20 Questions: Sara G. Austin, MD, Neurology

Sara G. Austin, MD, is a neurologist in private practice in Austin, Texas.

Austin earned her undergraduate at Texas A & M University in College Station (1981), and her MD from The University of Texas Medical Branch at Galveston in (1985). Austin completed both a postgraduate internship and a residency in internal medicine at The University of Utah in Salt Lake City (1985-86, 1986-87 respectively). She then completed a residency in neurology at The University of Southern California in Los Angeles (1988-91), followed by a fellowship in electromyography at The University of Texas Health Science Center in Houston (1991-92).

Most recently, she served as the American Association for the Advancement of Science’s Science and Technology Fellow for the Senate Health, Education, Labor and Pensions Committee (Minority) Senator Michael B. Enzi (WY) in Washington, D.C. (2007-08).

Dr. Austin is certified by the American Board of Psychiatry and Neurology (1993) and the American Board of Electrodiagnostic Medicine (1995, recertified 2005). Prior to opening her private practice in 2001, Dr. Austin had worked at Associated Neurological Specialties, Austin Neurological Clinic, and in the department of internal medicine at Southern California Permanente Medical Group in Woodland Hills, Calif. She was also an instructor and an assistant professor in the department of neurology at the University of Texas Health Science Center in Houston. She is a member of the American Academy of Neurology, American Association of Electrodiagnostic Medicine, Travis County Medical Society, Texas Medical Association, Texas Neurological Society, and the Southern Headache Society. Dr. Austin has lectured on numerous topics, including neuro-cysticercosis and mitochondrial cytopathy, and has been published in many medical journals, including the Canadian Journal of Neurological Sciences, Journal of Child Neurology, and Head and Neck Surgery.

When and why did you first decide to become a doctor?

For some crazy reason, I decided in eighth grade to become a doctor and never really explored any other career. I thought that I wanted to be in a profession where you had to keep learning. In retrospect, I had no idea what I was getting into or if it fit my set of talents. I was lucky that it seems to fit most, and it’s a great career.

How did you choose the medical school you attended?

I applied to three medical schools in my third year of college and got accepted by one. They only took three to four students per year per school without a college degree, and I was one of them. I was very young, especially now that I look back on it. I only applied to Texas schools because I was a resident, and only to the three best schools at that time because I figured that I always had the next year to apply to all Texas schools. I ended up liking UTMB a lot because I got a ton of hands-on experience–more than most of the other people that I did a residency with–so it was a good choice.

What surprised you the most about your medical studies?

I went into it thinking that I wanted to be a pediatrician, and then I rotated through pediatrics and absolutely hated it. I was oriented much more toward surgery or internal medicine. I was pretty surprised about that. I also really disliked rehab – not sure why, but it would always surprise me how bad my road rage was when I was driving to work in a rehab hospital. It was a good internal warning system to stay away from rehab. And I have.

How and why did you decide on your specialty?

I originally matched in internal medicine, but almost did neurology. During my internship, I was friends with several neurology residents and they ultimately talked me into changing specialties. I shouldn’t say it, but they said the pay was better, it was more fun, and there was less night call. I really think in retrospect that they just had an open neurology spot because someone had dropped out and they really needed to fill it. Funny how that happens in life.

If you had it to do all over again, would you still become a neurologist?

You bet. I have really liked it. I think the brain is fascinating. I like being the doctor who can pay attention to subtle signs and come up with a diagnosis that others didn’t suspect. I like spending time with patients and getting to know them, and you have to do that in neurology to be effective.

Has being a neurologist met your expectations? Why?

This is pitiful, but I’m not sure that I had many expectations, so yes, it met them. I feel like I have a guaranteed job in a lot of ways. Not many other doctors want or know how to do what I do, and that’s a good thing.

What do you like most about being a neurologist?

I like figuring out the diagnosis for people. Hearing their symptoms, looking for findings on exam, and coming up with a disease that would explain it, and then ordering the appropriate test that confirms it (that is hopefully treatable).

What do you like least about being a neurologist?

I had not really thought about the fact that we do a fair amount of hospital work and how erratic that schedule is. That is hard.

that there is so much to know it’s hard to keep up with all of it. Sometimes the pain patients and the psychosomatic patients get to me – it seems like we have more than our fair share, but I’m sure that other specialties have that as well.

Some diseases are difficult – for example, ALS, or primary brain tumors, or Alzheimer’s. We deal with disabling or fatal diseases frequently – I’m not sure that other specialties have to do that.

