Q&A: Dr. Ali Thaler, Neurologist and Author

Last Updated on September 12, 2023 by Laura Turner

Dr. Alison “Ali” Thaler is an Assistant Professor of Neurology at Mount Sinai Hospital, where she specializes in treating stroke and headache patients. She is a co-author of The Only Neurology Book You’ll Ever Need, an overview of neurology. She spoke to the Student Doctor Network about her journey and how she combines her love of writing with her medical career.

Tell us about yourself

Dr. Ali Thaler: I grew up in Villanova PA, went to college at Amherst College in MA and did all of my medical training in New York City, at Mount Sinai and NYU Langone Hospitals. I am now an Assistant Professor of Neurology at Mount Sinai Hospital, where I specialize in treating stroke and headache patients.

Before I decided to go to medical school, I wanted to be a writer: I was an English major in college, worked at several literary magazines, and spent a few weeks as an editorial intern at Vanity Fair. There are a lot of reasons that I ultimately chose to go into medicine, but one of the most important to me was that I knew I could continue to write as a physician – it’s a little harder to practice medicine on the side, as a writer! As I worked my way through neurology residency, the idea for this book was always in the back of my mind. I knew I could condense everything I was learning into something more manageable, friendly, and fun (yes, neurology can be fun!) – I wanted to write the neurology textbook that I would have loved to have when I was just starting out as a medical student on rotations. During my third year of residency, I started the project with my Dad (he’s an internist, the author of The Only EKG Book You’ll Ever Need, and a really awesome co-author even if he makes fun of my admittedly generous use of semi-colons). A short three years later, it was published!

When did you first decide to become a physician? Why?

I decided to become a physician when I was in college. I had several reasons: 1) I loved my science classes – I found evidence-based thinking incredibly satisfying – and, even more, loved the idea that I could one day use the information I was learning to help take care of patients; 2) As I started to think more practically about a future career, the security and stability that medicine offered became more and more appealing, and 3) I knew I could keep writing as a physician, though at the time couldn’t have told you what form that would take. While I was mulling all of this over, my parents moved to New York City and my father closed his internal medicine practice outside of Philadelphia. The outpouring of support from his patients, many of whom had known him for several decades, was overwhelming, and solidified my decision: what a privilege to choose a career that would allow me to make such an impact on so many people.

How did you choose the medical school you attended?

I went to college at a small liberal arts school in MA. I loved it, but after four years of bucolic New England life, I was ready for a change. I knew I wanted to be in New York City and loved everything about Mount Sinai when I visited. What was at the time known as the Humanities and Medicine program (now FlexMed) – a program that allows college students to apply to medical school as sophomores, thus freeing up the rest of their college years to pursue other, non-medical interests and develop a broader perspective with which to approach medicine – was incredibly appealing to me. Although I myself did not matriculate through that program, I loved that so much of the class had varied interests and skills outside of medicine.

What surprised you most about medical school?

I knew it would be a lot of work, but I wasn’t necessarily expecting that the best thing to come out of all of those classes and group study sessions would be some of the most amazing friends. My med school friends are still ‘my people’ in the Grey’s Anatomy sense of the term – they are my chosen family, and though many have since scattered across the country, we remain very close.

What was the biggest challenge you faced in medical school?

I found the sheer volume of information to be overwhelming. So much of what you learn builds on itself, and trying to keep all of the basic anatomy and physiology in mind while at the same time learning the details of different diseases and medications can feel crushing. Friends helped. Ridiculous mnemonics helped. Study breaks involving chocolate and caffeine helped.

Why did you decide to focus on neurology?

Choosing between neurology and medicine was tough. I ultimately chose neurology for two reasons: 1) I loved taking care of patients with headaches, and 2) I had several phenomenal mentors in the neurology department. With time, it became clear to me that I fit in well in the neurology world, but it took some time to feel comfortable with the decision. And as it turns out, stroke – which I fell in love with later, during residency – is, for me, the perfect combination of neurology and medicine. I get to work closely with cardiology and hematology, manage antiplatelets and anticoagulants, and determine blood pressure goals and management, all while relying heavily on my neurology training to localize lesions, interpret complex clinical trial results, and determine optimal stroke care for my patients.

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

Yes, no question.

Has being a neurologist met your expectations?

I don’t think I had any idea what ‘being a neurologist’ out in the real world would actually mean. And it turns out, it can – at least to some extent – mean whatever you want it to mean. I crafted my job out of my dual headache and stroke training, and love the balance I now have between inpatient and outpatient time. I enjoy the fast-paced and high-acuity inpatient environment but after a few weeks on service, feel incredibly lucky to go back to my office, take a breath, and get to take care of my patients with headaches.

