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Why didn't YOU choose Neurology?

Discussion in 'General Residency Issues' started by YoungFaithful, Feb 28, 2006.

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  1. YoungFaithful

    YoungFaithful Senior Member 7+ Year Member

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    I have been enlightened during the last week and now have made Neurology my career choice. In researching the speciality, it seems that it is the hidden gem of medicine. Here are a few of my reasons:

    Very interesting cases, growing at rapid pace, research is omnipresent, lifestyle is great and flexible, salary is great, can be inpatient or outpatient, opportunity for fellowships...do I need to go on?

    Why doesn't everyone go into Neurology? Am I missing something here? What are the negatives about Neuro? Are there any?

    I'm trying to get an honest opinion from the people who considered neuro, but passed on it.

    Thanks for helping me better understand neuro.


    Youngfaithful
    MS II
     
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  3. GoofyDoc

    GoofyDoc Senior Member 7+ Year Member

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    Different things appeal to different people. For me personally, I despise everything neuro.
     
  4. st0rmin

    st0rmin Unregistered User 5+ Year Member

    Chronic headache patients, fibromyalgia, BS consults about blurry vision (if they blink and it gets better it's probably not neurological [consulted 3 different times for this]), no real treatments (we know what you have and can treat some of the symptoms but you'll never get better), etc. It was an OK rotation but I hope never to have to do it again.
     
  5. penguins

    penguins Senior Member 5+ Year Member

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    I think the above really sums up why people don't like it even though, respectfully, I strongly disagree. There are lots of "real" treatments for neuro cases and the advances are exciting and bring a lot of hope to patients that wasn't there until recently. The interventional treatment with regard to stroke and DBS is really cool as well.
    To each his own, some people love and it and others hate it. That can be said about most specialties. Takes all kinds!
    To the OP: Have fun, neuro is the coolest. :thumbup:
     
  6. prominence

    prominence Senior Member 10+ Year Member

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    whats DBS?
     
  7. st0rmin

    st0rmin Unregistered User 5+ Year Member

    Deep brain stimulation
     
  8. Gut Shot

    Gut Shot 10+ Year Member

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    Neuroanatomy made me want to die.
    The neuro exam made me want to die.
    Dementia patients made me want to die.
    Headache patients made me want to die.
    Epilepsy patients made me want to die.
    Parkinson's patients made me want to die.
    Stroke patients made me want to die.
    Huntington's patients made me want to die.
    MS patients made me want to die.
    Chronic pain patients made me want die.

    So yes, I suppose you do need to go on.
     
  9. automaton

    automaton drone 5+ Year Member

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    the brain is a fascinating organ and many neurological disorders provide insight into some of its structure and function. i was interested in neurology for many years but that interest died during my third year rotation. people say there are things you can do in neurology to make their patients better. i say neurology probably does the least out of any specialty out there. out of the things that the poster above me listed:

    dementia - no tx, just delay inevitable
    headache - sometimes chronic headaches can't be treated, for the others, who cares, it's a headache
    epilepsy - moderately successful
    parkinson's - temporary tx only
    stroke - no tx except for the 1-2% of patients who get tPa
    huntington's - no tx
    ms - no tx
    chronic pain - no tx
    brain tumor - send to neurosurgeons

    these are the bread and butter cases, the core of most of your practice. other than epilepsy, the neurologist really doesn't have a huge impact on these main diseases. that to me is unsatisfactory. there are some rarer diseases that neurology can impact, but i can't rely on those to keep me going.

    the only reason why i would become a neurologist is to do neurological research, or for the lifestyle/reimbursement issues you brought up. the clinical practice of neurology is very very limited, and new technologies or procedures tend to be perpetually on the horizon, never relaly materializing. the longwinded debate over tPa is a perfect example of a "new treatment" that is much more hype than reality. neurologists tend to be a hands-off bunch so i wouldn't depend on much opportunity for intervention in the near future.
     
  10. TheThroat

    TheThroat SDN Moderator Moderator Emeritus 10+ Year Member

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    If I was a neurologist could I still go to the OR and wack out a dude's tongue cancer? (just picking an example from today). f not, I am not interested.
     
