Ask a neurosurgery resident anything

[neusu]

Hi thanks for doing this!

Out of curiosity, did you know anyone who wanted to go into neurosurgery that was unsuccessful/didn't match?

If so, what seems to be most common reason for unsuccessful applicants (bad step, no pubs, bad pre-clinical/clinical grades, etc.) ?

I know of several people who wanted to go in to neurosurgery and did not match. There does not seem to be one universal killer, all of the mentioned things play a role as well as letters and interviews. Gauging competitiveness can be difficult. Having deficits in more than one of those areas, however, likely is the killer.

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[qeee]

Hello Neusu!
I really like this thread and i think it's one of the best threads here at SDN. I am medical student from Charles University in Prague (CZE, Europe). I've always wanted to be a surgeon and next year I'll finish school and become M.D. In general, i find surgery very interesting, but long time i couldn't decide what surgical speciality would fit to me. I like plastics but in our country is imposible to match in this field, but now i spent some time shadowing a neurosurgeon and I love just the idea of operating on brain and spine and super-cool technology behind it. I have to say this thread helped me a lot to decide.

I have few questions - 1. I know you love NSGY, but if you couldn't do NSGY, what surgical field would you choose?
2. I am left handed, do you think it can be problem for a neurosurgeon?
3. I found NSGY surgeries very interesting but the the whole process looks always the same - you now crani, opening of dura, pia, ressection of tumour, closing and thinks like that - do you think neurosurgeons become bored after years of practicing it and the surgeries become like 'boring routine' for them? Or do you think that older neurosurgeons after years of practicing it are in general satisfied with their carreer choice?

Thank you very much for this thread it really helps me decide about my future carreer, you are truly inspiring person.

(and sorry for my basic english )

 

[neusu]

Hello Neusu!
I really like this thread and i think it's one of the best threads here at SDN. I am medical student from Charles University in Prague (CZE, Europe). I've always wanted to be a surgeon and next year I'll finish school and become M.D. In general, i find surgery very interesting, but long time i couldn't decide what surgical speciality would fit to me. I like plastics but in our country is imposible to match in this field, but now i spent some time shadowing a neurosurgeon and I love just the idea of operating on brain and spine and super-cool technology behind it. I have to say this thread helped me a lot to decide.

I have few questions - 1. I know you love NSGY, but if you couldn't do NSGY, what surgical field would you choose?
2. I am left handed, do you think it can be problem for a neurosurgeon?
3. I found NSGY surgeries very interesting but the the whole process looks always the same - you now crani, opening of dura, pia, ressection of tumour, closing and thinks like that - do you think neurosurgeons become bored after years of practicing it and the surgeries become like 'boring routine' for them? Or do you think that older neurosurgeons after years of practicing it are in general satisfied with their carreer choice?

Thank you very much for this thread it really helps me decide about my future carreer, you are truly inspiring person.

(and sorry for my basic english )

Thank you for reading, I am happy to hear you find this thread useful.

1) Tough question. In surgery I always liked cardiac surgery, so I suspect that. More related to neurosurgery, I like the skull base and reconstructive parts of otolaryngology and plastic surgery. Outside of medicine, I would probably be in research, engineering, or finance.

2) There are plenty of left handed surgeons. You will have to learn to adapt things to your handedness, but it should be fine.

3) Most anything in life can be deconstructed to its banal parts. Finding joy within helps keep things interesting. I won't lie, many surgeries can be routine, as you describe. That being said, every patient has different anatomy and every surgery is different. Likewise, as a passive observer, you may not have the knowledge base, as of yet, to appreciate the subtleties or dangers avoided by meticulous technique or excellent planning. It is an exhilarating feeling to turn a daunting, challenging surgery in to a routine walk in the park.

 

[Dvn711]

Wow, I'm glad I found this! I'm currently pre-med hoping to go into neurosurg.... I'm already in my early 30s. Do you see many... "Late bloomers" where you are? Any issues you think I may come into and advice for that? While, I know I'm not anywhere near the oldest going in, I'm not the youngest either, especially since I plan on doing the MDPhD route.

Also, I'm looking to focus on spinal nerve repair and nerve/prosthetic integration vs. the brain. I'm assuming this would still be in the neurosurgery subspecialty, or should I be focusing somewhere else?

Lastly, arguably the most important question you've received on here, do you participate in the annual neurosurgery softball tournament? How awesome is it?

Thank you for doing this!

 

[Psai]

Wow, I'm glad I found this! I'm currently pre-med hoping to go into neurosurg.... I'm already in my early 30s. Do you see many... "Late bloomers" where you are? Any issues you think I may come into and advice for that? While, I know I'm not anywhere near the oldest going in, I'm not the youngest either, especially since I plan on doing the MDPhD route.

Also, I'm looking to focus on spinal nerve repair and nerve/prosthetic integration vs. the brain. I'm assuming this would still be in the neurosurgery subspecialty, or should I be focusing somewhere else?

Lastly, arguably the most important question you've received on here, do you participate in the annual neurosurgery softball tournament? How awesome is it?

