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[aldol16]

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Why is there an expectation of basic science research when it takes years of graduate level work to get a high quality basic science paper published? There's literally little to no time in med school unless it's an MSTP

No idea why, but it exists at the tippity top places. Neurosurgery is one of those specialties that are still super academic. There's definitely time in the first two years of med school for basic science research. Whether you can get anything out of it is another story (lots of variability around basic science research productivity).

 

[machete fred]

Thanks for the insight. You're probably right about my view being not well-formed yet.
I'm curious what your thought process was in choosing neurosurgery over other brain-related medical fields like neurology and psychiatry. You mentioned that other specialties weren't very interesting. What about neurosurgery do you find particularly interesting?

As someone who matched into urology (another surgical subspecialty), it's hard to truly go through this thought process until you reach your third year rotations. The most important (and first) decision that you should make during third year is whether you want to do something surgical or not. And the only way you can answer this question is by going through your surgery rotation. Which is why I partially roll my eyes when you hear M1/M2's say they are set on a surgical specialty without ever having set foot in the OR/actually seen what surgical residents/attendings actually do during the day.

Let me put it this way: Do you like clinic? Do you like rounding? Do you hate rounding? Do you want to manage the overall care of a patient or do you want to be the one calling the shots for a specific organ system? Do you enjoy working with your hands? Or are you more of a cerebral person? Are you coordinated? Do you make decisions quickly or are you the type person who likes to mull things over with a lot of input from others? Can you tolerate waking up at 4am every day for 5-7 years? Can you tolerate harsh but constructive feedback? Are you comfortable/uncomfortable with failure? Can you physically stand in an OR for 8 hours a day for 5-7 years? What feels shorter for you: 4 hours of rounding vs 4 hours of being in the OR? Would you rather have a predictable schedule or an unpredictable schedule? Are you comfortable knowing you may get off at 10pm vs 5pm because a case runs late or you have an add-on?

IMO, these are only questions that you can answer once you go through your medicine and surgery rotations. If you are truly interested in neurosurgery, the best advice I can give you is to be the best medical student you can possibly be and get connected with your home program early in terms of research and mentorship. You may end up changing interests, in fact most medical students do. And that is ok. I went into medical school wanting to do medical oncology and here I am going to be a human plumber. Just try to keep an open mind. A lot of medical school, especially M3 and M4, is soul searching and figuring out what type of person you are.

 

[agiraffe999]

IMO, these are only questions that you can answer once you go through your medicine and surgery rotations. If you are truly interested in neurosurgery, the best advice I can give you is to be the best medical student you can possibly be and get connected with your home program early in terms of research and mentorship. You may end up changing interests, in fact most medical students do. And that is ok. I went into medical school wanting to do medical oncology and here I am going to be a human plumber. Just try to keep an open mind. A lot of medical school, especially M3 and M4, is soul searching and figuring out what type of person you are.

Honestly, as someone who is 90% committed to neurosurgery from early on, I think shadowing a bunch of different specialities with different attending that way your view of a speciality doesn't get clouded is the best way of determining. I've always like surgical specialities because I'm a glutton for punishment, but after shadowing neurosurgery with a variety of attending I realized I liked it the most. After comparing neurosurgery to other specialities (like ortho) I haven't found anything I enjoyed more. I haven't seen all surgical specialities, but if I'm still trying to explore to see if anything is as neat/fun as NSGY.

Also, urology is a great field. Hands down, the funniest group of plumbers I've ever met lol

 

[machete fred]

Honestly, as someone who is 90% committed to neurosurgery from early on, I think shadowing a bunch of different specialities with different attending that way your view of a speciality doesn't get clouded is the best way of determining. I've always like surgical specialities because I'm a glutton for punishment, but after shadowing neurosurgery with a variety of attending I realized I liked it the most. After comparing neurosurgery to other specialities (like ortho) I haven't found anything I enjoyed more. I haven't seen all surgical specialities, but if I'm still trying to explore to see if anything is as neat/fun as NSGY.

Also, urology is a great field. Hands down, the funniest group of plumbers I've ever met lol

That's smart. I'm lucky that I found a great field, but I do kind of wish that I shadowed more during my first and second year. Our school only lets us pick one surgical subspecialty during third year so I didn't really get any exposure to ortho, neurosurgery, or ENT. I was pretty much deciding on urology versus general surgery half way through my third year after I realized that I hated rounding and hated sitting around all day waiting for consulting teams to make decisions.

And yeah it's funny how all of the surgical subspecialties have these stereotypes that end up being true. Urology are the jokesters, ortho are the jocks, neurosurgery/vascular are masochists, CT have a god complex, ENT are nerdy academics.

 

[WhittyPsyche]

That's smart. I'm lucky that I found a great field, but I do kind of wish that I shadowed more during my first and second year. Our school only lets us pick one surgical subspecialty during third year so I didn't really get any exposure to ortho, neurosurgery, or ENT. I was pretty much deciding on urology versus general surgery half way through my third year after I realized that I hated rounding and hated sitting around all day waiting for consulting teams to make decisions.

And yeah it's funny how all of the surgical subspecialties have these stereotypes that end up being true. Urology are the jokesters, ortho are the jocks, neurosurgery/vascular are masochists, CT have a god complex, ENT are nerdy academics.

That’s unfortunate that you couldn’t do it earlier and now I understand your earlier comment about not knowing until 3rd year.

All of my surgical subspecialty friends knew surgery as M1s and M2s, which you said you roll your eyes at. I wonder if the difference is at our institution at least those of us that came in gun-ho went straight into the OR in the specialties we were interested in. As a M1 I was spending 3 days a week in the OR. I know others were doing at least one day in Ortho, plastics, transplant, CT, vascular. We also started our research as M1s as well.

When we got to 3rd year we all had already decided the sub-specialty. We also in 3rd year had the opportunity to do 6 week apprenticeships in whatever field, I did all 6 in Nsg and was encouraged by our PD to treat it as a Sub-i. A few people then switched, Nsg to plastics, ortho to uro, etc, but no one out of surgery altogether, and with pubs and time to spend several 4th rotations in the decided field.

I think for most of these fields deciding in third year puts you significantly behind, though not impossible to catch up. Caveat- this is a T5 super academic place so there might just be a more competitive culture with these expectations.

 

[machete fred]

That’s unfortunate that you couldn’t do it earlier and now I understand your earlier comment about not knowing until 3rd year.

All of my surgical subspecialty friends knew surgery as M1s and M2s, which you said you roll your eyes at. I wonder if the difference is at our institution at least those of us that came in gun-ho went straight into the OR in the specialties we were interested in. As a M1 I was spending 3 days a week in the OR. I know others were doing at least one day in Ortho, plastics, transplant, CT, vascular. We also started our research as M1s as well.

When we got to 3rd year we all had already decided the sub-specialty. We also in 3rd year had the opportunity to do 6 week apprenticeships in whatever field, I did all 6 in Nsg and was encouraged by our PD to treat it as a Sub-i. A few people then switched, Nsg to plastics, ortho to uro, etc, but no one out of surgery altogether, and with pubs and time to spend several 4th rotations in the decided field.

I think for most of these fields deciding in third year puts you significantly behind, though not impossible to catch up. Caveat- this is a T5 super academic place so there might just be a more competitive culture with these expectations.

My school in general is very hierarchical/traditional (old-school institution on the east coast), and even though though they are trying to move away from it, there is definitely less of an emphasis on shadowing. I don't really know anyone at my school who had the time to spend 3 days a week in the OR as an M1. I'm jealous of you because that sounds like an awesome opportunity and it definitely would have helped me decide on urology a little earlier.

I didn't mean to imply that you can't become interested in these fields early on. In fact, getting interested sooner will definitely help for the match as you said. I guess my point was even with shadowing, it's hard to compare watching cases in the OR as an M1/M2 versus actually being on your surgery rotation, waking up at 4 am, and seeing the s*** that surgical residents put up with during the day. Some of my classmates had good shadowing experiences in different surgical specialties but by the time they reached their 3rd year surgery rotation they noped out because of the hours and the commitment. Surgery is just a whole different animal and I personally had to experience the day-to-day in order to make an informed career decision.

 

[WhittyPsyche]

My school in general is very hierarchical/traditional (old-school institution on the east coast), and even though though they are trying to move away from it, there is definitely less of an emphasis on shadowing. I don't really know anyone at my school who had the time to spend 3 days a week in the OR as an M1. I'm jealous of you because that sounds like an awesome opportunity and it definitely would have helped me decide on urology a little earlier.

I didn't mean to imply that you can't become interested in these fields early on. In fact, getting interested sooner will definitely help for the match as you said. I guess my point was even with shadowing, it's hard to compare watching cases in the OR as an M1/M2 versus actually being on your surgery rotation, waking up at 4 am, and seeing the s*** that surgical residents put up with during the day. Some of my classmates had good shadowing experiences in different surgical specialties but by the time they reached their 3rd year surgery rotation they noped out because of the hours and the commitment. Surgery is just a whole different animal and I personally had to experience the day-to-day in order to make an informed career decision.

I think in line with this for me was picking a school with voluntary recorded lectures. I could do that because I only attended class the first week of M1 and never since unless specifically required (Dean lecture, etc). I think it’s important Pre-meds think about this, what gives you the fire, what school will facilitate that.

If I could not have done that I’m not sure I would have made it through med school tbh. Being in the OR and seeing patients pre/post op kept the fire burning for me over the years. And this of course is person dependent but I have always treated every “shadowing” opportunity as if I was on clerkship. Reading ahead of case, showing up at 5am, pre-rounding with resident, staying through entire case, debriefing after and waiting to be dismissed. As I graduated through the years with more knowledge and more skills learned that translated to more expectations and more responsibility. So my “shadowing” time meaning not part of a formal block, with attendings I started with as an M1 is basically a long never ending rotation.

But I am pretty intense in general haha, (so I am not saying everyone has to do this!!) but this really help me build strong relationships with my home department.

 

[longhaul3]

OP sounds extremely naïve but his/her interests are definitely compatible with neurosurgery. The first thing you need in our field and the only thing you can't make it without is interest.

Whether that interest will persist when you start to understand the realities will be the question. 6a-6p is a pipe dream in our field. Most of Residency is more like 5a-8p, 6 days a week, give or take. Plus there's always a very real chance that a herniating tumor or ruptured aneurysm comes in right when you're about to leave and you end up in the OR until dawn (this happened to me last night). Also, neurosurgery stands alone with gen surg as the only surgical specialties that involve a significant element of critical care, which I love but can be grueling and really adds to the workload.

I don't want to discourage anyone at the premed level from doing it because it's an amazing field, but it's understandably highly romanticized and therefore impossible to really experience until you're actually doing it, even as a senior medical student/sub-i. You will just have to see for yourself.

 

[longhaul3]

Thanks for sharing your perspective. At least with 5a-8p you can sleep at night. The thing that worries me is the night shift. How often do you have night duty in residency? And does it go away once you are an attending?

It varies. In my program we have a night float system for the most part so we spend a few months as junior residents working only at nights so that everyone else can go home. It's rough being on nights but better than q2-3 call. We also have a trauma service that is q2-3 call for about a year total spread over junior residency. On a 24h call you come in to round around 5am then leave anywhere between 10a-5p the next day.

As you become more senior there is less primary call but more frequent backup call, like q2 on average for a few years. As chief it's common to be on backup call for months at a time.

As an attending things can vary tremendously. At an academic center call may be split fairly evenly among all the attendings. Some places have separate attending call pools for general cranial vs vascular vs spine, which means you're on call more frequently but get called less often. Peds is usually pretty brutal because there are very few pediatric neurosurgeons to share the load. As the attending you are shielded from the low-level pages and don't usually need to be in the hospital, but compared to other specialties we have a very high rate of operative emergencies and we do operate a lot in the middle of the night.

 

[longhaul3]

Thanks for clarifying! It looks like working during nights doesn't go away when you become an attending. (I gather that being "on call" means you might be needed in the hospital at any time during a 24 hour period). How often are attending on call at your institution?

Being on call means that you are responsible for the service. That means different things depending on setting and seniority. For instance at a level 1 trauma center there must be a neurosurgery MD in the facility at all times. That is usually a junior resident, then if there is an operative emergency or if things get out of hand the senior and/or attending will come in. On the other hand, at other hospitals you may be able to take the pager home and be on call from wherever.

Where I am attendings are on call anywhere from one week every 1-2 months to always on call except for every other weekend.

 

[aldol16]

I see. So being on call as a resident means you're there waiting for something to happen, while as an attending, you're sleeping at home but may be woken up by a phone call saying you have to be there ASAP. I guess you'll have to live near the hospital then. The reason I was asking is because I'm worried that too many nights without sleep will start to hurt my health, especially when I'm older. I'm a nontrad, so I'm already several years behind most of my peers. I'll be entering med school at 28.

This isn't just in neurosurgery. Most attendings will take call in some capacity for emergencies. Part of the reason why certain specialties are "lifestyle" specialties is because their call tends to be light (few emergencies).

Also, residencies vary. Many have moved to night float systems. At some places, there's also home call for more senior residents (can take call from home). Obviously if the specialty has lots of emergencies, then this doesn't mean much since you'll be at the hospital most of the night anyway. The good thing with regular (in-house) call is that places tend to give you post-call off (not all places).

 

[agiraffe999]

That's smart. I'm lucky that I found a great field, but I do kind of wish that I shadowed more during my first and second year. Our school only lets us pick one surgical subspecialty during third year so I didn't really get any exposure to ortho, neurosurgery, or ENT. I was pretty much deciding on urology versus general surgery half way through my third year after I realized that I hated rounding and hated sitting around all day waiting for consulting teams to make decisions.

And yeah it's funny how all of the surgical subspecialties have these stereotypes that end up being true. Urology are the jokesters, ortho are the jocks, neurosurgery/vascular are masochists, CT have a god complex, ENT are nerdy academics.

I think Neurosurgery is also up there with the god complex 😆
Deformity spine are the true masochists

 

[Lost in Translation]

Every time I watch that movie and he breaks sterile practice to put his mask on I yell at the screen.

Just like in Get Out.

 

[longhaul3]

Deformity spine are the true masochists

Eh, it's not too bad. Their procedures bill for a zillion RVUs and there aren't really stat deformity cases to worry about when you're on call.

 

[agiraffe999]

Eh, it's not too bad. Their procedures bill for a zillion RVUs and there aren't really stat deformity cases to worry about when you're on call.

I thought masochists meant you liked to inflict pain, instead of liking your own pain. In that case I think neurosurg is definetly masochists

 

[longhaul3]

I thought masochists meant you liked to inflict pain, instead of liking your own pain. In that case I think neurosurg is definetly masochists

Oh. Yeah. Big fusions are the most painful surgeries I've seen for sure.

 

[agiraffe999]

Thank you everyone for your advice!
I want to be involved in research as a physician. Not just a few clinical trials here and there, but actually run a lab and publish regularly. I would also like to teach a little bit. Is this feasible in neurosurgery?

Absolutely. Also feasible in 99% of specialities