Fellowship dilemma: Interventional vs. MSK with interventions

[MinosoTheFool]

Current R1 in a top 30 DR program trying to figure out what the hell I want to do.

Being that I'm in the limbo year between the DR/IR combined residency and the end of one year IR fellowships, I'm not sure what my best options are. I love doing procedures, but I'm not sure how much I LOVE the bread and butter vascular side of IR. TIPS and TACE and EVAR are awesome, but I don't see myself fulfilled by banging on clotted fistulae, shooting TPA into HD caths, and running a PICC/Port parade for the rest of my life. On the other hand, I do love joint injections, vertebroplasties, epidural injections, and RFA work. In another life, I may have looked at interventional pain management, but I got exposed late in my M4 year. So I'm looking at the MSK programs that have interventional foci, but I'm having a hard time finding solid information on how to identify programs that focus more on procedure vs imaging. Also, I'm worried that I may not get to do a lot of procedures out in the wild if I don't do straight IR.

I'd appreciate any thoughts or insights you may have.

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[tco]

I don't know how common they are, but Radiology is approved for Pain Management fellowships now.

 

[vm26]

Current R1 in a top 30 DR program trying to figure out what the hell I want to do.

Being that I'm in the limbo year between the DR/IR combined residency and the end of one year IR fellowships, I'm not sure what my best options are. I love doing procedures, but I'm not sure how much I LOVE the bread and butter vascular side of IR. TIPS and TACE and EVAR are awesome, but I don't see myself fulfilled by banging on clotted fistulae, shooting TPA into HD caths, and running a PICC/Port parade for the rest of my life. On the other hand, I do love joint injections, vertebroplasties, epidural injections, and RFA work. In another life, I may have looked at interventional pain management, but I got exposed late in my M4 year. So I'm looking at the MSK programs that have interventional foci, but I'm having a hard time finding solid information on how to identify programs that focus more on procedure vs imaging. Also, I'm worried that I may not get to do a lot of procedures out in the wild if I don't do straight IR.

I'd appreciate any thoughts or insights you may have.

a few random thoughts...based on my experience, most of my co-residents and I were still fairly undecided about fellowship until mid/late R2, so cut yourself some slack with respect to having to make a decision asap...unless you go academics as an IR rad you will likely do a fair amount of diagnostics...you may have to simply contact individual MSK programs and ask about diagnostic/interventional ratio, I do think that MGH does do a large amount of interventional...I am not familiar with interventional pain management but if this entails having to clinically manage these patients (and their psychosocial/legal issues) then buyer beware...

 

[Doctor D]

I am somewhat biased as a person going into IR. I think there is a national trend for IR to take over procedures traditionally done by diagnostic radiologists. This has been particularly true in Body departments at academic centers. Some private practices are set up so only the IR guy does the procedures to maximize efficiency and also because many diagnostic attending hate procedures. If you do an IR fellowship you will spend 50+% of your time doing procedures and have the opportunity to grow a high end practice with oncology work and vascular work. If you do MSK a small fraction typically will be procedures ?10%. Of course there may be exceptions but I think this is more typical.

 

[narco33]

So I'm looking at the MSK programs that have interventional foci, but I'm having a hard time finding solid information on how to identify programs that focus more on procedure vs imaging.

Your big msk interventional programs are these guys:

MGH
MIR
NYU
Wisconsin
Colorado

Other programs do interventions as well, but for what you're looking for, these are the programs you'll want to start with.

 

[Light at end of tunnel]

Your big msk interventional programs are these guys:

MGH
MIR
NYU
Wisconsin
Colorado

Other programs do interventions as well, but for what you're looking for, these are the programs you'll want to start with.

Is there a resource one can go to to get more information regarding program specifics in this matter?

 

[narco33]

The best source will be faculty and fellows at your home program. If you're at a well-connected academic center, they know who does what and where. MSK is a small world, especially in academics. Outside of word of mouth from your home program, MSK Fellowships | Society of Skeletal Radiology is a good source listing fellowships, the current fellowship director, and many have descriptions what the program entails. Program websites are also a good source. But, you have to take everything you read with a grain of salt. There's a lot of programs that like to advertise "interventions" and what that usually means is arthrograms and the occasional joint injection, or maybe one month doing IR. You get the idea.

 

[SageRad]

I know a lot about the MIR program (under Jack Jennings), and it is terrific. They are very active in all of the procedural areas that you mentioned in the OP.

As for which path to choose, they are quite different IR and MSK, and it depends a lot on what you plan to do afterward (PP vs. academic), geographically, where you would like to go, etc. You have plenty of time to figure this out.

 

[Fab5Hill33]

You sound like an MSK person. I don't say that with any disrespect, but in my opinion if you don't enjoy even the routing cases then you're simply not an IR person. I'm not saying you should relish or savor something as relatively simple as a port. But someone with an IR mentality loves every opportunity to stick a needle and place a suture.

The analogy is someone enjoying scrubbing into a complex Whipple procedure as a med student. That doesn't mean you're future career lies in surgery. To be a surgeon you have to like being one 24 hours a day. Not just when the "cool" case comes up.

 

[RadsFTW123]

Agree with above - sure the sexy cases are fun to talk about, but I still relish every port, dialysis catheter, biopsy, etc since I love doing procedures. Even lame stuff like Mediport removals - I'd much do those than read a shoulder MRI. The IR lifestyle is painful relative to being an MSK radiologist, if you don't love any and all procedures I think you'll regret pursuing it.

 

[SageRad]

^^ From the perspective of a 21 year IR, MSK would be a more sustainable career over the long haul. Burnout in IR is significant. All things otherwise equal, the you in 20 years is more likely to appreciate the MSK path. This is especially so if you can carve out a practice with plenty of procedures, especially those procedures on otherwise well-patients, people you can and do really help, and people who do not need your services often at inopportune time.