Careers in Neurology

1
Careers in Neurology

• Why consider Neurology?
• What are the career options?
• How do I get there?
• --------------------------------------------------
  --------------------------------------------
• Paul B. Pritchard, III, M.D.
• Professor of Neurology
• January 26, 2006

2
What is neurology?
3
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).

4
What is a neurologist?
5
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.

6
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.

7
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.

8
(No Transcript)
9
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.

10
Medical Schools, MUSC Neurology Residents and
Fellows, 2003-2004
.
.
.
International Colombia Germany Hungary Turkey Chi
na (2) India

.
.
.
..
.
.
.
11
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 [phone]), mail
  (Suite 307, 96 Jonathan Lucas Street, Charleston,
  SC 29425), or via email pritchap_at_musc.edu. We
  look forward to seeing you at MUSC.

Paul B. Pritchard, III, M.D. Professor of
Neurology Director, Postgraduate Education
12
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.

13
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).

14
Other fellowship options

• Epilepsy.
• Critical care.
• Sleep medicine.
• Multiple sclerosis.
• Geriatric neurology.
• Movement disorders.
• Neuro-ophthalmology.
• Neuromuscular disease.

15
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 _at_ 12,200.

• Kurtzke et al., (Neurology 361576-1582, 1986).
  estimate national need of 19,100 by 2010, i.e.,
  availability 6900 short of the need.

16
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.

17
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.

18
Whats 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.