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Lifestyle of a neurosurgeon (academic & private)

Discussion in 'Neurosurgery' started by samsoccer7, Sep 27, 2003.

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  1. samsoccer7

    samsoccer7 Senior Member

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    I'm starting this thread b/c nobody really lays it out in other threads.

    What is the lifestyle like of an academic and a private practice neurosurgeon?

    I know what residency lifestyle is like, but I can't find anything on private practice especially. People tell me horror stories, I've heard of a couple guys who work 4 days a week and make $800+. I have no idea what to believe and what to expect.

    Neurosurgery is my love, but if it means missing out on my future family's life, I'm going to do something else. Please help!!!
  2. ent_doc

    ent_doc Neurotologist

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    Find another love. If you're that concerned about family now, wait until you're four years into training and you realize that your family will always come second to your job.
  3. samsoccer7

    samsoccer7 Senior Member

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    I understand any surgical specialty has a crazy residency. But that wasn't my question (no offense). I'm more concerned about AFTER residency. Everyone knows the training blows, but nobody has given any info, anecdotes, theories on life once you're BC/BE.
  4. oldandtired

    oldandtired Senior Member

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    Relax. 99% of 4th year medical students do not go into neurosurgery. Chances are you will change your mind along the way. If you feel like family and lifestyle are important then dont even think about neurosurgery. The residency is one of the worst and the lifestyle after residency can be quite bad in most cases.
  5. womansurg

    womansurg it's a hard life...

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    Every neurosurgeon I've ever known was exhausted, bitter and overworked - both private and academic. The residency is seven long years, and is one of the most inhumane in it's treatment of it's learners. It's really hard to not see your family or friends for seven years, even if you do know that things (might) be better when you finish. Not many marriages survive, and your children will be raised by someone other than yourself.

    Well, that's my happy take on the subject.
  6. Minimalist M

    Minimalist M Member

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    samsoccer7,

    Neurosurgery is not an easy life. Let's look at academic neurosurgery. Who do you think the resident calls at 2am for an emergency crani? Who will have to staff the OR at 7am, regardless of what you were doing at 3am? Who has to round on patients on the floor or the unit EVERYDAY when they are on service? Yep, the attending, board certified or otherwise. Weekends and holidays, the hospital must be staffed by an attending, period. That means somebody who is already out of residency and "living their life" is tied to that pager and must be ready to come into the hospital if the need arises. Toss in the research requirements of an academic neurosurgeon, and you've got a serious 100 hour week until you retire.

    Now let's look at private neurosurgeons. They don't have residents working under them, but they don't have staff call at major academic centers either, so it must be cush, right? You still have patients who need surgery, usually spinal surgery. They'll still line up to see you in clinics and still line up to the OR for their disc or pinched nerve. You'll still have to operate on them first thing in the morning because you'll have other cases backed up well into the afternoon, afterall, that's how you make a living...gotta make money in the OR, so stack them up on the OR schedule. And then, you must see the patients postoperatively. You must see them on post-op days, you must discharge them...etc etc, all the while, you're still stacking up patients in the OR and doing pre-ops or assessments in the clinics. It's just like primary care, except with several hours of OR time a day squeezed into it. With weekends and call, the private neurosurgeon probably push 80 hours a week easily.

    I've had the privilege of working with both private and academic neurosurgeons. The hours of the academics are horrible. They show up between 5-6am for some attendings and for the "more relaxed" attendings, 630am was the latest they've ever rounded. Naturally, they leave at night, around 7pm at the absolute earliest I've seen them take off, and usually 8-9pm with 11pm being a late time to leave on a regular basis. A 5am to 11pm day is not a rare event, although it's usually more like 6am to 8pm on a regular basis. This is for the attendings, NOT the residents (The residents must have ALL of the patients seen and notes written by 6am, so you can guess what time they must wake up!). On average, I would say an academic attending will be called to physically staff a case in the OR in the middle of the night, dragged out of bed...about 3 times a week at a medium department that sees about 2000 cases a year. On weekends, my experience with attendings is that they are called in about 1/2 of the time, which means, if you are the attending for the weekend, then you will probably get called to come in at least once either Sat or Sun during the day or night. This does not include the Sat and Sun morning rounds that you will make, because an attending must staff the patients everyday, period.

    My experience with privates is that it's pretty much the same, except there's more spine cases, so the patients are less critical, there are no residents, so things are done faster (!), but everything is done by the attending. That means the attending is the intern, resident and attending when caring for his private patients. The private works directly with the nursing staff. Now, keep in mind that private hospitals may see trauma patients and stroke patients too. And those patients will come in at 3am. Of course, private hospitals get a lot less of those patients, so the private docs may have long hours, but their free time is less frequently interupted.

