Ask a neurosurgery resident anything

[Cuongoff]

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Hey, do you know of any osteopathic neurosurgical residencies that allow you to obtain a PhD during residency? I know some allopathic NS residencies have that but can't find anything on osteopathic.

 

[nysegop]

What book do you recommend for neuroanatomy? What is the best way to study neuroanatomy/physiology?

 

[mappingmedicine]

Neusu, thank you so much for contributing time to build up this thread, I'd say many pre-meds have learned a great deal from your posts!

I was wondering if you know how many (percentage wise?) NS resident graduates elect to pursue fellowships? What are the various options and most popular fellowships residents pursue? And although this may sound very straight forward, what are the pros/cons of electing/not electing to pursue a fellowship in NS? Thank you!

 

[nychila]

What do you think about spine surgeons who obtained their training through an orthopedics residency, followed by a spine fellowship? Do they usually work on the same types of cases or do they usually have a division of labor based on their previous residency training; if so, how is it divided for spine cases?

 

[Sophocles]

What do you think about spine surgeons who obtained their training through an orthopedics residency, followed by a spine fellowship? Do they usually work on the same types of cases or do they usually have a division of labor based on their previous residency training; if so, how is it divided for spine cases?

MedPR actually asked this question, I believe and he already answered it. I wish I knew what page number so I could quote it, but it's definitely there.

 

[987439759]

medpr actually asked this question, i believe and he already answered it. I wish i knew what page number so i could quote it, but it's definitely there.

#384

 

[Sophocles]

#384

👍
wow, that was quick

 

[nychila]

#384

Oh thanks terrific!

In that case, I will ask another question: Are there any neurosurgery fellowships that can lead to a relatively lifestyle-friendly specialty, eg. total of 60h/week instead of the usual 80+h/week and minimal call? Maybe spine in private practice?

 

[Guero]

Oh thanks terrific!

In that case, I will ask another question: Are there any neurosurgery fellowships that can lead to a relatively lifestyle-friendly specialty, eg. total of 60h/week instead of the usual 80+h/week and minimal call? Maybe spine in private practice?

As we wait, I'd venture to say that functional NS has perhaps among the best hours. These surgeons perform DBS, lobectomies to treat epilepsy, etc. You could stick strictly to functional procedures and have a great lifestyle if you're willing to take a hit in reimbursement. Most in NS with functional fellowships must also work as a general neurosurgeon to maintain typical reimbursements. There isn't nearly the demand for functional procedures as there are in general practice. My mentor, a fxnl neurosurgeon, must also perform the gamut of general procedures from trauma to laminectomies as part of his position at an academic medical center.

I'm sure neusu has far more to say, but figured this would give you something to chew on in the interim.

 

[Coffee Machine]

Oh thanks terrific!

In that case, I will ask another question: Are there any neurosurgery fellowships that can lead to a relatively lifestyle-friendly specialty, eg. total of 60h/week instead of the usual 80+h/week and minimal call? Maybe spine in private practice?

He already answered this question as well. Look through the previous posts.

 

[neusu]

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?

Depending on the program, research/elective years can be protected or not protected. As previously mentioned, protected years are out of the call pool, with no clinical obligation to the neurosurgery service. Non-protected years may require call or vacation/conference coverage.

In the latter scenario, from what I gather, the residents in programs that do not have protected off-service time, they generally still have enough of a neurosurgical clinical exposure through the off-service years such that it isn't really like being off.

In the former, it may or may not be an issue.

For the most part, electives/research are undertaken after the 3rd or 4th year. If an average neurosurgery resident works 80-88/hrs week for 3 years straight that's roughly 12,000 hours of clinical exposure. Many of the things we do, both in the OR and on the ward/ICU/trauma bay, though complicated on initial glance, follow a standard algorithm but require a fair amount of circumstantial knowledge and build off one another. Likewise, in the off service years, residents are expected to continue studying and attend teaching conferences.

While I can't say placing a ventriculostomy drain is like riding a metaphorical bike, there are similarities. Having done it enough previously, thoroughly understanding the indication and anatomy, allows a more senior resident (or attending for that matter) to readily perform a procedure that he/she may not have performed in quite some time.

Hope this helps.

 

[487806]

Not sure if this has been asked before, but do all surgical subspecialties have an integrated version? Like does integrated neurosurgery residency exist?

