Finishing up 2nd year as a neurosurgery attending, ask me anything

[mmmcdowe]

I really like surgery but I have found the hospital to not be very enjoyable. I hate rounding and I find following every little lab value and radiograph tedious. I haven't done my surgery rotation so I'm wondering how different it is from IM. How long do the patients on your service usually stay and what percentage of the day in the first few years of residency do you spend managing the floor? I know part of being a good surgeon is taking care of the patients beyond surgery but I just find floor work to be too slow to hold my interest.

Do you think as someone who hated general IM that I would likely also dislike surgery since there is a lot of management involved as well? I am currently in my GI rotation and I enjoy it, we only see like 3-4 consults a day and each one takes like 15 minutes a piece, rest of the time in clinic or doing procedures. If surgery was similar to my GI rotation I would do it in a heartbeat, but from what I've heard it seems like the first 2-3 years of surgery you are very similar to a medical intern without capping restrictions.

I always hear if you love the OR and would not want to be anywhere else you should do surgery. I feel like I love the OR, I just don't love the floor work that goes on in between the OR.

Generally surgeons are less focused on differentials and discussion of medical issues. Rounds are far faster on surgery. This isn't to say that patient labs and exams aren't important, only that the purpose is different. Medicine focuses on analysis of each detail to determine one of a billion possible conclusions. Surgery's algorithm is in many ways more direct and simple. The primary questions a surgeon must ask are does a patient need surgery now, tomorrow, eventually, or never. Why the a creatinine went from 0.9 to 1.0 or a hematocrit went from 32 to 29 over the course of 3 days is of less importance to surgeons, merely the presence of a hematocrit of 29 is the primary consideration and whether or not a intervention based on the data is required is the primary question, not the why (exceptions are obviously present to this rule of thumb). A surgical resident and medical resident have vastly different existences. Not liking medicine probably increases the chances of liking surgery.

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[mmmcdowe]

Do you believe in free will?

I know it's a really old question, but I love neuroscience and have always been disappointed in the lack for information with respect to the whole free will issue. Although I understand there are too many unknowns to say for sure. It would be interesting to know what you think.

Yes, I believe we are physically driven by biological imperatives, but acting against one's own self interest or, alternatively, against the self interest of the community, suggests that we have the cognitive capacity to chose to go contrary to our instincts. Further, innovation has no direct biological basis. We can be driven to be creative by our bodies but what we create is not genetically coded. Our DNA did not create space shuttles.

 

[Merely]

Yes, I believe we are physically driven by biological imperatives, but acting against one's own self interest or, alternatively, against the self interest of the community, suggests that we have the cognitive capacity to chose to go contrary to our instincts. Further, innovation has no direct biological basis. We can be driven to be creative by our bodies but what we create is not genetically coded. Our DNA did not create space shuttles.

When does someone act against their own self interest?

 

[medic86]

When does someone act against their own self interest?

When they jump on a grenade to save their buddies from death.

 

[Merely]

When they jump on a grenade to save their buddies from death.

One could argue that that's not against their own self interest because they value the life of their friends more than their life so it is actually in their interest to die to save their friends since they could not live with the thought of knowing they could have saved their friends but were too cowardly.

 

[sloop]

One could argue that that's not against their own self interest because they value the life of their friends more than their life so it is actually in their interest to die to save their friends since they could not live with the thought of knowing they could have saved their friends but were too cowardly.

Uh oh, we have a sophist over here.

Of course if you take people's actions as absolute indications of their real interests, you are going to believe that people acting in ways that seem contrary to their interests in fundamental ways are really just acting toward their own interest. The problem is, you haven't really made a good argument. You've just defined terms in ways that people don't generally accept and proceeded to beg the question.

 

[Merely]

Uh oh, we have a sophist over here.

Of course if you take people's actions as absolute indications of their real interests, you are going to believe that people acting in ways that seem contrary to their interests in fundamental ways are really just acting toward their own interest. The problem is, you haven't really made a good argument. You've just defined terms in ways that people don't generally accept and proceeded to beg the question.

