Body vs Neuro

[Brill4]

R2/rising R3 here really struggling with the decision between the two. I’m truly 50/50.

Ideal job would be in private practice being able to read some of everything in addition to the complex cases in my subspecialty. I am also entertaining the thought of 1-on-2-off or night shift/ED job as I’ve found I really enjoy the cases in the ED.

I thought I’d list some of the pro’s and con’s I can think of and hope that you guys can provide your input or let me know if I’m just completely off base here. Some of these points may be more tailored toward stuff I’d see in an academic environment (i.e. fellowship year) rather than in the community or PP setting.

Neuro
Pros:
- High complexity/cool pathology
- Advanced/functional MR imaging seems really interesting
- High(er) pay/RVU’s
- Highly marketable


Cons:
- CTA’s and stroke codes on everyone with AMS
- Spines can be a slog
- Higher volumes of high acuity cases
- Higher liability (?)
- Not a big fan of ENT/Head neck stuff but that could change with more time in training
- I’ve seen that Neurosurgery and Neurology like to read their own imaging a lot. Feels like sometimes my reads don’t make that much of a difference


Body
Pros:
- Feels more “big picture” when reading complex cases in order to come to a unifying diagnosis which I enjoy
- Being able to read prostate, pelvic and body MR can be valuable to a practice
- Get to do procedures depending on the practice you join
- My interactions with surgeons and clinicians regarding body cases have been more fulfilling; actually feel like I’m making a difference

Cons:
- I’ve been told it’s not as generally marketable for PP/ ED jobs
- Can be delegated to doing just mostly generalist work (?) in the private practice setting
- May be pressured to read a higher volume of cases compared to Neuro due to generally lower average RVU’s per case
- Not a big fan of being the fluoro expert
- Could spend a lot of time training procedures to only join a practice where that’s done by IR
- MRCP/ Renal MRI follow-ups for lesion surveillance can be a slog

I know RVU’s and compensation should always take a back seat over “do what you enjoy the most” but in my situation that could be one of the tie breakers since I really do like both.

Also I don’t really find credence in this statement but I had a fellow at my program tell me that AI is coming for Neuro imaging first because of the pressure to improve outcomes with stroke care, with body MR being “safe”. As much as I’ve been trying to ignore that statement it still lingers in the back of my mind.

I know the market is hot right now but it’s hard to know where cyclical nature of the rads market takes it 5 or 10 years from now.


Thanks in advance!

---

Members don't see this ad.

 

[Oh_Gee]

not every body fellowship requires procedure rotations

 

[MadRadLad]

Neuro is better if you want to do ED as places like the stroke coverage. Acuity/liability may be a bit higher, but you will also be more comfortable with those studies. CTAs can suck but as an attending it will boost your RVU numbers at least.

Body is better if you want to do procedures. A little less variety in imaging unless you have some chest/cardiac as part of your fellowship too.

Fluoro is a generalist thing in most PPs regardless of your specialty. Each specialty has their slogs (degen spines, postop bellies, lung nodule hunting etc). Do you like reading prostate MR, livers, female pelvis more or would you prefer head and neck, peds neuro, advanced imaging.

Every specialist "reads" their own films, you still have to read it anyway. I wouldn't let that stop you. AI thing also, we've had RAPID and other softwares for a while and it helps with triaging but no company is going to put their neck on the line for missing a significant neuro finding. And body has some AI stuff for PE studies, dissections etc too. In the end these are useful tools for us, at least at this stage.

 

[clutch21]

Hot take from a biased body trained rad who reads everything:

A body fellowship is more helpful than a neuro fellowship for the community PP setting. I’ll be in the minority on this opinion though.

I think people overestimate their ability to read CT a/p well straight out of residency. I encounter complex abdominal cases in the ED more often than complex neuro stuff in my private practice. I frequently pull on stuff learned from fellowship. >95% of my neuro cases are stroke work ups and degen/trauma imaging. This will obviously vary though depending on the hospital system.

With that said, you can’t go wrong with either.

 

[bobjonesbob]

I think neuro is better if you want to work an ED job, but it doesn't really matter. You can get a job doing tele with any fellowship. As far as your cons for neuro, unindicated CTAs and degen spine are easy money once you're an attending. But one of the main points of most neuro fellowships is learning head and neck, so it makes a little less sense if you aren't interested in that.

 

[MadRadLad]

Hot take from a biased body trained rad who reads everything:

A body fellowship is more helpful than a neuro fellowship for the community PP setting. I’ll be in the minority on this opinion though.

I think people overestimate their ability to read CT a/p well straight out of residency. I encounter complex abdominal cases in the ED more often than complex neuro stuff in my private practice. I frequently pull on stuff learned from fellowship. >95% of my neuro cases are stroke work ups and degen/trauma imaging. This will obviously vary though depending on the hospital system.

With that said, you can’t go wrong with either.

This depends a lot on the system like you said. Our neurosurgeons and neurologists are far more particular and want neuro reads, call for clarifications and further looks a lot more. I think you're right that people overestimate their ability to read a CT AP as well as a body imager, but even for more complex CT cases we get far fewer calls about specifics or quality of our reads in our body division. MR prostate, rectal, enterography and some of the occasional weird hepatobiliary stuff is where our body guys really add value for the clinicians here, most haven't really cared about who reads the body CTs. Occasionally they will call the body guys for surgical planning or staging questions.

I think neuro is better if you want to work an ED job, but it doesn't really matter. You can get a job doing tele with any fellowship. As far as your cons for neuro, unindicated CTAs and degen spine are easy money once you're an attending. But one of the main points of most neuro fellowships is learning head and neck, so it makes a little less sense if you aren't interested in that.

Agree, the point of fellowship in neuro is basically peds, head/neck and advanced imaging along with a lot of volume of high end pathology that doesn't always show up in residency. Whether or not you use this stuff really depends on where you practice, although there is a good bit of head and neck in the community.

 

[guytakingboards]

Agree with everyone who said it matters what practice environment you're planning to go into.

My N is 2 (both >100 person multi-specialty groups), but I've found it's a lot harder to find a good body person than a good neuro person. Finding a body rad who will read whatever trainwreck MR/CT you put in front of him, also read body MR/complex CT at volume (and well) is like finding a damn near unicorn.

For whatever reason, neurorads rarely duck cases unless its a fringe study (brachial or lumbar plexus), peds, or advanced H&N. I've seen so many body trained people duck body cases.

I personally think it's a misconception that a good body rad isn't valued in the community. In my old group there were 20 neuro guys i'd trust for an opinion, really only 1 body guy. In my current group that's like 5 neurorads and 0 body rads.

I love being a neurorad but that being said I think there's a lot of opportunity out there for good body trained people.

You could be the classic hospital guy. Mostly general with procedures.
You could be the 'superbody' guy who reads all the body MRs and does all the different tumor boards.
You could be the outpatient/cancer/PET expert.

 

[MadRadLad]

I have found the same. Some body rads did it as an extension of residency because they didn't like the other specialties (a few in my group openly admit this), but their body reads, while probably better than mine, aren't really that different overall. Meanwhile some of the smartest people in my group are body trained but actually really GOOD at it and truly experts of many of the complex stuff and higher aspects of the routine stuff.

I think body fellowship can be quite variable based on the academic enviroment and how much is spent on CT/MR vs ultrasounds, plain film scutwork etc. A body MRI fellowship can be very different than the general "cross sectional" fellowship. Also agree with a lot of turfing, some harder female pelvic cases all get funneled to the pelvic reader, or the prostate guy etc. Our best body rads definitely don't do this - they have their expertises but I have found they are good at ALL aspects of body. Including chest.

Neurorads who duck the head/neck and peds stuff annoy me also. This is why you did your fellowship. I understand if its an occasional super rare study such as a lumbar plexus, TMJ mri or something but we have a low tolerance for those trying to pass off postop necks, spines etc.

 

[vm26]

I have found the same. Some body rads did it as an extension of residency because they didn't like the other specialties (a few in my group openly admit this), but their body reads, while probably better than mine, aren't really that different overall. Meanwhile some of the smartest people in my group are body trained but actually really GOOD at it and truly experts of many of the complex stuff and higher aspects of the routine stuff.

I think body fellowship can be quite variable based on the academic enviroment and how much is spent on CT/MR vs ultrasounds, plain film scutwork etc. A body MRI fellowship can be very different than the general "cross sectional" fellowship. Also agree with a lot of turfing, some harder female pelvic cases all get funneled to the pelvic reader, or the prostate guy etc. Our best body rads definitely don't do this - they have their expertises but I have found they are good at ALL aspects of body. Including chest.

Neurorads who duck the head/neck and peds stuff annoy me also. This is why you did your fellowship. I understand if its an occasional super rare study such as a lumbar plexus, TMJ mri or something but we have a low tolerance for those trying to pass off postop necks, spines etc.

