Stroke is the leading cause of long-term disability in the United States and the fifth leading cause of death. Nearly 800,000 people a year suffer from a stroke. One of the physicians that will likely help a stroke patient is a clinical neurophysiologist who focuses on a specific area of brain and nerve function – electrical signals.
What is a Clinical Neurophysiologist?
A clinical neurophysiologist works within the field of neuroscience in order to research, observe and investigate neurological disease including the central and peripheral nervous systems. The tests and procedures performed by a clinical neurophysiologist are designed to record the bioelectrical activity of the brain, and measure the electrical functions of the spinal cord and nerves in the limbs and muscles.
A physician who specializes as a neurophysiologist will work with patients and research that focuses on neuromuscular disease, nerve entrapments, epilepsy and ophthalmic disease. These cases may include diagnosing and monitoring for epilepsy, strokes, dementia, nerve and muscle dysfunction and multiple sclerosis among other disorders. Often, neurophysiology is used to help diagnose and monitor a disease, not necessarily as a treatment.
Clinical neurophysiologists have a broad understanding of medical conditions and work alongside other medical and surgical specialties in order to provide comprehensive patient care. They are able to interpret patient symptoms and test results, interpret EEGs, conduct nerve studies and perform electromyography. Some neurophysiologists choose to further sub-specialize in areas such as epilepsy, neuromuscular diseases, strokes or sleep disorders.
Educational Requirements for Becoming a Clinical Neurophysiologist
The minimum educational requirement for a clinical neurophysiologist is a doctorate degree. Further training is a specialized field may be obtained by completing a fellowship program, as explained below.
Step-by-Step Educational Path to Becoming a Clinical Neurophysiologist
The first step any aspiring physician must take is to begin their undergraduate education. While some medical schools accept undergraduate students with at least 90 hours of coursework, most medical school students have graduated with an undergraduate degree. During undergraduate studies, the student should pay special attention to the pre-requisites required by medical schools and subjects tested on the Medical College Admissions Test (MCAT). By planning their education to include these studies they are ensuring they have the foundational scientific knowledge necessary to score well on the MCAT, be accepted into and participate in medical school.
There is no specific degree required in order to apply to medical school, however many students choose to major in a science based degree program that will automatically include most of the science and lab credits that are needed to move forward with their education. It is important that students maintain a competitive cumulative GPA and competitive science GPA in order to apply to medical school. Some of the best schools require a 3.5 or higher for consideration.
In addition to studies, it is beneficial for the student to take on extra-curricular activities that can show leadership, volunteerism, or a dedication to the medical field. These activities will open the door to personal references that can submit letters of recommendation on the student’s behalf as they apply to medical school and speak to the student’s work ethic, academic standing, personal qualities and potential success as a medical school student and practicing physician.
Medical College Admission Test (MCAT)
The Medical College Admission Test is a challenging exam designed to score an undergraduate student on their scientific knowledge, critical thinking skills and problem solving abilities. The test is administered and taken during the student’s junior year of college.
Since MCAT scores are imperative to a student’s acceptance into medical school, it is recommended that every resource available be utilized to prepare the student for the exam. Most areas have group tutoring or study sessions that are lead by a trained instructor who specializes in the MCAT. Books, online pre-tests and other study resources will also help the student prepare.
It is important that the student know not only the subjects covered on the test, but the test format, in order to decrease any anxiety about test taking and increase the chances that the student will perform well.
A student who is focused on obtaining admission into a good medical school will be focused on being able to provide all the necessary documentation and requirements upon application. This includes being able to submit proof of a high GPA during undergraduate studies, submitting an excellent MCAT score, providing letters of recommendation that are meaningful and speak to the student’s personal characteristics that will help them succeed in their further studies and profession of choice. Medical school is competitive so all effort to help the student stand out from other applicants are beneficial to gaining entry to the school of choice.
Once admitted, the student can expect four years of challenging and strenuous study and experience. The first two years of study will be focused on coursework and lab work that will further the student’s understanding of the sciences. This will provide the student with the foundation they need to be able to move forward into patient care and clinical experience. After the first two-years the student will complete the United States Medical Licensing Examination Part 1 which will show that the student has obtained the proper knowledge to be able to begin patient care under direct supervision.
The second two years of medical school are called Rotations. This time is where the students are able to gain insight into the different specialties and environments physicians practice in. During rotations, physicians will likely experience a rotation in internal medicine, surgery, pediatrics, psychiatry, obstetrics and gynecology, family medicine, radiology and neurology.
