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THE PROMISED NEUROLOGY FELLOWSHIP THREAD: I’ve taken it upon myself to hype up neurology despite being under the tutelage of medicine for the next year. Neurology gets left behind when students resolve never to live in a world where ‘dysdiadochokinesia’ is used unironically.
Disclaimer: This thread is NOT comprehensive. Neurologists practice in vast spectrums that cannot be conveyed here. This is simply meant to inform prospective applicants about the options within the field of neurology, and hopefully, to entice them to explore something(s) new.
1/ #movementdisorders (MD)- starting out this thread with a backslap to naysayers who still make the tired claim that “there’s no instant gratification in neurology.” WRONG!
1/MD- Might I interest you in a field where there is effective, varied treatment for the majority of your patients, PROCEDURES, and Botox all in a regular clinic schedule with minimal inpatient/call?
1/MD- And Parkinsons? Sinemet is woefully downplayed in the way it can change someone’s whole life. And before you can say “on and off periods”, how many times do you see a patient presentation literally flip a switch the way it can after DBS generator implantation?
1/MD- But Selene, you say, what about diseases like Huntington’s? That’s depressing and there’s nothing you can do. Yes, that’s been the case for generations, but even in the darkest places, we have a very promising clinical trial (see Intrathecal RG6042) in the works.
1/MD- This is truly a specialty for those who love forming long-lasting relationships. Sometimes neurologic diseases can cause patients to jump from doc to doc, but in MD, you will be your patient and their family’s superhero in navigating some of the most disabling diseases.
2/#headache (HA)- When you wrote your essay for medical school, I’m bet it said something about wanting to help as many people as possible. How would you like to treat the 6th leading cause of disability in the WORLD?
2/HA- Patients often go years or decades, without a proper diagnosis or lasting relief. As a migraineur myself, this field is the definition of ‘whole patient’. It's up to you to find things in your patient’s life that are contributing to their pain, and the triggers are infinite
2/HA- You also have at your disposal a wide array of new and effective therapeutics. Injectables, IVs, and oral medications are rapidly being introduced that have cut down migraine days by over half w newer drugs providing pain freedom within hours.
2/HA- It’s hard to imagine the impact without having suffered yourself, but I will tell you personally that whoever can reduce the days that I am obtunded and throwing up while wearing sunglasses at night is pretty darn awesome.
2/HA- Oh, and more procedures! Occipital nerve blocks and Botox for the win (Derm is not the only one that can have it made in the shade). This is another example of a close-knit patient community where the difference you can make is profoundly palpable.
3/NM- If you love research, this field is all over the myriad of genetic variants of neuromuscular disease (where we have only scratched the surface) and targeted treatments. Gene therapies are in the works for SMA, Duchenne, Charcot Marie Tooth, and some variants of ALS.
3/NM- But it doesn’t stop there- this field branches heavily into neuroimmunology, and as a neuromuscular specialist you provide life-prolonging care and reduce the long-term damage caused by the inflammatory sequelae of these diseases.
4/#epilepsy (Ep)- In the words of @OnlineMedEd , “Everyone is allowed to have one seizure.” And that is the definition of job security. Enjoy variety? See your vEEG patients in the morning, review their EEG for the past 24 hours, consider if surgery is warranted.
4/Ep- In the afternoon, see your long-term clinic patients, or even electrocorticography in the OR. With neurophysiology, you can also do intraoperative monitoring, which, in the eloquent words of @WesleyKerr, is “like binging Netflix all day and getting paid bank.”
4/Ep- Neurological complications happen in the OR all the time, but you can see them coming as well as collaborate with surgeons for successful interventions. Epileptologists cure without surgery, and quite literally bring a chronic disabling disease to its knees.
5/#stroke- Team work makes the dream work! Stroke docs work closely with other acute docs, neurorads, neurosurgery, neuropsych, & rehab to address the leading cause of disability in the West. Stroke offers a range of clinical presentations, resulting in daily novel challenges.
5/Stroke- As a stroke doc, you're first on the scene at the ED, and patient outcomes rely on lightning decision making. Like much of neurology, it leans heavily on medicine knowledge, but also on cardiovascular disease, geriatric medicine, and rehabilitation medicine.
5/Stroke- With guidelines extended to include mechanical thrombectomy 24 hours after ‘wake-up’ symptoms, this is no longer ‘diagnose and adios’ that lent neurology infamy. The research cannot keep up with innovation. Download the Stroke trials app and it will bother you daily.
6/#neuroIR (NIR)- Whenever it comes up in conversation that I’m pursuing neurology, the knee-jerk reaction of people outside of medicine is, “Oh my gosh, brain surgery?” and in the past, I’ve had to let them down. But neurologists CAN train to work in the OR themselves!
