Ask a neurosurgery resident anything

[neusu]

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Are you implying that the PSLF 10-year clock starts from the beginning of the forbearance period?

Indeed, if you work for a non-profit and make payments, the 10-year clock starts. If you put the loan in forbearance, e.g. not making payments, it does not count. From what I gather, you have to make 120 payments, working for a nonprofit, and the loan is forgiven.

 

[neusu]

Hey There!
So my questions are about dexterity. Did you do any dexterity exercises, like play an instrument or work with paper craft, when you were young? If you did does it help you today, or can you develop the skills required to be a good surgeon right from your training years? Generally how important is dexterity in surgery?
Thank you for your time.

Most medical students have two left hands when they start their surgery rotation. Like most things in life, practice practice practice. Get a needle driver, forceps, and suture and practice throwing stitches and knot tying. I did play instruments when I was younger, but I can't say it seems to have made a difference in surgery. Not sure what you mean by paper craft.

Dexterity is important in surgery, but is learned by doing. The common mistake is to assume things will be learned in the OR. Certainly, there is a lot of teaching in the OR, but having a a basic understanding prior to getting there as well as some practice makes the time that much more valuable.

 

[neusu]

Thanks for volunteering your time!

How prevalent is skull base surgery for neurosurgery and what do you see happening to it in the future?

Skull base surgery is relatively common. Many of the approaches for skull base are low morbidity and most surgeons are comfortable with them. Others, on the other hand carry a higher morbidity and tend to be reserved for surgeons who specialize in these procedures and patients with unique pathology that can not be accessed with a less morbid approach. With the addition of endoscopy, the morbidity of skull base surgery is decreasing and, likely, will only become more prevalent.

 

[neusu]

What were your main motivations for becoming not just a neurosurgeon, but a physician in general?

Are you really an idealist and wanted to improve others lives and make a difference, are you in it for the money (doubtful), or somewhere in between? In short, what put that spark in your mind to go into medicine in general?

And what did you major in for undergrad? 😀

I think I went in to it as a bit of an idealist. I thought that both I was pretty smart and could use my abilities to help people and that there were certainly plenty of people in need. While I still have a lot of that initiative in me, many years of school and working in the bureaucracy that is academic medicine have somewhat taken that shine away from me. I still tell my junior residents with optimism that no matter how seemingly trivial the consult, that they should walk in to every consult to be the neurosurgeon the patients expect to see, no matter what the other service tells you there may be something more insidious there that they, the non sub-specialist service, may not know how to pick up on, and that is why the are calling a consult. I can not begin to tell you how often I have gone to see an "intact" back pain patient with a foot drop, an epidural abscess patient with "full strength" who was in fact paretic, or a r/o SAH patient who got blown off by the ED and re-ruptured in the the ED. Certainly, being over consulted is a wear on everyone on the service, but being vigilant is important. We are, after all, the experts in the field.

I majored in biochemistry. I started off thinking engineering and after that was torn between chemistry and biochemistry, but my research interests were more biological than chemical/physical so biochemistry it was. Again, for what it's worth, my undergraduate major adviser was in the National Academy of Sciences.

 

[Vaseline]

taking advantage off the "anything qualifier," i have a totally random question: in your journey from med student to physician, did you ever encounter a fellow student or colleague with palmar hyperhidrosis?

 

[stronghold]

Thanks Neusu for dedicating that time to answer questions. You look well oriented, I have couple of questions:
1) What are neurosurgery sub-specialties with greatest outcome (lowest morbidity)? Those with best life style (working hours compared to others? Those with the worst life style? Those pay the highest (Academic, not PP) and the net range? Those pay the lowest and the net range (some people say ped neurosurg) ?

2) What are neurosurgery sub-specialties that depends mostly on my hands alone? I mean no loupes, no feducials, no those modern techniques. I am thinking to spend couple of years in Africa and help people there, and you know, most of modern techniques are not available there. It's good to have CTs and MRIs there!!

3) Have you ever overslept and came late? Does it happen? Sometimes I unintentionally turn off the alarm and oversleep! On the other hand when do you usually get up and go back home?

4) How many weeks of vacation we have per year? Are conferences, Christmas, new year vacations considered part of them?

5) When do you have the time to study? To read from the big references (e.g., Youmans and S&S) ?

6) ABNS requests to complete the board process within 5 years following graduation. It states that the fellowship time does not lengthen the 5 year period, and even eats into the time. I wonder if I want to do 2 fellowships, is that possible with that rule? Are cases ,required to be submitted to ABNS in order to be eligible for oral boards, need to be done exclusively by me? Are cases of fellowships considered? How many cases we have to submit?

