Do people go into neurosurgery for big egos and to make money?

[surag]

I ask this question because this is basically what I have taken away from my experiences (shadowing and working). I'm not a troll...but I am clueless, so take that in mind.


i wont' go into too much detail but I havnt had the greatest experience where I shadowed/worked and I also have been discouraged by many MS4s and residents in other fields.

One of the things I hear and kind of observed is that neurosurgery is a field that cannot cure patients...mostly manage diseases such as cancer. I was mostly in the OR(observing) for tumor patients. Also, the bread and butter for most nsgs(PP or academic institutions where pay is dependent on how many patients are seen) seems to be back pain and spine surgeries.

Would you guys agree with this?


I guess non cancer tumors (non malignant tumors, glioma/astrocytomas) are an important facet of neurosurgery and do indeed lead to good outcomes...outside of this are there any other surgeries that NSGs do that have positive outcomes?

Also, what other types of surgeries do neurosurgeons perform? What are the outcomes?

From what I understand epilepsy surgeries are not common but do have a positive outlook compared to say brain cancer patients.

Its just that I am very disenchanted with neurosurgery. i was a huge fan of becoming one since childhood(if only because of some romantic notion of what it is) but have since been turned off by it.

My biggest question is, why do people go into it? you're not really saving lives say for a few non cancer tumor patients, and epilepsy surgeries, so do people go into it because of the ego/money reasons? do people go into it because they really want to make a difference? What are some honest reasons? I just felt like the nsg I worked for was a big ego jerk who wanted to do his thing for the money. he did research but i wasnt impressed-I.e. he did it because he wanted to feel like he was doing something intellectual. I'm not so sure why neurosurgeons go into basic science research in the first place...why not just go into research if thats what you want unless you're doing neurosurgery as well for the money/ego...

just my thoughts.

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[Shangal]

So you weren't impressed by an academic neurosurgeon. hmm, your one tough cookie

 

[sigmoid sinus]

am just planning 2 join ns b/c in the Ethiopian setup abt 50% of cases r Head injury due to RTA & also ns is in its primitive stages.So i want 2 see what i can change eventhough z outcome is said to be poor.

 

[surag]

am just planning 2 join ns b/c in the Ethiopian setup abt 50% of cases r Head injury due to RTA & also ns is in its primitive stages.So i want 2 see what i can change eventhough z outcome is said to be poor.

wow is this a joke? I'm actually trying to get real info out...but thanks. go away.

 

[surag]

So you weren't impressed by an academic neurosurgeon. hmm, your one tough cookie

I dont understand what this means at all.

 

[Shangal]

I am not applying for neurosurgery, so I am not biased here, but I have to admit that neurosurgery is an amazing field! I shadowed a senior resident at my home institution for one day, most of the cases were IP shunts on peds patients, and it seemed for the most apart that all the attendings and staff were excited to see a med student there and were explaining the anatomy involved while in the OR. They were very humble and easy going to talk too, and although I may have lucked out in meeting a good crowd of neurosurgeons, regardless of whether that person has a big ego or not, you have to respect a person for making a lifestyle dedicated to saving lives. And yes, they save lives, by excising tumors, draining SAH, epi/subdural hematomas, IP shunts, .... And they are working in an area where one mistake can pretty much paralyze of even kill you! talk about high stress

 

[BlueAvenue]

I think it's pretty bold as a pre-med to bash on neurosurgery. you've got too narrow a view, so one surgeon was a tool big deal. that doesn't mean the field isn't as legitimate and worthwhile as any other. my internist is a douchebag but I still want to go into medicine! there's plenty of reasons not to go into neurosurgery (length of training and lifestyle come to mind), but your personal opinion of one neurosurgeon shouldn't go on the list. you also have no idea why he went into that field, just because he's unpleasant doesn't mean he isn't passionate about helping people or fascinated by the science. didn't your mom teach you not to judge? come on now it isn't brain surgery

 

[SOLDIER]

i am not applying for neurosurgery, so i am not biased here, but i have to admit that neurosurgery is an amazing field! I shadowed a senior resident at my home institution for one day, most of the cases were ip shunts on peds patients, and it seemed for the most apart that all the attendings and staff were excited to see a med student there and were explaining the anatomy involved while in the or. They were very humble and easy going to talk too, and although i may have lucked out in meeting a good crowd of neurosurgeons, regardless of whether that person has a big ego or not, you have to respect a person for making a lifestyle dedicated to saving lives. And yes, they save lives, by excising tumors, draining sah, epi/subdural hematomas, ip shunts, .... And they are working in an area where one mistake can pretty much paralyze of even kill you! Talk about high stress

amen

 

[Blake]

Money, fast cars and women, obviously.

Don't take this the wrong way, but what kind of answer do you expect? Some of us actually like trauma cranies, tumor resections, laminectomies, ACDFs, and the occasional aneurysm/AVM case. Despite all the drawbacks, I still wouldn't do anything else, and same goes for the vast majority of residents in this field.

 

[greymew]

I do not agree with the original poster. While it seems obvious, I feel the need to say that neurosurgeons can not be generalized. Each has their own personality and behaviors. So it makes no sense to ask if "everyone goes into neurosurgery for money and ego."

While I am sure your experience was as bad as you say, you can not have seen enough to be making these statements. Neurosurgery does have some depressing moments, but there are plenty of saves across every subspecialty of neurosurgery.

I am having a hard time answering the final question in the original post: why did I go into neurosurgery? Not because I don't know, but because this poster seems to have such a bad attitude, that I do not care what he/she thinks. I don't care what they're disenchanted with, a fan of, or think about the outcomes or of academic neurosurgery. I have never given this advice before... but don't go into neurosurgery.

 

[surag]

I do not agree with the original poster. While it seems obvious, I feel the need to say that neurosurgeons can not be generalized. Each has their own personality and behaviors. So it makes no sense to ask if "everyone goes into neurosurgery for money and ego."

While I am sure your experience was as bad as you say, you can not have seen enough to be making these statements. Neurosurgery does have some depressing moments, but there are plenty of saves across every subspecialty of neurosurgery.

I am having a hard time answering the final question in the original post: why did I go into neurosurgery? Not because I don't know, but because this poster seems to have such a bad attitude, that I do not care what he/she thinks. I don't care what they're disenchanted with, a fan of, or think about the outcomes or of academic neurosurgery. I have never given this advice before... but don't go into neurosurgery.

Its pretty obvious you do care. you care enough to post this. Everyone is entitled to an opinion, this much you agree to. You're also entitled to your own opinion. But for you to acknowledge this and then go ahead and state that I 'have such a bad attitude' and thats the reason why reasonable conversation cannot take place is just a cop out. Don't symbolically agree that we're all entitled to an opinion. You just dont like mine.

What would you rather me do? wait until my 3rd or 4th year after rotations, after seeing 'enough' neurosurgeons before I make a more 'valid' observation? I dont think its feasable to see every neurosurgeon out there. My experiences weren't just limited to one doctor. It was at the institution itself. Many people were like this. I felt it was a pervasive attitude that most of the neurosurgeons seemed to have. And because its a well regarded and good institution, I figured it was a decent representation of neurosurgeons in general.

I think what offends you is that I acutally questioned the value of being a neurosurgeon. you after all chose it, and for me to question is probably an insult to you. I should apologize. And I do.

But that doesn't take away from my original question. What is the value of being a neurosurgeon. What do you get from it. What other operations do suregeons participate in? What are the success rates like? How do patients feel most of the time after surgery? How are follow ups?

Unfortunately my experiences were limited to hearing my boss talk about his work and watching him in the OR. I never got to see what the patients felt like. perhaps this was part of the problem for why or how I could not empathize with the profession as well as I could potentially.

 

[TRAIL]

What would you rather me do? wait until my 3rd or 4th year after rotations, after seeing 'enough' neurosurgeons before I make a more 'valid' observation? I dont think its feasable to see every neurosurgeon out there. My experiences weren't just limited to one doctor. It was at the institution itself. Many people were like this. I felt it was a pervasive attitude that most of the neurosurgeons seemed to have. And because its a well regarded and good institution, I figured it was a decent representation of neurosurgeons in general.


Here is the problem. I don't doubt that you had a bad experience at your program, however, this doesn't mean ALL neurosurgeons are bad, obnoxious people. You could have had this experience in any department, in any specialty. For instance, the ortho department at my university is extremely malignant, and many of the residents are complete douche bags. This goes against the stereotype of orthopods being the laid back, cool, jocks. This doesn't mean the ortho program at my school is a microcosm of the specialty, just that it happens to be that way in one place. If you are truly interested in neurosurgery you shouldn't give it up because of one bad experience. If you eventually try to match into neurosurgery, it will be expected that you do at least 1 away rotation (although 2 would probably be a smarter option). I've had the chance to work with my home department and spent 1 month at another university. Both have been great experiences.

In terms of what is the "value" of neurosurgery, I think you are being extremely narrow minded. Yes there are a lot of bad outcomes. And yes many of your patients will be very sick, with little you can do for them. Does that mean going into neurosurgery is a waste of time? If so, then you there are many more specialties you need to also cross off your list. The neurologist in the lab adjacent to mine treats Huntington's patients. Basically he gets to watch people wilt away with little he can offer them. Is there also little value in this? I think his patients and there families are extremely grateful for the care he gives them.

Many people are drawn to neurosurgery by the fact that much of the patient population is critically ill. When a patient comes in the middle of the night with a ruptured berry aneurysm, the neurosurgeon that is their only hope. Even if he can't make the save, I think the families value the fact that someone cared and at least tried. Similar for neuro-trauma and tumor patients. The neurosurgeon may not be able to make bring complete recovery 100% of the time. But if you or a loved one was in one of these situations that neurosurgeons see everyday, I think you would find tremendous value in their efforts.

If you don't like really sick people or can't handle bad outcomes, then neurosurgery is not for you. There are certain niches of neurosurgery (such as functional, spine) where the patients are not as critically ill. But to get to the point where you are only seeing these patients, you have to go through residency first. And you will definitely see a lot of the very sick people and bad outcomes for 7 years.

 

[surag]

What would you rather me do? wait until my 3rd or 4th year after rotations, after seeing 'enough' neurosurgeons before I make a more 'valid' observation? I dont think its feasable to see every neurosurgeon out there. My experiences weren't just limited to one doctor. It was at the institution itself. Many people were like this. I felt it was a pervasive attitude that most of the neurosurgeons seemed to have. And because its a well regarded and good institution, I figured it was a decent representation of neurosurgeons in general.


Here is the problem. I don't doubt that you had a bad experience at your program, however, this doesn't mean ALL neurosurgeons are bad, obnoxious people. You could have had this experience in any department, in any specialty. For instance, the ortho department at my university is extremely malignant, and many of the residents are complete douche bags. This goes against the stereotype of orthopods being the laid back, cool, jocks. This doesn't mean the ortho program at my school is a microcosm of the specialty, just that it happens to be that way in one place. If you are truly interested in neurosurgery you shouldn't give it up because of one bad experience. If you eventually try to match into neurosurgery, it will be expected that you do at least 1 away rotation (although 2 would probably be a smarter option). I've had the chance to work with my home department and spent 1 month at another university. Both have been great experiences.

In terms of what is the "value" of neurosurgery, I think you are being extremely narrow minded. Yes there are a lot of bad outcomes. And yes many of your patients will be very sick, with little you can do for them. Does that mean going into neurosurgery is a waste of time? If so, then you there are many more specialties you need to also cross off your list. The neurologist in the lab adjacent to mine treats Huntington's patients. Basically he gets to watch people wilt away with little he can offer them. Is there also little value in this? I think his patients and there families are extremely grateful for the care he gives them.

Many people are drawn to neurosurgery by the fact that much of the patient population is critically ill. When a patient comes in the middle of the night with a ruptured berry aneurysm, the neurosurgeon that is their only hope. Even if he can't make the save, I think the families value the fact that someone cared and at least tried. Similar for neuro-trauma and tumor patients. The neurosurgeon may not be able to make bring complete recovery 100% of the time. But if you or a loved one was in one of these situations that neurosurgeons see everyday, I think you would find tremendous value in their efforts.

If you don't like really sick people or can't handle bad outcomes, then neurosurgery is not for you. There are certain niches of neurosurgery (such as functional, spine) where the patients are not as critically ill. But to get to the point where you are only seeing these patients, you have to go through residency first. And you will definitely see a lot of the very sick people and bad outcomes for 7 years.

Thanks. I dont know that it answered my questions, but this may also be due to my lack of experience overall in medicine.

 

[FatPigeon]

To the original poster: No, I do not think most people go into neurosurgery for the prestige and the money. But your thinking is pretty accurate, and I'll tell you why.

The group of people who want to go into neurosurgery at the START of med school want to do it for the prestige and the money. The truth is that the vast majority of them, since their heart wasn't in it, fall off third year due to much of what you've mentioned - patient outcomes are generally miserable, operations (even for many academic neurosurgeons) center around laminectomies and sucking out hematomas. Even given the cases you'd expect to be most exciting, most of them involve picking at one tiny area through the smallest hole possible for hours, and hours, and hours on end. The days of large incisions and the satisfaction of working freely with your hands in an open field are nearly over, especially in neurosurgery, with exceptions going to orthopaedics and some of general surgery (although the number of lap chole's and lap appy's you'll do will have you yearning for a more interesting video game, like Fallout 3).

Take this into account, along with the brutal, long nature of the residency, inability to really choose where you want to be geographically (unless you're top 10% at Harvard), and impending control over your services and salary by the government....and many of those people who were in it for their ego are LONG gone. Where? Into otolaryngology. Why would you kill yourself for 7 years, and subsequently give up most of the rest of your life for operations which are largely tedious, patients who are in awful shape, and the near-complete absence of the rewards you deserve? You wouldn't...unless you're one of those few who truly love the subject and want to give your life to it.

Number of people in my class first year who were going to be neurosurgeons? Probably a dozen, myself included. Number remaining? Zero.

 

[Gigantron]

To the original poster: No, I do not think most people go into neurosurgery for the prestige and the money. But your thinking is pretty accurate, and I'll tell you why.

The group of people who want to go into neurosurgery at the START of med school want to do it for the prestige and the money. The truth is that the vast majority of them, since their heart wasn't in it, fall off third year due to much of what you've mentioned - patient outcomes are generally miserable, operations (even for many academic neurosurgeons) center around laminectomies and sucking out hematomas. Even given the cases you'd expect to be most exciting, most of them involve picking at one tiny area through the smallest hole possible for hours, and hours, and hours on end. The days of large incisions and the satisfaction of working freely with your hands in an open field are nearly over, especially in neurosurgery, with exceptions going to orthopaedics and some of general surgery (although the number of lap chole's and lap appy's you'll do will have you yearning for a more interesting video game, like Fallout 3).

Take this into account, along with the brutal, long nature of the residency, inability to really choose where you want to be geographically (unless you're top 10% at Harvard), and impending control over your services and salary by the government....and many of those people who were in it for their ego are LONG gone. Where? Into otolaryngology. Why would you kill yourself for 7 years, and subsequently give up most of the rest of your life for operations which are largely tedious, patients who are in awful shape, and the near-complete absence of the rewards you deserve? You wouldn't...unless you're one of those few who truly love the subject and want to give your life to it.

Number of people in my class first year who were going to be neurosurgeons? Probably a dozen, myself included. Number remaining? Zero.

Great answer. It answered a good amount for me, and your description pretty much describes the mood of the neurosurgeon who performed an operation on my sister. Anyway, I got to chat with him for a bit since I was interested, and asked him why he went into neurosurgery. He pretty much did it because he liked the prestige and the challenge. The prestige is there, but the challenge seems long gone. Okay so it's not a completely the same, but I could tell he really wasn't happy. (probably because of the loss of any challenge).

Now my question for you concerns the bold part of your post. Why would somebody, as a neurosurgeon, have the inability to choose where they would want to work geographically? Is it the small amount of openings that are available for neurosurgeons (if there are any)? Or are you talking about rotations, or perhaps, residency? I didn't quite follow you on that point. If you could clarify this, that would be great.

 

[Hoju]

To the original poster: No, I do not think most people go into neurosurgery for the prestige and the money. But your thinking is pretty accurate, and I'll tell you why.

The group of people who want to go into neurosurgery at the START of med school want to do it for the prestige and the money. The truth is that the vast majority of them, since their heart wasn't in it, fall off third year due to much of what you've mentioned - patient outcomes are generally miserable, operations (even for many academic neurosurgeons) center around laminectomies and sucking out hematomas. Even given the cases you'd expect to be most exciting, most of them involve picking at one tiny area through the smallest hole possible for hours, and hours, and hours on end. The days of large incisions and the satisfaction of working freely with your hands in an open field are nearly over, especially in neurosurgery, with exceptions going to orthopaedics and some of general surgery (although the number of lap chole's and lap appy's you'll do will have you yearning for a more interesting video game, like Fallout 3).

Take this into account, along with the brutal, long nature of the residency, inability to really choose where you want to be geographically (unless you're top 10% at Harvard), and impending control over your services and salary by the government....and many of those people who were in it for their ego are LONG gone. Where? Into otolaryngology. Why would you kill yourself for 7 years, and subsequently give up most of the rest of your life for operations which are largely tedious, patients who are in awful shape, and the near-complete absence of the rewards you deserve? You wouldn't...unless you're one of those few who truly love the subject and want to give your life to it.

Number of people in my class first year who were going to be neurosurgeons? Probably a dozen, myself included. Number remaining? Zero.

Not necessarily true. I wanted to go into neurosurgery at the start of med school due to my fascination with the nervous system and wanting a procedural/surgical field. The money and prestige parts are way down on the list.

 

[FatPigeon]

Not necessarily true. I wanted to go into neurosurgery at the start of med school due to my fascination with the nervous system and wanting a procedural/surgical field. The money and prestige parts are way down on the list.

Spare me. Maybe you thought you wanted to do it for those reasons, but choosing a surgical field has a million considerations which come ABOVE "fascination with <whatever relevant> organ system." Plus, there are a million other fields offering procedures and surgeries, often with much more variety and less spine CLINIC.