During rotations it is common for students to become aware of their particular skills and interests when it comes to patient care. If they already have a specialty in mind, rotations can confirm that they are moving towards a focus that will be a good fit for them. If they are still seeking a specialty, rotations may provide valuable experience in order to inform that decision.
After rotations students will take the United States Medical Licensing Exam Part II. Part two is designed to show that the student has acquired the clinical skills necessary to continue their education into residency without direct supervision. During residency, the doctor-in-training will still have access to teachers and mentors, but they will be expected to perform more independently than during medical school.
For one year after medical school, students will practice in general internal medicine in order to gain important experience in the clinical setting, understand how the different environments work, and begin to develop an understanding of the teams and positions that are designed to help patients throughout their care. This graduate training program should be accredited by the Accreditation Council for Graduate Medical Education (ACGME), the organization which also accredits residency programs.
After medical school an aspiring clinical neurophysiologists complete a focused residency in neurology. This portion of training can last up to four years, depending on the program the student selects. The residency may include training in child neurology, adult neurology or other specifics as offered by the program of choice. Some residency programs also offer an opportunity for students to be directly involved in research within the field, which can deepen their understanding of their specialty.
Regardless of the focus of the residency or location, it is likely that the time spent in residency will be split between patient care experience, rotations, conferences, elective study and other additional training that will help the doctor perform his or her job well upon graduation. Common topics for a neurology residency include: inpatient, stroke consults, epilepsy, psychiatry, clinic, neurosurgery, neuroradiology, child neurology, clinical neuro-physiology, neuro-pathology, palliative and hospice care, and others.
Fellowship programs further train the doctor to become a clinical neurophysiologist. It is at this point of education that the neurophysiologist can choose how to sub-specialize and focus on their interested area of expertise. Fellowships can focus on epilepsy, neuromuscular diseases, sleep disorders, stroke and many other topics that were introduced in previous years of training. By this time, students have required the knowledge necessary to begin obtaining a more detailed knowledge of their chosen sub-specialty.
The American Board of Neurophysiologic Monitoring (ABNM) offers a board licensure for those who wish to obtain specific certification. The requirements are as follows for physicians seeking the credential:
*Further information about the case logs including specifics can be found at the American Board of Neurophysiologic Monitoring website.
Understanding the Career Path
The work environment opportunities for a physician specializing in neurophysiology are similar to those of a neurologist. Opportunities are available in group practices, healthcare organizations, hospitals, and clinics. For those focusing on surgery, the opportunities include those listed plus outpatient clinics.
Some neurophysiologists choose to work in an academic setting, or in a laboratory. Overall, a neurophysiologist will find availability wherever patients are being treated because of issues with brain function or nerves.
The more specialized the neurophysiologist, the more likely it is that they will need to seek employment at a specialized clinic. For example, those who are focused primarily on epilepsy will work either in a hospital or clinic environment that serves a high percentage of patients with epilepsy. Though competitive, once in this setting it is likely that the highly specialized doctor will be able to make a higher income than physicians who have not specialized within the field.
The median income for a physician that works as a neurologist with a neurophysiology specialty is $198,884. The lowest pay reported for this position was $74,497 with the highest total pay at $327,789 including bonuses of up to $49,732.
One of the key factors relating to salary is the level of experience and number of years in the field. Entry level pay with zero to five years experience is around $160,000 with steady increases at mid-career and late-career intervals. Mid-career physicians with five to ten years of experience report around $200,000 in yearly salary and bonuses. Experienced neurophysiologists with ten to twenty years experience report closer to $225,000 in year earnings and those with over twenty years of experience enjoy a combined salary of $250,000.
The American Board of Psychiatry and Neurology, Inc. (ABPN) offers an initial certification in the subspecialty of clinical neurophysiology. In order to obtain this certification, the physician must: Be board certified in psychiatry, neurology, or neurology with a special qualification in child neurology; have an active, full, unrestricted medical license; have completed the specialized training requirements in clinical neurophysiology. Details about each of these requirements can be found at the American Board of Psychiatry and Neurophysiology website.
In the test for this certification the physician will be expected to answer questions on the following topics during the timed exam. This is just a sample of content covered. More details can be found by reviewing the Content Outline for the particular test year which is provided by the ABPN:
Obtaining certification From the American Board of Psychiatry and Neurology automatically enrolls the physician in the required Maintenance of Certification Program (MOC). The MOC ensures that all board certified clinical neurophysiologists meet the standards of the organization and are dedicated to continuous learning and development within the field. Requirements fall under the following four categories: