Big names in IR

[NoelG]

I'm a radiology SpR (a resident) in the UK. I'm really enjoying my IR attachments so far, and want to specialise in the field. We're being encouraged to look at fellowships abroad, and I need to start thinking about where I want to go.

(Now I know there are huge issues with visas, board certification and so on as an IMG coming to the USA or Canada. So I'm asking this question while temporarily forgetting about those issues!)

Who are the big names in Interventional Radiology in North America? Who are the giants, the rock stars, the great mentors and the one doing the most innovative procedures?

All other things being equal - family, location, everything really - who would you love to work under if you got the chance?

(Sorry if this sounds a bit ambiguous or airy-fairy, but I'm completely unfamiliar with the bigwigs in IR in North America, and this forum seems to be full of great info so far!)

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[TheRealDrDorian]

I'm a radiology SpR (a resident) in the UK. I'm really enjoying my IR attachments so far, and want to specialise in the field. We're being encouraged to look at fellowships abroad, and I need to start thinking about where I want to go.

(Now I know there are huge issues with visas, board certification and so on as an IMG coming to the USA or Canada. So I'm asking this question while temporarily forgetting about those issues!)

Who are the big names in Interventional Radiology in North America? Who are the giants, the rock stars, the great mentors and the one doing the most innovative procedures?

All other things being equal - family, location, everything really - who would you love to work under if you got the chance?

(Sorry if this sounds a bit ambiguous or airy-fairy, but I'm completely unfamiliar with the bigwigs in IR in North America, and this forum seems to be full of great info so far!)

Oh boy, extremely vague but great question. Are you talking historic or contemporary? (I'd love to work under Dotter...but he's dead...) What field within IR are you most interested (e.g. Interventional Oncology? Vascular work?). Even when you've picked a field in IR, what specific modalities interest/intrigue you (e.g. within interventional oncology, catheter directed therapies vs. ablation? What type of catheter directed therapies? etc. etc.) Do you want to be a jack-of-all-trades, or the world's expert on liver ablation?)

When I'm looking for mentors, you have to think about your future career goals. Reed Omary (former radiology research head at Northwestern in Chicago; now at Vanderbilt) gave a real nice talk a few years back speaking about how to truly be successful and devote yourself to IR (or anything for that matter), you really can only do 2 of 4 things: Business, Academics, Research, Clinical. It's easy to try to be a superstar, but hard to do EVERYTHING.

Fellowships are a tricky subject. If you want to be a big research academician, you might want to look at more research heavy programs that have had editors of journals or that publish quality studies. If your goal is purely clinical practice, some might say a smaller fellowship program with high volume (less fellows + more cases = more experience).

Who would I want to work under? Ideally all of them...but I'll have to figure that out in 3 years!

 

[NoelG]

Yeah it's pretty vague alright! Interesting point re: not being good at everything.

So who are the big names/great teachers/fantastic potential-mentors under the various headings then:

Interventional Oncology
Vascular Intervention
Paediatric Intervention
Neurointervention

 

[badasshairday]

Yeah it's pretty vague alright! Interesting point re: not being good at everything.

So who are the big names/great teachers/fantastic potential-mentors under the various headings then:

Interventional Oncology
Vascular Intervention
Paediatric Intervention
Neurointervention

Intervetional onc: UPENN, Northwestern
Vascular: Baptist Cardiac and Vascular Institute
Peds: ?
NeuroIR: ?

Strong all around: Brown, MCW, U of I Peoria (up and coming bringing the onc work up to speed)

Strong programs I have heard good things about but don't know first hand: UCLA, Stanford, USC, UT Houston, Dotter Institute.

Look up the names at the programs I've mentioned and you will see some heavy weights.

 

[NoelG]

Cool - and who are the big names propping these places up? Is it 'cause they're great teachers, or just heavy hitters academically?

(Some detail might avoid turning this into one of those 'Rank the fellowship' threads - thanks for the info though!)

 

[shark2000]

Intervetional onc: UPENN, Northwestern
Vascular: Baptist Cardiac and Vascular Institute
Peds: ?
NeuroIR: ?

Strong all around: Brown, MCW, U of I Peoria (up and coming bringing the onc work up to speed)

Strong programs I have heard good things about but don't know first hand: UCLA, Stanford, USC, UT Houston, Dotter Institute.

Look up the names at the programs I've mentioned and you will see some heavy weights.

NeuroIR only has parts of its name similar to IR. It was not and is not a part of IR. It is a different animal itself. If interested you have to go through Neuroradiology.

Anyway, the main problem with the current training of IR is the huge diversity of teaching and also practice models across the board. There are not a whole lot of places that teach you arterial work. A lot of places teach you oncology work. To make things more complicated, tubes, drains and biopsies are controlled by body section in many places. Spine work is done by neuro section in most places. Percutaneous ablation is done by body section in many places.

