A question: Why didn't you go into Interventional Neurology?
I've heard lots of stories about how Neurosurgeons and Radiologists made this field in their exclusivity and hospitals usually prefer to have them to do the intervention, since neurosurgeons can handle the possible adverse outcome such as ICH,... and radiologists can be helpful in reading the imaging in their extra times. Moreover, there are few programs to accept Neurologists for this subspecialty.
Here we go with my cynicism again. Be warned when asking for my advice.
Truly, you should check out the MANY threads regarding interventional neurology and stroke neurology on these boards (including radiology and neurosurgery) for more than you could ever want to know about this topic. For bonus credit, you can check out additional forums at auntminnie.com and uncleharvey.com (for pure, undiluted, vitrioloic, and vested financial interests, hubris, and concomitant insecurity).
First, I got married. There was more along the way in terms of "life issues" that happened to me also. Long story short...my priorities simply changed (you'll find it happens to most of us from M1 year to the end of residency). And sleep medicine is a skyrocketing, nascent field with good money potential, excellent lifestyle, fascinating subject matter (to me), great research potential, and plenty of cool respiratory and neurological overlap. I suppose you could surmise from the interest in interventional neurology that I was fond of critical care, pulmonary medicine, and neuroanatomy. You can at least find the latter two in sleep medicine.
But there's alot more to the story from a career viewpoint, too. Basically, I also got disillusioned with how much I would be a primary care doctor with a little bit of neuro knowledge (I meant to say "Vascular neurologist"
) to the ER and for the majority of my work. IVtPA is a rare thing compared to the overall number of times you get paged for an "acute stroke." And those elegant, fascinating interventions are even rarer. The work isn't very fast-paced most of the time...and really most patients "just" require meticulous medical management...not specialized neurologic knowledge. So, not too much adrenaline surge in most of those CVA alerts...it was just someone from another hospital trying to punt work/difficult patients/patients whose reimbursement was going to be unnatractive/anyone over the age of 90 (and of course, legal responsibility!) to a bigger hospital. Sort of like Trauma and lots of neurosurgery.
Have no fear from radiologists or neurosurgeons in the interventional neurology market. If you want to do it, go for it! Life is way too short to spend your work not doing what you love. NIR radiology spots will go unfilled (regularly I suspect) because radiology residents can make nearly as much money for a LOT less stress (and night call) by doing diagnostic radiology or diagnostic neuroradiology (why do most of them go into radiology to begin with, right?). This is why eventually they'll keep losing ground in this (and the other interventional) areas. Oh, make no mistake, there are some awesome radiologists who aren't afraid of seeing patients out there who will continue to be role models for ALL of us...but they are a shrinking minority of their specialty and will only become more endangered as time goes by. Those among them who do actually go into NIR usually are anxious to be exclusive proceduralists and consultants...not an admitting service like neurology and/or neurosurgery.
Neurosurgeons won't hold you back, either. Most of them are perfectly happy to share an interesting field with competent, professional colleuagues from ANY specialty. Some of them are terrified of losing ground to a medical-based specialty (CT surgery and cardiology throw things into an interesting, historical light, no?) and thus losing money, power, and patients (in that order I guess). So they will always keep a foothold in this area. And I think it's a wise move...who know what the future holds, right? But frankly, they can make much, much, much more money in spine surgery (and have a better lifestyle/call schedule to boot), and tend to opt out of the cerebrovascular route for similar reasons as the radiologists.
You have no need to be intimidated. Yeah, as a rule, both groups had better USMLE scores five, six or seven years ago (or whatever), but the quality of great neurology residents is going up and up, too. I believe we are in this subspecialty to stay - as we absolutely should be.
Long post. Still hoping to hear from advanced neurologists about their thoughts regarding the state of the neuro private practice market.
