Ask a neurosurgery resident anything

[neusu]

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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.

This is a relevant issue no matter which field you ultimately choose. There are surgeons who have to give up their operative practice because of progressive or acute disability. While they can likely continue in medicine in some capacity e.g. teaching, hospitalist roles or administration, their effective surgical or ability to perform a physical intervention become limited. It is important to have disability insurance that covers you well for both lost income and can be broadly applied. It's a dangerous world out there, but don't give up the things you love. Just make sure to have coverage and to make every effort for safety.

 

[disorder]

if you to pick a non surgical specialty, which and why? (if this has been asked, redirect me!)

 

[neusu]

if you to pick a non surgical specialty, which and why? (if this has been asked, redirect me!)

Personally, I would probably do something like medical genetics or maybe cardiology, radiology, or gasterointestinology. The latter 3 because they offer a bit of intervention in their scope of practice. It is important to note though, cardiology aside, these interventionalists tend to be technicians. Often, they do their procedure and the patient is admitted to a medicine or surgery service. Aside from the actual procedure, there is not much medical practice involved be it clinical or hospital based.

Medical genetics is interesting to me because of the changing technology involved which allows us to both understand genetic based diseases in greater detail, diagnose them earlier, and create/recommend screenings with higher specificity.

 

[deleted393595]

Out of curiosity, what is the malpractice system like for neurosurgeons?

 

[AestheticGod]

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...🙄

How about you take your sarcasm and go away.

 

[Zedor]

Out of curiosity, what is the malpractice system like for neurosurgeons?

http://skepticalscalpel.blogspot.com/2011/10/lets-play-whats-my-premium.html

Just an example until neusu responds. But it looks like some areas are outrageously high.

 

[AestheticGod]

http://skepticalscalpel.blogspot.com/2011/10/lets-play-whats-my-premium.html

Just an example until neusu responds. But it looks like some areas are outrageously high.

I SWEAR people WANT their family members to die under the knife or some sort of mistake, just so they can sue someone..

 

[def1]

Question about research.

What kind of research areas are residency directors looking for? Would basic neuroscience suffice or does it need to be more directly involved with neurosurgery.

The reason I ask is because I currently have the option to work with a PI who does neuroscience that hopefully I can work with over the next 6 months and try to pump out a paper or 2 before entering medical school, but I don't really want to waste my time if residencies care more about clinical research and not really bench work.

 

[neusu]

I SWEAR people WANT their family members to die under the knife or some sort of mistake, just so they can sue someone..

http://skepticalscalpel.blogspot.com/2011/10/lets-play-whats-my-premium.html

Just an example until neusu responds. But it looks like some areas are outrageously high.

Out of curiosity, what is the malpractice system like for neurosurgeons?

This is a rather convoluted topic. Neurosurgery malpractice insurance premiums, rightly so, remain relatively high. We do surgery on people with a variety of diseases who often end up severely disabled. We are only human ourselves and can and do make mistakes. That being said, malpractice suits tend to involve several parameters including direct costs, future costs, loss of wages, and intangibles (pain and suffering, punitive etc.). For example, if a surgeon operates on a child, the suit often involves life-long care needs as well as loss of income. Likewise, an able bodied patient who undergoes a spine procedure that does not have a good outcome may end disabled.

Part of the issue, as referenced, is educating families regarding realistic expectations. This is even more necessary in acute situations wherein we may be able to perform a heroic or life saving procedure but the patient will end up inevitably severely disabled. Families faced with such a decision often act impulsively to save life at all costs, which may be admirable. Some studies suggest that even a year out, families with a severely disabled relative would make the same decision given the opportunity to go back. That being said, proper patient selection in non-acute cases is also important. Back pain is a part of life and surgery often will not fix this. Making sure a patient understands what the goals of surgery are and what will not be accomplished is important.

On a final note. In neurosurgery, and most of medicine I imagine, it is not a question of whether you will be sued. You will be sued at some time, likely multiple times, throughout your career. This doesn't mean you are a bad person or bad doctor. It comes with the territory. Selecting insurance coverage that sufficiently covers you and has a sufficient tail (if you should happen to change jobs) is necessary.

