Ask a neurosurgery resident anything

[neusu]

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.

I'm glad to hear you find this thread useful. I don't think there are any firm figures with regard to how many take a year off. If you have research on your application you don't need a year off. Those that want to strengthen their application, however, because they don't have research, or want to be more involved in the process, do.

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[neusu]

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.

I don't pretend to know why the LCME has the standards it does, but that's what the current lay of the land is. For the most part, it seems to work. Students also seem to self select for the fields in which they are interested. I must admit, however, every spring I hear from M3s, who happen to rotate on service or find out, somehow, that they are interested in neurosurgery, asking if it is too late to apply.

 

[bioboy23]

I don't pretend to know why the LCME has the standards it does, but that's what the current lay of the land is. For the most part, it seems to work. Students also seem to self select for the fields in which they are interested. I must admit, however, every spring I hear from M3s, who happen to rotate on service or find out, somehow, that they are interested in neurosurgery, asking if it is too late to apply.

That leads me to another question (I'm sorry for all of the questions)! It may have been asked before but --how early do you need to decide/commit to a competitive subspecialty such as neurosurgery? What if you are weighing your options between neuro and something else, when do you need to narrow it down to just one?


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[neusu]

That leads me to another question (I'm sorry for all of the questions)! It may have been asked before but --how early do you need to decide/commit to a competitive subspecialty such as neurosurgery? What if you are weighing your options between neuro and something else, when do you need to narrow it down to just one?


Sent from my iPhone using SDN mobile

Questions are the reason I'm here! Feel free, ask away.

There really is no rule as to when is too early or too late. My suggestion, however, is the earlier the better. Further, if you are undecided between a competitive and less competitive specialty, do everything necessary to be a strong applicant for the competitive specialty. Thus, if you do end up choosing the less competitive specialty, you would be a stronger candidate. The reverse is not always true. Aiming for a less competitive specialty, then deciding to go for a more competitive one may lead to being a lower quality candidate and not matching.

 

[deleted738762]

Are neurons within the csf? What fluid is between neurons, because I know csf is usually in the sub-arachnoid space or the outer part of the brain, so is the csf also between neurons cells. Are the glial cells within csf or what?

 

[Go4Doc]

Are neurons within the csf? What fluid is between neurons, because I know csf is usually in the sub-arachnoid space or the outer part of the brain, so is the csf also between neurons cells. Are the glial cells within csf or what?

I'm not a neurosurgeon (yet) but I did major in neuroscience so I might be able to offer a little insight here...

Your wording is a bit ambiguous for the first question. Assuming you mean "bathed in" CSF, no. Technically the cells of the brain (both neurons and glia) are surrounded and cushioned by the CSF. As you said, the CSF exists predominantly in the sub-arachnoid space so it is essentially filling the lumen between two membranes, the arachnoid and the pia. Therefore, the pia prevents the CSF from making direct contact with most brain cells. To answer your last questions then, the CSF should not infiltrate the brain itself and the majority of neurons and glia are likely bathed in interstitial fluid and plasma, the same fluids that bathe all the other cells in the body. That being said, it's also important to understand that CSF isn't significantly different from this fluid because it is produced in the choroid plexus as a sort of plasma filtrate. If I remember correctly, the biggest difference between plasma and CSF is a lack of protein and some slightly different salt concentrations.

So @neusu , how'd I do?

 

[vellez]

If you infact lateral branches off the basillar artery, what findings would I see? And would you do an MRI or Angiography for that patient, provided their symptoms matched an infact in that area? Or just tPA or a stent? I was thinking about this in class...

 

[deleted738762]

I'm not a neurosurgeon (yet) but I did major in neuroscience so I might be able to offer a little insight here...

Your wording is a bit ambiguous for the first question. Assuming you mean "bathed in" CSF, no. Technically the cells of the brain (both neurons and glia) are surrounded and cushioned by the CSF. As you said, the CSF exists predominantly in the sub-arachnoid space so it is essentially filling the lumen between two membranes, the arachnoid and the pia. Therefore, the pia prevents the CSF from making direct contact with most brain cells. To answer your last questions then, the CSF should not infiltrate the brain itself and the majority of neurons and glia are likely bathed in interstitial fluid and plasma, the same fluids that bathe all the other cells in the body. That being said, it's also important to understand that CSF isn't significantly different from this fluid because it is produced in the choroid plexus as a sort of plasma filtrate. If I remember correctly, the biggest difference between plasma and CSF is a lack of protein and some slightly different salt concentrations.

