Blake Buletko, a vascular neurologist at Cleveland Clinic, and Galina Gheihman, a general neurologist at Mass General Brigham and assistant professor at Harvard Medical School, recently discussed the challenges early-career neurologists face when transitioning from training to independent practice. Their conversation, featured in NeurologyLive, highlighted the importance of mentorship, self-reflection, and adaptability during this key phase.
A Lifelong Calling and Unexpected Paths
Buletko’s interest in neurology began unusually young. At age 10, he declared his ambition to become a neurologist, inspired by his mother, a retired nurse who worked for a private practice neurologist. He spent time in the office, playing with brain and spine models, and even wrote a fourth-grade report titled “Why I Want to Be a Neurologist.”
Gheihman’s journey was different. Raised in Canada around her family doctor, she initially aimed for general medicine. However, her undergraduate background in neuroscience and her love for neuroanatomy and neuropsychology naturally steered her toward neurology. She is a general neurologist who becomes the primary neurologist for her patients.
“What draws me to neurology is that we see a kind of fracturing of the self,” Gheihman explained. “Much of what we deal with is philosophical, and I’ve been incredibly struck by the resilience of my patients as they recover through that disruption.”
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Avoiding Common Pitfalls and Adopting Exploration
Both physicians emphasized the importance of staying open-minded and avoiding premature decisions. Early-career neurologists often feel pressure to have everything figured out, but Buletko noted that it’s key to maintain the passion that drew them to medicine in the first place.
“It’s easy to become wrapped up in administrative work or frustrated by things you wish were different,” Buletko said. “I think it’s important to maintain the passion that brought you into medicine.”
Gheihman echoed this sentiment, advising trainees to ask the right questions. Instead of focusing solely on “Which fellowship do I want to do?” she suggested stepping back to consider “What do I actually want to do?” This shift in perspective led her to pursue a master’s degree in medical education rather than another fellowship.
Finding the right mentors is equally important. Gheihman stressed the value of both near-peer mentors, who understand the day-to-day challenges of early-career life, and senior mentors, who can provide guidance for long-term career planning.
“It took good mentorship to help me step back and recognize that I wasn’t asking the right question for myself,” she said.
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Building Community Through the NEST Program
Recognizing the lack of clear pathways for early-career neurologists, especially those interested in becoming clinician educators, Buletko and Gheihman developed the Neurology Early Career Clinician Educator Scholarly Training (NEST) program. NEST is a longitudinal, year-long faculty development initiative designed to support neurologists pursuing careers as clinician educators.
The program brings together 20 scholars from 15 states and 19 institutions for a structured curriculum that includes seminars, collaborative learning, and scholarly projects. The inaugural cohort recently began with an in-person retreat, followed by monthly webinars and ongoing mentorship from Buletko, Gheihman, and senior faculty.
“During residency, there’s a fairly clear definition of what success looks like,” Gheihman noted. “That becomes more difficult to handle after you complete training.”
Buletko highlighted the isolation many early-career physicians experience when they leave their training cohorts. “It’s often the first time in your adult life, and even in your childhood, that you lose that cohort of people with whom you’ve shared experiences throughout your training,” he said. “I think what we’re hoping to do is create a community of practice where people can continue to connect, feel that they have a home, and interact with others who are going through similar experiences.”
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Blake Buletko reflected on his decade since completing training, noting how his initial vision of practicing in a small-town community has evolved into his current role at Cleveland Clinic. “If you had asked me 20 years ago whether what I’m doing today would make me happy, I probably would have said, ‘There’s no way. That’s not what I want to do,'” he said.
Gheihman advised early-career neurologists to take things slower and view their careers as evolving documents rather than fixed structures. “Your job can change as your life circumstances and opportunities change,” she said. “I often tell trainees and mentees who are going through that process that their job is more like a working document.”
Trusting instincts, she added, is just as important as relying on data and analysis. “Use your brain, your heart, and your gut when making decisions,” Gheihman concluded.
Growth Through Community
The NEST program emphasizes collaborative learning as a core component of its curriculum. Scholars engage in monthly webinars led by experienced clinician educators, covering topics such as curriculum design, assessment strategies, and effective teaching methodologies. These sessions provide foundational knowledge while encouraging peer-to-peer interaction through breakout discussions and shared case studies.
