Orthopaedics vs. Neurosurgery

[adrexel]

Is anybody else having this same dilemma? And, if so, why did you choose one over the other. Input would be greatly appreciated.

---

Members don't see this ad.

 

[CutIt]

Similar dilemma here, except it's between ENT and Neurosurgery for me.

 

[edmadison]

Orthopaedics vs. Neurosurgery? Didn't Neurosurgery win by a TKO in the 11th round?


But seriously folks, I have the same problem but its Ortho vs. Critical Care. Take a step back and think about why you like each one, why you might not like each one. Then think about what you want in life and compare. It sounds easy but I know its not.

Personally, I'd go for Neurosurgery. Think about this conversation:

Hot Chick in Bar: "What do you do?"

CutIT: "I'm a Brain Surgeon."

Hot Chick: "Take Me!!!"

As opposed to this one:

Sweaty 300 lb. Football Player: "Ugh, leg hurts!"

CutIT: "Hmm, better get and X-ray -- GRUNT"

Football Player: "Thanks -- Ugh"

-----

Ed

 

[ArrogantSurgeon]

Originally posted by edmadison
Personally, I'd go for Neurosurgery. Think about this conversation:

Hot Chick in Bar: "What do you do?"

CutIT: "I'm a Brain Surgeon."

Hot Chick: "Take Me!!!"
Ed

edmadsion, it will more likely go down like this:


Semi-good looking nurse (SGLN) at 2:45 AM: "Hey"

You: "Hi"

SGLN: I see you quite a bit around the hospital.

You: "I'm a neurosurgeon, I live here"

SGLN: "Wasn't that new 80-hour per week rule supposed to change things?"

You: "HA HA!! Very funny...can we get serious now because I've been up for the last 39 hours and I'm in no mood for jokes."

SGLN: "Oh sorry...what did you become a neurosurgeon?"

You: "I thought it would be cool to operate on brains, plus I thought I could get loads of hot chicks whenever I wanted."

SGLN: "Did it turn out how you imagined it would?"

You: "Well I do operate on brains, but you're the first semi-good looking girl I've had the time to talk to since I started residency and moved into the hospital."

 

[gibna]

So what happened next? did the neurosurgeon commit suicide?

 

[Jova]

Hi Adrexel,

I'll give you my take on the issue--personally, I do not think this should even be a dilemma because the two fields are quite different.

#1 For neurosurgery, you need to love the brain. This is essential. A true passion for neuroscience and "how the brain works" is an absolute must. Also you must enjoy taking care of sick people. . . this is not the same as of becoming a physician and wanting to treat sick people, rather in neurosurgery, this means caring for a patient population where end-of-life decisions can be the daily norm (varies with subspecialty), i.e. they are often very, very sick and die despite your best efforts, or have a poor quality of life. This can be stressful for anybody, even more so when done on a daily basis; it takes a certain type of person to do this daily for forty or so years, and love what they do.

#2 For ortho you need to like bones, et. al. It is a lot of "physical" surgery that can sometimes be a bit of a workout. In ortho you get to fix things, and once you are done, unlike neuro, they are usually "fixed" (the patient is usually going to live). In general you would be treating a more relatively healthy patient population who have injuries to there bones, joints (like athletes, accident victims, etc). Although there would be some tumor work as well, again depending on how you choose to focus your eventual practice.

#3 Spine surgery. That is the question. I say if you truly like spine surgery, and that is why you are experiencing a dilemma, do ortho, do ortho, do ortho! Both ortho and neuro can do spine. Also there are spine fellowships for both. Most neurosurgeons do a lot of spine, but that is not why they choose neurosurgery (granted there are some who actually really like spine).

#4 So I guess my point is that both specialties are quite different. Choose your field based on a solid understanding of the kind of work you would be doing most of the time (i.e., do you better enjoy "bread and butter" ortho cases or neuro cases). If you are interested in spine, either field works, so definitely choose the field based on the other types of cases and patients you would be seeing on a daily basis. If you do not think the brain is the most interesting and beatiful organ in the body, do not do neurosurgery. Also ortho tends to have a much better lifestyle.

I hope that was helpful. . . I tried to write it as neutral as possible, without adding my own personal bias toward my absolute favorite field!

Jova

 

[ortho2003]

I disagree that you absolutely have to love the brain to be a neurosurgeon. I spent a month with a community neurosurgeon and the closest I got to the brain was a C2-3 fusion. Your average community neurosurgeon gets close to the brain maybe a couple times a month.

Now, if brain is your thing, you definitely won't get that with ortho, but the practice of a community neurosurgeon and a community ortho spine surgeon is nearly identical. Lumbar lammies, lumbar fusions, and cervical fusions all day every day.

