Is Neurology for me?

[QueryNeurology]

I'm a bit undecided as I take a liking to both Neurology and Psychiatry.

I found the neuroscience part in preclinical years fascinating and performed my best at those. I learnt the material quickly and did not put much effort in. I think of studying the brain (specifically memory, behaviour) and sleep medicine, pain medicine, psychopharmacology and treating headaches, epilepsy, sleep disorders and think this is for me but then I think of strokes (which I would hate to manage) and then I wonder. In my clinical rotations I would also preferred the surgical subspecialties (but my scores are too low for me to risk matching in these) and also would not like the big part diagnosis part and the little input in treatment.

I also find everything in psychiatry interesting and could easily see myself doing this and it was my favorite rotation in clinical years but the subjectivity and lack of respect was seriously off putting. I would love reading up on depression, ADHD, anxiety disorders, personality disorders etc. but don't know if I could see myself treating these day in day out and if I would, I fear I would become a pill pusher. But the lifestyle and options later on do seem intriguing.

Can anyone offer some advice on deciding between these two?

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[kchan99]

I thought about both neurology and psychiatry, and went into neurology. If you enjoy performing procedures, there are few procedures in neurology and almost none in psychiatry. Have you thought about other neuroscience specialties, such as PM&R? I'm bringing up PM&R because it seems more procedural than neurology (except the neurology subspecialities, interventional neuroradiology, neurocritical care, neurorehabilitation, and potentially neurophysiology for EMGs). There is some diagnosis in PM&R in EMG, spine, and sports medicine.

 

[QueryNeurology]

I thought about both neurology and psychiatry, and went into neurology. If you enjoy performing procedures, there are few procedures in neurology and almost none in psychiatry. Have you thought about other neuroscience specialties, such as PM&R? I'm bringing up PM&R because it seems more procedural than neurology (except the neurology subspecialities, interventional neuroradiology, neurocritical care, neurorehabilitation, and potentially neurophysiology for EMGs). There is some diagnosis in PM&R in EMG, spine, and sports medicine.

Thanks for the advice. How much neuroscience is found in PM&R? I didn't think there was much.

 

[Thama]

Neurology can be fairly procedural or not at all. Just depends on what you are interested in.

 

[kchan99]

Thanks for the advice. How much neuroscience is found in PM&R? I didn't think there was much.

While neuroscience serves as basic science in neurology, there is little neuroscience in the day to day practice of neurology. Although PM&R deals with many non-neurodisorders, patients with neurologic disorders, such as stroke, cerebral palsy, and traumatic brain injury to name a few, are seen in neurorehabilitation. Neurorehabilitation is a subspecialty open to both neurologists and physiatrists, but neurologists and physiatrists approach the same patients differently. In neurology, we tend to focus more on localizing the lesion(s), predicting the neuropathology, and providing some form of treatment. My understanding of PM&R is that the focus is on improving function.

Instead of focusing on what field has more neuroscience, I suggest looking at specialties that deal with "neuro" disorders (neurology, psychiatry, neurosurgery, PM&R, neuroradiology, neuropathology) and determine which field has day-to-day work that suits you the most. If you would like to spend a considerable amount of time thinking about neuroscience and research is your cup of tea, then start establishing a publication track record in residency and then do a research postdoctoral fellowship during or after a clinical fellowship for a career as a physician-scientist.

 

[QueryNeurology]

If you would like to spend a considerable amount of time thinking about neuroscience and research is your cup of tea, then start establishing a publication track record in residency and then do a research postdoctoral fellowship during or after a clinical fellowship for a career as a physician-scientist.

Is it possible to have a small practice (let's say in neurology/psychiatry) and do research/work as a physician-scientist?

 

[kchan99]

Unless a physician-scientist has an astronomical amount of grant funding, then he/she would have clinical service that may consist of outpatient (seeing patients and supervising residents and fellows) and/or inpatient duties.

 

[QueryNeurology]

Unless a physician-scientist has an astronomical amount of grant funding, then he/she would have clinical service that may consist of outpatient (seeing patients and supervising residents and fellows) and/or inpatient duties.

Your advice was much appreciated. Thanks.

 

[typhoonegator]

Is it possible to have a small practice (let's say in neurology/psychiatry) and do research/work as a physician-scientist?

With funding, that is how a great deal of clinician-scientists operate. My research pays most of my salary because my clinical time is insufficient to generate an acceptable income, and my grants require that I spend a certain percentage of my time on projects. I can't promise the NIH that I'm going to devote 85% of my time to a series of grants and then work 25 weeks on service. Your research management office keeps close track of these things, and you're defrauding the government if you lie.

If you don't have grants, though, then you're asking your department to lose money on you as an employee if your salary exceeds the billing you bring in. They won't be excited about paying you for your time to work on unfunded projects for very long. Some people involved with research in a less comprehensive way will take on comparatively greater clinical time so they aren't dependent on grant funding. But getting funded is hard work, time in the clinic is time away from working to get funded. This is the catch-22 of the clinician scientist, particularly early in your career. Having a clinical source of income is great, but the more you draw from that option, the less likely you are to be successful enough in the lab to get funded.

 

[Dr. Bruce Banner]

I'm a MS3 and is having a hard time deciding between PM&R and Neurology. Any advice or comment would be appreciated.

