Neurosurgery Vs Interventional Radiology

[libertyyne]

This is difficult decision, I have rotated through Neurosurgery and wont get to rotate through IR until March if i decide to rotate through. Mid tier MD. Top 25 percentile preclinical , 250+ step 1, Mostly Honors year 3 with one HP, will honor year 3. No AOA , Some neurosurgery related pubs in the works. a couple of poster presentations. Mid 30s non-trad with children. Decent MSPE comments.

Neurosurgery
Pros
-Technology
-Anatomy
-Being an expert and the last say
-managing Critically ill patients
-Trauma
- Neurointervention- I know you can do this with neurosurgery
-Philosophically working on something that makes us human and the great mysteries within of the black box.
- Like working hard and working myself to the bone.
- Love looking at neuroimaging
Cons
- Longer training , only by a year
- Physically taxing, will likely only get to practice 20ish years .
- Some Spine stuff seems of questionable efficacy. But this there is a lot of stuff in medicine that seems like that.
- No clear exit strategy after retiring .
-Zero Moonlighting
- Possibly an additional year of training for Neurointervention.

Interventional Radiology
-Technology
- Broader Anatomy
- The expert of last resort when other services dont want to touch the patient.
- Image guided procedures are dope
-Larger variety in cases involving more organ systems.
- Larger variety in patients
- Less physically taxing, could possibly work for longer, fall back on DR
-DR if IR procedures dont take up time.
-Shorter procedures
-Shorter Time
- Broad differential skills, broad understanding of pathology
- Moonlighting if i do DR=>IR pathway
Cons
-Will likely miss trauma
-Will miss the OR
-Less pay ? not sure what this looks like.
- Unsure of the NeuroIR pathway if thats what I end up wanting
- Uncertainty of Match, it is a bloodbath looking and NRMP.


Open to other suggestions. Maybe I have blinders on. I havent done psych of neuro yet, but I already think i wont like it.
Things I like
High tech
End of the line expert
Trauma
Imaging
High Intensity
Being part of a group of people dedicated to excellence.
Being in the hospital

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[efle]

Haven't rotated on either myself, but if there's any grain of truth in the common medical stereotypes, aren't neurosurgeons and radiologists very very different crowds/personalities? Having a masochistic worth ethic and desire to be the grand poobah to your OR/patients seems to fit one a lot better

 

[libertyyne]

Haven't rotated on either myself, but if there's any grain of truth in the common medical stereotypes, aren't neurosurgeons and radiologists very very different crowds/personalities? Having a masochistic worth ethic and desire to be the grand poobah to your OR/patients seems to fit one a lot better

The neurosurgeons definitely have a masochistic work ethic, but I might be wrong, but i think IR docs also work a lot .

 

[efle]

The neurosurgeons definitely have a masochistic work ethic, but I might be wrong, but i think IR docs also work a lot .

You could probably work yourself to death in IR too, I meant more like during the DR residency if you do the fellowship pathway or if your job ends up having a lot of time in the reading room. Other personalities on your wavelength would be a lot more common in the neurosurg path

seems like the way to answer this is to rotate in March

 

[Ho0v-man]

Do you like DR? Most IRs still do a lot of DR. There are pure IR jobs, but that limits you geographically. So you gotta ask yourself if you work 5 days/week, are you okay with 2-3 days being pure DR? I feel like someone considering neurosurgery would say no.

 

[libertyyne]

Do you like DR? Most IRs still do a lot of DR. There are pure IR jobs, but that limits you geographically. So you gotta ask yourself if you work 5 days/week, are you okay with 2-3 days being pure DR? I feel like someone considering neurosurgery would say no.

This is very true. I suppose its the same deal with neurosurgery clinic. I havent had exposure to DR yet, so cant really say how I would react to just reading. I do think i would enjoy the cerebral aspects of generating differentials, thinking about anatomy. Perhaps I am weird like that. A few neurosurgeons I have talked to have expressed that they would have probably chosen rads if it was not neurosurgery.But sample sizes are suspect.

 

[Ho0v-man]

This is very true. I suppose its the same deal with neurosurgery clinic. I havent had exposure to DR yet, so cant really say how I would react to just reading. I do think i would enjoy the cerebral aspects of generating differentials, thinking about anatomy. Perhaps I am weird like that. A few neurosurgeons I have talked to have expressed that they would have probably chosen rads if it was not neurosurgery.But sample sizes are suspect.