Thank you for doing this!

Dude you'll be like 50 years old when you're done

 

[neusu]

Wow, I'm glad I found this! I'm currently pre-med hoping to go into neurosurg.... I'm already in my early 30s. Do you see many... "Late bloomers" where you are? Any issues you think I may come into and advice for that? While, I know I'm not anywhere near the oldest going in, I'm not the youngest either, especially since I plan on doing the MDPhD route.

Also, I'm looking to focus on spinal nerve repair and nerve/prosthetic integration vs. the brain. I'm assuming this would still be in the neurosurgery subspecialty, or should I be focusing somewhere else?

Lastly, arguably the most important question you've received on here, do you participate in the annual neurosurgery softball tournament? How awesome is it?

Thank you for doing this!

Neurosurgery generally looks for more maturity in the applicants, those who are exceptionally young can be seen as a risk. Unfortunately, those on the opposite end of the spectrum are also seen as a risk. You certainly may have the drive and ambition to do the job, but human physiology is inescapable. As we age, we are less resilient, less able to accommodate. Staying awake for 30-hours straight every 3rd day for years is taxing for a 30-year old, but ominous for a 40 year old. While not impossible, and there are plenty of examples out there, it is the exception, not the rule.

I'm not sure what you mean by spinal nerve, but I'll assume spinal cord and peripheral nerve. Neurosurgery certainly is involved in this field of research and surgery. If peripheral nerve, in itself, were your desire other fields such as orthopaedics or plastic surgery also do a fair amount of these surgeries.

Unfortunately, I have not had the opportunity to play in the tournament. From colleagues and friends who have, they enjoyed it, and it is for a good cause. We would joke that those who had previous experience playing baseball or were athletic got extra points on their application to stack our prospective team.

 

[Kazaki]

I'm interested in neuroscience in general. Is there any actual neuroscience in neurosurgery besides functional neurosurgery? Do neurosurgeons do any of the diagnosing? Since they're tertiary providers mostly, do they only see patients who have been referred to them by other doctors? My understanding is that if you're torn between neurology and neurosurgery, then neurosurgery probably isn't the best choice to go with. Yay or nay?
If you had to do something besides neurosurgery, would you choose neurology or another surgical subspecialty?

 

[neusu]

I'm interested in neuroscience in general. Is there any actual neuroscience in neurosurgery besides functional neurosurgery? Do neurosurgeons do any of the diagnosing? Since they're tertiary providers mostly, do they only see patients who have been referred to them by other doctors? My understanding is that if you're torn between neurology and neurosurgery, then neurosurgery probably isn't the best choice to go with. Yay or nay?
If you had to do something besides neurosurgery, would you choose neurology or another surgical subspecialty?

On a day to day basis, there is not a ton of neuroscience in clinical medicine. For specific pathology, we will review the pathways, receptors, and such.

The diagnosis is performed by different providers in different settings. For clinic, you are correct, many of the referrals are specifically worked up and sent for a surgical assessment. In the hospital or emergency department, most patients present with a complaint and partial workup. We as surgeons play a role in determining tests, and if necessary, surgery, to help in the diagnosis. Tumors, for example, we often have a short differential prior to surgery. The pathologists make the final diagnosis.

Many students face the neurology vs neurosurgery question. I wouldn't say, "if it is even a question, don't do neurosurgery." However, focus on the negatives of neurosurgery and see if it is something that still interests you.

If I had to do go back and something else, I likely would do another surgical subspecialty. If neurosurgery ended today, I still might try to transition to another surgical field, I love surgery. That being said, the lifestyle for neurology certainly is something not to overlook.

 

[The Knife & Gun Club]

Thanks again for doing this! All us premed n00bs really appreciate it

If I had to do go back and something else, I likely would do another surgical subspecialty. If neurosurgery ended today, I still might try to transition to another surgical field, I love surgery. That being said, the lifestyle for neurology certainly is something not to overlook.

How does the lifestyle of neurosurgery compare with that of other surgical specialities (or surgery in general)?

In your opinion are there notables pros/cons in how neurosurgery is practiced vs other surgical fields, say CT or Ortho surgery?

 

[The Buff OP]

Doritos Nacho Cheese or Cool Ranch?

 

[neusu]

Thanks again for doing this! All us premed n00bs really appreciate it



How does the lifestyle of neurosurgery compare with that of other surgical specialities (or surgery in general)?

In your opinion are there notables pros/cons in how neurosurgery is practiced vs other surgical fields, say CT or Ortho surgery?

I'd have to say the lifestyle is comparable to general surgery. This depends on the practice, naturally. Specialties that can have a more office based practice tend to have a better lifestyle e.g. opththo, ENT, urology, and even PRS. The amount of call, and type of call makes a big difference. That is, call at a trauma center is typically more intense than call for a non-trauma hospital.

