psychiatry and internal medicine. Is this from lack of interest from academic neurologists, lack of opportunities, or less investment from neurology departments so doing research requires too much of a pay cut?


I think that may be the case. However, American Physician Scientist Association has these annual career events and I have seen representation there from literally every specialty for the past couple of years except neurology. Even dermatology sends people there to talk about their research tracks. It's very strange.


Absolutely. There are extremely few programs with R25 funding. ABIM specifically has a research short track for board certification that lets you switch out a year of clinical medicine with more research. Psychiatry gives a ton of time off for research if you're on a research track. Neurology only gives 6 months, plus two years only if you're at a R25 funded institution. The last time I checked, there were less than 20 neurology programs with R25 in the whole country.

Neurology residency is more clinically intense than IM and orders of magnitude more intense than psych, and so there's just less residency time for research.

I'm a NIH-funded physician scientist and this is literally the first time I've heard of this "American Physician Scientist Association". I go at various times to AAN, ANA, SFN, MDS, ISMRM... not a lot of room left for more organizations.

It definitely sounds like you're somewhere where neurology simply isn't strong enough to attract physician-scientists. In my current department there are dozens of funded physician scientists doing anything from basic to investigator-led clinical work. Most places I've interviewed for residency, fellowship, and faculty positions have had strong physician-scientist presences in neurology. IM always has "more" but you have to remember that IM departments are vastly larger than a neurology department - a lot fewer people go into research from IM by proportion. And psychiatry departments tend to have a lot of people doing very soft-science research with small-time grant support, with rare exceptions at the top-tier places doing actual biomedical research.

 

[MyelinatedPotato]

It definitely sounds like you're somewhere where neurology simply isn't strong enough to attract physician-scientists. In my current department there are dozens of funded physician scientists doing anything from basic to investigator-led clinical work. Most places I've interviewed for residency, fellowship, and faculty positions have had strong physician-scientist presences in neurology. IM always has "more" but you have to remember that IM departments are vastly larger than a neurology department - a lot fewer people go into research from IM by proportion. And psychiatry departments tend to have a lot of people doing very soft-science research with small-time grant support, with rare exceptions at the top-tier places doing actual biomedical research.

I guess it seems like they actively discourage a focus on research, which is vastly the opposite of many other departments. For example, the neurology residency director would mention how their main goal is to train clinicians, and how they're mainly looking for people who want to focus on clinical training, in contrast to medicine, psychiatry, etc. who tell you that they're looking for people who are interested in being independent investigators and will make the time and effort to help you find mentors, get time to do research in residency, support you in your early career grant submissions, etc. Glad to hear that it's not the same everywhere.

I find working with patients to be gratifying, and the job stability and compensation of clinicians is obviously great, but part of me really wants to do research, so I wouldn't give that up just to choose a specialty I like or spend too much time doing clinical fellowships.

 

[90sportsfan]

Absolutely. There are extremely few programs with R25 funding. ABIM specifically has a research short track for board certification that lets you switch out a year of clinical medicine with more research. Psychiatry gives a ton of time off for research if you're on a research track. Neurology only gives 6 months, plus two years only if you're at a R25 funded institution. The last time I checked, there were less than 20 neurology programs with R25 in the whole country.

Ok, but how many psychiatrist have a clinician-scientist career? Are psychiatry residency programs even funded by an R25? I don't disagree with you that Neurology residency programs may be way busier and harder to obtain protected research time, but for someone knowing from the start that they want to be involved in lab research (like the OP) or possibly translational research, I would think that (all things equal) Neurology would probably be a better specialty fit for that (rather than IM of psyc). I have come across many Neurology clinician-scientists, but far fewer in Psych.