- Joined
- Jan 28, 2013
- Messages
- 190
- Reaction score
- 3
Thanks for all the awesome insights! You are really inspiring to all of us here. Quick and potentially silly question. Do surgeons and other operating room staff ever listen to music during surgery?
I am currently a member of CNS. It was free, and is free for all residents. Nonetheless, it may not be worth it, as they send you a ton of spam mail.Is CNS membership worth it? When would be the best time to request it?
These two fields are not quite similar.endovascular vs skull base?
The current job market is fine. The majority of neurosurgeons in the country do "minor" brain neurosurgical procedures. Meaning, small or large tumors (depending on the center) and spine, spine, spine. You have to understand, the prevalence of back pain vs brain tumor/aneurysm/avm/cav mal/acoustic neuroma is such that it necessitates the majority of the general neurosurgeon's practice is spine. Likewise, if I have been in practice 20-years, and not done an acoustic neuroma since residency, am I the right person to do it? That being said. There are a large number of private practice neurosurgeons, at select community hospitals, who do amazing, world class neurosurgery. I hate to use Mayo as an example, because it isn't a community hospital. Nonetheless, they have a fantastic group there, who do anything under the sun as well as anyone else in the country. So private practice is not the end of the world.Fellowship vs residency alone, concerning the job market?
CheersCheers Nes.
Looks to me like the study was underpowered.
Seems reasonable. Not sure what you mean by EC. While it is admirable to want to spend time with the family, realize that during residency, at times, this will be a challenge. Perhaps, during school giving it a dry run and seeing if you, and they, can handle it, would be reasonable rather than investing a year or two of residency to find out you can't.hi neusu,
1. for someone starting med school with no previous publications/substantial research would the following "plan" generally apply to qualify for a neusurg spot:
a. do well in classes & rotations
b. do well on usmles
c. do a summer research between 1st & 2nd year (or is it 2nd & 3rd year?) - get a clinical project related publication
d. do an EC
e. Profit??? or No Profit???
or is an extended long term research project necessary? I am getting quite old already as a non traditional applicant and would like to spend as much time as possible with the lady (maybe kids) before any sort of residency kicks in.
a) I suspect in the future we will be able to have computers better adept at understanding the clinical scenario and aiding with diagnosis. Nonetheless, a doctor is much more than a neural network crunching the most probable solution to the given constraints. A history and physical involves a human interaction, reading the patient, seeing/hearing/feeling, and taking appropriate next steps to support/refute working diagnoses. Likewise, we do more than just examine and treat. We encourage, we comfort, and we care. Training a computer to do that will take several major steps forward. Mid-level encroachment is not terribly prevalent in the surgical fields and their role tends to be limited to paperwork or assisting in surgery. It may be anecdotal, but nearly every time I consent a patient for a procedure they ask who will be performing the procedure, or if the attending is "really" there. Granted, I am still in training, but I suspect mid-level providers out there have similar hesitancy on the part of their patients.2. expanding on a previous comment you made - What is your perspective on robots/AI (i.e. watson) + mid levels combo playing a role in the future in terms of a) patient care (both surgical and nonsurgical) b) gainful employment for physicians. i.e. how far is the future where DNPs evaluate the patient and input data into watson which spits out a treatment plan far superior to that of a physician. perhaps more of a concern for family practice than surgery but nonetheless.
Any time.thanks man.
Mid-level encroachment is not terribly prevalent in the surgical fields and their role tends to be limited to paperwork or assisting in surgery. It may be anecdotal, but nearly every time I consent a patient for a procedure they ask who will be performing the procedure, or if the attending is "really" there. Granted, I am still in training, but I suspect mid-level providers out there have similar hesitancy on the part of their patients.
b) This scenario is more likely to come to fruition than the former.
Thanks for all the awesome insights! You are really inspiring to all of us here. Quick and potentially silly question. Do surgeons and other operating room staff ever listen to music during surgery?
are these factors worth loosing sleep over if considering a nonsurgical specialty - say peds for example?
Hi neusu,
Does it matter if one gets an MD or a DO in pursuing neurosurgery?
About a month and a half ago I talked to you about the frustrations of obtaining a shadowship in neurosurgery in which you responded with "keep at it".