 

[neusu]

Question about research.

What kind of research areas are residency directors looking for? Would basic neuroscience suffice or does it need to be more directly involved with neurosurgery.

The reason I ask is because I currently have the option to work with a PI who does neuroscience that hopefully I can work with over the next 6 months and try to pump out a paper or 2 before entering medical school, but I don't really want to waste my time if residencies care more about clinical research and not really bench work.

The big secret to research, with respect to neurosurgery applications, is to have it. Each attending is most interested in research in his particular field so a vascular guy could care less if you have functional research and vice versa. That being said, bench research is generally seen as more rigorous and thus as more desirable than clinical research. Obviously, there are caveats regarding quality of the research and subsequent publications (e.g. a technique paper in a low tier journal vs an rct in nejm), but that's the general overview.

Do research, as much as you can, in both clinical and basic science. Be productive, publish or perish. If it's not in print, you didn't do it.

 

[Yorick]

What are some examples of work you do on patients? I know neurosurgery is concerned with the brain, spinal cord and nervous system, but do you typically work on patients who have suffered spinal cord injury and/or brain damage?

 

[RomanTaylor]

Already answered, multiple times.

 

[def1]

The big secret to research, with respect to neurosurgery applications, is to have it. Each attending is most interested in research in his particular field so a vascular guy could care less if you have functional research and vice versa. That being said, bench research is generally seen as more rigorous and thus as more desirable than clinical research. Obviously, there are caveats regarding quality of the research and subsequent publications (e.g. a technique paper in a low tier journal vs an rct in nejm), but that's the general overview.

Do research, as much as you can, in both clinical and basic science. Be productive, publish or perish. If it's not in print, you didn't do it.

Good to know. One more quick question. What is the best way to publish a lot? I have previous research experience and after several months I still did not have enough results for publication. I'm assuming clinical research allows for faster results, probably allowing for more publications, but for more laboratory type work it seems like most projects will take up to 6 months to publish. I'm just trying to figure out how a medical student who is already extremely busy can have 3-4 papers by the time they are done with 3rd year.

 

[neusu]

What are some examples of work you do on patients? I know neurosurgery is concerned with the brain, spinal cord and nervous system, but do you typically work on patients who have suffered spinal cord injury and/or brain damage?

The majority of our surgeries are elective procedures on subacute or chronic issues such as brain tumor, epilepsy, vascular issues, or degenerative spine. We do operate on a fair amount of patients with acute injuries, including spinal cord or brain trauma.

 

[tiedyeddog]

What would you advise someone on a neurosurgery rotation to carry in their white coat?

What other books beside greenberg are essentials for someone doing a neurosurgery sub-i/rotation?

 

[neusu]

Good to know. One more quick question. What is the best way to publish a lot? I have previous research experience and after several months I still did not have enough results for publication. I'm assuming clinical research allows for faster results, probably allowing for more publications, but for more laboratory type work it seems like most projects will take up to 6 months to publish. I'm just trying to figure out how a medical student who is already extremely busy can have 3-4 papers by the time they are done with 3rd year.

The best way to publish a lot is to stick with a project. All too often undergrads and medical students become frustrated or give up on projects when they are stalling. This is likely a poor choice. The work was done, now it is up to someone else to move it along. I always advise to work on multiple projects at once because of this fact. Having a project or two simmer in the background while you are working on another allows for maximum efficiency. This does not mean take on too many projects immediately as that is also a recipe for failure.

With respect to basic science or clinical projects, both can be as lucrative, depending on the principal investigator involved. There is a phenomenon called salami science wherein a great project that would likely yield one nature/science/nejm/jns/neurosurgery paper is cut in to pieces and results in a couple of lower tier journal publications. A good enough lab will still get the top tier journal publications out sometimes. That being said, picking the right mentor is important. A young start-up is often very enthusiastic and overstates how productive he will be. A well established lab may not provide enough guidance to push a project through.

