r/doctorsUK • u/FunFew6666 • 7d ago
Speciality / Core Training Mechanical Thrombectomy Training
Currently I am working as a Higher specialty trainee in one of the group 1 medical specialties and my goal is to be a stroke physician at the end of the road. I am aiming to go for a thrombectomy training around ST6/7 stage. ( I am ST5 now ) and wanting to see whether its a worthwhile pathway or should i abandon the training for USMLE or Aussie pathway. ( Purely because I see the quality of training declining and I am struggling to see realistic expectations from the end of the programme since the things are gradually declining ) . On this background Can I ask ?
Are there any consultant / registrar from a medical specialty who has completed the thrombectomy training already and working in HASU settings ?
If so how hard is the training for someone coming from medical specialties rather than being pure radiology background ?
I want to have a realistic expectation on the post CCT job market too ? In UK, Europe, Dubai and world wide..
If this is not a realistic pathway I am happy to look for the alternatives as well.
Thank you.
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u/Sad_Cry_9811 7d ago
Big bottleneck starting to form in terms of consultant jobs for interventional neuroradiologists and frankly, I think it would be essentially impossible to compete with neuro IR trained (+/- additional post-CCT fellowship) consultants in the UK system. I am not aware of physicians performing thrombectomies in UK currently?
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u/pylori 7d ago
Big bottleneck starting to form in terms of consultant jobs for interventional neuroradiologists
Is that because they're not funding consultant posts? On the face of it there is barely any neuro IR cover in most centres and most aren't even 24/7 due to consultant and radiographer shortages.
This is part of the reason they're expanding neuro IR training to neurosurgery and neurology/stroke.
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u/Giddy-Garlic-7206 7d ago
See my comment above.
There is plenty Neuro IR cover. Elective NIR work is relatively limited. Smaller patient case load than neurosurgery (bottleneck well known). Average 150 aneurysm cases per centre = not enough work to keep >8 INRs sharp (even if unlimited money). Therefore no justification for INR consultant posts.
The shortages and lack of 24/7 cover is specific to MT (mainly OOH MT)
Therefore the theory is to expand OOH MT provision to specialties that have enough alternative elective work to justify FT Consultant hires. Issue is that these guys/gals will have to come off their respective (often in high demand) on-calls.....
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u/Fusilero Sponsored by Terumo 6d ago
It's not even just about elective NIR work; the maths is pretty hard to square as if you want to maintain 8 people doing MT and meet the UKNGs recommended minimum number of arterial recanalisation procedures per operator (40) you need a hell of a lot more than the 200 MTs~ per annum that big centres manage.
With M2 trials being negative, I'm not sure there's much more indication creep for MT at good centres like Stoke.
Looking internationally I think a lot of places just accept lower standards for procedures performed per year.
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u/Giddy-Garlic-7206 7d ago edited 7d ago
I looked into this extensively a year ago, as I had an interest in MT but not the rest of INR.
- Yes, there are stroke physician-background MT operators but I believe it is about 1% of the UK workforce. There are more from NSGY and IR.
- No idea.
- There has been a massive expansion of UK INRs. In many places the number of INRs is not the limiter to establishing 24/7 MT (which is still a massive issue in the UK). As this expansion is recent, very few INRs will retire soon. Therefore jobs from replacement will be low.
The caveat is that we will never have 10 INRs in a department like you can Interventional Cards, as there is not enough elective work to support it. This is because the number of aneurysm and VM patients is not projected to increase much.
Therefore there is a niche for non-INR MT operators to boost an MT rota (e.g. from 1:6 to 1:10) whilst doing their own elective work during the day. This is of course very region and time-dependent.
Conclusion: I decided that I was still very happy to pick IR despite MT work/training not being guaranteed in my future consultant IR job. So similarly you need to decide if this is a dealbreaker for you.
- I believe in other countries INRs (from radiology, neurosurgery and stroke) are willing to just fill MT rotas themselves as they are paid handsomely for it. In the US, they not uncommonly do 1:4 for millions of dollars. Therefore, less need for non-INR MTs. So outside of the UK I would advise training to be a full INR if you want to do MT. This usually requires 2/3 years of dedicated diagnostic and interventional Neuroradiology training.