 

[neusu]

Hey, do you know of any osteopathic neurosurgical residencies that allow you to obtain a PhD during residency? I know some allopathic NS residencies have that but can't find anything on osteopathic.

Sorry, I'm not particularly familiar with the osteopathic programs. There aren't that many DO programs, you could try e-mailing the coordinators and pursue whether it would be an option.

 

[neusu]

What book do you recommend for neuroanatomy? What is the best way to study neuroanatomy/physiology?

For medical students the BRS Neuroanatomy, Neuroanatomy Through Clinical Cases, or the Neuroanatomy Made Ridiculously Simple tend to get the job done. For residents along with one of the board review books I usually recommend Rhoton Cranial Anatomy and Surgical Approaches and Schmidek and Sweet’s Operative Neurosurgical Techniques.

The best way to study is often, and review clinical cases you see after you see them. Try to understand in 3-dimensions what the pathology is or what you are seeing in the operating room.

 

[JohnDoe7]

I have a 206 on step 1 and unfortunately I failed Step 2 CS. I am willing to do anything at all to get into a neurosurgery residency even if it means doing another residency and try matching later on... Any tips?

 

[neusu]

Neusu, thank you so much for contributing time to build up this thread, I'd say many pre-meds have learned a great deal from your posts!

I was wondering if you know how many (percentage wise?) NS resident graduates elect to pursue fellowships? What are the various options and most popular fellowships residents pursue? And although this may sound very straight forward, what are the pros/cons of electing/not electing to pursue a fellowship in NS? Thank you!

I would suspect that slightly less than or nearly 50-percent of residents go on to pursue fellowships. Fellowship is a lot like the residency match in that each person chooses the field in which they are interested, popularity tends to not have a huge role. I will say though, the number and variety of spine fellowships seems to be greatest. Not every program will emphasize every technique or facet of spine (MIS, instrumented, scoliosis, oncology), and if that is of particular interest to you, a fellowship may be in order.

At the end of the day, everyone finishing residency and completing board certification should be a safe, competent neurosurgeon. For many, a broad case diversity and the life of private practice is exactly what they want. For others, especially those interested in academics, a focus in a particular area is desired. Likewise, some fields, a fellowship is mostly necessary due to the complexity involved. A fellowship allows for a year or more of focused training in that particular environment to hone the skills needed and see more of the zebra cases out there so that when out in practice it is less of an unknown.

 

[neusu]

What do you think about spine surgeons who obtained their training through an orthopedics residency, followed by a spine fellowship? Do they usually work on the same types of cases or do they usually have a division of labor based on their previous residency training; if so, how is it divided for spine cases?

I think this one came up already but to recap:

Spine surgeons operate on the spine and spinal cord. For the most part, surgery of the spinal cord itself is left to neurosurgeons. Depending on the individual institution, and surgeon personal preferences, it may be split differently. Many spine neurosurgeons do not do scoliosis and others do not do instrumented spine. Some neurosurgeons do not do spine at all and instead have orthopedic surgeons as approach surgeons for intradural surgery. Some institutions split spine call by day, week, or month. Others break it up by the part of the spine e.g. ortho gets lumbar and thoracic, neuro gets cervical.

At the end of the day, in practice, the hospital typically will allow you to do what you are comfortable with and trained to do. Negotiating with other practices regarding call and with primary providers regarding referrals is up to you.

 

[katz680]

Hello all,

I have just a random question about how the nervous system functions in regards to pain. I have a good friend who insists that the sympathetic nervous system is responsible for the perception of physical pain. However, I was under the impression that the sympathetic / parasympathetic nervous system regulate things like vasodialation and muscle contraction in the GI and respiratory tracts (fight or flight), and the central nervous system handled external sensory information. So what's going on? How is pain processed in the body?

 

[Guero]

Hello all,

I have just a random question about how the nervous system functions in regards to pain. I have a good friend who insists that the sympathetic nervous system is responsible for the perception of physical pain. However, I was under the impression that the sympathetic / parasympathetic nervous system regulate things like vasodialation and muscle contraction in the GI and respiratory tracts (fight or flight), and the central nervous system handled external sensory information. So what's going on? How is pain processed in the body?

This really isn't the place to ask that question.

 

[487806]

Hello all,

I have just a random question about how the nervous system functions in regards to pain. I have a good friend who insists that the sympathetic nervous system is responsible for the perception of physical pain. However, I was under the impression that the sympathetic / parasympathetic nervous system regulate things like vasodialation and muscle contraction in the GI and respiratory tracts (fight or flight), and the central nervous system handled external sensory information. So what's going on? How is pain processed in the body?

