Worried I made a mistake with neurology

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kitty3634

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Sorry if any of this comes off as whiny. Thank you to anyone that reads for letting me rant/express myself. I’m in my IM prelim year and understand that most of my unhappiness centers around the fact that I’m in my least favorite specialty and that I matched in a city that I am miserable in + far from support. But I also am worried because I’m not excited about neurology topics or patients like my coresidents, and keep getting told that PGY2/3 at this program can be rough which doesn’t make me feel better.

I initially came to med school wanting to do something surgical but realized that it didn’t align with my ideal lifestyle. I didn’t really have any other specialty interests or enjoy the my other MS3 rotations but had a good experience in community neurology so decided to pursue that. During MS4, I didn’t really enjoy the two neurology rotations I had, but thought the OP/community lifestyle didn’t seem terrible and I could do this for the rest of my life. One of my last rotations before match was two weeks of neurology and I absolutely hated that experience. The whole time I was on that rotation (both inpatient and outpatient at academic center) I thought to myself if I’d had this experience earlier I would not even have considered neurology. Now as a PGY1, I just get scared/stressed when I get assigned the neuro patients. I’m realizing that I’m not a big fan of the neuro exam (I’m not very good at it), I struggle with this complex neuro patients and I don’t get excited about the work-up.

I don’t have any neurology rotations till February/March to really know if I just had bad experiences previously and am still interested. I just don’t want to go through with this feeling I’ll be unhappy for the rest of residency and potentially taking a spot from someone else.
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I find myself struggling and even fearing unfamiliar subjects initially. As an example, neuromuscular portions of neurologic examination have always been the hardest for me, and I struggle with and shun neuromuscular patients early on in residency. With repeated exposure however (some not by choice as you are directly caring for the patient), I became more familiar with it and actually begin to like it. I had similar experiences with learning EEG and EMG as well as a PGY-2 resident but have now grown to appreciate them.

I give this example to highlight the steep learning curve transitioning from medical school to residency, and you will encounter similar experiences countless times (even as attending). You might have felt similar experience during your prior neurology rotations as neurology is one subject you don't learn much as a student and certainly not so much more as an intern.

That said, some people are just not interested in neurology or diseases of the nervous systems in general. If that is the case, it is not too late yet to switch career as you just started preliminary year. And on the topic of switching residency, if you have good rapport and performance with your program, it should not be a tremendous hurdle. I can think of 3-4 people in recent years who switched residency within the same hospital, some even after 2 years of residency (2 were prelim IM who stayed on as IM residents instead of transitioning to neurology).
 
What made you choose neurology in the first place?

If surgery was what interested you, you should’ve at least settled on a procedural specialty like anesthesia, IR, or even PMR.

Take time to reflect and think about what you really want. It’s not too late to jump boat.
 
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Definitely not too late to change career paths. However, keep in mind that nearly no one is “good” at the neuro exam as a PGY1. I would say that most are not “good” until halfway through PGY2. Also, it’s not uncommon to get imposter syndrome as you near the neurology years. Additionally, keep in mind that similar to IM there can be vastly different career paths through neurology. You may find you really like a niche area within neurology and if you subspecialize and go to academics you’ll be able to practice only in that niche area. Also, there are options like palliative, neuro-onc, pain, or sleep that are options after neurology residency without really practicing “neurology” long-term.
 
I would take the time to reflect but do it quickly. You still have time to reapply for the match I think for next year.

Definitely think about why you went into neuro and if it aligns with your interests and lifestyle. You should realize that when you enter into any speciality, there is an initial steep learning curve but with lots of practice and reading, you get over that hump and become much more confident as a clinician. I will also add there are specialized niches or paths in neuro (headache, pain, neuro critical care, NIR, sleep medicine) that can even appeal to those that realize that they don’t want to be your typical general neurologist.
 
You may have hated your neurology rotation because you were about to graduate and had senioritis.
 
If you’re procedure oriented- do neurocrit, NIR, or pain/headache. If you want a chill life- do neurophys/sleep and read EEGs from home. One of my attendings used to do telestroke codes and read EEGs during the lull period on the same shifts - he made bank ($600k+) working reasonable hours from home. Other options like neuropalliative are also unique careers. There’s something for everyone in neurology- you don’t have to do a neuromuscular exam and diagnose inclusion body myositis on every patient if you don’t like it.
 
Something else you could consider during residency/fellowship is making connections in industry with a plan to pivot to non-clinical work after you finish. The path to doing this is highly variable though so I think meeting the right mentors plays a big role.
 
I've known few other people who got that feeling. Even I had a little dysphoria (despite the fact I've always wanted to do Neuro) during my PGY1 and PGY2 years. Most of the times it goes away by PG3/4 and you start enjoying being a neurologist. As mentioned above, there are many paths after Neuro- clinical and non clinical; that you can pursue. Neuro is in a very high demand currently.
 
kitty3634 said:
Sorry if any of this comes off as whiny. Thank you to anyone that reads for letting me rant/express myself. I’m in my IM prelim year and understand that most of my unhappiness centers around the fact that I’m in my least favorite specialty and that I matched in a city that I am miserable in + far from support. But I also am worried because I’m not excited about neurology topics or patients like my coresidents, and keep getting told that PGY2/3 at this program can be rough which doesn’t make me feel better.

I initially came to med school wanting to do something surgical but realized that it didn’t align with my ideal lifestyle. I didn’t really have any other specialty interests or enjoy the my other MS3 rotations but had a good experience in community neurology so decided to pursue that. During MS4, I didn’t really enjoy the two neurology rotations I had, but thought the OP/community lifestyle didn’t seem terrible and I could do this for the rest of my life. One of my last rotations before match was two weeks of neurology and I absolutely hated that experience. The whole time I was on that rotation (both inpatient and outpatient at academic center) I thought to myself if I’d had this experience earlier I would not even have considered neurology. Now as a PGY1, I just get scared/stressed when I get assigned the neuro patients. I’m realizing that I’m not a big fan of the neuro exam (I’m not very good at it), I struggle with this complex neuro patients and I don’t get excited about the work-up.

I don’t have any neurology rotations till February/March to really know if I just had bad experiences previously and am still interested. I just don’t want to go through with this feeling I’ll be unhappy for the rest of residency and potentially taking a spot from someone else.
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'Neuro patients' are extremely scary until about 4 months into PGY2, especially stroke alerts. Almost everyone feels this. The medicine intern year sucks almost everywhere and feeling down is common. PGY2 in neurology sucks almost everywhere. It is a gauntlet to forge you into a neurologist, especially for emergencies where quick actions are needed but it is not the rest of your life and career.

I have two specific pieces of advice.
One, as others have said the medicine intern year is very portable and you can switch to something else like anesthesia if you want.
Two, neurology is extremely broad and all areas are likely to remain in demand for some time. You can find something you will like for day to day work ESPECIALLY if you felt you could live with general outpatient neurology after seeing it first hand. Outpatient neurology is 80-90% of the specialty and where the most demand is. You can subspecialize and see only the patients you want to see >80% of the time, even in the community. That means you can do movement all day or headache all day, have no call, and stick to whatever area you really enjoy. Neuro is a surprisingly broad specialty where you can form your own niche easily. Like procedures? Do pain, headache, movement for botox etc. Want to stay home? Do teleneuro/EEG.

You don't have to love residency- most hate it. I tolerated it and like inpatient neurology but the schedule and call really suck. There are plenty of neurologists that hated all of inpatient neurology and suffered through residency to get to the real world and are relatively happy outpatient. But most neurologists do end up loving the exam and pathophys, so you may want to consider your options.
 
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