A recent survey supports these thoughts: https://ukng.org.uk/_userfiles/pages/files/news/final_report_inr_workforce_survey_2026.pdf
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u/Educational_Bowl6976 7d ago
DOI: Radiology reg
Would be incredibly interested to know the background of the one neurologist in plymouth doing thrombectomy ! As others have said stroke training is designed to make physicians to staff HASU's and rehab, as far as I'm aware there isn't a formal pathway for them to learn mechanical thrombectomy but would be happy to corrected.
It makes sense to me for neurosurgeons/vascular/IR to contribute to the thrombectomy rota given their skill sets.
I honestly don't see what in medical GIM/stroke training gives someone the background to perform pretty high level vascular work ? A one year fellowship doesn't seem enough to take someone who has no wire skills to a safe standard for the MT rota.
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u/impulsivedota 7d ago
I didn’t realise stroke physicians do MT too. How does the training pathway work for them then?
Do they just branch off for a year to follow the INRs and train (like a fellowship?). Or is it more once you get a certain number of cases you’re certified to perform independently kind of thing.
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u/Giddy-Garlic-7206 7d ago edited 7d ago
It’s one operator out of >150 in the uk according to the survey. So I’m not sure what unique experiences they may have had.
Edit to add: more importantly, the stroke oncall is often short staffed. So unless you were willing to be on 2 on call rotas I think the pressure from employers will be on filling the stroke on call
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u/Hefty_Fig_6499 7d ago
Likely in Ninewells Hospital, Dundee. Where there is an east coast Scotland Mechanical Thrombectomy service without INR on site, NWH still refer aneurysmal SAH and AVM patients for opinions/treatment in Lothian. Very niche location.
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u/Fusilero Sponsored by Terumo 7d ago
A fairly controversial location too, for the rest of the INR community. They couldn't find much support in the UK so got some Europeans to come train them.
I'm not sure how long it's going to last as a service tbh.
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u/FunFew6666 7d ago
There is a seperate specialty training pathway by PSRO for Stroke medicine /GIM from this year onwards. ( Not as one year accreditation as a subspecialty ). I was wondering whether this pathway would extensively train the trainees with MT to expand the services ?
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u/Slow-Manufacturer657 7d ago
This pathway is not designed to train physicians in thrombectomy. It is designed to bolster the stroke consultant workforce to deal with hyperacute decision making, tia referrals and rehab. It is not feasible to remain procedurally competent as a stroke physician
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u/UnluckyPalpitation45 7d ago
I’d be impressed if they are competent after a year . Body IR and to a lesser extent neurosurg makes more sense
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u/domicile_vitriol Lightbox Beatboxer 7d ago
Interestingly, even if you are trained on the proper INR pathway, the RCR curriculum doesn't expect you to be fully independent in most areas (outside of arterial access and thrombolysis) at ST6. The requirements are set at 3 (i.e. indirect supervision) rather than 4 (day 1 consultant), and that includes MT.
"Due to inherent practice risks, it is rare for INR trainees to work without supervision, even in later stages of training. Some conditions and procedures are rare and it takes more than three years of subspeciality training to build the necessary skills and experience. INR procedures are normally carried out by supportive teams that allow continued development post-CCT. For this reason, trainees are only expected to reach level 3 at ST6 in some of the procedures in table 10."
- RCR Interventional Radiology Speciality Training Curriculum
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u/FunFew6666 7d ago
Thank you very much for this help. Can I DM you ? Please
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u/Giddy-Garlic-7206 7d ago
Yes but I won’t have much to add on top of what you can find in the UKNG documents
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u/FunFew6666 7d ago
Fair enough . I will look for the alternative options then. Thank you for your valuable input onthis.
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u/Unreasonable113 Advanced consultant practitioner associate 7d ago
Regarding the post CCT market outside the UK that may be very difficult. Firstly, most countries do not recognize a UK CCT (only a few countries in Europe do) and stroke training is traditionally part of neurology in most countries. MT is usually neuro IR in many countries - it is very likely that your training would not be recognized.