Ask a neurosurgery resident anything

[deleted393595]

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HAHAHA! I was gonna ask how many people he's killed, but this is much better!

Rudyrude

 

[neusu]

just to piggyback on this,

I keep hearing about how crazy the neurosurgery "lifestyle" is. could you touch on this for both residents and attendings?

Crazy is a relative term.

As a resident, it becomes the norm to get to the hospital between 5 and 6 AM, and not leave until at earliest 6 PM and at latest noon the next day. The 80 (or 88) hour work week becomes the norm with some weeks as high as 120+ and others as low as 60. Residents are often granted immense autonomy to diagnose, triage, perform procedures, talk to families, and make care plans. Beginning as a PGY-2, I was expected to be able to assess acute spine and brain trauma, subarachnoid hemorrhage, and brain tumor patients, place ventriculostomy/lumbar drains, central/arterial lines, cervical traction and external fixation, and read imaging to be able to tell the attending what the exam was, how it correlated with imaging pathology, and what surgical intervention we'd be doing. I may be exaggerating a little on the latter part, most attendings realize the junior residents don't know much about surgical plans, but the more you knew and could discuss the more you were able to do. Different programs run differently, but I've had friends that cover 50-80 patients over 2 or 3 hospitals and they're "it."

I can't speak for how crazy it gets as an attending, but there is no work hours limit. Hours are rather practice dependent as is income. I've had attendings with 6 kids living in the same house and driving the same car they did when they were in residency. I've also had attendings with sailboats, vacation homes in the mountains/beach/Europe/Caribbean who have multiple Ferrari's or other supercars.

 

[neusu]

how old will you be when you finish residency and become an attending physician?

I'll be in my mid-30's.

This age varies pretty widely within neurosurgery. The "standard" would be 18 for HS, 22 for college, 26 for med school, and 33 for residency. Add four years for MD/PhD and you're at 37. Many neurosurgery residents are non-traditional in the sense they gave up another successful career first. There are a few younger as well who did the 6-year BS/MD and would finish at 30.

 

[Trisphorin]

Thank you so much for taking the time to answer our questions, I really appreciate it. I have one more follow up question. In your experience as a neurosurgeon so far, how often have you experienced accidents during surgery that affected patients negatively? Are most of those accidents avoidable? And do you think most patients understand the risk and accidents during surgery?

 

[Sophocles]

Thank you so much for taking the time to answer our questions, I really appreciate it. I have one more follow up question. In your experience as a neurosurgeon so far, how often have you experienced accidents during surgery that affected patients negatively? Are most of those accidents avoidable? And do you think most patients understand the risk and accidents during surgery?

+1, great questions!

 

[neusu]

In.

Question: Do you ever feel that your relationships suffer as a result of your elite career? Although being a neurosurgery resident is not comparable to me being a pre-medical student, I often times feel that relatives, and sometimes immediate family members, are offended that I am pursuing surgery as a career while the rest of them got/are in pursuit of 4 year degree's at community colleges (I know it sounds like I am talking those types of degrees down, but I am not, nor would I ever judge someones choice in a career besides acting.)

Do you ever feel as if people dislike you because they feel inferior to you?

How do you respond to this? Do you care?

I suppose at first, getting in to medical school and so on, I noticed it. Many of my close friends have pretty high flying positions in their own field.

Most people will show respect if you act in a respectful fashion and don't lord it over them.

 

[Fifty 3rds]

neusu, thank you for offering so many responses to this thread.

I have a question:

1. Do you know anything about the training at osteoapthic neurosurgery programs? Do most people in the field believe they receive adequate training? Are there any programs that have very good reputations?

I know it's nebulous and each program waxes and wanes with the influx of new directors, residents, etc.

 

[neusu]

Is it true that you work 80 hours per week for all 7 years of residency?

This is generally true. It does depend a bit on the program and the rotation. For example, having a protected research year often results in <80 hours during that year.

That being said, most neurosurgeons work 80+ hours for the rest of their lives.

 

[sinombre]

This is generally true. It does depend a bit on the program and the rotation. For example, having a protected research year often results in <80 hours during that year.

