Psychiatry vs Neurosurgery

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lacrossegirl420

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Was anyone else ever making this decision? I do realize they are basically the polar opposite of specialties. What drew you one direction over the other?

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More people ponder surgery vs. Psychiatry than you would think. There's a certain congruence in personality type that exists just below the surface of the specialties. Both engage, as you could say, in a very invasive way with their patients.

Those who are in overwhelming love with the OR and the act of surgery itself choose surgery.

Everyone else realizes caring about pretty much anything else in your life makes psychiatry a better choice.
 
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They're not polar opposites. They're both not internal medicine and they both have to do with the brain, which some people are obsessed with. However, most people who actually end up doing neurosurgery seem to have their second choice be other surgical specialties, like ortho, plastics, or gen surg.

I briefly considered applying for neurosurgery (it is obviously a tough application, I think I would have had a decent chance of getting in but who knows) but then I did some of it and I found observing the surgeries to be very boring. Even in residency there is a lot of surgery observation. I didn't want to be there. I wondered if everyone thinks this when they are observing the surgeries and just puts up with it, but I figured that cannot be true and somehow some people actually find it interesting. Perhaps some others are better able to deal with the boredom because they want to get to the promise land so much. There is also a question of whether I could have dealt with the lifestyle aspects but it became a moot point once I realized that the core aspect of it was not for me.
 
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I considered neurosurgery. Quite seriously, in fact. My summer between M1 and M2 year was spent in the neurosurgery department, doing research, attending grand rounds, sitting in on case conferences, etc. Pretty much went to all the didactics the intern was going to other than M&M. My posters during med school were neurosurgery related.

My surgery rotation noped me out of neurosurgery. One attending told me he hadn't spent more than few hours total with his 2 month old daughter since she had been born. The lifestyle of neurosurgery was just fundamentally incompatible with what I wanted out of life. My enthusiasm for the field dwindled to zero once I realized that in the community, most neurosurgeons are primarily operating outside the brain, doing mostly (or exclusively) spine surgery.
 
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This is an unusual debate if you have spent a fair amount of time watching neurosurgery to strongly consider it.

The neurosurgeons I know are very passionate about what they do. In medical school, they would skip parties and post-test relaxation time to scrub in or just watch neuro surgeries, for fun. Intricate surgical details and hours spent in a single neurosurgery case was not just fascinating, it was a way of life. Where other surgeons view their occupation as an enjoyable career, neurosurgeons are almost obsessive about perfection in their field. There is no room for error. Their role is often the quiet carpenter that takes intense pride in their perfect handiwork.

Psychiatrists are generally more than happy to walk away from voluntary clinic/inpatient/surgery. You may find us debating psychological theories, behavioral research, or psychopharmacology. We can easily appreciate varied perspectives and live in a world where there is no one path back to “normal”. Our role is often as an educator.
 
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I considered neurosurgery. Quite seriously, in fact. My summer between M1 and M2 year was spent in the neurosurgery department, doing research, attending grand rounds, sitting in on case conferences, etc. Pretty much went to all the didactics the intern was going to other than M&M. My posters during med school were neurosurgery related.

My surgery rotation noped me out of neurosurgery. One attending told me he hadn't spent more than few hours total with his 2 month old daughter since she had been born. The lifestyle of neurosurgery was just fundamentally incompatible with what I wanted out of life. My enthusiasm for the field dwindled to zero once I realized that in the community, most neurosurgeons are primarily operating outside the brain, doing mostly (or exclusively) spine surgery.

I was very much considering neurosurgery right up to the point I got a chance to talk to a guy doing functional neurosurgery. He told me the specialty's reputation for excessive hours was not well-founded. 'Really, if you wanted to, after residency, you could probably cut back to 60 hours per week or so.'

Oh, that's what I have to look forward to? Hard pass.
 
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I find wanting to be a surgeon very fascinating. The few surgeons I know well, used to like watching surgeries on YouTube in middle school..
 
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I did an elective my M4 year on neurosurgery. Part of my profile earlier in med school was for surgery.
I had already committed, applied, and even learned my match results on the neurosurgery rotation for psych.
"Sushi, scrub out, go check where you matched."
The residents were all wondering why in the heck I did an elective rotation with them as Psych destined applicant, but were receptive after I explained.
Half way thru they were all like, we'll be sure you match, if you apply during your intern year. "come join us."

