At a certain point, every medical student is faced with the question of what kind of doctor they should become. Some begin with a pretty solid idea of the path they’d like to pursue, but others struggle with the decision.
“The most challenging part of my career was figuring out what type of doctor I wanted to be,” admits Dr. Stephanie Alessi-LaRosa, fellowship-trained sports neurologist and graduate of St. George’s University (SGU) School of Medicine. “But once I decided, I never looked back and have enjoyed every aspect of the journey; it has all been so worth it.”
If you’re like Dr. Alessi-LaRosa and have a natural sense of curiosity and a desire to solve problems, neurology could be a good fit for you.
But what do neurologists do, exactly? Keep reading to find out what draws medical professionals to this field, what you can expect from a career within this specialization, and how to lay the foundation for a successful career in neurology.
What is a neurologist, exactly?
Neurologists are essentially medical specialists who treat conditions related to the brain, spine, and other parts of the nervous system. While you wouldn’t be the first to confuse neurology with neurosurgery, they’re very different disciplines. Neurologists are not surgical specialists.
Neurologists make diagnoses, prescribe treatments, and help manage neurological conditions. They work with individuals who have Alzheimer’s disease, epilepsy, migraines, stroke, Parkinson’s disease, and more. Neurologists are well-versed in diagnostic technologies. They might, for example, recommend magnetic resonance imaging (MRI) or electromyography.
What is a neurologist?
Simply stated, neurologists are medical specialists who treat conditions related to the brain, spine, and other parts of the nervous system. Often confused with neurosurgery, neurologists are not surgical specialists. Neurology was once a subspecialty of medicine before it became its own specialty. Therefore, Neurologists primarily deal with the diagnostic workup and medical treatments of various neurological conditions.
“Neurology is an interesting field in which there is still so much to be discovered,” explains Dr. Catherine Alessi, neuromuscular specialist and SGU grad. “We are now in an era where we are treating diseases that were once thought to be untreatable.”
“Practicing neurology is like piecing together a puzzle.”
One survey of practicing neurologists found they were drawn to the field due to its intellectual content. Dr. Alessi loves the investigative nature of the field, with so many interesting and rare diagnoses she encounters.
“Practicing neurology is like piecing together a puzzle,” she says. “Each piece of the patient’s history, their exam findings, and their diagnostic workup puts together a much larger picture.”
What do neurologists do?
These medical professionals work with individuals who suffer from disorders nervous system which cause a wide array of symptoms disruptive to daily life. Neurologists are well-versed in diagnostic evaluation, which begins with a thorough history and neurological physical exam. In majority of situations can lead to an exact pinpoint location of the lesion in the nervous system. Examination findings are then supported by various diagnostic images/procedures which aid in confirming the diagnosis. Examples include magnetic resonance imaging (MRI), lumbar punctures, computed tomography (CT) scans, and electromyography (EMG).
Common conditions neurologists treat include:
- Alzheimer’s disease
- Epilepsy
- Migraines
- Strokes
- Parkinson’s disease
- Multiple Sclerosis
- Brain tumors
- Tourette’s Syndrome
Exactly what a neurologist’s day looks like will depend on a number of factors, including their area of focus. Patients are typically referred to these specialists by their primary care provider when it appears there’s a neurological condition at play. These physicians can work in an outpatient or inpatient setting.
“Regardless of the setting, neurologists take extensive histories and conduct a unique examination that can help them determine where the issue is,” Dr. Alessi-LaRosa says, explaining that some symptoms may trace back to the brain or spinal cord while others may deal more with peripheral nerves in the arms or legs.
“The inpatient setting deals with more acute critical or life-threatening neurologic conditions, and the outpatient setting deals with diagnosing and managing more chronic issues, which include things like neurodegenerative conditions, as well as various types of isolated neurologic events,” she explains.
When neurologists are seeing a new patient, the consultation will include a discussion about medical history and symptoms. The physician will also perform a physical exam, often focusing on mental status, language, strength and balance.
Neurologists then move on to tests, which will vary depending on the symptoms the patient is experiencing. They may conduct procedures involving cranial nerves, motor systems, coordination, sensation, cognitive abilities, and the autonomic nervous system—which controls subconscious functions like breathing and pulse. Neurologists may recommend further testing with some of the different diagnostic technologies listed above, if deemed necessary.
Dr. Alessi stresses the importance of these neurological examinations because they uncover a lot of valuable information. These thorough tests evaluate the different domains of the nervous system—both central and peripheral.
