Specialty Spotlight Podcast, Episode 14: Neurology

Introduction to the Podcast and Guest Overview

[00:00] Welcome to the W Med Specialty Spotlight podcast, your virtual mentor for choosing a medical specialty and planning a career in medicine. On this podcast, we probe practicing physicians with questions about their specialty, the decision algorithm,

[00:20] them that helped them determine that the specialty was right for them and then for advice about long-term career planning irrespective of the field they went into. I'm your host, Dr. Brun Shaw, WMed assistant dean for career development, learning with you all about the various medical specialties.

[00:40] Just a quick reminder that the show notes for this episode and all episodes can be found on our website at wmed.edu forward slash specialty spotlight. If you'd like to help support this podcast by sponsoring an episode or a physician willing to volunteer for an interview to talk about your specialty, please email

[01:00] me at brendotshaw at wmed.edu. The specialty of today's show is neurology and the physician here to tell us all about it is Dr. Ramesh Madhavan. Dr. Ramesh Madhavan serves as the residency program director for neurology at Garden City Hospital in Garden

Dr. Ramesh Madhavan’s Background and Career Path

[01:20] City, Michigan, and is a professor and inaugural chair of the Department of Neurology at Western Michigan University Homer Stryker MD School of Medicine. After earning his medical degree from Madras Medical College in 1984, Dr. Madhavan completed an internship at the

[01:40] Government General Hospital in India. He continued his training in India specializing in dermatology at Madras Medical College, Internal Medicine at Kastorba Medical College, and neurology at the Institute of Neurology. In 2001, he moved to the United States where he completed a stroke fellowship, a

[02:00] transitional year residency and a neurology residency all at Wayne State University. Since the start of his career, Dr. Madhavan has been actively involved in professional organizations within his field. He has served on numerous national committees and held leadership and mentorship roles

[02:20] at Garden City Hospital as well as during his previous work at Detroit Medical Center and Wayne State University. Additionally, he is a reviewer for several prominent neurology journals. Dr. Madhavan's academic achievements are extensive with a CV listed

[02:40] seen over 20 peer-reviewed publications, six book chapters, three review articles, and more than 35 abstracts presented at regional and national conferences. He has also led 17 clinical trials funded by grants. Among his many honors, Dr. Madhavan is a

[03:00] Fellow of the American Academy of Neurology, a Palatucci Advocacy Leadership Fellow of the American Academy of Neurology, and the recipient of the 2011 College Teaching Award from Wayne State University School of Medicine. Better than not, haven't? Welcome to the show.

[03:20] You heard me read your bio. Was there anything that you'd like to add? Thanks a lot Dr. Shah for this opportunity to share my views with future neurologists who are interested as part of your medical practice.

The Scope of Neurology: Diseases, Treatment, and Advancements

[03:40] The only thing I wish to add is that I got technology bug when I got into telehealth in 2006 and during that time I had applied for some of the patents

[04:00] in technology and I am one patent owner. I don't know what it means, whether it means much, but that's something that I thought was an interesting journey in a physician trying to apply for a tech patent.

[04:20] very interesting in the sense of the ability as a physician to kind of, you know, make an impactful change and create something, be an inventor and make an impactful difference. So hopefully we'll get to that during our conversation. Would you be able to take us back

[04:40] back to time before medical school and walk us through your decision to go to medical school in the first place. Yeah, there's not much when you're born in a South Asian Indian family. Most of the time, I was

[05:00] part of a business family and as kids your parents tell you, hey, either you become a doctor or an engineer or an architect, some professional field. That's what it is. So you write your entrance exams and

[05:20] If you don't get into medicine, you go into engineering or dental school. But I was lucky that I went into medical school in a great institution, Madras Medical College and my scientific career started from there.