You definitely need to do a pure DR rotation. One of my mentors as a premed was an ER doc who knew he was going into rads. He said a lot of the same things. 2 weeks into his only radiology rotation he said he went crazy and knew he couldn’t deal with the monotony.

 

[OnePunchBiopsy]

If someone is split between IR and any other surgical specialty, I recommend IR.

You get to be a technician. Doing procedures, don’t have to admit anyone. If you take call you can book overnight consults for the morning without even coming into work. You don’t even have to have clinic if you find the right work environment. Sounds way better than neurosurgery by a long shot.

My reason for not choosing IR is because DR was so boring for me. Also, even though hybrid rooms are increasing in popularity, the IR suite was never the same as the OR. That’s also why I’m not doing vascular surgery.

I say choose IR unless you feel the same as me, and my reasons for not choosing IR are reflective of your thoughts as well.

 

[radsisrad]

Neurosurgery

Cons

- Physically taxing, will likely only get to practice 20ish years .

- No clear exit strategy after retiring .

If you work 20 years in NSurg, you won't need an exit strategy. This is a field in which you can make into 5 digits for a single weekend of coverage.

 

[Piskaupf]

One thing about any interventional specialty people don’t take into account is there is a statistically significant non zero increased risk for cancer. This affects the nurses and techs the most, but interventional docs do face accumulative radiation.

I have decided for this reason I’ll never do anything interventional even though they’re taking over medicine and making millions while doing it.

 

[slowthai]

Do you like DR? Most IRs still do a lot of DR. There are pure IR jobs, but that limits you geographically. So you gotta ask yourself if you work 5 days/week, are you okay with 2-3 days being pure DR? I feel like someone considering neurosurgery would say no.

Yeah, I have heard this repeated many times. Like a third to half of your training is pure DR and it forms the basis for being a competent IR.

 

[Dr G Oogle]

Both are good choices, I have several friends in both specialties and I’ll say that the IRs get to see their families a lot more then NSGY do both in residency and in practice. And both make bank but I’d say IR makes a little less. Either one will help you retire. Also IR has potential to get saturated in big metro areas but nsgy not so much. Also IR has plenty of saving the day moments and can be called in for trauma for embolizations. IR is definitely the bleeding edge of innovation, but so is nsgy, I just heard of someone receiving a polio virus drip for GBM?!?

other specialties that are similar to what you describe (tech, expert, saving the day, $$$) are ENT (have family member doing stuff with 3D printing and tracheas), I imagine ortho is similar but not sure they’re quite as techy, could be wrong, urology also not as techy as nsgy or IR but certainly is innovative (I’m working on precision analytics using genomic and radiologic data for incontinence and helping one of our oncologists with doing the same in bladder cancer). Basically any interventional field will give you some but not all of what you’re looking for.

if You place a high premium on family life I recommend a field that allows you more time for that as an attending since all of the above will have you more or less living in the hospital between 5-7 years.

PM me if you want more insight into your specific specialty choice.

 

[Ho0v-man]

Yeah, I have heard this repeated many times. Like a third to half of your training is pure DR and it forms the basis for being a competent IR.

But it’s not just the training. Most IRs will spend the majority of their time grinding out scans in practice.

Also, I don’t think it gets mentioned enough on here that in practice IR gets called in a lot on weekends and overnight for stuff because no one else feels like coming in like for thoras/paras, chest tubes, LP’s etc. This stuff can magically get done during the week 8-4 without an IRs expertise🙄

 

[Neopolymath]

But it’s not just the training. Most IRs will spend the majority of their time grinding out scans in practice.

Also, I don’t think it gets mentioned enough on here that in practice IR gets called in a lot on weekends and overnight for stuff because no one else feels like coming in like for thoras/paras, chest tubes, LP’s etc. This stuff can magically get done during the week 8-4 without an IRs expertise🙄

In my experience GI is the absolute worst offender here. "Ugh we were just in there but we didn't place a tube so will you guys do it because it's after 4 pm?" That and the chest tubes that surgery magically can't do or manage on their own patients they claim to be the masters of so much lol.

OP, I've been following you and @Gurby with great interest. Do neurosurgery and don't look back. I don't think you will like DR to tell you truth. I'm kind of the opposite. I'm considering IR, after my rotation, based on how comforting it was to interpret studies between procedures. The procedures were like a break and it was an awesome balance. Doesn't sound like that's what you want.

