- Academia/Teaching in the subspecialties of critical care,
interventional, and stroke and vascular neurology. Purpose: to be able to
contribute in a meaningful way to the care of not only the patient of today
but also the patient of tomorrow. This approach keeps my scientific
curiosity satisfied requires that I stay at the forefront of medical
knowledge. Research and teaching are the cornerstones of medical
advancement.
- I see patients in clinic on certain days of the week. Other days I spend
in the interventional suite performing endovascular procedures. Hospital
rounds allow me to interact with residents and medical students one on one.
A great deal of time is spent on daily paperwork both for patient care as
well as for administrative and research reasons. Much of my research occurs
when I am at home where I can read and write.
- Interventional neurology combines the best of both worlds: the
cerebral/cognitive skills (pun intended) of a neurologist with the ability
to help patients in life-threatening situations by treating them. I do not
have to sit around while a surgeon or radiologist treats my patients with
stroke. I treat them myself. Nothing can be as rewarding as seeing a
hemiplegic or comatose patient wake up and walk out of the hospital.
- The path for physicians is getting ever more difficult and sometimes
less rewarding. Nonetheless there is not a nobler profession nor one that is
so rewarding. It is important to remember that the physician can be the last
line between life and death and he/she must not let anything get in the way
of exceptional and compassionate patient care. Even when others (health
professionals included) try to prevent you from doing the right thing (be it
patient care or an unusual training pathway like interventional neurology),
you must never shy away or give up.
¯Alex Abou-Chebl, MD
- My career option is academic neurology. I chose neurology because I
think that the brain is the most fascinating part of the body. I considered
psychiatry but thought that it was too depressing. I wanted to be in an
academic atmosphere; I enjoy doing clinical research, and at one time had
considered becoming a classical archaeologist. I chose epilepsy because it
seemed to be one of the most treatable neurologic disorders (I had done a
residency in internal medicine) and because the clinical manifestations,
involving transient disorders of perception and consciousness were
fascinating to me.
- In a typical day, I see a few patients, go to rounds and conferences,
meet with fellows and students and work on data analysis and manuscript
preparation. I can set my own hours.
- In addition to its intrinsic interest, neurology has practical
advantages, as the population is living longer, and aging, leading to a
greater prevalence of neurological disorders. Neurology is particularly
suited to people who like academic life, as it is a reflective field;
generally, one ought, and has time, to think before acting. The main
stresses in academic neurology (or any other academic medical specialty),
compared with practice, are related to institutional politics and getting
money for research. On the other hand, one's activities are more varied and
interesting, and one can interact with a much broader range of people.
¯William H. Theodore, MD, FAAN
Academic Neurology
I have chosen to be a neurologist because I liked the "detective work"
involved. The more I knew more I was interested in the unknown cases; I like
difficult cases. This was my reason to become an academic physician. My general
neurology practice in not more than 10 percent and I narrowed my practice to my
subspecialty interest. Approximately 60 percent of my referral comes from other
neurologists. This guarantees that I am well supplied with interesting
challenging cases. I rarely have a boring day.
Teaching gives me a challenge as well. The best questions come from medical
students who "do not know a lot" about the field and have a fresh eye that makes
me rethink my "old ideas."
Besides seeing patients I do electrophysiology studies. This lets me do
technical work and sit at the patient's bedside sometimes for hours. Every day I
do something different. One day I am in the outpatient office and see patients,
next day I do nerve conduction studies and electromyography, the third day I
look at patients sympathetic and parasympathetic responses in the autonomic
laboratory that I built, the fourth day I look at nerve and muscle biopsies
under the microscope and the fifth day I teach and discuss patients and conduct
or plan clinical research. I consider myself very lucky that I never have a dull
moment.
My latest interest is autonomic disorders. I am fascinated by the system that
makes us able to respond quickly to all sorts of challenges (e.g., standing up).
The disease of this system severely interferes with a person life and often
people (including physicians) do not understand patients suffering with
dysautonomias. Because the disease often cannot be seen it is ignored. I made my
mission to understand these disease and the patients better and to educate
physicians and general public to understand the nature of these diseases. This
made it possible for me to meet all sort of people and interact with them
socially.
¯Katalin J. Pocsine, MD
I work at an academic rehabilitation hospital where I focus on studying
stroke recovery. Clinically, I spend most of time as a rehabilitation
neurologist overseeing the rehab of patients with stroke, traumatic brain injury
and other brain insults. I have an outpatient clinic once a week, I do
neurorehab consults over at the acute hospital, and I do acute stroke attending
on the Neurology service for a few weeks each year. My call is light.
The majority of my time I spend on research, studying mechanisms of motor
system recovery after stroke and how to enhance it. I also do clinical trials of
recovery treatments and other recovery-related issues. I teach residents and
students regularly. In the past, I have been a medical director of
rehabilitation programs, fellowship director, and had other academic and
administrative roles.
I chose this career path because I was exposed to rehabilitation during
medical school and neurology residency, and I was immediately taken with how
patients recover from catastrophic injuries, and how little was known about how
this happens. Thus, I get to do bleeding-edge research while at the same time
focusing on issues of fundamental importance to patients.
I am very happy with my career choice. I have found it deeply satisfying on a
personal level, in part because I get to improve the status of patients that are
considered by others to be untreatable. These patients have great needs that
rehabilitation can help. The rehab setting allows me to interact with patients
over a longer period of time, usually months and years, and it is one of the few
places in medicine where old-school physician-patient relationships routinely
still happen. While the workload is just as high, the time urgency is less on
rehab, and allows me to control my work life more than those physicians whose
practice revolves around emergencies. Finally, while neurorehab is not currently
a glitzy specialty, I think it will be one of the fastest evolving areas of
medicine over the next 50 years, and I am excited to be a part of it.
¯Alexander W. Dromerick, MD
- Teaching, research, clinical care. I found it easier to work within a
focused area (behavioral/geriatric neurology) if I remained in an academic
setting. Teaching, research, and patient care are all part of most academic
careers, and I enjoy the opportunity to contribute to all three areas. I
have worked in an urban setting, but the setting has been more an accident
of where most academic medical centers are located.
- My typical day varies. It is different now than what it was, say, 10
years ago. I probably spend about 20-percent teaching (including teaching
preparation), 50-percent research (including grant writing and writing
scholarly papers), 15-percent outpatient clinical care (the percentage of
clinical care was considerably higher in prior years and at one time
included substantial inpatient clinical care), and 15-percent
administrative.
- It's fun! I cannot conceive of a field of medicine or a neurological
subspecialty more intrinsically interesting than the field that deals with
brain/behavior relations. Many patients with cognitive or behavioral
problems are elderly, so for me geriatric neurology goes hand in hand with
behavioral neurology.
¯Victor W. Henderson, MD, FAAN
