Is neuro IR 1 or 2 years after integrated IR residency?

[Shunsui]

Seeing one source online list 1 year but couple sources in person mentioned 2 years. Wondering what the consensus was. Figured DR-[ESIR]->IR->neuro IR was 6+2 but assumed you could shave a year off by doing integrated IR instead. Thanks

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[Clean7795]

Standard pathway is through DR->Neuroradiology->NIR, whole process about 7-8 years.

There are some IR trained docs who can enter the pathway without neuroradiology fellowship but those are not official pathways, and you have to know the right people at the right place.

This is mainly for historical reasons. Back in the day all neuroradiologists did diagnostic cerebral angiograms, so it made sense that NIR would come after a neuroradiology fellowship.

 

[Shunsui]

Standard pathway is through DR->Neuroradiology->NIR, whole process about 7-8 years.

There are some IR trained docs who can enter the pathway without neuroradiology fellowship but those are not official pathways, and you have to know the right people at the right place.

This is mainly for historical reasons. Back in the day all neuroradiologists did diagnostic cerebral angiograms, so it made sense that NIR would come after a neuroradiology fellowship.

Thanks for the info. Surprised to hear the integrated IR doesn't have an official pathway to NIR. Wonder if that will change in the future.

 

[Shunsui]

Standard pathway is through DR->Neuroradiology->NIR, whole process about 7-8 years.

There are some IR trained docs who can enter the pathway without neuroradiology fellowship but those are not official pathways, and you have to know the right people at the right place.

This is mainly for historical reasons. Back in the day all neuroradiologists did diagnostic cerebral angiograms, so it made sense that NIR would come after a neuroradiology fellowship.

I’m not going to pigeonhole myself but trying to wrap my head around when someone decides on NIR. How competitive are the NIR spots after neuroradiology?

 

[SeisK]

I’m not going to pigeonhole myself but trying to wrap my head around when someone decides on NIR. How competitive are the NIR spots after neuroradiology?

Not very. There are institutions that are still rad run that I think would want rad applicants, but they just don’t get them. The job pool for NIR is pretty dry. You need to be very location flexible.

 

[Mo991]

Not very. There are institutions that are still rad run that I think would want rad applicants, but they just don’t get them. The job pool for NIR is pretty dry. You need to be very location flexible.

Really? I was considering NIR after neurorad fellowship. Is the market that bad?

 

[SeisK]

Really? I was considering NIR after neurorad fellowship. Is the market that bad?

Lots of NIR trained people don’t do it anymore for various reasons. Reasons include being displaced by neurosurgery and not wanting to move, insufficient financial incentive from the hospital to cover the grueling call, and aging out / not being able to withstand the grueling call.

Lots of fellowships are popping up at lower-tier institutions resulting in too many trained people for too few spots. These are popping up to help offload work onto fellows to give attendings better lifestyles, at the expense of the job pool.

My frank opinion is that if you’re really interested in neuro vascular intervention, become a body IR person, work at a stroke center, and see if you can help offload stroke call from the people where you’re working. Odds are if you hang around long enough they’ll eventually be cool with it because of how unpleasant the call is. However, If you want to embolize AVMs or stent carotids (outpatient, scheduled, weekday work), you have your work cut out for you. Some people I know got attending offers simultaneous with fellowship application, which I think would be a reasonable path. But I don’t think this is typical.

 

[Cognovi]

Seeing one source online list 1 year but couple sources in person mentioned 2 years. Wondering what the consensus was. Figured DR-[ESIR]->IR->neuro IR was 6+2 but assumed you could shave a year off by doing integrated IR instead. Thanks

NIR fellowship is 2 years de facto. It is formally 1 year as accredited by ACGME and CAST, but the pre-requisite is experience doing 100 cerebral angiograms. Radiology trainees also need to spend time on a neurosurgery, vascular neurology, or neurointensive care service, while neurosurgery and neurology trainees need to attest to some learning of neuroradiology. There is the possibility of doing the prerequisite experience enfolded into neurosurgery or radiology residency. The former is common as the 7-year neurosurgery residency builds in a year of subspecialty training. The latter is formally possible but rare. Therefore the de facto experience is that the first year of the 2 year fellowship satisfies the pre-requisites and the second year is the formally accredited year.

 

[Mo991]

Lots of NIR trained people don’t do it anymore for various reasons. Reasons include being displaced by neurosurgery and not wanting to move, insufficient financial incentive from the hospital to cover the grueling call, and aging out / not being able to withstand the grueling call.

Lots of fellowships are popping up at lower-tier institutions resulting in too many trained people for too few spots. These are popping up to help offload work onto fellows to give attendings better lifestyles, at the expense of the job pool.

My frank opinion is that if you’re really interested in neuro vascular intervention, become a body IR person, work at a stroke center, and see if you can help offload stroke call from the people where you’re working. Odds are if you hang around long enough they’ll eventually be cool with it because of how unpleasant the call is. However, If you want to embolize AVMs or stent carotids (outpatient, scheduled, weekday work), you have your work cut out for you. Some people I know got attending offers simultaneous with fellowship application, which I think would be a reasonable path. But I don’t think this is typical.

Thank you!

 

[Shunsui]

So what I'm taking away is:

Integrated IR is only for people who are surefire they want to stick with body IR only.

If there's any potential desire to eventually do NIR, then applying DR is the smarter route since you can later decide to commit to body IR via ESIR or stick it out and do neuroradiology -> NIR or even just remain a DR.


Do you guys see a better future in body or NIR in terms of turf wars (vascular, IC vs nsrgy, neuro interventionists)?

 

[SeisK]

So what I'm taking away is:

Integrated IR is only for people who are surefire they want to stick with body IR only.

If there's any potential desire to eventually do NIR, then applying DR is the smarter route since you can later decide to commit to body IR via ESIR or stick it out and do neuroradiology -> NIR or even just remain a DR.


Do you guys see a better future in body or NIR in terms of turf wars (vascular, IC vs nsrgy, neuro interventionists)?

I’d say body IR has a better endovascular future than neuro IR does. Body IR has some endovascular stuff under its belt it will never lose despite turf, and if you’re willing to make the sacrifice can generate a higher end pure endovascular practice, although this will come at the cost of your earnings compared to DR.

Neuro IR is in a dicey situation due to neurosurg and vascular neurology turf wars, made worse by poor hospital financial incentive, how horrible the schedule is and programs popping up selling out the specialty to make attendings live easier, worsening the job pool. If you want to do endovascular and don’t care that much about neuro imaging, do body IR.

 

[irwarrior]

There are some combined tracks popping up such as Mt Sinai in NYC which has a 7 year Body IR/NeuroIR track and more and more programs are incorporating combination training. All fields will have competition. If you want to get referrals you have to be able to clinically evaluate and manage the disease. You need clinic with good follow up and need to get referrals directly from primary care, ER, hospitalists etc to be sustainable. . Getting comfortable with neuro devices is invaluable for peripheral VIR including stent retrievers, aspiration devices, balloon guides, distal access catheters, liquid embolic, coiling , stent assisted coiling etc

 

[Cognovi]

There are some combined tracks popping up such as Mt Sinai in NYC which has a 7 year Body IR/NeuroIR track and more and more programs are incorporating combination training.

That's surprising. Do you have links to back that up?