That being said, most neurosurgeons work 80+ hours for the rest of their lives.

Is there an average amount of vacation time, or is that highly variable depending on the job? I'm assuming most people working that much would want to be compensated by a decent amount of vacation time.

 

[neusu]

Thank you so much for taking the time to answer our questions, I really appreciate it. I have one more follow up question. In your experience as a neurosurgeon so far, how often have you experienced accidents during surgery that affected patients negatively? Are most of those accidents avoidable? And do you think most patients understand the risk and accidents during surgery?

Unfortunately, we're only human, and can, and do, make mistakes. We warn patients of the risks of surgery, but for the most part they don't understand the risks.

Accidents happen, some have an effect on outcome, some are pretty minimal. We have protocols and checklists to try to minimize errors, but even so things fall through the cracks or people make mistakes. It's a horrible feeling to know something you did negatively effects someone, and I think most doctors truly want to help their patients. Even so, errors we make can have long-lasting, negative impacts.

 

[def1]

I asked this in another thread, but since you are a resident in the field I'm most interested in, I think you'd be a little more knowledgeable about the subject.

How do you feel tattoos are viewed within this field? Obviously medicine in general is very conservative and surgery especially, but its a little too late to do anything about it now. So I'm just curious if something like a tattoo would keep an otherwise good candidate out of a residency? Do you have any experience with this and/or do you know any residents who have tattoos?

Thanks

 

[neusu]

neusu, thank you for offering so many responses to this thread.

I have a question:

1. Do you know anything about the training at osteoapthic neurosurgery programs? Do most people in the field believe they receive adequate training? Are there any programs that have very good reputations?

I know it's nebulous and each program waxes and wanes with the influx of new directors, residents, etc.

Sorry, I do not know a much about DO programs. I can't think of any that stick out in my mind as being better or worse. I get the impression, though, that the standards are lower than in the ACGME programs.

 

[neusu]

Is there an average amount of vacation time, or is that highly variable depending on the job? I'm assuming most people working that much would want to be compensated by a decent amount of vacation time.

For residents, most programs give the required 1 day off per week and then 3-4 weeks of vacation per year.

For attendings, the amount of vacation varies widely depending on the practice model and setting. From what I can tell, most attendings get 6-8 weeks off per year for vacation and then another 1-2 weeks for educational time such as conferences and courses.

 

[Sophocles]

For residents, most programs give the required 1 day off per week and then 3-4 weeks of vacation per year.

For attendings, the amount of vacation varies widely depending on the practice model and setting. From what I can tell, most attendings get 6-8 weeks off per year for vacation and then another 1-2 weeks for educational time such as conferences and courses.

I wonder how much of that one day off is spent relaxing with the family and how much of it is spent reading and preparing..

 

[PennDippody]

Not trying to derail this wonderful thread but i have a bit of a light-hearted question that I would totally understand if you didn't answer.

Brain Transplants (or head transplants): How far away are we and what are the barriers?

 

[neusu]

I asked this in another thread, but since you are a resident in the field I'm most interested in, I think you'd be a little more knowledgeable about the subject.

How do you feel tattoos are viewed within this field? Obviously medicine in general is very conservative and surgery especially, but its a little too late to do anything about it now. So I'm just curious if something like a tattoo would keep an otherwise good candidate out of a residency? Do you have any experience with this and/or do you know any residents who have tattoos?

Thanks

Neurosurgery is a fairly conservative field. I can't think of any attendings or residents with tattoos, but I imagine there are several out there. It likely depends on the tattoo, something like an ankle or arm tattoo won't draw too much attention, a Mike Tyson face tattoo on the other hand would likely preclude matching.

 

[MedPR]

This is generally true. It does depend a bit on the program and the rotation. For example, having a protected research year often results in <80 hours during that year.

That being said, most neurosurgeons work 80+ hours for the rest of their lives.

Man. Neurosurg seems so awesome but those are killer hours.