SDN isn't for homework help. Consult your textbook.

 

[katz680]

I'm a biologist, and I'm having a disagreement with another biologist about the matter; I was simply hoping to have the issue clarified by someone who knows more than both of us about neurology. Thanks for the condescension, though. You've been so helpful.

 

[neusu]

Oh thanks terrific!

In that case, I will ask another question: Are there any neurosurgery fellowships that can lead to a relatively lifestyle-friendly specialty, eg. total of 60h/week instead of the usual 80+h/week and minimal call? Maybe spine in private practice?

Most private practice neurosurgeons live pretty good lives. I would caution going in to it with this expectation though. The landscape of medicine is changing so what is the current norm may not be that way when you finish. Residency truly is incredibly difficult and is 7 years. Neurosurgery is not known to be a lifestyle specialty for a reason. If that part of it interests you, or at least doesn't put you off, it might be something to pursue. If lifestyle is that important to you, there are many other fields that are great.

 

[Daodejing]

It seems like 4th year - at least the first half of it - is quite busy in terms of preparing your ERAS, scheduling CS/CK, 4th year required rotations, away rotations, and interviews. How did you exactly manage all of this, besides meeting with your advisor? Did you take CK before/after submitting your ERAS?

Did you do any aways? If so, how many? How did you decide where to go; in particular, did you attend programs you thought you would match more easily at or were you swayed by the name of a particular institution?

 

[tiedyeddog]

Did you do any case reports during third year? How did you find and ask faculty about doing them? Would I wait until my surgery rotation to inquire about doing one or is it appropriate to ask at the start of my ms3 year?

 

[neusu]

As we wait, I'd venture to say that functional NS has perhaps among the best hours. These surgeons perform DBS, lobectomies to treat epilepsy, etc. You could stick strictly to functional procedures and have a great lifestyle if you're willing to take a hit in reimbursement. Most in NS with functional fellowships must also work as a general neurosurgeon to maintain typical reimbursements. There isn't nearly the demand for functional procedures as there are in general practice. My mentor, a fxnl neurosurgeon, must also perform the gamut of general procedures from trauma to laminectomies as part of his position at an academic medical center.

I'm sure neusu has far more to say, but figured this would give you something to chew on in the interim.

Functional is a great subspecialty. There are very few surgeons who can practice solely functional and as alluded to, most have to do general neurosurgery as well. Most programs will provide sufficient training to be proficient in the bread and butter functional procedures. As an aside, functional requires a pretty robust ancillary staff or referral base. Basically, a set of movement disorder or spasticity neurologists with whom you closely work. Without that, you a steady referral base and long-term follow up for your patients.

 

[neusu]

Not sure if this has been asked before, but do all surgical subspecialties have an integrated version? Like does integrated neurosurgery residency exist?

Historically, everyone did a prelim surgery year and then specialties like neurosurgery, urologu, orthopedics, and ophthalmology split off to an integrated program. Now, neurosurgery is completely integrated. You still spend several months on general surgery, but you are owned by neurosurgery.

 

[Sophocles]

Functional is a great subspecialty. There are very few surgeons who can practice solely functional and as alluded to, most have to do general neurosurgery as well. Most programs will provide sufficient training to be proficient in the bread and butter functional procedures. As an aside, functional requires a pretty robust ancillary staff or referral base. Basically, a set of movement disorder or spasticity neurologists with whom you closely work. Without that, you a steady referral base and long-term follow up for your patients.

Not sure if this has been covered, but what do you think about the future of functional neurosurgery with the recent "success" that UCSF has had in their transplantation of neural stem cells? Do you think in the next 15-20 years, it will become something feasible and common?

 

[neusu]

I have a 206 on step 1 and unfortunately I failed Step 2 CS. I am willing to do anything at all to get into a neurosurgery residency even if it means doing another residency and try matching later on... Any tips?

Unfortunately, those numbers are not compatible with neurosurgery residency. I'm not saying its impossible, but highly unlikely. As you suggested, I would pick another field to do for now. Perhaps doing several years of research with a program that loves you, you might get interviewed for an an advanced opening. As much as I dislike usmle step 1 as a screen, evidently there is a correlation between board scores and step scores.

