‍

What a neurologist actually does (and what they don’t)

Neurologists are medical doctors who specialize in diseases and disorders of the central and peripheral nervous systems. They do:

• Clinical evaluation & diagnosis: take histories (sometimes very long ones), perform neurological exams (cranial nerves, reflexes, strength, coordination, gait), and synthesize findings into differential diagnoses.
• Order and interpret tests: EEGs, MRIs, CTs, nerve conduction studies/EMG, lumbar punctures, blood tests, genetic tests, and decide which tests are truly necessary.
• Deliver medical management: prescribe and titrate medications (anticonvulsants, immunotherapies, dopaminergic agents), manage chronic disease courses, and coordinate care for symptom control and disease modification.
• Perform procedures (in subspecialties): some neurologists perform outpatient procedures (e.g., lumbar puncture), but interventional and surgical procedures (e.g., deep brain stimulation insertion, aneurysm coiling) are typically done by neurosurgeons, neurointerventionalists, or specialized fellows.
• Coordinate multidisciplinary care: work with neurosurgery, physical/occupational therapy, speech therapy, neuropsychology, nursing, and social work to support complex patients.
• Longitudinal care: many neurologic conditions require long-term follow-up, medication adjustments, and planning for progressive disability.

What neurologists don’t usually do: primary care (except for neuro issues), major surgeries (that’s neurosurgery), or heavy procedural radiology (unless in a neurointerventional subspecialty). They are diagnosticians, chronic-disease managers, and patient/family educators.

A realistic day-in-the-life snapshot

Neurology practice varies by setting (inpatient stroke service, outpatient clinic, academic practice), but here’s a blended example:

• 07:30 - Morning read & rounding prep: review overnight consults, MRI/CT scans, and EEG reports for inpatients.
• 08:30 - Inpatient rounds: assess stroke patients, adjust anticoagulation, check reperfusion status; coordinate with PT/OT.
• 11:00 - Outpatient clinic: see new consults (possible MS, new-onset seizure) and follow-ups (Parkinson’s medication adjustments, migraine management).
• 13:00 - Procedures/diagnostics: perform lumbar puncture, interpret EMG/NCS results with techs.
• 15:00 - Multidisciplinary conference: tumor board, neurovascular conference, or multidisciplinary MS clinic meeting.
• 16:30 - Charting & patient calls: follow up on test results, refill medications, and talk with families about prognosis.
• On-call (variable): cover ED stroke codes, supervise acute stroke thrombolysis decisions, consult on encephalopathy or neuromuscular respiratory failure.

Academic neurologists add teaching and research blocks; community neurologists may have fewer research duties but more clinic volume.

Core skills & competencies (what you’ll actually use)

Clinical reasoning & diagnostics

• Top-tier pattern recognition: connecting symptoms (e.g., focal weakness, aphasia, tremor) to likely lesion locations and etiologies.
• Comfortable synthesizing neuroanatomy with physical findings.

Neurologic examination proficiency

• Skilled at cranial nerve testing, reflex grading, motor power, coordination, sensory exams, and gait evaluation.

Interpretation of specialized testing

• Reading MRIs for ischemia/lesions, understanding EEG rhythms and seizure localization, interpreting EMG/NCS for neuropathies/neuromuscular junction disorders.

Procedural skills

• Lumbar puncture competence, bedside ultrasound in some settings, and sometimes botulinum toxin injections for dystonia/migraine.

Communication & counseling

• Discussing devastating diagnoses (ALS, advanced dementia), conveying prognosis, and guiding shared decision-making with patients and families.

Systems & care coordination

• Managing multi-disciplinary teams, arranging rehabilitation, and navigating disability benefits and home care needs.

Lifelong learning

• Neurology evolves rapidly (new MS disease-modifying agents, stroke thrombectomy advances); continuing education is essential.

