From Fellowship to Practice: Career Advice for Early-Career Neurologists

For neurologists in training, the transition from residency to fellowship and eventually independent practice can be an important period of professional development. Fellowship provides an opportunity to deepen clinical expertise within a specific area of neurology, while the early years of practice bring new responsibilities and decisions around career development, patient care, and professional identity. As the field continues to expand, trainees and early-career clinicians are also navigating an increasingly broad range of subspecialties and career paths.

To offer perspective on this stage of a neurologist’s career, NeurologyLive^® spoke with Uma Menon, MD, Adult Neurology Residency Program Director at Allina Health in Minneapolis, Minnesota, and a neurologist with experience in epilepsy. Drawing on her own career trajectory and experience working with neurologists at different stages of training, Menon discussed some of the considerations that can shape how clinicians approach fellowship, early practice, and their longer-term careers.

In the interview, Menon offered a reflective perspective on navigating the transition from neurology training into independent practice, emphasizing that career development does not need to follow a predetermined timeline. She discussed the importance of allowing clinical interests to develop before committingtoa subspecialty, finding mentors who can provide guidance throughout a career, and remaining open to opportunities for further training and professional growth. Menon also highlighted the value of maintaining curiosity, trusting the foundation built during training, and making time for life outside of medicine as clinicians establish fulfilling and sustainable careers.

NeurologyLive: What initially drew you to neurology, and what has kept you passionate about the field throughout your career?

Uma Menon, MD: I knew neurology was my specialty the moment I saw the brain during anatomy in medical school. When I held it, there was a special feeling. How can you not love an organ that weighs just about 3 pounds but defines who we are? I don't believe there is any other organ quite like the brain, because without the brain, all the other organs are essentially pointless. If the brain doesn't work, nothing else matters.

Eventually, I chose epilepsy and seizures as my subspecialty because I found that it connects with so many aspects of medicine. Seizures essentially happen because of an electrical malfunction in the brain, and even though the effects can be temporary, they can have a devastating impact on patients. Managing seizures requires an understanding of anatomy, physiology, pharmacology, and essentially every aspect of medicine. To me, that brought everything together.

Neuroscience itself continues to evolve, and the same applies to clinical neurology. The brain can truly be considered the last frontier, with many unknowns even today despite all of the advances we've made. Any disruption to brain function can have profound implications, and there is no greater satisfaction than caring for patients and bringing them back to their baseline. Getting a patient seizure-free or seeing a patient return to their baseline after a stroke is priceless. Those are the things that we live for.

As someone who works with trainees, what are some of the mistakes you see neurology residents making, and how can they avoid them?

First, I want to say that all of the neurology trainees I've come across are extremely smart people. They are poised to make significant impacts in the field, and especially because we are facing a shortage of neurologists, they are very passionate about what they do.

In terms of mistakes, unfortunately, I think some of it is related to the system rather than the trainees themselves. The system forces them to choose a subspecialty very early in their careers, sometimes before they have experienced the depth and breadth of neurology or even developed an interest in a particular area.

Because the process requires residents to apply for fellowships relatively early in training, I've seen residents apply for fellowships because they feel that pressure to pursue a subspecialty. Then, after they finish the fellowship, they realize that it isn't really for them and ultimately don't practice in that subspecialty. That's truly unfortunate because these are people with tremendous potential, and they may spend years of training pursuing something that isn't the right fit.

My advice to residents and trainees would be not to rush that decision, even if you feel pressure to make it. Residency should really be about learning neurology and exploring the different subspecialties through the rotations you have during those 3 years. Then you can figure out what interests you and what might be the right long-term option.

That decision can depend on the individual. Sometimes it's a particular patient you see or something that happens that changes their life. For me, seeing a patient become seizure-free was phenomenal because not having seizures can put someone at a disadvantage, particularly when it comes to driving. Giving that person the ability to drive again opens up so many possibilities. 

