Doing body but fell in love with advanced MSK/Neuro MRIs

[Lifeman]

Currently an R4 doing a body fellowship next year. As I'm going through fourth year rotations, I'm getting the chance to read more Neuro and MSK MRIs and am really enjoying it. I think apart of my problem was Body applications were due so early and as an R2/R3 everything was confusing before studying for CORE. But now I'm enjoying learning the complex anatomy and sequences.

I know body MRI is growing every year but the volume is still dwarfed by MSK and Neuro. I'm wondering what my options are or if anyone has any real world experience with this? I am working hard in my "mini-fellowships" this year and will do MSK and Neuro electives next year. Honestly I feel like I could read these cases once I'm out but I am in a competitive area so I'm sure PP would prefer subspeciality reads. Should I do 2 fellowships?

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[Aurum]

If you feel strongly enough, why not just try to switch fellowships? Sure, you may peeve the institution at which you are doing fellowship, but it’s your future happiness. People change their minds/bail out of fellowship all the time so open spots for both specialties should be available. The auntminnie forums show vacancies for MSK at MD Anderson and neuro at UCSF starting July 2024, for example.

As a current neuro fellow, I personally do not think a 3 month (or even 6 month) mini fellowship is enough to attain mastery.

 

[Cognovi]

Yea just try to switch fellowships.
If you're in a competitive area, I think getting the CAQ would be good, and doing a fellowship is prerequisite.

 

[cyberchicken001]

I’m a body fellow and I was in a similar situation as you. I chose to do body in third year and spent most of my fourth year doing neuro and MSK and really liked them. I think there’s a certain element of buyers remorse that goes on. I stuck with doing body fellowship and am currently happy.

Body MRI is a rapidly growing modality that I think most people who didn’t do a body fellowship - and older attendings who trained before mri was commonplace- are not comfortable reading. At my institution my attendings tell me the body mri volume has about tripled in the past few years. Everyone gets a prostate mri these days it seems. And many indications which used to get CT now get mri instead unless there’s a contraindication. So I think there’s a lot of room to find you’re niche and feel like you’re the expert at something.

But at the end of the day as the above posters have mentioned, if you truly find neuro/msk to be your calling, make the switch and don’t look back.

 

[clutch21]

Are there any smaller groups in your area that does general work? If you want to do both MSK and neuro that would be your best bet. I’m abdominal trained in a small PP group. Located in a suburb of a desirable city. I read everything including neuro and MSK MR.

Body MR is my favorite, but I really enjoy reading neuro MR. MSK MR I could take or leave. The daily variety though really keeps things fresh, at least for me.

If you take a sub-specialized job, you will have to forgo 2 of 3 between neuro, MSK, and body. Several medium groups will have general call, but it’s doubtful you’ll be reading any meaningful MR on those shifts outside of maybe some stat MR brain and spine.

 

[Tiger100]

If you really want to do high end imaging, either body or Neuro or MSK, you have to join academics or a big referral center. Otherwise, you will be disappointed by a typical private practice. Believe me. You can do a year of body fellowship with lots of MRI at Stanford and then join Kaiser ( which owns almost 3-40 % of market in big cities in California and is considered one of better jobs) and find out that you will read 1-2 body MRs per day at most and most of the so-called advanced body MRI is not done there.
Or you may do a 2 year Neuro fellowship at MGH and join a big private group in Boston but you find out that your first 20 MRs of the day are all degenerative spines and strokes. Or you can do 1 year of MSK fellowship at UCSD but you join a practice and you find out that your job is just to generate the report for the scanner that orthopods own for billing purposes and they pretty much don't care about what you put in the report.

I personally believe that 6 months of mini-fellowship is more than enough for most private practices. If you want to join MD Anderson, that's a different story and a year of fellowship might not be enough.

Having said that, the added value of Neuro and MSK fellowships are more than body for a typical private practice.
The subject of body and Neuro are a lot more interesting than MSK. YMMV.

I would definitely choose Neuro over body. Hint: I did a body fellowship but I read everything.