Ask a neurosurgery resident anything

[neusu]

1. What were you like in undergrad?
2. Were you always studying throughout the year in undergrad to prepare for the MCAT?

As an undergrad I was pretty average I guess. Most of my friends were in similar majors and ended up in medical school as well.

I studied for each class, but for the mcat just a little time that semester before the test was dedicated to it.

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[Toutie]

As an undergrad I was pretty average I guess. Most of my friends were in similar majors and ended up in medical school as well.

I studied for each class, but for the mcat just a little time that semester before the test was dedicated to it.

Out of curiosity, what did you get on the MCAT?

 

[neusu]

Out of curiosity, what did you get on the MCAT?

It's been so long, I'd have to check. If I recall correctly, it was sufficient to get in to medical school.

 

[LebronManning]

Is neurosurgeon salary affected by the same things that affect all physician salary, namely desirability of location. I would think it has less of an effect of neurosurgery since the supply is so low.

I think it's reasonable for a mid career neurosurgeon to make 500-800 in a nice medium city, but how does this change in Los Angeles? I just can't imagine a neurosurgeon making 250 anywhere even in the middle of manhattan

 

[neusu]

Is neurosurgeon salary affected by the same things that affect all physician salary, namely desirability of location. I would think it has less of an effect of neurosurgery since the supply is so low.

I think it's reasonable for a mid career neurosurgeon to make 500-800 in a nice medium city, but how does this change in Los Angeles? I just can't imagine a neurosurgeon making 250 anywhere even in the middle of manhattan

Your question would be better phrased as "are neurosurgeon salaries affected by market forces?"

The answer is yes, but like most of medicine salary is highly variable depending on individual and practice model.

 

[LebronManning]

What's your take on the chatter about the possible dismal future of spine surgeons, both Ortho and Neurosurg, based on supposed poor outcomes of spine surgeries. I admittedly have not researched these outcomes myself but have seen quite a few posts on SDN about them often not providing much relief. This, along with consistent new innovation of spinal therapy, some which can be done without needing a surgeon, makes some people say spine surgery is going to take a major hit in terms of reimbursement. Wondering your thoughts about this.

 

[neusu]

What's your take on the chatter about the possible dismal future of spine surgeons, both Ortho and Neurosurg, based on supposed poor outcomes of spine surgeries. I admittedly have not researched these outcomes myself but have seen quite a few posts on SDN about them often not providing much relief. This, along with consistent new innovation of spinal therapy, some which can be done without needing a surgeon, makes some people say spine surgery is going to take a major hit in terms of reimbursement. Wondering your thoughts about this.

First and foremost, reimbursement is tied to several things, and outcomes is only part of it. Indeed, there are many, many; many, many, many failed spine surgeries. Even so, there are more successful spine surgeries. For every field of medicine, there are experts involved, and compensation is tied accordingly. I am not as familiar with the spine therapies you mention, but even within spine surgery, there is constant innovation. I don't think spine surgery is going anywhere, though the practice will change.

 

[LebronManning]

Do you think Neurosurgeons will have an integral role in the future of brain/computer interface? Do you think cool technology in the future regarding that will require direct contact with the brain requiring a neurosurgeon and his/her expertise? Obviously you don't have the answers to these existential questions but would love to hear your thoughts.

 

[Saifa]

Hi again @neusu

M1 now and trying to narrow down a variety of specialty interests-- I picked up a research project in plastics and was wondering how much impact (if any) non-neuro surgical research carries in a neurosurgery application. I'm at a "top 5" and would really like to end up in an academic center, just not certain between plastics neuro ortho uro or gen surg yet. Thanks as always.

 

[Psai]

This thread is so old it could almost be done with neurosurgery residency

Props to neusu

 

[Ms Procrastinator]

This thread is so old it could almost be done with neurosurgery residency

Props to neusu

Actually, I think it's got one more year.

