So You Want to Be a Pediatric Neurologist

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So you want to be a pediatric neurologist. You’re fascinated by the great unknown of the brain and are comfortable working with both children and their parents. Let’s debunk the public perception myths and give it to you straight. This is the reality of pediatric neurology.

Welcome to our next installment in So You Want to Be. In this series, we highlight a specific specialty within medicine to help you decide if it’s a good fit for you. You can find the other specialties on our So You Want To Be blog category or YouTube playlist.

 

What Is a Pediatric Neurologist?

Pediatric neurology focuses on the diagnosis and treatment of conditions affecting the brain, spinal cord, nerves, and muscles in infants, children, and adolescents. The bread and butter of the specialty includes headaches, seizures and epilepsy, cerebral palsy, brain injuries, and developmental delay.

The work can also include research or treatment of complex and unique cases, such as strokes, tic disorders, sleep disorders, neuromuscular disorders, infectious or autoimmune encephalitis, neonatal encephalopathy, Guillian Barre, nerve injuries, and functional neurologic disorders.

The specialty is much like adult neurology, except you receive 2 to 3 years of general pediatric training in addition to general neurology and child neurology training.

In pediatrics training, residents learn about the various stages of development, from babies to children to adolescents, which is now up until the age of 25. In this age range, the body is still evolving, and certain treatments and medications you would use for adults may have dangerous results for children.

And because children are more resilient than adults, they can seem unaffected by the disease process until their bodies give out and they crash abruptly. This sudden decompensation requires prompt intervention.

Neurology can be an emotionally challenging specialty since you’re dealing with babies and children suffering from chronic and progressive diseases. And what’s additionally difficult about this field of medicine is that although research continues to evolve and improve, there is still so much we don’t understand about the brain.

It’s common for people to confuse psychiatry and neurology because they both deal with the human brain. The difference is in the approach. Neurology focuses on the brain, meaning the nuts and bolts, such as physical dysfunctions and pathologies of the neural and glial cells or brain vessels. In contrast, psychiatry deals with the mind, including emotional, cognitive, and behavioral symptoms caused by chemical imbalances in the brain, past trauma, or developmental issues.

Inpatient vs Outpatient

Many child neurologists are associated with larger academic institutions, so they tend to practice in both inpatient and outpatient settings, in addition to having teaching opportunities. However, many child neurologists decide to have outpatient private practices only. The beauty of the specialty is you’re free to choose the type of work and practice you enjoy most.

When working in an inpatient setting, you’ll see more emergent or not well-controlled conditions, such as traumatic brain injuries, intractable headaches, status epilepticus, pediatric strokes, various cases of altered mental status, and so on. 

When working in an outpatient setting, you’ll see follow-ups for chronic issues. These can include medication management of seizures or headaches, concerns about abnormal movements, myotonic dystrophy, spinal muscular atrophy, sensory changes, or a work up for behavioral disorders or developmental delays.

If you love the work of inpatient, you can also be a neurology hospitalist without having an outpatient clinic. Call depends on how your practice is designed; doctors may take call for their own patients or rotate through an “on-call” service.

Most pediatric neurologists will have to take call and occasionally work nights or weekends.

Common Misconceptions About Pediatric Neurology

The biggest misconception about pediatric neurology is that career paths are limited and training is only geared toward children, when there is actually a lot of freedom in choosing a career path after training. This is because pediatric neurologists all train for at least a year in adult neurology.

As a peds neurologist, you can take care of both children and adults with neurologic disorders, but only about 3% of pediatric neurologists provide general adult neurology care.

You also receive training in general pediatrics and have the option to take the pediatrics board exams, although most don’t pursue this option. If you are interested in any general pediatric management, you have the opportunity to incorporate it into your practice.

Many people go into pediatric neurology because they are passionate about neurology and working with kids, so they stick with that path. However, the option to change your direction is always there. The beauty of the training is that for those who are unsure about this path or worry about the commitment, it’s very easy to make a switch to either pediatrics or adult neurology.

 

How to Become a Pediatric Neurologist

Pediatric neurology is established as a 5 year residency training process. However, there are two ways to enter this field.

The first is to apply directly to a child neurology residency program for a total of 5 years. 2 years of that time is general pediatrics, with a list of specific rotations needing to be completed, 1 year of adult neurology, and 2 years of pediatric neurology. There are currently over 70 child neurology residency programs.

Note that the 12 months of adult neurology can be scattered throughout the final 3 years, depending on the residency program. For example, you might have 6 months of adult neurology during PGY-3 and the other 6 months scattered throughout PGY-4 and PGY-5.

Your second option takes a little longer. You first complete a general pediatric residency of 3 years and then apply for a child neurology fellowship, which takes 1 year of dedicated adult neurology and another 2 years of dedicated pediatric neurology. This route is one year longer than the first option but gives residents more time to decide whether pediatric neurology is the right fit.

No matter the path you choose, to become a pediatric neurologist, you also receive training in adult neurology and sit for general neurology boards.

Overall, pediatric neurology is not very competitive. On our Med School Insiders Specialty Competitiveness Index, which takes into account match rate, Step scores, publications, and more, child neurology is ranked 18th out of 24 specialties. Child neurology is also on the lower end of Step 2 CK score averages, ranking in the bottom 7, with a 2022 average score of 247.

To learn more about how child neurology compares to other specialties, check out our list of top 10 least competitive specialties.

Data from the NRMP Match consistently shows unfilled spots for pediatric neurology with 3 spots unfilled in 2023, 16 unfilled in 2022, and 12 unfilled in 2021.

