Neurosurgery v. Neurology?

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mangareader

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I have an interest in neuroscience and have an interest in neurology as a specialty, but I also consider neurosurgery from time to time. My question is why did you choose neurosurgery over neurology?

Also as an aside. I was wondering how much research relating to robotics is done in both these specialties?

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I'll take a crack at this one, mainly because I was and am in a very similar situation. I've heard from many neurologists that they were initially interested in neurosurgery, primarily because of their interest in neuroscience and the brain, until they realized that there is not really all that much neuroscience in neurosurgery. There is a lot of neuroanatomy that must be known, and a lot of surgical technique that must be known. But knowing how a lesion is actually affecting cognition, and things of that sort, is of less importance in the field. There are certainly fields within neurosurgery that are heavier on the neuroscience aspect, such as neurotransplantation and functional neurosurgery for movement disorders, where it is necessary to known what a particular region of the brain is doing. These are the fields that I am most interested in, having a predilection for both neuroscience and hands-on procedures. However, the bulk of neurosurgery, which is still tumors and trauma, places less emphasis on the neuroscience behind the procedures. There are, to be sure, things you must utilize about the brain to preserve as much functionality as possible, but less brain science, per se.

I have been told that if you are torn between both fields, your best bet is probably neurology. I more and more find this to be true; most neurosurgeons decide they want to be surgeons first, and neurosurgery follows from that based on interests and personality. If you follow around doctors in both specialties, it shouldn't be hard to decide between the two. But having said that, look into functional neurosurgery, which is of course very hands-on, but with an added emphasis of knowing the neuroscience behind the procedures. The other area you could look into is interventional neurology, which focuses on minimally invasive vascular procedures, but with your training done through neurology. You will be competing with neurosurgeons for these spots though.

As far as robotics goes, there is not as much going on in neurosurgery vis a vis robotics as there is in OBGYN or urology. Robotics during surgery is mainly used when there are open interior spaces but tight angles that must be operated around. There is a NS at University of Toronto that pioneered an intra MRI robotic arm for neuro procedures, but at this point, the only large benefit to using it is reducing surgeon tremors. Robotics on the patient side is very active in both fields however, with computer brain interface being a hot research area. The difference between neurology and NS is that the most sensitive sensors must be implanted, necessitating the use of a neurosurgeon, while ones based on EEG or MEG are managed by neurologists. I tend to believe that there will be a point when implantation will not be necessary due to high sensitivity EEG/MEG sensors, and that neurosurgeons will play a smaller role in this research field. I could be very wrong though. Some input from attendings working in these areas would be very helpful.

So I guess my final piece of advice would be that stick with neurology unless you find yourself especially drawn to surgery, in which case you should really try to shadow a functional neurosurgeon.
 
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Thanks for that post MP! Very informative, really just affirming my prior thoughts. How would you recommend i find/ approach a NS or neurologist about shadowing? This is something I am VERY interested in doing. I am going to be a sophomore this year in undergrad and im volunteering at a hospital now as essentially a watered down patient care assistant.
 
Thanks for that post MP! Very informative, really just affirming my prior thoughts. How would you recommend i find/ approach a NS or neurologist about shadowing? This is something I am VERY interested in doing. I am going to be a sophomore this year in undergrad and im volunteering at a hospital now as essentially a watered down patient care assistant.

send cold emails to doctors at your nearest university affiliated hospital and tell them you want to shadow them, most doctors are receptive of undergrad students
 
I agree with that perspective. They are very different. Most of the neurosurgeons I know were never torn between those specialities. I also thought about neurology early on but quickly realized it is not for me. We all have interest in neuroscience (neurologists and neurosurgeons both) but the manner in which the specialties care for patients is so vastly different that they are in all respects completely different fields in medicine; almost as different as an allergist as compared to a thoracic surgeon. Spend time observing in both and I think you'll quickly come to realize which is right for you. A healthy interest in neuroscience is imperative for either.

There are some areas of neurology that tend a bit more to the aggressive side of providing care such as neurointensive care and interventional neuroradiology. But even the functional neurosurgeons I know are certainly more surgeon than neurologist.
 
mpp has it right. I thought about neurology briefly but realized that a career spent in the clinic would be wholly unsatisfying to me. I seem to recall that someone once polled some neurosurgeons, and the majority would choose another surgical field rather than neurology if they couldn't be neurosurgeons.
 
