I love preclinical neuroscience. Is that enough of a reason to consider neurology?

[mumixam]

Having one of those Oh-God-What-Am-I-Going-To-Do-For-A-Living days. I really love neuroscience in an academic sense, but I'm not sure about how that stacks up to the clinical realities. For example, I don't particularly like physical exams, and I think that peripheral neurology is pretty boring. Once you get into the brain, things get interesting. I'm also concerned about the relatively low compensation that neurology seems to be known for. Does anyone care to share some wisdom?

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[Spinothalamic]

Yes, that's certainly enough to at least consider neurology. Best thing to do is shadow in the field or wait for third year to actually experience clinicals. Neurology was the right fit for me as I thought it was the most interesting field (think about which journals you want to be reading for the rest of your life), there are many different paths you can go within neurology (including neuro-onc and neurocritical care), and there are opportunities for good work-life balance.

I don't particularly "like" physical exams either, but I appreciate the breadth and depth of a good neurological exam. It's so much more reliable to me than many of the other exam techniques that we learn.

As for compensation... just a few points to consider. Neurologists on average make more than many other specialties, which is enough to live very comfortably unless you have incredibly high student loans or want to live in a very big house in an expensive area. If making a lot of money is very important to you, there are still opportunities within neurology to make good money relative to most other specialties, but you have to be flexible on location, call schedule, etc (there are other threads that cover this). Obviously your earning potential is much higher in other specialties, but there are trade offs.

 

[OrangeOrange]

Having one of those Oh-God-What-Am-I-Going-To-Do-For-A-Living days. I really love neuroscience in an academic sense, but I'm not sure about how that stacks up to the clinical realities. For example, I don't particularly like physical exams, and I think that peripheral neurology is pretty boring. Once you get into the brain, things get interesting. I'm also concerned about the relatively low compensation that neurology seems to be known for. Does anyone care to share some wisdom?

I think you owe it to yourself to go into the field that you find most interesting. At the end of the day, true interest is a bigger motivator than a slightly better schedule or a slightly nicer car (for me, anyway).

I also found the physical exam extremely boring and frustrating until I got to do it on real patients with abnormal findings. Then it got interesting in a hurry!

 

[OrangeOrange]

(think about which journals you want to be reading for the rest of your life)

This is really good advice and helped me a lot when I was deciding!

 

[chajjohnson]

To throw in a different opinion, first year neuroscience was by far my favorite class of med school and I hated my neurology rotation. I loved learning about the theories of how memories form, how consciousness works, which areas of the brain control which parts of cognition and motor or sensory function, I even enjoyed learning the neurophysiology and anatomical tracts. However clinical neurology is pretty detached from this stuff. I remember starting my second year neurology block and the professor the first day said something like "well you can go ahead and forget 90% of what they taught you in neuroscience, it doesn't matter anymore". In my experience this was true. The basic neuroscience principles used in clinical neurology are only the ones known to be completely essential to the pathophys and treatment of specific diseases, all other basic stuff is gone. If it's hypothetical or just cool neuroscience it's gone. Further training in neurology didn't seem to focus on learning more cool basic neuroscience that doesn't apply to disease, but more clinical science like which drugs and which doses work best, sens and specs of exams, etc. Beyond being disappointed a lot of basic neuroscience is irrelevant, people either love or hate clinical neurology. Despite the major advancements in a lot of areas of neuro, a ton of patients still either just get better on their own without us doing much, don't get better at all, or get better with the help of a team of therapists and neurologists just coordinate that care (e.g. ALS, dementias).

I still find neuroscience so interesting neuro is my first choice at this point, but I was really disappointed with what type of neuroscience knowledge is used in clinical medicine. I actually found that psychiatry, especially more basic or neuroimaging psych research fit more with my neuroscience interests so I am also considering that.

 

[Spinothalamic]

Some good points made above! I just want to add in a response regarding the thought that neurologists don't actually treat many diseases just in case others reading are considering neurology. While it is certainly true that many neurological afflictions still are awaiting truly impactful therapies, there are also a lot of conditions where neurologists can make huge differences for patients. Migraine treatment (some cases with botox) can completely turn someone's life around. Seizure management with medications or VNS or surgical planning for resection surgery--lots happening in this arena. Acute stroke therapy. Botox post-stroke. Parkinson's with meds, or DBS. MS and disease-modifying drugs. Neurooncology as a field, neurocritical care as a field, sleep medicine, interventional neuroradiology--all accessible through neurology residency. Just a brief list of some areas where neurologists can make a very tangible impact, in addition to roles where patient care is enhanced via "coordinating care" or using treatment with modest benefit like mentioned above.