So @neusu , how'd I do?

That's what I thought as well, but this guy is telling me otherwise. Yes, I meant bathed by CSF. So are you saying the ependymal cells separate the CSF from the IF, and the IF bathes the neurons?

 

[Go4Doc]

That's what I thought as well, but this guy is telling me otherwise. Yes, I meant bathed by CSF. So are you saying the ependymal cells separate the CSF from the IF, and the IF bathes the neurons?

Yes I believe that's the case. I'm pretty sure I'm right but it wouldn't hurt to wait for confirmation from our resident neurosurgeon though.

 

[WhittyPsyche]

@neusu, can I just say how amazing your are? I've been reading this thread since you created it. It's gold.

Props for your commitment to blessing us with that knowledge. Seriously.

 

[neusu]

Are neurons within the csf? What fluid is between neurons, because I know csf is usually in the sub-arachnoid space or the outer part of the brain, so is the csf also between neurons cells. Are the glial cells within csf or what?

As mentioned by @Go4Doc there are several distinct spaces within the skull that we classify. The dura mater (tough mother) is the first membrane, then the arachnoid. The CSF is contained in the subarachnoid space, and is produced by the choroid plexus in the ventricles. The pia mater (tender mother) is the direct covering of the brain. The blood vessels to the brain run in arachnoid space and send branches to the pia and in to the parenchyma. Larger vessels are surrounded by an arachnoid space called the Virchow Robin space. The parenchyma itself is a semi-solid consisting of glial cells such as neurons, astrocytes, microglia, and oligodendrocytes. The extracellular fluid here is much like the 3rd space in the rest of the body, but the difference is the astrocytic foot processes create a tight junction on the basement membrane of the endovascular cells. This is the blood brain barrier. The center of the brain contains the ventricles which are lined with ependymal cells.

So in essence, the CSF is surrounding the brain and neurons, but the fluid in direct contact with the neurons is not CSF.

 

[neusu]

If you infact lateral branches off the basillar artery, what findings would I see? And would you do an MRI or Angiography for that patient, provided their symptoms matched an infact in that area? Or just tPA or a stent? I was thinking about this in class...

Interesting question.

Are you asking about large branches or perforating branches?

In either case an MRI would be better to demonstrate occlusion. Restricted diffusion and FLAIR signal change would be consistent with an acute infarct.

An angiogram would only show larger vessels being absent, so the perforators would not be visible. A named branch of the basilar, however (AICA, SCA, PCA) would be noticable on angiogram.

The treatment for the infarct would depend on the reason for infarct. Use of tPA or some other medication may be useful. Larger vessels can be accessed with a stent-retriever device to pull back clot. Flow diverting stents can be used in the basilar itself, but again any occlusion of the perforating branches is frought with complications.

 

[bioboy23]

What is your approach to Chiari I malformations? I was diagnosed with a malformation of 24mm about two years ago. Currently on a waitlist to see some famous doc in Maryland. Im not super symptomatic, just frequent pounding headaches but not debilitating or anything. I havent yet decided if I want to get the decompression surgery.

By the way, the MRI in my profile pic is not mine. Just somebody else's with Chiari.

 

[vellez]

Interesting question.

Are you asking about large branches or perforating branches?

In either case an MRI would be better to demonstrate occlusion. Restricted diffusion and FLAIR signal change would be consistent with an acute infarct.

An angiogram would only show larger vessels being absent, so the perforators would not be visible. A named branch of the basilar, however (AICA, SCA, PCA) would be noticable on angiogram.

The treatment for the infarct would depend on the reason for infarct. Use of tPA or some other medication may be useful. Larger vessels can be accessed with a stent-retriever device to pull back clot. Flow diverting stents can be used in the basilar itself, but again any occlusion of the perforating branches is frought with complications.

Thanks! I was talking about the perforating branches. Not sure what I'd look for in an H and P or vignette. I got the question wrong, because I was thinking you'd see pontine CN findings, but the answer turned out such that you'd see midbrain CN findings.

