Going for a mediocre rads spot or an elite neuro spot?

[Terpskins99]

Hi folks. 3rd year osteopathic med student here wondering if you could spare some advice. I'm debating which route to head towards... rads or neurology.

I absolutely went bananas over neuroanatomy during head and neck dissections and received honors in neurology. For a while, I strongly considered pursuing neurosurgery (that is until I had a couple less than inspiring interactions with several neurosurg folk at my hospital).

My class rank is just about in the middle. I'm doing well in rotations thus far, but more importantly I did well on the USMLE (235) which should be good enough to help me land a radiology position someplace (I'm pretty certain I have an excellent chance of matching at my hospital's radiology spot). But the thing is, my first love is neuro. And I'm wondering if my board score would help me to land one of the really elite neuro programs. The thought of completing a neurology residency at a top notch institute such as Partners or whatnot... it just sounds like it would be an absolutely amazing experience. Or is it the case that those select neuro residencies simply don't place that much weight in board scores to begin with?

I hope to eventually go into INR, so both Rads and Neuro can get me there. Also, rads and neuro both have a number of really interesting fellowships that I can pursue should I decide not to continue towards INR.

Any of your thoughts would be greatly appreciated! Thanks!

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[neurologist]

Hi folks. 3rd year osteopathic med student here wondering if you could spare some advice. I'm debating which route to head towards... rads or neurology.

I absolutely went bananas over neuroanatomy during head and neck dissections and received honors in neurology. For a while, I strongly considered pursuing neurosurgery (that is until I had a couple less than inspiring interactions with several neurosurg folk at my hospital).

My class rank is just about in the middle. I'm doing well in rotations thus far, but more importantly I did well on the USMLE (235) which should be good enough to help me land a radiology position someplace (I'm pretty certain I have an excellent chance of matching at my hospital's radiology spot). But the thing is, my first love is neuro. And I'm wondering if my board score would help me to land one of the really elite neuro programs. The thought of completing a neurology residency at a top notch institute such as Partners or whatnot... it just sounds like it would be an absolutely amazing experience. Or is it the case that those select neuro residencies simply don't place that much weight in board scores to begin with?

I hope to eventually go into INR, so both Rads and Neuro can get me there. Also, rads and neuro both have a number of really interesting fellowships that I can pursue should I decide not to continue towards INR.

Any of your thoughts would be greatly appreciated! Thanks!

Since nothing about your post suggests that you have much interest in direct patient care, and that is the key factor between the two fields, I would strongly urge you towards radiology.

#1. You can go into neuro-rads or INR
#2. You can wax eloquently over neuroanatomic findings on your MRIs without having to deal with patients
#3. You can get into INR much more readily via rads than from neuro
#4. Elite neuro residency = $$ . . . Mediocre rads residency = $$$$$$$

If you still choose neuro, your scores and grades should get you into a very strong neuro program. I can't comment on your chances in rads.

By the way, not to complicate things even more, but since you liked head and neck dissections so much, have you ever thought of ENT?

 

[buckley]

they're really quite different, so it's just a question of what it is you really want. i think the stereotypes are fairly accurate to a certain degree. but in the end, i think you ought to go with whatever gets you really hyped up. "anything less than mad passionate love is a complete waste of time!" teeheehee

as for board scores, i think neurology is a field where the whole package is really looked upon. last year, i think the average score for those who matched was 214.

ive done some visiting and i find that there really is great variation among the training programs. partners of course is on a class of its own (im biased) but I actually like many of the small programs and consider ranking them very highly. My reason is that withe smaller programs faculty to resident ratio is so much higher and there are more one-on-one times with faculty. I love clinical neurology so that means a lot to me.

well, goodluck!

 

[danielmd06]

They are very different, but you're not the first person around here to be interested in both (or Neurosurgery for that matter).

Be very honest with yourself about what you want to do with your life. Radiology offers a better "default" job than Neurology in terms of hours and paycheck.

But there are some mighty nice Neurology jobs out there, too.

 

[Astrocyte]

You want to do INR, go to radiology. Even a commuity program can get you into a top INR fellowship.
Don't go for neurology because of the 'elite experience'. You will regret it. Also you have to understand the difference between clinical neurology and neuroanatomy. Make sure you like the former as well.

Good luck.

 

[Head]

Despite your excellent board scores, I don't think you would match at one of the top 5 neuro programs simply because you are coming from a D.O. school. Add a PhD to your name and that might change.

