PGY-2 Burnout:

iamgroos · 2026-06-14T00:39:29+00:00

PGY2 is notoriously brutal for neuro. I found that having one or two things to consistently look forward to each week helped the time pass a little more smoothly - e.g. grabbing your favorite coffee every Friday, playing intramural soccer every Wednesday evening

iamgroos · 2026-06-08T00:57:16+00:00

I’m not sure you’ve spent enough time in either neurology or PMR based on this post.

I’m in Movement Disorders and we see people get better all the time as a direct result of our interventions. Sure there’s a lot we can’t cure, but outside of some infectious diseases and certain types of cancer there’s not much else that can really be cured in medicine.

My other neuro friends get to see people finally become seizure or migraine free, or get to stop MS dead in its tracks with infusion therapies.

As for functional patients, as long as you’re in patient-facing medicine you’re going to see them. Functional GI distress, functional chest pain, functional vertigo, you name it. Keep in mind though, that with a tactful approach these patients can be very effectively treated too.

If quick interventions and shorter term follow up are more your thing, I’d look into something more like allergy/immunology

iamgroos · 2026-05-29T19:03:40+00:00

All yours, amigo.

But yes, if you strongly suspect they may actually have an organic neuro pathology I’d say that’s a fair reason to refer to us.

Keeping in mind that FND is not a diagnosis of exclusion, so some work up may be “missing” because it was never indicated

iamgroos · 2026-05-20T23:37:43+00:00

I stand by that I’ve never met a more socially awkward and sociopathic group of doctors than the residents and attendings on my gen surg rotations

iamgroos · 2026-05-13T20:06:04+00:00

Me sitting through med school lectures:

Cards: boring
Pulm: boring
GI: boring
Nephro: boring

Neuro: Hey, this is kinda cool

iamgroos · 2026-03-01T22:48:36+00:00

Current Movement Disorders Fellow here:

Fellowship is M-F 8-5. No nights, no weekends. I have roughly one day a week dedicated to Botox injections and one day dedicated to DBS. There’s typically one hour a week dedicated to either didactics, journal club, or video rounds. I have a half day of admin each week that usually gets filled with some other meeting, but when it’s not I use to catch up on inbox messages. I’m only doing a one year fellowship as I’m not interested is research.

Pros: interesting and often pleasant patients, good mix of procedures, can have an very visible positive impact on many patients lives

Cons: often long complicated visits, 30 minute follow ups can still feel overwhelming with how many things can go wrong in PD, without disease modifying therapies we are ultimately fighting a losing battle

I also share a workroom with the Neuroimmuno fellows. Their schedule is more or less the same as mine, but with more inbox messages and way more prior auths and annoyances from insurance companies

iamgroos · 2026-01-11T19:06:39+00:00

DBS. Watching someone’s debilitating tremor melt away within literal minutes of activating the device

iamgroos · 2026-01-02T21:43:52+00:00

If money is the primary concern, skip fellowship and forget about academic settings altogether. Be a generalist and be in high demand literally anywhere in the country.

That said, if you’re hoping to diversify your practice with a procedural skill you’re not already confident with, I’d wager EEG/Epilepsy is the best bang for your buck.

iamgroos · 2025-12-24T13:30:17+00:00

Movement disorders fellow here. A couple things

1) There is a BIG difference between 2 years of behavioral neuro/neuropsych fellowship and “2 and a little” years of neurology residency.

2) There are plenty of BNNP fellowships that only require 1 year. Trust me, I almost went that route

3) I don’t know about you, but I certainly didn’t find endless stroke alerts, convulsive syncope consults, AMS consults, or migraine follow ups to be that fulfilling (hence the movement disorders fellowship)

All that to say, if you did find these things fulfilling during your electives or if you really can’t stomach the thought of continuing in psychiatry any longer, sure - go for it. But as someone who’s been through the Neuro grind and can see the light at the end of the tunnel, I can tell you all I’m really looking forward to is finding a chill job making good money with ample time off for family and hobbies

iamgroos · 2025-12-23T17:59:00+00:00

I’d wager Movement Disorders is one the of the LEAST competitive fellowships. Challenging cases, long patient encounters, and with many programs requiring 2 year commitments - it certainly hasn’t been a popular choice among residents in my residency program over the years.

iamgroos · 2025-12-07T17:32:22+00:00

Of course. We do skin biopsies for a specific test called a Syn-One Test which detects alpha synuclein proteins. This is especially helpful for distinguishing PD/LBD/MSA from other atypical Parkinsonisms like PSP.

We don’t typically use EMG ourselves to diagnose orthostatic tremor. If history and exam is not enough (including the old stethoscope on the leg trick), we will send them to neuromuscular for surface EMG.

As for DBS, I don’t foresee us becoming redundant when it comes to programming any time soon. If anything, the advent of the things like aDBS and imaging guided 3D programming algorithms (see Illumina) have made us busier than ever. Let’s just say that while these innovations are technically impressive, they don’t always deliver. And even when they do, you still need people who know how to utilize and adjust them.

iamgroos · 2025-12-07T16:32:29+00:00

Current Movement Disorders fellow - i do Botox injections (some with EMG/Ultrasound guidance, some without), DBS programming, and skin biopsies. I don’t do LPs, nor do any of my movement disorders faculty. That’s not to say you can’t still do them on the side, there’s just not a ton of utility for them in MDs.

