How does one survive neurosurgery residency?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
KinasePro said:
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...
Click to expand...

First, it's not an 80 hour ceiling, it's an 80 hour average. You will go over 80 hours at times. Second, on paper , programs are always in compliance. Schedules will set down hours that average out to 80 or less. Third, your time cards are self reported, so the program isn't going to get in trouble if its residents aren't reporting an abuse. Finally, there's a culture at many/most programs of getting into as many cases as possible, never turning down the once in a lifetime chance to scrub into something cool, and not leaving your co-residents in a bad situation if there are fires you have yet to put out, so some folks will do what they need to and the time cards will just reflect the paper schedule.
Members don't see this ad.
 
Here's an nice post from uncleharvey by a then-resident/now-attending neurosurgeon at UVa:

"i have to say that a lot of the horror stories that you hear are only partially due to career choice. i know plenty of happily married neurosurgeons who enjoy a nice lifestyle. a lot of what happens comes from your personality. if you’re a “career above everything else” kind of person, your personal life may suffer. you can be a successful neurosurgeon and still make your personal life a priority. Neurosurgery is an amazing field and i think it’s one of the only fields in medicine, if not the only one, that is growing at an explosive rate. the brain is still a black box and we’re learning new things about it every day. stuff we couldn’t treat surgically 20 years ago is now being treated with surgery: epilepsy, parkinson’s disease, essential tremor, depression, and even tourette’s. imagine years down the line when epidemics like obesity and hypertension could be treated neurosurgically. fields change. things like brain tumors and aneurysms may be treated differently in years to come, but there is so much more to the brain. Manual dexterity and stamina play a very small role in neurosurgery. if you think it’s the coolest job in the world, then you should do it. all kinds of people become neurosurgeons. tremor or no tremor, we’re all neurosurgeons, and there’s always going to be something for us to do."

It's an interesting perspective, much different than the oft-cited motto "only go into nsurg if you can't stand anything else."
 
  • Like
Reactions: 1 user
Law2Doc said:
First, it's not an 80 hour ceiling, it's an 80 hour average. You will go over 80 hours at times. Second, on paper , programs are always in compliance. Schedules will set down hours that average out to 80 or less. Third, your time cards are self reported, so the program isn't going to get in trouble if its residents aren't reporting an abuse. Finally, there's a culture at many/most programs of getting into as many cases as possible, never turning down the once in a lifetime chance to scrub into something cool, and not leaving your co-residents in a bad situation if there are fires you have yet to put out, so some folks will do what they need to and the time cards will just reflect the paper schedule.
Click to expand...

To add: from what I have heard if they go over it usually isn't by a whole lot. However even if they are over residents don't report it because if they do then their program gets in trouble. This could eventually result in their program being suspended which in turn would ruin their ability to train. Therefore residents don't report because the incentive not to report is greater than it is to report.
 
Members don't see this ad :)
Law2Doc said:
First, it's not an 80 hour ceiling, it's an 80 hour average. You will go over 80 hours at times. Second, on paper , programs are always in compliance. Schedules will set down hours that average out to 80 or less. Third, your time cards are self reported, so the program isn't going to get in trouble if its residents aren't reporting an abuse. Finally, there's a culture at many/most programs of getting into as many cases as possible, never turning down the once in a lifetime chance to scrub into something cool, and not leaving your co-residents in a bad situation if there are fires you have yet to put out, so some folks will do what they need to and the time cards will just reflect the paper schedule.
Click to expand...

I don't have the link offhand but roughly half of all programs have an exception which allows for 88 hour work weeks as I recall, so that also adds to staying compliant.
 
Law2Doc said:
First, it's not an 80 hour ceiling, it's an 80 hour average. You will go over 80 hours at times. Second, on paper , programs are always in compliance. Schedules will set down hours that average out to 80 or less. Third, your time cards are self reported, so the program isn't going to get in trouble if its residents aren't reporting an abuse. Finally, there's a culture at many/most programs of getting into as many cases as possible, never turning down the once in a lifetime chance to scrub into something cool, and not leaving your co-residents in a bad situation if there are fires you have yet to put out, so some folks will do what they need to and the time cards will just reflect the paper schedule.
Click to expand...

