The Role Of A Clinical Neurophysiology Doctor:
Neurophysiology is a clinical and diagnostic branch of medicine consisting of a combination of neurology and physiology. It involves studying the functioning of the nervous system- brain, spinal cord, peripheral nerves and sensory organs.
A clinical neurophysiologists job is to investigate and record the functions of the above by using a variety of methods including EMGs, EEGs, nerve conduction studies and many more.
Clinical neurophysiologists are involved in conditions such as motor neurone disease, Parkinson’s, amyotrophic lateral sclerosis, spinal injuries, encephalitis and epilepsy. They work with patients of all ages- including children.
Procedures involve EMGs (electromyography) to detect neuromuscular abnormalities, EEGs (electroencephalography) for epilepsy diagnosis, nerve conduction studies to evaluate nerve damage and diagnose nerve disorders such as carpal tunnel syndrome and Guillain-Barré syndrome.
Evoked potential tests can be used for multiple sclerosis diagnosis by measuring the time it takes for the brain to respond to sensory stimulation.
Further specialised procedures involve intraoperative monitoring of the spinal cord during surgeries involving the spine, as well as mapping the cerebral cortex and localising subthalamic nuclei for epilepsy surgery and ablative Parkinson’s surgery respectively (1).
There is a mix of inpatient and outpatient work in neurophysiology. There is a significant number of outpatient appointments combined with inpatient appointments from ITU units and theatres. Direct patient contact is common in this speciality, but long-term patient continuity is uncommon.
According to the 2014-2015 census, in 2014, there were 119 clinical neurophysiologist consultants- 88 were male and 31 were female (2).
As with any medical speciality, multi-disciplinary team working is to be expected. Neurophysiologists are typically the clinical lead within their department.
This role involves liaising with neurophysiologist specialist healthcare scientists and managerial staff to run the department. Neurophysiologists also work with neurologists, neurosurgeons, orthopaedics, psychiatrists and rheumatologists.
Neurophysiology is an attractive role for those interested in the anatomy and physiology of the neurological system. It is suitable for those with analytical skills, long concentration spans, manual dexterity and practical skills for technical equipment management.
The future of neurophysiology is exciting with the potential of continuous brain monitoring technologies for critical ill patients as well as the potential neuromodulation as treatment for certain neurological conditions.
A Typical Week:
A standard contract for a full time NHS consultant is 10 PAs (programmed activities) per week. This is typically divided into 7.5 PAs for direct patient care and 2.5 SPAs (supporting activities) which are tailored to each doctors’ interest.
PAs includes direct patient contact such as ward rounds and outpatient clinics. SPAs can include teaching, appraisal, audit and research.
As part of their daily working life, neurophysiologists will often examine and diagnose patients with neuromuscular diseases during EMG clinics, report EEGs and supervise technical staff undertaking procedures of their own in the department. EEGs are often reviewed and interpreted without the patient present.
A typical day as a neurophysiologist:
Depending on the nature of the job and subspeciality, teaching and managerial duties might be expected.
Most of the work is delivered during typical working hours which makes for a good life working life balance. Out-of-hours services are not uncommon for emergencies in most departments with over 25% of consultants reporting weekend on-calls (1).
The working week is limited to 48 hours as per the EU Working Time Directive (1).
The Route To Becoming A Clinical Neurophysiologist:
Entry to clinical neurophysiology is possible following the completion of two foundation years training and core training. Core training can be completed via Core Medical Training (CMT), ACCS (Acute Care Common Stem) or paediatrics level 1 training.
While all of these routes allow for clinical neurophysiology speciality training, it should be noted that the CMT route is 2 years while ACCS/paediatrics level 1 are 3 years.
After the completion of core training, candidates must pass the Membership of the Royal College of Physicians UK Exam (MRCP UK) or the Membership of the Royal College of Paediatrics and Child Health exam (MRCPCH) to begin speciality training.
Speciality training lasts four years with one year focussing on neurology and three on neurophysiology. Currently, there is no speciality exam, instead there are two knowledge-based assessments (KBA) during the four years of speciality training (3).
A CCT is awarded to trainees upon satisfactory completion of their speciality training.
Interested candidates can apply for speciality training at the level of ST3 if they hold the MRCP UK or the MRCPH.
Clinical neurophysiology has a competition ratio of 1.54 with 20 ST3 applications for 13 posts in 2018 (5).
At the medical student level, interest can be demonstrated by choosing a Student Selected Component (SCC) in neurology/neuroscience. At the foundation year level, choosing a rotation in neurology/neurosurgery either with adults or paediatrics can serve as an advantage.
Some neurophysiology departments may offer a taster day allowing interested candidates to experience the job and simultaneously show their interest.
The Department of Clinical Neurophysiology at the National Hospital for Neurology and Neurosurgery is a centre of excellence renowned internationally and is significantly involved in training neurophysiologists and neurologists.
Trainees spend 20% of their training focussing on becoming skilled in three advanced techniques including:
Advanced EEG (electroencephalogram
Advanced NCS (nerve conduction studies) and EMG (electromyogram)
Advanced evoked potential studies.
Depending on their area of sub-specialisation, trainees may select further procedures to complement their sub-speciality. Sub-specialities include:
For those interested in research, it would be possible to spend a whole year doing neurophysiology research during speciality training or alternatively be involved in various research projects.
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.
As with any speciality, there is the potential to enhance NHS earnings via private practice. JRSM reported in 2008 that the total income for clinical neurophysiologist consultants is £101,717 with NHS income making up £71,407 and private income making up £30,310 making the ratio 0.42.
This ratio is higher than respiratory medicine (0.37) and anaesthetics (0.34) but lower than neurology (0.50) and medical oncology (0.70) (6).
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
The Journal of Clinical Neurophysiology publishes research as well as topical reviews relating to recent findings and issues in clinical research.
Clinical Neurophysiology publishes reports detailing the underlying pathophysiology of diseases affecting the nervous system such as epilepsy, motor control and movement disorders and many more.
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Clinical neurophysiology [Internet]. Health Careers. 2020 [cited 12 October 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/clinical-neurophysiology
2014–15 census (UK consultants and higher specialty trainees) [Internet]. RCP London. 2020 [cited 12 October 2020]. Available from: https://www.rcplondon.ac.uk/projects/outputs/2014-15-census-uk-consultants-and-higher-specialty-trainees
Clinical Neurophysiology | Royal College of Physicians of Edinburgh [Internet]. Rcpe.ac.uk. 2020 [cited 12 October 2020]. Available from: https://www.rcpe.ac.uk/careers-training/clinical-neurophysiology
Clinical neurophysiology curriculum [Internet]. Gmc-uk.org. 2020 [cited 13 October 2020]. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/curricula/clinical-neurophysiology-curriculum
2018 Competition Ratios [Internet]. 2020 [cited 5 September 2020]. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Content/Resource%20Bank/Competition%20Ratio%27s/Competition%20Ratios%202018.pdf
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. Journal of the Royal Society of Medicine. 2008;101(7):372-380.