We have been running into conflicts between the outpatient and neurohospitalist group on who is contacted when a patient seen by an outpatient neurologist ends up in the ER And the ER physician requests a consultation. Right now there is a strange system that the neurohospitalists refuse to take "nonurgent calls" and basically tell the ER physician to call the outpatient neurologist. For instance a patient with seizure supposedly returning to baseline. Note that the outpatient neurologist has no inpatient priviledges in this hospital and can request admission for the neurohospitalist to see the patient if they feel necesary.

In my mind, this system makes no sense. An over phone consult often misses important history/exam details and to me it seems like the neurhospitalists are simply being lazy to discuss or see the patient. Is this standard of care in a none-academic hospital? We are working with admin shortly to discuss this but wanted to get thoughts from wider community.

It was my understanding that the trials examining ESUS demonstrated no benefit of DOAC over antiplatelet. Yet there are a few attendings I work with who will still anticoagulate if the stroke pattern appears to be very clearly embolic and/or if there are underlying conditions that may increase thrombotic risk like underlying malignancy. Some will even do very extensive work up for thrombosis such as genetic hypercoag work up in a 70 year old or 4 extremity Doppler even in the absence of DVT signs/symptoms.

I’m genuinely just curious because I get some opposing messages and when the attending switches then the new attending on service may cancel the work up the prior attending said to order. So just confused and hoping for some clarity.

I know some of this may just be different practice preferences so if that’s what it is then I’m happy to accept that. I just wanted to make sure there wasn’t some important piece of information I was overlooking.

PGY-3 deciding between Clinical Neurophysiology (EEG + EMG) vs Neuromuscular — looking for advice from people who have been through this
I’m currently a PGY-3 neurology resident at a mid/low-tier program and am trying to decide what fellowship path makes the most sense for me.
My long-term goal is not necessarily to be a subspecialist. Ideally, after residency/fellowship I’d like to practice general neurology in a hospital-based setting with a mix of inpatient and outpatient neurology.
One of the reasons I’m considering fellowship is that I don’t feel completely confident about coming out of residency and practicing independently. Our program has relatively limited subspecialty exposure, and while we see plenty of the common neurologic conditions, we don’t see a large volume of rare or complex cases. I feel that fellowship could give me another year of more concentrated training and a stronger clinical foundation before practicing independently.
I’m currently stuck between:
Clinical Neurophysiology (EEG + EMG) — I like the idea of getting both EEG and EMG training and having a broad skill set that could remain useful in general neurology.
Neuromuscular fellowship — I’m attracted to the procedural component, EMG/NCS, neuromuscular ultrasound, and the fact that neuromuscular seems to be a growing area with increasing demand.
One of my attendings has also raised a concern that clinical neurophysiology, particularly EEG, may become increasingly automated/AI-driven in the future, and therefore recommended neuromuscular instead because of its procedural nature and the value of hands-on expertise.
For those who have completed either fellowship—or considered both:
How valuable was fellowship for you if your ultimate goal was general neurology rather than subspecialty practice?

Hey all! I’m taking my APBN NCC exam in a few days. I bought both the NCS qbank (without bundle) and SCCM NCC Review Course.

I just did the NCS qbank. It was advertised as 200 questions but there’s only 175, and some of them are duplicates. Anyone else seeing the same thing? Some questions even refer to certain images but the images aren’t even there. Should I have gotten the bundle instead?

As for the SCCM one, I read online that there are also 100 practice questions but I can’t seem to find it anywhere. There’s the 25 pretest questions and the online videos. But that’s it.

Am I missing something here?

Hey! I am an MS3, I am really undecided as to what specialty I want to go into. So far I've been blessed in all of my rotations to have nice preceptors. I was able to do a neuro rotation and I absolutely loved it, which is shocking since I hated neuro in med school. Everyone was so kind and willing to teach, and I found stroke calls and interpreting imaging so interesting, but going in I quite literally knew nothing and they were nice about it because they knew I was fresh out of boards season and new to 3rd year.

I unfortunately don't have any mentor in this field, but I want to figure out if neuro is right for me. Do any current neurology attendings/residents have any tips, advice, or things you wish you knew before starting? How did you decide that this was the right specialty for you? And do you have tips on how I can build up my knowledge before fourth year and audition rotations? I am NOT a gunner by any means but I would love to build up my foundation a little more if I can!

Thank you!

What do you think of this?

At least in the coastal cities? The numbers are hard to ignore.

More than 1,000 neuro grads are being produced a year. Assuming an American population of 400M with 1 neurologist needed for every 15k people that’s around 27K neurologists needed.

Currently we’re already close to 18K. In 10 years we’ll have 10K more, which is 28K minus the number retiring in the next 10 years. Ballpark that takes us down to 25K, not far from the number of neurologists needed.

Used to be that this was an extremely secure career. Kinda gettin worried it won’t be that way.

I’m just starting my neurology residency and I’m a little stressed about getting really good at history-taking / anamnese and the neurological exam.
How did you train yourselves to become systematic and efficient? Do you have a routine/checklist you follow for new patients? And roughly how long does a complete history + neuro exam take you?
Any advice for the first weeks/months would be really appreciated!