Right, I understand all of this and it's consistent with what I've heard at my institution.

But what I was trying to ask in my original question, is how non-compliant do programs tend to be with regard to the actual resident labor hours (not the "paper hours")? For example: Some of our MS4's matching into ortho/ENT/urology clocked ~110 hr/wk on average during their 4 week sub-i's just to keep up with their residents & interns. That's a solid ~30 hours of number-fudging per week, per house staff member. I know of 5 institutions where they rotated and this was the case, and I'm wondering if it's the norm at many others.

Of course, no one complains about it (more likely to brag), but if this is indeed the norm or at least common across sub-specialties and institutions, then the work hour restrictions are essentially meaningless.
 
Last edited:
KinasePro said:
Right, I understand all of this and it's consistent with what I've heard at my institution.

But what I was trying to ask in my original question, is how non-compliant do programs tend to be with regard to the actual resident labor hours (not the "paper hours")? For example: Some of our MS4's matching into ortho/ENT/urology clocked ~110 hr/wk on average during their 4 week sub-i's just to keep up with their residents & interns. That's a solid ~30 hours of number-fudging per week, per house staff member. I know of 5 institutions where they rotated and this was the case, and I'm wondering if it's the norm at many others.

Of course, no one complains about it (more likely to brag), but if this is indeed the norm or at least common across sub-specialties and institutions, then the work hour restrictions are essentially meaningless.
Click to expand...

I doubt those MS4s spent all 100+ hrs with the same resident. I spent just as much time on my neurosurgery rotation but i went from one resident to another. There are no time restrictions on med students. At 2 of the 3 programs I rotated at, on more than one occasion the program director or chief resident sent the post-call junior home.
 
I did 3 Ortho Sub-Is, so it's obviously not the same as Neurosurgery, but you couldn't compare sub-I hours to resident hours and equate them at any of the places I rotated. As a Sub-I, you're going to always look for any excuse to stay so you can make a good impression. You're taking frequent call and staying the whole next day post-call and trying to find reasons to stay even later. The residents at many institutions didn't take call during the week because there was a night-float system. You're going home and reading like crazy so you can learn some of the basics in your field and prepare for cases the next day.

As a resident, your days are slightly more structured and on many rotations at many different residencies, the hours really aren't that bad (at least in Ortho). By and large, residents didn't stay post-call the next day unless they were on "home call" (some of them of course did spend the whole night in-house and worked the whole next day). That's not to say that residents never went over 80 hours per week on average or that they even got all 4 days off over a 4-week period, but generally, they seemed to at least be close to those numbers. That being said, there were definitely programs where I got the vibe that residents were being worked well in excess of 80 hours.
 
CassieBagley said:
Proposal:

Hire more residents and attending per hospital and have overlapping shifts to enhance continuity of care. For example, one neursurg works from 6 am to 6 pm, while a second joins in a 9 am till 9 pm, while a third joins in at 12 pm to 12 am. This way, there is less "handing off" of cases since the incoming resident/attending more or less knows what procedures happened with that patient. Any single neurosurg won't be able to do pre-op, op, and post-op, but at least you contributed in some way to the care of that patient. Updated medical records will keep everything well documented and up to date in terms of meds, complications, etc. Residents/attendings work a maximum of 12 hours in pre-determined shifts. Residents/attendings make it home in time for dinner/breakfast etc. and have a life outside neurosurgery.

Assume that hospitals can afford to hire the resident and attendings to begin with by cutting down their salary.

Shoot this proposal down.
Click to expand...

The amount of ego in the room during the overlap would reach a critical mass leading to catastrophic meltdown.
 
CassieBagley said:
Proposal:

Hire more residents and attending per hospital and have overlapping shifts to enhance continuity of care. For example, one neursurg works from 6 am to 6 pm, while a second joins in a 9 am till 9 pm, while a third joins in at 12 pm to 12 am. This way, there is less "handing off" of cases since the incoming resident/attending more or less knows what procedures happened with that patient. Any single neurosurg won't be able to do pre-op, op, and post-op, but at least you contributed in some way to the care of that patient. Updated medical records will keep everything well documented and up to date in terms of meds, complications, etc. Residents/attendings work a maximum of 12 hours in pre-determined shifts. Residents/attendings make it home in time for dinner/breakfast etc. and have a life outside neurosurgery.

Assume that hospitals can afford to hire the resident and attendings to begin with by cutting down their salary.

Shoot this proposal down.
Click to expand...

Ok.

Proposal: Move to Europe.
 
Members don't see this ad :)
That proposal seems like a good idea, in the sense that the doctors coming in wouldn't be lost and feel like they have to "put out fires" because the previous doctor working doesn't just leave. Of course, if there is still a case going on, the doctor isn't just gonna drop and leave, but on the floors/ICU.
 
Lbgem said:
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.
Click to expand...

Whats ID?
 
CassieBagley said:
Proposal:

Hire more residents and attending per hospital and have overlapping shifts to enhance continuity of care. For example, one neursurg works from 6 am to 6 pm, while a second joins in a 9 am till 9 pm, while a third joins in at 12 pm to 12 am. This way, there is less "handing off" of cases since the incoming resident/attending more or less knows what procedures happened with that patient. Any single neurosurg won't be able to do pre-op, op, and post-op, but at least you contributed in some way to the care of that patient. Updated medical records will keep everything well documented and up to date in terms of meds, complications, etc. Residents/attendings work a maximum of 12 hours in pre-determined shifts. Residents/attendings make it home in time for dinner/breakfast etc. and have a life outside neurosurgery.

Assume that hospitals can afford to hire the resident and attendings to begin with by cutting down their salary.

Shoot this proposal down.
Click to expand...

Logistically this is impossible:

1) OR starts range from 7 am to 8 am (depending on hospital). Longer neurosurgery cases can take upwards of 16 hours and not fit in to your system. Likewise, surgical cases simply can not be handed off from one surgeon to another. The critical details involved in exposure of anatomy and operative technique during the critical portion can not easily be passed along to someone else.

2) Signing out in of itself is inefficient. In your model, the 6 am person would literally just finish rounds and taking care of morning daily issues before signing out to the 9am person. That signout would be just finishing as the 12pm person arrived. Evidently, there is no coverage from 12am to 6am.

The benefit of the 30-hour call system is as such. The team meets in its entirety each morning (ranging from 4:30 to 7am, depending on institution). The person who has been there can convey all of the critical information to the team from the last 24 hours, and is available for another 6 hours to aid in transfer of information. The signout model is inherently flawed because it both requires overlap of teams (e.g. 2 14 hour teams) and does not allow for sufficient overlap. People forget things and information is not passed on. Having that person available allows for the information that is initially not conveyed to be readily available and not out of hospital.
 
I feel like after 24 hours, I would end up killing patients by staying the extra 6 hours :eek:

Unless I took a nap or something at night for a while :p
 
KnuxNole said:
I feel like after 24 hours, I would end up killing patients by staying the extra 6 hours :eek:

Unless I took a nap or something at night for a while :p
Click to expand...

Do surgeons nap in the OR if the cases are longer than 8-10 hours?
 
neusu said:
Logistically this is impossible:

1) Longer neurosurgery cases can take upwards of 16 hours and not fit in to your system.
Click to expand...

I find this pretty impressive. What types of cases take this long, and how frequently do you have them?
 
neusu said:
The benefit of the 30-hour call system is as such. The team meets in its entirety each morning (ranging from 4:30 to 7am, depending on institution). The person who has been there can convey all of the critical information to the team from the last 24 hours, and is available for another 6 hours to aid in transfer of information. The signout model is inherently flawed because it both requires overlap of teams (e.g. 2 14 hour teams) and does not allow for sufficient overlap. People forget things and information is not passed on. Having that person available allows for the information that is initially not conveyed to be readily available and not out of hospital.
Click to expand...

