Neurosurgery vs Plastic surgery

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IooI

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I'm an early 3rd year med student trying to decide what to do here. Since childhood, I've been set on pursuing neurosurgery, but it has recently dawned upon me that I might be more fascinated by "being a neurosurgeon" than "doing neurosurgery." Clearly, there is a dichotomy between public and even self-perception of this job and one's actual duties. Pros for me: I love the ideas of being an expert in one field, working with cutting edge technology, a high guaranteed salary, and admittedly "playing God" (to some extent - and this is me just being honest, not facetious). Cons to me: Limited to CNS (PNS, I've been told, is rarely pursued by neurosurgeons - and if pursued only at highly academic centers), surgeries limited to minimally invasive prodding of jello-like substance for hours on end, work hours, minimal international work (is that truth?)? can I handle the sickest of the sick all day every day (I don't know, does it make you happy?)?

I've done plastic surgery research for 2 years now (which ironically I did not seek out, long story) and have a solid application in line. However, I have absolutely no inclination to do cosmetics work. I've been told by a senior plastic surgeon that neurosurgery is "just poking around in goo," which sounds flip, but does not seem far from the truth. He said plastic surgery, on the other hand, is a great field because of good outcomes, working on every part of the body including muscle, bone, nerve, and blood vessels, capacity for international work, and ability to mold one's career path in any way (in terms of options to sub-specialize, although this quality is not unique to plastics). He mentioned that in the academic setting, there is very little cosmetic work. Pros to me are all of the aforementioned. Cons to me: Cosmetics, public/colleague perception of plastic surgeons, regret for not pursuing neurosurgery, lack of CNS research, don't care for many topics in plastics (intimidated by need for extensive knowledge of anatomy. Don't care for wound healing, dealing with pressure sores, breast reconstruction, cosmetics; things that I more or less consider "menial"), some part of me wants to handle life and death situations (is that ego and self-righteousness or genuine compassion? Don't know, probably the former)

So I guess my question is, how did you all come to a decision (not necessarily even between plastics and neurosurgery, but any other field you were considering)? Was your decision immediately apparent to you from the get-go? I have heard that it comes down to being able to tolerate bread and butter cases in whatever field you do. What is bread and butter plastics/neurosurgery? What can I do to help myself answer these questions? I've shadowed 2-3 cases in each field but was not particularly impressed (probably since I was just standing in the background for several hours, neither seemed to "click" but then again NOTHING has seemed to "click" for me up to this point). Also, if you started your residency without being completely enamored by your field, did it grow on you as the time passed or just lead to regret?

I definitely have the dedication to pursue whatever I decide on, but things at this stage in the game seem clear as mud. ANY insight would be appreciated.

Thanks for the thoughts!

PS I am qualified to match in either specialty, if that is something that might cause hangups.

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I've got one piece of advice, and if you try to follow it maybe it will help you arrive to a decision: stop caring about how others perceive you and your occupation. Nobody cares whether you are a neurosurgeon or a pediatrician. You are a doctor...which puts you way above most other professions in terms of salary, prestige, etc...and you want to be a super specialized surgeon at that. Maybe if you stop caring about what other people think about your occupation (it looks like thats one of the reasons why u want to be a neuro over a plastics dude)...it will help lean you toward...........PLASTICS...which is a far better field.
 
Thanks, I appreciate the response. You're right, a part of me does worry about what people will think of my life's work, but that is only a minor concern of mine. Absolutely I will have to deal with this. Any thoughts on my other concerns? Why did plastics feel right for you?
 
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It's silly for you to even ponder this question if you haven't spent your two or three months on surgery yet. You're just beginning third year. I was SURE I'd be a neurosurgeon, and then a vascular surgeon, and then an orthopedist....and then I realized that surgeons are the most deprived and miserable group of poor fellows I've met in my entire life.