 

[Alakazam123]

I think a lot of people are interested in neurosurgery because of exposure to neuroscience as an undergrad. This is great to have a wider exposure for the field and a lot of interest in neuroscience. However, there is little actual neuroscience on a day to day basis in neurosurgery, and if you want to do a neurosurgery residency you will have to reconcile that, that for 7 years you will likely have to hang up your neuroscientist hat. Even so, there are a number of exceptional neurosurgeons who are also exceptional at neuroscience. Many will say pick one and be good at that because trying to be both will make you great at neither. If it's your true passion though, go for it. It can be and has been done.

Hello, I know this is coming very late, but would appreciate some insight on the following:

1. Is Neurology a better fit for people interested in becoming seasoned neuroscientists and clinicians?

2. If you come up with an idea for a new drug, can you work with professors in other departments to carry out the research?

3. Apart from Parkinson's Disease, do NS's do much with any other neurodegenerative disorders (Alzheimer's, Huntington's, ALS, MS, specifically)?

 

[RogueUnicorn]

Hello, I know this is coming very late, but would appreciate some insight on the following:

1. Is Neurology a better fit for people interested in becoming seasoned neuroscientists and clinicians?

2. If you come up with an idea for a new drug, can you work with professors in other departments to carry out the research?

3. Apart from Parkinson's Disease, do NS's do much with any other neurodegenerative disorders (Alzheimer's, Huntington's, ALS, MS, specifically)?

I'm not neusu or even a neurosurgery resident but I can't resist on a couple of these

1. The personality types that go into nsg vs. neurology are so vastly different that this isn't a real consideration for most. I would also argue that surgeons make fine clinicians, thank you.
2. This is a pretty naive understanding of drug development and scientific endeavors in general. If you are in a position to conceive of a truly novel drug, you are 100% already deeply entrenched in the pharma/molec sci world. This isn't like apps where you come up with a cool idea and outsource the coding.

 

[Alakazam123]

I'm not neusu or even a neurosurgery resident but I can't resist on a couple of these

1. The personality types that go into nsg vs. neurology are so vastly different that this isn't a real consideration for most. I would also argue that surgeons make fine clinicians, thank you.
2. This is a pretty naive understanding of drug development and scientific endeavors in general. If you are in a position to conceive of a truly novel drug, you are 100% already deeply entrenched in the pharma/molec sci world. This isn't like apps where you come up with a cool idea and outsource the coding.

Yeesh, chill out man. I'm just asking a question. I'm still a pre-med. I never said that neurosurgeons are not good clinicians. What I was wondering, was based off the OP's original statement, that you have to "hang up" your neuroscientist hat before going in. Hence, my question.

I'm sorry for committing the cardinal sin of asking your holiness a question. Please, smite me.

 

[neusu]

Do you think Neurosurgeons will have an integral role in the future of brain/computer interface? Do you think cool technology in the future regarding that will require direct contact with the brain requiring a neurosurgeon and his/her expertise? Obviously you don't have the answers to these existential questions but would love to hear your thoughts.

Neurosurgeons are the only people who can place devices on, or in to, the brain. Depending on which side of the fence you are, the neurosurgeon is instrumental in developing and managing these implanted devices. Alternatively, they are simply the technician placing the device. In my experience, the former tends to be the way we feel about it, though some neuro scientists, neurologists, and psychiatrists I have worked with see it as the latter.

 

[neusu]

Hi again @neusu

M1 now and trying to narrow down a variety of specialty interests-- I picked up a research project in plastics and was wondering how much impact (if any) non-neuro surgical research carries in a neurosurgery application. I'm at a "top 5" and would really like to end up in an academic center, just not certain between plastics neuro ortho uro or gen surg yet. Thanks as always.

Research is good, regardless of what you would like to do. Publish as much as you can. It means less to the neurosurgeons to do plastic surgery research, because we can relate to it less. If you do end up deciding neurosurgery, be sure to get something published (even a case report) on a neurosurgery topic. That being said, you could choose a hybrid e.g. craniofacial, that covers both.

 

[InTypical]

I'm sorry if you've been asked this already, but what did your ECs look like in undergrad? And thank you for still answering questions - I understand if you can't provide a solid answer due to how long it has been.

 

[neusu]

This thread is so old it could almost be done with neurosurgery residency

Props to neusu

Indeed!

 

[neusu]

Actually, I think it's got one more year.

I think you are correct

 

[Ms Procrastinator]

I think you are correct

It must be so glad it's almost done residency.

 

[neusu]

Hello, I know this is coming very late, but would appreciate some insight on the following:

1. Is Neurology a better fit for people interested in becoming seasoned neuroscientists and clinicians?

2. If you come up with an idea for a new drug, can you work with professors in other departments to carry out the research?

3. Apart from Parkinson's Disease, do NS's do much with any other neurodegenerative disorders (Alzheimer's, Huntington's, ALS, MS, specifically)?

1. They each have their strengths and draw-backs for neuroscience. The term, itself, is rather broad. I know surgeons, though, who do 20% clinical time and 80% lab research. Anything is possible, you just trade income for lab time

2. Yes

3. The ones you mentioned are not surgical diseases. As a field, we continuously look for surgical (and non-surgical) treatments for pathologies. While they are not currently treated with surgery, perhaps, with future research, they may be.

 

[Alakazam123]

1. They each have their strengths and draw-backs for neuroscience. The term, itself, is rather broad. I know surgeons, though, who do 20% clinical time and 80% lab research. Anything is possible, you just trade income for lab time

2. Yes

3. The ones you mentioned are not surgical diseases. As a field, we continuously look for surgical (and non-surgical) treatments for pathologies. While they are not currently treated with surgery, perhaps, with future research, they may be.

1. What are the strengths and drawbacks in each case?

2. Would the NIH prevent you from writing grants to do research on Neurology-related diseases like ALS, MS, if you are a neurosurgeon? Or would the department frown upon you by chance?

3. Also, if you are a successful researcher, can you make income off your research?

 

[neusu]

I'm sorry if you've been asked this already, but what did your ECs look like in undergrad? And thank you for still answering questions - I understand if you can't provide a solid answer due to how long it has been.

I can't really recall specifically. I think I was in some club sports, nominated to an honor society, and volunteered locally and abroad. I think whatever you do, be able to talk about it, and why you listed it on your application. The interview committee wants to get a feel of who you are as a person, and these activities help shape their impression of you as a person, outside of school.

 

[neusu]

1. What are the strengths and drawbacks in each case?

2. Would the NIH prevent you from writing grants to do research on Neurology-related diseases like ALS, MS, if you are a neurosurgeon? Or would the department frown upon you by chance?

3. Also, if you are a successful researcher, can you make income off your research?

1. Neurosurgery: gets to operate, higher salary, but longer hours. Neurology: more time to think about each problem, less salary to divert to research if desired.

2. No. Likely not.

3. You can, though to do so is incredibly difficult. Most true researchers focus solely on that, and much of their income is from grants they write. Alternatively, if drug design/discovery is your desire, get a PhD, work for Pharma. They pay pretty well.

 

[neusu]

It must be so glad it's almost done residency.

Yeah, definitely a world of difference after residency!

 

[LebronManning]

Curious about the practice variety of a private practice or community hospital employed neurosurgeon.

I heard it’s about 80/20 spine to cranial. Is that accurate? I’m curious about what types of cranial cases make up the majority of your cranial practice? Is it mostly tumors and trauma?

Does doing a cerebrovascular, neuro IR, or tumor fellowship help weigh that ratio more toward cranial?

 

[bioboy23]

Since this thread is about to be out on its own soon, is it going to tailor its practice towards one aspect of neurosurgery or do a fellowship? Or is it going to remain general and take all that comes in?

 

[neusu]

Curious about the practice variety of a private practice or community hospital employed neurosurgeon.

