Coolest field but...

[TripleDegree]

Hi folks

I'd love to go into NS, but here's my situation. Being a non-trad, I'll be somewhat older when I finish up a 7 year residency (mid 40s). What I'm scared of is the hand-eye coordination and delicate motor skills u would need to be a neurosurgeon. While I'm in perfect health now, who knows what wll happen in the future. Last thing I want to end up with is a situation where I've completed all this trianing, and just have too many tremors to operate!

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[JMD]

That is actually one of my concerns, too. I am pretty shaky in general, especially when tired or stressed. I have had people tell me that they were the same way, but when they're doing surgery and concentrating on something it's no problem. I guess while cutting in anatomy my hand/eye coordination seemed alright. Can anyone comment on this?

 

[ecpiii]

Early medical students always worry about this, if they have the true "Physical Genius" of a Charles Wilson. You stood looking at your hands and wonder if they can perform miracles. This just serves to pad your ego about going into neurosurgery, and hopefully you dispense with it quickly, as it places you in no privileged spot above other med students choosing non-surgical specialties.

Generally, unless you are a complete fumbler now, this should not be a concern. I discussed this topic on the interview trail, as I will be 43 when I complete my training (this is assuming I match of course) . These skills are fostered and trained into your procedural muscle memory by repetition, AKA operating when you're a resident, and just get better (not worse) with time. There are concerns for rheumatoid arthritis, etc., and there is one chairman that I know of who is retiring because of the deformity. I have heard no such stories of attendings forced into retirement because of loss of coordination.

If you want to get an idea of how you shake under the microscope, do some small animal model neurosurgery procedures/research project involving rats, mice, etc. Someone at some lab at your school is probably doing this, so make a friend, ask nicely for a rat to sacrifice, pick up the instruments, and put your mind at ease. Good luck to us all.

 

[ecpiii]

One more thing I forgot: attendings say that some residents are better at the extremely fine movements than others, and this often helps dictate what sub-specialty (if they choose to sub-specialize) the resident gets "encouraged" to pursue. Even if we don't get the "hands of God", there are still lots of PLIF's, lami's and tumors to do.

 

[TripleDegree]

One more thing I forgot: attendings say that some residents are better at the extremely fine movements than others, and this often helps dictate what sub-specialty (if they choose to sub-specialize) the resident gets "encouraged" to pursue. Even if we don't get the "hands of God", there are still lots of PLIF's, lami's and tumors to do.

Thanks, fantastic reply.

Short of going into a lab, are there any quick tests we can do to check steadiness/coordination? For example, extending hand and keeping it steady?

 

[ecpiii]

Thanks, fantastic reply.

Short of going into a lab, are there any quick tests we can do to check steadiness/coordination? For example, extending hand and keeping it steady?

Uh, none that I know of, but again, I am just a fourth year, and have sought out other ways to test my interest in the microscopic work. They don't let you do operations that fine until your the chief...

I can think up a funny comment about "extending hand and..." but I will not go there.

 

[Ecthgar]

I'll reiterate what ecpiii said about microsurgery in a research lab. I have done work with ischemia models in adult rats and making these models is very delicate work. At first, it wasn't very pretty (or successful)....but after a few attempts I became much more steady (and confident) and now I can do this procedure fairly easily. Getting some exposure to microvascular surgery at this level is not only good for your steadiness/confidence, but will aslo look good on applications.

 

[mpp]

I'll also be in my 40's when I finish...the way I look at it are that most of the great neurosurgeons of today are no spring chickens. They still seem to operate a ton. I'm not too worried about it.

 

[Blake]

Just found this forum ! Thanks a lot to the ones who created it (and a special thanks to mpp). I hope people from nsmatch will come here too

 

[glc549]

I'll also be in my 40's when I finish...the way I look at it are that most of the great neurosurgeons of today are no spring chickens. They still seem to operate a ton. I'm not too worried about it.

At what age does the average neurosurgeon call it quits?

I would be 50 or 51 when I completed my residency if I chose NS. If I could operate until I were 70 or 75, that would be a nice 20-25 year career of helping thousands of patients. If most quit when they're 60 for fear of hurting someone, then I would probably have to choose another field. Any thoughts?

