Neurology was a broad field with many subspecialty areas. I was trained in my
residency to do Neuroimaging and clinical research. When I first began
practicing, I found no time for research but remained very involved with
imaging, going on to CT and then MRI interpretations. Out of clinical interest I
went for additional training in Pain Management. I subsequently set up an
Interventional Pain Center. As I narrowed my practice down I was more successful
financially but more importantly I had time for clinical research and a happier
quality of life.
¯Frank D. Hussey, Jr., MD
For career options: "When I began my internship in 1977,
cardiology and
pulmonology were the only specialties that interested me. I chose rotations
early in my internship year, hoping to cement my decision for one of those
areas. Much to my surprise, neither of those rotations was satisfactory. The
rotation that I dreaded the most was next on the calendar¯neurology. I
quickly liked many things about neurology, even though I despised my rotation as
a medical student. Neurology and neuroanatomy now revealed an organization, a
pattern, a simplicity that were not evident earlier. I opted out of my internal
medicine residency and enrolled in a neurology residency, where I was astonished
at the number of subspecialties available. The list of considerations included
neuromuscular disease, MS, stroke, movement disorders, and neuroradiology.
Though I was offered fellowships in neuromuscular diseases, I chose to enter the
private practice of general neurology. After several years of general practice,
the number of subspecialties had grown noticeably, and I found myself deeply
interested in pain management. My practice is now 99 percent pain management,
and I find it most rewarding. The practice is a combination of academic and
clinical work.
There are many physicians who fearfully avoid the chronic, unrelieved pain
patient, thus generating the crisis of under treatment of pain in America.
Thirty to 40 percent of Americans have pain syndromes that are inadequately or
poorly treated. It is estimated that 80 percent of nursing home patients have
unaddressed pain needs. My patients are profoundly grateful for the concern
shown them, and even small reductions in pain allow them noticeable changes in
their daily activities. With proper monitoring and chart maintenance, I have
little anxiety about drug mis-users or pernicious monitoring by federal
agencies. It has long been stated that neurology is the specialty that diagnoses
but does not treat. That statement can now be used only by those ignorant of the
progress of our specialty. I enjoy each day, knowing that my patients will find
additional comfort by the end of that day."
¯Don H. Bivins, MD
I am a senior stroke neurologist and vice chair of a major neurology
department. My day begins by meeting the residents and teaching them regarding
decisions made overnight in the emergency ward. Each day we read all the
neuroimaging studies from the night before. This is followed by a visit to my
patients who happen to be in hospital. My practice is diverse. Mostly made up of
stroke patients that I cared for acutely. Some treated with intravenous or intra
arterial thrombolytic therapy. Some being managed closely for secondary stroke
risk reduction. I also care for diverse set of patients with migraine and
parkinsonism in whom medical management is an ongoing process.
I generally do paperwork and correspondence in late morning or meet with
members of the various stroke research teams to advance the research effort.
During some periods we are intensely researching and writing grants, during
others analyzing data. I am part of a call schedule in which the acute stroke
team rushes to a "stroke code" and evaluates stroke patients for the optimal
therapy. Three months a year I attend on the inpatient neurology, neurointensive
care or stroke ICU consult team. I also regularly see patients in our
rehabilitation hospital as a consultant.
With the American Academy of Neurology, I also get to work with groups of
neurologists as they consider and execute plans to improve neurologic care and
practice. Lecturing on stroke to other neurologists or other physician groups is
also an important part of my work. Finally, I have had the opportunity to work
with disease-related organizations as we team up to treat or prevent stroke.
The most fun thing about my job is that it is always interesting and lots of
new things to get involved with. More so than any other field of medicine there
are tons of ways to make a difference. As an example, since I started the entire
stroke field underwent a revolution. Very exciting times to be in neurology.
¯Walter J. Koroshetz, MD, FAAN
- I am currently professor of neurology at The Ohio State University,
Columbus, OH. I chose the field of neuromuscular disease, which involves the
study of diseases affecting the peripheral nerve, muscle, neuromuscular
junction, and motor nerves. I chose is for two main reasons. The first is
that it was one of the few areas in neurology where one could go from the
clinical presentation of the patient and then look at the physiology of
their problem (through EMG studies) as well as the patho-anatomy (through
nerve and/or muscle biopsy). This ability to look at all three aspects of a
patient's case is extremely rewarding.
The second reason is that I simply found the relationship that a physician
has with neuromuscular patients to be very special, requiring a combination
of neurologic, psychologic, orthopedic, rehab medicine, and general medical
skills. I follow many of my ALS and muscular dystrophy patients from
diagnosis to death, and develop an extremely close relationship with most of
my patients.
- Typically, I will be in the clinic for at least half, and sometimes the
whole day in an outpatient setting. On months when I am "on-service," I also
have to round on the in-patients or see consults for the other services.
Usually, I try to do some academic work as well (writing grants or papers,
participating in clinical trials, teaching students or residents, etc). It
makes for a busy, but extremely varied and rewarding, day!
- The rewards of academic neurology are too numerous to mention! Every day
is different and an intellectual challenge. You are never bored, and you are
doing your part to advance our knowledge base and improve lives for your
patients. There is nothing more rewarding than participating in a study that
provides new insights into the cause or manifestation of these terrible
diseases, and how we can better treat patients suffering from them.
- Only that it is very ironic that when I was a beginning third year
medical student, I decided to do my neurology rotation first to get it out
of the way, since it was the ONLY specialty that I was absolutely CERTAIN I
would NOT go into! I was immediately struck, however, by the team approach
taken to most neurologic disease and the very special relationship that
develops between a neurologist and their patients. Neurologic disease
affects the things that make us most human, like cognition, speech, moving
around, walking, and the ability to care for ourselves. When diseases
threaten these basic aspects of life, patients need a physician with unique
skills and a caring, professional approach!
¯John T. Kissel, MD, FAAN
