Neuroradiology Fellowships - One vs Two Years

[sunnysnow7]

I am currently making a rank order list for neuroradiology fellowships and am having trouble deciding how to rank programs. I was fortunate to receive interview invitations at some excellent one- and two-year programs. The two-year programs were the most impressive and seemed to offer incredible opportunities for those interested in an academic career. However, given the current job market, it seems like a two-year program may not be worth the opportunity cost. In addition, moonlighting seemed fairly limited at the two year programs, and I am worried about my body/MSK skills atrophying over the course of reading only neuroradiology studies for a full two years.

I am hoping to pursue a career in academics, but there is a small chance that private practice (or hybrid academic/private practice) will end up being my calling.

My question is primarily directed to those in or on the other side of fellowship: does the quality of clinical training at a top two-year program justify the extra year? Or is it possible to train at a good one-year program and become equally proficient at the end of the day?

Any advice would be appreciated!

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[maxxor]

I am currently making a rank order list for neuroradiology fellowships and am having trouble deciding how to rank programs. I was fortunate to receive interview invitations at some excellent one- and two-year programs. The two-year programs were the most impressive and seemed to offer incredible opportunities for those interested in an academic career. However, given the current job market, it seems like a two-year program may not be worth the opportunity cost. In addition, moonlighting seemed fairly limited at the two year programs, and I am worried about my body/MSK skills atrophying over the course of reading only neuroradiology studies for a full two years.

I am hoping to pursue a career in academics, but there is a small chance that private practice (or hybrid academic/private practice) will end up being my calling.

My question is primarily directed to those in or on the other side of fellowship: does the quality of clinical training at a top two-year program justify the extra year? Or is it possible to train at a good one-year program and become equally proficient at the end of the day?

Any advice would be appreciated!

Real talk:

2 year programs shouldn’t exist anymore now that catheter angiograms are no longer part of conventional neurorad skills.

Do a 1 year and get a job at a place that has a 2 year and then coast off the training program that takes advantage of fellows.

 

[MadRadLad]

2 year are for suckers these days. Even a lot of the staff at these places didn't do 2 year programs. Unless your goal is to be a section chief at specifically MGH or UCSF I wouldn't do it, especially in this market. Plenty of really good 1 year programs out there.

Most 2nd year neuro fellowships also don't give you much more, they just have you do more final reads and pay you a little bit more under guise of junior faculty. You're better off getting a job and running complex cases by your colleagues.

 

[GadRads]

Agree. 2 yr programs should be stopped. It’s just cheap labor. Many people who have done it did not see the value.

 

[Cognovi]

A 2 year program is a good fit for some people.

For those bound for private practice: Getting a private practice job and running complex cases by your colleagues is often much harder than running cases by your colleagues in an academic program with 2nd year fellows. I get texts all the time from some of my former co-fellows asking about cases, presumably because they don't have someone at their practice readily available or trustworthy, which is suboptimal because I'm looking at cell phone pics or curbside questions without images. Obviously if you are in a large practice with subspecialized high quality rads with a culture/workflow that supports consults, you can do it, but it's not a guarantee. Being a first-year attending at an academic place where you see the most complex cases and have supportive colleagues to consult can be a helpful transition to a small practice where you're alone.

For those bound for academics: Making connections with your academic attendings at your fellowship can help land your first academic job and also figure out what you want in a job. Doing this is hard when you are a 1 year fellow and applying for jobs just a few months into fellowship. People barely know you. You have had no time to make headway on academic projects. In a 2 year fellowship, you also have more opportunity to develop more niche clinical skills with which to market yourself. Maybe you can be the spine interventionalist, the functional MRI reader, the head and neck consultant, or maybe you can roll in peds neuro as your second year at the same institution.

As for whether you need a 2 year fellowship to land a desired academic job: in this job market, no. All kinds of places are desperate for people. But it's also true that essentially all the neuro staff including new hires at MGH and UCSF did 2 years. When I was on the interview circuit a year ago, I even had an interviewer at another academic program with 1 yr fellowship comment that they really prefer candidates with 2 years.

It is definitely possible to be a proficient general neuro reader with one year at a good program. It helps if you had extra time in neuro as an R4.

