DO and Neurology

[drthedude]

Hello everyone! I have been grateful to have been accepted into a DO school and was wondering how DO friendly Neurology is and whether or not how worried I should be as a DO matching into Neuro. Ty in advance!

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[Just D.O. it]

How DO-friendly is neurology

Prospective applicant here with a strong interest in neurology. Assuming someone gets average complex/step scores, is neurology at reach?

forums.studentdoctor.net

 

[Doctoscope]

Neurology is a terrible specialty and nobody should apply to it until the 2026-2027 match, after which it turns into a great specialty.

 

[drthedude]

Neurology is a terrible specialty and nobody should apply to it until the 2026-2027 match, after which it turns into a great specialty.

Agreed, stay away 🤝

 

[DrStephenStrange]

I matched last cycle, and I only had a 425 Level 1 and 435 Level 2 (pass is 400 for both). I actually failed Level 2 on my first attempt with a 384. Only had Step 1 of 204 (pass is 196) and not Step 2. So I'd say very friendly at the moment. Of course, some people with similar stats or even slightly better probably didn't match as well, but I mean, it's very doable as long you don't flunk anything. I anticipate it will get slightly more competitive every year though.

 

[drthedude]

I matched last cycle, and I only had a 425 Level 1 and 435 Level 2 (pass is 400 for both). I actually failed Level 2 on my first attempt with a 384. Only had Step 1 of 204 (pass is 196) and not Step 2. So I'd say very friendly at the moment. Of course, some people with similar stats or even slightly better probably didn't match as well, but I mean, it's very doable as long you don't flunk anything. I anticipate it will get slightly more competitive every year though.

would you say step 1 is necessary for neuro? or only COMLEX

 

[DrStephenStrange]

would you say step 1 is necessary for neuro? or only COMLEX

Not necessary, but it would help a tone if you have both step 1 and 2. I sincerely believe that I got at least half of my interviews because I had a Step 1.

See my original thread below that cycle. I had interviews at some pretty impressive places despite my low stats. And I match at very good program.

What are my chances applying neurology this year?

So I am at one of the newer DO schools and also URM/black (if that makes a difference) applying Neuro this year. Step 1 and Level 1 didn't turn out great with a 204 and 425 (on first attempt). Still working on Step 2 and Level 2, and my scores won't come out until 2 weeks into the cycle...

forums.studentdoctor.net

 

[Postictal Raiden]

The field does feel terrible at times but when you apply for jobs and realize that everyone is begging you to choose them, you realize how fortunate you are for choosing this specialty.

 

[drthedude]

Not necessary, but it would help a tone if you have both step 1 and 2. I sincerely believe that I got at least half of my interviews because I had a Step 1.

See my original thread below that cycle. I had interviews at some pretty impressive places despite my low stats. And I match at very good program.

What are my chances applying neurology this year?

So I am at one of the newer DO schools and also URM/black (if that makes a difference) applying Neuro this year. Step 1 and Level 1 didn't turn out great with a 204 and 425 (on first attempt). Still working on Step 2 and Level 2, and my scores won't come out until 2 weeks into the cycle...

forums.studentdoctor.net

appreciate your help, congrats on your match again!!

 

[Doctoscope]

I matched last cycle, and I only had a 425 Level 1 and 435 Level 2 (pass is 400 for both). I actually failed Level 2 on my first attempt with a 384. Only had Step 1 of 204 (pass is 196) and not Step 2. So I'd say very friendly at the moment. Of course, some people with similar stats or even slightly better probably didn't match as well, but I mean, it's very doable as long you don't flunk anything. I anticipate it will get slightly more competitive every year though.

This is probably another example of why every DO should take at least USMLE Step 1. It seems passing it has benefited you greatly, and programs don't really GAF about COMLEX scores.

 

[drthedude]

This is probably another example of why every DO should take at least USMLE Step 1. It seems passing it has benefited you greatly, and programs don't really GAF about COMLEX scores.

Seems like maybe not step 2 however?

 

[Doctoscope]

Seems like maybe not step 2 however?

Well this was before Step 1 going P/F, and everyone seems to agree Step 2 replaces Step 1 in terms of scores in the eyes of PDs.

 

[Doctoscope]

The field does feel terrible at times but when you apply for jobs and realize that everyone is begging you to choose them, you realize how fortunate you are for choosing this specialty.

