M4 can't decide between neurology and surgery

[WalkingOnTheSun]

So I know it's not typical to have a tough time choosing between specialties that are so different! But that's where I am right now. I'm on a research year between M3 and M4 year so I have more time to decide.

I came into medical school thinking neurology because of a neuroscience background, I was fascinated by the complexities of the brain and how much there still is to learn. But after M3 year, I realized that while neurology is engaging and interesting, clinical neurology is pretty different from the basic neuroscience that I liked. And I unexpectedly really liked my general surgery rotation. I've even thought of combining those two interests in the form of neurosurgery, but have gotten intimidated by the career path and the advice to only do neurosurgery if that's the only thing you can see yourself liking. That's not me--I could see myself happy as a neurologist, general surgeon, or even a procedural internist. So my dilemma is, how can I choose between these very different specialties? How can I commit to one specialty without, down the line, feeling regretful about the career possibility I didn't choose?

I see it as a venn diagram.

Neurology and neurosurgery share certain things I enjoy: studying the CNS, using the neuro physical exam to localize the lesion, dealing with serious conditions, having meaningful patient interactions. Neurology even has some avenues I could pursue where you could continue being in the OR (interventional neuro with mechanical thrombectomies).

General surgery doesn't overlap as much with neurology, but within general surgery I would likely pursue surgical oncology or breast surgery and in those subspecialties, there certainly is overlap in dealing with serious conditions and having meaningful/longitudinal patient interactions.

Neurosurgery and surgery share several other things I enjoy: being in the OR, making a rapid fix in a patient's condition, and teamwork. But they also share things that I am very wary about: long hours in residency and potentially even after residency is completed (I've heard the 80 hour rule is a joke and few programs actually even follow it and that as a junior surgeon your hours may even be worse than in residency), and less accommodation for family life (ex: pregnancy). I want to be able to live a fulfilling life outside the OR, and I am worried that I won't be able to do that. I'm not the type of person who can get by on 5 hours of sleep for more than a couple nights and still feel functional, and I'm worried that that fact alone should lead me to consider a different field.

Any insight or help? Thanks!

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[CidHighwind]

Do Neurosurgery if you got the CV for it. Both GS and Neurosurgery are long hours, and since most GS residents do fellowships nowadays, similar length. May as well do one that includes more aligned to your interests, and I’ve heard the pay can be pretty decent.

 

[WalkingOnTheSun]

Why decide between the two? Do Neurosurgery.

I have thought about it, as I detailed above, but am frankly worried about the lifestyle aspects, and I've been told that someone who worries about lifestyle should not enter that specialty.

 

[7331poas]

Do you have the board scores or manuscripts for neurosurgery? Yes the training is brutal, but if you go a fellowship after general surgery the length of training will be similar.

 

[WalkingOnTheSun]

Do you have the board scores or manuscripts for neurosurgery? Yes the training is brutal, but if you go a fellowship after general surgery the length of training will be similar.

I have the board scores for it. Most of my research has been in neurology, my current year-long project is, but I could probably collaborate on some clinical project with a neurosurgeon to get a neurosurgery poster or manuscript.

 

[9blade]

As a person who is still premed but with brothers in surgery, one of whom is a neurosurgeon, I agree with the above poster to look into doing neurosurgery. If you do general surgery, you might as well add the extra 2 years and do neurosurgery. My brother is happy as a neurosurgeon. He seems to enjoy life more than my other brother who is a general surgeon. Again, I'm just a premed trying to get where you are. My advice doesn't mean much. lol

 

[WalkingOnTheSun]

As a person who is still premed but with brothers in surgery, one of whom is a neurosurgeon, I agree with the above poster to look into doing neurosurgery. If you do general surgery, you might as well add the extra 2 years and do neurosurgery. My brother is happy as a neurosurgeon. He seems to enjoy life more than my other brother who is a general surgeon. Again, I'm just a premed trying to get where you are. My advice doesn't mean much. lol

No that's helpful, thank you! Since you get a perspective into the family/personal life in those specialties, do you feel like they're able to have sufficient time in that arena?

For example, I have several hobbies I don't want to give up (hiking, olympic weighlifting, reading); is there enough time for hobbies?

 

[9blade]

No that's helpful, thank you! Since you get a perspective into the family/personal life in those specialties, do you feel like they're able to have sufficient time in that arena?

For example, I have several hobbies I don't want to give up (hiking, olympic weighlifting, reading); is there enough time for hobbies?

Honestly, my brother who is a neurosurgeon seems less stressed out than my brother who is a general surgeon. The general surgeon is busy but it could be because he lives and works in a small county(<100,000 people). However, both spend plenty of time with family. Both find plenty of time for golf and the gym. The gym much more so now that they're attendings. When they were residents, they were miserable...but I think that's almost any student in residency. My brother who is a neurosurgeon still finds time to coach little league soccer every week. I think once you're an attending, it just depends on you to decide how busy or how much time you want to spend at the hospital.

 

[libertyyne]

here is an off the wall suggestion.

Have you thought about radiology ? => neuro IR.

I do think that the personality types in neuro vs neurosurgery are very very different, which is why it is interesting that you would have it in consideration.

I would not do Gen surg as the lifestyle is miserable espcially if you have other options and have the cv.

 

[WalkingOnTheSun]

here is an off the wall suggestion.

Have you thought about radiology ? => neuro IR.

I do think that the personality types in neuro vs neurosurgery are very very different, which is why it is interesting that you would have it in consideration.

I would not do Gen surg as the lifestyle is miserable espcially if you have other options and have the cv.

I have thought of neuro IR, my understanding is you can enter a neuro IR fellowship from radiology, neurology, or neurosurgery (if I were to do that, I think I would enter it from neurology rather than radiology since patient contact is really important to me).

I haven't encountered drastically different personalities in the two fields, but maybe I haven't had enough exposure to neurosurgery (only did a 2-week rotation in it).

 

[Angus Avagadro]

2 very different specialties, both intellectual, but one is interventional, one is not. Neurologists are great diagnosticians, but dont offer many solutions. Surgeons might actually solve the problem. Lifestyle would be much better as neurologist.

 

[Dave1980]

Choose neurology and don't look back. If lifestyle is important to you and you don't function well with little sleep you should not go into surgery. I honestly don't know how the residents get through training. It seems so brutal...minimum 12 hour days, 6 days a week on a good week.

 

[CidHighwind]

I have thought about it, as I detailed above, but am frankly worried about the lifestyle aspects, and I've been told that someone who worries about lifestyle should not enter that specialty.

That’s the thing about medicine. All the “cool” specialties have awful lifestyles. You could still work as a spine surgeon making 1 mil+ a year, but getting through 7 years of hellacious call would weed you out if you just wanted the paycheck.

 

[WalkingOnTheSun]

That’s the thing about medicine. All the “cool” specialties have awful lifestyles. You could still work as a spine surgeon making 1 mil+ a year, but getting through 7 years of hellacious call would weed you out if you just wanted the paycheck.

I know, that's what I'm realizing. And I haven't gotten this far to cop out and choose a traditionally "lifestyle" specialty that I'm not interested in (ex: derm, ophtho). But I also am hesitant of pursuing the "cool" stuff without considering lifestyle at all, since the cool stuff at some point in one's career will likely become routine and possibly even mundane when you've done it a million times. It's easy to resent something that you used to love if you're insanely sleep deprived.

 

[CidHighwind]

I know, that's what I'm realizing. And I haven't gotten this far to cop out and choose a traditionally "lifestyle" specialty that I'm not interested in (ex: derm, ophtho). But I also am hesitant of pursuing the "cool" stuff without considering lifestyle at all, since the cool stuff at some point in one's career will likely become routine and possibly even mundane when you've done it a million times. It's easy to resent something that you used to love if you're insanely sleep deprived.

Well if that’s the case, look deep inside, write personal statements for what you’re thinking about, and read them back. The one that sounds the most “authentic” should be the one you apply to. If you’re super worried about lifestyle, you can always just take less call or work part time as you get older. Also it seems like many fields in medicine don’t have great lifestyles (even the 9-5 office jobs usually have 10-15 hours of paperwork to do after they’re done).

 

[WedgeDawg]

My advice: reach out to neurology, general surgery, neurosurgery, and interventional radiology residents and attendings here on SDN and IRL at your medical school and ask them questions about what drew them to the field, what they like and don't like about the field, what their day to day life looks like, what other fields they were considering, and what advice they have for you in making your decision.

I will say that these three main specialties (not counting IR right now) are all very different. Most neurologists would not be happy as neurosurgeons. Most neurosurgeons would not be happy as neurologists. Most general surgeons would not be happy as neurosurgeons and vice versa. There are aspects that link these specialties (though in my opinion, general surgery and neurology don't have that much in common other than them both being potential avenues to a specialized form of critical care, but neurocritical care is a relatively niche subspecialty of neurology).

All of these are on the harder half of residencies. Neurology will probably be the easiest, but if you don't like the incredibly detail oriented day to day of neurology, the vast and deep array of knowledge of some very obscure parts of medicine, and the fact that many patients ultimately will do worse than their counterparts in internal medicine, you will likely be a very unhappy neurologist. General surgery and neurosurgery both have brutal residencies, and if you decide to pursue fellowship, your training period will likely be equally as long in either. You can have a decent lifestyle in either specialty as an attending, but that comes at a cost of practice style, practice location, pay (sometimes), types of surgeries performed, and several other factors. If your interest is oncology, it's much easier to get into oncology from neurosurgery than from general surgery, though it's much harder to get a neurosurgery residency spot than a general surgery spot, so perhaps it evens out (though to be fair surgical oncology residents likely disproportionately come from top general surgery residencies, which are likely as hard to match into as neurosurgery residencies).

I also want to respond to an above poster's comments about neurologists being great diagnositicians but not offering any solutions. Neurology on the whole is mostly the management of chronic neurological disease, just as internal medicine is, on the whole, the management of chronic systemic diseases. Internal medicine manages conditions like diabetes, hypertension, heart failure, COPD, and cancer in the long term just as neurology will manage headaches, epilepsy, stroke, dementia, MS, and cancer in the long term. Both have acute pathologies that they can manage that may or may not lead to long term sequelae requiring follow up (i.e. MI leading to heart failure vs. stroke leading to functional debilitation). Both have critical care fellowships where you have the opportunity to address a decompensation or acute event so that the patient can then be managed from a preventative standpoint once they're back on their feet. Both have the opportunity to treat infectious disease which can very well be curative. However, if your comparison is internal medicine, it's pretty unfair to say that neurologists don't offer solutions. They manage chronic diseases and are able to modify the natural history of these diseases such that patients can have improved quality and longevity of life, just like most of internal medicine.

Surgical specialties have the opportunity to address problems that then don't require long term management (appendectomies, cholecystectomies, many of the more common spine surgeries, etc). However, a lot of surgical patients become life-long patients that require constant follow-up and long term management (any surgical oncology patient in either general or neurosurgery, vascular patients in neurosurgery, colectomy patients in general surgery, shunt patients in neurosurgery, transplant patients in general surgery). So it's also not a one and done fix. I think thinking of specialties in this manner is unnecessarily reductionist and obfuscates a lot of aspects about these specialties that people really need to think about, consider, and, ideally, experience for themselves before deciding which one is right for them.

 

[kb1900]

My advice: reach out to neurology, general surgery, neurosurgery, and interventional radiology residents and attendings here on SDN and IRL at your medical school and ask them questions about what drew them to the field, what they like and don't like about the field, what their day to day life looks like, what other fields they were considering, and what advice they have for you in making your decision.

I will say that these three main specialties (not counting IR right now) are all very different. Most neurologists would not be happy as neurosurgeons. Most neurosurgeons would not be happy as neurologists. Most general surgeons would not be happy as neurosurgeons and vice versa. There are aspects that link these specialties (though in my opinion, general surgery and neurology don't have that much in common other than them both being potential avenues to a specialized form of critical care, but neurocritical care is a relatively niche subspecialty of neurology).

All of these are on the harder half of residencies. Neurology will probably be the easiest, but if you don't like the incredibly detail oriented day to day of neurology, the vast and deep array of knowledge of some very obscure parts of medicine, and the fact that many patients ultimately will do worse than their counterparts in internal medicine, you will likely be a very unhappy neurologist. General surgery and neurosurgery both have brutal residencies, and if you decide to pursue fellowship, your training period will likely be equally as long in either. You can have a decent lifestyle in either specialty as an attending, but that comes at a cost of practice style, practice location, pay (sometimes), types of surgeries performed, and several other factors. If your interest is oncology, it's much easier to get into oncology from neurosurgery than from general surgery, though it's much harder to get a neurosurgery residency spot than a general surgery spot, so perhaps it evens out (though to be fair surgical oncology residents likely disproportionately come from top general surgery residencies, which are likely as hard to match into as neurosurgery residencies).

I also want to respond to an above poster's comments about neurologists being great diagnositicians but not offering any solutions. Neurology on the whole is mostly the management of chronic neurological disease, just as internal medicine is, on the whole, the management of chronic systemic diseases. Internal medicine manages conditions like diabetes, hypertension, heart failure, COPD, and cancer in the long term just as neurology will manage headaches, epilepsy, stroke, dementia, MS, and cancer in the long term. Both have acute pathologies that they can manage that may or may not lead to long term sequelae requiring follow up (i.e. MI leading to heart failure vs. stroke leading to functional debilitation). Both have critical care fellowships where you have the opportunity to address a decompensation or acute event so that the patient can then be managed from a preventative standpoint once they're back on their feet. Both have the opportunity to treat infectious disease which can very well be curative. However, if your comparison is internal medicine, it's pretty unfair to say that neurologists don't offer solutions. They manage chronic diseases and are able to modify the natural history of these diseases such that patients can have improved quality and longevity of life, just like most of internal medicine.

Surgical specialties have the opportunity to address problems that then don't require long term management (appendectomies, cholecystectomies, many of the more common spine surgeries, etc). However, a lot of surgical patients become life-long patients that require constant follow-up and long term management (any surgical oncology patient in either general or neurosurgery, vascular patients in neurosurgery, colectomy patients in general surgery, shunt patients in neurosurgery, transplant patients in general surgery). So it's also not a one and done fix. I think thinking of specialties in this manner is unnecessarily reductionist and obfuscates a lot of aspects about these specialties that people really need to think about, consider, and, ideally, experience for themselves before deciding which one is right for them.

Also MS, epilepsy are 2 neuro fellowships where the many of your patients can be event free from their disease potentially.


If op legitimately has neurology in contention even though it’s not surgical, they should consider EEG or neurophys fellowship -> intra-operative monitoring of neurosurgery-epilepsy cases. It’s somewhat analogous to becoming an anesthesiologist if you like but don’t love the surgical OR imo

 

[babybrains]

As others have noted - I wouldn't consider nsurg as being more likely to "cure" diseases than neurology. A lot of neurosurgical interventions, as noted, are only part of solutions for problems like brain tumors and spinal diseases. We also can do a lot more interventions now than we could in the past as neurologists, and it's a field that is continuing to grow. Plus, if you like instant fixes, wait until you see your first tPA that works...

Do you enjoy clinical neurology at all, or are you just a fan of neuroscience? I'm in the bucket of loving both, and I personally find surgery of any kind incredibly boring, so I never was making the decision you are currently. But if you truly like the OR and would miss operating, that's a good sign to pursue a surgical specialty. For me, I'm perfectly content limiting myself to LPs, EMGs, and the like, and I'd much rather be the one making the diagnosis than just slicing and dicing after it's been made for me. Other things to consider are whether you'd prefer being inpatient vs outpatient, or a primary team vs a consulting team.

I'd definitely start talking with neurologists, general surgeons, and neurosurgeons about your interests and goals, as that might help you with making decisions.

 

[WalkingOnTheSun]

My advice: reach out to neurology, general surgery, neurosurgery, and interventional radiology residents and attendings here on SDN and IRL at your medical school and ask them questions about what drew them to the field, what they like and don't like about the field, what their day to day life looks like, what other fields they were considering, and what advice they have for you in making your decision.

I will say that these three main specialties (not counting IR right now) are all very different. Most neurologists would not be happy as neurosurgeons. Most neurosurgeons would not be happy as neurologists. Most general surgeons would not be happy as neurosurgeons and vice versa. There are aspects that link these specialties (though in my opinion, general surgery and neurology don't have that much in common other than them both being potential avenues to a specialized form of critical care, but neurocritical care is a relatively niche subspecialty of neurology).

All of these are on the harder half of residencies. Neurology will probably be the easiest, but if you don't like the incredibly detail oriented day to day of neurology, the vast and deep array of knowledge of some very obscure parts of medicine, and the fact that many patients ultimately will do worse than their counterparts in internal medicine, you will likely be a very unhappy neurologist. General surgery and neurosurgery both have brutal residencies, and if you decide to pursue fellowship, your training period will likely be equally as long in either. You can have a decent lifestyle in either specialty as an attending, but that comes at a cost of practice style, practice location, pay (sometimes), types of surgeries performed, and several other factors. If your interest is oncology, it's much easier to get into oncology from neurosurgery than from general surgery, though it's much harder to get a neurosurgery residency spot than a general surgery spot, so perhaps it evens out (though to be fair surgical oncology residents likely disproportionately come from top general surgery residencies, which are likely as hard to match into as neurosurgery residencies).

