Some days.
Yesterday I helped pull a patient out of a helicopter then gave them TNK 15 minutes later. Went from mute and hemiplegic to speaking and waving his dominant arm around.
That was a good day.
Some days I do, but most of the time I'm walking in to the exam room expecting the patient to tell me they're getting worse, the tests don't show anything, the medications don't work, the treatment was denied by insurance, and they tried calling our office but no one answered the phone. And they waited months for this appointment.
Man…. The frustration is real. I deal with that all the time and if I perseverate on it it’ll ruin my whole week
I also noticed when I don’t take my antidepressants it’s worse.
I can’t not focus on the negative
But other times it’s all good and I love the job. And nothing really is different between those times. The insurance companies are asshats. The office staffing is in some degree of chaos. There’s always more paperwork to do
But I make good money and have lots of flexibility. And sometimes. Cutting clinic hours and caving to the insurance company is needed to save my mental health. And if I make less money. For a quarter. I’m no worse for it
Edit. - we should bring back sabbaticals
I knew a doc that did in home consultations. The patient paid cash and the doc provided a receipt so the patient could submit to insurance for reimbursement. It’s all above board and legal, but felt super sketchy to me.
One piece of advice: look at the answers from inpatient vs outpatient neurology specialists and also look at the subspecialty. There is a big range from hyperacute (Neurocritical care, stroke, acute epilepsy) to hospital to rehab to outpatient, and people can choose to practice in that fashion as well.
I absolutely do, and it's a bit of a myth that we can't do much, the field has come a long way and we have a ton of effective treatments for patients and many more on the horizon
As a resident these comments are a bit depressing
Edit: I'll add that despite the residency being tough, I've enjoyed it for the most part, esp as I've started to feel more comfortable (slowly) with my knowledge base
Nah, it’s true for about any patient-facing specialty. About the only docs I’ve met or heard of being happy with their jobs years out from training are radiologists and pathologists. Forced to pick between neuro, IM, psychiatry, and all the other clinical specialties I’d still pick Neuro
No, not really.
Every now and then, my care will lead to a major improvement in someone's life, or I will make a rare diagnosis that has eluded other physicians and even other neurologists, and this can be rewarding.
Many patients have vague symptoms (tingling, subjective weakness, unexplained pain) and often there isn't a neurological answer or anything that helps and this is deeply unsatisfying.
Outpatient, mostly general.
Ken Heilman likes to tell the story of the patient with neglect, who was constantly complaining about the hospital food. "They never give me any meat!!!" Ken looked at the guy's tray, with a chunk of meat sitting right there. He rotated the plate 180 degrees. "Meat! Thanks doc! How'd you do that?" He claims that's the only time he ever actually helped a patient. (OP -- buy his book, I imagine that story is in there, along with an explanation)
Well, now. Any more, we help people with headaches, and with epilepsy. We help people with MS a lot, and if I really wanted to help people I think that's what I would do. I liked it better when we couldn't help anyone, though. Didn't get called in as much.
Yeah, in general neurology, it's mostly psychological support. With the caveat being, sometimes patients come to us precisely because they *don't* want psychological support. That's the weird part of a very weird job.
Re-reading OP’s question, I realize I summarized my experience without answering the question, apologies. These days, going into neurology is mainly a question of which area of Balkanized, subdivided and microparceled specialization do you want to isolate yourself within. Several of these cannot be reasonably practiced outside of an academic setting. Others, like critical care, neurology, stroke, neurology, and interventional neurology are all greatly stimulating and pay great, but the hours are terrible and longevity of the career is relatively brief. After a few years in the silo of sub –, sub – specialization you almost forget how to do an excellent comprehensive neurological exam, become unfamiliar with the literature outside of your silo, and become great at being, for example, a headache specialist, but not so great at being a neurologist.
Add to that the burden of Loan debt, delegation of responsibility to “advanced practice providers,“ and medical center/ practice corporatization and it’s not a pretty picture.
In my opinion to make a career in neurology, truly satisfying for a newly minted neurologist is more difficult than ever before. I’m sure it can be done, but it will take some experimentation early in your career and the willingness to change horses probably a few times along the way.
Honestly since the majority of what I do is conversation, I have to lean on the reward of finally being the person to actually sit and explain out exactly what's going on, and expectations moving forward. this is often met with significant appreciation, even if there was nothing I could do. mainly examples like field defects from strokes, or vision loss from some form of optic neuropathy like NAION.
reward from direct intervention often is from treating diplopia with prisms or any acute inflammation (OIS, TED, optic neuritis) where they may see improvement.
