Why isn't neuro more popular???

[plusminus]

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I don't want to rehash old arguments but I am determined to find the answer to this question. With the gaining popularity of "lifestyle" specialties, I can't understand why neurology is not competitive. The possible reasons I have heard so far are:

1) Pay is not as good as other specialties
2) Patients are depressing and treatments are not extremely effective
3) Field is shrinking/dying due to neurosurg and neurorad

I am interested in Neuro and am going rotate and find out for myself, but this really makes no sense. You always hear people complaining about "settling" for IM or FP, so did they not even consider neurology? You would think neurology would at least get a good deal of overflow from these kinds of folks, thus reducing the large FMG influx into the field which is pretty much an indication of competitiveness. Thanks.

 

[shrink]

No one on this forum has said the field is shrinking or dying because of neurosurg and neurorads. There just is a situation where neurologists are not able to break into interventional procedures in vascular neurology. This again is not an absolute. We don t know how vascular neurology is going to evolve and what is true in 2005 may note be true in 2010. If a neurologist really wants to interventional work there are fellowships open though they are few and far between! But people who have tried for these fellowships ultimately do manage to get in but the lifestyle is not pleasant.

I don't want to rehash old arguments but I am determined to find the answer to this question. With the gaining popularity of "lifestyle" specialties, I can't understand why neurology is not competitive. The possible reasons I have heard so far are:

1) Pay is not as good as other specialties
2) Patients are depressing and treatments are not extremely effective
3) Field is shrinking/dying due to neurosurg and neurorad

I am interested in Neuro and am going rotate and find out for myself, but this really makes no sense. You always hear people complaining about "settling" for IM or FP, so did they not even consider neurology? You would think neurology would at least get a good deal of overflow from these kinds of folks, thus reducing the large FMG influx into the field which is pretty much an indication of competitiveness. Thanks.

 

[dongfeng41]

1. In terms of pay, Neuro ain't bad. It's no neurosurg, but with a projected 30% shortage of neurologists by 2010, an aging population, more effective treatments coming out for neuro ailments, the prospects are looking good. the average salary of Neuro may seem very mediocre, but keep in mind the relative large number of academic neurologists, ie there are plenty of old-timers, research-minded folks and Md-PhD's who are in pursuit of new truths and discoveries rather than the almighty dollar. But given how Neuro is steadily moving more and more towards outpatient setting, and given the nature of medical grads these days, expect the average salary to steadily go up. As for competitiveness, it's not hard to get into *a residency*, but many of the more reputable places are certainly competitive. Back to the pay issue: if u go into a field like Sleep, Headache, interventional Neuro, Neurophys, open up ur own practice or join a group practice, u can make out very very well.

2. Treatments for brain diseases will come with time. It's an exciting time in Neurology. The brain is considered the final frontier of Medicine, and many new discoveries are on the way. Several decades ago, Cardiology was in the same predicament as Neuro is in now. Just give it a little more time before Neuro fully blossoms.

3. Neuro is an ever expanding field. Thirty percent of all current drug research goes towards Neurological diseases. Neurosurg will not replace Neurology, and neither will Neuroradiology.

As to reasons why not that many choose to do Neuro, it most likely involves some of the following:
a. Many med schools don't offer Neuro as a 3rd yr course, and unless u know relatively early, most med students complain that they didn't realize how interesting Neuro was until it was too late. Neuro is early match too, so that doesn't help this phenomenon.
b. The nature of the subject. Many folks find the brain daunting, and will do their best to stay away from it. Most who go into Neuro, however, find it fun, logical and interesting.
c. Average pay is not as high as other fields; again refer to what I mentioned earlier about academic-based Neurologists' salaries dragging down the average salary figure. If you go into private/group practice, do procedures and have a good business sense, you'll be in very good financial shape.

Personally, I think Neuro is one of the best kept secrets out there. But no matter what, choose a field YOU love and can see yourself doing for the rest of your life.


😎

I don't want to rehash old arguments but I am determined to find the answer to this question. With the gaining popularity of "lifestyle" specialties, I can't understand why neurology is not competitive. The possible reasons I have heard so far are:

1) Pay is not as good as other specialties
2) Patients are depressing and treatments are not extremely effective
3) Field is shrinking/dying due to neurosurg and neurorad

I am interested in Neuro and am going rotate and find out for myself, but this really makes no sense. You always hear people complaining about "settling" for IM or FP, so did they not even consider neurology? You would think neurology would at least get a good deal of overflow from these kinds of folks, thus reducing the large FMG influx into the field which is pretty much an indication of competitiveness. Thanks.

