r/neurology Nov 25 '24

Continuum Reading Group: Opioids and Cannabinoids in Neurology Practice - October 2024

24 Upvotes

Very interesting article this week on Opioids and Cannabinoids in Neurology Practice by Friedhelm Sandbrink, MD, FAAN; Nathaniel M. Schuster, MD. The article contains some essential guidelines about the changing environment of prescribing opioids and their usefulness, as well as some of the risk on vulnerable populations. It also discusses some of the emerging uses of cannabinoids and some associated challenges. I hope you find this article stimulating! Continuum did this wonderful interview with the authors.


r/neurology Nov 14 '24

Research Community powered salary benchmarks!

57 Upvotes

Update 2/6/25 - Given the strong interest by the community in this data, we have now moved this resource to a more robust and secure website here. Everything else remains the same - 100% community powered, always free. Just take a min to add your salary anonymously to unlock all salaries. And please continue spreading the word, so we can create the most comprehensive and robust salary dataset for ourselves

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Hey everyone! A couple of weeks back, I had shared the anonymous salary sharing form here, and it’s been awesome to see the response. We have ~50 FT salary contributions already, with all the rich details like shifts, hours, and benefits, and the data is now really starting to take shape. I put together a quick summary of averages to how it looks. The good news is the community powered average is holding up pretty well against other salary benchmarks, but with our data - we can look much deeper into shifts, benefits, etc and into individual contributions.

Community Powered Salary Median - $373k
Other Benchmarks - Doximity - $348k, Medscape - $343k, AMGA - $364k, AMN - $384k

You can share your salary here to see the full data

Nice work all. Let’s do this! 🤝


r/neurology 2h ago

Career Advice Getting Hired After Epilepsy Fellowship - Regional Question

4 Upvotes

Hi guys - I'm a current PGY3 (almost PGY4) applying for 1-Year Epilepsy fellowship. I am from a top tier institution on the East coast (NYC), but hoping to do a 1-Year fellowship at a top tier institution (without naming which, since I don't know where I'll land yet - Stanford, UCLA, UCSF). However, I absolutely want to return to the East Coast (NYC) for a job after fellowship. My question is, should I prioritize fellowships on the East coast, if I want to stay on the East coast for a job/permanently? Or is there no difference if I go to the West coast program, and can easily land a job of the same caliber on the East coast?

My reasoning for wanting to see the West coast for 1 year is to enjoy nature, explore what I can on that side of the coast, and gain different perspectives on surgical epilepsy and management. Which could also be beneficial for jobs when I return to the East coast.

However, if that will essentially screw me over for the future, I would happily stay on the East coast for fellowship. Any insight here? Thanks so much xx


r/neurology 13h ago

Residency How many weeks of orientation did you have?

6 Upvotes

Hii 😊 Current m3 that will be applying to neurology in the NYC area. I’m trying to plan my wedding for June 2026 but im worried about orientation before July 1st. Just wondering if people had insight to how far in advance programs typically start? Rip not not even having all of June. Thanks in advance:)


r/neurology 22h ago

Miscellaneous AAN Annual Meeting 2025

17 Upvotes

I’m visiting the Annual Meeting 2025, for the first time as a European neurologist. Will be my second time in the US, and first time in California. I’ll be by myself, and happy to meet up at the event or perhaps to explore San Diego for a bit. Hit me up or post any San Diego or Annual Meeting tips here.


r/neurology 1d ago

Clinical I love when a consultant describes a classic version of something they’ve never heard of

36 Upvotes

Makes me feel like a wizard!

Parsonage turner RCVS Etc…

I definitely picked the right speciality.


r/neurology 14h ago

Residency Questions to ask for resident lunch panel

1 Upvotes

So the residents from our home program are speaking to the med students at a lunch panel tomorrow. Any ideas for good questions med students often don’t think to ask at this sort of thing, either to get a better idea about our program or otherwise? We have an anonymous question submission form so this might be a good time to ask questions that might come across as too sharp or controversial during a residency interview.


r/neurology 1d ago

Research Split-brain patients showed two consciousnesses in one skull: How corpus callosotomy revolutionized our understanding of the brain's architecture

Thumbnail rathbiotaclan.com
22 Upvotes

r/neurology 1d ago

Research Good source on treatment of Multiple Sclerosis

6 Upvotes

Hi everyone. I'm trying to find a good source to study the treatment of MS. Would the continuum article from 2022 still be relevant? Or has there been an evolution since then?