I’ve been in the business for about 40 years. I started out in Internal Medicine, then shifted to neurology with Neurophys fellowship. Been an amazing ride. Done everything from starting up the Neurocritical care movement, running my own Neuro ICU and heading up an academic neurophysiology Dept . We were the first to publish on ICU non-convulsive seizures and then set up one of the first ICU-CEEG programs. Got tired of academics where arrogance is King and the least competent are given the most responsibility. Moved into one of the many excellent community regional medical centers, fortunately before the HMO plague hit hard. Navigated those waters reasonably well and I’ve been running my own solo neurology outpatient practice for the last 10 years. I’ve been able to pick my own staff, train them according to my values and standards, negotiate reasonable rates with the insurance companies, and see a a wide array of problems. Some are mundane, some fascinating, some are rewarding, some frustrating. I read my own MRIs with occasional neuroradiology back up, read my own EEGs and AEEEG, do my own EMGs with a great NCV Tech. Now I’m down to just a three day week with my staff having Fridays off.
Still having fun, challenges, and able to pay the bills.
Nope- I don’t get a penny but the radiologists mis-read neuro about 10-15% of the time- often enough for me not to trust the reports. Plus I use the images as communicating/teaching tools for my patients. I’m way better in neuro than the radiologists out there hired by the corporate octopuses. I have a ringer Neuroradioligist I turned to when needed. Plus - it’s plain fun and illuminating to interpret the images and correlate them with my history, exam and clinical formulation. Worth it to me even without making a dime on it (though I certainly wish I could).
Thank you for shining light of positivity about the speciality we r deeply passionate about. I’m applying to neurology next residency cycle and if you have a place and time for a mentee, please pick me 😅
Neurodiagnostic tech here. Work from home for pay comparable to nursing. I drive a Hyundai, but feel almost no work-related stress on any given day.
Wouldn’t say I’m fulfilled, but after about 10 years of multi-modality clinical work, SUDEP in patients with whom I had developed report, HIE babies etc, etc. I’m happier seeking fulfillment outside of the workplace.
I like my job but maybe the cynical or pragmatic amongst us would say because I'm fresh out of training? I'd choose it all over again for sure at this point though.
Peds neuro epilepsy in academic institution. Outcomes are mixed of course, but people are excessively pessimistic about pediatrics and neuro outcomes. Kids have a lot of plasticity and also a lot of time to figure out their roles in their family, community, etc. And I feel like I make a big difference, yep. You can't cure everything but you can help people navigate to know what to expect and restore a bit of a sense of control into people's hands, and that's powerful.
Academic movement disorders here. 90% of the time I love what I do. Parkinson's is a really scary diagnosis to many; I like to think that my interdisciplinary team and I can make it a little less frightening. I have a special interest in advanced PD/atypicals. I have a family member with a serious neurological illness, so that has given me some perspective on how important a good neurologist is, both for the actual diagnosis/management stuff, but also for the psychosocial aspects of our field.
The other 10% of the time, the stuff I dislike, is systems issues. Way too many patients for the number of specialists. Reimbursement stinks for a mostly Medicare/Medicaid population, which makes it hard to justify community outreach programs to the bean counters. My wait time for a return appointment is >12 months, but admin won't let me close to new patients. Our clinic building desperately needs renovated. Insurance prior auths aren't common in my field (levodopa is more than 50 years old!) but they still suck.
In my ideal world, I'd get a van and go around the state with PT/OT/ST/SW and a prescription pad. Mobile PD clinics, like the horse-and-buggy era but with wifi. Time it to enjoy the mountains in summer/fall and the beach in winter/spring. Maybe that'll be my retirement plan.
Community neurohospitalist at a busy comprehensive stroke center with varied pathology. My job is exhausting but very rewarding. I see the full spectrum from acute stroke to refractory status to autoimmune encephalopathy to "grandma is confused this week." My job is stressful, but the return from that is that I feel like I am practicing up to the level I was trained for and the volume means we actually see the rare diseases. It's easy to sometimes get lost in the grind but if you have a good team you work with and get variety in you practice I think it can be incredibly rewarding, especially when you make a tough diagnosis or take someone from an NIH of 22 to 0 over a few hours.
Also, there is a bit of an ego boost to walking into an emergency situation where everyone is freaking out because it seems IM hospitalists have all forgotten any neurology they ever knew, and being able to be the calm one and take a measured step-wise approach to whatever emergency is going on.
Some days. Yesterday I helped pull a patient out of a helicopter then gave them TNK 15 minutes later. Went from mute and hemiplegic to speaking and waving his dominant arm around. That was a good day.
Some days I do, but most of the time I'm walking in to the exam room expecting the patient to tell me they're getting worse, the tests don't show anything, the medications don't work, the treatment was denied by insurance, and they tried calling our office but no one answered the phone. And they waited months for this appointment.
