Matter, Energy, and Life of Michaela A. Castello.

How I’m Spending the Next-Next Decade

Mark recently remarked that it has been about…oh, hey, a decade…since I last attempted to lead my family and friends through the masochistic labyrinth of my poor life choices. Having now reached the “Post-Graduate” heading of that infamous post, I suppose an update would be beneficial. Regrettably, despite my prior efforts, many of my loved ones remained in a near-perpetual state of confusion—I suspect very little will change.

You may recall that I matched to a residency in Child Neurology, and that going from “new med school graduate” to “licensed physician” to “independently practicing doctor” has a number of intermediate levels. At this point in my career I have traveled far enough down the tech tree that my explanations are more specific to me personally and less generalizable to the wider community of medical residents. Oddly reminiscent of some of my other choices, Child Neurology is peculiar enough that even others in medicine are often unsure of the specifics.

It may come as a surprise, but Child Neurology is, in fact, its own residency, meaning that the vast majority of people interested in pursing it as a career must make that decision during med school and apply to it specifically during the Match process. Once matched, the newly-minted physician essentially knows they’ll be in a residency program for the subsequent five years.

What creates a lot of the confusion is that, much like MD/PhD (and much to my chagrin), Child Neurology is a hybrid of Adult Neurology and Pediatrics programs, requiring some post-graduate years (PGYs) of training in each to synthesize a complete practitioner. After that, they can pursue either gainful employment, or trade a variable number of years for further subspecialty training in something neurologic such as epilepsy, headache, or neuromuscular disorders. The unfortunate souls who opt to pursue the latter route are called fellows instead of residents, perhaps because instead of residing at the hospital, they’re simply very close companions of it.

At the end of residency, Child Neurologists take the Adult Neurology specialty board exams with extra questions, becoming a Board-Certified Neurologist with a Special Qualification in Child Neurology. Most child neuro residents are also eligible to take the Pediatrics specialty boards, although that is optional. If one wants to pursue research in addition to clinical medicine, say, because they went and got an MD/PhD for some reason, they can attempt to do so during residency (with a lot of luck), or during a fellowship, where there is typically dedicated research time (by trading years for the opportunity).

After reading all of this, you may find yourself asking, “When are you going to simply be done?”

I ask myself the same question almost daily.

Child Neurology from Start to Finish

Pre-Graduate (Medical School)

  • Decide to go into Child Neurology
  • Apply for Child Neurology residencies
  • Match to a Child Neurology residency program


  • PGY-1 (intern year)
    • USMLE Step 3 (sometime during intern year)
    • Receive general medical license
  • PGY-2 (I am here)
Adult Neurology
  • PGY-3 (mostly adult, some child)
Child Neurology
  • PGY-4
  • PGY-5 (“chief” year in some programs)
End of Residency
  • Specialty board exams
    • Neurology (with special qualification in Child Neurology)
    • Pediatrics (optional)

Fellowship (optional)

  • PGY-6
  • PGY-7
  • Subspecialty certification

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