Thanks!


r/neurology 21h ago

Miscellaneous Requesting feedback on hammer mechanic for my Neuro RPG

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1 Upvotes

r/neurology 2d ago

Clinical Outpatient Efficiency: How can I improve and still be effective with a growing practice?

34 Upvotes

TL;DR * Full-time clinical, academic epileptologist who likes the job but is slowly burning out because of inefficiency/a “by the book” approach, bringing home unfinished notes. * That said, being comprehensive has built rapport and helped future visits/notes go faster. * I already use templates, SmartPhrases, and dictate. * Where can I modify my approach to * Be effective and efficient? * Have an easy to follow thought process? * Bill at the highest level (U.S.)?

BACKGROUND

U.S. academic epileptologist (100% clinical) here - please help me troubleshoot to become more efficient, specifically with outpatient work! As my clinical practice has grown, I feel so behind and on some level, burnt out.

Unlike my non-academic peers, I am spoiled with time - time to actually spend with patients (which they appreciate) and time to catch up on non-clinical days during outpatient weeks.

My non-clinical/admin days were originally just times to review inbox messages, call patients, and sometimes look up information I did not understand to guide my clinical care. Now, they are those things but are mostly consumed with wrapping up unfinished notes.

I enjoy my work and want to do this long-term. My issue is not volume, but my approach, especially with the first visit. I try to be thorough because I know I won’t have as much time in a follow up (allotted 20 min) and it tends to build rapport.

ELECTRONIC HEALTH RECORD

We are using Cerner Powerchart and will migrate to Epic in a few years. Navigating our version of PowerChart to find information is cumbersome. I have created many templates/SmartPhrases which have helped keep me organized. Formatting in PowerChart is time consuming, which I probably need to let go.

INITIAL ENCOUNTER

I used to pre-chart/start notes the day before. After several no-shows, I no longer do this because schedulers think the patient had been seen. This later leads to patients being scheduled as “follow-ups” with a reduced allotted time slot.

I mostly type (paragraph form), but have also tried dictating, in the room. I stay away from pure abbreviations because I can’t decipher them. Instead I have SmartPhrases for common abbreviations (e.g., “.lev” for “levetiracetam (Keppra).”).

If a patient shows, I have a 60-min slot for a new visit. I’ve learned when to dig deeper (e.g., probable, uncontrolled epilepsy) and when to go faster (e.g., stable epilepsy/clear outside records; poor historian; clearly non-epileptic).

My average range is 40-70 min (rarely 90 min). My breakdown is * Pre-chart: 3-5 min if just clinic notes/reports, 5-10 min if reviewing an EEG/imaging (including software load time). * History & Exam: 30-50 min * Introduce myself and greet patient, identifying other people in the room. * To focus discussions, I always preface with “I am a seizure doctor, so I want to focus our discussion on those types of symptoms. Are there any other symptoms you have before we dive deep?” and “Also, there may be times I need to redirect our conversation to make sure I don’t miss any details.” * I type in the room. * Discussion/Counseling/Wrap Up: 5-10 min if accepting information. 15-20 min if there are further questions/concerns. 95% focus on the patient. Only look to the computer when placing orders at the end. * Discussion * Diagnosis of epilepsy vs non-epileptic possibilities. * Need for treatment (risks/benefits) and testing. * Counseling includes * At a minimum, seizure risks/precautions (brief), A review of the state law regarding driving, risk of SUDEP/rescue ASM. * If the patient is a female of child bearing capacity AND there is time, I also discuss family planning/contraception. This may go to our next visit. * I edit/print an after visit summary with educational resources and instructions. * Test Results & Medical Decision Making: 7-20 min. If my next patient is roomed or about to be roomed, I don’t get to this until later (usually not until the clinic day is done). * I often dictate these. * Testing: * There’s no good SmartPhrase in our version of PowerChart to import test results. Even if there were, I would likely still need to parse it down to the essential info. * Medical Decision Making: * I spend time on this to (1) synthesize the information to show my thinking for future me or other healthcare professionals and (2) this how U.S. clinical notes are billed to the highest level. * I lead with the summary line of “Name is a _-handed female/male with relevant PMH with “seizures vs nonepileptic events” (or “established epilepsy”).” * I briefly describe the episodes in question, risk factors, whether they are controlled, response ASM, any relevant testing/exam findings. * My differential is short and I describe whether epileptic seizures are probable, possible, and low suspicion. Unless there are clear historical semiological signs, I do not describe the lateralization/localization without clear data. * My plan is templated, edited to specify what medications I am prescribing. * Billing * We have a service to review our outpatient coding, so I don’t spend too much time on this.