Sorry for many questions!

 

[neusu]

taking advantage off the "anything qualifier," i have a totally random question: in your journey from med student to physician, did you ever encounter a fellow student or colleague with palmar hyperhidrosis?

I can't say I have seen a student or physician with hyperhidrosis, though I am sure they are out there. I have done thoracic sympathetctomy for hyperhidrosis in patients with refractory cases. It's a great little case!

 

[neusu]

Thanks Neusu for dedicating that time to answer questions. You look well oriented, I have couple of questions:
1) What are neurosurgery sub-specialties with greatest outcome (lowest morbidity)? Those with best life style (working hours compared to others? Those with the worst life style? Those pay the highest (Academic, not PP) and the net range? Those pay the lowest and the net range (some people say ped neurosurg) ?

Lowest morbidity tends to be a bit difficult to assess in neurosurgery as often the patients we deal with are significantly affected by what we do or have a relatively high pre-existing morbidity. That being said, functional and pediatrics tend to be either the least amount of negative side effects for what we do and best recovery, respectively. Best life style tends to be functional or peripheral nerve. Worst is trauma, vascular, and spine (if trauma is covered).

2) What are neurosurgery sub-specialties that depends mostly on my hands alone? I mean no loupes, no feducials, no those modern techniques. I am thinking to spend couple of years in Africa and help people there, and you know, most of modern techniques are not available there. It's good to have CTs and MRIs there!!

Most tumor surgery and non-instrumented spine can be done without much technology. Loupes really do add a lot to your ability to see and can be taken anywhere in the world. That being said, much of what we do is tehcnology driven, so neurosurgery has struggled to some degree to have much of a presence in the 3rd world. There are groups that bring instruments with them and such to do ETVs or shunts, someone previously mentioned the project shunt group at Michigan.

3) Have you ever overslept and came late? Does it happen? Sometimes I unintentionally turn off the alarm and oversleep! On the other hand when do you usually get up and go back home?

I can't say I have ever overslept, I'm more the type that wakes up before the alarm goes off. We have had residents who have trouble getting to rounds on time, they generally get a pass the first time, but if it's a persistent issue it gets fixed.

4) How many weeks of vacation we have per year? Are conferences, Christmas, new year vacations considered part of them?

We get 4-weeks of vacation time. Also, days off for holidays and conferences. Obviously, the service has to be covered so not everyone gets to go to every conference or have every holiday off.

5) When do you have the time to study? To read from the big references (e.g., Youmans and S&S) ?

Studying happens both here and there and at night/on days off. I try to keep up with the journals and read through the "big references." When I was a junior I would make a point to look up in the text regarding every interesting patient I was consulted on.

6) ABNS requests to complete the board process within 5 years following graduation. It states that the fellowship time does not lengthen the 5 year period, and even eats into the time. I wonder if I want to do 2 fellowships, is that possible with that rule? Are cases ,required to be submitted to ABNS in order to be eligible for oral boards, need to be done exclusively by me? Are cases of fellowships considered? How many cases we have to submit?

The board requires 150 consecutive surgical cases over 36 months. Whether or not fellowship counts towards this number is dependent on the fellowship structure. At some institutions the fellow is considered hospital staff and those cases would likely count.

Sorry for many questions!

Keep them coming!

 

[ToldYouSo]

What's the burnout rate like? In such a demanding field, are older neurosurgeons (60+) a rarity?
Great thread btw!

 

[neusu]

What's the burnout rate like? In such a demanding field, are older neurosurgeons (60+) a rarity?
Great thread btw!

There are quite a few neurosurgeons who are 60+ still practicing. From what I gather, after finishing residency burnout is less of an issue. Every resident I have worked with has had periods of burnout somewhere throughout residency. Some get through it and keep going, others switch out of neurosurgery. Picking the right field for you is important because residency is no walk in the park, no matter what field you choose.

 

[Guero]

There are quite a few neurosurgeons who are 60+ still practicing. From what I gather, after finishing residency burnout is less of an issue. Every resident I have worked with has had periods of burnout somewhere throughout residency. Some get through it and keep going, others switch out of neurosurgery. Picking the right field for you is important because residency is no walk in the park, no matter what field you choose.

Please forgive me if this falls out of the purview of an answerable question since you're not in their shoes, but regarding burnout and overall intensity, how would you say your neurosx residency compares to those in the gen surg residency at your institution?

Thanks again for answering all of our questions.

