Ask a neurosurgery resident anything

[neusu]

Hi everybody. I noticed interest in the discussion with resident/intern from general and vascular surgery and wanted to offer some insight on another surgical sub-specialty, neurosurgery. Feel free to ask away regarding whatever questions you may have from general what do we do questions to how to lay plans to pursue this field. I'll try to check back and get to each of your questions, feel free to PM me for anything you don't want to ask in a public forum. Also, there is an attending in the neurosurgery forum writing from his perspective: http://forums.studentdoctor.net/showthread.php?t=919891

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[wholeheartedly]

what would you say is the biggest misconception about neurosurgery that you've encountered?

 

[CuttingCorneas]

Can you provide your general stats? USMLE, class rank, amount of research, etc.

 

[mimelim]

Can you give the basics of your training from med school through residency/fellowship? Mainly what you did differently as a medical student than everyone else to prepare for or make you go into NSGY and then what you do in the different years of your program?

 

[coyotelime]

When/how did you discover your passion for neurosurgery, and why did you choose it as a specialty?

 

[neusu]

what would you say is the biggest misconception about neurosurgery that you've encountered?

That's a good question. Generally, my impression, is that we do something special. Like any other service we come in and do our best to take care of patients, work hard, and try to have fun in the process. In the hospital, it seems, often that the central nervous system gets treated like a black-box which results in having neuro "on board." Some of this may come from medical education having less introduction to neuro, as several schools have decreased or dropped the requirement, and many residencies do not rotate on neurology or neurosurgery. Compare that to cardiology or cardiac surgery where most medicine/surgery residents feel comfortable working up chest pain before calling.

 

[lazymd]

Hey!

Thanks for taking the time to do this. I have a few questions about research.

1. Can you offer any info on how to find research?
2. Does the school help with this at all?
3. Do you have any tips for how to get published once we find research?

Thanks again!

 

[Arbor Vitae]

What is a typical day in your life?

 

[neusu]

When/how did you discover your passion for neurosurgery, and why did you choose it as a specialty?

I was one of the lucky ones who found it early (e.g. during undergrad) and was only more interested in the field with increased exposure throughout medical school. I chose it for numerous reasons, but namely I love the anatomy, pathophysiology, use of technology, and the variety of patients/procedures. For nearly every patient we see, a brief history and focused neurological examination can give major insight to localize the lesion and use of imaging helps correlate/confirm. With respect to the variety of cases, various approaches for craniotomy are vastly different; spine requires anterior, lateral, and posterior approaches to the neck, chest, and abdomen; and we do peripheral nerve.

 

[Lollygag]

Ohhhh my goshhhh I'm so excited!!!! Thank you for making this

1. Do you know any female neurosurgeon's who got pregnant and had kids during residency and how it went for them? Is it close to impossible or is it doable?

2. Do you think someone could do neurosurgery and go into academic medicine? (like teaching residents on the side or research). Or have you seen neurosurgeon's go into healthcare management in hospitals or is that typically not a feasible career path? Sometimes it seems like neurosurgery is so daunting that it's next to impossible to do anything else on the side or advance. I just want to know how true that is.

Thanks again!!!!

 

[Lollygag]

And one more question I just thought of lol, do you need to continue studying while you're in residency? I mean with textbooks every night always brushing up on things? I heard that neurosurgery is one of the more difficult residencies and you need to be on top of you're stuff all the time but to what extent.. how often do you have to come home and study after working?

 

[Bangersandmash]

I think most of us will ask about your lifestyle and free time, and I am no exception. I will say its comforting that you have time to make this thread though.

I am interested in neurosurgery entering my first year of medical school, but I am concerned about the heavy research focus. I've done research in undergrad, but bench work isn't my favorite thing in the world. Is there a big focus on research once you're in residency, or does it "end" after med school?

 

[deleted303591]

Have you ever performed surgery on a patient with a rare neurological disease, where there was no standard of treatment established?

Do you implant a lot of medical devices as a neurosurgery resident?

