M4 deciding between Neurology vs Radiology
M4 currently applying and pretty torn between Neurology and Diagnostic Radiology, with the long-term goal of pursuing neurointerventional surgery (NIR).
I realize neurosurgery is probably the most straightforward pathway into NIR (I’ve got a solid step 2 and research), but I don’t think it’s the right residency for me. I enjoy endovascular procedures, but I’m much less interested in open cranial surgery and especially spine surgery, so committing to 7 years of NSGY primarily to get to NIR doesn’t make much sense.
My main interests within NIR are stroke, cerebrovascular disease, and eventually the more functional side of the field: endovascular neuromodulation, BCIs, electrophysiology, etc. I also want enough clinical ownership that I’m not purely a procedural consultant.
I’m basically weighing:
Neurology
Pros
● Much stronger foundation in stroke, neurocritical care, neurophysiology, localization, and longitudinal management of neurological disease
● Could build a pathway around stroke/NCC + NIR and potentially neurophysiology
● Better preparation for clinical ownership of neurovascular/neurological patients especially moving forward
● More directly aligned with my interest in functional neuroscience/BCI and I have some connections in this space saying neurology would be their recommended route
● long term, organ proceduralists seem to box out IR (vascular surgery +cardiology on PAD, PE etc.)
Cons
● Far fewer procedures during residency
● Potentially entering NIR fellowship with significantly less catheter/wire experience than DR/IR trainees
● NIR access seems highly program- and mentor-dependent
● Concerned about spending most of residency doing general neurology when my long-term interests are heavily procedural although I think I’d be happy in stroke, NCC, pain or maybe NeuroPhys
● Smaller number of NIR fellowships seem accustomed to taking neurology-trained applicants
Diagnostic Radiology
Pros
● Much stronger procedural/imaging foundation, particularly if I aggressively pursue IR and neuroangiography exposure
● CTA/MRA/DSA and cross-sectional neuroimaging expertise seems extremely valuable for NIR
● Potentially much more opportunity to develop catheter skills before fellowship
● DR itself gives me a procedural/technical career I would be happy doing if NIR doesn’t work out.
● Seems easier to tailor electives toward neuroradiology/IR/NIR than to create procedural exposure from scratch in neurology
Cons
● Much less ownership of stroke/neurovascular patients
● Less clinical neuroscience, neurophysiology, and neurological examination (acute Neuro exam is freaking awesome!)
● Would need to deliberately seek stroke/NCC/neurology exposure
● I’m concerned about becoming technically strong but having a weaker clinical foundation than neurology/NSGY-trained NIR physicians
● The exact DR → NIR pathway seems to be changing, so I’m not sure what training will look like by the time I get there. I know new cast pathway from IR exists but it seems really hard to fit 6 months of stroke/neurosurg/NCC in that hectic schedule also would lose the neuroradiology expertise to an extent
For people currently in NIR, or residents/fellows pursuing it: If you knew during M4 that NIR was the goal but NSGY wasn’t a good fit, would you choose Neurology or DR today?
I’m especially interested in how much the residency background actually matters once you’ve completed a strong NIR fellowship, and whether you would prioritize clinical neuroscience/ownership (Neurology) or imaging + procedural foundations (DR) before fellowship.