Guest DancingDoc Posted February 23, 2006 Report Share Posted February 23, 2006 Hi Ian, Interventional neuroradiology sounds really interesting, but I know nothing about except what I just read on here. I'm not in medical school yet, but I have always found the brain really interesting but working for a neurosurgeon has told me I do not want to be one and I've followed a neurologists and it wasn't exactly what I was hoping to someday do either. This, however, sounds right up my alley or at least something for me try if I get into medical school this coming fall. What exactly would the day to day life of an interventional neuroradiologist be (responsibilities, call?, patient contact)? Thanks! Link to comment Share on other sites More sharing options...
Guest satsumargirl Posted February 23, 2006 Report Share Posted February 23, 2006 Hey Ian, Thanks for your helpful posts (well thought out and informative...as usual!). Neuroradiology does sound like a great field (interventional or not). For me there are 2 downsides: 1) having to do a fellowship to do neuroradiology (don`t really want to do general radiology residency...at least right now I feel like I`d just want to get on with the neuro) 2) and this is the biggy...I am afraid that I would miss patient contact and being involved in their care. (especially assuming I wasn`t an interventional radiologist...'cause at this point I am not sure how I feel about 2 (!!) fellowships). A few weeks ago I had an MRI done of my knee and I never even met, saw or heard the radiologist! Didn`t come out to say hello, didn`t come out to tell me how my knee was. So...how do you deal with this aspect of radiology? Does it bother you or is it one reason why you chose radiology? Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted February 25, 2006 Report Share Posted February 25, 2006 Day to day of an INR isn't something I know much about. The ones that I've worked with/talked to are all in academic centers, which is often necessary to have the requisite manpower and specialized equipment/techs to run such a program. Call is heavy, simply because there's relatively few INR folks around. If there's 12 diagnostic radiologists in a group, then a very simplified call schedule has you on call 1 out of every 12 days. If within this group of 12, there's only 2 radiologists trained in interventional neuroradiology (INR), then you're going to be on call 1 out of every 2 nights. That's got pain written all over it. As a result, you tend to see these groups mainly in academic centers, where there's enough critical mass to keep your call schedule sane. As well, in academics, you often have fellows and residents working under you, which adds an extra dimension of manpower. INR call can be very difficult, since many cases are emergent, and can't be delayed until the next day. A couple of the INR docs I'll be working with next month are in a group with the local neurosurgeons, which adds the extra benefit that you are no longer competing with that group of neurosurgeons, but rather bring in additional specialized skills into their group. The overall trend in interventional radiology has shifted towards increased patient care, simply because other specialties are not interested in doing the patient workup, having IR do the procedure, and then taking the patient back to deal with any post-procedure complications. Patient contact is greater than a diagnostic radiologist, but still relatively limited. You spend time talking with patients and their families to get consent, but by the time you get called, other clinicians have usually already seen the patient and gotten things well in gear, and you are simply tasked with performing the procedure that is felt to be best for the patient. As IR and INR become more clinical, there are already several groups in the US where radiologists see patients in clinic, order investigations, and follow up with their patients after the procedure. Satsumargirl, Just a couple of comments. If you aren't interested in the procedures and bad lifestyle of INR, diagnostic neurorads can be done in a 1 year fellowship. That's a total of 6 years, which is incredibly more civilized than a 5 or 6 year neurosurg residency, and probably along the lines of the same number of hours as a 5 year neurology residency. Many neurologists do fellowships too. Once you are done residency and fellowship, neurorads is easily the most flexible of the three specialties in terms of controlling your hours, in large part due to the fact that you can work shiftwork, and don't have the additional investment of time in managing and building your practice. As far as the mandatory years of general diagnostic radiology go, much of that is because the diseases of the nervous system manifest themselves all over the body. A bony lesion of the tibia may show up in the skull. When you get an MRI of the lumbar spine, part of your job is not to miss the 3 cm renal cell carcinoma hanging off the edge of the visualized kidney. When you are interpreting a carotid artery doppler study, there's a tremendous overlap with a doppler arterial study of the legs. Diseases of the body don't respect organ boundaries, and