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Academia/Teaching/Critical Care

  1. 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.
  2. 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.
  3. 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.
  4. 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

Academic Neurology

  1. 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.
  2. 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.
  3. 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

Research/Academia/Teaching/Neurorehabilitation and Neural Repair

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

Behavioral neurology & Geriatric neurology

  1. 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.
  2. 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.
  3. 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


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