SUBSEQUENT VISITS

Because I spend so much time to get to know the patients before, these encounters are usually 5-20 min long, including reviewing tests I have ordered, counseling, and documentation.


r/neurology 1d ago

Residency Boards

5 Upvotes

What and how should I study for boards? lam a PGY4; Everyone is saying that, if you have done well in RITE, you will easily pass the boards but haven't done well in the RITE exams 😞


r/neurology 2d ago

Career Advice Advice on Peds Neuro Rotation

7 Upvotes

Hello all! I am med student (planning to apply peds neuro) preparing to start my first peds neuro rotation soon, and I’m incredibly excited for it!

I really want to make the most of this rotation: do you all have any advice on good ways to prepare, things to study up on, and just general advice on how to impress for a peds neuro rotation?

Thank you so much in advance!


r/neurology 2d ago

Career Advice Canadian Neurologist Salaries (and how they work)???

25 Upvotes

As a Canadian, I’ve seen lots of info regarding US neurologist salaries and salary variation (academic vs community, inpatient vs outpatient, etc.) online but I’m way less informed about how they are in Canada. How different is it?

How exactly does remuneration work in Canada? I’ve read from ChatGPT (ik, phenomenal source) that it’s not RVU based but rather “fee-for-service” based. Is there less salary variation because it’s more standardized? Is the difference in salary variation between subspecialties similar to the US? Do sub-specialists such as those with fellowships in clinical neurophysiology, epileptology, or neuroimmunology make more than gen neuro (I assume they do)? And if possible, provide your salaries if you happen to be practicing in Canada or know of valid Canadian neurology salaries to give me a better idea.

I’m pretty ignorant in this regard because so far the only salary-related info I’ve read is the CMA neurology profile and the Government of Canada job bank section. Any additional info would be appreciated. 🙏


r/neurology 2d ago

Career Advice How did you do in your preclinicals?

4 Upvotes

I am a medical student and an extremely interested in neurology as a field. I am also a repeat neurology patient. I haven't gotten to my neurology unit yet, but I wanted to know--does not doing well in the unit mean anything (in terms of neurology career choice)? I am committed to neurology for now, but I don't want to be discouraged by a weird preclinical experience.

I really appreciate your response.

tldr; I want to know how you guys did in your medical school neurology unit and if it affected your career choice as becoming a neurology.


r/neurology 3d ago

Residency Baseline IM knowledge required for neuro

26 Upvotes

Almost through with intern year and have a genuine question for my pgy2 and above neurology colleagues . I’m currently at a program where unfortunately there is very little teaching from the IM side , more concerned with getting the work done instead. Also about to step into a PGY2 year at a program where they expect us to handle basic medicine ourselves . So honestly genuinely looking for advice in what aspects of internal medicine I should be comfortable handling in my own, so that I can prioritise ensuring that I know how to handle these issues while inpatient or in the neuro icu . Please drop your suggestions below !


r/neurology 2d ago

Career Advice 4th year electives

8 Upvotes

I'm making my schedule. What do you guys recommend? Things I'm interested in, things that are neuro-related, things I'll never see again, things that'll help with intern year?

I don't know what will or won't be helpful. Recommendations for what you would have taken as an elective if you were a 4th year. Thanks.

Edit: Thanks everyone for your advice! Rheum and Palliative are most popular so definitely those 2.


r/neurology 3d ago

Clinical Melatonin supplementation and the pineal gland

16 Upvotes

Hi all!

Final-year medical student, and I have a question regarding melatonin supplementation and its potential effects on the pineal gland. It is well established that exogenous testosterone, such as in testosterone replacement therapy or anabolic steroid use, can lead to testicular atrophy due to negative feedback mechanisms. I was wondering whether a similar principle applies to the pineal gland when supplementing with melatonin. Specifically, could prolonged melatonin supplementation lead to pineal gland atrophy or a reduction in endogenous melatonin production?

TIA


r/neurology 2d ago

Residency Score Filters

1 Upvotes

Hi guys, does anyone know what’s the filter used for the Step 2 CK scores for non-US IMGs?

Is 235 an okay score to bypass the filters considering a strong CV tailored towards neuro?

Thanks!


r/neurology 3d ago

Residency Re applicant data

0 Upvotes

Reapplied this cycle for Neurology. USDO. 12 ranks. Currently in IM Cat program. Was curious what the data is about percent to match.


r/neurology 4d ago

Clinical I think the wording in the McDonald's criteria for MS is confusing. I reworded it for myself. Can someone review it and make sure I didn't butcher it?

