Session 03

In this episode, Ryan talks with a neurologist, Dr. Allison Gray, as they discuss all things about neurology. Notice that Ryan follows a standard regimen of questions in his episodes so you can compare each of the answers to hopefully help enlighten you in choosing your residency.

Allison is working as a neurologist at a large medical group in a community setting in Colorado.

Here are the highlights of the conversation with Allison:

When Allison knew she wanted to pursue Neurology:

• Getting fascinated at neuroscience
• Her father being a neuropsychologist

Why community versus academic:

Being drawn more to clinical practice

Types of patients:

• Of all ages - teenagers and up (Pediatric Neurology is a separate specialty with a separate board of accreditation)
• Fairly healthy and dealing with chronic conditions like migraine
• People very debilitated by acute neurologic problem like stroke or chronic problem like ALS

A typical day in the life of Allison:

8am - 5pm

Sees 10 patients a day (This is a lot for neurologists since they have long examinations and they take long histories.)

Breakdown of her 10 patients-

• 6 new consults
• 1 procedure (ex. EMG)
• 4 follow up visits

On work-life balance:

• Where she works has emphasis on creating work-life balance
• Flexibility in setting her schedule
• Work-life balance is a challenge for her being a mom
• Getting amazing support from staff who let her do physician work because they take as much administrative stuff off her plate as possible

Traits that lead to being a good neurologist:

• Being cerebral (focusing not just on what the problem is and the best treatment, but where the problem is)
• Interest in solving a puzzle
• Being able to dive into action quickly (ex. stroke patient)

What makes a competitive applicant for neurology:

• Getting better grades
• Getting good board scores
• Depends on geography (Neurology as a whole is not as competitive as orthopedic surgery or radiology)
• Good shadowing experience
• Find a way to participate in a neurology elective

Is matching competitive for Neurology?

Middle range - It depends on geography and whether you're going to a very competitive program at a big name institution.

Do you see any bias between MDs and DOs for Neurology?

None that she's aware of.

What is residency like for Neurology?

• Her residency was volume-heavy and she was seeing a great deal of patients
• Great in-patient heavy doing a lot of in-patient rotations in stroke and acute neurology and Neuro-ICU
• Out-patient time depends on the academic institution
• Residency is 4 years (1 year of Internal Medicine and 3 years of Neurology residency)

What she wished she knew going into Neurology?

Appreciating that Neurology was sad sometimes considering there is still no good treatments for Alzheimer's, Dementia, ALS, etc. So you see people facing very devastating illnesses that are chronic, debilitating, and even deathly. Also, Neurology is acutely devastating sometimes. It really takes guts to see someone suffering.

However, Neurology has a great promise and they're seeing wonderful new therapies coming out. Compared to 20 years ago, now there's a huge difference in the way they treat things like MS and genetic disorders.

What do you wish primary care providers knew about Neurology?

Neurologists are here to help and they're happy to help primary care physicians and they can always ask for help.

Specialties she works the closest with:

• Neurosurgeons
• Orthopedic surgery
• Spine clinic
• Physical therapy

Special opportunities outside of clinical medicine for Neurology:

Working with industries to discover new treatments

What Allison likes most about being a Neurologist:

• A wide variety of problems in a day
• She enjoys helping people and their families in difficult situations.

What she likes least about being a Neurologist:

The difficulty in not being able to offer someone something to fix a problem

Would she have chosen Neurology if she had to do it all over again?

Yes, Allison thinks the brain is the most fascinating thing in the human body because it defines who we are as people and human beings.

Sub-specialty opportunities for a Neurologist:

• Epileptologists
• Neuromuscular specialists
• Behavioral neurologists
• Headache specialists
• Movement disorder specialists
• Sports neurology
• Neuro-infectious disease specialists

The future of Neurology:

• Expanding the knowledge of the nervous system and its treatments
• Huge number of new therapies coming out

Some pieces of advice for those thinking about entering Neurology:

• Explore both sides of Neurology - inpatient and outpatient.
• Do an elective and go to another institution to see what neurology is like there.
• Get to see as much as you can because there is a wide variety in neurology and you don't want to miss out on what you think it encapsulates just by seeing a piece of it.

Links and Other Resources:

ryan@medicalschoolhq.net