I chose to go into academic child neurology with a subspecialty interest in
epilepsy. My job combines research, clinical practice and teaching in an
academic setting. In a typical week, I will spend one day seeing patients.
Another day will be spent seeing research patients (I do primarily NIH funded
clinical research with an emphasis on longitudinal studies of long term outcome
of children with seizures, autism and other neurological disorders). If
attending, I will make rounds every morning. The rest of my day is spent in
research, teaching and writing as well as my duties as director of the epilepsy
unit. The advantage of an academic career is that one can combine the
satisfaction of seeing patients with research and teaching. I find that the
combination makes each one more interesting. My research is clinically relevant
and keeps me up to date. Conversely being a teacher and a researcher makes every
patient an opportunity to learn more. The reason I chose child neurology is that
you have a shot at making an impact that can last a lifetime and because kids
are more fun. It is true that losses are more difficult in children but the
rewards of success are also so much greater. If I had to do it again, I would
still choose the same career path as I love what I do (except for all the
paperwork but that would be the same regardless of which career path you
choose).
Shlomo Shinnar, MD, PhD, FAAN
I am an epileptologist at an academic teaching institution. I chose epilepsy
because it offered a unique combination of both procedural and cognitive based
skills, and a myriad of both surgical and medical treatments that would be
available to help individuals with both new onset and refractory epilepsy. On an
average day, I typically will either be working in an epilepsy monitoring unit
facilitating evaluations of patients who are either being referred for surgical
evaluation for intractable epilepsy or a diagnosis is being confirmed for their
condition. This will alternate with seeing outpatients and staffing residents
and fellows in a busy clinical setting for both epilepsy and clinical
neurophysiology cases. The advantages of my particular career path are that it
there is a variety of various skill sets that you can use on a given day. On one
day you can be involved in a clinical neurophysiology question; on another you
are involved in ethical and legal issues surrounding the condition. The biggest
advantage is that there are a number of treatments that can be offered to
patients and that is most satisfying. If I were a medical student I would very
much consider a career as an epileptologist.
In addition, I am involved in education administration and that has been also
a highly fulfilling position in being able to strategize how medical knowledge
will be delivered for a new generation of physicians.
In summary, epilepsy and clinical neurophysiology is a wonderful career path
in Neurology that never becomes boring. There is enough variety for individuals
who need to have a variation as part of the typical workday. It has been most
rewarding and I would happily encourage individuals to seek more information
regarding this career choice because it has been such a fulfilling choice.
Joseph I. Sirven, MD
- LA County, mostly general office Neurology, two weeks of eight are on a
fast-paced neurology inpatient and consultative service to wards and ER,
including acute pediatric neurology. Night call mostly from home at but
exhausting, 24/14. Teaching of internal medicine residents, medical and PA
students is almost entirely during ward rotation along with shared
supervision of 14 physicians' assistants and additional PA trainees.
- Situation in flux. Expect increasing amount of office neurology and
elimination of inpatient neurology service with heavy ER consultation in its
place. Up until this point the practice has been freewheeling, the
pathology
astounding, teaching fun. There is time for research. So far I have been
trying to find my way around the facility. My subspecialty is oto-neurology.
I hope a half-day clinic opened in the area of dizziness and eye-movement
disorders.
- If I had it do over again, I would have chosen this path over my
original private/multispecialty-group/paper-shuffling choices. But there are
trade-offs in benefits and currently in job security.
Nina L. Zasorin, MD
General neurology
I was always interested in science but medicine allowed for human contact
along with my interest in science. I chose neurology because of my medical
school anatomy teacher who made me realize how fascinating the nervous system
is. I see six new consult patients and four follow-up patients. On weeks where I
am on call I see patients in the hospital. There is nothing more complex and
fascinating as the brain and nervous system. It is a rapidly changing field and
never dull. The problems that patients have are often complex and difficult to
understand but are rewarding once you determine the diagnosis. It is very
important to know how to communicate in a compassionate way before going into
medicine.
Barbara Scherokman MD, FAAN, FACP
I feel a bit uncomfortable answering these questions because I'm doing so
little neurology these days. I have chosen to answer, though, not just out of
respect for the Academy committees, but also because I recognize that my own
career path has been so unusual that it may interest medical students.
I originally chose, as a fourth career (after having been an academic and in
private practice, and a drilling Reservist in a field hospital unit), to be a
military clinician, or, as we like to call ourselves, soldier medic. I spent
four years after going active duty doing the Army's version of academic
neurology, with an active clinical practice, an active clinical appointment at a
fine civilian medical school, and some active research protocols. I was assigned
as the go-to-war physician for an infantry unit and trained regularly with them.
During that time I had the chance to deploy with Army forces and co-run a clinic
in Saudi Arabia, where I also got to admit to Saudi military hospitals and to do
a great deal of mass casualty planning for metropolitan Riyadh. Previous to this
I had deployed to Central America for a month as the only physician in the
country, which was a real baptism of fire since I hadn't done general
(non-neurology) medicine for 12 years before that.