 

[mpp]

I don't know the actual numbers for practice length...however from the AANS practice survey in 1999, more than 20 percent of practicing neurosurgeons were older than 60 years old, 1% had been practice more than 40 years, and 10% had been practice between 30-39 years (link). If you figure the average medical school graduate is 27 years old, +7 years NS residency, plus 30 years pracitcing that puts you at age 64...I think you'll be fine.

 

[ToxicFugu]

Although I plan on going into GS or Ortho, I think this is a superb thread.

So if tremors improve over time, what steps can one take to prevent arthritis? When does arthritis begin to become an issue?

Thanks

 

[mpp]

I don't think there is much you can do to prevent osteoarthritis in your hands if you are going to get it. The expert suggestions are to rest your hands often, use instruments that are more ergonomic, etc. Not sure if these options are available to most surgeons. Perhaps there are so low impact hand exercises you can do to beef up intrinsic hand muscles to help prevent future joint injury.

You can always treat the pain of osteoarthritis when it comes with NSAIDs. And there is evidence that glucosamine, chondroitin, and S-adenosyl-methionine can improve pain symptoms although most of the evidence is in knee and elbow pain.

You're going to get old no matter what you do. It seems stupid to limit your choices now because of the inevitable changes due to age.

The real question should be will you be at a disadvantage due to age. Now certainly a 50 year old applying to neurosurgery will likely be at a disadvantage. But how about a 30-year old? Is there any advantage to having had a prior career, perhaps a bit more maturity (although of course age and maturity aren't always linearly correlated), etc., when applying or is it always a disadvantage to be older than the average?

 

[Big Bill]

I will be 44 if I decide on neurosurgery and would think that they would want someone of that age due to maturity issues. lets say I get out of residency when I am 50 and practice for at least 15 years, man that is still 15 years which is a long time. You can always switch to neurology when you get done. I mean dont get me wrong you will have to keep in shape. However, the age issue would still be a plus in my book.

 

[ToxicFugu]

bumpers...

i like this thread. it addressed some concerns I had when i first started considering surgery. So i'm gonna revive it for all the new medical students who might have the same questions.

 

[neuro74]

You can always switch to neurology when you get done.

I know that neurosurgeons are very capable and intelligent physicians. However, there are many areas of neurology, i.e. neuromuscular disorders as a small example that neurosurgeons have really no exposure to during their training and in practice. Wishful thinking but one would be fumbling to catch up to years of changes in clinical practice of neurology after being in the OR for many years.

 

[modisrules]

Keep in mind - 1 in 5 people have detectable tremor, and I'm sure the stats aren't much different for neurosurgeons. Few surgeons have a "natural skill" - there's a learning curve for everything, and with practice and dedication you can develop the skills. The most delicate surgery uses resources more precise than 'good hands.' Having worked with the team of Fred Epstein, world renowned resector of intermedullary tumors until his tragic accident, it was the physiology that made his surgery great and his complications so low(kudos to the fabulous Vedren Deletis and the neurophysiologic monitoring team).

Though, if you think you might need VIM-DBS for essential tremor, maybe NS isn't for you...

 

[island doc]

Being an FP, I know I am in a strange place, but for what it's worth, one of my colleagues was in a Urology residency when he spontaneously developed a tremor, had to switch to FP. The same could happen in NS I suppose.

 

[Monitor]

If you develop a TREMOR , then shot yourself. You'll do it anyway if you start practicing FP after NS.

 

[Monitor]

All good Brain Men take them, they'll steady that little shimmy right out.

 

[dexadental]

Hey guys,
I'm just really bored right now...my thing is dentistry, but I've often contemplated returning to do medical school someday later in life and become a neurosurgeon. About the shakes, alot of dentists I know DO take sedatives before performing a long surgery...somewhat equivalent to Xanax I suppose. This can help with the hand eye coordination, improve concentration, and ease the tremors. I'm sure the coffee and frequent outings to Starbucks don't help much either.

