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.
This is in large part because you're dealing with primarily chronic illnesses and there
are fewer procedures in neurology compared to something like gastroenterology or cardiology.
And because of the wide breadth of neurology, the overwhelming majority of neurologists
pursue fellowship.
That means your training will last at least another 5 or 6 years after medical school,
which is on the longer end for a non-surgical specialty.
Should you go into neurology?
If you're the type of person that loves the complexity of neuroscience and enjoys using
the physical exam and deductive reasoning to come up with a diagnosis and treatment
plan, neurology may be a good fit.
If you want to be part of a specialty that's rapidly growing, evolving, and focusing more
on holistic longitudinal treatment now rather than the "diagnose and adios" mentality of
the past, consider this specialty.
In terms of patient population, you should be comfortable with longitudinal relationships
with sensitive patients who may have debilitating and sometimes terminal illness, which isn’t
as rosy as some other specialties.
You'll be their primary provider, guiding them to live the rest of their life meaningfully.
Those that go into neurology also tend to be on the intellectual side of things, enjoying
discussing the nuances of the physical exam, strange labs, and unique imaging findings.
Big shout out to Dr. Prashanth V and Dr. Masaki N from UC Irvine, and the other neurologists
at Med School Insiders for helping me with the creation of this video.
Are you interested in neurology?
To get into medical school and match into a strong neurology residency, you’ll need
to score well on your class tests and standardized exams.
If you need help acing your MCAT, USMLE, or other exams, our tutors can maximize your
test day performance.
If you’re applying to medical school or neurology residency, our Insiders can share
the ins and outs of what it takes and how to navigate the highly competitive process
most effectively.
We’ve become the fastest growing company in the industry, and it’s no surprise.
Our customers love us because we’re committed to delivering results, period.
Learn more at MedSchoolInsiders.com .
Thank you all so much for watching!
If you enjoyed this video, check out So You Want to Be a Neurosurgeon, or another specialty
on our So You Want to Be playlist.
Much love, and I'll see you guys there.