Ask a neurosurgery resident anything

[tiedyeddog]

---

Members don't see this ad.

If someone asked this already I apologize.

How many publications did you have listed when you applied for residency? Do you think having basic publications over clinical matters at all, in terms for prestige?

 

[neusu]

If someone asked this already I apologize.

How many publications did you have listed when you applied for residency? Do you think having basic publications over clinical matters at all, in terms for prestige?

The National Residency Matching Program publication Charting Outcomes in the Match uses data from Electronic Residency Application Service (ERAS) and counts publications in a peculiar way. A "publication" in that report, charting outcomes, can vary from a peer-reviewed journal publication to a poster at your medical student research day.

When I applied, I had 7 peer-reviewed journal publications, 4 of which were 1st or 2nd author, 3 basic science and 4 clinical studies and numerous posters/oral presentations. Basic science in general is seen as "better," but prestige can vary as well due to the impact factor of a publication. For example, a clinical paper in NEJM or JAMA (or JNS or Neurosurgery for that matter) carries a fair amount of weight and would likely been seen as favorable over a a little known basic science journal. As a medical student it can be difficult to block off enough time to be in a lab and be productive so an ongoing clinical study can be easier to keep going with a demanding schedule. Just do your best to get involved in projects along the way and eventually something will bear fruit.

 

[Bangersandmash]

The National Residency Matching Program publication Charting Outcomes in the Match uses data from Electronic Residency Application Service (ERAS) and counts publications in a peculiar way. A "publication" in that report, charting outcomes, can vary from a peer-reviewed journal publication to a poster at your medical student research day.

When I applied, I had 7 peer-reviewed journal publications, 4 of which were 1st or 2nd author, 3 basic science and 4 clinical studies and numerous posters/oral presentations. Basic science in general is seen as "better," but prestige can vary as well due to the impact factor of a publication. For example, a clinical paper in NEJM or JAMA (or JNS or Neurosurgery for that matter) carries a fair amount of weight and would likely been seen as favorable over a a little known basic science journal. As a medical student it can be difficult to block off enough time to be in a lab and be productive so an ongoing clinical study can be easier to keep going with a demanding schedule. Just do your best to get involved in projects along the way and eventually something will bear fruit.

Would you say your numbers are a considerable outlier, even in the competitive field that is neurosurgery? In my time preparing one clinical publication as an undergrad, I can't imagine the effort 7 pubs must have taken unless you had an easy in for some of them.

 

[neusu]

Would you say your numbers are a considerable outlier, even in the competitive field that is neurosurgery? In my time preparing one clinical publication as an undergrad, I can't imagine the effort 7 pubs must have taken unless you had an easy in for some of them.

From what I gather, my stats are average for those who matched. I had friends who matched with 0 peer reviewed publications and those who had 20+. Most residents are involved in projects and are more than happy to scut out some work to a medical student or undergraduate. While it may not be terribly glamorous, reviewing charts and entering data can get your foot in the door to do some analysis and be on a paper.

 

[Bangersandmash]

From what I gather, my stats are average for those who matched. I had friends who matched with 0 peer reviewed publications and those who had 20+. Most residents are involved in projects and are more than happy to scut out some work to a medical student or undergraduate. While it may not be terribly glamorous, reviewing charts and entering data can get your foot in the door to do some analysis and be on a paper.

I am currently involved in chart review/data entry work along with my own stats project developments at a big public research university and the ease with which you speak of churning out publications makes me think my own department is pretty lackadaisical then.

I'll be on the lookout for opportunities.

 

[neusu]

I am currently involved in chart review/data entry work along with my own stats project developments at a big public research university and the ease with which you speak of churning out publications makes me think my own department is pretty lackadaisical then.

I'll be on the lookout for opportunities.

Research is a long and tedious process, and then you wait. Keep chipping away at it though. Hard work pays off if you're persistent and patient.

 

[sinombre]

How likely are you to work in academics once you're finished with residency/a possible fellowship?

 

[lazymd]

Which specialty requires more critical thinking: Neurosurgery or neurology? Why?