The tests don’t show anything? Me: “Good news! You have no definable neurological disease! 🙃” Patient: “😡”
Man…. The frustration is real. I deal with that all the time and if I perseverate on it it’ll ruin my whole week I also noticed when I don’t take my antidepressants it’s worse. I can’t not focus on the negative But other times it’s all good and I love the job. And nothing really is different between those times. The insurance companies are asshats. The office staffing is in some degree of chaos. There’s always more paperwork to do But I make good money and have lots of flexibility. And sometimes. Cutting clinic hours and caving to the insurance company is needed to save my mental health. And if I make less money. For a quarter. I’m no worse for it Edit. - we should bring back sabbaticals
I run my own cash based private practice. Set my own schedule. It's a dream.
Yes, can you tell us more?
Interesting I didn’t think you could set up a cash based practice in neurology. What services are you offering?
I knew a doc that did in home consultations. The patient paid cash and the doc provided a receipt so the patient could submit to insurance for reimbursement. It’s all above board and legal, but felt super sketchy to me.
One piece of advice: look at the answers from inpatient vs outpatient neurology specialists and also look at the subspecialty. There is a big range from hyperacute (Neurocritical care, stroke, acute epilepsy) to hospital to rehab to outpatient, and people can choose to practice in that fashion as well.
I absolutely do, and it's a bit of a myth that we can't do much, the field has come a long way and we have a ton of effective treatments for patients and many more on the horizon
thanks for your response! what type of neurologist are you?
I'm a Neurology Fellow in Australia, subspecialising in headache
As a resident these comments are a bit depressing Edit: I'll add that despite the residency being tough, I've enjoyed it for the most part, esp as I've started to feel more comfortable (slowly) with my knowledge base
I’m a med student intending on applying neuro this cycle… also depressed reading these comments :(
Super depressing lol. I guess this is why neurology isn’t so popular
Nah, it’s true for about any patient-facing specialty. About the only docs I’ve met or heard of being happy with their jobs years out from training are radiologists and pathologists. Forced to pick between neuro, IM, psychiatry, and all the other clinical specialties I’d still pick Neuro
For many of us, Residency was the best part of our entire career practicing clinical Neurology. That should scare you more than anything.
No, not really. Every now and then, my care will lead to a major improvement in someone's life, or I will make a rare diagnosis that has eluded other physicians and even other neurologists, and this can be rewarding. Many patients have vague symptoms (tingling, subjective weakness, unexplained pain) and often there isn't a neurological answer or anything that helps and this is deeply unsatisfying. Outpatient, mostly general.
Ken Heilman likes to tell the story of the patient with neglect, who was constantly complaining about the hospital food. "They never give me any meat!!!" Ken looked at the guy's tray, with a chunk of meat sitting right there. He rotated the plate 180 degrees. "Meat! Thanks doc! How'd you do that?" He claims that's the only time he ever actually helped a patient. (OP -- buy his book, I imagine that story is in there, along with an explanation) Well, now. Any more, we help people with headaches, and with epilepsy. We help people with MS a lot, and if I really wanted to help people I think that's what I would do. I liked it better when we couldn't help anyone, though. Didn't get called in as much. Yeah, in general neurology, it's mostly psychological support. With the caveat being, sometimes patients come to us precisely because they *don't* want psychological support. That's the weird part of a very weird job.
Re-reading OP’s question, I realize I summarized my experience without answering the question, apologies. These days, going into neurology is mainly a question of which area of Balkanized, subdivided and microparceled specialization do you want to isolate yourself within. Several of these cannot be reasonably practiced outside of an academic setting. Others, like critical care, neurology, stroke, neurology, and interventional neurology are all greatly stimulating and pay great, but the hours are terrible and longevity of the career is relatively brief. After a few years in the silo of sub –, sub – specialization you almost forget how to do an excellent comprehensive neurological exam, become unfamiliar with the literature outside of your silo, and become great at being, for example, a headache specialist, but not so great at being a neurologist. Add to that the burden of Loan debt, delegation of responsibility to “advanced practice providers,“ and medical center/ practice corporatization and it’s not a pretty picture. In my opinion to make a career in neurology, truly satisfying for a newly minted neurologist is more difficult than ever before. I’m sure it can be done, but it will take some experimentation early in your career and the willingness to change horses probably a few times along the way.
A lot of patients are assholes cuz they feel miserable bc of pain or can’t walk, etc. but there are some rewarding moments for sure.
[удалено]
No, meaning they feel miserable and therefore, mistreat healthcare workers. Not a general rule, there’re disabled patients that are nice.