I see what you're saying, so give me an argument that refutes my original argument that everything people do is self interested. Give me a case where someone acts against their own self interest and then explain how you were able to determine that it was against their own self interest since you don't want to accept my indication of their interest based on their actions.

 

[sloop]

I see what you're saying, so give me an argument that refutes my original argument that everything people do is self interested. Give me a case where someone acts against their own self interest and then explain how you were able to determine that it was against their own self interest since you don't want to accept my indication of their interest based on their actions.

Well, self destruction seems a priori counter to all interests of an individual. An individual can have no interests when they are dead, so any interests they had prior will be subverted by an act of self-destruction.

I know that was abstract but to make it more concrete: spend a day on any psych service and you will run into people who do impulsive things for various reasons and will tell you subsequently how much they regret doing them. It is not uncommon for people to act against their own interests.

 

[tvelocity514]

Depends on if you are referring to the ones that I log or the ones that I work

That being said, no the hours are not nearly as hard to endure as feared, especially in comparison to neurosurgery sub-is.

Can you explain the hours you worked on sub-is and how many you worked as a pgy1-2 (including not logged). I know it's different depending on if you are in critical care during pgy1 etc but just an average or some idea would be very helpful!

Also, at what point did you feel really comfortable with knowing everything about all the major spinal tracts and pathways? Did you know them all inside and out on away rotations?

 

[Merely]

Well, self destruction seems a priori counter to all interests of an individual. An individual can have no interests when they are dead, so any interests they had prior will be subverted by an act of self-destruction.

I know that was abstract but to make it more concrete: spend a day on any psych service and you will run into people who do impulsive things for various reasons and will tell you subsequently how much they regret doing them. It is not uncommon for people to act against their own interests.

Thank you for your response but it seems to me you are just assuming that dying is against ones own self interest simply because one cannot have any self interest once one is dead. I don't accept that killing yourself is a priori contrary to self interest. I also don't accept that self interest is subverted once you kill yourself. Can you provide a reason for that assertion instead of presupposing it?

 

[medic86]

Thank you for your response but it seems to me you are just assuming that dying is against ones own self interest simply because one cannot have any self interest once one is dead. I don't accept that killing yourself is a priori contrary to self interest. I also don't accept that self interest is subverted once you kill yourself. Can you provide a reason for that assertion instead of presupposing it?

...

I can't even.

 

[Merely]

...

I can't even.

? I'm not trying to start anything I'm genuinely curious about this. If you have something to add then feel free, I'm not sure what you are frustrated with?

 

[sloop]

Thank you for your response but it seems to me you are just assuming that dying is against ones own self interest simply because one cannot have any self interest once one is dead. I don't accept that killing yourself is a priori contrary to self interest. I also don't accept that self interest is subverted once you kill yourself. Can you provide a reason for that assertion instead of presupposing it?

I think your argument is self refuting—hence why I called you a sophist. Your argument is basically that dying can be in one's interests. Since dying entails transitioning to a state where one can have no interests, you are arguing that it can be in one's interests to have no interests. Destruction of one's interests is antithetical to having interests at all so it makes no sense that you could have an interest in that. This is like saying you would enjoy the state of not enjoying anything.

You are falling into the exact relativistic trap that the sophists fell into. Your proposal is one of logical nihilism and formal contradiction.

As to your point about not accepting that one cannot have interests after death: to what exactly do the interests belong after death? Unless you believe in some mystical plane where interests go after death, it does not make sense to say a person can have them afterwards.

 

[Merely]

I think your argument is self refuting—hence why I called you a sophist. Your argument is basically that dying can be in one's interests. Since dying entails transitioning to a state where one can have no interests, you are arguing that it can be in one's interests to have no interests. Destruction of one's interests is antithetical to having interests at all so it makes no sense that you could have an interest in that. This is like saying you would enjoy the state of not enjoying anything.

You are falling into the exact relativistic trap that the sophists fell into. Your proposal is one of logical nihilism and formal contradiction.

