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  • So you want to be a neurologist.

  • You like the idea of the brain, knowing all of its intricacies, and the idea of being

  • a brainiac yourself.

  • Let's debunk the public perception myths, and give it to you straight.

  • This is the reality of neurology.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • Welcome to our next installment in So You Want to Be.

  • In this series, we highlight a specific specialty within medicine, such as neurology, and help

  • you decide if it's a good fit for you.

  • You can find the other specialties on our So You Want to Be playlist.

  • If you want to vote in upcoming polls to decide what future specialties we cover, make sure

  • you are subscribed.

  • If you'd like to see what being a neurologist looks like, check out my second channel, Kevin

  • Jubbal, M.D., where we'll be covering a day in the life of a neurologist soon.

  • Neurologists are the physicians that specialize in the non-surgical management of the variety

  • of central and peripheral nervous system disorders.

  • For surgical management, neurosurgery is the specialty you're looking for.

  • Neurologists manage everything from headaches and migraines to the most devastating and

  • incurable diseases like amyotrophic lateral sclerosis, or ALS, and Huntington's disease.

  • Strokes, which are the fifth leading cause of death and first leading cause of disability

  • in the United States, are diagnosed and treated by neurologists.

  • Many believe that neurologists primarily diagnose conditions, but cannot do much to treat any

  • of them.

  • While there are several conditions for which modern medicine has limited management options,

  • research in neurology is rapid and our therapies are improving.

  • For example, strokes used to be untreatable, leaving patients with lifelong disability.

  • However, in the past few decades, our understanding of strokes has improved drastically.

  • As they say, "time is brain", and rapid interventions such as tPA and endovascular thrombectomy

  • are now understood as critical in favorable outcomes.

  • Parkinson's disease care has been revolutionized with deep brain stimulation.

  • Epilepsy care has improved through new anti-seizure medications, vagus nerve stimulation, and

  • epilepsy surgery.

  • Brain tumors of all types now have a multitude of treatment options.

  • ALS is still a devastating illness, but clinical trials for novel therapies are showing tremendous

  • promise.

  • When you think about the patients requiring neurological care, it makes sense that it's

  • a specialty with less rosy outcomes.

  • A substantial portion of diseases in neurology are chronic and progressive, but neurologists

  • help their patients live a life of dignity and enjoy the time they have left in a meaningful

  • way.

  • The bread and butter of neurology consists of stroke, seizures, headaches, and dementia,

  • but there's a great deal more to it, as we'll explore shortly with the wide variety of fellowship

  • opportunities.

  • There are a few ways to categorize neurology:

  • Inpatient neurologists work in the hospital setting, treating admitted patients with seizures,

  • acute demyelinating disease, stroke, complications pre-op or post-op from neurosurgery, neuromuscular

  • disorders, meningitis, encephalitis, and more.

  • The lifestyle of an inpatient neurologist is similar to that of a hospitalist - it's

  • common to work 7 days on and then have 7 days off, or 2 weeks on followed by 2 weeks off.

  • Outpatient neurologists work in the clinical setting, managing patient's chronic neurologic

  • conditions including headache, peripheral nerve disorders, Parkinson's disease, dementia,

  • epilepsy disorders, myasthenia, ALS, stroke prevention and rehabilitation, and more.

  • As is usually the case in an outpatient practice, you can expect 9 to 5, Monday through Friday,

  • regular business hours.

  • As an academic neurologist, you'll be working at an institution affiliated with a medical

  • school or teaching hospital, which generally means a large tertiary center with comprehensive

  • stroke, epilepsy, and ALS treatment centers.

  • In academic neurology, a fellowship is generally advised, and compared to other practice settings,

  • you'll be more narrowly focused on that fellowship subspecialization.

  • As with any academic setting, you'll also be teaching medical students and residents

  • in addition to doing research on the side.

  • Compensation in academia is usually about 30 percent less compared to community or private

  • practice.

  • Community neurologists usually have clinic in addition to a weekly call schedule.

  • They normally see less acute patients either pertaining to general neurology or their fellowship,

  • which is most commonly headache, neurophysiology, neuromuscular, and movement.

  • Private practice neurologists focus on less acute neurology, including pathologies such

  • as headache, neuropathy, less severe Parkinson's disease, and well controlled seizure disorders

  • in their clinics.

  • They also usually take call for stroke or general neurology at local hospitals.

  • While the pay is higher, you're more likely to have more demanding call, needing to service

  • multiple hospitals in a given radius.

  • After 4 years of medical school, neurology residency is another 4 years.

  • Your first year in residency, or PGY-1, is an internship in internal medicine.

  • After all, a strong internal medicine foundation is prerequisite to be successful as a neurologist.

  • During your second through fourth years of residency, you'll be focused exclusively on

  • neurology.

  • As a PGY-2, you'll be focusing primarily on inpatient coverage of stroke, general neurology,

  • epilepsy, and neuro-critical care.

  • As a PGY-3, you'll begin having more outpatient clinic exposure, but still lean towards inpatient,

  • while also begin working on fellowship applications.

  • As a PGY-4, you'll be more evenly split between inpatient and outpatient, and this

  • is also when most residents focus on research.

