Wondering if anyone would recommend doing neurosurgery over IR to pursue endovascular/vascular neurosurgery in the future? Obviously you can only be dual trained as a neurosurgeon which is appealing but it seems like the NIR guys have a foothold in the field as well.
I’m currently a MS3 at a top 5 med school, 260+ with 5 first author basic science papers in cerebrovascular. Both my home programs in IR and neurosurgery seem supportive of me pursuing their specialty but I don’t see one being better than the other besides IR being a shorter/easier residency but may be harder to get into.
It comes down to, do you like the rest of the IR path and Neurosurgery path? The Neurosurgery path is a lot of spine and cranial, trauma, tumors, degenerative disease etc. Can you do 6-7 years of that to eventually get to NIR? Then, will you look forward to taking cranial or spine call in addition to being a interventionalist. Being dually trained is hugely attractive to hospitals, academic and private, because they can buy stroke and neurosurgery call in one individual. It's a lot of work, but you can make it what you want, either in academics or private practice. NIR via the radiology route is a much easier path. They do have a strong standing in NIR like Neurosurgery. Vascular neurosurgery is headed toward endovascular treatment by and large. You won't worry about your territory being taken by open surgery.
The old adage is, if you can do something other than neurosurgery, do it. If knowing cranial and spine surgery isn't a priority for you, go the radiology route.
Neurosurgery route every day of the week. You’ll be a dual trained surgeon, which is a huge asset when it comes to job searches, because you are able to able to take both endovascular call and general call. There’s also a huge difference in attitudes and philosophy between the two clinicians. Personally, I find endovascular neurosurgeons to be bolder and more decisive. We have both at my institution, but quite frankly the IR-trained guys are viewed with contempt by their peers, as they are more skittish, often turn down cases and defer to their neurosurgical colleagues, and frequently chicken out during interventions and ask the endovascular neurosurgeons for help.
Yeah I agree with the sentiment above. Do neurosurgery if you think you’d like doing open vascular, skull base, tumor or spine on the side of endovascular. If you’d rather read neurorads cases or do IVC filters on the side then do IR. Neurosurgery residency will be manyfold harder than IR residency so that’s a consideration.
The NIR people I’ve come across are excellent at endovascular so I can’t speak to the personality types and turf wars there are at other institutions.
FYI, DR, not IR, is the main rads pathway into neuroendovascular. There are some people trained in both body IR and neuro, and you may get some neuro exposure through body IR, but it is not a typical pathway into INR fellowship. Someone coming from an integrated IR program would almost definitely need to do a neuroradiology fellowship, like DRs do, before an INR fellowship. I would suggest speaking with your programs IR / INR faculty about this since some institutions do different things.
Re: neurosurgery vs rads- surgery will likely prove to be a better career move. Some people these days argue that neurology even is a better path into INR than rads, since neurologists and neurosurgeons offer more to stroke centers than radiologists. The trend seems to be, though, that neurosurgeons have an (much?) easier time than radiologists finding jobs after fellowship.
My real advice: hope you fall in love with something else during your rotations or residency. INR has one of the worst lifestyles in medicine. Really both paths are fine but ask yourself would you rather potentially bail on INR to do body IR/neurorads or to do spine/neuro-surgery.