I am curious because I have a rare autoimmune neuromuscular disease. It is an autoimmune autonomic neuropathy (more specifically, ganglionopathy). It is not a neurodegenerative disease because the antibodies are against the ion channels of the nerves in my spine, blocking nerve signaling. I am getting better every day and I receive IVIG treatments. I am interested in neurology and neurosurgery.

 

[neusu]

Can you give the basics of your training from med school through residency/fellowship? Mainly what you did differently as a medical student than everyone else to prepare for or make you go into NSGY and then what you do in the different years of your program?

Undergrad: If you can do research now it helps set the groundwork for both medical school and residency applications. You have more time and leeway to learn how to do things. Do well on the MCAT and get in to the best/cheapest medical school you can. A medical school with a neurosurgery program, though not imperative, is more desirable than one without because it can be your launch pad to getting a residency.

Medical School: Do well in preclinical classes. If you have grades/honors, try to do well. Step 1 is the great equalizer, do the best you can. Third year rotations are again important, notably surgery. While a letter from the surgery chairman is not necessary, having honors in surgery looks good. Most applicants have some sort of research project during medical school. These range from a case report to a clinical study. If you know you want to do neurosurgery early, get involved with something with the department as early as possible and push it through. Even a chart review for a retrospective cohort trial can be done over the summer between 1st/2nd year. This both helps establish that you are interested, teaches you about neurosurgery and the terms/procedures, and introduces you to the department. During the 4th year do sub-internships on the neurosurgery service at your home program and 1-3 away programs. In neurosurgery in particular these away rotations are important because the letter from the away program helps establish that you are a team player and a good fit. It's a small field and everybody knows everybody.

Residency: Each program structures it differently and it can vary widely, but in general the following applies.

Internship: Up to 6 months of neurosurgery. Some general surgery and electives (neurology, critical care, interventional neuroradiology).

PGY 2-6: A mix of junior resident in the unit, on the floor, consults. Depending on the model, some break the hospital in to services i.e. pediatrics, spine, cerebrovascular, trauma while others lump them together still others use an apprentice model where a resident is assigned an attending(s). For the most part juniors (PGY-2) do scut and seniors (PGY6) operate. Most programs have 1-2 years in the middle for electives and research time. This can either be protected from the call schedule, where you do not take call, or not where you are mixed in to the call schedule in varying ways (2 calls/month, weekends, etc.)

PGY 7: Chief year. Run the service/operate. Some programs have moved to having the chief be a junior faculty member with admitting privileges.

Call is very program dependent. Some are q3 for the junior years and others are q12.

Fellowship: Specialties include cerebrovascular, endovascular, spine, peripheral nerve, skull base/endoscopic, pediatrics, trauma, and functional. Depending on the structure, fellows get to pick cases over the chief, or are tasked to work with the chief and walk them through cases. Most take home call, sometimes they have admitting privileges.

 

[Cuongoff]

I am extremely interested in pursuing neuroscience research as a physician. I also want to pursue neurosurgery. Do you think the lifestyle will allow for research? Do you think the knowledge of neuroscience that you gained while in med school and maybe residency will prepare someone who wants to do basic science research (maybe not overly clinical but can have clinical implications)?

 

[neusu]

Hey!

Thanks for taking the time to do this. I have a few questions about research.

1. Can you offer any info on how to find research?
2. Does the school help with this at all?
3. Do you have any tips for how to get published once we find research?

Thanks again!

1. Look at the website for the professors in your department. Often they will have their interests listed there and you can e-mail inquiring about a project you may work on. Also, most departments have a basic science component with labs who are always looking for eager undergrads/med students for projects.
2. Your school should be able to help either through a research office, your dean of students, or perhaps more senior students who have an interest in your field. Residents are generally pretty approachable and love to farm out projects to medical students. Don't bite off more than you can chew, and stay interested. Projects take forever, keep it on the back burner even when you have other things that are demanding more time.
3. Getting published is always a chore. Write your project up early, often having a rough draft before the results are finalized helps to be able to plug the results in and revise. Hound your adviser to review the manuscript. Submit to an appropriate journal. If it's rejected, move down the spectrum in impact factor until one takes it.