  11. Claymore

    Claymore Yankees Suck 10+ Year Member

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    Recent neurology matchee here so I feel a little obligated to defend my chosen turf. I'd agree that probably the main reason people don't like neuro is that many of the diseases have limited treatment options and many think all they see is stroke and boring stuff like headache. However, I think that as med students we often get a pretty narrow perspective of what neurologists actually do and the impact that they can have.

    Most students' neuro rotations are primarily inpatient-based in my experience. The majority of actual practicing neurologists, however, spend the vast majority of their time in the outpatient setting. In the inpatient setting you see mostly stroke/TIA, MS exacerbations, seizures, coma, mental status changes, infections, etc. Outpatient neuro is a completely different world with things like EMG, sleep, botox, etc. It is a far more diverse specialty than most people think.

    Also, a very good argument as to the limited treatments available for neurological diseases has been brought up before on this board. For instance, MS. No, we cannot cure it. And yes, there is a good chance as a patient you will ultimately become disabled to some degree. However, if YOU were diagnosed with MS, wouldn't you want to see an expert who was up-to-date on the latest available treatment options? Sometimes treating the symptoms, or at least prolonging onset of disability and improving quality of life is just as important as finding a cure. Ever known someone who had epilepsy, both before treatment and after finding a successful treatment regimen? It completely changes their lives...even though the epilepsy itself may not be "cured".

    Neurology as a specialty is underappreciated in my opinion, but is certainly not for everyone. Go into your rotations with an open mind.
     
  12. ramonaquimby

    ramonaquimby I'm a PGY3?! WHAT?! 5+ Year Member

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    omg, you took the words RIGHT out of my mouth. i'm not one for immediate gratification given that i'm going into primary care, but neuro drives me INSANE...its diseases seem 'impossible' to treat and i would get very frustrated...and i wouldn't even be the sick one/patient. NO THANKS!
     
  13. Danger Man

    Danger Man Senior Member 5+ Year Member

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    This post sounds about right. Neurologists "admire" disease as I learned in medical school. As a group, neurologists seem to be very bright. Neuro diseases are the worst also--I remember having ALS described to me as "being a witness to your own funeral." Imagine being a 36 year old professional baseball player (Lou Gehrig) stricken with a disease that robs you of all of your skills to the point of being unable to tie your shoes--that is a fate truly worse than death. I knew after about 3 minutes of my neuro rotation that it was definitely not for me.
     
  14. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    For all the reasons listed previously. :)

    The brain is cool. I was a neurobiology/physiology major as an undergrad ... did a couple years working in a neuro lab sticking electrodes into monkey brains (bite me, PETA) ... may have been the only person who genuinely loved neuroanatomy in med school ... and as an MS 3 thought I was on the track to being a neurologist. And then I actually spent some time working in an outpatient neuro clinic (which also did inpatient consult work) and discovered this overwhelming, depressing, mind-bending, soul-searing, heart-wrenching, unbearable feeling of helplessness.

    I liked some parts of the diagnostic side of neurology, but the big gaping hole of sorry nothing we can do on the treatment side of the equation was more than I could stand. But to each his own.


    Besides, as an MS3 I found the path of enlightenment and realized that anesthesiology is the best specialty. :)
     
  15. CasaElGato

    CasaElGato anti- vs. byronic hero 5+ Year Member

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    Neuro is becoming more popular. But because of the relatively large number of slots it doesn't seem that "competitive" just like anesthesia with its large number of slots.

    If there were fewer slots, then even a small increase in interest would make it seem much more competitive.
     
  16. Coach

    Coach Member 7+ Year Member

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    the same could be said for fp, decrease the # of slots and it could be competitive
     
  17. anon-y-mouse

    anon-y-mouse Senior Member 10+ Year Member

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    Thanks for posting this, it is the exact same thing I've been wondering. I was a neuro major in college and absolutely loved learning about the brain / neuroscience. It would be quite disheartening to spend one's life on conditions with little scope of treatment. However, I am considering a combined IM/neurology 5 year residency. This would offer me the ability to explore my passion, without feeling utterly helpless treating chronic headaches.