I also want to respond to an above poster's comments about neurologists being great diagnositicians but not offering any solutions. Neurology on the whole is mostly the management of chronic neurological disease, just as internal medicine is, on the whole, the management of chronic systemic diseases. Internal medicine manages conditions like diabetes, hypertension, heart failure, COPD, and cancer in the long term just as neurology will manage headaches, epilepsy, stroke, dementia, MS, and cancer in the long term. Both have acute pathologies that they can manage that may or may not lead to long term sequelae requiring follow up (i.e. MI leading to heart failure vs. stroke leading to functional debilitation). Both have critical care fellowships where you have the opportunity to address a decompensation or acute event so that the patient can then be managed from a preventative standpoint once they're back on their feet. Both have the opportunity to treat infectious disease which can very well be curative. However, if your comparison is internal medicine, it's pretty unfair to say that neurologists don't offer solutions. They manage chronic diseases and are able to modify the natural history of these diseases such that patients can have improved quality and longevity of life, just like most of internal medicine.

Surgical specialties have the opportunity to address problems that then don't require long term management (appendectomies, cholecystectomies, many of the more common spine surgeries, etc). However, a lot of surgical patients become life-long patients that require constant follow-up and long term management (any surgical oncology patient in either general or neurosurgery, vascular patients in neurosurgery, colectomy patients in general surgery, shunt patients in neurosurgery, transplant patients in general surgery). So it's also not a one and done fix. I think thinking of specialties in this manner is unnecessarily reductionist and obfuscates a lot of aspects about these specialties that people really need to think about, consider, and, ideally, experience for themselves before deciding which one is right for them.

This is really great advice, thank you very much for taking the time to write this out. I agree that simplifying neurology to just being a diagnostic specialty is inaccurate and simplistic, just like only viewing surgery as solving acute problems is also overly simplistic. I think that's part of what makes it challenging to choose a specialty, is that there is a lot of breadth within each one--for example, neuro-ICU as you mentioned would be very different from a headache clinic, which would also be very different from being a stroke hospitalist. I will definitely reach out to residents and physicians in each of the specialties I am considering to get some more insight (and I'm thankful to have some more time to do so).

 

[WalkingOnTheSun]

Also MS, epilepsy are 2 neuro fellowships where the many of your patients can be event free from their disease potentially.


If op legitimately has neurology in contention even though it’s not surgical, they should consider EEG or neurophys fellowship -> intra-operative monitoring of neurosurgery-epilepsy cases. It’s somewhat analogous to becoming an anesthesiologist if you like but don’t love the surgical OR imo

I've observed some intraoperative monitoring and found it really interesting, so I could definitely look into that a bit more!

 

[WalkingOnTheSun]

As others have noted - I wouldn't consider nsurg as being more likely to "cure" diseases than neurology. A lot of neurosurgical interventions, as noted, are only part of solutions for problems like brain tumors and spinal diseases. We also can do a lot more interventions now than we could in the past as neurologists, and it's a field that is continuing to grow. Plus, if you like instant fixes, wait until you see your first tPA that works...

Do you enjoy clinical neurology at all, or are you just a fan of neuroscience? I'm in the bucket of loving both, and I personally find surgery of any kind incredibly boring, so I never was making the decision you are currently. But if you truly like the OR and would miss operating, that's a good sign to pursue a surgical specialty. For me, I'm perfectly content limiting myself to LPs, EMGs, and the like, and I'd much rather be the one making the diagnosis than just slicing and dicing after it's been made for me. Other things to consider are whether you'd prefer being inpatient vs outpatient, or a primary team vs a consulting team.

I'd definitely start talking with neurologists, general surgeons, and neurosurgeons about your interests and goals, as that might help you with making decisions.

So I did enjoy my neurology rotation, which was mostly inpatient/consults. I liked the cases where we discussed localizing the lesions, myasthenic crises, MS/CIS, GBS and other inflammatory neuropathies that improved with IVIG, etc. I liked how there seemed to be a lot of variety, and I definitely saw a lot of the patients improve which was great. After my neuro rotation however, I had a outpatient block which combined all the outpatient stuff from all the specialties -- IM, peds, ob/gyn, etc. In that outpatient block, I also was assigned to a dementia clinic. I'll be honest--compared with inpatient medicine, outpatient medicine did not seem my style and quickly grew old. I began to question my desire to enter a field (neurology) that is mostly outpatient-based, although of course there are neurologists that are hospital-based only. The dementia clinic as well was depressing-- long neurocognitive testing and expensive brain imaging and medically, very little to offer in the way of treatments that will help. That colored my perception of the field as well, although I definitely did remind myself that neurology is not just treating dementia.

I like the variety in the field, and one of the things I worry about is how subspecialized it seems to be becoming (although that's a trend in all specialties). I understand why it's necessary to subspecialize, but worry about getting bored with seeing the same 2-3 types of patients, rather than seeing the whole scope of the field.

 

[babybrains]

So I did enjoy my neurology rotation, which was mostly inpatient/consults. I liked the cases where we discussed localizing the lesions, myasthenic crises, MS/CIS, GBS and other inflammatory neuropathies that improved with IVIG, etc. I liked how there seemed to be a lot of variety, and I definitely saw a lot of the patients improve which was great. After my neuro rotation however, I had a outpatient block which combined all the outpatient stuff from all the specialties -- IM, peds, ob/gyn, etc. In that outpatient block, I also was assigned to a dementia clinic. I'll be honest--compared with inpatient medicine, outpatient medicine did not seem my style and quickly grew old. I began to question my desire to enter a field (neurology) that is mostly outpatient-based, although of course there are neurologists that are hospital-based only. The dementia clinic as well was depressing-- long neurocognitive testing and expensive brain imaging and medically, very little to offer in the way of treatments that will help. That colored my perception of the field as well, although I definitely did remind myself that neurology is not just treating dementia.