 

[JESSFALLING]

I only have one good eye due to a retinal detachment (it's fixed, but w/ vision loss). Do you think that would that preclude me from surgical fields? I plan to become a doctor, regardless, but I would like to know my options.

Thanks!

 

[neusu]

Hello all,

I have just a random question about how the nervous system functions in regards to pain. I have a good friend who insists that the sympathetic nervous system is responsible for the perception of physical pain. However, I was under the impression that the sympathetic / parasympathetic nervous system regulate things like vasodialation and muscle contraction in the GI and respiratory tracts (fight or flight), and the central nervous system handled external sensory information. So what's going on? How is pain processed in the body?

The autonomic nervous system, or sympathetic and parasympathetic (as well as enteric) nervous system is purely efferent, or from the central nervous system to the body. There is no afferent, or return to the central nervous system, involved. Increase in sympathetic nervous system causes an increase in release of adrenaline/epinephrine from the adrenal/suprarenal glands which can have a central effect. The physical perception of pain is from a delta and c fibers. Overstimulation of any peripheral nerve can be perceived as pain e.g. too much contraction on a alpha or too much vibration on a beta is painful, but pain is transmitted via the aforementioned fibers. Again, sympathetic response augments this, and perception of pain is certainly increased with increased sympathetic output.

Even so, I question if, perhaps too much sympathetic output causes an analgesia. Certainly, there are examples when someone was severely injured, say a soldier in battle who was shot and kept charging, and didn't feel the pain of the injury. Perhaps, though, they may just have endorphines as well. Nonetheless, interesting question.

 

[neusu]

It seems like 4th year - at least the first half of it - is quite busy in terms of preparing your ERAS, scheduling CS/CK, 4th year required rotations, away rotations, and interviews. How did you exactly manage all of this, besides meeting with your advisor? Did you take CK before/after submitting your ERAS?

Did you do any aways? If so, how many? How did you decide where to go; in particular, did you attend programs you thought you would match more easily at or were you swayed by the name of a particular institution?

Personally, I knew I was interested in neurosurgery. This helped because I became familiar with the department at my home institution, got involved with research, went to conferences, gave talks periodically, was set up nicely from there.

For taking Step 2, historically neurosurgery was in the San Francisco Match which took place earlier than the regular match. This was fantastic because A) you knew where you were going and had more time for looking for a place to live/finding a job for your spouse B) if you didn't match you didn't have to scramble. Now, it's regular match. Nonetheless, neurosurgery program directors historically never got Step 2, as such, they still don't typically ask for it. There are several programs that have wisened up and do ask it to be submitted. Regardless, my general recommendation is: 1) >Average: delay 2) < Average: a) can do better - take and show b) probably not - hold. There is no reason to take another unnecessary test that you are judged by unless it is required. Certainly, take Step 2 at some point (if you want to be licensed), but unless you think it will increase your standing in PD eyes do not take it early! On a similar note, if you bomb Step 1, Step 2 doesn't make up for it.

I did 3 away rotations. I picked 2 at "top" programs and 1 at somewhere in which I was very interested. At every away rotation I was amazed at how things ran. Nonetheless, I didn't rank them as highly as other places I interviewed. Certainly, every program trains residents to be surgeons, but the culture of the program says a lot about what kind of surgeon is made. Regardless of where your away rotations are done, you will see along the trail many places you may or may not like. My best advice is find a place in which you fit, where you don't mind being, where you feel confident you will get the training you want.

 

[Guero]

Hello all,

I have just a random question about how the nervous system functions in regards to pain. I have a good friend who insists that the sympathetic nervous system is responsible for the perception of physical pain. However, I was under the impression that the sympathetic / parasympathetic nervous system regulate things like vasodialation and muscle contraction in the GI and respiratory tracts (fight or flight), and the central nervous system handled external sensory information. So what's going on? How is pain processed in the body?

The autonomic nervous system, or sympathetic and parasympathetic (as well as enteric) nervous system is purely efferent, or from the central nervous system to the body. There is no afferent, or return to the central nervous system, involved. Increase in sympathetic nervous system causes an increase in release of adrenaline/epinephrine from the adrenal/suprarenal glands which can have a central effect. The physical perception of pain is from a delta and c fibers. Overstimulation of any peripheral nerve can be perceived as pain e.g. too much contraction on a alpha or too much vibration on a beta is painful, but pain is transmitted via the aforementioned fibers. Again, sympathetic response augments this, and perception of pain is certainly increased with increased sympathetic output.