I have another question about the basal ganglia...such as...why should I care about it. But you don't need to answer that--I'll suffer through finding an answer on my own

 

[Go4Doc]

Thanks! I was talking about the perforating branches. Not sure what I'd look for in an H and P or vignette. I got the question wrong, because I was thinking you'd see pontine CN findings, but the answer turned out such that you'd see midbrain CN findings.

I have another question about the basal ganglia...such as...why should I care about it. But you don't need to answer that--I'll suffer through finding an answer on my own

As someone who has spent the last 4 years studying Parkinson's disease, the basal ganglia is awesome! You can thank it for helping to regulate your movement. In short, if any of the nuclei in the BG become dysfunctional you're gonna have a bad time.

 

[vellez]

As someone who has spent the last 4 years studying Parkinson's disease, the basal ganglia is awesome! You can thank it for helping to regulate your movement. In short, if any of the nuclei in the BG become dysfunctional you're gonna have a bad time.

I've managed to glean that, but the direct and indirect pathways and the neuroanatomy has got me like !

 

[neusu]

That's what I thought as well, but this guy is telling me otherwise. Yes, I meant bathed by CSF. So are you saying the ependymal cells separate the CSF from the IF, and the IF bathes the neurons?

To be honest, I'm not sure there is a huge distinction between the interstitial fluid and CSF. We are somewhat in the process of rethinking our understanding of how these spaces interact, and there is a whole concept of a neurolymphatic system. Needless to say, the way you are thinking should be sufficient for what is currently accepted, and will be tested on your exams.

 

[neusu]

@neusu, can I just say how amazing your are? I've been reading this thread since you created it. It's gold.

Props for your commitment to blessing us with that knowledge. Seriously.

Thanks! Happy to hear you find this useful.

 

[neusu]

What is your approach to Chiari I malformations? I was diagnosed with a malformation of 24mm about two years ago. Currently on a waitlist to see some famous doc in Maryland. Im not super symptomatic, just frequent pounding headaches but not debilitating or anything. I havent yet decided if I want to get the decompression surgery.

By the way, the MRI in my profile pic is not mine. Just somebody else's with Chiari.

Hmm, I can't really give medical advice here. That being said, there are numerous ways people manage Chiari (and it depends on the subtype). Globally, I think of it as split in to sub-occipital decompression with duraplasty or without, and for the former with lysis of arachnoid adhesions or without. Each surgeon has a personal preference and experience that they use to guide their management. Speak with your surgeon and see what he recommends and why.

 

[neusu]

Thanks! I was talking about the perforating branches. Not sure what I'd look for in an H and P or vignette. I got the question wrong, because I was thinking you'd see pontine CN findings, but the answer turned out such that you'd see midbrain CN findings.

I have another question about the basal ganglia...such as...why should I care about it. But you don't need to answer that--I'll suffer through finding an answer on my own

Basilar perforators feed the brainstem, so you're not that far off with pontine findings being a possibility. Upper basilar will feed the midbrain.

The basal ganglia is important in tuning our fine motor ability. Think of the signal going from the motor strip to the limbs as a specific instruction. The feedback to the brain from our senses (proprioception, muscle spindle and joint stretch organs, visual cues, and cerebellar vestibular input) all send feedback to the brain to determine whether that task was accomplished right. The basal ganglia is the brains hardware to continuously modify this movement and make sure it is precise and specific. As mentioned, issues with the basal ganglia lead to loss of regulation of this control, so you see gross over correction for these imbalances (e.g. tremor). So, in essence, it is a tuning system to allow us to utilize our limbs with the fine motor control we have.

 

[vellez]

Basilar perforators feed the brainstem, so you're not that far off with pontine findings being a possibility. Upper basilar will feed the midbrain.

The basal ganglia is important in tuning our fine motor ability. Think of the signal going from the motor strip to the limbs as a specific instruction. The feedback to the brain from our senses (proprioception, muscle spindle and joint stretch organs, visual cues, and cerebellar vestibular input) all send feedback to the brain to determine whether that task was accomplished right. The basal ganglia is the brains hardware to continuously modify this movement and make sure it is precise and specific. As mentioned, issues with the basal ganglia lead to loss of regulation of this control, so you see gross over correction for these imbalances (e.g. tremor). So, in essence, it is a tuning system to allow us to utilize our limbs with the fine motor control we have.