Took your advice and will be scrubbing up to observe endoscopic disc surgery in a few weeks, thanks again!
Hey neusu. Thanks for paying so much attention to this awesome thread. I'm currently a 2nd year med student finishing around the middle of my class. I have quite an interest in neurosurgery, but am worried that I won't be the most competitive candidate ever. What do you think it takes to get into the less competitive neurosurgery residencies concerning step score, clerkship grades, and research?
Neusu, have you ever done a resection or a partial resection of a hippocampus due to a tumor or epilepsy?
Or is operating on the hippocampus off limits?
Thanks..
Yes, I have done surgery on the temporal lobe. Temporal lobectomy, and its variants, are somewhat common surgeries we do for epilepsy as well as tumor.
Hmm.I know someone who did a neurosurgery residency and then an endovascular fellowship, and a little over 2 years after he finished his fellowship he was hired as a director at a top 20. Is this common in specialties like neurosurgery where schools really only employ 1-2 surgeons of a specific sub-specialty? Or was he just a unique case?
Hmm.
Are you sure it was 2 years? The less I've seen is directorship after 5 years of experience.
Neusu,
Are you in the Seattle area?
Or the institution just started a new program. Most of the time they are new programs.His fellowship ended 2011 and he was hired last year after working as a clinical instructor for a year somewhere else. Guess he's just crazy good at what he does
Or the institution just started a new program. Most of the time they are new programs.
I know someone who did a neurosurgery residency and then an endovascular fellowship, and a little over 2 years after he finished his fellowship he was hired as a director at a top 20. Is this common in specialties like neurosurgery where schools really only employ 1-2 surgeons of a specific sub-specialty? Or was he just a unique case?
Hi Neusu,
Just wondering what the situation is with hospitals in the US hiring Canadian neurosurgery grads. I've heard the AANS blocked Canadian grads from writing the American boards but that hospitals can still hire Canadians. Do you know anything about this?
I know someone who did a neurosurgery residency and then an endovascular fellowship, and a little over 2 years after he finished his fellowship he was hired as a director at a top 20. Is this common in specialties like neurosurgery where schools really only employ 1-2 surgeons of a specific sub-specialty? Or was he just a unique case?
Hmm.
Are you sure it was 2 years? The less I've seen is directorship after 5 years of experience.
Neusu,
Are you in the Seattle area?
I know someone who did a neurosurgery residency and then an endovascular fellowship, and a little over 2 years after he finished his fellowship he was hired as a director at a top 20. Is this common in specialties like neurosurgery where schools really only employ 1-2 surgeons of a specific sub-specialty? Or was he just a unique case?
It's not terribly uncommon in subspecialties within neurosurgery that are in high demand but not terribly popular. Peripheral nerve, for example. I am fairly confident that any neurosurgery resident who completes a fellowship in peripheral nerve and wants to be director of peripheral nerve in a department of neurosurgery would have no trouble finding a position out of residency. There just aren't that many people who do it, and it is a feather in the cap of programs who have someone who does that.
Your friend did endovascular, perhaps combined endo/cerebrovascular. While this is becoming more popular, a dual trained vascular specialist is still not terribly common. Some places who currently do not have a vascular trained surgeon, or have someone who is looking to retire, would make a younger surgeon the director of cerebrovascular.
Hmm.
Are you sure it was 2 years? The less I've seen is directorship after 5 years of experience.
Neusu,
Are you in the Seattle area?
No, sorry!
Yup, that was his fellowship! Thanks
How much time do you spend on average seeing patients (post op checkups, finding good candidates for surgeries, etc)? I'm curious because I was surprised to hear how much time an orthopedic surgeon spent each week outside the operating room.
As a resident this varies widely compared to an attending.
We have a resident clinic, wherein we see patients who are uninsured. We get referrals from PCPs, the ER and so on, as well as see our post-op patients. Likewise, we follow all of the patients while they are in the hospital.
