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IM/Neuro is an extra year, right? Is is worth the extra year, to have the IM certification?
1. Sorry, but in my last post I overlooked one very obvious medicine/neurology subspecialty overlap: neuro-oncology is a field where you can be kept pretty busy doing just that.
2. The forefront of neurology? Good question. Neurology is kind of interesting in that our knowledge of basic science and pathophysiology has, in the last decade, far outstripped our ability to translate that knowledge into meaningful treatment. The biggest example of this is in the genetics arena. Pick up any neuro journal and you will be flooded with papers about new developments in identifying genes, cloning proteins, etc, but little of this has led to anything meaningful to our patients other than "genetic counseling." We've now got over a dozen different genetic flavors of spinocerebellar ataxia, but we still can't reverse or halt the pathologic process. I suspect this will change, slowly, but I am frankly not optimistic that there will be any slam-dunk "genetic treatments" available in my professional lifetime. I think in the short term (10-15 years) a lot of progress will be made in the immunologic side (vaccines for Alzheimers, treatments for immune-mediated processes like MS and myesthenia). I'm not talking cures, but possibly more effective disease-modifying agents. I also think surgical and biomechanical treatments will continue to advance as well (think deep brain stim for Parkinsons, vagal nerve stim for epilepsy and perhaps a bunch of other indications, visual and hearing prostheses). And by the way, don't worry about being unemployed. Barring any incredibly drastic changes in the health care environment, the aging population is going to need more neurologists to deal with all those strokes, dementias and peripheral neuropathies.
3. Yes, I would probably still pick neurology. But to be fair I have to admit I am still pretty "fresh" and not yet old and burned out and cynical. Ask me again in 10-15 years.