Thanks. I suspected I was on the verge of the correct answer by saying pontine findings, but it's good to know that upper basilar will feed midbrain. I'm sure that's a nitpicky detail Step 1 will like to try and trip me up on.

Why couldn't our lecture on the BG just have started the lecture with your paragraph? Ha. Now time to get bogged down with the direct and indirect pathways, and trying to make sense of the anatomy.

 

[deleted738762]

To be honest, I'm not sure there is a huge distinction between the interstitial fluid and CSF. We are somewhat in the process of rethinking our understanding of how these spaces interact, and there is a whole concept of a neurolymphatic system. Needless to say, the way you are thinking should be sufficient for what is currently accepted, and will be tested on your exams.

I did some digging and they both are very similar in ionic composition. Both are called interstitial fluid, but CSF is just a specialized name for it.

 

[neusu]

As someone who has spent the last 4 years studying Parkinson's disease, the basal ganglia is awesome! You can thank it for helping to regulate your movement. In short, if any of the nuclei in the BG become dysfunctional you're gonna have a bad time.

What were you guys studying? Any interesting findings?

 

[Go4Doc]

What were you guys studying? Any interesting findings?

I spent the first three years in one lab at my undergrad studying PD pathophysiology and it's modulation by DBS of the GPi in Rhesus Macaques. Did some interesting single unit electrophysiology there but I can't comment on the results yet because we're working on a publication.

Since my graduation in May, I moved to a lab at Stanford where I've spent the last ~8 months or so studying PD pathophysiology and DBS in humans with PD. We use the activa PC + S sensing neurostimulator so we can do all sorts of stuff. Currently working on publishing a case report on the first patient in the world to receive adaptive DBS via a completely embedded system. I'm also following up on the long term effects of chronic DBS. We have data on some patients who are now up to three years post- surgery. Interestingly it seems that chronic DBS seems to "permanently" attenuate beta frequency (13-30Hz) oscillations in the STN. This also correlates with lower OFF meds/ OFF stim UPDRS-III scores. In short, there does seem to be a positive long term effect.

 

[neusu]

I've managed to glean that, but the direct and indirect pathways and the neuroanatomy has got me like !

The first step is just memorizing the pathways. Somewhere down the line it'll click and just make sense. Until then, cramming it in your head is the best strategy.

 

[neusu]

I did some digging and they both are very similar in ionic composition. Both are called interstitial fluid, but CSF is just a specialized name for it.

How's the glucose between the two?

 

[deleted738762]

How's the glucose between the two?

I think it would be the same since both are interstitial fluids, but one just has a specialized name for it because of its position in the body. Plus, one has astrocytes and the other doesn't, but I don't think that part really matters.

 

[jowblow997]

How's the glucose between the two?

I know others have said this, but just wanted to thank you for your continuing presence. Many online neurosurgery resources are dead/outdated so I appreciate you helping those who are going down this path.

 

[daenschl]

http://neurosurgerymatch.org/

This is fairly basic info, but it's new and a good start.

 

[neusu]

I know others have said this, but just wanted to thank you for your continuing presence. Many online neurosurgery resources are dead/outdated so I appreciate you helping those who are going down this path.

You're welcome! I am happy to hear that you find this useful.

Back in the day, when I was a medical student, there were a couple of residents on here who followed the neurosurgery forum and were very helpful. There was also another, now defunct, website nsmatch.com and then uncleharvey.com. From what I gather, uncleharvey.com closed and the forums moved to nsgapplicants.boards.net and now neurosurgeryhub.org.

My best advice is to get to know the people at the program you are at. The anymous forums are also helpful, but you have to take the validity of the statements with a grain of salt.

 

[neusu]

http://neurosurgerymatch.org/

This is fairly basic info, but it's new and a good start.

I think this is an official site from the young neurosurgeon committee, but I could be mistaken.

 

[jowblow997]

You're welcome! I am happy to hear that you find this useful.

Back in the day, when I was a medical student, there were a couple of residents on here who followed the neurosurgery forum and were very helpful. There was also another, now defunct, website nsmatch.com and then uncleharvey.com. From what I gather, uncleharvey.com closed and the forums moved to nsgapplicants.boards.net and now neurosurgeryhub.org.

