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

[mmmcdowe]

1) Tough question. Legally it cannot be but the reality is that residency is hard on the body and there are occasionally concerns voiced about the ability of someone pushing 40 to perform. That being said I havent seen much evidence to support that and we have a 40 year old resident.

2) I have heard that your malpractice starts to skyrocket at 65 but certainly some surgeons push on into their 70s.

3) Lot of collaboration lot of use of precollected databases.

4) I dont think it will and I dont think theres a great replacement. In terms of subspecialties that have the most growth potential Id say functional is at the top only becausr so few patients with movement disorders are being referred to neurosurgeons relative to other diseases

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?

---

Members don't see this ad.

 

[mmmcdowe]

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.

Tough question to answer, I made my ranklist based on a relationship rather than it representing my best fit. Letters are a tricky thing. Some programs right terrible letters almost exclusively whereas other not so much. Its hard to correlate residency prestige with letter difficulty.

 

[mmmcdowe]

H

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

Honestly I dont know much about it.

 

[mmmcdowe]

Depends on how much. I have tense muscles daily but i forget aboit it while operating. However it is definitely true thay many surgeons develop neck and back issues and it may or may not be related to operating. It also depends on how much moving and stretching you need to do. If work on core and back excercises to reduce pain.

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.

 

[bannie22]

What do you think about this? http://www.seattletimes.com/seattle...investigate-cherry-hill-hospital-top-surgeon/

 

[pbrocks15]

H

Honestly I dont know much about it.

What do you think about this? State regulators investigating Swedish’s Cherry Hill hospital, top surgeon

He responded to this one earlier saying he doesn't know much about it

 

[bannie22]

He responded to this one earlier saying he doesn't know much about i6t

Thats why I shared the link. ☺

 

[mmmcdowe]

What do you think about this? State regulators investigating Swedish’s Cherry Hill hospital, top surgeon

Hard to know. Lot of nonspecific claims such as inadequate fellow supervision. What does that mean? Fellows should be fairly independent so it comes down to what was specifically the level of supervision. In terms of the billing, what does that look like when you average it out by case volume? What is the level of complexity? Nothing wrong with looking over the books but as usual our media follows a guilty until proven innocent (and even then, still probably guilty) modality of reporting. One of the surgeons at my hospital was written up by the paper unflattering using several legal cases that had been brought up but had neither been seen in court yet nor settled.

 

[831929]

Thank you for taking the time to answer our questions!

I was wondering whether doing non-neuro research first year would limit my options in applying for neurosurgery. It seems that having mentors during the summer in a different specialty my play a big role in what one might end up going into. If we spend, for example, first two years working with a nephrologist and doing bench/lab research because we had a great opportunity and also appreciate the subject, would that be an issue once we apply for residency? I hope to do a few rotations in neurosurgery and possibly get involved in neuro research during that time period.

 

[bannie22]

Do you get adequate operating experience when in the OR, or are you more of an observer?
And how does case logging work in your specialty?

 

[WhittyPsyche]

@mmmcdowe I would love to talk about the personal side of your path, regarding the former engagement, if you're willing to discuss in PM. Specifically, the ways in which medical school and then residency affected your relationship.

If you don't message I'll take it as you don't want to discuss


Sent from my iPhone using SDN mobile

 

[mmmcdowe]

Not necessarily but it does place the onus back on you to buff up your research cv for nsg.

Thank you for taking the time to answer our questions!

I was wondering whether doing non-neuro research first year would limit my options in applying for neurosurgery. It seems that having mentors during the summer in a different specialty my play a big role in what one might end up going into. If we spend, for example, first two years working with a nephrologist and doing bench/lab research because we had a great opportunity and also appreciate the subject, would that be an issue once we apply for residency? I hope to do a few rotations in neurosurgery and possibly get involved in neuro research during that time period.

 

[mmmcdowe]

Do you get adequate operating experience when in the OR, or are you more of an observer?
And how does case logging work in your specialty?

Different programs have different levels of involvement but pitt is definitely one where operative ecperience is very involved. At this point many uncomplicated surgeries are done by me skin to skin with the attending observing and guided.

Basically there is an acgme case logging webpage and you input patient mrns and surgical procedure info as well ass the date of surgery, attending involved, and approximate level involvement (lead if you did parts of the critical portion, senior if you did everything but that, asdist if you opened and closed skin essentially.

 

[mmmcdowe]

@mmmcdowe I would love to talk about the personal side of your path, regarding the former engagement, if you're willing to discuss in PM. Specifically, the ways in which medical school and then residency affected your relationship.

If you don't message I'll take it as you don't want to discuss


Sent from my iPhone using SDN mobile

Im happy to discuss it openly. I was in a long distance relationship for five years in medical school. My significant other and eventual fiance lived in Mexico City so I saw her maybe 4 times a year during breaks and 3 day weekends. I spent a fair amount of my year off there working long distance as well. My focus on med school slowly eroded my availability and willingness to spend time communicating by phone and daily skype sessions and she eventually found someone to replace the emotional unavailabilty.

It was a tough time and it all broke during subis and the match process so it definitly had an impact on my focus at that point. Multiple failed relationships with bitter ends has taught me that I may be trying to hard to subscribe to traditional values of what a good life entails. A wife teo kids and a white picket fence may not be mandatory for my own happiness.

 

[Matthew9Thirtyfive]

Im happy to discuss it openly. I was in a long distance relationship for five years in medical school. My significant other and eventual fiance lived in Mexico City so I saw her maybe 4 times a year during breaks and 3 day weekends. I spent a fair amount of my year off there working long distance as well. My focus on med school slowly eroded my availability and willingness to spend time communicating by phone and daily skype sessions and she eventually found someone to replace the emotional unavailabilty.

It was a tough time and it all broke during subis and the match process so it definitly had an impact on my focus at that point. Multiple failed relationships with bitter ends has taught me that I may be trying to hard to subscribe to traditional values of what a good life entails. A wife teo kids and a white picket fence may not be mandatory for my own happiness.

Or you might just not be ready for it yet. I didn't meet my wife until I was 29 and we had our kids when I was 30 and 31. Not sure how old you are, but if you were a traditional med student, then you'd only be about the age I was. My wife was 32 when we met. It can happen at different times for everyone. But don't settle into a life you don't want just because it's expected. If it doesn't feel right, it probably isn't.

Thanks for this thread btw. Great info!

 

[WhittyPsyche]

Im happy to discuss it openly. I was in a long distance relationship for five years in medical school. My significant other and eventual fiance lived in Mexico City so I saw her maybe 4 times a year during breaks and 3 day weekends. I spent a fair amount of my year off there working long distance as well. My focus on med school slowly eroded my availability and willingness to spend time communicating by phone and daily skype sessions and she eventually found someone to replace the emotional unavailabilty.

It was a tough time and it all broke during subis and the match process so it definitly had an impact on my focus at that point. Multiple failed relationships with bitter ends has taught me that I may be trying to hard to subscribe to traditional values of what a good life entails. A wife teo kids and a white picket fence may not be mandatory for my own happiness.

Thank you so much for writing about it openly. Do you know of many people that make the traditional life work too?

I mean I already have two kids, I can't really return them now, passed the 30 day limit.

I know one female neurosurgeon but she is single, no relationship, no kids.


Sent from my iPhone using SDN mobile

 

[onceawolverine]

@mmmcdowe
Were there any "low points" during your time in medical school, and how did you overcome them?
In tandem, were there any moments during medical school that you felt were particularly formative?
Worst moment in residency so far?
Were there any other specialties that you seriously considered?

Sidebar:

I know one female neurosurgeon but she is single, no relationship, no kids.


Sent from my iPhone using SDN mobile

Every female nsg attending I know is married with children. (3/3). Life is hard and nsg is harder, but all kinds of different people with different priorities find their own ways to make their lives work for them.

 

[HybridEarth]

Hi, thanks for doing this. I'm really interested in spine and was wondering if it would be wiser to do ortho then fellowship(s) or neurosurgery. What are your thoughts on which route is a better idea?

 

[NeuResurgens]

What would you say are some of the most common traits of people who go into neurosurgery? Personality types, habits, etc. what aspects of it did you feel were the best fit for you? What personality traits would someone have that would lead you to discourage them from pursuing it? (Besides the obvious things like being a total arse)

 

[bannie22]

What are your thoughts on the most recent match for Neurosurgery?

 

[mmmcdowe]

Oh yes most of my more senior classmates are happily married. That being said the nsg divorce rate is astronomical.

Thank you so much for writing about it openly. Do you know of many people that make the traditional life work too?

I mean I already have two kids, I can't really return them now, passed the 30 day limit.

I know one female neurosurgeon but she is single, no relationship, no kids.


Sent from my iPhone using SDN mobile

 

[mmmcdowe]

I enjoyed medical school a lot. Subis were miserable at times but overall I was happy. See my old thread I love medical school.

I found my h&p course very formative and had a great mentor. Working w a resident in nsg for five years doing reaearch also affected me a lot positively. Doing a research year was formative academically in the sense it made me an independent investigator.

@mmmcdowe
Were there any "low points" during your time in medical school, and how did you overcome them?
In tandem, were there any moments during medical school that you felt were particularly formative?
Worst moment in residency so far?
Were there any other specialties that you seriously considered?

Sidebar:

Every female nsg attending I know is married with children. (3/3). Life is hard and nsg is harder, but all kinds of different people with different priorities find their own ways to make their lives work for them.

 

[mmmcdowe]

Hi, thanks for doing this. I'm really interested in spine and was wondering if it would be wiser to do ortho then fellowship(s) or neurosurgery. What are your thoughts on which route is a better idea?

No right answer but Id say which do you prefer in terms of the other stuff you will have to do furing residency and likely as a junior attending? Meaning do you want to spend time doing shunts or shoulders? I will say that spine makes up probably 50 percent of resident case volume at many places which I would guess is more that ortho but dont know that.

 

[mmmcdowe]

What would you say are some of the most common traits of people who go into neurosurgery? Personality types, habits, etc. what aspects of it did you feel were the best fit for you? What personality traits would someone have that would lead you to discourage them from pursuing it? (Besides the obvious things like being a total arse)

Meticulous, hardworking, high physical and mental endurance, a bit on the assertive side. If you tend to be emotionally shaken up by getting yelled at, hurting patients, and being asked to go above and beyond your duties at the loss of your free time then it will be a difficult time for you. If you don't like operating and working long hours then it isn't an ideal fit either. If you don't like working at a racehorse pace while still being highly detail focused it isn't a good fit. If you can't work under strong authority figures with minimal opportunity to get in the moment explanations of decisions or like to debate decisions then it isn't a good fit because NSG residency is very much a hierarchical military structure.

 

[mmmcdowe]

What are your thoughts on the most recent match for Neurosurgery?

I am very happy with our match, we got some great candidates and, importantly, finally managed to attract two women into our program which has been all male for 2 years now. It looks very bad to be all male and it has been completely unintentional but once you are all male it can be a bit difficult to convince many women to come.

I am aware of the major controversies that have sprung up regarding certain applicants matching at certain programs. I know many of them personally and several did sub-internships or interviewed with us here so I will decline to comment on them specifically because it would not be appropriate to disclose their confidential information.

 

[sabsaf123]

Depends on how much. I have tense muscles daily but i forget aboit it while operating. However it is definitely true thay many surgeons develop neck and back issues and it may or may not be related to operating. It also depends on how much moving and stretching you need to do. If work on core and back excercises to reduce pain.

What are the core and back exercises that you do? Do you think these exercises would also help with the back/neck pain that a lot of students develop from sitting hunched over their laptops all day?

 

[mmmcdowe]

What are the core and back exercises that you do? Do you think these exercises would also help with the back/neck pain that a lot of students develop from sitting hunched over their laptops all day?

I couldnt say. I did ballet for my core and back so i dont have any standard things but yes it will help all those pains.

 

[aalamruad]

Oh yes most of my more senior classmates are happily married. That being said the nsg divorce rate is astronomical.