 

[plusminus]

Thanks for the great post! If you don't mind me asking, do you have the source for the projected 30% shortage? Thanks again! I also PM'd this to you.

1. In terms of pay, Neuro ain't bad. It's no neurosurg, but with a projected 30% shortage of neurologists by 2010, an aging population, more effective treatments coming out for neuro ailments, the prospects are looking good. the average salary of Neuro may seem very mediocre, but keep in mind the relative large number of academic neurologists, ie there are plenty of old-timers, research-minded folks and Md-PhD's who are in pursuit of new truths and discoveries rather than the almighty dollar. But given how Neuro is steadily moving more and more towards outpatient setting, and given the nature of medical grads these days, expect the average salary to steadily go up. As for competitiveness, it's not hard to get into *a residency*, but many of the more reputable places are certainly competitive. Back to the pay issue: if u go into a field like Sleep, Headache, interventional Neuro, Neurophys, open up ur own practice or join a group practice, u can make out very very well.

2. Treatments for brain diseases will come with time. It's an exciting time in Neurology. The brain is considered the final frontier of Medicine, and many new discoveries are on the way. Several decades ago, Cardiology was in the same predicament as Neuro is in now. Just give it a little more time before Neuro fully blossoms.

3. Neuro is an ever expanding field. Thirty percent of all current drug research goes towards Neurological diseases. Neurosurg will not replace Neurology, and neither will Neuroradiology.

As to reasons why not that many choose to do Neuro, it most likely involves some of the following:
a. Many med schools don't offer Neuro as a 3rd yr course, and unless u know relatively early, most med students complain that they didn't realize how interesting Neuro was until it was too late. Neuro is early match too, so that doesn't help this phenomenon.
b. The nature of the subject. Many folks find the brain daunting, and will do their best to stay away from it. Most who go into Neuro, however, find it fun, logical and interesting.
c. Average pay is not as high as other fields; again refer to what I mentioned earlier about academic-based Neurologists' salaries dragging down the average salary figure. If you go into private/group practice, do procedures and have a good business sense, you'll be in very good financial shape.

Personally, I think Neuro is one of the best kept secrets out there. But no matter what, choose a field YOU love and can see yourself doing for the rest of your life.


😎

 

[scared sh*tless]

Dude, as a neuro PGY1 in my IM year -- i.e. putting in my time before I can just do neuro -- reading this post was like music to my eyes. Big up yourself, dongfeng41. I agree with everything you have ever said.

1. In terms of pay, Neuro ain't bad. It's no neurosurg, but with a projected 30% shortage of neurologists by 2010, an aging population, more effective treatments coming out for neuro ailments, the prospects are looking good. the average salary of Neuro may seem very mediocre, but keep in mind the relative large number of academic neurologists, ie there are plenty of old-timers, research-minded folks and Md-PhD's who are in pursuit of new truths and discoveries rather than the almighty dollar. But given how Neuro is steadily moving more and more towards outpatient setting, and given the nature of medical grads these days, expect the average salary to steadily go up. As for competitiveness, it's not hard to get into *a residency*, but many of the more reputable places are certainly competitive. Back to the pay issue: if u go into a field like Sleep, Headache, interventional Neuro, Neurophys, open up ur own practice or join a group practice, u can make out very very well.

2. Treatments for brain diseases will come with time. It's an exciting time in Neurology. The brain is considered the final frontier of Medicine, and many new discoveries are on the way. Several decades ago, Cardiology was in the same predicament as Neuro is in now. Just give it a little more time before Neuro fully blossoms.

3. Neuro is an ever expanding field. Thirty percent of all current drug research goes towards Neurological diseases. Neurosurg will not replace Neurology, and neither will Neuroradiology.

As to reasons why not that many choose to do Neuro, it most likely involves some of the following:
a. Many med schools don't offer Neuro as a 3rd yr course, and unless u know relatively early, most med students complain that they didn't realize how interesting Neuro was until it was too late. Neuro is early match too, so that doesn't help this phenomenon.
b. The nature of the subject. Many folks find the brain daunting, and will do their best to stay away from it. Most who go into Neuro, however, find it fun, logical and interesting.
c. Average pay is not as high as other fields; again refer to what I mentioned earlier about academic-based Neurologists' salaries dragging down the average salary figure. If you go into private/group practice, do procedures and have a good business sense, you'll be in very good financial shape.