 

[Kgizzle]

@libertyyne speaking on my personal experience as I've explored different procedural fields... I feel like IR was the most "technician" field. The one guy that I rotated with took pride in that he didn't have to get to know the patient. He said that IR/DR was the best of both med/surg specifically because he didn't like dealing with pts. For me, I wanted more ownership of my patients so that's definitely something that you need to consider. But honestly being non-trad myself in my 30s, staring down the barrel of surgical residency, I have had doubts on wether I can hold up to the rigors. But then I realize there's 40 year olds matching surgery. If you want NSG, you will kill it.

 

[slowthai]

@libertyyne speaking on my personal experience as I've explored different procedural fields... I feel like IR was the most "technician" field. The one guy that I rotated with took pride in that he didn't have to get to know the patient. He said that IR/DR was the best of both med/surg specifically because he didn't like dealing with pts. For me, I wanted more ownership of my patients so that's definitely something that you need to consider.

Interestingly enough, it appears that the tides are beginning to turn in regards to this. Some of them are beginning to take ownership of their patients. I think it's at least partly because of the loss of lucrative procedures to cards and vascular. Being the first stop for interventional procedures gives you power/control that a run and gun IR doesn't have.

 

[Dr G Oogle]

I have some experience with this so don’t come for me. The problem with IR ownership is the same problem with RO. It’s not the ownership of the patient but the knowledge base and ability to treat disease without the intervention. Having a clinic and seeing patients doesn’t all of a sudden make you able to provide full spectrum care for PAD, fibroids, BPH, aneurysms, cancer. Yes it is nice to have a clinic and establish a rapport with a patient prior to their procedure and post procedure care but it doesn’t replace the expertise that a specialist who’s focus is disease rather than intervention provides in addition to being able to provide this. The new training paradigm will likely lead to less procedure creep out of IR and make them less needle jockeys and more like clinicians but the push of IR to get referrals from PCP for UFE, PAE, and my favorite “pelvic congestion syndrome” etc is misguided at best and dangerous at worst.

 

[FindersFee5]

This is difficult decision, I have rotated through Neurosurgery and wont get to rotate through IR until March if i decide to rotate through. Mid tier MD. Top 25 percentile preclinical , 250+ step 1, Mostly Honors year 3 with one HP, will honor year 3. No AOA , Some neurosurgery related pubs in the works. a couple of poster presentations. Mid 30s non-trad with children. Decent MSPE comments.

Neurosurgery
Pros
-Technology
-Anatomy
-Being an expert and the last say
-managing Critically ill patients
-Trauma
- Neurointervention- I know you can do this with neurosurgery
-Philosophically working on something that makes us human and the great mysteries within of the black box.
- Like working hard and working myself to the bone.
- Love looking at neuroimaging
Cons
- Longer training , only by a year
- Physically taxing, will likely only get to practice 20ish years .
- Some Spine stuff seems of questionable efficacy. But this there is a lot of stuff in medicine that seems like that.
- No clear exit strategy after retiring .
-Zero Moonlighting
- Possibly an additional year of training for Neurointervention.

Interventional Radiology
-Technology
- Broader Anatomy
- The expert of last resort when other services dont want to touch the patient.
- Image guided procedures are dope
-Larger variety in cases involving more organ systems.
- Larger variety in patients
- Less physically taxing, could possibly work for longer, fall back on DR
-DR if IR procedures dont take up time.
-Shorter procedures
-Shorter Time
- Broad differential skills, broad understanding of pathology
- Moonlighting if i do DR=>IR pathway
Cons
-Will likely miss trauma
-Will miss the OR
-Less pay ? not sure what this looks like.
- Unsure of the NeuroIR pathway if thats what I end up wanting
- Uncertainty of Match, it is a bloodbath looking and NRMP.


Open to other suggestions. Maybe I have blinders on. I havent done psych of neuro yet, but I already think i wont like it.
Things I like
High tech
End of the line expert
Trauma
Imaging
High Intensity
Being part of a group of people dedicated to excellence.
Being in the hospital

Have you considered endovascular neruointervention? You can get there through a lot of different pathways. Neurosurgery is the most well established, but also the longest - 7-8 year residency + 2 year fellowship. You can also do it through DR, then a neuro fellowship, then neurointerventionalist training (I think 8 years, 5 + 1 + 2). You can also match from neurology (less certain but given your work ethic and accomplishments I think you could do it), takes 4 years residency + 3 year fellowship.

 

[BigRedBeta]

How much will you miss the OR? Surgeons gotta surgeon. And while IR is obviously a procedural field, it's not the OR.

The other thing I would push you to consider is what mundane stuff in each field actually interests you? It's super common as a medical student when everything is new to get super jazzed about every slightly unusual case and gloss over the day to day stuff. But that excitement will fade and in a lot of instances you'll end up preferring to not have crazy unusual cases most days. Ask the anesthesiologists and I bet a lot of them loved the feeling of getting an intubation or an arterial line when they were students, but once they've made it through residency and any fellowship training, that sort of thrill has completely left and it's just another day. So which field's bottom of the barrel cases are least problematic for you? Putting in 10 PICC lines in a day? Doing a few VP shunts?

 

[neusu]

This is difficult decision, I have rotated through Neurosurgery and wont get to rotate through IR until March if i decide to rotate through. Mid tier MD. Top 25 percentile preclinical , 250+ step 1, Mostly Honors year 3 with one HP, will honor year 3. No AOA , Some neurosurgery related pubs in the works. a couple of poster presentations. Mid 30s non-trad with children. Decent MSPE comments.

Neurosurgery
Pros
-Technology
-Anatomy
-Being an expert and the last say
-managing Critically ill patients
-Trauma
- Neurointervention- I know you can do this with neurosurgery
-Philosophically working on something that makes us human and the great mysteries within of the black box.
- Like working hard and working myself to the bone.
- Love looking at neuroimaging
Cons
- Longer training , only by a year
- Physically taxing, will likely only get to practice 20ish years .
- Some Spine stuff seems of questionable efficacy. But this there is a lot of stuff in medicine that seems like that.
- No clear exit strategy after retiring .
-Zero Moonlighting
- Possibly an additional year of training for Neurointervention.

Interventional Radiology
-Technology
- Broader Anatomy
- The expert of last resort when other services dont want to touch the patient.
- Image guided procedures are dope
-Larger variety in cases involving more organ systems.
- Larger variety in patients
- Less physically taxing, could possibly work for longer, fall back on DR
-DR if IR procedures dont take up time.
-Shorter procedures
-Shorter Time
- Broad differential skills, broad understanding of pathology
- Moonlighting if i do DR=>IR pathway
Cons
-Will likely miss trauma
-Will miss the OR
-Less pay ? not sure what this looks like.
- Unsure of the NeuroIR pathway if thats what I end up wanting
- Uncertainty of Match, it is a bloodbath looking and NRMP.


Open to other suggestions. Maybe I have blinders on. I havent done psych of neuro yet, but I already think i wont like it.
Things I like
High tech
End of the line expert
Trauma
Imaging
High Intensity
Being part of a group of people dedicated to excellence.
Being in the hospital

You won't get to see your kids much in neurosurgery residency.

 

[efle]

Isn't the oft repeated wisdom from surgeons: "if you can see yourself doing anything but this, do that other thing!" I myself got that advice from one of the surg specialty chiefs on my rotation a few months ago. Every year there's a whole bunch of surgical residents that switch to radiology because they couldn't keep putting themselves through the gauntlet while seeing their peers walk in at 7 and clock out at 5pm. Have to ask yourself what the odds are that'll be you. I know my happiness drops off a cliff when I'm on a rotation that keeps me in the hospital 15 hours/day, think about whether that affects your own psyche at all (or your family's).

 

[Gurby]

The bread and butter of IR is biopsying things and putting drains/tubes into various body cavities.

I feel like you're going to be severely underwhelmed by the average day-to-day in IR if you're seriously considering neurosurgery. Highly recommend trying to spend a day or two shadowing in IR and DR if at all possible asap.

OP, I've been following you and @Gurby with great interest. Do neurosurgery and don't look back. I don't think you will like DR to tell you truth. I'm kind of the opposite. I'm considering IR, after my rotation, based on how comforting it was to interpret studies between procedures. The procedures were like a break and it was an awesome balance. Doesn't sound like that's what you want.

At this point it's looking more and more like vascular surgery for me, though I'm only 2 weeks into my M3 clerkship and the first half of my clerkship is on a really cush gen surg service. We'll see how burned out I am after 6 more weeks of clerkship + 2 surgery sub-i's. Going to try to keep a foot in the door if I decide to audible into DR or anesthesia at the last minute.

I did a 4-week radiology elective (mostly DR with a few IR days) and have to say it was probably the happiest I've been during medical school thus far. DR is awesome, and I did enjoy the minor procedures sprinkled throughout the day - you don't have to do IR to do procedures. But I feel like IR just gives up too much lifestyle compared to DR, and the majority of the IR procedures aren't earth-shattering enough to justify that for me.

I feel like surgery and DR are both awesome for different reasons. IR kind of gets the worst of both worlds in many ways, at least from my perspective.

 

[efle]

The bread and butter of IR is biopsying things and putting drains/tubes into various body cavities.

I feel like you're going to be severely underwhelmed by the average day-to-day in IR if you're seriously considering neurosurgery. Highly recommend trying to spend a day or two shadowing in IR and DR if at all possible asap.



At this point it's looking more and more like vascular surgery for me, though I'm only 2 weeks into my M3 clerkship and the first half of my clerkship is on a really cush gen surg service. We'll see how burned out I am after 6 more weeks of clerkship + 2 surgery sub-i's. Going to try to keep a foot in the door if I decide to audible into DR or anesthesia at the last minute.

I did a 4-week radiology elective (mostly DR with a few IR days) and have to say it was probably the happiest I've been during medical school thus far. DR is awesome, and I did enjoy the minor procedures sprinkled throughout the day - you don't have to do IR to do procedures. But I feel like IR just gives up too much lifestyle compared to DR, and the majority of the IR procedures aren't earth-shattering enough to justify that for me.

I feel like surgery and DR are both awesome for different reasons. IR kind of gets the worst of both worlds in many ways, at least from my perspective.

"DR was awesome, but I think I'm going into the surgical specialty with the worst lifestyle and worst income/hour instead"

I'm not following help me out here

 

[slowthai]

"DR was awesome, but I think I'm going into the surgical specialty with the worst lifestyle and worst income/hour instead"

I'm not following help me out here

I think he's saying he's willing to deal with a poor lifestyle if the procedures are baller/crazy enough. That's vascular, in his case. For him, IR doesn't fulfill that criterion and it can have a poor lifestyle, depending on the practice setup. So that's why IR wouldn't be a great option for him. Also, because he values those procedures, DR wouldn't be a great option either.

 

[Gurby]

"DR was awesome, but I think I'm going into the surgical specialty with the worst lifestyle and worst income/hour instead"

I'm not following help me out here

I guess it's really a gut feeling more than a rational one - I'm just not as excited about DR. While DR avoids much of the non-medicine BS associated with direct patient care, it also loses out on a lot of the highs and lows that come with direct patient care. I want to be there in the trenches of the human condition - I don't want to see the MRI of an 8yo with brain cancer from afar and say "that sucks, ah well".

I find that whenever I go down to the reading rooms now, I picture myself in the future as a radiologist and immediately miss the buzz and activity of being on the wards or in the OR. I miss the team atmosphere, dropping by to check in on patients, seeing consults in the ED, etc.

With regards to lifestyle, I'm not sure this is a great way to compare the surgical specialties because there is so much variation in how you can set up your practice. Vascular will probably always be on the worse side of the spectrum for lifestyle given the sick patients and percentage of emergent/urgent cases, but I think you can maneuver yourself into a decent lifestyle in any field if you're willing to take a pay cut (most likely I'll sign myself away to work like a dog though). Of course ENT or ophtho or urology are probably more conducive to this.

Income is subject to change basically at the drop of a hat. The Relative Value Update Committee could decide next week to slash reimbursement for spinal fusions and poof, suddenly ortho and neurosurgery both take a big hit on the income/hour chart. There's a real possibility that the reimbursement landscape might be different 10 years from now when we all start paying off our loans. I think the worsening shortage and increasing demand for vascular surgeons will play to the specialty's advantage in terms of salary. The future feels really bright.

Any surgical field is going to be a tough row to hoe, so it seems to me that you should just go after what you like the most if you're gonna do surgery.

All that said... There is still a lot of M3/4 left to experience, good chance I'll be putting my foot in my mouth 9 months from now.

So are you doing DR then?

 

[efle]

I guess it's really a gut feeling more than a rational one - I'm just not as excited about DR. While DR avoids much of the non-medicine BS associated with direct patient care, it also loses out on a lot of the highs and lows that come with direct patient care. I want to be there in the trenches of the human condition - I don't want to see the MRI of an 8yo with brain cancer from afar and say "that sucks, ah well".

I find that whenever I go down to the reading rooms now, I picture myself in the future as a radiologist and immediately miss the buzz and activity of being on the wards or in the OR. I miss the team atmosphere, dropping by to check in on patients, seeing consults in the ED, etc.

