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Choosing which specialty you'll go into is one of the biggest decisions you'll ever make. If you're considering becoming a neurologist, you know that it's a difficult specialty to enter into. We interviewed a neurologist, J. Chad Hoyle, MD, to bring you all the details on what he likes best about his specialty, and what challenges he faces as a neurologist
1. How To Become a Neurologist
To become a neurologist, you'll need to receive an undergraduate degree and complete all prerequisite course to apply to your desired medical school as well as take the Medical College Admissions Test (MCAT).
The next step to become a neurologist is to apply for and attend a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) program and become a physician. During this time you'll need to take United States Medical Licensing Examinations (USMLE) or United States Comprehensive Osteopathic Medical Licensing Examinations (COMLEX) depending on if you're in an MD or DO program.
After medical school, you'll need to apply and match into a residency program. Residency for a neurologist consists of 1 intern year followed by 3 years of neurology residency. Pediatric neurology training includes 2 years of general pediatrics followed by 1 year of adult neurology and 2 years of pediatric neurology. After residency, you will take your board certification exam. For neurology, these exams are administered through The American Board of Psychiatry and Neurology (ABPN).
It is also common to complete a fellowship after training. This is usually 1 year, although some fellowships are longer. Examples of fellowship options in neurology are neurophysiology (EEG and EMG), neurovascular disorders (stroke), neurocritical care, neuroimmunology (e.g., multiple sclerosis), movement disorders, cognitive disorders, interventional pain, sleep medicine, neurooncology, headache disorders, epilepsy, and neuromuscular disorders.
To become a neurologist, you'll need to complete 4 years of undergraduate education, 4 years of traditional med school education, and then varying lengths of residency and fellowship training depending on where you'd like to specialize. So, all in all, becoming a neurologist will take 12-15 years.
According to the U.S. Bureau of Labor Statistics, the mean annual wage for a neurologist is $267,660, with a mean hourly wage of $128.68.
Chart from Occupational Employment and Wages, May 2021, U.S. Bureau of Labor Statistics
Keep in mind that the American Medical Association rates neurology as one of the top medical specialties with the highest student-loan debts with median debt of $187,500.
Neurologists diagnose and treat conditions that affect the nervous system. These include a wide range of disorders at all levels of the neuraxis (i.e., those that affect the brain, spinal cord, or peripheral neuromuscular system).
Common examples of neurologic conditions include stroke, epilepsy, multiple sclerosis, tremor, Parkinson disease, Alzheimer disease, vertigo, migraine and other headache disorders, and neuromuscular disorders (e.g., neuropathy, myopathy, amyotrophic lateral sclerosis, and myasthenia gravis). Many esoteric conditions are diagnosed in neurology as well.
Diagnosis by physical examination remains paramount in neurology. Neurologists enjoy having the ability to translate a bedside examination and history into a clinical diagnosis. Neurologists also tend to have an innate fascination with the brain and the nervous system, so studying this field can be very gratifying.
Examples of common procedures neurologists perform include lumbar punctures, electroencephalography (EEG), electromyography (EMG), and onabotulinumtoxina injections (for spasticity and chronic migraine). Treatment options are becoming more and more robust for the field, and research is highly active.
"I like the impact that the bedside neurologic examination has on making a diagnosis. In the field of neurology, the physical examination is still a paramount aspect of diagnosis. The field is very intellectually satisfying. Additionally, it is incredibly rewarding when patients respond to treatments and regain neurologic function, such as patients with myasthenia gravis who regain muscle strength, develop the ability to swallow again, or experience a resolution of double vision." J Chad Hoyle, MD
"Disorders without robust treatments can be difficult because you want to be able to offer more; however, many conditions in neurology do have robust and rewarding treatments already, and a strength of the field is how quickly research is advancing.
Genetic therapy is just starting to take off in the field, and this coming generation of neurologists will see a transformative advance in therapeutics. It’s an exciting time to be a neurologist clinically and also to be involved with research in the field." J Chad Hoyle, MD
"It is a combination of both but is generally more outpatient. For instance, a neurologist in practice might typically be on inpatient service for 1 week and then in the clinic the rest of the month.
There are subspecialties that are predominantly inpatient, though, such as neurocritical care, neurovascular disorders, and neurohospitalist care, and, conversely, some neurologists’ practices are entirely outpatient per their preference. Neurology has many practice options available." J Chad Hoyle, MD
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