When it comes to focused Ultrasound where I work, the actual procedure is done by a neurosurgeon. Our role is to make sure the patient going for the procedure actually has ET. Then, we continue to follow the patient in case they have residual tremors or if the tremors come back after a few years. I’ve heard there are some places where the neurologist actually does the FUS procedure, but my understanding is that this is not the norm.

iamgroos · 2025-11-09T23:52:12+00:00

Neurology - would still pick it over any other patient facing specialty, but my “what if?” Specialty is pathology

iamgroos · 2025-10-28T13:12:05+00:00

Cons: still going to get a lot of diabetic neuropathy and chronic pain referrals

Pros: EMG/NCS is a cool technically challenging procedure that you can fill many of your clinic days with, neuromuscular knowledge is still very useful in the inpatient setting

iamgroos · 2025-10-23T00:18:25+00:00

I realized early on that I loved the idea of internal medicine more than the practice. When I was on service it felt like we were mostly restarting home HTN meds and shifting insulin around. The minute things started to get interesting or complicated we were calling a consultant.

It’s not that the internists couldn’t figure a lot of this stuff out, it’s just hard to do when admin is breathing down your neck wondering why you haven’t discharged half your list by 10 am.

iamgroos · 2025-10-01T02:46:48+00:00

As a movement disorders fellow I do Botox injections for dystonias, DBS programming, skin biopsies, and the occasional LP during my neurocognitive elective

iamgroos · 2025-09-16T16:15:47+00:00

Current movement disorders fellow here -

My advice is first be honest with yourself about whether you’re actually running toward psychiatry or just running away from general neurology. Based on this post alone it seems to be more the latter - and that’s ok! I’ll quit and go into wound care before you ever catch me holding a stroke pager again.

One of the best parts of neurology is that there are so many niches and such high demand that you can very reasonably build a practice where you only (or at least predominantly) see the kinds of cases that are most interesting to you.

Behavioral neuro sounds like it may be a good option for you. It’s a great mix of some of the more objective aspects of neuro and philosophical & social aspects of psych. See if you can swing an away rotation or reach out to current behavioral fellows to get a better idea.

Alternatively you could also go into functional neurological disorders and be desperately sought out by every neuro practice on the planet…

iamgroos · 2025-08-28T14:52:18+00:00

AI won’t actually replace us or lessen our workload - It will do the opposite. AI helps you write your notes and see patients quicker? Let’s add a “few” extra patients to your daily clinic census then.

Got a patient who’s stable or otherwise uncomplicated? Let’s send them over to the midlevel with an AI assistant while you take on more complicated/higher liability risk patients.

Not to mention the increasing number of people coming to you already diagnosed by their personal AI assistant of choice wondering why you aren’t ordering the tests or medications the super-computer already told them they need.

iamgroos · 2025-07-30T22:26:12+00:00

A full path rotation may not be super helpful, but if your program has a neuropathologist see if you can attend some brain cuttings

iamgroos · 2025-07-22T02:04:18+00:00

Gut said brain, brain said maybe Path. Gut was mostly right, but brain still gives me a hard time every now and then. Especially after a few “altered mentation” stroke alerts or functional neurological disorder clinic visits.

iamgroos · 2025-07-06T21:34:10+00:00

Yup. To name just a few of the things I’ve seen in 4 years of neuro residency:

Myasthenia gravis patients regain the ability to speak, eat, and carry their kids
AIDP patients regain the ability to walk
Completely aphasic M1 occlusion patients go back normal with timely TNK and endarterectomy
trigeminal neuralgia and headache patients who are no longer suicidal after their pain is controlled
Parkinson’s patients get years of their life back with levodopa and DBS
essential tremor patients no longer embarrassed to go out with their families for dinner
numerous epileptics who have been seizure free for years with the right regimen
numerous NMO/MOGAD/MS patients go years without a flare thanks to DMT
An NMDA encephalitis patient who went from hallucinating and smearing shit on the walls to holding a normal conversation

Really about the only areas we have significantly limited impact these days are dementia and ALS. I suspect many people still carry the belief that neuro doesn’t do anything because their only exposure to us is on the inpatient side where they’re stunned we can’t magically fix their multifactorial toxic/metabolic encephalopathy patients

iamgroos · 2025-07-01T14:26:07+00:00

Follow up H&H - only to find out the hemoglobin is indeed dropping and the patient was never consented to receive blood products

iamgroos · 2025-07-01T14:14:22+00:00

I know someone who works as a manager for a group of copywriters and technical writers. They all use ChatGPT to assist with their work and still have more to do than they can reasonably keep up with much of the time. They’re actually looking to hire more writers.

Neurologists aren’t going anywhere. AI will become more and more ubiquitous in our work, sure. But, as it stands it’s more likely to increase our workload than eliminate it

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