Thanks! 😀

 

[neusu]

How likely are you to work in academics once you're finished with residency/a possible fellowship?

I like the idea of working in an academic setting and getting to teach residents so I think it will be pretty likely.

 

[kgpremed11]

So what was your MCAT score?


Also people ( especially girls), are not impressed by the neurosurgeon line? 😕 I would think NS would get laid frequently, unless they are not attractive. Do you date a lot?

 

[neusu]

Which specialty requires more critical thinking: Neurosurgery or neurology? Why?

Thanks! 😀

This is a bit of an apples and oranges kind of question. We tend to do different things and manage different problems, but nonetheless have a fair amount of overlap. Neurosurgeons tend to be direct and problem focused, neurologists tend to be more esoteric. Neurologists probably perform better physical exams and are more thorough.

 

[neusu]

So what was your MCAT score?


Also people ( especially girls), are not impressed by the neurosurgeon line? 😕 I would think NS would get laid frequently, unless they are not attractive. Do you date a lot?

I got a 35Q (VR:11 PS:12 BS:12).

Attractiveness has little to do with what you do. I do have plenty of dates, just not because of the fact I'm a neurosurgery resident. In fact, most women seem more intimidated by my schedule than anything so it can be an obstacle, actually.

 

[sinombre]

How does your free time change as you progress through residency, if at all?

 

[neusu]

How does your free time change as you progress through residency, if at all?

Generally, as a junior resident and chief resident, free time is limited and at a premium. The juniors take a lot of call and hold the pager a lot and the chief is responsible for the whole service, operates at night, and is in charge of conferences and the like. The mid-year residents can have a somewhat lighter schedule, especially on research or off service electives.

 

[smooththrow]

So if the general public is asked to name the most challenging surgical profession (which one requires the most intelligence and skill), I think the most likely answer would generally be neurosurgery. Probably due to media & television show representations. What is your general opinion on that?

And thanks for this thread, it's been extremely informative and helpful!

 

[JoshuaGuit]

I guess this could be more of a general surgery question but:

I've shadowed two surgeons in my local hospital's OR last year, and this year I've been shadowing a bunch of ortho surgeons (carpal tunnel release, plif, rcr, kyphoplasty, total knee, acl reconstruction, trauma). The surgeries are relatively interesting, but probably about half the time I'm just sorta bored despite being "up close and personal" in the surgical zone. Did you ever feel this way? Before each surgery I read up on the exact protocols they're going to be doing and know generally which step comes next along with some complications. I'm not sure if it is just the fact that I'm not the one doing the surgery, or if I'm just genuinely not interested in being a surgeon.

Thanks!

 

[Owlie]

How does a surgeon, particularly a neurosurgeon, avoid damaging nervous tissue when dissecting? I've always been interested in how one goes about working around so many sensitive tissues with a knife.

 

[neusu]

So if the general public is asked to name the most challenging surgical profession (which one requires the most intelligence and skill), I think the most likely answer would generally be neurosurgery. Probably due to media & television show representations. What is your general opinion on that?

And thanks for this thread, it's been extremely informative and helpful!

I find it mildly amusing. We do a lot of technically and intellectually challenging surgery and can do some great things for people. On the other hand, we also do a fair amount of mundane run of the mill surgery as well. As I alluded to before, there seems to be a bit of a knowledge gap between neurosurgeons and the rest of the medical community, and the greater community as a whole. Often the central nervous system is treated in a special way, like some sort of mysterious black box that magically makes us be who we are. Perhaps, that is what always fascinated me about it as well. The difference, I suppose, is we want to take it apart and put it back together, figure out how it works, and make it better if we can.

 

[Freesia88]

I find it mildly amusing. We do a lot of technically and intellectually challenging surgery and can do some great things for people. On the other hand, we also do a fair amount of mundane run of the mill surgery as well. As I alluded to before, there seems to be a bit of a knowledge gap between neurosurgeons and the rest of the medical community, and the greater community as a whole. Often the central nervous system is treated in a special way, like some sort of mysterious black box that magically makes us be who we are. Perhaps, that is what always fascinated me about it as well. The difference, I suppose, is we want to take it apart and put it back together, figure out how it works, and make it better if we can.

