How did you decide between neurology and neurosurgery

[darksideone]

I would like to hear what basis you guys made your decision off of to go the neurology route rather than the neurosurgery. I am struggling between the two, but leaning towards neurology based on lifestyle, residents and attendings seem happier, shorter training, and less stressful field. What other criteria did you guys use.

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[AlternateSome1]

The fields are like night and day. The question is akin to asking would you rather build a bridge or jump off one because they both are activities done with bridges. Neurology is an analytical field dealing with the diagnosis and medical management of neurological diseases. Neurosurgery is a practical field where you deal with physical issues compromising neuroanatomy.

 

[darksideone]

The fields are like night and day. The question is akin to asking would you rather build a bridge or jump off one because they both are activities done with bridges. Neurology is an analytical field dealing with the diagnosis and medical management of neurological diseases. Neurosurgery is a practical field where you deal with physical issues compromising neuroanatomy.

Yeah I have realized that from my two rotations. I can just see myself doing both of them, so I am wondering what other intangibles people used when making a decision if they were contemplating both of them.

 

[PhakeDoc]

My brother is a neurosurgery resident. I'm interested more from the neurology aspect. From what I gather from him, they love operating (whether they readily admit it or not), they seem to enjoy the punishment, they like immediate results, and they very much like the renumeration (I will never even make half of what he'll make on a yearly basis - maybe 1/3, though even that might be pushing it).

From what I've seen of my rotations, neurology seems much more (pardon the pun) cerebral and analytical - like solving a mystery or a puzzle with multiple clues instead of just diving in for the solution. Also, especially through clinics, you can develop more long-term relationships with the patients. For some that's a plus; for others, that's a minus.

I think much depends on your state of mind/personality in determining which is your following.

 

[danielmd06]

I was interested in both fields as a third and fourth year medical student. I was actually more surgically oriented than clinical as a student...and really still am. In my fourth year I actually applied to both. While I had Neurosurgery interviews, I cancelled my application midway through the process and focused purely on Neurology.

Basically, I found the call schedule and lifestyle of a Neurosurgeon (for either resident or attending) to be unacceptable. The promise of future money simply wasn't worth what I would have been asked to do to obtain it (for me).

As a fourth year student, I had to give up all of my hobbies and only saw my future wife for fifteen minutes QOD when she would bring me supper while I was on call (in order to comply with the q 2 or q 3 call schedule and experience a rough parallel to the lifestyle of a PGY-2 or PGY-3 in NSG). Oh, and that meal would be the only one I would eat during the entire day.

I became very interested in new developments in Vascular/Stroke Neurology, Neurocritical care, and Neurointerventional, and realized that completing a formal resiency in Neurology instead of Neurosurgery wouldn't necessarily preclude me from a proceduralist lifestyle.

The future of Neurology is bright. The field is growing rapidly right now and will continue to do so. As you may already know, there are fellowships in Pain, Neurocritical Care, and Neurointerventional that are much more surgically focused than other areas of Neurology - though they can be a challenge to obtain in many instances for the Neurology applicant.

I couldn't be happier and I've never looked back. It was the right fit for me.

 

[Nerdoscience]

In general, we don't WANT people in Neurology who want to be neurosurgeons but are too lazy. If this is how you would characterize yourself, think hard about what you really want out of your career.

Having said that, there are many people (as suggested in above posts) that go into Neurology who are interested in more aggressive subspecialties where having more of the surgeon vs. the medical doctor personality is a good fit. Interventional Neurology and Neurocritical care come to mind. You don't save much on lifestyle or years of training, though.

The decision used to be far easier before subspecialties like those took off.

 

[bustbones26]

Back in my medical school days, I recall rotating with a neurosurgeon. After getting behind in his clinic all day, at about 6PM he would look at me and say, "why don't you go home and read, I'll go do these three consults tonight that have accumulated throughout the day (at different hospitals)". I often wondered, what time does this guy get home at night?

But that of course was on clinic days, surgery days were a little more smooth but certainly busy. Now, imagine this. This particular neurosurgeon that I rotated with was in a practice with one other senior surgeon and there was only one other neurosurgeon on staff at the hospital in a separate practice. Three neurosurgeons at one major medical center that had a level II trauma center? What better way to be on call indefinitely?

There is no doubt that the surgeon I rotated with liked being a neurosurgeon and loved being in the OR, but the other aspects of his job just made him downright miserable!

Overall, I saw 7 years of residency (6 at some places) working 100 hours per week (don't ask me how, but some institutions do have exemptions from teh 80 hour work week) so that whenever you graduate you still work 100 hours per week in an area with a shortage of neurosurgeons with malpractice premiums at an astronomic price as well as be in a profession that will guarantee lawsuits no matter how good/bad you do your job. That pretty much steered me away from neurosurgery as a profession. I can't say that it threw me into be a neurologist, but it certainly made me not want to be a neurosurgeon.

 

[AznTrojan]

i realized shortly in neurology career that outpatient neurology wasn't for me.. that's why i'm gonna do neurocritical care.. no more clinics

Back in my medical school days, I recall rotating with a neurosurgeon. After getting behind in his clinic all day, at about 6PM he would look at me and say, "why don't you go home and read, I'll go do these three consults tonight that have accumulated throughout the day (at different hospitals)". I often wondered, what time does this guy get home at night?

But that of course was on clinic days, surgery days were a little more smooth but certainly busy. Now, imagine this. This particular neurosurgeon that I rotated with was in a practice with one other senior surgeon and there was only one other neurosurgeon on staff at the hospital in a separate practice. Three neurosurgeons at one major medical center that had a level II trauma center? What better way to be on call indefinitely?