I'm not saying this to be harsh. Personally I don't find any difference between those trained at MD vs. DO schools. Program directors, on the other hand, are keenly aware of how their schools are perceived by the masses. Outsiders will not see your board scores, but will see that MGH matched a D.O. in its class and wonder if they're slipping. I would encourage you to search through the match lists of the residencies you are applying to because many are more open to DO's / FMG's than others. You would certainly be a strong candidate and probably match at one of the next tier of schools.

 

[darksideone]

Despite your excellent board scores, I don't think you would match at one of the top 5 neuro programs simply because you are coming from a D.O. school. Add a PhD to your name and that might change.

I'm not saying this to be harsh. Personally I don't find any difference between those trained at MD vs. DO schools. Program directors, on the other hand, are keenly aware of how their schools are perceived by the masses. Outsiders will not see your board scores, but will see that MGH matched a D.O. in its class and wonder if they're slipping. I would encourage you to search through the match lists of the residencies you are applying to because many are more open to DO's / FMG's than others. You would certainly be a strong candidate and probably match at one of the next tier of schools.

Good advice by the above post. OP, don't you find it a little pretenious to say that you will get an "elite spot" in neuro? That is exactly one aspect of personality/character that a lot of neuro programs don't want out of a resident. Sounds like you are better suited for radiology.

 

[Terpskins99]

Good advice by the above post. OP, don't you find it a little pretenious to say that you will get an "elite spot" in neuro? That is exactly one aspect of personality/character that a lot of neuro programs don't want out of a resident. Sounds like you are better suited for radiology.

Wow darkside, you dug a little deep to pick up this thread since I started it almost a year ago (November '07). I'm a little confused as to why. Care to explain?

Anyhow, read my post a little more carefully. I never claimed I would get a spot. I was merely inquiring as to what kind of shot I might have. You can decide how "pretentious" (<---- correct spelling ) I am based on everything else I write. You'll find plenty of material to work with in the Lounge. Its ironic you feel neurology in particular would object to a pretentious applicant... and yet you agree those top 5 neuro programs would only consider an MD candidate (which I know for a fact is not true), well wouldn't that make it a PRETENTIOUS program? Chemistry 101: like dissolves like.

Anyhow, I guess I should update my situation. I wrote that post towards the middle of my 3rd year of med school before I had even rotated through neurology or radiology. I have since done so and loved both of them (as well as general surgery... interestingly enough, my attending recommended I pursue ENT and neurosurgery as well... which I briefly did). I have submitted applications to both neurology and rads and am delighted to say I have received several interviews so far. Why both? Well, it turns out I really do enjoy patient interaction. And I enjoy the camaraderie shared by those working on the hospital floors. I LOVE discussing neurology! Without question, the coolest diseases and clinical presentation are in neuro.

The only real drawback that I had with neuro (which is similar to what a lot of others have), is the lack of curative treatment for so many of the diseases. Telling people they will be paralyzed for the rest of their life or have an inoperable tumor in their head is an awful job. But most people around me have said they feel I can handle it, and that its a job I need to be doing. If I'm going to do it, then I want to secure the absolute best training possible. If that means I'm being pretentious, so be it.

 

[buckley]

Why both? Well, it turns out I really do enjoy patient interaction. And I enjoy the camaraderie shared by those working on the hospital floors. I LOVE discussing neurology! Without question, the coolest diseases and clinical presentation are in neuro.

sounds like neurology has a new recruit...
aim high, you won't get that interview if you don't risk being rejected. you may also find, quite surprisingly, that the famous programs may not be the best fit to get the best training for you. pretentions are pretty hard to live with every day. good luck!

 

[Howser]

I agree, these are the 2 fields that I am choosing between as well. They don't seem very much alike, but in a way they are.

 

[kapMD/PhD]

so, i've recently become interested in neurorads too, which unfortunately is a fellowship off of radiology rather than neurology (if you know of a program that accepts neurology residents, i'd love to hear about it. there apparently used to be joint neurology/radiology programs, but i think they have all closed). I know that there are 'neuroimaging' fellowships, but they don't really put you in the same job market position that a neuroradiology fellowship does.
I'm finishing my phd in physiology and starting 3rd year this summer, so i've got some time to think it over, but i've had my heart set on neurology for quite a while - so i'm hesitant to consider anything different, but i like the imaging idea and i've done some research using micro-CT (in mice), so i think i have a chance at a radiology spot.
Anyone else considering both? Any decisions made if you applied to both neuro and rads? Thanks.