A rough estimate for time for a project to go from design to collecting data to data analyzation to manuscript writing/revision to submission for being published is 6-12 months for a clinical project and 6-24 months for a basic science project. There really aren't any short cuts, just do the work and reap the rewards. The guys you see with 3-4 publications applying during residency worked hard in medical school and earned it. True, some people get lucky and end up in a lab with a bunch of projects nearing completion and get thrown on them last minute. That is the exception, though, not the rule.

 

[neusu]

What would you advise someone on a neurosurgery rotation to carry in their white coat?

What other books beside greenberg are essentials for someone doing a neurosurgery sub-i/rotation?

I had to think back to when I was a student rotator. I kept Greenberg in my coat pocket as well as a patient list (or the last 10), a drug manual, and flashlight.

Now I keep a safety pin on my whitecoat (for spine exams), a reflex hammer, and a flashlight. I keep my list and my scrub cap in my scrubs pocket because I really only wear my whitecoat for clinic or when a patient "needs the doctor."

I think Greenberg really covers it for subIs. Obviously, if you could carry around an Osbourn or a surgical atlas or two (Rhoton, Schmidek and Sweet) that would be great. What I gathered from my subI experiences, as well as having subIs on our service, and talking to residents at other programs, no one is expecting you to know everything (or anything for that matter). They want to see how you fit in to the team, how well you take directions/initiative, how you respond to criticism, and overall have a character assessment. Look at the juniors, see what they do and try to do it first. Read about your cases, know the details from positioning to skin incision to dissection, relevant anatomy, critical portion. Practice suturing and knot tying, nothing looks worse than being offered to tie for a resident and air knotting over, and over, and over again (these are things you can teach yourself). Look at all of the films for the service. Know when a film or study will be resulted and report it to the resident e.g. be on top of it. Ask questions. Learn.

 

[chayo234]

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.

I am not sure if this would be considered a dumb question, but what are some key differences between a neurologist and a neurosurgeon besides surgery? Or are there much of a difference?

 

[mcloaf]

I am not sure if this would be considered a dumb question, but what are some key differences between a neurologist and a neurosurgeon besides surgery? Or are there much of a difference?

Really? Not sure why people keep wasting the opportunity to get inside info from a neurosurg resident with questions that could be answered in 2 seconds on Google. 🙄

 

[RomanTaylor]

Really? Not sure why people keep wasting the opportunity to get inside info from a neurosurg resident with questions that could be answered in 2 seconds on Google. 🙄

Not to mention that he answered this question more than once in this thread.

 

[chayo234]

Really? Not sure why people keep wasting the opportunity to get inside info from a neurosurg resident with questions that could be answered in 2 seconds on Google. 🙄

90% of the questions that have been asked on these boards can be googled. I asked specifically because google does not give all perspectives of a field. Also, google answers are very generalized and doesn't take into scope of a lot of internal interactions inside of a hospital. I have been visiting this thread several times a week and I might've possibly glossed over the question that I have just asked but I did not see it answered directly.

I would still like your perspective, if you do not mind, on what you feel are the key differences between a neurologist and neurosurgeon in your opinion, besides the obvious surgery. Better questioned - if someone was having a difficult time between neurosurgery or neurology, regardless of the amount of training, why neurosurgery? Do you have an insurmountable passion for surgery?

 

[neusu]

I am not sure if this would be considered a dumb question, but what are some key differences between a neurologist and a neurosurgeon besides surgery? Or are there much of a difference?

Fundamentally, both neurologists and neurosurgeons treat diseases of the nervous system. Neurologists focus on medical management and tend to be longer term (stroke, neurodegenerative disorders, epilepsy, infection, movement disorders). Neurosugeons focus on surgical treatment of both acute and chronic problems of the nervous system and tend to be involved for the period immediately surrounding surgery.

In a good system, neurologists and neurosurgeons work together such that the neurologists manage things and ask for a neurosurgical evaluation when medical therapy is maximized and symptoms persist. One example would be for stroke (ischemic or hemorrhagic) where the patient continues to swell despite appropriate/maximum intensity medical treatment. A surgery can create more room to swell and prevent the patient from dying. Another would be for epilepsy. Patients with seizure disorder refractory to antiepleptics with a focus that is able to be resected can benefit from surgery.