I heard it’s about 80/20 spine to cranial. Is that accurate? I’m curious about what types of cranial cases make up the majority of your cranial practice? Is it mostly tumors and trauma?

Does doing a cerebrovascular, neuro IR, or tumor fellowship help weigh that ratio more toward cranial?

Every surgeon is different. The case variety varies on the surgeons practice and referral base. Some surgeons do 100% spine, some do 0%. My impression, of private practice, is that spine reimburses well, so it tends to be desirable. Similarly, some surgeons do 100% cranial cases, even 100% tumors and 0% trauma. Life is a trade-off.

A fellowship certainly does help, as does working at an academic center. Though, again, it is a trade-off.

 

[neusu]

Since this thread is about to be out on its own soon, is it going to tailor its practice towards one aspect of neurosurgery or do a fellowship? Or is it going to remain general and take all that comes in?

Ha. I think the thread will stay general. Most students don't know enough about a particular subspecialty to make it useful to focus on that particular aspect of neurosurgery. I specialized in cerebrovascular, but know a bit about other fields, as I looked in to many before settling on this.

 

[panbimbo]

Hi, I am interested in neurosurgery as an undergraduate. I have the opportunity to work in neuroradiology for a research project. Would you say that as a neurosurgeon that you work a lot with radiology and imaging? Or are the disciplines separate in the sense that neurology and neurosurgery are different? Do neurosurgeons do research in this field?

 

[neusu]

Hi, I am interested in neurosurgery as an undergraduate. I have the opportunity to work in neuroradiology for a research project. Would you say that as a neurosurgeon that you work a lot with radiology and imaging? Or are the disciplines separate in the sense that neurology and neurosurgery are different? Do neurosurgeons do research in this field?

We use a lot of imaging in what we do. A good neuroradiologist can be amazing. There is some overlap between neurosurgery, neurology, and radiology on the neuro interventional side. For the most part, though, these fields are widely different

 

[teriyakibeef]

Hi @neusu , when neurosurgeons are on call, e.g. 30 hour call, is all that time spent at the hospital and working? Is there downtime and opportunity to work out or study? Do residents or attendings on call get to go home and return to the hospital if they get a call?

 

[neusu]

Hi @neusu , when neurosurgeons are on call, e.g. 30 hour call, is all that time spent at the hospital and working? Is there downtime and opportunity to work out or study? Do residents or attendings on call get to go home and return to the hospital if they get a call?

This varies depending on the department and program. For residency programs, if it is busy, the 30-hour call is often "in-house," so the resident does not go home. It may slow down, and studying or work can get done, though it is frustrating because the pager is always there and goes off sporadically. Senior residents will most commonly take back up, or home call. They come in when the Jr in house is overwhelmed, or for cases. Attendings rarely spend any more time the necessary in the hospital. Often, they will spend a week, or month on call.

Throughout training, the efficiency in the ability to triage and dispo patients is increased. Likewise, the more autonomy granted, the easier the task becomes. For instance, an attending has residents to see the patients immediately, and will come for rounds in the morning. In private practice, there may be mid-level providers, or a hospitalist, who does much of the immediate work (admission, medical management, etc), and the neurosurgeon is a consultant.

 

[Premed2295]

What is the best advice you have on conducting a stellar patient interview? I use the exact same approach every time, and some patients and facilitators love my "rolling history" approach while others think of it as a little disorganized. I speak to them all as naturally as I know how, but its sometimes hard to guess just what will work.

 

[neusu]

What is the best advice you have on conducting a stellar patient interview? I use the exact same approach every time, and some patients and facilitators love my "rolling history" approach while others think of it as a little disorganized. I speak to them all as naturally as I know how, but its sometimes hard to guess just what will work.

Be thorough, but concise. As you mentioned, having a routine, so you don't miss or forget anything, helps. Most prefer to go head to toe.

 

[Vladimir7]

What is rolling history?

