Why does it seem as if Neuro is such an undesirable specialty to do?

[phagocytosis41]

Hi all. Why does Neuro seem not so hard to get into and yet its one one field where there is a very high burn out rate. I really enjoy neurology, especially in medical school, but it doesn't seem to correlate with a career that seems 'cush.' I'm just wondering... is it because the field is very intense and interventions do not really cure but just focus on managing incurable conditions?

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[Postictal Raiden]

Hi all. Why does Neuro seem not so hard to get into and yet its one one field where there is a very high burn out rate. I really enjoy neurology, especially in medical school, but it doesn't seem to correlate with a career that seems 'cush.' I'm just wondering... is it because the field is very intense and interventions do not really cure but just focus on managing incurable conditions?

I think the “doesn’t really cure” is not associated only with neurology. Most fields are like that. When was the last time you heard of a cardiologist who cured heart failure, pulmonologist cured a COPD, a rheumatologist cured lupus? Very few non-surgical fields offer curative solutions (infectious disease comes to mind).

 

[BoneWizard]

Hi all. Why does Neuro seem not so hard to get into and yet its one one field where there is a very high burn out rate. I really enjoy neurology, especially in medical school, but it doesn't seem to correlate with a career that seems 'cush.' I'm just wondering... is it because the field is very intense and interventions do not really cure but just focus on managing incurable conditions?

Brain stuff hard.

 

[Thama]

Neuro is about as hard to match to as most clinical fields, comparable to IM, and average stats move up each year. It's not psych or FM.

 

[phagocytosis41]

Neuro is about as hard to match to as most clinical fields, comparable to IM, and average stats move up each year. It's not psych or FM.

psychs not easy to match anymore. you have to work for it.

 

[Splenda88]

Neurologists are burned out because most other physicians call them for things that may or may not be neuro related... ED physicians are the main culprit

 

[romanticscience]

Something that complicates the practice of neurology, especially outpatient, is the high rate of "psych" (ie, conversion/functional Neuro disorders make up ~50% of outpatient neurology visits). These are hard to teat, even from a psychiatry standpoint.

I'm a psychiatrist.


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[Telamir]

Neurologists are burned out because most other physicians call them for things that may or may not be neuro related... ED physicians are the main culprit

Not to mention that's how for those of us who do inpatient we're going to get exposed to Covid. I've already had a few consults that were borderline at best, or stroke alerts on folks that ended up being covid rule outs.

Something that complicates the practice of neurology, especially outpatient, is the high rate of "psych" (ie, conversion/functional Neuro disorders make up ~50% of outpatient neurology visits). These are hard to teat, even from a psychiatry standpoint.

I'm a psychiatrist.


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Also, agreed. There's a high portion of psych in our specialty and that's combined with how little people know about neurology anyway. In fact the incredibly high number of pseudoseizures is why I decided not to practice epilepsy. The average internist knows a fair amount about cards/GI/Pulm/ID/Neph/etc. They don't know neuro. This also goes for the average ED doc. Like I've said before, to consult neph you need an abnormal CNP. To consult cards you need trops, EKG changes, chest pain, or abnormal echo/arrhythmia etc. To consult ICU you need concrete reasons why the patient is crashing etc. To consult Neuro though? Something tingles, someone's acting strangely, someone's numb/weak, or someone loses consciousness without anyone having any description of the event. You're often stuck trying to "prove negatives".

 

[GuillainMollaret]

Also, agreed. There's a high portion of psych in our specialty and that's combined with how little people know about neurology anyway. In fact the incredibly high number of pseudoseizures is why I decided not to practice epilepsy. The average internist knows a fair amount about cards/GI/Pulm/ID/Neph/etc. They don't know neuro. This also goes for the average ED doc. Like I've said before, to consult neph you need an abnormal CNP. To consult cards you need trops, EKG changes, chest pain, or abnormal echo/arrhythmia etc. To consult ICU you need concrete reasons why the patient is crashing etc. To consult Neuro though? Something tingles, someone's acting strangely, someone's numb/weak, or someone loses consciousness without anyone having any description of the event. You're often stuck trying to "prove negatives"

Yep. On the flip side, this leads to a super high demand for neurologists which is generally good for our profession.

I don't mind most functional patients and look at it is a diagnosis just like any other we make in neurology. But trying to counsel a functional patient with poor insight is never a good time for anyone involved.

 

[Phantom Spike]

Yep. On the flip side, this leads to a super high demand for neurologists which is generally good for our profession.

I don't mind most functional patients and look at it is a diagnosis just like any other we make in neurology. But trying to counsel a functional patient with poor insight is never a good time for anyone involved.

Agreed. Oftentimes, the consulting physician genuinely doesn't know if the patient's presentation is neurological or not. Being able to say, "etiology of the patient's symptoms is uncertain, but history/exam is not consistent with stroke/seizure/multiple sclerosis/neuropathy or any defined neurological process. Consider canceling the previously-ordered MRI/CTA/EEG/EMG and followup as outpatient" is rather satisfying and more helpful to the hospitalist than we realize (if appropriate, I may also add, "recommend psychiatry evaluation", but not always). I try not to get too involved in challenging the patient about the functional aspect of their problems; giving them the good news that it's not a stroke/MS/brain tumor or whatever concerns them, and suggesting that stress can often look like those things and that it usually resolves, is generally good enough.

 

[Thama]

Something that complicates the practice of neurology, especially outpatient, is the high rate of "psych" (ie, conversion/functional Neuro disorders make up ~50% of outpatient neurology visits). These are hard to teat, even from a psychiatry standpoint.

I'm a psychiatrist.


Sent from my iPhone using SDN

That percentage is way, way off in my experience. Maybe 1 out of 20 or 30 patients I see at most I would consider likely to be functional.

 

[phagocytosis41]

Wow great answers guys! Thanks everyone!

 

[romanticscience]

That percentage is way, way off in my experience. Maybe 1 out of 20 or 30 patients I see at most I would consider likely to be functional.

Yea, that number is off. I went back to my resources and it looks more like ~15%.

Stone, J., Carson, A., Duncan, R., Roberts, R., Warlow, C., Hibberd, C., ... & Cavanagh, J. (2010). Who is referred to neurology clinics?—the diagnoses made in 3781 new patients. Clinical neurology and neurosurgery, 112(9), 747-751.

 

[Thama]

Frankly, the most common reason for a functional diagnosis I have seen is insufficient knowledge on the part of the clinician. "I don't understand therefore must be functional" is altogether too common.