Sent from my SGH-T999 using SDN Mobile

 

[bennybrak]

Thanks for the post. I have quite a number of questions for you:

1. Which medical apps do you have on your phone? In order of importance to you(or how frequently you use them) Is NSG a must-buy? Btw, which phone do you use?

2. What are your top 3 favorite non-academic/medical sites.

3. What are your top 3/best medical memoirs you've ever read?

4. What were you reading between the time you finished medical school and the time residency began?

5. In your view, who is the most respected neurosurgeon or which neurosurgeon totally inspires you? (Let me guess...Yasargil, Berger, Carson, Dr. Q, Keith Black, Martuza, Spetzler????)

6. What do you think makes some neurosurgeons exceptional?

6. Lastly, Do you keep any pets?

Merci!

 

[nychila]

Can spine surgeons work in private clinics? In other words, would patients with spine conditions trust smaller clinics, rather than renowned local clinics, to perform such important surgeries?

Also, what pros and cons exist for a patient to choose between public hospitals and private clinics for spine procedures?

 

[neusu]

I wonder how much of that one day off is spent relaxing with the family and how much of it is spent reading and preparing..

Depends on the year of residency and family obligations. Single residents tend to socialize more, married residents tend to spend more time with family. Junior residents spend more time studying, seniors spend more time reviewing for cases.

 

[neusu]

Not trying to derail this wonderful thread but i have a bit of a light-hearted question that I would totally understand if you didn't answer.

Brain Transplants (or head transplants): How far away are we and what are the barriers?

With our current technology this will never happen. The architecture of central nervous system neurons and their associated structures such as astroglia and macro/microvasculature are far too complicated to remove from one individual and place in another. Other solid organs (heart, lung, kidney, liver, pancreas, etc.) are relatively robust in their innate function. Essentially hooking the in to the in and the out to the out of associated functions (blood flow, ducts, airways), is sufficient for viability. While neurogenesis is possible, and peripheral nerve axons do sprout after injury, the central nervous system (brain and spinal cord) is both exceptionally responsive to hypoxia/ischemia and poor at regenerating distal function. What I mean is, if you bag a ureter or pancreatic duct, you can stent it or anastamose the proximal and distal portions and the function will return. You transect the spinal cord or part of the central nervous system, and re-approximate the sections, nothing happens. It would take a major leap forward or several before we have the technology where we can fix these types of injury which are innate to a brain transplant

That being said, there is a promising future for neural implants and neural prosthetics. We are starting to be able to implant arrays in the brain to restore sensory information like sight and hearing as well as understand functions like motor control. I could, perhaps, see a future, where we have a viable brain interfacing with machines for sensory interfacing/communication/transportation, in absence of what we traditionally view a body.

 

[sinombre]

Do you have any experience with DBS by chance? They just started doing it where I work, so there have been several lectures/grand rounds about it recently. All I can say is... wow. Probably the most inherently fascinating medical innovation I've stumbled across (perhaps that's not saying much, being that I haven't even started medical school yet).

It's also interesting that, as far as I can tell, no one has been able to explain exactly why it works.

 

[MedPR]

If one wanted to do spine surgery what are the pros and cons of doing Neurosurg residency instead of ortho?

Sent from my SGH-T999 using SDN Mobile

 

[Sophocles]

If one wanted to do spine surgery what are the pros and cons of doing Neurosurg residency instead of ortho?

Sent from my SGH-T999 using SDN Mobile

I thought these were two different things. For instance, ortho works on the bones/ ligaments and neurosurgeons work on anything inside the dura. Is this correct? I'm sure there are also a myriad of differences inherent to the types of surgery each one does and the lifestyles associated with residency and practice that I would love to read about, as well.

 

[stronghold]

You are overwhelmed with many questions here. I will appreciate if you could answer my questions.
I want to know more about appilication reviewing process. In specialties like Internal Medicine, Peds...etc, PDs and coordintor who put the cutoffs and filter applications before even reading them. Does this apply to NS too?

Then, who review applications that met the cutoffs? PD, chairman, residents? If the latter, what PGY residents?
What factors that bring interview? I am not asking about factors that rank applicants or those looked at just before interviewing, BUT I am asking about those factors that are initially glanced to send out interviews?

