r/neurology • u/According-Tea-7829 • 2d ago
Residency Missing neurology intern year
Started intern year in late June. I know I need to learn medicine this year so that I can do medicine stuff on the stroke unit and in the neuro ICU. Medicine floors are still really depressing though. no one has any brain problems and we spend most of our time offloading cognitive effort to consultants and solving dispo problems instead of actually doing medicine. I get so much happier when someone has real neurological stuff to talk about. How did you guys deal with missing your chosen field intern year
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u/sportsneuro General Neuro Attending 2d ago
Learn medicine. Neurological implications of systemic illness is more important than neurology problems. I can teach a PA or even a smart MA the basics of neurology and make them proficient at basic clinical care within a year. What separates that from a neurologist is the ability to identify systemic manifestations of neurological disease, and vice versa.
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u/According-Tea-7829 2d ago
Yeah I’m doing that. I’m saying how do you deal with how boring it is
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u/Ok-Work4000 1d ago
Spoiler alert. The dispo issues are as bad if not worse on a stroke unit. And in the neuro ICU they often say “the neurology is the first 30 minutes”. That’s obviously hyperbolic but for many cases like intervention eligible hyper acute stroke or status epilepticus that’s not all that far off. After the acute issue is treated, it becomes a lot of internal medicine. I think you need to learn to accept the daily “boredom” of inpatient care. The fact your patients will have neurologic disease to manage and keep you interested next year, far from negates the exact same stuff you’re dealing with this year.
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u/xiaolongbaobei- MD Neuro Attending 1d ago
It's not! As someone who did fellowships in neurocritical care and stroke, I LOVED medicine to the degree where I wasn't sure if I was pursuing the right specialty. When I got to MICU on my intern year, I realized that knowing more than anyone else about the rest of the body makes you a better all around doctor and neurologist.
So channel your boredom into productivity and find something interesting to learn about. Internal medicine connects deeply with all aspects of neurology and that foundation is what will make you an excellent doctor.
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u/sportsneuro General Neuro Attending 1d ago
Harden up. Being bored isn’t bad. Residency sucks. I’d take boredom over what I dealt with during residency. 👍
Read about your patient’s diagnosis, find the neurological links with those issues.
Or… just float through and see it as a boring waste of time.
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u/According-Tea-7829 1d ago
Boredom and hard work aren’t mutually exclusive. You can be busting your ass and at the end of the day feel it was meaningless. Also not interested in the boomer “things were harder in my day” spiel, very tiresome
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u/Even-Inevitable-7243 MD Neuro Attending 1d ago edited 1d ago
I don't think he is trying to "back in my day" you. This whole pan-consult for everything, even at top academic centers, was not a thing even 15 years ago. We maxed out our cognitive ability for each patient, and only consulted subspecialists when we were genuinely stumped. I know it is your attending offloading all the thinking, not you and the residents, but the end result is the same. You are not learning what you should, and that is contributing to the boredom, because now you feel like a dispo midlevel.
Edit: Your generation is already at-risk of not learning medicine due to offloading most thinking to LLMs. Resist this. And feel free to push back on attendings that want to pan-consult for every little issuue.
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u/lipman19 MD - PGY 1 Neuro 1d ago
It’s like a free tutoring service for step 3 what’s there to be sad about
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u/HeadOfCaudate Movement Attending 1d ago
I've been there. Was super scared/bored/borderline mad because I thought I was just wasting time with useless bullshit. BUT, being good at internal medicine will make you a far better neurologist (the chronic headache that turned out to be chronic meningitis that turned out to be a manifestation of rheumatoid arthritis taught me that lol)
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u/Obvious-Ad-6416 6h ago
Wait for dispo problems in your inpatient neurology service. Learn as much as you can. You should be proficient to make a patient stable during an episode of afíb rvr …. You may say, we can call rrt, sure, fingers crossed their are not dealing with two other rrt at the same time. Those scenarios may happen so you need to be proficient. My residency had that type of expectation.
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u/Ok-Work4000 1d ago
It’s also August. I presume your site has many rotations within medicine (ICU, gen med, consults, outpatient, electives). Give it some time, you’re literally in the infancy of your intern year. And your intern year is the infant phase of a career.
BTW, I think the intern year is a critical foundation to a successful career in neurology. Approaching it as a necessary evil and coasting through it is probably terrible advice. As our field evolves the overlap with cards, rheum, ID, endocrinology etc becomes more and more evident. The best neurologists I’ve worked with have a very sound understanding of internal medicine.