 

[stronghold]

Thanks a lot! You are the man! I sent you another PM, check it please

 

[neusu]

Please forgive me if this falls out of the purview of an answerable question since you're not in their shoes, but regarding burnout and overall intensity, how would you say your neurosx residency compares to those in the gen surg residency at your institution?

Thanks again for answering all of our questions.

My class was the last to do a true general surgery internship and was prior to the 16-hour limit for interns. That being said, my experience on general surgery is that the work intensity varies depending on the rotation, and there typically is a built in hierarchy to fall back on.

Certainly, general surgery residents work long hours, suffer verbal abuse, and don't often see the fruits of their labor. They work very hard and manage a wide range of medical and surgical issues. Depending on how the rotations are split, what kind of cross-covering there is, and if there is night-float the call rotation varies widely in general surgery.

Neurosurgery often relies on the ability of the junior residents to possess independence and ability to triage and multitask. Many smaller departments have only a PGY-2 to 4 in house (or home call) as the first line and a PGY-6/7 at home as chief back-up. For a program with 1-a-year, there really are only 5 or 6 people in the call pool (minus the intern and chief). For call rotation, 30 days with 5 people averages 6 calls/month for 5-years. Larger programs have the luxury that they may have a junior and senior in-house. Set up of the call schedule varies, but one example is a program with 2 residents a year, the PGY-2/3 are in the rotation and everyone else is out, averaging 7 calls/month for 2-years. On another note, the rest of the hospital seems to treat the brain and spine as a black-box and pretend they don't know anything about managing patients with associated issues. This results in the service swelling with patients that would be more appropriately treated by a different department.

For what it's worth, burnout does happen. For me I realized up until this point in life there were clear ebs and flows in life such as gearing up for the next exam or having time off for winter or summer break. Spending time on service with no clearly defined goals to look forward to took a toll. Sure, the work was hard, I didn't get enough sleep, my social life was shot, but I could reconcile that as being part of the decision I made by picking this field. Recognizing burnout when it's happening and making changes keeps you going gets you through it.

Hope this helps, feel free to PM me if you guys have any specific or personal questions you don't want aired here.

 

[Guero]

My class was the last to do a true general surgery internship and was prior to the 16-hour limit for interns. That being said, my experience on general surgery is that the work intensity varies depending on the rotation, and there typically is a built in hierarchy to fall back on.

Certainly, general surgery residents work long hours, suffer verbal abuse, and don't often see the fruits of their labor. They work very hard and manage a wide range of medical and surgical issues. Depending on how the rotations are split, what kind of cross-covering there is, and if there is night-float the call rotation varies widely in general surgery.

Neurosurgery often relies on the ability of the junior residents to possess independence and ability to triage and multitask. Many smaller departments have only a PGY-2 to 4 in house (or home call) as the first line and a PGY-6/7 at home as chief back-up. For a program with 1-a-year, there really are only 5 or 6 people in the call pool (minus the intern and chief). For call rotation, 30 days with 5 people averages 6 calls/month for 5-years. Larger programs have the luxury that they may have a junior and senior in-house. Set up of the call schedule varies, but one example is a program with 2 residents a year, the PGY-2/3 are in the rotation and everyone else is out, averaging 7 calls/month for 2-years. On another note, the rest of the hospital seems to treat the brain and spine as a black-box and pretend they don't know anything about managing patients with associated issues. This results in the service swelling with patients that would be more appropriately treated by a different department.

For what it's worth, burnout does happen. For me I realized up until this point in life there were clear ebs and flows in life such as gearing up for the next exam or having time off for winter or summer break. Spending time on service with no clearly defined goals to look forward to took a toll. Sure, the work was hard, I didn't get enough sleep, my social life was shot, but I could reconcile that as being part of the decision I made by picking this field. Recognizing burnout when it's happening and making changes keeps you going gets you through it.

Hope this helps, feel free to PM me if you guys have any specific or personal questions you don't want aired here.

Beautiful reply, both here and in the old PM you recently addressed: can't thank you enough. All of these "ask a X resident/attending" threads have really narrowed down my potential specialties to 4 choices. All I have left to do is rotate and make that decision after having the hands-on experience, after finishing those dreadful M1 and M2 years, of course. 🙂

Cheers!

