When did you decide on your fellowship?

[DerpyNeuroMD]

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I'm getting this question a lot on the interview trail (what fellowships are you interested in, etc), but I'm not 100% sure what I want to do. I'm kind of interested in one or two, but at this point I feel like I should just focus on becoming a good general neurologist first.

Did you go into residency having already decided on a fellowship? If not when did you decide (or decide not) to do one?

 

[DrSatan]

Many residents have no idea what they're specializing in until end of pg2/early pg3 year, if even then. You are certainly not expected to know because you haven't been exposed to it all yet, but you may still have an idea about something specific you'd like if you look at all the different options. Being able to explain why a fellowship may or may not interest you would look good probably.

 

[DocMom1]

In theory, the above advice is good from what I saw my coresidents who pursued fellowship do. I myself did not do fellowship and it is not required to get a good job after residency.

 

[Telamir]

Honestly I didn't know until 2nd half of PGY-3. During PGY-2 all you get is exposure to the hospital and you're trying to get your bearings regarding neurology in general. PGY-3 you get a bit more exposure but there were other fields such as Neuro-Ophthalmology that I did enjoy but got basically no exposure to until I had already matched neurophys.

 

[xenotype]

You don't need to think about fellowship at all until the very end of PG2/beginning of PG3. By the end of PG3 you'll need to have something lined up. Fellowship is not required at all to get a good job, but really helps on the outpatient side. Pick a residency on the interview trail that teaches you basics you need like >25 botox for migraine, a high volume and acuity of stroke throughout, aim to get >200 routine EEGs read during residency. Then you can easily survive without a fellowship should you decide. I did neurophys personally for continuous EEG and ambulatory EEG competence and credentialing, and comfort with EMG as I had little residency exposure to EMG.

 

[Telamir]

Interpreting eegs with only 200 eegs under your belt will make you a sharp wave over calling keppra prescribing machine, in my opinion.

 

[Thama]

Interpreting eegs with only 200 eegs under your belt will make you a sharp wave over calling keppra prescribing machine, in my opinion.

And get paid the same as the people actually doing it right. Same with EMGs, BTX, DBS, etc if you don't mind grifting on the backs of others that are just going to have to repeat the procedures you billed for.

 

[xenotype]

It happens all the time unfortunately, and I am not defending it. My point however, is that I have seen several go into practice having read less than 10 or 20 routine EEGs(!), with reading EEGs as part of their expected daily billing. Specific example is stroke fellows who trained at residency programs that somehow provided minimal to no EEG training for their residents, and then taking neurohospitalist jobs with EEG interpretation expected. My program the average resident finished with around 300-500 routine EEGs regardless of how much they liked reading them. There is a huge gulf between these two situations. Ideally EEG would always be read by fellowship trained, but that isn't the reality anywhere. EMG situation is even worse in the community.