what's the impact?

[zama]

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I am planning on going into neurosurg. or neurology. I have a step 1: 243 and one year of neuro research. However, I did not honor neurology (excellent clinica evaluation, bad test day I guess). What does this do to my chances of getting into a top program. Serious replies only please 🙂

 

[neurologist]

I am planning on going into neurosurg. or neurology. I have a step 1: 243 and one year of neuro research. However, I did not honor neurology (excellent clinica evaluation, bad test day I guess). What does this do to my chances of getting into a top program. Serious replies only please 🙂

The serious reply is . . . nobody here really knows.

I mean lets face it -- if some anonymous person on a website (who may in fact be applying to the same "top programs" and therefore has a vested interest in keeping other applicants away) tells you that your chances at Hopkins or MGH or Mayo are zero, would that really convince you not to apply there? I certainly hope not.

If you really want opinions, you are much better off discussing this with the faculty in your school's neuro program, or other residencies. And you really ought to apply to a range of programs -- couple of "dream programs" (even if they may seem like long shots), couple of strong-but-not-quite-top-10, couple of "safe" programs. ALL of these should be in geographic areas you'd be interested in spending 4+ years.

As the old saying goes: "nothing ventured, nothing gained." You NEVER know what your chances are at any program until you've got the accept or reject letter in hand . . .

Best of luck.

 

[mantooth]

Deciding between neurology and neurosurg is of primary importance. These are very different in every way, including competitiveness of residency matching. Neurosurg is certainly more difficult to match in (far fewer spots), so any weaknesses in your application will be more apparent in this match. I am quite sure that failing to get an honors in neurology will NOT disqualify you from any Neurology programs- your success will depend on the rest of your application and your interview (your step I is very competitive for neuro, not sure about neurosurg).

 

[Onco]

I am planning on going into neurosurg. or neurology. I have a step 1: 243 and one year of neuro research. However, I did not honor neurology (excellent clinica evaluation, bad test day I guess). What does this do to my chances of getting into a top program. Serious replies only please 🙂

If you are applying to 2 specialities than you are CONFUSED 😉

Neurosurgeons are the elitest and most respected members of the medical community. On the other hand there are many Neurologists around...

It really depends on your ambition. But if I was that damn good, I would've definitely gone for Neurosurgery.

 

[Methyldopa]

If you are applying to 2 specialities than you are CONFUSED 😉

Neurosurgeons are the elitest and most respected members of the medical community. On the other hand there are many Neurologists around...

It really depends on your ambition. But if I was that damn good, I would've definitely gone for Neurosurgery.

What? I would say that most fields of medicine are respected. And to decided on the field based solely on your grades is myopic and stupid.

Choose a field you'll enjoy, because 40-50 years from now, when all is almost done, you have to be happy with the work you've done.

 

[Methyldopa]

You NEVER know what your chances are at any program until you've got the accept or reject letter in hand . . .

Well said. Just apply and see what happens.

 

[mpp]

Step 1 score is competitive for neurosurgery. Not honoring neurology will likely have little to no impact on your application.

However, the fields are completely different. Find out 3rd year if you want to work in the OR and ICU all day (and most of the night) or prefer working in an outpatient clinic all day (not that neursurgeon's don't have clinic or that neurologists don't work in ICU's).

The top programs in neurosurgery are some of the most competitive spots in all of the match and require research experience and good connections (i.e., good letters).

 

[Onco]

Dudes, no offence but Neurology is amongst the most boring fields of medicine. I did not like my neurology rotation for one simple reason.. you cannot fix anything.. its plain frustrating. Plus, other than stroke (in some regions), the patient population is very thin. It is very similar to psychiatry in some ways.. 'dry'. Most of us become doctors to treat, relieve suffering... and use a stethoscope, literally. Medicine or surgery gives you a certain personality... on the other hand neurology or psychiatry makes you paranoid and frustrated.

Neurosurgery is the most exciting field in Medicine. With Stealth MRI technology and microscopic neurosurgery, the advances over the next 15 years will be mind-boggling. If I was good enough to be a neurosurgeon, I would do it.

 

[epicurusman]

Dudes, no offence but Neurology is amongst the most boring fields of medicine. I did not like my neurology rotation for one simple reason.. you cannot fix anything.. its plain frustrating. Plus, other than stroke (in some regions), the patient population is very thin. It is very similar to psychiatry in some ways.. 'dry'. Most of us become doctors to treat, relieve suffering... and use a stethoscope, literally. Medicine or surgery gives you a certain personality... on the other hand neurology or psychiatry makes you paranoid and frustrated.

Neurosurgery is the most exciting field in Medicine. With Stealth MRI technology and microscopic neurosurgery, the advances over the next 15 years will be mind-boggling. If I was good enough to be a neurosurgeon, I would do it.

I don't know where you did your neurology rotation, but IMHO neurology has some of the weirdest, coolest cases in medicine. I felt neurosurgery, internal medicine was way boring compared with my neurology rotation. Yeah, sure there are cases that are 'unfixable' but like you said, we all became doctors to relieve suffering. Neurologists, esp the pain fellowship trained docs are VERY good and doing just that. Don't write off neurology so fast; it deserves a lot of respect, both the field and the people who do it.

 

[epicurusman]

Dudes, no offence but Neurology is amongst the most boring fields of medicine. I did not like my neurology rotation for one simple reason.. you cannot fix anything.. its plain frustrating. Plus, other than stroke (in some regions), the patient population is very thin. It is very similar to psychiatry in some ways.. 'dry'. Most of us become doctors to treat, relieve suffering... and use a stethoscope, literally. Medicine or surgery gives you a certain personality... on the other hand neurology or psychiatry makes you paranoid and frustrated.

Neurosurgery is the most exciting field in Medicine. With Stealth MRI technology and microscopic neurosurgery, the advances over the next 15 years will be mind-boggling. If I was good enough to be a neurosurgeon, I would do it.

I don't know where you did your neurology rotation, but IMHO neurology has some of the weirdest, coolest cases in medicine. I felt neurosurgery, internal medicine was way boring compared with my neurology rotation. Yeah, sure there are cases that are 'unfixable' but like you said, we all became doctors to relieve suffering. Neurologists, esp the pain fellowship trained docs are VERY good and doing just that. Don't write off neurology so fast; it deserves a lot of respect, both the field and the people who do it.

 

[Onco]

Neurology residents do get 'headache' fellowships but trust me dude.. 'pain' is medicine territory..
The neurosurgeons and radiologists have already stolen 'interventional neuroradiology' from you guys. Really, the day NINDS/NIH cuts its budget by 30-40%, many academic neurologists will find it difficult to sponsor their salaries.

