Pathways to Interventional Neuroradiology from IR

[srirachamayonnaise]

Been doing some search to find out what the pathway is like from an integrated IR program to INR. The SINR site says the fellowship is one year after IR residency. But all the programs I looked into don’t say anything about the pathway from IR. All they say is if it’s from DR you need a neuroradiology fellowship first before you can do INR. A bit confused.

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[guytakingboards]

It's a bit nebulous for a couple of reasons.
-the new integrated IR paradigm kinda conflicts with the traditional pathway of residency-> Diag neuro --> interventional neuro
-the CAST certified pathway is the longest way (2 year endovascular neuro fellowship)
-some hospitals with credential you for NIR work with less fellowship time than others

Some hospitals are cool with one year of NIR fellowship after diag neuro or IR. You just gotta make sure you've reached their required number of cases.

Others want the two year CAST-certified fellowship which guarantees you've had enough NIR cases.

When I was in diagnostic neurorad fellowship, an in-house resident had done a 9mo mini-neuro fellowship in his R4 year the prior year and was doing his NIR fellowship year in his first post-residency year. He cut a lot of time off the CAST track but he might not have been able to get credentialied at certain hospitals in his first job. Lotta ways to skin a cat.

 

[srirachamayonnaise]

It's a bit nebulous for a couple of reasons.
-the new integrated IR paradigm kinda conflicts with the traditional pathway of residency-> Diag neuro --> interventional neuro
-the CAST certified pathway is the longest way (2 year endovascular neuro fellowship)
-some hospitals with credential you for NIR work with less fellowship time than others

Some hospitals are cool with one year of NIR fellowship after diag neuro or IR. You just gotta make sure you've reached their required number of cases.

Others want the two year CAST-certified fellowship which guarantees you've had enough NIR cases.

When I was in diagnostic neurorad fellowship, an in-house resident had done a 9mo mini-neuro fellowship in his R4 year the prior year and was doing his NIR fellowship year in his first post-residency year. He cut a lot of time off the CAST track but he might not have been able to get credentialied at certain hospitals in his first job. Lotta ways to skin a cat.

Thanks for the info. Watched a video on SINS about creating a fellowship match since the current landscape is quite chaotic. What’s the advantage of CAST? How’s the job market for interventional neuro?

 

[guytakingboards]

Thanks for the info. Watched a video on SINS about creating a fellowship match since the current landscape is quite chaotic. What’s the advantage of CAST? How’s the job market for interventional neuro?

I'm not an NIR but I'd hazard to guess a match for NIR is an unnecessary burden. I don't think there's enough spots or applicants to make a match worth it.

The advantages of CAST is that it's a standardized set of requirements and everyone going through (neurosurgery, neurology, radiology) should come out with a defined and similar level of competency. Some hospitals have already made it mandatory for their credentialing. The flip side for radiologists is that it guarantees a longer track. The rad CAST pathway requires 6 mo of clinicals. A non-CAST fellowship probably skips that.

The job market for interventional neurorad is complicated. INR itself isn't a big money maker but it can bring a lot of money to hospitals for stroke admissions. More and more places become stroke centers each year so the jobs are there. The pay is obviously pretty good. If you join a PP radiology group, expect to do some diagnostic rad on the side. I feel like hospital employed NIR's will become a bigger thing, cuz they can afford to subsidize an NIR service.

 

[srirachamayonnaise]

I'm not an NIR but I'd hazard to guess a match for NIR is an unnecessary burden. I don't think there's enough spots or applicants to make a match worth it.

The advantages of CAST is that it's a standardized set of requirements and everyone going through (neurosurgery, neurology, radiology) should come out with a defined and similar level of competency. Some hospitals have already made it mandatory for their credentialing. The flip side for radiologists is that it guarantees a longer track. The rad CAST pathway requires 6 mo of clinicals. A non-CAST fellowship probably skips that.

The job market for interventional neurorad is complicated. INR itself isn't a big money maker but it can bring a lot of money to hospitals for stroke admissions. More and more places become stroke centers each year so the jobs are there. The pay is obviously pretty good. If you join a PP radiology group, expect to do some diagnostic rad on the side. I feel like hospital employed NIR's will become a bigger thing, cuz they can afford to subsidize an NIR service.

Say one goes into NIR from IR. Is it possible to have a practice exclusively doing IR and VIR without any DR? The reason I am asking is that I really don’t think I can stand being in a reading room at all but the procedural aspect is quite attractive to me.

 

[guytakingboards]

Say one goes into NIR from IR. Is it possible to have a practice exclusively doing IR and VIR without any DR? The reason I am asking is that I really don’t think I can stand being in a reading room at all but the procedural aspect is quite attractive to me.

Anything is possible. I think you'd have an easier time finding an all procedural job in some employed gig, some place where your service line(s) can be subsidized. Think academic center/hospital-employed.

On the private practice side, probably much less likely. It's very uncommon to find a PP gig where IR's don't do at least some diagnostics. There's just not enough IR work at most community hospitals to justify a full FTE to procedures.