The difference comes to your call. What do you want to do when you are on call? Do you want to rod a femur, plate and ankle, and set a few fractures? Do you want to do craniotomies and take care of cauda equina syndrome. Honestly, in the community call for the ortho spine is probably busier than the neurosurgeon, but when the neurosurgeon gets called in, it is typically life and death. Only occassionally will your ortho call be life and death.


If you aspire to be an academic, then this post is useless, but make sure you realize that life in the real world is much different than life in a major academic center. Community neurosurgeons aren't taking out brain tumors every day, just like community orthopods are doing complicated tumor cases and total femurs every day. Those cases go to the major academic centers. The community guys do the bread and butter.

 

[adrexel]

Thanks for the input Jova and ortho2003. My interest is actually in spine surgery. So, the question is which residency will better prepare a person to treat bread and butter conditions of the spine. I plan to complete a fellowship in spine either way and be in private practice after I finish. Further input would be greatly appreciated.

 

[ortho2003]

If you are interested in only spine surgery, then ortho is probably the way to go. The residency is a little less taxing and you can do all the spine you want. Lamies, fusions, scoliosis, etc...

 

[orthoneuro]

If you are interested in only spine surgery, then ortho is probably the way to go. The residency is a little less taxing and you can do all the spine you want. Lamies, fusions, scoliosis, etc...

I also have the same dilemma. Is ortho residency and lifestyle afterwards really all that better than neurosurgery? If you take call as an orthopod don't you get killed by the trauma? I mean every single MVA that has broken bones, you will be IT for any surgery that needs to be done...not every MVA has a CHI that needs to be assessed by a neurosurgeon...

so which do you think has the quieter call nights..ortho or neuro?

 

[kinetic]

so which do you think has the quieter call nights..ortho or neuro?

Derm.

 

[orthoneuro]

Derm.

while dermatology sounds nice...I'd rather have my left nut chopped off by a chainsaw than be a pimplepopperMD just kidding..well maybe not

 

[Idiopathic]

while dermatology sounds nice...I'd rather have my left nut chopped off by a chainsaw than be a pimplepopperMD just kidding..well maybe not

Ill go out on a limb and say that those priorities could use a little tweaking.

Id pop zits for free for the next 10 years to AVOID having my left nut chopped off...God forbid it should come to that.

 

[johnny_blaze]

Why spine? Do vascular surgery instead… it just sounds cooler. Say it with me now “vascular surgery”

That was cool

 

[doc05]

another thing to consider is that your priorities now may not be the same 5 years down the road. Are you really that excited about SPINE?? Will that remain your #1 priority? You may be tired after a grueling residency and just want to go out into practice. So if the fellowship thing doesn't work out, which bread-and-butter cases would you rather deal with??

 

[orthoneuro]

another thing to consider is that your priorities now may not be the same 5 years down the road. Are you really that excited about SPINE?? Will that remain your #1 priority? You may be tired after a grueling residency and just want to go out into practice. So if the fellowship thing doesn't work out, which bread-and-butter cases would you rather deal with??

I'm a pretty big, strong guy and enjoy the physicality of ortho...however, at the same time I also enjoy the very delicate and precise nature or neuro...I guess it's gonna come down to a coin toss...no wait, I'll still gotta think this over...geez

 

[Soon2BENT]

i feel that pain of those deciding which surgery to do. i my self am stuck between Ortho, ENT, and Gen Surg. Seems like Ortho would be fun, especially since I would love to treat sports related injuries. ENT does interesting things as far as Head/Neck oncology and plus it has such a plush lifestyle. My con for ENT is that alot of Peds is involved and i'm not the hugest fan of Peds. Gen Surg is definitely cool and affords a wide variety of fields to get invovled in (ie, lapro, CT, Surg. Onc., etc.). I'd like anyone elses input if interested. I realize Neuro is mentioned on this thread, but I've just never had an interest. Maybe I'm not seeing the light.

 

[doc05]

i feel that pain of those deciding which surgery to do. i my self am stuck between Ortho, ENT, and Gen Surg. Seems like Ortho would be fun, especially since I would love to treat sports related injuries. ENT does interesting things as far as Head/Neck oncology and plus it has such a plush lifestyle. My con for ENT is that alot of Peds is involved and i'm not the hugest fan of Peds. Gen Surg is definitely cool and affords a wide variety of fields to get invovled in (ie, lapro, CT, Surg. Onc., etc.). I'd like anyone elses input if interested. I realize Neuro is mentioned on this thread, but I've just never had an interest. Maybe I'm not seeing the light.

think about where you want to live. There are many more G-surg spots than Ortho or ENT, and it's likely you'll have a better chance at going to/staying in a particular geographic region if that is important to you.

as far as lifestyle goes, remember that you can tailor your practice to what you want. Ortho can mean lots of trauma; ENT can be cush, but if you're doing tons of H/N cancer surgery, you'll have long hours and very sick patients. General surgery offers the widest variety as far as subspecialty options, but the downside is that it takes longer when you consider fellowship, which is less common in Ortho or ENT.

