Neurology Residency Overview

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Neurology is the branch of Medicine concerned with the diagnosis and treatment of nervous system disorders – covering the brain, spinal cord and a range of various other nerve or muscular conditions. Neurologists are used to both managing chronic conditions (such as MS), and acute conditions like CVA. Much of the work of a neurologist is consultative, although they may also undertake work in primary care. Whilst often considered one of the most difficult areas of Medicine (certainly in the public consciousness), salaries are not remarkably high – the median clinical salary of $268,000 puts this field in the middle of the pack, rather than towards the top.

Residency Core Requirements

The core requirement for training as a neurologist is a minimum of four years of postgraduate education. Before entering into a neurology residency training program, one must first undertake a one year transitional or preliminary period, in which one typically works in general internal medicine, establishing core clinical knowledge. Upon completion of the residency, one can then take subspecialty (fellowship) training, in either child neurology or clinical neurophysiology.

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Application Statistics & Competition

Neurology is perhaps less competitive than one might think it would be – in the most recent available data, there were a total of 1249 applicants for 1014 spots, making a ratio of 1.23 applicants to each position. Looking specifically at US MD Seniors, 562 applied, and only 13 failed to match. Meanwhile, there were 163 US DO Senior applicants, of whom 150 matched. That’s a 92% match rate, making Neurology one of the most accessible fields for US DO applicants. Considering IMG applicants, this is also a relatively accessible field, with 0.55 US MD applicants for each 1 spot, meaning that there is considerable space for IMGs as well. The mean USMLE Step 1 score for those who successfully matched into neurology was 233, and the mean Step 2 score was 246. The overall competitiveness is actually, as mentioned, relatively low, with a Step 1 Score of 200 making for a 90% probability of matching, and a Step 1 Score of 240 making for a 98% chance of matching.

Sample Interview questions

Tell me about the typical symptoms of optic neuritis, and what you might find on examination.

Symptoms of ON will typically include acute or subacute unilateral visual loss, with visual acuity ranging from 6/6 to a total inability to detect light; peri-ocular and retrobulbar pain, which is present in more than 90% of cases and exacerbated by eye movements; photopsias; reduced sensitivity to contrast and colour; visual field loss (which may occur in any pattern). Vision will worsen over hours or days, and recovery will start within two weeks whether treatment is provided or not. Particular points to note on exam include a positive RAPD, and swelling of the optic nerve on fundoscopy (in some cases).

Tell me about the medical management of Parkinson’s.

The medical management of Parkinson’s should be initiated by a specialist, and aims to replace dopamine and prevent its breakdown. Levodopa is typically first line, which is metabolised into dopamine. MOAB inhibitors like selegiline will prevent the breakdown of dopamine, while dopamine agonists like ropinirole will stimulate dopamine receptors (although can cause impulse control disorders). COMT inhibitors decrease dopamine breakdown and increase the duration of action of levodopa. Care must be taken to avoid missed or late doses, and medications cannot be stopped suddenly – this can cause neuroleptic malignant syndrome. Common side effects of medical management include dyskinesias and the re-emergence of symptoms in the run-up to the next dose of medication.

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Important considerations

It’s vital to think about the first year before the main part of the residency, in which you will need to work in internal Medicine. This is, obviously, quite far removed from pure neurology and can either be very rewarding or quite stressful, depending on your point of view. You will likely face long hours and substantial amounts of on-call time. Equally, the relatively low salary and significant amount of consultative work could be off putting for some. Nonetheless, this is balanced out by a relatively short residency, and one which is not competitive, especially for US MD applicants, almost all of whom will be able to match.

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