you need an overall familiarity with them in order to recognize them when they occur. A neurologist is going to miss a middle ear cholesteatoma because their training generally doesn't incorporate ENT radiology. They also are less likely to notice the bony lesion in the skull, or the cancer in the parotid gland. Neuroradiologists are far more likely to catch these lesions because of our whole-body training, and because our training engrains in us the requirement to look at the entire film, not necessarily the main area of interest. The secondary point is that unless you are in a large group, with sufficient volume where you can read 100% neuroradiology studies, it is highly likely that you'll be asked to devote a certain percentage of your time to general radiology as well, such as chest x-rays or abdomen CT scans, etc. In that sense, you'll need to retain the skills you picked up in residency. As far as lack of patient care being a downside, this is something you'll need to decide for yourself. I would ask that you reserve judgement on whether you like patient care until you've done all your third year rotations, preferably where you are first call, and are getting paged all night for ward questions and ER admissions. For me, lack of in-depth patient care is a *benefit* of radiology. I like people, and I like patients. I don't, however, enjoy patient care, at least not the way it was presented in my internship year. Spending large proportions of your day walking throughout the hospital, ER, and office, constantly looking for charts, tracking down consultants who haven't yet seen your patient, making numerous phone calls while being paged incessantly, and having an incredible slew of relatively meaningless paperwork to fill out were some of the negatives of patient care during internship that I'm glad to have left behind. When each patient you admit to a service needs an admission note, list of orders, change-over sheet for handing off to the on-call resident, discharge form, nursing home admission form, multiple filled out prescriptions, discharge instructions with a clinic appointment for followup, and a fully dictated discharge summary within 12 hours of them leaving the hospital, that's a lot of paperwork. In radiology, I might pick up a pen and write something down a few times a day. The rest of the time is spent looking at images, dictating an impression, and moving on to the next interesting case. This is actually what I love most about the specialty, is its relative efficiency. In the time it would have taken me to walk to the ER from my on-call room as an intern, I could have dictated out a CT scan. In the time from arriving in the ER, to finding the patient's room and the patient's chart, that's easily another study. In the amount of time it would take me to do one admission on Internal Medicine, it's easily possible to have looked at, and dictated anywhere from 5-15 studies. That means that you are constantly being challenged, and you are seeing an incredible volume of cases, several of which, by definition, will be interesting. We had a very busy day today on service. One of my fellow residents told me that his staff attending dictated 210 cases in approximately 9 hours. That doesn't include all the cases the resident dictated and then discussed with the staff. In Radiology, you are always encountering new and interesting cases, and there's no shortage of work. A very busy clinician, in contrast, would be hauling tail in order to see 50 patients in clinic the same amount of time. When you are able to process 3-4x the number of studies as a clinician can do in clinic, that's pretty fun. As far as the knee MRI goes, that's again a part of the efficiency puzzle. If you really wanted, you could do outpatient imaging, and personally discuss results with each patient. Many mammographers who work in outpatient settings actually do this. However, like I mentioned earlier, this time spent talking to patients is time not spent on doing more studies. If that seems a little cold-hearted, just think back to your last physician appointment. Most likely, that visit lasted only a few brief minutes, and likely felt far too short. There were probably other things you wanted to say or ask your physician. Your physician COULD have spent more time with you, but elected not to because that would just mean that much less time spent with other patients. In the end, I still get enough patient contact to keep me happy, in that we talk to patients regarding invasive procedures in order to get their informed consent. I have a chance to educate them a little on what we'd like to do, and answer their questions before getting to do the procedure. At the same time, I'm not tasked with all of their medical problems, just the most pressing problem that the clinician wants addressed. I'm pretty sure that I could do just as fine with absolutely no patient contact, since we spent a lot of time talking with clinicians regarding test results, and I prefer that over talking with patients anyway. Radiology has lots of people contact, just not as much patient contact. Ian Link to comment Share on other sites More sharing options...