We dissected a sheeps brain recently in anatomy lab.😱

All I can say is I am happy there are people like you out there.

👍

 

[wholeheartedly]

I know this has been touched on a little bit, but can you talk a little bit about what your life outside of residency is like? You mentioned carving time to work out even when exhausted. How do you achieve balance with a demanding schedule? Other than working out, do you find yourself forgoing other activities due to being exhausted or have you found some balance where you can have a hobby or something as well? If so, what do you think is the key to maintaing this balance despite your professional obligations.

 

[cortana431]

Are the very high neurosurgeon salary median (Upward to $600,000 ?) and highest (close to $1 million i heard?) actually accurate or are there hidden costs such as malpractice suits that substantially curtail your salaries?

And as a resident, are you considered a neurosurgeon or must wait until after your residency?

 

[syoung]

Have you operated on a brain (think you answered this but can't remember)? If so, (this relates to previous question) how do you tell the different areas in the brain apart? There's no markers or tell-tale signs that this is the demarcation of the which cortex/lobe/area, right?

 

[neusu]

I guess this could be more of a general surgery question but:

I've shadowed two surgeons in my local hospital's OR last year, and this year I've been shadowing a bunch of ortho surgeons (carpal tunnel release, plif, rcr, kyphoplasty, total knee, acl reconstruction, trauma). The surgeries are relatively interesting, but probably about half the time I'm just sorta bored despite being "up close and personal" in the surgical zone. Did you ever feel this way? Before each surgery I read up on the exact protocols they're going to be doing and know generally which step comes next along with some complications. I'm not sure if it is just the fact that I'm not the one doing the surgery, or if I'm just genuinely not interested in being a surgeon.

Thanks!

There's a saying about surgery that if there is no place in the world that you would rather be than the OR go in to surgery, if there is no place in the hospital you would rather be go in to anesthesia. For what it's worth, the first time I saw many different procedures I was very interested and amazed. After seeing the same thing over and over again it became a little less exciting. Getting to actually do the case, though, always remains exciting. Even for a procedure I have done 1000 times before, doing it again trying to increase speed or efficiency, or try a newer technique makes it great.

 

[neusu]

Have you operated on a brain (think you answered this but can't remember)? If so, (this relates to previous question) how do you tell the different areas in the brain apart? There's no markers or tell-tale signs that this is the demarcation of the which cortex/lobe/area, right?

I indeed have operated on human brains. Unfortunately, the body isn't labeled as well as anatomy textbooks so we have to do a number of other things to determine what's what. Firstly, a firm understanding of neuroanatomy is critical. Surgery is living anatomy and knowing what's where in relation to what you're looking at, in 3-dimensions, is imperative. Second, having adequate preoperative imaging and thoroughly reviewing prior to a case is important. Two examples are tumors and aneurysms. For tumor surgery, depending on the type of tumor, we can see where it is and make our craniotomy appropriately for the surgery. Intraoperative landmarks such as cortical veins, the natural sulci/fissures, and ventricles help orient during surgery. We also use functional assessments such as intraoperative electrocorticography to help stay away from areas of more importance. For aneurysms, preoperative imaging again is important. Knowing the orientation of the aneurysm as well as adjacent vessel anatomy helps guide the approach and verify that you're in the right spot. Intraoperative angiography (either traditional fluoroscopy or fluorescent microscopy) help determine direction of flow, artery vs vein, and ensure complete aneurysm occlusion and prevent any small vessel from being involved in the aneurysm clip.

Also, the advent of neuronavigation allows us to use instruments that are registered to the preoperative image and show us, in real-time, the structures that we are visualizing in the surgical field. This can be updated with intraoperative MRI or CT since the brain can change shape during surgery and the preoperative image is no longer relevant.

