Explore a Career in Neurology
- Featured Physician Interview
Meet Dr. Michael Abraham
What Is Neurology?
Neurology is the branch of medicine devoted to disorders of the nervous system.
That includes the:
Neurologists diagnose and manage an enormous spectrum of disease.
A neurologist might care for one patient experiencing seizures, another with progressive weakness, another with multiple sclerosis, and another who suddenly cannot move one side of their body because of an acute stroke.
Neurology encompasses both acute emergencies and chronic disease, which allows physicians to build very different careers within the same specialty.
What Does a Neurologist Treat?
Neurologists may care for patients with:
Dr. Abraham specifically describes the breadth of Neurology as including stroke, neuromuscular disease, multiple sclerosis, epilepsy and seizures, movement disorders, neuro-oncology, and neurocritical care.
Why Is the Neurologic Exam So Important?
Neurology has one of the most distinctive physical examinations in medicine.
Before imaging or laboratory testing, the neurologic exam can provide clues about where within the nervous system a problem is occurring.
Neurologists may evaluate:
A patient's symptoms and examination can help the neurologist localize the lesion.
Is the problem in the brain?
The spinal cord?
A peripheral nerve?
The neuromuscular junction?
The muscle itself?
This localization-based reasoning is one of the defining intellectual features of Neurology.
What Subspecialties Are Available in Neurology?
Neurology offers numerous paths after residency.
Vascular Neurology / Stroke
Focuses on disorders involving blood vessels supplying the brain, particularly ischemic and hemorrhagic stroke.
Epilepsy
Focuses on seizure disorders and their diagnosis and management.
Movement Disorders
Includes conditions such as Parkinson disease, tremor, dystonia, and other disorders affecting movement.
Neuromuscular Medicine
Focuses on peripheral nerves, muscles, and neuromuscular junction disorders.
Multiple Sclerosis / Neuroimmunology
Focuses on inflammatory and immune-mediated disorders of the nervous system.
Neurocritical Care
Focuses on critically ill patients with severe neurologic disease.
Interventional Neurology
Uses minimally invasive catheter-based procedures to diagnose and treat disorders involving blood vessels of the brain and neck.
Neuro-Oncology
Focuses on tumors affecting the brain, spinal cord, and nervous system.
Behavioral Neurology
Focuses on cognition, dementia, memory disorders, and related neurologic disease.
Headache Medicine
Focuses on migraine and other headache disorders.
Sleep Medicine
Neurologists may also pursue specialized training involving sleep disorders.
The diversity of these fields means two neurologists may have completely different day-to-day careers.
How Do You Become a Neurologist?
The general pathway is:
Often 1–2+ additional years depending on subspecialty.
Dr. Abraham completed a four-year Neurology residency followed by integrated fellowship training in Neurocritical Care and Interventional Neurology.
Fellowship training can allow neurologists to develop highly specialized careers ranging from outpatient movement disorders to intensive care or procedural neurointervention.
What Is Neurocritical Care?
Neurocritical Care combines Neurology and Intensive Care Medicine.
A neurointensivist manages critically ill patients whose primary problem involves the brain or nervous system.
Patients may include those with:
Dr. Abraham describes it essentially as an ICU for patients with severe primary neurologic disease.
This can be an attractive pathway for students who love Neurology but also enjoy critical care, physiology, emergencies, and managing very sick patients.
What Is Interventional Neurology?
Interventional Neurology—also called Neurointerventional Surgery or Interventional Neuroradiology—uses minimally invasive, catheter-based procedures to diagnose and treat diseases affecting blood vessels of the brain and neck.
Rather than opening the skull, physicians can enter the vascular system through a small incision and navigate tiny wires and catheters through blood vessels toward the brain using real-time imaging guidance.
Interventional neurologists may treat:
It combines:
Who Can Become a Neurointerventional Physician?
One unusual feature of this field is that physicians may enter it from different backgrounds.
Dr. Abraham explains that neurointerventional specialists can come from:
At his institution, the neurointerventional team included physicians from all three backgrounds who ultimately performed similar procedures.