 

[eunik]

Hi everybody. I noticed interest in the discussion with resident/intern from general and vascular surgery and wanted to offer some insight on another surgical sub-specialty, neurosurgery. Feel free to ask away regarding whatever questions you may have from general what do we do questions to how to lay plans to pursue this field. I'll try to check back and get to each of your questions, feel free to PM me for anything you don't want to ask in a public forum. Also, there is an attending in the neurosurgery forum writing from his perspective: http://forums.studentdoctor.net/showthread.php?t=919891

Hi i kinda need your help. When i read this post on neurosurgery. I do not really know a lot about the field. I want to learn more about the field because i really like to become a neurosurgeon. Am a Nigerian and we do not really have neurosurgery as one of the fields in medicine in Nigeria. Here in Nigerian the way we go about medicine is kinda different from the it is run overseas. Am hoping you could enlighten me more on neurosurgery coupled with the little things i know about it. What steps i need to take as an high school graduate. And lastly the part you said about the PM i do not know the meaning of PM because i do have other questions to ask you that i wouldnt want to ask in a public forum. Thanks

 

[bennybrak]

Eunik, ppl here are being very kind to you by not commenting on your puerile post because you just finished high school. Some piece if advice from me: Do your homework by reading all about neurosurgery or any topic for that matter before you post. Just use google. The kind doctor giving us info here is extremely busy but is making sacrifices to give us insight into info we ordinarily may not be privy to, so ask well-informed questions. Do you even know about the West African College of Surgeons and it's residency programs? Guess what, they have a neurosurgery program. Find out the limitations with neurosurgery in Nigeria and how an American training might be beneficial.

Hope I didn't spank that hard...I'm only saving you from future trouble. And oh, FWIW I'm not a racist, I'm an African like you(from Ghana).

Btw, PM means "private message"

 

[Dick Jones]

Is it possible to match into Neurosurgery if you attend a primary care oriented medical school? The school doesn't have a neurosurgery residency program. Do you think I could do research with another institutions neurosurgeon for MSSRF?

 

[neusu]

Hi i kinda need your help. When i read this post on neurosurgery. I do not really know a lot about the field. I want to learn more about the field because i really like to become a neurosurgeon. Am a Nigerian and we do not really have neurosurgery as one of the fields in medicine in Nigeria. Here in Nigerian the way we go about medicine is kinda different from the it is run overseas. Am hoping you could enlighten me more on neurosurgery coupled with the little things i know about it. What steps i need to take as an high school graduate. And lastly the part you said about the PM i do not know the meaning of PM because i do have other questions to ask you that i wouldnt want to ask in a public forum. Thanks

Hello. I am not quite familiar with medical training in Nigeria, but there are neurosurgeons at the main teaching hospital in Accra. Neurosurgery is the study of the central nervous system and associated structures. We perform surgery for pathologies that can be treated with surgery.

As a high school graduate, if you desire to train in the US, the best course of action would be to attend college and medical school in the US and apply for a residency as a US graduate. Even then, a visa would be required for training and potentially prohibit being trained.

 

[tiedyeddog]

What is the minimum step 1 score you need to get interviews at "top tier" programs?

 

[BariumOxide]

Thanks for all your insights. I have some questions myself:

(1) What recommendations do you have for summer plans before going to medical school? (if possible, could you offer your summer experience?)

(2) Could a neurosurgeon perform neuroscience research (specifically, cellular, molecular, and computational) complementary with neurosurgery? Do you happen to know some neurosurgeons who do so?

(3) Do neurosurgeons who pursue academia typically become professors? And if they become professors, what type of lifestyle do they have? Is it viable to continue to practice while simultaneously doing research?

(4) Have you ever had moments of regret for getting into neurosurgery?

I really appreciate your time and consideration. Your input has definitely enlightened me and others.

 

[neusu]

Is it possible to match into Neurosurgery if you attend a primary care oriented medical school? The school doesn't have a neurosurgery residency program. Do you think I could do research with another institutions neurosurgeon for MSSRF?

It certainly is possible to match from primary care oriented medical schools and does happen yearly. You will have a greater obstacle to overcome as the school without a neurosurgery program may not have research, or neurosurgeons to work with for recommendations.

As you asked, though, it is possible to conduct research with another institution during medical school. Proximity tends to help, so that you may be able to facilitate face to face meetings with your advisers. That being said, arranging for a summer research position between m1/m2 years may also be possible.

This begs the obvious question though, if you are interested in neurosurgery, and intend to go to a school that is interested in training primary care physicians, why not go somewhere else?

 

[Dick Jones]

It certainly is possible to match from primary care oriented medical schools and does happen yearly. You will have a greater obstacle to overcome as the school without a neurosurgery program may not have research, or neurosurgeons to work with for recommendations.

As you asked, though, it is possible to conduct research with another institution during medical school. Proximity tends to help, so that you may be able to facilitate face to face meetings with your advisers. That being said, arranging for a summer research position between m1/m2 years may also be possible.

