Best path to interventional neurology

[lalalaland1234]

I am highly interested in pursuing interventional neurology. There is really no other subspecialty of neurology that I would be interested in pursuing other than INR. I was curious if there were any vascular/NCC programs that either guarantee an opportunity to do in house NIR fellowship afterwards or have a track record of extremely high placement rate into NIR fellowships? I am trying to figure how realistic it is for a neurology resident to match into NIR. Is it something that is very difficult to match even if you try really hard or is it something that is easily achievable if you take the proper steps. In other words what would you estimate the match rate is for neurology trained physicians trying for NIR/endovascular fellowships.

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[Aldertonghen]

Yes. The university of Minnesota for example has a 3 year combined ACGME accredited vascular+NIR fellowship. Used to be offered in certain years only, but they now take 1 person minimum per year on this 3 year track. The good thing is even as stroke fellow (PGY-5) you rotate in NIR a fair bit as it’s a combined track- and because of the extra time the fellows become really proficient with things outside of thrombectomies, aneurysms, bleeds.

Another good example of a combined track is JFK’s 4 year stroke/NCC/NIR track, it’s an extra year though but you get triple board certified which is sweet. They have some pretty decent faculty too. Since these are neurology specific tracks (therefore not open to radiology or neurosurgery), graduates of these residencies essentially have dibs on the NIR if they wish to pursue it (internal recruitment).

The best residencies for doing NIR would be UPMC, UMiami, Emory, however, to my knowledge these do not have combined tracks like Minnesota or JFK does and are slightly harder to get. In practice, it depends. UMiami NIR is fairly tough to get even for in house neuro residents, UPMC on the other hand seems to be a bit easier (based on the residents there I’m in touch with) as their neuro department has full control over NIR. But technically not a combined track to the best of my understanding.

The bigger question is if you’re okay with the nature and lifestyle of NIR. I initially built my RoL around NIR opportunities (that and neuromodulation were my two big interests), and have been lucky enough to get a program where I could scrub into the angio suite in PGY1 itself, but I am not sure anymore about the field. The complications are pretty devastating to stomach.

 

[xenotype]

I am highly interested in pursuing interventional neurology. There is really no other subspecialty of neurology that I would be interested in pursuing other than INR. I was curious if there were any vascular/NCC programs that either guarantee an opportunity to do in house NIR fellowship afterwards or have a track record of extremely high placement rate into NIR fellowships? I am trying to figure how realistic it is for a neurology resident to match into NIR. Is it something that is very difficult to match even if you try really hard or is it something that is easily achievable if you take the proper steps. In other words what would you estimate the match rate is for neurology trained physicians trying for NIR/endovascular fellowships.

Yes you can totally, 100% bundle an NCC or a stroke fellowship at a variety of programs. It isn't necessarily even difficult/competitive to do if you A) do residency at a place that has neurologist NIR and a fellowship and B) have a reputation of being a good resident, good RITE scores. Not that many people want to be NIR.

 

[lalalaland1234]

That is great to hear! Because NIR does not really seem to have a formal match process I was worried that pursuing this field would be a pipe dream for neurology trained physicians but I'm pretty glad that it seems to be a very doable thing.

 

[Thama]

1) It's not a pipe dream - it's becoming more widely done by neurologists.

2) It's still a competitive and sometimes frustrating process for neurology applicants, as opposed to neurosurgery and radiology applicants who basically walk into open spots. If you *only* want to do NIR and have no interest in practicing any other area of neurology, then it would be absolutely negligent not to tell you to look at those pathways first.

 

[Aldertonghen]

That is great to hear! Because NIR does not really seem to have a formal match process I was worried that pursuing this field would be a pipe dream for neurology trained physicians but I'm pretty glad that it seems to be a very doable thing.

There is another thread on neurology controlled NIR programs, you can check that. Unfortunately there are some very reputed residencies that don’t have this (such as Mayo) so just be a touch careful about that. But overall it’s easier to get than say interventional pain (where neuro almost never controls the program except in 3-4 places).