That makes neurointervention an interesting example of how different specialties can converge on the same highly specialized area of medicine.
What Is a Mechanical Thrombectomy?
A mechanical thrombectomy is a procedure used to remove certain blood clots causing an acute ischemic stroke.
If a major artery supplying the brain becomes blocked, part of the brain may suddenly lose blood flow.
Through a catheter, a neurointerventional physician can navigate into the blocked artery and physically remove the clot.
Methods may include:
A specialized catheter is used to suction the clot.
A retrievable device expands into the clot, captures it, and allows the physician to pull the clot from the artery.
Dr. Abraham describes both techniques in the interview.
This can produce some of the most dramatic treatment responses in modern medicine.
How Are Brain Aneurysms Treated?
A brain aneurysm is an abnormal bulging or ballooning area of a blood vessel.
Certain aneurysms can rupture and cause devastating intracranial bleeding.
Some can be treated from inside the blood vessel.
Dr. Abraham describes navigating a microcatheter into the aneurysm and placing small platinum coils to fill it and redirect blood flow away from the aneurysm.
Stents and other devices may also be used depending on the vascular anatomy and type of aneurysm.
Again, this demonstrates how procedural some areas of Neurology can become.
How Are Vascular Malformations Treated?
Certain patients have abnormal connections between arteries and veins within the brain.
These vascular malformations may carry a risk of bleeding.
One interventional treatment involves navigating a tiny catheter deep into the abnormal blood vessels and delivering specialized material to close off the abnormal connection.
The interview describes the use of a medical embolic agent—or “medical glue”—to accomplish this in selected vascular malformations.
Why Choose Neurology?
The nervous system is responsible for virtually everything that makes human function possible:
Movement. Speech. Memory. Emotion. Coordination. Sensation. Consciousness.
That complexity can be incredibly compelling.
A Physician's Path to Neurology
Dr. Abraham's fascination began unusually early.
During a high-school anatomy project, he became fascinated by the nervous system and the fact that the brain has no obvious moving parts—yet it coordinates extraordinarily complex functions such as speech, movement, emotion, and coordination.
That fascination continued through his path into medicine and eventually Neurology.
This is a particularly good theme for the page:
The brain looks still. Yet almost everything we do begins there.
What Is Rewarding About Neurology?
Neurologic disease can take away some of the most fundamental human abilities.
A severe stroke may suddenly leave someone unable to:
Modern stroke treatment has created situations where physicians can sometimes reverse portions of that devastation extraordinarily quickly.
Dr. Abraham describes patients arriving unable to move one side of the body or unable to speak, undergoing clot retrieval, and beginning to regain movement or speech within hours.
Being able to see somebody who comes in not moving one side of their body, not able to speak, and then after we pull the clot out... within a few hours they may start to speak.
What Is Challenging About Neurology?
Neurologic decision-making can involve enormous stakes.
Sometimes the challenge isn't whether you can perform another intervention.
It's whether you should.
During a thrombectomy, for example, the major clot may be successfully removed while a smaller piece travels farther into a smaller artery.
It may technically be possible to pursue that smaller clot.
But doing so can also create additional risk, including vessel injury, hemorrhage, or worsening stroke.
Dr. Abraham describes this challenge using a phrase common in his field:
The enemy of good is better.
The goal isn't necessarily to create the perfect angiographic image.
The goal is to achieve the best outcome for the patient without creating unnecessary harm.
How Small Are the Blood Vessels Neurointerventionalists Work In?
Very small.
The interview describes arteries in the range of approximately 1–5 millimeters, highlighting the precision required when manipulating catheters and devices within the cerebral circulation.
That combination of microscopic anatomy, imaging, technical skill, and high-stakes decision-making is a major part of neurointerventional medicine.
How Collaborative Is Neurology?
Neurology can be highly collaborative.
Depending on the disease, neurologists may work with:
Dr. Abraham describes regular neurovascular conferences where difficult cases are reviewed collaboratively.