 

[Pir8DeacDoc]

I've found that I have a really tough time with chronic pain management. I wonder if it's different at other places?? Where I am, the orthpods and neuro guys spend a lot of time following up with lumbar fusion folks or DJDers that just always seem to hurt. Maybe I'm focusing too much of my energy on specific patients and not noticing all the happy success stories?? Anyone have thoughts on this?

BTW, I hope this doesn't come across as me bashing either field, I have the utmost respect for ortho and neuro. Just wondering out loud really. I wish you guys all the best in deciding what you want to do!

 

[doc05]

managing chronic pain is a huge problem in a ton of specialties, from ortho to neurosurg, to IM. Sometimes surgery works great, sometimes not. If you've tried and can't effectively manage their pain, I suggest you refer your patients to a pain specialist.

 

[undecided05]

Pir8... I totally agree with your post. A lot of spine sugery is chronic pain/workman's comp. This turns off so many of the ortho people to spine. Just say with me now in your best patient voice... "will you sign my disability?"

As for the OP, I've heard from many a people that if you want to do Spine surgery, be solid at it, and willing to make a bigger sacrifice, you may be better off doing neurosurgery. The reason for this is that many ortho programs tend not to focus on Spine as an important rotation. With most programs, you will get most of your spine exposure on Pedi Ortho. With neurosurgery, you are more comfortable doing the spine approaches becuase you will do them more often and from what I've heard... quicker with less blood loss.

Just my $.03 from others.

 

[Pir8DeacDoc]

Good point Doc05... I have noticed that many of the docs that I work with do indeed refer their patients to the pain clinic. I muse on this only because at one point I really considered that ortho was a career that I would love. I got turned off by the patient population that I saw on my junior clerkship. I really do just get the willies when it comes to worker's comp and disabilty. I feel as though I'm jaded to these folks and I'm only 2/3 done with my MS-3 year. It's definitely something that I need to work on. Sorry for the rant, just something that's on the brain today for some reason

 

[orthospine]

I'm an ortho pg3 right now. Just finished my spine rotation (first of 2) and loved it, looking for fellowships right now. I'll give my meandering opinions of some of the things I've read here.

In college I thought I wanted to be a neurosurgeon. It seems glamorous, cool surgeries, operate on the brain (oooohhhh woww!). Then I got to med school and met some neurosurgeons. Probably the most miserable group of people I've ever met personally. Not that they weren't cool guys, many of them are. But they never leave the hospital and they get their dicks kicked in constantly while there, both from their attendings and their patients and families. Some people can tolerate that, I found I was not one of them. Then there is the whole "brain surgeon" thing. Unless you do academics, you won't be a brain surgeon. Almost all private practice neurosurgeons do a lot of spine to pay the bills while waiting for that next craniotomy to come around. If you don't like spine surgery, run from neuro or do it and go into academics. The other things I got tired of in neurosurg were: patients really sick, requiring lots of attention (i.e. not operating), patients frequently die as noted by others here, patients who are "successes" still fare pretty poorly as human beings they're just not dead in many cases.

The things I liked about ortho have already been noted: healthy patients in general, they get better in general, very problem focused (if it's broke fix it, if not then break it and fix it), lots of cool technology and toys to play with, the money is great, the lifestyle can be great.

Since I'm half way done with my residency I'll share some of the good and bad that I could not have known prior to matching in ortho.

Bad: people with orthopaedic problems hurt, and will use their voices/family/attorneys/work comp agents to hurt you. Contrary to some people's beliefs this is in NO way isolated to the spine clinic. Old people with arthritic hips complain and many continue to complain after they get a shiny new one. Athletes complain. I laugh my ass off at all these guys who drool over the opportunity to take care of athletes. If you want unrealisitic, noncompliant, whiny little pains in the ass in your clinic then pursue athletes as patients. They always expect their limb/joint to function as "new" in a very short time without putting forth all the rehab effort they should. Personally I have found these people to be very ungrateful and not fun at all to care for. Obviously not everyone feels this way.
All areas of ortho see the work comp/disability crap. You can't avoid it. You just have to decide if you're going to deal with it or not. You CAN flatly refuse to see work comp and simply refuse to do disability assessments. It's easy, just say no. Work comp pays really well though, so if you can tolerate those people then ring the cash register and buy that bigger boat you've been looking at.