6/NIR- Using minimally invasive techniques, you embolize intracranial aneurysms, AVMs, DAVFs, carotid artery stenosis, SAH, cavernomas, Moya Moya, and more. Talk about instant gratification- if you love stroke but want to actually get your hands in there, this is for you!
6/NIR- In addition to being procedure-heavy, NIR bridges well into NCC. There are only 3 fellowships right now for neurologists (neurosurg and rads can also do NIR), but the field is rapidly growing as many believe it should be built within the domain of neurology training!
7/#neurocriticalcare (NCC)- for the sickest of the sick neuro patients. Your regular patients will be TBI and spine injury, severe stroke/hemorrhage, fulminant meningitis, and neurosurgical patients. NCC is the domain of the nervous system interfacing with all other organ systems
7/NCC- Does not typically involve outpatient responsibilities. If having control of your acutely ill patients appeals to you, NCC docs are typically the primary team. This varies from place to place, but this field relies on medical management (fluids, glucose, etc.)
7/NCC- The elephant in the room is that many in the medical community refer to NCC as ‘tending a vegetable garden’, but this simply isn’t representative. With swift intervention and the high level of collaboration in these teams, seemingly ‘lost causes’ can do exceedingly well.
7/NCC- You also have ample procedures! Intubate, insert lines, pressure monitors, and POCUS. NCC is rewarding but you must be prepared for the ups and downs of critically ill patients, many of whom will, despite your best efforts, unfortunately end up comatose or braindead.
8/#neuroimmunology (NI)- One of the newer kids on the block, this field has grown in popularity since its inception as a training program in 2005 to become one of the fastest evolving fields in neurology.
8/NI- The most well-known patients in this field are MS pts which, thanks to the slew of new anti-inflammatory meds, can live life largely free of relapse. Encompassing MS, neuroinfectious disease, and autoimmune neurology, this field may just have the largest domain of all.
8/NI- Known as some of the most notorious mimickers in medicine, autoimmune disease can manifest in encephalitis, epilepsy, movement disorders, and systemic diseases such as SLE and vasculitis.
8/NI- Neuroimmunologists are worth their weight in gold, and especially in academic settings where they play a large role in guiding immunomodulating therapy across psychiatry, infectious disease, gastroenterology, and rheumatology.
8/NI- Many of these patients have refractory disease before an expert diagnosis, which presents a unique and exciting challenge to those who pursue this field.
9/#behavioralneuro (BNNP)- If you’re like me, you probably had/having a crisis in your 3rd/4th year because you LOVE the brain and disease, but also how disease changes who we are. Welcome to the intersection of neurology and psychiatry. We aren’t ‘double boarded’ for nothing!
9/BNNP- The setting is largely academic, but not exclusively. Those in private practice have a split between general and cognitive, and others may have a memory disorders clinic, especially if they have a larger practice.
9/BNNP- Routine diseases include Alzheimer’s, primary progressive aphasia, FTD, Lewy Body dementia, TBI, and rapidly progressive dementias. Many manifestations of these diseases (hallucinations, delusions, language problems) are often construed with psychiatric disorders.
9/BNNP- it is your privilege to guide patients and families through the unexpected, often jarring changes that they are experiencing in themselves or their loved one. As most of these conditions worsen, they will need your strength in finding palliative support.
9/BNNP- A field for those who love the mental status exam, cognitive exam, & would prefer the ability to take more time with their patients. Additionally, with much of this practice in an academic setting, you can be directly involved in the potential treatments in development!
10/GENERAL NEURO! Last but absolutely NOT least, this option is often overlooked in our modern age where specializing as far as you can seems to be the norm But let’s not forget that it’s okay to love everything, and to want to have a constant stream of variety in your office.
10/General neurologists establish deep and lasting patient relationships because they regularly see the full gamut of diseases, and patients will often present with more than one neurologic condition in their lifetime.
10/Although recent research suggests that general neurology practice is in a decline, I met many on the interview trail who chose it for the prior reasons, and also because it is a practical option for earning at your full potential faster.
11/Special Shoutouts- #childneuro! Adorable patients, early and lasting relationships with their families, and intervening early enough to quite literally change lives and opportunities. This can be entered directly for residency, or after completing a residency in pediatrics!
That's a wrap! Special thanks to @RenegadeSynapse @StaceyLClardy @wesleytkerr for your detailed input, and to so many more of you who have offered your insight on other threads!
For anyone wishing to read this in essay form:…
On that note, if you are a neurologist PLEASE add your input/corrections! Your insight benefits students learning from a distance about this profession.
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