My best advice is to get to know the people at the program you are at. The anymous forums are also helpful, but you have to take the validity of the statements with a grain of salt.

Yeah and neurosurgeryhub.org has been rather quiet. I think the issue is that it's a small community + candidates usually limit their online presence during interview season. You are also correct that that website is sponsored by the young neurosurgeon committee.

Unfortunately, I don't have a home program and in the last decade we have 2 alumni who have matched neurosurgery. I'm an MS2 (and might take a research year) so I do have some time to get to know the neurosurgery community better.

If I make it one day, I'll be sure to return the favor to online forums

Also, for anyone that reads this, I just found a mentorship program through the AANS:
http://www.aans.org/Young Neurosurg...nt Membership/Resident Mentoring Program.aspx

 

[neusu]

Yeah and neurosurgeryhub.org has been rather quiet. I think the issue is that it's a small community + candidates usually limit their online presence during interview season. You are also correct that that website is sponsored by the young neurosurgeon committee.

Unfortunately, I don't have a home program and in the last decade we have 2 alumni who have matched neurosurgery. I'm an MS2 (and might take a research year) so I do have some time to get to know the neurosurgery community better.

If I make it one day, I'll be sure to return the favor to online forums

Also, for anyone that reads this, I just found a mentorship program through the AANS:
http://www.aans.org/Young Neurosurgeons/Residents/Resident Membership/Resident Mentoring Program.aspx

Not having a home program, you are at a disadvantage for several reasons. First, research opportunities may be fewer, at least in neurosurgery. Second, you don't have residents to work with or a home subI to learn from before going on aways. Third, when match time comes, you don't have a PD to call on your behalf. While each of these may not play a major role in themselves, and certainly many many students match from schools with programs, if possible it is better to be from a school with a program.

The mentorship program is nice, especially if you are at a program that doesn't have a strong focus in a particular area in which you are interested. Though finding a mentor at your home program is also very important.

 

[vellez]

So, another question.

Here is the situation: Pt comes in f/u eval for HTN + complaints of depression, loneliness (wife died 6 mos ago--kids don't really pay attention to him, occasional suicidal ideations, no plan to carry-out).

PMH: HTN, dyslipidemia, 2 beers per day.
PE: HEENT: "subtle" right sided facial paralysis sparing forehead, RUE spasticity, 3+ R biceps brachii reflex, Babinski + on right. Rest of PE is unremarkable.

My first thought was...focal neurologic findings, let's get some sort of imaging and do a neuro work up. But we were told to pursue their psych problems, including a CAGE assessment. This was a CBL and we didn't pursue imaging at the get-go because I was told that the focal neurological signs were very "subtle". But I feel Babinski + and hyperreflexia warrants a neurology work-up more than a psych work up? Anyway, provided my poor explanation of the case, what is a reasonable work up for this patient?

**Disclaimer: I fully acknowledge my role as a student, and respect the opinion of my professors who chose to pursue their psych issues, first

 

[neusu]

So, another question.

Here is the situation: Pt comes in f/u eval for HTN + complaints of depression, loneliness (wife died 6 mos ago--kids don't really pay attention to him, occasional suicidal ideations, no plan to carry-out).

PMH: HTN, dyslipidemia, 2 beers per day.
PE: HEENT: "subtle" right sided facial paralysis sparing forehead, RUE spasticity, 3+ R biceps brachii reflex, Babinski + on right. Rest of PE is unremarkable.

My first thought was...focal neurologic findings, let's get some sort of imaging and do a neuro work up. But we were told to pursue their psych problems, including a CAGE assessment. This was a CBL and we didn't pursue imaging at the get-go because I was told that the focal neurological signs were very "subtle". But I feel Babinski + and hyperreflexia warrants a neurology work-up more than a psych work up? Anyway, provided my poor explanation of the case, what is a reasonable work up for this patient?

**Disclaimer: I fully acknowledge my role as a student, and respect the opinion of my professors who chose to pursue their psych issues, first

This depends on the context and duration of the findings. Was the chief complaint depression? Was he weak on the right arm or leg? Was the facial palsy something he had ever noticed before? How about the spasticity, or any coordination issues?

In primary care and outpatient medicine, often the plan is based on what the patient wants, and presented with. That isn't to say we should ignore findings. This may well have warranted a neurological workup, but a more thorough history and or physical is the first step.