Malpractice for ortho is terribly expensive and worsening in most geographic areas similar to neuro.


Good stuff: we are in huge demand and it is only going to increase in coming years. The supply of orthopedists has been tightly regulated for decades by some very savvy dudes, and the job market is incredibly good. There are opportunities virtually everywhere in the US.
The surgery is really fun. If you like anatomy and understanding how to reconstruct aberrant anatomy to near normal with all sorts of tools and implants, then you'd have fun in ortho.
If you like research, there is limitless opportunity for ortho research. The literature in ortho is relatively young with few good controlled trials to rely on in many areas. An interested researcher could go far easily.

As for spine:
There is a great deal of overlap in Neuro and Ortho spine practice. In general ortho guys don't go in the blue water balloon (there is nothing worth seeing in there any way). So if intradural tumors are your thing then don't do ortho. Ortho guys are generally more comfortable with instrumentation, at least at first, because of their background with hardware going into bones. But now most neuro residencies probably have spine guys doing a lot of instrumentation. Overall the difference in practice probably breaks down to: neuro does more tumor, ortho does the vast majority of deformity cases (scoliosis, spondylolisthesis, kyphosis, etc). If you're doing private practice this difference is negligible.

Some people point to "bread and butter" as the difference. I'm not sure that is true. Sure, if you are in a small group of orthopods and take call at a busy trauma center you'll have to do the occasional femur or washout in the middle of the night. But most community surgeons arent covering the war zone type ERs that we do in training. If you do a spine fellowship in ortho and join a group with a big enough referral base, you can distill down to almost 100% spine fairly quickly. Or if you like general practice with some spine you can do that. The more frequent complaint I have heard from guys is that once you are labeled as the spine guy you get all spine and your general practice dries up. I would say that post residency the lifestyles of NSG vs ortho are very close except in bigger cities with level I/II trauma centers. In those centers the private orthopedist can get spanked with trauma where the NSG would not.

One last thing. There is no question whatsoever that ortho residencies offer better lifestyles than Neurosurg. There will be isolated examples where that is not the case, but across the board neurosurg residents grab their ankles for 6 or 7 years. My own residency is very kind and gentle since the 80 hour thing. I am averaging in the 50s this year, but it has hurt our case experience some. That is a whole different topic.

Not sure if any of this was helpful, but I'm on call and bored.

 

[MD Dreams]

It was very helpful, thank you.

 

[GMO2003]

I'm an ortho pg3 right now. Just finished my spine rotation (first of 2) and loved it, looking for fellowships right now. I'll give my meandering opinions of some of the things I've read here.

In college I thought I wanted to be a neurosurgeon. It seems glamorous, cool surgeries, operate on the brain (oooohhhh woww!). Then I got to med school and met some neurosurgeons. Probably the most miserable group of people I've ever met personally. Not that they weren't cool guys, many of them are. But they never leave the hospital and they get their dicks kicked in constantly while there, both from their attendings and their patients and families. Some people can tolerate that, I found I was not one of them. Then there is the whole "brain surgeon" thing. Unless you do academics, you won't be a brain surgeon. Almost all private practice neurosurgeons do a lot of spine to pay the bills while waiting for that next craniotomy to come around. If you don't like spine surgery, run from neuro or do it and go into academics. The other things I got tired of in neurosurg were: patients really sick, requiring lots of attention (i.e. not operating), patients frequently die as noted by others here, patients who are "successes" still fare pretty poorly as human beings they're just not dead in many cases.

The things I liked about ortho have already been noted: healthy patients in general, they get better in general, very problem focused (if it's broke fix it, if not then break it and fix it), lots of cool technology and toys to play with, the money is great, the lifestyle can be great.

Since I'm half way done with my residency I'll share some of the good and bad that I could not have known prior to matching in ortho.

Bad: people with orthopaedic problems hurt, and will use their voices/family/attorneys/work comp agents to hurt you. Contrary to some people's beliefs this is in NO way isolated to the spine clinic. Old people with arthritic hips complain and many continue to complain after they get a shiny new one. Athletes complain. I laugh my ass off at all these guys who drool over the opportunity to take care of athletes. If you want unrealisitic, noncompliant, whiny little pains in the ass in your clinic then pursue athletes as patients. They always expect their limb/joint to function as "new" in a very short time without putting forth all the rehab effort they should. Personally I have found these people to be very ungrateful and not fun at all to care for. Obviously not everyone feels this way.
All areas of ortho see the work comp/disability crap. You can't avoid it. You just have to decide if you're going to deal with it or not. You CAN flatly refuse to see work comp and simply refuse to do disability assessments. It's easy, just say no. Work comp pays really well though, so if you can tolerate those people then ring the cash register and buy that bigger boat you've been looking at.