    Questions:

    (1) compensation - how good is it? If you had to compare it as above/below any other specialty... it doesn't seem highly procedure-based as the other "well-paying" specialties are.

    (2) neurosurgery (sorry, another specialty) -- what is the prognosis for improvment in most neurosurgical cases? I mean, after a heart bypass, people generally live as they normally did. However, do people generally make it through brain surgery without drastic effects? If not, here must be another specialty where practitioners may feel futile. (I'd also be really scared to screw up)
     
  18. avgjoe

    avgjoe Senior Member 5+ Year Member

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    Besides the nothing I can do sentiment and the torture of having to round daily on the multiple stroke patients without really offering them much if anything in terms of treatment, I really found a personality mismatch between me adn the neuro residents.
    I myself am pretty anal. However, they were the MOST anal-retentive, detail-oriented gang I have ever seen. Of course, that makes sense, since the neuro exam has got to be the most detailed, long and outright boring exam out there. Doing the whole thing daily on patients who really didn't change much over the past 24 hours was really not fun. Not to mention, that the responses to my exam at 5 am were quite different than the residents' at 8am when the patient was actually AWAKE and able to/cared more to respond to commands.
    All in all, I agree with all those who said that they knew within 5 minutes whether it was for them or not.
    Since you're an MS2, it's great that you'r ethinking about which specialty you want to go into, but definitely keep an open mind in each rotation. Maybe neuro is for you, then again, maybe it's actually neurosurg or even something you're not interested in currently.
     
  19. Finally M3

    Finally M3 Senior Member 10+ Year Member

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    Surprisingly, you can set up a neuro practice where you do quite well; EEG & EMGs can be lucrative if you have a good referral base. Sleep, from my understanding, can be as well, but you have competition w/ pulmonary in some places. Also surprisingly, neurologists have higher malpractice rates than other non-surgical specialties.

    As for postop neurosurg patients...it varies. Of course, I have a biased viewpoint since most of the postop neuro patients I see DO have deficits (and thus would require rehab to be involved). But anecdotally, my aunt had a meningioma resection back in the late 90s, and is doing fine without deficits.
     
  20. I would die of boredom in an IM residency.
     
  21. Samoa

    Samoa 10+ Year Member

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    I would probably develop some serious anger management issues in an IM residency. It's best for everyone (at least all the staff) if I stay out of that field. :smuggrin:
     
  22. chicamedica

    chicamedica 1K Member 7+ Year Member

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    I would have done neuro, if I didn't have my chosen specialty that I liked even better. I agree, the subject matter is absolutely fascinating, the research potential incredible and very much needed, the culture collegial. . .
    The aspect that clinched it as my #2 career choice was what several people here have touched upon: often you have no choice but to throw your hands up in helplessness watching the patient die right in front of you, cause often there is just nothing that can be done. My senior and I had the misfortune of experiencing this with the very patient I was following on my neuro rotation, and it was extremely tragic. . .the situation bothers me to this day (not to mention how hard it was on the resident).

    If i were to do purely research, I may have gone for neuro, but I wanted a career in both research and clinical medicine, so I feel much happier in a field where I actually have a way to intervene and try to help a patient out if they try to die on me.

    (not to recruit too many more people to THIS hidden gem, but I am yet another going into the great field of anesthesiology ;) . . .well, hopefully. . .if i match :eek: )
     
  23. CameronFrye

    CameronFrye Senior Member 7+ Year Member

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    I hated my two weeks of inpatient neurology, but the 2 weeks I spent in a private outpatient clinic was suprisingly interesting. It was actually one of the only clinics that I've ever been able to tolerate. In the clinic, I saw almost none of the "diagnose and then adios" cases. Most of the patients had been helped and were very grateful.

    The doctors I worked with also made some pretty serious cash. The partners who did EMG's and botox were bringing in over 400,000 a year.
     
  24. automaton

    automaton drone 5+ Year Member

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    it's great if you are interested in EMG and botox but most people are interested in neurology for the brain, not the PNS..
     