[05:40] Great. I think this is a great opportunity to transition to our first part of the interview where I basically ask you to tell us everything about neurology. And the way I like to start off this section is by reading you a description of your field from the Association of

[06:00] American Medical College's Careers in Medicine website and then I'll ask you what you think and we'll take it from there. Neurology. A neurologist specializes in the evaluation and treatment of all types of disease or impaired function of the brain,

[06:20] spinal cord, peripheral nerves, muscles, and autonomic nervous system, as well as the blood vessels that relate to these structures. The disorders include stroke, brain and spinal tumors, muscular dystrophy, headache and other pain, meningitis,

[06:40] encephalitis, epilepsy, Parkinson's disease, Alzheimer's disease, and other memory disorders, multiple sclerosis, and effects of systemic diseases like high blood pressure and diabetes on the nervous system. How much of that do you agree with and

Daily Life of a Neurologist: Work Settings and Career Options

[07:00] What would you add or subtract to ensure that anyone listening was well informed of the practice of neurology? I think the definition and classification of the diseases under neurology is something which is well described in a lot of

[07:20] career-building sites. But if you look at the holistic picture, I think neurology starts off from the preventive side to the disease management side. We have to take it as

[07:40] a whole and start off from the time of childbirth till the time that we leave the world. So, neurology extends throughout this and that's the interesting part of this field that there can be a lot of scientific research

[08:00] that can go because you saw that with the large pandemic at this time, there are several conditions which we still do not know. They call it brain fogging. They think attributed to vaccines. There's so much of differences there have

[08:20] been created in this field and that's why I find neurology to be fascinating that so much of things can be done in this field right from the time you are a student till you are a practicing physician or a

[08:40] scientist or an entrepreneur. Thank you for that. Can you tell me what a typical daily or weekly routine looks like? And you can change the timeframe to whatever is conducive to your answer. And what does it

[09:00] typical series of patients look like and what's the typical outcome for these patients? It's interesting that you asked this question to me. You know, when I started my neurologic career as a young practicing neurologist, I went into academic

[09:20] in India as well as a practicing physician and my days used to start from 5.30 or 6 in the morning till I went to bed at 11 p.m. So you know it

[09:40] That was a busy program. I used to be usually teaching the residents and technicians on different things in neurology during the day where I was faculty in a medical school.

[10:00] But after that particular time period, start seeing patients both at a hospital level and in an office level. And you can do amazing things in this field depending on your interest.

[10:20] Your lifestyle will depend on what you want to do. So there are physicians who like to do only outpatient work. Generally, there are a lot of sub-specializations. For example, if you want to do neuromuscular, you can do procedures and everything.

[10:40] which is all office based. If you would like to do things like multiple sclerosis, it can be again outpatient based, but some of it is reading images, looking at your scan pictures where there's a mix of both neuro radiology and

[11:00] other parameters like biochemistry and all that. So it totally depends on what's the field you want. Right now there are a lot of younger neurologists who don't like outpatient work. They like the seven day on and seven day off program. So what

[11:20] they do is take up neuro-hospitalist work. So they do telemedicine, they do telehealth, they do inpatient rotations. So the subspecializations in neurology has grown and just to list a few, you

Subspecialties in Neurology: Academic vs. Private Practice

[11:40] have vascular fellowship, you have behavioral neurology and dementia, we have neuromuscular, neurophysiology, epilepsy. So the field has an amazing potential in the clinical side.

[12:00] On the research side, a lot of physicians who'd like to do inventions and drug discoveries and all that, the number of opportunities have really grown and that's

[12:20] One of the reasons I tell medical students who are interested in any field to have an open mind, I mean there's nothing that you need to decide on day one. I want to be a neurologist. I want to be a cardiologist. Go with an open mind.

