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Neurosurgery vs Plastic surgery

Discussion in 'Neurosurgery' started by IooI, Jun 12, 2009.

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  1. IooI

    IooI Member

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    I'm an early 3rd year med student trying to decide what to do here. Since childhood, I've been set on pursuing neurosurgery, but it has recently dawned upon me that I might be more fascinated by "being a neurosurgeon" than "doing neurosurgery." Clearly, there is a dichotomy between public and even self-perception of this job and one's actual duties. Pros for me: I love the ideas of being an expert in one field, working with cutting edge technology, a high guaranteed salary, and admittedly "playing God" (to some extent - and this is me just being honest, not facetious). Cons to me: Limited to CNS (PNS, I've been told, is rarely pursued by neurosurgeons - and if pursued only at highly academic centers), surgeries limited to minimally invasive prodding of jello-like substance for hours on end, work hours, minimal international work (is that truth?)? can I handle the sickest of the sick all day every day (I don't know, can you and does it make you happy?)?

    I've done plastic surgery research for 2 years now (which ironically I did not seek out, long story) and have a solid application in line. However, I have absolutely no inclination to do cosmetics work. I've been told by a senior plastic surgeon that neurosurgery is "just poking around in goo," which sounds flip, but does not seem far from the truth. He said plastic surgery, on the other hand, is the "best" field because of great outcomes, working on every part of the body including muscle, bone, nerve, and blood vessels, capacity for international work, and ability to mold one's career path in any way (in terms of options to sub-specialize, although this quality is not unique to plastics). He mentioned that in the academic setting, there is very little cosmetic work. Pros to me are all of the aforementioned. Cons to me: Cosmetics, public/colleague perception of plastic surgeons, regret for not pursuing neurosurgery, lack of CNS research, don't care for many topics in plastics (intimidated by need for extensive knowledge of anatomy. Don't care for wound healing, breast reconstruction, cosmetics; things that I more or less consider "menial"), some part of me wants to handle life and death situations (is that ego and self-righteousness or genuine compassion? Don't know)

    So I guess my question is, how did you all come to a decision (not necessarily even between plastics and neurosurgery, but any other field you were considering)? Was your decision immediately apparent to you from the get-go? I have heard that it comes down to being able to tolerate bread and butter cases in whatever field you do. Will any of you offer some perspective on that sentiment? What is bread and butter plastics/neurosurgery? What can I do to help myself answer these questions? I've shadowed 2-3 cases in each field but was not particularly impressed (probably since I was just standing in the background for several hours, neither seemed to "click" but then again NOTHING has seemed to "click" for me). I definitely have the dedication to pursue whatever I decide on, but things at this stage in the game seem clear as mud. ANY insight would be appreciated.

    Thanks for the thoughts!

    PS I am qualified to match in either specialty, if that is something that might cause hangups.
  2. IooI

    IooI Member

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    Just for extra info, the two things that REALLY drive me to neurosurgery are Radiosurgery/stereotactic surgery and Endovascular surgery. I am absolutely in love with those fields, but I don't know why because I haven't seen either (I think it's the high-tech, cutting edge aspect).

    But the 12 hr craniotomies and spine surgeries (minus the $$$, obviously) seem a little mundane to me. One could argue that my faves aren't even really surgery... Should this play any role in my decision? In other words, would one be able to deal with the long residency if he/she were not 100% engaged by "typical brain surgery"? Thanks, I know my posts are ridiculously long.
  3. DHT

    DHT The Most Potent Androgen

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    You should seriously take a look at ortho. It has all the pros and none of the cons that you state (in both plastics and neuro).

    I was in the same boat as you starting 3rd year. I thought I wanted to be a neurosurgeon and every other surgical specialty at some point. I changed my mind every 2 weeks and it was very frustrating because I just wanted to make up my mind and put all my efforts into that one specialty. The truth is you will have no clue of what you like the best until you actually see it first hand. Make surgery your 3rd block and rotate through those specialties.

    My experiences:

    Plastics: I HATE HATE HATE wound care. Wounds smell and the people that get the decubs are just going to keep getting more and more until they die a slow painful death. This is not my idea of fun and seems to be a pretty big part of plastics (at least at my institution). I didn't want to do cosmetics. Im sure its nice, but I just never saw myself as a cosmetic surgeon. Things I liked: Great knowledge of anatomy. Intricate surgeries, especially on the face. Large variety being able to operate on any part of the body. Outcomes are good.

    Neurosurgery: Thinking about being a neurosurgeon is much better than being one. They spend countless hours taking care of the sickest, most hopeless patients in the hospital. The outcomes are dismal. Although few and far between, they do get some GREAT saves. Neurosurgery has some of the highest highs and the lowest lows. The lows greatly outweighed the highs for me and in the end would not be enough to keep me going. I would be terribly depressed all the time. I was really not impressed with the anatomy. The brain is TERRIBLE at healing and that is very frustrating to me. I hate seeing people robbed of their humanity, PEGed and Trached at the vent farm. The first crani was amazing, but by the 3rd it had already lost its thrill/novelty and it became more of a hassle especially knowing that the patient is f***ed either way and you will be there for 5 more hours. The Good: You get to call yourself a neurosurgeon, but you will be talking to yourself or your coworkers who are also neurosurgeons because you are working all the time.

    Ortho: Outcomes are great. Trauma is very cool and you put people back together. You get delicate hand surgeries, wide open cases, arthoscopic cases, and fluoro cases. You operate everywhere on the body except for the skull/mandible. Patients are usually healthy which means less BS and what you do really matters to their quality of life. The surgeries are the most fun that I experienced. It is not uncommon for ortho to do split thickness skin grafts and some rotate their own flaps. In the end if you decide you want to do plastics you can do the plastics residency after 5 years of ortho. The patients are usually grateful and you work with the coolest guys (and some girls). The cons: No face.

    Sorry if my description of neuro was harsh, I had a pretty bad couple weeks on that service. I don't know if its like that all the time.
    Lawgiver and Jonassen like this.
  4. Excelsius

    Excelsius Carpe Noctem

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    Very interesting posts here about why not NS. Had never heard about cons other than the long hours in residency.
  5. qmcat

    qmcat Heat

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    Have you looked into neuro-interventional radiology or interventional radiology?
  6. Dimoak

    Dimoak Member

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    I'm not an expert on the matter, but I think that a lot of the time, a large portion of people go through their "Neurosurgery phase", where they're drawn to the "prestige" of being the brain and spine people, working with some of the sickest patients, being some of the "high priority" people on staff, and last but not least, rumors of enormous salaries of graduating residents. But most people will eventually find something they'd prefer overall when they see a bigger picture, which is why many see Neurosurgery as a sort of "self-selecting" field; the people who do decide on it are not only generally competitive numbers-wise, but the thing many of their peers found disenchanting about the field can be the very thing that draws them to it.
  7. JackADeli

    JackADeli

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    You have been giving quite a bit of advice throughout the forums. I think I read you comment on new Interns... I have seen suggestions on treatment, malpractice, etc.... I have read your advice to residency applicants. When potential applicants to residencies have asked the dreaded "what are my chances" question, you even suggested your needing more information on the questioner/s so as to provide better advice.
    It would seem, based on the dates of your prior posts, you would at most be starting your second year of medical school. Can you tell us exactly what your expertise and/or credentials are? Have you even made it into college? Nursing school? Law-school? Medical school? etc???
    Last edited: Jul 10, 2009
  8. Dimoak

    Dimoak Member

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    I have no credentials that I would like to bring up due to concerns about identifiability, nor I have ever been dishonest about what my credentials are. If someone doesn't want to take any of the advice I provided, or give any credence to my opinions, it is certainly their right. If you feel that it is inappropriate for me to continue attempting to give advice or answer questions on this forum, I'll stop. As I've mentioned before, I'm not here to ruffle feathers, and have offered to stop posting before, but was told that wasn't necessary. So if you want me to stop posting here, just let me know and I'll stop posting here.
  9. JackADeli

    JackADeli

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    It is not my place to tell you not to post on an open forum. I am not a moderator or forum authority. I would hope you could show some self-control in the topics you choose to reply to if you are unwilling to honestly disclose the degree to which you lack expertise. For example, I could write in response to a subject in neurosurgery, "I am no expert, but...". Coming from a board certified surgeon that is quite different then coming from an aspiring medical student. There is such a thing as being dishonest through a failure of disclosure and/or ommission.... If you are an honest individual then behave as such.

