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Should neurointerventional fellowship training be suspended indefinitely?
  1. David Fiorella1,
  2. Joshua A Hirsch2,
  3. Henry H Woo1,
  4. Peter A Rasmussen3,
  5. Muhammad Shazam Hussain3,
  6. Ferdinand K Hui3,
  7. Donald Frei4,
  8. Phil M Meyers5,
  9. Pascal Jabbour6,
  10. L Fernando Gonzalez6,
  11. J Mocco7,
  12. Aquilla Turk8,
  13. Raymond D Turner9,
  14. Adam S Arthur10,
  15. Rishi Gupta11,
  16. Harry J Cloft12
  1. 1Cerebrovascular Center, Department of Neurosurgery, State University of New York at Stony Brook, Stony Brook University Medical Center, Stony Brook, New York, USA
  2. 2Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4Department of Interventional Neuroradiology, Radiology Imaging Associates, Swedish Medical Center, Denver, Colorado, USA
  5. 5Departments of Radiology and Neurological Surgery, Columbia University, College of Physicians and Surgeons, NYC, New York, USA
  6. 6Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
  7. 7Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA
  8. 8Cerebrovascular Center, Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
  9. 9Cerebrovascular Center, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA
  10. 10Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  11. 11Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital Atlanta, GA, USA
  12. 12Department of Radiology, Mayo Clinic, Rochester, MN, USA
  1. Correspondence to Dr David Fiorella, Cerebrovascular Center, Department of Neurosurgery, State University of New York at Stony Brook, Stony Brook University Medical Center, Health Sciences Center 080, Stony Brook, NY 11794, USA; david.fiorella{at}sbumed.org

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To bring about destruction by overcrowding, mass starvation, anarchy, the destruction of our most cherished values—there is no need to do anything. We need only do nothing except what comes naturally—and breed. And how easy it is to do nothing. Isaac Asimov

The purpose of any training program is to provide a supply of skilled workers to address an unmet demand for their services. With respect to medical training, new physicians are required either to take the place of retiring physicians or to address an unmet demand for patient care. Evolving data strongly suggest that the supply of neurointerventional (NI) physicians is not only sufficient, but has exceeded the present need for services. Despite this, we continue to train new neurointerventionists (NIs) in unprecedented and increasing numbers every year. These new NI physicians are finding it progressively more difficult to secure employment and, once hired, face considerable challenges in building a practice and developing/maintaining their skills. Fellowship training is ingrained into the fabric of our academic practices and currently seems to be perpetuated more by inertia than a dynamic evaluation of the present workforce needs. It is the position of the authors that, if we do not re-evaluate this process, we are potentially doing a tremendous disservice to the people we are training, to patients in need of treatment (and maybe more importantly to those patients with lesions who are not in need of treatment), and finally to ourselves.

One of the more difficult aspects of evaluating the NI workforce is obtaining accurate data to characterize the status of current supply and demand—such as the number of practicing NI physicians, the number and growth rate of neuroendovascular cases and the number of new graduates entering the market each year. These statistics must be triangulated using several available sources, the most …

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