Peds neuro

[mshalom13]

So I'm currently in my third year rotations and am debating between pursuing two very different fields, interventional radiology and pediatric neurology (but hear me out). The parts of this decision that I am considering are lifestyle, procedural, salary, and doing what I like. Interventional radiology is both procedural and makes good money, but I am scared of the diagnostic radiology part because I want a procedural job and diagnostics interests me less (and diagnostic radiology is a huge part of residenc, no matter which pathway to interventional radiology I would take). I also love neuro and working with children, which is the benefit of peds neuro. If I decide to pursue peds neuro, I would most likely want to continue with a subspecialty in neurointerventional radiology (a subspecialty of adult neurology, but since peds neuro residents get board certified in both adult neurology and peds I'd be able to do it), which allows me to be procedural as well. The cons of peds neuro is the less-procedural aspect if for whatever reason I do not pursue neuro interventional radiology and that peds neurologists stereotypically don't make a lot of money, relative to other specialties.
I'm curious if anyone had any thoughts on my conflict and/or if anyone knows anything on the option of doing neurointerventional radiology after peds neuro as I know that isn't a classic pathway.

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[JBM16BYU]

Please someone correct me if I am wrong, but a neurointerventional radiology or an interventional neuroradiology fellowship is extremely competitive, even if you’re an adult neurologist. I am not sure if pediatric neurologists typically go into this area, both because it is more adult focused and pediatric neurologists already have an extra year of training compared to adult neurologists. That being said, if I were in your shoes, I do not think I would pursue pediatric neurology with the sole intent of this fellowship. You want to enjoy enough aspects of your primary specialty that if you decide to change your mind or do not match into fellowship that you will still have a fulfilling career for you.

IR is highly procedural, but like you said, there is a heavy component of diagnostic radiology throughout residency and this could be in practice too. Other very procedural, non-surgical fields, include: Pain Medicine (from anesthesiology, PM&R, neurology, psychiatry, even EM), GI (from IM), Interventional Cards (from Cards from IM), Sports Medicine (from FM, IM, EM, Peds, PM&R). Both Anesthesiology and PM&R can be highly procedural as primary specialties. There are others but these come to mind first.

 

[mrbreakfast]

(a subspecialty of adult neurology, but since peds neuro residents get board certified in both adult neurology and peds I'd be able to do it), which allows me to be procedural as well.

Pediatric neurology residents are eligible for a number of adult neurology fellowships, though I'm not sure if neuro-interventional is one. Of course, you'd never actually match, because no program in their right mind would take a resident with one (junior) year of stroke neurology over an adult neuro resident with three years of experience, let alone over a neurosurgery or IR-trained applicant. Also, if you're a neurology-trained neurointerventionalist, any hospital is going to want you to also take stroke call - it's not like you do procedures all day every day - and again, you're not going to be able to compete with actual adult-trained neurologists. Even after completing a vascular fellowship, you very likely would've seen fewer, potentially far fewer, stroke cases than the average adult neurology resident.

If you want to do neuro-interventional as your end goal, regardless of the means to get there, you should be applying either to neurosurgery or interventional radiology. If you can't match those, the next path is adult neurology + vascular fellowship + endovascular fellowship (combined = 7 years minimum).

Also, as an aside, I would strongly recommend doing rotations in pediatric neurology before considering it. Peds neurology isn't neurology + kids, it's its own thing and has its own unique challenges. That's why it's such a small field. It also is one of the lowest-paying medical specialties, and doesn't necessarily have a great lifestyle (lots of patient calls).

I would recommend meeting with a faculty advisor or someone else who can help you with your career plans before you make any major decisions.

 

[SurfingDoctor]

Pediatric neurologists don't do neurointervention, so if that's your path, it's not through pediatric neurology FYI.

We have 1 pediatric neurointerventionalist in our entire institution. Their path was adult neurology --> vascular fellowship --> interventional fellowship. The number of adult cases they do far outpaces the number of pediatric cases.

 

[chord]

Have you considered neurosurgery? It's procedural (obviously), you work with both children and adults during residency, you have the option of doing a pediatric fellowship or a NIR fellowship (or both), the compensation is good, and you become very proficient at reading neuro-imaging!

Obviously don't do it if you don't like surgery, but something to think about.

 

[mshalom13]

Have you considered neurosurgery? It's procedural (obviously), you work with both children and adults during residency, you have the option of doing a pediatric fellowship or a NIR fellowship (or both), the compensation is good, and you become very proficient at reading neuro-imaging!

Obviously don't do it if you don't like surgery, but something to think about.

I have, and for a while I really wanted to do neurosurgery. I realized during medical school however that I don’t have the stats to get into a good neurosurgery program (I am also an IMG, so the odds aren’t in my favor) and that I don’t want the lifestyle if a neurosurgeon.

 

[mrbreakfast]

I don’t want the lifestyle if a neurosurgeon.

You are asking questions in this thread about how best to pursue a neurointerventional endovascular fellowship, a neurosurgical fellowship, after which, as a neurointerventionalist, you will likely have (at least in terms of overnight call) the worst lifestyle of any subspecialty in medicine. Neurointerventionalist are, at the core, emergency surgeons, and you will be performing truly emergent, life-saving surgeries. Those thrombectomies, unstable aneurysms, and angioplasties aren't waiting until business hours, and depending on where you work, you'll possibly be expected to round on your patients post-op.

Just food for thought. Have you rotated through these specialties as electives yet? If not, that would probably be a good first step.

 

[chord]

You are asking questions in this thread about how best to pursue a neurointerventional endovascular fellowship, a neurosurgical fellowship, after which, as a neurointerventionalist, you will likely have (at least in terms of overnight call) the worst lifestyle of any subspecialty in medicine. Neurointerventionalist are, at the core, emergency surgeons, and you will be performing truly emergent, life-saving surgeries. Those thrombectomies, unstable aneurysms, and angioplasties aren't waiting until business hours, and depending on where you work, you'll possibly be expected to round on your patients post-op.

Just food for thought. Have you rotated through these specialties as electives yet? If not, that would probably be a good first step.

I would agree that vascular neurosurgery (especially dual trained in NIR which is the contemporary standard) has, in general, the worst lifestyle of all the neurosurgical subspecialties.

 

[babybrains]

As others have said - I don't know anyone from the child neurology side who does neurointerventionalist work. If you want to do procedures, it'd be mainly LPs (gen neuro, neuroimmuno, neuromuscular) vs EMGs (neuromuscular). Our NCC attendings, while mega smart, don't do any of the ICU procedures - that's all done by the ICU attendings themselves. You may have more luck through the adult neuro side, but neurointerventionalists in general seem pretty few and far between in my experience.

As a child neurologist, I'll admit I have relatively low interest in procedures, though I'm doing one of the more procedurally-heavy fellowships. I'm not sure that child neuro would be for you, especially since you'd have to get through 5 years of (likely procedurally-light) residency before pursuing any fellowships.