I was/am in a very similar position. My main thing is I am not a huge fan of clinic and I really really enjoy being in the OR. So Neurosurgery became an easy choice for me. If you need any help, feel free to PM me. :)
 
Do you/ did you guys ever call a doctor to ask if you can shadow him? I found several names in a directory from the hospital i volunteer at, but only one NS had an email, so i shot him an email. I still want to get more feelers out there and shadow a few neurologists too. All the other docs only have phone numbers listed.
 
I would call their offices and speak with the secretaries first (instead of sending out emails directly to the docs). They'll tell you directly whether said NS is receptive to students (or just relay your message and get a direct response). Plus, if you actually find one that's receptive, it's the secretary that is going to set up your appointment anyway.

Trust me, they'll greatly appreciate you going through the proper channels (and not blowing up their in-boxes).
 
Agree about contacting the secretary first--that person knows where the neurosurgeon should be at any given time better than the neurosurgeon him/herself. :) I personally didn't follow any neurosurgeons until I actually started med school since my mom (an ICU nurse) hooked me up with all my jobshadowing experiences and in my small town, the neurosurgeons did only spine/peripheral nerve and avoided cranial stuff whenever possible. Plus they weren't exactly known for being very nice people...

I also agree with the statement that neurology and neurosurgery are vastly different fields, despite their mutual foundation in the neurosciences. I suppose if one did neurology then neurocritical care there would be more overlap, but it's a divide more like that between surgical oncology vs. medical oncology than say gen surg surgery vs. GI (a procedure-heavy IM specialty). I also looked at ENT, ortho, and craniofacial plastic surgery once I became serious about neurosurg as those are all procedure-heavy fields, and I suppose now if I had to go back and change specialties (not saying that I want to), then I would pick ENT over neurology in a heartbeat.
 
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I'm in a similar position as I've always loved neuro but basically want to do surgery. I personally could not handle the intensity of training and lifestyle of neurosurgery, so I've been exploring my options. Regarding ENT, it definitely contains aspects of both fields which I like. For example, in ENT you can do some of the cool cranial surgeries like getting access to the pituitary -- granted you'll be calling in a nsurg to remove it :) -- and there's all of the temporal bone and skull base surgery if you want it. There's also a substantial medical side to ENT like neuro. Depending on what you like about neuro, it might not satisfy esoteric desires to ponder consciousness and other cognitive marvels, but I think a substantial side of neuro is more mechanistic than cognitive anyway. On the flip side, ENT certainly has a substantial amount of work that is in no way neurological. You're much more of a GP than a neurologist. But I like that there's a little medical diversity.
 
from the (very) brief conversation i had with a neurologist resident who was formerly a neurosurg resident, it was said that neurosurgeons are more interested in operative methods (eg how to gain access to remove tumor) than actual neuroscience (eg signs & symptoms produced by a tumor)

feel free to agree/disagree
 
from the (very) brief conversation i had with a neurologist resident who was formerly a neurosurg resident, it was said that neurosurgeons are more interested in operative methods (eg how to gain access to remove tumor) than actual neuroscience (eg signs & symptoms produced by a tumor)

feel free to agree/disagree
Getting to the tumor requires that knowledge of neuroscience (more properly, neuroanatomy). You have to know where all the vital structures are, and what they do, so you don't go straight through the motor cortex on your way to that intraventricular tumor, or pull out the fornix along with the colloid cyst.
 
Well a quick update. I was also considering both of these fields and was very gung ho about neurosurgery. But at the end of the day after what I saw in my recent sub-I regarding the attendings and especially their lifestyle, along with seeing how a brand new junior attending was being treated, I changed to neurology, albeit with a lot of remorse.
Neurosurgery is a fantastic field, but the only way you will know if you want to do Neurology or Neurosurgery is to experience the field like everyone said.
Good luck. There is a lot of good advice in this thread. PM me if you need any info.
 
Well a quick update. I was also considering both of these fields and was very gung ho about neurosurgery. But at the end of the day after what I saw in my recent sub-I regarding the attendings and especially their lifestyle, along with seeing how a brand new junior attending was being treated, I changed to neurology, albeit with a lot of remorse.
Neurosurgery is a fantastic field, but the only way you will know if you want to do Neurology or Neurosurgery is to experience the field like everyone said.
Good luck. There is a lot of good advice in this thread. PM me if you need any info.
What happened to the attending if you don't mind posting. Of course with changing a few details out and such.
 
What happened to the attending if you don't mind posting. Of course with changing a few details out and such.