Malpractice for ortho is terribly expensive and worsening in most geographic areas similar to neuro.


Good stuff: we are in huge demand and it is only going to increase in coming years. The supply of orthopedists has been tightly regulated for decades by some very savvy dudes, and the job market is incredibly good. There are opportunities virtually everywhere in the US.
The surgery is really fun. If you like anatomy and understanding how to reconstruct aberrant anatomy to near normal with all sorts of tools and implants, then you'd have fun in ortho.
If you like research, there is limitless opportunity for ortho research. The literature in ortho is relatively young with few good controlled trials to rely on in many areas. An interested researcher could go far easily.

As for spine:
There is a great deal of overlap in Neuro and Ortho spine practice. In general ortho guys don't go in the blue water balloon (there is nothing worth seeing in there any way). So if intradural tumors are your thing then don't do ortho. Ortho guys are generally more comfortable with instrumentation, at least at first, because of their background with hardware going into bones. But now most neuro residencies probably have spine guys doing a lot of instrumentation. Overall the difference in practice probably breaks down to: neuro does more tumor, ortho does the vast majority of deformity cases (scoliosis, spondylolisthesis, kyphosis, etc). If you're doing private practice this difference is negligible.

Some people point to "bread and butter" as the difference. I'm not sure that is true. Sure, if you are in a small group of orthopods and take call at a busy trauma center you'll have to do the occasional femur or washout in the middle of the night. But most community surgeons arent covering the war zone type ERs that we do in training. If you do a spine fellowship in ortho and join a group with a big enough referral base, you can distill down to almost 100% spine fairly quickly. Or if you like general practice with some spine you can do that. The more frequent complaint I have heard from guys is that once you are labeled as the spine guy you get all spine and your general practice dries up. I would say that post residency the lifestyles of NSG vs ortho are very close except in bigger cities with level I/II trauma centers. In those centers the private orthopedist can get spanked with trauma where the NSG would not.

One last thing. There is no question whatsoever that ortho residencies offer better lifestyles than Neurosurg. There will be isolated examples where that is not the case, but across the board neurosurg residents grab their ankles for 6 or 7 years. My own residency is very kind and gentle since the 80 hour thing. I am averaging in the 50s this year, but it has hurt our case experience some. That is a whole different topic.

Not sure if any of this was helpful, but I'm on call and bored.

hmm..I'm leaning more and more toward ortho with spine fellowship...I guess, my gut will have to lead me to the specialty I was to pursue..I hope

 

[Bombrainiac]

I'm an ortho pg3 right now. Just finished my spine rotation (first of 2) and loved it, looking for fellowships right now. I'll give my meandering opinions of some of the things I've read here.

In college I thought I wanted to be a neurosurgeon. It seems glamorous, cool surgeries, operate on the brain (oooohhhh woww!). Then I got to med school and met some neurosurgeons. Probably the most miserable group of people I've ever met personally. Not that they weren't cool guys, many of them are. But they never leave the hospital and they get their dicks kicked in constantly while there, both from their attendings and their patients and families. Some people can tolerate that, I found I was not one of them. Then there is the whole "brain surgeon" thing. Unless you do academics, you won't be a brain surgeon. Almost all private practice neurosurgeons do a lot of spine to pay the bills while waiting for that next craniotomy to come around. If you don't like spine surgery, run from neuro or do it and go into academics. The other things I got tired of in neurosurg were: patients really sick, requiring lots of attention (i.e. not operating), patients frequently die as noted by others here, patients who are "successes" still fare pretty poorly as human beings they're just not dead in many cases.

The things I liked about ortho have already been noted: healthy patients in general, they get better in general, very problem focused (if it's broke fix it, if not then break it and fix it), lots of cool technology and toys to play with, the money is great, the lifestyle can be great.

Since I'm half way done with my residency I'll share some of the good and bad that I could not have known prior to matching in ortho.

Bad: people with orthopaedic problems hurt, and will use their voices/family/attorneys/work comp agents to hurt you. Contrary to some people's beliefs this is in NO way isolated to the spine clinic. Old people with arthritic hips complain and many continue to complain after they get a shiny new one. Athletes complain. I laugh my ass off at all these guys who drool over the opportunity to take care of athletes. If you want unrealisitic, noncompliant, whiny little pains in the ass in your clinic then pursue athletes as patients. They always expect their limb/joint to function as "new" in a very short time without putting forth all the rehab effort they should. Personally I have found these people to be very ungrateful and not fun at all to care for. Obviously not everyone feels this way.
All areas of ortho see the work comp/disability crap. You can't avoid it. You just have to decide if you're going to deal with it or not. You CAN flatly refuse to see work comp and simply refuse to do disability assessments. It's easy, just say no. Work comp pays really well though, so if you can tolerate those people then ring the cash register and buy that bigger boat you've been looking at.