Can you comment on what aspects feel terrible at times?

 

[voxveritatisetlucis]

currently, very friendly but with rapid school expansion, it’s impossible to predict. Look at radiology. Used to be very easy for DOs to match..now will have a DO match rate lower than surgery

 

[Goro]

currently, very friendly but with rapid school expansion, it’s impossible to predict. Look at radiology. Used to be very easy for DOs to match..now will have a DO match rate lower than surgery

Please, you're an M1. Let's focus on the facts that Neurology has always been a DO-friendly specialty.

 

[DrStephenStrange]

Can you comment on what aspects feel terrible at times?

Lazy consults, functional patients you can do nothing about, stroke alerts for things that aren't strokes, very long hours in residency. Just to name a few.

 

[Postictal Raiden]

Like mentioned above, poorly differentiated consults makes me feel that neurology is a dumping ground.

Any loss of consciousness (including due to having a plasma EtOH level of 400)? consult neurology
Generalized weakness (including chronic deconditioning and failing to thrive)? consult neurology
Woke up in the morning feeling "strange"? consult neurology

At times, I feel that my job is to basically an accurate history.

The above is compounded by a great deal of unease among other physicians when confronted with anything brain related. Suddenly, everything becomes a STAT/ASAP. Understandable and I would probably act the same way if I didn't do a neurology training, but it still takes toll on us.

Also don't get me started on the psychogenic presentations...

 

[Doctoscope]

Lazy consults, functional patients you can do nothing about, stroke alerts for things that aren't strokes, very long hours in residency. Just to name a few.

Like mentioned above, poorly differentiated consults makes me feel that neurology is a dumping ground.

Any loss of consciousness (including due to having a plasma EtOH level of 400)? consult neurology
Generalized weakness (including chronic deconditioning and failing to thrive)? consult neurology
Woke up in the morning feeling "strange"? consult neurology

At times, I feel that my job is to basically an accurate history.

The above is compounded by a great deal of unease among other physicians when confronted with anything brain related. Suddenly, everything becomes a STAT/ASAP. Understandable and I would probably act the same way if I didn't do a neurology training, but it still takes toll on us.

Also don't get me started on the psychogenic presentations...

Outside of the job market, what are some things that make you glad you picked the specialty? I am strongly interested in the specialty simply based on the fact that I really enjoyed neuroscience at a premed level, and I'm curious how much of that translates to appreciating neurology as a medical specialty.

 

[drthedude]

Outside of the job market, what are some things that make you glad you picked the specialty? I am strongly interested in the specialty simply based on the fact that I really enjoyed neuroscience at a premed level, and I'm curious how much of that translates to appreciating neurology as a medical specialty.

+1 but I was a neuroscience major

 

[voxveritatisetlucis]

Please, you're an M1. Let's focus on the facts that Neurology has always been a DO-friendly specialty.

It’s happening to gas and rads (two specialties that have been DO friendly for about a decade). Why assume it couldn’t happen in neurology as well. It would almost certainly happen if neurologists begin to make a significant premium over hospitalists

 

[ProReduction]

+1 but I was a neuroscience major

0% of it translates. The day-to-day of Neurology in 2022 is closer to being a Social Worker than it is to being a Neuroscience PhD. I'd venture that 5% of my fellow Neurologists (or less) can explain the Hodgkin-Huxley model. However, I am certain that 100% of my fellow Neurologists have a go-to list of exam tasks to detect conversion disorder.

 

[deleted1139416]

It’s happening to gas and rads (two specialties that have been DO friendly for about a decade). Why assume it couldn’t happen in neurology as well. It would almost certainly happen if neurologists begin to make a significant premium over hospitalists

Yes but GAS and Rads don’t experience nearly the same level of burnout that Neurology does. Not to mention the hot job market for IM and several DO friendly IM subspecialties. There’s also still a high number of IMGs going into neuro, those will probably get replaced by DOs.

All specialties are getting more competitive, but neuro is not getting more competitive than others.

 

[Kardio]

It’s happening to gas and rads (two specialties that have been DO friendly for about a decade). Why assume it couldn’t happen in neurology as well. It would almost certainly happen if neurologists begin to make a significant premium over hospitalists

Nobody goes into neurology to escape medicine the way (some) go into gas or rads to escape it.

If the compensation changes, that’s a different story.

