Two fellowships in neurology advice (1 outpatient+1 inpatient)

[TNKay]

Hello,

I have read threads of doing multiple neurology fellowships before, however I wanted to kind of run again my idea of doing two fellowships by the members of this group.
I like stroke but hate the lifestyle. I okay-ish like multiple sclerosis/epilepsy but love their lifestyles (MS>Epilepsy).
Thus I was wondering if doing (stroke+ MS) or (stroke+epilepsy) is a good idea with a hope to later transition to only outpatient practice.
I know stroke doesn't need a fellowship especially if residency training has been robust, however I personally would want to do a fellowship in it if I intend to practice it.
Will appreciate the suggestions from this group- please let me know if any of these combinations is stupid or too ambitious or infeasible, etc.

Thank you!

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[Telamir]

Stroke and epilepsy will essentially make you into an inpatient doc although I guess you could transition to outpatient but you’ll do general as well as epilepsy. If you spend a lot of time doing inpatient then you won’t likely do any sort of surgical epilepsy management.

MS and stroke is nonsensical honestly.

Sounds like you need to decide between inpatient and outpatient focus and go from there, friend.

 

[NEApplicant]

What would a practice setup look like for someone who goes into stroke but likes outpatient practice too?
For example, is it possible to do something like 2 weeks of stroke, 2 weeks clinic?

 

[Telamir]

Likely would be doing inpatient with a stroke followup clinic or general neurology on clinic time.

 

[Boxer1]

Another consideration is practice. Completing a fellowship can be a valuable springboard but if you don't practice in that subspecialty for a few years you will loose the skills you learned.

 

[Telamir]

Eh. Depends. I'm epilepsy boarded, been doing inpatient. If anything I find that while my skills are more niche (managing status, anesthetics, seizures inpatient), I still feel plenty comfortable doing outpatient if the need came up, and my EEG skills are just as good since I always have to do some EEG while working in the hospital, something that has been a plus in most jobs.

 

[Aldertonghen]

Eh. Depends. I'm epilepsy boarded, been doing inpatient. If anything I find that while my skills are more niche (managing status, anesthetics, seizures inpatient), I still feel plenty comfortable doing outpatient if the need came up, and my EEG skills are just as good since I always have to do some EEG while working in the hospital, something that has been a plus in most jobs.

Does being epilepsy boarded lead to higher paying neurohospitalist jobs (since you can read eegs on your week on plus do consults)?

 

[Telamir]

Not directly. Caveat, I'm doing locums currently.

If you're working somewhere big and you have outpatient neurologists/epileptologists on production they will want to take EEGs for obvious reasons, and it's unlikely they'll let you read a bunch of EEGs unless it's your own that you've ordered.

If you're working somewhere smaller then you'll be able to read your own and you may or may not be able to charge more. Sometimes the job itself requires EEG interpretation.

While doing locums though I will bill for time. For instance, I had a job as a neurohospitalist and they may have needed me to cover EEG for a few days, and so depending on the volume I'd charge them 2-3 hours more of overtime which amounted to ~500-750/day for the reads. Typically that was for a good amount of EEGs like 8+. I wouldn't charge 3 hours for 3 EEGs for example. All of this was agreed upon before I started covering EEG for them, so in that case I did get paid more than my non-epilepsy colleagues who took call with me.

 

[Aldertonghen]

Not directly. Caveat, I'm doing locums currently.

If you're working somewhere big and you have outpatient neurologists/epileptologists on production they will want to take EEGs for obvious reasons, and it's unlikely they'll let you read a bunch of EEGs unless it's your own that you've ordered.

If you're working somewhere smaller then you'll be able to read your own and you may or may not be able to charge more. Sometimes the job itself requires EEG interpretation.

While doing locums though I will bill for time. For instance, I had a job as a neurohospitalist and they may have needed me to cover EEG for a few days, and so depending on the volume I'd charge them 2-3 hours more of overtime which amounted to ~500-750/day for the reads. Typically that was for a good amount of EEGs like 8+. I wouldn't charge 3 hours for 3 EEGs for example. All of this was agreed upon before I started covering EEG for them, so in that case I did get paid more than my non-epilepsy colleagues who took call with me.

Thank you for that explanation. So although EEG helps with finding more jobs, it’s not necessary to maximise possible revenue? One could easily do movement and still work as a neurohospitalist or locums and earn the same, even though the fellowship training might not be useful for the job.

 

[oopsy]

You can certainly create a niche of being the vascular neurologist people send their post-discharge follow-ups to. This is a big hole in most neuroscience centers, follow-up is hard. If that would be satisfying to you, you'd have to work with a hospital/system/group to advocate being that person. That said, MS/Stroke is an odd pairing, but I know one person who did it with an interest in focusing on vasculitides, etc (academic center). I think you may find it hard to operationalize that in community practice, but nothing in theory makes it impossible.

Keep in mind, if you do general neurology, a decent percentage of referrals (especially with a hospital system) is going to be post-stroke follow-up. You could also go to internists and sell yourself as that person for their post-hospital follow-up patients that likely dont have a neurologist.