would you still do neuro if it was an IM subspeciality?

[Raygun77]

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Just wondering. This is the situation in Australia, and it's a bit of a turnoff having to be undifferentiated for an extra 2 odd years and having to sit extra exams to get a seat.

What do you think?

 

[danielmd06]

I feel that more internal medicine training wouldn't hurt any of us. I would still do it.

The only problem as I see it becomes the total number of years of residency you would then be faced with and the repercussions this would mean for those of us wishing to complete fellowships. Is the neruology residency three additional years after three internal medicine years for you?

 

[Mattchiavelli]

Probably not- if it were another 3 years on top of an IM residency it'd be too long for me with not enough specialization. If it were just a year fellowship off of IM I would feel like I'd just scratched the surface of the material.

I know that neurophysiology in some countries is a specialty to its self [like PT/OT] so pulling that out of the curriculum would shorten training but IMO make it less interesting. Not sure how it works down under [and my reference for this is wikipedia so believe at your own risk]. The neurophys stuff and opportunity to evaluate it was one of the draws to Neurology for me and is on my short list for fellowships. Without it I'd probably be in Psych or PM&R.

 

[bronx43]

I honestly don't understand why there are even fellowships. The value add of the 3 years of IM you do before 3 years of cardio is questionable at best. There is no way in hell it takes a full IM residency to develop the "IM" skills necessary for any medical sub-specialty. Neurology did the right thing by not making themselves a sub-specialty of IM. But, even within neurology, the fact that it takes 7-8 years for interventional neurology is just equally absurd. And this is mirrored by interventional cardiology, where you're essentially a glorified technician- I'm not even sure if some of the older guys can even hear a 2/6 S3 heart sound. The entire medical education system is antiquated and thoroughly inefficient.

 

[coup de chance]

NO. 4 years is a reason why I chose Neurology.

 

[Raygun77]

I feel that more internal medicine training wouldn't hurt any of us. I would still do it.

The only problem as I see it becomes the total number of years of residency you would then be faced with and the repercussions this would mean for those of us wishing to complete fellowships. Is the neruology residency three additional years after three internal medicine years for you?

Yep exactly. It's a year of internship, 2 years as a 'basic physician trainee', then 3 years of your 'advanced physician training' aka IM subspecialization. After that would come your PhD, 3 years of interventional neurology training, or whatever you decide to pursue.
Must keep in mind that all postgrad training is more protracted here in Australia- for example to become a neurosurgeon its internship, one undifferentiated year as a surgical 'house medical officer' then your eligible to enter the 6 year training program. Similar for radiology though it is 5 years and they get a dedicated fellowship year. This is offset by that school leavers go straight into a 6 year MBBS degree though.

Anyway, thanks for the thoughts. Right now deciding if I'm a more medical or surgically oriented person, given neurosurgery is relatively more benign here in Australia and the training program isn't longer given most graduates don't need to seek a fellowship to have an 'area of interest'.

 

[Raygun77]

So in addition to the original question, I'm wondering- would you consider neurosurgery if it involved only two extra years of training, and was relatively more benign in terms of hours- say 80 hours per week max, with most weeks being 60ish hours...the benefits of having 'house medical officers' covering the floor/scutwork! Of course, with neurosurgery also comes much higher remuneration (Australia also reimburses procedural specialities far more favourably in the private system)

Being honest with myself I'm most fascinated by neuroanatomy and disease process like CA, movement disorders, strokes- all having a medical and surgical aspect. I also like acute care. But I do find some aspects of surgery repetitive and boring (opening, closing..).

From those who also considered neurosurg...perspectives would be great!

 

[Mattchiavelli]

Being honest with myself I'm most fascinated by neuroanatomy and disease process like CA, movement disorders, strokes- all having a medical and surgical aspect. I also like acute care. But I do find some aspects of surgery repetitive and boring (opening, closing..).

Do you have access to any neurologists that are specialized in movement and do DBS implantation? The neurologist goes in to the OR for the actual implantation, it might do you good to see if you can go in to observe and check it out. I'm going in with one of our new movement attendings to observe next month during my vacation, it's supposed to be pretty interesting. They also do botox for dystonia which I always thought was a nice way to do procedures without all the major ritual involved in OR work.

 

[neurologist]

Just wondering. This is the situation in Australia, and it's a bit of a turnoff having to be undifferentiated for an extra 2 odd years and having to sit extra exams to get a seat.

What do you think?

Nope. In fact, that was one of the big attractions of neuro as far as I was concerned. One year of medicine internship was all I was up for . . .

 

[danielmd06]

Sheesh.

If you have to do 3 years of IM and THEN 3 years of neurology and THEN potentially a year (or years) of respective fellowship...you are looking at a relatively unattractive training period for our job in the US from my perspective. Life is about compromises sometimes.

I would seriously consider neurosurgery and/or neuroradiology or another field altogether based upon total training time requirements versus work and paycheck and love of the subject matter.

Best wishes.

 

[Raygun77]

Sheesh.

If you have to do 3 years of IM and THEN 3 years of neurology and THEN potentially a year (or years) of respective fellowship...you are looking at a relatively unattractive training period for our job in the US from my perspective. Life is about compromises sometimes.

I would seriously consider neurosurgery and/or neuroradiology or another field altogether based upon total training time requirements versus work and paycheck and love of the subject matter.

Best wishes.

Yeah...the bright side is here residents/registrars are at least compensated more fairly with a ramp up each year 🙂.