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Neurology

What is Neurology?

Neurology is a specialty devoted to the function of the nervous system, including motor and sensory functions, cognition, and sleep. Neurologists encounter a range of disorders including: headache, stroke, epilepsy, multiple sclerosis, movement disorders (Parkinson’s disease), cognitive/behavior disorders (dementia/Alzheimer’s), neuromuscular disorders (ALS, myasthenia gravis, muscular dystrophy, Guillain-Barre and other peripheral nerve disorders), neuro-oncology, neuro-ophthalmology, neuro-otology and vertigo, sleep, neuro-HIV/ID, pain, neuro-radiology, and trauma. Neurologists can pursue fellowships to gain expertise in one of these subspecialty areas, which are generally 1 to 2 years long.

How do neurologists spend their time?

There are many different career paths within the field of neurology, and you can choose between almost any mix of inpatient, outpatient, clinical work, and research. Some neurologists go on to take faculty positions in academic institutions to pursue basic science or clinical research in addition to their clinical work. Others choose to work in the community (i.e. in private practice or other non-academic organizations). Traditionally, much of their time is spent in the outpatient setting. However, some neurologists take call at local hospitals and see inpatients as a consultant. There are few full time neuro-hospitalists that attend on a Neurology Ward or Consult-Only service, but the field is trending in that direction. Of note, neuro-ICUs are popping up in many hospitals around the country, with many residents now pursuing fellowships in neuro-critical care. These neuro-intensivists are trained to care for critically ill patients in the ICU.

Although there are many high-tech studies available to the neurologist, the history and physical exam still hold the greatest information for diagnosis. For this reason, neurologists successfully petitioned to bill for longer office visits (30-45 min) than most other specialties (15-30 min).

A large percentage of research is dedicated to the neurosciences. Recent advances in the way neurologic disease is diagnosed and treated have broadened the field to make it less purely diagnostic and more therapeutic. Neurologists now have more long-term follow up with patients. Yet, many of the brain’s mysteries remain untapped, resulting in countless research opportunities. In general, those who choose neurology as a specialty vary greatly in personality types. Applicants, however, all share a common fascination for how the brain works and its intricate connections with the rest of the body.

According to AAMC Careers in Medicine, starting salaries for neurologists in clinical practice range from $134,000 to $270,000, and starting salaries for neurologist in academic medicine range from $149,000 to $210,000 (January 2016).

How to pursue neurology training

  • Adult vs. Peds: The application processes for 4th year medical students differ, depending on if you want to become either a general adult neurologist or instead, a general pediatric neurologist. See the pediatric neurology tab on the left side of the screen.  
    1. Do you see children if you undergo training to become an adult neurologist? Depends. It is possible to see children with only adult neurology training if practicing in a rural community. ACGME requires an adult neurology resident to complete a minimum of 3 months of training in pediatric neurology. In addition, you could potentially treat children through various subspecialties of neurology, such as epilepsy, movement disorders, neuromuscular disorders, etc.
  • Adult Neurology Program Options: Neurology is part of the National Residency Matching Program (NRMP), and applicants provide information through the ERAS application. Neurology residency training includes 1 preliminary year and 3 years of neurology. Neurology residency programs are either categorical or advanced. There are also a few combined neurology/medicine (5 years), neurology/psychiatry (4-5 years) and neurology/neuroradiology (7 years) programs.
    1. Categorical programs are 4-year programs that include a preliminary year. These programs do not require a separate application for a preliminary year. Conducting your preliminary (as known as intern) year at the same hospital as the rest of your neurological training has many benefits, such as providing opportunities: 1.) to become acquainted with the hospital, staff, electronic medical systems, and other trainees and specialists outside neurology, and 2.) to complete up to 4 rotations in neurology during your intern year, which can allow you to become familiar with the neurology department and hit the ground running as a PGY2. In other words, you get started with neurology training sooner.
    2. Advanced programs are 3-year programs that do not include the first year of internal medicine (preliminary/intern year). These programs require a separate application for a preliminary internal medicine program. Some programs collaborate with internal medicine and are able to guarantee all of their residents spots in the preliminary internal medicine year. These programs often do not require a separate interview. Meanwhile, other programs are able to guarantee some but not all spots and may require a separate interview. You always have the option of doing your preliminary year elsewhere. For instance, you could do your internship in a community-based setting or closer to home. Of note, the neurology ACGME has specific requirements for the intern year (8 months of internal medicine or 6 months internal medicine + 2 months of peds/ER/FamMed). When making your rank list, each advanced neurology program will have an associated list of preliminary internal medicine programs that is linked to it.