I was so sure I would do something surgical that I scheduled my IM rotation at the very end of the year. And guess what I'm going into: IM!! IM to cards, or to GI, which as most reasonable people conclude is the path of least resistance to some awesome invasive procedural fields...without the requisite leaving behind of everything you've learned thus far (e.g. all surgery but general, and even then it's diluted).

I know this sounds like a dick response but seriously, you'll see what I'm talking about when you've worked 16 hours per day for 2 months, starting at 4am, and the OR isn't the glorious experience you'd thought it would be...as you watch the cards guys emerge from the cath lab, ALSO covered in blood but SMILING.

My advice is to totally forget about this issue you're trying to figure out. Pose the question again in 12 months.
 
First off I will say that I was in the same situation as you except I also liked Ortho for a while. The decision as to what career to pursue is something that no one can make for you nor should you let anyone sway you in one direction or the other, because everyone has differing opinions as what is important to them.
For me it came down to two simple things:
1. Unfortunately, both fields will have a significant amount of clinic time associated with them and this leads to a big question. What types of patients do you want to see on a daily basis and how do you want the interaction to be. For me, I liked the idea of seeing happy people and being able to help them. If it is a reconstructive patient you get to be the one to help piece their lives back together. You get to rebuild their hands after an injury, help someone gain movement back after burns, help a woman regain her sense of self after breast cancer. If it is a cosmetic case you get to help that person look like the person the feel, help them feel that they fit in with the environment around them, etc...
I truly did not want to spend my days giving bad news about tumor prognosis and telling a child that their tumor is not treatable, or that their dad will not survive, or that the car wreck left them paralyzed and or brain dead. Past that, I did not want to see "gorked" people all day. I am not putting down any field as I am simply admitting that maybe I am not strong enough to do that and anyone who can is truly an amazing person. It all comes down to preference.
2. How well do you fit in with each. After doing a couple plastics rotations, especially an away rotation, you will know who you fit in better with. I found that plastic surgeons share the same outlook, have similar interests that I do, and I simply fit better with them than any other group of surgeons.

Do a rotation in each and the answer will hit you. For me it was not a slap in the face but a gradual realization and a feeling.
 
I was so sure I would do something surgical that I scheduled my IM rotation at the very end of the year. And guess what I'm going into: IM!! IM to cards, or to GI, which as most reasonable people conclude is the path of least resistance to some awesome invasive procedural fields...without the requisite leaving behind of everything you've learned thus far (e.g. all surgery but general, and even then it's diluted).

I know this sounds like a dick response but seriously, you'll see what I'm talking about when you've worked 16 hours per day for 2 months, starting at 4am, and the OR isn't the glorious experience you'd thought it would be...as you watch the cards guys emerge from the cath lab, ALSO covered in blood but SMILING.

"I going to be a 9-5 surgeon. If my patients have complications outside those hours, it's surgery's problem."
 
"I going to be a 9-5 surgeon. If my patients have complications outside those hours, it's surgery's problem."

Fair enough. However we all know what the job entails before signing up for it, and prospective surgeons know what they're getting themselves into.

I'll go home at 5 or 6 most nights, and as payment I'll never be able to call myself "a surgeon." Adolescent dreams die hard, but OP, I encourage you to keep an open mind...there are other amazing fields out there with less bitterness and alimony.
 
Fair enough. However we all know what the job entails before signing up for it, and prospective surgeons know what they're getting themselves into.

I'll go home at 5 or 6 most nights, and as payment I'll never be able to call myself "a surgeon." Adolescent dreams die hard, but OP, I encourage you to keep an open mind...there are other amazing fields out there with less bitterness and alimony.