 

[neusu]

How does a surgeon, particularly a neurosurgeon, avoid damaging nervous tissue when dissecting? I've always been interested in how one goes about working around so many sensitive tissues with a knife.

It really depends on the surgery. For intraaxial cranial surgery it is unavoidable to damage some nervous tissue. Avoiding critical structures, or eloquent cortex, is a combination of knowledge of anatomy and, if need be, intraoperative monitoring. For other surgeries (extraaxial crnail surgery, spine, peripheral nerve, etc.) we again use our knowledge of anatomy to operate around nervous structures and, at times, utilize monitoring to warn us if a nearby nerve is being affected.

 

[smooththrow]

I don't think these questions have been asked yet, but I apologize if they have. How does the neurosurgery residency compare to other surgical residencies in reference to time commitments and overall stress on a daily basis (I do know it is several years longer than some other surgical residencies)? And how important is it that my research as a medical student be closely related to the field I end up choosing?

Thanks!!

 

[mclysek]

Research is a focus of most residencies and most have a year dedicated to it. While bench research is great there are many other kinds out there including clinical trials, device and surgical approach design, and translational research. If research isn't your thing, when you apply look for programs that aren't as research heavy. Some will allow you to instead do an enfolded fellowship or pursue a second degree (MPH, MBA, JD).

Do you know any that allow you to pursue a degree, or a place to find them?

 

[45408]

Also, the advent of neuronavigation allows us to use instruments that are registered to the preoperative image and show us, in real-time, the structures that we are visualizing in the surgical field. This can be updated with intraoperative MRI or CT since the brain can change shape during surgery and the preoperative image is no longer relevant.

how often do you use intra-op MRI?

 

[neusu]

I know this has been touched on a little bit, but can you talk a little bit about what your life outside of residency is like? You mentioned carving time to work out even when exhausted. How do you achieve balance with a demanding schedule? Other than working out, do you find yourself forgoing other activities due to being exhausted or have you found some balance where you can have a hobby or something as well? If so, what do you think is the key to maintaing this balance despite your professional obligations.

This, actually, is a lot more important than a lot of people let on. Neurosurgery, like a lot of residencies, leaves you with little free time and exhausted for most of it. My social life and activity calendar has certainly taken a hit from undergrad/medical school. Whenever a new junior comes on service, I make a point to tell him that it is as important to figure out how to destress/decompress during his junior years as it is to learn neurosurgery. Running around, exhausted the whole time, with bottled up anxiety and agitation leaves you in a bad place.

Personally, I struggled with this a bit. I tend to jump in to things entirely, so adjusting to not having enough time to get really in to what I wanted left me, for a short period, not doing anything outside work except sleeping and reading. To compensate I had to compromise and lower my expectations. Since then I've rekindled my interest in some activities I enjoy and find some newer hobbies.

That being said, there still is a bit of personal sacrifice required. Most programs allow residents to have 2-4 weeks of vacation a year, and at a minimum 4 days off a month. This likely means you won't be able to attend every wedding, Thanksgiving, family holiday, or weekend date night you'd like. Most programs attempt to accommodate individual requests, but there is a limit to what can be done.

 

[mclysek]

Does research in medical school need to be neurosurgery focused, or is any research acceptable. Does research without a neurosurgery focus carry less weight with programs?

 

[neusu]

From what I gather (I'm not an attending yet) the range you described is accurate. There have been economic impact studies suggesting that adding a neurosurgeon increases a hospital income around $2-3 million/year. While not all of this is from direct billing from procedures and consultations (e.g. a neurosurgeon requires a lot of expensive studies such as MRI scans that the hospital can bill for), gross billings for a neurosurgeon often exceed over $1-2 million.

As a resident you are considered a neurosurgeon, albeit an assistant or in training. You're not a full-fledged neurosurgeon until you are done with residency.

Are the very high neurosurgeon salary median (Upward to $600,000 ?) and highest (close to $1 million i heard?) actually accurate or are there hidden costs such as malpractice suits that substantially curtail your salaries?