I'm not sure what you mean by pros/cons in how neurosurgery is practiced. Like CT surgery, neurosurgery (at least cranial neurosurgery) requires a fair amount of infrastructure (advanced imaging, intensive care, ancillary services [neurology, neuro-onc/rad onc, pt/ot]). Ortho can range from purely elective procedures to trauma. We overlap in spine and peripheral nerve. For the most part, however, neurosurgery cases tend to be longer e.g. a lumbar fusion takes an hour or two whereas a hip or knee replacement is less than an hour.

Generally, the sentiment is that spine is reimbursed rather well compared to cranial, and we are happy about this. Essentially, we ally ourselves with ortho so that it is reimbursed well because the orthopedic representation at the Relative Value Scale Update Committee (RUC) meeting is larger. Thus, a balanced practice allows spine reimbursement to offset cranial.

 

[neusu]

Doritos Nacho Cheese or Cool Ranch?

Not much of a chip guy anymore. I used to love the classic nacho cheese, but the tangy taste of cool ranch was refreshing as well.

 

[Rifampicin]

1. Does your hospital have a neurosurgery training program? Being a referral center does help increase the volume of things that naturally occur less frequently. It would be tough to tell though, if 120 is sufficient. How many other residents are sharing these cases? How is the neuro/rad-onc at your center? If research is important to you, it might be worth spending a couple years at a center in another country that has a strong research program. Alternatively, attend a meeting or two and get some ideas on how you can structure a program in your center. A single center/national experience in a 3rd world country is an important study to help understand the global presentation, management, and impact of the diseases we treat.

2. As a resident, we typically operated every day of the week. We had designated didactics/clinics, but would have to cover cases as well. My program is probably 60% spine and 40% cranial. Operative trauma tends to be relatively uncommon, but can come in waves. I've had stretches where I only had 2 emergency craniotomies in a week or 7 in 24 hours. Same with spine trauma. The vast majority is non-operative, but occasionally we'll have them stacked up and be operating constantly.

Thanks for your answer, Neusu!

Yeah, our hospital does have a neurosurgery training program. The neurosurgery department (and residency program) is literally the oldest in our country (it was established around 1960s, I think).
Our program admits 1-2 residents every year. It's 6 years in length. There are 2 or 3 tumour and neuro-oncology consultants, but neurosurgeons from other divisions (e.g., cerebrovascular, functional, spine) can delve into tumour as well if they wish to.
Unfortunately, I don't know how tumour cases are shared among residents and consultants. I'm gonna inquire one of the neurosurgery residents, though.

We do have a decent rad-onc department, relatively speaking. Our hospital is one of the only 2 centers equipped with Gamma Knife technology in the country.

 

[The Buff OP]

Not much of a chip guy anymore. I used to love the classic nacho cheese, but the tangy taste of cool ranch was refreshing as well.

So you rather eat like Triscuits? Those are bomb too.

 

[NeuResurgens]

I apologize if it was asked before - how does the lifestyle and salary differ between academic neurosurgery and private practice? You mentioned how these factors can be different between various private practices, so is there variability in things like hours per week depending on what kind of academic setting or program you're working in? Further regarding academics, what kind of research commitments do academic neurosurgeons have - more clinical or basic science? Ratio of research time to clinical time? Are there variations where more time is spent teaching residents vs. performing research, or are they generally equal? Finally, do most academics generally get fellowship trained? Sorry it's a confusing multi-faceted question, I think what I'm really trying to get a handle on is whether you can pursue your particular preferences and interests in academic surgery like you can in private practice. I'm interested in maybe working in this setting but my interests are clinical/teaching > research so I'm not sure how feasible that is. Any light you could shed on academics would be much appreciated since I don't know as much about it!

 

[neusu]

So you rather eat like Triscuits? Those are bomb too.

As of late, I've been on a health kick, so no snacking at all. As a kid, though, my mom would have Wheat Thins or Triscuits. We really only had chips to go with sandwiches, but Doritos were certainly my favorite. In college I like the jalapeno or sea salt & vinegar kettle chips, but would have Doritos periodically to reminisce. Be careful with the Cooler Ranch though. As opposed to the Nacho Cheese, which have 2 ingredients (cheese and chips), the Cooler Ranch evidently have over a million http://www.theonion.com/article/doritos-celebrates-one-millionth-ingredient-19914 Needless to say, everything in moderation I suppose.

 

[neusu]

I apologize if it was asked before - how does the lifestyle and salary differ between academic neurosurgery and private practice? You mentioned how these factors can be different between various private practices, so is there variability in things like hours per week depending on what kind of academic setting or program you're working in? Further regarding academics, what kind of research commitments do academic neurosurgeons have - more clinical or basic science? Ratio of research time to clinical time? Are there variations where more time is spent teaching residents vs. performing research, or are they generally equal? Finally, do most academics generally get fellowship trained? Sorry it's a confusing multi-faceted question, I think what I'm really trying to get a handle on is whether you can pursue your particular preferences and interests in academic surgery like you can in private practice. I'm interested in maybe working in this setting but my interests are clinical/teaching > research so I'm not sure how feasible that is. Any light you could shed on academics would be much appreciated since I don't know as much about it!