PS- Keep pushing in the IV tpA 😉

 

[llogg]

Neurology residents do get 'headache' fellowships but trust me dude.. 'pain' is medicine territory..
The neurosurgeons and radiologists have already stolen 'interventional neuroradiology' from you guys. Really, the day NINDS/NIH cuts its budget by 30-40%, many academic neurologists will find it difficult to sponsor their salaries.

PS- Keep pushing in the IV tpA 😉

Troll.

It's too bad the mods are not quicker to ban people like you.

 

[Wheezy]

Dudes, no offence but Neurology is amongst the most boring fields of medicine. I did not like my neurology rotation for one simple reason.. you cannot fix anything.. its plain frustrating.

I am planning on going into neurosurg. or neurology. I have a step 1: 243 and one year of neuro research.

I have been reading this thread since it began. I haven't replied yet because I've been busy & I'm trying to cut down on my obscenities.

Zama. A few years back, when I was a 3rd year I was thinking of both neurology & neurosurgery. I have almost exactly the same step 1 score as you. but I'm a FMG & don't have a full years research. Anyway, that's besides the point.

The worse thing you could do is to choose a speciality because other people think it's glamorous or difficult to get into. So don't go into plastics, ortho, neurosurg or any other competitive field for the sake of it being competitive.

choose what you love. If you like both neurology & neurosurgery, my advice is to do an elective in both. I did. I enjoyed them both, but I chose neurology. You might choose neurosurgery.... or maybe neither. For me, neurology offered more patient contact, family (the patient's) contact, variety & was more mentally stimulating.

NEUROLOGY: I liked the clinics, with all the patients with headache (commonest Outpatient neuro condition), epilepsy (2nd commonest), Parkinson disease, peripheral neuropathies, myopathies & other less common stuff. I loved taking care of our inpatients with stroke (commonest), meningitis, encephalitis, status epilepticus, multiple sclerosis & other less common stuff was pretty cool. That's the so called bread & butter of inpatients & outpatients for general neurologists.

NEUROSURGERY: Trauma, tumours & disc disease. Also Subarachnoid haemorrhage (aneurysms & AVMs). That's the bread & butter for neurosurgery. From what I've seen anyway.

I did my electives back to back. I had a patient with TB meningitis who we diagnosed & treated under neurology, then when I was on neurosurgery we put in a VP shunt for him because of hydrocephalus & the neurology team took care of the rest. Drilling your first hole through someones skull will give you a buzz that will last at least a month😀 But no one, even neurosurgeons thinks VP shunts (the commonest operation in neurosurgery where I was) are glamerous or sexy.😉 I enjoyed the neuro side of treating this patient more than the neurosurgical side. But my friends thought my operating room story was cooler than.... the we found out what caused his headache & put him on some meds.😎 but I live my dreams not my friends.

Listen, in med school we are way too competitive. We care way too much how other people view us. Your career, your job, your life (in & outside work) is yours. So do what suits you. You will see misery in Neuro, you will see it in neurosurgery & you will see it in internal medicine & even in general surgery.

For people who don't like neurology, neurology is boring/futile/miserable/frusterating. For people who don't like neurosurgery, neurosurgery is boring/futile/miserable/frusterating. For people who don't like medicine, medicine is boring/futile/miserable/frusterating. Get my point homie🙂

I'm not going to write out why I think neuro is exciting, interesting, fulfilling... etc. or explain how the services we provide are appreciated by patients & other doctors...... etc. and how that it is an essential part of health care. I'm not here to convert anyone to neurology. If you want me to elaborate, PM me & I'll reply, because you are interested in neuro.

People will ragg on you and tell you that you are wasting your life no matter what speciality you choose. the most important thing is that you think it's not a waste of your time & that your are happy about it. Even if it's working outside of medicine or academia..... e.g. bussines, McDonald's, a cafe.

Another point is that people will tell you, that you are confused because you haven't decided between neurology or neurosurgery. I bet if you spent a few months in my current department you'd be confused between neurology, neurosurgery or neuropathology. My hunch is you like the nervous system & you like being a part of healthcare. I like & have worked in neurology, internal medicine & neuropathology. I've done an elective in neurosurgery. But for me, I want to be a neurologist, that's my number one & i'm not compromizing.

Anyway, my final points are this... respect other peoples work if it's decent. Choose what's right for you & use your electives to make up your mind. Apply for want you want & let the PDs, chairmen & commitees decided if you are what they are looking for.... 😎

 

[nrosigh]

Wheezy - great post! You really gave a nice perspective...

 

[Onco]

I have been reading this thread since it began. I haven't replied yet because I've been busy & I'm trying to cut down on my obscenities.

Zama. A few years back, when I was a 3rd year I was thinking of both neurology & neurosurgery. I have almost exactly the same step 1 score as you. but I'm a FMG & don't have a full years research. Anyway, that's besides the point.

The worse thing you could do is to choose a speciality because other people think it's glamorous or difficult to get into. So don't go into plastics, ortho, neurosurg or any other competitive field for the sake of it being competitive.

choose what you love. If you like both neurology & neurosurgery, my advice is to do an elective in both. I did. I enjoyed them both, but I chose neurology. You might choose neurosurgery.... or maybe neither. For me, neurology offered more patient contact, family (the patient's) contact, variety & was more mentally stimulating.

NEUROLOGY: I liked the clinics, with all the patients with headache (commonest Outpatient neuro condition), epilepsy (2nd commonest), Parkinson disease, peripheral neuropathies, myopathies & other less common stuff. I loved taking care of our inpatients with stroke (commonest), meningitis, encephalitis, status epilepticus, multiple sclerosis & other less common stuff was pretty cool. That's the so called bread & butter of inpatients & outpatients for general neurologists.

NEUROSURGERY: Trauma, tumours & disc disease. Also Subarachnoid haemorrhage (aneurysms & AVMs). That's the bread & butter for neurosurgery. From what I've seen anyway.

I did my electives back to back. I had a patient with TB meningitis who we diagnosed & treated under neurology, then when I was on neurosurgery we put in a VP shunt for him because of hydrocephalus & the neurology team took care of the rest. Drilling your first hole through someones skull will give you a buzz that will last at least a month😀 But no one, even neurosurgeons thinks VP shunts (the commonest operation in neurosurgery where I was) are glamerous or sexy.😉 I enjoyed the neuro side of treating this patient more than the neurosurgical side. But my friends thought my operating room story was cooler than.... the we found out what caused his headache & put him on some meds.😎 but I live my dreams not my friends.

Listen, in med school we are way too competitive. We care way too much how other people view us. Your career, your job, your life (in & outside work) is yours. So do what suits you. You will see misery in Neuro, you will see it in neurosurgery & you will see it in internal medicine & even in general surgery.