  25. scrappy

    scrappy Member 5+ Year Member

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    as someone who unexpectedly loved the neuro rotation (hated neuroanatomy) but chose another field (gen surg), here's my tuppence.

    as claymore said, there's more diversity to neuro than people think. however, i strongly preferred the inpt setting. most gensurg folks despise neurology bc of the relative lack of tx (esp. curative tx) options, and one of the reasons we choose our field is the possibility of actual curing the pt. so yeah, i'm one of the few who actually enjoyed neuro, and i think it has to do with both my personality and finding what i liked about surgery in neuro.

    many surgery-types are very practical minded--they wanna stop talking and do something. they don't want to think about possibilities or worry about endless differentials. this, however, is more consistent with IM than neuro. i found myself fitting in with the neuro culture well. frankly, they're a bunch of quirky nerds who get off on the acquisition of knowledge, but the good ones also possess the social skills to empathize and relate to pts. the thing i liked about it the most was the logical thinking involved and the ability to use one's hands. differentials could be narrowed down with a 10 minute physical exam--i thought this was incredible. then you get all those studies to confirm what you already knew, and there's a certain satisfaction in proving you were right. logic and physical exams used to be all surgeons possessed to rely on before operating, but this is being deemphasized in modern american medicine in general.

    yeah, neurologists make an absolute killing, and they make it quickly. i think this is a well-kept secret. plus there's a huge demand for them as the population ages but interest fails to meet the increase.

    in the end, i just loved the OR too darned much *not* to choose surgery. and the warm and fuzzy feelings i got everytime we opened up the belly--that was a major clue. so i agree with everyone else--keep an open mind. you'll never know what you'll end up loving.
     
  26. scrappy

    scrappy Member 5+ Year Member

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    disagree. things become competitive for money and lifestyle.
     
  27. Magnus67

    Magnus67 Lord of Sleepytime 10+ Year Member

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    The untreatable aspect would be hard and so would the noncompliance with stuff like migraine, cluster, other headache, or fibromyalgia. "why am I still getting migraines?,,,,yeah i take my medicine like at least half the time" I cant believe how many times i saw poor medication compliance with these disease in a one week period.

    Non-compliance sucks in general

    Thats why im going into Gas. There is no non-compliance.

    Grandma, time to go to sleep. "im not tired yet, can i have some warm milk?"

    YOU WILL GO TO SLEEP OR I WILL PUT YOU TO SLEEP. READ THE NAME TAG, YOUR IN MY WORLD NOW GRANDMA.

    gotta love happy gilmore. :laugh:
     
  28. new_avatar

    new_avatar Member 5+ Year Member

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    Whatever happened to count with me backwards 10, 9, 8....
     
  29. Mumpu

    Mumpu Burninator, MD 5+ Year Member

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    I liked my neuro rotation and I enjoy neurology within the scope of general infernal medicine but I wouldn't go into it. My two big reasons:

    1. Too many patients you can diagnose but not make better.
    2. No procedure component (neurosurg/IR do all the invasive work, ulinke cards, neurology let that slip away and suffers badly now according to several attendings I spoke with).
     
  30. jc237

    jc237 Senior Member 5+ Year Member

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    I absolutely hated my neurology rotation. It takes my attending 2 hours to see a patient when we round. So every consult that comes in mean I have 2 hours less to do what I like after work, mainly, eat, live, drink, be merry. And they don't do much for the patient, except to diagnose. Once the diagnosis is made, that is it. Sure they'll adjust seizure meds occasionally but not much else. Many a times, neurologists are anal and nitpicky... which is good for the patient I guess, but I really don't care if the nystagmus is sideways, up and down, going in circles, or shooting laser beams at you. All I know is that those pupils are acting funky.

    And many of them think they're experts in neuroimaging... well... no. When they're unclear on something, who do they ask? Right, the neuroradiologist. Heck, even a regular good old radiologist would do sometimes. Just my 2 cents. Don't knock me for being honest. My roommate and I both thought that out of all 4 years of med school, the neurology rotation blows the most.
     
  31. gutonc

    gutonc No Meat, No Treat SDN Administrator 10+ Year Member

    Totally going off-topic here but this is something that I think is a huge problem in the way that medical school is structured today in comparison with how medicine is practiced. The vast majority of any non-surgical (and many surgical) practitioners do most of their work in the outpatient setting. With the rise of the hospitalist positions, many IM specialists don't even go into the hospital anymore.