 

[diagonal]

Do you know your child's name?

 

[neusu]

What is a typical day in your life?

Typical day varies. As an intern you are a run of the mill surgery grunt. PGY 2-7, we generally round from 6-7 AM or so, have a sign-out with the team over breakfast. At 7:45 the PGY-2's takes the pager and gets going running the floor/unit. I hit the OR and do from 2 to 6 cases a day, try to help the junior between cases, and get done from 6 to 10:30 pm. We have an evening sign-out for the person taking over on call around 6, post call you go to the OR until 10 (28 hour max) and finish up any loose ends before going home. The chief/senior on call takes home call and fields back-up calls from the on call junior and comes in for operative cases.

 

[neusu]

Ohhhh my goshhhh I'm so excited!!!! Thank you for making this

1. Do you know any female neurosurgeon's who got pregnant and had kids during residency and how it went for them? Is it close to impossible or is it doable?

2. Do you think someone could do neurosurgery and go into academic medicine? (like teaching residents on the side or research). Or have you seen neurosurgeon's go into healthcare management in hospitals or is that typically not a feasible career path? Sometimes it seems like neurosurgery is so daunting that it's next to impossible to do anything else on the side or advance. I just want to know how true that is.

And one more question I just thought of lol, do you need to continue studying while you're in residency? I mean with textbooks every night always brushing up on things? I heard that neurosurgery is one of the more difficult residencies and you need to be on top of you're stuff all the time but to what extent.. how often do you have to come home and study after working?

Thanks again!!!!

1. Yes, I know several women who have had children during residency. It went pretty well from what I can tell. If you're considering this I'd advise to plan for during your elective or research time. While most programs will accommodate a resident having a child on service, it is rather unfair to the team if it can be avoided.

2. Most neurosurgeons who work at university hospitals are in academic neurosurgery. They get to teach residents and that is often the reason to go in to academics. Often, a fellowship is required for this route.

3. We are constantly studying. Either for the cases the next day to review the history/physical and surgical approach or for general knowledge. We take our board exam during residency and passing is a requirement for completing residency. I generally spend 1-3 hours each evening studying and more on slow days/weekends off.

 

[neusu]

I think most of us will ask about your lifestyle and free time, and I am no exception. I will say its comforting that you have time to make this thread though.

I am interested in neurosurgery entering my first year of medical school, but I am concerned about the heavy research focus. I've done research in undergrad, but bench work isn't my favorite thing in the world. Is there a big focus on research once you're in residency, or does it "end" after med school?

Research is a focus of most residencies and most have a year dedicated to it. While bench research is great there are many other kinds out there including clinical trials, device and surgical approach design, and translational research. If research isn't your thing, when you apply look for programs that aren't as research heavy. Some will allow you to instead do an enfolded fellowship or pursue a second degree (MPH, MBA, JD).

 

[neusu]

Have you ever performed surgery on a patient with a rare neurological disease, where there was no standard of treatment established?

Do you implant a lot of medical devices as a neurosurgery resident?

I am curious because I have a rare autoimmune neuromuscular disease. It is an autoimmune autonomic neuropathy (more specifically, ganglionopathy). It is not a neurodegenerative disease because the antibodies are against the ion channels of the nerves in my spine, blocking nerve signaling. I am getting better every day and I receive IVIG treatments. I am interested in neurology and neurosurgery.

Yes, we do experimental procedures and depending on the procedure a variety of ethical and or protocol hoops have to be jumped through.

We implant a number of devices from short term ventricular and lumbar drain catheters to longer term shunts, intrathecal pumps, vagal nerve and deep brain stimulators.

I'm glad people out there are working on research that is helping you. That's our ultimate goal is to find out why/how things happen and be able to intervene in a long-standing, safe fashion to make people better.

 

[Fivo]

Has anyone in your field or at your hospital made mention of the neurosurgeon that claimed there is an afterlife?

http://news.yahoo.com/blogs/sidesho...rgeon-claims-visited-afterlife-213527063.html

If so. What is your take on the events he experienced?