And what were your steps from getting into med school to becoming a neurosurgeon? Anything to start doing early to get into such a competitive specialty?

 

[neusu]

What is rolling history?

And what were your steps from getting into med school to becoming a neurosurgeon? Anything to start doing early to get into such a competitive specialty?

Do well in medical school, do well on USMLE Step 1 and 2, publish research, interview well. The best thing you can do early is to do well in school and research. When Step comes around, focus on that.

 

[Alakazam123]

Do well in medical school, do well on USMLE Step 1 and 2, publish research, interview well. The best thing you can do early is to do well in school and research. When Step comes around, focus on that.

Do you believe neurosurgery is going to be obsolete soon due to the advent of immunotherapies for brain tumors, and clot busting drugs for stroke, etc. Leaving mostly just spine and neurotrauma work?

 

[puahate]

Do you believe neurosurgery is going to be obsolete soon due to the advent of immunotherapies for brain tumors, and clot busting drugs for stroke, etc. Leaving mostly just spine and neurotrauma work?

that is very optimistic lol. Not saying its not possible but we arent really close to that treatment for the brain

 

[Alakazam123]

that is very optimistic lol. Not saying its not possible but we arent really close to that treatment for the brain

Sorry, I shouldn't have said soon. But I mean in like 40+ years. Do you feel Neurosurgery will become like CT surgery, where the field name sounds sexy, but it's losing a patient base and in turn revenue base?

 

[neusu]

Do you believe neurosurgery is going to be obsolete soon due to the advent of immunotherapies for brain tumors, and clot busting drugs for stroke, etc. Leaving mostly just spine and neurotrauma work?

No. I think there will always be a role for neurosurgery, at least in the near future. The new technologies coming out are amazing, but they just are not quite there yet.

 

[Alakazam123]

No. I think there will always be a role for neurosurgery, at least in the near future. The new technologies coming out are amazing, but they just are not quite there yet.

I'm 22 yrs old rn. So, by the time I retire would it possibly be obsolete?

 

[neusu]

that is very optimistic lol. Not saying its not possible but we arent really close to that treatment for the brain

Agreed. Perhaps some day, we will be able to treat these pathologies in a non invasive manner, but my hunch is that is far down the road.

 

[neusu]

I'm 22 yrs old rn. So, by the time I retire would it possibly be obsolete?

Anything is possible. The likelihood of that being the case is very low.

 

[LebronManning]

How many surgeries total do you average per week?

 

[neusu]

as a medical student what type of research would you recommend doing in terms of basic vs. clinical? Is basic research recommended for applying for residency?

As a medical student, you will rarely have time to conduct basic science. If you can, and get a meaningful paper, great. Regardless, publish or perish. If you have a research experience, but do not have a paper from it, it does not matter for applications.

 

[neusu]

How many surgeries total do you average per week?

Depends on the week. If it's slow, 5 - 10. If it's busy, quite a few more!

 

[Nans]

Thank you immensely for doing this thread! I'm currently trying to schedule my MS4 electives and do you recommend any outside of the neurosurgery sub-I, NICU, neuroradiology, and neuropathology?

 

[WedgeDawg]

Thank you immensely for doing this thread! I'm currently trying to schedule my MS4 electives and do you recommend any outside of the neurosurgery sub-I, NICU, neuroradiology, and neuropathology?

You'll have to do at least 2 away Sub-Is at other institutions too, which will take precedence over NICU, neurorads, and neuropath (but do your home one first)

 

[LebronManning]

How much of a variety can/do private practice or community hospital employed neurosurgeons have? Is it reasonable for a endovascular trained doc to have a practice encompassing tumors, spine, carotids, neuro IR, a little open vascular, and then trauma call? Considering if they want to be that busy.

Obviously NSGY often has some poor outcomes for trauma cranis. How often do you see amazing recoveries following them? Do they help balance out and get you through the catastrophic outcomes?