Ask a neurosurgery resident anything

[neusu]

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How much money do you currently make per hour?

Realistically, between $10-15 /hr. The hospital says I get paid ~ $32 /hr based on the concept of a 40 hr work-week.

 

[Cyberdyne 101]

Realistically, between $10-15 /hr. The hospital says I get paid ~ $32 /hr based on the concept of a 40 hr work-week.

😱

 

[Guero]

Realistically, between $10-15 /hr. The hospital says I get paid ~ $32 /hr based on the concept of a 40 hr work-week.

Which is technically better than the negative $24/hr salary of a med student based on a 40hr week (or the more realistic -$12/hr of the 80hr week) of taking out $50,000 in loans each year of medical school. 😛
------
Neusu, how necessary would you say it is to to do an oncological fellowship if you'd like to focus slightly more on general oncological neurosurgical procedures while still covering the common elements of general call? Would you say it's sufficient to target a residency that promises a good chunk of oncological procedures during regular residency? Or are you limited to covering only the bread and butter tumor excisions as a general neurosurgeon, even when completing a program known for its oncological prowess? Thanks in advance.


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[neusu]

I'm sorry if this question was asked already, but how would you advise a female who wants to do MD/PhD, and wants to become a neurosurgeon? Most of the much older doctors (many of whom are male) who are MD/PhD tell undergrads and those interested in pursuing MD/PhD not to pursue such a path, but instead just go for the MD and you can still do research (granted the PhD is in a basic science field, not in the humanities). Especially for females, they say not to waste their youth and not ruin their chances of having children and getting married.

The only female MD/PhD that I know of who did her program in a record amount of time is Dr. Sujata Bhatia: http://www.seas.harvard.edu/directory/sbhatia

Tough question.

First, there are plenty of female MD/PhD neurosurgeons/neurosurgery residents. Perhaps contacting one of them directly for their opinion and advice would prove frutiful.

Like anything, there are two opposing viewpoints to the MD/PhD. In my assessment, the MD/PhD was designed to create a pathway to educate physician scientists. Essentially, practicing MDs who also have a research lab. Historically, there were people who would do this the long way (e.g. PhD or MD followed by the other degree). A continuous program allows for efficiency by using the pre-clinical years as the course-work requirement for the PhD. As you mentioned, many/most MDs will suggest that a PhD is entirely unnecessary. If basic science research is something desired, do a research post-doctoral fellowship (something which a PhD would have to do anyway) and learn the tools. A PhD will suggest that the training involved in a PhD program is rigorous and creates better scientists. I have heard some go so far as to say that the combined MD/PhD is watered down, the advisory committees are soft on the MD PhD candidates, and it's not a true PhD. Thus, doing the PhD first, or following the MD, is recommended.

Where does that leave us? In my, albeit limited, experience with MD/PhDs (having friends in the programs, co-residents etc) the underlying goal of the MD/PhD in creating physician scientists is not being achieved. There are plenty of "2-and-screw" people who take 2-years of tuition stipends and then leave the program as well as many, many who complete the program and go to residency with the goal of going in to private practice. Many simply burn out on the rigors of academic life and the delayed, delayed gratification. Even more in academic practice do not utilize the PhD part of their training for research.

Thus the fundamental question should be: "Why do you want to be a neurosurgeon?" "Why do you want a PhD?" "Can you do what you would like without an MD, or PhD?"

As an aside, glancing at your link it does not appear that Dr. Bhatia completed a residency. Perhaps, a PhD in engineering would have sufficed.

 

[neusu]

Tough question.

First, there are plenty of female MD/PhD neurosurgeons/neurosurgery residents. Perhaps contacting one of them directly for their opinion and advice would prove frutiful.

Like anything, there are two opposing viewpoints to the MD/PhD. In my assessment, the MD/PhD was designed to create a pathway to educate physician scientists. Essentially, practicing MDs who also have a research lab. Historically, there were people who would do this the long way (e.g. PhD or MD followed by the other degree). A continuous program allows for efficiency by using the pre-clinical years as the course-work requirement for the PhD. As you mentioned, many/most MDs will suggest that a PhD is entirely unnecessary. If basic science research is something desired, do a research post-doctoral fellowship (something which a PhD would have to do anyway) and learn the tools. A PhD will suggest that the training involved in a PhD program is rigorous and creates better scientists. I have heard some go so far as to say that the combined MD/PhD is watered down, the advisory committees are soft on the MD PhD candidates, and it's not a true PhD. Thus, doing the PhD first, or following the MD, is recommended.