What do you like most and least about being a neurologist?

I love teaching and have found neurology, specifically, to be so satisfying in that sense: neurology has the reputation for being overwhelmingly complex and esoteric, and I have worked hard to learn how to simplify all of the pathways and nuclei and disease processes down to something that is understandable, interesting, and clinically relevant. Having the opportunity to guide medical students and residents toward a clearer understanding and appreciation of neurology is hands down my favorite part of my job.

My least favorite part of my job at the moment is the administrative work that comes with my outpatient practice – the prior authorizations, insurance denials, and so forth. But my patients make these not-so-fun parts worth it.

Describe a typical day at work.

When I’m on stroke service, I round in the morning with the residents and PAs and spend the afternoon seeing any new patients and catching up on notes.

When I’m not on inpatient service, my week looks like this:

• Monday: Full day of headache clinic, a mix of new patients and return visits
• Tuesday: Administrative day. I often have several stroke and headache conferences, and typically spend the rest of the day pre-charting on my clinic patients for later in the week
• Wednesday: Administrative day. I spend the day in my office catching up on journal articles I’ve tagged, meeting with colleagues as well as medical student and resident mentees, and clearing out my email and EPIC inbox. These two administrative days also give me time to work on any book-related tasks such as updating (I keep a list of new articles and information that I will want to include in the next edition!) and advertising.
• Thursday: I see my stroke clinic patients in the morning and help run our fellows’ stroke clinic in the afternoon
• Friday: Grand rounds in the morning, headache clinic in the afternoon

How much of your work is research and/or teaching?

I am in the process of working on a few case reports and chapters for various textbooks, but I don’t have salaried time for research. The more research projects I worked on throughout my training, the more I realized that it wasn’t for me. I spend a lot of time teaching – I am a small group preceptor for our second year medical student neurology course, often have medical students shadow me in clinic, and work closely with our headache and stroke fellows.

How many hours do you sleep per night? How many weeks of vacation do you take?

Most of the time when I don’t sleep well, it has nothing to do with my job – I have a toddler at home, enough said. I do take stroke call at night but it’s usually only one night per week, and isn’t too bad. If you’d asked me this question as a resident or fellow, however, I would have had a very different answer for you!

I have four weeks of vacation per year, to use and break up however I would like. 

What would you say to yourself ten years ago?

Relax. Remembering all of the hand muscles and thalamic nuclei will NOT matter in the future. Appreciate the protected time in medical school to read and learn and shadow…but also don’t let anyone fool you into thinking that medical school is easy. Be kind to yourself. Take breaks. And also, mom was right: stick to the three date rule. If you aren’t into it by date three, walk away!

What do you wish you had known when you were pre-med?

As above. Everything you’re learning is good and interesting and it’s important to pay attention, but don’t worry too much – you’ll forget it all 100 times over and re-learn it another 100 times before it sticks. The important stuff will stick eventually.

What is the biggest problem in healthcare today?

There are too many. The biggest problem impacting me personally and the people I take care of at the moment is handling insurance companies. Why some patients get their Botox, CGRP or anticoagulant medications approved and others don’t continues to be an unendingly frustrating mystery to me. The amount of time it takes to fight these decisions is overwhelming, not to mention incredibly difficult for the patients who are struggling waiting for the medications they need. I wish we had learned more about all of this in medical school and residency. There’s a naiveté about ‘real world medicine’ that I – and suspect many of us – entered attending-hood with, which is doing none of us any favors.

Where do you see neurology in 10 years?

I LOVE the fact that I have no idea how to answer this question.  Ten years ago, the only option for acute stroke treatment was tPA. Now we have mechanical thrombectomy, which is one of the most successful medical interventions in history. I can’t wait to see what another 10 years will bring.

What types of volunteer work do you do?

Right now, volunteer work has taken a back seat to balancing new attending life with new mom life. I’ll get back to it. Another life lesson I’m working on: it’s ok to say no to things sometimes. I’m still learning how to be the best doctor I can be, and right now, that means aggressively protecting my free time so that I can take my time with each and every patient I see, and not miss out on important family time at home.

How do you spend your free time? Any hobbies?

Before my daughter was born, I would have said: running, swimming, exploring new restaurants, exploring new parts of the world.

Now, with a toddler: exploring parks and playgrounds, finding magic in the craziest of things (my daughter’s new favorite toy is our plastic microwave cover), spending Saturday night catching up on TV and going to bed by nine. And I wouldn’t want it any other way.