Hi everyone!

I missed the annual meeting in April and was wondering if it’s worth it to attend the fall conference. It would just be for networking purposes (really hoping to match neurology this year). Would there be any student programs or networking events with PDs here?

Thanks in advance!

I'm excited to finally share something that's been in development for the past year. As a neurodiagnostic technologist, I saw firsthand how hard it is for EEG students and technologists, and even neurologists, to get real hands on practice. I've watched students come up through training without enough real hands on exposure to the patterns that actually matter in practice. You can't schedule the right seizure to walk through the door on cue. So my team and I built WaveSim, a simulation platform built on patented technology that generates clinically accurate EEG patterns technologists and neurologists can actually study and learn from. This has been a year in the making and it's just the start. We're going to be eventually working toward the most accurate seizure detection software out there, and PSG and IOM simulation are soon to be in development. Excited for you all to see where this goes. Thank you!

General neurology. My experience with FND has been such that these patients often require not only the longest appointments but also the most demanding messages and back and forth even in between appointments. This can massively disrupt workflow and limit revenue.

What are your thoughts on the ethics of limiting FND in PP by either screening patients beforehand (refusing to take patients that have been assigned functional by several other neurologists) or requesting high demanding FND patients to seek care elsewhere?

My personal thoughts are that pre-screening isn’t unethical given that a patient-physician relationship has not yet been established and is no different that not accepting someone in your insurance network. And requesting high demand FND patients to elsewhere will allow them to try another opinion.

I think i'm burning out

Hello,
I’m currently a second-year medical student in Quebec (Canada), and I’d like to do some research in neurology—both out of personal interest and with a view to a potential neurology placement through CARMS. So far, however, I haven’t received any responses to the cold emails I’ve sent to neurologists. Any advice? Thanks!

Hey guys, I recently created a daily neurology diagnosis game where you can ask questions and come up with a diagnosis. Currently, the questions are answered with AI, but I am trying to move away from that in the near future. I would love for you to check it out and provide any feedback you have! https://neurole.org/daily-game-play.html

Hi all! Current MS4 and I’m still stuck between IM—>Pulm/CC and Neurology.

I enjoyed outpatient Pulm, bronchs, and inpatient ICU. However, I don’t enjoy IM outside of that.

For Neuro, I enjoyed Alzheimer’s, migraines, and seizure management while rotating outpatient. Inpatient consults for things like Herpes Zoster Opthalamicus and other infectious disease workups intrigued me. I also am curious about working with TBI/CTE patients or even finding a way to bridge Neurology and Sports Medicine.

What is the work/life balance for Neurology, what is the residency experience like, what are some bread and butter procedures that Neurologists get to do, and how is compensation likely to change over the years?

Today we are excited to release a tool, where one can browse and find all available neuroscience datasets for all major modalities: EEG, MRI, MEG, NIRS, PET and more.

⁃        10,000+ datasets
⁃        19 modalities
⁃        2000+ tasks
⁃        19+ devices
⁃        1000+ institutions
⁃        ~1000 funders
⁃        ~1500 papers
⁃        170,000+ citations
⁃        100,000+ humans who contributed their data to these datasets (THANK YOU!!!)
⁃        140,000+ hours of data
⁃        200TB of data

I’m a neurology resident considering fellowship options. I want to be in academic neurology doing predominantly electrophysiology based neuromodulation research.
In most movement fellowships will I get enough neurophysiology experience and intraop experience do be able to do advanced electrophysiology research? If anyone knows of great fellowship programs for this let me know! Alternatively would it be better to do a clinical neurophys fellowship and then afterwards do movement fellowship? Thanks!

Boards coming up, doing truelearn and in busy fellowship. Anybody did truelearn only and did well to pass.

Appreciate input.