Where does that leave us? In my, albeit limited, experience with MD/PhDs (having friends in the programs, co-residents etc) the underlying goal of the MD/PhD in creating physician scientists is not being achieved. There are plenty of "2-and-screw" people who take 2-years of tuition stipends and then leave the program as well as many, many who complete the program and go to residency with the goal of going in to private practice. Many simply burn out on the rigors of academic life and the delayed, delayed gratification. Even more in academic practice do not utilize the PhD part of their training for research.

Thus the fundamental question should be: "Why do you want to be a neurosurgeon?" "Why do you want a PhD?" "Can you do what you would like without an MD, or PhD?"

As an aside, glancing at your link it does not appear that Dr. Bhatia completed a residency. Perhaps, a PhD in engineering would have sufficed.

As a follow-up to your question regarding training length and being female.

This is a question that every female has to answer for herself. Medical school and residency is 6-7 years at minimum (some rural care programs will start during 4th year of medical school). Being a doctor is about making sacrifices. Having a family is about making sacrifices. Certainly, you can and there are people who do both. Is it easy? Undoubtedly no. Many people forgo even considering such extensive arduous training for the explicit reason they are unwilling to compromise family. Similarly, some doctors forgo family life to focus on their career. Ask yourself what's important, would you be happy without a husband, house, and kids until potentially your late 30s? Can you juggle having a toddler during your internship? Having a supportive family certainly helps, as does finding someone who understands the demands of your calling and is willing to both compromise and support.

 

[altitudinarian]

Thank you very much @neusu; that was very thorough and thought-provoking.

 

[neusu]

What books should a neurosurgery intern read before/during intern year? Besides The Handbook, is there anything else I should be reading?

Handbook is a good start. The rest of what you'll learn is trial by fire. No amount of pre-reading will give you a "leg-up"

 

[dirigo]

Is this how you are at parties?

[youtube]

...I shadowed a neurosurgeon who looked and talked like this.

 

[dirigo]

Do you get along well with the female neurosurgeons?

Not neusu-but it would probably depend on what they looked like.

 

[HoboCommander]

Is it easy for neurosurgeons to meet young nurses who work in the same hospital for "call room visits"?

 

[neusu]

Do you get along well with the female neurosurgeons?

Yes

 

[Dr. Retractor]

[deleted]

 

[Symmetry11]

Thank you so much for taking time out of your busy schedule for us neusu!

So I am a person that has been diagnosed with social anxiety disorder and schizoaffective disorder. So I have to take medications for this everyday which make me drowsy. I see taking my meds as problematic in the future if I match into neurosurgery because of the unpredictable schedule of a neurosurgery resident. I might be off of work, take my meds then, be called back in for some emergent reason when my meds take effect. How many hours of sleep do regularly get a night? Is there anyway I could explain to someone that I need at least 4-6 hours of sleep a night because of my condition?

Also, will people that show symptoms of SAD be fired from the program? I mean symptoms like lack of confidence etc. Have you every met a NS that has been open about having a mental illness?

You also mentioned that a few residents don't make it through the 7 years of training. Which specialties do they switch to? Will any of the neurosurgery years count towards there new residency program?

Do you think it would be a good idea for a NS resident to live at home during residency? Because I see stuff like cooking, laundry, cleaning, grocery shopping, taking up time that you could be studying during. How much time do you spend doing these things in a week?

 

[HoboCommander]

neusu, how much extra do neurosurgeons get paid if they do 5-6 surgeries a day instead of 1-2?

 

[neusu]

Which is technically better than the negative $24/hr salary of a med student based on a 40hr week (or the more realistic -$12/hr of the 80hr week) of taking out $50,000 in loans each year of medical school. 😛
------
Neusu, how necessary would you say it is to to do an oncological fellowship if you'd like to focus slightly more on general oncological neurosurgical procedures while still covering the common elements of general call? Would you say it's sufficient to target a residency that promises a good chunk of oncological procedures during regular residency? Or are you limited to covering only the bread and butter tumor excisions as a general neurosurgeon, even when completing a program known for its oncological prowess? Thanks in advance.


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Not sure what to make of your question.

First, any graduating neurosurgery resident is trained to do any case. Individual comfortableness, possibly from amount of training provided during residency, varies so some refer cases they do not wish to do or are uncomfortable with to others. That being said, to do "general oncological neurosurgical proceures" any training should suffice. If you intend that to be your practice focus having a referral base that gives you those cases is important. Competing for cases in an environment with someone who finished a fellowship in the field you like may not prove very fruitful. Second, what would you consider "general oncological neurosurgical procedures" and what would you consider "bread and butter tumor excisions?" Finally, could you, after completing residency, do a clival or sacral + pelvic chordoma? Absolutely. Would it, possibly, be better for the patient to have a skull base or spine specialist take the case? Most likely.

 

[Guero]

Not sure what to make of your question.

First, any graduating neurosurgery resident is trained to do any case. Individual comfortableness, possibly from amount of training provided during residency, varies so some refer cases they do not wish to do or are uncomfortable with to others. That being said, to do "general oncological neurosurgical proceures" any training should suffice. If you intend that to be your practice focus having a referral base that gives you those cases is important. Competing for cases in an environment with someone who finished a fellowship in the field you like may not prove very fruitful. Second, what would you consider "general oncological neurosurgical procedures" and what would you consider "bread and butter tumor excisions?" Finally, could you, after completing residency, do a clival or sacral + pelvic chordoma? Absolutely. Would it, possibly, be better for the patient to have a skull base or spine specialist take the case? Most likely.

I guess it was more nebulous of a question than I realized. As always, thanks for taking the time to answer. Take care.

-G


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[neusu]

Is it easy for neurosurgeons to meet young nurses

Yes

who work in the same hospital

Yes

for "call room visits"?

Depends on the person. It's easy for some, not so much for others.

 

[neusu]

Do you get along well with the female neurosurgeons?

Yes

How well

Pretty well. I am not involved with any of them, if that is what you are asking

 

[Lucca]

Hey @neusu to what extent do attending neurosurgeons decide their own schedule? If they want to operate 7 days a week one week and then 4 days a week the other do they have that option available to them? I also imagine it varies from practice to practice/setting.

 

[neusu]

Thank you so much for taking time out of your busy schedule for us neusu!

So I am a person that has been diagnosed with social anxiety disorder and schizoaffective disorder. So I have to take medications for this everyday which make me drowsy. I see taking my meds as problematic in the future if I match into neurosurgery because of the unpredictable schedule of a neurosurgery resident. I might be off of work, take my meds then, be called back in for some emergent reason when my meds take effect. How many hours of sleep do regularly get a night? Is there anyway I could explain to someone that I need at least 4-6 hours of sleep a night because of my condition?

Also, will people that show symptoms of SAD be fired from the program? I mean symptoms like lack of confidence etc. Have you every met a NS that has been open about having a mental illness?

You also mentioned that a few residents don't make it through the 7 years of training. Which specialties do they switch to? Will any of the neurosurgery years count towards there new residency program?

Do you think it would be a good idea for a NS resident to live at home during residency? Because I see stuff like cooking, laundry, cleaning, grocery shopping, taking up time that you could be studying during. How much time do you spend doing these things in a week?

Tough question.

1) "How many hours of sleep do regularly get a night? Is there anyway I could explain to someone that I need at least 4-6 hours of sleep a night because of my condition?"
I don't really get "regular hours of sleep." For programs that have a traditional call model, there are nights where you simply will not get any sleep. Zero. You will be awake for your entire 28-h0ur "shift," plus whatever time it takes you to get up and get to the hospital and get home and asleep. Certainly you could explain your need for 4-6 hours of sleep. Will it be considered? Potentially. Will you be given an arrangement wherein you are able to get 4-6 hours of sleep? Highly unlikely.

2) "Also, will people that show symptoms of SAD be fired from the program? I mean symptoms like lack of confidence etc. "
Unlikely. I can not think of a neurosurgery resident who does not show symptoms attributable to SAD. The difference between being "normal" and having SAD is both a clinical diagnosis and the latter not having the ability to control the symptoms.

3) "You also mentioned that a few residents don't make it through the 7 years of training. Which specialties do they switch to? Will any of the neurosurgery years count towards there new residency program?"
This is very resident dependent. Often the switch is to something more "lifestyle" such as radiology, anesthesia, emergency medicine, or pathology. There have been folks who switch to ortho/prs/gen surg. The number of years that count depend on the program being switched.