For someone else, it could be lifestyle. Maybe they prefer an outpatient practice, or perhaps they want continuous hospital-based or acute medicine through stroke or critical care. Once you understand what interests you, you can make a decision based on that.

I would emphasize again that you don't have to rush into choosing a fellowship. You can always go back and pursue additional training later. I did one of my fellowships several years after completing my initial training and practicing. You can always go back and do that, and I think a lot of trainees don't realize that. Your subspecialty choice can influence how you practice for the next 20 or 30 years, so you have to be truly passionate about what you want to do.

Beyond choosing a subspecialty, what other advice would you give clinicians who are early in their careers as they begin to establish themselves professionally?

The first thing I would say—and this applies to everyone, regardless of specialty or where they are in their career—is to always listen to your patients. To paraphrase Sir William Osler, therein lies the answer for most things. It's such a profound statement, but it is very true. Listen to the patient.

Especially early in your career, right after residency when you begin practicing, everybody worries that they are going to make the wrong decision. I would say trust your instinct. It isn'treally instinct; it's all those years of training coming into play. But it can feel like instinct, and you should trust it because that training is going to guide you.

People worry about making a mistake, but most often that doesn't happen. And if you don't know something, don't be afraid to say, "I don't know." There is nothing wrong with being open with a patient and saying, "I don't know exactly what this is." You can explain what the possibilities are and acknowledge that you don't have the answer yet.

The important thing is not to stop there. Go back and do the research, talk to your colleagues, reach out to your mentors, and use the same tools and resources you used during training to find the answer. It doesn't necessarily have to happen during that visit. If you don't know, say so, and then go figure it out. Always give the patient the end result.

And don't be afraid to refer patients out. Sometimes a case may be beyond what you can deal with or may fall into another subspecialty. Send the patient to a colleague or wherever the best option is for them. At the end of the day, that's what matters.

Finally, never stop learning. Neurology is constantly advancing, and if you don't keep up, you may miss things that you could offer your patients. Learning doesn't end with training. You have to continue doing it, and at the end of the day, you always have to do the right thing for the patient.

What are some best practices or strategies for developing expertise in a particular neurologic subspecialty?

Again, this comes back to choosing the right specialty, one that you are truly passionate about. If you pick the right specialty, I think you will find a way to develop your expertise because you are passionate about it and want to do the best for your patients. That's the critical piece.

After that, a lot of it is about networking. Build relationships with your peers and mentors, and keep up with what's happening in your field. That means attending conferences nationally and internationally. If you can't attend physically, we now have the option of virtual attendance, as well as webinars and other resources that are available after major meetings. Whatever the format, you have to continue doing that so you can keep up and grow your expertise.

At the same time, I caution people because saying all of this is one thing, but once you finish training and enter practice, you are extremely busy. There aren't enough neurologists, and everybody is after your time. Time is a critical piece because we only have a finite amount of it, and then you have family and your own responsibilities to take care of.

It is challenging, but you have to keep in mind that if you don't keep up with the literature and your specialty, you won't be able to do as much for your patients. Again, it comes back to passion. If you are truly passionate about what you do, you will find a way to make it work.

Looking back at your own career, what is one piece of advice you would give your younger self?

Actually, I would give 2 pieces of advice, one about career and one about life.For my career, I would say pace yourself. That's a big one. There is always a rush to get somewhere or accomplish something, but instead of that, pace yourself and be very sure of your choices. Once you are 100% sure, then go for it.

The other thing I would say is that I really missed having a great mentor. I think that is such an important thing to have, a person who is there to guide you. You may not always know your strengths, and sometimes you may be blind to some of your faults. Having a good mentor is critical because they can guide you in so many ways. I think every person early in their career should look for that one great mentor, and I think it can help tremendously.

The second piece of advice is about life: Take time for yourself and your loved ones, including your family and friends. Take care of your own health and, at the end of it all, enjoy life. We only have one life, and it's precious and fragile, so enjoy life.