“We use diagnostic testing as an extension of detailed physical examination,” she elaborates. “We typically use CT and MRI scans to evaluate the central nervous system, while EMG testing and muscle or skin biopsies aid in our evaluation of the peripheral nervous system. Electroencephalography (EEG) is used to evaluate for disruptions in brain wave activity.”
With existing patients, the process is a little different. These individuals have been working with their neurologist for some time already, so visits are mostly about managing a known condition. A neurologist working with a patient who has Parkinson’s disease, for example, may prescribe and adjust medications, recommend physical therapy, or suggest surgery.
What are some neurology subspecialties?
Neurologists have the option to specialize even further if they choose. Some choose to seek subspecialty certification from the American Board of Psychiatry and Neurology.
“Neurology is a vast field with many subspecialties. There is an interest for everyone.”
“Neurology is a vast field with many subspecialties. There is an interest for everyone,” Dr. Alessi says. “And our field is constantly evolving. Neurologists are always thinking, discussing, and putting together the puzzle pieces.”
You can obtain certification in a number of neurology subspecialties. Here’s a sampling of some of the options:
Brain injury medicine: Physicians in this subspecialty focus on individuals who’ve suffered a brain injury, working to provide quality care throughout the recovery process.
Clinical neurophysiology: These specialists spend their careers treating nervous system disorders using both clinical evaluation and electrophysiologic testing.
Epilepsy: Neurologists in this specialization work specifically with individuals who have recurrent seizures or seizure disorders.
Hospice and palliative medicine: These physicians provide end-of-life care for patients, working to address physical, psychological, social, and spiritual needs of those individuals and their families.
Neurocritical care: Specialists in this area of expertise provide intensive care to patients with life-threatening neurological conditions.
Neurodevelopmental disabilities: This subspecialty focuses on chronic conditions that affect both the developing and mature nervous system, including cerebral palsy, autism spectrum disorders, and learning disabilities.
Neuromuscular medicine: These specialists diagnose and treat conditions that affect the nerves and muscles, such as amyotrophic lateral sclerosis (ALS) and muscular dystrophy.
Pain medicine: Physicians in this neurology specialty work with patients who have acute, chronic, and cancer-related pain. They coordinate care with other specialists as well.
Sleep medicine: These neurologists are trained to manage clinical sleep conditions.
Vascular neurology: Physicians who practice vascular neurology treat conditions that affect the structure and function of blood vessels supplying the brain and spinal cord. They’re sometimes called stroke specialists.
“There are so many options in the type of neurologist you want to be or area of neurology to practice, you can really make your career what you want,” Dr. Alessi-LaRosa says.
How do you become a neurologist?
Every physician’s journeybegins the same way: completing medical school. During that time, you’ll dedicate two years to lab and classroom learning and two years to clinical rotations. Upon graduating, you’ll receive your medical degree.
You’ll also begin the United States Medical Licensing Examination (USMLE) series and apply for residency positions during your medical education. Most students take the USMLE Step 1near the end of their second year, then take both portions of the USMLE Step 2 in their third or fourth year. You’ll submit completed residency applications in the fall of your fourth year, attend interviews into the winter, and then learn where you’ll complete your training on Match Day—an annual event during which fourth-year medical students find out if they’ve been accepted to a residency program.
Residency for neurology is four years, but your first year of postgraduate training will be an internship in Internal Medicine. While some residencies combine both training portions into one program, others require you to find an intern position independently. And if you’re interested in specializing even further, you’ll need to complete additional fellowship training.
Lastly, you’ll need to obtain board certification and complete any state-specific licensing requirements. At this point, you’re able to begin practicing as a neurologist.
Let your curiosity and compassion drive your career
Neurology is both a challenging and fascinating field of medicine. If you’re craving a career that will push you to work hard and will allow you to explore your hunger to dissect and solve problems, this could be a great path for you.
“I like to think of neurologists like detectives, because we strive to make sense of any list of a patient’s symptoms with a single neurologic condition,” Dr. Alessi-LaRosa says. She urges aspiring physicians who are interested in this specialty to explore more.
“Neurologists are needed in all parts of the country, and we are true experts in what we do,” she says. “As a result, we feel a great sense of satisfaction and reward in what we do for our patients and their families.”
But before you can begin to pursue neurology, you’ll need to complete your base medical education and training. The initial step in this process is applying to medical school. Learn more about the requirements you need to complete by visiting our article ““A Sneak Peek at the Medical School Application Process.”
* This article has been updated from a previous version to include current facts and figures.
