The Role Of A Neurologist
A neurologist is a doctor who specialises in managing patients with diseases affecting the central and peripheral nervous system. However, owing to the nature of the nervous system, you can expect some degree of overlap with other body systems; for instance, hypertension may be a cardiovascular issue, but if it results in a stroke, it also becomes a neurological matter (1).
More than 5,000 neurological conditions have been identified that neurologists may diagnose and treat, including (1):
Peripheral neuropathy (including neuropathic pain)
Neurodegenerative diseases such as Parkinson’s, Alzheimer’s & Motor Neuron Disease (MND)
Spinal cord diseases
Muscle diseases (e.g. muscular dystrophies)
Myasthenia gravis (autoimmune disease of the central nervous system)
Infectious diseases (meningitis)
Functional disorders (symptoms not explained by neurological damage)
Thorough history-taking and meticulous physical examinations comprise a large amount of a neurologist’s work. In addition, they perform imaging tests (MRI or CT scans) as well as interventions such as electroencephalography (EEG), nerve conduction tests, injections, and occasional nerve or muscle biopsies. Should a patient require surgery, the neurologist refers them to a neurosurgeon (1).
Long-term care is a crucial aspect of neurology as patients often require monitoring over a long period of time, fostering a strong doctor-patient relationship. Therefore, a neurologist may see six to ten follow-up patients along with seven or eight new patients on a standard day.
They spend most of the time in outpatient clinics, either at a regional centre or at a district general hospital, and occasionally do ward rounds in inpatient clinics. Neurologists work within a diverse multidisciplinary team consisting of neurosurgeons, neuroradiologists, specialist nurses and technicians, as well as administrative staff (1).
Apart from the necessary skills employed by all doctors, aspiring neurologists should demonstrate certain qualities and traits. A high aptitude for problem-solving, listening and research skills is crucial since gaps in our understanding of neurological conditions still persist.
Furthermore, the lack of treatments for incurable and degenerative conditions necessitates honed communication skills and empathy to support patients and their families. Nonetheless, tremendous scientific breakthroughs have been made over the past decades, thus allowing significant improvements in existing diagnostic technologies and treatments, as well as providing new cutting-edge therapies. Furthermore, after having had a reputation for being heavily male-dominated, neurology has witnessed an increasing proportion of women (1).
A Typical Week
On a usual day, a neurologist starts between 8am and 9am and finishes by 5.30pm to 6pm. On-call commitment varies between sub-specialty and region, but is usually moderate (2). 45% of neurologists are on call on weekends (1). These may involve advice over the phone or physically attending the workplace. In general, neurology is flexible and family-friendly as it is more outpatient-based than other medical specialties.
On-calls are more frequently observed in acute and stroke neurology, where trainees may commit to weeks or half-weeks every 8-12 weeks (2).
While most days would involve direct clinical care, registrars and consultants also get involved in teaching on a weekly basis. Moreover, they spend at least half a day a week attending academic meetings with neurological colleagues. Some time is allocated to clinical management and governance (3).
The Route To Becoming A Neurologist
Interested undergraduate medical students can join the medical society at their university and attend conferences for an opportunity to explore the specialty and network with potential future colleagues.
You may also want to consider joining associated societies, institutes or professional bodies such as the Association of British Neurologists (ABN) and the British Medical Association (BMA) (1).
During your foundation years, if a rotation in neurology is not possible, aim to do it in related fields. Try to make use of the ABN or Royal College of Physicians (RCP) career mentoring schemes whereby a neurology consultant or trainee will guide you through your journey (1).
After completion of your foundation programme, you are required to either complete a three-year internal medicine training (IMT) – formerly a two-year core medical training (CMT) – or three-year acute care common stem (ACCS) (1,4). Although both meet the entry requirements for specialty training (ST3) recruitment to neurology, IMT and ACCS trainees emerge with different skill sets.
