Neurointerventional radiology

[RadsonRads]

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I can understand that the call can be busy, but am I mistaken in thinking that the majority of the work is elective aneurysm work, AVMs, etc.?

Yes. A lot of their time is spent doing stroke work.

 

[JoshSt]

Could you talk a little bit more about general IR lifestyle? I know it varies but when people say IR has a better job market, I am guessing that the lifestyle for most of those available jobs isn't great but I don't know. Also, which specialties tend to be more procedurally based but are still generally DR? It sounds like you do quite a few as MSK. I like procedures but I don't think I would prefer them enough lean the way of IR.

At ~some~ large academic medical centers, the body or GI section does nonvascular procedures, like drains for abdominal abscesses, tumor ablations, liver/other organ biopsies, and other things; some do more/less/none.

I can't speak in general for the lifestyle. At my med school's center, there are few IR's and they work very hard and have lifestyles similar to busy, frequently on-call surgeons.

 

[Doghead]

My understanding is that the niche of neurointerventional radiology is small, given that neurosurgery and vascular take the majority. For an aspiring neurointerventional radiologist, what residencies and/or physician groups practice neurointerventional radiology without the threat of overlapping these other specialties?

 

[TUGM]

ESN (the official name of the specialty) is a multidisciplinary field by nature. There are some programs that are run specifically by radiology departments (UCSF comes to mind), but becoming rarer and rarer to find a practice where NIR is staffed exclusively by radiology. Neurosurgeons currently dominate the field, and neurologists are growing in number, as well. I have not heard of may vascular surgeons doing intracranial procedures, just CEA/CAS.

Some radiology dominated programs include UCSF, UCLA, Northwestern, MGH... can't think of many more off the top of my head. If you're interested do some Google searching...

 

[TUGM]

Just my 2 cents is that radiologists, neurologists, and neurosurgeons should work to keep the ESN field a subspecialty closed to neuroscientist-physicians. Given the nature of the work, it is crucial to have knowledge from all 3 specialties. Current and future ESNs should be working to keep vascular surgeons and interventional cardiologists from obtaining privileges.

 

[PL198]

NIR sounds like the coolest job ever but if the life style blows then...

 

[RadsonRads]

NIR sounds like the coolest job ever but if the life style blows then...

It's ridiculously cool. Do a rotation and it will solidify your thought. I've considered going into it, but man the lifestyle and turf-wars suck hard.

 

[TUGM]

There's an "easy" solution to "turf" wars: training programs need to get ACGME accreditation, strive for standardization of training, and restrict fellowship spots to tertiary care centers. NIR is and should be a multidisciplinary field that accepts radiologists, neurosurgeons, and neurologists. Physicians from all three backgrounds have contributed to the research and development of technology. And it's a perfect combination of principles from all three specialties.

As far as lifestyle, there's no way around it, but it should stay that way - akin to that of an interventional cardiologist. Once again, this falls back on education. Skills that should be learned by the Neurointerventionalist include things like neurocritical care and monitoring (all ICU procedures, intubations, EVD/Licox placement), vascular imaging/interpretation (including carotid ultrasound and TCDs), and significant knowledge of vascular anatomy/physiology. I think if training becomes standardized in this fashion, then within the next five or six generations, the model of care could be changed to allow for a more sustainable, busy, and consistent practice... i.e. angio (elective, emergent), ICU/floor, diagnostic reading (TCDs, carotids, CTA/MRA, angiograms, etc.). It would inevitably vary a bit depending on the background of the physician. This is just one person's opinion (I'm biased).

And yes, ridiculously cool field.

 

[radiology_hopeful]

Going back to lifestyle for a second: I can completely understand how the NIR call experience could suck and burn you out quickly. But outside of call, is the lifestyle uniquely bad? Isn't most of the work just schedule, elective embolizations and such?

 

[TUGM]

It's on par with any other surgical field, depending on what your referral base is like.

 

[je355804]

Can anyone speak to the competitiveness of the NIR field? Are these fellowships extremely difficult to land?

 

[gonogo]

Going back to lifestyle for a second: I can completely understand how the NIR call experience could suck and burn you out quickly. But outside of call, is the lifestyle uniquely bad? Isn't most of the work just schedule, elective embolizations and such?

Call can be very busy depending on your practice. If you're on a busy center with lot of SAH and trauma patients, your pager may be going off several times a night. You'll have to come in for acute stroke, emergent vasospasm treatment, acute arterial injury, etc... A neurosurgeon may want you to do an angiogram over the weekend so they can clip an aneurysm on Monday morning, just to name another example of why you'd be busy on a weekend. Again, all of this depends on how busy your practice is. Also, NIR sections tend to be small, with usually 2-3 NIRs on the call pool, which means you'll be on call q2 or 3.

 

[TUGM]

gonogo, are you a neuroIR fellow yet?

 

[gonogo]

gonogo, are you a neuroIR fellow yet?

Yes

 

[TUGM]

Yes

Can I PM you?

 

[gonogo]

Can I PM you?

Sure

 

[TUGM]

Looks like endovascular therapy for acute ischemic stroke is here to stay. MR CLEAN, EXTEND-IA, ESCAPE, SWIFT PRIME, REVASCAT are all significantly positive. Next steps will be to restructure our approaches to stroke care.