Andaaz Posted August 21, 2011 Report Share Posted August 21, 2011 Hi everyone, I am a medical student who has been extremely interested in neurology for a really long time! However, over the last several months, I have begun to seriously reconsider my decision to pursue neurology. The primary reason for this is because of what I am sure you have all heard many many times.. "Neurologists can diagnose, but can't really do all that much in terms of treatment". I should make it clear that I personally do disagree with this sentiment...to a degree. Neurologists can indeed have a huge impact on the quality of life of several people, and while they may not be able to (yet) cure Parkinson's or Alzheimer's, they can slow the decline of several diseases, and giving someone the ability to walk again for another 6 months is kind of a cure in itself... But to be honest with you, I see what neurologists are capable of doing for their patients, and then I see what other specialists like urologists, orthopaedic surgeons, oncologists, etc. are able to do, and I am being drawn to these other specialties for the primary reason that it seems that others are able to do more for their patients! I realize that this opinion may be somewhat ignorant or misinformed, and this is why I am posting this...I wonder if you disagree with me, and if you do, please enlighten me. More specifically, I know neurology is an extremely broad field, so are there any subspecialties of neurology where you can cure your patients to a greater degree? The future of neurology is unarguably bright, but I hesitate to make a decision based on what I *think* neurology may perhaps look like in 10 years time, because I know of at least one neurologist who regrets his decision to choose neurology, for this very reason. Thanks for reading, I would love to hear your thoughts! Andaaz Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 21, 2011 Report Share Posted August 21, 2011 Are you currently in preclerkship or clerkship? It sounds like you have been talking to people already, but have you had a chance to spend time on the wards and in the clinics, and ask these questions to more people? As an anecdote, I saw TPA given for an acute stroke once, and the effect was dramatic. I would note that there is a distinction between "curing" and "doing more" for your patients - the lack of a diagnosis can bother patients greatly, and by giving them an answer, a plan, and your support, they may feel you have done a great deal for them. There are many areas of medicine and many conditions in which we manage problems rather than cure outright (and it's funny you mention oncology, but I guess it really depends what type and stage of cancer you are treating!). Link to comment Share on other sites More sharing options...
Maxime Posted August 24, 2011 Report Share Posted August 24, 2011 Neurologists actually do a lot, contrary to what some people think(my wife is R4 in neurology, did a bit myself). They treat epilepsy, thrombolysis for acute stroke, take care of people at neurologic intensive care (guillain-barré syndrome, myasthenia gravis crisis, status epilepticus...). They treat MS, neurologic pain, prevent complications and recurrences of stroke, treat parkinsons disease, are implicated in treating dystonia, etc... They have their regular bread and butter, but this is like every other specialty. Link to comment Share on other sites More sharing options...
Satsuma Posted August 24, 2011 Report Share Posted August 24, 2011 You need to do some electives and see how you feel about the field. Part of the problem is that the brain is pretty complicated to fix when it's broken, and when it is broken the effects can be pretty devastating. As understanding of the diseases improve then you are right, in 10 years time who knows...maybe significant advances will be made. I think you have to decide what you want to get out of medicine. We cure few things in medicine regardless of specialty. And I don't think medicine is all about curing things. It is about, as you mentioned, improving quality of life, being there for your pt and supporting them through their journey. And sometimes a diagnosis is better than nothing, when a pt has been going from one doc to another trying to figure out what is wrong with them. Neuro isn't for everyone, but if your personality suits it, it could be an interesting career! You may also like to investigate PM&R - where you could focus on neuro rehab. Link to comment Share on other sites More sharing options...
colbert2011 Posted September 7, 2011 Report Share Posted September 7, 2011 Neurology, as it is practiced in Canada today, is certainly focused on the diagnostic aspect---which in and of itself can be quite challenging/satisfying. However, the situation may change in the near future (or at least that is the hope). People often like to draw a parallel with Cardiology, a discipline that has undergone a revolution in the past 30 years. In the US, for instance, specialized centers have established interventional neurology programs. There are also opportunities in interventional pain management, critical care, rehabilitation, neuro-ophthalmology, neuroimaging, etc.... Additionally with fellowship training a neurologist may be able to collaborate with neurosurgeons in areas of common interest such as movement disorders (e.g. deep brain stimulation for tremor) pre/post-op and in the OR as well. Hope this helps! Link to comment Share on other sites More sharing options...