What was it like finding a job in your field –what were your options and why did you decide what you did?

I have never had a hard time finding a job and I think for the most part neurologists are in demand. I do think that you need to be good at what you do, and you have to market yourself to some extent; be available, be helpful, be relatively energetic, be nice to patients. I have ended up in solo practice for the past 10 years and love it. I share space with a group of neurologists but like having my own employees and keeping my own books, and making my own business decisions. I personally think that small practices are the most efficient and by being solo, I can make sure that we take care of my patients the way that I want them cared for.

Describe a typical day at work.

I start to see patients at 9 a.m. (I’m a late starter), and new patients or EMGs are one hour, and follow-ups are 30 minutes. I stop seeing patients at 4:30 p.m. or 5 p.m., finish charts, and I am home by 6 p.m. or 6:30 p.m.

On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?

I still work part-time (I have kids at home). I work about 32 hours per week, I sleep eight hours per night, I take call about every sixth weekend, and I take about four weeks of vacation per year.

Are you satisfied with your income? Explain.

Yes. I suspect most neurologists make more than me, in fact, a lot more, but I have other obligations to family and so my time trumps income.

If you took out educational loans, is/was paying them back a financial strain? Explain.

I was so lucky and hardly had any. Med school tuition when I was in school was $800 a semester. Total. Unbelievable, huh?

In your position now, knowing what you do – what would you say to yourself when you started your neurology career?

Pick a city that you want to live in that has some need for neurology or that is growing.

What information/advice do you wish you had known when you were beginning medical school?

I would have taken more of a break between college and med school. Once you are on the med school path, you can’t get off, so travel, or take a weird job for a couple of years – round yourself out because you can’t do that once you start med school.

From your perspective, what is the biggest problem in health care today?

The disconnect between what the patient pays (or perceives they pay) and what it costs. It allows costs to skyrocket, which is a bad thing in the long run. It’s painful to have to pay for health care and I think we all wish it was just the insurance company’s job to provide payment for whatever, but it is an unsustainable system that we have now.

Health care is almost 20% of the GDP, which is equivalent to housing or food, but it’s hidden so most people don’t take it into account. I think unless we get a handle on health care spending, we will be in trouble as a country in the next 40 years. The most immediate problem is the cost of pharmaceuticals. It has skyrocketed, it feels like it’s crazy. We will have to get a handle on that as well. I am sitting here wondering why I did not list the 47 million uninsured as the biggest problem, but I really think if we address cost, then that problem will solve itself. It worries me that a chronic disease could bankrupt a family, even a well-to-do one with good insurance. That is a big problem. I also worry that there are very few forces in the marketplace to reward efficiency and value. That needs to change and I don’t think the federal government can make it change by the Product Quality Research Institute.

Where do you see the neurology specialty in 5 to 10 years?

I think we will need to stay proactive so that other specialties don’t take away our disease. Cardiology has been very good about this–we need to follow in their footsteps. I think the division between hospital and clinic will continue – it’s a more efficient system that seems to make sense.

What types of outreach/volunteer work do you do, if any?

I am very active. I am the president of the Texas Neurological Society this year. I have been involved for about seven years. We have a very large society here in Texas, and put on two Continued Medical Education meetings per year. I am on the council on legislation for the Texas Medical Association (TMA) for the past three years. I stay active in state policy and politics and I have learned a ton from the TMA. I am on the government relations committee for the American Academy of Neurology for the past four years. I have also learned a bunch from them and really enjoy federal politics. I did the Viste Neurology Public Policy Fellowship in the U.S. Senate in 2007-2008, working on the Health Education Labor and Pensions committee. That was awesome. I volunteer at People’s Community Clinic seeing neurology patients. I volunteer in my church.

Do you have a family? If so, do you have enough time to spend with them?

I have been lucky enough to work part-time. I have three kids, my two older ones are in college now. Yes, I think I have had enough time. How do you balance work and life outside of work? I don’t very well. I always wish I could do better. Mostly though I think that my career is a benefit to my family. I learn new things every day and I try to pass those things along to my kids. Not necessarily technical things about medicine, but just things about people and about life. Being a physician is so great because you have a level of trust with people automatically. They tell you all kinds of things, and the way my clinic is set up, I have time to really talk to them. My life is so much richer because of my profession.

Do you have any final piece of advice for students interested in pursuing neurology as a career?

It’s a long haul, make sure it’s your real interest and then go for it. I think without a doubt, there will always be a need for us. You will always have a job.