Ask a neurosurgery resident anything

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Hi @neusu
Neurosurgery has the longest range of hours out of all the specialities indicated on this graph. Can you elaborate on this? At least a couple of us are curious. Thanks!!
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The Buff OP said:
@neusu Now that you are a chief resident, can you give us a day in the life about how your schedule goes and what surgical procedures you do on a weekly basis?
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The procedures we do on a week to week basis varies based on the OR schedule, but over a month and the year it is generally stable with respect to overall volume and diversity. The cases range from bread and butter spine/brain tumors/shunts to cerebrovascular/skull base tumor and so on. Our program picks cases based on seniority, so the chiefs have first pick. Each chief tends to pick the more complex and or interesting cases. For instance, someone interested in pursuing spine may pick a complex spine case over a pediatric brain stem tumor and someone interested in peds may pick the tumor over a complex spine case. Some highlights for me in the last month were aneurysms, avms, spinal cord tumors/avms, and skull base tumors. Personally, I tend to pick cases based on my interests (vascular and skull base) as well as autonomy provided by the attending.

The usual day is pretty standard: rounds at 6, breakfast, first starts at 7:30. I check in with the ICU and floor between cases. If I'm covering trauma overnight I sign-out with the in-house junior before going home (earliest was 4:30 pm, latest 2:30 am). I've done as few as 1 case in a day (CPA meningioma) and as many as 8. Overall, it is very busy/stressful, but very fulfilling. Certainly, this field isn't for everyone, but I love it.
 
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neusu said:
The procedures we do on a week to week basis varies based on the OR schedule, but over a month and the year it is generally stable with respect to overall volume and diversity. The cases range from bread and butter spine/brain tumors/shunts to cerebrovascular/skull base tumor and so on. Our program picks cases based on seniority, so the chiefs have first pick. Each chief tends to pick the more complex and or interesting cases. For instance, someone interested in pursuing spine may pick a complex spine case over a pediatric brain stem tumor and someone interested in peds may pick the tumor over a complex spine case. Some highlights for me in the last month were aneurysms, avms, spinal cord tumors/avms, and skull base tumors. Personally, I tend to pick cases based on my interests (vascular and skull base) as well as autonomy provided by the attending.

The usual day is pretty standard: rounds at 6, breakfast, first starts at 7:30. I check in with the ICU and floor between cases. If I'm covering trauma overnight I sign-out with the in-house junior before going home (earliest was 4:30 pm, latest 2:30 am). I've done as few as 1 case in a day (CPA meningioma) and as many as 8. Overall, it is very busy/stressful, but very fulfilling. Certainly, this field isn't for everyone, but I love it.
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Thanks for your respond, buddy.
 
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Perzt said:
Hi again,

Sorry, maybe I formulated it a bit odd. I would like to know if there are any clear stereotypical people in each subspecialty. Something along with what I had written from my very modest experience. Or.. if you find that there is no such thing as steretypical neurosurgeons in the different subspecialties.

For the second question, I would like to know some about where your interst lay in.. Maybe some words about the different specialty what you have enjoyed/disliked so far in your training.
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I can't say there really is a great personality stereotype for any particular sub-specialty within neurosurgery. Neurosurgery is such a small group to begin with, the sub-specialties are even smaller. Certainly, there may be a particular personality type clique within a sub-specialty but the sampling size is so small that having someone with a different personality skews the "average" greatly. Rather, I'd suggest within particular sub-specialties there are clear "schools." Essentially, if you were trained by someone, your operative style and approach to clinical problems is similar. This makes more sense as well, given a clear lineage can be defined and certain particularities (e.g. to which head frame, stereotactic radiosurgery, or navigation system a surgeon is partial: Mayfield vs Sugita, Gamma Knife vs Cyber Knife vs Proton Beam, Brain Lab vs Stealth vs NavSuite) are passed on because of familiarity from training.
 
Is this how you are at parties?

