Interventional neuroradiology/endovascular neurosurgery fellowship for neurologists

[Captain_Jack]

I have just started neurology training (PGY-2) and would like to apply for interventional neuroradiology (INR)/endovascular neurosyrgery (EVNS) after the residency. I would like get answers to some of my questions in order to plan fellowship application wisely.

1. What kind of fellowship will give you better change to get into INR program vascular neurology/stroke or neurocritial care (NCC)? Most people say that vascular neurology would make you more competitive for INR fellowship. They also said that most ACGME programs accept only (or at least strongly prefer) vascular neurologists. Is that true? Does vascular neurology make me more competitive for INR fellowship compared to NCC training?

2. If you do not find a spot for INR immediately after you finished stroke/NCC fellowship, what would increase your changes next year better diagnostic neuroradiology fellowship or year of practice as an attending?

3. Once you done with INR fellowship who would have higher changes to get better job neurologists with vascular/storke or NCC training?

4. A lot of INR programs are non-ACGME certified. Does ACGME certification matter for internventional neuroradiologist for the future job search? I have heard that it matters only if you want to get a position in academy but not in private hospital.

5. I would greatly appreciate if you name neurologist friendly INR fellowship programs.

I would greatly appreciate help with any of the above mentioned answers.

Thanks.

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[TUGM]

In the process of applying this year to NCC, and likely applying to NIR fellowship next fall (positions tend to fill 2-3 years in advance). As stated many times previously on these forums on this topic, the ACGME approved pathway for neurologists entering into NIR is:

1) Neurology residency --> Vascular neurology fellowship (1 year) --> NIR fellowship (2 years) OR
2) Neurology residency --> Neurocritical care fellowship (2 years) --> NIR fellowship (2 years)

It is important to note that the recommendations actually suggest you only have to do 1 year of NCC fellowship, but highly doubtful that NCC programs will sign you on only for a year, and you will not be able to board certify in neurocritical care if you do only 1 year. Some choose to do 1 year of vascular neurology and try to get a 1 year NCC position to get experience before NIR (total 4 years).

Now to answer your questions:

1) Based on anecdotal evidence from my peers and fellows, vascular neurology fellowship is preferred, is shorter in duration (1 year vs 2), and tends to be somewhat less labor-intensive compared to NCC fellowship. NCC trained applicants need to demonstrate interest in stroke medicine and research, as a big focus in NIR currently (especially from a neurologist's standpoint) is acute stroke intervention. I know of fellows from both pathways securing good spots.

2) There are 2 NEUROIMAGING fellowship programs currently in the country available for neurologists. You will not qualify for training in diagnostic neuroradiology unless you are radiology trained. Even with neuroimaging fellowship, you will not find a place that will give you privileges to read neuroimaging and bill for it. You can get neurosonology trained and certified, and read/bill your own carotid/vertebral dopplers and transcranial dopplers. Better to do a year of research and try to get time scrubbing in and assisting in the angiosuite, or as mentioned above, do a stroke fellowship year if you are NCC trained, or a year of NCC if you can arrange it if you are stroke trained, (in my opinion).

3) Can't comment really on one vs the other. NIR job market is tight at the moment. But both stroke neurologists and neurointensivists are in high demand, especially in the community setting (every hospital wants to be a stroke center).

4) ACGME certification, in general, does not matter. What matters in a fellowship is case volume and hands-on training time.

5) Still an uphill battle to secure fellowship coming from neurology, but doable if you want it, and have the right things on your application (read research in stroke and intervention, and LORs from prominent faculty). Programs that have taken neurologists in the past (although can't speak for their neurology-"friendliness"): UCSF (I think only 2 in the past), UCLA, Colorado, Medical College of Wisconsin, University of Minnesota, Iowa, St. Louis University, Texas Stroke Institute (Dallas/Ft. Worth), UTSW, UT Houston, Case Western, Cleveland Clinic, Columbia, NYU, Mt. Sinai, University of Buffalo, Wayne State/Michigan Stroke Network, MGH/BWH/Partners, Boston University, Lahey Clinic, University of Maryland, University of Massachusetts, Mayo-Jacksonville, University of Florida, University of Miami/Jackson Health System.

Hope this helps.

 

[TUGM]

Update to question 4, for the sake of accuracy. Professional societies are moving towards CAST (Committee on Advanced Subspecialty Training) certification for their programs. Essentially under this certification (which is under neurosurgical domain) will standardize things for everyone, including neurologists. The training pathway does not change, although surgeons will likely continue to be allowed to pursue in-folded training.

 

[kchan99]

In the process of applying this year to NCC, and likely applying to NIR fellowship next fall (positions tend to fill 2-3 years in advance). As stated many times previously on these forums on this topic, the ACGME approved pathway for neurologists entering into NIR is:

1) Neurology residency --> Vascular neurology fellowship (1 year) --> NIR fellowship (2 years) OR
2) Neurology residency --> Neurocritical care fellowship (2 years) --> NIR fellowship (2 years)

It is important to note that the recommendations actually suggest you only have to do 1 year of NCC fellowship, but highly doubtful that NCC programs will sign you on only for a year, and you will not be able to board certify in neurocritical care if you do only 1 year. Some choose to do 1 year of vascular neurology and try to get a 1 year NCC position to get experience before NIR (total 4 years).

Now to answer your questions:

1) Based on anecdotal evidence from my peers and fellows, vascular neurology fellowship is preferred, is shorter in duration (1 year vs 2), and tends to be somewhat less labor-intensive compared to NCC fellowship. NCC trained applicants need to demonstrate interest in stroke medicine and research, as a big focus in NIR currently (especially from a neurologist's standpoint) is acute stroke intervention. I know of fellows from both pathways securing good spots.

2) There are 2 NEUROIMAGING fellowship programs currently in the country available for neurologists. You will not qualify for training in diagnostic neuroradiology unless you are radiology trained. Even with neuroimaging fellowship, you will not find a place that will give you privileges to read neuroimaging and bill for it. You can get neurosonology trained and certified, and read/bill your own carotid/vertebral dopplers and transcranial dopplers. Better to do a year of research and try to get time scrubbing in and assisting in the angiosuite, or as mentioned above, do a stroke fellowship year if you are NCC trained, or a year of NCC if you can arrange it if you are stroke trained, (in my opinion).

3) Can't comment really on one vs the other. NIR job market is tight at the moment. But both stroke neurologists and neurointensivists are in high demand, especially in the community setting (every hospital wants to be a stroke center).

4) ACGME certification, in general, does not matter. What matters in a fellowship is case volume and hands-on training time.

5) Still an uphill battle to secure fellowship coming from neurology, but doable if you want it, and have the right things on your application (read research in stroke and intervention, and LORs from prominent faculty). Programs that have taken neurologists in the past (although can't speak for their neurology-"friendliness"): UCSF (I think only 2 in the past), UCLA, Colorado, Medical College of Wisconsin, University of Minnesota, Iowa, St. Louis University, Texas Stroke Institute (Dallas/Ft. Worth), UTSW, UT Houston, Case Western, Cleveland Clinic, Columbia, NYU, Mt. Sinai, University of Buffalo, Wayne State/Michigan Stroke Network, MGH/BWH/Partners, Boston University, Lahey Clinic, University of Maryland, University of Massachusetts, Mayo-Jacksonville, University of Florida, University of Miami/Jackson Health System.

Hope this helps.

Add Pittsburgh to the list of programs.