Neurology

Neurology is a specialty devoted to the function and dysfunction of the nervous system, including motor and sensory functions, cognition, and sleep. The wide array of neurological diseases warrants many subspecialties including: headache, stroke, epilepsy, neuroimmunology (e.g. multiple sclerosis), movement disorders (e.g. Parkinson’s disease), cognitive/behavioral disorders (e.g. Alzheimer’s), neuromuscular disorders (e.g. ALS, myasthenia gravis, muscular dystrophy, Guillain-Barre, etc.), neuro-oncology, neuro-ophthalmology, neuro-otology and vertigo, sleep, neuro-infectious disease, pain, neuro-radiology, sports neurology, trauma, neurocritical care, and interventional neurology/neuroradiology. Neurologists can pursue one or more fellowships to gain expertise in one of these subspecialty areas, which are generally 1 to 2 years long but vary by specialty. Although subspecializing is becoming more common, neurologists need not pursue fellowship training in order to practice.

There are many different career paths within the field of neurology, and you can choose between almost any mix of inpatient, outpatient, clinical work, research, and teaching. Some neurologists pursue faculty positions in academic institutions to pursue basic science/translational research, clinical research, teaching, and/or administrative duties in addition to clinical practice. Others pursue community practice via private/group practice, “privademics”, or other non-academic organizations. Traditionally, much of their time is spent in the outpatient setting. However, some neurologists take call at local hospitals and see inpatients as a consultant. There are few full-time neuro-hospitalists that attend on a Neurology Ward or Consult-Only service, but the field is trending in that direction. Additionally, as with other medical specialties, there are individuals who pursue non-traditional non-clinical routes including industry, consulting, and government. In short, residency training in neurology opens many doors to various future careers.

For those interested in research, a large percentage of research is dedicated to the neurosciences, which is expectedly broad. Recent advances in the way neurological diseases are diagnosed and treated have broadened the field to make it less solely diagnostic and more therapeutic. Neurologists now have more long-term follow up with patients. Yet, many of the brain’s mysteries remain untapped, resulting in countless research opportunities. In general, those who choose neurology as a specialty vary greatly in personality types. Applicants, however, all share a common fascination for how the brain works to construct the mind and for its intricate connections with the rest of the body to regulate function.

Neurology also offers the opportunity to combine detailed history taking and physical examination skills with a large arsenal of diagnostic tools including neuroimaging, lumbar puncture, electromyography, electroencephalography, etc.

According to AAMC Careers in Medicine, average starting salaries for neurologists in clinical practice range from $255,000 to $395,000 (Merritt Hawkins 2018), and average starting salaries for neurologists in academic medicine range from $181,000 to $312,000 (AAMC 2018). The average hours worked per week, which again will vary based on practice setting, is 50.8 hrs.

• Adult vs. Peds: The application processes for 4th year medical students differ, depending on if you want to become either a general adult neurologist or instead, a general pediatric neurologist. See the pediatric neurology tab on the left side of the screen.   
  1. Do you see children if you undergo training to become an adult neurologist?

     Depends. It is possible to see children with only adult neurology training depending on subspecialty (e.g. epilepsy, movement disorders, neuromuscular disorders), practice setting, availability of pediatric neurologists, etc. ACGME requires an adult neurology resident to complete a minimum of 3 months of training in pediatric neurology.

• Adult Neurology Program Options: Neurology is part of the National Residency Matching Program (NRMP), and applicants provide information through the ERAS application. Neurology residency training includes 1 preliminary year of internal medicine and 3 years of neurology. Neurology residency programs are either categorical or advanced. There are also a few combined neurology/medicine (5 years), neurology/psychiatry (~6 years) and neurology/neuroradiology (7 years) programs.
  1. Categorical programs are 4-year programs that include a preliminary year at the same hospital. These programs do not require a separate application for a preliminary year. Conducting your preliminary (also known as intern) year at the same hospital as the rest of your neurological training has many benefits, such as providing opportunities: 1.) to become acquainted with the hospital, staff, electronic medical systems, and other trainees and specialists outside of neurology, 2.) to complete introductory rotations in neurology during your intern year, which can allow you to become familiar with the neurology department and hit the ground running as a PGY2, and 3.) to minimize the number of moves needed post-graduation.
  2. Advanced programs are 3-year programs that do not include the preliminary/intern year. These programs require a separate application for a preliminary internal medicine program. Some programs collaborate with their internal medicine department and are able to guarantee all of their residents spots in the preliminary internal medicine year. These programs often do not require a separate interview. Meanwhile, other programs are able to guarantee some but not all spots and may require a separate interview. This is important information to pay attention to closely when researching programs as it is program specific.

  You always have the option of doing your preliminary year elsewhere. For instance, you could do your internship in a community-based setting or closer to home. Of note, the neurology ACGME has specific requirements for the intern year (8 months of internal medicine or 6 months internal medicine + 2 months of peds/ER/FamMed). When making your rank list, each advanced neurology program will have an associated list of preliminary internal medicine that is linked to it.

On average, applicants apply to 15 to 17 programs and interview at 8 to 12. Per the NRMP’s “Charting Outcomes in the Match 2018” the average number of programs ranked is 11.7. Your MSPE advisor from the OSA will go over this with you on a case-by-case basis.

Applicants generally apply to a similar number of preliminary programs. Some preliminary programs will be linked to neurology programs; as a result, you may ultimately do fewer preliminary interviews.