I repeat, fascination with the nervous system is NOT an adequate reason to go into neurosurgery. Especially since you spend much more time microdissecting and running the surgical ICU than you do working with actual neurological theory/substance. Spend much time thinking about Neurology when you're picking at that intervertebral disc under a microscope for hours, which comprises (I'm guessing) 70% of what you do each month? Indeed, it has nothing to do with neurology aside from its location near-enough to the dura to potentially paralyze someone if it's done incorrectly. My point: The best place for someone who truly loves the nervous system is Neurology.

I am not a resident or someone who has done more than spend a couple of months on a neurosurgical service. But I went into school absolutely convinced I'd be a neurosurgeon, and luckily I was reasonable enough to, somewhat reluctantly, walk away from the idea. Just make sure that you understand what it is before giving your career to it. It's not about removing huge meningiomas every day. The biggest academic guys I know do about 12 shunts and 8 laminectomies just to get their hands on one of these.

 

[surag]

Spare me. Maybe you thought you wanted to do it for those reasons, but choosing a surgical field has a million considerations which come ABOVE "fascination with <whatever relevant> organ system." Plus, there are a million other fields offering procedures and surgeries, often with much more variety and less spine CLINIC.

I repeat, fascination with the nervous system is NOT an adequate reason to go into neurosurgery. Especially since you spend much more time microdissecting and running the surgical ICU than you do working with actual neurological theory/substance. Spend much time thinking about Neurology when you're picking at that intervertebral disc under a microscope for hours, which comprises (I'm guessing) 70% of what you do each month? Indeed, it has nothing to do with neurology aside from its location near-enough to the dura to potentially paralyze someone if it's done incorrectly. My point: The best place for someone who truly loves the nervous system is Neurology.

I am not a resident or someone who has done more than spend a couple of months on a neurosurgical service. But I went into school absolutely convinced I'd be a neurosurgeon, and luckily I was reasonable enough to, somewhat reluctantly, walk away from the idea. Just make sure that you understand what it is before giving your career to it. It's not about removing huge meningiomas every day. The biggest academic guys I know do about 12 shunts and 8 laminectomies just to get their hands on one of these.

This is precisely why I was depressed about the prospect of being a neurosurgeon. There is hardly any 'fascination of the nervous system' going on in neurosurgery. For the most part, almost all the fascination goes on in the PhD department for our neuroscience building and perhaps in the neurobiology department of the medical school and the neurology department.

Almost all the neurosurgeons make a concerted effort to recruit patients from around the region as well as make most of their money from routine procedures and spinal surgeries for patients with back pain.

I attempted to make this statement but some of the residents/surgeons weren't to pleased with my comments as you can see. I just dont get it.

 

[Hoju]

Spare me. Maybe you thought you wanted to do it for those reasons, but choosing a surgical field has a million considerations which come ABOVE "fascination with <whatever relevant> organ system." Plus, there are a million other fields offering procedures and surgeries, often with much more variety and less spine CLINIC.

I repeat, fascination with the nervous system is NOT an adequate reason to go into neurosurgery. Especially since you spend much more time microdissecting and running the surgical ICU than you do working with actual neurological theory/substance. Spend much time thinking about Neurology when you're picking at that intervertebral disc under a microscope for hours, which comprises (I'm guessing) 70% of what you do each month? Indeed, it has nothing to do with neurology aside from its location near-enough to the dura to potentially paralyze someone if it's done incorrectly. My point: The best place for someone who truly loves the nervous system is Neurology.

I am not a resident or someone who has done more than spend a couple of months on a neurosurgical service. But I went into school absolutely convinced I'd be a neurosurgeon, and luckily I was reasonable enough to, somewhat reluctantly, walk away from the idea. Just make sure that you understand what it is before giving your career to it. It's not about removing huge meningiomas every day. The biggest academic guys I know do about 12 shunts and 8 laminectomies just to get their hands on one of these.

Right now the most appealing path for my future is based on my interests and experiences. The experiences are minimal in terms of neurosurgery since I am only an M1 and have not shadowed a neurosurgeon, but I am getting in with the department and will get some exposure. It is possible that I could change my mind though. My point was that not everyone that starts medial school wanting to be a neurosurgeon has the future prestige and money in mind as the deciding factor. Whatever I do pick in the end I would like to be passionate about and involved in research. As of now that is the brain, etc. and neurology seems too hands off for me. Neurosurgeons at my school are involved in some interesting research.

 

[surag]

Right now the most appealing path for my future is based on my interests and experiences. The experiences are minimal in terms of neurosurgery since I am only an M1 and have not shadowed a neurosurgeon, but I am getting in with the department and will get some exposure. It is possible that I could change my mind though. My point was that not everyone that starts medial school wanting to be a neurosurgeon has the future prestige and money in mind as the deciding factor. Whatever I do pick in the end I would like to be passionate about and involved in research. As of now that is the brain, etc. and neurology seems too hands off for me. Neurosurgeons at my school are involved in some interesting research.