4) "Do you think it would be a good idea for a NS resident to live at home during residency? Because I see stuff like cooking, laundry, cleaning, grocery shopping, taking up time that you could be studying during. How much time do you spend doing these things in a week?"
I always joke that if I could live at home, I would for that exact reason. I probably spend about 5 hours a week doing these things and often try to multitask (e.g. read while doing laundry, exercise while food is cooking etc.) I would have to say, though, I recommend against living at home during residency. As a resident you are a grown-up, but still treated as a student at times. Learning your role in medicine and how to function independently, and successfully, is an important part of your training. This includes your personal life.

 

[demystifie]

What is the best and worst part about neurosurgery, in your opinion?

 

[neusu]

neusu, how much extra do neurosurgeons get paid if they do 5-6 surgeries a day instead of 1-2?

This depends on the reimbursement model of their contract. If they are paid as a fee for service then they get 3-6 times as much doing 5-6 surgeries instead of 1-2. If they get paid a salary, then there is no difference.

 

[neusu]

Hey @neusu to what extent do attending neurosurgeons decide their own schedule? If they want to operate 7 days a week one week and then 4 days a week the other do they have that option available to them? I also imagine it varies from practice to practice/setting.

This, as you suggested, varies from practice to practice. Simply put, as a surgeon you have to operate. Most hospitals at which surgeon's have privileges have some sort of organizational arrangement for scheduling cases (e.g. block time, OR days, etc.). Likewise, to have people to operate on, a surgeon must evaluate patients in some capacity be it the clinic, the ED, or inpatient consultations. A liberal estimate of evaluations to cases booked is 10:1, meaning for every 10 patients seen in clinic, 1 patient requires surgery.

 

[mz1990]

How closely do residency programs follow the 80 hour work week limit?

 

[neusu]

What is the best and worst part about neurosurgery, in your opinion?

BEST - chicks, money, cars, and chicks. Worst - nothing

Real answer now. For me the best part about neurosurgery is that it fits me and my interests exceptionally well. I love the cases we do. Being involved in the care process of someone who comes in to you either with a new, serious, diagnosis or an emergent, life-threatening, injury and seeing them recover is exhilarating. The worst part is tough to determine without sounding like a whiner. The training is long and hard. Many of the patients are challenging both clinically and socially.

 

[neusu]

How closely do residency programs follow the 80 hour work week limit?

This varies on the individual program and year within the program. I'm sure all programs follow that limit on paper. N.B. many programs have the 10% exemption and thus can have 88 hours.

I alluded to this previously, but there the PGY-2 and PGY-7 years tend to be the most intense with respect to clinical requirements and may reach or exceed 80 frequently. The PGY-3 to PGY-6 years vary by program, but often involve research and electives in some capacity which are far lighter.

Further, different programs have different structure and factors such as manpower and case volume. Take 2 programs, one with 1 resident/year and the other with 2 residents/year. Program 1 has 1500 cases/year and program 2 has 2000. Program 1 has 215 patients/resident/year while program 2 has 143 patients/resident/year. A resident at program 1 is seeing 50% more patients per year of residency.

Food for thought.

 

[dirigo]

Has any practice or hospital try recruiting you yet?

 

[neusu]

Has any practice or hospital try recruiting you yet?

Yeah, I have entertained several offers. I'd rather not go in to any details for privacy sake.

In any case, there are both physician recruiters looking for neurosurgeons and those who help neurosurgeons find their dream job.

 

[mz1990]

This varies on the individual program and year within the program. I'm sure all programs follow that limit on paper. N.B. many programs have the 10% exemption and thus can have 88 hours.

I alluded to this previously, but there the PGY-2 and PGY-7 years tend to be the most intense with respect to clinical requirements and may reach or exceed 80 frequently. The PGY-3 to PGY-6 years vary by program, but often involve research and electives in some capacity which are far lighter.

Further, different programs have different structure and factors such as manpower and case volume. Take 2 programs, one with 1 resident/year and the other with 2 residents/year. Program 1 has 1500 cases/year and program 2 has 2000. Program 1 has 215 patients/resident/year while program 2 has 143 patients/resident/year. A resident at program 1 is seeing 50% more patients per year of residency.

Food for thought.

Thank you for your thoughtful reply!

 

[neusu]

Thank you for your thoughtful reply!