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BrCo said:
What would you say defines you? Is it neurosurgery or something else? Also, what drove you towards becoming a neurosurgeon?
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Tough question. I would have to say, during residency neurosurgery does define me. Due to the demands of the job, have had to pare back on the majority of things that defined me before residency. Prior to starting residency, all the common things drove me toward being a neurosurgeon: love for surgery, the central nervous system, and grand ambition. Young and naive, it is easy to reason that idealism and a bit of hard work can overcome any obstacle. As residency has worn on, the initial reasons I entered the field are still present, but in addition there are the relationships with my patients and the feeling I need to refine the skills I have learned and culture those I haven't.

Residency is as much a self-learning process as it is a didactic process of passing on a set of knowledge. Certainly, at the end of the day, each program should ensure that its graduates have the minimum set of tools to practice safely as an independent physician. Some are better than others, however, at choosing applicants who can reflect on their training. As stated previously in this thread, in surgery in general, and also in neurosurgery, there is a fair dose of machismo. Knowing the limits of ones capabilities to help, and ability to harm, takes an incredible amount of introspection and, often, humility to admit.
 
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Do you ever get bored of surgery or do you ever find yourself spending so much time in surgery that you don't have any time for other things like bench related research?

My PI recently made a strong case against me going into surgery since he said it takes so much time, I won't have any other time to do research , learn new things, teach in lecuttre...etc
 
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Hayyyy

Why Not MD? said:
Hi @neusu, you are amazing for answering these questions. It took me about 3 days to go from page 1 to 19, but you have helped so many people out (including answering various repeated questions with patience and politeness).

Here's my question:

How well do you think homosexuals are accepted in neurosurgery in these days by their co-residents, fellows, and attendings? I'm sure this will change as millenials fill residency positions, but I think the change will be rather conservative.

Do you think non-effeminate homosexual males will generally be more accepted than a more effeminate one? On this note, do you know any homosexual males or females in neurosurgery?

Is there a factor of machismo involved in work (like, say, a stereotypical surgeon or ortho) no matter whether male/female?
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Gauss44 said:
Regarding the part of the quote in bold:

Would you characterize a lack of neuroscience research as "greatly hurting" an application?
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For the most part, yes. We do look for having research within neurosurgery as a sign of interest in the field. Having a copious amount of cardiac research, while good for a CV, does not help as much as having some neuro research.

Likewise, and more to the point, neuroscience is a broad field and can be loosely defined as anything from psychology and ophtho to neurosurgery clinical studies. The latter helps your application. The former, not as much.

So yes, doing single cell patch clamping of cochlear nerve cells helps your application. Does it more so than studying renal ciliary cells? No. Would writing case reports reviews of the literature in neurosurgery help more? I would suspect so.

For what it's worth, do research in something in which you are interested. You will be far more productive and learn more than if you simply do it in hopes it will "greatly help" an application.
 
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Cyberdyne 101 said:
View attachment 184289
Hi @neusu
Neurosurgery has the longest range of hours out of all the specialities indicated on this graph. Can you elaborate on this? At least a couple of us are curious. Thanks!!
Click to expand...

What is the source on this? I'd like to see the sample size for each specialty. I suspect that there is a pool of outliers on the low end who skews both the mean and the 95% CI.
 
neusu said:
What is the source on this? I'd like to see the sample size for each specialty. I suspect that there is a pool of outliers on the low end who skews both the mean and the 95% CI.
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Upon closer examination, it looks like it might be an error. With a mean of 270 hrs above family practice, the range should be from -418 to 958. But if it's supposed to be +418 to 958 (which is more plausible) then the graph should indicate neurosurgery at 688 hrs above family practice. This would essentially place it just below critical care internal medicine on the graph (which makes more sense).
 
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hoihaie said:
Do you ever get bored of surgery or do you ever find yourself spending so much time in surgery that you don't have any time for other things like bench related research?

My PI recently made a strong case against me going into surgery since he said it takes so much time, I won't have any other time to do research , learn new things, teach in lecuttre...etc
Click to expand...

At times, during some surgeries, with particular attendings, yes, I do get bored. That being said, I love surgery and would rather be in the OR doing a case than most anything.

As a resident, in any specialty, when you are on service the possibility of doing bench research is minimal. The demands of the clinical responsibilities are simply too great to have time to conduct bench research in any meaningful fashion. Anyone else out there can feel free to correct me if I'm wrong, but had trouble finding time for basic life functions (e.g. eating, sleeping, self hygiene, etc.) during my busier rotations and on the less busy ones it's still busier than being able to keep a lab presence of any meaningful fashion for any meaningful duration. Neurosurgery allows a research year (or two), during which time lab research is typically feasible unimpeded.
 
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Thanks for answering so many questions.

I would like to know what would you need on your step 1, 2, and 3 to get a neurosurgery residency?
 
Doudline said:
Favorite dessert?
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Mine changes depending on my mood. I don't really eat dessert often, but favs include ny style cheesecake, french silk pie, lemon meringue pie, key lime pie, black forest cake, tiramisu, truffles, milk chocolate, chocolate souffle, vanilla ice cream, pistachio ice cream, and irish coffee.
 
neusu said:
Thinking about it. I haven't decided 100% though.
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What are the positives and negatives that you are using to decide?

Do you have MD/PhDs in your residency? Is is atypical for an MD/PhD to go into surgery?

Thanks for answering!
 
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Thanks again neusu for replying to all of these questions!

What can a neurosurgeon do in terms of international pro bono work? It seems that joining an organization like MSF is not really feasible since most third-world countries' hospitals aren't equipped for neurosurgical procedures (also MSF doesn't take neurosurgeons). I know Duke's residency program has some time dedicated to general surgical training for this exact reason, and I would imagine life-saving neurosurgery would be welcomed anywhere, so I wanted to ask if you knew anything more about this. Thanks!
 
barsoum.michael said:
Thanks for answering so many questions.

I would like to know what would you need on your step 1, 2, and 3 to get a neurosurgery residency?
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Neurosurgery was previously in the early match and tends to focus on Step 1 as a metric for standardized tests. There is no minimum, but the average is in the 230s or 240s. Are there neurosurgeons who failed step 1? Probably. I personally do not know of any.

Step 2 is often taken after, or during, the application process and is not typically included in residency selection. Some try to use it to offset a poor Step 1 score.

Step 3 is taken after medical school, typically during residency, and is required to have an unrestricted license. I have heard stories regarding chief residents who put off step 3 for long enough that they failed because the didn't review enough. Also, (not clear on the rules, maybe someone can help me out here) I believe all 3 tests have to be taken within a 7 year span. So a MD/PhD student who takes Step 1 then goes off to the lab for 4 years, and back to med school for 2 clinical years has 1 year, or else he will have to retake steps 1 and 2.
 
pepocho said:
I apologize if you have already answered this, but what with the little free time you have, what do you do? and my second question is, what is your plan after you finish your residency?
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The realistic answer is that outside work I mostly eat, sleep, and decompress. The idealistic answer is I enjoy traveling and reading, like to run, pretend to be in to photography, go out to eat, and visit friends and family.

At the moment I am trying to decide between a career in academics or private practice. They each have their benefits and drawbacks so it can be a tough decision.
 
neusu said:
The realistic answer is that outside work I mostly eat, sleep, and decompress. The idealistic answer is I enjoy traveling and reading, like to run, pretend to be in to photography, go out to eat, and visit friends and family.

At the moment I am trying to decide between a career in academics or private practice. They each have their benefits and drawbacks so it can be a tough decision.
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Would you mind elaborating about the pros and cons of academics vs. private practice in neurosurgery?

Edit: sorry, didn't see this was already asked!
 
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pbrocks15 said:
What are the positives and negatives that you are using to decide?

Do you have MD/PhDs in your residency? Is is atypical for an MD/PhD to go into surgery?

Thanks for answering!
Click to expand...