A general rule of thumb is folks in PP make 2x what those in academics make. Obviously, this is a crude assessment and many, many factors contribute to salary.

You can have whatever type of practice you want, you just have to pay for it. By pay, I mean either with time, work, or sacrifice of another interest. Love research? Me too. Want to have a day or two a week (or more) dedicated? Compensation is decreased. Love money? Who doesn't? Doing cases and seeing patients is what makes money. Love teaching? Residents and students are great. They also, often, slow cases down and decrease the number you can do in a day. Yes, they have benefits of rounding and putting in orders, but are you willing to take a 50% cut in your salary for that luxury?

Most academic neurosurgeons have a research interest. Clinical research tends to be easier, and less time consuming, than bench research. Those with basic science interests may have dedicated time, be it 20%, 50% or 80%. The productivity requirement varies by department. Many have no clear-cut minimum, but it inevitably comes up at your tenure meeting. Some departments have an annual publication requirement.

Medicine is somewhat of a business, and while academics centers understand they exist to be innovative and educate future surgeons, at the end of the day, the bills have to be paid. These ideals, teaching and research, do not reimburse well. A good academic department will have some sort of factor to offset those who focus more on teaching or research loss of RVUs, but many do not. Thus, those efforts often take a back seat to clinical practice and keeping the patients coming in and going out.

Many people pursue fellowship because of their academic interest, or to help with securing a job at an academic center. Keep in mind, when you join a practice as the more junior surgeon, you still have to build a practice. You take more call, often have the cases no one else wants, and have to balance the new found independence with judgement.

So yes, academics affords one the ability to pursue interests in medicine. You can as well in private practice, but ability to teach or research infrastructure is often less than an academic department. Hope this helps.

 

[NeuResurgens]

A general rule of thumb is folks in PP make 2x what those in academics make. Obviously, this is a crude assessment and many, many factors contribute to salary.

You can have whatever type of practice you want, you just have to pay for it. By pay, I mean either with time, work, or sacrifice of another interest. Love research? Me too. Want to have a day or two a week (or more) dedicated? Compensation is decreased. Love money? Who doesn't? Doing cases and seeing patients is what makes money. Love teaching? Residents and students are great. They also, often, slow cases down and decrease the number you can do in a day. Yes, they have benefits of rounding and putting in orders, but are you willing to take a 50% cut in your salary for that luxury?

Most academic neurosurgeons have a research interest. Clinical research tends to be easier, and less time consuming, than bench research. Those with basic science interests may have dedicated time, be it 20%, 50% or 80%. The productivity requirement varies by department. Many have no clear-cut minimum, but it inevitably comes up at your tenure meeting. Some departments have an annual publication requirement.

Medicine is somewhat of a business, and while academics centers understand they exist to be innovative and educate future surgeons, at the end of the day, the bills have to be paid. These ideals, teaching and research, do not reimburse well. A good academic department will have some sort of factor to offset those who focus more on teaching or research loss of RVUs, but many do not. Thus, those efforts often take a back seat to clinical practice and keeping the patients coming in and going out.

Many people pursue fellowship because of their academic interest, or to help with securing a job at an academic center. Keep in mind, when you join a practice as the more junior surgeon, you still have to build a practice. You take more call, often have the cases no one else wants, and have to balance the new found independence with judgement.

So yes, academics affords one the ability to pursue interests in medicine. You can as well in private practice, but ability to teach or research infrastructure is often less than an academic department. Hope this helps.

Very informative - thanks so much for taking the time to answer this. As you gain seniority within academic practice, does the flexibility to control your work hours and call increase?

 

[CCMDOC9254]

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

Hey neusu, I'm curious what your outlook on ESN is? I know it can be achieved via neurosurg, rads, or neurology. Do you think it will eventually become a field dominated by neurology since they are essentially the first line, like cards ended up dominating interventional work instead of CT? Or do you think it will continue to be mainly rads and neurosurg. I'm curious because it's a field I'm highly interested in, but I can't really imagine myself going through a neurosurgery or radiology residency, both sound unappealing, whereas a neurology residency does spark my interest.


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[neusu]

Very informative - thanks so much for taking the time to answer this. As you gain seniority within academic practice, does the flexibility to control your work hours and call increase?

For most practices yes, with seniority you have more control over things. Again, however, it really depends on the practice structure and your willingness to forgo other things.

 

[neusu]

Hey neusu, I'm curious what your outlook on ESN is? I know it can be achieved via neurosurg, rads, or neurology. Do you think it will eventually become a field dominated by neurology since they are essentially the first line, like cards ended up dominating interventional work instead of CT? Or do you think it will continue to be mainly rads and neurosurg. I'm curious because it's a field I'm highly interested in, but I can't really imagine myself going through a neurosurgery or radiology residency, both sound unappealing, whereas a neurology residency does spark my interest.