Malpractice for ortho is terribly expensive and worsening in most geographic areas similar to neuro.


Good stuff: we are in huge demand and it is only going to increase in coming years. The supply of orthopedists has been tightly regulated for decades by some very savvy dudes, and the job market is incredibly good. There are opportunities virtually everywhere in the US.
The surgery is really fun. If you like anatomy and understanding how to reconstruct aberrant anatomy to near normal with all sorts of tools and implants, then you'd have fun in ortho.
If you like research, there is limitless opportunity for ortho research. The literature in ortho is relatively young with few good controlled trials to rely on in many areas. An interested researcher could go far easily.

As for spine:
There is a great deal of overlap in Neuro and Ortho spine practice. In general ortho guys don't go in the blue water balloon (there is nothing worth seeing in there any way). So if intradural tumors are your thing then don't do ortho. Ortho guys are generally more comfortable with instrumentation, at least at first, because of their background with hardware going into bones. But now most neuro residencies probably have spine guys doing a lot of instrumentation. Overall the difference in practice probably breaks down to: neuro does more tumor, ortho does the vast majority of deformity cases (scoliosis, spondylolisthesis, kyphosis, etc). If you're doing private practice this difference is negligible.

Some people point to "bread and butter" as the difference. I'm not sure that is true. Sure, if you are in a small group of orthopods and take call at a busy trauma center you'll have to do the occasional femur or washout in the middle of the night. But most community surgeons arent covering the war zone type ERs that we do in training. If you do a spine fellowship in ortho and join a group with a big enough referral base, you can distill down to almost 100% spine fairly quickly. Or if you like general practice with some spine you can do that. The more frequent complaint I have heard from guys is that once you are labeled as the spine guy you get all spine and your general practice dries up. I would say that post residency the lifestyles of NSG vs ortho are very close except in bigger cities with level I/II trauma centers. In those centers the private orthopedist can get spanked with trauma where the NSG would not.

One last thing. There is no question whatsoever that ortho residencies offer better lifestyles than Neurosurg. There will be isolated examples where that is not the case, but across the board neurosurg residents grab their ankles for 6 or 7 years. My own residency is very kind and gentle since the 80 hour thing. I am averaging in the 50s this year, but it has hurt our case experience some. That is a whole different topic.

Not sure if any of this was helpful, but I'm on call and bored.

This information could not be more misleading, but it's coming from a PGY-3 in ortho, so take it with many grains of salt. To clarify a few hilariously inaccurate points that this guy is saying while on he was call and bored…

Neurosurgeons spend 7 hard years training in an environment that is simply unparalleled in any other specialty. You don't get to say your a neurosurgeon and not pay your dues. Neurosurgeons do not need to do spine fellowships to do spine, although some do one anyway in order to get an academic position in a neurosurgery department. These days, neurosurgery residents are doing in-folded fellowships during their residency training. Over the course of 7 years, a neurosurgery resident will have logged MANY more spine cases than a fellowship trained ortho spine surgeon and even an ortho spine surgeon who has been in practice for a couple of years doing only spine surgery. The reason is simple math; 7 years of training x 50-60% spine. Additionally, neurosurgeons do a TON of bone work and much more delicate BONE work than orthopedic surgeons. Try drilling down the posterior clinoid process with a diamond drill bit and a low-riding basilar tip aneurysm a couple of millimeters away. Nuff said. Also, the skull happens to be made out of bone and has a much more complex outer and inner surface than long bones. For an ortho PGY-3 resident to say that there's nothing worth seeing in the "blue water balloon" is simply comical; that's like saying driving a Bugatti Veyron is not that exciting from a guy who drives a Toyota and has never even sat in a Bugatti. Neurosurgeons are licensed to go intradural and ortho spine surgeons simply cannot, so they NEVER go into the "blue water balloon." Intradural work is amazing, but you've got to complete neurosurgery residency to have that privilege. Also, most ortho guys don't do cranio-cervical junction work.

As for trauma: trauma call for neurosurgeons AND orthopedic surgeons can be brutal. Trauma I centers have to have a neurosurgeon on call in order to obtain/maintain their Trauma I status and get state funding. They have to have a neurosurgeon on call BY LAW. If the neurosurgeon drops their service, the center literally has to go on trauma diversion.