Guest satsumargirl Posted February 26, 2006 Report Share Posted February 26, 2006 Thanks Ian You have given me alot to think about. I hadn`t actually considered the "job" aspect of specializing....and yeah, I guess it would be unusual to have just neuro cases. And the manisfestation of disease in the brain/surrounding tissues originating from other areas (and vice versa) is also something I hadn`t thought about. But something I am actually intrigued about now. As for patient care...I seem to flip flop between how I feel. I will definitely know better after clerkship. One reason why I applied to medical school was that as a speech-language pathologist I felt frustrated sometimes when I wasn`t happy with the general medical management of some patients, and had little ability to make things better for that patient. Worried that radiology might set me up for the same (making a diagnosis - which is cool - but then having no impact on the management of the problem). But in my last year at work, something happened where by the time I was starting med school my thoughts on patient care were "I can take it or leave it". And now that I am away from direct patient care, I kind of miss it. So I will have to wait and see how I feel as a clerk. But I can definitely see how it can be a pro of radiology. But I would say right now radiology is up there in my top 3-5 interests. It is nice to hear someone who is consistenty enthusiastic about his field too! On efficiency...you know my last job, the radiologist wasn`t even around for the MBS studies. It was an interesting set-up and definitely got patients seen faster. It was just the SLP and 2 techs. Since the still images were digital if there was anything wierd and wonky we could page the radiologist at the other site to look at it. Otherwise he would get a copy of our reports and could flag him to anything he should look at. In 2 years I only saw the radiologist once! Well, off to go for a skate on the canal Thanks again for your insight...very helpful!! Sats Link to comment Share on other sites More sharing options...
Guest RedBull33 Posted February 27, 2006 Report Share Posted February 27, 2006 Hey all, Very interesting thread. A previous poster mentioned that neurologists may be less inclined to take the interventional route as they may be "more cerebral" or "less A type"...I'm wondering how true this actually is and more importantly, whether this will really hinder the evolution of this subspecialty. I agree that many neurologists NOW will likely shy away from this interventional route, but there are always those that would find this very exciting given the ability to potentially manage and care for patients AND perform procedures. In the future, it is likely that individuals interested in neurological patient care and procedures would enter the field and there would likely be more "A types" in the field. I don't see how this is necessarily different from the early days of interventional cardiology where there was doubt as to whether cardiologists would end up doing cath lab and procedures. This proved to be wrong, obviously. I personally think it would be an advantage for patients to have neurologists diagnose, care, intervene, and then manage follow up. I understand that interventionalists in other fields (cardio) might perform procedures all day without care, but the possiblity of combining all of the above aspects is a possibility. I myself am interested in neurology as a specialty (Med-2), but am concerned that I being an "A-type" would eventually prove frustrating if I could diagnose, manage but not intervene with a potentially curative procedure/therapy i.e. think about the limitations we have for stroke today. The idea of neurology becoming more interventional is exciting. I've met lots of cerebral types in neurology, and this is the reputation it upholds, but to generalize this notion to everyone would be simply an exagerration. I'd appreciate any comments/feedback regarding this topic as I am wary that radiology is the be all and end all for anything interventional. RB Link to comment Share on other sites More sharing options...