The training is vastly different. Neurosurgery is 7 years and involves a large amount of operative training as well as neurocritical care. Neurosurgery typically manages trauma and aneurysms. Neurology is 4 years and is similar to internal medicine in its structure with respect to rotating throughout different services as well as has less exposure to neurocritical care.

For the most part, students are attracted to one or another for whatever reasons. The difference between the two is vast enough that not many would be equally happy with both. That is, one in particular is typically very appealing while the other is much less so.

 

[chayo234]

Fundamentally, both neurologists and neurosurgeons treat diseases of the nervous system. Neurologists focus on medical management and tend to be longer term (stroke, neurodegenerative disorders, epilepsy, infection, movement disorders). Neurosugeons focus on surgical treatment of both acute and chronic problems of the nervous system and tend to be involved for the period immediately surrounding surgery.

In a good system, neurologists and neurosurgeons work together such that the neurologists manage things and ask for a neurosurgical evaluation when medical therapy is maximized and symptoms persist. One example would be for stroke (ischemic or hemorrhagic) where the patient continues to swell despite appropriate/maximum intensity medical treatment. A surgery can create more room to swell and prevent the patient from dying. Another would be for epilepsy. Patients with seizure disorder refractory to antiepleptics with a focus that is able to be resected can benefit from surgery.

The training is vastly different. Neurosurgery is 7 years and involves a large amount of operative training as well as neurocritical care. Neurosurgery typically manages trauma and aneurysms. Neurology is 4 years and is similar to internal medicine in its structure with respect to rotating throughout different services as well as has less exposure to neurocritical care.

For the most part, students are attracted to one or another for whatever reasons. The difference between the two is vast enough that not many would be equally happy with both. That is, one in particular is typically very appealing while the other is much less so.

Thank you. This thread has been invaluable to me. Currently finishing up my class in Neuroanatomy and it has changed my direction and perspective to possibly thinking about neuro as a potential field in the future.

 

[mcloaf]

Going back to some of what was being discussed earlier with regard to orienting yourself within the tissue during procedures, I was wondering if you're familiar with these new technologies to help neurosurgeons differentiate tumor from regular tissue during operations. Looks like pretty cool stuff. http://vimeo.com/focusforwardfilms/semifinalists/51888804

 

[iforget2]

What % of diseases and disorders that doctors (in general) diagnose do you think come out to be incorrect (the diagnosis)?

 

[Sophocles]

Disclaimer-sorry for the dumb question....

How many opportunities do you have to get involved in the community or do something for underserved communities?

Is there pro bono work, or anything like that?

 

[RomanTaylor]

Disclaimer-sorry for the dumb question....

How many opportunities do you have to get involved in the community or do something for underserved communities?

Is there pro bono work, or anything like that?

There is nothing dumb about that question at all! I am interested in the answer as well.

 

[wholeheartedly]

U Mich has a cool program called Project Shunt

http://medicine.umich.edu/dept/neurosurgery/projectshunt

 

[Sophocles]

U Mich has a cool program called Project Shunt

http://medicine.umich.edu/dept/neurosurgery/projectshunt

Wow. That's pretty amazing and exactly what I was looking for. I also read in Uncleharvey that U Mich is supposed to be more family friendly than the other schools.

I can't even begin to imagine the logistics behind all of this.

 

[wholeheartedly]

Yeah, the posts on Uncle Harvey make U Mich seem like a pretty sweet program.


It's pretty involved, there were more posts around there that talked about the planning that went into it and the involvement of the residents in the planning process. If I remember correctly, they let a couple of the residents go on the trips and in order to go you have to have been in the planning group for the previous 2 years or something to be able to go. (might be wrong on specifics, but something like that) Don't think this is the only place that does stuff like this, it's just the major one I've come across.


edit: there was also this thread in the neurosurgery res forum, not much more info but same topic :http://forums.studentdoctor.net/showthread.php?t=763761

 

[Yoseph101]

Have you preformed psychosurgery? What is your opinion of psychosurgery and what are the outcomes of the patients?