With regards to lifestyle, I'm not sure this is a great way to compare the surgical specialties because there is so much variation in how you can set up your practice. Vascular will probably always be on the worse side of the spectrum for lifestyle given the sick patients and percentage of emergent/urgent cases, but I think you can maneuver yourself into a decent lifestyle in any field if you're willing to take a pay cut (most likely I'll sign myself away to work like a dog though). Of course ENT or ophtho or urology are probably more conducive to this.

Income is subject to change basically at the drop of a hat. The Relative Value Update Committee could decide next week to slash reimbursement for spinal fusions and poof, suddenly ortho and neurosurgery both take a big hit on the income/hour chart. There's a real possibility that the reimbursement landscape might be different 10 years from now when we all start paying off our loans. I think the worsening shortage and increasing demand for vascular surgeons will play to the specialty's advantage in terms of salary. The future feels really bright.

Any surgical field is going to be a tough row to hoe, so it seems to me that you should just go after what you like the most if you're gonna do surgery.

All that said... There is still a lot of M3/4 left to experience, good chance I'll be putting my foot in my mouth 9 months from now.

So are you doing DR then?

My DR rotation is also coming up in the next couple months, have to figure out what feels like less of a grind: a DR shift vs 50 patients/day in a skin or eyeball clinic.

If you've got the puritanical work ethic and the OR is a magical place for you, honestly you'd probably just as happy in any of these high hour, very sick patient subspecialized surgeries. Can't go wrong!

 

[Gurby]

My DR rotation is also coming up in the next couple months, have to figure out what feels like less of a grind: a DR shift vs 50 patients/day in a skin or eyeball clinic.

If you've got the puritanical work ethic and the OR is a magical place for you, honestly you'd probably just as happy in any of these high hour, very sick patient subspecialized surgeries. Can't go wrong!

I think the >400,000 anki reviews I did over M1-M2 attest to my love of the grind

Hope one of those options clicks for you! It's going to be an interesting next few months for all of us.

 

[Angus Avagadro]

Both Neurosurg and IR have very difficult lifestyles. Neurosurg with bleeds, trauma, and embolic stroke.
The IR folks I know read about 1/3 of the studies the DR people read and the rest are procedures. Many mundane drainage, nephrostomy, pic lines, etc. Plus every Friday night cold leg the cardiologist or vascular surgeon doesnt want to see. They do get to bill RVUs for the PA on their service., mostly thoracentesis and paracentisis .
Neurosurg is starting to branch out into specializing in heads or spines.
I'm a little masochistic and would probably go neurosurg. IR gets a lot of dump consults. I think both are quite intellectually stimulating and would be a very rewarding career. Good luck and best wishes!

 

[NeuResurgens]

I do think you should do the IR rotation just to see, but based on your last group of things you value at the end of the OP, it definitely sounds like your personality is neurosurgery > IR

 

[libertyyne]

One thing about any interventional specialty people don’t take into account is there is a statistically significant non zero increased risk for cancer. This affects the nurses and techs the most, but interventional docs do face accumulative radiation.

I have decided for this reason I’ll never do anything interventional even though they’re taking over medicine and making millions while doing it.

This doesnt pan out to increased cancers in the physician population. Plus both of the fields have a large amount of exposure to radiation. It is a risk I am completely ok with, consideirng looking at population data it doesnt seem to drastically incraease cancer risk or reduce life expectancy.

But it’s not just the training. Most IRs will spend the majority of their time grinding out scans in practice.

Also, I don’t think it gets mentioned enough on here that in practice IR gets called in a lot on weekends and overnight for stuff because no one else feels like coming in like for thoras/paras, chest tubes, LP’s etc. This stuff can magically get done during the week 8-4 without an IRs expertise🙄

I never put this together before. This was probably one of the worst aspects of IM, asking services to do procedures or getting incomplete workups from ETC. getting dumped is not a great attribute of a field.

You won't get to see your kids much in neurosurgery residency.

Absolutely ok with this. If i was working blue collar jobs I wouldnt be seeing them either since i would be working two.

 

[libertyyne]

I know this might sound crazy, but one of the sticking points for Neurosurgery has been the thought of making a residents salary for 7 years. Having elderly parents that may need help financially really bothers me, since i cant give them time or help drastically financially during training.

 

[Ho0v-man]

I know this might sound crazy, but one of the sticking points for Neurosurgery has been the thought of making a residents salary for 7 years. Having elderly parents that may need help financially really bothers me, since i cant give them time or help drastically financially during training.