 

[Guero]

. . .
There are plenty of kids from the 100th out of 100 medical school who end up at the #1 most competitive residency of their choice and plenty of kids at the #1 medical school who fail out, don't match, or are just plain unhappy. . . .

Neusu, thank you so much for all of these thorough and informative answers. I have a question regarding your above comment: Would you recommend an aspiring NS med student opt and pay more for a highly ranked school or perhaps opt for the cheaper, far lower rated state school (~80 research, ~50 primary care), but which has far more opportunity for clinical learning.

To elaborate, the former school is within the top 40 research and top 5 primary care, with a far more desirable region/culture, the one at which I think I'd be most happy overall. However, the state school boasts the 3rd busiest general hospital, chock-full of trauma, where med students are given insane amounts of autonomy during rotations and are allowed to suture tech during their free-time. I believe the latter would afford far better clinical training and is also home to a couple of my friends that will be M2s when I'd enter.

I'm by no means overly focused on ratings, but understand that they do offer a slight edge to your ERAS. I'm also thinking that the higher ranked research institution will have better opportunities for research during my M1-M2 summer. Moreover, I've cited several papers from that institution in my current NS research.



I'd be very grateful for any advice/insight you're willing to offer. Thanks in advance.

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.. . .

Ugh, that's simultaneously one of the worst and best feelings.

Neurosurgery is a fairly conservative field. I can't think of any attendings or residents with tattoos, but I imagine there are several out there. It likely depends on the tattoo, something like an ankle or arm tattoo won't draw too much attention, a Mike Tyson face tattoo on the other hand would likely preclude matching.

I intend to write more about this as I go through med school and residency. I have full sleeves, an expansive and encompassing backpiece, and several tattoos on my legs and chest, most of which would not be seen in a positive light by any conservative party.

I was talking to a GenSurg resident on a return flight from one of my interviews this season and discussed how this might affect my evals during rotations. He suggested making every effort possible to scrub in before and after the attending. I though that was pretty good advice. But you can't honestly expect that to work during residency. That said, once you've matched into a program, everyone knows you're not a tool, that you're hard working, and exemplified that you fit in with the team. I imagine the tattoos wouldn't matter that much at that point as long as you keep them covered while you're at work. I currently wear Starter UnderArmor. It works very well when you're not scrubbing in. Hope this helps somewhat.

 

[neusu]

Thanks for the post. I have quite a number of questions for you:

1. Which medical apps do you have on your phone? In order of importance to you(or how frequently you use them) Is NSG a must-buy? Btw, which phone do you use?

I don't really have many medical apps. I have epocrates but it's slow and a pain so I hardly ever use it. I had the SLIC spinal cord injury app but it's also not very good and thus uninstalled. I use an android.

2. What are your top 3 favorite non-academic/medical sites.

The 3 that I visit most frequently are reddit.com, the New York Times, and my hometown or college newspapers

3. What are your top 3/best medical memoirs you've ever read?

I can't say I ever really got in to medical memoirs; if anything Brian's Song and Lou Gehrig: Luckiest Man.

4. What were you reading between the time you finished medical school and the time residency began?

I read some travel brochures, Greenberg, and probably something I hadn't read yet by Steibeck or Hemmingway.

5. In your view, who is the most respected neurosurgeon or which neurosurgeon totally inspires you? (Let me guess...Yasargil, Berger, Carson, Dr. Q, Keith Black, Martuza, Spetzler????)

Most respected, I would have to go with John Jane. The surgeon that inspires me most is Spetzler.

6. What do you think makes some neurosurgeons exceptional?

Being exceptional among a field of exceptional individuals is a tall task. Like anything in life some natural gift may play a role, but mostly dogged determination and a hearty work ethic.

6. Lastly, Do you keep any pets?

Not at the moment, but I'd like to have a dog.

Merci!

Avec plaisir!

 

[neusu]

Can spine surgeons work in private clinics? In other words, would patients with spine conditions trust smaller clinics, rather than renowned local clinics, to perform such important surgeries?

Also, what pros and cons exist for a patient to choose between public hospitals and private clinics for spine procedures?

Spine surgeons can certainly work in private clinics. Most private attendings do mostly spine for that matter. The reason people go to private surgeons are numerous, but most likely from a referral. The pro's of a private setting are that the hospitals are often more patient focused and the attendings have a higher volume. The pro's of a public/university setting are perhaps the attending is more well known and it has bee shown that having residents/medical students involved in patient care decreases overall major morbidity associated with hospitalization.

 

[Sophocles]

Spine surgeons can certainly work in private clinics. Most private attendings do mostly spine for that matter. The reason people go to private surgeons are numerous, but most likely from a referral. The pro's of a private setting are that the hospitals are often more patient focused and the attendings have a higher volume. The pro's of a public/university setting are perhaps the attending is more well known and it has bee shown that having residents/medical students involved in patient care decreases overall major morbidity associated with hospitalization.

I sat at a panel of surgeons who came to talk to us. Two of them were Gen Surg/Ortho. They seemed to believe that although the true impact of the ACA is nebulous in regards to PP, they thought that this would actually decrease the amount of private practices. Something about too much responsibility and liability for the physicians and that with the new restrictions and regulations you don't have as much autonomy; ergo, going to work at a hospital could alleviate some of this stress. Is this something that you have encountered in Neurosurgery?

 

[iforget2]

How much do residents of a certain specialty know about other areas of medicine? For example, if somebody needed an appendectomy and you were the only surgeon there, would you be able to perform it?

 

[ChiDO]

How much do residents of a certain specialty know about other areas of medicine? For example, if somebody needed an appendectomy and you were the only surgeon there, would you be able to perform it?

no.

 

[neusu]

Do you have any experience with DBS by chance? They just started doing it where I work, so there have been several lectures/grand rounds about it recently. All I can say is... wow. Probably the most inherently fascinating medical innovation I've stumbled across (perhaps that's not saying much, being that I haven't even started medical school yet).

It's also interesting that, as far as I can tell, no one has been able to explain exactly why it works.

Functional neurosurgery certainly is interesting, and I have done my fair share of DBS cases. It is scary that we can put a stimulator in to the brain and augment function but not necessarily understand how the interaction works. We're getting closer to both implantable arrays that read function as well as arrays that interact with nervous tissue.

 

[neusu]

If one wanted to do spine surgery what are the pros and cons of doing Neurosurg residency instead of ortho?

Sent from my SGH-T999 using SDN Mobile

I thought these were two different things. For instance, ortho works on the bones/ ligaments and neurosurgeons work on anything inside the dura. Is this correct? I'm sure there are also a myriad of differences inherent to the types of surgery each one does and the lifestyles associated with residency and practice that I would love to read about, as well.

A neurosurgery residency vs an orthopedic residency with spine fellowship is quite a bit different. As suggested, orthopedics focuses on bones and ligaments whereas neurosurgery focuses on the central/peripheral nervous system and associated structures.

That being said, the difference between spine ortho and neuro, for the most part, is as suggested many orthopedic spine surgeons do not operate on intradural spinal pathologies. Both do laminectomies/discectomies. For the most part, both put in hardware.

A lot of the overlap (or lack thereof) comes down to an agreement made between the groups about who does what and/or covers what.

 

[neusu]

Though I can't say for sure as I only review the applications after they get past that point, I suspect there are cutoffs in neurosurgery as well. Most likely the chairman and/or PD tell the coordinator what the cutoff should be and then someone is tasked with skimming the remainder of applicants for outliers.

At my institution, the PGY-5 is part of the selection committee and receives input from the PGY 1-7 on how the applicant is perceived during the interview. It's tough because I can tell a lot of the applicants are tired etc and give a negative impression because of that.