 

[neusu]

What % of diseases and disorders that doctors (in general) diagnose do you think come out to be incorrect (the diagnosis)?

I laugh, because one of my favorite professors told me this: basically a young student was so mad at him for missing a point on an exam. At the time he stood by his mark and the student failed that question. The next year it was proven wrong and the student was actually right.

We as doctors are human. We are, often, wrong. Nonetheless, we strive to be right. I would give up surgery in a second if you gave me a magic wand. In the mean time, this is the best thing we have with the best people we have trying to be the best they can. If you can think of a better system I will gladly sign on.

Tl😀r we mess up, all of the time.. but its the best we have at the time

 

[neusu]

Disclaimer-sorry for the dumb question....

How many opportunities do you have to get involved in the community or do something for underserved communities?

Is there pro bono work, or anything like that?

This really depends on your program.

Many programs have an international experience wherein you go abroad (be it to Africa, Ireland, New Zealand or what haveyou). This can be a benefit or a handicap depending on the case volume or autonomy allowed.

Many programs have a resident clinic wherein you are the dumping ground for the patients who are uninsured and the attendings don't want to see in follow up. Depending on the hospital, you may or may not be able to offer surgery from your clinic.

Nonetheless, neurosurgery requires a fair amount of support. Pro bono work, in the truest sense, with respect to the surgeons fee, will not get anyone operated on. A staffed operating room and their time is mighty expensive. Likewise, having a desire to volunteer in the 3rd world myself, neurosurgery is not conducive to it (for the most part). The things we deal with are too infrequent or require too much post operative care. The exception I can think of is endoscopy for 3rd ventriculostomy, but that is not terribly indicated.

 

[503224]

This may be a silly question, but I am genuinely wondering how you deal with the sleep deprivation.

 

[Lollygag]

This may be a silly question, but I am genuinely wondering how you deal with the sleep deprivation.

+1 I want to know this as well lol to add, have you ever made any serious or life threatening mistakes as a resident as a result of sleep deprivation?

 

[neusu]

This may be a silly question, but I am genuinely wondering how you deal with the sleep deprivation.

Sleep deprivation is part of medicine, and surgery even more so. The sleep when you can mentality allows for residents to sleep if things are slow. That being said, napping tends to be more of an idea than an actuality. As a resident, you get used to sleep deprivation. Most people adapt, but some can't and have to switch to something less demanding. I can't say I can recall any specific mistakes from lack of sleep aside from things taking a lot longer (e.g. closing a case/suturing/knot tying after 30 hours of work).

 

[smooththrow]

.

 

[Bangersandmash]

Sleep deprivation is part of medicine, and surgery even more so. The sleep when you can mentality allows for residents to sleep if things are slow. That being said, napping tends to be more of an idea than an actuality. As a resident, you get used to sleep deprivation. Most people adapt, but some can't and have to switch to something less demanding. I can't say I can recall any specific mistakes from lack of sleep aside from things taking a lot longer (e.g. closing a case/suturing/knot tying after 30 hours of work).

That may be you, but didn't they initiate resident work week hour maximums because of research showing the negative effects of fatigue? Would you say then that surgical residencies largely ignore the hour caps?

 

[randomquestions]

Do you think certain degrees like an MS in Clinical Research or an MS in Statistics can give a medical student an edge in obtaining a summer research position? Or would a summer research position be too brief for anyone to care?

 

[Lucidity]

That may be you, but didn't they initiate resident work week hour maximums because of research showing the negative effects of fatigue? Would you say then that surgical residencies largely ignore the hour caps?

It only means that a program has to have an average of 80 hours per week over a 4 week period. This means one week you could work 120 hours and have that time be deducted from another week. That is if that program follows the guidelines which to my knowledge are self reported by residents.