    Folks come here for a certain level of advice and/or experience. For someone... at best just starting a second year of medical school (and that is in doubt) to not disclose (and suggesting others disclose CV info) while giving advice on the multitude of topics you frequently comment, I believe to be completely innapropriate. Further, for you to pull out a text book or whatever reference and then engaged in sparring type matches on what is or is not appropriate medical care is also innapropriate.

    JAD

    PS:while I have no authority, if it was up to me and/or you would honor my decision, I would ask you depart these forums and not participate further. I would suggest you go to a forum consisten with your credentials.
    Last edited: Jul 10, 2009
  10. Dimoak

    Dimoak Member

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    Fair enough; I will abstain from replying to posts on this forum on matters in which I am not a credentialed expert on. It was inappropriate for me to have done so earlier and deception was not my intent.
  11. greymew

    greymew Junior Member

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    This is too much...

    Dimoak, you may or may not be an expert in anything, but you have every right to participate in these forums.

    JackADeli, your intentions may be genuine, but you are effectively acting like a forum-bully.

    If anyone has questions/comments about neurosurgery that they are hesitant to post, feel free to email me. I'm happy to help and will not put you down.

    -Jason
    [email protected]
  12. Dimoak

    Dimoak Member

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    I appreciate your response, but JAD is accurate in that I have made a lot of posts on these forums and answered many questions even though I was not an authority on the matter, and as such may have deceived many people into thinking I was, which would dilute or invalidate any instances in which I actually did end up helping anyone.
  13. JackADeli

    JackADeli

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    I disagree with your assessment, but you are entitled to your opinion. I made it quite clear I lack any authority in the management of this forum. I did however answer his question as to my ~opinion/position on the individual's participation.

    I frankly find the need for hiding identity a very weak excuse to not provide even rudimentary disclosure when giving what may appear to be authoritative responses... i.e. very easy to say, "I am a liberal arts major" or " I am a PhD" or "I am a nurse" or "I am a NP" or 'I am a PA" or "I am a MS x,y, or z" or "I am a resident".... I also find someone sparring on appropriate therapy without appropriate training to be innapropriate. If you feel that is the position of a bully so be it.... Again, neither you nor I have the authority to preclude any individual from replying.

    just my 0.5
    JAD
    Last edited: Jul 10, 2009
  14. Excelsius

    Excelsius Carpe Noctem

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    Hey, thanks. If you could, it would be great if you answered some of the questions in this thread Neurosurgery Facts, Figures, and Links, otherwise I will e-mail or PM you.

    Thanks,

    X
  15. Docster

    Docster Junior Member

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    I think once the OP has gone through a bit more of 3rd yr, especially after having done 12 wks of surgery and rotating through the different sub-specialties, he'll see that NSGY and plastics are really, really different.

    I'm doing a research fellowship in a neurosurg lab this year after completing my 3rd yr, and I'm becoming more and more confident of applying into NSGY after seeing the field from different perspectives (lab bench, clinic, OR, floor.) I like being in the OR and love all the details of neuroanatomy along with basic neurology stuff. NSGY also has huge research potential.

    I wasn't a fan of gross anatomy at all, which you need to intimately know for plastics. I also didn't like dealing with the decub ulcers, abscesses, etc. that plastics gets in the hospital. Cosmetic plastic surgery, at least facialoplastics that I saw while on ENT, was pretty darn cool, at least the couple of cases I saw.
    Last edited: Jul 14, 2009
  16. Raygun77

    Raygun77

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    if you like radiosurgery, perhaps rad onc is a worthwhile field to consider.

    and i second interventional rad if you like end. neurosurgery
  17. c5212

    c5212 to look fly in scrubs

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    I wouldn't think that it would be particularly enjoyable to someone who wasn't EXTREMELY interested in the brain - especially from a quote your original "post prodding of jello-like substance for hours on end"