For people who don't like neurology, neurology is boring/futile/miserable/frusterating. For people who don't like neurosurgery, neurosurgery is boring/futile/miserable/frusterating. For people who don't like medicine, medicine is boring/futile/miserable/frusterating. Get my point homie🙂

I'm not going to write out why I think neuro is exciting, interesting, fulfilling... etc. or explain how the services we provide are appreciated by patients & other doctors...... etc. and how that it is an essential part of health care. I'm not here to convert anyone to neurology. If you want me to elaborate, PM me & I'll reply, because you are interested in neuro.

People will ragg on you and tell you that you are wasting your life no matter what speciality you choose. the most important thing is that you think it's not a waste of your time & that your are happy about it. Even if it's working outside of medicine or academia..... e.g. bussines, McDonald's, a cafe.

Another point is that people will tell you, that you are confused because you haven't decided between neurology or neurosurgery. I bet if you spent a few months in my current department you'd be confused between neurology, neurosurgery or neuropathology. My hunch is you like the nervous system & you like being a part of healthcare. I like & have worked in neurology, internal medicine & neuropathology. I've done an elective in neurosurgery. But for me, I want to be a neurologist, that's my number one & i'm not compromizing.

Anyway, my final points are this... respect other peoples work if it's decent. Choose what's right for you & use your electives to make up your mind. Apply for want you want & let the PDs, chairmen & commitees decided if you are what they are looking for.... 😎

That's too emotional.. 😉

Again, point is there always are limitations when one practices a certain field. Emotionally, your perspective is correct. However, realistically and logically, one has to realize those limitations that any field imposes upon you before you practice that field. In that regard peer/colleague perspective is also very important. You should not enter Neurology with the aim of practicing active intervention on the patients. If you like intervention, do Neurosurgery. They will train you appropriately.

 

[Sir Elroy]

Again, point is there always are limitations when one practices a certain field. Emotionally, your perspective is correct. However, realistically and logically, one has to realize those limitations that any field imposes upon you before you practice that field. In that regard peer/colleague perspective is also very important. You should not enter Neurology with the aim of practicing active intervention on the patients. If you like intervention, do Neurosurgery. They will train you appropriately.

Just out of curiosity, how is it that you know so much about what is and is not true of the fellowships? Are there stats somewhere that we can look up? With all due respect, I'm not sure I trust a medical student to give the realistic and logical truth about fellowship eligibility.

 

[Wheezy]

That's too emotional.. 😉

Again, point is there always are limitations when one practices a certain field. Emotionally, your perspective is correct. However, realistically and logically, one has to realize those limitations that any field imposes upon you before you practice that field. In that regard peer/colleague perspective is also very important. You should not enter Neurology with the aim of practicing active intervention on the patients. If you like intervention, do Neurosurgery. They will train you appropriately.

I partially agree with what you are saying. It's true that if you are into intervensions then neurology doesn't offer many. Also, if you'd rather do something with your hands than think about a problem, that's not a characteristic that is common in neurology. But one of the things I was trying to say is this, if you want to tackle some of the most interesting & challenging diseases there are, & help patients with these disorders, then neurology offers the most (in my opinion of course).

The student is trying to decide about his future career. One way to look at it is by asking "so what does a neurosurgeon/neurologist do, would I like to do that for 30 years?' Another approach is 'so what does a neurosurgeon/neurologist deal with, would I like to deal with that for 30 years?' I think that illustrates, partially at least, the differences in how we are approaching this.

Let me expand on my last point. According to the first approach, if you go into neurology you are limiting yourself because you can't excise the oligodendroglioma causing your patient's seizures. A neurosurgeon can. Same goes for subdurals, AVMs & other neurosurgical stuff. According to the second approach, if you go into neurosurgery you are limiting yourself because you won't be the main physician for/or even see patients with Strokes, epilepsies, Multiple sclerosis, Parkinson, peripheral neuropathies, myopathies. So "limitations" can mean different things depending on your prespective. Also if you want to be the stroke dude, be a neurologist. if you want to be the brain tumour dude be a neurosurgeon or a neuropathologist.

Now here is a twister for you, what if you wanna be the epilepsy dude😕 ................................. Then it depends on your perspective; if you want to be the guy they call when they suspect it, when they misdiagnose it, when it's too tough for them to manage or the main dude taking care of these patients, then be a neurologist. If you want to be the guy with they present the minority of patients to, those with mesotemporal sclerosis MTS or other lesions or palliative cases, because you got the valuable skills to get the job done, then be an epilepsy neurosugeon.

I've done the neurology bit as a Dr., Seen misdiagnosis, taken care of patients in the epilepsy monitoring unit EMU presurgery & seen patients post surgery. Also, i've attended the epilepsy surgeries (mostly MTS). I've interpretted the biopsies & resections of these patients. I work with both neurology & neurosurgery teams & the main attendings. We (neurologist, neurosurgeons & neuropathologist) see different groups of patients usually, but sometimes we see the same patients and we have very different things to offer.

Onco makes a good point of looking at what you will actually be doing, (i'd add- physically & mentaly). And also what you can offer your patients as a neurologist vs. neurosurgeon. Equally important is what you will be experiencing & seening. Both fields are interesting. I love neurology, onco seems to love neurosurgery. Both are high tech. Both involve a lot of human suffering. And in BOTH fields you will see a lot of patients you can't do Jack for with regards to mortality, intervension & alterning natural history. If you think you are going to Waltz into clinic or theatre & cure everyone & they'll all love you...... you are in for a real shocker. But these fields are extremely rewarding for those who love them. If you want tons of procedures, lots of cures, interesting mechanics then check out orthopaedics. It's pretty cool too. But for me it's neuro neuro neuro.

 

[Bonobo]

The comments shared so far are very thoughtful and good -- Onco's also (are you a jaded neurologist? neuroradiologist? IM?). But I was in a similar dilemma a few years ago and chose neurology over neurosurgery. I believe that I was good enough to do neurosurgery, but I got married and based on very good advice from my neurosurgical advisors, my wife and I discussed things and we decided that it would be better for me to do neurocritical care or interventional neuroradiology via neurology.

The mistake is to think that there is one right answer. Seriously. To say that you can't do procedures as a neurologist would be saying the same thing to cardiologists, gastroenterologists, radiologists, etc. You are only as good at a procedure as how often you end up doing it, and how much training you have in dealing with patients who you are doing the procedure on. Thus, for interventional stroke, do neurology, for interventional tumors, aneurysms, AVM's do neurosurgery, for diagnostics and rare interventions, do radiology.

My point is, if you know exactly what patients you want to treat, and how you want to treat them, then it will be easy to decide which path to take.

If you don't, then you will have to factor in multiple aspects to your life before deciding on one specialty. One sagely advice that I received was to make sure to NOT select a specialty that could potentially make me miserable. I was told that if not making half-a-million a year would make me sick inside, then I should stay clear of neurology. I was also told that if only seeing my family one day a week, plus a couple hours every other day was simply not enough, then forget neurosurgery (or forget having kids until after I am done being a junior attending). Be realistic about these things. While you can fix them, you will have to make major other sacrifices in order to do so (e.g. reading sleep studies all day every day or becoming an exclusive spine surgeon).