Applications should be submitted on September 15th, which is when ERAS opens for submission. Although transcripts and Dean’s letters are sent later on in the application cycle, some programs will interview as early as October. Some programs stop reviewing applications as soon as they fill their allotted interview spots. As such, keeping track of emails and responding promptly is in your best interest to be guaranteed an interview spot.

This is a very personal choice and should be multi-layered. Aspects to consider include but are not limited to: research or not research-oriented programs, geography and cost of living, categorical vs. advanced, fellowship/subspecialty availability, distribution of inpatient vs. outpatient rotations, availability of early subspecialty clinic exposure, number of residents, night float vs. 24+-hour call, etc.

The American Academy of Neurology has an excellent web-site of resources for medical students interested in neurology residency. Students applying to neurology should becoming a member (free!), which will also add a line to your CV. Also discuss with your mentors and set up a meeting with UMMC Neurology chair Dr. Crino, who is well known throughout the field, as well as the Neurology residency program director at UMB, Dr. Cronin, for advice on how to boost your application and which programs might be a good fit.

A strong LOR comes from someone who knows you and your accomplishments well. Most programs want 3-4 LORs. The basic recommended formula for neurology residency LORs is two letters from neurologists and one letter from an internist. In addition, one of your letters can be from faculty that supervised any of your research experiences, work experiences, or extracurricular activities. Some programs want a Chair letter, but this may not be an absolute requirement and so should be researched on a program-by-program basis via their websites. Neurologists are a tight-knit community and tend to know one another more than some larger specialties. When asking for a letter, it is best to meet individually with the faculty member. You can achieve this by emailing them or their administrative assistants first. Have your CV and personal statement available. If you are applying to advanced programs that require a separate application for a preliminary year, a representative faculty member from internal medicine will send out an email to your class during the end of 3rd year/early 4th year about setting up meetings to acquire a letter from the department of internal medicine.

The program director has almost certainly read your personal statement carefully, as well as many of your other interviewers. It is a great way to show the department what you are all about. Have neurology faculty and/or residents review your personal statement before submission. It may be useful to have a variety of people review your personal statement, so that you can evaluate how your words come across to individuals with different personalities and experiences. Additionally, the University of Maryland, Baltimore has a Writing Center located in the SMC Campus Center that is an excellent resource for Personal Statement revisions. Appointments can be made online at the  Writing Center.

Neurology interviews take place from October-January, with most interviews taking place in November and December. Most interview days consist of four to six 15- to 30-minute interviews, including with the chairman and program director, a tour of the hospital, lunch with residents and/or faculty, grand rounds and/or a lecture, and a briefing from the program director about the program.

Have a list of questions ready before attending the interview. This will not only be informative for you but will also convey your interest. Some good question topics include: research opportunities, weekly teaching conferences, Neuro-ICU exposure, outpatient subspecialty exposure, dedicated clinic time, elective opportunities, resident involvement with medical student education, faculty mentorship for residents, unique strengths of the program, and where graduates go after residency.

Some programs will offer you the opportunity to request meetings with particular faculty. Others provide you with a schedule with your interviewers listed a few days prior to arrival. Others will wait to give you the schedule the day of the interview. If given a list, research who they are and ask questions within that person’s scope. For instance, ask program directors about the residency schedule and setup, whereas ask the chairman about expected changes within the department and ask attendings about resident exposure to their particular subspecialty field. Common interview topics include describing how you became interested in neurology, describing any research experience or extracurricular experience you may have, recalling an interesting patient, or talking about your hobbies. It would help to re-read any abstracts or papers you’ve written. Make sure you know everything that is on your ERAS application. If you have any potential red flags or hiccups on your application, be prepared to answer any questions about these as well.

Preliminary interviews can often be more challenging and less straight-forward than neurology interviews. Also keep in mind that other competitive fields require preliminary positions, like ophthalmology, radiology, dermatology, etc. Common questions to be asked include: what you are looking to gain out of your intern year, how you think internal medicine and neurology overlap, what are your proudest accomplishments, what is your greatest weakness, what is an ethical predicament with which you were faced, and to recall a memorable patient, etc.

Most neurology programs provide a pre-interview dinner and many provide a hotel room.The pre-interview dinners are a great chance to get to know the residents, to get a feel of how well you fit in with them, and to eat yummy food! These dinners are also an excellent time to ask the residents questions you would not ask the faculty. For example: are the faculty good about teaching? Are you overworked/do you have a good balance of learning and seeing patients? The dinners are definitely worth attending, and you should try to make it to as many as possible. Some programs open the invitation for significant others as well, and so feel free to take them up on this offer. Many programs really consider all aspects of a prospective applicant’s life in deciding who would be a good fit.

Neurology had not been a very competitive match in the past. Therefore, USMLE scores, class rank, and honors are not as important as they are in many of the more competitive specialties. However, neurology has become more popular in recent years and its competitiveness has increased, especially at academic/research-oriented programs. Average Step 1 score: 230. Average Step 2 score: 242. Percent AOA: 12.3. However, clinically-oriented programs, and really all programs, look for well-rounded applicants. Dr. Cronin and Dr. Crino, as well as other Neurology faculty member or MS4 on campus are able to offer insight into whether or not you’d be a competitive applicant for any given program. When assessing your own competitiveness, try not to be drawn down the rabbit hole of blogs/websites such as Reddit or Student Doctor Network. If so advised, confidently apply to programs in which you are interested – the worst thing that can happen is that you will not receive an interview.

ABOVE ALL, BE YOURSELF, BEST OF LUCK!

Last Revision: February 5, 2020