    I agree with Raygun77 about rad onc- from your posting it sounds like it might be worth looking in to
  18. Garni

    Garni

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    As a graduating resident in Neurosurgery, I can attest that I have debated all the above regarding different fields. Overall, the anatomy of neurosurgery, the brain, nerves, and cranial structures are the most complex of any body part. The statement that we operate in "Goo" is absolutely not true. Any tool large enough will treat structures like "Goo." Take for example a tree mill, it chomps up tree branches with ease. The reality is that the general tools we use to manipulate the brain must be extremely delicate to respect the different brain structures (i.e. gray matter, white matter, fiber tracts, cranial nerves, pia, arachnoid, etc...) With a fine enough instrument, one can dissect many tumors from the brain without significantly damaging any vital brain structure. The reason many say that the brain anatomy is boring is that they have not delved into its complexities. Once you harness the complex circuitry of the brain, you will be amazed at its capacity and will be humbled with the general lack of knowledge of this most sophisticated computer.

    The trick of neurosurrgery is to use aggressive methods to expose the brain (drills, saws, etc) and then use the most delicate means to protect and preserve the brain itself. This sort of challenge is appealing to a small group of doctors, and is the reason that they spend long hours (and years of training) to study this craft.

    While Neurosurgery does have the lowest lows and the highest highs, depending on which subspecialty you chose, the proportion of both is varied. A cerebrovascular surgeon must tolerate a high morbidity and mortality rate, while a functional neurosurgeon performing deep brain stimulators will rarely lose a patient.

    I recommend anybody interested in the field to spend time with a neurosurgeon in the OR, the ICU, and the clinic to gain a better understanding of the field. It is truly one of the most rewarding in medicine.
  19. medstudent987

    medstudent987

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    Does anyone know the differences between salaries between Neurosurgery and Plastic surgery? I am a third year medical student, interested in surgery, delicate ones (not as much ortho), and probably have enough stats that if i push for one of the fields, i will be able to match. I have seen the differences in the work they do, but i have heard huge rumors and vastly different amounts that each field can make. I was wondering if someone has any insight into the difference between these two fields?
  20. BurghStudent

    BurghStudent lurker

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    The MGMA Physician Compensation Survey may overestimate a little, but the version I have, which I believe is <3 years old, shows that the median salary for NS = $600K and for PRS = $392K
  21. mmmcdowe

    mmmcdowe Duke of minimal vowels Moderator

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    Dont do a neurosurgery residency for the money.
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  22. rigid

    rigid

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    You have seen the differences in the work they do so im assuming you already know which one you prefer and just want to know that you will make a decent living. The answer is YES, you will make lots of money and be comfortable so do whichever one you can see yourself doing for the rest of your life
  23. ram006

    ram006 Godina Complex

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    I'll take 392 and a reasonable lifestyle over 600 and a career of middle of the night emergencies any day of the week...
  24. Serous Demilune

    Serous Demilune

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    Plastics has trauma call too
  25. rigid

    rigid

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    Yes but when compared to NSx they have a lot more stuff you can just give some advice over the phone about and sort out in the morning rather than actually having to come in
  26. Winged Scapula

    Winged Scapula Cougariffic! Administrator SDN Senior Moderator Lifetime Donor

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    You are assuming an academic practice (which is the minority of practice options). In a PP community setting you most certainly are not required to take Trauma call as many hospitals have dropped that medical staff requirement when they realized the surgeons just took their cases elsewhere. You may take trauma call if you do desire bot of my friends doing PRS, none of those on PP take trauma call.
  27. ram006

    ram006 Godina Complex

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    Surely you're not comparing plastics trauma call and NS...
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  28. Jonassen

    Jonassen Too pale

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    Ortho has trauma call too. Or rather, "all the trauma that can wait until tomorrow" (aside from pelvic fxs and compartment syndrome).

    Not at all in the same league as neurosurgery.
  29. Lawgiver

    Lawgiver

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    Old but great thread, very interested in surgery and this thread has lots of new bits of info that I hadn't heard about.

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