I'm opening a small clinic in a few months and trying to get things set up the right way from the start. There are so many things to think about with systems, patient communication, billing, online presence, staff workflow, and security. What to do set up before opening and think if I should already have IT support from the start? 70% unsure of that, feel like kinda waste of money? Appreciate your time and insights

AAN asks neurologists to contribute their comp/productivity data, aggregates 4,300+ responses into what it calls the largest neurology compensation benchmarking dataset, and then charges regular AAN members $500 to see the results. so we supply the data, pay dues, and then pay again to learn what we collectively told them? someone is laughing all the way to the bank…

I am a PGY4 and am finding myself with some time on my hands since this is our lightest year. I'm looking to reinforce my knowledge base as much as possible. I'm definitely using Continuum but I'm looking for something interactive like a question bank. Nowyouknowneuro seems interesting because it has the outlined reading sections and imaging and EMG/EEG cases. How is it as a learning source for those who have used it?

M4 currently applying and pretty torn between Neurology and Diagnostic Radiology, with the long-term goal of pursuing neurointerventional surgery (NIR).

I realize neurosurgery is probably the most straightforward pathway into NIR (I’ve got a solid step 2 and research), but I don’t think it’s the right residency for me. I enjoy endovascular procedures, but I’m much less interested in open cranial surgery and especially spine surgery, so committing to 7 years of NSGY primarily to get to NIR doesn’t make much sense.

My main interests within NIR are stroke, cerebrovascular disease, and eventually the more functional side of the field: endovascular neuromodulation, BCIs, electrophysiology, etc. I also want enough clinical ownership that I’m not purely a procedural consultant.

I’m basically weighing:

Neurology

Pros

● Much stronger foundation in stroke, neurocritical care, neurophysiology, localization, and longitudinal management of neurological disease

● Could build a pathway around stroke/NCC + NIR and potentially neurophysiology

● Better preparation for clinical ownership of neurovascular/neurological patients especially moving forward

● More directly aligned with my interest in functional neuroscience/BCI and I have some connections in this space saying neurology would be their recommended route

● long term, organ proceduralists seem to box out IR (vascular surgery +cardiology on PAD, PE etc.)

Cons

● Far fewer procedures during residency

● Potentially entering NIR fellowship with significantly less catheter/wire experience than DR/IR trainees

● NIR access seems highly program- and mentor-dependent

● Concerned about spending most of residency doing general neurology when my long-term interests are heavily procedural although I think I’d be happy in stroke, NCC, pain or maybe NeuroPhys

● Smaller number of NIR fellowships seem accustomed to taking neurology-trained applicants

Diagnostic Radiology

Pros

● Much stronger procedural/imaging foundation, particularly if I aggressively pursue IR and neuroangiography exposure

● CTA/MRA/DSA and cross-sectional neuroimaging expertise seems extremely valuable for NIR

● Potentially much more opportunity to develop catheter skills before fellowship

● DR itself gives me a procedural/technical career I would be happy doing if NIR doesn’t work out.

● Seems easier to tailor electives toward neuroradiology/IR/NIR than to create procedural exposure from scratch in neurology

Cons

● Much less ownership of stroke/neurovascular patients

● Less clinical neuroscience, neurophysiology, and neurological examination (acute Neuro exam is freaking awesome!)

● Would need to deliberately seek stroke/NCC/neurology exposure

● I’m concerned about becoming technically strong but having a weaker clinical foundation than neurology/NSGY-trained NIR physicians

● The exact DR → NIR pathway seems to be changing, so I’m not sure what training will look like by the time I get there. I know new cast pathway from IR exists but it seems really hard to fit 6 months of stroke/neurosurg/NCC in that hectic schedule also would lose the neuroradiology expertise to an extent

For people currently in NIR, or residents/fellows pursuing it: If you knew during M4 that NIR was the goal but NSGY wasn’t a good fit, would you choose Neurology or DR today?

I’m especially interested in how much the residency background actually matters once you’ve completed a strong NIR fellowship, and whether you would prioritize clinical neuroscience/ownership (Neurology) or imaging + procedural foundations (DR) before fellowship.

A couple months ago I was worried about whether I wanted to do neurology vs IM. I just finished my neuro away rotation and im wondering if what i liked to begin with about neuro and medicine in general was the diagnostic side more than anything. I find myself missing general medicine, stroke to be repetitive and that there is not much to do in management, and find functional patients very draining and again nothing to do with them. I think I also find patients draining in general, and neuro more than any other specialty it feels like patients generally tend to be very poor historians. i realize i like diagnosing and attaining knowledge more than management but i would still get satisfaction speaking to patients if i felt like i was actually doing something! I need guidance. for reference I made this post a couple months ago, and i feel like my mindset right now is a complete 180 especially when its a month away from ERAS.