This begs the obvious question though, if you are interested in neurosurgery, and intend to go to a school that is interested in training primary care physicians, why not go somewhere else?

Honestly, I can't afford to relocate. My parents are poor. Also, I do not make enough to pay for it myself. At 3 of the 4 schools that offered me admission, they gave me a full tuition scholarship. I just don't have the money to relocate and I don't have a car. I think I would make a great neurosurgeon but I have to make it past this stage in my life.

 

[neusu]

What is the minimum step 1 score you need to get interviews at "top tier" programs?

While every program is different, there really is not a minimum score as the application as a whole is considered. I have heard numbers for step 1 ranging from 200 to 230 as pre-screening criteria. Even so, if the average step 1 score is in the mid 230s, having significantly lower than that would require a far stronger application otherwise.

 

[stronghold]

Neusu, please check your PM, man! I sent you a message more than 10 days ago!

 

[Sophocles]

Buddy take it easy, I'm sure he's super busy. Just because he hasn't said one malicious word to any posts doesn't mean he might not be getting upset at some of them. I'm sure you didn't mean it in a mean way but it could easily be misconstrued as such.

 

[tiedyeddog]

While every program is different, there really is not a minimum score as the application as a whole is considered. I have heard numbers for step 1 ranging from 200 to 230 as pre-screening criteria. Even so, if the average step 1 score is in the mid 230s, having significantly lower than that would require a far stronger application otherwise.

thanks, you've been an amazing source of information on here. 👍👍👍

 

[neusu]

Thanks for all your insights. I have some questions myself:

(1) What recommendations do you have for summer plans before going to medical school? (if possible, could you offer your summer experience?)

My last summer before medical school I traveled a lot, went to friends' weddings, visited family, and tried to enjoy myself. I tried to get in touch with the neurosurgeons at my school to get involved early and arranged to meet prior to orientation. They offered me to get involved in some clinical projects so I worked on the paperwork such as getting added to the IRB and CITI training to work with charts.

(2) Could a neurosurgeon perform neuroscience research (specifically, cellular, molecular, and computational) complementary with neurosurgery? Do you happen to know some neurosurgeons who do so?

Certainly, neurosurgeons can perform any kind of research in which they are interested. There are a host of neurosurgeons involved in molecular biology. Visit the departmental websites of some programs and look at research interests of the faculty. Fields that tend to translate more to molecular biology are tbi, spinal cord injury, and tumor. Computational is a pretty broad field and can be applied anywhere from vascular to functional.

(3) Do neurosurgeons who pursue academia typically become professors? And if they become professors, what type of lifestyle do they have? Is it viable to continue to practice while simultaneously doing research?

There are generally two broad swaths of neurosurgery: academics and private. Those in academics tend to be professors etc and are encouraged to participate in research and teaching. Those in private practice aren't typically required to be involved in research, but many are. It certainly is possible to conduct broad and impacting research in private practice.

(4) Have you ever had moments of regret for getting into neurosurgery?

Haha, nothing that stuck. As I have mentioned, it is a very hard and challenging endeavor and I suspect most residents have had points during their training where they question if they are doing the right thing or should switch. Many do switch.

I really appreciate your time and consideration. Your input has definitely enlightened me and others.

Thanks, glad to be able to help.

 

[punkedoutriffs]

Do you ever get the experience of reflecting back on a year in residency, or even just your residency so far in general and just went, "Wow, where did those years go?"

I kind of had this feeling at the end of undergrad where I had 65-75 hr week schedules of school/work/ec's for the last several years. This was not a bad thing, cuz it meant I was very engaged, one of those 'time flies when you're having fun' things. This is directly opposed to high school where i was a lot less busy but at the same time a lot less engaged and spent the entire time watching the proverbial clock. I'm getting the same feeling now as I'm nearing my gap year of doing absolute squat.

So my question is, do you ever get that feeling in Neurosurgery residency? Cuz that would be a great draw for me - I'd love to be engaged like that.

 

[neusu]

Honestly, I can't afford to relocate. My parents are poor. Also, I do not make enough to pay for it myself. At 3 of the 4 schools that offered me admission, they gave me a full tuition scholarship. I just don't have the money to relocate and I don't have a car. I think I would make a great neurosurgeon but I have to make it past this stage in my life.

Might be worth considering relocating and taking out the federal loans for housing/transportation during school. With a full tuition scholarship your loan total would still be rather low at the end of 4-years. Even so, graduating debt free would be nice and it is still possible to match in neurosurgery from a primary care focused school.