    The Application Process

    On average, applicants apply to 15 to 17 programs, interview at 8 to 12, and rank 6 to 10. Applicants generally apply to a similar number of preliminary programs. Some preliminary programs will be linked to neurology programs; as a result, you may ultimately do fewer preliminary interviews. The sooner you can send out your applications, the better – the suggested target date is September 15th but the deadline set by individual programs varies – usually mid October through early December. Although transcripts and Dean’s letters are not sent earlier than November 15th, some programs will interview as early as October. Some programs stop reviewing applications as soon as they fill their allotted interview spots.

    Where to apply? Think geographically, and think research versus clinically-oriented. The Americal Academy of Neurology has an excellent web-site of resources for medical students interested in neurology residency. Becoming a member (free!) will also add a line to your CV. Also discuss with your mentors and set up a meeting with UMMC Neurology chair Dr. Stern, who is well known throughout the field, as well as the Neurology residency program director at UMB, Dr. Cronin, for advice on how to boost your application and which programs might be a good fit.

    Letters of Recommendation (LOR): Whether applying to college, medical school, graduate school, or residency, a strong LOR comes from someone who knows you and your accomplishments well. With that said, the basic recommended formula for neurology residency LORs is two letters from neurologists and one letter from an internist. Neurologists are a tight-knit community and tend to know one another more than some larger specialties. When asking for a letter, it is best to meet individually with the faculty member. You can achieve this by emailing them or their administrative assistants first. Have your CV and personal statement available.  If you are applying to advanced programs that require a separate application for a preliminary year, a representative faculty member from internal medicine will send out an email to your class during the end of 3rd year/early 4th year about setting up meetings to acquire a letter from the department of internal medicine. In addition, one of your letters can be from faculty that supervised any of your research experiences, work experiences, or extracurricular activities.

    Personal Statement: The program director has almost certainly read your personal statement carefully, as well as many of your other interviewers. It is a great way to show the department what you are all about. Have neurology faculty and/or residents review your personal statement before submission. It may be useful to have a variety of people review your personal statement, so that you can evaluate how your words come across to individuals with different personalities and experiences. Additionally, the University of Maryland, Baltimore has a Writing Center located in the SMC Campus Center that is an excellent resource for Personal Statement revisions. Appointments can be made online at www.umaryland.edu/writing/.

    The Interview Process

    Neurology interviews take place from October-January, with most interviews taking place in November and December. Most interview days consist of 4-6 interviews, including the chairman and program director, tour of the hospital, lunch with residents and/or faculty, grand rounds and/or a lecture, and a briefing from the program director about the program.

    How to excel during the interview? Have a LONG list of questions ready before attending the interview. You MUST have questions ready; if you don’t, you are clearly not interested in being there. Some good question topics include: research opportunities, weekly teaching conferences, Neuro-ICU exposure, outpatient subspecialty exposure, dedicated clinic time, elective opportunities, resident involvement with medical student education, faculty mentorship for residents, unique strengths of the program, and where graduates go after residency.

    Some programs will provide you with a schedule with your interviewers listed a few days prior to arrival. Research who they are and ask questions within that person’s scope. For instance, ask program directors about the residency schedule and set up, whereas ask the chairman about expected changes within the department and ask attendings about resident exposure to their particular subspecialty field. Common questions include how you became interested in neurology, describing any research experience or extracurricular experience you may have, recalling an interesting patient, or about your hobbies. It would help to re-read any abstracts or papers you’ve written. Make sure you know everything that is on your CV.

    Preliminary interviews can often be more challenging and less straight-forward than neurology interviews. Also keep in mind that other competitive fields require preliminary positions, like ophthalmology, radiology, dermatology, etc. Common questions to be asked include: what you are looking to gain out of your intern year, how you think internal medicine and neurology overlap, what are your proudest accomplishment, what is your greatest weakness, and what is an ethical predicament with which you were faced, etc.

    The Pre-interview Dinner: Most neurology programs provide a pre-interview dinner and/or a hotel room. The pre-interview dinners are a great chance to get to know the residents and to get a feel of how well you fit in with them. These dinners are an excellent time to ask the residents questions you would not ask the faculty! (Are the faculty good about teaching? Are you overworked/do you have a good balance of learning and seeing patients?). The dinners are definitely worth attending, and you should try to make it to as many as possible. If you have a spouse or partner and he/she is available, it would not be amiss to ask if he/she could also attend the dinner. Many programs really consider all aspects of a prospective applicant’s life in deciding who would be a good fit.

    Is neurology competitive?

    Neurology had not been a very competitive match in the past; therefore, class rank and honors are not as important as they are in many of the other specialties. However, this has changed in recent years as neurology has become more popular. High board scores and especially research are helpful for those who are interested in matching at academically oriented programs. However, clinically-oriented programs also look for well-rounded applicants.

    ABOVE ALL, BE YOURSELF, BEST OF LUCK!

    Last Revision: May 1, 2018