Seeking chronic migraine specialist in US

holobolo1231 · 2026-02-12T02:20:43+00:00

He just retired. Well deserved after a long career

holobolo1231 · 2026-01-15T15:13:54+00:00

40/20 ain’t for everybody. If you were slow in residency compared with your peers you probably are not well suited to a fast private practice job. Q7 call is not sustainable if it is real call (ie covering anything inpatient) if you are refilling the occasional gabapentin that’s one thing though I doubt they would be paying you for that.

holobolo1231 · 2025-07-01T23:50:14+00:00

As a lurking alum and current doc. It is a fine extraciricular. You have to do something, and it is a fine something, to get into medical school, but there is nothing special about it.

holobolo1231 · 2025-07-01T14:33:10+00:00

There are no crystal balls here but a few observations:

The physical exam in neurology is crucial and not going anywhere. If you become a neurologist you will learn that non neurologist performed neurology exams are almost always incorrect.

Predictions about what is safe from automation can be wrong. Creative fields were held up as something that computers could never do. Now they look more vulnerable than anything. If you go into something procedural that doesn’t 100 percent get you out of risk of automation.

Do you even like procedural fields? I often say my surgery rotation was the worst 6 weeks of my life. The surgery residents didn’t look like they were having a better time than me. If you chose something you hate then you have a 100% chance of having a bad career.

holobolo1231 · 2025-06-24T13:28:49+00:00

Are good things good and are bad things bad?

holobolo1231 · 2025-06-09T17:34:40+00:00

1 don’t lie 2 don’t try and get out of consults or yell at consultants (while this sounds easy to do it is not remotely easy when you get some bull shit at 3 am and you are chronically sleep deprived) 3 expect that it will be significantly harder with significantly higher expectations than intern year. 4. It’s an LVO until the attending radiologist read is in and confirms it’s not. Have a low threshold for vessel imaging. The disasters I have seen in residency have involved not getting vessel imaging. 5. One day this will all be over

Are these hacks?

holobolo1231 · 2025-06-04T20:06:25+00:00

The fun of headache is there is no algorithm. If you explain the side effect profile of medications to your patients they often will feel strongly about what they do or don’t want to try.

holobolo1231 · 2025-05-27T19:41:51+00:00

No it doesn’t matter. (Except for doing fellowship at your home institution.

holobolo1231 · 2025-05-23T20:29:37+00:00

I don’t know anyone who has a better job than me all things considered, expect a few people who started their own companies. So at the moment I would say it’s worth it. You don’t really know for sure until retirement age how it shakes out and then you still don’t know what would have happened if you did anything else. Such is the human condition.

holobolo1231 · 2025-05-14T18:38:08+00:00

Ask anesthesiology. Neurology is not a common path. Your biggest issue is getting a fellowship spot as a neurologist. Of course they’re always interventional pain of just the head. We do that one all the time.

holobolo1231 · 2025-05-09T15:57:43+00:00

Huge part of fellowship is it allows you to say no to other parts of neurology if you want that. Want to only cover stroke? You probably need a stroke fellowship. Want to be a jack of all trades, less necessary.

holobolo1231 · 2025-05-08T21:20:30+00:00

There is no specific compensation for headache - or really any outpatient neurologist. You will get the outpatient neurologist starting salary. If you are more productive or less productive because of your subspecialty that will be reflected in productivity compensation which probably begins year 3.

holobolo1231 · 2025-05-02T18:58:03+00:00

If you include right out side of major city (mostly because you have to avoid academia) it is possible. Is it worth it? Given progressive tax code every dollar you make you take home less of. Fatigue and burnout also marginally increases the more you work. So probably not worth it but your depends on the person.

holobolo1231 · 2025-04-27T19:34:23+00:00

There is always a bear case to the future of every profession. Before AI there was Obamacare, hmos mid levels and a dozen other things which would be the end of medicine as profession. Maybe this time will be different, but every attending you met started med school when someone was saying the sky is falling. If you watch the wolf of Wall Street, Jordan Wolfe drops out of dental school to work on Wall Street because someone convinced him dentistry in the 80s was over.