I would like to divulge the details, but I don't want someone to read it and figure out what place I'm talking about. It wouldn't be too hard. Don't want to get in trouble. :scared:

Also kitsunepixie, if I'm not mistaken you are a pgy 1 in neurosurgery right? I'm not gonna lie. Even though I am happy with my decision, I still wake up every morning and have massive amounts of regret of not going for neurosurgery, to the point where I think about this for hours on end during my studies. Granted I just put in my ERAS application about 2 weeks ago, it might just be the after effects of a hard decision....:(
 
I have had similar feelings. For example, for a while I had an extreme desire to become a military pilot. I even considered doing this over medicine for a while. However, almost instantly, once I started med school, those desires dont really affect me anymore. I still love aviation, but my experiences in med school so far have shown me that I wouldn't really be happy in any other career.
 
Getting to the tumor requires that knowledge of neuroscience (more properly, neuroanatomy). You have to know where all the vital structures are, and what they do, so you don't go straight through the motor cortex on your way to that intraventricular tumor, or pull out the fornix along with the colloid cyst.

right. hence the HOW to gain access (around the vital structures rather than through them) of the tumor.
 
In the defense of neurosurgery usage of neuroscience, if you are in an academic setting the opportunity to flex that sort of muscle is abundant. I work in a neurosurgeons lab focusing on SAH/ICH and also arteriovenous malformations from bench to bedside. The PI, a full time surgeon, definitely knows his pathways and specializes in those surgeries.
 
Obviously one of the major factors is how competitive an applicant you are for residency (class rank, board scores, publications, etc.). Hence the reason why most medical students initially interested in neurosurgery would rather go into other surgical fields (ortho, plastics, ENT, etc.) if they decide not to do neurosurgery (rather then going into neurology) - these fields are more on par in terms of competition.
 
Your answer typically boils down to money.

Currently, the average neurosurgery applicant is much more competitive than the average neurology applicant. Thus, the average neurosurgery applicant is considering jobs that pay more than the average neurology job.

This salary information is public domain and includes jobs less competitive than NSG (arguably like ENT) - and much, much more competitive than NSG. The more competitive jobs are usually in surgical subspecialties (like plastics, ortho, and urology) and rare medical subspecialities like dermatology. You will thus frequently find people on these forums answering your question with *seemingly* strange replies that individuals considering neurosurgery consider these surgical subspecialty fields over neurological medicine.

Rare applicants are competitive for both specialites and actually choose neurology. People like this are attracted to both fields because of similar subject matter - though they often utilize discrepant methodologies.

The nascent field of endovascular surgical neuroradiology blends radiology, neurological medicine, and neurological surgery...and might be of interest to those of you interested in the common subject matter/methodology often considered the sole purview of neurosurgery.
 
Also consider interventional neuroradiology, lot of interesting procedures but also a good mix of neuroimaging which is extremely fascinating and involves lot of neuroscience knowledge, especially with all the newer modalities gaining ground in the clinical arena (spectroscopy, diffusion tensor imaging, etc...).
 
If you're a neurologist, I'd encourage you to learn more about the neurosurgical procedures that your patients need.
If you're a neurosurgeon, I'd encourage you to learn more about the neurology workup and differentials.

The fact is that these are two related fields with vastly different treatment modalities and attitudes. Neurosurgeons tend to have more in common with stroke and neurointensive care neurologists and interventional neuroradiologists (there is a growing population of neurosurgeons who get fellowship-trained in INR). Neurosurgery is 7 grueling, intense years of residency where the pressure is high, the stakes are high, and the expectations are high. Neurology is a large part of our training and it is high-yield on the neurosurgical specialty board examination. I don't know how much neurosurgery shows up on the neurology boards, but I doubt any, mainly because there is not as much utility for a neurologist to understand the surgical techniques, complications, or the anatomy. However, it is more useful for neurosurgeons to understand the neurology-side of the diseases they treat, so neurosurgeons end up learning quite a bit of general neurology obligatorily, and rightly so. Neurologist are some of the smartest people I know. It's a privilege to work with them and learn from them. And it's totally necessary for a neurosurgeon to understand lots of neurology. I can't say that the opposite is true.

In addition, the personality of neurosurgery and neurology end up being quite different. Rotate or shadow each specialty. You'll see what I mean in no time.
 
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I've always been curious about this, but is there a pathway that allows one to experience Neurology first and then Neurosurgery? I'm not talking about rotations, I'm talking about residency i.e. do a full residency in Neurology and then apply to a Neurosurgery program? How about INR? I know that both Neurologists and Neurosurgeons can become INRs, but which applicant is more preferable or are they equally competitive?
 
That's going to be 11 years of residency shadowfox87. Neuro is 4 years and Neurosurg is 7 years on average. If you want to do interventional then I think it is a total of 6 or 7 years through neurology nd 8 or 9 through neurosurgery.
 
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