I like the variety in the field, and one of the things I worry about is how subspecialized it seems to be becoming (although that's a trend in all specialties). I understand why it's necessary to subspecialize, but worry about getting bored with seeing the same 2-3 types of patients, rather than seeing the whole scope of the field.

In my experience with outpatient clinics in adult neuro, dementia clinic was probably my least-favorite as well. There isn't a lot to stop the progression of the disease, I agree, though I'd disagree that we can't help - there are a lot of ways of helping patients that aren't pharmacologic or curative. Things like helping them get resources, therapies, etc. But it sounds like you didn't enjoy your other outpatient experiences either, so probably you're more of an inpatient person. You can definitely do that in neurology as well as surgery.

I'm someone who plans on doing fellowship after I complete my child neuro residency, so maybe I'm not the right person to be saying this - but I've yet to see subspecialization (at least in adult or child neurology) lead to seeing the same thing over and over again. Maybe if you go into headache, but for fields like neurocritical care, neurogenetics, epilepsy, and movement disorders (just to name a few), there's still a lot of variety in that box. There are multiple conditions that fall under each umbrella, and even more varied presentations of each condition. Even in specific clinics, there's usually a bunch of variety. But you can also just be a general neurologist as well, and find a job that has more inpatient work than outpatient.

I'd also think that you'd run that same risk of repetitiveness in nsurg or gen surg - I was bored with lap appys & choles after 2 months on surg, and most of the nsurg residents I met were deciding whether to specialize in spine or skull base. It's more a medicine thing than a neurology thing, imo.

 

[libertyyne]

In my experience with outpatient clinics in adult neuro, dementia clinic was probably my least-favorite as well. There isn't a lot to stop the progression of the disease, I agree, though I'd disagree that we can't help - there are a lot of ways of helping patients that aren't pharmacologic or curative. Things like helping them get resources, therapies, etc. But it sounds like you didn't enjoy your other outpatient experiences either, so probably you're more of an inpatient person. You can definitely do that in neurology as well as surgery.

I'm someone who plans on doing fellowship after I complete my child neuro residency, so maybe I'm not the right person to be saying this - but I've yet to see subspecialization (at least in adult or child neurology) lead to seeing the same thing over and over again. Maybe if you go into headache, but for fields like neurocritical care, neurogenetics, epilepsy, and movement disorders (just to name a few), there's still a lot of variety in that box. There are multiple conditions that fall under each umbrella, and even more varied presentations of each condition. Even in specific clinics, there's usually a bunch of variety. But you can also just be a general neurologist as well, and find a job that has more inpatient work than outpatient.

I'd also think that you'd run that same risk of repetitiveness in nsurg or gen surg - I was bored with lap appys & choles after 2 months on surg, and most of the nsurg residents I met were deciding whether to specialize in spine or skull base. It's more a medicine thing than a neurology thing, imo.

The same way you would find variation in varied presentation of the same few diseases surgeons would find variation in anotomy, approach, presentation in surgical patients. Neurosurgery also has research years where some programs allow enfolded fellowships , and formal fellowships may not even be necessary for specialisation at that level so I would hardly call it the same.

 

[babybrains]

The same way you would find variation in varied presentation of the same few diseases surgeons would find variation in anotomy, approach, presentation in surgical patients. Neurosurgery also has research years where some programs allow enfolded fellowships , and formal fellowships may not even be necessary for specialisation at that level so I would hardly call it the same.

I'm failing to see what you're saying is different. Some programs may allow concurrent fellowships, but others do not - the program at my med school was the latter, hence why so many were going off for fellowships as mentioned. That being said, neurosurg involves ~7 years of training rather than 4, so even if the fellowship is folded in, it's the same or greater length of time. But just as you don't have to do a fellowship for nsurg, you don't have to do one for neuro.

Note that I think OP should pursue what he's interested in, and if that's neurosurg, that's awesome! I just think that worrying about variation in neuro vs neurosurg is a little silly, and not a reason to choose one over the other.

 

[libertyyne]

I'm failing to see what you're saying is different. Some programs may allow concurrent fellowships, but others do not - the program at my med school was the latter, hence why so many were going off for fellowships as mentioned. That being said, neurosurg involves ~7 years of training rather than 4, so even if the fellowship is folded in, it's the same or greater length of time. But just as you don't have to do a fellowship for nsurg, you don't have to do one for neuro.

Note that I think OP should pursue what he's interested in, and if that's neurosurg, that's awesome! I just think that worrying about variation in neuro vs neurosurg is a little silly, and not a reason to choose one over the other.

The point was
1. just like you dont find same bread and butter cases repetitive, surgeons dont find their "bread and butter" cases repititve .
2. most neurosurgeons do not end up doing additional fellowship training post graduation, and their skill sets tend to reflect exposure they had during residency. Spine fellowship is not necessary for most neurosurgeons unless they do not recieve adequate exposure in residency.

 

[babybrains]

The point was
1. just like you dont find same bread and butter cases repetitive, surgeons dont find their "bread and butter" cases repititve .
2. most neurosurgeons do not end up doing additional fellowship training post graduation, and their skill sets tend to reflect exposure they had during residency. Spine fellowship is not necessary for most neurosurgeons unless they do not recieve adequate exposure in residency.

Ok, I thought you were arguing that there was a difference, hence my confusion. But I think we agree on point 1. Point 2 doesn't fit with what I've heard from neurosurgeons I've worked with on rotations, but I'll admit that I've never been interested enough to look into it deeply, so maybe my home program was unusual in that regard.

