Can neurologists compete?

[chunkymonkey]

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Can neurologist-trained INR guys really compete for the same INR positions that are open to radiologists and neurosurgeons? It seems like the few guys that are have started their own departments at academic hospitals. Could this be because it is difficult for an interventional neurologist to get a job in a radiologist or NS-run department or in private practice?

 

[neurologist]

Can neurologist-trained INR guys really compete for the same INR positions that are open to radiologists and neurosurgeons? It seems like the few guys that are have started their own departments at academic hospitals. Could this be because it is difficult for an interventional neurologist to get a job in a radiologist or NS-run department or in private practice?

It's probably more because there aren't enough interventional neurorads or neurosurg docs to fill the demand. If you are a neurologist who finished an interventional neurorads program, I'd suspect you are just as good at interventional neurorads as a radiologist or a surgeon.

 

[chunkymonkey]

I don't know. I've been looking at job listings for this field and many say must be board-certified in NS or Rads.

 

[danielmd06]

All of the fellowship programs for Endovascular Surgical Neuroradiology are ACGME-accredited through either a Neurosurgery or Radiology department. They accept Neurologists for the positions, but the certification is through Radiology or Neurosurgery departments.

Yes, there are Neurologists currently in private practice for ESN.

 

[chunkymonkey]

Thanks for the info. Have you spoken to ESN-trained neurologists in private practice? I wonder if not being a radiologist or neurosurgeon was a detriment while they were looking for ESN jobs. I'm guessing the pay would probably be less as well.

 

[danielmd06]

Thanks for the info. Have you spoken to ESN-trained neurologists in private practice? I wonder if not being a radiologist or neurosurgeon was a detriment while they were looking for ESN jobs. I'm guessing the pay would probably be less as well.

I've spoken with Interventional Neuroradiologists mostly, as they make up the vast majority of the current ESN practicioner pool. I have also spoken to one Endovascular Neurosurgeon, and one Interventional Neurologist.

Those aforementioned Neuroradiologists that have known Neurology-trained ESN docs were highly complementary about them.

The pay for different ESN people would be the same across the board, as would the frequent call, the hours, and the stress.

 

[chunkymonkey]

I've spoken with Interventional Neuroradiologists mostly, as they make up the vast majority of the current ESN practicioner pool. I have also spoken to one Endovascular Neurosurgeon, and one Interventional Neurologist.

Those aforementioned Neuroradiologists that have known Neurology-trained ESN docs were highly complementary about them.

The pay for different ESN people would be the same across the board, as would the frequent call, the hours, and the stress.

Well I think NS would get paid more as they can do traditional procedures if necessary while the INR and the interventional neuro guys would be limited to ESN. What do you think?

 

[danielmd06]

Well I think NS would get paid more as they can do traditional procedures if necessary while the INR and the interventional neuro guys would be limited to ESN. What do you think?

A Neurologist wouldn't be limited to just ESN. They would have training in Neurocritical Care, general Neurology, and Stroke/Vascular. Like Neurosurgeons, the Neurologist could manage the patient in a variety of settings.

I don't think the salaries vary that much due to specialty.

The INR guys I've spoken to say the Neurology-trained ESN people make the same money as they do. I never asked the Neurosurgeon. Logically, if a Neurosurgeon was doing ESN in addition to "regular" Neurosurgery, he could easily make more. It just depends on what type of group you join.

 

[Nerdoscience]

Well I think NS would get paid more as they can do traditional procedures if necessary while the INR and the interventional neuro guys would be limited to ESN. What do you think?

You mean like they're stenting an internal carotid, and something goes wrong, and they cut open the skull with a drill and a bone saw right then and there?

 

[chunkymonkey]

Exactly. I've heard of that happening (on uncleharvey.com so take it for what it's worth).

 

[danielmd06]

Exactly. I've heard of that happening (on uncleharvey.com so take it for what it's worth).

In certain, select circumstances it could happen. Though not quite in the way you are imagining.

You shouldn't just drill a burr hole in the Neurorad suite. 😉

Say you have an aneurysm that cannot be coiled while you are in the Special Procedures Room, you could move that patient promptly to the OR and clip it - if you are a Neurosurgeon.

Truthfully, I never saw this happen either in my third or fourth year Neurosurgery rotations, or my fourth year Neuroradiology rotation. It just wasn't common.

 

[Bonobo]

I think this is really a major issue for neurologists entering the field of interventional. Most interventional procedures are done on traditionally neurosurgical patients (aneurysms, AVM's, and resectable tumors). Carotid stenting is the one major exception, and of course is being done by vascular folks and cardiologists also. So the question becomes, what is a neurologist doing as an interventionalist when "stroke interventional" procedures are still only a fraction of what an INR person does?

It really has little to do with whether the neurosurgery-trained interventionalist can take the patient to the OR, or whether the radiology-trained interventionalist is able to better understand and diagnose the condition using available MR/CT techniques in addition to the angiogram. It has much more to do with comfort of the trained interventionalists in dealing with all of the different types of patients encountered in INR. If evidence proves the superiority of stroke interventions (e.g. stenting for intracranial arterial stenosis, or local intraarterial tPA), then I think neurologists can stake a good claim to the field alongside radiologists and neurosurgeons. If not, then the neurosurgeon wins in most cases. The radiologist's only real advantages to neurosurgeons other than political/historical factors is their anatomical knowledge of the entire head and neck (for epistaxis treatment and the like) and beyond (when looking for aortic pathology or fibromuscular dysplasia in the femoral artery for example).

I am a neurology resident planning to do interventional, and my only claim will be that I will get the necessary additional training prior to the INR fellowship (radiology or via years in neurocritical care and stroke), and that I am planning to pursue a career that advances interventional care of stroke patients. Hopefully, this will get me an academic position at some stroke center where they will let me practice INR (more likely if I have trained in radiology rather than just neurovascular fellowships after neurology). This is the reality for now. Maybe in the future stroke interventions will become better than medical and surgical treatments and the field will mature for neurologists.

B

 

[chunkymonkey]

Thank you for the helpful information. It seems a bit scary to want to do this at this point since it's so new and almost seems like as an INR-trained neurologist you might be considered second-string to NS and rads INR docs. I think large academic institutions might be the most amenable to bring an interventional neurologist on board. What do you think?

Other than the required ACGME requirements, what else do INR/ESN fellowships look for in a neurology candidate? What would make you stand out to them? Are fellowships really as political as I've read?

 

[neuro-cocks]

i think another part of the equation you mentioned and that people have failed to address was at "academic hospitals." hospitals across the country are looking for interventionalists and would do nearly anything to fill these positions. your mentioning academic throws another issue into the discussion. currently there are very few neurology-trained interventionalists to compete for those positions, so obviously by pure statistics, it would be foolish to say that neurology-trained interventionalists could dominate the position fight. community-based hospitals are looking for interventionalists and do not emphasize the training nearly as much as having one in their institution. did you mean by your question if one neurology-trained interventionalist were to go head-to-head with a neurosurgery or radiology-trained interventionalist in competition for a spot, would the neurology-trained candidate get the spot? again, another issue.

 

[chunkymonkey]

Yeah I mean if they went head-to-head for a position.

How do you know hospitals "would do nearly anything to fill these positions"?

Thanks!

 

[hans19]

Well I think NS would get paid more as they can do traditional procedures if necessary while the INR and the interventional neuro guys would be limited to ESN. What do you think?

When the INR isn't coiling, he's doing vertebroplasties, facet injections, or reading MRIs back to back which generates on the average more RVUs per unit time than a neurosurgeon clipping an aneurysm or even coiling itself. They biggest money maker for neurosurgeons is spine surgery, but most spine surgeons don't want to have anything to do with aneurysms.

 

[chunkymonkey]

From Uncleharvey.com:

INR does not bring in the RVUs. The professional surgical compontent is like $1000. Each coil is 1 grand a pop. Medicare insurance pays for the 1st 10 coils, each one you use afterwards, you eat the cost. If you are coiling a giant aneurysm you are gonna lose money. So for a 5 hour coiling of a giant aneurysm you get a little over $200/hour, but over you lost money for the group. The practice subsidizes you b/c they need you so bad. Spine brings in the true RVUs.