    For all that though, my school requires 11 weeks of outpatient medicine in the 2 clinical years (10 IM and 1 Peds). Then, as a medicine resident at least, you spend 1/2 day a week in an outpatient setting with the occassional month of ambulatory (2 or 3 during the 3 years in most of the programs I looked at) and then, for themost part, finish up and go into outpatient medicine with little or no training in how to really do it.

    I took a bunch of electives that were almost all outpatient this year. Not because I liked the hours (although that was a nice bonus) but because I felt like I had so little ambulatory training that it was something I needed to bone up on.

    Back to your regularly scheduled Neuro-bashing now.

    BE

    (and I hate Neuro but loved my Neuro rotation if that makes any sense)
     
  32. CameronFrye

    CameronFrye Senior Member 7+ Year Member

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    Yeah, there were quite a few fields that probably would've interested me more if I could've actually seen what the job is really like.
     
  33. penguins

    penguins Senior Member 5+ Year Member

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    I fell in love with neuro on day #1 of my rotation. I adored all 8 weeks. I never would have thought I would have liked neuro before I did my rotations in it.
    What I don't understand is why people always talk about how neuro only has diagnoses and no treatment. That is what IM was to me. You can diagnose people with HTN, DM, CHF, COPD all day long and little ever changes. Change some meds do some tests, check lab work again. That's it. Radiologist (except interventionalists which are the minority) just diagnose/read, anesthesiologist don't treat unless they are in pain, ID just switches antibiotics when bugs get resistant, nephrology hooks people up to dialysis again, etc. I KNOW all these folks do more than just the above but doesn't this show that neuro isn't the only field in which you are diagnosing more than curing?
    Surgeons are the only ones I can think of that really could judge without being a hypocrite because they cut it out or put it in. Something concrete! We are the ones they consult when their pts are getting neuropathy due to vitamin def after a gastric bypass though.

    Sure we can't cure MS, but we can give meds to make their lives a heck of a lot better. There is no more grateful patient than a woman whose migraines have been "cured" and even though there is no cure for Huntingtons there is treatment and support to be given. Medicine is about more than just curing people. Because some of the neurological diseases are the most disruptive, sad and life changing that makes it an even more important field.
    To me, IM was much more about diagnose but never successfully treat than neuro was. It is just a matter of perception. That is why we all have different niches.

    Oh, and it matters what kind of nystagmus it is because then you can localize it, come up with a differential based on that localization and then investigate with more exam, then a test and then treat it. It is quite logical and methodical. It is amazing what you can learn through a good exam. I hated in IM always waiting for the labs. Rounds can't begin until the lytes come back! Not knocking them but that is how I see it.

    Hey, my 2 cents. We are each an important spoke in the wheel. I don't think any specialty "cures" any more than neurologists do (except maybe surgeons of some type and they create problems in the process sometimes too)
     
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  34. penguins

    penguins Senior Member 5+ Year Member

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    Oh, and whenever I told people that I wanted to do neuro, they were always so shocked. Saying things like, "you are so nice" "you are so friendly" "you don't have that personality"
    What the heck????
    How'd we get such a bad rap? Because we sometimes are the ones rounding in the ICU pronouncing people brain dead? here comes the death squad...
     
    NWwildcat2013 likes this.
  35. Gut Shot

    Gut Shot 10+ Year Member

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    Oh I don't know...

    "Come on heart, beat a little more, come on, give Daddy a beat, just one little contraction, come on..." :laugh:
     
  36. Magnus67

    Magnus67 Lord of Sleepytime 10+ Year Member

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    OK. Good Point........ :) smartass.
     
  37. CameronFrye

    CameronFrye Senior Member 7+ Year Member

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    You bring up a pretty good (and scary) point that I didn't realize until I was in med school. As advanced as modern medicine appears to be, there is very little that doctors actually "cure". Except for infections and various surgical/non-surgical procedures, most of medicine is still supportive.
     
  38. njbmd

    njbmd Guest Moderator Emeritus 5+ Year Member

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    Hi there,
    Thank God for you and those like you so that I can consult when I need a good neurologist. I did an elective in neurology during my fourth year so that I would be facile with doing a good neurological exam but I had no interest in neurology as a career.

