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How does one survive neurosurgery residency?

Discussion in 'Allopathic' started by CassieBagley, 05.05.12.

  1. surftheiop

    surftheiop

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    Good point, in no other job could you have a success rate as small as neurosurgery's survival rates and not get fired after 2 weeks ;)


    (Joking aside, neurosurgery/neurointensive care has to have one of the worst dollars spent to QALY gained ratio of any medical field right? )
  2. duckie99

    duckie99

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    glad you said that because I too was going to point out your snarky comment haha. But I wouldn't say everyone is "the same". I would just say everyone has their own role. True no family med doc will be talking to a post op pt in the neuro ICU about prognosis but then again no neurosurgeon will will be supporting a pt and close family through a long life with many ups and downs.

    also remember every single person around needs a good pcp but only a very few ever need a neurosurgeon.
  3. Priti Dave

    Priti Dave

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    Which school are you? what was your MCAT/cGPM / I need to know this for some body trying get admission in USA?
  4. 45408

    45408 aw buddy

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    :cool: :laugh:

    They're not all the same, but your neurosurgical patient won't be your patient for long with a ruptured AAA or an open femur fracture, and you won't be the one to fix either of those.

    They may not exactly be brain surgery, but they might be just as important to the patient at hand...
  5. neusu

    neusu Chief Resident

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    Tut tut.. We've all taken ATLS. Clearly, in order of importance ruptured AAA > blown pupil > SCI >> open femur. I don't fix Foley's either but I don't see you waving that around like a flag.
  6. Morsetlis

    Morsetlis SGU MS-4

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    :laugh::thumbup:
  7. jcu

    jcu should have been dr. who

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    In mother Russia, neurosurgery residency survives YOU.
  8. sportsperson

    sportsperson

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    And it's for these reasons I'm avoiding all forms of surgery. I like surgery a lot, the technical challenges... the practical thinking required.. the 3D visualizing, etc etc. but I just cant see myself working that many hours for the majority of my working career. It just wouldnt be worth it in my opinion and to me... hobbies/women/working out/partying/free time/family > anything involving school/work.
  9. tiedyeddog

    tiedyeddog

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    Different strokes for different folks.
  10. 45408

    45408 aw buddy

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    What are you talking about?
  11. KinasePro

    KinasePro Das it mane

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    Could any of the surgery folks ITT give us an idea exactly how non-compliant w/ the 80hr wk your residencies are? It seems to me that asking about this sort of thing in person gets you pegged as a slacker, so it's hard to get an idea about what people are actually working.

    I'm at a high-volume urban hospital, and it seems like our surgical residents are consistently having their asses handed to them. I have no clue how they would convince the ACGME that they're working 80/wk on average, unless they get a solid 7 days off each month. Yet nothing changes, and our programs remain competitive and in good standing. I must be missing something...
  12. neusu

    neusu Chief Resident

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    You trot out AAA repair because we don't do that, but I don't dick around with Foley's much either FWIW. Just sayin, there's someone for every job no matter how big or small.
  13. JackShephard MD

    JackShephard MD

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    At our teaching hospital, I've spoken to a handful of GS residents and specifically asked them about this. They said they are pretty good about sticking to it (i.e. rarely go over, less than once a month). I think it's pretty variable depending on the hospital.
  14. michaelrack

    michaelrack All In at the wrong time SDN Advisor

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    Every single person does not NEED a pcp- having a good pcp might be nice, but many people get by going to a nurse practitioner, urgent care center, etc.

    I agree that few need a neurosurgeon, but when you need a neurosurgeon, you usually need him right now and you really need him.
  15. kitsunepixie

    kitsunepixie Kunoichi Extraordinare

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    I agree with neusu's posts. I've done a 120 hour week before but my PD yelled at the attendings whose service that I was on...I didn't even realize it before it was too late because it was a pretty epic week, and in the heat of trauma season. I did get pretty short-tempered and impatient though. :) Luckily people knew how hard I was working and forgave me, and knew that it wasn't my baseline personality...

    In general, it's survivable if you are super organized and have good multitasking and time management skills. I workout for about 15 minutes every day, no matter what. I have a husband who works from home and helps me make healthy meals every day, drives me to and from work so that we can visit with each other and I can do last-minute preparation for my cases, and other miscellanea that makes my home a relaxing haven. Oh, and I take a nice, relaxing bath or shower EVERY day. :rolleyes:

    Oh yes, I approve of all of the Game of Thrones references. Neurosurgeons at my program love that show. I bet neurosurgeons at EVERY program loves that show. :thumbup: My pleasures in life are quite simple.
  16. duckie99

    duckie99

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    well a majority of neurosurgery isn't trauma related... however when it is I agree you need a good one quick (though isn't most nsurg trauma craniotomies that a trauma surgeon can do and I think ortho trained spine guys can do spine decompressions but maybe not?).

