Cannot decide on fellowship

[Unkle]

Hello I am in residency and cannot decide on what to do with my career. Any thoughts on neuro versus MRI fellowship if your plan is to read everything except mammo eventually? My concern with MRI is that I wouldnt become an expert at anything, but if I do neuro how am I going to learn MRI of the body or msk?

Also some neuro fellowships offer spine procedural experience, but is that something that is realistic in private practice , or is that the realm of pmr and anesthesia? It would be lame to learn to do vertebroplasty and facet injections if you're not going to do it. Do private radioogists do a lot of neck biopsies? Or spine biopsies?
Thanks!

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[Gadofosveset]

If your eventual goal is to read everything except mammo...

Two things to consider:

- What were the weak spots in your residency? Every residency has relative weak spots. If you know you got good exposure to neuro in residency, but not in MSK, I'd use fellowship as a time to supplement your weak spot. If you need to work on more than one area, see if your target fellowship will allow you elective time in other areas.

- What does your target practice want?

If you don't know either of these things, you're pretty much selecting at random. You don't need to be an expert if you plan on reading everything, but you can market both expertise (if the group needs it) and breadth. Every group needs people that can cover everything. Procedural experience is usually marketable. Niche applications in a subspecialty can sometimes be marketable, but it's hit or miss unless you know what your target group wants.

It's kind of analogous to training to be a part of a football team, but you're not sure what position you're eventually going to play. You plan on being able to be in every position except kicker. What should your workout be? More squats? Running routes? Speedwork? Well..... it's going to be hard to choose unless you know your eventual position. In lieu of that, work on your weak spots.

 

[colbgw02]

If it's a true pick 'em, then choose the organ-system based fellowship over the modality based one.

 

[loljkttyl]

To the original poster, the answer is: It depends. There is no right answer. Every practice is structured differently and even within the same practice hiring needs change over time depending on which radiologists are retiring. Some larger practices might looking for subspecialists with fellowships in MSK or neuro or body. Other smaller practices might prefer to have a little more flexibility so that when someone goes on vacation, the MRI person can cover both the body and MSK list, for example.

 

[scootad.]

Based on my experience:

If you want to join small outpatient-only PP group, where odds are you will be expected to read everything, MSK is your best bet.

For traditional hospital based PP group, neuro becomes more desirable, esp in jobs with hospital contracts at stroke centers. But you can pick neuro, MSK, body and still have similar prospects.

 

[Unkle]

Thank you for your responses.

 

[dr seuss]

Agree with above - choose Neuro, MSK, or Body over MRI. If you truly have no preference, consider what your residency is weak in. Most places are weakest in MSK so that is a common recommendation, but no specialty is so difficult that you have to do a fellowship to be able to read it. People denigrate body fellowships (because you do so much body in residency), but all the people I know who did a body fellowship got good jobs.

I chose neuro because I was most interested in it. In my 4th year I will be doing 2 months of electives in body MRI and 3 months of MSK MRI in case I end up reading everything.

For your other question: most diagnostic radiologists aren't doing vertebroplasties and facet injections, but for some practices it is valuable. During neuro fellowship interviews the programs with good spine experience promoted it because it can be a marketable skill.

 

[meister]

Five months of electives during a neuro fellowship? Something tells me you won’t be working in the lab for those cerebral angios.

 

[dr seuss]

Electives during my 4th year of residency. Most of 4th year is electives now. Some places allow you to do "mini-fellowships" with the whole year in 1 area. Where I am you can only do up to 3 months unless you are doing IR/DR.

 

[txguy]

This is a little off topic, but even if you plan to read everything except mammo, do not let that diminish your mammo skills, or focus duiring any remaining mammo rotations in your residency. If your goal is to join a private practice, the ability to read mammo will help you immensely. Basically if you're a team player and willing to do whatever it takes to help the group, you really open up your options and make yourself more marketable. Even in a good job market, you will have a better chance at obtaining your ideal job and location if you are willing and able to read everything including mammo.