I did a mixed fellowship that was neuro MR heavy at a midwest academic center...The "head/neck rad" was always the one with the least seniority!

 

[vm26]

R2/rising R3 here really struggling with the decision between the two. I’m truly 50/50.

Ideal job would be in private practice being able to read some of everything in addition to the complex cases in my subspecialty. I am also entertaining the thought of 1-on-2-off or night shift/ED job as I’ve found I really enjoy the cases in the ED.

I thought I’d list some of the pro’s and con’s I can think of and hope that you guys can provide your input or let me know if I’m just completely off base here. Some of these points may be more tailored toward stuff I’d see in an academic environment (i.e. fellowship year) rather than in the community or PP setting.

Neuro
Pros:
- High complexity/cool pathology
- Advanced/functional MR imaging seems really interesting
- High(er) pay/RVU’s
- Highly marketable


Cons:
- CTA’s and stroke codes on everyone with AMS
- Spines can be a slog
- Higher volumes of high acuity cases
- Higher liability (?)
- Not a big fan of ENT/Head neck stuff but that could change with more time in training
- I’ve seen that Neurosurgery and Neurology like to read their own imaging a lot. Feels like sometimes my reads don’t make that much of a difference


Body
Pros:
- Feels more “big picture” when reading complex cases in order to come to a unifying diagnosis which I enjoy
- Being able to read prostate, pelvic and body MR can be valuable to a practice
- Get to do procedures depending on the practice you join
- My interactions with surgeons and clinicians regarding body cases have been more fulfilling; actually feel like I’m making a difference

Cons:
- I’ve been told it’s not as generally marketable for PP/ ED jobs
- Can be delegated to doing just mostly generalist work (?) in the private practice setting
- May be pressured to read a higher volume of cases compared to Neuro due to generally lower average RVU’s per case
- Not a big fan of being the fluoro expert
- Could spend a lot of time training procedures to only join a practice where that’s done by IR
- MRCP/ Renal MRI follow-ups for lesion surveillance can be a slog

I know RVU’s and compensation should always take a back seat over “do what you enjoy the most” but in my situation that could be one of the tie breakers since I really do like both.

Also I don’t really find credence in this statement but I had a fellow at my program tell me that AI is coming for Neuro imaging first because of the pressure to improve outcomes with stroke care, with body MR being “safe”. As much as I’ve been trying to ignore that statement it still lingers in the back of my mind.

I know the market is hot right now but it’s hard to know where cyclical nature of the rads market takes it 5 or 10 years from now.


Thanks in advance!

I would remove RVUs from the equation unless your goal is a pay-per-click tele-job or academics...Ultimately it doesn't really matter aside from what you prefer reading. I read both but I would take relatively normal study "X" over complex study "Z" any day...I would also say that complex body MR is more soul-sucking that complex neuro MR (even "normal" prostate MR is not normal-organized chaos etc)...if you want academics/employment then go with whatever floats your boat. For PP you will be reading everything regardless of your subspecialty unless you are employed by a mega-PP likely owned by PE (this should not be your goal in my humble opinion)

 

[yungspleen]

I would remove RVUs from the equation unless your goal is a pay-per-click tele-job or academics...Ultimately it doesn't really matter aside from what you prefer reading. I read both but I would take relatively normal study "X" over complex study "Z" any day...I would also say that complex body MR is more soul-sucking that complex neuro MR (even "normal" prostate MR is not normal-organized chaos etc)...if you want academics/employment then go with whatever floats your boat. For PP you will be reading everything regardless of your subspecialty unless you are employed by a mega-PP likely owned by PE (this should not be your goal in my humble opinion)

If you join a small-medium PP (like 30-40 partners) and are neuro trained, what % of the studies you read would typically be neuro? And what if you are breast trained?

 

[meister]

I’m a neurorad. Do what you like more.

 

[vm26]

If you join a small-medium PP (like 30-40 partners) and are neuro trained, what % of the studies you read would typically be neuro? And what if you are breast trained?

Clearly all depends on what specific group/geographic area/HC system etc. I'm in a group this size (cover level 1 trauma, stroke center), and if you include ER CT heads, CT C/S, CT facial bones, CTA/perfusion, then maybe 35-40%...If you can do breast well (regardless of fellowship), then you'd be doing this the bulk of your time aside from call shifts...This stuff can/will change for whatever reason (eg. new great AI that can handle screeners). Aside from picking something you enjoy reading, I would recommend obtaining/maintaining a wide skill-set.