Since much of neurology, especially child neurology, is still unknown the medical students who are most likely to thrive in this field are curious, not ego-driven, teachable, and hard-working. And given your patient population, you have to be willing to be silly, patient, and not sweat the small stuff.

 

Subspecialties Within Pediatric Neurology

Pediatric neurologists can differentiate themselves through subspecialization. For example, a peds neurologist could subspecialize in epilepsy, neurocritical care, or sleep medicine.

About 93% of adult neurology residents will go on to complete a post-residency fellowship, compared to only 56% of peds neurologists. That’s still a fairly significant number, considering that training to become a pediatric neurologist already takes 5 to 6 years before a fellowship.

Fellowship provides extra training in areas of neurology with the potential of establishing your own subspecialty practice within a larger institution.

Subspecialization can increase compensation, which is lower than average, but whether you choose to pursue a fellowship or not, most pediatric neurologists will treat general neurology cases as well.

People who pursue epilepsy as a fellowship tend to be technical folks who like looking for patterns.

Those who go into neurocritical care often enjoy acute treatment of complex and often unknown pathologies, and they may thrive in a high-stress environment.

Headache medicine specialists are generally compassionate and patient physicians, many of whom have had personal experience with headaches themselves.

Other subspecialization options include but are not limited to:

  • Clinical neurophysiology
  • Sleep medicine
  • Neurogenetics
  • Movement disorders
  • Neuroimmunology
  • Autonomic disorders
  • Cognitive disorders
  • Neuro-Oncology, and
  • Addiction medicine

Most fellowships are 1 to 2 years, depending on fellowship and research requirements. This puts training at a total of 6 to 8 years after medical school.

 

What You’ll Love About Pediatric Neurology

There’s a lot to love about pediatric neurology. You get to work with children while focusing on the most complex and fascinating organ system in the human body. And because it’s a specialty in such high demand, there is plenty of freedom to design your practice as you see fit.

For the somewhat medically indecisive, pediatric neurology gives you a ton of flexibility and options to alter your career path should you choose to.

Since you’re trained in both adult and child neurology and sit for general neurology boards, you can see both of these patient populations. You can also focus your practice exclusively on adults or children, or adults and children—which may occur in more suburban or rural settings.

Neurology is a field that’s far from stagnant since we continue to learn more about how the human brain works, with a lot of treatment research coming down the pipeline. What were once thought incurable diseases now have great treatment options.

For example, our knowledge and treatment of epilepsy has greatly improved thanks to new anti-seizure medications, implantable devices called vagus nerve stimulators, and advances in epilepsy surgery.

Your work will be far from dull, and you’ll have a career that’s filled with lifelong learning. New developments in neurology will continue, as neurologic diseases are consistently in the top 3 most funded diseases by the NIH each year.

It’s also a chance to build strong, longitudinal relationships with your patients and their parents. Most neurology pathologies are chronic, so you’ll often see patients and their families for many years. In addition to your patients, you’ll be working with other physicians who are very passionate about what they do.

 

What You Won’t Love About Pediatric Neurology

That said, seeing the whole family can have its downsides. Working in any pediatric specialty, including peds neurology, means you’ll essentially have two patients with different needs and demands—the child and their parents.

If you didn’t enjoy your pediatric rotation in medical school because of the parents or because you dislike working with children, adult neurology is better suited to you. Check out So You Want to Be a Neurologist.

Compensation for the specialty is lower than average, typically ranging between $127,000 and $392,000, with an average salary of around $224,000. Similar to other specialties, the pediatric version of the specialty receives lower compensation than the adult version. The average salary of an adult neurologist is $313,000.

Although there is flexibility in the type of work you do, you may have to be on call, which can eat into your work-life balance.

Lastly, while there are many ways we can help patients with neurologic disorders as research advances, certain disorders have some limitations. Plus, you will be dealing with children who are neuro-devastated either by trauma or disease and face worse outcomes, which can be emotionally taxing, to say the least. There are also limited resources for children with neurologic conditions, especially those with combined psychiatric disorders.

 

Should You Become a Pediatric Neurologist?

So, should you become a pediatric neurologist?

Neurology is filled with unique and interesting cases that are ideal for those who are curious and don’t mind the unknown. If you’re inquisitive, hard-working, patient, have good rapport with both children and adults, and like to work in team settings, pediatric neurology may be a good fit.

Those who go into pediatric neurology also tend to enjoy the intellectual side of things; they like to discuss the nuances of the physical exam, unique imaging findings, and strange labs.

It should go without saying that you like children and are patient, empathetic, and kind. You must be comfortable cultivating longitudinal relationships with parents and their children, who may have debilitating and sometimes terminal illnesses.

Traits of a Pediatric Neurologist

If you’re someone who lacks curiosity, likes shift work more than solving medical puzzles, or hates doing neurological exams, this isn’t the field for you.

Are you hoping to become a child neurologist? Getting into a top residency program, regardless of the specialty, is far from easy. You’ll have to do well in medical school, thrive at standardized tests, stand out in your clerkship training, and match into your top choice program. On top of that, just to get into medical school, you’ll need to craft a stellar application that illustrates your unique story, past adversity, and commitment to medicine.

Med School Insiders has helped thousands of premeds and medical students design their ideal career paths. Our team of physicians has been where you are before, and they’ve become top of their class, attended their dream medical schools, and matched into the nation’s best residency programs. And they can show you how to do the same, every step of the way. If you decide on Med School Insiders, we’d love to be a part of your journey to becoming a future physician.

Special thanks to pediatric neurologists Dr. Victoria Lorah and Dr. Tara K. Mangum for helping us in the creation of this video.

It’s never too early to begin thinking about the specialty you want to pursue. Our So You Want to Be playlist is a great place to start.

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