They thoughts of telling the future Psych PD, uh, sorry, I'm bailing to go do NSx half way through intern year (and wasting time on a psych intern year) seemed like such a horrible future conversation to have [what I know now of business, medicine, etc now - don't sweat it future students if this is you, just do it, and don't feel any remorse]. And similar to a poster above, the "lifestyle" side of NSx, doing spine in an ambulatory group practice was, a 'chill' 60 hours per week.

Elements of needing to have a quality, well adjusted spouse, who was prepared and willing and wanting to be the "domestic" half of a marriage, is a hard thing to find in a spouse these days unless you have certain culture/ethnic roots you can find such a spouse. A pissed off spouse who is resentful of your family absence is a hard thing to find, and never mind hobbies? NSx is the hobby.

Ultimately the pros/cons of Psych vs NSx, psych won out, but some times I have a very low level, regret is too strong of word, but a wondering of 'what if?'

*Money wise, some one could treat NSx like a military experience, you put in 10 years for practice, live frugal as can be, marry/retire in your final year. Sort of like a FIRE approach? Then maybe be the vacation coverage guy for a group?
 
*Money wise, some one could treat NSx like a military experience, you put in 10 years for practice, live frugal as can be, marry/retire in your final year. Sort of like a FIRE approach? Then maybe be the vacation coverage guy for a group?

Except if you have the personality and mental discipline to do that, you don't have the personality type to know what to do with yourself once you retire; I guess you could have a slightly less masochistically intense second career lined up, but you could have done that in the first place....and surgical skills atrophy no matter how good you were, so it's unclear that a group would want someone who isn't consistently in the OR getting called when **** hits the fan.

There's a reason I know multiple people in my medical school class alone who transitioned out of surgical subspecialty into other things, and have never encountered someone who left psych for something else....
 
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Do you prefer

A) Patients who believe they are a God

B) You believing you are a God
 
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You would be wise to consider the effects of aging on one's ability to continue in the neurosurgery field.

If your back hurts now, after leaning over for 5 hours...it's not going to get better when you are 50.
 
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I hated pretty much everything other than psych in med school, but I did chuckle at the above comment "they're both not internal medicine." It is true that I hated that most of all (and it seemed so did many of the people practicing it).
 
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You would be wise to consider the effects of aging on one's ability to continue in the neurosurgery field.

If your back hurts now, after leaning over for 5 hours...it's not going to get better when you are 50.
 
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Beyond all the mumbo jumbo of what it takes to be good/make it through neurosurgery training, the real question is what do you want from life? Do you want to be comfortable and work 30-40 hours/week and be in the top 2% in income or do you want work to be life and making in the top 1% of income. If your user name indicates your gender, do you want to have a family? It's a wildly different proposition in psychiatry vs neurosurgery. You are in charge of crafting the life you want to live, best of luck whatever you choose.
 
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Beyond all the mumbo jumbo of what it takes to be good/make it through neurosurgery training, the real question is what do you want from life? Do you want to be comfortable and work 30-40 hours/week and be in the top 2% in income or do you want work to be life and making in the top 1% of income. If your user name indicates your gender, do you want to have a family? It's a wildly different proposition in psychiatry vs neurosurgery. You are in charge of crafting the life you want to live, best of luck whatever you choose.

This. The lifestyle difference is night and day for 99% of people in these fields. I've met a few psychiatrists who work like neurosurgeons but never heard of a neurosurgeon having a real life outside of their job. If OP wants to have a life outside of work other than brief stints of maternity leave or FMLA every couple of years, neurosurgery would be a rough road. If OP wants to live their job, neurosurgery is more congruent.

I was very interested in surgery early on (ortho), so I can relate to the general concept. I figured out pretty early that I value a life outside of medicine (and sleep!) too much to pursue a surgical route.
 
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*Top 5-7% not 2%, carry on y'all.

The top google search result for "income by percentile". It says 98th percentile would be ~$400k equivalent to $200/hour at ~40 hours per week, which most of us would agree is the minimum rate for 1099 work in psychiatry.

Granted, good luck breaking $400k per year as a W2 without a lot of hard work.
 
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The top google search result for "income by percentile". It says 98th percentile would be ~$400k equivalent to $200/hour at ~40 hours per week, which most of us would agree is the minimum rate for 1099 work in psychiatry.

Granted, good luck breaking $400k per year as a W2 without a lot of hard work.