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I will assume you mean neurointerventional surgery. Neurosurgeons watched what happened to cardiac surgery and could see the writing on the wall for open vascular neurosurgery. As such, the specialty as a whole has postured to maintain involvement, and even drive the direction of, neurointerventional surgery. As such, it is a part of neurosurgery training for all residency programs. You are correct, however, there are three pathways to learning how to do it neurosurgery, radiology, and neurology. As such, the Society of Neurointerventional Surgery was created http://www.snisonline.org/ and admits members from all three fields.

I will admit, being a neurosurgeon, I have a bias towards neurosurgery. Of the three, we are most equipped to handle the whole spectrum of disease for acute stroke. Politics aside, the new data on clot retrieval for large vessel occlusion indicates there will be increased need for interventionalists.

With respect to first line, the ER doc, or even triage radio operator, is the one making the call. Thereafter, it really depends on the specific arrangement for the hospital. For acute stroke symptoms, many stroke centers notify the interventionalist as soon as they get the call that there is an incoming patient. The ER does the initial assessment en route to the CT scanner. If there are signs of a retrievable clot, and it is not contraindicated, they are in the angio suite immediately thereafter. Following treatment, the patient ends up in the ICU admitted to the ICU attending (neurointensivist, general intensivist, neurosurgeon). The stroke neurologist may only really get involved days later when the patient is stable and sent to the floor.

The difference I see between neurology and cardiology, with respect to interventional, are many. Acute MI is not uncommon and something traditionally handled by cardiologists. Prior to interventional cardiology, CABG was really the only treatment available for stenosis or occlusion. Cardiologists really were involved from the beginning with cardiac angiography, angioplasty, and stenting. With respect to the brain, historically it has been neuroradiologists and neurosurgeons performing diagnostic angiography and pushing the envelope for interventional techniques. Further, neurologists have a more diverse array of sub-specialties they can pursue (stroke, critical care, electrophysiology, MG, GB and so forth).

Finally, what about neurosurgery or radiology sounds unappealing?

 

[Guero]

. . .

With respect to first line, the ER doc, or even triage radio operator, is the one making the call. Thereafter, it really depends on the specific arrangement for the hospital. For acute stroke symptoms, many stroke centers notify the interventionalist as soon as they get the call that there is an incoming patient. The ER does the initial assessment en route to the CT scanner. If there are signs of a retrievable clot, and it is not contraindicated, they are in the angio suite immediately thereafter. Following treatment, the patient ends up in the ICU admitted to the ICU attending (neurointensivist, general intensivist, neurosurgeon). The stroke neurologist may only really get involved days later when the patient is stable and sent to the floor.

The difference I see between neurology and cardiology, with respect to interventional, are many. Acute MI is not uncommon and something traditionally handled by cardiologists. Prior to interventional cardiology, CABG was really the only treatment available for stenosis or occlusion. Cardiologists really were involved from the beginning with cardiac angiography, angioplasty, and stenting. With respect to the brain, historically it has been neuroradiologists and neurosurgeons performing diagnostic angiography and pushing the envelope for interventional techniques. Further, neurologists have a more diverse array of sub-specialties they can pursue (stroke, critical care, electrophysiology, MG, GB and so forth).

Finally, what about neurosurgery or radiology sounds unappealing?

Also, those aspiring or considering these fellowship specialties might want to consider how the demand for stroke interventionalists is highly correlated with the regional epidemiology. The demand will be far higher in the stroke belt than other regions. It also seems the demand will be especially promising in non-urban community hospitals (e.g., Level III trauma facilities) as the availability of cath lab technology increases and the pricing decreases. So urban tertiary hospital (e.g., Level I & II trauma facilities) slots will likely be in lower demand. I've been thinking a great deal about these types of things now that I'm approaching crunch time to choose a specialty...

 

[tantacles]

Also, those aspiring or considering these fellowship specialties might want to consider how the demand for stroke interventionalists is highly correlated with the regional epidemiology. The demand will be far higher in the stroke belt than other regions. It also seems the demand will be especially promising in non-urban community hospitals (e.g., Level III trauma facilities) as the availability of cath lab technology increases and the pricing decreases. So urban tertiary hospital (e.g., Level I & II trauma facilities) slots will likely be in lower demand. I've been thinking a great deal about these types of things now that I'm approaching crunch time to choose a specialty...

Hah, I had never heard of the stroke belt until right now. That is a quality google search.

 

[Cyberdyne 101]

Also, those aspiring or considering these fellowship specialties might want to consider how the demand for stroke interventionalists is highly correlated with the regional epidemiology. The demand will be far higher in the stroke belt than other regions. It also seems the demand will be especially promising in non-urban community hospitals (e.g., Level III trauma facilities) as the availability of cath lab technology increases and the pricing decreases. So urban tertiary hospital (e.g., Level I & II trauma facilities) slots will likely be in lower demand. I've been thinking a great deal about these types of things now that I'm approaching crunch time to choose a specialty...

What specialties are you most interested in?

 

[Guero]

Hah, I had never heard of the stroke belt until right now. That is a quality google search.

