Vascular Neurology vs General Neurology

[Luka75]

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Hey guys, I was hoping to get some guidance from you all. I'm a Neurology PGY 2 and at this point, I have nearly ruled all but 3 paths: General Neurology Vs Vascular Neurology vs >> Neurocritical care. The latter is nearly off my ddx but I feel I need more exposure before I confidently make that decision.

A bit about what I value most: I'd like to be almost exclusively inpatient; preferably with the 1wk on/ off schedule. I'm indifferent about being in academia. I do care about earning a salary on the higher end (> 300K) such that I can comfortably support global health extracurricular endeavors. I'd like to be in the southeast or the Mid- Atlantic. I don't mind overnight phone calls as long as I don't have to come in.

I thoroughly enjoy almost all aspects of Neuro (even functional cases at times) however, I feel not subspecializing would put me at a disadvantage when it comes to the job market. If I do subspecialize, I think the Vascular route makes the most sense, especially because I probably enjoy those cases a bit more than the rest of neuro. The issue is, I can't seem to convince myself that doing an extra year of hardcore training will be worth it in the long run, particularly because I don't care much for research nor do I care about running a stroke center.

So here's my question, if I decide not to subspecialize, would that truly make me less competitive when it comes to neuro-hospitalist positions? And if I do subspecialize, does that grant me a bit more leverage when it comes to negotiating my salary for a primarily inpatient position? In other words, is a Vascular Neurologist more likely to be paid more than a general neurologist for the same Neurohospitalist position?

Thanks!

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[Telamir]

Doesn’t make you less competitive unless you’re in the big city market where it’s more saturated.

In general it doesn’t give you any “leverage” unless you’ve got a procedure you can do that the hospital may need and you can get paid a bit more for (EMG, EEG, basically).

The pay is the same if it’s the same job.

There are a few people here who did a fellowship and are doing a lot of inpatient. Some are stroke trained or neuro ICU, some are movement trained. I myself did epilepsy and find it made it more flexible since I can read EEGs and some hospitals value that.

Search the forums though this question has been answered to some degree several times. You may find more insight.

 

[Postictal Raiden]

I am a neurohospitalist. I didn’t do a fellowship and haven’t had difficult finding jobs.

With that said, if I were to do a fellowship to improve my marketability/inpatient skill set, I’d probably do an epilepsy year or EEG oriented neurophys. Stroke is in demand but every neurology trained person should be comfortable doing stroke but you can’t expect everyone to be comfortable reading continuous EEGs

 

[CnsCrit]

I don't think having a stroke fellowship will increase your income as a hospitalist, it's just a matter of whether the dept wants to hire someone with a stroke background not. That probably depends on the organization of the department, whether they have a dedicated stroke team, or have a contract with a telestroke company, whether they want you to consult in the ICU, what their general case mix is, etc. Imo there's still demand in the community for inpatient neurology without a fellowship. Academics is a little different, as they'll be looking for someone with a niche clinical/admin/teaching interest. ICU won't increase your income by that much in academics, but definitely will in the community.

It depends on your goals. 1 year fellowships really aren't too bad, even if busy.

 

[chexmyx]

It seems like there are quite a few tele stroke groups that take general neurologists. My hospital uses telespecialists and the majority of them that do our Ed stroke consults don’t have a stroke fellowship.

 

[Telamir]

Cause it’s a fairly new fellowship and most neurology residencies adequately prepare you (or should) to see the vast majority of stroke cases out there.

Sometimes those companies ask for X years of experience in lieu of a fellowship though.

 

[Drhappyface]

If a vascular neurologist and neurohospitalist get paid the same, why are their salary discrepancies with on MGMA? I think it's about a 60k, 70k difference if you have a vascular fellowship. Is that because you have more leverage with contract negotiations due to your fellowship?

 

[Telamir]

Read above.

 

[Luka75]

Thanks for the insight, everyone!

 

[Sage of Pale Bones]

I am a neurohospitalist. I didn’t do a fellowship and haven’t had difficult finding jobs.

With that said, if I were to do a fellowship to improve my marketability/inpatient skill set, I’d probably do an epilepsy year or EEG oriented neurophys. Stroke is in demand but every neurology trained person should be comfortable doing stroke but you can’t expect everyone to be comfortable reading continuous EEGs

What are your thoughts on NM/ EMG for marketability?

 

[Postictal Raiden]

What are your thoughts on NM/ EMG for marketability?

For outpatient? Definitely improves your job prospects and earning potential

 

[chexmyx]

For outpatient? Definitely improves your job prospects and earning potential

Every time I talk to a locums agency they seem impressed that I do emg/eeg and inpatient neurology. They say it’s hard to find neurologists that do everything. I have not taken any locums opportunities yet but it seems like being a jack-of-all-trades would make you more versatile and potentially more valuable? It definitely helps break up the monotony and makes me a more complete neurologist doing emg.