To get an interview, I'm not quite sure if there is anything in particular that will absolutely guarantee an interview. Perhaps, being a medical student here and doing a SubI, but not all students who do a SubI as an away are granted an interview. For the rest, generally a mix of board scores, grades, publications, ties to the school or area are what does it. It is a relatively homogeneous applicant group, everyone seems to have excellent scores, grades, research, and incredible extra-curricular involvement.

For what it's worth, most applicants go on most interviews and won't match there, nor would they care to. There is a lot of inefficiency in the match, but evidently it works in that most people get their top choice (or top 3) and all but a few programs fill.

You are overwhelmed with many questions here. I will appreciate if you could answer my questions.
I want to know more about appilication reviewing process. In specialties like Internal Medicine, Peds...etc, PDs and coordintor who put the cutoffs and filter applications before even reading them. Does this apply to NS too?

Then, who review applications that met the cutoffs? PD, chairman, residents? If the latter, what PGY residents?
What factors that bring interview? I am not asking about factors that rank applicants or those looked at just before interviewing, BUT I am asking about those factors that are initially glanced to send out interviews?

 

[neusu]

Neusu, thank you so much for all of these thorough and informative answers. I have a question regarding your above comment: Would you recommend an aspiring NS med student opt and pay more for a highly ranked school or perhaps opt for the cheaper, far lower rated state school (~80 research, ~50 primary care), but which has far more opportunity for clinical learning.

To elaborate, the former school is within the top 40 research and top 5 primary care, with a far more desirable region/culture, the one at which I think I'd be most happy overall. However, the state school boasts the 3rd busiest general hospital, chock-full of trauma, where med students are given insane amounts of autonomy during rotations and are allowed to suture tech during their free-time. I believe the latter would afford far better clinical training and is also home to a couple of my friends that will be M2s when I'd enter.

I'm by no means overly focused on ratings, but understand that they do offer a slight edge to your ERAS. I'm also thinking that the higher ranked research institution will have better opportunities for research during my M1-M2 summer. Moreover, I've cited several papers from that institution in my current NS research.

Tough call. Do both schools have a home neurosurgery program? If not, go to the one that does. You're right, the bigger research school would likely have more opportunities, but medical school is what you make of it meaning you'll find opportunities if you look for them and work hard. My sense is, that if it's "top 40" vs "top 100" it likely won't make a major difference. It's important to consider the cost, or not, as well. Going somewhere you'll end up $300,000 in debt vs $0-100,000 may be worth considering. Even so, once you're an attending it's water under the bridge.

I intend to write more about this as I go through med school and residency. I have full sleeves, an expansive and encompassing backpiece, and several tattoos on my legs and chest, most of which would not be seen in a positive light by any conservative party.

I was talking to a GenSurg resident on a return flight from one of my interviews this season and discussed how this might affect my evals during rotations. He suggested making every effort possible to scrub in before and after the attending. I though that was pretty good advice. But you can't honestly expect that to work during residency. That said, once you've matched into a program, everyone knows you're not a tool, that you're hard working, and exemplified that you fit in with the team. I imagine the tattoos wouldn't matter that much at that point as long as you keep them covered while you're at work. I currently wear Starter UnderArmor. It works very well when you're not scrubbing in. Hope this helps somewhat.

As long as they're not overtly offensive it likely won't be that big of a deal. If they're like many tattoos, you should probably look in to removing them because they will cause issues. Covering them on the wards is a good idea, and scrubbing early can help, but you're right, if you're wearing just a scrub top in the OR suite they'll be seen. Just work hard, keep your head down otherwise, and it likely won't come to anything.

 

[neusu]

While I'm not in a position to comment directly, that is the impression I get as well. The ACA seems to have a prerogative to decrease the ability for physicians to practice independently, or in small groups, and to push them in to larger, managed care groups. In a sense, this should increase efficiency by decreasing/combining overhead costs and allow for better integration of medical records. On the other hand, it in essence, makes it prohibitive for a doctor to own his own business. Take this to an extreme and doctors are nothing more than revenue sources for medical businesses run by business school graduates and the bottom line becomes the imperative, not patient care.

I sat at a panel of surgeons who came to talk to us. Two of them were Gen Surg/Ortho. They seemed to believe that although the true impact of the ACA is nebulous in regards to PP, they thought that this would actually decrease the amount of private practices. Something about too much responsibility and liability for the physicians and that with the new restrictions and regulations you don't have as much autonomy; ergo, going to work at a hospital could alleviate some of this stress. Is this something that you have encountered in Neurosurgery?

 

[Guero]

Tough call. Do both schools have a home neurosurgery program? If not, go to the one that does. You're right, the bigger research school would likely have more opportunities, but medical school is what you make of it meaning you'll find opportunities if you look for them and work hard. My sense is, that if it's "top 40" vs "top 100" it likely won't make a major difference. It's important to consider the cost, or not, as well. Going somewhere you'll end up $300,000 in debt vs $0-100,000 may be worth considering. Even so, once you're an attending it's water under the bridge.




As long as they're not overtly offensive it likely won't be that big of a deal. If they're like many tattoos, you should probably look in to removing them because they will cause issues. Covering them on the wards is a good idea, and scrubbing early can help, but you're right, if you're wearing just a scrub top in the OR suite they'll be seen. Just work hard, keep your head down otherwise, and it likely won't come to anything.

Thank you so much!

Yes, they both have home NS programs and only differ by about $10-20k per year in cost, minus the move. I'm thinking my happiness is probably the most important factor. I think that would be more likely to affect my overall performance in med school. I know I'd be happier in the "better" school's locale and would more likely move out there even if the situation was vice versa.

The most difficult choice would be if my top choice falls through and it comes down to choosing between my second choice (which is nearly tied for first) and my back-up (the state school). My second choice is about $30k more expensive each year plus an inordinately high cost of living.

As for the tattoos, thankfully none of the ones on my arms are offensive. 🙂

 

[neusu]

How much do residents of a certain specialty know about other areas of medicine? For example, if somebody needed an appendectomy and you were the only surgeon there, would you be able to perform it?

I did a full general surgery internship and took out my fair share of appendixes.

Surgeons are able to request privileges at hospitals to do any procedure that they are competent to do. Could I request privileges to do appendectomies? Probably. Would I? Absolutely not. It is imperative in surgery to know your skill set and limitations therein. In neurosurgery we have quite a bit of sub-specialization. Even at major centers, the surgeon on call will hand-over patients outside his scope of practice to colleagues who are better trained to deal with that (e.g. even though you clipped 100 aneurysms in residency 15 years ago you realize you're not up to it now because the majority of your practice is functional).

I've said previously, that in a life or death situation, I could probably still take an appendix out as I remember the anatomy and the procedural steps. I would not be comfortable doing it and would do everything possible to temporize the situation first, because more often than not a procedure can be delayed until a qualified surgeon is available.

 

[neusu]

Thank you so much!

Yes, they both have home NS programs and only differ by about $10-20k per year in cost, minus the move. I'm thinking my happiness is probably the most important factor. I think that would be more likely to affect my overall performance in med school. I know I'd be happier in the "better" school's locale and would more likely move out there even if the situation was vice versa.

The most difficult choice would be if my top choice falls through and it comes down to choosing between my second choice (which is nearly tied for first) and my back-up (the state school). My second choice is about $30k more expensive each year plus an inordinately high cost of living.

As for the tattoos, thankfully none of the ones on my arms are offensive. 🙂

Sounds like you have things pretty well figured out. Feel free to PM me as things progress. Best wishes!

 

[duhyesorduhno]

In terms of prestige and residency applications, does attending an HBCU medical school make it more difficult to match into a neurosurgery program? I've always been told that no matter what school you go to it is best to strive be par excellence (i.e. involved in campus activity, good step scores and grades, etc).; is this true?

Sorry for rambling

 

[neusu]

In terms of prestige and residency applications, does attending an HBCU medical school make it more difficult to match into a neurosurgery program? I've always been told that no matter what school you go to it is best to strive be par excellence (i.e. involved in campus activity, good step scores and grades, etc).; is this true?

