applying for both rad and neurosurgery

[gonogo]

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I hope I'm posting this on the right forum. I will be applying this year for residency and I like both neurosurgery and radiology. If I do radiology, I'd then try to go for fellowship in INR.

Now here's my problem: For personal reasons I will be very limited geographically when I apply, which means I won't be able to apply for too many programs (there are only 4-5 academic hospitals in the area). Since I really want to match, and in fact I think I'd be happy with either of the specialties, I figured that if I apply for both rad and neurosurgery, I could probably increase my chances of matching. Obviously, this means I'll be applying to both of them at the same institutions. Is this advisable, or would applying to two different residency programs in the same institution harm my application?

Of course, I can always wait until I can actually apply more broadly... but that means waiting 3 more years after I'm done!

I'd appreciate any advice on what to do.

 

[colbgw02]

Isn't neurosurgery still in the earlier match? Don't they get their match results several weeks before everyone else? Radiology is definitely in the general match, so if neurosurgery isn't you need to find out the ramifications, contractual and otherwise, of applying to both matches.

 

[werewethere]

NSGY is early match. You can apply to both and if you were to match NSGY, then you would automatically pull out of the NRMP. There is no way of making a mixed match list with early match program and NRMP, so you won't be able to rank, let say your favorite 2 NSGY, followed by rads, followed by another NSGY. Also remember that at each given institution, there likely will be either NSGY or radiology doing INR. Relatively few institutions have dually appoint faculty that train both, at least in my limited experience. Another consideration for you might be, given your interest and geographical limitations, whether the neurology to INR path might be acceptable, although I'd be careful about choosing this given that most fellowships for INR are run by rads or NSGY. Finally, keep in mind that the skill sets of a surgeon and an inteventionalist are different. It can be difficult to keep up both sets simultaneously, so even though having both forms of training might look good on paper, you may end up having to choose between the two, if not now, when you are done with residency in NSGY. On the flip side, if you choose radiology, you have to consider whether you're willing to learn and cover all non-neuro fields and whether you want to fight the seemingly changing turf battles that interventionalists, IR and INR, have to fight.

 

[gonogo]

NSGY is early match. You can apply to both and if you were to match NSGY, then you would automatically pull out of the NRMP. There is no way of making a mixed match list with early match program and NRMP, so you won't be able to rank, let say your favorite 2 NSGY, followed by rads, followed by another NSGY. Also remember that at each given institution, there likely will be either NSGY or radiology doing INR. Relatively few institutions have dually appoint faculty that train both, at least in my limited experience. Another consideration for you might be, given your interest and geographical limitations, whether the neurology to INR path might be acceptable, although I'd be careful about choosing this given that most fellowships for INR are run by rads or NSGY. Finally, keep in mind that the skill sets of a surgeon and an inteventionalist are different. It can be difficult to keep up both sets simultaneously, so even though having both forms of training might look good on paper, you may end up having to choose between the two, if not now, when you are done with residency in NSGY. On the flip side, if you choose radiology, you have to consider whether you're willing to learn and cover all non-neuro fields and whether you want to fight the seemingly changing turf battles that interventionalists, IR and INR, have to fight.

Many thanks for your comments. I'm totally aware that if i choose radiology i'll deal with all the non-neuro fields, and i'm fine with that during residency. In fact, i'm sure i'd enjoy it. It's good that you mention the neurology option, I'm just not sure how easy it'd be to do INR fellowship coming form a neurology residency. I'd definitely settle for neurology if i can't match in my other choices. Actually, neurology and then INR sounds pretty good. But how should i proceed in terms of my geographical limitations? I don't have too many places where to apply. Is it bad seen if one applies at two different programs (let's say neuro and radiology) at the same institution?

 

[werewethere]

Many thanks for your comments. I'm totally aware that if i choose radiology i'll deal with all the non-neuro fields, and i'm fine with that during residency. In fact, i'm sure i'd enjoy it. It's good that you mention the neurology option, I'm just not sure how easy it'd be to do INR fellowship coming form a neurology residency. I'd definitely settle for neurology if i can't match in my other choices. Actually, neurology and then INR sounds pretty good. But how should i proceed in terms of my geographical limitations? I don't have too many places where to apply. Is it bad seen if one applies at two different programs (let's say neuro and radiology) at the same institution?