For particularly complicated or lengthy procedures, neurointerventional physicians may also operate together.
What Does a Typical Day Look Like?
There is no single typical Neurology schedule.
A general outpatient neurologist may have a traditional clinic day.
A neurohospitalist may spend the day seeing hospitalized patients.
A neurointensivist may round in an ICU.
An interventional neurologist may spend the day performing procedures.
Dr. Abraham's Neurocritical Care schedule included morning rounds with a multidisciplinary team of:
Rounds could last approximately two to three hours, followed by documentation, bedside procedures, teaching, and end-of-day reassessment.
This also illustrates the academic and teaching component available within Neurology.
What Is the Lifestyle Like in Neurology?
This varies enormously by subspecialty.
Outpatient Neurology
Can offer relatively predictable clinic hours.
Hospital Neurology
May involve inpatient service and call.
Neurocritical Care
Involves critically ill patients and hospital-based medicine.
Interventional Neurology
Can be substantially less predictable because acute strokes and other neurovascular emergencies occur 24/7.
Dr. Abraham describes his interventional call as running Monday-to-Monday during call weeks.
During those periods, emergency cases such as acute stroke requiring thrombectomy could occur at any hour of the day or night.
At the time of the interview, he reported approximately 19 weeks of call per year.
That should be presented as his particular practice, not as the standard lifestyle of every neurologist.
Is Neurology Procedural?
It can be—but it depends heavily on subspecialty.
Many neurologists primarily practice cognitive and diagnostic medicine.
Other areas involve procedures such as:
And at the far procedural end of the spectrum, Interventional Neurology involves catheter-based procedures within the cerebral vasculature.
So a student can potentially choose Neurology while building a career that is predominantly:
That flexibility is one of the field's major strengths.
Is Neurology Competitive?
Dr. Abraham noted that Neurology was becoming more competitive as advances continued across stroke and other neurologic subspecialties.
However, this should not be used as current national competitiveness data.
How Much Do Neurologists Make?
Compensation varies significantly depending on:
The interview discussed the possibility of general neurologists earning approximately 300,000–400,000 in certain smaller-city or community practice environments at the time of the interview.
What Are Common Misconceptions About Neurology?
This is increasingly outdated.
Neurology has experienced major advances in areas including stroke treatment, epilepsy, multiple sclerosis, migraine, movement disorders, neuroimmunology, and other diseases.
No.
While diagnosis and localization remain central, many neurologic diseases have active medical treatments, and some neurologists practice highly procedural medicine.
Some don't perform many procedures.
Others perform them regularly.
Interventional Neurology can involve navigating catheters into the cerebral circulation to remove clots, treat aneurysms, place stents, and treat vascular malformations.
Not exactly.
Neurointerventional physicians can come from Neurology, Neurosurgery, or Radiology backgrounds and undergo specialized training in endovascular treatment of neurologic disease.
Not at all.
An outpatient headache specialist and an interventional stroke physician may have dramatically different schedules.
Who Is a Good Fit for Neurology?
You may enjoy Neurology if you:
And if you enjoy procedures, critical care, or emergencies, Neurology can still provide paths that incorporate those interests.
Neurology may be particularly appealing to someone who loves asking:
“Where in the nervous system is the problem—and what does that tell me about the disease?”
Do Neurologists Only Treat the Brain?
No.
Neurology covers the entire nervous system, including the:
This is an important misconception to correct for pre-med students.
What Advice Is There for Future Physicians?
Dr. Abraham's advice goes beyond Neurology.
First, make sure medicine is something you genuinely want to do.
Second, don't approach medical education as simply memorizing enough information to pass an examination.
Try to understand how the material fits together.
And once clinical training begins, participate actively.
Go into the patient's room.
Pay attention during rounds even when the team isn't discussing your assigned patient.
Take advantage of the opportunity to learn from every case.
His advice was essentially that students get out of clinical training what they are willing to put into it.
Get your feet and hands dirty... be very active.
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