And as a resident, are you considered a neurosurgeon or must wait until after your residency?

 

[neusu]

Do you know any that allow you to pursue a degree, or a place to find them?

I don't recall specifically. From what I gather most are pretty flexible as long as you are productive. Perhaps ask program directors or chairman on interviews to get a better feel for the possibility.

Does research in medical school need to be neurosurgery focused, or is any research acceptable. Does research without a neurosurgery focus carry less weight with programs?

Any research is good, neurosurgery focused research is better. If you can be productive and publish in another field that is a good sign. I'd recommend getting involved in the department at your institution early though. Research in another field, unless you can spin it as neurosurgery related in some way, may raise questions on how interested you actually are in neurosurgery.

 

[neusu]

I don't think these questions have been asked yet, but I apologize if they have. How does the neurosurgery residency compare to other surgical residencies in reference to time commitments and overall stress on a daily basis (I do know it is several years longer than some other surgical residencies)? And how important is it that my research as a medical student be closely related to the field I end up choosing?

Thanks!!

I'm not as familiar with other residencies except general surgery because we formerly had to do an internship with general surgery prior to starting neurosurgery (since my time, the internship is controlled by neurosurgery). We try to play down our overall time commitment and stress level, but even so, most other residents seem to understand we're likely busier and work more.

It's always better to have research in the field you intend to pursue because you will get the most out of it both in understanding of your field and capital for your residency application. That being said, any research is better than no research. If you can get involved in the department early on that is good. Residents always have ongoing research projects that they could farm out pieces to an interested, available, attentive medical student.

 

[smooththrow]

Thanks for all your answers! I've just got one more question, it's a bit different ha. Are surgeons obsessive about keeping their hands in excellent aesthetic condition? I lift weights often and have calluses and the occasional scrape, but I've started using gloves over the past year just in preparation for going into surgery. Obviously the hands are the moneymakers so they need to at least be in tip-top functional shape.

 

[neusu]

how often do you use intra-op MRI?

Intraoperative MRI is frequently used for pituitary tumors, intraaxial brain tumors, and deep brain stimulator electrode placement. Depending on the setup, the MRI can be used for multiple rooms or even as a regular MRI scanner when not in use for the OR.

 

[neusu]

Thanks for all your answers! I've just got one more question, it's a bit different ha. Are surgeons obsessive about keeping their hands in excellent aesthetic condition? I lift weights often and have calluses and the occasional scrape, but I've started using gloves over the past year just in preparation for going into surgery. Obviously the hands are the moneymakers so they need to at least be in tip-top functional shape.

Surgeons tend to be at least cognizant of the fact that their hands are a big role in their livelihood. Aesthetics have little to do with operative skill and technique. With respect to the gloves in the gym, it might be a little overkill. That being said, I wouldn't go juggling chain saws or anything if I were you. We do, however, at least on my service, joke because everyone tends to stick a foot up to hold the elevator.

 

[Bangersandmash]

Surgeons tend to be at least cognizant of the fact that their hands are a big role in their livelihood. Aesthetics have little to do with operative skill and technique. With respect to the gloves in the gym, it might be a little overkill. That being said, I wouldn't go juggling chain saws or anything if I were you. We do, however, at least on my service, joke because everyone tends to stick a foot up to hold the elevator.

So I take it no surgeons are operating with their feet?

 

[Lollygag]

Forgive me if someone asked this already... I always hear that neurosurgeons during residency have 1-2 years of research. When exactly are these research years if the residency is 6-7 years? Is it the first 2 years, middle 2 years or last 2 years? Thanks!

 

[neusu]

Forgive me if someone asked this already... I always hear that neurosurgeons during residency have 1-2 years of research. When exactly are these research years if the residency is 6-7 years? Is it the first 2 years, middle 2 years or last 2 years? Thanks!