As to your point about not accepting that one cannot have interests after death: to what exactly do the interests belong after death? Unless you believe in some mystical plane where interests go after death, it does not make sense to say a person can have them afterwards.

You can't see that dying can be in one's self interest?

 

[sloop]

You can't see that dying can be in one's self interest?

No, I can't, for the reasons I just described. A dead person has no interests so the act of dying can further no interest. Dying may be a rational choice of people for whom living is so antithetical to their interests (not being in pain, etc.) that they are miserable, but the act of dying does not further those interests. It merely takes away all interests so none are available for an individual's existence to be in conflict with (since they no longer exist).

This being said, most self-destructive activity is not logically justified in this way. It is usually impulsive activity in response to some internal or external stimulus.

 

[Merely]

No, I can't, for the reasons I just described. A dead person has no interests so the act of dying can further no interest. Dying may be a rational choice of people for whom living is so antithetical to their interests (not being in pain, etc.) that they are miserable, but the act of dying does not further those interests. It merely takes away all interests so none are available for an individual's existence to be in conflict with (since they no longer exist).

This being said, most self-destructive activity is not logically justified in this way. It is usually impulsive activity in response to some internal or external stimulus.

If you are living in extreme pain, your interest is to take that pain away. Dying takes the pain away, therefore dying is in your own self interest?

 

[22031 Alum]

If you are living in extreme pain, your interest is to take that pain away. Dying takes the pain away, therefore dying is in your own self interest?

As a spectator: you guys are ruining this thread. Start a new one for the philosophical debate and let people learn about neurosurgery here.

 

[PL198]

I'm a lot more concerned about the lack of dunking ability on a 9 foot hoop.

come on man

 

[PhillyMed777]

Getting back to the topic...

What are some examples of cool technology that you have used?

 

[mmmcdowe]

Getting back to the topic...

What are some examples of cool technology that you have used?

Endoscopes to clip aneurysms through the nose, the stunning reduction in tremor immediately after turning on DBS, stenting of the transverse sinus to treat pseudotumor cerebri.

 

[mmmcdowe]

Can you explain the hours you worked on sub-is and how many you worked as a pgy1-2 (including not logged). I know it's different depending on if you are in critical care during pgy1 etc but just an average or some idea would be very helpful!

Also, at what point did you feel really comfortable with knowing everything about all the major spinal tracts and pathways? Did you know them all inside and out on away rotations?

You should know all the tracts and basic neuroanatomy prior to your sub-i's. Knowing all the gyri, this membrane and that, etc isn't as important but if someone points to the temporal lobe and asks you what the eloquent function of it is you should know.

I worked more on sub-is than at any other point subsequently. Sub-i's can be miserable at some institutions, and I had the misfortune of experiencing this. On the plus side, it gave me perspective that life could be worse than my current lifestlye. I worked anywhere from 50-100 hours on a given rotation a week.

 

[NickNaylor]

How's life? How you doin?

Feel like I never see you post anymore.

 

[mmmcdowe]

L

How's life? How you doin?

Feel like I never see you post anymore.

Life is good, done with day call forever. Mostly just operate and go home. Got a dog. How you doing?

 

[rednote]

Thank you for sharing your insights! I have three questions on research and publication.

1. You said you starting early in terms of medical school research. How early did you start? Summer before MS1? During MS1? Summer between MS1/MS2?
2. Also, I'm going to be MS1 this fall and was wondering if I should get involved in research during MS1 because i'm not sure if I would have significant time to contribute enough.. any thoughts?
3. Lastly, if I do get involved in research MS1.. is researching under two different neurosurgeons inadvisable? I found a neurosurgeon at my medical school who has a lab and focuses on neuro-oncology basic science research but not much on clinical side in terms of pubs(At least from what i gather. All the medical students who graduated from the lab seems to only have basic science research pub). I was thinking I might not have enough time during MS1 to actually contribute significantly.. so I would rather do clinical research under a different neurosurgeon during MS1 and work for this other neurosurgeon starting in the summer. Thoughts? I have some background experience in basic science neuro-oncology research but no clinical research experience.