I would apply to all programs that offer a realistic chance at INR in your area. When applying, do not emphasize INR to NSGY programs, but do mention it to radiology and neurology programs. You are right, getting to INR from neuro is, at this point, much more difficult, regardless of the quality of the neuro program you attend. So neuro should be your fall back in case NSGY and rads are not available to you. If you are sure that NSGY is for you, then you are set, do the early match, and if it doesn't work, then you have rads second, neuro as back up. When interviewing at programs at the same location, I would make a point of highlighting your specific interests and patient populations you want to work with if a questions should arise about how you are applying. The point is not to gain a title of INR, but the ability to treat patients, regardless of the type of track you take. This is particularly relevant in INR because it is split among NSGY/neuro/rads. In the end, any reasonable program will understand your need to find the best path to a very highly specialized field without being constrained to applying to only one "field."

 

[gonogo]

I would apply to all programs that offer a realistic chance at INR in your area. When applying, do not emphasize INR to NSGY programs, but do mention it to radiology and neurology programs. You are right, getting to INR from neuro is, at this point, much more difficult, regardless of the quality of the neuro program you attend. So neuro should be your fall back in case NSGY and rads are not available to you. If you are sure that NSGY is for you, then you are set, do the early match, and if it doesn't work, then you have rads second, neuro as back up. When interviewing at programs at the same location, I would make a point of highlighting your specific interests and patient populations you want to work with if a questions should arise about how you are applying. The point is not to gain a title of INR, but the ability to treat patients, regardless of the type of track you take. This is particularly relevant in INR because it is split among NSGY/neuro/rads. In the end, any reasonable program will understand your need to find the best path to a very highly specialized field without being constrained to applying to only one "field."

I really appreciate your comments! Your advise sounds pretty good. Just making sure I got your point, you're saying I should apply to NSGY, neuro and rads at each of the 4-5 institutions in the area. Of course, I'll see how many interviews I get and so on. Assuming I get a couple of interviews for NSGY and rad, and probably more for neuro, I'd first wait for the the early NSGY match, and in case I don't match I'd just go ahead and rank rad and neuro for the NRMP. Hopefully it shouldn't matter that I'm applying to several programs in the same institution.

 

[Long Dong]

I don't know if it is true but I read on another thread that Neuro Surg was going to move to the regular match. You might wanna look into that.

 

[gonogo]

If you end up matching Rads I'll bet money that in 5 years you won't end up doing NIR. Fiddy dolla!!!???

Really? Why do you say so? I've seen both diagnostic and INR, and I'm very much attracted to INR. I think it's a perfect combination of neuro and doing procedures, which are the two things that appeal to me the most. On the one hand, I'm 100% sure I'm interested in doing something related to the brain (undergrad was neurobio, and have done research in neuroscience labs). Second, I like to use my hands and love to 'solve' problems. In other words, neurorad alone will make me feel i'm missing something. The same with neurology.

Generally speaking, how competitive are INR fellowships? Is there a reason why you're sure I wouldn't want to do it?

 

[Docxter]

I am surprised myself, but for once I see myself agreeing with apacheindian. The majority of people seriously and sincerely interested in INR when applying to radiology (myself included) will end up not doing it as a career 6-7 years later down the road. hell, I've seen at least three neurosurgeons bail out of INR programs.

 

[gonogo]

A lot changes in 5 years brotha... you're 20's are gone... you're a full-blown adult... a lot of what seems "interesting" and "fun" now may very well seem like a royal P.I.T.A. down the road. I don't mean to be cynic -- just a realist.

That said a Rads-->NIR path is a FAR better choice than straight skull-cracking. If you truly are still gung-ho in 5 years you can do NIR, and if you're truly still enthusiastic 5 years after that you can continue it. BUT if you're not no biggie -- you can always do the oh-so-sweet gig of diag rads. Great position to be in if you ask me.