BTW, the argument that if you are good enough to do NSGY you should is ridiculous. I heard that all the time, and both neurosurgeons and neurologists used that to encourage me to go into neurosurgery. This is your life and you need to do something that will make you happy. Society will be better off that way. On the other hand one of my friends told me when choosing neurosurgery that if he hadn't chosen it, he would have still ended up in some profession working 80-100 hours a week. If you are that person, well then, NSGY may not be so bad.

It would be nice if neurology had a subspecialty like cardiology, because lets face it, they pretty much have it all. I believe that a couple decades from now, cerebrovascular neurology will be there. But for now, you will have to choose.

B

 

[Onco]

double post.. sorry

 

[Onco]

I am MS4 and have applied to IM, EM and IM/EM programs.

With neurology the aphormism that at any time 'there are more neurologists around than the number of patients', without disrepecting the speciality, is true. After all what's the prevalence of Parkinson's Disease compared with say Rheumatoid Arthritis or SLE or Hypertension or Diabetes Mellitus or Breast Cancer? This difference has enormous impact on the lives of people which has infact led many academicians to criticize the allocation of NIH research funds to Neurology. Talking with clinicians, I am pretty sure that if a situation arises when the NIH pulls money out of research, Neurology will be severely affected before other specialities... its a known fact in all medical circles. And I am not saying a clinical trial on PD has less worth than a clinical trial on RA. 😉

You will say Neurologists can enter private practice.. But then, even in private practice they are among the more dispensable physicians. A small hospital in a nice suburb of Seattle is not complete without a Internist and subspecialists in core medicine and typically does not need a neurologist. Most neurology is restricted to university affiliated medical centers.

Finally, the lack of treatment makes it frustrating.. you cannot cure anything. I have had the oppurtunity to rotate at the Radcliffe Hospital, affiliated with University of Cambridge, UK, for a month. Here in US, the EM staff takes care of acute stroke, in the UK, internal med. staff does that. I mean what the heck are Neurology staff doing??? hiding the friggin MRIs at the morning report and jibbering with each other on who locates the lesion??? I also found the neurology residents to be most political among all specialities. I dont know where the ego comes from because, from my perspective, they arent contributing as much to medicine as most other people in the hospital at any point in time. No offence.

 

[danielmd06]

With neurology the aphormism that at any time 'there are more neurologists around than the number of patients', without disrepecting the speciality, is true.


Finally, the lack of treatment makes it frustrating. Here in US, the EM staff takes care of acute stroke, in the UK, internal med. staff does that. I mean what the heck are Neurology staff doing???

I was a medical student interested in both Neurosurgery and Neurology who wound up selecting Neurology.

For your former quote, I would submit that stroke is the third leading cause of death in the United States. This also anwers a portion of your second point questioning lack of treatment. Interventional techniques and newer drug therapies for ischemic stroke are at the current forefront of Neurology research.

Many Cardiology group practices are recruiting Neurolgoists with Stroke/Vascular fellowship training because cardiovascular and neurovascular disease are so closely linked.

The push is currently for comprehensive Stroke or Brain Attack Teams to be on call 24 hours a day for fast response time in the treatment of these issues. I am not sure about your experiences with ER staff, but in my own experience, these tasks are specifically handled by Neurologists.

 

[salmonella]

I was actually deciding between neuro and IM. In the end I chose IM (and eventually subspecialty fellowships) because:
-Lack of encouragement from neuro faculty/resident: I remember a faculty told me if his kid were thinking about doing neuro, he would strongly discourage him/her because salary is so bad (especially in academia) and neuro's respect in the medical community is dwindling quickly. Also, other faculty looked at me all weird and surprised, as they thought American med students wouldn't be interested in neuro these days. The residents (almost half is FMG) complained about job market (starting salary in the 120's). All they want to do is EMG fellowship so they can make some money in the real world. Other specialties such as ophtho, derm, rad onc and even PM & R, their faculty and residents are proud of their specialties and encourage others to enter. I did not get that feeling with neuro
-I am kind of frustrated with rounds. They are mostly (at least to me) unnecessarily lengthy intellectual exercises in which you try to guess where they lesion is. Why can't they just looking at the radiology report! Plus, seems like whether they spend 10 min or 2 hours discussing the pt's lesion, the management doesn't change most of the time. The "plan" section of my soap note still says pt/ot consult, PM&R acute rehab eval, continue plavix/asa, rec brain CT/MRI/EEG....Also, they spend so much time reading images, but they cannot even bill for them! At least in medicine, even seemingly trivial discussion at rounds (debating how much metoprolol to give, rate of IV fluid, NS vs 1/2NS, etc) has some direct impact on patient management/outcome.
-Neuro people spend so much time learning about rare diseases (which is what makes neuro interesting), but how often are you going to see creutzfedt-jakob, neurofibromatosis, gerstmann-straussler syndrome, von hippel lindau disease in real life? Probably only a few, at the most, especially for community neurologists.
-After my neuro rotation, I realize neurologist's neuro exam is not as sophisticated as I thought. Probably because of the imaging modalities, they don't go into much detail in their neuro exam as in the past. Other specialties such as IM, ortho, rheum, and PM and R can probably do as good of a clinically meaningful neuro exam as neurologists. Even faculty and residents admit that neuro exam is not helpful most of the time, except for the big things like reflex and extremity strength, which is pretty easy to assess and interpret by non neurologists as well.

 

[neurologist]

I am MS4 and have applied to IM, EM and IM/EM programs.

With neurology the aphormism that at any time 'there are more neurologists around than the number of patients', without disrepecting the speciality, is true. After all what's the prevalence of Parkinson's Disease compared with say Rheumatoid Arthritis or SLE or Hypertension or Diabetes Mellitus or Breast Cancer? This difference has enormous impact on the lives of people which has infact led many academicians to criticize the allocation of NIH research funds to Neurology. Talking with clinicians, I am pretty sure that if a situation arises when the NIH pulls money out of research, Neurology will be severely affected before other specialities... its a known fact in all medical circles. And I am not saying a clinical trial on PD has less worth than a clinical trial on RA. 😉

You will say Neurologists can enter private practice.. But then, even in private practice they are among the more dispensable physicians. A small hospital in a nice suburb of Seattle is not complete without a Internist and subspecialists in core medicine and typically does not need a neurologist. Most neurology is restricted to university affiliated medical centers.

Finally, the lack of treatment makes it frustrating.. you cannot cure anything. I have had the oppurtunity to rotate at the Radcliffe Hospital, affiliated with University of Cambridge, UK, for a month. Here in US, the EM staff takes care of acute stroke, in the UK, internal med. staff does that. I mean what the heck are Neurology staff doing??? hiding the friggin MRIs at the morning report and jibbering with each other on who locates the lesion??? I also found the neurology residents to be most political among all specialities. I dont know where the ego comes from because, from my perspective, they arent contributing as much to medicine as most other people in the hospital at any point in time. No offence.