Lifestyle in training: To anyone who is worried about their lifestyle while they're training in a surgical specialty as demanding as orthopedic surgery or neurosurgery, you should just stop and think for a minute about the level of expertise you need to gain that will last you for your entire career. You have one chance to train--there are no shortcuts. The ortho-3 resident is correct in recognizing that 50-hour weeks affect training experience. And, in the real world, you'll be hustling, so just get used to long hours and managing your time to be as efficient as possible. Neurosurgery training is built to break you, and build you back up into something stronger. Not everyone makes it through--the attrition rate is high. I know miserable neurosurgeons and happy neurosurgeons, just like I know miserable cardiologists and happy cardiologists, miserable arthropods and happy ones, and miserable plastic surgeons and happy ones. Welcome to medicine and the real world -- if you go into your specialty for the love of what you do, and if you're a happy person, guess what? You'll be happy. There are hard times during the training process without a doubt, but that's part of the training, and it is designed with a purpose. Personally, I loved my residency training; not all of it all the time, but that's life.

I won't bash on this ortho-3 guy too much, because he has shared some developmentally salient points and some of what he's saying is in fact true and beyond his years of training, so he's clearly a smart guy and has done good homework. Neurosurgery is a hard field to get to know -- it's not a required rotation in medical school, and even on rotation, it takes a while to gain enough knowledge to actually know what the hell is going on when you look at an angiogram, or an MRI brain, or a peripheral nerve case with the brachial plexus splayed out in front of you.

Neurosurgery and orthopedic surgery are vastly different fields. The coffee table/party line of "I'm a brain surgeon" wears off quickly and the training is hard, to say the least. Neurosurgeons operate all over the body and they see ridiculous pathology. It's a lot of fun, BUT the road to neurosurgery will never be paved with 50-hour work weeks.

Orthopedic surgeons do amazing work and they are extremely well-trained; their standard of excellence is high, and most of them are quite happy with their field. The ones who do spine end up doing mostly spine, but can still float some general orthopedic cases. The fact is that there are a LOT of spine patients out there, so that population keeps both the ortho spine guys and the neurosurgeons plenty busy with enough work to go around (it also helps that we do 28 times more spine fusions in the US than in Europe, but that's a topic for another discussion).

 

[KinasePro]

These days, neurosurgery residents are doing in-folded fellowships during their residency training. Over the course of 7 years, a neurosurgery resident will have logged MANY more spine cases than a fellowship trained ortho spine surgeon and even an ortho spine surgeon who has been in practice for a couple of years doing only spine surgery. The reason is simple math; 7 years of training x 50-60% spine.

Sorry, but this is complete bullsh1t. The ACGME median total # of adult spine cases scrubbed by chief year for neurosurgery residents is 275 vs 160 for ortho. Ortho spine fellowship case loads range from 300 too 500. In one study by both neuro and ortho surgeons, the authors conclude: "Thus, before entering independent practice, when compared with neurosurgery residents, most orthopedic spine surgeons complete as many spinal procedures or more..."

(source: http://www.ncbi.nlm.nih.gov/pubmed/25471922 )

Ortho spine surgeons are often exposed to a higher, more complicated extra-dural spine volume in 1 less year of training than neurosurgery. They also take the lion share of pediatric and deformity cases... If you have no interest in intracranial surgery, ortho seems to be the better choice for spine training.

 

[Bombrainiac]

Sorry, but this is complete bullsh1t. The ACGME median total # of adult spine cases scrubbed by chief year for neurosurgery residents is 275 vs 160 for ortho. Ortho spine fellowship case loads range from 300 too 500. In one study by both neuro and ortho surgeons, the authors conclude: "Thus, before entering independent practice, when compared with neurosurgery residents, most orthopedic spine surgeons complete as many spinal procedures or more..."

(source: http://www.ncbi.nlm.nih.gov/pubmed/25471922 )

Ortho spine surgeons are often exposed to a higher, more complicated extra-dural spine volume in 1 less year of training than neurosurgery. They also take the lion share of pediatric and deformity cases... If you have no interest in intracranial surgery, ortho seems to be the better choice for training.

No need to get angry, especially since your facts are still incorrect despite you citing an article. You should actually read your own source. It states clearly that neurosurgical residents do more than double the spine cases as ortho residents, and this number is more consistent across all residency programs surveyed. There are also numerous other articles that conclude that neurosurgeons get more spine training. Read those, too. It's widely known. Ask any ortho spine surgeon, or better yet, just ask your ortho chairman or program director. This is not some secret that ortho spine surgeons try to hide from residents.

As for scoliosis, ortho spine fellowship trained surgeons do more. Neurosurgery just hasn't ever seemed to jump onto the scoliosis surgery bus, and if you do these (pediatric cases), you either love them or hate them. I personally like them, but can't see myself doing them regularly, especially with how incredibly time-consuming these surgeries ca. Be. Also, you need a GIGANTIC referral base to have a purely deformity practice (real deformity, not grade 1 or 2 spondys).