 

[Fortyfive]

Hi! Thank you for this thread!

Did you or any of your colleagues have lower back issues before starting your career as a surgeon?

If not, have you or any of your colleagues developed chronic back issues from performing long surgeries?

I ask because I am interested in surgical specialities but I have chronic lower back pain. The pain gets worse if I sit/stand in the same place for 30 mins or longer. I constantly need to keep moving and stretching to keep my back pain to a minimum level. I am currently in my early 20s and I think that the pain will get worse as I age.

I want to know if I should explore medicine specialties instead of surgical ones because of lower back problems.

Sorry if this is a silly question.

 

[IlyaR]

Third, when match time comes, you don't have a PD to call on your behalf. While each of these may not play a major role in themselves, and certainly many many students match from schools with programs, if possible it is better to be from a school with a program.

Out of curiosity, how willing are PDs to call on behalf of applicants? I recently met with my home neurosurgery PD and am starting a summer program between M1 and M2, but I'd imagine asking them to call another program during M4 indicates a lack of interest in theirs.

 

[NeuResurgens]

Out of curiosity, how willing are PDs to call on behalf of applicants? I recently met with my home neurosurgery PD and am starting a summer program between M1 and M2, but I'd imagine asking them to call another program during M4 indicates a lack of interest in theirs.

This is a point I'm also curious about. How much do the attendings try to lobby you to stay at the home program, if at all? I imagine if they like you enough to call they'd like you enough to want you to stay.

Also, would you say having a few people each year Match from your med school into your home program is generally a good thing? Does it indicate a good/non-malignant work environment at all?

 

[neusu]

Hi! Thank you for this thread!

Did you or any of your colleagues have lower back issues before starting your career as a surgeon?

If not, have you or any of your colleagues developed chronic back issues from performing long surgeries?

I ask because I am interested in surgical specialities but I have chronic lower back pain. The pain gets worse if I sit/stand in the same place for 30 mins or longer. I constantly need to keep moving and stretching to keep my back pain to a minimum level. I am currently in my early 20s and I think that the pain will get worse as I age.

I want to know if I should explore medicine specialties instead of surgical ones because of lower back problems.

Sorry if this is a silly question.

A lot of people in the OR have varying degree of back pain. Depending on the symptoms things like stretching and therapy can help or you may benefit from an evaluation by a surgeon. Aches and pains do tend to worsen with age and use. Understanding the mechanism of the pain generator and adjusting things like posture, gait, or shoes/clothes to aid in this also helps.

For what its worth, a little (or even a lot of) back pain is likely to be on the lesser end of evils you would suffer through as a surgical subspecialty resident.

 

[JB50]

Do you get to enjoy family life at all? The biggest turn off/fear for me regarding surgery is the slavery that can be involved.

 

[neusu]

Out of curiosity, how willing are PDs to call on behalf of applicants? I recently met with my home neurosurgery PD and am starting a summer program between M1 and M2, but I'd imagine asking them to call another program during M4 indicates a lack of interest in theirs.

Quite the contrary, most PDs and/or chairman are more than happy to call on a student's behalf. In my experience, the student meets with the PD to discuss rank list order etc. and leaves the home program off the proposed rank list to prevent any conflict of interest. The PD wants the student to end up happy and successful, and landing the student at a prestigous, sought after program looks good on the home program's behalf.

 

[neusu]

This is a point I'm also curious about. How much do the attendings try to lobby you to stay at the home program, if at all? I imagine if they like you enough to call they'd like you enough to want you to stay.

Also, would you say having a few people each year Match from your med school into your home program is generally a good thing? Does it indicate a good/non-malignant work environment at all?

This is widely variable depending on the number of spots at the home program and number of students applying. Some home programs are less interested in their own students and want them to go away to experience another institution. Others are very comfortable with their own students and offer them to stay if they so desire.

Most programs are 2-3 residents/year, so it is unlikely that a few each year would stay. Patterns do emerge, though. For instance, if one student from a school matches at a program, and does well, the students from that school in the following years may have more interest, and the progam has a better feel for the quality of the student coming.

 

[neusu]

Do you get to enjoy family life at all? The biggest turn off/fear for me regarding surgery is the slavery that can be involved.

