Careers in NeurologyWhy consider Neurology?

What are the career options?How do I get there?

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Paul B. Pritchard, III, M.D.

Professor of NeurologyJanuary 26, 2006

What is neurology?

Neurology?

• Study of disorders of the brain, spinal cord, peripheral nerves, neuromuscular junction, and muscles.

• Includes care of pediatric and/or adult age groups.

• Diagnoses are as benign as tension headache and as lethal as amyotrophic lateral sclerosis (ALS).

What is a neurologist?

A neurologist?

• Thoughtful and logical. True enough.• Favor eponymous, obscure diagnoses,

preferably named in memory of some French physician, eg., Guillain-Barre syndrome.

• Diagnose and adios: can one really do anything about neurological disease?

• The latter two characterizations are not really the case.

Neurology then and now

• 1974: a 38 y.o. woman came into the ER with global aphasia and right hemiplegia.

• Dx/Tx plan: – make bedside

diagnosis – start an IV– hope and pray for

improvement

• 2004: a 38 y.o. woman, same story.

• Dx/Tx plan:– obtain history/exam– stat CT scan, labs– arteriogram, intra-

arterial tPA– 2 days later patient has

only mild facial weakness, occasional paraphasic error.

– Exam now normal.

What do neurologists do?

• Evaluate patients with possible neurological disorders.

• Perform studies which assist in diagnosis/treatment:– Lumbar punctures– EMG, nerve conduction studies.– Evoked potentials.– Sleep studies (polysomnography).– And in some cases: CT/MRI scans, epidural

blocks, video-EEG, Botox injections.

Training in Neurology

• One year of internal medicine.

• Three years of neurology.

• Two options:– combined program, eg., MUSC: 4 year

residency, with 10 months of internal medicine during the first year. Advantage: go through one match (NEMP).

– Separate internal medicine year, then 3 years of neurology. Disadvantage: 2 matches.

Medical Schools, MUSC Neurology Residents and Fellows, 2003-2004

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International:ColombiaGermanyHungaryTurkeyChina (2)India

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Director, Postgraduate Education

• “We are pleased to learn of your interest in the MUSC Neurology residency. Our residents are a diverse and highly capable group in whom we take considerable pride. If we may assist you, please contact us by telephone (843-792-3222), mail (Suite 307, 96 Jonathan Lucas Street, Charleston, SC 29425), or via email: pritchap@musc.edu. We look forward to seeing you at MUSC.”

Paul B. Pritchard, III, M.D.Professor of NeurologyDirector, Postgraduate Education

Board Certification

• Successful completion of 4 years of residency (IM + neurology). Take RITE years 2, 3, and 4.

• Pass written board exam given by the American Board of Psychiatry and Neurology (ABPN).

• Pass oral board exam given by the ABPN.

Subspecialty certificates for adult neurology offered by the ABPN:

residency + fellowship

• Clinical neurophysiology (EEG, EMG, evoked potentials, other monitoring techniques).

• Vascular neurology (vascular imaging and evaluation).

• Pain medicine (diagnostic and treatment procedures).

Other fellowship options

• Epilepsy.

• Critical care.

• Sleep medicine.

• Multiple sclerosis.

• Geriatric neurology.

• Movement disorders.

• Neuro-ophthalmology.

• Neuromuscular disease.

How many neurologists do we have? How many do we need?

• 1950: 1500.• 1970: 2400.• 1980: 4600.• 1990: 8100.• 2000: 11,000.• 2010: expect

plateau @ ~12,200.

• Kurtzke et al., (Neurology 36:1576-1582, 1986). estimate national need of 19,100 by 2010, i.e., availability = 6900 short of the need.

Why is the need for neurologists increasing at this rate?

• The general population is aging.

• Aging brings increased incidence of common neurological disorders, eg., stroke, epilepsy, and dementia.

• Availability of effective treatments for neurological disorders is growing rapidly.

Career prospects

• Private practice:– Outpatient only.– Combined outpatient/inpatient.– Critical care neurology: ICU, stroke unit.

• Academic practice:– Clinician/teacher.– Investigator/teacher.

• Industry careers, eg., pharmaceutical.• Mean income (Business 2.0, March

2003): $185,000.

What’s the attraction?

• Interesting diagnostic exercise.• Rapid advances in diagnosis and

treatment over past 25 years, with better things yet to come.

• Opportunity to help patients with problems as mundane as migraine and as obscure as Osler-Weber-Rendu.