I would just like to state for the record that the whole resident to resident patient transfer process is, at times, one of the most inefficient wastes of time I have ever witnessed. I was absolutely floored the first time I saw it, although it's not always that bad. Inefficiency like this could never exist in private hospital.

At least rounds is supposed to be about teaching rather than patient care ostensibly.
 
Found this on the AMA site today:

Neurosurgery complications rise as duty-hours drop

Restrictions on the number of hours neurosurgical residents are allowed to work is associated with an increase in complication rates, but no change in mortality rates, at teaching hospitals, a study has found.

Researchers believe the increase in complications witnessed at teaching hospitals occurred because of duty-hour restrictions implemented in 2003 by the Accreditation Council for Graduate Medical Education (ACGME). View an abstract of the study, which appeared in the January issue of the journal Neurosurgery.

The findings were discussed in April during the 80th annual Scientific Meeting of the American Association of Neurological Surgeons (AANS). View an AANS news release about the study.

Brian Hoh, MD, associate professor of neurological surgery at the University of Florida in Gainesville, reported on the study during the AANS meeting. In an interview with Medscape Today News (registration required), Dr. Hoh speculated that "duty-hour restrictions have resulted in increased transfers of care, and these transfers of care are the strongest predictor for potentially preventable adverse patient events."
 
napoleondynamite said:
**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.
Click to expand...


This is the best post I have ever read on SDN.

I am saving this. Hopefully, it will make me consider these things when I choose my specialty down the road.

Thanks for the thoughtful response. :thumbup:
 
napoleondynamite said:
Found this on the AMA site today:

Neurosurgery complications rise as duty-hours drop

Restrictions on the number of hours neurosurgical residents are allowed to work is associated with an increase in complication rates, but no change in mortality rates, at teaching hospitals, a study has found.

Researchers believe the increase in complications witnessed at teaching hospitals occurred because of duty-hour restrictions implemented in 2003 by the Accreditation Council for Graduate Medical Education (ACGME). View an abstract of the study, which appeared in the January issue of the journal Neurosurgery.

The findings were discussed in April during the 80th annual Scientific Meeting of the American Association of Neurological Surgeons (AANS). View an AANS news release about the study.

Brian Hoh, MD, associate professor of neurological surgery at the University of Florida in Gainesville, reported on the study during the AANS meeting. In an interview with Medscape Today News (registration required), Dr. Hoh speculated that "duty-hour restrictions have resulted in increased transfers of care, and these transfers of care are the strongest predictor for potentially preventable adverse patient events."
Click to expand...

Very few can make the argument that a work-restricted physician can outperform a dedicated monk that eats, sleeps, and breaths neurosurgery 120 hours a week. The people that can do that are obviously going to be good at what they do.

The question that all of us must answer, is being good at something more important than relationships, sleep, hobbies, and for lack of a better word, life.

I'd love to say you can have it all, but most (not all) people won't be able to be a neurosurgeon and have the life/balance of a guy working 50-60 hours a week.
 
JackShephard MD said:
I respect your field and the dedication, but to think that neurosurgery provides a greater service to patients than other specialties is convenient when you're a neurosurgeon. There are dozens of specialties that make equivalent contributions to patients.

You want to believe that because of the time invested and complexity of what you do, but a great diagnosis does just as much, so does a basic surgical procedure performed. We like to elevate our importance, but everyone's contribution is valuable and to begin to compare is the beginning of vanity and conceit.

Reminds me of a video...
[YOUTUBE]THNPmhBl-8I[/YOUTUBE]
Click to expand...

You, my good Sir, are very wise:thumbup: The banality that is self-aggrandizement is the hallmark of bad medicine, and makes a mockery of the relative worth of every life any physician has to care for.
 
KnuxNole said:
I feel like after 24 hours, I would end up killing patients by staying the extra 6 hours :eek:

Unless I took a nap or something at night for a while :p
Click to expand...

Speaking as someone who interned under the thirty hour rule, you usually get a second wind sometime in the 24-26 hour window and have very little trouble banging out those last few hours. Those go by quickly and relatively painlessly. It's kind of like running a marathon. The 21-24 hours are the worst of it. But if you are lucky strong coffee and adrenaline from crashing patients will keep you on edge until you get that second wind. If you nap for n hour, you usually feel a lot worse than if you stay up.

Patients weren't getting killed by residents under the 30 hour shift rules (or even in the unlimited shift rules that preceded this) any more than today. This is the great flaw in the duty hour controversy -- it really hasn't showed the promised benefit to patient care. Probably because more handoffs are added to the system, and this is where the lions share of errors creep in.
 
chicago5950 said:
This is the best post I have ever read on SDN.

I am saving this. Hopefully, it will make me consider these things when I choose my specialty down the road.

Thanks for the thoughtful response. :thumbup:
Click to expand...

You really needed that spoon fed to you? You have that little insight?
 
I have always been told by every physician in a surgical field to only go into surgery if you can't envision yourself in any other field. With that in mind, why would you really pick anything else if you could only see yourself happy in something like Neurosurgery.

Personally, I would rather take the risk of being unhappy later in my field opposed to picking something else and then wondering my entire life if I should have went into the speciality with the more demanding lifestyle. At least in neurosurgery, as the climate currently stands, you can probably pretty easily come out, go into private practice, live frugally, and retire in 10-15 years pretty comfortably....

On a side note, I have met plenty of physicians from fields from Derm to Neurosurg. who wish they had done something else. We humans are always looking at lawns and then across to our neighbors only to then yearn for the greener grass...
 
napoleondynamite said:
**Disclaimer, I am not a neurosurgeon

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.
Click to expand...

I agree that developing intimate relationships is not exclusive to neurosurgery and that the highs and lows in cancer care are shared by many, even the cancer care that neurosurgeons partake in. However, I would disagree on the acuity and frequency with which these relationships develop. After spending 4 months rotating on various neurosurgery services, often interacting with radiation oncologists in tumor board meetings, it is clear that the level of ownership for a patient is not the same between a neurosurgeon and a radiation oncologist. The odds that a patient remembers their neurosurgeon is going to be many times greater than a patient remembering who planned their radiation oncology treatment. So saying you get to 'experience all that for ~50 hours per week' is your interpretation of the situation. It's a situation where you don't know what you don't know (an unknown unknown) and are quite content with it. Never in one of my rotations other than that spent on neurosurgery have I had a patient pull out of her wallet a picture of her neurosurgeon and state that that's her hero. One of my friends recently matched in radiation oncology after spending most of medical school leaning towards neurosurgery. In a sense he feels he sold out and as the poster above mentions and won't ever know what is was like to trod down this different, more intense path.
 
Last edited:
Mortal_Lessons said:
I agree that developing intimate relationships is not exclusive to neurosurgery and that the highs and lows in cancer care are shared by many, even the cancer care that neurosurgeons partake in. However, I would disagree on the acuity and frequency with which these relationships develop. After spending 4 months rotating on various neurosurgery services, often interacting with radiation oncologists in tumor board meetings, it is clear that the level of ownership for a patient is not the same between a neurosurgeon and a radiation oncologist. The odds that a patient remembers their neurosurgeon is going to be many times greater than a patient remembering who planned their radiation oncology treatment. So saying you get to 'experience all that for ~50 hours per week' is your interpretation of the situation. It's a situation where you don't know what you don't know (an unknown unknown) and are quite content with it. Never in one of my rotations other than that spent on neurosurgery have I had a patient pull out of her wallet a picture of her neurosurgeon and state that that's her hero. One of my friends recently matched in radiation oncology after spending most of medical school leaning towards neurosurgery. In a sense he feels he sold out and as the poster above mentions and won't ever know what is was like to trod down this different, more intense path.
Click to expand...

Why exactly does your friend feel "sold out" after matching in to radiation oncology? I think there is a misconception that only the top surgical specialties like neursurg or ortho are for the elite, hard-working, power-driven people and all other specialties are for the softer, lazier people. And it sounds like neurosurg appeals to you because of the image patients or other will have of you (ie. a hero). Though you can excise a spinal tumor you can also treat it with radiation- both are heroes in my book.
 
CassieBagley said:
Why exactly does your friend feel "sold out" after matching in to radiation oncology? I think there is a misconception that only the top surgical specialties like neursurg or ortho are for the elite, hard-working, power-driven people and all other specialties are for the softer, lazier people. And it sounds like neurosurg appeals to you because of the image patients or other will have of you (ie. a hero). Though you can excise a spinal tumor you can also treat it with radiation- both are heroes in my book.
Click to expand...

Doesn't matter what his motivations are--whether he just loves the brain or wants to be a badass. Nothing wrong with either IMO.

What matters is that he has the drive/work ethic that it takes.

He probably feels he "sold out" because he traded something that he really wanted to do that was hard, for something that was easier.

No one said rad onc is for those who are lazy, but you can't say working 50 hours a week is just as hard as working 100+. I mean, you have to know that.
 
Last edited:
CaptainSSO said:
...

No one said rad onc is for those who are lazy, but you can't say working 50 hours a week is just as hard as working 100+. I mean, you have to know that.
Click to expand...

actually, speaking as a career changer, I have to say that it's less about number of hours and more about how you spend them. A 50 hour a week job you don't enjoy is going to leave you feeling more drained and beat down than a 100 hour job you actually enjoy. Because at some level if you enjoy it, it's not really work, it's recreation. It's how you might be willing to spend some of your free time anyway. There are plenty of folks in every specialty who do research and read and write articles in their spare time, not because it's required or necessarily has a tangible benefit to them (although in many cases this is a nice side benefit) but because they truly find the field enjoyable, and like to stay immersed in it even when they are on their own time. Maybe it's a workaholic mentality, but I'd say many of these folks do gravitate to the "harder" paths, and actually find them easier than the folks looking for the shortest way through. Basically I'm saying if you pick a lower hour field because it's easier, you are going to feel more burnt out at the end of the day. In professional fields you really can't be living for the weekend like you might as the stock boy at WallMart.
 
CassieBagley said:
Proposal:
Hire more residents and attending per hospital and have overlapping shifts to enhance continuity of care...

Shoot this proposal down.
Click to expand...

OK

Neurosurgery is one of the smallest fields of medicine in this country; there are rural areas of the country without a neurosurgeon for 300 miles. Even in large teaching hospitals it's not as if neurosurgeons are tripping over one another the way that say internists are. So it's impossible to simply hire more staff. Training positions are capped by the federal government, and often a program will have only 1-2 residents per year. Increasing these numbers would require a Congressional initiative for a broad-based increase across the board, the funding of which would cost the gov't many millions of dollars and is quite unlikely in these fiscal times.

NSGY residents in my experience don't want more continuity of care. They don't want to share cases or make multiple handoffs a day. They're extremely driven and, if you all of a sudden came down with a law saying residents have to live in a small dorm adjacent to the OR, they would by and large not complain much. University chairs typically trained in an era where q2 call was the norm; they already think their residents are going home at the end of their 88-hour weeks to wash their panties.

But suppose some congressman does draft a proposal to increase Medicare funding to support a 10% increase in training slots. Move away to your private practice neurosurgeon in BFE Wisconsin. You're one of two in town, with a bustling practice generating an income of $1.6M/year. You've got a hospitalist group to manage floor issues and a PA to first assist and see f/u clinic. Are you really going to support this measure, knowing that in a few years it's going to result in more competition and a drop in income?
 