Personally, I think Neuro is one of the best kept secrets out there. But no matter what, choose a field YOU love and can see yourself doing for the rest of your life.


😎

 

[bustbones26]

Think of a typical neuro patient, old, retired, getting diagnoses with dementia or Parkonsonism, how are they paying you? Social security, how crappy!

Now the younger patients coming to the neurologist? Their condition probably landed them on medical assistance/disability as well.

To summarize, crappy health care coverage for your patient population equals crappy reimbursement equals low salary compared to other specialties.

But I do agree with others above, there are many aspect of neuro that are up and coming that will make the specialty more desirable

1) neurointervention: young idea letting neurologist turf this field, yes turf war with neurorads, but as time goes on, and more neurologist take an interest, it will be more like interventional cards, thus big bucks, but consider the long hours and crappy lifestyle

2) procedures procedures procedures, botox, accupuncture, biofeedback, OMT, EMG/NCV, EEG, great reimbursements and/or cash

3) sleep medicine: AS long as fat old guys with big necks and COPD are around, there will always be a need for sleep studies

4) Pain medicine: High stress (in my opinion), getting dumped on with drug seekers, but nice reimburseable procedures

5) headache medicine: using some nice reimburseable procedures from 2) above, this can be a lucrative specialty

So in summary, a neurologist that finds his/her niche and opens shop in their own subspecialty has the opportunity to break the mold and increase their salary quit nicely. In my opinion, neuro will become more competitive over time, especially as path and rads start to overflow

 

[DrIsh]

After speaking to a neurologist, I was told that he was in a field that generally made the most intricate, understood, and accurate diagnoses but could do the least about it. There is little in the ways of neuro-pharmacology and a majority of effective treatments lie in the realm of intervention. Until we can break into interventional therapies, I think neurology will stay relatively unpopular.

 

[neurosign]

I partly disagree with the statement that there is little in the way of neuropharmacology because there are numerous treatments available for a realm of neurological disorders such as dementia, movement disorders, neuropathies, epilepsy, and now stroke. Many of these treatments, notably the neuroleptics and even deep brain stimulation, have been in the maintenance category as they do not modify course of diease.

However, numerous drugs as well as ideas are currently in the pipeline and emerging as breakthroughs which makes it an exciting time for neurology. As stated earlier, outpatient neurology will become more popular while the interventional aspects make their way into fellowship programs.

 

[bustbones26]

Keep in mind that medicine is not all science but is science + art. Neurology is one field where a cure for the disease is limited, but the art of medicine is invaluable. People with horrible diseases such as MS, parkinsons, etc. truely appreciate a neurologist that is compassionate, shows true interest for their welfare, does not display a high and mighty attitude, guides the patients to the proper support groups, and goes above and beyond the call of duty to help his/her patients despite there is no cure.

Ultimately, patients appreciate that neurologist understand that their condition is a disease and appreciates a neurologist advocacy toward helping them meet any special needs required: work restrictions, disability, assist devices, medicines, etc.

 

[neglect]

I was going to start a thread on this, but will subsume it.

I started moonlighting with a practice, doing NCVs and seeing patients (when you are a fellow you have time to do such things). My conclusion is that neurology is excellent in terms of lifestyle and $. You already know that they patients are interesting and offer what I would call unique cognitive challenges not seen in the rest of medicine.

Lifestyle: strictly 9 to 5 if wanted. Several of the neurologists in the group I'm familiar with go 4 days a week, and take personal time to do consulting - which adds variety and, they tell me, an additional 10 to 20% income. Or more if they want. There seems to be an unlimited need for IME's - medical exams to determine if an accident under litigation lead to an injury.

Call is minimal. They go into the hospital, on average, 2-3 times per year for status and tPA (I'm hazy on how some tPA cases work, but ER doctors can and do). Because the DRG code just changed for tPA, this will no doubt increase - tPA is going to create a trade off between money and lifestyle.

