VIR training after Vascular Neurology

[bonran]

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Just an update:

I know of a stroke guy who has matched in a VIR Radiology fellowship (ACGME approved) through the radiology NRMP fellowship match. The word on the street is that the Neurovascular Coalition was not able to come out with a joint statement for training pathways to include Neurologists, Neurosurgeons, Neuroradiologists, Vascular & Interventional Radiologists & Cardiologists for neurointervention. It seems the coalition has broken into 3 groups-Neurologists & Neurosurgeons, Neuroradiologist & VI Radiologists (yeah we radiologists stick together) and finally Interventional Cardiologists; each developing their own pathways for NIR. So it seems that VIR will have its own independent pathway for neurointervention training. The Neurologists & Neurosurgeons jointly are coming up with a board exam in the next few years (possibly 5 years time). There should be a grandfathering process for all people doing neurointervention for this test.

The gist is, with VIR matching 40-60% of their spots in each MATCH (radiologists are not too keen to stand around patients for 4-10 hrs pushing catheters or needles & dealing with post-op complications) this is a good way to enter into NIR & get some catheter training if one doesnt get an NIR spot straingt out of VN fellowship.

VIR itself is trying to break away from radiology by developing the VIR-DIRECT pathway which will be a 7-yr residency/fellowship training program with 2 yrs of clinical training (preferably surgical), 2-yrs of imaging training & then 3 yrs of VIR. Radiologists in VIR have acknowledged the need for greater clinical exposure before doing interventional procedures. The lack of clinical experience has lead to loss of turf to other specialties like interventional cardiology, vascular surgery, radiation oncology & interventional radiology. The proposal is in the works with ACR. There are about 19 training programs on the list who are developing this kind of a program. My guess is, some of these programs are trying out clinicians in their vacant fellowship positions to see how this future program will work out.

Check out:

http://theabr.org/ic/ic_vir/ic_vir_direct.html

http://neurovascularcoalition.com/

 

[Raygun77]

Im just curious-

Since when did interventional cardiologists feel like they have any grounds pushing catheters past the carotids? I didn't realise they wanted a piece of the neurointerventional pie- how is that even feasible since technically strokes aren't in their domain and should be referred on?

Also curious- what turf has rad onc adopted from interventional radiology? I don't know any rad onc game enough to even try a radioembolization or anything interventional oncology related.

VIR direct- does that qualify you to be a diagnostic radiologist as well? I don't see the advantage time-wise in this direct route otherwise...

 

[bonran]

The arguement from cardiology is that since there are about 22000 of them around the country, they can cover the acute shortage of NIR physicians in the periphery. They say that since they are good at pushing catheters in the heart, they can do it in the brain too (not that it matters that the DRG for a cerebral angiogram is $23,000 compared to a cardiac cath & intervention $1200-1500).

I dont have much info on what turf has been taken over by radiation oncology from VIR but the news is that radiation oncology has started doing biopsies & chemoembolizations.

Interventional nephrology has started doing recanalization & declotting of shunts.

Interventional pulmonologists & gastroenterologists have started doing stents in cancer strictures etc.

I am a neurologist. I do not know how VIR-Direct is going to turn out. I think the aim of VIR-DIRECT is to instill a greater appreciation for clinical sciences in people who go into this branch rather than make them imaging-specialists.