 

[Sophocles]

**Disclaimer: Dumb question

Can you talk about how to keep the balance between being interested and involved and not being a pest as a med student when conducting research, shadowing, etc.?

Especially in clinical years, or even as a resident, how does one show interest without being "that guy" that everyone hates?

 

[987439759]

Do you ever do the under-the-table craniotomy on the side?

http://chicago.craigslist.org/chc/cto/3808111672.html

No, but seriously. Thank you for this thread. Very informative.

 

[neusu]

Do you ever get the experience of reflecting back on a year in residency, or even just your residency so far in general and just went, "Wow, where did those years go?"

I kind of had this feeling at the end of undergrad where I had 65-75 hr week schedules of school/work/ec's for the last several years. This was not a bad thing, cuz it meant I was very engaged, one of those 'time flies when you're having fun' things. This is directly opposed to high school where i was a lot less busy but at the same time a lot less engaged and spent the entire time watching the proverbial clock. I'm getting the same feeling now as I'm nearing my gap year of doing absolute squat.

So my question is, do you ever get that feeling in Neurosurgery residency? Cuz that would be a great draw for me - I'd love to be engaged like that.

Every day. It feels like I was still in medical school yesterday and now I'm doing surgery all but on my own for some cases. On a day to day basis, when I was a junior on the service, I would often be surprised when it was already 6 PM and I wonder what happened to the whole day. The pace of the OR tends to have better landmarks for time and what's been done, but still time flies.

 

[neusu]

class rank, amount of research, etc.

My medical school didn't rank people, but I would have been in the top 25% from what I gather. I had 5 papers: 3 first author, 2 in neurosurgery journals, 2 basic science in high impact journals (e.g. nature/science/cell) as well as presentations at several national meetings. My board scores were competitive and I did well on my subI rotations at places where a number of students rotate.

 

[addy]

My medical school didn't rank people, but I would have been in the top 25% from what I gather. I had 5 papers: 3 first author, 2 in neurosurgery journals, 2 basic science in high impact journals (e.g. nature/science/cell) as well as presentations at several national meetings. My board scores were competitive and I did well on my subI rotations at places where a number of students rotate.

Regarding the bolded statement above, based on what you saw on the interview trail, was this normal? Would you say you were 'overprepared' with respect to research? Also, when did you start doing research in medical school? How did you manage it? Any tips?

 

[punkedoutriffs]

My medical school didn't rank people, but I would have been in the top 25% from what I gather. I had 5 papers: 3 first author, 2 in neurosurgery journals, 2 basic science in high impact journals (e.g. nature/science/cell) as well as presentations at several national meetings. My board scores were competitive and I did well on my subI rotations at places where a number of students rotate.

These credentials are inconceivable to me.

 

[Lollygag]

Hey neusu! Thanks again for doing this!

I work in a pharmacy as a technician and I'm in a state where abuse of controlled medications has risen rapidly in the past few years. Many pharmacies, especially mine, have introduced A LOT of new policies on these medications.

Apparently, they have turned many of the CII's into extended release or added acetaminophen (like percocet) but I guess Oxycodone, Dilaudid and some other CII's are still immediate release so drug abusers go after them. So in the past month, a DEA # and diagnosis code on these types of prescriptions are no longer enough, now doctors have to fax complete medical reports with a detailed diagnosis on why the patient needs it and do full background checks in order for us to fill Oxycodone or Dilaudid. We're not allowed to fill it unless we speak with the doctors themselves and the doctors say it is too time consuming for them.

I get yelled at, at least three times a day for this by patients because they are in severe pain and can't get their medication, but mostly from doctors who are furious that we won't fill the medication when they are busy in surgery and unavailable. It's an incredible hassle.

I know you might not be from a state where this is an issue, but I just wanted to know if you have dealt with this type of problem as I know that post surgery pain medication is often a CII drug. And if you have, how much of a hassle and how much of your time is consumed with dealing with this annoying problem? I know that doctors in pain management would obviously deal with this A LOT, but is it just as much of an issue for neurosurgeons? It would pain me to know that I could potentially have to deal with this my whole life lol

 

[sinombre]

I know you might not have time to read this, but if you do, would you mind briefly commenting on what you think about it?

http://projectwordsworth.com/life-love-neurosurgery/

It's basically a commentary by the wife of an ex-prospective neurosurgeon/current anesthesiology resident on the obsessive nature that is supposedly inherent in neurosurgery, and consequently inherent in neurosurgeons. I didn't find any of what she said hard to believe, and don't doubt that any field as demanding as neurosurgery attracts obsessive people, but part of why this thread has been so interesting to follow is because of how well-balanced you seem to be.