    These guys are right. Samsoccer7, while I encourage all medical students to take a look at this great field of neurosurgery, I also think you should think seriously about pursuing another specialty if you do not love neurosurgery enough to make certain sacrifices. As you can tell, I'm deeply passionate about neurosurgery and so are the people I work with. My collegues and I make sacrifices in our lives all the time because we love what we do. We can not have everything we want in life, you need to ask yourself what is the most important thing for you when you are in your 30s, or your 40s. Neurosurgery and family life is not incompatible, but you have to define the extent of familial involvement in your life. There's no way you can be like everybody else if you pursue neurosurgery because not too many people will work the hours you must work. If you have a loving wife, then maybe you can make it work. Will you miss out on your kids? Maybe. Maybe not. The neurosurgeons I worked with see me more than they see their family. They can accept that. The time they share together is quality. That's fine. If you can't accept that, then there are certainly many specialties in medicine that are extremely rewarding, interesting, fun as heck but does not have the same level of time demands as neurosurgery. You chose one of the worst specialties to consider if family life is that important to you. You chose one of the worst specialties if lifestyle is a consideration. The divorce rate among neurosurgeons must be very high, because out here in California, about 50% of the residents and attendings I know are single/divorced. Other poor choices would be vascular surgery, trauma surgery, transplant surgery, thoracic surgery and obstetrics. Too many variables and lots of things happen at night with these specialties. Good choices for a "better" life include optho, ortho, ent, plastics, uro, pediatric surgery and surgical oncology. Many people who will make excellent neurosurgeons, but have desires of a better life end up in ent or ortho because their fields are very similar to neurosurgery in scope of practice and challenges. So similar, in fact, that many cases overlap....acoustic neuromas can be ent or neurosurgery, herniated discs can be either ortho or neurosurg...but the lifestyles are dramatically better in both ent and ortho. Think seriously about the last few sentences I just wrote.

    By the way, $800,000 is waaaaay high for a neurosurgeon's salary. Academics in California start with Assistant professor at $160-170K, Associate Prof at $200-250K, Full professor gets $250-300K and the chair of my department (who's nationally recognized, on the board of AANS, CNS, ABNS, Journal of Neurosurgery and Neurosurgery) makes about $400,000. Private neurosurgeons that I've worked with, told me that they clear about $300,000 on average, but that's before their overhead, which includes staff salaries and insurance (His insurance was close to $100,000/yr, and that was in 1999, before things got really bad!!!).

    So I hope this answers some of your questions and gets you thinking realistically about your future. If you were my classmate, and came to me with this same question, I'd discourage you from applying to neurosurgery. It sounds like that's the answer you wanted from the start. We lost 2 residents in our program who decided that the lifestyle compromise was too much. One became an anesthesiologist and the other one went into real estate. They took two spots that could have been filled by someone who was more dedicated to neurosurgery and now, the remaining residents have to take up the extra work of two missing residents. If you even have a little bit of doubt, then the best thing is to not pursue neurosurgery. You can be challenged, intellectually and physically in other fields without the time commitment. Try ENT or Ortho. Your USMLE I score is more than enough to get some attention from PDs in those fields. Good luck! And if you have more questions, don't hesitate to ask, that's why this board is here!
    CastleOfGlass and voicesinmyhead like this.
  7. Life AFTER redsidency means you are no longer subjected to some 80 hr work week rule

    if you are a in a small NS group, you might be working a Hell of a lot more than 80...and certainly more than 24 straight.
    dittos for taking staff call in an academic program

    don't get married
    don't have kids
    buy a really cool car
    get some hot girlfriends
    get used to having 5% of your life not related to your job, so you'd better love your job

    otherwise do something else
  8. samsoccer7

    samsoccer7 Senior Member

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    Minimalist... that was by far the best and most informative post I've ever seen on these forums. I appreciate your honesty. I love neuroscience, but at the same time, my parents worked enough when I was growing up, but they were always home by 5:30 or 6 at the latest. I loved the fact they could come to my soccer or basketball games and not have to worry about anything else. Obviously they weren't physicians, but still, it made a huge impact on my life. I love neurosurgery and the science behind the field, but at the same time, there is no way I think I could give up those great times w/my family. I appreciate your honesty, and even though I think I could make a great NS, I don't want to regret anything later on. What made you choose NS, even with the lifestyle? You'll probably say b/c you "LOVE" the field, but so do I, but I'm still having this problem. Can you convince me either way? You did a pretty good job already, but ENT sounds boring, and plastics I'm not sure I could really get at this point, besides doing the 5yr general (which must blow so hard) and a 2yr plastics fellowship. What do you think??? Thanks again, your post really makes a difference in my life.... Did I mention I'm drunk?? :) This is all from the heart though...
  9. Minimalist M

    Minimalist M Member

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    Samsoccer7, I love the neurosurgery lifestyle. Call me a masochist, but I love that I see three shift changes in the nursing staff during an average day! I love that I have what it takes to stay til midnight when I'm post call. I love that I exceed the 80 hours by Thursday morning every week. I still can't believe I am allowed to open human heads. I still can't believe that after that, the person wakes up! Like most neurosurgeons, I'm definitely a workaholic. During my sub-I in my home town, staying with my folks, I didn't see them for 28 days straight despite living in the same house (I left at 415am and got home at 10-11pm, they were already asleep). And you know what? I'm not the hardest working member of my department. I'm probably middle of the road. But the deviation from me is very small. Most of my collegues are very similar to me in our work ethics (I tend to think they work harder than me).

    Most of my neurosurgical collegues are way into neurosurgery. Not just the technique or pathologies of neurosurgery, but all aspects of it. Six of the residents are heavy into the history of neurosurgery (one of them has an autographed first edition of Fulton that was autographed to his grandfather, a pioneer neurosurgeon!). These guys eat, breathe, sleep (once in a while, yes they do sleep) and live neurosurgery. Unfortunately for you, I have never met a neurosurgeon who said that they wanted a full and rich life and that neurosurgery is only a job to them...neurosurgery IS the full and complete life. Compare the life of a neurosurgeon to that of an Olympic athlete. They live their work, but it's not really work, is it? It's a way of life. Neurosurgery is self-selecting. You're going through the process right now. By the time you apply, you would have either decided to go 100%, or you would have selected yourself out of the applicant pool.

    As far as ENT being boring, I'm sure most of the clinic days are not super fun, but you should scrub on some of the full neck dissections! Looks just like the Rohen Anatomy Atlas, definitely NOT boring! These guys can rip a human face apart and put it back together! I'm sure you realize that ENTs can set up a plastics practice, which is highly lucrative and highly structured....with little or no call schedules. Why do you think that ENT is such a competitive field? They have great hours, great cases and great salaries. You can decide how much or how little work you want to do by structuring your practice to suit your lifestyle. You can spend all your time in clinics if that's your pleasure or spend all your time in the OR on massive dissections. As you can tell, ENT was a second choice for me behind neurosurgery.

    If family is first and career is second, then neurosurgery is definitely not the field for you. If you pursue neurosurgery hoping that I'm wrong, then only your family will suffer, because your patients will not change to accomodate your family's demands, it can only be the other way around. If you love the nervous system, consider neurology. If you must have surgery, then consider surgical specialties that offer a better lifestyle. Neurosurgery is one of the harshest out there. Good luck!
  10. Minimalist M

    Minimalist M Member

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    Mitchell Berger: Jag convertible

    Michael McDermitt: Cooper vintage race car (open wheel, open cockpit single seater!), and oh yeah, he's in Indianapolis for the F1 USGP this very minute!

    Paul Muizelaar: Maseratis and Ferraris

    Hmmm...yes, I see a pattern;)
  11. samsoccer7

    samsoccer7 Senior Member

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    #1, I hope UC Davis is working out great for you :) (my buddy here may be joining you shortly). How does he have ferraris making less than $350K a year? Do these guys have outside money from investments and stuff?

    But I really appreciate your input, you're the first person to give me a real glimpse, and I think I'm slowly changing my mind. It's hard b/c I've kinda set up myself for NS, by doing some research, spending time w/Northwestern's surgeons last summer, etc. But at the same time, I think this is the time to really evaluate what I want, b/c if I wait any longer I'm gonna get sucked in.

    That being said, will the research I do in NS help me for ENT if that's what I decide to do? Or should I jump ship (I'm working on an NS paper right now) and do some ENT stuff?
  12. Minimalist M

    Minimalist M Member

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    I'm not at Davis (I'm further south), but Paul Muizelaar had a Mondial convertible, before his wife took it in his divorce settlement. Mondials aren't terribly expensive, about the price of a BMW 5 series. I heard he took some of the applicants out in his Maserati Quattroporte for dinner. Great guy! Very eccentric, to be sure!

    ENT PDs don't care too much about research. Of course, it won't hurt to have research, but it should be somewhat related to ENT and not all neurosurgery slanted eg. Avoid brain tumors and spine topics in research, but do consider peripheral neuropathies and things of that nature. I did a research project on acoustic neuromas in my neurosurgery/ent phase and the project works for both disciplines. Cranial nerve topics (like trigeminal neuralgia) are great overlapping subjects. If you do a research project that is too related to one field, it may raise eyebrows in another field. Since you've done research in neurosurgery and worked at Northwestern (with neurosurgeons?), you've created a theme in your CV already. If you are currently working on a neurosurgery project, that may only reinforce the neurosurgical theme some more. I wouldn't encourage you to "quit" your project, but give it an ent or plastics spin, just to give yourself some options later on.

    But don't get hung up on research, because ent isn't neurosurgery, research in ent is very low on their list of priorities. Just get a good sub-internship experience at your desired ENT program and secure some letters. Do it fast, because ENT is an early match too. Be sure to get some face time with the ENTs at your own school. You'll want a letter from the chairman of your ENT department. With ENT, it's all about letters and boards, never research. Get your Step 2 early (ie. summer between 3rd and 4th year). You will want a 90+ on your Step 2 to go with your Step 1 score (ENT matched applicants had 240 on the Steps). That's what you should be concentrating on rather than research. There's 250 spots in ENT and about 130 in neurosurgery, so the numbers are in your favor if you decide to enter that field.

    Final caveat: Don't let the anonymous postings of a stranger determine your decision on your own future. Spend some time with ent and neurosurgery to make sure that you'll be happy in either field. Be critical of yourself and figure out what you really want in life. Talk to residents who are in these fields and talk to attendings about their family life and their practice parameters. If you're married, talk to your wife (actually, you should probably consult her first!). Good luck!
  13. 1Neuro1

    1Neuro1 Junior Member

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    Minimalist...the above was a good overview of the field but I think I disagree with many of your observations:

    Rounding at 6AM is a rarity in all the programs I've been to, usually closer to 7AM. That means work rounds start at 5:45AM and the notes are usually very short. Operations are scheduled to start at 7:30AM but the first incision is more along the lines of 9AM.

    NS attendings leave later than other attendings, but by no means is leaving at 7PM considered an early day...thats an average day. Most of the time they're just sitting and reading in their office doing nothing important when they're staying in late anyway. (this was even the case at Ivy League programs Ive been to).

    The salary ranges you spoke of seem extremely low, at all the institutions I've been to (and got a good feel for the slaries) the average income is closer to high 6 figures for all attendings. A full professor making less than 300K is doing something wrong. The chief of the department at my institution makes so much that he does not even charge any patients for surgery, he only takes his regular salary home and he is extremely well off.
    The private prac NS usually is close to 7 figures as well. Those in private prac work a lot less than you portray, most of them have PA's or nurse prac's who do the scut work in the hospital. It is not a common event for them to have to go into the hospital at 3AM to do an LP or something. They have a decent lifestyle.


    Any surgical field is time consuming and has a brutal residency (except ortho that is), many people speak of NS as if you have to be a complete workaholic/neurotic and be obsessed with your job in order to be happy, this is not unique to NS!! You do not have to eat/sleep/breath NS every second of everyday and never see yoru family in order to just barely fit in the door. This is the typical hype that surrounds NS and perpetuates the self selectivity of the field. My advice to anyone considering the field is to get a feel for it for themselves. I wouldnt dare discourage someone from entering the field just after reading a post of theirs on some internet forum. After I spent alot of time in the field, doing research, and rotating at multiple institutions, my observations were that it was much more laid back and promising than what others originally led me to believe. Basicaly I'm saying that, after reading your post and comparing it with my experiences, I think you make it seem a lot worse than it really is. It is a difficult lifestyle and you have to love what you do, but not to the extent that you wrote of.
  14. Minimalist M

    Minimalist M Member

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    I can only speak from what I've seen personally. Unfortunately, the neurosurgeons I've worked with never round at 7am on a weekday (Even on weekends we round at 6am, 630am at the latest). Mitchell Berger is sitting in the neuroradiology reading room at 545am, by 602am, if we're not already reading films, he makes me page the chief resident! And we frequently have up to 5 neurosurgical ORs running to 10pm at least 3-4 nights a week at Moffit Hospital. Our patients are in the OR by 7am. First incision usually occurs by 730am.

    I totally agree with you on this one!
    I agree with you on this too! As previously mentioned, vascular, trauma, transplant, etc. are very similar to neuro in terms of work load and intensity.


    I normally wouldn't discourage someone from entering a field, but our young friend sounds like he already made up his mind!;) Besides, he wanted actual experiences and anecdotes, of which I provided. Myth or not, he should be aware of how life can be if he entered this field, and I didn't want to sugar-coat anything to make it sound easier. Many people in neurosurgery, myself included, like to "tell it like it is". This guy sounds like he doesn't want to enter neurosurgery, so I will point out that observation to him. Sugar coating is for other specialties, neurosurgery has no time for such nonsense. My personal experience is that there are people who thought neurosurgery was not that rough, but decided to leave the residency after 3 years (to the dismay of the remaining residents) because reality set in and the time commitment was too severe. These events are not my interpretations or what I thought, it's what really happened. These things actually happened. Those residents left. samsoccer7 asked the question, and I gave him my answer, no more, no less. No sugar coating.

    It sounds like you've experienced something differently from me, and I'd love to hear some more about it. The best thing for this discussion are two opposite points of view with experience to back it up. I think 1neuro1's input is exactly what samsoccer7 needs in addition to my observations.
  15. Minimalist M

    Minimalist M Member

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    quoted my post:

    from 1neuro1's post:

    Sounds like we're saying the same thing!! :)

    1neuro1, which hospitals have you worked in? I got the impression that programs on the east coast (NYC, Boston, Philly) are pretty malignant, but you're telling me otherwise. It actually sounds pretty sweet where you are.
  16. samsoccer7

    samsoccer7 Senior Member

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    Thanks for all the input. I'm struggling b/c I truly love neuroscience and surgery. That being said, I know ENT's can do neurotology and some of their surgeries are borderline NS. I'm also having a problem b/c my school makes us do 2 months general and 1 month subspecialty, so I feel like I have to make a decision right now about what to do, otherwise I may never get a chance to work with the ENT docs or vice versa.

    As for income, I thought minimalist's numbers were, well, minimalistic :) I figured it'd be upper 6 figs, maybe 600 or 700 g's. Where would you put ENT, after a neurotology or plastics fellowship?

    And how much neurology/neurosurgery related cases do ENT's see? If it's a decent amount, then I think I could be really happy with it. If not, then I might have to learn to like mouths a lot more.
  17. Minimalist M

    Minimalist M Member

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    You already know you love neurosurgery, so take the ENT rotation and see if you find it as stimulating as neurosurgery. It's a very light schedule, thus giving you an opportunity to study for your surgical shelf exam. Then at the end of the rotation, you can decide if you want to pursue ENT or neurosurgery.

    I hope for my sake you're right! :) Although I can live happily on $250K/year, heck, I live happily on $40K/year!
  18. samsoccer7

    samsoccer7 Senior Member

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    But by not doing NS, aren't I missing out on working with the attending here (only 2 attendings, 1 is new, no residency program) and thus losing a great rec letter? That might be a rhetorical question, but I'm just sayin'....

    Is this your day off Minimalist? :) Lots of quick replies, I like it.
  19. Minimalist M

    Minimalist M Member

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    No, I'm in the resident offices and on-call. There's a bit of downtime today. Hopefully it will stay quiet so that I can get some reading done.

    If you want a neurosurgery rec letter, then yeah, you're going to have a dilemma if you don't rotate with your attending. But if you're contemplating ENT or another field, then you will be better off exploring that option, just in case it's something that will make you as happy as neurosurgery.