We say this but median salary for psych is still well under $400k and probably under $300k. Your source says $286k-310k is the 95th-96th percentile, so top 5% like previously stated is pretty spot on. Your source is for household incomes, but at those percentiles unless you're married to another doctor or solid 6-figure earner, it's not going to change that percentile by much more than 1.
 
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We say this but median salary for psych is still well under $400k and probably under $300k. Your source says $286k-310k is the 95th-96th percentile, so top 5% like previously stated is pretty spot on. Your source is for household incomes, but at those percentiles unless you're married to another doctor or solid 6-figure earner, it's not going to change that percentile by much more than 1.
Yeah, you're right. So is Sushi. That does show that anywhere from top 5% on up is very possible in psychiatry. Neurosurgery would be exclusively the top percentile, no matter how that's calculated.
 
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The top google search result for "income by percentile". It says 98th percentile would be ~$400k equivalent to $200/hour at ~40 hours per week, which most of us would agree is the minimum rate for 1099 work in psychiatry.

No.

Gross receipts =/= income. Generating $400k in 1099 pay is not the same as netting $400k income. Far from it.
 
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If your user name indicates your gender, do you want to have a family?
If you feel the urge to point out that men can also enjoy meeting their kids, stay away from neurosurgery
 
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You would be wise to consider the effects of aging on one's ability to continue in the neurosurgery field.

If your back hurts now, after leaning over for 5 hours...it's not going to get better when you are 50.
The neurosurgeons I observed were obsessive about their surgical field. Residents got yelled at for hunching over.
 
The neurosurgeons I observed were obsessive about their surgical field. Residents got yelled at for hunching over.
I was just using the spine as an example to aide in anonymity for individuals a VERY small speciality. I know one neurosurgeon who has retired from surgical practice due to cervical radiculopathy, and another who retired due to something affecting vision. But I also know two, maybe three, who are still in operative practice in old age or older.

My point is that it’s a profession that has some physical requirements. I don’t know, but I would guess that some surgical specialties skew towards more gross motor skills that are more resilient in older age, while the specialities that skew towards finer motor skills may be less resilient in old age.
This. The lifestyle difference is night and day for 99% of people in these fields. I've met a few psychiatrists who work like neurosurgeons but never heard of a neurosurgeon having a real life outside of their job.

Hey, they say they a social life. I have two neurosurgeons who believe we are friends. Not that I really want to be friends. Or want to do things with them. They just tell me that we are doing something, and ignore my attempts to get out of it.
 
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*Top 5-7% not 2%, carry on y'all.
Was anyone else ever making this decision? I do realize they are basically the polar opposite of specialties. What drew you one direction over the other?
This is a good discussion, if you are really making this choice, I would highly encourage you to perhaps go for the Gold. In time you can always come to Psychiatry from Neurosurgery. In hindsight, I think surgery would have been the best option for me, at the time just sitting there watching the surgeries , I didn't realize how it is probably one of the coolest thing you can do. Psychiatry is a remarkable specialty with an outstanding platform to study and investigate the brain/mind, but to date, the way it is practiced on the ground and treatments centered around giving medications, is not necessarily the most visceral experience. That being said, the vast majority of medical specialties are not necessarily going to be very engaging because of the way the clinical machine is setup. And agree, more like 5-7%, ALTHOUGH truly many many many exceptions.
 
This is a good discussion, if you are really making this choice, I would highly encourage you to perhaps go for the Gold. In time you can always come to Psychiatry from Neurosurgery. In hindsight, I think surgery would have been the best option for me, at the time just sitting there watching the surgeries , I didn't realize how it is probably one of the coolest thing you can do. Psychiatry is a remarkable specialty with an outstanding platform to study and investigate the brain/mind, but to date, the way it is practiced on the ground and treatments centered around giving medications, is not necessarily the most visceral experience. That being said, the vast majority of medical specialties are not necessarily going to be very engaging because of the way the clinical machine is setup. And agree, more like 5-7%, ALTHOUGH truly many many many exceptions.
A few years out of residency the lifestyle thing might be over rated especially if you are really excited about what you do at work, where it viscerally charges you up.
 
In time you can always come to Psychiatry from Neurosurgery.

While technically possible, this would be such a difficult path that I would not think of it as an option. Imagine working away your youth in neurosurgery training and then working a hard few years as a neurosurgery attending just to apply to repeat residency in psychiatry and start right back over as a trainee in a new field. It sounds exhausting.