Anyway, if you do end up reading it and could briefly comment on what you think, it would be much appreciated. Thanks!

 

[neusu]

**Disclaimer: Dumb question

Can you talk about how to keep the balance between being interested and involved and not being a pest as a med student when conducting research, shadowing, etc.?

Especially in clinical years, or even as a resident, how does one show interest without being "that guy" that everyone hates?

This is a fine line to walk, and many students fail miserably. Generally, be around and available, enthusiastic, and try to help out. Try to relax and be yourself. Ability helps for things you should know how to do such as suturing and knot tying (take home a needle driver and suture and practice suturing and knot tying). Offer to do things, ask to be shown how or walked through things you don't know how to do. Realize there are some things you may not get to do, or one resident will allow you to do while another won't. If you are told to go home, do it. Read for your cases and patients and ask questions that are relevant at an appropriate time.

 

[neusu]

Do you ever do the under-the-table craniotomy on the side?

http://chicago.craigslist.org/chc/cto/3808111672.html

No, but seriously. Thank you for this thread. Very informative.

Haha, haven't tried it. Poor guy, sounds like he has other issues aside from the cyst in his head.

 

[mwall003]

Did you ever consider Otolaryngology instead of Neurosurgery? Did you go into medical school knowing you wanted to pursue NS right off the bat?

 

[neusu]

Regarding the bolded statement above, based on what you saw on the interview trail, was this normal? Would you say you were 'overprepared' with respect to research? Also, when did you start doing research in medical school? How did you manage it? Any tips?

On the trail there were students who had no research experience and there were people with 20+ publications and there were MD/PhDs. I would say my application was average to above average. Like any challenge in life, I tried to be over prepared instead risk regretting not doing enough.

As a disclaimer, I did bench research (molecular biology/biochemistry) as an undergrad and had publications from that. They count towards residency as well. I started research in medical school during my first year, approached people with ongoing projects and just latched on. As a student, a lot of what you can do relatively easily is collect data and build a database to mine information and write papers. Find someone at your school who has an interest in research, write a broad IRB, and then crunch numbers.

 

[neusu]

These credentials are inconceivable to me.

Thanks, I guess.

Neurosurgery is a competitive field. It tends to self select for people who are interested in neurosurgery, able to handle the work load and sacrifices involved, and are motivated.

 

[AlteredScale]

Any fun hobbies that you enjoy on your spare time?

What made you interested in pursuing private practice instead of sticking with academic medicine?

Do you partake in pre-medical shadowing at your clinic? I've been trying to contact multiple neurosurgeons in my city and ask to shadow and so far I've been SOL.

I think it's absolutely wonderful that you have time to do this so thank you!

Believe it or not, my first conversation with a neurosurgeon was in 7th grade. He was PGY-3 and he summed up his joining into the residency as "trying to jump across a mile-wide river of s**t, and then wading across the rest of the way there". Ever since then I've been completely fascinated with the specialty, not to say I will be able to do it because I haven't even started med school. But I find joy in being inspired in it.

 

[neusu]

Hey neusu! Thanks again for doing this!

I work in a pharmacy as a technician and I'm in a state where abuse of controlled medications has risen rapidly in the past few years. Many pharmacies, especially mine, have introduced A LOT of new policies on these medications.

Apparently, they have turned many of the CII's into extended release or added acetaminophen (like percocet) but I guess Oxycodone, Dilaudid and some other CII's are still immediate release so drug abusers go after them. So in the past month, a DEA # and diagnosis code on these types of prescriptions are no longer enough, now doctors have to fax complete medical reports with a detailed diagnosis on why the patient needs it and do full background checks in order for us to fill Oxycodone or Dilaudid. We're not allowed to fill it unless we speak with the doctors themselves and the doctors say it is too time consuming for them.

I get yelled at, at least three times a day for this by patients because they are in severe pain and can't get their medication, but mostly from doctors who are furious that we won't fill the medication when they are busy in surgery and unavailable. It's an incredible hassle.

I know you might not be from a state where this is an issue, but I just wanted to know if you have dealt with this type of problem as I know that post surgery pain medication is often a CII drug. And if you have, how much of a hassle and how much of your time is consumed with dealing with this annoying problem? I know that doctors in pain management would obviously deal with this A LOT, but is it just as much of an issue for neurosurgeons? It would pain me to know that I could potentially have to deal with this my whole life lol

I haven't quite had that experience writing for narcotics and that does sound like an incredible hassle. The things I write for most often are oxycodone/tylenol, hydrocodone/tylenol, keppra/dilantin, dexamethasone, and senna. My biggest issue is forgetting to put my DEA# on a vicodin Rx. We tend to pass the patient back to their PCP or refer to a pain specialist for pain meds if it's non-op or after the immediate perioperative period.