    You should make an appointment with your residency advisor and see what he recommends regarding exploring ENT vs pursuing neurosurgery and the timing of either plan of attack, remember, both are early matches. Either case, the most important thing for right now is to decide if you're commited to neurosurgery (in which case, do the neurosurgery rotation) or if you want to pursue another field. Once you've made that decision (ie. the decision to explore other options), then you should take a rotation in your desired specialty. If the other specialty is what you want, then you don't have to worry about a neuro letter. If it's not what you want, then you can still take a neurosurgery Sub-I at your home school and one at an away location. But if you're already thinking that neurosurgery isn't the field for you, then you owe it to yourself to explore something else before you invest several years of residency in this field. The logistics of getting letters and doing sub-Is are small matter when you look at the big picture of whether you will be happy for the rest of your life with the decision you're making right now.
  20. Carbon Klein

    Carbon Klein Senior Member

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    Minimalist sounds like he's speaking from experience. I can definitely vouch for his observations. Mininalist's stated salaries are about right for academics. I never heard of any neurosurgeon making 7 figures! It does seem like samsoccer is looking for an excuse to not go to neurosurgery. Well you got it buddy. It's a sh*tty lifestyle and the pay isn't the 800,000 taht you hoped for. If you don't love it, forget it. It's not worth it. 50 bucks says you'll go into another field.
  21. ent_doc

    ent_doc Neurotologist

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    I will be applying for neurotology fellowships next year. Income varies based on location. Many neurotologists are in academic positions, where incomes are lower. If you are in private practice, chances are you're doing much more otology than neurotology/acoustics, although you can do them.

    Private practice income for otology/neurotology starts at around $225k and can increase substantially. Depends on type of practice.

    That being said, I think that in whatever field you want to pursue, you have to like the bread and butter. That means in neurosurgery, you have to enjoy doing backs/spine. In ENT, you have to enjoy tubes, tonsils, sinus, etc.

    You have plenty of time to look at both fields (and others). My personal list of fields to evaluate is:

    Ortho, NS, ENT, urology (Surgical)
    Anesthesia, Radiology, Derm (others)
  22. samsoccer7

    samsoccer7 Senior Member

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    You're somewhat right Carbon, I'm looking for a reason NOT to go into NS b/c I really want to make sure it's for me. I love the field, I've said that before, but I have other interests and I really want to be a family man (not saying that you don't). But I need to check all angles, god forbid I realize during residency I'm never gonna have a life afterwards. The input from everyone is awesome and even though you guys haven't changed my mind, you've helped me realize something I think I've been suppressing (or repressing) in my mind for a while.

    I always told myself that, as a neurosurgeon, I will be able to control my practice and work as few hours as I want. It's starting to sound like that's only somewhat true, and that there are WAY too many variables, meaning the hours escalate, and next thing you know, you forgot what your wife and kids look like, and you start calling your residents "hunny" :)

    That being said, it seems like my ENT dept at my school might suck, and they've all but told friends of mine who've rotated through there not to go into ENT. Do you think they're just bored, not respected, or do they really mean "don't go into ENT?" I'm sure ent_doc can say something about this. And ent_doc, seems lots of ENTs are doing plastics fellowships after residency, what's your take on that?

    Lastly, if I don't get a chance to rotate ENT at my own school, does that screw me over bigtime? I would then have to do back to back sub-I's july and august next yr, and one would have to be here, and another at my school of choice.

    Ok, NOW lastly, where can I find info on good ENT residencies? I'm a midwest guy and would love to go to Chicago or back up to U of Michigan (my undergrad).
  23. Carbon Klein

    Carbon Klein Senior Member

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    Dude, the fact that you are looking for a reason not to enter neurosurg is reason enuf! You have second thoughts for a reason. Trust your instincts. You have been given a lot of advice, which you asked for. Now take that advice and don't look back. Leave neurosurgery for the fanatics like Minimal and me! You'll sleep better at nights, bro.
  24. ZanMD

    ZanMD Senior Member

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    I have to say my mind has been changed. I'd always had an interest in neurosurgery, but after reading this, I'm extremely doubtful. After all, what good is all that money anyways, if you never have time to enjoy it? I do want to be in a field that I love, but I think the price (for me anyways) is too high. While it may be acceptable while I'm still young, I think if I'm working 100 hours in 20 years I'd burn out.

    Maybe plastics....
  25. Carbon Klein

    Carbon Klein Senior Member

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    You know, most people do neurosurgery because they enjoy the field. The money is nothing compared to what we could earn with our work ethics in other fields (like business). The money is not an issue. If you don't understand what I'm talking about, then you've got your answer, neurosurgery isn't for you, because nothing could scare me away from pursuing my dream of being a neurosurgeon. I probably sound harsh right now, but that's probably what you need to hear. Better now than 8 years from now when you're completely miserable! Good luck!
  26. Carbon Klein

    Carbon Klein Senior Member

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    (Delete this double post, hate it when my computer freezes up and I click the submit button a zillion times)
  27. LaCirujana

    LaCirujana Smoking Gun

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    samsoccer7:

    Since you asked about Michigan.....

    As far as neurosurgery residencies go, UMich is probably one of the cushiest (if ANY neurosurg residency could be called cushy), as well as one of the best. I'm a general surgery resident there, but had to do a month of Neurosurg as an intern. Yeah, everyone still works like crazy and staff has to come in in the middle of the night for the blown aneurysm or whatever, but there's no pre-rounding, rounds are at 6:30am weekdays and 8am on weekends. The attendings are WONDERFUL. They're all just bloody brilliant, love to teach (even we gut surgeons learned a few things) and are some of the best in their field, as well as just plain nice, normal guys (with wives and kids, BTW). You couldn't pay me enough to do their job, but compared to the neurosurgeons where I went to med school (known as an evil NSurg program), they've got a good thing going on. At least from an outsider's perspective, if one were to decide to go into neurosurg, UMich would definitely be a place to seriously consider.

