According to the Association of American Medical Colleges (AAMC) database, there are between 2,000 and 3,000 future neurologists looking to specialize in neurology each year. So what exactly does a neurologist do? How do you become one, and why should you consider becoming one?
So much more than just the brain
Neurology is a fascinating specialty that entails a wide breadth of all things neurological. So what does that actually mean? One of the most common misconceptions about the field is that the neurologists only deal with diseases of the brain. Our nervous system is comprised of much more than just the 3 pound organ; it also includes the spinal cord, the peripheral nervous system, the neuromuscular junction, and much more. Neurologists work with patients with diseases like Alzheimer’s Disease, epilepsy, cerebral palsy, migraine, pain, lower back pain, Guillain-Barre Syndrome, diplopia, and sciatica, stroke, to name a few. The majority of neurologists practice in an outpatient setting, but many pursue a hybrid model, especially in academia, where they spend several weeks each year attending the inpatient neurology service, spanning the general neurology, consults, or stroke service. The other end of the spectrum includes neurohospitalists and neurocritical care physicians, who are mainly involved with inpatient services.
Upon graduating from medical school in the US, one typically joins either a categorical or an advanced neurology residency program through the AAMC residency matching system. This post focuses on the adult neurology residency (there is a separate application process for child neurology residency). Adult neurology residencies are either...
- Categorical: A 4-year combined residency program where residents complete the 1-year mandatory internal medicine year, followed by the 3-year neurology residency program, in the same or affiliated institution. This is usually (but not always) the preferred choice to minimize having to move twice in one year.
- Advanced: A 3-year neurology residency program where residents typically have to secure a separate 1-year internal medicine year (commonly called the “prelim” year – short for preliminary internal medicine year). Some applicants prefer this if they want to maximize training at different institutions to widen their exposure, and/or prefer to stay near their medical school they are graduating from for personal reasons (e.g. couples matching, proximity to family, etc).
The majority of programs are becoming categorical programs. It is not uncommon to see programs that offer both options, where they designate a certain percentage of incoming residents into a categorical vs. advanced position.
In addition to the aforementioned misconception (re: neurologists only work with diseases of the brain), another common myth is that neurologists often diagnose the diseases, but cannot treat them. This cannot be further from the truth. Neurology is not just about localizing the pathology, but about how to intricately manage the disease, whether the management be curative, preventive, and/or maximizing the quality of life. It is true that certain types of insults to the nervous system cannot be undone and require lifelong management, but the same argument can be made for every other organ system. Furthermore, with the advent of clinical research, such as gene therapy for spinal muscular atrophy, diseases that were once considered “incurable” are making these descriptions obsolete.
Another common myth is that neurologists do not perform procedures. There are myriads of procedures that neurologists can perform, including lumbar punctures, Botox injections (for dystonia, sialorrhea, migraine, etc), nerve blocks, thrombectomies, and muscle biopsies.
What comes next?
After the 4 years of residency (1 year of internal medicine, followed by 3 years of neurology), well-above 90% of graduating neurology residents pursue fellowship training in their respective areas of interest, to become a sub-specialized neurohospitalist, neurointensivist, neuro-ophthalmologist, neuroimmunologist, epileptologist, strokologist, or others. Length of fellowship programs range from 1 to 4 years, and many fellowships have dedicated research track.
Is neurology the right path for you?
It really depends! I personally fell in love with the field of neurology because of the cerebral nature of the field, and the mentors (including residents and attending neurologists) I had the opportunity to work with during medical school; when I saw them interact with the patients, and share their passion for the field, it became clear to me that these were the physicians I want to emulate, someone who is caring, pensive, inquisitive, thorough, and cerebral. Furthermore, neurology arguably is one of the most exciting fields when it comes to translational research, so if you are driven by the inquisitive nature to understand how the nervous system functions, and how to manage issues that arise within the intricate neurobiological pathways, neurology may very well be the perfect fit for you!