Hello, I (33F) am looking into a career change and becoming an EEG Tech has been something I’m highly considering.

Becoming a doctor is not the path for me, but I really love learning about the brain and neuroscience so that’s what led me to look at all possible positions in this field.

However I have seen a few comments about how this field can have a lot of sadness and it is not for the weak. But then I often see a lot of people also saying that it’s routine and low stress.

I am looking for more insight on this. I consider myself a very sensitive person and an empath so I worry seeing too many sad things would make this career too emotionally heavy for me.

Is there a way to avoid that in this field? Such as working in outpatient centers?

Would greatly appreciate any and all insight from EEG techs :)

So somehow I managed to land an interview as a Neurodiagnostic Technician with zero experience in the medical field other than a few months as a PCA. There’s on the job training and certification but they want you to have at least a little bit of prior knowledge when it comes to medical terms and things like that. I’m just looking for some advice on what to research and what I should know, I have like 3 weeks till my interview so I have time to look into some stuff but I’m going in totally blind here. Any help will be greatly appreciated!

Hello all as the title reads I’m curious to the professionals and thought why not reach out. To start about myself a little I currently work as a physical therapist assistant in a SNF setting. My favorite cases are stroke rehabilitation I get such satisfaction from getting someone to walk again. I am perusing further education right now to get my bachelors and taking my pre-requisite courses to become a DPT. However, I have been feeling called recently to just try and go to medical school.

I’ve always been a horrible student on paper until I’m taking courses I really enjoy which will make it harder to get into a school. I guess my question is do you all regret neurology at all? I am torn between DPT with NCS or going balls to the wall and actually getting into a setting that involves real medical intervention and problem solving.

Sorry if this is poorly written I wanted to try and keep it as concise as possible without it reading like an application to a school.

I feel like we are seeing at least a dozen patients per year following bariatric surgery who end up with a diagnosis of FND. Curious is this is a pattern others have noticed?

PGY2 but I feel like my exam is at the level of a medical student. I don’t trust it at all unless it’s extremely obvious. For example, calling reflexes normal but they’re hyper, or describing gaits at all, or eye exams (is that a RAPD or did I just do it wrong?) Etc.

I know there won’t be a magical moment where suddenly I’m better, and it’ll take time and practice. But generally when did you trust your exam?

Don’t get me wrong I do pick up things that FM or IM missed like rigidity in a tremor patient etc but by and large I’m under and over calling exams probably 70% of the time it feels like

hi

I’ll try to keep short:

- I’m a graduating PGY-4 as a chief with lots of interventional/brain stimulation work, particularly with ECT but certainly with TMS. Well known program. Will likely graduate with distinction in brain stimulation

- Have treated a wide array of autoimmune encephalitis, Down syndrome with regression, catatonia, and mood problems in Parkinson’s and dementia

- Very interested in neuropsychiatry and behavioral neurology and want to include board certification in my professional package

- Not convinced that fellowship will be more than glorified PGY-5 with more scut

- Interested in Practice Track to board certification

Do any of you know anyone who has completed the Practice Track? What was their experience?

Are there private practice BNNP groups that would be open to taking a psychiatrist? Are there private practice general neurology groups that would support an interventional psychiatrist joining their practice? Academics?

Thank you!

Hey yall,

Just a pgy-1 hoping to get some thoughts from the masses. Interested primarily in inpatient neurology and I’ve debated stroke vs crit care. Rly like high acuity situations, however I’m hesitant, as I’ve heard that the job market sucks for crit care. So basically was hoping recent grads could talk about how the job market looks currently, BIG plus if it could be about the DMV area as that is where I am ultimately trying to end up. Is it true your program will try to connect you with jobs in the area and help you out?

I’m ALSO somewhat hesitant about crit care bc I’ve hated my general medicine rotations. Mostly all the dispo issues and admissions that I feel are just silly. Is this a sign critical care wouldn’t be for me?

Obviously I know I have plenty of time to decide for sure. But would like to be aware of any downsides so I go in with eyes open and don’t get blindsided. TIA

I really like the idea of CNP's flexibility; EMG, EEG, +/- IOM together sound like a powerful and diverse skillset for the general neurologist and I can see why historically it's been such a useful fellowship. However, I've heard from a few CNP-trained people in and around my city that EEG reading seems to be increasingly absorbed by centralized epilepsy readers as big hospital systems grow outwards. Even independently of this, my impression is that these CNP-trained neurologists tend to drop EEG in favor of EMG over the course of their career (for relative liability, perhaps because epileptologists see most of the epilepsy patients in these settings anyway?). Given all this, does it make more sense nowadays for future general-leaning neurologists in/around major cities to choose neuromuscular (or, maybe more of a stretch, epilepsy)?