Even so, I question if, perhaps too much sympathetic output causes an analgesia. Certainly, there are examples when someone was severely injured, say a soldier in battle who was shot and kept charging, and didn't feel the pain of the injury. Perhaps, though, they may just have endorphines as well. Nonetheless, interesting question.

(FTFY , lol)

This really isn't the place to ask that question.

I didn't think neusu would elect to answer. I stand corrected. 😳 But per SDN custom, asking questions off topic to the thread at hand is still frowned upon. Nevertheless, I loved the answer. 👍

Great answers and questions, please keep them coming ladies and gents.

 

[PennDippody]

I didn't think neusu would elect to answer. I stand corrected. 😳 But per SDN custom, asking questions off topic to the thread at hand is still frowned upon...

How was that off-topic in an "ask me anything" forum? While most stick to the general advice on becoming a n-surg, it still seems OP put himself out there for other things as well. Besides he/she handles unwanted questions just fine - by ignoring them.

 

[nysegop]

Historically, everyone did a prelim surgery year and then specialties like neurosurgery, urologu, orthopedics, and ophthalmology split off to an integrated program. Now, neurosurgery is completely integrated. You still spend several months on general surgery, but you are owned by neurosurgery.

Haha... owned.

 

[Guero]

How was that off-topic in an "ask me anything" forum? While most stick to the general advice on becoming a n-surg, it still seems OP put himself out there for other things as well. Besides he/she handles unwanted questions just fine - by ignoring them.

Good point, totally forgot about the "anything" qualifier. I stand corrected yet again lol

 

[487806]

Good point, totally forgot about the "anything" qualifier. I stand corrected yet again lol

No you're right. It's unconventional to ask the AMA OP a typical "homework" question, like how something works etc., when it can be found via a textbook or a search. Still, neusu took the time to respond to that question, which is good.

 

[Xenops]

Neusu, thank you very much for this thread! I am very interested in surgery, and neuro is one I'm considering.

I have a question for you; I had an opportunity to watch a general surgery of removing the gall bladder and fixing a hiatal hernia. I realized that I would not enjoy working with laparoscopy; I would much prefer a surgical specialty where I can actually see the said organ and not fully rely on a screen. I assume in neurosurgery that you get to actually see the organ while using technology to pin-point a tumor? Do you know of other specialties that don't rely heavily on screens?

 

[neusu]

Is it worth it?

Depends on the day. Like anyone, I have good days and bad days. I won't sugar coat it: it is very hard; mentally, physically, and emotionally taxing; and a lot of sacrifices with respect to personal life have to be made. That being said, the best of the best is unbeatable, and the worst of the worst is still better than most any other field I entertained.

80 hours a week for life? How is it possible to have ANY kind of life out side of work?

This question comes up often. In most surgical fields long hours are required. Creating efficiency both in the hospital and at home help workflow and having a semblance of a normal life. Likewise, creating personal priorities helps maintain balance.

Im interested in neurology, do you guys respect them?

Of course. We have different areas of expertise, however we do work together in numerous areas. Fostering good relationships with other specialties is always something we strive for.

 

[neusu]

Did you do any case reports during third year? How did you find and ask faculty about doing them? Would I wait until my surgery rotation to inquire about doing one or is it appropriate to ask at the start of my ms3 year?

I got involved in research during my first year and had ongoing projects I was working on. Unfortunately, I did not complete any case reports during my 3rd year. I would try to get involved as early as possible either on a project or case reports. Try not to be discouraged if it drags on and on, publishing is a very slow process.

 

[seattlewapremed]

Thanks again for your time.

Do you plan to stay in academics? Does academics usually lead to a better lifestyle because the residents take the bulk of the call or a worse lifestyle because of the additional requirements of publishing, etc.?

 

[neusu]

Not sure if this has been covered, but what do you think about the future of functional neurosurgery with the recent "success" that UCSF has had in their transplantation of neural stem cells? Do you think in the next 15-20 years, it will become something feasible and common?

Functional has a bright future. We are figuring out more and more about how and why what we do works and learning more about how to interface with the human nervous system.

I am not particularly familiar with the UCSF study. Perhaps post a link?

 

[Sophocles]

Functional has a bright future. We are figuring out more and more about how and why what we do works and learning more about how to interface with the human nervous system.

I am not particularly familiar with the UCSF study. Perhaps post a link?