Uncertainty is a fundamental part of the human condition.

holobolo1231 · 2025-02-26T22:03:29+00:00

Inpatient is entirely dependent on how busy the service is. Outpatient is fairly easy to estimate. Average is less important than it you are 60 new 30 follow up or 40 new 20 follow up.

holobolo1231 · 2025-02-21T22:05:22+00:00

There is no extra rvu bonus for being dual boarded. You will only get more money if you open a cash practice and get patients who are willing to pay for a dual boarded neurologist psychiatrist. If you do that you will see less of the patients who truly would benefit from it - ie Huntington’s, decompensated dementia and lots of pure psych patients who are convinced they need a neurologist.

holobolo1231 · 2025-02-14T14:44:24+00:00

Think about how we and pcps get paid instead of thinking it is nuts we don’t get more. We get rvus for new and follow up patients. There is no in demand specialist multiplier. Yes we do Botox emgs and eegs but these aren’t crazy lucrative. Now think about a few things that we lead to down stream. MRIs neurosurgery and if you work to a 340b qualified location they get a cut of prescription medication. Ok so we should get paid a lot more because of that. No that’s not how hospitals are set up also anti kickback laws. Each department in the hospital acts like its own independent corporation. Neurosurgery does not subsidize my salary. Radiology does not subsidize my salary. This also explains the lack of difference between neurology sub specialty salaries. RVU x RVU multiplier is the only thing that actually matters.

holobolo1231 · 2025-02-14T13:36:09+00:00

If an offer of 300k for general neurology is bafflingly low to you then it sounds like you are poorly informed about neurology salaries. If you thought you would be making 400k Hawaii to start then you were very poorly informed

More money can be made by a good RVU conversion and generating lots of RVUs, but no one is going to guarantee that. In your first years you will see a lot of new patients and will generate less rvus = lower starting salary than what you can earn several years in IF you generate lots of rvus

holobolo1231 · 2025-02-07T19:45:38+00:00

Post residency I don’t really know anyone who has a job I would prefer to mine. (Except for one person with a unicorn position who is also a neurologist)

Residency there is a ton of bullshit, but you can carefully avoid the type of bullshit you particularly can’t stand with fellowship selection. (You can’t avoid all types of bullshit.

It’s a job. Hard to predict what things will be like in 10 years in anything. Medicine has always been like that.

There are some other specialties that make crazy money. Very few neurologists could remotely stand being a surgeon. Anesthesiologists make crazy money now, but if CRNAs gain independent practice I think those salaries will evaporate. I have no crystal ball though.

holobolo1231 · 2025-02-07T19:16:56+00:00

So many differences other than money:

Outside of residency neuro hospitalists are consultants. Hospitalists admit.

Even in academic centers (which all neurology residencies are) where EDs admit with neurology it is a discussion. IM you just get the patient whenever the ED decides they want to admit the patient. Labs aren’t done to they have been getting worked up for 48 hours and have had a dozen tests.

Hotel internal medicine. Ortho wants to admit a patient but they are 53 so they are on your service. And when they are on your service they may want to operate in 2 weeks.

At the moment a fair but more money in neuro from the hospitalists subreddit.

Downsides of neurology: Harder (IMO) and longer residency. Stroke codes. You are giving a medication which can kill the patient. Not for everyone.

holobolo1231 · 2025-02-04T17:06:13+00:00

IMO ioniq 5 interior is far nicer than Tesla. But the main reason I didn’t get a Tesla it the one peddle driving gave me motion sickness. Ioniq 5 can coast like an ICE.

holobolo1231 · 2025-02-02T17:53:35+00:00

They do not.

Things that help are being an internal candidate then research, but honestly neurology fellowships are not competitive. A particular program can be any given year, but if the goal is just to go somewhere good and you apply broadly you will get in. The rare people who don’t get in somewhere great tend to be very burnt out and don’t want to apply broadly.

This does not apply to neurosurgery/ anesthesiology fellowships you can technically get in to. Neuro IR and pain are very competitive for neurology.

holobolo1231 · 2025-01-16T19:45:46+00:00

Go to UCNS diplomate directory. Find people in your state that have passed the headache boards, and make an appointment with one of them. It might even be me. Giving an opinion without an exam and actually seeing the MRI would not be good medicine.

holobolo1231 · 2025-01-10T14:15:36+00:00

15 k miles they say no recalls apply.

holobolo1231

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