Neurosurgery Vs Interventional Radiology

[slowthai]

@libertyyne, don't let him discourage you with his lackluster attitude. Some people have a zeal for life; others are just walking corpses


@efle I'm playing with you bro, just couldn't resist

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[efle]

@libertyyne, don't let him discourage you with his lackluster attitude. Some people have a zeal for life; others are just walking corpses
@efle I'm playing with you bro, just couldn't resist

No worries - around these parts, I'm very used to being the only guy in the room with any concern for lifestyle/happiness

 

[libertyyne]

No worries - around these parts, I'm very used to being the only guy in the room with any concern for lifestyle/happiness

To be fair I got a radiology letter just in case I see the light .

 

[Lucca]

To be fair I got a radiology letter just in case I see the light .

If you go into rads you won’t be seeing the light for some time.

 

[piii]

If you go into rads you won’t be seeing the light for some time.

Except for the screen in front of you, emitting light..

 

[Matthew9Thirtyfive]

No worries - around these parts, I'm very used to being the only guy in the room with any concern for lifestyle/happiness

Right there with you bro.

 

[TheVagüs]

Meanwhile I'm out here applying ophtho. Life is a real ****in rollercoaster.

Congrats libertyyne on the decision. It feels good to have the arrow pointed.

 

[slowthai]

Meanwhile I'm out here applying ophtho. Life is a real ****in rollercoaster.

Congrats libertyyne on the decision. It feels good to have the arrow pointed.

Whatttt. Again, whattttt.

 

[aafisahar]

How so? These rad docs have arguably the best clinical job in the hospital. They are somewhat immune from the day-to-day BS that go on in the hospital while making 400-500k/yr with 8-10 wks vacation.

intrinsically motivated vs extrinsically motivated.

outside looking in, you would think that most people are extrinsically motivated, however, as a group, we are mostly intrinsically motivated and we don't realize that until we get a job with few intrinsic motivators and lots of extrinsic motivators.

 

[efle]

intrinsically motivated vs extrinsically motivated.

outside looking in, you would think that most people are extrinsically motivated, however, as a group, we are mostly intrinsically motivated and we don't realize that until we get a job with few intrinsic motivators and lots of extrinsic motivators.

Counterpoint - there are droves of people who match intrinsic rich training with crappy extrinsic (surgical, OBGYN, IM) that switch over to something cushier. I've met many people so far who switched from those. Oh, plus the people who switch out of medicine altogether.

I've yet to meet someone who matched rads or derm and switched from that into something life-consuming because they didnt feel fulfilled enough.

 

[Neopolymath]

Counterpoint - there are droves of people who match intrinsic rich training with crappy extrinsic (surgical, OBGYN, IM) that switch over to something cushier. I've met many people so far who switched from those. Oh, plus the people who switch out of medicine altogether.

I've yet to meet someone who matched rads or derm and switched from that into something life-consuming because they didnt feel fulfilled enough.

Surprisingly, it's the same for anesthesiology. It's probably the most switched to specialty of them all despite the constant end of the world panic lol.

Clearly, there is something to radiology and anesthesiology. I would rather pursue it from the start than to switch haha.

 

[libertyyne]

Counterpoint - there are droves of people who match intrinsic rich training with crappy extrinsic (surgical, OBGYN, IM) that switch over to something cushier. I've met many people so far who switched from those. Oh, plus the people who switch out of medicine altogether.

I've yet to meet someone who matched rads or derm and switched from that into something life-consuming because they didnt feel fulfilled enough.

There was a an intern who matched rads at my institution , did a surgical intern year and decided to stay in surgery.

 

[efle]

There was a an intern who matched rads at my institution , did a surgical intern year and decided to stay in surgery.

Very interesting that he switched before even experiencing R1. We might get him back yet!

 

[Splenda88]

There was a an intern who matched rads at my institution , did a surgical intern year and decided to stay in surgery.

hey he is still young...

 

[aaronrodgers]

Just an MS-3 but my decision tree ultimately led me towards radiology. Before, I had also considered anesthesia and neurosurgery. The questions I had asked myself were the following:

1. Do I feel like I am making a meaningful contribution to someone's care on a daily basis? (rads gas nsg)

2. I know I am an MD but will I "feel" like I am a doctor? (rads gas nsg )

3. Are there any midlevels who falsely claim that they can do the same thing as me and are actively/successfuly lobbying against my profession. (rads gas nsg dear god I hope not )

4. Can I physically keep up day-to-day when I am in my 40s, 50s, and 60s? (rads gas nsg)

5. Able to move whenever I want and not feel stuck because I already established a panel/referral network in the area? (rads gas nsg )

6. Will I be sitting in a chair? (rads gas nsg)

Not to mention these are all completely different day-to-day jobs. Gas and Rads are appealing too because they are mostly "action" and no rounds, socials, H&Ps, progress notes, DC summaries, etc. I am also overall more happy if my patient outcomes are great like in gas/rads... neurosurgery takes the cake on death and dying. While it is very meaningful to rescue the acutely ill, it is a double edge sword and the heaviness of it will utterly drain me in a 30 year career.

For Gas vs Rads, the former I will be the surgeon's bitch while for the latter that same surgeon might consult me as the expert on a hard read. Arguably, rads is more cerebral and intellectually simulating and scratches my anatomy/pathophysiology itch better than gas.

These questions I asked for myself were very personal and catered to my own set of priorities. I don't think everyone reading this will share all of my values.

 

[slowthai]

3. Are there any midlevels who falsely claim that they can do the same thing as me and are actively/successfuly lobbying against my profession. (rads gas nsg dear god I hope not )

And we thought it was safe:


I didn't really think it was safe, because there's no limit to ignorance and there's no limit to greed

 

[Ho0v-man]

And we thought it was safe:


I didn't really think it was safe, because there's no limit to ignorance and there's no limit to greed

Lol. Go ahead and let them. It’ll finally be clear cut irrefutable proof that they don’t know what they’re talking about.

 

[Neopolymath]

Lol. Go ahead and let them. It’ll finally be clear cut irrefutable proof that they don’t know what they’re talking about.

NPs with 10+ years experience in pulm on my service couldn't even interpret imaging better than me as a 3rd year LOL.

At the risk of arrogance and to borrow a phrase from our 2nd amendment fanatics, "Come and try to take it" you noctor losers.

 

[slowthai]

Lol. Go ahead and let them. It’ll finally be clear cut irrefutable proof that they don’t know what they’re talking about.

Yep, the good thing about radiology is that that disastrous decision making will be caught and permanently apparent for everyone to see, unlike in primary care where they get to engage in plausible deniability and shift the blame after a long term bad outcome.

 

[aaronrodgers]

It's an absolute joke that NPs can somehow interpet their own images. Likewise, I think the objective nature of rads will swiftly reveal the midlevel's incompetence. Rads should not be complacent though and make the same mistake as gas - nip this **** in the bud.

 

[Splenda88]

And we thought it was safe:


I didn't really think it was safe, because there's no limit to ignorance and there's no limit to greed

That law will amount to NOTHING except it shows that NPs are very effective in their campaign... No physicians will act on a read by NP/PA. If that happens, the game is over for us.

 

[Ho0v-man]

NPs with 10+ years experience in pulm on my service couldn't even interpret imaging better than me as a 3rd year LOL.

At the risk of arrogance and to borrow a phrase from our 2nd amendment fanatics, "Come and try to take it" you noctor losers.

Dude I remember an ER NP trying to get an MRI of the shoulder to evaluate a “tumor” on a kid the radiologist “missed”.

This NP had over 10 years experience as an NP too.

It was the coracoid process.

 

[slowthai]

That law will amount to NOTHING except it shows that NPs are very effective in their campaign... No physicians will act on a read by NP/PA. If that happens, the game is over for us.

Hope you're right. I really wonder what things will look like on this front by the time I'm an attending, which is in like a decade from now.

 

[Splenda88]

Hope you're right. I really wonder what things will look like on this front by the time I'm an attending, which is in like a decade from now.

No one knows but NP won't stop lobbying in trying be physician-like. If you look at states like AK, NV, I can't even be licensed to practice medicine if i quit residency today as a PGY3. But for whatever reason, a nurse that completes an online master degree with 500-600 hrs preceptorship can practice medicine in these states.

 

[TheVagüs]

Whatttt. Again, whattttt.

I could do another long post about how I came to this point, but y'all are probably over those lol.

In the end, it was the best true fit for my interests, personality, and life goals. I'm excited for my chosen career path.

Also, my rads rotation showed me I needed to operate and have my ownership of my patients. I drove the radiologists nuts asking "what are they gonna do about that?" over and over. They were all very skilled, super happy and did a lot of cool stuff, but it wasn't for me.

 

[slowthai]

I could do another long post about how I came to this point, but y'all are probably over those lol.

In the end, it was the best true fit for my interests, personality, and life goals. I'm excited for my chosen career path.

Also, my rads rotation showed me I needed to operate and have my ownership of my patients. I drove the radiologists nuts asking "what are they gonna do about that?" over and over. They were all very skilled, super happy and did a lot of cool stuff, but it wasn't for me.

No, another long post! Please please please please please please please

 

[AnatomyGrey12]

Very interesting that he switched before even experiencing R1. We might get him back yet!

If he made it through a prelim surgery year and wanted to stay on that train I think it's safe to say he's in it to win it.

 

[Matthew9Thirtyfive]

Counterpoint - there are droves of people who match intrinsic rich training with crappy extrinsic (surgical, OBGYN, IM) that switch over to something cushier. I've met many people so far who switched from those. Oh, plus the people who switch out of medicine altogether.

I've yet to meet someone who matched rads or derm and switched from that into something life-consuming because they didnt feel fulfilled enough.

Like half the path residents at Walter Reed were surgical interns who switched into path.

 

[efle]

If he made it through a prelim surgery year and wanted to stay on that train I think it's safe to say he's in it to win it.

Really? My room mate scrubbed 3 times in his month long away sub-I recently. Seems pretty hard to get a taste of life as a PGY2+, let alone compare it to the R1 life they'd never sampled at all

 

[AnatomyGrey12]

Really? My room mate scrubbed 3 times in his month long away sub-I recently. Seems pretty hard to get a taste of life as a PGY2+, let alone compare it to the R1 life they'd never sampled at all

Prelim surgery years are notoriously brutal. If you can get through one and go, "man I want to do this for a career" then I don't think you're ever going back.

 

[aaronrodgers]

They just passed the bill in CA. Radiology is officially being encroached lol

 

[Matthew9Thirtyfive]

They just passed the bill in CA. Radiology is officially being encroached lol

by whom?

 

[aaronrodgers]

by whom?

Nurse practitioners Bill Text - AB-890 Nurse practitioners: scope of practice: practice without standardized procedures.

ctr-f "diagnostic" yields some of these sections

"The bill would authorize a nurse practitioner who meets certain education, experience, and certification requirements to perform, in certain settings or organizations, specified functions without standardized procedures, including ordering, performing, and interpreting diagnostic procedures, certifying disability, and prescribing, administering, dispensing, and furnishing controlled substances. The bill bill, beginning January 1, 2023, would also authorize a nurse practitioner to perform those functions without standardized procedures outside of specified settings or organizations in accordance with specified conditions and requirements if the nurse practitioner holds an active certification issued by the board "

...

"'Diagnostic imaging' includes, but is not limited to, all X-ray, computed axial tomography, magnetic resonance imaging nuclear medicine, positron emission tomography, mammography, and ultrasound goods and services."

...

"(2) Order, perform, and interpret diagnostic procedures. Diagnostic procedures involving imaging refers to x-rays, mammography, and ultrasounds. "

 

[slowthai]

Nurse practitioners Bill Text - AB-890 Nurse practitioners: scope of practice: practice without standardized procedures.

ctr-f "diagnostic" yields some of these sections

"The bill would authorize a nurse practitioner who meets certain education, experience, and certification requirements to perform, in certain settings or organizations, specified functions without standardized procedures, including ordering, performing, and interpreting diagnostic procedures, certifying disability, and prescribing, administering, dispensing, and furnishing controlled substances. The bill bill, beginning January 1, 2023, would also authorize a nurse practitioner to perform those functions without standardized procedures outside of specified settings or organizations in accordance with specified conditions and requirements if the nurse practitioner holds an active certification issued by the board "

...

"'Diagnostic imaging' includes, but is not limited to, all X-ray, computed axial tomography, magnetic resonance imaging nuclear medicine, positron emission tomography, mammography, and ultrasound goods and services."

...

"(2) Order, perform, and interpret diagnostic procedures. Diagnostic procedures involving imaging refers to x-rays, mammography, and ultrasounds. "

Stupid is as stupid does. Gonna need NPs to interpret each and every one of those state politicians' imaging immediately.

 

[efle]

I think you guys might be reading this differently than intended. Any MD/DO can technically read the imaging they order. Radiology doesn't have to be a part of the process.

This is going to be the same thing but for NP/PAs.

It is not that MD/DO are going to require radiologists while NP/PA do it all themselves.

 

[Splenda88]

I think you guys might be reading this differently than intended. Any MD/DO can technically read the imaging they order. Radiology doesn't have to be a part of the process.

This is going to be the same thing but for NP/PAs.

It is not that MD/DO are going to require radiologists while NP/PA do it all themselves.

We aren't...

Do NP/PA have any training in reading films at all? At least we have some training in reading the most basic film for every organ system in med school, and residency for our specific specialty...

 

[aaronrodgers]

Ortho, neurosurg, and pulm/icc love to read their own images but that's a completely different scenario with vastly different implications on patient outcomes than an NP. I think the # of NPs who will be interpreting their own images will be a small minority but just the fact that they have the ability to do so is now opening up pandora's box

 

[Matthew9Thirtyfive]

Nurse practitioners Bill Text - AB-890 Nurse practitioners: scope of practice: practice without standardized procedures.

ctr-f "diagnostic" yields some of these sections

"The bill would authorize a nurse practitioner who meets certain education, experience, and certification requirements to perform, in certain settings or organizations, specified functions without standardized procedures, including ordering, performing, and interpreting diagnostic procedures, certifying disability, and prescribing, administering, dispensing, and furnishing controlled substances. The bill bill, beginning January 1, 2023, would also authorize a nurse practitioner to perform those functions without standardized procedures outside of specified settings or organizations in accordance with specified conditions and requirements if the nurse practitioner holds an active certification issued by the board "

...

"'Diagnostic imaging' includes, but is not limited to, all X-ray, computed axial tomography, magnetic resonance imaging nuclear medicine, positron emission tomography, mammography, and ultrasound goods and services."

...

"(2) Order, perform, and interpret diagnostic procedures. Diagnostic procedures involving imaging refers to x-rays, mammography, and ultrasounds. "

Yeah I don’t think this means what you’re reading into it. It just means they can legally interpret studies they order. AFAIK a radiologist licensed in the US still has to read every study.

Now whether they SHOULD interpret their own studies is a different story. I’ve had only bad experiences with midlevels and imaging.

 

[Matthew9Thirtyfive]

Ortho, neurosurg, and pulm/icc love to read their own images but that's a completely different scenario with vastly different implications on patient outcomes than an NP. I think the # of NPs who will be interpreting their own images will be a small minority but just the fact that they have the ability to do so is now opening up pandora's box

They were already anyway. When my wife saw an NP for what she thought might be a scaphoid fracture, a radiologist might have read it at some point, but the NP treated her (incorrectly) based on her own (incorrect) interpretation.

 

[RTC19]

Congratulations on your decision, @libertyyne . Keep us posted!

I have been an active SDNer since 2014 and remember you from pre-allo. I enjoyed reading this thread and seeing you "grow up" (you are grown up, but you know what I mean - progress through your career).