Most programs have a research requirement of 1 year. Many offer up to 2 years. This time can be "protected" meaning you are free from taking call or having any service obligations or "unprotected" meaning you have to take call or cover vacation for other residents. Previously, many programs offered the ability to do an "enfolded" fellowship, meaning instead of doing research you would spend the year focusing on one facet of clinical neurosurgery. Obviously, there were some limits to this i.e. a pgy-4 with little operative experience could not do a very technically demanding fellowship. Recently though, the RRC has indicated that enfolded fellowships would no longer be allowed. Depending on the program, and the individual, the research year can be an asset or a waste of time. Having to cover a lot of service obligations obviously hinders the ability to do clinical or basic research. On the other hand, remaining involved in the service allows those who want to go in to private practice to not have a gap in clinical education.

 

[moosetracks]

Most programs have a research requirement of 1 year. Many offer up to 2 years. This time can be "protected" meaning you are free from taking call or having any service obligations or "unprotected" meaning you have to take call or cover vacation for other residents. Previously, many programs offered the ability to do an "enfolded" fellowship, meaning instead of doing research you would spend the year focusing on one facet of clinical neurosurgery. Obviously, there were some limits to this i.e. a pgy-4 with little operative experience could not do a very technically demanding fellowship. Recently though, the RRC has indicated that enfolded fellowships would no longer be allowed. Depending on the program, and the individual, the research year can be an asset or a waste of time. Having to cover a lot of service obligations obviously hinders the ability to do clinical or basic research. On the other hand, remaining involved in the service allows those who want to go in to private practice to not have a gap in clinical education.

If I may follow up on that, what about those that have gained a significant amount of basic science research, ie: PhD? Do they have the same guidelines or could they pursue some sort of postdoctoral work?

 

[lazymd]

Can you offer any insight on the lifestyle, outcomes, competitiveness, etc of the neurosurgeons who have decided to do a trauma fellowship?

Thanks 🙂

 

[RomanTaylor]

I am sorry, but a lot of these questions are looking very familiar... Like they have been asked 20 times already.

 

[neusu]

If I may follow up on that, what about those that have gained a significant amount of basic science research, ie: PhD? Do they have the same guidelines or could they pursue some sort of postdoctoral work?

The sky is the limit. Some MD/PhD do a postdoctoral fellowship during these years while others had enough and just want to be done. It can be harder to secure funding (stipend asid) if you're still a resident though.

 

[neusu]

Can you offer any insight on the lifestyle, outcomes, competitiveness, etc of the neurosurgeons who have decided to do a trauma fellowship?

Thanks 🙂

As a rule all neurosurgeons are trained in trauma and neurocritical care. In practice, many neurosurgeons try to minimize their exposure to trauma due to the unpredictable nature, low reimbursement, lengthy hospital stay and relatively poor outcome when compared to elective neurosurgery. Neurosurgery trauma fellowships, like general surgery, tend to offer both operative neurotruama and neurocritical care. From what I gather, trauma fellowships are not terrible competitive, nor in high demand. It seems many who do a neurotrauma fellowship want to run a neurocritical care unit or do trauma research.

 

[Kunu]

I was shown an article relating to this guy...and being a man with no religion...I am highly skeptical. Dr. Ben Carson, my inspiration, is a creationist. When he came to my university to speak and he mentioned creationism, I just couldn't believe it. Men of science, especially in a field like neurosurgery, should know better. Sorry, just my little rant.

Edit: And I'm not the one whose opinion you care to listen to. Oh well.

I know, right. I mean who wouldnt look at the complexity of the anatomy, physiology, let alone the embryology of the central nervous system and think- obviously this formed randomly with no designor or purpose...🙄

 

[mcloaf]

I know, right. I mean who wouldnt look at the complexity of the anatomy, physiology, let alone the embryology of the central nervous system and think- obviously this formed randomly with no designor or purpose...🙄

Please don't hijack what has been a fantastically interesting and useful thread to preach your opinion on how the CNS arose.

 

[sinombre]

Please don't hijack what has been a fantastically interesting and useful thread to preach your opinion on how the CNS arose.

+1

Do you have any friends/peers that didn't match into neurosurgery? What did they end up doing? I'm apprehensive about doing only neurosurgery research as a med student in the event that I don't match--I assume general surgery program directors would be skeptical about an applicant who was obviously set on neurosurgery.