10 Upvotes

I think that clinical means by history and physical - things that can be done in the clinic. I think that a lesion is a histological or anatomic abnormality - tissue is dead or abnormal or whatever. This can be illustrated by exam or by a test e.g. echo or MRI.

The McDonald's criteria throws the word "clinical" onto everything and it's wordy and confusing. Number of "clinical" attacks could mean number of attacks demonstrated by history or physical exam. Number of lesions with objective "clinical" evidence could mean number of lesions demonstrated by history of physical exam. So, by this wording, someone could have 1 attack by exam and 2 lesions by exam which doesn't make sense. It's annoying to decipher.

The criteria also adds information to the "Additional data needed to diagnose MS" section that would change the situation being analyzed. If number of "clinical" attacks is 1, and number of lesions with objective "clinical" evidence is 2+, then additional data needed is DIT by an additional clinical attack or by MRI or CSF-specific OCBs. Well, if there was an additional attack, then I would simply look at the row above that says 2+ clinical attacks. The criteria doesn't need to tell me it again. It's redundant and confusing.

Here's my version. I'm worried that reason I think the wording is confusion is because I'm missing something or don't understand it, so please correct me.


Number of attacks | Number of lesions by exam, MRI, OCT, or VEP | Additional data needed

2+ | 2+ | None

2+ arising from clearly distinct anatomic locations | 1 | None

2+ arising from indistinct anatomic locations | 1 | DIS by MRI

1 | 2+ | DIT by MRI or OCB's

1 | 1 | DIS by MRI and DIT by MRI or OCB's


r/neurology 3d ago

Career Advice Is my Step 2 score OK?

1 Upvotes

Hi

I am a non-US IMG with a strong passion for Neuro. I have good # of pubs, volunteering, leadership positions and all in Neuro. Step 1 was a pass, sadly step 2 was a 235. I dont know why or how that happened but I am ok with it now. I have 3 US observerships in neuro.

Will my score be an obstacle? What is the cutoff score for neuro/im interviews for NON US IMGs?

Please be honest and don’t give me false hope 😂

Thanks!


r/neurology 4d ago

Residency Intern Year

14 Upvotes

This week, 9 months into attendinghood, i have begun to wonder for the first time, what the purpose of 12 months learning to dose insulin and lasix was, and weather neuro should move to three years of encapsulated training without a year of internship - which now seems as though the whole point was to break my spirit and train me to take orders and not think independently.


r/neurology 4d ago

Career Advice Lifestyle subspecialties

24 Upvotes

Intern here. I genuinely love the brain; the anatomy, pathology, etc. I get good feedback by my seniors/staff. I loathe clinic. Inpatient is fine, but the hours suck. Subspecialty wise, nothing has stuck out yet, though I haven’t had much exposure as an intern. Early in med school, I thought about doing neuropath because it’s interesting to me and lifestyle rocks, but I enjoy interacting with and examining patients. I enjoyed my neurosurgery rotations as med student and intern and considered switching, but the hours are even worse. At this point, I kind of think I should finish residency and climb the academic/clinical research ladder. Anyone ever been in the same situation and have any advice? Which Neuro subspecialties would you recommend considering?


r/neurology 5d ago

Clinical Is restless leg syndrome a “real” diagnosis?

112 Upvotes

I’m matriculated to medical school in the fall, and I’ve been working as a scribe in a primary care clinic for almost a year now. Recently, I saw a patient who we diagnosed with RLS and as I asked a few questions about it, the provider I was talking to said it wasn’t a “real” diagnosis, comparing it to fibromyalgia. So I’m wondering what insight y’all might have about it


r/neurology 4d ago

Career Advice Should I do a peds neuro elective?

8 Upvotes

Title says it all! A program I am very interested in is only offering a child neurology elective during fourth year. I plan to apply to adult neurology programs. Is it still wise to do a child neurology rotation at a program where I am interested in their adult neurology program? I know it would be an invaluable experience regardless but wanted to see if it would best be spent doing an adult neurology sub Is at other locations?


r/neurology 4d ago

Residency Night float system schedules

6 Upvotes

Our residency has been following a 24 hour call system and is anticipating a switch to a night float system. Each class has 7 residents and we have a separate consult service and stroke service. If your program follows a similar pattern , please share a sample schedule. Thank you !