What should students be thinking about when considering applying neuro?

[PathNeuroIMorFM]

I'm a US-MD student who just finished their neuro rotation (and a neuro + path research year) I really liked it, but it is competing with my interest in pathology. Both have been my interests since day 1 of med school.

I love neuro for the flexibility. Being able to work anywhere and everywhere. ICU, outpatient, inpatient, rehab, telehealth. Wide range of fellowships. Ability for good lifestyle post-residency. It has the most interesting cases in medicine by a mile. Feels very detective-like, which is why I got into medicine. Rounding and social work/dispo kind of kill me, though. I also have zero outpatient experience.

I love the workflow of path more. I like the bench, driving the scope, leadership opportunities, the details. The kicker is the lack of flexibility kind of kills me. Less employable outside of large hospitals and private groups or conglomerates, which is pretty important to me.

Seeing patients is kind of a neutral point for me. I don't absolutely love it, but I don't absolutely hate it either.

What else should I consider when considering neuro?

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[s5260205]

Majority of neurology will be outpatient based, so it would be important to also gain exposure to some of the subspecialty clinic to see if you are truly interested in neurology.

While the subject matters in both specialties may be of great interests, the daily practice of medicine is usually more mundane. In choosing a specialty, I often recommend thinking about if the most mundane, bread-and-butter part of the specialty is something that you can tolerate. As an example, are you okay with seeing patients with migraine, non-specific sensory complaints, or cognitive complaints day in and day out, on the outpatient side? Are you okay with seeing "altered mental status" patients one after the other on the inpatient side? If these are something that you can tolerate or may even enjoy, then the specialty is for you.

As you said, there is a great variety of fellowships available to neurology, so you can really shape your practice how you see fit eventually, though there will be similar "mundane" things within each subspecialty that you will start to realize through residency.

 

[PathNeuroIMorFM]

Majority of neurology will be outpatient based, so it would be important to also gain exposure to some of the subspecialty clinic to see if you are truly interested in neurology.

While the subject matters in both specialties may be of great interests, the daily practice of medicine is usually more mundane. In choosing a specialty, I often recommend thinking about if the most mundane, bread-and-butter part of the specialty is something that you can tolerate. As an example, are you okay with seeing patients with migraine, non-specific sensory complaints, or cognitive complaints day in and day out, on the outpatient side? Are you okay with seeing "altered mental status" patients one after the other on the inpatient side? If these are something that you can tolerate or may even enjoy, then the specialty is for you.

As you said, there is a great variety of fellowships available to neurology, so you can really shape your practice how you see fit eventually, though there will be similar "mundane" things within each subspecialty that you will start to realize through residency.

Thanks for the advice!

I think I got a pretty good look at "mundane" inpatient neurology. I was not on stroke service, but spent a good amount of time with bread and butter wards/NICU stuff like post-stroke care, encephalitis, SIH, brain death, coma, EEG/seizures, some headache, TBI, some neuro-optho, some useless consults. Sadly didn't get a single movement disorder or MS, but not surprised. It was pretty cool. The only thing I didn't really like was some AMS/patients that can't communicate well. That was sometimes frustrating.

I get my choice of almost any outpatient sub-specialty for my 4th year electives. EMG, EEG, MS, headache, you name it. Any in particular that I should consider or that would be more strongly representative of the field as a whole? Or do I just go with whatever seems interesting?

 

[s5260205]

Thanks for the advice!

I think I got a pretty good look at "mundane" inpatient neurology. I was not on stroke service, but spent a good amount of time with bread and butter wards/NICU stuff like post-stroke care, encephalitis, SIH, brain death, coma, EEG/seizures, some headache, TBI, some neuro-optho, some useless consults. Sadly didn't get a single movement disorder or MS, but not surprised. It was pretty cool. The only thing I didn't really like was some AMS/patients that can't communicate well. That was sometimes frustrating.

I get my choice of almost any outpatient sub-specialty for my 4th year electives. EMG, EEG, MS, headache, you name it. Any in particular that I should consider or that would be more strongly representative of the field as a whole? Or do I just go with whatever seems interesting?

I personally recommend neuromuscular and movement but note that I am biased as these were the two fellowships I had to choose between. More so than other subspecialties, they more heavily emphasize on neurologic examinations, and the nuanced examination findings are often what allow you to make the diagnosis (e.g., differentiating Parkinsonian syndromes based on examination findings at bedside or localizing unilateral hand weakness to a mononeuropathy, plexopathy vs. radiculopathy). You may additionally be able to see procedural side of neurology, such as NCS/EMG, nerve/muscle biopsy for neuromuscular and botulinum toxin injections and DBS programming (even microelectrode recording) for movement disorders.

 

[deathmerchant]

Its hard to compare Path and Neuro, not many similarities to be honest. I think, if you like talking to patients/people/families- which is sometimes frustrating (very) and sometimes rewarding, pick neuro. If you don't like that, pick path.

 

[Spinothalamic]

My prior research mentor did a year of neuromuscular and a year of autoimmune neurology (not MS but autoimmune) after a neurology residency. He reads muscle and nerve biopsy slides 1.5 days a week, tissue IFA and CBAs 0.5 day, EMG 1 day and clinic 2 days. He rotates through neurohospitalist service 2-4 weeks a year. He has a joint appointment under neurology and pathology as he reads the slides. This is possible in most large academic institutions - so neurology won’t stop you from reading slides under a microscope and noticing details, doing more lab work per se. But it also has so much more to provide.

Neuropathology fellowships are also open to neurology- although most people don’t go this route.

I am biased but I think the versatility of neurology to tailor your career to your needs is unmatched.

I totally agree that the versatility of neurology and practice settings is nearly unmatched—the only other comparable specialty is IM with all of the different fellowship paths. However, people need to realize they may need to move to a very specific place in the country and spend a ton of research/training time to pursue those very atypical practice settings. Probably not the most realistic example to mention a dual-fellowship trained neurologist at the cutting edge of autoimmune/paraneoplastic neurology research at the world’s most premiere autoantibody lab who is an expert of Kelch-like Protein-11 autoimmunity! This kind of stuff sounds amazing until you hit midway through PGY3 year and you think about how you want to spend the rest of your life, and whether you want to be extremely geographically limited due to subspecialty limitations, and whether you want to spend your weekends working on research/publications.