goleafsgochris Posted November 22, 2011 Report Share Posted November 22, 2011 Hi everyone, I am a medical student who has been extremely interested in neurology for a really long time! However, over the last several months, I have begun to seriously reconsider my decision to pursue neurology. The primary reason for this is because of what I am sure you have all heard many many times.. "Neurologists can diagnose, but can't really do all that much in terms of treatment". I should make it clear that I personally do disagree with this sentiment...to a degree. Neurologists can indeed have a huge impact on the quality of life of several people, and while they may not be able to (yet) cure Parkinson's or Alzheimer's, they can slow the decline of several diseases, and giving someone the ability to walk again for another 6 months is kind of a cure in itself... But to be honest with you, I see what neurologists are capable of doing for their patients, and then I see what other specialists like urologists, orthopaedic surgeons, oncologists, etc. are able to do, and I am being drawn to these other specialties for the primary reason that it seems that others are able to do more for their patients! I realize that this opinion may be somewhat ignorant or misinformed, and this is why I am posting this...I wonder if you disagree with me, and if you do, please enlighten me. More specifically, I know neurology is an extremely broad field, so are there any subspecialties of neurology where you can cure your patients to a greater degree? The future of neurology is unarguably bright, but I hesitate to make a decision based on what I *think* neurology may perhaps look like in 10 years time, because I know of at least one neurologist who regrets his decision to choose neurology, for this very reason. Thanks for reading, I would love to hear your thoughts! Andaaz I dont really find this to be an issue, but I can see how it would bother some. Not being able to "cure" isnt really a more serious problem than in most other fields. You can VERY successfully treat things you will commonly encounter (new strokes, seizures, etc). If you really want more "curing," surgery is really your option! Neurology is an awesome field ps. Fairly good lifestyle (some ppl do a lot of call for strokes, but you dont have to and it isnt bad if you do), pay is very high (at the Toronto hospital Im at now, no one makes under 280k), and things are very interesting. I considered both psych, physiatry and neurosurg and every day I am INSANELY thankful I did not go into either of those, especially knowing what I know now (psych and physiatry have terrible pay, neurosurg has brutal lifestyle). I have hundreds of conversations with toronto drs to back this up, but the best way it to just try out neuro for yourself by doing electives! Link to comment Share on other sites More sharing options...
qkx Posted December 22, 2011 Report Share Posted December 22, 2011 pay for neurologists is that high? I was under the impression that neurologists arent paid that well when compared to cardiologists and other internists...someone please enlighten me Link to comment Share on other sites More sharing options...
A-Stark Posted December 22, 2011 Report Share Posted December 22, 2011 I think it's decent enough. It's true that they don't do much if any procedures, but they read and interpret EMG/EEG studies. Link to comment Share on other sites More sharing options...
leviathan Posted December 22, 2011 Report Share Posted December 22, 2011 tPA sucks, but I've seen some pretty great outcomes using embolectomy for stroke. The future of neurology and many other areas of medicine is pretty exciting. Link to comment Share on other sites More sharing options...
cheech10 Posted December 23, 2011 Report Share Posted December 23, 2011 Wow, I would have said the opposite. Almost none of the embolectomies I've seen had good outcomes (despite being a highly selected group of patients), where I've had a lot of recoveries post-tPA. Just goes to show you how anecdotes differ from statistics. Link to comment Share on other sites More sharing options...
rmorelan Posted December 23, 2011 Report Share Posted December 23, 2011 pay for neurologists is that high? I was under the impression that neurologists arent paid that well when compared to cardiologists and other internists...someone please enlighten me That is my understanding as well (from our head of neurology) but maybe something special is going on? Link to comment Share on other sites More sharing options...
olecranon Posted December 24, 2011 Report Share Posted December 24, 2011 my dad's a neurologist. he makes roughly 200k net doing predominantly outpatient care. Link to comment Share on other sites More sharing options...
leviathan Posted December 24, 2011 Report Share Posted December 24, 2011 Wow, I would have said the opposite. Almost none of the embolectomies I've seen had good outcomes (despite being a highly selected group of patients), where I've had a lot of recoveries post-tPA. Just goes to show you how anecdotes differ from statistics. Yeah it's funny how that works hahaha...I can't find any studies that compare tPA to mechanical removal but I saw 2 really amazing outcomes during my internal rotation. Again n=2 but, it was really awesome to see. Link to comment Share on other sites More sharing options...
BrendanJ Posted December 29, 2011 Report Share Posted December 29, 2011 Yeah it's funny how that works hahaha...I can't find any studies that compare tPA to mechanical removal but I saw 2 really amazing outcomes during my internal rotation. Again n=2 but, it was really awesome to see. there are a number of large trials currently being conducted, but a number of them are facing issues hindering their completion. There has been a loss of clinical equipoise. Clinicians are beginning to see some really great outcomes with the newer stent retrieval systems and don't wish to randomize the acute cases, they feel they already know the superior treatment. This will likely revolutionize stroke treatment, and is likely to be the "next tPA". This is being done mainly by interventional neuroradiologists in Canada currently. A lot of work is yet to be done. Many places still don't include CTA in their acute stroke protocols!! Link to comment Share on other sites More sharing options...
leviathan Posted December 29, 2011 Report Share Posted December 29, 2011 The university where I did my core rotations had a quaternary hospital that used something called the MERCI device. Not sure if that's new or old but I saw a few awesome cases with it. One was a really sad case of a guy in his 50s, looked young for his age, completely healthy prior. Had L MCA stroke, completely aphasic and paralyzed. By the time I moved off service he was talking again and ambulating with OT/PT. Link to comment Share on other sites More sharing options...
youngdad Posted January 25, 2012 Report Share Posted January 25, 2012 I am curious about the lifestyle, call, and pay characteristics of Neurology. I am starting to get a feel for the clinical work, which I realize is the most important factor in choosing my field. But I want a sense of what a career in Neuro is really like. The only Neuro I know didn't really give me a straight answer. Can anyone help? Link to comment Share on other sites More sharing options...
youngdad Posted January 25, 2012 Report Share Posted January 25, 2012 my dad's a neurologist. he makes roughly 200k net doing predominantly outpatient care. Does he work like a dog for his 200k? Or is it manageable? Hrs per week? Call? Thanks. Link to comment Share on other sites More sharing options...
rswim Posted February 9, 2012 Report Share Posted February 9, 2012 blue book some neuro's in bc - many are in the mid 4's. Its definitely not an underpaid specialty, but they work hard! would love to know more about lifestyle during residency as compared to internal or anesthesia etc. Link to comment Share on other sites More sharing options...
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