So you want to be a neurologist. You like the idea of the brain, knowing all
of its intricacies, and the idea of being a brainiac yourself. Let's debunk the public perception myths,
and give it to you straight. This is the reality of neurology. Dr. Jubbal, MedSchoolInsiders.com. Welcome to our next installment in So You
Want to Be. In this series, we highlight a specific specialty
within medicine, such as neurology, and help you decide if it’s a good fit for you. You can find the other specialties on our
So You Want to Be playlist. If you want to vote in upcoming polls to decide
what future specialties we cover, make sure you are subscribed. If you’d like to see what being a neurologist
looks like, check out my second channel, Kevin Jubbal, M.D., where we'll be covering a day
in the life of a neurologist soon. Neurologists are the physicians that specialize
in the non-surgical management of the variety of central and peripheral nervous system disorders. For surgical management, neurosurgery is the
specialty you're looking for. Neurologists manage everything from headaches
and migraines to the most devastating and incurable diseases like amyotrophic lateral
sclerosis, or ALS, and Huntington's disease. Strokes, which are the fifth leading cause
of death and first leading cause of disability in the United States, are diagnosed and treated
by neurologists. Many believe that neurologists primarily diagnose
conditions, but cannot do much to treat any of them. While there are several conditions for which
modern medicine has limited management options, research in neurology is rapid and our therapies
are improving. For example, strokes used to be untreatable,
leaving patients with lifelong disability. However, in the past few decades, our understanding
of strokes has improved drastically. As they say, "time is brain", and rapid interventions
such as tPA and endovascular thrombectomy are now understood as critical in favorable
outcomes. Parkinson's disease care has been revolutionized
with deep brain stimulation. Epilepsy care has improved through new anti-seizure
medications, vagus nerve stimulation, and epilepsy surgery. Brain tumors of all types now have a multitude
of treatment options. ALS is still a devastating illness, but clinical
trials for novel therapies are showing tremendous promise. When you think about the patients requiring
neurological care, it makes sense that it's a specialty with less rosy outcomes. A substantial portion of diseases in neurology
are chronic and progressive, but neurologists help their patients live a life of dignity
and enjoy the time they have left in a meaningful way. The bread and butter of neurology consists
of stroke, seizures, headaches, and dementia, but there's a great deal more to it, as we'll
explore shortly with the wide variety of fellowship opportunities. There are a few ways to categorize neurology: Inpatient neurologists work in the hospital
setting, treating admitted patients with seizures, acute demyelinating disease, stroke, complications
pre-op or post-op from neurosurgery, neuromuscular disorders, meningitis, encephalitis, and more. The lifestyle of an inpatient neurologist
is similar to that of a hospitalist - it’s common to work 7 days on and then have 7 days
off, or 2 weeks on followed by 2 weeks off. Outpatient neurologists work in the clinical
setting, managing patient's chronic neurologic conditions including headache, peripheral
nerve disorders, Parkinson's disease, dementia, epilepsy disorders, myasthenia, ALS, stroke
prevention and rehabilitation, and more. As is usually the case in an outpatient practice,
you can expect 9 to 5, Monday through Friday, regular business hours. As an academic neurologist, you’ll be working
at an institution affiliated with a medical school or teaching hospital, which generally
means a large tertiary center with comprehensive stroke, epilepsy, and ALS treatment centers. In academic neurology, a fellowship is generally
advised, and compared to other practice settings, you’ll be more narrowly focused on that
fellowship subspecialization. As with any academic setting, you’ll also
be teaching medical students and residents in addition to doing research on the side. Compensation in academia is usually about
30 percent less compared to community or private practice. Community neurologists usually have clinic
in addition to a weekly call schedule. They normally see less acute patients either
pertaining to general neurology or their fellowship, which is most commonly headache, neurophysiology,
neuromuscular, and movement. Private practice neurologists focus on less
acute neurology, including pathologies such as headache, neuropathy, less severe Parkinson’s
disease, and well controlled seizure disorders in their clinics. They also usually take call for stroke or
general neurology at local hospitals. While the pay is higher, you’re more likely
to have more demanding call, needing to service multiple hospitals in a given radius. After 4 years of medical school, neurology
residency is another 4 years. Your first year in residency, or PGY-1, is
an internship in internal medicine. After all, a strong internal medicine foundation
is prerequisite to be successful as a neurologist. During your second through fourth years of
residency, you'll be focused exclusively on neurology. As a PGY-2, you’ll be focusing primarily
on inpatient coverage of stroke, general neurology, epilepsy, and neuro-critical care. As a PGY-3, you’ll begin having more outpatient
clinic exposure, but still lean towards inpatient, while also begin working on fellowship applications. As a PGY-4, you’ll be more evenly split
between inpatient and outpatient, and this is also when most residents focus on research. You can do either a categorical or advanced
residency. Categorical means you do all 4 years at a
single program, whereas for advanced programs, you'll do your intern year as either a preliminary
year or transitional year and then do neurology residency at a different program. Medical students that apply to neurology are
stereotypically the quirky nerds who have a strong interest in reading, tend to talk
a lot, and enjoy explaining to others what they've learned. In terms of competitiveness, neurology is
considered less competitive, ranking at 16 out of 22 specialties. The average Step 1 score is 232, average Step
2CK is 245, and match rate is 97%. After completing residency, you can subspecialize
further with fellowship. Vascular neurology is almost entirely inpatient
in nature. This is the subspecialty for neurologists
that love staying on top of research and have a deep interest in vascular anatomy and acute
care. This is a 1 year fellowship, although some
programs are 2 years in duration when research is involved. If you love the high acuity of inpatient and
love acute lesion localization, then this may be the field for you. But you will be called at odd times for stroke