 

[medsRus]

so, i've recently become interested in neurorads too, which unfortunately is a fellowship off of radiology rather than neurology (if you know of a program that accepts neurology residents, i'd love to hear about it. there apparently used to be joint neurology/radiology programs, but i think they have all closed). I know that there are 'neuroimaging' fellowships, but they don't really put you in the same job market position that a neuroradiology fellowship does.
I'm finishing my phd in physiology and starting 3rd year this summer, so i've got some time to think it over, but i've had my heart set on neurology for quite a while - so i'm hesitant to consider anything different, but i like the imaging idea and i've done some research using micro-CT (in mice), so i think i have a chance at a radiology spot.
Anyone else considering both? Any decisions made if you applied to both neuro and rads? Thanks.

I am in a similar boat and I would love to hear about the feasibility of neuroradiology after completing a neurology residency. Thanks...

 

[neurologist]

so, i've recently become interested in neurorads too, . . . if you know of a program that accepts neurology residents, i'd love to hear about it.

Yeah, so would a lot of other neurologists.

I am in a similar boat and I would love to hear about the feasibility of neuroradiology after completing a neurology residency. Thanks...

The feasibility is zero. Neurorads fellowships require a radiology residency.

There is the ability to go into "interventional neurology" via a neuro residency. A very long process often requiring prior neurocritical care and/or stroke fellowships, and in the end still not the same scope of practice as neuroradiology.

 

[typhoonegator]

Actually, it is possible to get into an ACGME neuroradiology fellowship from neurology. At MGH, there is a neuroradiology attending who trained in neurology and did a neurorads fellowship. And next year, one of our chiefs, and one of our recent graduates, are going into a Boston neuroradiology fellowship. They will have to make up some radiology training during fellowship, but they will end up in the same place as a radiologist at the conclusion of fellowship. These people will be fully certified as neuroradiologists and neurologists, and can have dual appointments in neurology and radiology.

This is not to be confused with UCNS Neuroimaging fellowships, which can lead to certification for reimbursement to read brain and spine MRIs in certain environments.

Hence, the feasibility to enter neuroradiology from neurology is certainly NOT zero.

 

[medsRus]

Actually, it is possible to get into an ACGME neuroradiology fellowship from neurology. At MGH, there is a neuroradiology attending who trained in neurology and did a neurorads fellowship. And next year, one of our chiefs, and one of our recent graduates, are going into a Boston neuroradiology fellowship. They will have to make up some radiology training during fellowship, but they will end up in the same place as a radiologist at the conclusion of fellowship. These people will be fully certified as neuroradiologists and neurologists, and can have dual appointments in neurology and radiology.

This is not to be confused with UCNS Neuroimaging fellowships, which can lead to certification for reimbursement to read brain and spine MRIs in certain environments.

Hence, the feasibility to enter neuroradiology from neurology is certainly NOT zero.

Great to know. Which fellowship programs accept neuro-trained docs? Also, what is "interventional neurology" and how is it different from "interventional neurorads"? Thanks!

 

[memento]

Actually, it is possible to get into an ACGME neuroradiology fellowship from neurology. At MGH, there is a neuroradiology attending who trained in neurology and did a neurorads fellowship. And next year, one of our chiefs, and one of our recent graduates, are going into a Boston neuroradiology fellowship. They will have to make up some radiology training during fellowship, but they will end up in the same place as a radiologist at the conclusion of fellowship. These people will be fully certified as neuroradiologists and neurologists, and can have dual appointments in neurology and radiology.

This is not to be confused with UCNS Neuroimaging fellowships, which can lead to certification for reimbursement to read brain and spine MRIs in certain environments.

Hence, the feasibility to enter neuroradiology from neurology is certainly NOT zero.

You are talking about neuroradiology (as in reading films) or interventional + neurorads (as in reading films and doing procedures)? I know that the latter is possible, but the former is news to me (but good news!).

 

[typhoonegator]

I actually mean neuroradiology, like as in reading films. Dare to dream.

 

[neuroir]

Yeah, so would a lot of other neurologists.




The feasibility is zero. Neurorads fellowships require a radiology residency.

There is the ability to go into "interventional neurology" via a neuro residency. A very long process often requiring prior neurocritical care and/or stroke fellowships, and in the end still not the same scope of practice as neuroradiology.

Nonsence...

1. Neurologists can enter diagnostic neuroradiology fellowships in certain select programs similar to the way described above by typhoonegator. Another program that allows that is UCSD

2. The process of becoming an interventional neurologist or neurointerventional radiologist or endovascular neurosurgeon (those are all synonyms) takes EXACTLY the same number of years for a neurology resident as it does for a radiology resident, i.e. - SEVEN years. Many practicing neurology-trained neurointerventionalists do the same scope of procedures as neurosurgeons and radiologists - vertebroplasties, tumor embolizations, AVMs - you name it.

