Neuro residency after IM residency completion

[prn2oblivion]

I am currently a PGY-1 doing IM and would like to go into an advanced neurology residency program after the completion of my residency. I was told that I could apply to neurology as a fellowship. I was also told that I could apply to any specialty I wanted at the completion of my residency.

Do I apply to an advanced neurology residency through the fellowship match? Or, do I apply to advanced neurology programs during my PGY-2 year with the intent of starting after completing my IM residency?

Has anyone done this? Is this even possible because of funding issues?

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[typhoonegator]

It is possible but the program will have to cover your salary, because medicare wouldn't. If you can get a training grant from the NIH or a foundation that would help your chances and make you more attractive to programs. The big programs would be more able to swallow the cost.

I know people that have done it, but not through "fellowship". Neurology is a residency, and you would need to complete 3 years of neuro to be board eligible. Of course, fellowship programs like stroke and NCC would be very happy to recruit you when you are done, as more extensive medicine backgrounds would be prized in those communities.

You need to think about the opportunity-cost of another 3 years of training post-residency. Remember, after 7 years you still would be a IM generalist and a neuro generalist. If you wanted to sub-specialize you'd still be looking at another year or two on top of that.

 

[bustbones26]

It is possible but the program will have to cover your salary, because medicare wouldn't. If you can get a training grant from the NIH or a foundation that would help your chances and make you more attractive to programs. The big programs would be more able to swallow the cost.

I know people that have done it, but not through "fellowship". Neurology is a residency, and you would need to complete 3 years of neuro to be board eligible. Of course, fellowship programs like stroke and NCC would be very happy to recruit you when you are done, as more extensive medicine backgrounds would be prized in those communities.

You need to think about the opportunity-cost of another 3 years of training post-residency. Remember, after 7 years you still would be a IM generalist and a neuro generalist. If you wanted to sub-specialize you'd still be looking at another year or two on top of that.

Unfortunately, you will be paid as a resident starting out as PGY-2. However, if you can find time, you probably could fit in a little moonlighting as an internist. The local teaching hospital where I am nearby has several FP/IM residents getting paid a generous hourly rate for manning an urgent care on the side. Likely no time during your PGY-2 year as most neuro programs kill the PGY-2 with inpatient rotations. Things get lighter as PGY-3, PGY-4.

I would have to second the sentiments of TN negator above, after 7 years, you'd still be a general neurologist and not sure what the incentive would be? Maybe if you went to a program with strong NCV training you could do your own in the office, but we just suffered a 50% cut in rates!! If you are a hospitalist, I suppose you would not have to run and call neurology for every stroke or seizing patient and maybe you could review your own EEGs, but that will not supplement your income much.

Now if you have any specific interest in the overlaps, such as critical care, neuro-oncology, neurohospitalist, or headache, there are a number of programs that would consider you as a fellow.

 

[danielmd06]

It's your life, and you should certainly be true to what you want to do in your career, but financially, this would not be a smart move.

I commented on a situation similar to yours here: http://forums.studentdoctor.net/showthread.php?t=953654

I've known an attending (in vascular neurology) who was in private practice IM and then went back to do a complete neurology residency and stroke fellowship. He was obviously driven and his credentials and training made him competitive at a relatively young age for high rank in academics.

It didn't hurt that his wife was a lawyer and he therefore had financial support, either. If you are independently wealthy, or your spouse is a physician (or high wage earner), then that gives you much greater flexibility to do this if you want.

 

[prn2oblivion]

My interest in cardiology edged out neurology narrowly when applying to residency. By the time I lost interest in cardiology and realized more and more and more I should have gone neurology, it was way too late in the application process. The only other IM subspecialty I though was slightly appealing was ID, which I have less interest in and pays less than neuro anyways. I originally framed it in my mind that I would be applying to Neuro as if it was a fellowship, eventually do general neuro, and still be doing something I like more and pays more than ID.

But I like the overlap idea. I had no idea that NCC took from IM. That's pretty exciting news to me.

 

[typhoonegator]

Well, some NCC programs take IM people. Not all. You'd definitely want to do some heavy elective work in neurology prior to starting an NCC fellowship. IM people can be successful in NCC fellowship, but they need to learn both neurology and critical care as they go, while neuro and anesthesia people have a leg up from a background perspective (in different ways, obviously).

IM people might know a bit more critical care than neurologists after residency, depending on the program, but a few rotations in the MICU and CCU don't give you a big leg up over a neurologist who spent all their free time in the NCCU.

 

[bustbones26]

My interest in cardiology edged out neurology narrowly when applying to residency. By the time I lost interest in cardiology and realized more and more and more I should have gone neurology, it was way too late in the application process. The only other IM subspecialty I though was slightly appealing was ID, which I have less interest in and pays less than neuro anyways. I originally framed it in my mind that I would be applying to Neuro as if it was a fellowship, eventually do general neuro, and still be doing something I like more and pays more than ID.

But I like the overlap idea. I had no idea that NCC took from IM. That's pretty exciting news to me.

In neurology, there are two different ways to hang your hat onto a certain subspecialty. The ABPN has board exams for a number of subpsecialites (neurophysiology, sleep, vascular, pain, etc). In order to be eligible for those examinations, you of course need your primary board certification in general neurology.

The other pathway is the United Council for Neurological Subspecialties (UCNS). This organization offers certification programs in a number of neurological subspecialites not offered by the ABPN such as neurocritical care, behavioral neurology, headache medicine, etc. The UCNS is NOT a member of the American Board of Medical Specialities, thus, you cannot say "I am board certified" but to say that you earned a certificat from the UCNS is something. To clarify this, "board certified" has different meanings and in TX (where I practice) you can only legally say that you are board certified in a specialty if and only if the certification comes from an ABMS organization.

Okay, that being stated, I would encourage you to develop your interests and go for the long haul. What happens if there is no board for a certain subspecialty? What happens if there is no certifying organization for a subspecialty? E.g. you mentioned an interest in neuroinfectious disease.

Neuroinfectious disease is a real specialty and a few I know that hang there hat on that specialty of course work at major university centers and do major work/research in neurological complications of AIDS/HIV, Syphillis, and weird infections that the average Joe does not see. There is no hard set fellowships out there in neuroinfectious disease per se. Johns Hopkins has one that is combined with neuroimmunology. NIH may fund such a program through their heavy research grants as another example.

For the ones that I know who hang their hat on neuroinfectious disease, they did one of the following: double residency + IM ID fellowship (ouch!!). Or what I would deem a more reasonable option, finish general neuro residency and get an MPH on the side that focuses on infectious disease and get into researching all of those weird neuroinfectious things.

I would suggest considering the later if neuroinfectious disease is truly an interest of yours. If you finished 3 years of general neuro, then got an MPH on the side, that would perhaps be less painful than doing another 3 years of ID fellowship. But if you established yourself as an "expert" through your research, you can hang your hat. Of course, in my opinion, neuroinfectious disease is something to consider only if you want an academic career working in a major university.

Because neuroID is in its infancy, should the ABPN develop a board certification program, or the UCNS develop a certification program, there would be a grandfathering practice track phase and you would easily be able to do so.

You also mentioned a prior interest in cardiology. The NIH has a neurocardiology program. Well, that is bascially for all of those "passing out" patients, blah!