 

[efle]

We aren't...

Do NP/PA have any training in reading films at all? At least we have some training in reading the most basic film for every organ system in med school, and residency for our specific specialty...

Primary care MD/DOs are not making their decisions based on their own interpretations of imaging, except maybe very basic plain film. NPs/PAs won't either.

Technically speaking, my understanding is that a PCP MD is allowed to do a surgery. Obviously nobody is doing that (and nobody would provide them the chance to try it) but they could.

If we passed a bill giving NPs/PAs the same, they would also not be trying to perform independent surgeries.

 

[Splenda88]

Primary care MD/DOs are not making their decisions based on their own interpretations of imaging, except maybe very basic plain film. NPs/PAs won't either.

Technically speaking, my understanding is that a PCP MD is allowed to do a surgery. Obviously nobody is doing that (and nobody would provide them the chance to try it) but they could.

If we passed a bill giving NPs/PAs the same, they would also not be trying to perform independent surgeries.

Agree with you, but they will get reimbursed for basic plain film when they have ZERO training in interpreting them...

I remember half way thru PGY2 i had a patient with PNA... and the radiologist (PGY4) read it as PNA.. went to the reading room and talked to her and pointed out to her there was something more than infiltrates in the film...she looked at it again and agreed and corrected her read and recommended a CT chest... CT chest came back with evidence of a mass... patient was diagnosed with lung carcinoma after a bronchoscopy...

These are the catastrophic stuffs that we even as physicians can miss with our extensive training... Imagine you let someone with very minimal training to start acting like physicians, many people will get hurt unnecessarily.

 

[zero0]

They just passed the bill in CA. Radiology is officially being encroached lol

Midlevels aren't even allowed to order CT at my hospital and many others. You can expect radiation exposure and cancer rates to go through the roof there in coming decades. Just goes to show again how little they actually care about patients.

 

[Ho0v-man]

Midlevels aren't even allowed to order CT at my hospital and many others. You can expect radiation exposure and cancer rates to go through the roof there in coming decades. Just goes to show again how little they actually care about patients.

I need to train at this magical place. Everywhere I’ve ever been the midlevels order w/o and w/ on every abd/pel and pan scan every 3 y/o who falls off their tricycle.

 

[Splenda88]

Midlevels aren't even allowed to order CT at my hospital and many others. You can expect radiation exposure and cancer rates to go through the roof there in coming decades. Just goes to show again how little they actually care about patients.

Wow... Where is that?

It's not like they don't care about their patients; they just don't have a good understanding of these 'modalities' (for lack of a better word).

 

[zero0]

I need to train at this magical place. Everywhere I’ve ever been the midlevels order w/o and w/ on every abd/pel and pan scan every 3 y/o who falls off their tricycle.

Yup and eventually the radiology dept got tired of that crap and pushed for that rule.

And midlevels absolutely do not care for their patients, otherwise they wouldn't practice medicine so recklessly and would make sure what they were doing was safe before they did it. All they care about is themselves, getting to play doctor in their big white coat, their job market, and salaries.

 

[Splenda88]

Yup and eventually the radiology dept got tired of that crap and pushed for that rule.

And midlevels absolutely do not care for their patients, otherwise they wouldn't practice medicine so recklessly and would make sure what they were doing was safe before they did it. All they care about is themselves, getting to play doctor in their big white coat, their job market, and salaries.

You work at a good institution. There would have been a lot of complaining if something like that happened where I am. Where I am training, midlevels had the privilege to order Covid19 test before residents.

 

[Neopolymath]

@libertyyne what is your favorite NS operation?

 

[libertyyne]

@libertyyne what is your favorite NS operation?

Probably ACOM aneurysm clippings since the anatomy is so beautiful. I find epidural, and subdural evacuations very satisfying as well.
Spine wise any fusion tends to be fun.

 

[Oso]

Sounds to me like you want to do neurosurg, though I don’t have any specific advice on deciding between the two fields and I think others have made great contributions already.

Best of luck to you good sir