A little background on my current position, etc. I'm currently at an allopathic school, have done all of the core rotations and neuro with only surgery left and have gotten honors so far for the year. I have pretty extensive community service work, a step 1 in the 230's, and a first author pub and a couple others. I really want to have an outpatient based practice, see my own patients, follow them long term, and develop relationships with each of them. I think that because of the decline in starting a private practice, joining a group of physicians and joining up in partnership would probably be ideal. Lifestyle is also pretty important to me, as family becomes a greater piece of my life. I really desire something that's stable, 40-50 hours a week, and without much call. I know pay would probably suffer in both specialties, but I'm not really worried as growing up in a single parent home comfortably on 50k a year reassures me that with either specialty I wouldn't be wanting for much after making at least 3-4x that.
Long story short, I think these are the pros and cons that I am weighing in choosing between the two:
Neuro
My first rotation of third year was neurology, and I really put it first because I hated the class during second year and just wanted to get over the requirement. Going through it though, I realized that I really enjoyed the subject matter in clinical practice. I enjoyed being able to use a quick exam and deduce the localization of a patients lesion and come up with differentials on the pathology, while being reaffirmed with imaging/studies. I also enjoyed being on the team that was being consulted, and in that regards having the answer most of the times at the end.
Some things that have cropped up that I've heard/thought about however are things like degenerative diseases. I know that things like GBS, myasthenia, and MS have come along way, but I'm currently involved in a parkinson's project that follows the patients throughout their clinical course and it worries me that many diseases in this field have this sort of prognosis. I'm also worried about becoming too specialized and losing the breadth of medicine that I have acquired or have the potential to acquire. This also inspired something that is somewhat counter intuitive to those who think family is boring, as I'm worried that the diseases and treatments for those seen in neuro might become too routine. Also, after talking to a private general neurologist I am concerned about the lifestyle after he mentioned that almost all private neurologist require hospital privileges and have to be on call for admissions, ED coverage, and rounding in the morning pushing work hours even greater. (Is this pretty much true? I know there are probably the few unique jobs that are the exception, but is this pretty regular? What are the work hours like for those practicing in the field?) Lastly, I'm worried about some who say that chronic pain and psychosomatic complaints make up the majority of a general neurologists day.
Family
I love the variety that each day and patient brings. I enjoy how one room can be the 60 year old COPD, chronic hypertension, and a-fib, while 15 minutes later a 2 month well child, and 15 minutes later a pregnant woman for pre-natal care. I like that you never have to say something like "you're going to have to bring that up with your PCP", as if someone has 10 questions you could probably answer 8/10 and know the two people they need to go to for the other 2 while helping them make arrangements for it. I enjoy how you get to grow with your patients, and that sometimes you even get to know an entire family. The treatable psych cases of depression and anxiety are also a plus. I also really like the prospects of the lifestyle (8-5, no call, and no weekends). The small procedures that don't last for hours and can be done in the office are also a plus (skin biopsies, small lacerations, endometrial biopsies, etc).
Some downsides I've found are that there is a lower assumed prestige among other specialist (had an ophthalmologist tell me I should have gone to PA school if I was gonna do family for example), more competition than neuro among PA's and NP's. I'm also not too keen on OB (though I know many family docs who don't do any OB). I'm also slightly afraid to not choose/lose neurology, I'm not sure why, but maybe its the finality of the decision and being afraid of being the guy who "only manages blood pressure and diabetes."
Thank you in advance for reading this long winded dilemma I've hit in choosing what I want to go into. I appreciate you taking the time to read this, while helping to share your opinions. I've been mulling this over for quite some time, and now as the time draws nearer to finalize our fourth year schedules its causing me greater worries. Lastly, if this is not the right area for this post, I'd appreciate the help of anyone moving it!
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Advice on Neurology Vs Family Med
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