    ENT at Michigan is nothing to sneer at either (I almost typed sneeze and then realized the horrible unintentional pun that would make). Lots of acoustic neuromas--combined w/neurosurg--, facial reconstruction (they take face trauma call along w/plastics and OMFS), head and neck oncology, etc. You really couldn't go wrong here with either specialty, but both are very competitive, top tier programs.
  28. DuneHog

    DuneHog Senior Member

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    Interesting thread. It's nice to hear so many informed replies.

    I have met a few people who chose ENT as a kind of "back door" to neurosurgery. But it's worth pointing out that not every ENT program does a ton of acoustics and the like, and the level of involvement that ENTs have in these cases varies by institution. Also, a fellowship is pretty much manditory of you want to do a lot of skull base stuff in practice. You will get lots of exposure to head and neck oncology and facial trauma at most ENT programs, as this is bread and butter for ENT referral centers. However, most ENTs don't do a lot of head and neck oncology or facial trauma in private practice, because the lifestyle is brutal and the pay is poor. A fellowship in facial plastic surgery is a very appealing option, however this is a competative fellowship in specialty full of people with incredible CVs.

    If you are considering midwest programs, most would agree that U of Michigan is a stronger program than any of those in the Chigago area. However, you will get very good training at almost all of the 100 or so ENT programs. And because ENT is so competative, it is a rare applicant that is able to choose where he or she wants to go.
  29. BusterDO

    BusterDO

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    You have to consider that those estimates are based on a survey. The data isn't likely to be all that accurate; some docs that don't make as much might not respond, others may lie about how much they make, only getting the top tier responses, etc.

    Honestly, I don't know how much an average NS makes, but I have a hard time believing it's in the low $100's. Just based on the hours they have...they would be making $20/hr :rolleyes:.
  30. BusterDO

    BusterDO

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    Where are these numbers coming from? "I know a guy who knows a guy" isn't the best form of substantial evidence. Besides the link you've provided, where is the factual data? i'm not calling :bullcrap:, i'm just one of those guys who likes data.

    Another problem in Penn (right state) is that the malpractice insurance for a NS is through the roof. So some NS may be making close to 500K, but there insurance is around 200K. It's a similar story in NJ (home state), and it isn't limited to NS, a lot of OB/Gyn docs started dropping their OB practice b/c the malpractice was too high.
  31. Chronic Student

    Chronic Student So Fresh, So Clean

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    I have had a different experience.

    I've got a little background, as I was a scrub tech for many years and did a lot of neuro, when I was in PA school I did an elective rotation in a very large academic neurosurgery service and now that I've graduated I work for a private practice neurosurgeon.

    As far as pay goes, he pays me very, very well and we had a semi-retired neurosurgeon that would occasionaly scrub in surgery and see the new patients 20-25 a week, all in the mornings. He was salaried at 300,000 a year. Logic would assume that the primary neurosurgeon made a lot more than that.

    As far as work hours, we are in a smaller city with only 2 neurosurgeons and we take call every other week for a week at a time and get trauma from 100's of miles around. We have clinic on Monday and Friday and operate the other three days of the week. We trade weekend rounds.

    Clinic days usually start at 8 am with rounds in the hospital and clinic starts at 9:30 and we usually finish by four. We cover two hospitals (one is in a sister city 15 miles away) and we, about half the time, have to make rounds over there and we usually tag team it so that one of us is not stuck going all the time. Op days start at 7:30 and we usually finish by 5 or 6 PM and we try and round in-between cases.

    Call is, well call. You never really know when its going to be quiet or when you're going to get trauma and consults out the wazoo. On average I would say we work 50-60 hours a week and we have our occasional 30 and 80 hour weeks.

    My doc has a wife and three kids and one of the real advantages of him having a PA is getting to spend more time with his family. The other neurosurgeon in town has basically the same set-up.

    Just my experience, yours may differ. BTW, I'm not trying to sell you on PA's, but in my experience they do change the equation.

    -Mike
  32. dilated

    dilated Fought Law; Law Won

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    What is call for you? Just when the surgeon goes to the OR you come in to assist? Do you take calls on his inpatients and then refer to him as needed? I assume you can't come in to do ED evaluations because of EMTALA.
  33. Chronic Student

    Chronic Student So Fresh, So Clean

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    Call for me means that I assist at operation, see consults and yes I evaluate patients in the ER.

    Typically what happens is that we will get a call from the ED about a patient and my doc will review the images online and talk with the ER doc and decide if the patient requires his immediate attention or if it can wait.

    If it requires immediate attention we typically both see the patient and I'll basically scribe while he gets the history and physical. I'll then do the H and P and get the consent ready while he calls the OR and puts in orders.

    If it is semi-emergent he will typically send me to see the patient in the ER and I will do the H and P and then call him with my findings. He decides at that point if he wants to operate, admit or discharge to office F/U. At that point I'll get consent if needed and will write orders and do whatever needs to get done to get the ball rolling.

    We have never really told the nurses or docs whether to call me or my doc. The other neurosurgeon in town routes all of his calls through his PA except for emergency calls. As for the calls I get, they tend to be the ones the nurses don't want to disturb the doc for. There are also quite a few calls that require some moderate level of decision making and if I can't answer them or don't feel comfortable I'll call my doc or have them call him.

    In emergency situations I will give orders that I feel comfortable with. For instance, my boss has told me that its never wrong to get a CT and I hold him to it. As an example, a few weeks ago I got a call about a patient we were covering for the other neurosurgeon as he was out of town. Guy had an abscess drained 4-5 days ago and they call me to say that he is bleeding from his wound and that it is copius.

    I figure that its probably a scalp bleeder, but he didn't hire me not to be cautious, so I also ordered a stat CT and went to the hospital a few minutes later to check on him. He's already in the CT scanner when I get there and they start the scan and holy crap he has a huge epidural and like 15 mm of midline shift. I called my boss immediately and told him I was going to call the OR to open a room.

    I guess he trusts me because he said he was on his way and I divert this guy to the ICU which is next to the scanner and have them get IV's, foley and I got phone consent from the wife. This guy starts bradying down and his BP shoots through the roof and he is getting difficult to arouse. Doc is there in 15 minutes and by the time we get him to the OR he is non-responsive. Luckily we got to it pretty quickly and he did fine. I did not save the guys life as the same things would have happened with or without me. However, I did get the ball rolling about as quickly as possible and maybe I saved him from permanent neurologic damage.

    I will also start mannitol, load someone with dilantin or ativan if they are seizing of order BP meds for hypertensive emergencies, etc and then contact my doc.

    As far as EMTALA goes, I do see people in the ER. I do not claim to be an expert on those laws but I thought they were entitled to an evaluation. I did not think that the level of provider was specified. Even if it does the ER doc has evaluated them and I'm the second eval.

    -Mike
  34. latinfridley

    latinfridley

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    You need to chill on the whole salary deal.
    Im assuming you're not in medical school, probably not in college. If that's the case, none of this salary stuff means anything for you. By the time you went through college, med school, residency, things will probably have changed dramatically.
    If you are in med school, you really should take a neurosurgery rotation before jumping the gun and getting excited about salaries.
  35. H_Caulfield

    H_Caulfield Junior Member

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    Oh, yea; clearly in highschool. I'm thinking maybe even middle-school. Last year, just before he decided to do neurosurgery, he was probably set on professional baseball player.
  36. BusterDO

    BusterDO

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    In the end, none of this discussion really matters b/c if you really want to do NS, the pay should be at the bottom of the list.

    If you looked, salary.com compiles a list of data from SURVEYS. Again, you are posed with the problems i mentioned before. The blogs seem a little more legit, but still, anyone can post a blog and claim whatever they want. Most likely that data came from some other surveys which broke it down by region. If you notice, some of those numbers were in the 300K region, i don't know about you, but going from 500K to high 300's is still more than a 100K drop; if that's not a lot of money to you, call me up in the future and hook me up! The job listing just don't look legit at all. Can you honestly think that a residency trained NS will be looking to that type of website for a job; looked shady to me.

    bottom line, i've never heard of a NS not making a good amount of cash, so whether it's 300K or 500K or 1 mil, it's still a lot. They work a ton of hours, a lot of cool procedures and are compensated. Malpractice is high too. Again, i want to emphasize that if money is the motivation for medicine, you are in for a world of hurt.
  37. H_Caulfield

    H_Caulfield Junior Member

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    Yea, that's good information, but what the rest of us are trying to convey is that it's hardly worth talking about. This kid is yelling at me like a 14-year-old girl yells at her first boyfriend when he doesn't stop at her locker after class. If I honored my little, 4th-grade nephew's questions about how to "be a fireman" I'd waste a lot of breath.

    Kid, relax. You'll change your mind about four hundred times by the time you grow up.
  38. -Goose-

    -Goose-

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    You're probably right... then he saw Gray's Anatomy and saw all the chicks that want to sleep with McDreamy... LOL.

    Wait til he gets to see the NS residents with their bags under the eye halfway awake post-call look. That really gets the chicks...
  39. H_Caulfield

    H_Caulfield Junior Member

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    Hmm...let's not make someone go off and "get banned;" what would we have done around here thus far without all 6 of his posts?

    Factors motivating career choice:
    1. Saw (since "Saw" is what being a neurosurgeon is all about. Clearly.)
    2. Easily making over 200k.

    Family guy, he's crazy about you. Don't be surprised if you receive some anonymous love notes during recess tomorrow.
  40. arrhythmia7

    arrhythmia7 New Member

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    Sorry to drop in, but I think you guys are underestimating the salaries substantially (esp. in private practice). I'm in cardiology (not neurosurgery), and offers first year out of fellowship are around 350-375k (after malpractice, overhead, etc.). I know neurosurg. pays quite a bit more than this. The chief neurosurg resident two years ago at my hospital did a spine fellowship and then set up practice in Milwaukee and is pulling in over a million after expenses. Alot of internists are making around 300k in good groups. Preop consultations for cardiologists reimburse about $400, so if you do 3 or 4 of these a day on top of regular practice - the numbers add up. I think you would be hard pressed to find a private neurosurgeon working full-time who is making less than half a mil. Also, don't believe the salary surveys posted online - they contain crap data.
  41. BrainDoc22

    BrainDoc22 Junior Member

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    Don't do it. Neurosurgery hours suck in both, but especially private. You really have to love it and be 150% dedicated to it, not family. Sorry to bust your bubble.
  42. Ligament