My school lies therein and thus tends to do a crap ton of CVA/TIA RCTs. They teach a lot of regional epi to prep us for wards. So I'll likely be way out of the loop in terms of Western Epi when I (hopefully) match back home, aside from coccidiomycoses and such.


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[Guero]

What specialties are you most interested in?

::sigh:: It's a bit of a sore subject considering I've been in love with NS since I first decided to pursue medicine. I've loved the research and getting along so well with the residents and attendings. But I decided against it due to its timeline, which brought forth irreconcilable incompatibility with my family and financial circumstances.

So my two paths depend on my Step score: (1) urological surgery (hi score & unlikely) or (2) medicine with a clinician scientist emphasis on LGBT medicine and policy. I absolutely love surgery, but not enough to endure the cons I've seen in general surgery or OBGYN surgery. So TBH, it's likely the medicine route considering my practice tests and history with standardized tests.

There are always procedures and plenty of room for procedure heavy fellowships down the road, though. In the end I'm just thankful I made it this far. I'll take what I can get and shape it accordingly.


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[Cyberdyne 101]

::sigh:: It's a bit of a sore subject considering I've been in love with NS since I first decided to pursue medicine. I've loved the research and getting along so well with the residents and attendings. But I decided against it due to its timeline, which brought forth irreconcilable incompatibility with my family and financial circumstances.

So my two paths depend on my Step score: (1) urological surgery (hi score & unlikely) or (2) medicine with a clinician scientist emphasis on LGBT medicine and policy. I absolutely love surgery, but not enough to endure the cons I've seen in general surgery or OBGYN surgery. So TBH, it's likely the medicine route considering my practice tests and history with standardized tests.

There are always procedures and plenty of room for procedure heavy fellowships down the road, though. In the end I'm just thankful I made it this far. I'll take what I can get and shape it accordingly.


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Thanks. I appreciate the thorough response!

Better to not dive into surgery if another field will give you more overall satisfaction. Best of luck with the rest of your journey!!

 

[neusu]

::sigh:: It's a bit of a sore subject considering I've been in love with NS since I first decided to pursue medicine. I've loved the research and getting along so well with the residents and attendings. But I decided against it due to its timeline, which brought forth irreconcilable incompatibility with my family and financial circumstances.

So my two paths depend on my Step score: (1) urological surgery (hi score & unlikely) or (2) medicine with a clinician scientist emphasis on LGBT medicine and policy. I absolutely love surgery, but not enough to endure the cons I've seen in general surgery or OBGYN surgery. So TBH, it's likely the medicine route considering my practice tests and history with standardized tests.

There are always procedures and plenty of room for procedure heavy fellowships down the road, though. In the end I'm just thankful I made it this far. I'll take what I can get and shape it accordingly.


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Keep your head up, life has many facets and I am sure you can find something that makes you happy and fits your individual needs. Indeed, neurosurgery requires significant sacrifice, both on a personal level, and for those with families, by family members. I am excited to hear what you end up choosing!

 

[Guero]

Thanks everyone!

 

[neusu]

Thanks. I appreciate the thorough response!

Better to not dive into surgery if another field will give you more overall satisfaction. Best of luck with the rest of your journey!!

Indeed. Don't do surgery unless you are set on it.

 

[live2figure_sk8]

Hi neusu,
Thank you so much for taking so much time to answer all these questions.

From what you've seen, what kind of a career do MD/PhD's in neurosurgery have? Are these lives/careers much different from those of neurosurgeons who have just an MD?
I ask because I might be interested in doing an MD/PhD, but I've heard that MD/PhD's tend to do more research than anything else. What would you say, from the MD/PhD's you've seen?

Thank you so much!

 

[WhittyPsyche]

Hi neusu,
Thank you so much for taking so much time to answer all these questions.

From what you've seen, what kind of a career do MD/PhD's in neurosurgery have? Are these lives/careers much different from those of neurosurgeons who have just an MD?
I ask because I might be interested in doing an MD/PhD, but I've heard that MD/PhD's tend to do more research than anything else. What would you say, from the MD/PhD's you've seen?

Thank you so much!

Just want to mention this is brought up a few times in the thread. Search for it if you can't find by flipping. Just so it lightens the load for neusu answering repeat questions.


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[numbersloth]

Did you know you were interested in neurosurgery during undergrad? What did you study in undergrad? Any advice to current undergrads in terms of courses, ECs, life, etc.?

 

[neusu]

Hi neusu,
Thank you so much for taking so much time to answer all these questions.

From what you've seen, what kind of a career do MD/PhD's in neurosurgery have? Are these lives/careers much different from those of neurosurgeons who have just an MD?
I ask because I might be interested in doing an MD/PhD, but I've heard that MD/PhD's tend to do more research than anything else. What would you say, from the MD/PhD's you've seen?

Thank you so much!

You're welcome.

I will be honest here, and I hope not to offend any of my MD/PhD colleagues. It has been my observation that the vast majority of MD/PhD neurosurgeons do not use the PhD.

 

[neusu]

Did you know you were interested in neurosurgery during undergrad? What did you study in undergrad? Any advice to current undergrads in terms of courses, ECs, life, etc.?

