Fellowship and practice trends in neuroradiology training programs in the United States

BACKGROUND AND PURPOSE: Neuroradiology has become an increasingly diverse a nd subspecialized discipline. We evaluated the current status and trends af fecting fellowship programs and the practice of clinical neuroradiology at academic medical centers, with emphasis on invasive procedures. METHODS: All 85 program directors at Accreditation Council for Graduate Med ical Education-approved fellowships in neuroradiology were sent a detailed questionnaire pertaining to various demographic aspects of their program an d the performance of certain radiologic examinations of the brain and spine . RESULTS: Sixty-seven programs (79%) responded. As many as 50% of programs a re I year in length. Twenty-five percent of 2-year fellows leave their prog ram after I year of training. During the past 5 years, 36% of programs have decreased in size and 73% reported a decline in the number of applicants. The majority (55%) of programs have had applicants renege on their commitme nt to begin a fellowship. Twenty percent of 2-year programs do not offer tr aining in endovascular interventional procedures. Neurosurgeons perform end ovascular interventional procedures at 18% of centers. There is an 18-fold variation in the volume of neuroangiographic procedures performed each year and a 150-fold variation in the volume of myelographic procedures performe d. In 29% of programs, neuroradiologists are nonparticipants in nonvascular interventional spinal procedures; in 40%, they share these procedures with musculoskeletal radiologists/nonradiologists. CONCLUSION: Interest in fellowship programs in neuroradiology is declining. An applicant's commitment to either begin a fellowship or complete 2 years of training cannot be regarded with assurance, and there is a lack of unif ormity in many areas of the training experience, particularly in invasive d iagnostic and therapeutic procedures.