I have been in practice for a year in a southern hospital-based clinic, where I practice general neurology. I first became disenchanted with neurology in my final year of residency. Seeing patients and learning was exciting as a resident but having to rush through appointments with patients to make certain RVU targets to maintain a salary is hard. It has taken me 12 years to get to this position — to finally find a real job — and to hear about all the looming cuts and the number of patients that I would have to see to make a decent salary is depressing.
It takes the fun out of neurology when I have to spend my time filling out prior authorizations. I have frequent requests for disability forms — often from lawyers, which I don't mind helping with. But this is does not figure into my compensation and I receive no credit for the additional work. All of this has made we start to think that it would be easier to be a surgical specialist and not have to deal with lower reimbursements for complex patients.
Meanwhile, I owe more than $200,000 in student loans. So my first thought is that I need to pay this debt off before reimbursements drops any further. It is stressful to wake up every morning with that debt, especially when I have a wife, a two-year-old, and another child on the way.
Most of my colleagues feel the same way. They were shocked when they found out how hard they would have to work after residency. I had thought about specialization but did not end up doing a fellowship. I figured it would “cost” me more to give up a salary while accumulating debt interest doing a fellowship without much financial gain. With all the talk about budget cuts, it seems like working earlier is better than watching reimbursements fall during fellowship training. That way, at least I can start paying off debt and get on the road to a more balanced life.
If I had to do it all over again, I would still choose neurology. Neurological disease is always fascinating and never boring, and there is always something to learn. It is the one field where the history and physical can be your best diagnostic tool and it can all be accomplished in one office visit. However, I do feel that medicine in general has become less appealing when it comes to compensation.
You work so hard in school for so many years and by the time you are in a full-time position you are saddled with family, time, and financial constraints — all slightly late in life. Even though as physicians we make more money than many other professions, I still sometimes wonder if it was the bet investment of my time and efforts. But then a patient comes into my office, someone who I can help and make a difference in their life, and it all cycles back: Yes, I would choose this field again and again.
Doris Kung Sung, DO
Assistant Professor of Neurology
Baylor College of Medicine
If I had to begin my education again, I would still choose medicine — although the increasing popularity of fellowships combined with the upward trend in educational debt makes the choice less appealing when compared with competing professional fields such as engineering, business, and law.
That said, I would not choose neurology again. Neurology is a fascinating field with strong potential for new discoveries and treatments, which can impact our patients. But our inability to collectively advocate for ourselves as effectively as other specialties seriously jeopardizes the long-term success of our field — including our ability to recruit tomorrow's talent.
AAN PRESIDENT RESPONDS:
We can't know all the reasons why young neurologists are unhappy in their careers, but we are aware of, and understand, their concerns.
What we do know is that fledgling neurologists face enormous economic stressors, starting out with significant debt burden. When I left medical school, I faced $3,000 in medical school loans. A few years ago, the average medical school debt burden was $60,000–$70,000. Today, these young neurologists leave training programs owing more than $150,000, on average, just when they are starting new families and new lives.
We also are aware that what they experience in training — the number of hours they work — may be different from what they face in practice. In training, their duty hours are heavily regulated and limited — not so, when they enter practice.
And so, among other things, I think we — and the mentors involved in training our young neurologists — could do a better job of managing their expectations. Neurologists in training need to know, for example, that if they choose neurology, they may not be able to retire their debt as quickly.
That said, the situation is far from hopeless. Those starting careers have far more options once they complete training. Many employers, for example, will offer to repay the medical school debt as part of their recruitment efforts. And new graduates are in a good position to negotiate their employment terms — not only how they get paid, but also, the number of hours they work. A number of places offer less than full-time equivalent positions, allowing neurologists to work part-time.
At the AAN, we do have a Residents Section and a listserv, and we encourage young neurologists to get together as a community — and to meet with mentors — at our annual meetings and other events held during the year. We are also trying to make more career development resources available through our AAN Career Center online — not just by posting neurology jobs, but also by offering advice and tips on how you look for employment, negotiate and revise contracts, among other employment skills.
In terms of advocacy and reimbursement models, I think we are beginning to see some appreciation and respect for what we do — as non-proceduralists — in Congress. We have been engaged in a multiyear effort to implement better -recognition for the care we manage — at a time when the federal debt is a national issue. But we have gotten our message out there, and we have found that the committees with jurisdiction over Medicare — the Senate Finance and the House Ways & Means Committees, for example —know about our issues. We have developed friends on both sides of the aisle.
We don't expect any major changes until after the presidential election, but in the long-term, we are optimistic that with increasing demand for our services — and a burgeoning elderly population — neurology will continue to be recognized as the dynamic specialty that it is — and one, which the medical community cannot do without.
Bruce Sigsbee, MD
Editor's Note: “Young Neurologists Express Career Regret” (Nov. 3, http://bit.ly/rtD4bq) — which informally surveyed new neurology residents about career satisfaction — drew a mixed response from readers, some of whom asked to remain anonymous owing to sensitivities about their current employment. We asked AAN President Bruce Sigsbee, MD, to respond to the sentiments expressed — both positive and negative — from young neurologists on their career choice.