Money: I'm not going to give stats on exactly what and how I'm doing, but you can expect an hour worth of NCV/EMG to yield high hundreds of dollars. I was shocked to learn from a primary source that a neurosurgeon doing a simple disk will garner the same. Office practice without an electric way to evaluate nerves gives rise to an hourly income in the low hundreds. Other people on this board talk about how horrible it is to diagnose nervous system disorders, but thus far I've spent time telling people that migraine headaches do not mean they are going to die of a brain tumor and instead have a managable problem, that an essential tremor does not mean they have PD, and that the tingling in their feet is due to diabetes: so they better get thin. It's easy and personally satisfying. I've also seen some cool cases and some damn brave people.

Personally I slipped into neurology because I found the nervous system interesting and because I found the rest of medicine much less so. I didn't make a decision based on finances, but I can't tell you how wonderful it is to realize that after only 4 years of training (I'm doing more this year), you can enter this cool, up and coming, and rich specialty. I wish someone had told me all of that 2 years ago when I felt like I was stroked out.

Next year I'm going to go into practice full time and I'm looking forward to it. I feel very lucky I'm doing neurology. One poster said neurology is a hidden gem - this is exactly correct. I'm actually happy that intro neuroanatomy courses, perceptions outside the field, and poor inpatient experiences kept people from entering neurology for all the wrong reasons and glutting the field. As it is, the lack creates demand, which benefitted me getting into residency, and will help my next few steps.

 

[adore33sp]

I was going to start a thread on this, but will subsume it.

I started moonlighting with a practice, doing NCVs and seeing patients (when you are a fellow you have time to do such things). My conclusion is that neurology is excellent in terms of lifestyle and $. You already know that they patients are interesting and offer what I would call unique cognitive challenges not seen in the rest of medicine.

Lifestyle: strictly 9 to 5 if wanted. Several of the neurologists in the group I'm familiar with go 4 days a week, and take personal time to do consulting - which adds variety and, they tell me, an additional 10 to 20% income. Or more if they want. There seems to be an unlimited need for IME's - medical exams to determine if an accident under litigation lead to an injury.

Call is minimal. They go into the hospital, on average, 2-3 times per year for status and tPA (I'm hazy on how some tPA cases work, but ER doctors can and do). Because the DRG code just changed for tPA, this will no doubt increase - tPA is going to create a trade off between money and lifestyle.

Money: I'm not going to give stats on exactly what and how I'm doing, but you can expect an hour worth of NCV/EMG to yield high hundreds of dollars. I was shocked to learn from a primary source that a neurosurgeon doing a simple disk will garner the same. Office practice without an electric way to evaluate nerves gives rise to an hourly income in the low hundreds. Other people on this board talk about how horrible it is to diagnose nervous system disorders, but thus far I've spent time telling people that migraine headaches do not mean they are going to die of a brain tumor and instead have a managable problem, that an essential tremor does not mean they have PD, and that the tingling in their feet is due to diabetes: so they better get thin. It's easy and personally satisfying. I've also seen some cool cases and some damn brave people.

Personally I slipped into neurology because I found the nervous system interesting and because I found the rest of medicine much less so. I didn't make a decision based on finances, but I can't tell you how wonderful it is to realize that after only 4 years of training (I'm doing more this year), you can enter this cool, up and coming, and rich specialty. I wish someone had told me all of that 2 years ago when I felt like I was stroked out.

Next year I'm going to go into practice full time and I'm looking forward to it. I feel very lucky I'm doing neurology. One poster said neurology is a hidden gem - this is exactly correct. I'm actually happy that intro neuroanatomy courses, perceptions outside the field, and poor inpatient experiences kept people from entering neurology for all the wrong reasons and glutting the field. As it is, the lack creates demand, which benefitted me getting into residency, and will help my next few steps.

Hello, I'm pretty new here but I'd like some input from neglect, and anyone else, who can expand on neglect's post. I'm done with undergrad, researching full time in structural neuroimaging before med school, and have long wanted to be a neurologist. In the past year, I've been bombarded by doctors telling me first of all 1.) they wish they were never doctors because it's too much responsibility and training for too little pay and 2.) being a neurologist is boring because it's all strokes. I think this is an example of why neurology isn't more poplular--I haven't even started medical school and people are advising me against it. About the post, I'd like more information on what some of it means -- what is it like to do IME's for litigation? What do those doctors do for consulting and how do they break into it? What is doing NCV/EMG? I'm absolutely fascinated by neurology, but I have to be honest -- money is a big issue for me because I've already paid my own way through undergrad and will have to take out huge loans for med school, resulting in debt that is probably higher than the average med student. These concerns -- only seeing strokes, neurology doesn't pay, etc are giving me a very hard time. I'd appreciate any and all input. Thank you!