For clinic, it varies. Each appointment lasts anywhere from 10-30 minutes. If the patient is a follow-up, we generally check everything over, look at the wound, and reassure them that they'll be up to speed soon. For a new patient, it often requires ordering new imaging, if it isn't already completed, scheduling an OR date, or just reassuring the patient that, though they do have pain, it isn't neurological/surgical in origin. The latter group often eats up clinic time. Essentially, they are sent to you by a pcp or pain specialist. My paradigm is to walk in and ask a general question such as "What's troubling you," or "How can I help you?" If they respond with a clinical or radiological diagnosis I, generally, think they're full of ****. I realize, I'm a specialist, and perhaps they have heard it before. However, when a patient is in my office and says, in response to the former question, "I have an L4 radiculopathy," I am a little suspicious. ALWAYS perform an in depth history and physical examination. Certainly, if the images correlate with the actual findings, it may be operative. Nonetheless, there is so much information available now, people will feign an exam to be operated on, to no avail..
Hey neusu, I've been following this thread for a while and wanted to say thank you for taking the time to answer all of these questions. It's been a pretty huge contributing factor to my growing interest in neurosurgery. I'm an OMS1 and we just started our nervous system block last week, which is absolutely blowing my mind. I'm going to start trying to get plugged into something research-wise for this summer between 1st and 2nd year. I don't think that it's realistic for me to find neurosurg-related research, since my school doesn't have an NS department, but hopefully I can find something interesting either way.
I wanted to ask what the typical fate is of somebody who fails to match the first go around? For those who are really really driven to enter neurosurg, would you say that most of them elect to do a preliminary gensurg year and then reapply? From what you've seen, are these individuals successful in matching the second time more often than not?
Again, thanks for doing all of this for us and I hope work is going well. Really inspiring thread.
What are your thoughts on psychiatric neurosurgery?
Any conjecture as to the etiology of such behavior (e.g., Munchausen Sx, malingering, or such immense idiopathic pain that they think any surgical intvxn is better than nothing)? I never really thought of a pt feigning a neurosx exam in order to undergo surgery... Medical? Sure. But surgical? WOW.
Hope all is well broheem.
By now you should get Alerts on your SDN Forum home screen, Neusu.I'm going to bump this x1.
I think I answered all of the questions that were posed, if you have another, please ask it now..
I'll keep an eye on this thread, should it become active after it falls to the gallows of SDN. Even so, feel free to PM me if you have a question and this thread is dead.
Neusu,
I'm beginning my prereqs for medical school next semester, planning on taking summer classes this year and next year. For someone who doesn't
have much of a science background and hasn't done math for a few years, what do you suggest I do to prepare? Taking Chem/Calculus/Biology, and a 1 credit neuro class next semester, and plan on graduating Spring 2016.
What you have so far looks reasonable. I'd consider trying to get involved in research early. As a undergraduate, you have more time than a medical student.
How do I get exposed to research? Emailing science professors about it? And If I have a weak science/math background, Do you suggest me to start practicing early like on my spare time now and over winter break before spring semester starts?
There often is a student job board for positions in research labs. Unless you have prior experience, you'll likely start off washing glassware and making reagents. If you stick to it though, the techs/grad students/post docs will typically teach you techniques and allow for you to take on pieces of a project.
What do you mean by practicing early?
Not to steal neusu's thunder here, but to answer your question, the vast consensus is to focus on your current classes and enjoy your time off before matriculating. Pre-study is not helpful at all. You'll learn all you need to know once you're in medical school. Much of the material you'll test on is unique to each professor.Oh i see, I'll look into the student job boards for research experience. I mean starting early by researching the material before i start them next semester, using websites like MIT opencourse, and Khanacademy.
Not to steal neusu's thunder here, but to answer your question, the vast consensus is to focus on your current classes and enjoy your time off before matriculating. Pre-study is not helpful at all. You'll learn all you need to know once you're in medical school. Much of the material you'll test on is unique to each professor.
This also holds true for most undergraduate courses. That said, many students choose to read Organic Chemistry as a Second Language and/or The Nuts and Bolts of Organic Chemistry to prep for orgo. I did that myself and found it fairly helpful.
Good luck.
P.S. Thankfully, there also isn't much math in medical school.
Thanks Neuro & Geuro. I'm almost registered up for classes. Chem 105, Bio 106, Math 171, & Astronomy 450.
What year are you? Certainly, doing well in classes and actually understanding the material is the primary goal of undergraduate. The latter makes the MCAT easier, and you will be more successful.
I'm a sophomore on a 5 year plan. I just finished all my general requirements for school this semester, and will start the pre reqs next semester.