It seems a little like advising someone who is debating between medicine and law to go with medicine because they can always go back to law.
 
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While technically possible, this would be such a difficult path that I would not think of it as an option. Imagine working away your youth in neurosurgery training and then working a hard few years as a neurosurgery attending just to apply to repeat residency in psychiatry and start right back over as a trainee in a new field. It sounds exhausting.

It seems a little like advising someone who is debating between medicine and law to go with medicine because they can always go back to law.
Fair enough, I assume this student is a MS 2? , I felt this was appropriate in the sense , enough of a scope for imagination. I meant as a PGY1 or 2 can switch.
 
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I see, catching the mistake at PGY1 is far better. I have seen a few surgeons or OBs make that switch relatively smoothly. Still I would want to avoid such a switch if at all possible.
 
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From my perspective, biased as a psychologist, of course, is that the happiest psychiatrists seem to be interested in a lot of aspects of psychology nearly as much as me. I’ve never met a neurosurgeon, but they probably enjoy the fact that they don’t have to talk to patients much. I love figuring out the bio-psycho-social puzzle and that makes up for having to talk to patients to figure that out. I really only enjoy interacting with a small number of my patients, most are just ok to talk to, and there are a few that I dread.
 
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Thanks so much for the responses everyone! Really appreciate it

I’m very interested in getting involved with pharmaceuticals in the future (eg developing new drugs on a large scale, like in industry or something) alongside clinical medicine, and was wondering which specialty would be better specifically for this?

Work-life balance isn’t that important to me and I don’t really want kids, BUT I'd like a specialty where I can heavily pursue some other career interests aside from pure clinical medicine. I could see psych and nsgy both having an advantage on this end - psych would probably give me more time, but nsgy might give more opportunities since the training/knowledge base is bigger it seems. Could be totally wrong about this and would love to hear any thoughts.

I’m also still leaving rads, gas, and ophtho (in that order) in consideration, if there’s anything I said that might lead someone to suggest reconsidering one of these. Everything else I’ve pretty much eliminated
 
Thanks so much for the responses everyone! Really appreciate it

I’m very interested in getting involved with pharmaceuticals in the future (eg developing new drugs on a large scale, like in industry or something) alongside clinical medicine, and was wondering which specialty would be better specifically for this?

Work-life balance isn’t that important to me and I don’t really want kids, BUT I'd like a specialty where I can heavily pursue some other career interests aside from pure clinical medicine. I could see psych and nsgy both having an advantage on this end - psych would probably give me more time, but nsgy might give more opportunities since the training/knowledge base is bigger it seems. Could be totally wrong about this and would love to hear any thoughts.

I’m also still leaving rads, gas, and ophtho (in that order) in consideration, if there’s anything I said that might lead someone to suggest reconsidering one of these. Everything else I’ve pretty much eliminated
But do you think there will be a role for clinicians in pharmaceutical development? It kind of seems like the model going forward will be high-throughput AI-based molecular prediction followed by large-scale synthesis and in vitro testing, with select candidates moving to in vivo. Where does the clinician come in, except at the end when the product is ready for human trials?
 
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Thanks so much for the responses everyone! Really appreciate it

I’m very interested in getting involved with pharmaceuticals in the future (eg developing new drugs on a large scale, like in industry or something) alongside clinical medicine, and was wondering which specialty would be better specifically for this?

Work-life balance isn’t that important to me and I don’t really want kids, BUT I'd like a specialty where I can heavily pursue some other career interests aside from pure clinical medicine. I could see psych and nsgy both having an advantage on this end - psych would probably give me more time, but nsgy might give more opportunities since the training/knowledge base is bigger it seems. Could be totally wrong about this and would love to hear any thoughts.

I’m also still leaving rads, gas, and ophtho (in that order) in consideration, if there’s anything I said that might lead someone to suggest reconsidering one of these. Everything else I’ve pretty much eliminated
I really get the sense from your posts you don't understand how all-consuming surgery residencies are in general and neurosurgery residencies in particular.
 
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I really get the sense from your posts you don't understand how all-consuming surgery residencies are in general and neurosurgery residencies in particular.

I feel like there's a simple test here. Does writing a PhD thesis while training for an iron man and also learning two languages intensively sound like a good time? If yes, congrats, you are the kind of chronically driven overachieving type that thrives in nsgy. If not, maybe skip it.
 