[12:40] look at what your life is dealing with you, what you like as you get trained and the opportunities are great in any field that you take. Now I have a lot of my residents, I have been doing this academic teaching

[13:00] for a number of years and I have found residents or even before their residency when they do the audition rounds they say hey I want to do cardiology, I want to do PMNR, I want to do medicine but then when they do the audition

[13:20] rotation, they find that neurology has everything that a cardiologist can do like intervention. Interventional neurology is a huge field right now. We go right into the smaller branches of the drain vessels and we

[13:40] take out clots as part of vascular neurology. It's an amazing field that I find has grown so much since I became a vascular fellow in 2001. So the subspecialty is a huge

[14:00] that I feel the opportunities that any medical student wants are available in neurology from being a bench neurologist to an armchair neurologist to one who is running around and is

[14:20] from morning till evening putting catatas into the brain. Wow, no thank you for that. Do most residents that complete a neurology residency do a fellowship or is it career as a general neurologist not

[14:40] No, I think it totally depends on their situation. A lot of the neurologists who get into this field go into fellowships. I think a majority, about 70 to 80% go into their fellowships.

[15:00] specialties try to do a one year fellowship or a two year fellowship depending on what they want to do. Others depending on their school loans and all that they take up general neurology work and there's a lot of opportunity

[15:20] for even general neurologists to start off. But some of them feel that we need to finish a fellowship so that your job opportunities are a little better. But I think there's a big shortage all over.

[15:40] for good neurologists and even with general neurology you can start and then you can see what is it that you want to do to understand because like I told you, the opportunities are amazing if they want to go

[16:00] into private practice or academics, it's all there right now. So I know it's kind of difficult to kind of really answer what a typical daily or weekly routine is because if you're a specialist in a particular area, your routine would

Challenges and Rewards in Neurology: Work-Life Balance and Career Growth

[16:20] be different from another subspecialty neurologist. But if you were to keep a cap on as far as a general neurologist, what is a typical day like of a general neurologist in terms of patients that they see?

[16:40] what their daily routine would look like or weekly routine would look like. Are you able to touch on that? There are a lot of opportunities like I said, but a typical general neurologist or one who has done a basic

[17:00] neurophysiology fellowship. They have a good 9 to 5 lifestyle. Your new patients, most of the places allow them to see the new patients between 45 minutes and an hour and their follow-ups are between

[17:20] 20 to 25 minutes. Of course now with all the nuances of practice, there's a lot of pressure on them to finish the cases, finish the notes. You have to dictate your notes and get your billing done because

[17:40] A lot of medicine is how you treat your computers these days. So I keep telling them, you know, patient care becomes very important. And of course, you have a lot of technologies. But in the end, if you follow the basic

[18:00] rule of localizing, knowing what your patient has, treating, spending a little more time on explaining the management things to your patient. That should be the priority for any young neurologist to start. And so that's the outpatient practice.

[18:20] Some physicians do both hospital work and in-patient work so they can balance it out that they spend, say, a week, especially in academics, they are given a lot of money.

[18:40] given time to round on their inpatients on one-week slots or two-week programs and have half a day clinics on a few days either in the morning or afternoon depending on their slots. So that's the other model that is happening.

[19:00] 14 is the one week on and one week off for neuro-hospitalists that a lot of the employed models use so that these individuals just do two weeks in a month and then the rest of the time they can do whatever they feel like.

[19:20] This is at a general neurology level. Now if they are fellowship trained, they have their specialty clinics that they concentrate on. Suppose they are an epilepsy fellow. I'm just giving an example, epilepsy fellowship trained.

[19:40] They read the EEGs which are routine long term, ambulatory EEGs or inpatient long term EEGs. They have time slots for that. They have their outpatient epilepsy clinic where they can do even procedures.

[20:00] vagal nerve stimulators that are put in are managed by these epilepsy trained physicians. And also if it is an academic program, they can go into invasive things like where they work with the neurosurgeons.

[20:20] inputting grids and everything for their epilepsy work. So that's epilepsy fellowship ring. Multiple sclerosis, I already told you, demyelinating. They work closely with the neuroradiologists because a lot of it is imaging.