I suppose my interests in neurosurgery began during undergrad. When I entered medical school, it certainly was something I was aiming for. Personally, I studied biochemistry as an undergraduate.

My advice for undergraduates is to both have goals and a plan to reach them, but also realize life goes on. Picking activities based on your personal interests helps to make everything along the way more enjoyable. Likewise, there are requirements for a reason. Some of them may seem arbitrary, and yes, some of these are unnecessary. Even so, not having completed the requirements, you are in no position to pass judgement on whether it is needed or not and just come off as lazy or self-centered when making complaints. That being said, look for and make opportunities. You may hate research, but if you find a topic that interests you it is more palatable. Unfortunately, for things like the MCAT, aside from entering a program that does not require it, I am not of much help for techniques to make it more tolerable.

 

[Guero]

. . .
My advice for undergraduates is to both have goals and a plan to reach them, but also realize life goes on. . . . Even so, not having completed the requirements, you are in no position to pass judgement on whether it is needed or not and just come off as lazy or self-centered when making complaints. . .

QFT

Sometimes you need to see aphorisms twice, highlighted for emphasis by someone closer to your level, before you realize they're not gold. They're platinum.


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[teriyakibeef]

Hi neusu, thank you so much for making this thread. I am an undergraduate studying for the MCAT and preparing to apply to medical school next year. I have been doing research in neural regeneration for the last 3 years, operating on mice, and enjoying it very much. I love working hard and pushing myself, but I also enjoy family time. I would be no where without my parents, so I am wondering if there is time during a neurosurgery residency to visit family once in a while (e.g. 2-3 times a year). Also wondering if there are a few hours each week for hobbies or exercise. I am keeping an open mind in terms of specialty choice, but it is hard for me to imagine doing anything other than neurosurgery. I want to make sure it is a realistic choice for me because I also want other things in life!

Do neurosurgery residents get vacation time? If so, how long? Do you get at least a week off in a year to relax and not think about work?

How many days a week do you work? How many hours in a week do you work? In your previous posts, you've said you sleep 4-6 hours every night. If there are 168 hours in a week, that leaves 126 - 140 hours a week for work and other things. How many of those hours do you spend doing work-related things and non-work-related things?

 

[neusu]

Hi neusu, thank you so much for making this thread. I am an undergraduate studying for the MCAT and preparing to apply to medical school next year. I have been doing research in neural regeneration for the last 3 years, operating on mice, and enjoying it very much. I love working hard and pushing myself, but I also enjoy family time. I would be no where without my parents, so I am wondering if there is time during a neurosurgery residency to visit family once in a while (e.g. 2-3 times a year). Also wondering if there are a few hours each week for hobbies or exercise. I am keeping an open mind in terms of specialty choice, but it is hard for me to imagine doing anything other than neurosurgery. I want to make sure it is a realistic choice for me because I also want other things in life!

Do neurosurgery residents get vacation time? If so, how long? Do you get at least a week off in a year to relax and not think about work?

How many days a week do you work? How many hours in a week do you work? In your previous posts, you've said you sleep 4-6 hours every night. If there are 168 hours in a week, that leaves 126 - 140 hours a week for work and other things. How many of those hours do you spend doing work-related things and non-work-related things?

Can I ask why you can not imagine yourself doing anything other than neurosurgery? Have you shadowed a neurosurgeon or spent much time working with them?

The reason I ask is that not being able to see yourself doing anything but neurosurgery, yet not knowing much about it at all, seems a little peculiar.

As a resident, you will have however many weeks off that are designated at your program (2-4 weeks). The work hour restrictions limit you to 80-hours each week (some programs have an exemption to work 88 hours). Residents are also required to have 1 24-hour period off every 7 days.

First and foremost, it is possible to have a family as a neurosurgery resident. It will be difficult, and you and they will have to make sacrifices for you succeed as a resident. Second, while the work hours are the "limit" that is widely variable. Even if you are "done" at that time and sprint out of the hospital and get home, 80-hours is a long week. Likewise, in any residency, but especially neurosurgery, the field is especially physically, emotionally, and intellectually draining. The time you have "off" is often spent simply decompressing. You may have time, but will not want to do anything with it. Finally, the 80-hours does not account for outside of work related work requirements. Do you have to present for grand rounds? This involved doing a literature search and making a powerpoint, or several hours. Do you have to review for the following day's cases (charts, films, pathology etc.)? Does your department have a publication requirement? Most weeks, I work full-time job hours on my outside of work obligations. Not exactly quality time I could be spending with a wife and kids.