    If you love neurology (as I love surgery) there are no negatives that will send you away from the career. People should do what they enjoy and not try to love something because someone else (you parents, your classmates) tells you it is not a good specialty.

    Enjoy the neuro and do it well!
    njbmd :)
     
  39. njbmd

    njbmd Guest Moderator Emeritus 5+ Year Member

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    Gone Walkabout!
    Hi there,
    Thank God for you and those like you so that I can consult you when I need a good neurologist. I did an elective in neurology during my fourth year so that I would be facile with doing a good neurological exam but I had no interest in neurology as a career.

    If you love neurology (as I love surgery) there are no negatives that will send you away from the career. People should do what they enjoy and not try to love something because someone else (you parents, your classmates) tells you it is not a good specialty.

    Enjoy the neuro and do it well!
    njbmd :)
     
  40. supercut

    supercut Senior Member 7+ Year Member

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    I feel exactly the same way about my career choice, surgery, as you do about neurology! That's one of the great things about medicine, there's a niche for everyone. Personally, I have no patience for long rounds, and from my perspective, many neuro problems have no good treatment. I like dealing with fixable problems.

    I'm glad you found something you enjoy so much.
     
  41. DrNick2006

    DrNick2006 Senior Member 5+ Year Member

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    LOL neurology is too easy to be fun, my neurology professor summed it up:

    If the deficit is unilateral in the face and body give em a head CT/MRI. If facial deficit is contralateral to body then MRI the brainstem. If you don't see anything then do a EMG. When you find out were the lesion is, you treat whatever medical problem put it there, cause you can't fix the lesion. Finally, If they're unconcious then get an EEG too.

    There you just did a neurology residency.
     
  42. Good conditional statement there - I was going to say, besides palliative operations, many of our OR cases are meant to cure disease!
     
  43. NRAI2001

    NRAI2001 3K Member 10+ Year Member

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    Lol :laugh: Wow that was easy :laugh:
     
  44. shemozart

    shemozart northern girl 5+ Year Member

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    What a great thing to say.... :D (not trying to be mushy here) Everyone likes something different - as long as you you enjoy what you're doing and get damn good at it, do what you want! Wouldn't we all rather refer patients to a happy neurologist than a grouchy hates-their-job neurologist?? I think in residency we've all worked wth docs who clearly HATE (or came to dislike) what they do....(as an FP resident, I can think of at least couple docs at my hospital that seem to hate their jobs and take it on everyone in sight (nurses, other docs, residents))....
     
  45. Bonobo

    Bonobo Senior Member 5+ Year Member

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    My feeling is that there are 4 reasons why people don't go into neurology:

    1. It's true that cures or near cures are not easy to find in this field (not counting interventional neurology). Occasionally, one can use IVIG or plasmapheresis to treat certain rare acute autoimmune diseases. Certain neuro-infectious diseases are often diagnosed and then cured by neurologists. Epilepsy can be essentially cured often times, as well as certain sleep disorders. And, yes, the stroke neurologist can cure about 2% of their acute stroke patients with tPA (assuming a tPA rate of about 15% and a NNT around 7). But compare this to cardiology, oncology, GI, general surgery, orthopedics, etc. where cures are the common goal. This is the single most clear deterrent to going into neurology.

    2. Average income statistics for neurologists are not that great ($170k/yr). Making $200k/yr straight out of residency isn't hard, but only if one is willing to do EMG's, sleep and/or botox injections 50% of the time. To do the real interesting stuff, you get paid less (except in stroke and critical care... and of course interventional...)

    3. There aren't many "cool" procedures in the field, again except for interventional and neurocritical care (where one can do bedside intracranial procedures fairly frequently).

    4. Exposure in medical school is to a complicated messy course in neuroanatomy, a poorly inpatient run rotation often in the fourth year, and a bad reputation.