[20:40] and what are the plaques looking like, what are the things and infusion centers. We manage infusion centers for these because a lot of these patients now the newer drugs are infusions that happen. So that's the demyelinating

[21:00] or the immunology fellows who are trained. Now vascular has got non-interventional and interventional. The non-interventional team members mainly look at patients who come acute

[21:20] in the ICU or in a vascular unit and see them as in patients and follow them up in the outpatient program as part of their clinic for vascular strokes, vascular dementia and

[21:40] It's a mixed pattern of inpatient, outpatient work that they can do. Whereas the interventional team members have a very high degree of involvement. They have to be available day and night because of the emergencies that they handle.

Future of Neurology: Technological Advancements and New Discoveries

[22:00] So their lifestyle is a little more difficult but then the pay scale is equally better and lot of the individuals love it because they are almost paid like neurosurgeons of the olden days. I hope I've sort of given you a

[22:20] whole range. No, no, this is great. What do you find most exciting about your specialty and conversely what do you consider most mundane about your specialty? The excitement is all the scientific discoveries and

[22:40] inventions that are going on. As we all know, the field of vascular neurology has grown in leaps and bounds that we have new molecules that are being introduced for the management of

[23:00] strokes, the catatas and the treatments of acute strokes and the vascular diseases have really grown quite a lot. Similarly, in the field of demyelination, a lot of drug discoveries have

[23:20] improved the outcomes in multiple sclerosis and the other diseases of demyelination. In the field of dementia, again, as there's aging population all over the world and more and more individuals are

[23:40] notice to have cognitive impairment, drug discoveries and approval by FDA and the European organizations. There's a lot of interest and developments in these fields. So these are the

[24:00] path. Telehealth, telemedicine, which is something very close to my heart, was when I started trying to develop telemedicine, telestroke, there was nothing in 2008

[24:20] 2005-2006. But now you would have seen how the field has been a leader in tele-stroke, telehealth, long-distance management and so much of it has happened.

[24:40] happened in that field. So technology with IOT, AI and all that is another big excitement. For example, nowadays I can see my strokes imaging being an radiologist. I'm sure you are also

[25:00] noticing it with AI, we see images of the CTs, MRIs on our phones with the reporting and all the development. So that's another exciting part of it. What is mundane was the other part of your question is all the

[25:20] bureaucracy and the things that come, especially for a physician, you just can't be excited about what you can do. But what does the system provide as support? The regulations, the licensing?

[25:40] insurance and the costs are the major part but that happens in any field. So this is where I think students have to realize that they have to get more into advocacy just not

[26:00] think only about science, but also be involved in advocacy programs, in understanding what are the disadvantages in the field that we are, for example, privacy. Privacy is a big thing and everyone hops onto

[26:20] privacy, but then when it comes to sharing your notes with all the whole world due to somebody making the rules is also a major problem because it's a pressure on you to do the right thing, but also make sure your documentation is

[26:40] So that you get your billing, you're doing the right thing for your patient, the right thing for people who read your notes on the legal side, so many things. So these are the mundane things, but that is something the whole medical community has to realize and

[27:00] do so that we do the right thing for the patient, right thing for the profession, and right thing for the community. Great, great. Thank you. What is one thing that you would have wished you would have known before entering neurology?

[27:20] What would you encourage a medical student to think about in earnest before committing to going into your specialty? I have no regrets. I have no regrets because I always loved what I wanted to do, but I'm very

[27:40] I am a very ambitious person. I like to be disruptive. I like to face things as it comes. So for me, I have no regrets in taking this field because I am so glad that I am here because of

[28:00] my drive and my commitment. I think that's what I would advise anybody going into any profession. You know, you should have a passion. You should not just look, oh, it's my lifestyle. Yeah, lifestyle is very important.