 

[WalkingOnTheSun]

In my experience with outpatient clinics in adult neuro, dementia clinic was probably my least-favorite as well. There isn't a lot to stop the progression of the disease, I agree, though I'd disagree that we can't help - there are a lot of ways of helping patients that aren't pharmacologic or curative. Things like helping them get resources, therapies, etc. But it sounds like you didn't enjoy your other outpatient experiences either, so probably you're more of an inpatient person. You can definitely do that in neurology as well as surgery.

I'm someone who plans on doing fellowship after I complete my child neuro residency, so maybe I'm not the right person to be saying this - but I've yet to see subspecialization (at least in adult or child neurology) lead to seeing the same thing over and over again. Maybe if you go into headache, but for fields like neurocritical care, neurogenetics, epilepsy, and movement disorders (just to name a few), there's still a lot of variety in that box. There are multiple conditions that fall under each umbrella, and even more varied presentations of each condition. Even in specific clinics, there's usually a bunch of variety. But you can also just be a general neurologist as well, and find a job that has more inpatient work than outpatient.

I'd also think that you'd run that same risk of repetitiveness in nsurg or gen surg - I was bored with lap appys & choles after 2 months on surg, and most of the nsurg residents I met were deciding whether to specialize in spine or skull base. It's more a medicine thing than a neurology thing, imo.

Thank you for your perspective, that is helpful!

 

[Medstart108]

I was in a similar situation to you, deciding between cardiology (w/ a view to interventional cardiology), general surgery and cardiothoracic surgery.

I ultimately chose cardiothoracic surgery and I haven't regretted it yet. I had somewhat similar concerns. I viewed cardiology as the safer choice, it had options for out, still had some medicine which I liked, but I always felt like it was missing on the procedural side for me. I liked general surgery because it let me delay my decision, but I wasn't the most keen on bowel. I liked cardiothoracic but was concerned about the future of cardiac surgery and felt like it might be too intense and wasn't sure if I was "cut out". Through my residency program I have gotten exposure to cardiology, cardiothoracics and general surgery and I can reasonably confidently say I made the right choice.

I worried about lifestyle as well, but ultimately I realized that what drove me was being good at something. I wanted to be good at something that was unique and I realized I would be more satisfied being good at my career and having a few hobbies to dabble in than be ok with my career and having a few more hobbies. I'm also fortunate enough to be able to dedicate my time since I don't have dependents etc.

What I can say is, from what I'm seeing, I think you should really delve deep into lifestyle. If you are even considering general surgery, you are open to the idea of a residency that pushes the 80 work week limit end of story. The reality is that neurosurgery and general surgery have similar lifestyles in both residency and staff. Both have subspecialties that push the work hour limit (ACS, Trauma, HPB, Transplant and Endovasc Neuro) and both have more lifestyle subspecialties (Breast, Surg Onc and Peds Neurosurg, Functional). Yes, neurosurgery is more of a commitment, i.e., more jobs are going to be academic and you are more likely to need to do academic work but the subspecialties you are interested in for gen surgery will also require this. This to me means you should at least give Neurosurgery a consideration. It seems to me that you like surgery but aren't sure about the hours, but if you are willing to consider doing those hours, Neurosurgery will be the same as Gen Surg hours wise but more interesting to you.

I don't think you will dislike neurology either. If you do end up in neurology, you will enjoy it, there may be days you will wonder about your life as a neurosurgery/general surgeon but the same will happen vice versa. There will always be a procedural component available and there are plenty of neurologists who enjoy more than just the non invasive side of neuro.

With that being said, I would strongly consider neurosurgery and neurology in your case. And importantly, you'll be happy with whatever you choose. Once you choose, your mind finds reasons to affirm your decision. All these specialties have their own different pros and cons and so you can't really go wrong.

 

[WalkingOnTheSun]

I was in a similar situation to you, deciding between cardiology (w/ a view to interventional cardiology), general surgery and cardiothoracic surgery.

I ultimately chose cardiothoracic surgery and I haven't regretted it yet. I had somewhat similar concerns. I viewed cardiology as the safer choice, it had options for out, still had some medicine which I liked, but I always felt like it was missing on the procedural side for me. I liked general surgery because it let me delay my decision, but I wasn't the most keen on bowel. I liked cardiothoracic but was concerned about the future of cardiac surgery and felt like it might be too intense and wasn't sure if I was "cut out". Through my residency program I have gotten exposure to cardiology, cardiothoracics and general surgery and I can reasonably confidently say I made the right choice.

I worried about lifestyle as well, but ultimately I realized that what drove me was being good at something. I wanted to be good at something that was unique and I realized I would be more satisfied being good at my career and having a few hobbies to dabble in than be ok with my career and having hobbies that i'm ok in. I'm also fortunate enough to be able to dedicate my time since I don't have dependents etc.

What I can say is, from what I'm seeing, I think you should really delve deep into lifestyle. If you are even considering general surgery, you are open to the idea of a residency that pushes the 80 work week limit end of story. The reality is that neurosurgery and general surgery have similar lifestyles in both residency and staff. Both have subspecialties that push the work hour limit (ACS, Trauma, HPB, Transplant and Endovasc Neuro) and both have more lifestyle subspecialties (Breast, Surg Onc and Peds Neurosurg, Functional). Yes, neurosurgery is more of a commitment, i.e., more jobs are going to be academic and you are more likely to need to do academic work but the subspecialties you are interested in for gen surgery will also require this. This to me means you should at least give Neurosurgery a consideration. It seems to me that you like surgery but aren't sure about the hours, but if you are willing to consider doing those hours, Neurosurgery will be the same as Gen Surg hours wise but more interesting to you.