Tic said:
OK

Neurosurgery is one of the smallest fields of medicine in this country; there are rural areas of the country without a neurosurgeon for 300 miles. Even in large teaching hospitals it's not as if neurosurgeons are tripping over one another the way that say internists are. So it's impossible to simply hire more staff. Training positions are capped by the federal government, and often a program will have only 1-2 residents per year. Increasing these numbers would require a Congressional initiative for a broad-based increase across the board, the funding of which would cost the gov't many millions of dollars and is quite unlikely in these fiscal times.

NSGY residents in my experience don't want more continuity of care. They don't want to share cases or make multiple handoffs a day. They're extremely driven and, if you all of a sudden came down with a law saying residents have to live in a small dorm adjacent to the OR, they would by and large not complain much. University chairs typically trained in an era where q2 call was the norm; they already think their residents are going home at the end of their 88-hour weeks to wash their panties.
But suppose some congressman does draft a proposal to increase Medicare funding to support a 10% increase in training slots. Move away to your private practice neurosurgeon in BFE Wisconsin. You're one of two in town, with a bustling practice generating an income of $1.6M/year. You've got a hospitalist group to manage floor issues and a PA to first assist and see f/u clinic. Are you really going to support this measure, knowing that in a few years it's going to result in more competition and a drop in income?
Click to expand...
:laugh::laugh::laugh:
 
Mortal_Lessons said:
I agree that developing intimate relationships is not exclusive to neurosurgery and that the highs and lows in cancer care are shared by many, even the cancer care that neurosurgeons partake in. However, I would disagree on the acuity and frequency with which these relationships develop. After spending 4 months rotating on various neurosurgery services, often interacting with radiation oncologists in tumor board meetings, it is clear that the level of ownership for a patient is not the same between a neurosurgeon and a radiation oncologist. The odds that a patient remembers their neurosurgeon is going to be many times greater than a patient remembering who planned their radiation oncology treatment. So saying you get to 'experience all that for ~50 hours per week' is your interpretation of the situation. It's a situation where you don't know what you don't know (an unknown unknown) and are quite content with it. Never in one of my rotations other than that spent on neurosurgery have I had a patient pull out of her wallet a picture of her neurosurgeon and state that that's her hero. One of my friends recently matched in radiation oncology after spending most of medical school leaning towards neurosurgery. In a sense he feels he sold out and as the poster above mentions and won't ever know what is was like to trod down this different, more intense path.
Click to expand...

I disagree whole heartedly with this post. In fact, I'd argue the opposite. Radiation oncologist form relationships with their patients that I think are unrivaled by nearly any other specialty, especially neurosurgery. I think rad onc may still be an unknown unknown for you... :)

A typical consult/CT sim for a patient who needs radiation can involve hours of time spent directly with the treating radiation oncologist. In other words, in the first appointment they've spent more time with the patient awake, talking, than the neurosurgeon will in many months.

Then, the patient generally has to come for radiation 5 days a week for four to six weeks. They won't see the physician every day, but they will at least once a week. Treatment is then followed by years of follow-up.

I don't intend to put down neurosurgery, they are amazing at what they do. My point is that while hardly anyone in the medical community knows much about radiation oncologists or what they do, their patients never forget the impact they've had on their lives.
 
don't forget to convert your units,

7 neurosurgery residents = 14 medicine residents
so that should bump up their relative n a bit
 
Law2Doc said:
actually, speaking as a career changer, I have to say that it's less about number of hours and more about how you spend them. A 50 hour a week job you don't enjoy is going to leave you feeling more drained and beat down than a 100 hour job you actually enjoy. Because at some level if you enjoy it, it's not really work, it's recreation. It's how you might be willing to spend some of your free time anyway. There are plenty of folks in every specialty who do research and read and write articles in their spare time, not because it's required or necessarily has a tangible benefit to them (although in many cases this is a nice side benefit) but because they truly find the field enjoyable, and like to stay immersed in it even when they are on their own time. Maybe it's a workaholic mentality, but I'd say many of these folks do gravitate to the "harder" paths, and actually find them easier than the folks looking for the shortest way through. Basically I'm saying if you pick a lower hour field because it's easier, you are going to feel more burnt out at the end of the day. In professional fields you really can't be living for the weekend like you might as the stock boy at WallMart.
Click to expand...