The positives and negatives, from my point of view:

Positives of academics: Get to teach residents/students. Lower risk or variability in income (e.g. built in referral pattern). Have the service to handle your patients daily care. Often connections through the department with other departments for research interests. Often can focus on sub-specialty more readily
Negatives of academics: Lower pay. May require further training (e.g. fellowship). University hospitals generally slower with respect to turnover.

Positives of PP: More personal/practice freedom. Higher pay. "better" lifestyle.
Negatives of PP: Don't work with trainees. Higher risk or variability with income, have to build a practices.

We do have MD/PhDs at my program. It is not atypical for MD/PhDs to go in to surgery. For neurosurgery, in particular, it is somewhat common.
 
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mentalhypoxia said:
Thanks again neusu for replying to all of these questions!

What can a neurosurgeon do in terms of international pro bono work? It seems that joining an organization like MSF is not really feasible since most third-world countries' hospitals aren't equipped for neurosurgical procedures (also MSF doesn't take neurosurgeons). I know Duke's residency program has some time dedicated to general surgical training for this exact reason, and I would imagine life-saving neurosurgery would be welcomed anywhere, so I wanted to ask if you knew anything more about this. Thanks!
Click to expand...

Neurosurgery is a resource intensive, expensive undertaking. Many facilities, even in the first world, lack the ability to support a neurosurgeon e.g. CT/MRI, and ICU as well as supporting physicians such as neurologists, oncologists, radiologists, and radiation oncologists let alone rehab facilities. The groups who do go, that I know of in any case, tend to do things like shunts and ETVs.
 
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ChEMD said:
Would you mind elaborating about the pros and cons of academics vs. private practice in neurosurgery?

Edit: sorry, didn't see this was already asked!
Click to expand...


The differences between private practice and academics can vary depending on the practice model. For the most part, PP is seen as higher income, better life-style while academics is less income and more educational responsibilities. The reality is typically somewhere in between.

To generalize, private practice can be an independent solo practice, a group/partner practice, a large multi-specialty group practice, or even a hospital employee. The same thing applies to academics in that the payment source for the surgeon varies by department. The difference, however, is the latter have an appointment with a school of medicine, educational responsibilities for fellows, residents, and/or medical students, and often other things associated with academics (Dean's Tax, tenure, academic output requirements, and so forth).

In the eyes of organized medicine, and certainly students, those in academics are well respected. That isn't to say that surgeons in PP are not respected, they simply aren't as visible, implicitly, by nature of their position.

The long and short of it comes down to what one wants to do with his or her career. Regardless of specialty interest, or lack thereof, no one walks in to a position focusing only on their specialty at a high pay with very few hours. Everyone must build a reputation, establish their practice; pay their dues so to speak. There are opportunities on both sides of the fence for things like partnering with industry, research, and advancement of the field. Academics, however, tends to be better known for this. Likewise, for those who want to fill the need of the general population, private practice is a great career. The vast majority of people who need neurosurgeons won't need them for the latest cutting edge or most specialized techniques. We have a term "bread and butter" to describe the common cases in neurosurgery because they are well established pathologies with well established treatment procedures. Certainly, continuing to evolve these procedures is necessary. For now, though, they are a safe way for the majority of people with neurosurgical issues to be treated.
 
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How do I get an opportunity to shadow a neurosurgeon? Right now all that I could get was volunteer in the ER :(
Please advise!
 
engr2dr said:
How do I get an opportunity to shadow a neurosurgeon? Right now all that I could get was volunteer in the ER :(
Please advise!
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Are you a high school student, undergrad, graduated but pre-med? If you have any connections, that can help put you in contact. If not, do your ER gig for a bit and build rapport with the docs there. One of them may be able to help you out and put you in touch with a neurosurgery. Otherwise, e-mailing or calling the department secretary may be useful. Worst case, e-mail the surgeon directly. Send a polite, brief message indicating your desire to shadow.
 
neusu said:
Are you a high school student, undergrad, graduated but pre-med? If you have any connections, that can help put you in contact. If not, do your ER gig for a bit and build rapport with the docs there. One of them may be able to help you out and put you in touch with a neurosurgery. Otherwise, e-mailing or calling the department secretary may be useful. Worst case, e-mail the surgeon directly. Send a polite, brief message indicating your desire to shadow.
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Thanks neusu!
I guess I would count as a premed., working full time and wanting to switch from engineering to medicine (32 y/o). At present, I have no contacts except the 20 y/o volunteers. I need to work on my social skills. I am not sure how I could approach a neurosurgeon, who doesn't know me and ask him for a favor for shadowing him.
 