Neusu,
Thanks for responding. This is the study I'm referring to:

http://www.ucsf.edu/news/2012/10/12...l-stem-cells-produced-myelin-ucsf-study-shows

I would love to get involved in this field and although you have stated that you don't need a PhD to do research as a neurosurgeon, I wonder if this would be better to form your own ideas and allows one to have greater autonomy (?) in regards to their direction in research.

 

[neusu]

I only have one good eye due to a retinal detachment (it's fixed, but w/ vision loss). Do you think that would that preclude me from surgical fields? I plan to become a doctor, regardless, but I would like to know my options.

Thanks!

I am sorry to hear about that, I'm sure it must have been tough for you. What does your vision correct to and how is your depth perception? Having both a strong visual 3D realization of anatomy as well as a mental 3D picture is important. On the mental picture side being able to "see through" structures, e.g. where am I, what's behind this, where does this lead to? is what makes the difference between an average surgeon and a good one. Likewise, being able to construct an anatomical image in your mind base on radiological imaging.

 

[Vitals]

A lot of the neurosurgery residents I talk to have their loans in the public service loan forgiveness program. They have several options for repayment, which are nice, including standard, income based, and graduated payment plans. Many residents defer or put their loans in forbearance during residency because the amount being paid per month is a sizable chunk of disposable income that could be utilized elsewhere.

Are you implying that the PSLF 10-year clock starts from the beginning of the forbearance period?

 

[onewayoranother]

Hey There!
So my questions are about dexterity. Did you do any dexterity exercises, like play an instrument or work with paper craft, when you were young? If you did does it help you today, or can you develop the skills required to be a good surgeon right from your training years? Generally how important is dexterity in surgery?
Thank you for your time.

 

[neusu]

Haha... owned.

Laugh now! You'll see, you really are pwn3d!

 

[neusu]

Neusu, thank you very much for this thread! I am very interested in surgery, and neuro is one I'm considering.

I have a question for you; I had an opportunity to watch a general surgery of removing the gall bladder and fixing a hiatal hernia. I realized that I would not enjoy working with laparoscopy; I would much prefer a surgical specialty where I can actually see the said organ and not fully rely on a screen. I assume in neurosurgery that you get to actually see the organ while using technology to pin-point a tumor? Do you know of other specialties that don't rely heavily on screens?

Haha, I had a similar realization during surgery. The screen just didn't do it for me.

We do do endoscopy for transphenoidal, 3rd ventricular, or minimally invasive spine approaches, so there is some watching the screen. We do tend to use the 3D cameras though, FWIW.

Many neurosurgery cases are done under loupe magnification. In fact, most spine and tumor cases can and are done this way. There seems to be somewhat of a rift though between the "loupes/scope" or "no loupes/scope" people. Meaning, if you're going to use loupes, bring in the scope, otherwise loupes just make you go slower and restrict your peripheral vision. Any time you magnify the field, your ability to perceive the entire surgical field is restricted and you tend to focus on things within your line of sight. That being said, there does not seem to be a huge time differential between the two schools of thought on their cases.

We do use a lot of microscopy in neurosurgery. This, however, is a 3-dimensional, binocular view of anatomy and is more natural, to me anyhow, than endoscopy.

Other surgical fields that tend to not use endoscopy include cardiac, plastics, and ophtho. Otolaryngology, thoracics, ortho, and uro tend to use a lot of scopes (but not exclusively). Vascular is a bit peculiar because they do both open and endovascular, which is an entirely different viewpoint.

PM me if you have any specific questions

 

[deleted407021]

Thanks for volunteering your time!

How prevalent is skull base surgery for neurosurgery and what do you see happening to it in the future?

 

[neusu]

Thanks again for your time.

Do you plan to stay in academics? Does academics usually lead to a better lifestyle because the residents take the bulk of the call or a worse lifestyle because of the additional requirements of publishing, etc.?

Haven't quite decided yet. In academics, you do have residents to take care of the scut, but as a PP attending you typically can afford to hire an NP or PA. Also, private hospitals tend to run more efficiently. Not all programs have a publishing requirement for residents or attendings.

 

[SteinmetzMD]

What were your main motivations for becoming not just a neurosurgeon, but a physician in general?

Are you really an idealist and wanted to improve others lives and make a difference, are you in it for the money (doubtful), or somewhere in between? In short, what put that spark in your mind to go into medicine in general?

And what did you major in for undergrad? 😀