I don't think you will dislike neurology either. If you do end up in neurology, you will enjoy it, there may be days you will wonder about your life as a neurosurgery/general surgeon but the same will happen vice versa. There will always be a procedural component available and there are plenty of neurologists who enjoy more than just the non invasive side of neuro.

With that being said, I would strongly consider neurosurgery and neurology in your case. And importantly, you'll be happy with whatever you choose. Once you choose, your mind finds reasons to affirm your decision. All these specialties have their own different pros and cons and so you can't really go wrong.

It's really helpful to hear your thought process as you went through making a similar decision, and I'm glad that you are happy in CT surgery! Thank you, and I will keep your advice in mind.

 

[ball123]

So I know it's not typical to have a tough time choosing between specialties that are so different! But that's where I am right now. I'm on a research year between M3 and M4 year so I have more time to decide.

I came into medical school thinking neurology because of a neuroscience background, I was fascinated by the complexities of the brain and how much there still is to learn. But after M3 year, I realized that while neurology is engaging and interesting, clinical neurology is pretty different from the basic neuroscience that I liked. And I unexpectedly really liked my general surgery rotation. I've even thought of combining those two interests in the form of neurosurgery, but have gotten intimidated by the career path and the advice to only do neurosurgery if that's the only thing you can see yourself liking. That's not me--I could see myself happy as a neurologist, general surgeon, or even a procedural internist. So my dilemma is, how can I choose between these very different specialties? How can I commit to one specialty without, down the line, feeling regretful about the career possibility I didn't choose?

I see it as a venn diagram.

Neurology and neurosurgery share certain things I enjoy: studying the CNS, using the neuro physical exam to localize the lesion, dealing with serious conditions, having meaningful patient interactions. Neurology even has some avenues I could pursue where you could continue being in the OR (interventional neuro with mechanical thrombectomies).

General surgery doesn't overlap as much with neurology, but within general surgery I would likely pursue surgical oncology or breast surgery and in those subspecialties, there certainly is overlap in dealing with serious conditions and having meaningful/longitudinal patient interactions.

Neurosurgery and surgery share several other things I enjoy: being in the OR, making a rapid fix in a patient's condition, and teamwork. But they also share things that I am very wary about: long hours in residency and potentially even after residency is completed (I've heard the 80 hour rule is a joke and few programs actually even follow it and that as a junior surgeon your hours may even be worse than in residency), and less accommodation for family life (ex: pregnancy). I want to be able to live a fulfilling life outside the OR, and I am worried that I won't be able to do that. I'm not the type of person who can get by on 5 hours of sleep for more than a couple nights and still feel functional, and I'm worried that that fact alone should lead me to consider a different field.

Any insight or help? Thanks!

It might be too late given how super competitive ophtho is but I would seriously consider ophthalmology - particularly Vitreoretinal Surgery (which is a 2 year fellowship after ophtho). It has all the things you mentioned - tons of neuroscience, really cool and fascinating surgeries, treatment modalities that actually WORK and make the patient better, amazing amazing technology and imaging, good teamwork in the OR and in clinic, meaningful/longitudinal patient interactions as you are seeing these patients forever, and you are dealing with a serious condition - blindness. Many patients are on the verge of tears in clinic and it can be an emotionally rewarding field. Lifestyle is GREAT compared to almost any other surgical field and almost any non-surgical field, and it can be very financially rewarding - if that is something that is improtant to you. Just a pitch for retinal surgery!

 

[WalkingOnTheSun]

It might be too late given how super competitive ophtho is but I would seriously consider ophthalmology - particularly Vitreoretinal Surgery (which is a 2 year fellowship after ophtho). It has all the things you mentioned - tons of neuroscience, really cool and fascinating surgeries, treatment modalities that actually WORK and make the patient better, amazing amazing technology and imaging, good teamwork in the OR and in clinic, meaningful/longitudinal patient interactions as you are seeing these patients forever, and you are dealing with a serious condition - blindness. Many patients are on the verge of tears in clinic and it can be an emotionally rewarding field. Lifestyle is GREAT compared to almost any other surgical field and almost any non-surgical field, and it can be very financially rewarding - if that is something that is improtant to you. Just a pitch for retinal surgery!

I did consider ophtho and did a rotation in it. I couldn't get past the extremely short clinic visits (<5 minutes in the retina clinic I was in per patient, with 50-60 patients on a clinic day), as well as the fact that at least for a general ophthalmologist, there really are only two operations they do. I also didn't like the idea of subspecializing within an eyeball which already is really tiny haha. Unfortunately it wasn't as aligned to my interests as I thought it would be, but thank you for the suggestion nonetheless!

 

[sovereign0]

But they also share things that I am very wary about: long hours in residency and potentially even after residency is completed (I've heard the 80 hour rule is a joke and few programs actually even follow it and that as a junior surgeon your hours may even be worse than in residency), and less accommodation for family life (ex: pregnancy). I want to be able to live a fulfilling life outside the OR, and I am worried that I won't be able to do that. I'm not the type of person who can get by on 5 hours of sleep for more than a couple nights and still feel functional, and I'm worried that that fact alone should lead me to consider a different field.

Your instinct was right - consider a different field. If you were worried about even one of these factors NSGY would not be a good match for you. All of the above plus the fact that you said you'd be happy doing any number of things - I would absolutely strike NSGY out of consideration. I'm not even sure why there's a discussion happening here to be honest.

 

[Chelsea FC]

PM&R?

 

[WalkingOnTheSun]

Your instinct was right - consider a different field. If you were worried about even one of these factors NSGY would not be a good match for you. All of the above plus the fact that you said you'd be happy doing any number of things - I would absolutely strike NSGY out of consideration. I'm not even sure why there's a discussion happening here to be honest.

Are you saying absolutely zero future or current neurosurgeons ever had the word "lifestyle" cross their brains? Thinking about life outside of your career in any way shape or form is slanderous? Is this based on actual conversations with current neurosurgeons/residents, or solely based on speculation?

