Medical Careers in Clinical Neurophysiology

What is a Consultant Clinical Neurophysiologist?

Clinical Neurophysiology as a medical discipline is practised all over the world.  In many countries, clinical neurophysiology is practised by neurologists, rheumatologists, paediatricians, psychiatrists and others. Some offer only those tests of use to their own patients, for instance either EEG or EMG but not both.

The UK is one of only a small number of countries which recognise clinical neurophysiology as a medical mono-specialty - that is as a career in its own right. Most UK consultants practise all the standard techniques in EEG, EMG and EP, with additional specialist techniques. Some do still contribute to continuing care of patients, for instance in epilepsy or movement disorders clinics.

There are some obvious parallels with radiology departments and careers. Both offer a range of diagnostic tests to other clinicians. In both, doctors carry out some of the tests themselves and write the clinical reports on others. Instead of radiographers, we have clinical physiologists, science graduates who typically carry out all the EEGs and some of the nerve conduction studies.

Training and Careers

Most clinical neurophysiologists started training as physicians with an interest in neuroscience, but some have entered the specialty from paediatrics, psychiatry or neurosurgery. These days, most will have undertaken core medical training or a similar "SHO" level course and have obtained the MRCP Diploma. Higher specialist training is in essence a four year programme, with a mixture of neurology, research and clinical neurophysiology.

There are in general ample opportunities for new appointees at both registrar and consultant level, although in such a small specialty jobs do not appear in every region at the same time.

Interpreting scientific data in the correct clinical context is very important to us, so an understanding of neuroscience, particularly neuroanatomy and neurophysiology, combined with neurology is key. Some understanding of other referring disciplines is also useful, including orthopaedics and paediatrics. Electronics technology, Information Technology and Management are also very important. But we are not all expert in everything!

What I Enjoy About My Job

So what is the point of a career in Clinical Neurophysiology? I spend at least half the week carrying out scientific studies on patients in a very direct way in the EMG clinic. I enjoy the dialogue I have with them, which is essential to relax patients for what is seen by many as frightening. I learn something new from my patients in nearly every clinic - but it is not always medical. It can be a challenge to explain the results to patients where appropriate.

Reporting EEGs takes up most of my remaining clinical work.  Most people seem to take longer to learn to appreciate EEGs, but turning a pile EEGS and videos into meaningful reports is also very satisfying and can be profoundly significant for patients. The patient is not usually present, but I often have joint reporting sessions with clinical physiologists and referring doctors. 

My patients range from neonates to centenarians. Most are outpatients but some of our most important studies are carried out in ITU. I have referrals from nearly every specialty and some have a very different training and approach to clinical problems from my physicianly one. Sharing our perspectives of a difficult clinical problem can be stimulating. I teach many different groups - medical students, medical trainees and clinical physiology trainees.

Few of us have on-call committments, unless responsible for an EEG telemetry unit. Some colleagues spend time in the operating theatre doing operative monitoring.

We do not have ward rounds - I thought I might miss these when I became a clinical neurophysiologist, but they are clearly now a source of endless frustration to many consultant colleagues in other specialties. The practice of a hospital consultant caring for his or her "own patients" over a series of visits is disappearing. I do have such a cohort of patients in whom I inject botulinum toxin under EMG control. It is odd and rather sad that such care is only possible for a "diagnostic" specialty, but I still enjoy it.

David Allen described his view of Clinical Neurophysiology in the BMJ Careers series.

Further Information

The work of consultant clinical neurophysiologists in caring for patients is described on the Royal College of Physicians site.  You can find out more about the formalties of training on the JRCPTB site and on the application process at CMT Recruitment. The RCP has a new website called ST3Recruitment, which might be one to watch (as yet little on our specialty). There have been frequent changes to recruitment and training over recent years so make sure you use current information. You may want to approach your nearest local department and you can find a  list of most of them in the directory on this site.

We have a trainees organisation, the Association of Trainees in Clinical Neurophysiology (ATCN) which helps to organise national training days and can be contacted for advice.

The following sites offer help too: