Ask a neurosurgery resident anything

[SValley]

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

It did! And yes, I'm flirting with the idea of neurosurgery. It's good to see that you and the other residents (or attendings?!) on here have maintained some semblance of work life balance. And you guys don't come across as jaded or bitter. So it makes the field slightly less intimidating. Just slightly.

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[neusu]

@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.

This can be tough to decipher. Generally, this is determined based on word of mouth and how your experience is during the interview. Generally, away rotations serve two purposes. First, rotating at a well known place allows other programs to gauge your competitiveness based on how your evaluation from that rotation is. Second, it can be like a month long audition. This works both for the top programs, as well as ones off the beaten path. Unfortunately, you will not know until you know. It isn't entirely uncommon, in any field, including neurosurgery, for an applicant to have one impression of a program, match there, and find out the reality is far different.

 

[NeuResurgens]

This can be tough to decipher. Generally, this is determined based on word of mouth and how your experience is during the interview. Generally, away rotations serve two purposes. First, rotating at a well known place allows other programs to gauge your competitiveness based on how your evaluation from that rotation is. Second, it can be like a month long audition. This works both for the top programs, as well as ones off the beaten path. Unfortunately, you will not know until you know. It isn't entirely uncommon, in any field, including neurosurgery, for an applicant to have one impression of a program, match there, and find out the reality is far different.

Cool, thanks for the insight!

 

[stickgirl390]

(Sorry if this has been asked already.) What steps can be taken to help a medical student earn the more competitive residency slots? Aside from good grades and high USMLE scores, what can M1s and M2s do to prepare for a competitive application?

 

[neusu]

(Sorry if this has been asked already.) What steps can be taken to help a medical student earn the more competitive residency slots? Aside from good grades and high USMLE scores, what can M1s and M2s do to prepare for a competitive application?

Good grades and scores are the minimum. For neurosurgery, as well as many other competitive fields, research is also important. Talk to the people in the department at your institution and get involved in a project. As an M3 and M4, getting good letters is the final majorly important step.

After that, simply being a good person helps. Certainly, it is easy to say you are a hard worker and do the right thing. Internalizing those idioms and making them a part of your daily life, on the other hand, is far more difficult. Finally, take a look at yourself and assess your strengths and weaknesses. If there is any glaring weakness, address it! Too many candidates have most of the pieces in place, but have a critical flaw. In assessment of it, they gloss over "well I don't interview well," or "nurses don't like me," and so on. While no one expects you to be perfect, they do expect you to show insight in deficiencies, and make tangible efforts to improve.

 

[neusu]

I got a notification about this thread, hard to believe it's going on 4 years since I started it!

 

[camtheram1815]

@neusu

As someone who is potentially interested in neurosurgery, my only question is this: I've been doing wet lab/bench research for the past year. I'd rather not have to ever do it again. Will I be required to do wet lab/bench research in medical school or perhaps doing a research year in residency?

I realize that if I were passionate about the research subject, this could change. Also, I hope I will enjoy clinical research much more. Moreover, I acknowledge that I'm naive and my interests will probably change.

Thanks for the response!

 

[sovereign0]

I'm sure that you've been asked this a few times, and feel free to refer me to a previous response of yours, but at what point in medical school did you decide on neurosurgery?

I'm potentially interested in NSG, but I'm only a first year. What kind of things do you recommend I do to narrow down my specialty preferences - especially what I should do to rule in/out NSG?

Also, how important is it to have neuroscience bench research as opposed to research in other fields?

 

[camtheram1815]

Don't want to speak for neusu, but in my (highly limited) experience, research is essential to a strong neurosurgery application, not just because residencies like people who are committed to the intellectual betterment of the field as well as show a longitudinal passion for it, but also because research helps you make connections with important people at your home institution and elsewhere. Neurosurgery is a small field where everyone knows everyone else. Being a productive researcher in xyz's lab at abc medical center means you'll get a lot more exposure to other neurosurgeons (through conferences, connections, even just getting your name on things and having some sort of recognition therE) then if you don't do research at all. Doesn't have to be bench research at all - clinical research is wonderful and a totally different experience. If you look at some of the major neurosurgery journals (JNS, Neurosurgery, World, Stroke, etc), you'll see that a lot of the publications are clinical (though a lot are basic too!).

Most (all?) neurosurgery residencies have 2 years of research built in, but, as I have been informed previously, more and more people are using one or both years to do an in-folded fellowship. However, I think the norm is still to do research during at least one of those years. Regardless, it is very very unlikely that you will go through 7 years of neurosurgery residency without doing any research at all.

Thanks, this definitely helps. Like I said, I'm hoping (expecting) to enjoy clinical research much more. There's an old saying in cell culture labs (my position): "the cells don't talk back". This has been my biggest issue, and being interested in neurosurg, which I know is research heavy, I just wanted to make sure I wouldn't run into a similar problem later down the road.

Another issue that I've thought about, seeing how neurosurg is a small community as you say, the school I've been accepted to and will likely attend doesn't have a home neurosurgery residency program. Granted, there are attending's in the field, but any thoughts as to how this might affect me? The school's match list includes neurosurgery matches in recent years; I expect this will be a disadvantage, but how big of one?

Thanks again!

 

[Seldon]

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!

I'm actually working in the Neurosurgery department of my college's medical school. I got it by searching through all of the list of active clinical trials and picking those (who I had an interest in) who had the most active clinical trials. I did this until someone responded. Maybe you should try this out for yourself.

Edit: Just realized that this thread started years ago... the advice still stands

Edit2: Just realized that this was referring to medical school. Not my greatest post.... Advice still stands

 

[The Buff OP]

I got a notification about this thread, hard to believe it's going on 4 years since I started it!

What is your spirit animal?

 

[neusu]

@neusu

As someone who is potentially interested in neurosurgery, my only question is this: I've been doing wet lab/bench research for the past year. I'd rather not have to ever do it again. Will I be required to do wet lab/bench research in medical school or perhaps doing a research year in residency?

I realize that if I were passionate about the research subject, this could change. Also, I hope I will enjoy clinical research much more. Moreover, I acknowledge that I'm naive and my interests will probably change.

Thanks for the response!

I can't think of a program that requires lab research during the research year. The RRC does not have any specific rules about the type of research, or whether it is actually required. Many people and programs pursue enfolded clinical experiences e.g. enfolded fellowships during this period.

As @WedgeDawg said, research is helpful for making connections in the field. This is both on a local letter, for your application to neurosurgery, and nationally for career advancement.

In a more cynical viewpoint, research is required and programs require it because it is a way to boost their stature. That is, if every attending needs publications and so forth to show their value in the department and for promotion within the system, requiring residents to publish as well pushes that work to them so the attending can supervise. So while some people really truly do love research, for many others it is simply a means to the end goal of getting in to medical school/residency/tenure.

 

[neusu]

I'm sure that you've been asked this a few times, and feel free to refer me to a previous response of yours, but at what point in medical school did you decide on neurosurgery?

I'm potentially interested in NSG, but I'm only a first year. What kind of things do you recommend I do to narrow down my specialty preferences - especially what I should do to rule in/out NSG?

Also, how important is it to have neuroscience bench research as opposed to research in other fields?

Hopefully I am not being a revisionist historian here, and feel free to call me out on it if I indicated otherwise in this thread or elsewhere, but I went in to medical school interested in and wanting to do neurosurgery. There were some residents on SDN in the neurosurgery forum that were helpful in guiding me towards things that would help me in the right direction. Namely, I took on some research projects, did well in school and USMLE, did some subIs and so forth.

Commonly, in medical school, if you express interest in a particular field, you get pegged as only interested in that. I tried to keep my cards close to my chest and not be particularly overt about it. On third year rotations I would go through each clerkship and try to see myself doing this specialty for the rest of my life. Each had it's upsides and downsides, and ultimately, none surpassed my desire for neurosurgery. On top of that, I would look for things that might apply to neurosurgery from each field, though as a student this is neither easy nor useful. In any case, as a resident, when we had students on service that were interested in other fields, I would try to teach them specific things in neurosurgery applicable to their field. Likewise, I would have a mental list of things from each field for which we have been consulted or routinely partake in care of their patients. So hopefully, they would be able to take something away from the rotation!

I hate to say it, but the best way to rule it in or out is to spend some time with us. You could shadow for a day or weekend or a week and see if you like it or not. A full rotation would a better experience, and a subI perhaps better. Ultimately, there is no substitute for the real thing, and even people who have done multiple subIs can be shocked at how different it is being a resident than a student.

Finally, and this is just my take on things from how I hear attendings talk about students and their publications on applications, no one cares about bench research. Yes, we think it is incredibly useful and great if you have. No, you do not need it. In fact, having a clinical article of importance is far more impacting than a basic science. To clarify, they can relate better to that, and every neurosurgeon can understand what you are discussing. Whereas, if you are describing molecular interactions of signaling molecules in an obscure condition it quickly becomes something they would need a fair amount of context and reading to be able to intelligently discuss.

 

[neusu]

Thanks, this definitely helps. Like I said, I'm hoping (expecting) to enjoy clinical research much more. There's an old saying in cell culture labs (my position): "the cells don't talk back". This has been my biggest issue, and being interested in neurosurg, which I know is research heavy, I just wanted to make sure I wouldn't run into a similar problem later down the road.

Another issue that I've thought about, seeing how neurosurg is a small community as you say, the school I've been accepted to and will likely attend doesn't have a home neurosurgery residency program. Granted, there are attending's in the field, but any thoughts as to how this might affect me? The school's match list includes neurosurgery matches in recent years; I expect this will be a disadvantage, but how big of one?

Thanks again!

Not having a home program is a big disadvantage for several reasons. First, they may be less likely to have research projects in which you can get involved. The research itself is a way to learn about neurosurgery, the diseases we treat, and so forth so when your subI rolls around you're not fresh to the idea. Also, being in research helps get face time with the attendings who will eventually write you a letter. Next, not having a home program removes both the ability to do a practice home rotation, as well as have a possible place you could stay.

So yes, it is a disadvantage. How big, tough to say. I don't think it has been quantified anywhere.

 

[camtheram1815]

Not having a home program is a big disadvantage for several reasons. First, they may be less likely to have research projects in which you can get involved. The research itself is a way to learn about neurosurgery, the diseases we treat, and so forth so when your subI rolls around you're not fresh to the idea. Also, being in research helps get face time with the attendings who will eventually write you a letter. Next, not having a home program removes both the ability to do a practice home rotation, as well as have a possible place you could stay.

So yes, it is a disadvantage. How big, tough to say. I don't think it has been quantified anywhere.

Interesting...If it is okay with you, I'll send a quick PM just so I can ask a more specific question regarding this.

Thanks again.

 

[sovereign0]

Thanks for the response. My school offers a second year weeklong preceptorship, so I am considering neurosurgery for that. However, I haven't had exposure to surgery (general or subspecialty) in any capacity, so I'm hoping to pick one up in the field to rule in or out surgery as a whole. Also, I can't agree more about keeping your cards close to your chest. I'd be lying if I didn't have certain people in my classed pegged as Ortho or Rads/Path simply because they have already expressed interest in that field early on.

Finally, and this is just my take on things from how I hear attendings talk about students and their publications on applications, no one cares about bench research. Yes, we think it is incredibly useful and great if you have. No, you do not need it. In fact, having a clinical article of importance is far more impacting than a basic science. To clarify, they can relate better to that, and every neurosurgeon can understand what you are discussing. Whereas, if you are describing molecular interactions of signaling molecules in an obscure condition it quickly becomes something they would need a fair amount of context and reading to be able to intelligently discuss.

This is very interesting. I attended a neurosurgery interest group meeting at my school which was conducted by our own program director, and he said that they actively look for basic science research in their applicants. But after hearing your take, I wonder if this is because of the particularly large focus on neuroscience at my institute as a whole.

 

[neusu]

What is your spirit animal?

Wolf? Bear? Lion? I guess people have described me as each of those at various points throughout my training

 

[neusu]

Thanks for the response. My school offers a second year weeklong preceptorship, so I am considering neurosurgery for that. However, I haven't had exposure to surgery (general or subspecialty) in any capacity, so I'm hoping to pick one up in the field to rule in or out surgery as a whole. Also, I can't agree more about keeping your cards close to your chest. I'd be lying if I didn't have certain people in my classed pegged as Ortho or Rads/Path simply because they have already expressed interest in that field early on.



This is very interesting. I attended a neurosurgery interest group meeting at my school which was conducted by our own program director, and he said that they actively look for basic science research in their applicants. But after hearing your take, I wonder if this is because of the particularly large focus on neuroscience at my institute as a whole.

Certainly, take it for a spin, see if you like it.

Don't get me wrong, basic science research is valued. I can say for certain, though, at least in my experience, it would neither be a deciding factor between two otherwise equally qualified applicants or whether someone gets an interview or not.

 

[sovereign0]

Are you pursuing an enfolded fellowship as part of your residency? If not, do you plan to do a fellowship?

What are some of your favorite procedures/cases and why?

Also, during procedures which hand holds the scalpel and which hand do you use to reply to us on SDN? Joking of course. Really appreciate you taking the time to do this.

 

[The Buff OP]

Wolf? Bear? Lion? I guess people have described me as each of those at various points throughout my training

I thought you skipped my dumb*ss question. You know how I am lol. So far what are your favorite cases that you have done?

 

[neusu]

Are you pursuing an enfolded fellowship as part of your residency? If not, do you plan to do a fellowship?

What are some of your favorite procedures/cases and why?

Also, during procedures which hand holds the scalpel and which hand do you use to reply to us on SDN? Joking of course. Really appreciate you taking the time to do this.

No enfolded fellowship, haven't decided whether to pursue a post residency fellowship or not. My favorite cases are the vascular cases and skull base, though for these a fellowship is typically needed.

Ha, I am probably on here too much!

 

[bioboy23]

Hi neusu. Really appreciate you taking time out of your busy schedule to talk with us.

Are the endovascular coils taking a lot of your open aneurysm clipping cases? Or does the aneurysm have to be "just right" to be fixed internally?


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[Panis et Circenses]

How many hours do neurosurgeons average per week? How many weeks off per year?

 

[aalamruad]

@neusu I hear that peds is currently the only area within neurosurgery that can't be pursued solely with an enfolded fellowship; what are the chances that'll change within 10 years?

 

[numbersloth]

Do a lot of neurosurgeons have MD-PhDs?

Did a lot of your fellow residents or fellow neurosurgeons now study Psych/Neuroscience in undergrad? How many of you knew it was the field you were interested in early on? Why did you choose it over neurology?

 

[bioboy23]

Do a lot of neurosurgeons have MD-PhDs?

Did a lot of your fellow residents or fellow neurosurgeons now study Psych/Neuroscience in undergrad? How many of you knew it was the field you were interested in early on? Why did you choose it over neurology?

I read that around 13% of neurosurgeons have an MD/PhD


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[neusu]

I thought you skipped my dumb*ss question. You know how I am lol. So far what are your favorite cases that you have done?

Ha, well it is an ask me anything, so I try to answer them all!

 

[neusu]

Hi neusu. Really appreciate you taking time out of your busy schedule to talk with us.

Are the endovascular coils taking a lot of your open aneurysm clipping cases? Or does the aneurysm have to be "just right" to be fixed internally?


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Endovascular is becoming the more common modality for treatment of ruptured and unruptured aneurysms. There are many aneurysms, however, that are less amenable to treatment using endovascular techniques. Likewise, in many settings, endovascular is less desirable, so open surgical treatment is necessary. In the future, a dual trained surgeon will likely be the standard. That way, he will be able to independently determine the best way to treat and pursue that modality without bias.

 

[bioboy23]

Thank you! Very interesting stuff.

I'm not sure if this has already been asked -- why do you think so few Med students apply to neurosurg each year? Is it that most simply don't have the stats? Or is it they don't want to get themselves into the lengthy/difficult residency and lifestyle, so they settle for something else?


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[pioneer22]

Thank you! Very interesting stuff.

I'm not sure if this has already been asked -- why do you think so few Med students apply to neurosurg each year? Is it that most simply don't have the stats? Or is it they don't want to get themselves into the lengthy/difficult residency and lifestyle, so they settle for something else?


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a pretty good amount apply each year for very few (1-3 usually) spots. it's a hyper-competitive field, so stats are very high and everything matters to get in and separate yourself. obviously the residency length and commitment neurosurgery demands can push people away too, especially if they are just seeking a high salary

 

[bioboy23]

a pretty good amount apply each year for very few (1-3 usually) spots. it's a hyper-competitive field, so stats are very high and everything matters to get in and separate yourself. obviously the residency length and commitment neurosurgery demands can push people away too, especially if they are just seeking a high salary

I see. It just seems like ~80% match rate for US seniors is so high for such a competitive residency. Is it just that all who apply are extremely strong applicants so it makes the match rate look a little better on paper?


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[Atom612]

a pretty good amount apply each year for very few (1-3 usually) spots. it's a hyper-competitive field, so stats are very high and everything matters to get in and separate yourself. obviously the residency length and commitment neurosurgery demands can push people away too, especially if they are just seeking a high salary

Do the rest usually scramble into a different surgical specialty, or do they wait and try again?

 

[pioneer22]

If you look at the recent match rate below (p. 12), it says 214/354 matched into neurosurgery.

1. http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf

So 61% of the applicants matched basically. That's not easy by any mean when neurosurgery seeks a certain competitiveness.

 

[neusu]

How many hours do neurosurgeons average per week? How many weeks off per year?

Like any field in medicine, the number of hours per week varies dramatically by the individual and the practice model. Residents, for example, work 80 hours/week and have 3-4 weeks off per year as well as 4-days per month. Attendings, on the other hand, really do not have a set number of hours. For an academic practice or employed position, the surgeon may be obligated to take call at a certain frequency and have obligations of rounding and performing emergent cases. Likewise, a productivity threshold is typically included. For a private practice, an attending may not necessarily take any call in the traditional sense. For an emergency department, they may contract to take call or may choose not to. For their own patients admitted to the hospital they may have a midlevel provider take call, share call with the group, or simply have the patient admitted to another service and really only be called for their patients for acute neurosurgical issues. Again, the number of hours in private practice vary widely depending on how much the surgeon chooses to work. Clinic and the OR can be busy and long hours, or they can be light; it all depends on what the surgeon is desiring for a life style with respect to hours work and compensation. Unfortunately, there is no such thing as free money, like all doctors neurosurgeons have to work to get paid. Vacation time also varies depending on the model, but from what I gather it can be anywhere from 4-weeks/year to 12-weeks/year, plus weekends that are not on call.

 

[neusu]

@neusu I hear that peds is currently the only area within neurosurgery that can't be pursued solely with an enfolded fellowship; what are the chances that'll change within 10 years?

Pediatric neurosurgery fellowships are run through the Accreditation Council for Pediatric Neurosurgical Fellowships and are obtained through the San Francisco match. They require completion of residency to be eligible.

There are a number of other fellowships that typically are not feasible through enfolded fellowship because the residents at that stage of training are not technically competent enough to perform the cases (e.g. open skull base or cerebrovascular).

I don't anticipate pediatrics changing to allow residents to enfold during residency.

 

[neusu]

Do a lot of neurosurgeons have MD-PhDs?

Did a lot of your fellow residents or fellow neurosurgeons now study Psych/Neuroscience in undergrad? How many of you knew it was the field you were interested in early on? Why did you choose it over neurology?

There are a fair number of neurosurgeons I know with combined MD/PhD degrees. I think someone else in this thread posted the national prevalence of this, but I'd say it's probably around 20%.

I don't think anyone I know pursued psych, but a fair number did neuroscience. The cliche personal statement regarding "why neurosurgery" discusses how enamored the applicant was with the brain during their neuroscience studies. Unfortunately, this is not terribly applicable to what we do on day-to-day basis, so I would suggest writing about something else. I think many of us knew fairly early in medical school, or even before, that we wanted to do neurosurgery. Neurology is quite a different mindset and approach to neurological diseases than neurosurgery. I chose neurosurgery for a multitude of reasons, but specifically with respect to it in comparison to neurology, we get to manage acute disease processes and change the course of a patient's disease through surgery. Much of what I have experienced on my neurology rotations was management of chronic diseases, using medicine to treat acute diseases, or performing a battery of diagnostic tests to determine the underlying disorder for an untreatable condition.

 

[libertyyne]

Would it be dumb to start a NS residency in your late 30s. Considering I would finish in my early 40s. I am unsure if there is an age when NSs tend to start winding down their practice by taking less taxing cases or switching focus on their careers. I have read about the anecdotal instances of surgeons practicing in their 60's . However I am unsure if that is the case for the average surgeon. Do you know of any data for median age of retirement or winding down for NS? NS sounds fascinating,however it would be silly to only be able to practice for 10years.

 

[neusu]

Thank you! Very interesting stuff.

I'm not sure if this has already been asked -- why do you think so few Med students apply to neurosurg each year? Is it that most simply don't have the stats? Or is it they don't want to get themselves into the lengthy/difficult residency and lifestyle, so they settle for something else?


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Most medical students have no exposure to neurosurgery. It is a small field, and the surgeons tend to be busy with clinical activities and less involved during the didactic years of medical school. After Step 1, when everyone has their scores and looks at the table of residencies out there and the associated Step 1 mean for each, they start to narrow their selection. Add to that the dichotomy of Yes/No: surgery. Finally, people look at lifestyle and duration of training. The 7 year price tag turns many away. The number of hours both in residency and after turn many people away. Neurosurgeons work a lot. Many students want a more balanced specialty. I suppose I am a little off the norm on the expectation of work/life balance when I say that for residency I fully expected it to be a 24 hour a day, 7 day a week, 365 day a year job for 7 years. I did not even bother to look at the call schedule because I had the assumption I was on call. If I wasn't, it was a pleasant surprise.

So taking all of those factors in to consideration, there are simply not many students exposed to neurosurgery early enough, to want to know more, build a strong application, have high enough scores, and willing to accept that they are in for a long, hard slog.

I would not say people who choose other fields are settling at all. I meet a lot of doctors who are exceptional at what they do, are passionate about it, that certainly could have done neurosurgery and would have done well, but chose another field because that was where their interests lie.

 

[2021Doctor]

Most medical students have no exposure to neurosurgery. It is a small field, and the surgeons tend to be busy with clinical activities and less involved during the didactic years of medical school. After Step 1, when everyone has their scores and looks at the table of residencies out there and the associated Step 1 mean for each, they start to narrow their selection. Add to that the dichotomy of Yes/No: surgery. Finally, people look at lifestyle and duration of training. The 7 year price tag turns many away. The number of hours both in residency and after turn many people away. Neurosurgeons work a lot. Many students want a more balanced specialty. I suppose I am a little off the norm on the expectation of work/life balance when I say that for residency I fully expected it to be a 24 hour a day, 7 day a week, 365 day a year job for 7 years. I did not even bother to look at the call schedule because I had the assumption I was on call. If I wasn't, it was a pleasant surprise.

So taking all of those factors in to consideration, there are simply not many students exposed to neurosurgery early enough, to want to know more, build a strong application, have high enough scores, and willing to accept that they are in for a long, hard slog.

I would not say people who choose other fields are settling at all. I meet a lot of doctors who are exceptional at what they do, are passionate about it, that certainly could have done neurosurgery and would have done well, but chose another field because that was where their interests lie.

Congratulations. This thread has 29 pages and is still going strong. Impressive.

 

[Psai]

Congratulations. This thread has 29 pages and is still going strong. Impressive.

You don't become a neurosurgeon without dedication to your work.

 

[bioboy23]

Most medical students have no exposure to neurosurgery. It is a small field, and the surgeons tend to be busy with clinical activities and less involved during the didactic years of medical school. After Step 1, when everyone has their scores and looks at the table of residencies out there and the associated Step 1 mean for each, they start to narrow their selection. Add to that the dichotomy of Yes/No: surgery. Finally, people look at lifestyle and duration of training. The 7 year price tag turns many away. The number of hours both in residency and after turn many people away. Neurosurgeons work a lot. Many students want a more balanced specialty. I suppose I am a little off the norm on the expectation of work/life balance when I say that for residency I fully expected it to be a 24 hour a day, 7 day a week, 365 day a year job for 7 years. I did not even bother to look at the call schedule because I had the assumption I was on call. If I wasn't, it was a pleasant surprise.

So taking all of those factors in to consideration, there are simply not many students exposed to neurosurgery early enough, to want to know more, build a strong application, have high enough scores, and willing to accept that they are in for a long, hard slog.

I would not say people who choose other fields are settling at all. I meet a lot of doctors who are exceptional at what they do, are passionate about it, that certainly could have done neurosurgery and would have done well, but chose another field because that was where their interests lie.

Wow, thank you for such a thought out answer. It's too bad that most students don't get enough exposure to certain specialties that they could likely be very good at.

Yes I agree with the "settling" comment. I did not mean to look down on other specialties at all, I just didn't word that correctly. I meant that if they have a list of other specialties they could possibly be into, they chose that over neuro for their lifestyle and different interests. Thank you neusu!


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[aalamruad]

Pediatric neurosurgery fellowships are run through the Accreditation Council for Pediatric Neurosurgical Fellowships and are obtained through the San Francisco match. They require completion of residency to be eligible.

There are a number of other fellowships that typically are not feasible through enfolded fellowship because the residents at that stage of training are not technically competent enough to perform the cases (e.g. open skull base or cerebrovascular).

I don't anticipate pediatrics changing to allow residents to enfold during residency.

I see, I guess an extra year isn't much of a concern for residents who've committed to such long training anyways.

One more question: is it possible for neurosurgery residents to go out of their way to get a lot of experience with peds, or do you kind of just take whichever cases you're handed? I suppose my concern with most surgical fields is that I don't know if I'd be happy going 5-7 years without working extensively with kids, so I'm wondering if there's any flexibility that allows surgical residents to get more experience with peds than average if they have a strong desire to do so.

 

[neusu]

Do the rest usually scramble into a different surgical specialty, or do they wait and try again?

I know several students over the years who failed to match. There are a number of options and strategies at this point.

First, the student needs to identify what went wrong and if it is a salvageable goal. Sometimes we become so narrowly focused on something, we fail to see the hallmarks of an impending event, despite all of the evidence. If there is an area that can be improved, such as research or exposure to neurosurgery, spending time as a research fellow or pre-residency fellow may help. If it is possible at your school, some students have deferred graduating a year. This allows you to reapply as a medical student. I don't know how the application handles whether or not you have previously applied, but it is much more evident if you have already graduated a year before. Entering a surgical preliminary year is another option. This gains a year of experience in the clinical setting and the letters from this year can help attest to your ability to handle the work load. Interviews and things of that nature may be difficult to schedule as a pre-lim, given the need of the program, but from what I gather most are understanding and work with the interns to let them go on interviews. The other upside of a preliminary year is that you would be eligible to start as a PGY-2 at a neurosurgery program, should an opening become available. More likely though, you would have to repeat the PGY-1 year as a neurosurgery resident. Finally, many students do scramble in to, or reapply for another specialty.

 

[mw18]

Hey @neusu thanks so much for doing this. I've learned a lot from the thread and I've read most/all of it. I apologize if this question has been asked/asked repeatedly and I missed it or forgot it. I was wondering what percentage of residents take a year off for research before applying? I would much rather not take a year and apply as a fourth year, but if that severely limits the chance of matching then I would have to consider that as I made my plans.

 

[neusu]

Would it be dumb to start a NS residency in your late 30s. Considering I would finish in my early 40s. I am unsure if there is an age when NSs tend to start winding down their practice by taking less taxing cases or switching focus on their careers. I have read about the anecdotal instances of surgeons practicing in their 60's . However I am unsure if that is the case for the average surgeon. Do you know of any data for median age of retirement or winding down for NS? NS sounds fascinating,however it would be silly to only be able to practice for 10years.

It would be much more difficult at that point in your life given the demands of the job. I'm not saying it is impossible, but I know the older I get the harder it is to stay up late and get up early all of the time. There are many surgeons who practice in to their 60s and 70s. Whether or not the should be is a different story altogether. I'd say do a subI and see if it fits, and you think it's something you want to do. Take in to consideration everything you've said and determine whether it is something worth pursuing or not.

 

[neusu]

Congratulations. This thread has 29 pages and is still going strong. Impressive.

Thanks. I do what I can.

 

[neusu]

You don't become a neurosurgeon without dedication to your work.

I feel like a slacker most days

 

[neusu]

Wow, thank you for such a thought out answer. It's too bad that most students don't get enough exposure to certain specialties that they could likely be very good at.

Yes I agree with the "settling" comment. I did not mean to look down on other specialties at all, I just didn't word that correctly. I meant that if they have a list of other specialties they could possibly be into, they chose that over neuro for their lifestyle and different interests. Thank you neusu!


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It would be nice if students could gain exposure to every specialty, instead of just the core clerkships plus whatever they happen to get assigned. Or even a larger range of things. I had no idea what nuclear medicine did until I had to do a shuntogram. Medical geneticist? Geriatrics? Fortunately there are people interested in these fields, but I have no idea how one finds out about them in the first place.

 

[neusu]

I see, I guess an extra year isn't much of a concern for residents who've committed to such long training anyways.

One more question: is it possible for neurosurgery residents to go out of their way to get a lot of experience with peds, or do you kind of just take whichever cases you're handed? I suppose my concern with most surgical fields is that I don't know if I'd be happy going 5-7 years without working extensively with kids, so I'm wondering if there's any flexibility that allows surgical residents to get more experience with peds than average if they have a strong desire to do so.

The ability to gain extra experience in pediatric neurosurgery really depends on the program. Most have some scheduled exposure to pediatric neurosurgery as well as elective time that may possibly be able to be used for that purpose. In reality, though, you likely will have long stretches of time without any exposure to patients < 18 years old. If this is a deal-breaker for you, it might be worth acknowledging that early. Likewise, before you jump in head-long, spend some time with a pediatric neurosurgeon. For me, anyway, dealing with non-accidental trauma, shunts, and terminal brain cancer in children is not particularly enthralling. Finally, as such, most neurosurgery residents would prefer to avoid pediatric neurosurgery.

 

[bioboy23]

It would be nice if students could gain exposure to every specialty, instead of just the core clerkships plus whatever they happen to get assigned. Or even a larger range of things. I had no idea what nuclear medicine did until I had to do a shuntogram. Medical geneticist? Geriatrics? Fortunately there are people interested in these fields, but I have no idea how one finds out about them in the first place.

It would be cool if they revamped the whole clerkship system and made the current required rotations shorter to make room for some more specialties and, in turn, more exposure to medicine for students. Even with the designated elective time, it seems like you would only be able to see a small sliver of the many interesting specialties.