Neurologists are actively invading the field of neuroradiology, both interventional and diagnostic and will undoubtedly, continue to succeed. The number of neurointerventional and neuroimaging fellowships grows every year and their popularity increases amongst the residents.

 

[kapMD/PhD]

so really all i need to do is match at MGH right? and i might have a slim chance of getting a neuro rads spot out of neurology.
No really though -thanks guys, that's really encouraging. I do love neurology, but like the idea of being really good at reading films, and possibly doing proceedures too.
If anyone else knows of programs that allow this, please post them too. Thanks!

 

[Brainologist6]

So here is what I know:
I am very interested in interventional neurology. I also considered radiology vs. neurology vs. neurosurgery. I have decided on Neurology. It makes sense to take care of the brain from the field that study the brain. Besides, you can provide the continuous care to the patient, just like cardiologist. Even though not common yet, some programs offer fellowship to neurologiest, and some programs have interventional neurology fellowship themselvs: example: Pittsburgh, cleveland clinic, Emory and Miami). At Pittsburgh, they take one neuro resident per year and I spoke to the guy who is starting next year. He was very encouraging. A Stanford neuro grad also just got a interventional spot at Organ. Another neuro resident at Cinccinati also got a interventinal spot at another place. So it is growing, and I believe it is going to be mostly neurologist and neurosurgeries who will provide the procedures.
But if you like to sit in a dark room reading films and just do the procedure and hand off the patient to someone else to take care of and don't talk to the patient, then you should go to Radiology.

 

[WingsBelieve84]

Hey, this is an interesting thread... just curious, as the fields seem quite different, what are the similarities and what might draw someone to both fields?

 

[Astrocyte]

Hey, this is an interesting thread... just curious, as the fields seem quite different, what are the similarities and what might draw someone to both fields?

Lack of understanding of what they do day to day.

 

[BrainBuff]

Neurologists are actively invading the field of neuroradiology, both interventional and diagnostic and will undoubtedly, continue to succeed. The number of neurointerventional and neuroimaging fellowships grows every year and their popularity increases amongst the residents.

You are absolutely right. This is one of the reasons neurology residencies are getting really hot. I have found out that the same thing happened decades ago with neurophysiology (EMG/NCVs) which were almost exclusively performed by Physiatrists (PMNR residencies.) Neurologists essentially took over the field in a few years.

 

[Astrocyte]

Actually, it is possible to get into an ACGME neuroradiology fellowship from neurology. At MGH, there is a neuroradiology attending who trained in neurology and did a neurorads fellowship. And next year, one of our chiefs, and one of our recent graduates, are going into a Boston neuroradiology fellowship. They will have to make up some radiology training during fellowship, but they will end up in the same place as a radiologist at the conclusion of fellowship. These people will be fully certified as neuroradiologists and neurologists, and can have dual appointments in neurology and radiology.

This is not to be confused with UCNS Neuroimaging fellowships, which can lead to certification for reimbursement to read brain and spine MRIs in certain environments.

Hence, the feasibility to enter neuroradiology from neurology is certainly NOT zero.

This is good to know. But I would think even neuro grad from this program might have problem finding a private practice neurorad/gen rad gig. Can this person take calls? Can he read ultrasound? Body CT? Nucs?

I think some clarification is due for those who want to do neuro residency but also want to 'be like a diagnostic neuroradiologist'. The motivation is clear: better lifestyle and/or money. But are you saying you want to read all the gen rad as well? That's what a neuroradiologist out in the community does 30-70% of the time. If you say yes, then you really should go into a rad residency. No neurologist can convince radiologist groups that they can read general radiology at the same level or better than rad grads, after just a year of neurorad fellowship. If you say no, then are you saying you want to be (A) a 'clinical neurologist who can convince the hospital to let him bill for scans' or (B) an 'academic neurorad who reads neuro CT and MRI all day long'? Both options appear to be opening up, the lack of market notwithstanding. But you need to have some 'special qualification' and maybe the 'right connection'. American Society of Neuroimaging is providing a certification process for mainly option (A). Now it looks like the MGH program is providing a path for option (B). Of course, these two paths are still in the formative stage, with the radiologists, understandably, resisting this movement, and the market for the most part, closed to these paths.