 

[PainDr]

I'm a neurologist...not a neurosurgeon, however, I think I can answer some of your questions. As a resident, I worked very closely with our NS residents and my best friend is a NS resident. First of all, regarding tremors, EVERYONE has a fine physiologic tremor, most of us just don't notice it unless we're stressed or have too much coffee. If it becomes a problem, it can easily be controlled (but NOT with sedatives...would you want YOUR neurosurgeon popping a benzo right before turning on the old drill???). Pathologic tremors are entirely different. Depending on the etiology, some can be minimized or controlled, others are progressive and debilitating. Regardless, if you have no family history of degenerative neurologic disorders, you shouldn't waste your time worrying about it.

Regarding age, advanced age is not an advantage, it is definately a disadvantage. The problem is stamina. Our NS residents worked like dogs. They often spent 2-3 days at a time in the hospital. Even though the new work hour rules are officially in place, NS programs are notorious for ignoring or "getting around" them. I know of one chairman who was fired for coercing residents into falcifying work hours. My friend, who's at a "resident friendly" program, routinely works 15 hr days and takes call Q2. Home call gives programs great flexibility and allows the residents to put in alot more time than they would with inhouse call. It all seems very glamorous, but it's really just brutal. Be careful of what you wish for.

Lastly, you cannot simply switch into general neurology. There are many neurologic disorders that neurosurgeons never deal with. Actually, there are entire categories of disease they're never exposed to. Also, most neurosurgeons (or at least all the ones I know) would rather poke their eyes out than deal with neuropathies, myopathies, dementia, MS, stroke, epilepsy, headache, PD, etc., etc., etc.

 

[paisano]

I will be 44 if I decide on neurosurgery and would think that they would want someone of that age due to maturity issues. lets say I get out of residency when I am 50 and practice for at least 15 years, man that is still 15 years which is a long time. You can always switch to neurology when you get done. I mean dont get me wrong you will have to keep in shape. However, the age issue would still be a plus in my book.

at Chile, they clearly say that they do not encourage applications for residency for people older than 30 (they tell the same for GS and ortho),
do you know, how hard it is for a neurosurgeon resident in Chile to do like a one year residency at a top hospital in the states. and what about fellowships???

 

[vmc303]

A sincere question, for all of you who are going into NS and won't be out of residency into your 40's -- what exactly are you thinking? Don't you have kids' college funds to worry about and retirements to plan for? Do you have special circumstances that permit you to do this (e.g. large inheritance, wife who earns a six-figure salary, etc.), or are you really just throwing all practical concerns to the wind for the sheer love of neurosurgery?

 

[mpp]

The older folks usually had jobs before hand, and hopefully have begun to plan for retirement. Add it's not like you don't get paid during residency...it's not much but it's more than the average american. Kids can pay their own way through college. If spouses work all the better but if not I think it can work out as well.

The younger folks going to neurosurery have plenty of time to deal with all these things later.

Although incomes in medicine are not guaranteed to stay high, I don't think there are many retired neurosurgeons living social security check to social security check or have kids that couldn't go to college because they couldn't afford it.

 

[Astrocyte]

Hi folks

I'd love to go into NS, but here's my situation. Being a non-trad, I'll be somewhat older when I finish up a 7 year residency (mid 40s). What I'm scared of is the hand-eye coordination and delicate motor skills u would need to be a neurosurgeon. While I'm in perfect health now, who knows what wll happen in the future. Last thing I want to end up with is a situation where I've completed all this trianing, and just have too many tremors to operate!

Thanks for bringing up this topic. I have seen some of the best neurosurgeons operate, including Wilson, Ransohoff, and especially Epstein--who operates with high tech microscope on brainstem tumors. They said a good head is harder to come by than sufficient hand-eye coordination. But seeing Epstein operating with his arms in mid air for long time without leaning on anything, I have to say that certain subspecialties in NS do require ultra steady hands, not affected by fatigue, stress, or substance. Whether you will have any problem down the road is really anyone's guess. Get some surgical instruments and see how good you are with them. If you have pretty good hand-eye coordination to begin with and no family history of early tremors, I think starting your career in your 40s should not be a problem. Good luck!