[28:20] But you can balance your lifestyle. You can balance your work. It's all up to you. So go with an open mind and be passionate. It's not about what you make, your paycheck. It's not about

[28:40] what you want to do for your own self. But this is a field where you can help millions of people. You know, we have about one in seven individuals, about 71 years becoming demented.

[29:00] Can we make a difference in their lives? There are about 800,000 new strokes in the US every year. Can we make a difference? If I sit and think, hey, I don't want to wake up in the night and give T and K, what

[29:20] What if it was our own family member? We would do it. So I think that passion is what counts rather than this work life's balance and all that. Yeah, it should be there because you don't want to burn yourself and that's one of the reasons I left

Advice for Medical Students: Choosing Neurology as a Specialty

[29:40] India when I was very young, in the year 97 I was a successful neurologist, but my lifestyle was quite bad. But that experience made me go through another residency when I came into the US.

[30:00] I was in the 40s, I was 40 years old and imagine I was in attending, I had trained hundreds of neurologists but I went through internship, I still remember taking calls, presenting cases to my attendings.

[30:20] residents come and tell, oh Dr. Maghuan, I have a problem, I have so much of work, I say, yeah, 80-hour rule is fine and all that, but just think what you're doing is something noble, something so have the passion. Then all of us

[30:40] have it in us. It's just how you get guided and how you want to do things for the profession that we are in. How many of the people in this world can treat strokes or can treat dementia or treat

[31:00] multiple sclerosis, treat the disabilities. If you do that way, you will get passionate. Of course, I mean I don't like getting woken up in the night, but that's my choice. After some time, your choice. You take it.

[31:20] You take a pay cut and you do enjoy your work. But as a physician, as a neurologist, you can work anywhere in the world and you can make a big difference in so many people's lives as we move on. That would be my advice to

[31:40] anybody getting into neurology any medicine program I think right any medicine program and the world has become smaller you know social media has made the world small my feeling that's why I am into technology to make medical media the same way that

[32:00] You can sit anywhere in the world and make a difference in somebody's life. Very well put. I want to hit on this one question and that is, what do you think is the biggest challenge facing neurology and where do you predict your specialty?

[32:20] be in 10 to 20 years from now? The advances are the biggest challenge. So when we take a person getting into business, business school, there are a lot of youngsters who get into

[32:40] a business program, an MBA, they make a killing once they finish. Whereas any field of medicine, especially fields like neurology, you have to go through your MCAT, then do your med school,

[33:00] Then score well in your med school because the field is so competitive. Then get into neurology. That's a four-year program. Then if you want to do more fellowship, another two years or three years. So by the time you come out of these programs, your gray matter is also stuck.

[33:20] started to shrink. So then it's climbing the totem pole. I always tell the medical students, you are at the bottom of the totem pole. When you become an intern, you're climbed up, but still you're at the bottom. Then you keep climbing

[33:40] The options are so huge, you do not know where to go, what to do. So it's your interests and your drive that can take you and that's a challenge. But if you can overcome that challenge and be patient, the world is available for you.

[34:00] to do whatever you want. I started as a general neurologist, then did my vascular fellowship, became a resident again. But then the climb for me, you know, I started the telehealth program for Wayne State. My career

[34:20] just grew and then it was all the choices. I could dictate what I wanted to do. I started the Michigan Stroke Network. We covered 40 hospitals. I started the entrepreneurial business, started my own practice. I've

[34:40] run an academic program. So yes, I wish there was more time in a day. But then you can achieve whatever you want. It's your choice. And that is also a challenge. You have to balance it out. What would you

[35:00] advise or recommend it to a student in terms of resources for them to learn more about your specialty? Yeah, I think organizations like the American Academy of Neurology are

[35:20] are a good resource for the students. A lot of hospitals and universities have what is called as the Sign Chapter. Sign Chapter is available internationally. It's called SIGN.

