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neurology as a specialty within internal medicine


Guest justanotherpremed

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Guest justanotherpremed

Hi everyone: I have an important question

 

I'm interested in neurology. I've noticed that my undergrad institution at least on their website, seems to group neurology under the subset of internal medicine... ie with respirology, gastrointerology, general internal medicine, cardiology, etc.... I presume this would indicate that one would do a general internal medicine residency of about three years, and later do a fellowship in neurology for two years, as one would do for cardiology for example>>

 

I've also noticed that utoronto and some other places I've looked seem to group neurology as a separate specialty. I'm guessing this would mean a resident would simply spend 6 years as a neurology resident, with no residency in general internal medicine....

 

Can someone clarify this for me.. is it inconsistent from school to school... or is the neurology residency always separate?

 

Thanks :smokin :hat

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I dunno about Canada but here in the US neurology can be combined with medicine (five years) and PM&R. Generally, you enter neurology after a one year residency in medicine, peds, FP or transitional so all in all it's four years long.

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Guest Ian Wong

In Canada, you apply to Neuro directly through CaRMS (it's not done through CaRMS). In the US, Neuro is an early match, and is done through SFMatch, and not ERAS/NRMP (which handles most other US residencies, such as Emerg, Surgery, Peds, Internal Medicine, etc).

 

The Neuro residency has a fair amount of Internal Medicine in it, at least at the beginning years of residency, but is applied to as its own specialty. I do not know if you can get to Neurology after Internal Medicine (in the same way that doing a fellowship after Internal Medicine gets you into Cardiology or Endocrinology, etc) as well.

 

I'm going to move this into the CaRMS and Residency forum.

 

Ian

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Guest justanotherpremed

hmm....

Any insights as to why that might be so? Quite frankly, I would like to be able to start an internal medicine residency and then choose between cardiology and neurology....

 

A second question - how competitive are the internal medicine versus neurology matches in Canada?:hat :smokin

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Guest marbledust

I don't have any facts or figures in front of me but a quick answer to your question is there are considerably more spots available in internal medicine than there are in neurology, making neurology more competitive. Although you have to take into consideration that far more people apply to internal than to neurology.

 

As an example:

Calgary has somewhere in the neighbourhood of 13 to 15

pgy-1 internal medicine spots each year, compared to 1 or 2 in neurology. I would assume that the ratio of internal to neurology spots would be about the same at other schools. Calgary also has a separate pediatric neurology program that accepts one person about every two years. There are only a couple of other such programs in the country. I believe UBC might have one too.

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Guest Valani9

I've looked into this a bit. I think this is how it works.

 

At least at Toronto - and maybe at one of the other big centres - there are a few spots for people who want to start in Internal, and switch to Neuro. But we're talking about maybe 2 or 3 spots.

 

As for competitiveness: Neuro is about middle-of-the-road. It's true that there are more Internal spots than there are for neuro, but there are also more people who want Internal. What I have been told is that if you really want Neurology, you've got a good chance at getting in somewhere.

 

I've also learned, though, that neuro is a very intellectually-challenging field. Other fields definitely have challenges too - long hours, highly skilled procedures, high stress, etc. It seems like neurology involves a lot of reading, studying, and scholarship. It's a crazy and really interesting area to be in, but I think that you really have to love it to be able to do it (I suppose this is the case with many specialties). I myself am not sure if I'm up for that, but I definitely have a lot of respect for people who do it.

 

 

Good luck.

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Guest UWOMED2005

Sounds about right, Valani9.

 

What you missed is the fact some med students are turned away by a perception best reflected in the following quotation:

 

Marge: Can't you do something for him?

Dr. Hibbert: Well, we can't fix his heart, but we can tell you exactly how damaged it is.

Homer: What an age we live in!

 

While that quotation is referring to cardiology, it matches the perceptions about neurology some students hold. . . in neurology you get to make fascinating diagnoses, often only to not be able to offer any satisfactory treatment.

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  • 2 weeks later...
Guest UWOMED2005

Are you saying a surgeon should be able to immediately pick up ovarian cancer before it metastasizes? Based on vague symptoms of minor abdominal distension, vague pressure sensation/discomfort, GI symptoms, bloating, dyspepsia? If you could, wow I'd be very impressed. Well, at least if you were able to do so by not ordering CTs and U/S on everyone who came in with abdominal gas.

 

And that doesn't even touch the issue of getting the patients to medical care before metastasis. My grandmother died of colorectal cancer back in 1986, and in no way at all was it the surgeon at St. Joe's (in London) fault. She was one of those Huron county farmers who never complain of pain (or other symptoms,) just dealt with mild discomfort, and by the time she went to her family doc about it, the ca was already metastatic. Even had the family doc himself operated that day and done a perfect job, it would have been to late. Same goes for Ovarian cancer - not even the greatest (or most resource wasteful) surgeon in the world could do much if ovarian cancer has already gone metastatic before they even went to their family doc or surgeon.

 

If you think my grandmother should have whined more, at least she's not one of those patients who repeatedly comes to emerg with nothing but a mild cough, a mosquito bite or a mild headache.

 

Or do you think the surgeon at St. Joe's should have resected her liver and her brain to get rid of the metastases that killed her?

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Guest UWOMED2005

No worries, it was 30 years ago.

 

What I said holds true for colorectal cancer. And for some other types of ca as well.

 

And what about removing a solitary metastases in the brain? The oncologists at LRCC said the neurosurgeons at LHSC will sometimes remove a single symptomatic metastasis in the brain, not for cure, but because you could alleviate a fair amount of symptomology (and dramatically increase QOL) for a few months.

 

Ditto for a 100 yr old with metastatic colorectal cancer. Another example from the LRCC. By all accounts, not a surgical candidate. Except for the fact the metastases are not symptomatic, but the lower bowel obstruction definitely was. As the rad onc presenting the case to us said

 

With cancer, you can't usually control IF someone will die. But you can often control HOW they die. Lower Bowel Obstructions is one of the most painful and drawn-out deaths possible. For this guy, dying on the operating table would be a much more ideal solution than that. . . and he's not automatically going to die from the Sx.

 

While a surgeon might not agree this guy is a great surgical candidate, the rad onc has a point.

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  • 1 month later...
Guest foekd89

Quote:

--------------------------------------------------------------------------------

In neurology you get to make fascinating diagnoses.

--------------------------------------------------------------------------------

 

 

 

 

No you don't. The fascinating diagnoses are made by the neuroradiologist.

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Guest strider2004
No you don't. The fascinating diagnoses are made by the neuroradiologist.

 

Don't forget about EMG and EEG studies. I doubt you could diagnose epilepsy with a CT scan. Neurology is much larger than just strokes and abscesses.

 

If you did your job right, as a surgeon, people don't get metastatic cancer.

What about small cell lung cancer?

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