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Scope of Hospital-Based Neurology Practice?


Guest Samhain_Grim

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Guest Samhain_Grim

Hiya folks.

 

I'm a current PA student with a passion for neuro-stuff. However, from searching around, there's a relative paucity of information on what PAs do in neurology (most of what I find is for neurosurgery, headache; I know we can do LPs, etc.). Now, I could wait until I get the chance to rotate through neurology, but I'm impatient and so.. here I am.

 

Can a couple of folks who have worked in neurology tell me a bit about what you do? Localizing lesions, managing MS, ALS, epilepsy? Do you feel limited in your scope of practice at all compared to your attending? What does your attending do that you can't (won't) do? Anything you can't do (e.g. are you mostly managing chronic, not seeing acute)? Was it difficult to get started since neuro isn't covered as heavily in PA school as other specialties? What do you like, dislike? Exposure to neurorads, neuro ICU, etc.? If you stopped working in neurology, why? The whole shebang, I want to hear it all. Every little detail, anecdote, or snippet will help me out a lot.

 

Thanks!

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I've been in Neuro for almost 8 years, so hopefully can answer some of your questions. Ultimately it really depends whether you wind up being hospital based or outpatient based. Inpatient practice is going to involve the acute management of strokes, strokes, and more strokes so you'd better like strokes. Outpatient is going to be a lot more variable.

 

Most neuro groups are going to hire a PA for a specific piece of their practice - epilepsy, MS, neurodegenerative disease, etc. It's probably best to start with one area and get good at it, then look for opportunities to expand your practice into other areas. I started doing just Parkinson's disease and now do all aspects of that and Alzheimers disease and dementia, epilepsy management, and I also see sleep patients and anyone else who needs to get in urgently. I manage lots on my own and usually alternate visits with the attending physicians or call them in. I do not take call but some neuro PAs do. I can interpret imaging studies (but the physician is the one who signs off) and I do not interpret EEGs and don't do nerve conduction studies. I order LPs but don't do them. Usually IR or pain management does them. So procedure wise I don't do a lot and I miss that but it is what it is. I don't know of any PAs in neuro radiology.

 

Not sure what else I can tell you. It's not an easy field to break into - I happened to have a rehabilitation background which is what my SP was looking for for the Parkinson's program. I haven't figured out what else I'd be good at doing so haven't looked to move. I also have a fairly flexible schedule which is really important since I have 3 kids and am full time Mom also.

 

Good luck

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Guest Samhain_Grim

I've been in Neuro for almost 8 years, so hopefully can answer some of your questions. Ultimately it really depends whether you wind up being hospital based or outpatient based. Inpatient practice is going to involve the acute management of strokes, strokes, and more strokes so you'd better like strokes. Outpatient is going to be a lot more variable.

 

Most neuro groups are going to hire a PA for a specific piece of their practice - epilepsy, MS, neurodegenerative disease, etc. It's probably best to start with one area and get good at it, then look for opportunities to expand your practice into other areas. I started doing just Parkinson's disease and now do all aspects of that and Alzheimers disease and dementia, epilepsy management, and I also see sleep patients and anyone else who needs to get in urgently. I manage lots on my own and usually alternate visits with the attending physicians or call them in. I do not take call but some neuro PAs do. I can interpret imaging studies (but the physician is the one who signs off) and I do not interpret EEGs and don't do nerve conduction studies. I order LPs but don't do them. Usually IR or pain management does them. So procedure wise I don't do a lot and I miss that but it is what it is. I don't know of any PAs in neuro radiology.

 

Not sure what else I can tell you. It's not an easy field to break into - I happened to have a rehabilitation background which is what my SP was looking for for the Parkinson's program. I haven't figured out what else I'd be good at doing so haven't looked to move. I also have a fairly flexible schedule which is really important since I have 3 kids and am full time Mom also.

 

Good luck

 

Thanks for the response! It's helpful. I think strokes are interesting in the sense that you need a good grasp on neuroanatomy to localize lesions. I'm not sure if it would get boring, though. Unfortunately a big consideration when finding a job will be loan forgiveness, but it's good to hear that you typically start off specializing in one disorder and then gradually branch out. I'll have to figure out whether or not the lack of hands-on procedures will bother me. 

 

I don't have any sort of rehab background, so I wonder what other employers will look for... I have a neuroscience background (graduate classes, but they're non-clinical), so I'm hoping I can use that to sell myself a bit. I'll have to see.

 

Thanks again!

 

If anyone else wants to chime in, go for it. It can only help.

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  • 4 weeks later...

Hi there!  

I am also a current PA student in the last 8 months of my training, so can give you insight of what I've seen as a student!  I am a self-proclaimed "neuro nerd" and have loved neurology even before school.  I worked with adults with ALS and neuromuscular disorders prior to school and plan to work in that field again after school.  For electives I had neurology and neurosurgery, which was very beneficial.  

 

I requested to be in a less populated area (I am from MN, so I chose Duluth rather than the Twin Cities) for this rotation as I wanted good hands on experience.  My rotations were absolutely amazing!  The PAs I worked with were both adult neurology, but saw a wide variety in their practice.  In any day we could see new seizures, MS, do botox injections, and diagnose PSP.  The hospital I was at also used their PAs to do both inpatient and outpatient, so rotate each week, which I felt provided a great variety of acuity and care! As a student there the physicians really took the time to teach me neuro rad and had me memorize it through quizzing.  I was also the only student in the department for the entire month I was there, which is a benefit of not being at a huge hospital. I would recommend doing a neuro elective if you can, and really making it into the experience you want it to be!  I divided my time up among the sub-specialties and general so I could get a feel for everything. If you truly want to practice in neuro after school this experience will be very beneficial. 

 

Neuro does seem to be a hard field to break into as a PA, but it is becoming more popular.  I recently became the first PA student member of AAN, and they are working towards developing a broader base of PA student members!  Take charge of your future career by getting involved as much as you can so it can provide you with the experience part you may be lacking right out of school. Also, don't be afraid to include your prior neuroscience experience when talking to potential employers as it is still background that not many people have.  

 

Hope this helps a bit and wasn't too rambling!  

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I'm glad that they have PAs in neurology in Duluth now. I lived there for one year. I loved Duluth.  However, I went there with a job at St. Lukes taking care of federal prisioners. It was a horrible job, sloted for 9 providers and I was number 4 but then we dropped down to just me. I was completely alone and it was a nightmare.  My background was in  neurology (headache clinic) and I approached every neurology practice in the area and none would give me an interview (this was in 1991) and some were rather rude about their opinions of PAs. So I had to move out of town. I'm glad things have changed.  With a nursing school and Family Practice residency (which at the time was anti-PA) it was  tough town to work.  I don't know who broke the ice.

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