Just playin'
 
Let me just say that at the end of my first year, I was 100% sure I wanted to do neurosurgery. I had in my head a very different view of the field and sense of my own strengths/weaknesses than actually panned out to be true. What turned me against neuro was when I started hanging out with the neurosurg residents, they were some of the most unhappy people I had ever spent time around. All of them "worked harder, spent more time in the hospital, did more grunt work, had personally saved more lives, etc" than anyone in the history of medicine up to that point. It's true that they got to "play God" on a daily basis, but that can have it's downsides as well when you're making life and death decisions multiple times every day. I also didn't like that all their patients were very sick and their goal every case was to get the best result possible rather than recovery completely back to baseline. (Also, it was pretty brutal--not nearly the delicate, intricate procedures I had imagined). Not to say it isn't an amazing field where they help piece back together so many people and save lives, I just found out very quickly that I just didn't enjoy it.

I got introduced into plastic surgery in the peds OR (not even knowing about the integrated pathway...just the independent) and so my first exposure was completely different than the mainstream makes it out to be. Don't get me wrong--I enjoy the cosmetic side as well--but I had thought about what surgical specialty I thought I would enjoy and really kind of liked a little of everything. I didnt' want to do gen surg because from my experience, they're basically limited to gut surgeries for the most part. I loved the breadth of the plastic surg field! You can do hand, micro, craniofacial, burns, breast, cosmetic, on and on and on. You can be as specialized or as broad as you want. The patients are healthy (for the most part) and good outcomes are not as foreign as in some of the other specialties! The biggest thing to me though was talking to the residents and attendings. I had so many people tell me to do surgery ONLY if I couldn't be happy doing anything else! I have yet to meet a plastic surgeon or resident who regrets his decision. Most people will tell you without hesitation that that was the best decision they've ever made! I feel like I could be happy doing most surgical specialties...I just like to operate. I made my decision based on what I had seen of the people in the field and the possibilities that come for lifestyle specific specialties on the other side!

I will echo what seth03 said: don't care what other people say about you and your specialty. You're the only one who has to live every day in the specialty you pursue. Keep your mind open, try to get as much exposure in the fields and just see which days you are excited to go into the hospital and which ones you really dread! The most important thing to figure out at this time is if you truly want to be a surgeon (which I think you do from your initial post) or if you just want to do procedures. Guess what happens when a complication from a cath or a colonoscopy happens? A surgeon gets called!! Beyond that, just try to do well on your clerkships, get good evals and don't worry too much about it. It'll come to you.

PS - I'm just curious about what "being qualified for either specialty" means to you. Have you gotten your step 1 scores back? Maybe you took yours earlier than mine, but I didnt' get my scores back until mid-July. But, even that doesn't matter as much depending on what specialty you decide...just try to work well with everyone, have a good personality and work harder than you've ever worked in your life--especially on your surg rotations!

Good luck!
 
Thank you for the great feedback. My current situation is that I've already got my Step 1 scores and have a few pubs that might help me pursue a career in surgery. I haven't done my surgery or medicine rotations yet.

As many of you advised, I think I need to figure out if I really want to be a surgeon. In my mind, I feel like surgery will be the most personally rewarding but to be honest I can't even tell if I have the baseline fine motor skills. I can barely suture and tie knots with gloves on, but I don't really enjoy doing it (probably because I suck at it right now). However, I do love taking direction from the senior resident/attending and getting my hands dirty during a case while I'm scrubbed in. So yeah, I don't know if that's a normal sentiment or whether people that eventually choose surgery loved every aspect of it from the beginning...

I definitely found Neurology, Cardiology and Heme/Onc the most interesting topics in school and I loved pathology and physiology in general. A part of me wants to stay connected with all of the cool knowledge I've accumulated over med school. So I guess I jumped the gun with my question, these next several months will probably be eye-opening.

Thanks again!
 
I have to chose between these two in 5 hours and grab a 3 hour sleep too. I was all about neuro untill very recently l but now when I know I will be accepted in both, I'm in a fix.
This thread didn't help me at all!!
I'm artistically inclined so cosmetic draws me towards itself. But CNS is so perfect to study, everything is like maths, the lesion localisation, the neuroanatomy it all fits in its place perfectly.
I wish it was easier to decide.
 
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