Thank you for your time!

 

[masaraksh]

Is functional neurosurgery the derm of neurosurgery? What is the competitiveness of the ~30 fellowships? What is the job marker (guessing this is all academic?)

 

[tiedyeddog]

done with day call forever

can't wait....

 

[mmmcdowe]

Is functional neurosurgery the derm of neurosurgery? What is the competitiveness of the ~30 fellowships? What is the job marker (guessing this is all academic?)

I may be off base but it has not been my impression that functional neurosurgery is overly competitive and tends to attract only a small subset of neurosurgery residents. I would anticipate the job market would grow as indications do.

 

[mmmcdowe]

Thank you for sharing your insights! I have three questions on research and publication.

1. You said you starting early in terms of medical school research. How early did you start? Summer before MS1? During MS1? Summer between MS1/MS2?
2. Also, I'm going to be MS1 this fall and was wondering if I should get involved in research during MS1 because i'm not sure if I would have significant time to contribute enough.. any thoughts?
3. Lastly, if I do get involved in research MS1.. is researching under two different neurosurgeons inadvisable? I found a neurosurgeon at my medical school who has a lab and focuses on neuro-oncology basic science research but not much on clinical side in terms of pubs(At least from what i gather. All the medical students who graduated from the lab seems to only have basic science research pub). I was thinking I might not have enough time during MS1 to actually contribute significantly.. so I would rather do clinical research under a different neurosurgeon during MS1 and work for this other neurosurgeon starting in the summer. Thoughts? I have some background experience in basic science neuro-oncology research but no clinical research experience.

Thank you for your time!

1. I started late in the Fall of MS1, I don't think starting before medical school is worthwhile.
2. Get your bearings and a few months in you'll know your time availability.
3. I'd start with one before trying to appease two. Taking on too much and producing nothign is bad form. Which you choose to start with is purely personal preference.

 

[mmmcdowe]

Aaaand bump/edit title. Finishing up PGY3 NSGY AMA

 

[BurghStudent]

What do you look for in a rotating medical student?

 

[mmmcdowe]

What do you look for in a rotating medical student?

Follows direction, shows common sense (for example, maybe dont do things unless told and dont ask questions if theres a torrent of blood and the attending is freaking out), accepts instruction feedback modestly, has a good sense of humor, hard worker but relaxed, enjoys the labor for its own sake.

 

[PhillyMed777]

Would you go through this if you were only able to make 200k per year and not a dollar higher?...assume the current taxation system applies to the the above

 

[PS2020]

Do you think you'll ever grow tired of what I assume to be repetitive technical work? If yes, then once the novelty wears off, how do you keep the boredom from creeping in on your work? For example if a head trauma comes in at 3AM, do you ever just wish that someone else could take care of it... or does it give you the same rush you experienced doing your first craniotomy? I am concerned that surgery would eventually get so routine that I would get bored and wish I could hire a tech to do the mundane cases. I suppose that's one reason attendings go into academics, to have the residents do that type of work.

Now that you are a bit more than half way done with residency, are you feeling burnt out? Any regrets for pursuing a field with such long training (especially now that many of your med school classmates are probably finishing up their own residencies)?

 

[failedatlife]

Where did you do your sub i's? Why does Columbia always match kids whose parents are on faculty?

 

[SurgeDO]

How do you become comfortable with procedures that you aren't heavily exposed to during residency?

For example, if you go to a program that coils 99.99% of aneurysms, how do you become comfortable clipping aneurysms when you graduate and become an attending? How do you become comfortable with XLIFs and ALIFs if your program is mostly doing TLIFs and PLIFs? Every program seems to teach their residents specific ways to handle certain pathology. Given the millions of ways to skin a cat and approach a problem in neurosurgery, how do you become educated in/comfortable with procedures that you may only see a couple times during residency?

Really appreciate it.