  • You can do either a categorical or advanced residency.

  • Categorical means you do all 4 years at a single program, whereas for advanced programs,

  • you'll do your intern year as either a preliminary year or transitional year and then do neurology

  • residency at a different program.

  • Medical students that apply to neurology are stereotypically the quirky nerds who have

  • a strong interest in reading, tend to talk a lot, and enjoy explaining to others what

  • they've learned.

  • In terms of competitiveness, neurology is considered less competitive, ranking at 16

  • out of 22 specialties.

  • The average Step 1 score is 232, average Step 2CK is 245, and match rate is 97%.

  • After completing residency, you can subspecialize further with fellowship.

  • Vascular neurology is almost entirely inpatient in nature.

  • This is the subspecialty for neurologists that love staying on top of research and have

  • a deep interest in vascular anatomy and acute care.

  • This is a 1 year fellowship, although some programs are 2 years in duration when research

  • is involved.

  • If you love the high acuity of inpatient and love acute lesion localization, then this

  • may be the field for you.

  • But you will be called at odd times for stroke emergencies, which may be unfavorable to many.

  • Epilepsy is a 2 year fellowship for the brainiacs of neurology.

  • You'll be reading EEGs and working with neurosurgeons for either intra-operative EEG monitoring

  • or for managing seizure patients with vagal nerve stimulators or responsive neurostimulation

  • devices.

  • This is primarily an outpatient practice, unless you work at a large epilepsy center,

  • where they do admit patients to the epilepsy monitoring unit to better characterize seizures

  • and see whether surgical treatment is warranted.

  • Movement disorders is a 1-2 year fellowship and is purely outpatient in practice.

  • These are the experts in treating Parkinson's, Huntington's, tic disorders, tremors, dystonias,

  • and more.

  • This subspecialty comes with a great lifestyle, with a 8-5 practice.

  • Botox injections are often a key procedural aspect of this specialty and can add to the

  • practitioner's compensation significantly.

  • If you work at a larger center, you'll also help manage devices like deep brain stimulators

  • for Parkinson's tremors with the neurosurgeons.

  • Neuro-critical care is a 2 year fellowship, and is a newer and rapidly growing subspecialty

  • of neurology.

  • These are the specialists of extreme neurologic illness such as brain hemorrhages, large strokes,

  • neuromuscular crises, acute spinal cord injury, and dealing with neurosurgery post-operative

  • care and complications.

  • This is for those who love the exciting, fast paced nature of the ICU and want to practice

  • both neurology and internal medicine elements.

  • It's more procedure heavy than other parts of neurology, dealing with more lumbar punctures,

  • intubations, central line placements, chest tubes, external ventricular drains, and more.

  • Call can be demanding as the patients are all very sick and can decline rapidly if not

  • monitored carefully.

  • Neuro-interventional surgery and radiology is for those who want to specialize in minimally

  • invasive procedures for large vessel strokes, aneurysm coiling, and arteriovenous malformations.

  • It's quite demanding, and has a steep learning curve for neurologists because it's purely

  • procedural.

  • This is an additional 1 or 2 year fellowship for which you can take one of three paths.

  • Either through neurology followed by vascular neurology or neuro-ICU fellowship, neurosurgery

  • residency, or radiology residency followed by neuroradiology fellowship.

  • It is the most competitive subspecialty of neurology and the lifestyle can be demanding

  • as you may be called at odd hours to activate an endovascular team to perform endovascular

  • procedures.

  • At the same time, it is the highest paying.

  • There are several other fellowship options to choose from as well, including neuro-immunology,

  • neuromuscular diseases, neurophysiology, neuro-ophthalmology, neurocognitive and neurodegenerative diseases,

  • neuro-oncology, neuro-rehab, headache, sleep, pain, neuro-infectious diseases, and neuro-endocrinology.

  • Neurology is a great specialty with a lot to love.

  • About 80% of neurology is outpatient, which means you're less likely to work weekends,

  • and you're more likely to have a regular 8-5 practice.

  • However, note that most private practice neurologists have to take call for local hospitals.

  • Neurology is concerned with the most fascinating organ system of the human body, and we've

  • seen dramatic improvements in our understanding of the brain and spinal cord in just the last

  • 20 years.

  • And that's likely to continue, as neurologic diseases are consistently in the top 3 most

  • funded diseases by the NIH each year.

  • If you enjoy building strong longitudinal relationships with your patients, neurology

  • has you covered.

  • Most neurology pathologies are chronic in nature, and you'll be seeing your patients

  • often for many months to many years.

  • While neurology is a great specialty, it's certainly not for everyone.

  • Despite the immense research funding being poured into the field, neurologic diseases

  • are debilitating in nature as treatment options aren't as robust as they are in something

  • like cardiology.

  • With less favorable outcomes, neurologists may need to be more comfortable with palliative

  • and hospice care, which can be emotionally challenging for many and can lead to burnout.

  • Neurology consistently ranks at the top in terms of burnout.

  • The lifestyle can be demanding, especially with a community practice.

  • In addition to having a busy clinic, you'll have to take stroke call at local hospitals.

  • Neurologist compensation is in the lower third of all specialties, making on average $280,000

  • per year.