What the hell are you talking about? We'll see how your tune changes when you're just another IM or ER consult ***** who's first reaction to anything that can't be fixed with motrin or demerol is to call for a subspecialty consult. Is having lots of neurologists an "absolute" societal need? No, or at least it wouldn't be if internists, FPs and ER docs knew or cared anything about neurology. But the fact is, most generalists turn off their "neuro brain" after first year neuroanatomy in med school and don't want anything to do with it subsequently. Believe me, I would LOVE not to see all the headaches, back pains, non-epileptic spells, and dizzy old ladies who parade through my office, and instead be able to focus on "real" neurology, but you know what? -- ALL YOU E.R. AND I.M. BOZOS WON'T STOP SENDING THEM!!!!!
And therefore, ergo, Q.E.D and cogito ergo sum, the need for neurologists: to pick up where general medicine fears to tread.

I am well aware that in other countries neuro is not as common a specialty, but that's because in other countries primary care physicians are expected to actually take care of their patients themselves, not shuttle them off to specialist after specialist. Also, the US system (for better or worse) largely works on market based principles: patient sees that there are specialists who take care of headaches --> patient wants to see specialist --> demand for more specialists is created.

As for neurologic disease not being prevalent, you simply have got to be kidding me. Last time I looked, stroke was, oh, about the #3 cause of death in this country. How many people die of SLE or RA on an annual basis?

As for your comment that neuro "can't cure anything," well, please give me a call when you have started "curing" all those diabetic hypertensive rheumatoid arthritic lupus patients of yours, and I will personally nominate you for a Nobel, ok?

In the mean time, go troll some other forum.

Sheeesh, I haven't gotten that riled up in ages . . . 😀

 

[Cephalorectus]

I am MS4 and have applied to IM, EM and IM/EM programs.

With neurology the aphormism that at any time 'there are more neurologists around than the number of patients', without disrepecting the speciality, is true. After all what's the prevalence of Parkinson's Disease compared with say Rheumatoid Arthritis or SLE or Hypertension or Diabetes Mellitus or Breast Cancer? This difference has enormous impact on the lives of people which has infact led many academicians to criticize the allocation of NIH research funds to Neurology. Talking with clinicians, I am pretty sure that if a situation arises when the NIH pulls money out of research, Neurology will be severely affected before other specialities... its a known fact in all medical circles. And I am not saying a clinical trial on PD has less worth than a clinical trial on RA. 😉

You will say Neurologists can enter private practice.. But then, even in private practice they are among the more dispensable physicians. A small hospital in a nice suburb of Seattle is not complete without a Internist and subspecialists in core medicine and typically does not need a neurologist. Most neurology is restricted to university affiliated medical centers.

Finally, the lack of treatment makes it frustrating.. you cannot cure anything. I have had the oppurtunity to rotate at the Radcliffe Hospital, affiliated with University of Cambridge, UK, for a month. Here in US, the EM staff takes care of acute stroke, in the UK, internal med. staff does that. I mean what the heck are Neurology staff doing??? hiding the friggin MRIs at the morning report and jibbering with each other on who locates the lesion??? I also found the neurology residents to be most political among all specialities. I dont know where the ego comes from because, from my perspective, they arent contributing as much to medicine as most other people in the hospital at any point in time. No offence.

Dude, what is your deal? It really amazes me how time and energy you've spent in this forum. Clearly, you've had some fairly negative experiences with neurologists and the field of neurology. I wouldn't bother replying to this kind of palaver, but I'm concerned that you might be giving our younger colleagues interested in neurology a very skewed, limited picture of what is an evolving field. (By the way, for your patients' sake, please read up on PD... )

Good luck on your applications for EM... an algorithm monkey, a concrete thinker like you, belongs in the ED. "No offence."

 

[neurologist]

salary is so bad (especially in academia) and neuro's respect in the medical community is dwindling quickly. . . starting salary in the 120's.

1. Who said you have to go into academia?
2. What's the salary after partnership? Believe me, I've lived off a LOT less that $120K a year at various times in my life . . .

All they want to do is EMG fellowship so they can make some money in the real world.

Yeah, and all ophtho docs want is to do LASIK fellowships so they can make some money. And all internists want to do is cards fellowships so they can make some money . . . So what?

Other specialties such as ophtho, derm, rad onc and even PM & R, their faculty and residents are proud of their specialties and encourage others to enter. I did not get that feeling with neuro

This is probably institution-specific. You may just have a lousy neuro department wherever it is you are. Where I've been, neurologists were always very happy with their jobs and generally very encouraging to students and residents.

I am kind of frustrated with rounds. They are mostly (at least to me) unnecessarily lengthy intellectual exercises in which you try to guess where they lesion is.

I went into third year of med school thinking I'd be an internist. After my first morning of IM rotation, where we spent THREE HOURS outside some patients door talking about the pathophysiology of community acquired pneumonia, I knew I was in the wrong place. Teaching rounds will always suck if you have no inherent interest in the material.

Why can't they just looking at the radiology report!

Always remember this quote: "The neurologist's job starts when the MRI comes back normal." Imaging, both normal and abnormal, can be highly misleading. It is a piece of information, not the be-all-and-end-all of diagnosis. Blood in the brain? Sure, call a surgeon. Seizures? Um . . . gosh, that MRI is NORMAL . . . so obviously there's nothing wrong with you, right? WRONG!!!!!!!!!!

Plus, seems like whether they spend 10 min or 2 hours discussing the pt's lesion, the management doesn't change most of the time. The "plan" section of my soap note still says pt/ot consult, PM&R acute rehab eval, continue plavix/asa, rec brain CT/MRI/EEG....

Well, sometimes the best test in medicine is the test of time . . . Not every one-point drop in hematocrit needs a transfusion, right?

Also, they spend so much time reading images, but they cannot even bill for them!

If you want to bill for reading images, be a radiologist. If you want to bill for reading EEGs, be a neurologist.

Neuro people spend so much time learning about rare diseases (which is what makes neuro interesting), but how often are you going to see creutzfedt-jakob, neurofibromatosis, gerstmann-straussler syndrome, von hippel lindau disease in real life? Probably only a few, at the most, especially for community neurologists.

Well, why did I have to learn about Blackfan-Diamond syndrome in med school and internship? I've never seen that. We have to learn about these so we can recognize them because chances are nobody else will, right? (and BTW, I've been averaging 1 CJD a month for the last 3 or 4 months)

I realize neurologist's neuro exam is not as sophisticated as I thought. Probably because of the imaging modalities, they don't go into much detail in their neuro exam as in the past.