 

[neusu]

I know you might not have time to read this, but if you do, would you mind briefly commenting on what you think about it?

http://projectwordsworth.com/life-love-neurosurgery/

It's basically a commentary by the wife of an ex-prospective neurosurgeon/current anesthesiology resident on the obsessive nature that is supposedly inherent in neurosurgery, and consequently inherent in neurosurgeons. I didn't find any of what she said hard to believe, and don't doubt that any field as demanding as neurosurgery attracts obsessive people, but part of why this thread has been so interesting to follow is because of how well-balanced you seem to be.

Anyway, if you do end up reading it and could briefly comment on what you think, it would be much appreciated. Thanks!

I hadn't read it until I stumbled across it in the allo forum. There is a fair amount of truth to what she says. Indeed, neurosurgery isn't for everyone and does seem to attract people that fit the mold. That being said, the training also tends to mold people to a particular fit.

With respect to balance, first of all thanks, it's nice to hear I don't come off as a megalomaniac. I certainly have a number of interests outside of neurosurgery and continue to enjoy them when I can. That being said, it is all about compromise, priorities, and time management. Some days/weeks I am too exhausted to do anything but work, eat, and fall asleep reading. Others I can go out with friends, exercise, and enjoy hobbies. Life has a habit of changing, being able to adapt to challenges and find happiness certainly makes it more enjoyable. I don't think anyone truly enjoys working 120 hours a week or not having a day off for weeks on end, but if that's what is called for I dive right in and make adjustments to the other things I do.

 

[neusu]

Did you ever consider Otolaryngology instead of Neurosurgery? Did you go into medical school knowing you wanted to pursue NS right off the bat?

I went in to medical school thinking I wanted neurosurgery so I planned for that. I did do an ENT elective, though, and really enjoyed it. Perhaps, if I found it earlier I may have gone a different route. Neurosurgery and ENT are hugely different fields, but often work together. What I liked about ENT are the things that aren't terribly possible in neurosurgery: office visits of long term/frequent patients, multiple short procedures, and minimal call obligations.

If I had to do it over again, I'd still pick neurosurgery.

 

[mwall003]

I went in to medical school thinking I wanted neurosurgery so I planned for that. I did do an ENT elective, though, and really enjoyed it. Perhaps, if I found it earlier I may have gone a different route. Neurosurgery and ENT are hugely different fields, but often work together. What I liked about ENT are the things that aren't terribly possible in neurosurgery: office visits of long term/frequent patients, multiple short procedures, and minimal call obligations.

If I had to do it over again, I'd still pick neurosurgery.

Thanks so much, great reply. I'm trying decide between the two specialities so thank you for your response!

 

[Dick Jones]

Thanks again for this thread! Would you recommend doing a neurosurgery elective at a highly competitive/well-known program or at a less competitive/well-known program? I'm assuming the less competitive/well-known program would give me the best opportunity to match into Neurosurgery.

 

[DrLoveee]

What are some of the sacrifices, besides for sleep and stress, that you've had to undertake for your neurosurgery residency?

 

[neusu]

Any fun hobbies that you enjoy on your spare time?

Many! My hobbies and interests somewhat adapt to the environment around me, but in most places I can run or cook.

What made you interested in pursuing private practice instead of sticking with academic medicine?

Actually, I haven't decided either way. Each has its own merits and drawbacks. I'll answer more completely when I finally decide!

Do you partake in pre-medical shadowing at your clinic? I've been trying to contact multiple neurosurgeons in my city and ask to shadow and so far I've been SOL.

We have medical students rotate on the service during their clinical years. Many of the attendings are open to having pre-meds shadow either in clinic or the OR. Private practice can be a little trickier to crack. If there is a program near you, or some academically affiliated neurosurgeons, try e-mailing the department coordinator.

I think it's absolutely wonderful that you have time to do this so thank you!

Believe it or not, my first conversation with a neurosurgeon was in 7th grade. He was PGY-3 and he summed up his joining into the residency as "trying to jump across a mile-wide river of s**t, and then wading across the rest of the way there". Ever since then I've been completely fascinated with the specialty, not to say I will be able to do it because I haven't even started med school. But I find joy in being inspired in it.

Having inspiration in life helps to maintain motivation. While the quote may be a little egregious, residency certainly is not something to take lightly.