Clinical Component

Navigating the Clinical Component

A Practice Designed Around Balance and Purpose

Your clinical responsibilities at St. Joseph’s Medical Center are organized into two well-defined teams that together cover the full spectrum of inpatient and outpatient neurology. This dual-team model ensures that no single physician is overburdened while also giving you flexibility to design a practice that aligns with your strengths, whether in stroke, general neurology, or subspecialty care.

Team A – Stroke & Vascular Neurology

As a stroke-focused neurologist, you will join a team that anchors inpatient care for the hospital’s busy emergency and referral service. The schedule follows a 7-on/7-off pattern from 7:00 am to 7:00 pm, with periodic night call during your service week. In the future, night call is expected to rotate among both stroke and general neurology attendings every 6–8 weeks.

During the day, you’ll lead a team of neurology residents, supported by a full complement across all levels (chief resident, PGY-4, PGY-3, PGY-2). Residents field most initial questions, escalating only when needed, which allows you to focus on advanced decision-making and teaching moments.

  • Daily census: Typically 5–15 patients
  • Consult volume: 4–7 new consults per day, with rare peaks up to 11
  • Support: Residents manage first-line calls and escalate when necessary
  • Future growth: Plans to establish a post-stroke clinic and a dedicated Epilepsy Monitoring Unit (EMU) as the program expands

Team B – General Neurology & Outpatient Practice

If your interests lie more in outpatient neurology, you’ll find a clinic model that balances continuity of care with periodic inpatient engagement. Outpatient neurologists typically work three clinic days per week (Tuesday–Thursday), seeing around 20 patients daily, though volumes are flexible depending on complexity and subspecialty mix.

Every 6–8 weeks, you will rotate into the hospital for a 7-day inpatient consult service (7:00 am–7:00 pm). During this week, your outpatient clinic pauses so you can focus fully on inpatient care. Mornings are dedicated to resident-led rounds, where you’ll guide learners through nuanced cases and reinforce clinical reasoning. Afternoons shift toward consults and emergent cases, often with a mix of general neurology presentations such as seizures, headaches, Parkinson’s disease, multiple sclerosis, and cognitive disorders. After your inpatient week, your outpatient schedule is lightened to 3–4 clinic days to ensure a manageable pace.

  • Clinic weeks: 3 days of outpatient care, ~20 patients/day
  • Inpatient rotation: One week every 6–8 weeks, dedicated consult service
  • Rounds: Morning rounds (9:00 am–noon); afternoon rounds as volume requires
  • Continuity clinic: Faculty may also staff the resident continuity clinic, supporting long-term training in patient follow-up care
  • Lifestyle consideration: Weekend work credited through either PTO or direct pay

Subspecialty Integration

You won’t need to choose between general practice and subspecialty focus. Physicians are encouraged to build subspecialty clinics — epilepsy, MS, headache, movement disorders, neuroimmunology, cognitive neurology, or neuro-oncology — while maintaining about 30% general neurology volume to support community need. Because referrals extend across Northern California and arrive daily in high numbers, most subspecialists can achieve a nearly full subspecialty schedule within their first year.

Teaching in Action

Teaching is seamlessly integrated into your clinical life. Instead of being confined to lecture halls, most instruction happens at the bedside or in the exam room. Residents shadow in clinic, participate in diagnostic discussions, and present cases on rounds, giving you opportunities to mentor while caring for patients. Didactic teaching accounts for a smaller portion of your time, allowing you to focus on clinical education where it has the most impact.

Residents consistently describe the culture as approachable and collaborative, with daily huddles that set the tone for both learning and patient care. As faculty, you will have the freedom to introduce new educational approaches and shape how the next generation of neurologists are trained.

Technology and EMR

Your work will be supported by Cerner, a widely used EMR that streamlines documentation, enhances continuity of care, and integrates efficiently with inpatient and outpatient workflows.

  • Two-team system ensures coverage without overextension
  • Stroke team: 7-on/7-off, census 5–15, consults 4–7/day, resident-supported
  • General neurology team: 3 clinic days per week + inpatient service every 6–8 weeks
  • Outpatient volumes: ~20/day, with rapid ramp-up for subspecialists
  • Subspecialists: ~30% general neurology + subspecialty flexibility; EMU planned
  • Residents: Support both inpatient and outpatient settings, including continuity clinic
  • Teaching: Woven into daily rounds and clinics, with protected academic time
  • EMR: Cerner

In this model, you are neither confined to a rigid hospitalist track nor left adrift in an overbooked outpatient clinic. Instead, you will practice in a thoughtfully structured system that balances inpatient, outpatient, and academic work. With Cerner to support your workflow, resident coverage to ease consult burdens, and plans for program expansion like an EMU, you will enjoy both immediate impact and long-term professional growth.

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