You're welcome, any time!

 

[soccerusa]

What percentage of neurosurgeons pursue fellowship training? Does anyone go into academia without a fellowship? Which fellowships are the most/least popular and why?

 

[N1D]

Read through most of the posts in this thread, thanks for you time. Another question about research. How much does your research output during residency effect your job search once your finishing residency. I imaging it has a role in making you competitive for fellowships and academic positions after that, but is do private practice groups care about research productivity? I would imagine it is more important for big groups like Swedish and Carolinas, but I would be interested to here your experience.

 

[neusu]

What percentage of neurosurgeons pursue fellowship training? Does anyone go into academia without a fellowship? Which fellowships are the most/least popular and why?

I'm not really sure there are firm numbers on this. However, the general feeling I get is that the majority of residents enter private practice. Many pursue fellowship following residency. Popular fellowships vary over time and are often based on individual preference e.g. someone who wants to do spine may not have any interest in functional, vascular, or pedi and vice versa. For the most part, academia prefers fellowship trained neurosurgeons. There are a fair number of "general" neurosurgeons in academics, but it is becoming less common.

 

[barsoum.michael]

Do you think the number of neurosurgeons are going to decrease because of Obama care?

Also to get into prestigious residencies like Johns Hopkins what should I do? All Ive heard is do really great on step 1. What else should be done?

 

[Cyberdyne 101]

Do you think the number of neurosurgeons are going to decrease because of Obama care?

Also to get into prestigious residencies like Johns Hopkins what should I do? All Ive heard is do really great on step 1. What else should be done?

Getting into med school should be your priority at this moment. The rest will fall into place later on.

 

[Cyberdyne 101]

@neusu, I apologize if this was already asked, but is there a difference between completing an "enfolded fellowship" during your residency and one post-residency? In other words, are you officially considered a fellowship-trained neurosurgeon if you complete a fellowship during your PGY-5 year? Or is it more advantageous to do one after your residency? (Or both?-lol)

Thanks again for doing this thread!

 

[IschemicBrain]

neusu,
Despite the many words of thanks already extended here, I offer mine as well: for whatever one more person's sincere and heartfelt gratitude may be worth, I thank you for your time and patience.

I'm a longtime lurker, and as my username implies, I'm extremely passionate about studying, treating, and developing novel interventions to mitigate cerebral ischemia. I'm a pre-med right now (in my second year), but I'm weighing all my options in terms of a future medical career.

I'd been thinking about neurology/neurocritical care (with the hope of time for both clinical practice and translational research), but neurological (cerebrovascular) surgery is extremely attractive to me....though I'm not sure how well it fits my long-term goals.

Given my narrow interest (cerebral ischemia) and my desire to have the opportunity to do clinical/translational (not basic) research, is neurosurgery an advisable path?

I'm also wondering about the sleep thing...given my interest in neuroscience, I know that an irregular 4-6 hours is extremely unhealthy in more ways than one. I don't mind the occasional sleepless shift, being on call, etc. (I'm more than willing to do that), but do you really not average more than 6 hours of sleep per day? That's very concerning....

 

[The Buff OP]

@neusu Happy belated anniversary on your AMA thread!

 

[neusu]

Read through most of the posts in this thread, thanks for you time. Another question about research. How much does your research output during residency effect your job search once your finishing residency. I imaging it has a role in making you competitive for fellowships and academic positions after that, but is do private practice groups care about research productivity? I would imagine it is more important for big groups like Swedish and Carolinas, but I would be interested to here your experience.

Research certainly can open doors for jobs in academia or fellowships. That being said, fellowship is often more of knowing people who know people, and are willing to make a call for you. Many/most private practice groups care little about research. The bigger groups may find it nice, but at the end of the day you are there to operate.

 

[neusu]

Do you think the number of neurosurgeons are going to decrease because of Obama care?

Also to get into prestigious residencies like Johns Hopkins what should I do? All Ive heard is do really great on step 1. What else should be done?