 

[neusu]

That may be you, but didn't they initiate resident work week hour maximums because of research showing the negative effects of fatigue? Would you say then that surgical residencies largely ignore the hour caps?

It only means that a program has to have an average of 80 hours per week over a 4 week period. This means one week you could work 120 hours and have that time be deducted from another week. That is if that program follows the guidelines which to my knowledge are self reported by residents.

They did institute work hour restrictions because of an error that was attributed to fatigue. As mentioned, the limit is 80 hours or less (or more -88 hours- if the program has the 10% exemption) averaged over 4 weeks. As mentioned, this can be 120 1 week and 60 the next 2 to average 80. Some residencies further limit work hours (emergency medicine for example), and by now nearly all programs are compliant (or making efforts to be more so) from what I hear. The residents who were originally affected, and cared less about compliance, are graduating and in their place a crop of younger residents who desire compliance.

That being said, fatigue and tiredness remains a part of neurosurgery. I have yet to meet a neurosurgery resident who had a walk in the park filled with sufficient sleep, time off, and exercise during their 2nd year. Some programs are lighter than others, some have a night float, some have an army of mid levels, nonetheless the job of learning neurosurgery hasn't dramatically changed its requirements or intensity despite the regulatory changes. I always tell students rotating on my service they won't see or learn about a case by being at home sleeping. Granted, I sent them home anyway because watching a junior resident do admission paperwork for back pain for the 20th time in a day wasn't terribly high yield. The point is, say an interesting or rare case did come in, they would miss it not being there. The same rings true as a resident. Seeing and doing everything possible while in training makes it safer for both the patient and you; the patient because someone who has seen it before is in charge and you so you have someone to fall back in case things aren't looking so swell.

 

[Kvothe]

I'm pretty sure the regulations were based off of speculation rather than hard facts showing that resident performance dropped.

UCLA is/has conducted a study for surgery residents (not sure if it was specifically NS?) fine motor skills pre and post call. The data wasn't very convincing that post call reduced skills very much.

My favorite anecdote about old school NS residency training is how in some hospitals the first 6 months of yr 2 required the resident to see every single ER NS consult... Ever wonder why they are called residents?

 

[mcloaf]

I'm pretty sure the regulations were based off of speculation rather than hard facts showing that resident performance dropped.

UCLA is/has conducted a study for surgery residents (not sure if it was specifically NS?) fine motor skills pre and post call. The data wasn't very convincing that post call reduced skills very much.

My favorite anecdote about old school NS residency training is how in some hospitals the first 6 months of yr 2 required the resident to see every single ER NS consult... Ever wonder why they are called residents?

Indeed, there was a recent NEJM article about this. The data are too scarce to draw any supportable conclusions about the effects of work hours in either direction.

 

[mmmcdowe]

Do you think certain degrees like an MS in Clinical Research or an MS in Statistics can give a medical student an edge in obtaining a summer research position? Or would a summer research position be too brief for anyone to care?

Summer research positions are a dime a dozen. Getting a degree wouldn't really help and certainly isn't worth it just for that purpose.

 

[drwilson]

Hello. Thank you for starting this thread. It is truly very helpful. I am a 4th year osteopathic medical student and have been rotating and interviewing at various neurosurgery programs. As you know, the match is coming up and I feel as if I am getting some cold feet. I begin to think about the LONG and grueling residency and commitments of being a resident as compared to other specialties such as emergency medicine or internal. Yes, it is true that neurosurgery is the most interesting and exciting stuff I have ever experienced but at the same time I have had many miserable neurosurgeons tell me to stay away because they were burnt out and even though they make a ***load of money it's not like they get to enjoy it anyway, this is in addition to missing their children grow up and never seeing their loved ones. Do you think there is any truth in those statements? I can see that for you the sacrifice is worth the reward but is that what you see with the majority of your colleagues?

Thanks in advance.

