Why is Neurology its own residency but Cardiology and GI are IM fellowships?

[fanc2234]

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This doesn't make sense to me... If Neurologists are being trained adequately under the current system, do you see other organ-specific specialties like Cards and GI becoming their own residencies (with 1 year of prelim medicine like Neuro) as well?

 

[Raryn]

This doesn't make sense to me... If Neurologists are being trained adequately under the current system, do you see other organ-specific specialties like Cards and GI becoming their own residencies (with 1 year of prelim medicine like Neuro) as well?

It's just a result of the historical development of the specialties. Neuro in many places is part of the overarching department of medicine. In other places it's grouped with psychiatry.

I doubt any of the fellowships are going to become direct training pathways, though I won't say it's impossible (it's happening with IR and a bunch of the surgical subspecialties, so who knows what may happen in the next few decades?).

 

[deleted547339]

Because if they did medicine they would have to learn at least some fundamentals of research and wouldn't be able to believe in tPA.

Sorry, had to.....

 

[gutonc]

It used to be a subspecialty of IM but eventually branched off on it's own.

 

[bronx43]

Cards and GI should really just branch off on their own... especially with the cardio sub-specialties, what's the point of doing 3 years of IM when you lose 95% of what you learn?

 

[BICpaid]

GI can branch off sure, but not cards!!!!!! cards is like so fundamental to the bread and butter of IM

 

[fanc2234]

GI can branch off sure, but not cards!!!!!! cards is like so fundamental to the bread and butter of IM

Why? It's also fundamental to the bread and butter of FM but that doesn't mean it has to be a fellowship after FM. The one thing that's for sure is if/when Cards and GI branch off, IM will become as competitive as FM/Psych.

 

[BICpaid]

Well if you put it that way you can probably make the same comment about any fellowship

 

[Siggy]

GI can branch off sure, but not cards!!!!!! cards is like so fundamental to the bread and butter of IM

...because I've never had to work up a patient with a GI problem. Oh, look, the non-complaint hypertriglyceridemia patient is back for the third time in acute panc.

 

[Raryn]

...because I've never had to work up a patient with a GI problem. Oh, look, the non-complaint hypertriglyceridemia patient is back for the third time in acute panc.

To be fair, I work up stroke patients all the time and neuro isn't a medicine subspecialty.

 

[Crayola227]

Neuro being branched off and not Cards makes sense to me at least

 

[Siggy]

To be fair, I work up stroke patients all the time and neuro isn't a medicine subspecialty.

True... but that wasn't my point. My point was that "cards is like so fundamental to the bread and butter of IM" is a false argument.

 

[deleted547339]

To be fair, I work up stroke patients all the time and neuro isn't a medicine subspecialty.

And by "work up" you mean, get the MRI, right? lol

 

[Raryn]

And by "work up" you mean, get the MRI, right? lol

Same as any other condition, there's indicated tests. So yes, I order the MRI. And the MRA vs CTA of the head and neck vs carotid doppler as appropriate. And the echo +/- bubble as appropriate. And the hypercoagulability workup if indicated based on distribution of stroke vs patient age. And the antiplatelet agent (changing them when appropriate).

Not to mention the million of other neurologic conditions that internists should be familiar with. I'm not exactly prescribing biologics for MS, but if I referred every essential tremor...

 

[deleted547339]

Same as any other condition, there's indicated tests. So yes, I order the MRI. And the MRA vs CTA of the head and neck vs carotid doppler as appropriate. And the echo +/- bubble as appropriate. And the hypercoagulability workup if indicated based on distribution of stroke vs patient age. And the antiplatelet agent (changing them when appropriate).

Not to mention the million of other neurologic conditions that internists should be familiar with. I'm not exactly prescribing biologics for MS, but if I referred every essential tremor...

Wasn't bashing internists - trying to make a joke about neurology. Swing and a miss. I'll try harder next time.

 

[IMreshopeful]

I disagree that you don't need a basis in IM for the various medical sub specialties. Beyond just the material you learn within IM, a residency in IM also teaches you to think like an internist, which in turn you carry over into fellowship. Also gives you an idea how to manage chronic disease. that's not to say it can't happen with cards splitting off as its own specialty but it's very unlikely

 

[PlutoBoy]

And by "work up" you mean, get the MRI, right? lol

Sometimes I'll go crazy and get an echo as well 🤣

 

[fanc2234]

I disagree that you don't need a basis in IM for the various medical sub specialties. Beyond just the material you learn within IM, a residency in IM also teaches you to think like an internist, which in turn you carry over into fellowship. Also gives you an idea how to manage chronic disease. that's not to say it can't happen with cards splitting off as its own specialty but it's very unlikely

If this is true are you saying that every Neurologist is inadequately trained and should do IM residency? Because there is absolutely no reason why Neurologists should get the easy way out and save two years of their life while Cards and GI docs need 6+ years of training.

 

[IMreshopeful]

If this is true are you saying that every Neurologist is inadequately trained and should do IM residency? Because there is absolutely no reason why Neurologists should get the easy way out and save two years of their life while Cards and GI docs need 6+ years of training.

Neurology used to be a fellowship of IM - as to why it split off I am not sure. I don't really have an opinion one way or the other as to whether to shorten it to two years IM then three years fellowship or whatever but I still personally feel there is some value to having done a full medicine residency. Plus a lot of people go into IM undecided about fellowship so it gives them good exposure to each field

 

[BICpaid]

you can ask the same question of why psychiatry and neurology take the same boards when their topics are so different

 

[PlutoBoy]

I think most specialties should branch off. I also think that we study a lot of bs that we never use. General Chemistry or Magnetic Physics never helped me treat a patient!