 

[mmmcdowe]

Would you go through this if you were only able to make 200k per year and not a dollar higher?...assume the current taxation system applies to the the above

Id go through it again for my resident salary (assuming debt forgiveness)

 

[mmmcdowe]

Certainly I can see it losing some of its pizaz but I have always enjoyed manual tasks like model building so ultimately I am not too worried because every case is unique no mater how simple. For me at least I also tend to be invigorated by teaching so I hope that by being involved in teaching I can remain engaged.

Im not halfway done yet its a 7 year program but no I dont feel burnt out and other than wishing I had been wiser in my personal life with relationships I have no regrets.

Do you think you'll ever grow tired of what I assume to be repetitive technical work? If yes, then once the novelty wears off, how do you keep the boredom from creeping in on your work? For example if a head trauma comes in at 3AM, do you ever just wish that someone else could take care of it... or does it give you the same rush you experienced doing your first craniotomy? I am concerned that surgery would eventually get so routine that I would get bored and wish I could hire a tech to do the mundane cases. I suppose that's one reason attendings go into academics, to have the residents do that type of work.

Now that you are a bit more than half way done with residency, are you feeling burnt out? Any regrets for pursuing a field with such long training (especially now that many of your med school classmates are probably finishing up their own residencies)?

 

[mmmcdowe]

Where did you do your sub i's? Why does Columbia always match kids whose parents are on faculty?

Hopkins and the Barrow. I couldnt say regarding the later question but I do know that fit is a big factor in who they take.

 

[mmmcdowe]

It can be difficult. It often involves cadaver courses and scrubbing with another attending to learn their case.

How do you become comfortable with procedures that you aren't heavily exposed to during residency?

For example, if you go to a program that coils 99.99% of aneurysms, how do you become comfortable clipping aneurysms when you graduate and become an attending? How do you become comfortable with XLIFs and ALIFs if your program is mostly doing TLIFs and PLIFs? Every program seems to teach their residents specific ways to handle certain pathology. Given the millions of ways to skin a cat and approach a problem in neurosurgery, how do you become educated in/comfortable with procedures that you may only see a couple times during residency?

Really appreciate it.

 

[PS2020]

Certainly I can see it losing some of its pizaz but I have always enjoyed manual tasks like model building so ultimately I am not too worried because every case is unique no mater how simple. For me at least I also tend to be invigorated by teaching so I hope that by being involved in teaching I can remain engaged.

Im not halfway done yet its a 7 year program but no I dont feel burnt out and other than wishing I had been wiser in my personal life with relationships I have no regrets.

You're awesome! I got a few more:

Is it true that most neurosurgeons training today need to do a fellowship?

Did you absolutely have to take a research year to match? If you didnt have to, how limiting would it be not to, assuming all else (step, clinicals) being equal.

What gives certain programs their top reputations? Is it cause of volume? Big fish who publish textbooks? Laymen recognition? pt outcomes? How can doximity or USNWR possibly compare NYP to NYU or Hopkins to UCSF.

 

[mmmcdowe]

New Question asked anonymously:

I'm half blind from birth. As you might know, this means I technically do not have stereo depth perception (I still have mono depth perception, meaning I can perceive depth with the aid of a background / contrast / shadows / motion but have difficulty doing so while looking at objects from a single angle, with flat / featureless backgrounds and no shadows or motion to help my brain adjust) but seeing as Ive had this condition my entire life my brain has somewhat "adapted" to the point I can do "depth perception" things like drive, play sports, etc. just as well as a person with healthy stereovision (while Im wearing my glasses).

I was wondering if my disability precludes me from surgery entirely. I fear it might, and some have said as much, seeing as a surgeon is incredibly dependent on their visual acuity, especially in a field dealing with very fine procedures like Neurosurgery.

I'm not particularly interested in surgery (I'm interested in med-onc or rad-onc myself) but I'd like to know what you think and if you think theres a way to sort of "figure out" if I would meet the technical standards of surgical training as a med student.