Actually, there is rarely the need to do the full, hardcore, med-student neuroexam. Most neurologists (through experience) have learned to do a focused exam that will provide them with the key info they need. Case in point: otherwise healthy patient in for followup for epilepsy. Do I really need to check tongue strength or ankle reflexes? Hell no. But I will just check ocular movements and gait for nystagmus or ataxia because that may indicate toxic levels of antiseizure meds.

Other specialties such as IM, ortho, rheum, and PM and R can probably do as good of a clinically meaningful neuro exam as neurologists.

Well, of course. And I could do as good of a clinically meaningful ortho exam as an orthopedist if I wanted to take the time at it. In fact, since many patients are sent to neurology with musculoskeletally based pain complaints, I often do. But the key isn't whether you can "do" the exam -- the key is making sense out of what you see.

OK, I REALLY have to get back to work. At least you had a few valid points, unlike that Onco goofball.

 

[Cephalorectus]

I was actually deciding between neuro and IM. In the end I chose IM (and eventually subspecialty fellowships) because:
-Lack of encouragement from neuro faculty/resident: I remember a faculty told me if his kid were thinking about doing neuro, he would strongly discourage him/her because salary is so bad (especially in academia) and neuro's respect in the medical community is dwindling quickly. Also, other faculty looked at me all weird and surprised, as they thought American med students wouldn't be interested in neuro these days. The residents (almost half is FMG) complained about job market (starting salary in the 120's). All they want to do is EMG fellowship so they can make some money in the real world. Other specialties such as ophtho, derm, rad onc and even PM & R, their faculty and residents are proud of their specialties and encourage others to enter. I did not get that feeling with neuro
-I am kind of frustrated with rounds. They are mostly (at least to me) unnecessarily lengthy intellectual exercises in which you try to guess where they lesion is. Why can't they just looking at the radiology report! Plus, seems like whether they spend 10 min or 2 hours discussing the pt's lesion, the management doesn't change most of the time. The "plan" section of my soap note still says pt/ot consult, PM&R acute rehab eval, continue plavix/asa, rec brain CT/MRI/EEG....Also, they spend so much time reading images, but they cannot even bill for them! At least in medicine, even seemingly trivial discussion at rounds (debating how much metoprolol to give, rate of IV fluid, NS vs 1/2NS, etc) has some direct impact on patient management/outcome.
-Neuro people spend so much time learning about rare diseases (which is what makes neuro interesting), but how often are you going to see creutzfedt-jakob, neurofibromatosis, gerstmann-straussler syndrome, von hippel lindau disease in real life? Probably only a few, at the most, especially for community neurologists.
-After my neuro rotation, I realize neurologist's neuro exam is not as sophisticated as I thought. Probably because of the imaging modalities, they don't go into much detail in their neuro exam as in the past. Other specialties such as IM, ortho, rheum, and PM and R can probably do as good of a clinically meaningful neuro exam as neurologists. Even faculty and residents admit that neuro exam is not helpful most of the time, except for the big things like reflex and extremity strength, which is pretty easy to assess and interpret by non neurologists as well.

Here's a prime example of one of my biggest pet peeves... The "all you do in neuro is localize the lesion" argument. I think it's based on the experience of medical students who didn't learn their neuroanatomy and struggle with the exercise during their clerkship. Honestly, it's really not that difficult of a skill. It should take five seconds, tops.

Despite all the reasons outlined in this forum (ironically) about why neurology is a dying/limited/stupid field, people nevertheless do go into it. Why?

I think it depends on where you find the "art" of practicing medicine. If it's technical skill in the OR, that's cool. Maybe it's in optimizing quality of life for very sick, disabled people through the course of their entire lives. That's why I chose neurology. I guess the compensation and prestige aren't where I would like them to be at the moment, but those things tend to work themselves out.

(Incidentally, I find EM personalities rarely understand what I'm talking about when I say "art." There's just something about that shift-work, monkey mentality. Again, "no offence."

 

[Wheezy]

I'm tired so I'll try to keep it short.😀 (I know my posts are too long)

In neuro, you will see a lot of the rare diseases. Trust me, I have more patients than I can put on our weekly conference.

In epilepsy & headache (our commonest Out patient illnesses) we have good therapies. In stroke (our commonest in patient illness) we can offer some improvement in mortality & morbidity. Plus, helping people with diagnosis & palliation of some of the worse conditions is what we can do well. Conditions that other doctors run away from. These patients are sometimes the most thankful for our efforts. Also diagnosing Functional disorders & somatization in pain patients can get them to psychiatry, which is what they need & save them from a lot of intervensions.

Stroke is the leading cause of morbidity in the western world. I don't know about the USA, but here in ireland we need to double the number of our neurologist at least. back home in Bahrain where I"m from we probably need even more.😀

I don't mind sorting out IM & ERs confusion ? cause, LOC ?cause, headache ?cause, backache ?treatment & I love sorting out ?something neuro.

In IM you will cure more, but you will also not cure alot of other stuff (end stage heart failure, obesity, diabetes, COPD, lung cancer, lung fibrosis, cirrhosis, crohns, chornic renal failure & many more), but like neuro you can offer these patients valuble care other than a CURE.

I respect my colleges in radiology, IM & ER, but I have a good relationship with them. this might be different in other places.


true we won't make a lot of money, but that doesn't matter to me. I don't care if people respect my speciality (eventhough most people do), my patients do respect my work. Interestingly, I have met some docs, & rotated through their team, that are very critical of neuro, but they've respected my work.😎

hope that gives a bit of perspective🙂

 

[OB/Gyn Kenobi]

I don't understand people who go to forums of specialties they don't like, and badmouth them. Obviously, if they want to go into something else, they don't appreciate the up side of your specialty. Just be glad Onco isn't going into Neuro.

 

[Faebinder]

Despite neurologist's nonchalant aggressive style... I would like to give him a 👍 for perfectly using the term "Consult *****".

 

[llogg]

I don't understand people who go to forums of specialties they don't like, and badmouth them. Obviously, if they want to go into something else, they don't appreciate the up side of your specialty. Just be glad Onco isn't going into Neuro.

I'm not sure why anyone has bothered responding to this troll. He's an MS4. His experience with the real-world practice of medicine is limited at best. His opinion of how other specialties view neurology carries almost as much weight as that of my 16 month old daughter. And his opinion of the practice of neurology after a 4-6 week rotation is as valid as Rush Limbaugh's opinion of the extent of Michael J. Fox's Parkinson's.

 

[epicurusman]

I'm not sure why anyone has bothered responding to this troll. He's an MS4. His experience with the real-world practice of medicine is limited at best. His opinion of how other specialties view neurology carries almost as much weight as that of my 16 month old daughter. And his opinion of the practice of neurology after a 4-6 week rotation is as valid as Rush Limbaugh's opinion of the extent of Michael J. Fox's Parkinson's.