[35:40] If there's interest, they can become members of it. There's a lot of opportunities for them for networking, to do research. There's funding available. They get grants to do some projects if they want. So in the US, that's the

[36:00] opportunity, but I have been involved with SINE for a long time and SINE is also available for international medical students and so American Academy of Neurology is one of the organizations I would recommend. Of course, the American

[36:20] Heart Association has similar programs with American Stroke Association for vascular neurology. We have other societies like Movement Disorders for anybody who, you know, students have multiple interests because of their own experiences.

[36:40] There are a lot of societies and organizations, Alzheimer's Association, because I see a lot of personal statements for residency application that one of their family members had this disease, so I want to become a neurologist.

Residency and Fellowship: The Path to Becoming a Neurologist

[37:00] whatever their disease the family member has, you also try to get in touch with that association and do some advocacy work or research or things like that which will also strengthen your application for the program. Now that's great and we'll add that to our show.

[37:20] notes as well as some of the people will have that. I kind of want to move to the next part in that was there ever a head-to-head decision between two or more specialties and if so what made you decide to choose the route that you did to go into neurology? You know

[37:40] As a medical student, I was very interested in neuroanatomy and I think there was, I don't know whether the textbook still exists because a lot of us now do online books and online reading. It was called Choose a

[38:00] And I used to really enjoy localizing the clinical deficit when I was a medical student. But then when I wrote my entrance exam, we are competing in a country of billion.

[38:20] And I got into dermatology and I know now dermatology is a huge field. But in 1986 dermatology had nothing except steroid creams and doing biopsies and looking at the pathology. So I.

[38:40] Once I finished my first residency, I still was passionate about doing neurology. So I did my internal medicine in India. You had to do your internal medicine first and then neurology versus subspecialty.

[39:00] So my passion was still the localization and after my medicine got into neurology and I don't regret it at all because I still remember when I took my vascular neurology fellowship in Wayne State after

[39:20] When I was trying to move into this country, we didn't have too many developments in the field at that time. So any specialty that you take, the potential is huge. That's my general advice to the students. There shouldn't be regrets.

[39:40] that I did the specialty or that specialty. It's your experience that you take it and you make it better and you know, neurology has so many subspecialties right from dementia to sleep to

[40:00] Same thing for every other specialty when you take the bigger picture though we once we finish medicine we are at that stage where we are wondering did I make the right choice? I think all of us make the right choice.

[40:20] choice but you have to have the luck and a little bit of passion in you to drive yourself to whatever you want to be. That would be my advice to anybody taking neurology. As far as neurology or way of

[40:40] electives necessary if you're a medical student? It depends on what your training site offers. If your training site has a good teacher, I think there's no reason to go for any away electives.

[41:00] But I find some of them, it's a little bit of struggle on who your teacher is, who your guide is. Because lot of it is what you are experiencing in your field.

[41:20] find a lot of students in good medical schools, if your neurology rotation was not ideal one, they think, oh, this field is not the best. So if they're having that interest, they

[41:40] should look at other electives, other electives also, especially in their fourth year rotations because that can really help them. Okay. And how important is research or scholarly productivity for matching into neurology?

[42:00] The field has become very competitive right now and I look at it in this manner. Of course, your scores are important. Your shelf scores become important. But some amount of work, you know, other than your clinical

[42:20] work, some scholarly activity can be helpful for you in your application into good residency programs. Is there anything else you think that a student should know or be doing to be a competitive applicant?

[42:40] for neurology? I think because the number of spots are quite limited in the field, it's very competitive. People compare what your recommendation letters are, what your presentations are, what your

[43:00] your scholarly research activities are. So the more you have, it's better. But I think it's also important to have an open mind and do what you really like. So you do, suppose you are

[43:20] are interested in neurology and you do a few more electives and have good recommendation letters for just your good clinical activity and your presentation that itself can help because especially for US grads there are enough spots

[43:40] in the country that you can match if your attitude is right and you are put in your effort during your med school days. Great. Thank you for that. Dr. Monatin, I wanted to ask you one

[44:00] One question which I always ask for every guess and that is what I call the third year question. If you were a third year medical student undecided on the specialty of neurology with limited time remaining before residency applications were to be submitted, what do you think would be

[44:20] the fastest, highest yield route to making the decision about the specialty? For anybody interested in neurology, if they have not had a chance of doing an elective rotation with the neurology

[44:40] It seems that it also influences some of the decision makers in medical school. They have high hopes of doing neurology and then they are very disappointed.