There is no doubt that the surgeon I rotated with liked being a neurosurgeon and loved being in the OR, but the other aspects of his job just made him downright miserable!

Overall, I saw 7 years of residency (6 at some places) working 100 hours per week (don't ask me how, but some institutions do have exemptions from teh 80 hour work week) so that whenever you graduate you still work 100 hours per week in an area with a shortage of neurosurgeons with malpractice premiums at an astronomic price as well as be in a profession that will guarantee lawsuits no matter how good/bad you do your job. That pretty much steered me away from neurosurgery as a profession. I can't say that it threw me into be a neurologist, but it certainly made me not want to be a neurosurgeon.

 

[darksideone]

As a fourth year student, I had to give up all of my hobbies and only saw my future wife for fifteen minutes QOD when she would bring me supper while I was on call (in order to comply with the q 2 or q 3 call schedule and experience a rough parallel to the lifestyle of a PGY-2 or PGY-3 in NSG). Oh, and that meal would be the only one I would eat during the entire day.

I became very interested in new developments in Vascular/Stroke Neurology, Neurocritical care, and Neurointerventional, and realized that completing a formal resiency in Neurology instead of Neurosurgery wouldn't necessarily preclude me from a proceduralist lifestyle.

The future of Neurology is bright. The field is growing rapidly right now and will continue to do so. As you may already know, there are fellowships in Pain, Neurocritical Care, and Neurointerventional that are much more surgically focused than other areas of Neurology - though they can be a challenge to obtain in many instances for the Neurology applicant.

I couldn't be happier and I've never looked back. It was the right fit for me.

Thanks for the great post. Those are some of the same thoughts that I have been having over the past couple of months. When I did a neurosurgery rotation, I didn't get to see my finacee much. I have also begun to build an interest in stroke/intervention and feel like it will give me a good balance of being able to do procedures and inpatient work since I hate clinic for the most part. I just worry that interventional will lead to a similar lifestyle as a neurosurgeon.

 

[buckley]

They actually deal with different cases. The surg people do craniotomies and evacs, tumor rsections, etc. the neuro people deal more with long term care. i agree with the lifestyle comments made here.

 

[igcgnerd]

What kind of procedures are typical for neurocritical care?

 

[AHillock]

I am also interested in this thread. I recently did a one month rotation in neurology as well as one in neurosurgery. I found them both to be extremely interesting and would be very satisfying to do either one. Since I need to try and make up my mind between the two of them I would be interested in hearing some more comments or experience of those who contemplated both. Would it be unwise to apply to both and then see how things turn out during interviews and then decide?

 

[soulofmpatel]

I enjoyed my neurosurgery weeks during my surgery rotation more than other aspects of surgery. However, I was more interested in neurodiagnosis of neurosurgical diseases than neurosurgery itself. I was often bored in the OR...even when they let me drill a burr hole. So for me, it wasn't a tough decision, but I can understand how it could be fore people interested in both neuroscience and surgery. Three of my classmates dropped out of the neurosurgery pathway after doing away rotations in neurosurgery. They described the lifestyle in unbelievably morbid terms. Just make sure you do a neurosurgery rotation before you committ to the field...else you'll become another misreable, chronically sleep deprived neurosurgeon (4/4 of the neurosurgeons I've met).

 

[Dasani0127]

I would like to hear what basis you guys made your decision off of to go the neurology route rather than the neurosurgery. I am struggling between the two, but leaning towards neurology based on lifestyle, residents and attendings seem happier, shorter training, and less stressful field. What other criteria did you guys use.

Exactly what you said, I couldnt have said it better! I didn't need any more reasons than that.

 

[tranzformer]

At least for me I am interested in neuroscience and research and neurology would give me a better chance of pursuing my interest in neuro and do research. Also life style is much better!!!

 

[neurolddoc]

The question should be "I'm a surgeon. Am I giong to be an orthopod or a Neurosurgeon?"

If you don't know that you are tempermentally destined to be a surgeon, then the answer of N vs NS is obvious.

 

[AHillock]

The question should be "I'm a surgeon. Am I giong to be an orthopod or a Neurosurgeon?"

If you don't know that you are tempermentally destined to be a surgeon, then the answer of N vs NS is obvious.

Found this quote in another forum that is a nice balance to the above post:

As you can already see, there are at least two approaches to neurosurgery: people who love neuroscience and want to work directly with the brain, spinal cord (and yes) peripheral nerves, and people who love surgery and want to surgerize the brain and cord, but would be just as happy working in other surgical fields.



While this may be a gross oversimplification, i think it holds true in more than a few cases. Personally, i have no interest in general surgery--i don’t relish asking patients about the moment to moment aspects of their bowel movements, i don’t really find the biliary tree particularly interesting, and am not excited by whipples or multi-visceral transplants. ENT isn’t my thing either-seems like “almost brain surgery, but not quite” to me. Ortho is kinda cool, but my arms aren’t twice the size of my thighs, so i’m out. I like neurology, but the endless rounding with no real solutions is too much for my attention deficoid nature.



I want to work with and treat disorders of the nervous system. I guess my ideal field would be one which focused on the nervous system as a whole, and which encorporates all the tools available, be they “medical” or “surgical” (artificial distinctions in my opinion) in the treatment of the nervous system. Reality doesn’t work that way unfortunately, and I decided I’d rather work on the “surgical” side of neuroscience than the “medical”...truth be told however, I’d rather be a neurologist and work with the nervous system, than a general surgeon and work with poop and pus.