Life is what you make of it. I certainly am not leaving for work to arrive at 9 AM and home by 5, nor is any neurosurgeon that I know of, for that matter. It is very, very time demanding and will be the dominant thing in your life for the next 7 years. You will miss life events like weddings and funerals, kids sporting events or concerts, and so forth. If this is an absolute necessity for you, then you will likely be unhappy with neurosurgery as a career choice. One of my mentors, early in my training, on the topic of divorce rate in neurosurgery, quipped "you only have time for one marriage." To that end, having a supportive spouse who understands the demand of the career certainly helps. In the end, every residency is a grind. The level to which this encompasses your life, and for what duration, is somewhat variable.

 

[JB50]

Life is what you make of it. I certainly am not leaving for work to arrive at 9 AM and home by 5, nor is any neurosurgeon that I know of, for that matter. It is very, very time demanding and will be the dominant thing in your life for the next 7 years. You will miss life events like weddings and funerals, kids sporting events or concerts, and so forth. If this is an absolute necessity for you, then you will likely be unhappy with neurosurgery as a career choice. One of my mentors, early in my training, on the topic of divorce rate in neurosurgery, quipped "you only have time for one marriage." To that end, having a supportive spouse who understands the demand of the career certainly helps. In the end, every residency is a grind. The level to which this encompasses your life, and for what duration, is somewhat variable.

Thanks for that perspective. Definitely something to keep in mind

 

[neusu]

Thanks for that perspective. Definitely something to keep in mind

You're welcome. It's so easy to get sucked in and see life through blinders of your own narrow experience. Sometimes taking a deep breath, taking a step back, and realizing there is much more to life than whatever the latest thing on which you are perseverating helps put things in perspective.

 

[neusu]

PM Q:
Hi, thanks a bunch for creating your thread and responding to questions. [removed due to personal identifying information]: Would I have a rough time in a prospective residency with mild amblyopia? I realize that surgical microscopes are used quite often, but I'm hoping it won't bar me from the field. The vision on my right eye is somewhat blurry and uncorrectable, but I can see with both eyes perfectly well. I've done research in an ophtho lab and had to cannulate hundreds of mice eyes, but once in a while my eyes would get tired using the microscope. Just wondering if it would greatly impact entering neurosurgery.

Thanks!

A:
How is your depth perception? I know several surgeons who have a lazy eye that seem to do fine. While none of them are neurosurgeons, I don't see an issue in and of itself if you are able to see the field in three dimensions.

 

[JPSmyth]

In your ideal life after residency how does one week potentially look? How much clinic time, how much OR time, how much down time, etc.

(In a somewhat realistic sense of what might be possible for you)

 

[Acquire2aspire]

Neusu, Thank you so much for your wisdom. I have a few questions. I am currently in a 6 yr BA/MD program at UMKC and am in the second year of medical school. My heart is set on neurosurgery and I have shadowed many surgeons, done research in the field and absolutely love it. In all honesty, I really wish I loved something else but I can't see myself doing anything else besides NSG. The thing is, my school has a cumulative science GPA from the first of 6 years that help determine AOA and stuff like that (but ofc rotations and ECs and Boards end up playing a role too). I used to have a 4.0 throughout my first year but because of some recent deaths and turbulence , I have gotten three Cs and two Bs in the middle of my schooling. If I have picked it up since then, and continued to get As throughout the rest of my medical classes and get High-Honors Pass on rotation and do well on Boards/research, do I have a shot? Or will those three Cs and two Bs that I got a long time ago immediately disqualify me? Also how important is AOA? Is there anything more I can do to help make up for those previous bad grades?

 

[neusu]

In your ideal life after residency how does one week potentially look? How much clinic time, how much OR time, how much down time, etc.

(In a somewhat realistic sense of what might be possible for you)

Tough to say, I suppose. Generally we have OR block time, 2 days a week. Then another 2-days of clinic. The last day is a mix depending on what is more pressing. Add in call here and there or academic needs. Things tend to change, though, so perhaps my interests or linkings will make this dramatically different.

 

[libertyyne]

This might be a stupid question. What are you thoughts on the efficacy questions surrounding spine procedures. Do you think this will ultimately lead to payors reigning in volumes? Where do you think NSG will shift if spine is greatly reduced?