I get where you’re coming from as I have a similar situation (at least based on these posts). You and I are both mid 30s non-trads with kiddos iirc. I’ve REALLY been hoping that a field like FM would appeal to me more bc I often do feel like I’ve sacrificed a lot up to this point and made my family sacrifice so much for me bc of this journey. I often feel guilty thinking about how long it will be before I can actually provide what I want for them. After a long talk with my wife about just going with a 3 year residency and getting it over with, she convinced me that I’ve worked too hard to just have a job. I could have kept going through the motions in my old career if that’s all I was gonna do. If you can wade through all this BS we’ve dealt with up til now and carve out something you actually love then ffs don’t ignore it! If this is your dream and you’ve done everything right to accomplish it up to this point, would people who care about you really want you to do something else?

Wish you the best of luck.

 

[libertyyne]

I get where you’re coming from as I have a similar situation (at least based on these posts). You and I are both mid 30s non-trads with kiddos iirc. I’ve REALLY been hoping that a field like FM would appeal to me more bc I often do feel like I’ve sacrificed a lot up to this point and made my family sacrifice so much for me bc of this journey. I often feel guilty thinking about how long it will be before I can actually provide what I want for them. After a long talk with my wife about just going with a 3 year residency and getting it over with, she convinced me that I’ve worked too hard to just have a job. I could have kept going through the motions in my old career if that’s all I was gonna do. If you can wade through all this BS we’ve dealt with up til now and carve out something you actually love then ffs don’t ignore it! If this is your dream and you’ve done everything right to accomplish it up to this point, would people who care about you really want you to do something else?

Wish you the best of luck.

Thanks. This post really resonated with me and my journey so far.

 

[efle]

Thanks. This post really resonated with me and my journey so far.

On the other hand, make sure your kids dont end up resonating with posts about absentee surgeon parents. The time in hospital that neurosurgeons in training have? Might as well sign up to go to outer space for 7 years

 

[Womb Raider]

Do yourself a favor and choose DR (with ESIR pathway) over neurosurgery. (ESIR offers the same 6 year path but doesn’t force you to do IR if you change your mind, whereas if you match integrated IR there’s no going pure DR.) Balance your family life with your work life - chances are your overall happiness/fulfillment (and your loved ones’ happiness) will flourish. Very, VERY few spouses and children can withstand a decade without you, which will 100% happen if you go neurosurgery. You might think you enjoy trauma and the excitement of surgery but do you really think you’ll enjoy waking up at 3am on a Saturday to respond to a trauma when you’re 50 for the thousandth time? The initial infatuation fades in every job - eventually it will become “just a job.” DR is easier on your body, on your family, and on your soul. It is easier to transition to part-time work as well if you want to start transitioning to retirement or spending more time with the kids.

 

[Cognovi]

I think the >400,000 anki reviews I did over M1-M2 attest to my love of the grind

Hope one of those options clicks for you! It's going to be an interesting next few months for all of us.

Someone who can grind through that many Anki reviews has what it takes to do DR. The job involves rapid-fire retrieving diverse medical knowledge at random all day nonstop.

 

[slowthai]

Someone who can grind through that many Anki reviews has what it takes to do DR. The job involves rapid-fire retrieving diverse medical knowledge at random all day nonstop.

Crushing Anki and UWorld for eternity, I like it.

 

[Scrubs101]

IR is the one other specialty that i cant shake off my mind besides the surg specialty ive been gunning for since day 1. I definitely understand the dilemma. I like the vascular and IO work a lot, but our IR is like 50/50 DR and IR and most of the IR at this smaller community hospital consists of paracentesis, abscesses surg doesnt wanna touch, and biopsies (doesnt sound or seem super flashy to a med student but their lifestyle and $$$ is solid for just doing this) Im gonna shadow at a larger center to see the full spectrum of practice, but still go ahead with my plans for applying my surg specialty. Just so i dont regret not at least looking into it.

From what ive heard the practice of IR can differ greatly depending on your set up. Can do more DR, quick and easy procedures that arent as interesting, or more intricate and emergent procedures. Can basically work on any anatomical region of the body with the plethora of procedures IR has at their disposal, can have no/minimal clinic, or you can have as much clinic as you want if thats your cup of tea.