 

[NeuroHopeful1]

would you say step 1 is necessary for neuro? or only COMLEX

My COMLEX 1 is in the low 400s, no step and I'm sitting at 8 interviews. It's not necessary but having a pass would probably help. My Step 2 is 24x so a good Step 2 score is probably more important.

 

[EArlyBirdGetsTheWorm]

Neurology is a terrible specialty and nobody should apply to it until the 2026-2027 match, after which it turns into a great specialty.

I concur. Please wait until 2028.

 

[mrbreakfast]

Can you comment on what aspects feel terrible at times?

Just to re-emphasize what others said: to paraphrase one of the Dr. Glaucomflecken videos, a large percentage of your neurology referrals/consults will be placed by people who didn't pay attention to neuroscience in preclinicals, didn't have a neurology rotation in clinicals, and view the nervous system as a scary black box, to which any symptom may be attributed and which cannot be probed by anyone other than an experienced neurologist. There is no symptom which is exempt from a referral to a neurologist for the question "is this either MS, a stroke, or a neuromuscular condition?" On the inpatient side, you will see plenty of consults for patients who "feel strange" or "feel tired" or are "confused." If you walk into an ED and tell them you have a headache without giving any other details, you will likely see a neurologist. Etc. You gotta pick your poison. If you like the inpatient workup of autoimmune encephalitis, for example, you also need to be ready to explain to a hospitalist that the decompensated cirrhotic in renal failure whose BUN and ammonia numbers are both higher than their serum sodium probably doesn't need an autoimmune encephalitis workup. Depending on where you work, the consult "I don't feel like I can confidently do a neuro exam on this patient, will you do one for me?" may not be uncommon. There are some hospitals where consults are relatively rare and complex because the hospitalist already did a reasonable workup, and there are others where your day is full of mostly very brief, very simple consults.

Also, functional patients. Also, you get one brain, and unlike almost any other major organ in the body, if you wreck it you can't get another one from a cadaver. You will have to explain that to crying family members more times than you can count.

It would almost certainly happen if neurologists begin to make a significant premium over hospitalists

Neurologists have done an excellent job of keeping their compensation to themselves. Neurohospitalists already make a significant premium over medicine hospitalists. That hasn't been enough to tip the needle sufficiently.

 

[Dantes]

So what are the good parts? You guys regret choosing neuro?

 

[Postictal Raiden]

So what are the good parts? You guys regret choosing neuro?

Regret choosing it over Opthalmology or Dermatology? Sure, but then I didn’t have the drive to put in the work to match these fields

Some of the good parts of neurology for me are:
- being a very cerebral (pun) field. I enjoy thinking about stuff rather than reflexively jump to conclusions
- the complexity of the nervous system and how knowing your Neuro anatomy helps pinpoint (for the most part) the lesion.
- the various clinical manifestations of brain disease (cognitive vs weakness vs convulsive, rigidity vs coma etc)
- the various manifestations you get from an identical injury.

 

[DrStephenStrange]

Anesthesia and Rads are more competitive because 1) they uniformly start at 400-450k 2) they let you escape medicine for the most part

Neuro does neither, usually has a brutal residency and salary isn’t so far off of general IM that people will debate IM+fellowship vs neurology. I doubt it’ll become like Rads/anesthesia anytime soon

That last part is not true. The salary difference between IM and Neurology grads fresh off residency with no fellowship is actually pretty significant. Like 100K or more difference.

 

[Ho0v-man]

Consider ignoring anyone who says neurology will get competitive. That person has never done a neurology rotation.

 

[Catsfordays]

The field does feel terrible at times but when you apply for jobs and realize that everyone is begging you to choose them, you realize how fortunate you are for choosing this specialty.

Then as a 4th year applying to neuro, can I infer that most residencies will train us to be a competent neurology with good job prospects? I ask this as someone who is looking into community programs and just to be a decent general neurologist with maybe a fellowship in vascular.

 

[Postictal Raiden]

Then as a 4th year applying to neuro, can I infer that most residencies will train us to be a competent neurology with good job prospects? I ask this as someone who is looking into community programs and just to be a decent general neurologist with maybe a fellowship in vascular.

Yes, most programs should provide you with the bread and better training to handle 90% of general neuro stuff as well as neurologic emergencies

 

[deleted1139416]

What do competitive neuro programs really care for? Is it research, boards, or audition performance - or will I just have to become a triple threat?