    Ligament Interventional Pain Management SDN Advisor

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    Was just popping in here out of curiosity. I'm a pain doc, not a neurosurgeon but have rotated with and worked with my fair share of neurosurgeons. I have nothing but the most respect for them. At the same time I think they are 99% crazy for giving up their family and social lives for their careers. But I do believe that is what it takes. If a HEALTHY family and social life is important to you, do not pursue neurosurgery.
  43. JosephFaecesMD

    JosephFaecesMD

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    Neurosurgery: It's great to make all that money. You can buy your wife the nicest gold-laced lingerie ... so she can wear it with someone else while you are gone all night.
  44. Jackofknives

    Jackofknives

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    oh shut it and get back to work :smuggrin:
  45. drvechman

    drvechman Member

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    By the way, $800,000 is waaaaay high for a neurosurgeon's salary. Academics in California start with Assistant professor at $160-170K, Associate Prof at $200-250K, Full professor gets $250-300K and the chair of my department (who's nationally recognized, on the board of AANS, CNS, ABNS, Journal of Neurosurgery and Neurosurgery) makes about $400,000. Private neurosurgeons that I've worked with, told me that they clear about $300,000 on average, but that's before their overhead, which includes staff salaries and insurance (His insurance was close to $100,000/yr, and that was in 1999, before things got really bad!!!).

    Considering overhead of about 50%, you are suggesting private practice neurosurgeons are making about 150K per year. That is silly. Silly!!
  46. TweetyPie

    TweetyPie `

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  47. wellwell

    wellwell

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    Oxygen please!

    *gasps for air*
  48. Phenomena

    Phenomena

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    thanks to samsoccer7 for asking the big question and to minimalist m and others for their illuminating and well laid out replies. i have quite a ways to go before i reach the stage of choosing my specialty but i've somehow always had my sights set on neurosurgery because
    1. i love the brain and nervous system and i'm intrigued by them
    2. i've always wanted to be a surgeon, due to my love of rebuilding and fixing things
    3. i'm a workaholic and an insomniac of sorts
    so all of my gratitude for a somewhat definitive, resourceful and insightful thread :)
    and i agree absolutely with the poster who said if you're in for medicine for the money, you're in for a world of hurt...nuff said
  49. Surgeonizer

    Surgeonizer Member

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    Dude, neurosurgery isn't THAT bad. Geez! Although it's true that neurosurgery is a demanding field, you can still have a decent lifestyle in the field as a resident and certainly as an attending in academia or private practice. I'm a resident at Michigan and residents here average 70-75 hours/week and get two weekends off every month. Most surgery residents, regardless of specialty, work more than 70 hours per week. The attendings at Michigan are (with one exception) married and have children; they're all very happy and spend plenty of time with their families. Michigan is not unique--I observed very similar circumstances at multiple institutions when I interviewed for residency (Hopkins, Mayo, Vanderbilt, Cincinnati).

    In general, neurosurgeons are paid extremely well relative to their peers in other specialties. The last few years of chief residents at Michigan have gotten jobs with very generous starting salaries. For example, one of the chiefs last year took a job on the West Coast in a highly desirable city with a starting salary of approximately $750K/year AFTER expenses including malpractice. The other chief went to the Southeast for a job that started at $800K/year with the potential of a million plus (again, this salary is after expenses including malpractice). Neurosurgeons may get shafted in California when it comes to money, but this certainly is not the case elsewhere in the country. Neurosurgeons make a lot of money--not as much as they did in the 1980s but they're still generating mucho dinero these days. If you really want the big bucks, you can focus on spine surgery and make 1-2 million per year. And, by the way, spine surgeons don't have to work that much to bring in serious cash--many of them only work 4 days per week.

    Just my $0.02.
  50. Surgeonizer

    Surgeonizer Member

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    One other thing: always take into consideration institutional affiliation when you hear the someone's perspective on neurosurgery. There are some EXTREMELY MALIGNANT institutions out there where residents and faculty work themselves to death and (big surprise) they're toxic as hell. I know of several programs in California that have this reputation, including a program that is frequently listed in the top tier of neurosurgery programs nationwide.

    Likewise, there are some terrible private practice setups in the community where the attendings are miserable. Even so, there are plenty of great practices in the community where neurosurgeons work a reasonable number of hours and get paid well, leaving ample time to spend with their families. If you want to have a decent life, there are plenty of options in neurosurgery that will enable you to have a good life. You can focus on spine surgery or do functional. You can join a decent-sized group practice such that the call schedule is reasonable instead of going into a solo practice where you'll be on call 24:7. You can stay away from level 1 trauma centers where you're gonna be absolutely inundated with head trauma when you're on call. You can hire a PA to help you with the mountains of paperwork and other b.s. You can make $400K/yr instead of $800K by working fewer hours.

    Like all things in medicine, neurosurgery is what you make of it. If you want a decent lifestyle, there are avenues in the field that will enable you to have the lifestyle that you desire. On the other hand, if you want to work 100+ hour weeks for the rest of your life, there are plenty of opportunities in the field for this as well. It's all about your priorities in life.

    The truth of the matter is that neurosurgery is an awesome field and neurosurgeons, in general, truly LOVE what they do. There is nothing more exhilarating in medicine than operating on the human brain. Period. I personally don't mind the idea of working a lot as a neurosurgeon because I love the field. I think many people in neurosurgery would tell you the same thing.

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