Answer

Yes and no. There are a couple fields which I have heard of programs that require a visual assessment to match but in general it is not required and I have heard of people without two functional eyes in surgery. It ultimately is up to you to decide if you are able to perform tasks through trail and error. The big difficulty with neurosurgery would be if you can comfortably operate under microscope.

 

[libertyyne]

Thank you for taking the time to answer all these questions.

1) Do you think age should be considered a limiting factor if starting medical school as a non-trad and thinking about embarking on the long journey of NSG? Do you think PDs take it into account ?
2)Is there a median age of retirement for Neurosurgeons or age where productivity is starts to go down?
3)How did your friend get 80 articles published! Are these case reports?
4)If the well of spine surgery dries up what is the next big thing for NSG?

 

[failedatlife]

Did you match at your #1 choice? Those are impressive places to rotate at, but I imagine not very easy to get strong letters from.

 

[mmmcdowe]

You're awesome! I got a few more:

Is it true that most neurosurgeons training today need to do a fellowship?

Did you absolutely have to take a research year to match? If you didnt have to, how limiting would it be not to, assuming all else (step, clinicals) being equal.

What gives certain programs their top reputations? Is it cause of volume? Big fish who publish textbooks? Laymen recognition? pt outcomes? How can doximity or USNWR possibly compare NYP to NYU or Hopkins to UCSF.

I believe less than fifty percent do a fellowship but a larger number of academic neurosurgeons do them. This trend may decline some because there is increasing pressure from the senior society to allow for infolded fellowships.

Less than half of matched applicants take a research year I believe unless thats changed recently. If you got substantial research pubs in medical then even going to a top academic program isnt out of reach.

USNWR is especially flawed because of the fact that it lumps nsg with neurology but the reality is that everyone has their own ranking system because neurosurgery is a field of people with very strong opinions. A program may be well recognized for its researxh, its training, its fellowships, the number of graduates that go into academics, or the number of faculty in key leadership positions nationally.

 

[bannie22]

Great stuff.
What do you think about the recent news about Swedish/Delashaw?

 

[Spectre of Ockham]

Dear Duke of minimal vowels,

I am interested in developing neuroprosthetic implants. I have been working since my early teen years in IT and I believe that my dream of partially restoring or augmenting brain functions would be best served by my skills marring microchips , microelectronics and AIs with medical knowledge of neuroanatomy , neurophysiology , etc. plus the training I will receive during a neurosurgical residency.
Do you think this is a feasible dream in the current climate ? I know a handful of neurosurgeons in Europe that run research projects but nothing on this scale.

What residency programs would you choose to pursue such a goal ? Would Texas be a good place to go to ? I mean all I need a bit of funding and 5-8 hours per week off my schedule.

I gunning for neurosurgery for a somewhat selfish reason besides absolutely adoring to remove the dura and work on the most amazing organ in the body. I want to money so I can self start the financing for such research. Would that be a plus or a minus if a program director hears it ? Should I keep my dream to myself or cut out the selfish part and sell it a more diplomatic version of it ?

Also by the time I move to the US I will most likely have a family and maybe 1-2 kids with maybe another one on the way. I have seen most neurosurgeons working a normal 8 to 18 day 5 days per week coming in when needed for emergencies (unless they are on call). However this is the EU where doctors and not treated as plantation slaves (too much) and from what I've read so far the hours are insane in the US.
Should I expect that with a stellar resume and maybe even a 5 to 10k salary cut to get such hours with a little bit of negotiations ?
Or would should I expect that such a dream is unfeasible unless I have the program director and the administrators by the balls which is a massive time investment and might land me in hot waters with colleagues and authorities.

I have overcome quite a few challenges in my life and I hope that with come cunning , hard work and determination to be able to continue to do so. All I want is to advance the knowledge of mankind and save lives however I do not see how it helps my patients if I am working 100 hours per week for the rest of my life and will die at 50 from chronic fatigue and stress.