Do you happen to have any stats on this? I've read that the divorce rate for surgeons overall is around 33%, which is still lower than the national average (~35%), but I can't find any stats on divorce rates of the various surgical specialties/subspecialties

 

[bannie22]

Are those pedicle screws difficult to place? Do you need a lot of strength for them?

 

[failedatlife]

Are those pedicle screws difficult to place? Do you need a lot of strength for them?

Shouldn't you be in residency by now....

 

[mmmcdowe]

Do you happen to have any stats on this? I've read that the divorce rate for surgeons overall is around 33%, which is still lower than the national average (~35%), but I can't find any stats on divorce rates of the various surgical specialties/subspecialties

Ive heard 60 percent quoted for younger neurosurgeons but I font know the data. Pretty sure divorce rates for newer marriages are much higher than 35% as well.

 

[mmmcdowe]

Are those pedicle screws difficult to place? Do you need a lot of strength for them?

They do require a fair amount of strngth but you get used to it. I find using the drill for long periods of time for a multi level lami is actually more tiring then screws.

 

[Matthew9Thirtyfive]

Ive heard 60 percent quoted for younger neurosurgeons but I font know the data. Pretty sure divorce rates for newer marriages are much higher than 35% as well.

Actually, divorce rates are down again for the third year in a row and are almost as low as they were in 1970 for the first time since. First marriages have a much better chance of lasting than second or third marriages. The divorce rate was 16.9 in a thousand.

 

[aalamruad]

Actually, divorce rates are down again for the third year in a row and are almost as low as they were in 1970 for the first time since. First marriages have a much better chance of lasting than second or third marriages. The divorce rate was 16.9 in a thousand.

There's no way.. source?

 

[bannie22]

for open spine when u are closing what suture do u close fascia, deep dermals, and skin with?
for an evd, where is teh ideal positioning for the catheter, lateral vent or foramen of monroe?

you said you do ballet. thats not very common in the male gender.are you able to continue to practice it ?

Shouldn't you be in residency by now....

what do you mean?

 

[Matthew9Thirtyfive]

There's no way.. source?

http://www.bgsu.edu/content/dam/BGS...nderson-divorce-rate-us-geo-2016-fp-16-21.pdf

 

[mmmcdowe]

for open spine when u are closing what suture do u close fascia, deep dermals, and skin with?
for an evd, where is teh ideal positioning for the catheter, lateral vent or foramen of monroe?

you said you do ballet. thats not very common in the male gender.are you able to continue to practice it ?


what do you mean?

0 vicryls 2-0 vicryls staples.

Ideal positioning is to have the evd tip at the start of the foramen but not actually in it. The foramen is more likely to collapse so ideally you are in lateral vent or threaded all the way to the third, which theoretically might allow for better bilateral drainage but has its on risks of obstruction and injury to critical structures if you miss

 

[mmmcdowe]

http://www.bgsu.edu/content/dam/BGS...nderson-divorce-rate-us-geo-2016-fp-16-21.pdf

that appears to be incidence rather than prevalenvce. When I say 60 percent i mean liketime tisk not annual. Multiply that by, say, 40 to het an estimate of prebalance assuming average marriage around age 30 and assuming no repeat marriages.

 

[Matthew9Thirtyfive]

that appears to be incidence rather than prevalenvce. When I say 60 percent i mean liketime tisk not annual. Multiply that by, say, 40 to het an estimate of prebalance assuming average marriage around age 30 and assuming no repeat marriages.

Yes, lifetime risk is the risk that someone will be divorced or have multiple marriages in their lifetime, which is around 35%. But incidence is still down, meaning fewer people are divorcing each year. I wouldn't be surprised if neurosurgeons have a higher divorce rate. Do you think it's really that high? That would be remarkable.

Also, what do you think contributes to that? Is it the long hours and stress that gets brought home when they are home? Or do you think part of it is the personalities that go into neurosurgery, which may be more prone to divorce?