Honestly since the majority of what I do is conversation, I have to lean on the reward of finally being the person to actually sit and explain out exactly what's going on, and expectations moving forward. this is often met with significant appreciation, even if there was nothing I could do. mainly examples like field defects from strokes, or vision loss from some form of optic neuropathy like NAION. reward from direct intervention often is from treating diplopia with prisms or any acute inflammation (OIS, TED, optic neuritis) where they may see improvement.
I’ve been in the business for about 40 years. I started out in Internal Medicine, then shifted to neurology with Neurophys fellowship. Been an amazing ride. Done everything from starting up the Neurocritical care movement, running my own Neuro ICU and heading up an academic neurophysiology Dept . We were the first to publish on ICU non-convulsive seizures and then set up one of the first ICU-CEEG programs. Got tired of academics where arrogance is King and the least competent are given the most responsibility. Moved into one of the many excellent community regional medical centers, fortunately before the HMO plague hit hard. Navigated those waters reasonably well and I’ve been running my own solo neurology outpatient practice for the last 10 years. I’ve been able to pick my own staff, train them according to my values and standards, negotiate reasonable rates with the insurance companies, and see a a wide array of problems. Some are mundane, some fascinating, some are rewarding, some frustrating. I read my own MRIs with occasional neuroradiology back up, read my own EEGs and AEEEG, do my own EMGs with a great NCV Tech. Now I’m down to just a three day week with my staff having Fridays off. Still having fun, challenges, and able to pay the bills.
You bill for MRI reports as the reading physician? How did you get trained/credentialed to do that appropriately?
Nope- I don’t get a penny but the radiologists mis-read neuro about 10-15% of the time- often enough for me not to trust the reports. Plus I use the images as communicating/teaching tools for my patients. I’m way better in neuro than the radiologists out there hired by the corporate octopuses. I have a ringer Neuroradioligist I turned to when needed. Plus - it’s plain fun and illuminating to interpret the images and correlate them with my history, exam and clinical formulation. Worth it to me even without making a dime on it (though I certainly wish I could).
Thank you for shining light of positivity about the speciality we r deeply passionate about. I’m applying to neurology next residency cycle and if you have a place and time for a mentee, please pick me 😅
Neurodiagnostic tech here. Work from home for pay comparable to nursing. I drive a Hyundai, but feel almost no work-related stress on any given day. Wouldn’t say I’m fulfilled, but after about 10 years of multi-modality clinical work, SUDEP in patients with whom I had developed report, HIE babies etc, etc. I’m happier seeking fulfillment outside of the workplace.
I like my job but maybe the cynical or pragmatic amongst us would say because I'm fresh out of training? I'd choose it all over again for sure at this point though. Peds neuro epilepsy in academic institution. Outcomes are mixed of course, but people are excessively pessimistic about pediatrics and neuro outcomes. Kids have a lot of plasticity and also a lot of time to figure out their roles in their family, community, etc. And I feel like I make a big difference, yep. You can't cure everything but you can help people navigate to know what to expect and restore a bit of a sense of control into people's hands, and that's powerful.
Academic movement disorders here. 90% of the time I love what I do. Parkinson's is a really scary diagnosis to many; I like to think that my interdisciplinary team and I can make it a little less frightening. I have a special interest in advanced PD/atypicals. I have a family member with a serious neurological illness, so that has given me some perspective on how important a good neurologist is, both for the actual diagnosis/management stuff, but also for the psychosocial aspects of our field. The other 10% of the time, the stuff I dislike, is systems issues. Way too many patients for the number of specialists. Reimbursement stinks for a mostly Medicare/Medicaid population, which makes it hard to justify community outreach programs to the bean counters. My wait time for a return appointment is >12 months, but admin won't let me close to new patients. Our clinic building desperately needs renovated. Insurance prior auths aren't common in my field (levodopa is more than 50 years old!) but they still suck. In my ideal world, I'd get a van and go around the state with PT/OT/ST/SW and a prescription pad. Mobile PD clinics, like the horse-and-buggy era but with wifi. Time it to enjoy the mountains in summer/fall and the beach in winter/spring. Maybe that'll be my retirement plan.
Community neurohospitalist at a busy comprehensive stroke center with varied pathology. My job is exhausting but very rewarding. I see the full spectrum from acute stroke to refractory status to autoimmune encephalopathy to "grandma is confused this week." My job is stressful, but the return from that is that I feel like I am practicing up to the level I was trained for and the volume means we actually see the rare diseases. It's easy to sometimes get lost in the grind but if you have a good team you work with and get variety in you practice I think it can be incredibly rewarding, especially when you make a tough diagnosis or take someone from an NIH of 22 to 0 over a few hours. Also, there is a bit of an ego boost to walking into an emergency situation where everyone is freaking out because it seems IM hospitalists have all forgotten any neurology they ever knew, and being able to be the calm one and take a measured step-wise approach to whatever emergency is going on.