 

[DPPM]

To add to the questions of the last post:

A common complaint about medicine is all of the paperwork, and not enough time to spend with each patient to do what you need. How does neurology stack up in these aspects? Less or more paperwork than most specialties? Less or more rushed?

 

[Whisker Barrel Cortex]

I think neurology is a great field, with a bad reputation. One important factor that many people point to is the relative lack of treatment options for many patients that neurology sees, especially the stroke patients. However, it seems that the options are increasing continuously and will likely continue to do so.

As more and more research goes into the management of strokes, this high morbidity and mortality illness will hopefully become more treatable. The rate of improvement, in my opinion, will unfortunately not match that of cardiology given the unique properties of the brain.

I agree with the other posters above that other factors include the lack of early exposure to neurology combined with the early match. Not many get a chance to "discover" neurology during med school as they do other specialties. If they do, it may already be too late.

Income doesn't seem to be a huge issue. The income of neurologists is actually pretty good for a non-surgical subspecialty.

 

[neglect]

Hello, I'm pretty new here but I'd like some input from neglect, and anyone else, who can expand on neglect's post. I'm done with undergrad, researching full time in structural neuroimaging before med school, and have long wanted to be a neurologist. In the past year, I've been bombarded by doctors telling me first of all 1.) they wish they were never doctors because it's too much responsibility and training for too little pay and 2.) being a neurologist is boring because it's all strokes. I think this is an example of why neurology isn't more poplular--I haven't even started medical school and people are advising me against it. About the post, I'd like more information on what some of it means -- what is it like to do IME's for litigation? What do those doctors do for consulting and how do they break into it? What is doing NCV/EMG? I'm absolutely fascinated by neurology, but I have to be honest -- money is a big issue for me because I've already paid my own way through undergrad and will have to take out huge loans for med school, resulting in debt that is probably higher than the average med student. These concerns -- only seeing strokes, neurology doesn't pay, etc are giving me a very hard time. I'd appreciate any and all input. Thank you!

1. Strokes aren't boring (compared with what? Appy? SAH? PNA?).
2. Neurology isn't all strokes. Even inpatient services tend to be 50% stroke, 50% other. Outpatient: rare stroke follow ups.
3. Typically non-neurologists cannot appreciate how interesting neurology actually is. Doctors like this tend to think that the medical world revolves around what they do - and everyone should be interested in what they do. I don't think GI bleeds are fun or interesting, but GI guys do.

You're early in your training. While it's good to have early interests, don't get too tied into anything. Neurology is cool. The money is there with work. (The neurologists I talk to are approached by lawyers and pharm). There are other cool specialties out there that pay well and are also interesting.

Good luck.

 

[neurolome]

As someone who *hated* anything to do with the brain my first year of Medical school, grudgingly admitted it was interesting my second year and then was falling over herself third year to go to Neurology rounds because everything else seemed boring, I can truly say I have come full circle. It's a fascinating subspecialty that will enagage my intelligence all my life, and even cooler it is on the cusp of a host of exciting developments like interventional procedures and nanotechnology set to change the face of the discipline. I may be scared, I may have lots to learn and memorize about nerve tracts and which gyrii do what, but I'm excited(and that's more than I can say about a lot of my colleagues). 🙂

Nice to find a group of young people who are excited about Neuro too (somedays I honestly feel like I am the only one applying...)

 

[ptolemy]

I don't want to rehash old arguments but I am determined to find the answer to this question. With the gaining popularity of "lifestyle" specialties, I can't understand why neurology is not competitive. The possible reasons I have heard so far are:

1) Pay is not as good as other specialties
2) Patients are depressing and treatments are not extremely effective
3) Field is shrinking/dying due to neurosurg and neurorad

4)most people are stupid

but seriously, i think people have a warped view of neuro that it doesnt treat anything, etc. it is not the best pay, but pay isn't shabby either. and if you do a neuro subspecialty, there can be a lot of tx options. if you go into stroke, though, i think you lose the "lifestyle" advantage the OP was thinking about.

but it has to be what you want to do. lets face it, in medicine, for the most part everyone will make enough money to survive and live comfortably, but not break the bank. so, do what you want to do, in terms of your enjoyment. but most people don't follow this theory and choose their specialty based on money, prestige, etc. oh well.