The number of neurosurgeons has been relatively steady to slowly increasing. This will likely continue under Obama care. The changes in reimbursement haven't been fully realized so a dramatic decrease in compensation may decrease the number of neurosurgeons. While it's a different scenario, look at CT surgery. When stenting became the initial treatment modality in favor of CABG, the number of cardiothoracic surgeons declined. There simply were too many CT surgeons and not enough cases. Surgeons get paid to do cases. Less cases means less need for cardiac surgeons. To equilibrate, either the number of surgeons has to decrease and compensation stay the same or the amount of compensation decreases and the number of surgeons stays the same. While this may be a great analogy because of different dynamics, e.g. cutting compensation per case leading to less neurosurgeons, I know many of my colleagues would seek other opportunities and the field would be less attractive to medical students.

There is no single factor that gets you into a prestigious residency. A pattern of excellence, e.g. good grades, good board scores, good recommendations, good publications, etc. is what does it.

 

[neusu]

@neusu, I apologize if this was already asked, but is there a difference between completing an "enfolded fellowship" during your residency and one post-residency? In other words, are you officially considered a fellowship-trained neurosurgeon if you complete a fellowship during your PGY-5 year? Or is it more advantageous to do one after your residency? (Or both?-lol)

Thanks again for doing this thread!

Historically, there was not a difference between enfolded or post-graduate fellowships. The biggest reason to do a fellowship, aside from the extra training in a focused area, was to have a piece of paper to hang on the diploma wall indicating fellowship training. Classically, some sub-specialties (e.g. cerebrovascular), did not partake in the enfolded model. This was, simply, because the technical skills required to perform these procedures were not developed by the PGY-3/4/5/6 year. Likewise, an enfolded fellowship is often conducted at the same institution as residency. There are many who advocate going away for fellowship to see how others do things, learn a different culture, widen horizons.

Glad you guys find it informative.

 

[AndreaBackmann]

Hey, thanks for your effort here 🙂 I have a very urgent question regarding electives looking forward to neurosurgery residency. Which of these two neurosurgery electives would be most beneficial for me as an IMG (in terms of recommendations and practical experience) - MSKCC Neurosurgical oncology or UNC Acting internship in neurosurgery? Do they allow assisting in the OR as well?
Thank you very much in advance!

 

[neusu]

neusu,
Despite the many words of thanks already extended here, I offer mine as well: for whatever one more person's sincere and heartfelt gratitude may be worth, I thank you for your time and patience.

I'm a longtime lurker, and as my username implies, I'm extremely passionate about studying, treating, and developing novel interventions to mitigate cerebral ischemia. I'm a pre-med right now (in my second year), but I'm weighing all my options in terms of a future medical career.

I'd been thinking about neurology/neurocritical care (with the hope of time for both clinical practice and translational research), but neurological (cerebrovascular) surgery is extremely attractive to me....though I'm not sure how well it fits my long-term goals.

Given my narrow interest (cerebral ischemia) and my desire to have the opportunity to do clinical/translational (not basic) research, is neurosurgery an advisable path?

I'm also wondering about the sleep thing...given my interest in neuroscience, I know that an irregular 4-6 hours is extremely unhealthy in more ways than one. I don't mind the occasional sleepless shift, being on call, etc. (I'm more than willing to do that), but do you really not average more than 6 hours of sleep per day? That's very concerning....

Thanks, happy to hear you guys get something out of this.

Cerebrovascular is a multifactorial field. There are a variety of different specialists who play a significant role, and the level of involvement by each varies depending on the training of the party involved and the institutional agreement.

In general, there are 4 teams who may play a role: neurosurgery, neurology/stroke, neurocritical care, neuro-interventional (rads/neurology/neurosurgery). Stroke involves a multitude of underlying pathologies and each has its own management algorithm. You mention ischemia, so I will focus on that.

Ischemic stroke, from a neurosurgeon's perspective has two general classifications. Operative and non-operative. The former involves decompression for edema and the latter we generally are not involved. These patients are generally admitted to and managed by the stroke neurologist or the neuro critical care intensivist. While we could go in to all of the variables such as carotid disease +/- cea/cas or clot retrieval/reperfusion, that seems outside the scope of your question.

Given your interest of translational research, stroke neurology or critical care would likely afford you the most opportunity to deal with these patients and have time to be involved in studies. Neurosurgeons absolutely can and do involve themselves in this field, and if it is an interest of yours, certainly neurosurgery is an option. That being said, having a neurosurgery practice that focuses on ischemic brain disease would likely be difficult given the competition from the aforementioned fields in caring for the non-operative patients. If, however, stroke in general is your interest, being a cerebrovascular surgeon would likely be sufficient.