 

[Cuongoff]

I was shown an article relating to this guy...and being a man with no religion...I am highly skeptical. Dr. Ben Carson, my inspiration, is a creationist. When he came to my university to speak and he mentioned creationism, I just couldn't believe it. Men of science, especially in a field like neurosurgery, should know better. Sorry, just my little rant.

Edit: And I'm not the one whose opinion you care to listen to. Oh well.

Has anyone in your field or at your hospital made mention of the neurosurgeon that claimed there is an afterlife?

http://news.yahoo.com/blogs/sidesho...rgeon-claims-visited-afterlife-213527063.html

If so. What is your take on the events he experienced?

 

[neusu]

Can you provide your general stats? USMLE, class rank, amount of research, etc.

Step 1: 99, Step 2CK: 99, Step 2CS: Pass, Step 3: I forget but pass. We didn't rank at my school. I had a number of publications and presentations at national conferences on my application.

 

[neusu]

I am extremely interested in pursuing neuroscience research as a physician. I also want to pursue neurosurgery. Do you think the lifestyle will allow for research? Do you think the knowledge of neuroscience that you gained while in med school and maybe residency will prepare someone who wants to do basic science research (maybe not overly clinical but can have clinical implications)?

I think a lot of people are interested in neurosurgery because of exposure to neuroscience as an undergrad. This is great to have a wider exposure for the field and a lot of interest in neuroscience. However, there is little actual neuroscience on a day to day basis in neurosurgery, and if you want to do a neurosurgery residency you will have to reconcile that, that for 7 years you will likely have to hang up your neuroscientist hat. Even so, there are a number of exceptional neurosurgeons who are also exceptional at neuroscience. Many will say pick one and be good at that because trying to be both will make you great at neither. If it's your true passion though, go for it. It can be and has been done.

 

[neusu]

Has anyone in your field or at your hospital made mention of the neurosurgeon that claimed there is an afterlife?

http://news.yahoo.com/blogs/sidesho...rgeon-claims-visited-afterlife-213527063.html

If so. What is your take on the events he experienced?

Have not previously seen that report nor heard of the individual. Each person has their own individual spiritual beliefs, I generally try to respect their beliefs and accommodate any special practices they require.

 

[tiedyeddog]

Thanks for doing this!

I have heard that doing the dual MD/PhD can be an application booster during neurosurgery applications. Do you think it's worth, given most neurosurgeons with an MD/PhD probably do very little bench research?

Also, just wondering, but how did you select what sub-I's to do when the time came?

Thanks!

 

[cortana431]

Was landing the neurosurgery residency extremely difficult relative to other surgical residencies? i.e were you evaluated at a higher standard and needed higher USMLE scores, grades, more extensive ec's, etc

 

[iforget2]

How much does a specialist in one field know about another field? For example, if you had a friend who was complaining about chest pain and wanted you to check it out for him, would you be able to more or less find out what's causing his chest pain?

 

[neusu]

Thanks for doing this!

I have heard that doing the dual MD/PhD can be an application booster during neurosurgery applications. Do you think it's worth, given most neurosurgeons with an MD/PhD probably do very little bench research?

Also, just wondering, but how did you select what sub-I's to do when the time came?

Thanks!

MD/PhD can boost an application. I don't think its worth it for the most part because as you mentioned not a lot of neurosurgery is bench research. If you are interested in it though go for it. One other drawback is MD/PhD is additional medical school years to an already long residency.

I spoke to the people at my home program about where they liked for rotations and picked a couple of places I wanted to look in to more or thought I'd like to go for residency.

 

[Waggles]

Do you get breaks to eat/drink/ use the bathroom during long cases? Can one surgeon take over for a while the other takes a break?

 

[neusu]

Do you get breaks to eat/drink/ use the bathroom during long cases? Can one surgeon take over for a while the other takes a break?