For instance, IMT provides a more diverse grounding in medical specialties, but compromises procedural skills, whereas ACCS focuses on handling acute and critically ill patients, but puts less emphasis on chronic illnesses. (5). Once either is completed, you must obtain full Membership of the Royal College of Physicians (MRCP) prior to ST3 (1).
Nevertheless, completion of IMT or ACCS and MRCP does not guarantee an ST3 training post due to the level of competition; in 2019, there were 2.65 applications per place (6). Be ready to move to a different location as certain hospitals – such as the National Hospital for Neurology and Neurosurgery in Queen Square, London – are renowned for their excellence in this specialty and would prove beneficial to your career prospects (7). Once you acquire a post, training will last five years (ST3-ST7). The curriculum now includes one year of internal medicine and 6 months of stroke (4).
During specialty training, you must pass the RCP Specialty Certificate Examination (SCE). Most neurologists pursue a research degree, usually an MD (2-3 years) or a PhD (3-4 years), before or during specialty training. At the end of training, you will be awarded the certificate of completion of training (CCT) to go on to work as a consultant neurologist (1).
Many neurologists develop specific interests and complete post-CCT subspecialty courses, for example in neuroinflammatory diseases, neuroradiology, peripheral neuropathy, and epilepsy. If you wish to work in stroke medicine, you should express your interest before your final year of specialty training since an additional year of stroke training will be required in order to qualify for subspecialty CCT.
Note that paediatric neurology is a separate paediatric specialty and not a subspecialty of neurology. Since neurology is a highly academic specialty, neurologists are strongly encouraged, almost expected, to get involved in research along with being a clinician (1,4).
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
Consultant neurologists may also wish to run private practices to supplement their salary. On average, neurologists can make a profit of an additional 50% of their NHS salary by working in the private sector. This is higher than many other specialties, e.g. general psychiatry (20%) or paediatrics (16%), placing neurology in the top 15 specialties for private earning potential (8).
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
If you are interested in deepening your knowledge in neurology and neuroscience, you may find it useful to consult relevant journals, such as the ones listed below:
Journal of Neurology and Neuroscience
Journal of Neuroscience and Neuropharmacology
Brain Disorder & Therapy
Journal of Neuroinfectious Diseases
Research & Reviews: Neuroscience
The following societies and institutes offer a wealth of information on conferences, podcasts, essay prizes, research, tutorials, courses, and learning resources relevant to neurology:
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Other Complete Guides By BMJ Careers
1. Neurology [Internet]. Healthcareer | NHS. [cited 2020 May 1]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/neurology
2. Becoming a Neurologist [Internet]. Association of British Neurologists. [cited 2020 May 3]. Available from: http://www.abnt.org.uk/docs/Becoming_a_Neurologist_ABN.pdf
3. Job planning for NHS consultant neurologists and clinical academic neurologists [Internet]. Association of British Neurologists. 2019 [cited 2020 May 3]. Available from: https://cdn.ymaws.com/www.theabn.org/resource/collection/219B4A48-4D25-4726-97AA-0EB6090769BE/ABN_2019_Job_Planning_Document.pdf
4. Shape of Training [Internet]. 2020 [cited 2020 May 3]. Available from: https://www.theabn.org/page/shape_of_training
5. Nazir MS, Sharp C, Fryer J, Edwards M. Acute care common stem pathway. BMJ [Internet]. 2011 Dec 2;d7640. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.d7640
6. Specialty Recruitment Competition Ratios [Internet]. Specialty Training | NHS. 2019. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Competition Ratios 2019_1.pdf
7. National Hospital for Neurology and Neurosurgery [Internet]. University College London Hospital. [cited 2020 May 3]. Available from: https://www.uclh.nhs.uk/OurServices/OurHospitals/NHNN/Pages/Home.aspx
8. Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D, et al. Analysis of consultants’ NHS and private incomes in England in 2003/4. J R Soc Med [Internet]. 2008 Jul;101(7):372–80. Available from: http://journals.sagepub.com/doi/10.1258/jrsm.2008.080004