 

[neusu]

Dear Duke of minimal vowels,

I am interested in developing neuroprosthetic implants. I have been working since my early teen years in IT and I believe that my dream of partially restoring or augmenting brain functions would be best served by my skills marring microchips , microelectronics and AIs with medical knowledge of neuroanatomy , neurophysiology , etc. plus the training I will receive during a neurosurgical residency.
Do you think this is a feasible dream in the current climate ? I know a handful of neurosurgeons in Europe that run research projects but nothing on this scale.

What residency programs would you choose to pursue such a goal ? Would Texas be a good place to go to ? I mean all I need a bit of funding and 5-8 hours per week off my schedule.

I gunning for neurosurgery for a somewhat selfish reason besides absolutely adoring to remove the dura and work on the most amazing organ in the body. I want to money so I can self start the financing for such research. Would that be a plus or a minus if a program director hears it ? Should I keep my dream to myself or cut out the selfish part and sell it a more diplomatic version of it ?

Also by the time I move to the US I will most likely have a family and maybe 1-2 kids with maybe another one on the way. I have seen most neurosurgeons working a normal 8 to 18 day 5 days per week coming in when needed for emergencies (unless they are on call). However this is the EU where doctors and not treated as plantation slaves (too much) and from what I've read so far the hours are insane in the US.
Should I expect that with a stellar resume and maybe even a 5 to 10k salary cut to get such hours with a little bit of negotiations ?
Or would should I expect that such a dream is unfeasible unless I have the program director and the administrators by the balls which is a massive time investment and might land me in hot waters with colleagues and authorities.

I have overcome quite a few challenges in my life and I hope that with come cunning , hard work and determination to be able to continue to do so. All I want is to advance the knowledge of mankind and save lives however I do not see how it helps my patients if I am working 100 hours per week for the rest of my life and will die at 50 from chronic fatigue and stress.

I'll let @mmmcdowe give his $0.02 but these are my thoughts.

Residency in the US has zero flexibility. There is no negotiation. There are no changes to the plan. You sign up for 7 years, 80 hours/week.

Some program directors and chairman may like the drive and idea you have. That being said, unless you show up at an interview with funding and/or a working device, it is simply an idea. Many of us have grand aspirations and lofty ideas. Those of us who have the gumption to stick to it, despite the long and difficult road, try to find a way to do both. Even so, it is exceedingly difficult and most, even within neurosurgery, do not end up continuing with the same level of optimism and idealism they have in their youth.

 

[Spectre of Ockham]

I'll let @mmmcdowe give his $0.02 but these are my thoughts.

Residency in the US has zero flexibility. There is no negotiation. There are no changes to the plan. You sign up for 7 years, 80 hours/week.

Some program directors and chairman may like the drive and idea you have. That being said, unless you show up at an interview with funding and/or a working device, it is simply an idea. Many of us have grand aspirations and lofty ideas. Those of us who have the gumption to stick to it, despite the long and difficult road, try to find a way to do both. Even so, it is exceedingly difficult and most, even within neurosurgery, do not end up continuing with the same level of optimism and idealism they have in their youth.

Thank you for your input. I wanted to ask some similar questions in your thread but I never got the guts and time to formulate my questions.

From the tone I perceive from your answer it sounds like you've went trough hell and back or are just really angry right now. What you are describing sounds like a Nazi style regime with my only option being to pay off the chairman (main decision maker) with a large donation , defer most of my salary and wage defensive war against my colleagues who will resent me for not being treated like a slave. In this way I may still have access to the needed facilities and investors .

Having a residency in Switzerland (the only other stable country that favors research) would offer me a far more anemic research possibility with very limited funding and when push come to shove and I will need more funding and facilities I'd still have to move to the US where I'd be forced to redo 7 years of residency which would be unacceptable.
Is there any chance to not redo 7 dam years of residency and only go trough one year of residency in the US as a trial by fire (excepting the board exams which are the norm obviously) ?
Would it help to have pull with some state politicians that could put some leverage on a board maybe to make just one exception ?

 

[Duke1K]

I ended up winning some grants late during fourth year as well that I took with me to residency.

What kind of grants can you take with you from medical school into residency?

 

[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.