With respect to sleep, everyone sleeps and/or needs a different amount of sleep to function. I tend to naturally function well on 4-6 hours of sleep, and even on my days off will wake up after 6 hours without setting an alarm.

 

[neusu]

@neusu Happy belated anniversary on your AMA thread!

Thanks!

 

[neusu]

Hey, thanks for your effort here 🙂 I have a very urgent question regarding electives looking forward to neurosurgery residency. Which of these two neurosurgery electives would be most beneficial for me as an IMG (in terms of recommendations and practical experience) - MSKCC Neurosurgical oncology or UNC Acting internship in neurosurgery? Do they allow assisting in the OR as well?
Thank you very much in advance!

I do not know much about the Cornell oncology rotation. I would suspect that doing a sub-I would garner better practical experience and more useful letters. It is institutional dependent the level of involvement, if any, with respect to patient care and/or assisting in the OR. Are you a US citizen IMG or a foreigner FMG? In either case, you are at a disadvantage when compared to USMGs.

 

[AndreaBackmann]

I do not know much about the Cornell oncology rotation. I would suspect that doing a sub-I would garner better practical experience and more useful letters. It is institutional dependent the level of involvement, if any, with respect to patient care and/or assisting in the OR. Are you a US citizen IMG or a foreigner FMG? In either case, you are at a disadvantage when compared to USMGs.

Thank you for answering!

I am a foreigner - more like FMG at the moment. Yes, I understand that I am in a disadvantageous situation as compared to US med graduates, but for now I am still a final year medical student just hoping for as much practical exposure as possible including good LORs in Neurosurgery. When I applied for the elctive, I included a LOR from a neurosurgeon, the chair of my country association of neurosurgeons stating my practical skills regarding patient care and assisting in the OR, I have been working actively under his supervision for more than a year now. But I also do not know wether the department officials/neurosurgeons with whom I will have to do my elective are reading those materials in order to evaluate elective applicants personally... or they just receive a list of applicants and just assign them randomly depending on the availability of free spots/number of local students in rotations for every particular month...
May I ask your opinion? Maybe you have some kind of experience with this - direct or indirect?

In UNC Acting Internship they state that the elective will allow students to fit themselves in a role of 1st year neurosurgery residents, they include procedural and patient examination skill demonstration as well as OR exposure in their objectives, but I of course do not know what is meaned under the "OR exposure" (assisting or observing). In MSKCC they wrote in the elective description that assisting is included, but in the official letter there was mentioned only "observing of the procedures" which makes me suspicious... But maybe you could tell me from your aspect - how popular in US is it to evaluate student practical skills during surgery at all? Or is it presumed that a student does not have such skills and it is too advanced for students to assist in the neurosurgical operations at all? Sorry if my questions seem silly, but as I do not have any real experience of US system practically, I do not know how it happens in real life with students coming for electives there.

Thank you!

 

[neusu]

Thank you for answering!

I am a foreigner - more like FMG at the moment. Yes, I understand that I am in a disadvantageous situation as compared to US med graduates, but for now I am still a final year medical student just hoping for as much practical exposure as possible including good LORs in Neurosurgery. When I applied for the elctive, I included a LOR from a neurosurgeon, the chair of my country association of neurosurgeons stating my practical skills regarding patient care and assisting in the OR, I have been working actively under his supervision for more than a year now. But I also do not know wether the department officials/neurosurgeons with whom I will have to do my elective are reading those materials in order to evaluate elective applicants personally... or they just receive a list of applicants and just assign them randomly depending on the availability of free spots/number of local students in rotations for every particular month...
May I ask your opinion? Maybe you have some kind of experience with this - direct or indirect?

In UNC Acting Internship they state that the elective will allow students to fit themselves in a role of 1st year neurosurgery residents, they include procedural and patient examination skill demonstration as well as OR exposure in their objectives, but I of course do not know what is meaned under the "OR exposure" (assisting or observing). In MSKCC they wrote in the elective description that assisting is included, but in the official letter there was mentioned only "observing of the procedures" which makes me suspicious... But maybe you could tell me from your aspect - how popular in US is it to evaluate student practical skills during surgery at all? Or is it presumed that a student does not have such skills and it is too advanced for students to assist in the neurosurgical operations at all? Sorry if my questions seem silly, but as I do not have any real experience of US system practically, I do not know how it happens in real life with students coming for electives there.