 

[libertyyne]

Are you saying absolutely zero future or current neurosurgeons ever had the word "lifestyle" cross their brains? Thinking about life outside of your career in any way shape or form is slanderous? Is this based on actual conversations with current neurosurgeons/residents, or solely based on speculation?

Neurosurgeons care about lifestyle. The lifestyle is neurosurgery.

7 Years is a long time to go through the grinder, if lifestyle is your concern you are unlikely to last those seven years to get to the other side. Plus the field is extremely self selecting, people are weeded out before that even happens.

 

[RuralEDDoc]

I’ll echo others comments - look very closely at Neuro IR. Strong future. High impact.

 

[WalkingOnTheSun]

I’ll echo others comments - look very closely at Neuro IR. Strong future. High impact.

This might be silly, but I would be concerned about being in a field constantly exposed to radiation (mostly with regards to fetal exposure) -- although other than that concern I do think that field is very promising.

 

[sovereign0]

Are you saying absolutely zero future or current neurosurgeons ever had the word "lifestyle" cross their brains? Thinking about life outside of your career in any way shape or form is slanderous? Is this based on actual conversations with current neurosurgeons/residents, or solely based on speculation?

Life is built around your career in neurosurgery. Having "lifestyle" on your mind after you've finished 7 years of residency and a few years as a junior attending (working longer hours than you did in residency, potentially) is one thing, but I can tell you that most people who have made it that far won't have it on their mind because it's a self-selecting field. There are plenty of med students who have gone into neurosurgery with lifestyle in mind, thinking that they could stick it out and it would eventually be worth it. They didn't graduate residency and either left medicine or went into other fields.

I'm a MS4 going into neurosurgery who just finished several months of sub-internships at various institutions in various practice settings, so no, it's not speculation.

 

[sovereign0]

This might be silly, but I would be concerned about being in a field constantly exposed to radiation (mostly with regards to fetal exposure) -- although other than that concern I do think that field is very promising.

Neurosurgery is exposed to a lot of radiation both in endovascular neurosurgery as well as in spine surgery where fluoroscopy and intraoperative CT scanning is very common.

 

[WalkingOnTheSun]

Neurosurgery is exposed to a lot of radiation both in endovascular neurosurgery as well as in spine surgery where fluoroscopy and intraoperative CT scanning is very common.

I know but it is a bit different when fluoro is the ONLY thing you do vs a component of what you do.

 

[nimbus]

The only 2 physicians I know who have completed Ironman distance triathlons both happen to be neurosurgeons. A 3rd neurosurgeon I work with races his GT3 cup car just about every month. You can have outside interests, just not too many.

 

[libertyyne]

I know but it is a bit different when fluoro is the ONLY thing you do vs a component of what you do.

https://pubs.rsna.org/doi/full/10.1148/radiol.2017161306
This article is a little old, but indicates that increased rates or mortality and morbidity are not associated with it. Neurosurgeons also have higher rates of CJD compared to background baseline tho.

 

[WalkingOnTheSun]

The only 2 physicians I know who have completed Ironman distance triathlons both happen to be neurosurgeons. A 3rd neurosurgeon I work with races his GT3 cup car just about every month. You can have outside interests, just not too many.

That's awesome haha I'm glad they manage those outside interests!

 

[mlovelley]

That's awesome haha I'm glad they manage those outside interests!

Hey everyone, I'm new to SDN and not entirely sure how this works but I'm going through the same dilemma. what did you end up choosing @walkingon thesun?

 

[nimbus]

Flying and motorsports are not good hobbies for neurosurgeons.

Austin neurosurgeon dies during car race in Florida

An Austin neurosurgeon died while racing in a Michelin Sports Car event at Sebring Speedway in Florida Sunday.

www.google.com

Here are some more neurosurgeons that died in small plane crashes:

https://www.kansascity.com/news/local/article2701581.html

Top N.J. neurosurgeon killed in Ohio plane crash Sunday

Hackensack University Medical CenterViswanathan Rajaraman, 54, of Franklin Lakes, was a top neurosurgeon at the Hackensack University Medical Center. Along with his wife, Rajaraman was killed in a plane crash earlier today. COLUMBUS, Ohio — A leading New Jersey neurosurgeon...

www.nj.com

FAA/NTSB to investigate plane crash that killed Birmingham, AL neurosurgeon - JusticeNewsFlash.com

Legal News for Florida Aviation Accident Attorneys. A vintage World War II plane crashed in the Florida panhandle, fatally injuring its two occupants.

www.justicenewsflash.com

Kentucky Couple Killed In Plane Crash

A plane crash in central Kentucky killed a former Louisville physician and his wife.

www.wkyt.com

Crash Kills Prominent Surgeon

MEMPHIS, Tenn. -- Two people, one a prominent Florida neurosurgeon, died Wednesday when a small plane the doctor was flying flipped while landing at

www.theledger.com

Neurosurgeon killed in plane crash a 'giant' in his fieldPosted on April 21

BILLINGS - Dr. John Oakley's death leaves a void not only in his office, but in the field of chronic pain management in general, his peers said this week.

missoulian.com

UPDATE: Pilot killed in Taylor County plane crash was neurosurgeon in New England

Investigators haven't found witnesses to Monday's plane crash in Taylor County, an NTSB spokesperson told 5 News.

www.wdtv.com

 

[libertyyne]

Flying and motorsports are not good hobbies for neurosurgeons.

Austin neurosurgeon dies during car race in Florida

An Austin neurosurgeon died while racing in a Michelin Sports Car event at Sebring Speedway in Florida Sunday.

www.google.com

High Risk/ High Reward. Seems about right.

 

[khaled salah]

I haven't regretted it yet

and now ??

 

[Lost in Translation]

Holy thread necro Batman!