Medical student Web forums frequently feature posts about “which-specialty-offers-the-best-lifestyle,” and sadly, neurology often falls short in these discussions. One only needs to look at the results of polls, like the recent Medscape Physician Compensation Report — conducted between February and March, 2011 — which examined data from over 15,000 US physicians across 22 medical specialties, to understand why. It ranked neurology as the seventh lowest compensated, yet among the top three in terms of time spent per patient. Indeed, 55 percent of the neurologists surveyed reported spending 25 minutes or more per patient, compared to primary care physicians (13-16 minutes), and dermatologists and ophthalmologists (9-12 minutes). No wonder less than half of the participating neurologists felt fairly compensated.
But as this publication has chronicled over time, neurology is often a family affair, and it's not unusual to hear about successive generations of neurologists. For a series of upcoming columns that focus on career choices, Neurology Today spoke to several families with more than one generation of neurologists, to neurologists who work part-time, and in this story, to children of neurologists, to hear why, despite all the challenges facing them today, and after watching their fathers come home late at night, they still chose this specialty.
A FAMILY-WORK BALANCE
Solo neurologist M. Sean Marquez, MBBS, felt very proud when his son, Graeme, decided to become a medical doctor, and even more so when he recently selected neurology, since he believes that there is no finer profession in the world. Dr. Marquez, whose weekday begins at 7 AM and may run to 8 or 9 PM some days, said, “For a field like neurology, which is one of the more difficult specialties, the love for the specialty is paramount in my mind, and it's what made me become a neurologist in the first place.”
Graeme Marquez, the oldest of eight children, has observed his father strive to achieve balance as a neurologist in solo private practice in Barbados for the past 17 years, raising a large family. Graeme has just completed his second year of medical school at the University of the West Indies in Mona, Jamaica and, although it's not set in stone, he is also likely headed for neurology.
“Lifestyle is very important in selecting a specialty,” noted Graeme, adding, “I want something which I'll be able to enjoy, but which won't take up all of my time so I am not constantly consumed with medicine.”
He admires the way his father has been able to juggle his heavy workload.
“He would routinely be the last doctor at the clinic at night, but he would still arrange his schedule so that he could spend time with his family and also pursue his hobbies,” he said. “His professional life and private life are something to emulate, and this will definitely influence the kind of physician I become and what I choose to do,” he said.
When Graeme was nine, an illness caused Dr. Marquez to re-evaluate his demanding schedule as one of only two very busy solo neurologists servicing the entire eastern Caribbean. “Graeme was hospitalized with a severe case of acute disseminated encephalomyelitis — with brainstem involvement, coma and status epilepticus — and I quickly realized that my professional life was like a vacuum, with work always filling it, and that it would continue so unless I set some limits,” he recalled.
So he decided to work a half-day on Fridays and close his practice on the weekends, allowing him to spend weekends with his family, barring the rare neurologic emergency. He now gets up at 4 AM daily to work out, plays golf on Fridays, and goes on regular “date nights” with his wife of 23 years.
“Quality of life issues are important,” he said, adding that he hopes that his son will learn to create that balance that we all need. ”I've been able to do this as a neurologist in solo private practice, and I guess that he's taken note,” he said.
FAMILY PLANNING, FLEX SCHEDULES
Kathryn Sara Stevens, a 25-year old third-year medical student at Indiana University, recently surprised her father, current AAN board member James C. Stevens, MD, when she announced that she had selected neurology for her residency.
“I really enjoyed my neurology rotation,” said Kathryn who plans on taking two more neurology electives in June and July.
Kathryn remembers waiting for her father at the dinner table at 8:30 at night, knowing that he often had to go back to the hospital afterwards. Although it made her a little wary of pursuing medicine as a career, she hopes that she can carve out a future that will allow her to work a lighter schedule when she has children.
“Some of my female classmates are planning to work only five to ten years and then quit, and others intend to work part-time from the start,” she said, remarking that there seems to be a trend for women staying home more.
Dr. Stevens, who practices in a large neurology/neurosurgery practice in Fort Wayne, IN, is thrilled by his daughter's choice and cannot wait to share neurologic academic, clinical, business, and political topics with her. He recalls leaving home before Kathryn and her brother were up for school, then returning home at 8 pm with the family waiting for him to share the evening meal.
“The worst days were when I arrived home at night after they had already been tucked into bed,” he said.
With the growth of his practice, however, he eventually had more time “off call” and was able to ensure that he would be in attendance for their important school, social, and church-related events, and to coach them in their various clubs and sports-related activities.
“My dad loves what he does, and it certainly played a role in my choice,” Kathryn said. “I also hope I can both be there for my children and have a fulfilling career.”
And so does her father, who noted that there are more flexible scheduling options being offered to new trainees in neurology than when he began to practice 24 years ago. He attributed that change, in part, to the influx of women in medicine and to the relaxation of training hours. “I am pleased that my daughter sees her desire for family and motherhood as every bit as important as her desire to be an excellent physician; it's a much more realistic prospect than when I finished training,” he reflected.
A FAMILY GAME: ‘WHERE'S THE LESION?’
Before Alexis Bashinski, MD, began medical school, she spent the summer working in her father's neurology practice, taking histories and shadowing him while he was seeing patients. At the time, all neurological problems seemed the same, and she wondered how her father didn't get bored. His neurologist game of “where's-the-lesion?” left her baffled, and although rarely able to answer, it didn't matter. She was planning on becoming a surgeon, as she announced to anyone who'd ask if she, too, was going to be a neurologist.
But by the end of her first year at the Medical College of Georgia, a course entitled “Brain and Behavior” changed all that, and she found her summer clinical experience beginning to gel. Later, as she went through her neurology rotation, she discovered that solving the puzzle of localization came naturally to her, and what's more — she loved it!
Alexis, who recently got married, and is starting her neurology residency at the University of Alabama at Birmingham next month, is unlikely to fulfill her father's secret fantasy of having her join his practice one day. She's always loved teaching and intends to go into academic neurology. She hopes that it will afford her more flexibility in her schedule than her father, Benjamin Bashinski III, MD, had when she was growing up. He often worked 12-hour days and there were many a dinner interrupted by emergencies.
Alexis admires how her mother, a pathologist, has been able to carve out a three-day-a-week schedule over the past ten years, and intends to adopt a more structured schedule in a field like neuro-intensive medicine or neuromuscular disease.
“Alexis makes good decisions and will balance things a whole lot better than I, or my father, who was a urologist, have done,” said Dr. Bashinski, who has been practicing general neurology in Augusta, GA, for the past 28 years. “I'd love to tell you that I had some kind of magical influence on her,” he mused. Delighted when, after being away in Nashville for college, his daughter was able to come home again regularly while attending medical school, he nevertheless doubts that dinner conversations about clinical neurology actually played a role in her decision. But, like the other fathers interviewed, he's thrilled.
“I really like what I do and I like to think that Alexis perceived that I'm happy in this selection, and that may have rubbed off a bit,” Dr. Bashinski said.
Despite the hours, and despite the lower compensation, that's what each of these children knew in their hearts. Neurology simply makes their parents happy.
Dr. Avitzur, a neurologist in private practice in Tarrytown, NY, holds academic appointments at Yale University School of Medicine and New York Medical College. She is an associate editor of Neurology Today, as well as the editor-in-chief of the AAN Web site, AAN.com, and chair of the AAN Practice Management and Technology Subcommittee.