Neurology

What are some important statistics around the specialty?

One out of three people are affected by a neurological disorder (WHO).

What general advice do you have for someone choosing this specialty?

Neurology is one of the few fields that still relies on physical exam; the science is also changing quickly with new treatments and diagnostic methods

What are the top three areas that students can focus on to help prepare themselves for a successful residency application and a successful transition to residency? 

USMLE scores, a letter of recommendation that states they exhibit professionalism and are a good team player, and research in Neurology.

What resources would you share with a student who is just starting to research their interest in this specialty and/or wants to learn more specifics of this specialty?

AAMC offers a lot of information in the (Prepare for Residency) section and the (Choose Your Specialty) section

American Academy of Neurology (AAN) American Board of Psychiatry and Neurology

American Neurological Association (ANA), National Institute of Neurological Disorders and Stroke, Society for Neuroscience, World Federation of Neurology

The best way to know what you like is to do rotations in that specialty. Neurology is very large, and there are a lot of differences between inpatient and outpatient work. Make sure you rotate in both settings to get a feeling for the workday.

Ask the Residents what their workday looks and feels like.

What subspecialties exist with this specialty?

Vascular neurology, interventional neurology, epilepsy, headache, neuromuscular, neuro-ophthalmology, neuro-otology, neuroimmunology, neurology in women, movement disorder, neuro-oncology, neuro-intensive care, pain management, etc.

What does a typical workday or work week look like (hours/schedule/shifts, work setting, team-based environment, acuity, etc.)?

Neurology can be subcategorized into two domains: inpatient and outpatient. In most academic centers, neurologists do a combination of both inpatient and outpatient work. You can choose to do both or either.

Most outpatient neurologists have a 9-5 workday where they see stable patients either for the first time or for follow-up visits. Many people practice general neurology, which means they see all kinds of neurological complaints; others see patients only in their subspecialties. The most common subspecialties are:

1. Epilepsy: Mainly outpatient; Neurologists see patients in clinic for the first time or follow up, manage their medications and devices, and read EEGs. They can also have a comprehensive clinic with neurosurgery and neuropsychology for surgical candidates to prepare for epilepsy surgery.

2. Neuromuscular: Mainly outpatient; Neurologists see patients with peripheral neurological systems; the most common complaint is polyneuropathy. Most have an ALS clinic where they see patients with therapists. Most do EMG/NCS

3. Movement disorder: Mainly outpatient. The most common disorder is Parkinson's disease. Neurologists see patients and adjust their devices like DBS (deep brain stimulator), and also refer to neurosurgery for deep brain stimulator placement when the patient is a good candidate.

4. Headache: Mainly outpatient. The most common is migraine. Neurologists do medication management and procedures like Botox injection and occipital nerve block

5. Sleep: Mainly outpatient, where neurologists see patients with sleep disorders and read sleep studies.

6. Pain: Mainly procedure-based and medication management.

7. Neuro-ophthalmology: For disorders in vision that are related to the brain.

8. Neuro-otology: Mainly sees vertigo patients.

9. Neuroimmunology: They mainly see multiple sclerosis patients and manage their medications; most work in an infusion center.

10. Neuro-oncology: For tumors in the brain, either primary or metastatic.

Inpatient neurologists see patients who are admitted to the hospital; most work on a shift-based schedule. Inpatient neurologists work weekends and holidays. The most common subspecialties are:

1. Neuro-intensivist works in ICU, takes care of neurological patients who need ICU care, mainly brain bleeds, subarachnoid hemorrhages, strokes post TNK or thrombectomy, status epilepticus, myasthenia gravis crisis, and post-surgical patients.

2. Stroke neurologists: work mainly with patients but can also have clinics for follow-ups. See all stroke and brain bleed patients in the hospital, make decisions for thrombolysis and thrombectomy, work in close relationship with the neuro ICU, neurosurgery, and neurointervention.

3. Neuro-interventionists mainly perform procedures for neurology patients, like thrombectomy, aneurysm coiling, angiogram, etc.

4. Neuro-hospitalist works only in the hospital, shift-based, and sees all neurology patients who are admitted to the hospital.

What are the important traits, qualities, and/or considerations recommended for physicians in this specialty?

Patience, good exam skills, empathy, and understanding how the brain works.

How does the specialty work differ in various settings (e.g., a private vs a community vs an academic environment)?

Community jobs usually involve general neurology. It is hard to find a community job that offers subspecialty opportunities, while most academic places offer at least part-time subspecialty opportunities.

What does training for this specialty look like? 

Neurology is a four-year residency: one preliminary year, and three in Neurology.

Most Neurology programs are categorical; some of them are still advanced.

Most Neurology residency programs are academic, with a few that are community-based.

What types of experiences might strengthen my future residency application, especially in areas of service, leadership, and research?

Community outreach programs and volunteer work are great places to start. Additionally, research in Neurology and being part of a neuro-interested group in medical school are also beneficial experiences.

Is there a specialty interest group? If not, what other networking options would you recommend? Are there any specific national organizations or committees I should join? 

Yes, also research opportunities through the Waterfall Program.

Please reach out to James Bates - jamesbates@arizona.edu or Annalise Bracher - arb116@arizona.edu if you are interested in joining Waterfall.

What advice would you offer MS1s and MS2s who are interested in this specialty? 

Start a project in an area you are interested in, trying to answer a question you have. I am happy to guide you on whom to reach out to for the project, depending on the subspecialty.

How and where can I find other mentors for this specialty?

Waterfall Program and your CSA.

Is there anything else in addition to the suggestions above that could aid my future application, now that Step 1 is P/F?

Strong grades and a Step 2 average of 247.

Which group and association memberships might strengthen my future residency application (e.g., AOA, GHHS, MSG, specialty-specific groups, etc.)?

All of the above.

How important are Step 2 scores to this specialty?

Vital.

Are publications important to this specialty? Is there a general number of publications or presentations I should be aiming for? How important is it for these to be within the specialty I am pursuing?

All publications are great, especially if they are neuro-specific. They are not essential, but they strengthen the application.

Are there any special considerations when applying for residency?

My advice is to stay close to family or a support group, as residency is challenging. Make sure you get along with the current residents and share the same philosophy in life. Make sure the program offers mentorship.

What is a general recommendation for how many programs to apply to (recognizing that this may vary based on student situation)?

This depends on the number of applicants and the number of spots in any given year. The change to virtual interviews has also played a role in this.

On average, US MD students interview in 10 programs and apply to 43 programs on average (NRMP data).

What letters of recommendation are recommended for this specialty?

Students are allowed to send up to 4 LORS to the programs. We need at least, and you can submit up to 6. They don't all have to be from neurologists, but at least one has to, and the more neurology letters the student has, the better it is. We do read all LORs you submit; they can be from any other specialty.

If other disciplines are appropriate for letter of recommendation writers, are there specific specialties you would strongly recommend? 

N/A

How competitive are the residency programs in this specialty?

Neurology is not a very competitive specialty, but we are very selective in choosing residents. We aim to find people who have a passion for neurology, who have good abilities to explain disease, and who spend time doing a detailed neuro-exam.

Median Step 2 score is 247.

When do programs typically offer interviews?

October-December.

What is UA COM-P's history with matching in this specialty?

All our students who applied for Neurology in 24-25 matched successfully!

Are away rotations required for this specialty, and if so, when should I plan to do them?

They are not required.