 

[Bbooth]

This is from a different standpoint. My girlfriend is a PGY 1. She's in her first year of neurosurgical residency. I'm not a doctor. Far from it. But I'm trying to get a understanding of what she is going through. She's stressed. I love her and I want to educate myself on what she is going through. I would like to know if there's any resources on what a neurosurgical resident is up against, especially being a female. I would also like suggestions on anything I can do to help her in her stressed filled journey personally. Any and all information would be greatly appreciated. Want to help her as much as I can.
Thank You,
BTB

 

[tiedyeddog]

This is from a different standpoint. My girlfriend is a PGY1. She's is in her first year of neurosurgical residency. I'm not a doctor. Far from it. But I'm trying to get a understanding of what she is going through. She's stressed. I love her and I want to educate myself on what she is going through. Also, I would like to know of there's anything I can do to help her in her stressed filled journey? Any and all information would be greatly appreciated. Just want to help her as much as I can.
Thank You,
BTB

Wash her clothes and buy her food for her fridge.


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[Bbooth]

Wash her clothes and buy her food for her fridge.


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Thank you. I will definitely do that for her.

 

[neusu]

This is from a different standpoint. My girlfriend is a PGY 1. She's in her first year of neurosurgical residency. I'm not a doctor. Far from it. But I'm trying to get a understanding of what she is going through. She's stressed. I love her and I want to educate myself on what she is going through. I would like to know if there's any resources on what a neurosurgical resident is up against, especially being a female. I would also like suggestions on anything I can do to help her in her stressed filled journey personally. Any and all information would be greatly appreciated. Want to help her as much as I can.
Thank You,
BTB

As mentioned by @tiedyeddog, helping make her life outside the hospital would be of greatest benefit. This includes not only things like groceries, laundry, cleaning, and chores but also just being supportive, understanding, and not argumentative. She may be incredibly tired and gumpy after a 30-hour call and pick fights, or just sullen and reserved. It is nothing you did, just how she reacts to the stress (physical, emotional, and mental). Likewise, try to do nice and fun things for her, but without any commitment or involvement in preparation on her part. For instance, if you want to go out to dinner, pick the place and make the reservation etc. Sure, she might criticize the choice or complain, or even flake on you, but it's the thought that counts. And if she doesn't, you have a nice time.

Bottom line, a relationship is two people making sacrifices and accommodations for one another. Unfortunately for you, in this relationship, she'll likely put you second on her priority list for the next 7-years and you will be the one doing the majority of the sacrificing and accommodating.

Finally, if you feel this is too much for you, getting out cleanly and early is my advice. Drawing things out, making it more emotional, and building resentment will adversely affect both of you.

Best of luck!

 

[suntmihai]

Sorry if this question has already been asked, but are there any DO residents in your residency? Have you noticed any bias against acceptance of DO students in general?

 

[TheBiologist]

are you happy? do you have time to date and enjoy it or if you are married are you and your wife happy?

do you think you picked the right career

 

[neusu]

Sorry if this question has already been asked, but are there any DO residents in your residency? Have you noticed any bias against acceptance of DO students in general?

No DO residents. There is generally a bias against DO. They do have their own programs, though the ACGME and AOA merged recently. With respect to the future, it is tough to tell whether or not programs will take DO graduates more frequently or whether the DO programs will have a preference for DO graduates. From what I have heard though, during the provisional accreditation period, many of the DO programs are struggling and may not survive the transition.

 

[SValley]

are you happy? do you have time to date and enjoy it or if you are married are you and your wife happy?

do you think you picked the right career

This is..personal..

*awaits answer because I'm so curious*

 

[tiedyeddog]

are you happy? do you have time to date and enjoy it or if you are married are you and your wife happy?

do you think you picked the right career

I am married and happy. I wish I had more time with my family but it is something I knew would have to be sacrificed. It really helps my spouse also expects me to always be working and is supportive of me. I think a lot of the unhappy marriages involve unmet expectations that were never realistic.

I can't think of a single other career I would have enjoyed more, even within medicine.

 

[neusu]

are you happy? do you have time to date and enjoy it or if you are married are you and your wife happy?

do you think you picked the right career

I generally am pretty happy. Just like any one else, in any career, there are ups and downs.

I am sure I picked the right career. I couldn't see myself doing anything else in medicine. Outside of medicine, I am not sure what I would be interested in, or good at. Most neurosurgery residents will tell you there are days they wonder if they are doing the right thing for themselves, or if something else would have been better. It can be difficult to rationalize the delayed gratification, especially watching most everybody you know move on in life (starting real jobs, starting a family, career progression) when you feel idle. I find taking a step back and putting things in perspective helps. Likewise, enjoying life the way it is now, even with the associated perceived hardships, is important.

 

[neusu]

This is..personal..

*awaits answer because I'm so curious*

Hopefully it helped. Are you thinking neurosurgery? Related to someone in neurosurgery? Know me somehow?

 

[NeuResurgens]

@neusu For someone thinking about going into neurosurgery, what are some of the best ways to determine the research activity, reputation in academic circles, and overall fit between program culture and your own personality for various neurosurgery residencies? I figure elective away rotations at programs is a good thing to do, but since you can only do a limited number of elective rotations, how might I select the programs I should rotate at? I hear that finding a program with a good culture for your own personality is important for being successful in residency, and there are also various quirks of individual residency programs (like first years in gen surg, international rotation years, etc.) so I'm curious about tips for how to narrow it down and choose the programs you like best.