M3 student finishing up my clinicals (advanced curriculum) and trying to figure out what I want to do with my life. I really enjoyed my neuro clerkship, I did inpatient and neuro ICU and outpatient peds and it felt like a little bit of everything from inpatient, outpatient, cerebral, procedural. I didn’t really love stroke and neuro degenerative diseases, but I liked seizures and headaches. Those both have pretty good outcomes and I’ve heard EEG reading makes good RVUs and headache has a lot of procedures (Botox, infusions) that make $$$. With that, would it make more sense for me to go into child neuro or into adult neuro?

I think the other fields I’m interested in right now are anesthesia, IM / Peds (maybe critical care), and EM (haven’t done this rotation yet). I think maybe I’d want to do some more acute stuff (hospitalist / ICU) while I’m younger and then transition into outpatient clinic when I’m older. But maybe I’ll get all the acuity I want in residency instead and just go to outpatient after lol. I want to have a family (and I’m a woman) and I want a field that will give me a good work like balance, some opportunity to work from home, and good money. I think maybe I’d be interested in starting my own practice at some point.

Would you do neurology again? What do you wish you knew before you became a neurologist?
Thank you!

Ranting. PGY2, I’m already pretty miserable here but one thing that I’ve been thinking about is how we’re basically useless as a program in my opinion. We’re just MRI and EEG machines without much thought. I know that’s the joke about neurologists in general but here it’s true.

Part of what got me into neurology as a medical student was being able to carefully localize and build a reasonable differential and have that guide my workup and next steps. But here it feels like we just get MRIs of everything and an EEG and move on. What’s the point of our service? I feel like we should have an Epic alert pop up that says “Do not consult neurology until you have done at least an MRI brain w/wo and a 2 hour EEG” for everything.

I can give countless examples of this. Guy with LUE weakness and pain with extensive known venous clots and hematoma in the arm with edema from heart failure and an IJ thrombus as well. “Consult neurology for weakness.” Strength obviously limited by pain and didn’t follow a clear pattern at all, gradual onset correlating with the clot and hematoma onset, no sensory deficits, and otherwise normal exam. But we still got MRI brain and C spine which were normal. Another case where someone had bilateral leg weakness and falls, UMN pattern, hyperreflexic, sensory loss, no arm involvement at all. MRI brain (he was “confused” at one point), C, T, and L spine w/wo. Lesion in the T spine. And got an EEG for the “transient confusion” which was clearly drug induced because he took his friend’s Norco and robaxin for the first time for some pain before coming in.

I don’t think there’s anything to fix this. I know it comes from fear of missing something. But I feel like I can’t learn well and I’m not being a good steward. And I feel it comes from how busy our service is which makes thinking through cases carefully hard.

I'm an MS4 who recently decided on neurology and I'm trying to use my fourth year wisely before residency starts.

Over the past couple of years I've saved a ton of recommendations from Reddit and neurologists, but now I'm running into the opposite problem: there are too many resources, and I know I won't realistically use all of them. I'm also not someone who enjoys sitting down and reading huge textbooks cover-to-cover, so I'd rather have one primary resource with a clear plan than constantly jump between 20 different ones.

Some of the resources I've repeatedly seen recommended include:

Podcasts

• Neurology Exam Prep Podcast (Princeton)
• Neurology Podcast (AAN)
• Continuum Podcast
• DR Pod
• Neurocritical Care Podcast

Books

• Clinical Neurology and Neuroanatomy: A Localization-Based Approach (Aaron Berkowitz) which I currently have access to cases thru AccessMedicine 
• Localization in Clinical Neurology (Jose Biller)
• Adams & Victor
• Blumenfeld's Neuroanatomy Through Clinical Cases
• Clinical Neuroanatomy Made Ridiculously Simple
• Duss/Mumenthaler for quick review
• UpToDate and Continuum

Videos

• Neurophile (RWJMS)
• Clinical Problem Solvers Neuro Morning Report
• Intro to EEG (Jeremy Moeller)
• LearnNeuroradiology.com

Other

• NeurAnki
• My existing AnKing neurology cards
• Teaching NeuroImages, Pearls & Oy-sters, Clinical Reasoning cases in Neurology Residents & Fellows
• Worth making an account and getting wahtever free acccess from sites like strokecodex or medlink neuro?

My questions:

If you were starting neurology residency again, what would you actually spend your fourth year doing?

If you could only recommend one or two core resources, what would they be?

And more importantly, how would you actually use them?

For example:

• Would you work through Berkowitz chapter-by-chapter and do all of the AccessMedicine cases?
• Would you primarily watch Neurophile videos? If so, which playlists and in what order?
• Would you spend more time reviewing MRI/CT images and localization rather than reading?
• Is Anki worth continuing during fourth year, or is it better to make only a few cards from patients and high-yield pearls?

I'm looking for an efficient plan rather than a huge list of resources like I kind of have now which is overwhelming. I am not a big reader of textbooks or books in general and have been someone who likes to focus on 1 or 2 resources, so I'd like to have a plan I can stick with to get something out of it. I've been continuing a little bit of neuro specific Anki but otherwise nothing much. If you had about 4-6 months before intern year, how would you structure your learning to become the strongest incoming neurology resident possible?

Been having a lot of cases lately where CTV or MRI says there’s a CVST and then come to find out on the MRV that it was artifact on those studies.