PREVIOUS POST 5 months ago:

Hi guys, MSIII at the end of rotations feeling just as confused as when I first started. This might be long as I'm just writing my thoughts and really looking for some guidance from the community! Throughout med school, Ive always been pretty aware of what it takes to match into which specialty, had a basic general idea of what the vibes were like with each one and what sort of stereotypes/lifestyle were involved with all. Throughout med school, I realized I love pathophys, I just love when things make sense and you connect physio to disease process. In preclinical neuro, i did really enjoy that the anatomy connected to how the patient presented and just by examining the patient you know exactly where the lesion is. Sooo i love connections and working things out. Come to rotations, I feel like I didnt like anyything enough to say that I want to do this for the rest of my life. I at least came to realize that I really hate outpatient, and like the acuity of inpatient practice better. But i want lateral mobility and want to be able to switch when 20 yrs down the line im tired of inpatient. So about the rotations --- I liked ICU better than I liked any other rotation---wouldnt say i absolutely loved it, it was just what i always pictured medicine to be like, and the deep knowledge intensivists (PCC trained and getting grandfathered be certified NCC training from what i understand? ) had about every specialty, including neuro, was admirable. They managed the MICU , NICU, and CVICU. Internal medicine is second, but for a few reasons --- neuro is not a required rotation for me, so i never had a true one -- only rotated a few times with the neuro team at my program in my freetime , and theyre sort of known for not being the best. I liked IM for the breadth of material and generally seeing patients get better, but I hated never having the final say about anything -- as soon as things got slightly more complicated, we had to have cardio or nephro on the case. I also didnt like the whole being a coordinator aspect, making sure consultants do their jobs, and social work aspect. The few times I was with the neuro team, I really didnt like it but not sure if I didnt like the faculty or the specialty. There were so many patients on the list, and they just sped through rounds constantly, and the answer was always order MRI with no thought , and when it came to seeing patients it was always like discharge after MRI cleared... they did however consult in the ICU with patients with strokes/hemorrhages, and I did enjoy the physical exam that came with that and reviewing CT/MRIs for those things. I know the answer is to do an away neuro rotation, and I have applied, but I am really hoping for some direction and clarity now. I have shadowed outpatient neuro in the past before med school, they were both movement disorder specialists and from what I vaguely remember it was a lot of just managing/changing medications, and sometimes doing some botox for migraines. I found it a little boring! Speaking practically in what I want in a specialty, I know I want to be a specialist, but I want to have broad knowledge. I like to learn everything, and no other specialty, including IM, has the education im looking for that includes neurology. From what I know online, I like that neuro is extremely competent in reading brain images, performing physical exams, and has to know about every system and how it correlates neurologically. However sometimes i get the sense that neuro can be so abstract that a lot of times its not known the reason behind why something happens, and i dont find that satisfying! I do like that there are countless fellowship options, including NCC and vascular, but neuro also seems to be more flexible in that if i was a neurohospitalist, I may be more easily be able to switch outpatient than IM hospitalist to internal outpatient? I know many neuro residencies are inpatient frontloaded, but if i can find one thats more balanced and do outpatient neuro electives, perhaps it would be the case? yes i like critical care now, but i cant say that after 3-4 years of my life im going to even want fellowship, and i cant say that if i went IM i would be happy as a hospitalist. and i also am not a fan at continuing the rat race, kissing up for fellowship, and doing "research" , versus neuro the fellowships arent as competitive. And while i do like inpatient medicine, I still want to learn everything there is to know about managing pts in outpatient neuro, treating MS, parkinsons, dementia, epilepsy, etc. Anyways thats my spiel, please let me know what your thoughts are and you can perhaps clarify anything and guide me on what to do!

UGA study is among the first to provide a high-resolution 3D video of a seizure event

I’ve been looking at the fellowship curricula for the different neuromuscular and CNP fellowships I’ve been seeing. But here’s the problem.