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@clausewitz2 : Yes that actually sounds amazing and something I strongly vibe with, but the thing is would I actually be able to do something like that in NSGY? Since as mentioned, it’s pretty much all-consuming so I would really only have time for residency plus maybe a few other things.

It’s pretty obvious certain specialties would give more time to do that sort of stuff, but then again there are trade-offs (e.g. from others I’ve talked to, it’s clear neurosurgeons are very widely represented in a lot of the “extra”-clinical activities despite their paradoxically seemingly much busier clinical schedules). There could be lots of reasons but I’ve heard certain specialties are more “desired” for these sorts of things, but could be totally wrong
 
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@clausewitz2 : Yes that actually sounds amazing and something I strongly vibe with, but the thing is would I actually be able to do something like that in NSGY? Since as mentioned, it’s pretty much all-consuming so I would really only have time for residency plus maybe a few other things.

It’s pretty obvious certain specialties would give more time to do that sort of stuff, but then again there are trade-offs (e.g. from others I’ve talked to, it’s clear neurosurgeons are very widely represented in a lot of the “extra”-clinical activities despite their paradoxically seemingly much busier clinical schedules). There could be lots of reasons but I’ve heard certain specialties are more “desired” for these sorts of things, but could be totally wrong

It's not that you will have free time of any kind in neurosurgery but it speaks to how little you value leisure per se.
 
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I am an official departmental advisor for psychiatry. I have lots and lots of conversations with medical students about psychiatry vs other things.

When I talk about the lifestyle factors and I see in their eyes relief that there are options in medicine where one can have work life balance, they often end up in psychiatry.

When I see in their eyes confusion that one would need to consider such things, I know they aren't going to end up in psychiatry.

Psychiatry is still looked down on in some quarters. I did well on my surgical rotation and when I told one attending I was going into psych I saw the disappointment. It didn't bother me then and it doesn't bother me now. I work against that stigma by being very good at what I do and providing clear value to my non-psychiatrist colleagues.

Just reading your posts is exhausting me, and you've brought up concerns about prestige perception multiple times so if that's an indication... Go all in on surgery. It sounds like you've got plenty of backup plans if it ends up not being a good fit.
 
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@Celexa - Why would a (potential) psychiatrist who doesn’t care about work-life balance be frowned upon? That seems strange, isn’t that a good thing since it means they’ll probably work harder

Also, I never brought up prestige perception, my question was regarding which specialty would be most conducive to “extra”-clinical activities (eg getting involved with industry, etc.). Logically, it seems like residencies less demanding in terms of hours would be better, but then when I actually look at reality it seems like much of these are actually with people in residencies that seem all-consuming (eg surgery, and not as much in psychiatry). I’d like a career where I’m involved with many (career-related) things, hence one of my hesitations about surgery (total “hours-wise”, though, I doubt the specialty I choose will actually make a difference; more about how they’re distributed)

In terms of actual clinical interest, I’d say I like both equally (for different reasons obviously). Other options that haven’t been eliminated from consideration (but I prefer less) are rads, gas, ophtho in that order if any of these strike anyone as good ones to consider further as well
 
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@Celexa - Why would a (potential) psychiatrist who doesn’t care about work-life balance be frowned upon? That seems strange, isn’t that a good thing since it means they’ll probably work harder

Also, I never brought up prestige perception, my question was regarding which specialty would be most conducive to “extra”-clinical activities (eg getting involved with industry, etc.). Logically, it seems like residencies less demanding in terms of hours would be better, but then when I actually look at reality it seems like much of these are actually with people in residencies that seem all-consuming (eg surgery, and not as much in psychiatry). I’d like a career where I’m involved with many (career-related) things, hence one of my hesitations about surgery (total “hours-wise”, though, I doubt the specialty I choose will actually make a difference; more about how they’re distributed)

In terms of actual clinical interest, I’d say I like both equally (for different reasons obviously). Other options that haven’t been eliminated from consideration (but I prefer less) are rads, gas, ophtho in that order if any of these strike anyone as good ones to consider further as well
Psych, neurosurgery, rads, gas, and optho? Are you an undergrad? Choosing between psych and surgery is one thing, but no one who has actually done clinical rotations and experienced the day to day work of the fields has to put any serious thought into picking between so many very, very, different things.

Figure out what type of work you enjoy doing on a day to day basis. Not what topics are fun to read about. Careers are built from days you have to live through one day at a time.
 