This depends on the case and the surgeon. Some cases naturally lend themselves to breaks: spine cases where you flip from back to front, cases with extended intraoperative monitoring, cases with slow tedious resection. Attendings vary widely, some will let you scrub out and take a bathroom break, grab a drink or some food and scrub back in. Others force you to be there the entire time. The longest case I had to stay scrubbed continuously for was 16 hours. Longer spine cases with imaging requiring lead can be tiring!

 

[neusu]

Was landing the neurosurgery residency extremely difficult relative to other surgical residencies? i.e were you evaluated at a higher standard and needed higher USMLE scores, grades, more extensive ec's, etc

Difficulty is all relative. Neurosurgery seems to self select given the sacrifice that is required to pursue this field. Objectively, neurosurgery is more selective than surgical residency based on scores etc. Also, it is a much, much smaller class as there are less than 200 spots per year for neurosurgery. Compared to other surgical subspecialties neurosurgery is equally competitive, however plastics tends to require higher board scores and is a smaller compliment.

 

[Procyon]

Is neurosurgery residency as brutal as they say? Would you say the stereotypes about neurosurgeons have a basis in fact? Do the attendings really make the, "It's not brain surgery!" joke?

 

[neusu]

How much does a specialist in one field know about another field? For example, if you had a friend who was complaining about chest pain and wanted you to check it out for him, would you be able to more or less find out what's causing his chest pain?

I'm not particularly sure why we do this, but in the hospital, neurosurgery prefers to handle things and call consults for the extremes (e.g. dialysis, MI, etc.). Outside the hospital I could certainly get a thorough H&P on my friend, but I'd need further diagnostics to tell for certain in which case I'd likely refer him to his PCP or an acute care center for further workup. On the flip-side, we are consulted by other services for nearly anything in the head.

 

[tiedyeddog]

What personal attributes are needed to not only survive but thrive and be happy in neurological surgery?

Do you think having a great home life is possible after residency, or maybe even during?

 

[GNE24]

This depends on the case and the surgeon. Some cases naturally lend themselves to breaks: spine cases where you flip from back to front, cases with extended intraoperative monitoring, cases with slow tedious resection. Attendings vary widely, some will let you scrub out and take a bathroom break, grab a drink or some food and scrub back in. Others force you to be there the entire time. The longest case I had to stay scrubbed continuously for was 16 hours. Longer spine cases with imaging requiring lead can be tiring!

Whoa cool! I think the longest I've ever worked straight was 18 hours, but that involved nowhere near the amount of detail that your work involves. Amazing.

 

[911 Turbo]

Is the average salary for ns over 500k?

 

[neusu]

Is neurosurgery residency as brutal as they say? Would you say the stereotypes about neurosurgeons have a basis in fact? Do the attendings really make the, "It's not brain surgery!" joke?

Brutal is certainly a relative term and there is a wide range of program brutality out there both on malignancy and cushiness. Working like a dog in a supportive environment vs getting shot in the back daily makes a huge difference in your outlook at work. Likewise, there are programs with reputations for being "country clug" and "blue-collar." In the former, the call schedule is more forgiving and there is a lot of support from ancillary staff and the latter a more do-it-yourself service oriented program. The saying "where there is smoke, there is fire" may have some validity regarding the reputation of neurosurgery. I feel like we're a pretty happy/easy going group but to others we may be seen as a-type, overworked *******s. We do, on average, work a lot and deal with very acute patients. Anyone who is overstressed, overworked, underfed, and underslept is going to be more salty than average. We just tend to run on that end of the spectrum at baseline and don't hide it as well at some times.

I can't say I have heard any of my attendings or coresidents use the "it's not brain surgery joke." Interestingly, during cases or say we're doing a procedure in the ED (ventriculostomy/subdural drain etc.) I have heard the anesthesia/ED/trauma etc attendings say something to the effect of "Don't worry about [x, y, z], it's not like you're doing brain surgery or anything" where [x, y, z] is some housekeeping item or inconsequential finding.

 

[SolarLuminosity]

How close has your experience been to the experience of Frank Vertosick Jr. in his book When the Air Hits Your Brain: Tales from Neurosurgery?

 

[kpcrew]

Is the average salary for ns over 500k?

apparently the median salary is around 700k

 

[nychila]

It's possible to work in private practice for neurosurgery, according to the previous post you cited from the attending? Could you explain how please?