 

[Thama]

I'm a MS3 and is having a hard time deciding between PM&R and Neurology. Any advice or comment would be appreciated.

Conceptually, do you want to diagnose and treat, or restore function after the damage is done? Practically, neurology is much more diverse than PMR but PMR does have the advantage of lifestyle. Both can be quite procedural or not at all depending on your practice setting and preferences. Intellectually I have a hard time imagining how PMR would be satisfying but my colleagues there assure me that good coffee and 8:30 - 9:00 AM start times are quite satisfying, so I take them at their word.

 

[MrTaco92]

I didn't think the two specialties would've had very dramatic differences in lifestyle (pm&r vs neuro) once at the attending stage. Is it rare for a neurologist to have a pm&r-like lifestyle as an attending working in the coastal areas of the country? Good coffee and 9am start times just sound so enticing, but the fellowship options coming out of a neuro residency seem more enticing than the fellowship options following a pm&r residency.

 

[jd1031]

I'm a MS3 and is having a hard time deciding between PM&R and Neurology. Any advice or comment would be appreciated.

Do a rotation in both neurology and PM&R, preferably at the end of MS3 year. Comparing the two in person helped me decide. Was always interested in neurology but considered PM&R seriously at one point. For me, PM&R wasn't intellectually satisfying enough, and everything I liked in PM&R (neuro cases like GBS, EMG/NCS) was neurology related anyways.

Regarding lifestyle, it really depends on the neurology subspecialty and practice setting. There's a big difference between the lifestyle of a private practice neurocritical or vascular neurology doc and an academic behavioral neurologist.

 

[Dr. Bruce Banner]

Conceptually, do you want to diagnose and treat, or restore function after the damage is done? Practically, neurology is much more diverse than PMR but PMR does have the advantage of lifestyle. Both can be quite procedural or not at all depending on your practice setting and preferences. Intellectually I have a hard time imagining how PMR would be satisfying but my colleagues there assure me that good coffee and 8:30 - 9:00 AM start times are quite satisfying, so I take them at their word.

From what I understand, the procedures a neurologist would get to do are EMGs and botox injections for headaches. Maybe I'm biased, but the physiatrists I worked do some pretty cool procedures, from spinal injections, to EMGs, to spinal nerve ablation, to kyphoplasty. I LOVE neurology, but then again, I'm just a medical student that rotated 4 weeks in neuro. I also loved EM. But I also want to gauge whether I will still feel this way 5 years down the road, 10 years down the road. I'm trying to get more input from attendings and see how they're enjoying their jobs mid-career. Again, maybe I'm biased, but the physiatrists I work with LOVE their jobs and say they wouldn't want to do anything else. 50% of EM docs I worked with told me not to go into EM... even though I personally LOVED working in the EM... the Neurologists liked their jobs, but even the attending hours are pretty intense... and to put everything into perspective, I'm in the Midwest.

 

[Thama]

From what I understand, the procedures a neurologist would get to do are EMGs and botox injections for headaches. Maybe I'm biased, but the physiatrists I worked do some pretty cool procedures, from spinal injections, to EMGs, to spinal nerve ablation, to kyphoplasty. I LOVE neurology, but then again, I'm just a medical student that rotated 4 weeks in neuro. I also loved EM. But I also want to gauge whether I will still feel this way 5 years down the road, 10 years down the road. I'm trying to get more input from attendings and see how they're enjoying their jobs mid-career. Again, maybe I'm biased, but the physiatrists I work with LOVE their jobs and say they wouldn't want to do anything else. 50% of EM docs I worked with told me not to go into EM... even though I personally LOVED working in the EM... the Neurologists liked their jobs, but even the attending hours are pretty intense... and to put everything into perspective, I'm in the Midwest.

Your understanding is profoundly incorrect. Depending on subspecialization, neurologists do everything from LP, EMG, EEG, intraoperative monitoring, DBS, focused ultrasound ablation, botox for headache, nerve blocks, chemodenervation for dystonia and spasticity, the entire gamut of ICU procedures including intubation, central lines, arterial lines, EVD placement (at some institutions), polysomnograms in all their variations, VEPs, OCTs, thrombectomy, aneurysm coiling and other endovascular interventions, biopsy of muscle, nerve and skin, and probably others I'm forgetting.

Oh, and neurology isn't a particularly procedural field. It's just exponentially more broad and varied than the tiny corner of neuroscience covered by physiatry. But hey, lifestyle matters and PMR has that.

 

[Dr. Bruce Banner]

Your understanding is profoundly incorrect. Depending on subspecialization, neurologists do everything from LP, EMG, EEG, intraoperative monitoring, DBS, focused ultrasound ablation, botox for headache, nerve blocks, chemodenervation for dystonia and spasticity, the entire gamut of ICU procedures including intubation, central lines, arterial lines, EVD placement (at some institutions), polysomnograms in all their variations, VEPs, OCTs, thrombectomy, aneurysm coiling and other endovascular interventions, biopsy of muscle, nerve and skin, and probably others I'm forgetting.

Oh, and neurology isn't a particularly procedural field. It's just exponentially more broad and varied than the tiny corner of neuroscience covered by physiatry. But hey, lifestyle matters and PMR has that.

Thank you Thama! Definitely didn't see / know neurologists can do all those procedures

 

[Niels Bohr]

does anyone have good recommended reading for a 4th year student auditioning in neurology?