I know they're involved but how involved and in what? Neurosurgery research isnt exactly neuroscientific research. most of it from what I've seen is therapeutic, pharmaceutical, or clinical. Not to mention as a neurosurgeon you'll barely ever set foot in the lab, perhaps to interview, check in once in a while, or something simliar. Also, you'll hold lab meeting once a week and thats the extent of your 'involvement'.

Thats the thing, i mean sure your boss is 'involved' but he's not really doing anything other than get his name on a paper. ok, so he has an idea and they work on that but the reality is, your research is not going to ever really dig deeper into the mind or neuroscience.

 

[gonogo]

To the OP: People don't into neurosurgery for the money. First of all, whoever is truly interested in money wouldn't go into medicine in the first place. People who are truly into money go into business/banking/law. But let's say you're a med student already and are truly interested in money, you'd still not go into neurosurgery. There are many other fields in medicine that are as or nearly as lucrative as neurosurgery with a much better life quality (ortho, rads, gas, optho, ent, etc...). So whoever is in medicine for the money would most probably go to any of those fields instead of neurosurgery.

People who go into neurosurgery do it because they truly love the field. Neurosurgeons typically spend many long hours operating, residency is 7 years long and it's really tough.

 

[umean2tellme]

To the OP: People don't into neurosurgery for the money. First of all, whoever is truly interested in money wouldn't go into medicine in the first place. People who are truly into money go into business/banking/law. But let's say you're a med student already and are truly interested in money, you'd still not go into neurosurgery. There are many other fields in medicine that are as or nearly as lucrative as neurosurgery with a much better life quality (ortho, rads, gas, optho, ent, etc...). So whoever is in medicine for the money would most probably go to any of those fields instead of neurosurgery.

People who go into neurosurgery do it because they truly love the field. Neurosurgeons typically spend many long hours operating, residency is 7 years long and it's really tough.

To everything you said here. Anyone who goes into neurosurgery for the money is a little crazy, as you could be a dermatologist and make a boat load of money without the rough work hours. And if you have the stats/app to go into neurosurg you could also match into derm or any of the other specialties and have money and a better lifestyle.

To the OP: you haven't met all the neurosurgeons in your town, much less all of the NS in the country, so you can't just assume they go into it just for prestige and money. I would imagine that neurosurgeons like their role and the things they can do for their patients, not just the paycheck.

 

[skiz knot]

Do people go into neurosurgery for big egos and to make money?

No, they go into plastic surgery

 

[surag]

To everything you said here. Anyone who goes into neurosurgery for the money is a little crazy, as you could be a dermatologist and make a boat load of money without the rough work hours. And if you have the stats/app to go into neurosurg you could also match into derm or any of the other specialties and have money and a better lifestyle.

To the OP: you haven't met all the neurosurgeons in your town, much less all of the NS in the country, so you can't just assume they go into it just for prestige and money. I would imagine that neurosurgeons like their role and the things they can do for their patients, not just the paycheck.

thats actually not true. i mean derm is that much harder than neuro to get into.

actually i have met all the neurosurgeons in my town...they work at the hospital i was at and there are about 8. they cover a lot of ground in the state i was at and many went to the best programs for residency/medical school...jhu,ucsf,etc.

im sure most of them like their role, but are you telling me they'd still choose it if they made less money? what if they made 300 instead of 500?

Many of them do 'bench research' even though they dont participate in research other than hiring people to work for them. why is that? if research was their passion they could focus on that exclusivley-unless there was some concern for income.

most of them do high pay elective procedures, spinal surgeries, etc. or the same laminectomies everyday. why is that? its basically to supplement their income and give reason to why their business exists in the first place. sure they liked doing a lot of unique operations but when these are not all that common and most are routine jobs done over and over again including tumor surgeries that have mostly negative outcomes are you seriously going to tell me its because of a 'love' for operating? if so, then why not go into something with better outcomes, i.e. orthopedics, sports surgery, hand, etc.??

I find it hard to believe that the vast majority of neurosurgeons who choose their field choose it for reasons absolutely other than prestige.

 

[skiz knot]

I find it hard to believe that the vast majority of neurosurgeons who choose their field choose it for reasons absolutely other than prestige.

That's wonderful. Thank you for sharing your opinion. Clearly you've decided that neurosurgery is not for you. For some, it is a passion. Sure, you are more likely to do a laminectomy on a given day than do some sexy procedure, but that doesn't mean that the surgeon is only doing laminectomies for the money, it is because it is a commonly needed procedure.