I think a med student considering neurology vs. rad/neurorad needs to have a clear understanding of the differences.

 

[typhoonegator]

This is good to know. But I would think even neuro grad from this program might have problem finding a private practice neurorad/gen rad gig. Can this person take calls? Can he read ultrasound? Body CT? Nucs?

This is a good point. The fellowship to which I have alluded above would not train you as a general radiologist, and so you wouldn't be trained or capable of reading body CT, u/s, etc. This fellowship is really for people who want to do research in areas where neurology and radiology overlap, or for people who already know they are going to be restricted to academic centers with large neuroradiology departments for their entire careers, or to neuroradiology groups that contract with smaller hospitals.

If you want to be a straight-up neuroradiologist, you should probably go the traditional route. You'll be better trained in the disciplines of radiology and have fewer potential restrictions in your career.

 

[Terpskins99]

So I ultimately decided to rank the radiology sites first, then my neurology sites.

I still had a tough time deciding between the specialties, so I just went with my gut that it would be close to impossible to switch into radiology in the future should I decide that neurology wasn't for me. The opposite (switching later into neurology) wouldn't be nearly as difficult, though I assume the really standout training spots will be closed to me. Burned bridges and so-forth.

Thanks for the help guys!

 

[Astrocyte]

So I ultimately decided to rank the radiology sites first, then my neurology sites.

I still had a tough time deciding between the specialties, so I just went with my gut that it would be close to impossible to switch into radiology in the future should I decide that neurology wasn't for me. The opposite (switching later into neurology) wouldn't be nearly as difficult, though I assume the really standout training spots will be closed to me. Burned bridges and so-forth.

Thanks for the help guys!

No bridges burned. I doubt you will miss neurology. It's almost certain you won't switch residency. Good luck in the match!

 

[Astrocyte]

So here is what I know:
I am very interested in interventional neurology. I also considered radiology vs. neurology vs. neurosurgery. I have decided on Neurology. It makes sense to take care of the brain from the field that study the brain. Besides, you can provide the continuous care to the patient, just like cardiologist. Even though not common yet, some programs offer fellowship to neurologiest, and some programs have interventional neurology fellowship themselvs: example: Pittsburgh, cleveland clinic, Emory and Miami). At Pittsburgh, they take one neuro resident per year and I spoke to the guy who is starting next year. He was very encouraging. A Stanford neuro grad also just got a interventional spot at Organ. Another neuro resident at Cinccinati also got a interventinal spot at another place. So it is growing, and I believe it is going to be mostly neurologist and neurosurgeries who will provide the procedures.
But if you like to sit in a dark room reading films and just do the procedure and hand off the patient to someone else to take care of and don't talk to the patient, then you should go to Radiology.

A word about the Pittsburgh program...make sure you like the two guys running the show.

You must know about the CREST study? Have you thought about how the outcome of the study is going to impact your practice as a neurology trained interventionalist? Something to consider.

Add Columbia to the list of programs.

 

[drusso]

You are absolutely right. This is one of the reasons neurology residencies are getting really hot. I have found out that the same thing happened decades ago with neurophysiology (EMG/NCVs) which were almost exclusively performed by Physiatrists (PMNR residencies.) Neurologists essentially took over the field in a few years.

What does the "N" stand for in PMNR?

 

[Taurus]

But I would think even neuro grad from this program might have problem finding a private practice neurorad/gen rad gig. Can this person take calls? Can he read ultrasound? Body CT? Nucs?

This is an excellent post. Even a neuroradiology fellowship-trained radiologist can expect to spend only 30% of their time on neuro and the rest to general radiology. It would be very difficult to find a private practice radiology group that would hire you if you can only do neuro. Most likely, a neuroradiology-trained neurologist needs to find small niche in a large academic center to do neuro reads.

 

[Terpskins99]

What does the "N" stand for in PMNR?

"negro", of course. sheesh, where did you go to medical school?

 

[Amos]

You are absolutely right. This is one of the reasons neurology residencies are getting really hot. I have found out that the same thing happened decades ago with neurophysiology (EMG/NCVs) which were almost exclusively performed by Physiatrists (PMNR residencies.) Neurologists essentially took over the field in a few years.

Where my good friend currently trains ALL the interventional neurorad fellows first trained in neurology, not rads. It is also a strong program that offers superb training in stroke as well.

Some of my former classmates that are in radiology residency at the moment also have expressed that they do NOT want to do neuro rads because of the hectic lifestyle and long training path. That, and if they were that into the brain to start with they would have done neuro.