Drop me a PM letting me know if you end up in rads or neurosurg. I'd be curious to know.

OK, I do get your point, and you may actually be right in that eventually I may change my mind. But as of now, I rather go and try to pursue what I really want.

 

[gonogo]

I am surprised myself, but for once I see myself agreeing with apacheindian. The majority of people seriously and sincerely interested in INR when applying to radiology (myself included) will end up not doing it as a career 6-7 years later down the road. hell, I've seen at least three neurosurgeons bail out of INR programs.

Do you know why those three neurosurgeons bailed out of INR?

 

[Docxter]

Do you know why those three neurosurgeons bailed out of INR?

Poor lifestyle, as opposed to the better lifestyle they could have as a community-based general neurosurgeon, or if subspecializng in spine, functional, tumors, nonvascular skull base, etc.

All that said, I think the lifestyle of INR will improve, and sort of already has, since up until now, due to the shortage of INR trained people, most places had one or two INR people, making call and coverage very demanding. Now with the exponential growth of the number of practitioners, the lifestyle has and will be improving (though this will drive demand and possibly salary down in the future).

Plus realize that INR is quite subspecialized and the number of places you can work at is limited (larger centers with big stroke and neurosurgery services). Last year an INR was hired at a hospital I think somewhere in Virginia near DC to start a stroke intervention program. The majority of the neurologists in the hospital quit, because that meant they too now had to provide around the clock stroke care services. You get the picture. As an INR you need a strong neurology and neurosurgery service to keep you busy.

 

[FunkyR]

totally depends on what sort of work and where you want to do it as a fully qualified specialist.

Unless you're in a big hospital department with the appropriate qualifications/recognition or if you plan to do nothing but a particular kind of INR or neurosurgery your kind of work will vary imensely. Dont forget there isnt all that much INR work around, and the current INRs and NSG with a rad interest will all have their fingers in the pie. Unless you can prove that you are more qualified than the others or have luck and slot into a vacancy at the right time it may be quite hard getting your foot through the door. Dont forget hospital politics, some rad departments wouldnt let a NSG anywhere near their angio suite for political and turf protecting reasons.

I dont know what it's like in the US, but here in Australia you dont need more than about 5 full time INRs per approx 1 million population before people will start fighting over the high end work. Dont forget alot of general interventionalists will still do cerebrals/carotid stents/back injections etc which takes even more work away from the specialist INR.

Dont forget you may still have to do some bread and butter Xrays/CT/MRI/US as a radiologist and back laminectomies, nerve root rhysolysis and deal with chronic back pain as a neurosurgeon.

If you want to do mainly INR type work, then go for Radiology. If it's a moderate interest in addition to other neurosurgical interests, go neurosurg.

 

[latinfridley]

I hope I'm posting this on the right forum. I will be applying this year for residency and I like both neurosurgery and radiology. If I do radiology, I'd then try to go for fellowship in INR.

Now here's my problem: For personal reasons I will be very limited geographically when I apply, which means I won't be able to apply for too many programs (there are only 4-5 academic hospitals in the area). Since I really want to match, and in fact I think I'd be happy with either of the specialties, I figured that if I apply for both rad and neurosurgery, I could probably increase my chances of matching. Obviously, this means I'll be applying to both of them at the same institutions. Is this advisable, or would applying to two different residency programs in the same institution harm my application?

Of course, I can always wait until I can actually apply more broadly... but that means waiting 3 more years after I'm done!

I'd appreciate any advice on what to do.

You should seriously rethink what you want.
Rads and neurosurgery are completely different fields with completely different lifestyles.
First you need to decide whether you want to do surgery or not.
If it is not essential then do NOT go into neurosurgery. You will be extremely unhappy.
If you like the idea of INR, look into either rads or neurology, but not neurosurgery.
Both rads and neurology have routes into INR.

 

[Taurus]

Neurosurgery is now part of the NRMP.