Why neurology is a great fit for DOs

After completing their fourth year of osteopathic medical school, most newly minted DOs will further their careers by pursuing graduate medical education. It is well-known that many osteopathic physicians elect to pursue a primary care specialty, often in underserved areas.

When DOs choose a non-primary care specialty, they often select fields like emergency medicine, anesthesiology or OB-GYN, all of which lend themselves well to the skill set of the osteopathic physician. Another specialty that aligns very well with osteopathic medical training is neurology, the medical specialty that focuses on the human nervous system.

While it is true that the hours worked by a neurologist can be challenging at times (particularly when on stroke call), neurology is unique in that it provides a physician with the opportunity to truly care for the most fascinating organ system in the human body. For those who are interested in the myriad intricacies of the nervous system, pursuing this specialty can provide a rewarding and fulfilling career.

As a second-year medical student, I have personally been exploring my interest in neurology, and I wanted to share what I’ve learned with other medical students who are pondering their future specialty. I worked with David Kaufman, DO, a professor of neurology and the chair of the neurology/ophthalmology department at Michigan State University College of Osteopathic Medicine (MSUCOM), and Catherine Donahue, DO, an assistant professor of osteopathic manipulative medicine (OMM) at MSUCOM, to prepare this article.

The medical specialty of neurology

Firstly, neurology offers great career versatility, much like its cousin internal medicine. A neurologist can pursue a fellowship in a variety of subspecialties. In doing so, they can alter the nature of their practice to fit their clinical interest and ideal practice environment. For example, one can choose to practice general neurology in an outpatient setting or practice in an inpatient setting as a neurohospitalist (sometimes with a neurohospitalist or vascular fellowship).

Neuromuscular (NM), epilepsy and clinical neurophysiology (CNP) fellowship programs can hone a neurologist’s skills in the realm of electrodiagnostic with electromyography/nerve conduction studies (NM and CNP) and electroencephalography (epilepsy and CNP). Neurocritical care can provide a high-stakes neuro ICU environment if desired, and a behavioral neurology or movement disorders fellowship help a neurologist tackle neurodegenerative diseases such as Alzheimer’s or Parkinson’s disease respectively.

Neurologists can also pursue interdisciplinary fields such as neuro-ophthalmology (shared with ophthalmology), NM as mentioned above (shared with PM&R), pain medicine (shared with anesthesia, PM&R and psychiatry) and the list goes on!

Next, there is a major misconception that perpetuates the field. If you are a fan of medical comedy skits, you have probably heard a joke along the lines of “Neurologists don’t treat disease, they admire it.” The joke pokes fun at the notion that neurologists are superb diagnosticians without many options for treatment. However, there is one caveat: Neurologists determine the immediate and definitive treatment for an ischemic stroke; no other doctor can approve thrombolytics as effectively or confidently.

However, it is true that the perfect therapy does not exist for certain neurological diseases. Still, the profession has come a long way in the past few decades. For instance, about 65-70% of patients who suffer from epilepsy can see long-term seizure freedom with the right combination of anti-seizure medications. Likewise, deep brain stimulation for Parkinson’s disease and high-dose steroids for multiple sclerosis are avenues of scientific advancement that can help improve the quality of life for patients suffering from these diseases.

Even if there is no ideal management option for certain neurological diseases, that does not change the fact that patients still depend on their neurologists to help them navigate the disease progress, understand their options, make important decisions and even just provide support when needed. As a neurologist, you are on the frontlines of scientific research and clinical medicine as you incorporate cutting-edge technology with an ever-evolving armamentarium of pharmaceuticals and treatment modalities. It is an exciting time to be in neurology.

Osteopathic considerations

When students think about OMM, oftentimes they think about the hands-on treatment modalities of osteopathic manipulative treatment (OMT). While OMT is a notable portion of a DO’s OMM education, what can be overlooked is the didactic portion of our education.

OMM didactics focus on the underlying biomechanics of the human body through anatomy and physiology, with emphasis on the normal function of the peripheral nervous system and musculoskeletal system. Fun fact: OMM as a board specialty is called osteopathic neuromusculoskeletal medicine. OMM/COMLEX-USA review books, such as the famous “greenbook” by Robert Savarese, DO, will depict sections or tables discussing the pertinent neuromusculoskeletal anatomy/physiology of a body region or part. Dr. Savarese even includes a section on the neurological exam itself.

This knowledge of OMM can still benefit a DO neurologist even if they don’t employ hands-on OMT. I cheekily refer to this as the “indirect perks” of OMM education. When a DO assesses gait, they have the benefit of having learned the underlying biomechanics of the sacrum, pelvis and lower extremities.

When a DO grades the muscle strength of a patient, they have the experience of performing muscle energy technique, an OMT technique that elicits isometric muscle contractions in patients, which helps develop palpatory skills as a reference for normal muscle strength.

When needing to recall the nerve that innervates a muscle group, or a similar detail, a DO would have the benefits of being exposed to this content as early as day one of medical school. Not to mention the physical exam, additional palpatory skills and deep understanding of the function of the neuromusculoskeletal system an osteopathic medical student gains through the OMM core series.

If there are “indirect perks” of OMM in the neurology clinic, then one can assume there are “direct perks” in the skills learned using OMT as well.

Dr. Kaufman describes OMM/OMT as “invaluable” in the right clinical setting and he lists its use in the management of common clinical complaints such as neck pain, low back pain, specific headache disorders and repetitive use injuries in the shoulders, elbows and hands. Additional hands-on techniques such as the Epley maneuver for benign paroxysmal positional vertigo (BPPV) are another example of how manual medicine can be used to aid a physician in the clinic.

Neurology is a very physical exam-heavy specialty, and neurologists can use OMT as just one of the tools at their disposal to augment the treatment of their patients. Even if not used, the osteopathic principles and biomechanical knowledge one gains throughout osteopathic medical school can be quite helpful in the day-to-day clinical work of a neurologist.

Related reading:

How I Matched into neurology

How to specialize in neurosurgery