 

[mmmcdowe]

Depends on how many people are getting married. If that rate is going down then theres a bias towards older and stable marriages. Regardless, neurosurgeons are busy and have a lot of reaponsibilities that keep them away which decreases their attentiveness to the marriage. I cant prove it but I wouldnt be surprised if neurosurgeons have a higher infidelity rate as well. You arent around home much, you are stressed, and you have a lot of control within your sphere. You are surrounded by nurses and reps many of which are you and attractive.

Yes, lifetime risk is the risk that someone will be divorced or have multiple marriages in their lifetime, which is around 35%. But incidence is still down, meaning fewer people are divorcing each year. I wouldn't be surprised if neurosurgeons have a higher divorce rate. Do you think it's really that high? That would be remarkable.

Also, what do you think contributes to that? Is it the long hours and stress that gets brought home when they are home? Or do you think part of it is the personalities that go into neurosurgery, which may be more prone to divorce?

 

[Matthew9Thirtyfive]

Depends on how many people are getting married. If that rate is going down then theres a bias towards older and stable marriages. Regardless, neurosurgeons are busy and have a lot of reaponsibilities that keep them away which decreases their attentiveness to the marriage. I cant prove it but I wouldnt be surprised if neurosurgeons have a higher infidelity rate as well. You arent around home much, you are stressed, and you have a lot of control within your sphere. You are surrounded by nurses and reps many of which are you and attractive.

Well according to the data, marriages are going up as divorces go down.

That actually is what I was hoping to hear. I already have a career that keeps me from home more than a neurosurgery career ever could with all those other factors. Not sure if I'll end up in nsg, but I'm definitely going to do an elective if I'm competitive. Thanks for the response.

 

[tarsuc]

How do you a manage a dog during NSG residency? with the very few hours spend home daily?

 

[doctorneurosx]

how do you get a sense of general tiers for residency programs if one wanted to be an academic neurosurgeon?

if you were going to give advice to incoming interns what would it be?

 

[bannie22]

does saying ur a neurosurgeon get u all teh chicks?

 

[Spectre of Ockham]

Do you see yourself developing neuroprosthetics ?

 

[mmmcdowe]

How do you a manage a dog during NSG residency? with the very few hours spend home daily?

Well unfortunately I had to give him up but not because I didnt have time for him. Basically I got a breed that was tolerant of being on their own and I hired a dog walker daily

 

[mmmcdowe]

how do you get a sense of general tiers for residency programs if one wanted to be an academic neurosurgeon?

if you were going to give advice to incoming interns what would it be?

basically listen to lots of opinions and you start to develop a general sense based on averages.

I tell all my interns the following.


1) Do the right thing, no matter how much it hurts.

2) You can make almost any mistake, once.
3) The most unforgivable mistakes are lying and not asking for help.
4) The only way to survive falling out of an airplane is to go completely limp. You will shatter every bone in your body if you resist.
5) Show nurses respect even if they do something that annoys you. The first time a nurse doesn't page you when it is important because they are afraid to you have failed as that patient's physician. Nurses are your most valuable tool when wielded appropriately.
6) When you make a mistake and hurt someone, don't let your emotions impair the care you give next time. The only way to make it right is to do better the next time.
7) You should be working, learning, operating, eating, or sleeping at all times when in the hospital. If you aren't then leave or start doing one of them.
8) Teaching is learning.
9) You cannot avoids making mistakes out of ignorance or lack of skill, but you have the power to avoid mistakes of negligence.
10) There is always more work to be done, find it.
11) Better to be the fool that asks than the fool that doesn't
12) Prepare for failure in order to achieve success
13) Starbucks rewards cannot be redeemed at the Presby Starbucks, but they do get counted for rewards points.


The last one may not be universally applicable

 

[mmmcdowe]

does saying ur a neurosurgeon get u all teh chicks?

It does help some but probably doesnt make up for the weight gain and the lack of availabilty

 

[mmmcdowe]

Do you see yourself developing neuroprosthetics ?

Not really an interest of mine but I support technology in neurosurgery and always am open to collaboration so who knows.

 

[Anti-PD1]

When you were a neurosurgery applicant vs. what you know now: what are the most important factors to consider when comparing neurosurgery residencies?