Guest Blake128 Posted May 13, 2006 Report Share Posted May 13, 2006 Keeping this thread alive... So now that I've met all the NS residents here, and talked and exchanged a few thoughts with them, I think I can make the following statement without being a fool : ''Neurosurgery isn't competitive at all''. Also, a quick look through CARMS basically shows that since 2001, only 1 canadian graduate (graduate = finishing 4th year student) keen on NS didn't get a residency spot after both rounds of CARMS. As a resident here said, getting in neurosurgery isn't hard, it's finishing the residency that's one BIG challenge, probably the biggest of our young lives. He thought about quitting a few times, and he still isn't sure he made the right choice. Something to think about... Spent 2 days last week with the chair, saw a few surgical and Gamma Knife cases. Thrilling as always;) Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted May 13, 2006 Report Share Posted May 13, 2006 There are some very big differences between the competitiveness of specialties in Canada and the US. In the US, as seen on SDN, Neurosurg is a very competitive specialty. The money is astronomical post-residency in the US, which is not necessarily the case in Canada. In the US, as a private practice neurosurgeon, you can turf all the trauma and neurovascular stuff to the local academic center (which markedly improves your lifestyle as those tend to be the emergent cases), and, bankrolled by the big bucks you make per surgical case, you can hire a multitude of physician assistants and nurse practitioners to admit and round on all your patients, as well as all the other paperwork and ancillary scut. This means you spend MUCH more time operating and generating revenue. In Canada, as you've correctly deduced, GETTING a neurosurg residency is really not that hard (roughly the same number of applicants as spots). It's SURVIVING the residency that is the problem. Given the specter of markedly lower reimbursements, non-licensure in the US, and difficulty finding OR time in Canada, it's no wonder that NS currently isn't that desirable a residency in Canada. Ian Link to comment Share on other sites More sharing options...
Guest satsumargirl Posted May 13, 2006 Report Share Posted May 13, 2006 He thought about quitting a few times, and he still isn't sure he made the right choice. Something to think about... I think we spend the better part of our life trying to figure out what to do with it! If only it was a matter of finding an interesting job that would make us happy, but there are so many other factors that go into it! On my rural fam medicine week recently, I met a fam medicine resident who had completed 2 years of orthopedic surgery and decided to bail. Gutsy to be able to leave I think! Hopefully we will all make good choices in the end. As for radiology and me...well, not sure it's my calling! At least not anything to do with lungs (last block was respirology). Unless your lungs are completely consolidated or you have a huge massif very obvious abcess....you probably don`t want me diagnosing you! :b I still keep going back to neurology. Blake...happy to hear you are still enjoying neurosurgery...we do actually need them! Link to comment Share on other sites More sharing options...
Guest noncestvrai Posted May 14, 2006 Report Share Posted May 14, 2006 Hey Sats, You should definitely do an elective in neurology, you'll find out about the problem solving and the cool toys you can carry around in your MEC bag... I was on the neuro consult team for 2 weeks recently, and I realised that the physical exam in neuro is really cool and it will help you out in other specialties as well. About chest films, don't worry, it takes a whole residency to train a radiologist at reading films....not a couple of weeks! Good luck! noncestvrai Link to comment Share on other sites More sharing options...
Guest satsumargirl Posted May 16, 2006 Report Share Posted May 16, 2006 Hey NCV! Thanks I am dying to do a neuro elective, but they won`t let us until we are finished our neuro block. Grrrr!!! So I have to be patient BUT I am doing some work with a neurologist and a psychiatrist this summer....so hopefully I will get a feel of the 2 specialties that way. At some point, maybe I will start a neurology thread. Ok...off to finish my last PBL of the year!!!! Link to comment Share on other sites More sharing options...
Guest Blake128 Posted May 22, 2006 Report Share Posted May 22, 2006 Last PBL of the year already ? And to think I won't be done until june 22nd.:x The new CARMS match report is now available. Very good match for NS applicants;) It also seems that orthopaedics and cardiac surgery aren't very competitive. Same goes for neurology, Satsumargirl. Link to comment Share on other sites More sharing options...
Guest quebecboy Posted May 25, 2006 Report Share Posted May 25, 2006 Hey Blake, Where do you see the match report? I checked on the Carms site, but couldn't find it... QcBoy Link to comment Share on other sites More sharing options...
Guest quebecboy Posted May 25, 2006 Report Share Posted May 25, 2006 Found it! Link to comment Share on other sites More sharing options...
Guest copacetic Posted August 3, 2007 Report Share Posted August 3, 2007 you know for all their hardwork, i've heard that these neurosurg guys dont earn that much anyways. Link to comment Share on other sites More sharing options...
physiology Posted September 20, 2007 Report Share Posted September 20, 2007 you know for all their hardwork, i've heard that these neurosurg guys dont earn that much anyways. Maybe on the order of $400 000 to $600 000? Physio Link to comment Share on other sites More sharing options...
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