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Pain Management

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

Private Practice/Pain Management

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

Neuromuscular Disease

  1. 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.
  2. 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!
  3. 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.
  4. 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

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