INR questions

[tchantel21]

Hello all. I am very interested in INR because it combines my interest in neuro and love for surgery w/o doing a neurosurgery residency and being doomed to a surgical lifestlye w/ no real alternative mode of practice (i do not want to go into academics) If the INR lifestyle becomes too taxing for my family life then I plan on only practicing as a diagnostic radiologist.

1) I was wondering exactly how does the INR lifestyle compare to that of neurosurgery?

2)How much time is typically spent standing, doing actual procedures in INR?

3)Also, is switching back to Dx rads after fellowship common? If the INR lifestyle is as bad as some have told me it is then I would imagine that this happens all the time.

4)I have also read that unlike its cohorts on the R.O.A.D to happiness, radiology tends to have low career satisfaction as a specialty. I could probably make some good guesses why, but i was wondering if anyone practicing or entering the specialty might have an idea what exactly the problem might be based on your experiences.

Sorry for the deluge of questions here guys

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[lattimer13]

i speak from experience of knowing a boarded interventional neuro guy here in AZ. he works 4-4.5 days a week, usually ~45 hours per week. he said he's on call quite a bit since he's one of 2 INR guys in the area that take call and rarely ever gets called, sometimes he'll have to look at films from home, even more rare to go into the hospital. asking about time away from work he says he has enough and he can't remember how many rounds of golf he's played...but he knows it's more as time goes on and he's 4-5 years out of fellowship.

he loves his job and while he didn't mention how much he makes...he said it's more than enough.

kicker is even though he loves his job, he advised me to go the derm route cause "those guys have an even sweeter setup than we do."

as with anything take this with a grain of salt...i'm sure there are plenty of gigs out there not as sweet as his.

maybe this helps.

 

[tchantel21]

This is helpful b/c @ least I know that such a lifestyle is possible. I suppose I'll just have to make sure I'm competitive for the sweet jobs when the time comes. Thanks for the reply

 

[Docxter]

Almost all the INR people I know, and I know many of them, work very very hard and since they are usually 1-2 per hospital, they take a lot of call. Unless the guy you mentioned doesn't do stroke work and also doesn't work in a place that has a strong neurosurgery presence (hence the inevitable off hour SAH vasospasm treatments), those sweet hours are unheard of in INR. Emergent IA stroke and vasospasm treatment constitute the bulk of emergent calls with others being catheter venous sinus thrombosis work. They can happen at any time and guarantess a crappy lifestyle. Most neurosurgery residents don't want to focus on cerebrovascular surgery or INR for the same reason. Why have a crappy always emergent cerebrovascular work lifestyle when you can do spines, tumor, or functional work with much more regular hours. If you don't work in a trauma center, then urgent hematoma evacuations are even infrequent.

Overall, save for some exceptions, the INR lifestyle is quite tough. Plus if you do INR exclusively for a few years, you will lose enough diagnostic skills that reverting back to diagnostic rads will be hard.

 

[hans19]

There are 3 routes to a neurointerventional career:

Radiology, Neurosurgery, and now neurology. Once you start the fellowship, the training is identical. Once you finish, the work is identical. Once you finish, the lifestyle is the same no matter what your back ground. Basically Docxter has said it. You're lifestyle will be generally slightly worse than a private practice neurosurgeon's, and a lot worse if you take on stroke work.

Let me put it another way:

1. Realize that in private practice, you will be one of a few or the ONLY INR at your hospital--
2. consequently you will be on call ALL the time.
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Therefore, Your lifestyle will suck! QED.

The money can be really good depending on how bad a hospital wants you and is willing to subsidize your income to have you, but realize that per unit time, your work doesn't generate as much revenue as reading cross sectional imaging, or doing bread and butter IR. So despite the worse lifestyle, increased liability, stress, opportunity cost (3 years of fellowship) and complexity of cases (ever seen a spinal dural AVM embolized?), you won't necessarily get paid any more than a diagnostic radiologist. Apparently this is a one of they hottest fellowships to get now (for nonradiologists). Rumor has it, spots are filled in the NYC area till 2011.

After all this, who in their right mind would still wanna do INR?!?



I DO!!!

 

[Hopefulmeds]

Hans19's post and the other post above are all on point. INR is usually tougher than diagnostic rads and even regular IR. Many regular IR guys discouraged me from doing INR, saying the lifestyle sucks. While I'm still strongly considering INR, it definitely made me take a step back to see if I really want to go into the field.

 

[tchantel21]

Thanks for the replies guys. I guess the moral of the story is always that you can never, ever have your cake and eat it too in medicine

...unless you go into derm



Do most radiologists you know who have been practicing for a while still look forward to work (not whistling and clicking up their heels happy, but @ least genuinely interested) or does it become tedious and "just a job" after a while

For you guys who are residents how is it going? I know life as a resident is not something to base my decision on but im curious

 

[f_w]

There is INR and there is INR. Some people bill themselves as INR but all they do is pain-therapy and v-plasty. With that kind of practice, a 9-5 day is conceivable. Every 'real' INR I have met so far was on call 1/1 if lucky 1/2 and had lots of after-hours work.

 

[hans19]

There is INR and there is INR. Some people bill themselves as INR but all they do is pain-therapy and v-plasty. With that kind of practice, a 9-5 day is conceivable. Every 'real' INR I have met so far was on call 1/1 if lucky 1/2 and had lots of after-hours work.

FW is right. But to do INR 'lite', you don't have to do a 3 year fellowship. Quite a few 1 year DX neuro fellowships give you experience in plasties and facet injections.

That stuff is great and reimburses well, but I'm also interested in the high-risk, high-reward (<-not necessarily financial) aneurysms and AVMs.

 

[tchantel21]

dup

 

[tchantel21]

oh, so exposure to interventional procedures during the neurorad fellowship would allow me to perform these procedures, or do you mean that other 1 yr fellowships that I would take after neurorads offer such training?

 

[hans19]

The route to becoming a 'Real' INR:

1 year internship -> 4 year radiology residency -> 1 year diagnostic neuroradiology -> 2 years interventional neuroradiology

You may do a month or two of INR during your diagnostic neuro fellowship, but that by no means qualifies you to do the complicated vascular work. However, at the end of that year you should be proficient in doing 4 vessel diagnostic angiograms and possibly spine work if you are aggressive.

 

[f_w]

oh, so exposure to interventional procedures during the neurorad fellowship would allow me to perform these procedures, or do you mean that other 1 yr fellowships that I would take after neurorads offer such training?

Most diagnostic neurorads fellowships these days are pretty hands-off and heavy on the latest MRI gizz-whizz. Diagnostic neuroangio work is pretty minimal, MRA and CTA have pretty much put an end to it. The only places where I saw the neuro fellows get some INR and angio exposure where the fellowships where there was an active INR service but no fellow (and an INR attending who was interested in teaching, not all are).

So if you want to do INR, try to get out of the year of diagnostic neurorads and go into a 2 year INR fellowship instead.