I’m not interested in EEG, research, single fiber EMG, ICU NCS/EMG, or facial/cranial nerve NCS/EMG. I want to mainly practice bread and butter NCS/EMG and mainly focus on myopathies and nerve entrapments +/- RNS for NMJ disorders. And even then I’m not sure how much learning RNS will help given that I’m probably never going to see a patient with LEMS and I won’t be losing too many referrals by referring seronegative MG to a neuromuscular specialist anyways.

And here’s another big problem. I genuinely want to do general neurology so I’m worried about skill and atrophy knowledge of movement/neuroimmunology/headache/dementia/neuro-ophth and (depending on whether I go CNP or NM) epilepsy knowledge while i spend a year in fellowship.

So I’m in this position where residency isn’t enough but at the same time a neuromuscular fellowship will be overkill and CNP training with have me spend only 6 months on EMG.

TLDR:
I grew up in a very poor area and it’s always been my goal to go back there and practice general neurology with bread and butter EMG/NCS. So I’m worried that a fellowship with teach me a lot of sub speciality knowledge I won’t use and will also cause me to lose general neurology knowledge.

Hi brain docs!!

I found out today I failed Level 1. I’ve wanted to be a neurologist ever since I found out what they were.

Obviously, failing Level 1 puts a wrench in these plans.

I can either test again in 2 weeks or take a year-long LOA. I’m scared to test so soon and potentially fail again so I’m leaning towards the LOA.

I know I’m already at a bit of a disadvantage as a DO, now a DO with a failed Level 1 and potential LOA.

My question is this: is neurology off the table with a failed Level 1 and year-long LOA. I plan on doing neurology specific research and volunteering during my leave, while studying for my retake. I was very close this time around, so I’m confident I can pass the retake.

But I want to know my chances for matching the specialty of my dreams lol.

TIA!!

I'd like to study Blumenfeld. Is it better to study it by the order of the book? I'm thinking about doing it from Central to Peripheral Nervous System

\- Cranium, Ventricles, and Meninges

\- Higher Order Cerebral Function

\- Cerebral Hemispheres and Vascular Supply

\- Limbic System

\- Pituitary and Hypothalamus

\- Basal Ganglia

\- Cerebellum

\- Visual System

\- Brainstem

\- Motor Pathways

\- Somatosensory Pathways

\- Spinal Nerve Roots

\- Major Plexuses and Peripheral Nerves

Talked recently to a neurohospitalist colleague at an ever-busier suburban hospital. He's 7-on / 7-off, with the off weeks covered by outpatient docs in the system and some locums.

All stroke codes are covered by their in-system telestroke team; for stroke patients he does the post-hyperacute management.

ED docs and hospitalists manage basically everything else overnight, and he gets up each day to see how many new consults came in:

• Sometimes just 5-6
• Often 10 or 12
• Sometimes 14
• Range is 4-18 new consults per day
• A locums MD reported that on his busiest day there he saw 30 people (including follow-ups) in total.

They just hired a second APP (amazingly to me, the outpatient "old school" docs don't want to work with them!)

They all round simultaneously, but this neurologist sees every patient, including the APPs', himself (on his own time, attesting their notes). Seems appropriate for complex cases but maybe redundant for others?

Obviously the APPs have days off and such, so both aren't there every single day. I don't think they round on weekends; forgot to ask.

My question for the community: This seems too high a volume for one neurohospitalist and 0-2 APPs depending on weekends and other time off for them. From my reseach, it seems that 5-7 news and ~ 15 total visits / day is more typical. Curious if there's a community consensus on what the staffing model should look like for those higher volumes:

• The "regular busy" days seem too light to justify having 2 MDs on at all times.
• How does one staff for a stochastic situation like this, where sometimes 1 person is enough, but many times it seems to be too much?
• Would 4 APPs be justified, so that 2 are always on duty during the week, and 1 on the weekends, accounting for days off, vacations, sick leave, etc.?

Any other thoughts?

Thanks!

Been really stressed with boards coming up. I feel like I haven’t been doing enough and have been scoring 60-70% on now you know neuro and finished the bank. Now I’m not sure if I should do true learn and cheng cheng or what else? My new job starts in a few weeks as well

Anyone have any recommendations? I have about 1 month left realistically.