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@neusu This might be a personal question, but you being busy and all, do you have time for a relationship or dating?
 
How much money do you currently make per hour?
 
I'm sorry if this question was asked already, but how would you advise a female who wants to do MD/PhD, and wants to become a neurosurgeon? Most of the much older doctors (many of whom are male) who are MD/PhD tell undergrads and those interested in pursuing MD/PhD not to pursue such a path, but instead just go for the MD and you can still do research (granted the PhD is in a basic science field, not in the humanities). Especially for females, they say not to waste their youth and not ruin their chances of having children and getting married.

The only female MD/PhD that I know of who did her program in a record amount of time is Dr. Sujata Bhatia: http://www.seas.harvard.edu/directory/sbhatia
 
altitudinarian said:
I'm sorry if this question was asked already, but how would you advise a female who wants to do MD/PhD, and wants to become a neurosurgeon? Most of the much older doctors (many of whom are male) who are MD/PhD tell undergrads and those interested in pursuing MD/PhD not to pursue such a path, but instead just go for the MD and you can still do research (granted the PhD is in a basic science field, not in the humanities). Especially for females, they say not to waste their youth and not ruin their chances of having children and getting married.

The only female MD/PhD that I know of who did her program in a record amount of time is Dr. Sujata Bhatia: http://www.seas.harvard.edu/directory/sbhatia
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This woman is........amazing.
 
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altitudinarian said:
Yeah, and it surprises me even more how she did it in such a short amount of time...
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Words are insufficient to convey the precise amount of astonishment this woman elicits. It looks like I also unknowingly had the chance to utilize her invention while on a transplant rotation abroad. I can't fathom even trying to compete with those timelines and accomplishments. What's next?

/derailment


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altitudinarian said:
I'm sorry if this question was asked already, but how would you advise a female who wants to do MD/PhD, and wants to become a neurosurgeon? Most of the much older doctors (many of whom are male) who are MD/PhD tell undergrads and those interested in pursuing MD/PhD not to pursue such a path, but instead just go for the MD and you can still do research (granted the PhD is in a basic science field, not in the humanities). Especially for females, they say not to waste their youth and not ruin their chances of having children and getting married.

The only female MD/PhD that I know of who did her program in a record amount of time is Dr. Sujata Bhatia: http://www.seas.harvard.edu/directory/sbhatia
Click to expand...
If you browse academic neurosurgery programs, you will come across a few female residents who are MD/PhD's:
http://neurosurgery.ucsf.edu/index.php/about_us_residents.html
http://dura.stanford.edu/CurrentResidents.html
Although, it does look like more women in this field take the MD-only pathway. A female neuro chief resident told me that there is more free time during the research years (at least during residency) for "regular life."
 
engr2dr said:
Thanks neusu!
I guess I would count as a premed., working full time and wanting to switch from engineering to medicine (32 y/o). At present, I have no contacts except the 20 y/o volunteers. I need to work on my social skills. I am not sure how I could approach a neurosurgeon, who doesn't know me and ask him for a favor for shadowing him.
Click to expand...

I'd give it time. Try to make some contacts, get experience. When the opportunity arrives, take it.
 
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The Buff OP said:
@neusu This might be a personal question, but you being busy and all, do you have time for a relationship or dating?
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Life is about priorities. If it becomes a priority, it certainly is possible.

On a similar note, finding a suitable partner is important. Setting expectations about reality early in a relationship makes it easier.
 
Do you get along well with the female neurosurgeons?
 
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