I would take your specialty bashing somewhere it is deserved...
The OB/Gyn forums are open

 

[gonogo]

surag,

the question is whether neurosurgeons go for neurosurgery solely to make money. As others and I have said, that statement just doesn't make sense considering there are many fields in medicine where people make as much money as in neurosurgery and work much less hours. Ortho, rads, gas, ENT, and others are as lucrative as neurosurgery. But none of them is as time demanding as neurosurgery and have much better life quality. So if it'd be because of the money, why would someone choose neurosurgery and not ortho, rads, gas, etc...?

 

[Surgeonizer]

surag,

the question is whether neurosurgeons go for neurosurgery solely to make money. As others and I have said, that statement just doesn't make sense considering there are many fields in medicine where people make as much money as in neurosurgery and work much less hours. Ortho, rads, gas, ENT, and others are as lucrative as neurosurgery. But none of them is as time demanding as neurosurgery and have much better life quality. So if it'd be because of the money, why would someone choose neurosurgery and not ortho, rads, gas, etc...?

The majority of people who go into neurosurgery don't choose the field for its reimbursement per se. Many people go into neurosurgery because they love the operations.

That said, greed and ego are motivating factors in some instances. Neurosurgeons are typically at the very top of the food chain in most hospitals. Even as a neurosurgery resident, you will get plenty of respect from other staff in the hospital, including attendings in other fields. The potential income in this field is outrageous. The recent graduates from my program have taken jobs where they STARTED at over 800 grand/year. A seven figure income is very feasible in neurosurgery, depending on how you structure your practice. There are spine surgeons in major cities who have multimillion dollar practices.

The only fields that compare to neurosurgery in terms of income potential are cosmetic plastic surgery, some subspecialties of orthopaedic surgery (spine, sports med, joints), facial plastic surgery, and purely cosmetic dermatology. The average neurosurgeon's income considerably exceeds that of the average radiologist, anesthesiologist, or oto doc (these fields make some serious cash though).

Don't pick neurosurgery because of the potential money in the field. There are plenty of ways to make a lot of money in life if you have the internal drive, education, business savvy, etc.

Just my $0.02.

 

[JeffLebowski]

The majority of people who go into neurosurgery don't choose the field for its reimbursement per se. Many people go into neurosurgery because they love the operations.

Or for a variety of other reasons, like patient complexity, variety of disease process treated, intellectual devotion, etc.

That said, greed and ego are motivating factors in some instances. Neurosurgeons are typically at the very top of the food chain in most hospitals. Even as a neurosurgery resident, you will get plenty of respect from other staff in the hospital, including attendings in other fields. The potential income in this field is outrageous. The recent graduates from my program have taken jobs where they STARTED at over 800 grand/year. A seven figure income is very feasible in neurosurgery, depending on how you structure your practice. There are spine surgeons in major cities who have multimillion dollar practices.

Maybe greed and ego are factors (they are for everyone to varying degrees), but I think it's unfair to say they're bigger for neurosurgeons than for other physicians. Other physicians are generally not that impressed (if at all) with neurosurgeons, they know they work hard, tough lifestyle, tough training, often poor outcomes. And the most prestigious positions within the field typically pay less, for the record (academic positions) than lower prestige positions. I just sincerely doubt anyone goes into a career like this driven by the idea that people will think they're cool.

The only fields that compare to neurosurgery in terms of income potential are cosmetic plastic surgery, some subspecialties of orthopaedic surgery (spine, sports med, joints), facial plastic surgery, and purely cosmetic dermatology. The average neurosurgeon's income considerably exceeds that of the average radiologist, anesthesiologist, or oto doc (these fields make some serious cash though).

Don't pick neurosurgery because of the potential money in the field. There are plenty of ways to make a lot of money in life if you have the internal drive, education, business savvy, etc.

Agreed, don't pick a field because of perceived earning potential. Health care reimbursement undergoing a total overhaul right now, but you'll have to work your butt off for years and years just to get into the field in the first place, and 11 years down the line (4 yrs med school and 7 yrs residency) who knows what the reimbursement climate will be like.

Having said that, based on how hard we work, how much sacrifice is required, how much personal and financial investment we make, and how long we train, we should be well-paid, but only because we (and society, in general as well) just want a fair wage for all the achievement, training, work hours, and sacrifice we make combined with how sick/complex our patients are. Let's be honest - we're not writing scrips for ointment here. That's not ego, it's just good normal sense.

 

[SRK Jerk]

This post reeks of naivette leading to misguided antagonism.