There is a reason, however, that neuroradiology training in many other places in the world is 2 years, like Canada, and it's not because of catheter angiography.

 

[guytakingboards]

My question is primarily directed to those in or on the other side of fellowship: does the quality of clinical training at a top two-year program justify the extra year? Or is it possible to train at a good one-year program and become equally proficient at the end of the day?

As several people have mentioned, a lot depends on the job you take afterwards. My first job out of training was a hybrid practice with high quality subspec colleagues. We ran cases all day every day and after a few years I feel very comfortable with neuro. My new group is way more general and I'm now "the neuro guy". In retrospect, a second year of fellowship wouldn't have added much to that first job experience.

One of my new/current colleagues came straight from a 2-year program and he still runs a bunch of cases with me. I happen to think he wasted his time doing an extra year of fellowship only to take such a general job.

 

[maxxor]

There is a reason, however, that neuroradiology training in many other places in the world is 2 years, like Canada, and it's not because of catheter angiography.

This is irrelevant because most programs outside the US are not as good as the US; that is, they don't have sufficient MR case exposure.

In all cases, this is a big "it depends".

However, I personally think that if you feel so "weak" at Neuro that you need a 2 year neurorad fellowship, you are better off doing a 1 year neurorad fellowship then staying on as *actual* faculty, than taking one of these "junior faculty/assistant/nonsense" 2 year positions.

 

[Clean7795]

Do a 1-yr fellowship. The few additional skills gained from another year of training are small compared to the atrophy of your general skills.

I will add a caveat that doing a 1-year option in programs that traditionally do 2-years can be an issue in terms of exposure. You need to cover brain, spine, head/neck, and possibly peds—in some 2-year programs they may allocate some areas to the 2nd year only. There are also some niche exams that at some centers may not done often because they're split with the MSK division (e.g. brachial plexus, lumbosacral plexus, temporomandibular joints, etc.).

For those bound for academics: Making connections with your academic attendings at your fellowship can help land your first academic job and also figure out what you want in a job. Doing this is hard when you are a 1 year fellow and applying for jobs just a few months into fellowship. People barely know you. You have had no time to make headway on academic projects. In a 2 year fellowship, you also have more opportunity to develop more niche clinical skills with which to market yourself. Maybe you can be the spine interventionalist, the functional MRI reader, the head and neck consultant, or maybe you can roll in peds neuro as your second year at the same institution.

IMO this boils down to "culture/tradition" mostly. In other areas you can develop a diagnostic niche as an attending & getting paid as an attending.

Even regarding spine interventions, if 1-year was the norm, then fellows could probably try to negotiate adding on 3-4 months for procedures. And honestly spine interventions is not a good reason to do another year of training unless you've already signed a job that needs it—in many practices spine interventions are already saturated by IR, NIR, orthopaedics, interventional pain, or another specialty.

There is a reason, however, that neuroradiology training in many other places in the world is 2 years, like Canada, and it's not because of catheter angiography.

Canada is the similar to the U.S. in that there are graduates that either leave after 1 year, or negotiate a 1 year position.

Also similarly, the additional time is mainly used for research, spine interventions, or niche diagnostic skills. This mainly translates to finding a subspecialized academic job.

 

[sunnysnow7]

Thank you all so much for the helpful responses. I truly appreciate the insight.

@Cognovi - thank you for sharing your thoughts on two-year programs. I certainly do think that I am in the camp that would benefit from a second year of dedicated teaching. However, @Clean7795 , @maxxor , and @MadRadLad , @guytakingboards , and @GadRads bring up a good point - ranking a one-year program and staying on as junior faculty might be a great option for me.

I will have to consider my options further, but the replies have certainly been very helpful. Thanks again.

 

[Cognovi]

you are better off doing a 1 year neurorad fellowship then staying on as *actual* faculty, than taking one of these "junior faculty/assistant/nonsense" 2 year positions.

This is the best outcome but the stars do need to align. First you say you're not into academics so you don't go for the 2 year track. Then you arrive at fellowship and tell everyone you're interested in academics, you shine clinically from the start, you express interest in staying about 2-5 months in, and the place opens a job for you.