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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
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What is neurology?
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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).
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What is a neurologist?
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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.
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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.
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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.
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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.
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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: [email protected]. We look forward to seeing you at MUSC.”
Paul B. Pritchard, III, M.D.Professor of NeurologyDirector, Postgraduate Education
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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.
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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).
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Other fellowship options
• Epilepsy.
• Critical care.
• Sleep medicine.
• Multiple sclerosis.
• Geriatric neurology.
• Movement disorders.
• Neuro-ophthalmology.
• Neuromuscular disease.
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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.
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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.
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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.
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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.