Monday, May 14, 2012

Why I Didn't Do Neurology

Neurology was my last rotation of my third year of med school, and you guys, I Loved It. I found it so fascinating that for the first time ever, I didn't mind staying long hours at the hospital. When I did the consult service, it was like solving little puzzles all day. And the residents and attendings were my favorites... I fit so well with them (being Nerdy McNerderson and all).

So why didn't I do neurology?

I could list reasons, but there was one big reason that pretty much explained everything:

In the area of the country where I wanted to live to be near my husband, there were a total of eight neurology spots. Four of them were at a highly malignant program. And I felt that I wasn't competitive enough to win one of four spots in a very desirable region of the country where I had zero connections. So I didn't bother to try.

That said, here are the reasons I'm glad I didn't do neurology:

1) The job market is tight right now in neurology.

2) Not much in the way of procedures if you don't do a fellowship.

3) I think neurologists are much better at diagnosing than treating, especially in the area of stroke. I'm not impressed with the medications prescribed by neurologists. A neurologist friend of mine is convinced that neurontin is actually just a sugar pill.

4) A lot of neurologists are geeks, which is great. But a lot of them are also arrogant hyper-intellectual geeks, which is not so great.

I guess I can't come up with too many reasons. For me, it was all about location, location, location.


  1. Yeah, location makes a lot more sense than we care to admit in our big dreams...
    I have to agree with #4 too. One of my worst meetings ever was with a neuologist who was - and continues to be - arrogant and rude. And he keeps a grudge.

  2. What is it that makes a program "malignant"?

  3. Neurologists are an untapped gold mine for the entertainment industry. When I look online at pics of my hospital's Neuro dept. docs, it's like looking at a cast of characters for an off Broadway play. Big Bang Theory's got nothing on them.

    Hm. There's an idea.. I should write bios for each of them as a blog entry..

  4. The way you felt on neurology is how I felt on anesthesia - so glad I did it!

    The part of neurology that I could never handle is what you mentioned - it's more diagnosis than treatment. I want to fix things, and things I can't fix frustrate me.

  5. What, a whole blog post about neurology without a single joke about bowties, plaid jackets and fashion sense?

    Impressive. *hiss-wheeze* Most impressive.

  6. As you know, I loved my neurology rotation. One of the best moments came when we called a medicine consult on a patient for gout (for some reason he couldn't take the typical gout regimen). I remember thinking, "OMG, if I do Neurology, I don't ever have to think about gout AGAIN!!" There are a couple of other things I liked about it:

    1. Most neurologic problems aren't caused by patient behavior, and the ones that are (stroke comes to mind) often actually *aren't.* And even if the patient's behavior did contribute to a stroke, they were usually in bad enough shape that the drs didn't typically blame them for it.

    2. Lots of zebras. Also, I love minutia, and neurology has tons of it.

    3. Neuro-imaging is really interesting.

    4. Even though lots of people never get better, many still improve. I love watching neurology patients improve in increments, becoming more functional by the day.

    5. Mostly really cool nerds. I'm sure there are some nerd-jerks too, but I'll take that over frat boy jerks any day.

    6. Lots of psych, which I also enjoy.

    That said, most neurologists don't really "get" my research. Plus the whole field has become far too subspecialized. The fun part (in my mind) is the puzzle, but when you're a movement disorder specialist who sees mostly patients with Parkinsons, it could get old fast.

    1. The biggest reason I'm glad I didn't do neuro is #1. If I were a neurologist, I'd be unemployed now. Or else working some miserable job that was the only one I could find. Path and neuro are the roughest job markets now, I think. In PM&R, I've gotten two reasonable job prospects in the last month.... not that I'm moving, but it's nice to have options.

  7. #5 is why working on a cardiac post op/acute stroke floor was so interesting. It was like the football team and the chess club got locked into a jail cell over in the physician charting area. Very interesting watching them interact.

  8. Not sure I agree with no. 3, at least as pertains to stroke; it's true that the mainstay of recovery is still in rehab and, ahem, physiatry rather, but there's also tPA which (at my centre anyway) they're increasingly aggressive with. That made for some interesting Thursday afternoons when I was on the neuro consult service as a clerk, and the residents were at their half-day...

    Having said that, I like procedures, and it was only my love of patient management and my hatred of all things ostomy-related that has kept me from surgery.

  9. How is it possible that Dr. Grumpy hasn't chimed in on this thread? Is he polishing his collection of reflex hammers again?

  10. as we used to say during my residency(surgery) neurology is about the 3 Ds - Discuss, Diagnose, Dispose.

  11. Where's DR. GRUMPY!?!???!?!?!

    1. I was just thinking that.
      I have a passion for neurology, I rather feel stressed hoping I won't get laid off than be miserable dealing with runny-nosed crying children in peds.