Ask a neurosurgery resident anything

[nychila]

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.

Pardon me for my ignorance, but wouldn't that be very much like "working for a hospital" rather than in a purely private clinic? Are there neurosurgery clinics that are run for profit, or neurosurgeons working at a private surgery clinic? I'd imagine that the overhead would be very high as an economy of scale.

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[neusu]

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...

As Prowler mentioned we are pretty cognizant about fluids and caffeine. For a case like that that is expected to be long, not drinking a lot beforehand and emptying the tank immediately before scrubbing helps (i.e. after positioning/prepping, right before hand scrub). If you really can't hold it obviously you let the team know you have to step out for a minute, but generally it isn't an issue.

 

[neusu]

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?

Work hours vary from high 60's/70s to 120+, but average 80 over a 4-week period and tend to be near 80. Some rotations, such as research or electives, are a bit more forgiving.

In neurosurgery it is true we can some of the highest highs and some low lows and depends on the indication (emergent vs elective, spine vs cranial, etc.). I won't get in to the specific percentages because it is too broad of a question and detailed answer required for the scope of this discussion. There is a phenomenon in neurosurgery, and other surgical specialties I presume, that for certain cases there is an acceptable loss. Essentially, a complication or long-standing negative outcome from the surgery that, though undesirable, is acceptable. For example, in a brain tumor a mild hemiparesis might be an acceptable loss. That being said, the low lows are from elective patients who end up with severe deficits or young healthy people with bad diseases/trauma. I wouldn't say our lows are any more frequent than any other specialty, but perhaps scarier to the general population. A gunshot wound to the belly may result in a permanent ostomy; an inconvenience but not entirely life altering. A gunshot wound head or spine may result in aphasia, hemiplegia, or para/quadraplegia with months in rehab just to learn to walk/talk again (if at all).

I was foolish and didn't really have a 2nd or 3rd choice specialty. I would probably pick something like ENT or cardiac surgery or radiology

 

[Bangersandmash]

Pardon me for my ignorance, but wouldn't that be very much like "working for a hospital" rather than in a purely private clinic? Are there neurosurgery clinics that are run for profit, or neurosurgeons working at a private surgery clinic? I'd imagine that the overhead would be very high as an economy of scale.

I know quite a few doctors working in private groups/clinics run for profit. I don't know what their operating costs are, but believe me they are making their money.

 

[neusu]

Pardon me for my ignorance, but wouldn't that be very much like "working for a hospital" rather than in a purely private clinic? Are there neurosurgery clinics that are run for profit, or neurosurgeons working at a private surgery clinic? I'd imagine that the overhead would be very high as an economy of scale.

There are plenty of neurosurgeons who work in independent or small group practices/partnerships. They are purely for profit practices. Yes, there is an overhead for office space, office staff, any diagnostic equipment, and so on. They operate independently at outpatient surgery centers or inpatient at a hospital and bill for the procedures they perform.

 

[braindoc2016]

What medical school did you attend and what sort of programs did you do to get into that medical school (meaning summer internships and research projects)?

 

[nychila]

There are plenty of neurosurgeons who work in independent or small group practices/partnerships. They are purely for profit practices. Yes, there is an overhead for office space, office staff, any diagnostic equipment, and so on. They operate independently at outpatient surgery centers or inpatient at a hospital and bill for the procedures they perform.

For neurosurgeons who work at hospitals in private practice, do they simply rent space and equipment from the hospital/clinic, then get paid per service? Is that common?

 

[Renaissance Man]

Will you be pursuing a fellowship after your residency? Is a fellowship a common route after such a long residency? Thanks!

 

[neusu]

What medical school did you attend and what sort of programs did you do to get into that medical school (meaning summer internships and research projects)?

I went to a top midwest private school. I did sponsored research between 1st and 2nd year and interviewed/considered the HHMI program but ultimately decided against it. I had several ongoing clinical projects beginning my 1st year, mostly database management and data collection and thereafter analyzation and writing papers. I did 3 away rotations as well as my home rotation.

 

[neusu]

For neurosurgeons who work at hospitals in private practice, do they simply rent space and equipment from the hospital/clinic, then get paid per service? Is that common?

With respect to private practice, the clinical scope varies. Larger hospital/clinic based surgeons (Mayo Clinic, Cleveland Clinic, Lahey Clinic) are part of a larger group that owns the diagnostic equipment (xray, CT, MRI, etc.) and has an internal referral base. Others, depending on the scale, may rent or own the clinic space or equipment. It is entirely possible to have a small office solo practice provider establishment where you send people out for diagnostics, they bring the films on CD to your office and you schedule elective procedures at a hospital or surgery center. The hospital bills the patient for the hospital stay and you bill for your professional services.

These are two somewhat different models. If you work for the hospital, you are still in "private practice" e.g. not working for a department chairman and paying a "dean's tax" to the university, but not on a fee for service basis. You have to code for the procedures you do so the hospital can bill on your behalf and collect for it, but you are on a salary. There are different arrangements with respect to base pay and incentive bonuses, but you really aren't in practice for yourself. If you are in practice for yourself, you bill for what you do and receive that amount. You essentially "eat what you kill" and have to work with primary care providers to establish a referral base and thus a practice.

 

[neusu]

Will you be pursuing a fellowship after your residency? Is a fellowship a common route after such a long residency? Thanks!

I am undecided at this point, but am investigating fellowship opportunities. I have job offers already for private practice positions and am entertaining the idea as well. Most residents go in to private practice. There are nearly 100 neurosurgery programs in the country. Many will make a point during the interview process that their intent is to train academic neurosurgeons. If you look at their history though, nearly 50% end up in private practice. Then, there are programs that make no qualms about it that their goal is to train competent neurosurgeons to go out in the community and become practicing neurosurgeons. To be honest, a lot of the drive for creating academic neurosurgeons is legacy planning e.g. if you have chairmen of other programs come from your department that means you did a good job. Nonetheless, the world needs plenty of neurosurgeons who want to do less complex and elective cases and refer the more complicated cases on to people who specialize in that particular pathology.

 

[MilkIsGood]

I went to a top midwest private school. I did sponsored research between 1st and 2nd year and interviewed/considered the HHMI program but ultimately decided against it. I had several ongoing clinical projects beginning my 1st year, mostly database management and data collection and thereafter analyzation and writing papers. I did 3 away rotations as well as my home rotation.

how do you get started on projects during 1st year? Im going to have some free time now that anatomy is over

 

[neusu]

how do you get started on projects during 1st year? Im going to have some free time now that anatomy is over

After getting settled with classes and everything I arranged to meet some of the attendings in the department and discuss their ongoing projects. They tend to be very receptive to students who want to shadow for a day, come to clinic or the OR, or get involved in research projects. Among other possible sources of medical student summer research funding, the American Association of Neurological Surgeons has a great program for sponsoring medical student research http://www.aans.org/Grants and Fellowships/Medical Students Summer Research Opportunities.aspx Try to identify a project early, put together a proposal with your mentor, and submit for it. Showing initiative and following it through is all it takes. Just be careful, the average student shows up excited for about a week and then fades and never gets anything done. The ones who do well realize it's a long/slow process and stick with it.

 

[braindoc2016]

What types of things would you suggest for a student inundergraduate studies to do in order to become a competitive applicant for topmedical schools?

 

[A7X]

This thread is really informative.

 

[neusu]

What types of things would you suggest for a student inundergraduate studies to do in order to become a competitive applicant for topmedical schools?

Study well, do well in class and score good marks which prepares you best for the MCAT. Do well on the MCAT. Try to get involved in research. Have a life outside of school so you are well rounded.

For what it's worth, you can match in to neurosurgery from any accredited medical school in the world. Coming from a top US allopathic school just makes it slightly easier. It remains, nonetheless, a lot of hard work and a bit of luck.

 

[neusu]

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.

Most programs allocate 1 year of electives and 1 year of research which is included in the 6 or 7 year total. The neurosurgery ACGME/RRC recently decided that all programs have to be 7 years now and require 54 months of on-service neurosurgical rotations which leaves 18 months after internship for electives/research. There is a push to mandate both a 6-month neuro-interventional radiology rotation and a 6-month neurocritical care rotation. The intern year is changing slightly as well. There remains a possibility of up to 6 months of neurosurgery time and then 6 months that can be filled in with neurology, critical care, general surgery, or interventional neuro-radiology. So to answer your question, the 2 years are included in the 7 year total.

 

[neusu]

Do you know your child's name?

No children. I'd probably remember their names and be able to tell you his/her birthday if asked, but forget the week of that it is coming up, and have to grab a cake/card on my way home from the hospital.

 

[Bangersandmash]

No children. I'd probably remember their names and be able to tell you his/her birthday if asked, but forget the week of that it is coming up, and have to grab a cake/card on my way home from the hospital.

Gotta love the honesty.

I know you've been talking a little bit about cranial and spinal cases, but what would you say the breakdown of your procedures are between cranial operations, spinal operations and peripheral nerve operations? I've seen many threads in the neurosurg forum saying a 70/30 split for spine/brain.

And how involved are non-operative consultations (I.e. pre-op/post-op care and management with patients)?

 

[neusu]

Gotta love the honesty.

I know you've been talking a little bit about cranial and spinal cases, but what would you say the breakdown of your procedures are between cranial operations, spinal operations and peripheral nerve operations? I've seen many threads in the neurosurg forum saying a 70/30 split for spine/brain.

And how involved are non-operative consultations (I.e. pre-op/post-op care and management with patients)?

At an academic medical center we tend to be closer to 50% cranial 50% spine. In private practice it trends more towards your numbers and there are guys out there who are 100% spine.

Non-operative consultations tend to pretty easy. We make an initial eval, recommend follow-up studies or testing, and follow along until the patient is neurologically stable. Depending on the admitting pattern and arrangements with the surgery/medicine/trauma services, non-op ED consults for neurosurgery patients is painful because the patient inevitably ends up on the neurosurgery service. Having to round on an isolated head bleed or compression fracture for a week or two because the patient can't be placed or develops hospital acquired everything is not enjoyable.

 

[neusu]

Does it feel good when you are at the bar and a hot girl asks you what you do for a living and you reply "im a neurosurgeon"?

Most people are less than impressed and crack some joke about it not being brain surgery.

 

[neusu]

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?

Sorry, haven't read that one. I'll get back to you after I do.

 

[Vitals]

Is hand-eye coordination more or less important compared to other surgical specialties?

 

[SnoopyMD]

How rampant is litigation in the field of neurosurgery compared to OB/GYN?

 

[neusu]

Is hand-eye coordination more or less important compared to other surgical specialties?

For any surgical specialty hand-eye coordination is likely more important than for nonsurgical specialties given the nature of the field. That being said, unless you have two left hands most of surgery can be learned. Everyone has a tremor the severity of which varies from person to person and even intra-person due to factors like sleep deprivation, caffeine intake, and nervousness. This can typically be compensated for and isn't an issue. There is a saying in neurosurgery that "you can teach a monkey to operate," meaning the surgery itself isn't the most demanding feat of a neurosurgeon but the pre- and post-operative care for the patient as well as proper patient selection.

 

[neusu]

I can't speak for ob/gyn directly, but my friends who are in the field seem to convey they are also in a highly sued field.


In medicine in general, you should expect to be sued. Fields with where patients have high expectations that can not always be delivered, no matter how poor the prognosis is painted, will be sued more. Society in general seems to have the opinion that doctors, and science, should be infallible and when things that naturally happen do happen they become upset. Life and limb are not like a used car where if you aren't satisfied with the product or repair you can have it replaced. The stakes are much higher, both emotionally and physically.

While the likelihood of being sued may be equal, the reasons are widely different. An Ob that has a delivery complication can be sued for lifetime care and loss of wages etc. A neurosurgeon can also be sued for lifetime wages, but it's harder to argue a mid-40s factory worker has a shot at being center fielder for the yankees.

 

[punkedoutriffs]

I can't speak for ob/gyn directly, but my friends who are in the field seem to convey they are also in a highly sued field.


In medicine in general, you should expect to be sued. Fields with where patients have high expectations that can not always be delivered, no matter how poor the prognosis is painted, will be sued more. Society in general seems to have the opinion that doctors, and science, should be infallible and when things that naturally happen do happen they become upset. Life and limb are not like a used car where if you aren't satisfied with the product or repair you can have it replaced. The stakes are much higher, both emotionally and physically.

While the likelihood of being sued may be equal, the reasons are widely different. An Ob that has a delivery complication can be sued for lifetime care and loss of wages etc. A neurosurgeon can also be sued for lifetime wages, but it's harder to argue a mid-40s factory worker has a shot at being center fielder for the yankees.

How do you personally handle the stress of actual/potential litigation? Does it change how you practice or treat the patient?

 

[neusu]

How do you personally handle the stress of actual/potential litigation? Does it change how you practice or treat the patient?

I've personally been named twice in lawsuits. The first, I was dropped immediately as the accuser did a chart biopsy and named anyone who was in the chart. The second is still in discovery so I can not really discuss that. It is not uncommon to be named in suits as a neurosurgeon or a resident in training (all of the attendings I have worked with and 70% of the residents have been involved in a lawsuit at some level). The level to which it sticks varies depending on the validity of the claim. Our risk management department says for our field, based on their numbers, most suits (>60%) are dropped or thrown out. Of the remaining, most (>80%) are settled and the remainder make it to trial.

Everyone handles stress differently. Neurosurgery is relatively stressful to begin with, so having a good stress defusing network in place helps. I personally try to compartmentalize things to some degree. I suspect most of you have never been sued, but the initial document you receive is pretty nasty. I personally have a philosophy of always see the patient, do the right thing, and admit/acknowledge when you're wrong. That being said, I try not to take personally the allegations in the suit document and leave it to the attorneys, that's what malpractice insurance is for.

My personal outlets for stress are exercise, being with friends, and reading. I've learned that even if I think I will be exhausted, waking up 30 minutes earlier to run or lift weights leaves me feeling a lot better throughout the day. Having good relationships in and outside of work helps allow you to both stay grounded and relate to others. Finally, just having time for yourself and what you want to do is important. After all, how can you take care of someone else if you don't take care of yourself?

 

[squat]

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...

cath bag?

 

[squat]

And life after residency? Do you see yourself continuing to work 80-hour weeks or is that just part of the in-training lifestyle? Do those going into academic neurosurgery have more of a "normal" life with shared call for their 50%-or-so clinical practice?

 

[lazymd]

How...

...many hours of sleep do you get on average?

...many days off per month ?

...bad is the call schedule in academia?


Thanks again!

 

[neusu]

How...

...many hours of sleep do you get on average?

...many days off per month ?

...bad is the call schedule in academia?


Thanks again!

When I'm on call I get 0 overnight, maybe 2-4 hour nap post call. Most nights I get 4-6 hours.

I get 4 days off per month.

In practice call can vary depending on structure for the practice, all residency programs are at academic centers. A lot of places have attendings take call for a week straight and then rotate through all of the attendings (i.e. 1 week every 6 weeks). Some let the chief resident have admitting priveleges and therefore the attendings are only on call for questions about their own patients and not for the ER.

 

[neusu]

And life after residency? Do you see yourself continuing to work 80-hour weeks or is that just part of the in-training lifestyle? Do those going into academic neurosurgery have more of a "normal" life with shared call for their 50%-or-so clinical practice?

Once you get used to it, 80 hours is not as much as it sounds. I'd like to have a little more free time and vacation but overall I am pretty happy with how things are. I don't have kids, so I imagine things will change when the day comes. The attendings seem to have a normal life. Even at academic centers, not many surgeons have specific lab time so they are 100% clinical. After residency I imagine I'l continue working hard, I'm not one to slow down even if the opportunity is there.

 

[ClemsonFirst]

I just want to say thank you for making this thread. The questions have been good and all of your answers have been spectacular and insightful. This is probably the only thread I check every time I log on because I know it is informative and keeps me entertained.

 

[Tipp]

I just want to say thank you for making this thread. The questions have been good and all of your answers have been spectacular and insightful. This is probably the only thread I check every time I log on because I know it is informative and keeps me entertained.

Same here. Thanks a lot!

Also, do you do a lot of work with technology like implants? Someone I know just got some sort of implant in his chest with wires linking it to his brain, and he controls it with a remote. I'm not even sure exactly what it does, but he got it to remedy a problem he had with a sort of tremor/spatial awareness problem. It was very interesting to see and I was just curious about how common procedures like that are.

 

[RomanTaylor]

This is the one of the most informative AMAs that I have every read and participated on! You're the man, thanks again!!!

 

[neusu]

Same here. Thanks a lot!

Also, do you do a lot of work with technology like implants? Someone I know just got some sort of implant in his chest with wires linking it to his brain, and he controls it with a remote. I'm not even sure exactly what it does, but he got it to remedy a problem he had with a sort of tremor/spatial awareness problem. It was very interesting to see and I was just curious about how common procedures like that are.

Thanks guys, I'm glad you appreciate it and I am able to provide some insight in to our field. In a lot of places, student exposure to the neurosurgery department remains low which leaves a lot of doctors out there not entirely sure what we do.

We do a lot of work with different types of implants. The most common are ventricular shunts that is basically a tube from the ventricle in the brain to somewhere else in the body (abdomen, lung, heart) to allow for the pressure from extra CSF to be relieved. Other common implants are intrathecal pumps and deep brain, spinal cord, or vagal nerve stimulators Pumps are for pain or spasticity and contain a narcotic and or baclofen. The pump itself sits in the subcutaneous abdominal fat and the catheter enters the spinal column/thecal sac in the lumbar spine. Deep brain stimulators have the pulse generator in the infraclavicular region and the stimulator itself is placed in a specific target in the brain. Deep brain stimulation helps with tremor, parkinsons, and several other indications. Vagal nerve stimulators are also infraclavicular, though sometimes they are placed deep to the breast on the supra pectorial fascia for cosmesis. The leads sit on the vagal nerve and the generator is used to prevent seizures. Spinal cord stimulators are typically placed in the thoracic spine and are generally for persistent back pain. The generator is either in the "wallet pocket" over the gluteal muscle (think where you would put a wallet in a pair of pants) or in the anterior subcutaneous fat like a intrathecal pump.

We also implant hardware that doesn't function such as screws and rods for spinal surgery, screws and plates for cranial fixation, and prosthetic bone pieces for cranial defects.

 

[wholeheartedly]

What are some of your favorite things about the field ?



(sorry if someone asked that, I've read the whole thread as it's been posted and don't remember that one)

 

[Tipp]

Thanks guys, I'm glad you appreciate it and I am able to provide some insight in to our field. In a lot of places, student exposure to the neurosurgery department remains low which leaves a lot of doctors out there not entirely sure what we do.

We do a lot of work with different types of implants. The most common are ventricular shunts that is basically a tube from the ventricle in the brain to somewhere else in the body (abdomen, lung, heart) to allow for the pressure from extra CSF to be relieved. Other common implants are intrathecal pumps and deep brain, spinal cord, or vagal nerve stimulators Pumps are for pain or spasticity and contain a narcotic and or baclofen. The pump itself sits in the subcutaneous abdominal fat and the catheter enters the spinal column/thecal sac in the lumbar spine. Deep brain stimulators have the pulse generator in the infraclavicular region and the stimulator itself is placed in a specific target in the brain. Deep brain stimulation helps with tremor, parkinsons, and several other indications. Vagal nerve stimulators are also infraclavicular, though sometimes they are placed deep to the breast on the supra pectorial fascia for cosmesis. The leads sit on the vagal nerve and the generator is used to prevent seizures. Spinal cord stimulators are typically placed in the thoracic spine and are generally for persistent back pain. The generator is either in the "wallet pocket" over the gluteal muscle (think where you would put a wallet in a pair of pants) or in the anterior subcutaneous fat like a intrathecal pump.

We also implant hardware that doesn't function such as screws and rods for spinal surgery, screws and plates for cranial fixation, and prosthetic bone pieces for cranial defects.

Oh ok yea it was definitely some sort of deep brain stimulator. That's so awesome, the stuff that you guys can do now.

 

[neusu]

What are some of your favorite things about the field ?



(sorry if someone asked that, I've read the whole thread as it's been posted and don't remember that one)

I like the people in neurosurgery, everyone is hard working and a team-player. I like the things we treat from elective spine to spinal cord injury, brain tumor to ruptuered or unruptured aneurysms. I like the toys we get to play with like intraoperative MRI, drills and saws, 3D imaging, and neuromodulation devices. More than anything though, I like learning about the brain, how it works, why it stops working, and how we can fix it.

 

[squat]

I like the people in neurosurgery, everyone is hard working and a team-player. I like the things we treat from elective spine to spinal cord injury, brain tumor to ruptuered or unruptured aneurysms. I like the toys we get to play with like intraoperative MRI, drills and saws, 3D imaging, and neuromodulation devices. More than anything though, I like learning about the brain, how it works, why it stops working, and how we can fix it.

This has been so informative. Another thread I've been reading says (basically), "you know what specialty you want to do before you even start rotations."

I DO know my personality type, but there is so much in medicine that I haven't had exposure to. This thread has been great!

When you were doing your electives, what did you pick? I am interested in neurology, but I don't know if I see myself in surgery. During the typical neuology rotation, how much is a student exposed to neurosurgery? Are there a few rotations you recommend applying to?

 

[pv515]

I'm interested to know whether you came into med school thinking about doing neurology or neurosurgery. I always hear that most med students do not end up doing what their initial instinct is entering med school.

Would you say that most neurosurgeons pick the field themselves, or does the field "pick you" while you're in med school?

Depending on your answer, is it the same way with other surgical fields?

 

[UrshumMurshum]

Have you read the case study on treating parkinson's with autologous stem cells?

There is currently clinical trials in the UK employing autologous stem cell surgeries for stroke damage, when do you think stem cell therapies will become common practice in neurosurgery?

Will you be conducting any surgeries utilizing autologous stem cells (derived from patient's brain) during your residency?

 

[neusu]

This has been so informative. Another thread I've been reading says (basically), "you know what specialty you want to do before you even start rotations."

I DO know my personality type, but there is so much in medicine that I haven't had exposure to. This thread has been great!

When you were doing your electives, what did you pick? I am interested in neurology, but I don't know if I see myself in surgery. During the typical neuology rotation, how much is a student exposed to neurosurgery? Are there a few rotations you recommend applying to?

Some schools allow for elective time and/or neurology or neurosurgery during the 3rd year. I spent some time on neurosurgery as part of my surgery clerkship and then did sub-internships during 4th year. Typically, rotating on neurology will not grant much exposure to neurosurgery. There is a fair amount of interaction between the services in the form of consultation but other than that there is little overlap or co-management.

If you think you might be interested in neurosurgery look in to the possibility of being on service during your 3rd year, if you like it, apply for sub-internships. Typically those who apply do 2-4 sub-internships (including a home rotation) during 4th year. Most other electives are purely for your own interest. I go back and forth between recommending taking had things you may not have much of an interaction with in the future to learn the most (e.g. cardiology, oncology, etc.) or whatever is easiest so you can kick your feet up before residency.