Thank you!

Generally, for rotations, students just show up. The attendings/residents may or may not have prior notification, and at most a little background information. OR exposure is simply that, you'll be in the OR. Often, you will be scrubbed in to observe, potentially even first assisting the resident or attending. With respect to practical skill, for surgical/operative skill, there is no formal evaluation system that I am aware of for either residents or students. For the most part, students are limited to knot tying, knot cutting, potentially suturing. Placing a burr hole or something of that nature does occur as well. The evaluation on skill will more likely represent your ability to perform a neuro-exam and localize a lesion based on the thoroughness and appropriateness of your exam.

In any case, in the US students are severely limited as to what they are enabled to do. Much of this derives from the litigiousness environment in the US, that is to say if a patient has an adverse event because a student performs a procedure the liability is on the student, the resident, the attending, the hospital, and the school. In a similar vein, patients are more entitled and demanding. Less and less are they allowing trainees or students to be involved in their care in any significant capacity.

 

[neusu]

Just a general word of advice as I've been approached either in person or PM regarding interest in neurosurgery and how to position oneself to be competitive:

1) The earlier you know, the better. While you may fall in love with neurosurgery during the spring of your M3 year, investigating a potential interest during M1 or M2 year offers more opportunity to broaden that exposure and potentially build your CV and connections.

2) To be competitive, regardless of the field, there are standard things everyone knows about such as USMLE/grades/class rank. These are within your control, do your best to maximize these factors. Another thing that looks good when applying is research. Certainly, within neurosurgery demonstrates more clearly an interest in neurosurgery, but any research shows you understand how the process works (developing an idea, pitching a project, dealing with the IRB/animal use etc, interpreting data, stats, authoring manuscripts, publishing) and can deliver. Get started as an M1 workng on a diabetes project and find out you want to do neurosurgery? Great, at least you have some papers on your CV.

Finally, and this applies to all medical students. Be realistic with your aspirations. Nearly every thread I read here asking for advice uses top programs and/or top fields as the yardstick (e.g. I just failed anatomy, biochemistry, and my OSCE can I still get in to Derm at MGH?). True, aiming high is a natural impulse. Likewise, falling slightly short from a high goal is better than the same from a lower goal. That being said, medicine in general is competitive, don't underestimate your peers. At the end of the day, regardless of in whatever field, at whichever program you end up training, your goal should be what will make you the most happy and the best doctor.

 

[Serous Demilune]

Just a general word of advice as I've been approached either in person or PM regarding interest in neurosurgery and how to position oneself to be competitive:

1) The earlier you know, the better. While you may fall in love with neurosurgery during the spring of your M3 year, investigating a potential interest during M1 or M2 year offers more opportunity to broaden that exposure and potentially build your CV and connections.

2) To be competitive, regardless of the field, there are standard things everyone knows about such as USMLE/grades/class rank. These are within your control, do your best to maximize these factors. Another thing that looks good when applying is research. Certainly, within neurosurgery demonstrates more clearly an interest in neurosurgery, but any research shows you understand how the process works (developing an idea, pitching a project, dealing with the IRB/animal use etc, interpreting data, stats, authoring manuscripts, publishing) and can deliver. Get started as an M1 workng on a diabetes project and find out you want to do neurosurgery? Great, at least you have some papers on your CV.

Finally, and this applies to all medical students. Be realistic with your aspirations. Nearly every thread I read here asking for advice uses top programs and/or top fields as the yardstick (e.g. I just failed anatomy, biochemistry, and my OSCE can I still get in to Derm at MGH?). True, aiming high is a natural impulse. Likewise, falling slightly short from a high goal is better than the same from a lower goal. That being said, medicine in general is competitive, don't underestimate your peers. At the end of the day, regardless of in whatever field, at whichever program you end up training, your goal should be what will make you the most happy and the best doctor.

Bottom line, how hard is it to get any residency in neurosurgery? Assuming preference due to regional bias, how competitive are the people matching at Upstate, Buffalo, NYMC, Albany, LIJ, Tufts, Temple, UMDNJ, etc, etc, etc? 240s Step 1 with 2-3 pubs? More? Less?

 

[The Buff OP]

@neusu What is your opinion on backboards and C-collars? Are they even necessary? There hasn't been any actual prove that C-collars and backboards actually help immobilizing the spine.

Also, PS4 or Xbox One?