Sorry for rambling

In and of itself, I wouldn't say it makes it harder. None of the associated medical schools, West Virginia aside, have departments of neurosurgery, so that does indeed make it harder.

No matter where you go, do your best. If it is in alignment with or above the selection criteria for neurosurgery, you should match. The reason I state it this way is to include the Caribbean and foreign grads (IMG/FMG). As a US grad of a school w/o a neurosurgery program, average will likely cut it. As an IMG/FMG it certainly won't. If I had to go back to school and do it over again, I'd set my bar higher than the average and make sure I hit that.

 

[bennybrak]

That was a great thread neusu! Thanks for dedicating time for this. I suggest the moderators sticky this thread on the neurosurgery section.

 

[neusu]

Oh no! What about those of us that are lactose intolerant? Soy milk? I think I might be fine with the protein aspect but idk about the fat part.

There is lactose free milk. Nonetheless, the fat is important for staving off hunger. You remain sated longer with a fat dense meal than a carbohydrate dense meal.

 

[BurghStudent]

Maybe this was asked already, but are neurosurgeons working at hospitals allowed to work less hours for less pay?

Thanks for doing this!

 

[487806]

Do neurosurgeons and ENTs share similar procedures and cases?

 

[neusu]

Maybe this was asked already, but are neurosurgeons working at hospitals allowed to work less hours for less pay?

Thanks for doing this!

Once you are in practice, especially private practice, you can typically work as much or as little as you like and are paid accordingly. If you work for the hospital or a large group practice, there likely are some performance expectations. If you negotiate the position you desire up front though, it should not be too much of an issue to work less and get paid less.

 

[neusu]

Do neurosurgeons and ENTs share similar procedures and cases?

There really is not much overlap between neurosurgeons and otolaryngologists. We do work together on some cases such as transnasal and translabrynthine approaches to the skull base. A general rule of thumb though is that if the issue is inside the dura it's neurosurgery.

Likewise, we work closely with ophthalmology for orbital issues and plastic/reconstructive or oral/maxillofacial for skull fractures/craniosynostosis.

 

[seattlewapremed]

Thank you very much for your time.

My question is about the research years of residency. Obviously this varies widely between programs because of different call requirements and such, but what are the hours like for those 1-2 years?

 

[neusu]

Thank you very much for your time.

My question is about the research years of residency. Obviously this varies widely between programs because of different call requirements and such, but what are the hours like for those 1-2 years?

You are right, this varies widely both on the program, and the lab in which you work. I have heard as little as 20-25/week to as much as 80.

As a rule, hours tend to be more for residents in programs without protected lab time. This means that you still have clinical responsibilities which range from clinic, overnight call, night float, to weekend call. Likewise, the culture of the lab that you associate with, and the PI expectations, have a lot to do with how many hours are worked. Some labs, things pick up around 8 or 9 and settle down around 5 or 6. Others are far more intense with people showing up at 5 or 6 and others leaving after midnight. Some labs have a weekly lab meeting where everyone goes over data/results, journal club, grand rounds etc. Others are more independent where you have a project, come and go as you feel, and things are pretty easy going.

Programs with protected time tend to allow for a better lab experience as well as the possibility of extramural research.

 

[seattlewapremed]

You are right, this varies widely both on the program, and the lab in which you work. I have heard as little as 20-25/week to as much as 80.

As a rule, hours tend to be more for residents in programs without protected lab time. This means that you still have clinical responsibilities which range from clinic, overnight call, night float, to weekend call. Likewise, the culture of the lab that you associate with, and the PI expectations, have a lot to do with how many hours are worked. Some labs, things pick up around 8 or 9 and settle down around 5 or 6. Others are far more intense with people showing up at 5 or 6 and others leaving after midnight. Some labs have a weekly lab meeting where everyone goes over data/results, journal club, grand rounds etc. Others are more independent where you have a project, come and go as you feel, and things are pretty easy going.

Programs with protected time tend to allow for a better lab experience as well as the possibility of extramural research.

Thank you!

Although this is far off, I'm curious. How do you keep your clinical skills up to par if you don't do anything clinically related for 1-2 years?