Before entering the market you don't know were you will end up. You apply almost 3 years before entering the market. To make things more complex, the IR practice changes fairly rapidly over time in different academic places. For example, a place that is doing vascular work now may change into an oncology center just in 3 years because of market push.

Now you are trained in IR and you want to enter market. Let's say you were trained very well in oncology. If you end up in pp, in most places they don't do oncology work or if they do, they do it once in a while. Or you may have been trained well for PAD, but you may end up in a hospital where it is controlled by vascular surgeons. You may get cases once in a while.

To make things more complex, you may get a perfect training in PAD, but you may end up in a practice where they want you to do a lot of spine procedures or they may ask you to do a lot of oncology.

I have seen complaint from both sides, and both of them have really reasonable points. There is a discrepancy between the needs of many groups and the skills of many trainees. Also there is a great discrepancy between the desires of a group and a trainee.
Most groups want you to do DR and then take care of some IR in between or do IR 2 days a week and the rest DR. This model is doomed to fail if you want to build a practice. You need full time to build your practice. Or even if you get full time IR, you may not find the same way of thinking from other IR people in the group. On the other hand, the groups also have good reasons. Building a new IR practice is expensive. You have to lose money for the first 2-3 years. In this market, most groups can not take that risk.

Bottom line is the skill sets of IR trainees are not uniform across the board. On the other hand, the requirement skills for IR jobs is not uniform across the board and may be very very different. As a trainee you have to try to broaden your skill set as much as you can to be able to fit many job requirements.

 

[NoelG]

NeuroIR only has parts of its name similar to IR. It was not and is not a part of IR. It is a different animal itself. If interested you have to go through Neuroradiology.

Anyway, the main problem with the current training of IR is the huge diversity of teaching and also practice models across the board. There are not a whole lot of places that teach you arterial work. A lot of places teach you oncology work. To make things more complicated, tubes, drains and biopsies are controlled by body section in many places. Spine work is done by neuro section in most places. Percutaneous ablation is done by body section in many places.

Before entering the market you don't know were you will end up. You apply almost 3 years before entering the market. To make things more complex, the IR practice changes fairly rapidly over time in different academic places. For example, a place that is doing vascular work now may change into an oncology center just in 3 years because of market push.

Now you are trained in IR and you want to enter market. Let's say you were trained very well in oncology. If you end up in pp, in most places they don't do oncology work or if they do, they do it once in a while. Or you may have been trained well for PAD, but you may end up in a hospital where it is controlled by vascular surgeons. You may get cases once in a while.

To make things more complex, you may get a perfect training in PAD, but you may end up in a practice where they want you to do a lot of spine procedures or they may ask you to do a lot of oncology.

I have seen complaint from both sides, and both of them have really reasonable points. There is a discrepancy between the needs of many groups and the skills of many trainees. Also there is a great discrepancy between the desires of a group and a trainee.
Most groups want you to do DR and then take care of some IR in between or do IR 2 days a week and the rest DR. This model is doomed to fail if you want to build a practice. You need full time to build your practice. Or even if you get full time IR, you may not find the same way of thinking from other IR people in the group. On the other hand, the groups also have good reasons. Building a new IR practice is expensive. You have to lose money for the first 2-3 years. In this market, most groups can not take that risk.

Bottom line is the skill sets of IR trainees are not uniform across the board. On the other hand, the requirement skills for IR jobs is not uniform across the board and may be very very different. As a trainee you have to try to broaden your skill set as much as you can to be able to fit many job requirements.

Yeah I see your points re: future proofing yourself alright. I'd already planned to do so if I can - most of the UK appointed consultants would have done a minimum of two fellowships, and many three. I don't think you can hang your hat on arterial work - too many endovascular surgeons are coming through the vascular side, and I don't want to be jobless in ten years!

The way I see it, I'd like a job in a big academic centre where there's a need for a good, solid interventionalist who can do all the IR-Onc work, as well as whatever abdominal tubes need putting in, and lend a hand with some arterial work if they're trained to do so. I plan on doing at least one IR year - in which I'd like to get as well rounded a training as possible - as well as a year of a 'subspeciality IR'.

Paeds-IR is interesting, but you're limiting yourself to working in a handful of centres. NeuroIR is, as you've said, a different beast, but it also interests me. I know I'd also be limiting where I can work, and as you're said it's a different beast that requires at least 2 fellowship years, but it's a possibility - there could be a big demand for endovascular stroke work in ten years, depending on the outcomes of ongoing trials.

So it certainly is all about future proofing oneself, and trying to get as well rounded an education as possible - where can do that for me?