 

[neusu]

I'm interested to know whether you came into med school thinking about doing neurology or neurosurgery. I always hear that most med students do not end up doing what their initial instinct is entering med school.

Would you say that most neurosurgeons pick the field themselves, or does the field "pick you" while you're in med school?

Depending on your answer, is it the same way with other surgical fields?

I knew I wanted to do neurosurgery coming in to medical school and got involved in research in the department during the fall of my M1 year. Most students change their career goals various times throughout medical school. I was either lucky enough to know coming in or foolish enough to follow through with it, but I went in to 3rd year trying each rotation on to see if I would be happy doing that for the rest of my life. Invariably, there were things I enjoyed about each rotation and things I did not. At the end of the day, my worst days of neurosurgery are still better than the best days I had in the other fields.

I think neurosurgery is rather unique as both applicants self select and successful applicants are selected. Most students are deterred by the length of training and physical/mental/time demands involved. The ones who remain interested are generally well qualified, but are further vetted on rotations. Something that isn't talked about a lot is that there is a reasonably high attrition rate even after this. Over the years, I have noticed roughly 10% or so of the people in my "class" (the people I interviewed with) are no longer in neurosurgery. Most of these people are incredibly smart and capable doctors and likely did not leave for lack of ability. It is a long, hard road and things change, be it family or personally, that maybe it isn't what they wanted to do anymore or maybe they went in to it for the wrong reasons. I think this is similar to other surgical fields, perhaps the novelty wears off or something more important in life happened that can not be delayed. Nonetheless, I wasn't interested in other surgical fields so I can't say with much accuracy how their residents found the field. I get the impression, though, that not many students came to medical school knowing they wanted to do urology or otolaryngology, but instead found it during medical school. Orthopaedics, on the other hand seems to have an abundance of interest early in medical school.

 

[iforget2]

Are there certain things you don't like about being a physician in general?

 

[neusu]

Have you read the case study on treating parkinson's with autologous stem cells?

There is currently clinical trials in the UK employing autologous stem cell surgeries for stroke damage, when do you think stem cell therapies will become common practice in neurosurgery?

Will you be conducting any surgeries utilizing autologous stem cells (derived from patient's brain) during your residency?

I probably skimmed the report but at the moment recall neither the institution where it was conducted nor the results.

Neuroregeneration is a very active field of research and neurosurgeons are implicitly involved on several levals. At my institution, we are involved in trials for implanting multiple vectors including stimulators, viral transduction, and are investigating stem cells. The involvement of neurosurgeons ranges from those who conduct basic science research to develop the vectors, to pre-clinical animal testing, to human clinical trials. As you can imagine, the process is exceptionally long, costly, and arduous to transition from an idea to human trials. Nonetheless, we remain dedicated to the pursuit of developing future treatments.

 

[neusu]

Are there certain things you don't like about being a physician in general?

There are a multitude of things I dislike about being a physician. Many of our patients have no interest in their own health or safety. After you have done your 4th hemicraniectomy on the same patient for being a for a homeless alcoholic you begin to wonder why you do what you do. Families can be very demanding, and aggressive because they are uninformed and scared, and sometimes interactions therein can be difficult. Our health care system is flawed, so patient disposition is often an issue.

Being a physician has lost its luster in the eye of the public. Part of it is our fault for being so greedy, for letting midlevels and ancillary staff displace our presence, and for not knowing what to do. Nonetheless, I still think it is a great profession and am happy I went in to it.

 

[deanthedream17]

I have heard from two former neurosurgery residents that residents in surgery specialties especially neurosurgery are treated like crap from the attendings. To what extent is this true?

 

[neusu]

I have heard from two former neurosurgery residents that residents in surgery specialties especially neurosurgery are treated like crap from the attendings. To what extent is this true?

This very much depends on the program. There are malignant programs out there that you get treated like **** and hospitable programs that you aren't. Fortunately, my program is in the latter group.