Fact is, onco does not know what he is talking about. If he were in a neurosurgery residency, then at least he would have real life examples to back his completely subjective argument of the fact that it's so much better than neurology. But he's not, he's just going to be a jaded internist/ER doc who will neglect an entire field that will revolutionize how CNS diseases will be treated.

Zama, I had a hard time deciding between neurology and neurosurgery. The PD in neurosurgery at my institution told me I would have no problems getting into a neurosurgery residency. So it was purely a personal decision that I decided to go into neurology. The opportunity for extensive patient contact, groundbreaking research (NIH/NINDS will NOT be withdrawing funding from neurology--it would cut back on other specialties first), and opportunity to work with radiologists, neurosurgeons, psychiatrists, etc. on very difficult cases is what drew me to the field. And quite honestly, I liked the fact that neurologists can choose to have a life outside of the hospital even as a resident. A neurosurg resident wisely told me, "don't choose neurosurgery unless you've decided absolutely nothing else will come close to making you happy". So in sum, getting in is not going to be the biggest challenge; it's deciding whether the specialty is the best fit in all respects that is going to be the hard part.

 

[Onco]

I apologize if I offended anyone. I wont stoop to the level of some posters who perhaps have read the oath of hippocrates but cannot follow it.

Every branch of medicine is equally fascinating. Reading a page of Harrison is as much fun as reading a page of Shwartz. Both surgery and medicine have their pros and cons. While Salmonella and I have given a logical assessment it seems that others have certain 'entitled' views on the subject and are not willing to be flexible. You cannot have a discussion without the willingness to listen to other's point of view, so, I think we should perhaps close this discussion.

Good luck.. 🙂

 

[Cephalorectus]

Good-bye, toolbox!

 

[Cephalorectus]

Good-bye, toolbox!

 

[AlternateSome1]

Neurology residents do get 'headache' fellowships but trust me dude.. 'pain' is medicine territory..

A good reason not to trust you...pain is not a medicine fellowship. Anesthesiologists, Neurologists, Psychologists, and PM&R physicians are the ones who can apply. I hope you didn't go into medicine thinking you were going to do pain.

Subspecialty/fellowship - from FREIDA
Cardiovascular Disease (IM)
Clinical Cardiac Electrophysiology (IM)
Critical Care Medicine (IM)
Endocrinology, Diabetes, and Metabolism (IM)
Gastroenterology (IM)
Geriatric Medicine (IM)
Hematology (IM)
Hematology and Oncology (IM)
Infectious Disease (IM)
Interventional Cardiology (IM)
Nephrology (IM)
Oncology (IM)
Pulmonary Disease (IM)
Pulmonary Disease and Critical Care Medicine (IM)
Rheumatology (IM)
Sports Medicine (IM)

 

[Methyldopa]

A good reason not to trust you...pain is not a medicine fellowship. Anesthesiologists, Neurologists, Psychologists, and PM&R physicians are the ones who can apply. I hope you didn't go into medicine thinking you were going to do pain.

Good pick up! It's tough to sift through Onco's ******ed and misinformed diatribe and he's just a fourth year student. Can't wait till an attending gives him the good kick in the 'nads he clearly needs.

 

[danielmd06]

Pain fellowships are very clearly available to a large percentage of different residents. Check FRIEDA.

 

[neurologist]

A good reason not to trust you...pain is not a medicine fellowship. Anesthesiologists, Neurologists, Psychologists, and PM&R physicians are the ones who can apply. I hope you didn't go into medicine thinking you were going to do pain.

Subspecialty/fellowship - from FREIDA
Cardiovascular Disease (IM)
Clinical Cardiac Electrophysiology (IM)
Critical Care Medicine (IM)
Endocrinology, Diabetes, and Metabolism (IM)
Gastroenterology (IM)
Geriatric Medicine (IM)
Hematology (IM)
Hematology and Oncology (IM)
Infectious Disease (IM)
Interventional Cardiology (IM)
Nephrology (IM)
Oncology (IM)
Pulmonary Disease (IM)
Pulmonary Disease and Critical Care Medicine (IM)
Rheumatology (IM)
Sports Medicine (IM)

While I agree with Methyldopa's "kick in the 'nads" comment just because it's a good idea, I will defend Onco (sort of) by pointing out that he didn't say that pain was a medicine "fellowship" -- he said pain was medicine "territory." I interpret that as meaning that internists, not neurologists, should be treating pain. And hey, I won't argue that one!

 

[AlternateSome1]

Pain fellowships are very clearly available to a large percentage of different residents. Check FRIEDA.

What I posted is directly from frieda (with editing of non-IM fellowships). Again, anesthesia, neurology, pm&r and psych can do pain fellowships. This is also listed on frieda.

 

[danielmd06]

What I posted is directly from frieda (with editing of non-IM fellowships). Again, anesthesia, neurology, pm&r and psych can do pain fellowships. This is also listed on frieda.

I completely agree with you. I was actually posting in support of your comments - not against them.

I was informing the individual who seemed to be confused to check with FRIEDA for clarification.

 

[Onco]

A good reason not to trust you...pain is not a medicine fellowship. Anesthesiologists, Neurologists, Psychologists, and PM&R physicians are the ones who can apply. I hope you didn't go into medicine thinking you were going to do pain.

Subspecialty/fellowship - from FREIDA
Cardiovascular Disease (IM)
Clinical Cardiac Electrophysiology (IM)
Critical Care Medicine (IM)
Endocrinology, Diabetes, and Metabolism (IM)
Gastroenterology (IM)
Geriatric Medicine (IM)
Hematology (IM)
Hematology and Oncology (IM)
Infectious Disease (IM)
Interventional Cardiology (IM)
Nephrology (IM)
Oncology (IM)
Pulmonary Disease (IM)
Pulmonary Disease and Critical Care Medicine (IM)
Rheumatology (IM)
Sports Medicine (IM)

HA! Let me know if you spot a neurology resident who is currently a pain fellow. That would be a rare creature.

Remember.. brain stimulation for PD and AD, brain implants and lobectomies for Epilpesy.. Lets hope Neurology EXISTS in 2015 and is not an archived field of medicine. You cant say I dont like Neurology.

 

[Faebinder]

HA! Let me know if you spot a neurology resident who is currently a pain fellow. That would be a rare creature.

Remember.. brain stimulation for PD and AD, brain implants and lobectomies for Epilpesy.. Lets hope Neurology EXISTS in 2015 and is not an archived field of medicine. You cant say I dont like Neurology.

Like epilepsy, the third most common chronic condition will ever go away... Could a moderator please ban this troll?

 

[Onco]

Like epilepsy, the third most common chronic condition will ever go away... Could a moderator please ban this troll?

Do you have a problem with free speech? This is America and we dont need J1 visas to stay here.

Or may be you're afraid truth is bitter?