I completely agree with the above poster. It's funny how on my outpatient rotations that were the "easiest" with respect to hours, I felt the most tired and rundown at the end of the day, whereas on my surgery (and neurosurgery) rotations, I felt more alive, awake, and energized during the day despite the terrible hours. This is such a true and under-appreciated phenomenon.
 
Mortal_Lessons said:
I completely agree with the above poster. It's funny how on my outpatient rotations that were the "easiest" with respect to hours, I felt the most tired and rundown at the end of the day, whereas on my surgery (and neurosurgery) rotations, I felt more alive, awake, and energized during the day despite the terrible hours. This is such a true and under-appreciated phenomenon.
Click to expand...

totally agree with this. I'm finishing third year tomorrow and my last two rotations have been psych and family med, and I am just tired all the time and miserable, vs a happy energetic camper getting into the hospital at 4 or 5 and working 14-16 hours days while on surgery rotations.
 
Encephalectomy said:
totally agree with this. I'm finishing third year tomorrow and my last two rotations have been psych and family med, and I am just tired all the time and miserable, vs a happy energetic camper getting into the hospital at 4 or 5 and working 14-16 hours days while on surgery rotations.
Click to expand...

Check back in 10 years.

Physician career satisfaction within specialties
http://www.biomedcentral.com/1472-6963/9/166

Table 3 left-side, provides descriptive statistics for the 42 specialties. Specialties with the greatest numbers of incumbents included family practice (1,341), internal medicine (1,005), pediatrics (740), and emergency medicine (408). Table 3, right-side, provides linear regression results on the 42 specialties, and ranks them based upon the population weighted satisfaction score variable. Each specialty was compared to the satisfaction score for family medicine. The top two statistically significant specialties that were positively associated with satisfaction were pediatric emergency medicine and geriatric medicine. The bottom two statistically significant specialties that were negatively associated with satisfaction were pulmonary critical care medicine and neurological surgery.
Click to expand...
 
Last edited:
JackShephard MD said:
Check back in 10 years from now.

Physician career satisfaction within specialties
http://www.biomedcentral.com/1472-6963/9/166
Click to expand...


will do, though as noted 24 neurosurgeons is not much of a sample.

there was another study which interestingly found that ENT and urology had higher burnout than other surgical specialties,so it definitely isn't all about the hours... though I'd guess burnout is higher in surgeons than non-surgeons

http://www.facs.org/surgerynews/update/academic0511.html
 
Encephalectomy said:
interestingly duty hours may lead to worse patient outcomes in neurosurgery

http://www.aans.org/Annual/2012/Pre...l-17th/F2012AMScientificReleaseHohApril17.pdf
Click to expand...

KinasePro said:
How did they manage to publish a "study" with only n=7? Clearly, post-call residents can still write shtty papers :laugh:.
Click to expand...

Encephalectomy said:
don't forget to convert your units,

7 neurosurgery residents = 14 medicine residents
so that should bump up their relative n a bit
Click to expand...

Encephalectomy said:
will do, though as noted 24 neurosurgeons is not much of a sample.
Click to expand...

:thumbup:
 
You must log in or register to reply here.
Next unread thread

Similar threads

S
MS1 curious about Neurosurgery residency
Replies
7
Views
2K
YoungMoneyMint
YoungMoneyMint
T
Internal Medicine residency applicant: okay to only have one IM rotation prior to ERAS?
Replies
2
Views
466
NotAProgDirector
NotAProgDirector
CuriousMDStudent
How does one put research on a CV for residency purposes?
Replies
21
Views
5K
mvenus929
mvenus929
m2regen
Choosing between Vascular Surgery vs. Neurosurgery
Replies
21
Views
4K
m2regen
m2regen
S
Advice for getting involved with neurosurgery residents and getting on research
Replies
3
Views
699
NeuResurgens
NeuResurgens
Top