 

[neusu]

Hello. Thank you for starting this thread. It is truly very helpful. I am a 4th year osteopathic medical student and have been rotating and interviewing at various neurosurgery programs. As you know, the match is coming up and I feel as if I am getting some cold feet. I begin to think about the LONG and grueling residency and commitments of being a resident as compared to other specialties such as emergency medicine or internal. Yes, it is true that neurosurgery is the most interesting and exciting stuff I have ever experienced but at the same time I have had many miserable neurosurgeons tell me to stay away because they were burnt out and even though they make a ***load of money it's not like they get to enjoy it anyway, this is in addition to missing their children grow up and never seeing their loved ones. Do you think there is any truth in those statements? I can see that for you the sacrifice is worth the reward but is that what you see with the majority of your colleagues?

Thanks in advance.

Hi, thanks, hope it helps in some fashion.

I find most people who go in to things for the money end up with neither enough money nor happiness. Neurosurgery is an incredibly demanding field intellectually, physically, emotionally, and spiritually. I can't say I have, or anyone in the field for that matter has, all the answers. Picking it for any other reason than you love the patients, pathology, personalities, and the fact that it is hard work may be the wrong reason. The attendings I see that are the happiest have reconciled that it is not a lifestyle field, yet nonetheless make the best of it. The ones who are the least happy? Those who are disgruntled that they don't see their family enough or get paid what they think they should. Personally, when I was applying, I thought of it in the way "would I still do this of I earned a resident salary for my entire career?" It's a silly question, obviously, but it really put in perspective my interests and motivation.

 

[eefen]

Just wanted to say that this has been an awesome thread. As of right now, I'm not necessarily interested in neurosurgery (although I suppose that could change), but it is certainly interesting hearing the "real-life" perspective of a neurosurgical resident on the field. Thanks for doing this. 👍

 

[neusu]

U Mich has a cool program called Project Shunt

http://medicine.umich.edu/dept/neurosurgery/projectshunt

Project shunt is great, and I wish we could do more work like this. While I'm not at Michigan, I am friends with some residents there and hear it unanimously is felt to be a great place to train. That being said, the only criticisms I have heard regarding the program is that, often, spinal bifida also requires a shunt (thus the shunt part of project shunt). Leaving a patient with hardware prone to infection /failure and no means for treatment is less than ideal. Likewise, NGO influence to provide a service often supplants what should be cultured locally. While, unlike some other NGO groups who come in with similar aims of providing care and displacing local providers, it seems project shunt has found a niche. Nonetheless, its not a perfect world or else they wouldn't be doing what they are.

 

[hunterjumper14]

Just wanted to say that this has been an awesome thread. As of right now, I'm not necessarily interested in neurosurgery (although I suppose that could change), but it is certainly interesting hearing the "real-life" perspective of a neurosurgical resident on the field. Thanks for doing this. 👍

Agreed!!! Thanks a lot for taking the time to answer all of these questions. Awesome thread! 👍👍👍

 

[wholeheartedly]

Project shunt is great, and I wish we could do more work like this. While I'm not at Michigan, I am friends with some residents there and hear it unanimously is felt to be a great place to train. That being said, the only criticisms I have heard regarding the program is that, often, spinal bifida also requires a shunt (thus the shunt part of project shunt). Leaving a patient with hardware prone to infection /failure and no means for treatment is less than ideal. Likewise, NGO influence to provide a service often supplants what should be cultured locally. While, unlike some other NGO groups who come in with similar aims of providing care and displacing local providers, it seems project shunt has found a niche. Nonetheless, its not a perfect world or else they wouldn't be doing what they are.

Right, I do believe I read that the program also does training and capacity building with local neurosurgeons and other providers as well to make sure it's not an operate and leave kinda of deal and proper after care can happen. There are always a lot of considerations for global projects like this and the goal should be to problem solve and build local capacity.

Yeah here it is "In addition to performing operations, the group provides teaching to other surgeons, nurses and parents. An important educational objective was to improve the quality of life for children with spinal bifida and train the health care professionals in state-of-the-art management techniques. By developing an intermittent catheterization program and providing catheters to patients and their families, there has been a dramatic decrease in urosepsis and death among these patients. Working with local neurosurgeons, we have seen a shift to more complex cases as they take on the more routine cases. "