[45:00] when they see a practice where things run like a 15 minute machine, the patients are seen and disposed. So choosing the right place for the elective will be very important and if it is not possible, at least they should

[45:20] call other places, academic institutions and ask for an audition. A lot of academic institutions allow it, a lot of practices allow it and I think that's a good way for them to experience what real neurology is.

Final Thoughts: Career Planning, Passion, and The Importance of Mind in Medicine

[45:40] And then again like I had previously mentioned, neurology is like a spectrum of clinical experience. One is pure outpatient, other one is pure inpatient. So if they are able to get a mix of both, experience

[46:00] they will really love and like neurology and in the case of our practice especially for the students of W Med, I would request them to feel free to call us anytime and we'll be able to

[46:20] help them with this audition rotation. Great, well thank you for that. I'm going to move on to the third part and that is where kind of give us advice for long-term career planning irrespective of the choice of specialty. And my first question is,

[46:40] If you could go back and do it all again, what would you do differently and what would you do the same and why? I was always passionate once I was in medical school to become a neurologist and I went through

[47:00] very convoluted route in my training. Like I mentioned, I went through dermatology, then did internal medicine, then did one residency in neurology in India and was attending for a long time, was not shy to repeat the

[47:20] Though I could have been a non-board certified neurologist attached to the university, but even later in my life, I took the plunge and did it and I don't regret it one bit.

[47:40] I know that I meet a lot of students, I meet a lot of residents. I have been a guide and a mentor for a number of individuals who have gone through neurology. They have had the challenges because any

[48:00] residency is tough. You have to go through the steps and then the step three and then the internal exams through the years. You know, we have to be prepared for that and I think if pure

[48:20] If you are prepared with all these ups and downs, I think any specialty is okay. Now when I start my rounds with residents and students, I make it a habit to ask them about the core components.

[48:40] competencies of residency, the same core competency goes on as we become attendings. It's only that we don't have duty hours. We have to do the same thing like the residents, except that we are higher up on the totem pole.

[49:00] So as long as we understand that this is the way of life and then start doing it, enjoy it, things will work out well in any specialty. In terms of neurology, you have options. You want to do a 9 to 5 job.

[49:20] make this much of your income, you're fine. If you want to work day and night to acute neurology and to make a big difference with emergencies, neuro ICU and there are so many

[49:40] subspecialties where you can make a lot of money in the bank but also your lifestyle is compromised. There are a number of neurologists who go through all these phases but at a stage in

[50:00] lives, we can always decide, okay, I want to stop taking calls. I don't want to do this much. So I think the options are with us, but we can't have everything in life and we have to go with system, with

[50:20] We, the practice of neurology in this country works and accept it. Great advice. And I'll ask you as far as what is a career mistake that you've seen other physicians make and what is something that you've seen a physician

[50:40] positioned you well that has made you want to emulate it. The mistakes we make is, you know, as we start our careers, our expectations do not match what your experience is.