 

[neusu]

What personal attributes are needed to not only survive but thrive and be happy in neurological surgery?

Do you think having a great home life is possible after residency, or maybe even during?

To thrive and be happy in neurosurgery you have to know what you're getting yourself in to and be prepared to make sacrifices. Residency is 7 years, and for that period, training should be the priority in your life. It really isn't the kind of field you can come in, punch the clock, hang out, and leave. Most residents feel an obligation to their patients and the team and this often fosters the strong bonds between the residents. However, every program seems to have residents who aren't as involved for various reasons. It certainly is possible to have a great home life as a resident and thereafter, but there are obligations that you have to plan around. You won't be home for dinner every night at 5 or be able to see the kids off to school in the morning. That being said, balance is key and having things you do outside of work that make you happy are important. I have a range of coresidents from single and mingle types to married with multiple kids. At the end of the day, it is still just a job and your life should be the number one priority for you. Focusing on residency during residency, though, helps get the most out of training and helps everyone around you.

 

[iforget2]

Is there anything that bothers you about being a doctor in general?

 

[Anonymous01]

With a 16 hour surgery, do you just pee in your pants? How does that work, going in if you don't know you won't be allowed to leave...

Also, are surgeons cognizant as far as avoiding caffeine or just about any liquid before surgery? I always think that surgeons probably need caffeine the most, but they're probably the least able to consume it...

 

[KinasePro]

How many hours do you work each week? (Not including studying @ home)

Could you give us a rough breakdown of nsurg patient surgical outcomes ( format= % patients enjoy full recovery: % patients with limited recovery: %patients with severe impairment: %patients with likely or imminent mortality)? I ask this because I've heard people say that nsurg has the best highs of pretty much any specialty, but the lows are very low & more frequent.

What were your 2nd and 3rd choice specialties?

 

[45408]

For the most part juniors (PGY-2) do scut and seniors (PGY6) operate. Most programs have 1-2 years in the middle for electives and research time. This can either be protected from the call schedule, where you do not take call, or not where you are mixed in to the call schedule in varying ways (2 calls/month, weekends, etc.)

How much research time can you take, and does that time have to be "replaced" elsewhere? In general surgery, taking 1-2 years to do research means a 6-7 year residency.

What year are you?

Also, are surgeons cognizant as far as avoiding caffeine or just about any liquid before surgery?

No, they completely forget about it and chug a Coke right before scrubbing in!

Yes, I am quite mindful of it. I don't drink soda unless I know that there's no chance I'll be scrubbing into a case in the next hour. Milk will keep you going for a long time (fat+protein), and you'll never have to pee from drinking milk.

 

[MangoPlant]

With a 16 hour surgery, do you just pee in your pants? How does that work, going in if you don't know you won't be allowed to leave...

Also, are surgeons cognizant as far as avoiding caffeine or just about any liquid before surgery? I always think that surgeons probably need caffeine the most, but they're probably the least able to consume it...

I too want to know.

 

[Cuongoff]

Oh no! What about those of us that are lactose intolerant? Soy milk? I think I might be fine with the protein aspect but idk about the fat part.

How much research time can you take, and does that time have to be "replaced" elsewhere? In general surgery, taking 1-2 years to do research means a 6-7 year residency.

What year are you?


No, they completely forget about it and chug a Coke right before scrubbing in!

Yes, I am quite mindful of it. I don't drink soda unless I know that there's no chance I'll be scrubbing into a case in the next hour. Milk will keep you going for a long time (fat+protein), and you'll never have to pee from drinking milk.

 

[neusu]

It's possible to work in private practice for neurosurgery, according to the previous post you cited from the attending? Could you explain how please?

Very possible, and most graduates end up in private practice. There are several models ranging from independent practice, group practice, or working for a hospital. No matter the case, you typically are associated with one or more hospitals, take call for the emergency room, and operate at those hospitals. Just like any other specialty for private practice you have to arrange for coverage when you are gone and billing etc.