 

[neusu]

+1

Do you have any friends/peers that didn't match into neurosurgery? What did they end up doing? I'm apprehensive about doing only neurosurgery research as a med student in the event that I don't match--I assume general surgery program directors would be skeptical about an applicant who was obviously set on neurosurgery.

Great question. My experience has been that along the way, on some level, there are a fair number of people interested in pursuing neurosurgery as a career. The level of involvement and steps to properly position oneself vary, but here is a general overview from my experience.

M1/2: Much like undergrad does for pre-meds, the pre-clinical years help to stratify medical students. The great equalizer is Step-1, but before that many people are interested and shadow, do research etc. This interest can wane or intensify, and Step-1 can either make things easier or much, much harder. For example, a guy I did research with during the summer of M1/2 ended up matching in to a great IM program and is now doing a cards fellowship with only neurosurgery research. Others I know that stepped out along the way prior to or after rotations went in to surgery, EM or ENT.

M2/3: The whole game changes during M3 year. Aside from vague generalizations, many students have little to no exposure to clinical medicine, nor do they understand what different doctors do on a day to day basis, let alone for a career. Plenty of students catch the neurosurgery bug during 3rd year, and plenty match (even if it's late in 3rd year). I'll warn you though, don't go in to 3rd year shopping for a career. All too often someone will treat it like car shopping wherein they know their board score, the averages for specialties, and try to shoe-horn themselves in to something.

Post-match:
You gave it your all, crushed step-1, multiple letters from top programs, first author papers in relevant journals, or the opposite, yet didn't match. What to do from here? Based on what I've heard/experienced from friends/med students having to go through it this is what happens: 1) re-evaluate whether or not neurosurgery is for you. why are you interested in it, could something (anything) else suffice? are you being realistic? If you're still interested then go for it. 2) Most pre-lim surgery programs are very understanding of the mutual situation. Try to find one at a program that has a neurosurgery department. Work on establishing connections and a clinical track record of excellence. Continue the hard work that was done (publish, present, get to know people) and look for advanced position openings. 3) Pre-residency fellowship or clinical research are options. Both allow you to work closely with a department of neurosurgery and establish a track record as being a hard worker and someone they want to be with for 7 years. Both strengthen weak applications by adding to research or letters to your file. 4) Find something else. If it just isn't working out, work on a back-up plan in the meantime. Every surgeon has a plan for when things don't go right. This shouldn't be anything different. I have had friends who failed to match, scramble in to pre-lim gen-surg and end up in ENT, Plastics, ortho, anesthesia, radiology, and emergency medicine.
You found out you matched in the wrong field and want to switch from ortho/anesthesia/ent/neurology to neurosurgery. Work with the departments at your institution. Often there is a resident being fired or the program is expanding, perhaps you can slide right in. Keep your ear to the ground, openings at all levels do occur. In the meantime, keep your CV up to date and get letters together for an application when you do hear about an opening. Letters from your field are great, especially your chair or program director, but you really need neurosurgeons to write you letters. Try to rotate on the neurosurgery service if you have electives. Help the team out, residents (at some programs) can be the biggest advocates for a candidate.

TL/DR - Life is long, putting all of your eggs in to one basket does not mean you can't switch.

 

[Bangersandmash]

I have a question about something that may or may not be a reality. I know of a few surgeons at my med school who have stopped practicing surgery and are now chairs/professors due to physical ailments (bad back, wrist, etc.) I have already had a back problem in high school (bulging disc, fixed with PT) and back/wrist problems run in my family.

While I understand that I could never have a back/wrist issue in the future, do you know of any surgeons (any field) who have had to give up their dream early due to physical reasons? Whether I practice for 5 years or 20 years, I worry that a health issue could cut my surgical career short, while a less intensive specialty might still allow me to practice.

 

[kasmir8199]

I think I'm in love…with the idea of neurosurgery now! Thanks for this! You're amazing.