 

[danielmd06]

HA! Let me know if you spot a neurology resident who is currently a pain fellow. That would be a rare creature.

The Pain attending that I had contact with at my home medical school was a Neurologist.

Onco, you apparently have no desire to read the accurate information that others are supplying to you from official sources, or listen to advice from those who are more experienced. That is certainly your choice, but it doesn't make you right.

 

[Wheezy]

Remember.. brain stimulation for PD and AD, brain implants and lobectomies for Epilpesy.. Lets hope Neurology EXISTS in 2015 and is not an archived field of medicine. You cant say I dont like Neurology.

Dude, now you are just trying to wind us up. I wouldn't normally reply, except other medical students might read this & believe you.

The vast majority of patients don't meet criteria for surgery in epilepsy & parkinsons. Ask any epileptologist, epilepsy surgeon, movement disorder specialist or surgeon that implants DBS. Or maybe media hype is enough evidence for you! Even for those patients that meet criteria they are selected by neurologists, assessed by neurologist & the follow up care is continued by the neurologist. If surgery becomes more main stream in these conditions, then you will need even more neurologists.

is AD Alzheimer disease. I hope you don't think a diffuse neurodegenerative condition like AD will be completely treated by brain stimulation!!😱 Currently there isn't even a remote role for brain stimulation in AD.

Initially I thought you wanted to answers Zama's question, but just had strong feelings about the speciality. Now I think you need to cool off & take a real look at these disorders, the patients, the practice of medicine & where things are & then maybe where they are going. Or maybe you just like to wind up neurologists & neurologist wannabies (we are passionate about it after all)😉

 

[Faebinder]

Do you have a problem with free speech? This is America and we dont need J1 visas to stay here.

Or may be you're afraid truth is bitter?

I am not a neurologist so nothing to be bitter about.... and I don't need a J-1 visa to stay in the US... 😉

Carry on speaking... it doesn't mean I have to listen anymore. You officially gained my ignore list.

 

[AlternateSome1]

Lets hope Neurology EXISTS in 2015 and is not an archived field of medicine.

We can always hope. 🙄

 

[llogg]

HA! Let me know if you spot a neurology resident who is currently a pain fellow. That would be a rare creature.

Remember.. brain stimulation for PD and AD, brain implants and lobectomies for Epilpesy.. Lets hope Neurology EXISTS in 2015 and is not an archived field of medicine. You cant say I dont like Neurology.

To any students who may think this troll knows of what he speaks, allow me to present this link from the International Association for the Study of Pain which lists training programs (i.e. fellowships) in pain management. You will note that some programs list the Neurology department as one of the sponsoring departments (Memorial Sloan-Kettering, Duke), and others explicitly include neurologists in the list of qualified applicants (University of Rochester, Dartmouth), while others state that applicants need only have an MD and be eligible for licensure. While it is true that many of the programs appear to be the exclusive province of anesthesiologists, none appeared to be exclusive to internists as suggested by the troll's assertion that pain was under the aegis of medicine.

 

[Onco]

Dude, now you are just trying to wind us up. I wouldn't normally reply, except other medical students might read this & believe you.

The vast majority of patients don't meet criteria for surgery in epilepsy & parkinsons. Ask any epileptologist, epilepsy surgeon, movement disorder specialist or surgeon that implants DBS. Or maybe media hype is enough evidence for you! Even for those patients that meet criteria they are selected by neurologists, assessed by neurologist & the follow up care is continued by the neurologist. If surgery becomes more main stream in these conditions, then you will need even more neurologists.

is AD Alzheimer disease. I hope you don't think a diffuse neurodegenerative condition like AD will be completely treated by brain stimulation!!😱 Currently there isn't even a remote role for brain stimulation in AD.

Initially I thought you wanted to answers Zama's question, but just had strong feelings about the speciality. Now I think you need to cool off & take a real look at these disorders, the patients, the practice of medicine & where things are & then maybe where they are going. Or maybe you just like to wind up neurologists & neurologist wannabies (we are passionate about it after all)😉

Wheezy,

You sound more mature than rest of the trolls/4th year kids on this forum.. 😀 Tell us more about yourself and your background.


Cortical stimulation and intrathecal infusion of certain medications are currently at initial stages of research.. You know many drugs simply cannot pass the blood brain barrier so I am very dubious if there will ever be medications suited for neurological treatment. I know of a neurosurgery resident at UCSF who will publish a paper (hopefully that should end up in Nature or Science) on invasive treatment of AD within the next year.

Neurology is full of people who want to make easy money by doing EMGs or monitoring epilepsy or migraine all their lives. Take an example of Trigeminal neuralgia. For a hundred years neurologists could not come up with a drug to treat the condition. Now Neurosurgeons are doing thousands of microvascular decompressions every year and treating this disease. Isnt that a failure of the Neurologist? Same goes for PD and deep brain stimulation.

Neurologists have to think invasively.. they have to create interventions and be genuinely interested in 'treatment'. Otherwise Neurosurgeons will continue to dominate the direction of thought and research on disorders of the central nervous system. From researching on viral vectors to treat CNS disorders, to using endovascular and endoscopic treatment of various CNS conditions, neurosurgeons are eons ahead of you guys.

And finally, unlike neurosurgery, there are very few neurologists who are GENUINELY interested in research.

 

[danielmd06]

Mark Twain once said that "Generalizations aren't worth a damn, including this one."

Friend, you are making incredibly broad statements and assumptions.

Every medical specialty includes both people who seek easy money and those who don't. You cannot possibly intelligently stereotype such issues.

How is a microvascular decompression surgery for trigeminal neuralgia representative of a failure on the part of Neurologists? I recently cared for a patient who had undergone two failed microvascular decompressions for trigeminal neuralgia. She was in intense pain, and the neurosurgical resident (who had discharged her less than a week previously) actually refused to see her in the ED. Failure indeed? This story is no attempt to detract from Neurosurgery as a specialty. I admire it's practitioners immensely. Nevertheless, you cannot judge "failure" and "success" of treatment so quickly or arbitrarily as you seem to think.

You think that all treatments are exclusively in procedures? And you're interested in IM and ER? This is a hotly debated topic that expands well beyond the borders of the neurosciences.

Of course many non-surgeons are interested in procedures and invasive interventions. Cardiologists, Gastroenterologists, and (now) Nephrologists are all examples of non-surgeons successfully expanding the horizon of their specialty. It's fascinating ground to explore and not a few of us (including myself) were strongly interested in surgical careers to begin with and even recruited by surgical departments as fourth year medical students. And IM. And ER. Some people have multiple facets to their personalities after all.

Of course there are many Neurologists who are deeply interested in research. Again, this is something impossible to stereotype.

I sincerely hope that my comments are illuminating to medical students reading these posts. That is rapidly becoming my sole purpose in continually contributing to this stale discussion.