    however I disagree about your pcp comment. I think people with the best pcp have the best health. Can a NP handle htn? Yeah probably. But does that np have the critical thinking ability to connect htn to other disease manifestations? likely no. People who only use urgent care or the ED are part of the problem with health care and costs in this country. You should know it's necessary to have good outpatient followup.
  17. cowme

    cowme ACFAS Member

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    I know people at ~10 different institutions in different surgical residencies (general, ortho, uro, ENT). They all go way over the 80/hr restriction, and probably average closer to 100 hrs in a typical week
  18. KnuxNole

    KnuxNole Sweets Addict

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    I would be terrified if some little NP manages primary care as a replacement for a MD. I don't think those people are even close to what a doctor can ever do lol
  19. sportsperson

    sportsperson

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    An NP managing any aspect of primary care asides from very *basic* follow ups is just pure dangerous.
  20. Chakrabs

    Chakrabs

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    A myopic and increasingly irrelevant view. NPs and PAs are treating patients in much the same way primary care docs do (used to do?). That mode of practice is here to stay unless we incentivize more people to go into primary care.
  21. duckie99

    duckie99

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    NPs are good for f/u patients who are otherwise generally healthy and when they can consult a nearby MD. I don't think it's a good idea for a stand alone NP doing whatever she/he wants. I don't think "dangerous" is the word I would use because they'll soon figure out they have no idea what's going on and send the patient off to someone who does. I would say they are probably more of a waste and don't know how to utilize resources or even how to manage patients on the most effective meds (though they may use meds that otherwise may work: think ccb before ace-I for htn -- just an example not sure if that's actually the case on a wide scale).

    But then again maybe I'm giving some docs too much credit... In my experience I have seen some super good docs and then some mediocre ones in the same fields.
  22. duckie99

    duckie99

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    ...it's not like primary care spots aren't being filled. IMGs do it if USgrads don't. Most family med residencies fill in the end. The problem is there simply aren't enough doctors to meet the demand. Another problem is that there is a bottleneck for how many docs you can train. It's not like you can just add residency spots. There are requirements that residents must meet to graduate and get licensed and a program might not meet qualifications to expand their spots.

    So PAs and NPs fill a role. I just don't think they should be doing it on their own. How can they say they are equivalent when they don't do the same training and can't pass the same tests?
  23. FSU2013

    FSU2013

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    I don't think this is true......you don't know what you don't know.

    I talked to an NP who had been doing peds for over 20 years recently. She has a patient with a "goiter" that "impinged" her breathing (she actually had a panic attack). She got a ultrasound saying that she thought there was a palpable mass. Ultrasound showed a 2mmx2mmx3mm nodule and she got tsh, t4 et al which were all normal. She promptly got a surgical consult.
  24. Chakrabs

    Chakrabs

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    I don't understand your point. You say that we have too many patients and not enough docs to see them. Yet you then say that NPs and PAs can't do it on their own. What would you have them to? Run every patient by a physician? The very same physicians who are in such scarcity? Something has to (and already has) give. Mid-levels can manage strep throat and routine pap smears. They can f/u post-surgical patients following non-complex procedures.
    Last edited: 05.07.12
  25. akwho

    akwho

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    No offense, but this is a mythical view point with no data to back it up. I personally believe the differential diagnosing skills earned over 10,000 hours of training are vital to the practice of a primary care physician.

    In 2009, 2,311 Family Medicine residency positions were filled out of an available 2,535. U.S. MD seniors compromised only 1,071 of the 2,311 filled slots. As you can see, already U.S. MD Seniors do not make up the majority of practicing family medicine doctors.

    Frankly a far better solution to the primary care problem would be opening up more D.O. schools with the understanding that the are being created to produce primary care physicians. Currently over 60% of D.O.'s enter primary care specialties upon completion of their degree.

    Another solution would be to increase the number of International Medical Graduates (IMGs) taken. In 2009, only 3,112 out of 11,267 IMGs were accepted into residency positions, and only 1,619 out of 4,927 U.S. Foreign Medical Graduates (FMGs) were accepted into residency positions.

    There are talent pools to draw from the would be significantly more effective at providing primary care than allowing under-trained nurses primary prescribing and diagnosing power.

    Solutions:
    1. Increase the number of D.O. slots, and increase the number of U.S. FMG's and IMG's accepted into primary care residencies.
    2. Increase the number of primary care specialty residencies.

    Sorry to derail the thread... :rolleyes:
  26. michaelrack

    michaelrack All In at the wrong time SDN Advisor

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    Agree with what you are saying, except for the word "necessary". It would be optimal if everyone had a primary care physician. Health care outcomes would be better. However, many people do get by going to NP's. Most NP's can manage HTN just fine. However, I don't know of any NP who can manage a subarachnoid hemorrhage. I consider a neurosurgeon a necessity for someone having a subarachnoid hemorrhage.

    By the way, I am a former primary care physician. Up until mid-2005, I supervised a 1/2 day a week resident primary care (IM) clinic.
  27. Zedor

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    Nope, but apparently in certain instances they perform procedures that I find to be surprising...

    ACNP (Acute Care Nurse Practitioner)

    Many procedures are done by the ACNPs; however, in order to ensure training of house staff, interns are first given the opportunity to perform the procedures. Examples of procedures currently performed by ACNPs at UVA and RMH include management of ventriculostomy/lumbar drains, drain removal, insertion of arterial catheters, insertion of lumbar drains with and without fluoroscopy, and shunt reprogramming. Procedural competence evolves from an academic base or from on-the-job training.

    http://ccn.aacnjournals.org/content/26/6/57.full
  28. Chakrabs

    Chakrabs

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    You make it sounds so easy. Pray tell, how will you pay for the increased number of residency spots? Funding for current residency spots is threatened as is. That said, I'm with you, I'd rather see more physicians treating our patients, but thats not likely to happen anytime soon.
  29. KnuxNole

    KnuxNole Sweets Addict

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    I would have lots of doubts if a NP or PA wants to do things solo ever. Maybe that can do some bare bones basics, but nothing compared to the actual doctors. The ones that assist the doctors are a huge help though.
  30. akwho

    akwho

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    The money is there if we decide primary care is a priority for the country. We can get qualified doctors into this country practically for free through the use of foreign medical schools. What we need is more primary care residency spots. The need to have DNP's practice primary care is a red herring argument and won't alleviate the primary care shortage in this country any better than opening more residency slots.

    The Obama administration realized this and put over $250 million dollars in guaranteed funding towards primary initiatives in the 2011 Patient Protection and Affordable Care Act.

    The countries legislators realize the primary care shortage this country faces and are doing what they need to, to combat it.

    The main issue is the nursing lobby using a doctor shortage to make a professional land grab, rather than the more sensible solution of increasing the doctor supply.
    Last edited: 05.07.12
  31. akwho

    akwho

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    .
    Last edited: 05.07.12
  32. surftheiop

    surftheiop

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    I think the independent practice NP issue gets blown way out of proportion. The vast majority of NP's are hired on to work under the supervision of a physician. Just because you hear about some randoms wanting to practice independently, its not happening at any important rate. Its hard to start a solo PC practice as a physician, let alone a NP, so naturally they are going to get hired by existing practices.

    The group family practice I went to growing up hired one on a while back and its been great for both the physicians and patients. There was no reason that when I was a healthy 17 y/o that I really needed to see my MD to get a refill on my allergy nose spray (that was originally prescribed by the MD).
  33. 45408

    45408 aw buddy

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    Right. Vascular surgeons don't really work with Foleys either.

    The point is, there are other specialties that operate "at the depth and magnitude of neurosurgery," which is what the med student was talking about.
  34. sportsperson

    sportsperson

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    You have to remember it's all relative. You'll find some crappy primary care doctors but that just mans you'll find that much worse NPs.
    People will always go "oh well that family doctor didn't have a clue what's going on" or "well doctors don't always get it either." The problem is... the human body is highly complex (and the general public does not understand this to the fullest degree). If someone with more training makes mistakes, then it's a "no sh*t" situation towards the person with less training making even more mistakes.
  35. JackShephard MD

    JackShephard MD

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  36. pre med 2014

    pre med 2014 SDN Gold Donor Gold Donor

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    oh but don't you know the bureaucrats know more about brain surgery than the neurosurgeons!
  37. nmskyle

    nmskyle

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    :thumbup:
  38. Morsetlis

    Morsetlis SGU MS-4

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    What's this.
  39. auburnO5

    auburnO5

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    This thread.
  40. napoleondynamite

    napoleondynamite Chief Resident

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    **Disclaimer, I am not a neurosurgeon

    I stumbled onto this thread and thought I would add my 2 cents. I am a PGY5 in radiation oncology. I am married, I have kids and I also dedicate a large amount of time to exercise and preparation for my hobbies (mainly mountain climbing).

    I love my job. It is extremely rewarding. Very intimate relationships with patients. Life and death is frequently on the line. There are highs and lows in cancer care, just as I am sure there are in neurosurgery. The difference is, I get to experience all of that for ~50 hours per week, then I go home to my actual life. My real life - outside the hospital.

    It has been interesting for me to watch colleagues and friends from medical school in lifestyle altering fields and how there perspective changes rather quickly when they get into the real daily grind of their specialty. Many feel trapped. Many regret their decision.

    In medical school it is often frowned upon to discuss medical specialties in terms of lifestyle. It's as if your future specialty is some magical match, like a soul mate. I don't buy into that. You choose it. The unfortunate part is that many medical students are choosing it at the wrong time in their lives. Many aren't married. Many have not yet had chidren. They cannot fathom how these major life changes will color their thinking..but many will later wish that they had a time machine and could go back and choose differently.

    I say this not to bash any other specialty. I have nothing but respect for those who choose to go into neurosurgery. But what I am saying is that you really need to think long and hard about this and you need to realize what you are choosing. You are choosing the LIFE of a neurosurgeon. Many are ok with this. I personally would not be. If you foresee yourself has raising a family, being involved in other activities, your community, your church, etc....well, you can't have it all as another poster said above. A choice of neurosurgery is a choice of career first above all.

    Don't be brainwashed that choosing a specialty is anything more than choosing a job. It is an important job. You need to be a good match for what you choose. But the JOB is not the only consideration. Don't choose a specialty just because you like it the most. See the entire picture..it's nearly impossible to do if you are 26, single and have lived a largely self-absorbed life focused on nothing other than your career. But if you foresee that changing in your future, well, you need to consider that. Find people who are 10 years ahead of where you are in the specialty you are choosing..find people who are living the life that you envision for yourself within that specialty..then get their advice and perspective.

    I'm very grateful that I made the choice that I did. I realize not everyone can be a radiation oncologist..but there are plenty of fields that would have been amenable to the life that I wanted for myself. There is no way neurosurgery could have been one of them..even though I think it is a really cool job.
  41. JP2740

    JP2740

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    Why are people so insecure by the fact that some people go into medicine because they don't just see it as their job? Listen, no one will knock you for doing it for the cash and lifestyle. Some people think of it more than their job. Does that mean working 100 hours a week? Maybe not, but it's really lame to come out and say "it's just a job." To many of us, it isn't just a job, and some people just will never understand that.
  42. auburnO5

    auburnO5

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    Pretty sure last time I checked it was still a job.
  43. RandomHero117

    RandomHero117 winning

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    no, to some people it's something more--- an entitlement bestowed upon them by the gracious public to boost their self-esteem and give them power over the fragile lives of others


    ... at least that's what i wrote in my personal statement ;)
  44. napoleondynamite

    napoleondynamite Chief Resident

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    I knew I'd get bashed. I of course don't mean it's "just" a job. Like I said, it's a very important job. The gist of my post though is that you should not choose your entire professional life off of purely whether you "like" or "dislike" the job itself. In the overall scheme of things, you are in fact choosing a JOB, but what I am saying is that you need to think about whether you are the type of person that wants your entire LIFE defined by your job. If you are, and it is ok to be one of those people - there are plenty in medicine, then green light on N.surg if that interests you. But if you are not one of those people, you probably are not a good fit and will be unhappy and conflicted the rest of your life if you choose a career that demands more than you want to give to it later on. Just sayin.
  45. RandomHero117

    RandomHero117 winning

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    :thumbup::thumbup::thumbup:
  46. thomprya

    thomprya

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    I for one really appreciate your insight and thoughts on the matter. It's pretty great to have someone who has seen the whole picture and is on the tail end of their training to provide some input and perspective. Additionally, the advice on finding someone 10yrs deep to their field and finding what sort of life they are leading is a sage suggestion.
  47. JackShephard MD

    JackShephard MD

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    You had me @ 50 hrs per week. :)

    Agree 100%. Great wisdom.

    I agree with you and I think there are some fields of medicine which offer a good mix.

    I agree with everything you said. I also believe that individuals can find balance working < 70 hrs a week. I think once you hit 80-90 and higher, you run into trouble. Most professionals work 60 hrs a week. Anyway, you're very fortunate and it's a positive (not something to be looked down on).

    Balance is the key. Don't let your job be your life, but also don't let your job just be a job. Have passion for what you do, when you do it, but have a life and other interests too. I.e. Don't be a neurosurgeon (just kidding... kind of).
    Last edited: 05.08.12
  48. JP2740

    JP2740

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    I agree w/ this.
  49. Lbgem

    Lbgem Junior Member

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    I appreciated your post. I have to say personally that my goals have changed from a few years ago. I used to think medicine was the end all and it was more important to me than anything else. Now, I don't really *want* to be spending all my life in something like surgery and 80-100+ hours a week. I am not on the wanting a kid train at the moment, and don't see that changing, but I definitely enjoy going out to nice places with a significant other. I also really really want to get a puppy (which will have to wait until at least residency if not later). I think you can be super awesome and happy with what you do without having to dedicate your entire life to medicine. Don't get me wrong, I still love the field, but there's definitely other things I like doing too, that I wouldn't be able to do with 100+ hours working.

    Hence leaning towards ID/EM, though more towards ID, cause I'm not sure how I'd like dealing with a lot of drug seekers + night owl shifts.
  50. 45408

    45408 aw buddy

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    Well said.

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