I know that we are past the match at this point, but for other students reading this post, if you like the brain a lot, like the idea of doing some procedures and are maybe thinking academics I would go neuro. If on the other hand you are most interested in doing procedures in general in any area of the body and are interested in earning potential I would instead go rads with the idea of IR fellowship. If you are a good student you will get into either, though as pointed above you will still need to be an outstanding applicant to match at the top programs in either speciality.

Only do neurosurg if you can't possible imagine doing anything else. It's a super cool specialty, but the time involved in insanity and unless you are in academics you will mostly just do spine stuff, shunts, other other pericranial procedures. I have met a lot of miserable neurosurg residents.

 

[BrianUM]

Where my good friend currently trains ALL the interventional neurorad fellows first trained in neurology, not rads. It is also a strong program that offers superb training in stroke as well.

Some of my former classmates that are in radiology residency at the moment also have expressed that they do NOT want to do neuro rads because of the hectic lifestyle and long training path. That, and if they were that into the brain to start with they would have done neuro.

I know that we are past the match at this point, but for other students reading this post, if you like the brain a lot, like the idea of doing some procedures and are maybe thinking academics I would go neuro. If on the other hand you are most interested in doing procedures in general in any area of the body and are interested in earning potential I would instead go rads with the idea of IR fellowship. If you are a good student you will get into either, though as pointed above you will still need to be an outstanding applicant to match at the top programs in either speciality.

Only do neurosurg if you can't possible imagine doing anything else. It's a super cool specialty, but the time involved in insanity and unless you are in academics you will mostly just do spine stuff, shunts, other other pericranial procedures. I have met a lot of miserable neurosurg residents.

thanks amos for this post...i am ending 2nd yr and have shadowed an interventional neurologist (neurology) and think its such an awesome field...ive read that some of these interventional neurologists are doing research where they transplant genes and stem cells via endovascular methods

i dont mind the legnth of training so much but the hectic lifestyle you mentioned is a little worrisome...you said not to do nsurg unless you absolutely love it because the lifestyle is terrible but encourage students interested in the brain and some procedures to do interventional neuro...does this mean then that the lifestyle in interventional neuro (neurology) is busy but not quite at the level of nsurg

once again thanks for the info

 

[Astrocyte]

thanks amos for this post...i am ending 2nd yr and have shadowed an interventional neurologist (neurology) and think its such an awesome field...ive read that some of these interventional neurologists are doing research where they transplant genes and stem cells via endovascular methods

i dont mind the legnth of training so much but the hectic lifestyle you mentioned is a little worrisome...you said not to do nsurg unless you absolutely love it because the lifestyle is terrible but encourage students interested in the brain and some procedures to do interventional neuro...does this mean then that the lifestyle in interventional neuro (neurology) is busy but not quite at the level of nsurg

once again thanks for the info

The asnwer is: yes.
Residency/fellowship: nsgy much worse than interventional neurologist fellowship
Post-residency: depends on the nsgy practice

 

[travis]

I dealt with this same question, as I was very interested in Neurology (went on about 6 neuro interviews). IMO, neurointerventional through neurology is difficult and often impossible for neurologists to get into because the small number of spots that accept neurologists and the intense competition. One of my attendings told me he tried for years for one of these spots before giving up. One senior resident at a top program i interviewed at sort of 'created his own fellowship' in this and the PD and everyone were bragging him up (in a good way) as it is rare. In contrast, there are many Rads IR and Neuro fellowships spots unfilled each year. Neurosurgeons also have little trouble doing fellowships in this and some i think get training in it during residency.

Also, there are neuroradiology fellowships for neurologists, but its not like you can then join a radiology group and start billing for the reads, or read other neurologists films, at least I don't believe it is common, im not sure if you can even bill for reading your own films after doing a fellowship like this. Maybe there are cases of people doing this, probably mostly academically, but my understanding it is few and far between.

My interest was in neuro, but also neuroradiology, diagnostic, not interventional, primarily for the research opportunities and wide pathology. I think rads is really the only realistic way to do neuroradiology, diagnostic or interventional full time, without really having to pull strings, IMHO.
One of my mentors did a few years of a neuro residency before switching to rads and then doing 2 years of neuroradiology fellowship, and i think his neurobackground combined with everything else really makes him a world class guy in his field.

So, I ended up matching into a DO rads program despite receiving Neuro interviews from some really great MD places. Hopefully this helps ppl faced with this decision, because i spent a great deal of time agonizing over it, and i still have much love for neuro, as you can tell cuz im in the neuro forum