    Keeping stroke/critical care/interventional aside, there are equally 4 reasons to choose neurology over every other field in my opinion:

    1. While you may not be to do the miraculous neurosurgical cure of a brain tumor, the neurologist (especially those that love the field) has the opportunity to make a remarkable diagnosis for patient that has eluded many doctors prior. Sherlock Holmes, I believe is modelled after a neurologist in London. I have seen patients who have gotten spinal surgery, multiple painful procedures of various sorts, been tossed around from doctor to doctor, only to finally see a neurologist who makes the diagnosis of MS and stops the unnecessary harm.

    2. Neuroscience is obviously the most intersting topic in the world. It cross-sections philosophy, economics, ethics, art, biology, evolution, etc, and gives great opportunities to physician-scientists, physician-ethicists, etc.

    3. It is the fastest growing specialty and has more funding from the government than any other specialty (including basic science awards). The rate of advance is accelerating, and is exhilirating to watch and be a part of. While it is financially rewarding to be in a field at its peak (cards), I and other neurology residents are betting that neurology will pay off nicely in the long run.

    4. As a neurologist, you can make immense difference in patients lives, particularly for those who are "watching their own funerals". MS patients, relieved from simply being properly diagnosed, can now take treatment that delays further attacks by an average of 2 years, and lessen the impact of each attack thereafter by proper further treatment. A new additional treatment has just been announced in the NEJM, and other await. The choice of treatment is complex as is the diagnosis and the long-term management making it difficult to simply apply an algorithm that is taught to the GP. Epilepsy is more obvious. So are movement disorders. Just wait for the same thing to happen for stroke, neurological tumors, and maybe even neurodegenerative diseases...


    B
     
    NWwildcat2013 likes this.
  46. YoungFaithful

    YoungFaithful Senior Member 7+ Year Member

    187
    1
    Sep 29, 2003
    Can someone comment on academic neuro vs private?

    In general how competitive are the fellowships?
     
  47. Methyldopa

    Methyldopa Pharmacopoeia 5+ Year Member

    305
    2
    May 13, 2004

    Your neurology professor sounds bitter about entering the field, which is sad.

    Neurology can actually be very challenging. Unlike other fields, you can't just biopsy a lesion to figure out what is going on. You must use other clues and hints to come up with the diagnosis and treatment (eg lymphoma v. TB meningits/encephalitis v. vasculitis ...)
     
  48. flighterdoc

    flighterdoc Rocket Scientist 7+ Year Member

    It's those stupid bow-ties that neurologists wear.
     
  49. sophiejane

    sophiejane Exhausted Moderator Emeritus 7+ Year Member

    2,779
    5
    Sep 18, 2003
    Waco, TX
    HA! I thought that was an anomaly...until I saw my 4th neurologist in a row wearing a bow tie. WTF?
     
  50. chael

    chael Junior Member 10+ Year Member

    33
    0
    Apr 9, 2005
    just wanted to point out the hidden hidden gem that is interventional neuroradiology. I did one month in this last june on the spur-of-the-moment because I needed a non-surgical rotation. Basically, it combines everything cool about neurology and interventional radiology, and you make an absolute killing right after residency. You can match to the fellowship after doing either a radiology, neurology, or neurosurgery residency (I think radiology and neurosurg are the most common paths though). 3-D reconstruction angiograms of cerebral vasculature, ablating AVM's, tumors, and much much more...95% procedure based with lots of fascinating neuro path, plus you can really help people by plugging up their aneurysms before they explode...new interventional acute stroke techniques..I actually stood there with a syringe in my hand pumping anti-clot meds through a catheter directly to the MCA of a stroking patient..a little nerve-wracking though watching the vessel pulse as i pushed on the syringe (was just praying - please don't blow up on me). granted case like that is not often, but you really have to be on top of your sh*t..constantly switching syringes and flushing while trying to maneuver the catheter through a tangle of mm-sized vessels...and one little air bubble from a syringe and its game over. intense.
    Life style can be a little intense, but reimbursement can't be beat. The graduating fellow was telling me about his job offers..he was debating whether to go with the "safe" 7-800k/year job, or to take slightly lower-paying job but with incentive potential to go >1mil/year..this is directly after fellowship.
     
  51. mysophobe

    mysophobe Recovering Germophobe 5+ Year Member

    760
    1
    Mar 10, 2006
    I think you just picked my specialty for me.
     

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