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A few years out of residency the lifestyle thing might be over rated especially if you are really excited about what you do at work, where it viscerally charges you up.
But life is not just a few years out of residency...
This is a bit like saying go for whatever partner gets your gonads tingling with desire. Sure that might last for a bit but eventually that feeling is coming to an end and you are left with the day to day of real life. Find something you can tolerate and ideally enjoy but searching to be viscerally charged up constantly is a recipe for disaster.
 
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Skip Gas. Just go read the anesthesiology forums.

Go do a 2 week minimum rotation in Rads. You will quickly realize it is your future, or not.

Ophthalmology has some overlap with NSx. I could see that on your list. <--Notice my pun? LOL.

Opthalmology might be your midland answer. Has the surgery. Has options of fellowships too for throwing yourself at your career and research and possibly even drug trials/research as mentioned. But yet still the flexibility to dial things back to have work/life balance in years to come if you realize you want that as your older self. And opthalmology has just enough of Private Equity decay taking place to give you the experience of Gas.

With Opthalmology now on the table, go optho.
 
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@Sushirolls - the thing about ophtho is I really tried to like it, but it just is not as interesting to me as some of the others. I didn’t dislike it enough to remove it from consideration, but it was overall kind of bland (maybe I just haven’t tried it enough though idk, or maybe every specialty eventually becomes bland). Does psych not have the benefits you mentioned?
 
It does, too.

But when you really sit down and soul search. Purge the noise of society, classmates, friends, family, romantic, etc and listen your self you'll be able to figure out which is better for you Psych versus NSx. You've made other tough decisions in life, you can do this one, too. G'Luck

And if you truly don't know. Flip a coin, say eff it, and run with it.
Choosing between pizza and a calzone... both are good options, both are going to take care of dinner, and both just might leave you with some degree of heart burn in the end anyways.
 
Everything becomes bland with time to a degree unless you balance it out. My rads, gas, surgeon etc friends all say the same. The happiest ones have the best lifestyle because it allows them time for hobbies, date nights, working out, good sleep. I've noticed all my friends who are doing overnight calls or have a job that sleep is going to be compromised aren't in as good of health. Sleep may be more important than diet and exercise so if you want to be the healthiest for the longest either by getting sleep adequately or having the most energy to workout or make healthy choices that is something to consider.
 
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Everything becomes bland with time to a degree unless you balance it out. My rads, gas, surgeon etc friends all say the same. The happiest ones have the best lifestyle because it allows them time for hobbies, date nights, working out, good sleep. I've noticed all my friends who are doing overnight calls or have a job that sleep is going to be compromised aren't in as good of health. Sleep may be more important than diet and exercise so if you want to be the healthiest for the longest either by getting sleep adequately or having the most energy to workout or make healthy choices that is something to consider.
I agree with the exception being that the NSGY people I know are just not wired this way. They would be despondent working 30 hours/week and not having people think they have super powers. They would report sleeping is what you do when you are dead and are fine burning out in a blaze of glory at the age of 65 in the middle of case. Even compared to trauma surgery, gyn/onc, surg/onc, and other extremely hardcore specialties, NSGY is just a different breed. If you aren't that 1% of the 1% of type A, then 100% agree with your post.
 
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I agree with the exception being that the NSGY people I know are just not wired this way. They would be despondent working 30 hours/week and not having people think they have super powers. They would report sleeping is what you do when you are dead and are fine burning out in a blaze of glory at the age of 65 in the middle of case. Even compared to trauma surgery, gyn/onc, surg/onc, and other extremely hardcore specialties, NSGY is just a different breed. If you aren't that 1% of the 1% of type A, then 100% agree with your post.

Sure but id say they r probably needing therapy more than average to understand this better.
 
So the thing is the hours/lifestyle for neurosurgery is not a turn-off for me at all (since I’m pretty sure I would work equally hard regardless of the specialty), it’s more that I have a lot of different career interests and don’t only want to be doing surgery. So basically, I anticipate working all the time either way, just distributed differently (depending on specialty). I thought less demanding (hour-wise) residencies would be better in this regard, but then it seems like there’s a high density of neurosurgeons in the kind of career I want, hence my confusion.
Does that make sense
 
Why not go OB/GYN for the mix of surgery and medicine, then get an MBA so you can be admin? You'll be overworked and have your hands bloody, while also getting to do non-clinical tasks.
 
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