r/neurology

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I'm an MD student in the US and I am having a hard time deciding between neurology or anesthesiology. I'm involved in both the anesthesia and neurology departments and have mentors in both, but I honestly can't seem to make up my mind. Would appreciate some advice.

Neurology:

(+) Enjoyed preclinical neurology (liked localization, neuromuscular, vascular and neuroanatomy)

(+) Enjoyed inpatient consult service during my rotation

(+) Love the geographical flexibility and job security (any concerns over AI or scope creep?)

(+) Never met a neurology attending or resident I did not like (good fit for culture)

(+) Like the idea of being a specialist with a skillset few others possess

(-) Disliked rounding. Would be fine with clinic, but drawn towards inpatient medicine

(-) Dread the idea of never-ending MyChart inbox

(-) Unsure if I would be content with the bread and butter as a generalist

Anesthesiology

(+) Shift-based and inpatient

(+) Good mix of pharmacology, physiology and procedures

(+) Geographic flexibility and solid job market

(+) Love the teamwork aspect of the OR and the ICU

(+) Compensation

(-) The politics of Anesthesia (CRNAs, scope creep etc.)

(-) Limited longitudinal care. Unsure if this is a good or bad thing, but find myself more excited about potential developments in neurology than I do about technological advances in anesthesia.

(-) Not being a specialist with "unique knowledge". This feels unfair to anesthesiologists many of whom are fellowship trained, but if CRNAs can do hearts and pediatrics unsupervised it sort of defeats the purpose?

We have been running into conflicts between the outpatient and neurohospitalist group on who is contacted when a patient seen by an outpatient neurologist ends up in the ER And the ER physician requests a consultation. Right now there is a strange system that the neurohospitalists refuse to take "nonurgent calls" and basically tell the ER physician to call the outpatient neurologist. For instance a patient with seizure supposedly returning to baseline. Note that the outpatient neurologist has no inpatient priviledges in this hospital and can request admission for the neurohospitalist to see the patient if they feel necesary.

In my mind, this system makes no sense. An over phone consult often misses important history/exam details and to me it seems like the neurhospitalists are simply being lazy to discuss or see the patient. Is this standard of care in a none-academic hospital? We are working with admin shortly to discuss this but wanted to get thoughts from wider community.

It was my understanding that the trials examining ESUS demonstrated no benefit of DOAC over antiplatelet. Yet there are a few attendings I work with who will still anticoagulate if the stroke pattern appears to be very clearly embolic and/or if there are underlying conditions that may increase thrombotic risk like underlying malignancy. Some will even do very extensive work up for thrombosis such as genetic hypercoag work up in a 70 year old or 4 extremity Doppler even in the absence of DVT signs/symptoms.

I’m genuinely just curious because I get some opposing messages and when the attending switches then the new attending on service may cancel the work up the prior attending said to order. So just confused and hoping for some clarity.

I know some of this may just be different practice preferences so if that’s what it is then I’m happy to accept that. I just wanted to make sure there wasn’t some important piece of information I was overlooking.