Things in IR that have kinda gone against what im looking for/kinda shy me away:
- The anatomical regions and procedures im most interested with in IR make for the worst lifestyle for IR and some of the sickest patients (but youre looking between neurosurg so im sure this is more of a pro for you)
- high likelyhood of having to do DR->IR and im not completely sold on the possibility of not matching an IR fellowship after (same reason that kinda pushed me away from vascular)
- theres only 5 total IR spots in our state, but there is tons of ESIR (which concerns me that even some ESIR people could end up not making it into IR? Ik the IR residency match rate post DR is very high but im getting sick of all this possibility of not making it to the next level... med school, residency, then fellowship match blah..) (edit:
just realized this is similar to neurosurg so a small field/small amount of spots isnt a turn off for you)
- Will i miss the OR?
- Kinda said before but, do i like DR enough?

Edit: tbh seems like a close call, def do some IR shadowing in a few different set ups if you can. See if you like the DR side of things as well!

 

[redsox93]

Someone who can grind through that many Anki reviews has what it takes to do DR. The job involves rapid-fire retrieving diverse medical knowledge at random all day nonstop.

This is exactly why I want to do DR haha

 

[Gurby]

Someone who can grind through that many Anki reviews has what it takes to do DR. The job involves rapid-fire retrieving diverse medical knowledge at random all day nonstop.

I actually really enjoyed the M1-M2 grind. I love learning and thinking about medicine. I may end up in DR yet - we'll see how the rest of the year plays out!

 

[Newyawk]

I just love how ophtho never gets talked about

 

[Dantes]

On the other hand, make sure your kids dont end up resonating with posts about absentee surgeon parents. The time in hospital that neurosurgeons in training have? Might as well sign up to go to outer space for 7 years

For sure, I know of a few surgeon families like that in real life. Just curious, OP, but why are you ok with the not seeing your kids part? Your initial post does seem like you'd be a little happier in neurosurg though.

 

[Neopolymath]

I just love how ophtho never gets talked about

Congrats on matching. Cool field but I think a lot of people find it to be like a little bit of an inbetweener field in a negative way. I think it's polarizing and occupies a strange space.

 

[efle]

Congrats on matching. Cool field but I think a lot of people find it to be like a little bit of an inbetweener field in a negative way. I think it's polarizing and occupies a strange space.

I'm on my ophtho rotation right now and am shocked at how different the personalities are than the surgeons on my gensurg and subspecialty rotations. Very different space imo

 

[FindersFee5]

I'm on my ophtho rotation right now and am shocked at how different the personalities are than the surgeons on my gensurg and subspecialty rotations. Very different space imo

Most of the ophthalmologists I've worked with have kinda been weenies. Definitely didn't vibe with them like I did with most subspecialties.

 

[Newyawk]

Congrats on matching. Cool field but I think a lot of people find it to be like a little bit of an inbetweener field in a negative way. I think it's polarizing and occupies a strange space.

I hear that. Dont have much to say in response but i hear it. I consider myself a pretty social person but definitely have certain people that I click with pretty quickly. Not surprisingly met a bunch of those people on the trail. A lot of talk about sports, smack talk about other fields, the usual.

 

[slowthai]

Congrats on matching. Cool field but I think a lot of people find it to be like a little bit of an inbetweener field in a negative way. I think it's polarizing and occupies a strange space.

Yeah, too much medicine, too much eyeballs, too much microsurgery.

But on a serious note, I think that's part of why they get the "they're not real surgeons" rap sometimes. Not to mention that it's a pretty cush field, even including residency.

 

[Neopolymath]

I hear that. Dont have much to say in response but i hear it. I consider myself a pretty social person but definitely have certain people that I click with pretty quickly. Not surprisingly met a bunch of those people on the trail. A lot of talk about sports, smack talk about other fields, the usual.

I was not speaking of personalities. I was saying it's obviously surgery but not the same as gen surg and it has things people picking surgery don't like and things people picking medicine don't like. It takes a special fit. Didn't mean anything about the people in the field at all. All the best.

 

[Gurby]

I just love how ophtho never gets talked about

I think a lot of that maybe comes from lack of exposure and baseline knowledge too. I often will look at an ophtho note in the chart, and not even be able to make enough sense of it to answer whatever clinical question I had. They go so deep down their own rabbit hole at times that it's a little bit hard to approach.

 

[efle]

Most of the ophthalmologists I've worked with have kinda been weenies. Definitely didn't vibe with them like I did with most subspecialties.

And vice versa I felt like the surgeons all needed to take a chill pill or five