Education & training pathway (how long and how intense)

Becoming a neurologist is a long, structured path:

1. Undergraduate (4 years): pre-med coursework (biology, chemistry, physics).
2. Medical School (MD/DO, 4 years): core clinical rotations including neurology exposure.
3. Neurology Residency (typically 4 years total): usually 1 intern year (internal medicine or transitional) + 3 years of adult neurology training. Residency is where you learn the neurological exam, inpatient consult work, EEG/EMG basics, and outpatient disease management.
4. Board Certification: American Board of Psychiatry and Neurology (ABPN) certification after residency (exam + eligibility requirements).
5. Fellowship (optional, 1–3 years): many pursue subspecialty training,  stroke/vascular neurology, epilepsy, neurocritical care, neuromuscular medicine, movement disorders, cognitive/behavioral neurology, neuroimmunology, neuro-oncology, pediatric neurology (which has a different pathway). Fellowships deepen procedural skills, research, and grant access to specialized practice models.
6. Maintenance of Certification & CME: ongoing.

Total time post-high school: typically 12+ years (4 undergrad + 4 med school + 4 residency; add 1–3 fellowship years for subspecialization).

Salary & compensation (real-world numbers)

Compensation varies by subspecialty, geography, practice setting (academic vs private), and call duties.

• General neurologists (U.S. median): historically in the $250,000–$320,000 range annually (figures fluctuate by source and year).
• Subspecialists: stroke/vascular neurologists and neurohospitalists may earn toward the higher end; procedural subspecialists (e.g., interventional neuro specialists: which may be neurosurgeons or neurointerventional radiologists) can earn more. Epileptologists or movement-disorder experts in high-demand markets may command premium salaries.
• Academic vs private: academics may have lower base salaries but benefits include protected time for research and teaching; private practice and employed physician roles often pay more with productivity bonuses.
• Other compensation: moonlighting, CME stipends, and research grants can augment income.

Remember: cost of living, loan repayment programs, and institutional support vary widely: salary is only part of the calculus.

Job outlook & demand

• Strong demand: aging populations increase prevalence of stroke, dementia, and neurodegenerative disease, driving demand for neurologists.
• Workforce gaps: many regions, especially rural areas, have neurologist shortages, creating opportunities and loan-repayment incentives for those willing to practice outside major metros.
• Emerging roles: teleneurology (remote stroke assessment, outpatient follow-up), neurohospitalists, and integrated multidisciplinary clinics are expanding.

Pros & cons: be candid

Pros

• Deep intellectual challenge and diagnostic satisfaction.
• Long-term relationships with patients; you often follow someone’s journey for years.
• Growing therapeutic options in many neurologic diseases (e.g., new MS drugs, clot retrieval for stroke).
• High societal impact: stroke and dementia care especially matter to public health.

Cons

• Lengthy training and high educational debt for many.
• Emotionally heavy: delivering bad news, managing progressive neurologic decline.
• Work–life balance challenges in some settings (on-call, night stroke codes).
• Complexity of care coordination: navigating disability systems, rehabilitation, and long-term care logistics.

Tips to succeed (practical, not generic)

• Master the neuro exam early: it gives you diagnostic leverage that tests can’t replace.
• Learn to read images and EEGs: even a basic fluency helps you order smarter tests and discuss results confidently.
• Communicate clearly and compassionately: patients with neurologic illness and their families need honest guidance.
• Build multidisciplinary networks: strong PT/OT, speech therapy, rehab, and social work connections improve outcomes.
• Consider subspecialty strategy: if you love acute care, stroke/critical care may suit; if you prefer clinic-based management, MS or movement disorders could be better.
• Protect your resilience: peer support, periodic debriefing, and structured time off are essential for longevity.

Would you like it? (personality checklist)

You’re likely to enjoy neurology if you:

• Thrive on intellectual puzzles and pattern recognition.
• Are comfortable with long-term care relationships and complex chronic management.
• Have the emotional resilience to handle tough outcomes and end-of-life issues.
• Enjoy continuous learning and staying current with fast-moving science.

Might not fit if you prefer rapid technical procedures/surgical intervention, strictly 9–5 schedules, or minimal emotional involvement with chronically ill patients.

My MAPP Fit

Career assessments like the MAPP can help you understand whether your motivations and strengths align with neurology. Traits common among successful neurologists include high Investigative (curiosity, problem-solving), significant Social (helping, patient interaction) orientation, and often a comfort with structure/complexity. Take a free career assessment at www.assessment.com to see your profile and how it aligns with neurology.

Is this career path right for you? Find out Free.

‍