emergencies, which may be unfavorable to many. Epilepsy is a 2 year fellowship for the brainiacs
of neurology. You'll be reading EEGs and working with neurosurgeons
for either intra-operative EEG monitoring or for managing seizure patients with vagal
nerve stimulators or responsive neurostimulation devices. This is primarily an outpatient practice,
unless you work at a large epilepsy center, where they do admit patients to the epilepsy
monitoring unit to better characterize seizures and see whether surgical treatment is warranted. Movement disorders is a 1-2 year fellowship
and is purely outpatient in practice. These are the experts in treating Parkinson's,
Huntington's, tic disorders, tremors, dystonias, and more. This subspecialty comes with a great lifestyle,
with a 8-5 practice. Botox injections are often a key procedural
aspect of this specialty and can add to the practitioner’s compensation significantly. If you work at a larger center, you'll also
help manage devices like deep brain stimulators for Parkinson's tremors with the neurosurgeons. Neuro-critical care is a 2 year fellowship,
and is a newer and rapidly growing subspecialty of neurology. These are the specialists of extreme neurologic
illness such as brain hemorrhages, large strokes, neuromuscular crises, acute spinal cord injury,
and dealing with neurosurgery post-operative care and complications. This is for those who love the exciting, fast
paced nature of the ICU and want to practice both neurology and internal medicine elements. It's more procedure heavy than other parts
of neurology, dealing with more lumbar punctures, intubations, central line placements, chest
tubes, external ventricular drains, and more. Call can be demanding as the patients are
all very sick and can decline rapidly if not monitored carefully. Neuro-interventional surgery and radiology
is for those who want to specialize in minimally invasive procedures for large vessel strokes,
aneurysm coiling, and arteriovenous malformations. It's quite demanding, and has a steep learning
curve for neurologists because it's purely procedural. This is an additional 1 or 2 year fellowship
for which you can take one of three paths. Either through neurology followed by vascular
neurology or neuro-ICU fellowship, neurosurgery residency, or radiology residency followed
by neuroradiology fellowship. It is the most competitive subspecialty of
neurology and the lifestyle can be demanding as you may be called at odd hours to activate
an endovascular team to perform endovascular procedures. At the same time, it is the highest paying. There are several other fellowship options
to choose from as well, including neuro-immunology, neuromuscular diseases, neurophysiology, neuro-ophthalmology,
neurocognitive and neurodegenerative diseases, neuro-oncology, neuro-rehab, headache, sleep,
pain, neuro-infectious diseases, and neuro-endocrinology. Neurology is a great specialty with a lot
to love. About 80% of neurology is outpatient, which
means you're less likely to work weekends, and you're more likely to have a regular 8-5
practice. However, note that most private practice neurologists
have to take call for local hospitals. Neurology is concerned with the most fascinating
organ system of the human body, and we've seen dramatic improvements in our understanding
of the brain and spinal cord in just the last 20 years. And that’s likely to continue, as neurologic
diseases are consistently in the top 3 most funded diseases by the NIH each year. If you enjoy building strong longitudinal
relationships with your patients, neurology has you covered. Most neurology pathologies are chronic in
nature, and you’ll be seeing your patients often for many months to many years. While neurology is a great specialty, it's
certainly not for everyone. Despite the immense research funding being
poured into the field, neurologic diseases are debilitating in nature as treatment options
aren't as robust as they are in something like cardiology. With less favorable outcomes, neurologists
may need to be more comfortable with palliative and hospice care, which can be emotionally
challenging for many and can lead to burnout. Neurology consistently ranks at the top in
terms of burnout. The lifestyle can be demanding, especially
with a community practice. In addition to having a busy clinic, you'll
have to take stroke call at local hospitals. Neurologist compensation is in the lower third
of all specialties, making on average $280,000 per year. This is in large part because you're dealing
with primarily chronic illnesses and there are fewer procedures in neurology compared
to something like gastroenterology or cardiology. And because of the wide breadth of neurology,
the overwhelming majority of neurologists pursue fellowship. That means your training will last at least
another 5 or 6 years after medical school, which is on the longer end for a non-surgical
specialty. Should you go into neurology? If you're the type of person that loves the
complexity of neuroscience and enjoys using the physical exam and deductive reasoning
to come up with a diagnosis and treatment plan, neurology may be a good fit. If you want to be part of a specialty that's
rapidly growing, evolving, and focusing more on holistic longitudinal treatment now rather
than the "diagnose and adios" mentality of the past, consider this specialty. In terms of patient population, you should
be comfortable with longitudinal relationships with sensitive patients who may have debilitating
and sometimes terminal illness, which isn’t as rosy as some other specialties. You'll be their primary provider, guiding
them to live the rest of their life meaningfully. Those that go into neurology also tend to
be on the intellectual side of things, enjoying discussing the nuances of the physical exam,
strange labs, and unique imaging findings. Big shout out to Dr. Prashanth V and Dr. Masaki
N from UC Irvine, and the other neurologists at Med School Insiders for helping me with
the creation of this video. Are you interested in neurology? To get into medical school and match into
a strong neurology residency, you’ll need to score well on your class tests and standardized
exams. If you need help acing your MCAT, USMLE, or
other exams, our tutors can maximize your test day performance. If you’re applying to medical school or
neurology residency, our Insiders can share the ins and outs of what it takes and how
to navigate the highly competitive process most effectively. We’ve become the fastest growing company
in the industry, and it’s no surprise. Our customers love us because we’re committed
to delivering results, period. Learn more at MedSchoolInsiders.com . Thank you all so much for watching! If you enjoyed this video, check out So You
Want to Be a Neurosurgeon, or another specialty on our So You Want to Be playlist. Much love, and I'll see you guys there.