[51:00] lot of situations where the stress factor is very high in every field. I don't think it's only neurology. In any field we take, stress factors are high and if we are not an individual who can

[51:20] take that kind of stress, I think we shouldn't be in this field. I think that's the most important thing. The second thing I find all the medical students and the residents are, I mean,

[51:40] there's a lot of advertisement of work lifestyle balance. You and I know that that's yeah, it's how you take it and there's nothing like a work lifestyle balance. Something can go wrong one day and

[52:00] You have to accept it and go about it. Being a neurologist, I think because of my interest in behavioral neurology as part of vascular neurology, I think the negativity in our brain is the worst

[52:20] problem for all of us. If we have that positive focus in our lives, I think every one of us can do well and go through this in a way that we go with our passion, we go with our focus

[52:40] that we are doing something different from anybody else because only a doctor can treat a patient and we are physicians, we are medical providers and no one can take away that job from us. Whatever may

[53:00] changes they make. I think if that thing works in everyone's mind, every medical student can be a successful physician because the day they join as an intern, the pressure is, did I finish my notes? Did I do this? Did I do that? But if

[53:20] If you are organised and you do your work and finish your commitment, take good care of your patients, things will fall in place. I think that thing should be driven in every student's brain as they enter their residency.

[53:40] Yeah, yeah, that's great. What is one thing that you are struggling with or lamenting about your career today? What are you doing to remedy it? And what would you encourage a medical student to do right now to help avoid this problem?

[54:00] entirely later in life. If you take my personal career and my work-life balance, I wish there were 48 hours in a day.

[54:20] Because I'm a person who is very driven. I multitask. I try to do so many things. I try to help people. I try to counsel people. I treat patients. I do administrative work. Keep checking my emails.

[54:40] all kinds of things and multitasking is the major problem for me right now and I'm wishing I can be more mindful and cut down. So sometimes I keep telling

[55:00] People are the individuals around me. Hey, I feel that I should retire But I don't know whether I can I can retire But that's the only thing I keep lamenting about that. I wish there was more time in the day Yeah

[55:20] I like to end the interview by asking what is one book, medical or non-medical, that you think every person pursuing a career in medicine should read? The book I really enjoyed as a medical student was

[55:40] I think it was called Neurocorrelative Anatomy by Chuseid. It made my career. I mean, I went through a tortuous path, but I always loved that book of localization and how the brain works and everything. That was one book.

[56:00] I would recommend, I don't know if it's still in print or it's online, but that is one book. Other one is there was a book by a doctor from the UK called Primer of Medicine by Patworth which

[56:20] gives you the whole thing about medicine and how you manage and systematically analyze symptoms and do that. That was the second book that I still enjoy and cherish. Regarding other books, it may be worth

[56:40] Forget the name of the author, it's called The Digital Doctor. That's about the current state of medicine. It's a well-written book, I think every physician because now we have become transcriptionists, we are treating patients

[57:00] computers, we are taking care of insurance, not direct patient care. We are more a digital doctor. Though I love computers and I am a technology guy, I think it has really taken over and it may be worth

[57:20] medical students and doctors to go through that book and see if they enjoy it. Right and what we'll do for our listeners, we'll put that in our show notes those books that you've mentioned. Is there anything that we haven't discussed that

[57:40] You want to make sure our listeners know about the field of neurology. You know, if at all anything is important, if you do not have a mind, you can't exist. Right? We become mind, yes. And

[58:00] That's why I think neurology is important. We don't know where the mind is, but I think it's in the brain. So I would recommend listeners to think of neurology and become a neurologist because the mind is everything.

[58:20] thing and that's the brain and whatever AI does, still we have to build AI. Well put and excellent. I really enjoyed this conversation. It's been a pleasure having you on the Wmed Special

[58:40] specialty spotlight. For everyone listening, we'll wrap up the show with that. I hope you enjoyed the conversation with Dr. Modavin. For the resources and other tidbits that were mentioned in this episode, you can find them in the show notes on the WMED website, wmed.edu forward slash specialty

[59:00] spotlight. If you liked what you heard, please share this episode with your fellow medical students, especially if they're having some career anxiety. It truly is my hope that these conversations with physicians who've been there and done that will help you move forward with your own career choices. For any questions or if you'd like to reach out to me for any

[59:20] season, which I encourage you to do. You can do so by emailing me at brendatshaw at Wmed.edu. But until next time, take care.