As for the article quoting 300 to 500 cases done in fellowship, the source of this number is unreliable, AND, this includes all spine procedures, which no doubt includes tons of bread and butter cases that don't have a lot of value in fellowship training.

And as for you just making up the idea that ortho spine surgeons are exposed to more complicated extradural work, that's just ignorant. There's nothing more complicated and delicate in the spine than doing extradural spine work when there's intradural pathology, and last I checked, the bone is the same whether it's a neurosurgeon or ortho spine surgeon operating. Scoliosis surgery is long, can be complicated, but not as greuling as adult scoli, and, you are correct that pediatric ortho spine surgeons do the lion's share of that work.

The article itself is based on ACGME case logs, which are wholly inaccurate. It's also published in an orthopedic NON-SPINE journal. Ha ha ha. You've GOT to evaluate your sources, my friend.

Look, it's not a pissing contest. In practice ortho spine guys and neurosurgeons who do mostly spine have essentially identical practices with the Neuro guys doing intradural work and more craniovertebral junction work. I've worked with both and there's lots to learn from both. There's so much cross pollination in the training with Neuro guys and ortho guys training each other that the result is spine surgeons are all learning the same stuff in the end. The more training you have, the better. Period.

If you want to do spine and stay extradural, ortho spine sems like the less painful route and you'll be well-trained. If you want to go intradural and enjoy cranial work, then you'll have to become a neurosurgeon. Personally, I love spine surgery. It's not too stressful, the patients can be painful, but altogether have good outcomes, and the cases can be efficient. There are tons of patients out there who need spine surgery. But, I must say, when it comes to seeing patients in my office who want second opinions, there's lot of weight behind the fact that I'm a neurosurgeon. I almost always agree with my colleagues in ortho spine and, in fact, I work with ortho spine surgeons in my practice.

It's a personal choice whether to do ortho spine or neurosurgery. The differences abound in each field, so just figure out what you want.

 

[KinasePro]

No need to get angry, especially since your facts are still incorrect despite you citing an article. You should actually read your own source. It states clearly that neurosurgical residents do more than double the spine cases as ortho residents, and this number is more consistent across all residency programs surveyed. There are also numerous other articles that conclude that neurosurgeons get more spine training. Read those, too. It's widely known. Ask any ortho spine surgeon, or better yet, just ask your ortho chairman or program director. This is not some secret that ortho spine surgeons try to hide from residents.

The article itself is based on ACGME case logs, which are wholly inaccurate. It's also published in an orthopedic NON-SPINE journal. Ha ha ha. You've GOT to evaluate your sources, my friend.

So a better source for case numbers is an anonymous SDN poster, such as yourself? Please. The only thing you've convinced us of, is that you personally think you'll do more spine that a fellowship trained orthopod when you finish resodency. The authorities in your field disagree with you, and have made their opinions public in a prestigious journal. I'm not going to go back and forth, cherry picking numbers from the article. Instead, I'll give you the authors' conclusion:

"Thus, before entering independent practice, when compared with neurosurgery residents, most orthopedic spine surgeons complete as many spinal procedures or more..."

"The authors" in this case include two big names in neurosurgery at two of the most prolific training programs (UCSF and UVa). Also, JBJS is not some random "non-spine" journal, it's the most prestigious journal in orthopaedics (really second only to NEJM or Lancet) and regularly publishes spine studies, is more selective to publish in than any of the spine journals, and has a higher impact factor than the top spine journals. Your critiques of this article fall flat. If you have better articles in higher quality journals, authored by big names in neurosurgery and orthopaedics, please do post them for us to see.

As for the article quoting 300 to 500 cases done in fellowship, the source of this number is unreliable, AND, this includes all spine procedures, which no doubt includes tons of bread and butter cases that don't have a lot of value in fellowship training.

Same can be said of the cases one performs in neurosurgery training... what's your point though?

But, I must say, when it comes to seeing patients in my office who want second opinions, there's lot of weight behind the fact that I'm a neurosurgeon.

Perhaps this is a regional thing. To the contrary, the public in my experience doesn't know who is the content matter expert. When there is something wrong with their spine-- why should they consult a neurosurgeon who operates inside the head all day? That is the conventional wisdom I've encountered. Most people are surprised to learn that neurosurgery operates on the spine. Again, perhaps it is regional. I have lived in places where ortho dominates the spine market (Chicago, Philadelphia, St Louis, NYC, etc...), so maybe that is the difference.

A good spine surgeon is a good spine surgeon, regardless of their training background. I only take issue with the misconceptions you've voiced about spine training.