Nine years ago I was recruited into the medical chemical defense community. I
spent eight years instructing in the training courses in chemical casualty care
at the US Army Medical Research Institute of Chemical Defense, serving as the
Institute's operations officer, deploying regularly with expert response teams
from the Army, the Department of Justice, and the Department of State, writing
military (four-service) doctrine regarding chemical casualties, advising all
sorts of people on these issues including the Surgeons General of Thailand,
Bahrain, Korea, Kuwait, and Korea, and training forces worldwide including 14
foreign countries. In addition to helping to build the most frequently visited
web site in the Department of Defense, we also produced the largest CME events
ever held, satellite television training courses that reached 10,000 students
(mostly physicians, nurses, and EMT's) at one time. I spent the last of these
years working half-time as the chemical defense expert for the Secretary of the
US Department of Health and Human Services, trying to ready the civilian sector
for chemical terrorism. For the last four years I've been the Consultant for
Chemical Casualty Care to the US Army Surgeon General. While at the Institute I
also started a neuroprotection research program and have coordinated research to
produce a post-exposure neuroprotectant for nerve agent survivors. I also
obtained funding to entice industry to develop a far-forward seizure monitor for
nerve agent survivors.
Last year I was asked to take a new assignment as Deputy for Medical Affairs
to the Joint Program Executive Office for Chemical/Biological Defense. My boss,
a two-star general, commands over $1.5 billion in acquisition programs for
chemical and biological defense, of which about 15 percent is medical. We
include within our portfolio of programs of record medical countermeasures
including vaccines for anthrax, smallpox, and plague, drugs such as
pyridostigmine, oximes, atropine, and skin lotions for chemical agents, and
medical devices including a biological agent detector. My primary job is to make
sure that my general makes acquisition decisions which make medical sense and to
keep him informed of what is going on in the chemical and biological medical
defense community.
I retain my consultancy within the Army and continue to teach in the USAMRICD
courses.
Clinically I am a full professor of neurology at the military's medical
school, the Uniformed Services University of the Health Sciences, and attend on
the wards and clinic at Walter Reed Army Medical Center, our biggest military
hospital and the location of our largest neurology residency. I try to get to
clinic about one half-day per week, and attend one month per year.
I don't have a typical day any more. As mentioned, I'm lucky if I can get to
clinic on Friday mornings. That's when we have a live patient for discussion;
following that, I try to hang out in the clinic and supervise residents who
present cases. I lecture at the medical school several times a year and in the
USAMRICD courses on chemical casualty care about once a quarter. Most of the
rest of my time is spent working for the Joint Program Executive Office for
Chemical/Biological Defense, where I'm the highest-ranking military officer
below our commanding general. Tasks that come across my desk are highly varied.
Here are a few: commenting on legislation pending before Congress, responding to
a Senator whose constituent, at one of his state universities, has a technology
that he's trying to sell to the government as a great idea for chem/bio defense,
advising panels of three-star generals on where the budgetary priorities for
chem/bio defense should be, helping to set up an office to run a new program
which will try to accelerate development of defenses against intracellular
bacterial pathogens and haemorrhagic fever viruses, justifying proceeding with a
program to develop a circulating bioscavenger for nerve agents, representing my
two-star general in bilateral negotiations with visiting delegations from Japan
and Poland, assisting the Department of Health and Human Services in setting
requirements for the civilian sector which complement rather than compete with
the efforts in the Department of Defense, etc. And then there's the occasional
job which comes with being the Army Consultant for Chemical Casualty Care,
including policy meetings with the other leaders in Army medicine, reviewing
clinical records of people who may have been exposed to chem/bio agents, and,
very rarely, actually evaluating such patients clinically.
To the best of my knowledge, no neurologist has ever had a career in
chemical/biological defense before, and so the concept of a "career path" is a
bit tenuous. I can tell any medical student interested in this area that it is
burgeoning, and that there are a lot of self-appointed experts therein. The best
advice is to get thoroughly well-trained in neurology, or another recognized
specialty, and obtain proper specialty boards, not only for
self-preservationit's always good to have a clinical skill upon which to
fallbut mostly for respect. Fully trained MD or DO physicians in this
field form a tiny percentage of the universe of self-appointed experts, and they
are given great respect because of their clinical skills. Being a neurologist
has helped because I can say I know a lot about the brain and nerves, which no
one else tends to know much about; it also allows me somewhat to understand the
psychopathology of some the people I need to work with!
On the other hand, I can warmly recommend the military as a career for a
neurologist who is looking for the opportunity to do things that most
neurologists don't get to do. Recognize that deployments are indeed part of the
job; over 50 percent of military neurologists have deployed in the past five
years, by my rough calculation. But it is indeed a privilege to take care of
those who have volunteered to take care of the country. And the quality of the
women and men whom I have seen as patients, and even more, the quality of those
with whom I serve, is so high as to make many of the inconveniences trivial by
comparison.
Jonathan Newmark, MD, FAAN