Surag, looks like you wanted to mix neurosurgery with a basic science neuroscience lab. Let me ask you though -- you wanted to be a neurosurgeon from childhood...why? Clearly, if you are finding out in college that 99% of neurosurgeons cannot do basic research and run a clinical practice, you obviously didn't interact with them much from childhood---meaning you fell in love with some romanticized version of what a neurosurgeon should be. And now that you realize that dream is near impossible to make a reality, you're lashing out.

Pretty lame, if you ask me.

 

[bustbones26]

Here is my opinion of neurosurgeons in general. The stress of having a bazillion sick patients on your service, working 100 hours per week (yeah, those ACGME rules just don't seem to apply to neurosurgeons!), and doing it for 6-8 years (yes, I can think of at least one program that is 8 years!), would turn anybody into a jerk or difficult person to deal with at times. On the other side, when they get out and so into the community and are away from those stresses, they tend to be a lot nicer.

 

[Excelsius]

To the original poster: No, I do not think most people go into neurosurgery for the prestige and the money. But your thinking is pretty accurate, and I'll tell you why.

The group of people who want to go into neurosurgery at the START of med school want to do it for the prestige and the money. The truth is that the vast majority of them, since their heart wasn't in it, fall off third year due to much of what you've mentioned - patient outcomes are generally miserable, operations (even for many academic neurosurgeons) center around laminectomies and sucking out hematomas. Even given the cases you'd expect to be most exciting, most of them involve picking at one tiny area through the smallest hole possible for hours, and hours, and hours on end. The days of large incisions and the satisfaction of working freely with your hands in an open field are nearly over, especially in neurosurgery, with exceptions going to orthopaedics and some of general surgery (although the number of lap chole's and lap appy's you'll do will have you yearning for a more interesting video game, like Fallout 3).

Take this into account, along with the brutal, long nature of the residency, inability to really choose where you want to be geographically (unless you're top 10% at Harvard), and impending control over your services and salary by the government....and many of those people who were in it for their ego are LONG gone. Where? Into otolaryngology. Why would you kill yourself for 7 years, and subsequently give up most of the rest of your life for operations which are largely tedious, patients who are in awful shape, and the near-complete absence of the rewards you deserve? You wouldn't...unless you're one of those few who truly love the subject and want to give your life to it.

Number of people in my class first year who were going to be neurosurgeons? Probably a dozen, myself included. Number remaining? Zero.

Can you please elaborate why neurosurgeons can't choose where they want to practice? Are you implying that there are some residency programs in NS that are so bad that no one will really want you and you will pretty much have to go to whoever expresses the slightest interest? This doesn't make too much sense to me. If there is a shortage of neurosurgeons, what does it matter where you did your residency? Finally, Harvard is not really at the top of NS residencies. Many of these top programs are barely known outside the profession, like Barrow...

I think when listing a desire about wanting to become an NS, it is pivotal to list why you wanted to become one. So what was your reason? For me, I am mainly interested in the academic part. I don't care as much about patient outcomes as understanding the brain in general for all patients. I am already heavily involved in brain research/brain injuries. Sure, the procedures I use are very invasive and could be viewed as more interesting than dealing with humans, but you know, there are very few people out there who even like to do this at this stage (electrophysiology). It can take over 11 hours to collect data from ONE animal and yes, you're still dealing with "goo." Does this exclude the probability that I might change my mind about going into NS? Of course not. But at least I know that I have a lot of interest in the brain and might be willing to do some laminectomies just to have the privilege of the occasional, more involved procedures. This is just like in the lab - most of the time it's business as usual and nothing too exciting. But sometimes you do get that eureka moment, especially during data analysis...

Do you want to see a field that is truly depressing? Check out pediatric neurology. Doctors go from one room to the next and prescribe pills (sometimes the same) full well knowing that they are not going to get better and not even being sure exactly what's the problem. I even wondered what is the reason that specialty exists. Seems to be just for psychological comfort. Very depressing.

I think that as far as life is concerned, there are two very interesting phenomena. The first is our universe and the mysteries of the physics behind it. Why do we exist? The second is our brain. Why do we perceive the universe as we do? And guess what? The next breakthrough about the hands on functionality of the brain is going to be done by a neurosurgeon. Those are the only people who get such an enviable access to the human brain. The field is in its immaturity because we can't exactly practice on humans, but some animals serve as a good analog. And I often wonder what experiments are possibly going on behind the closed doors of the FBI.

 

[zinciest]

Can you please elaborate why neurosurgeons can't choose where they want to practice? Are you implying that there are some residency programs in NS that are so bad that no one will really want you and you will pretty much have to go to whoever expresses the slightest interest? This doesn't make too much sense to me. If there is a shortage of neurosurgeons, what does it matter where you did your residency? Finally, Harvard is not really at the top of NS residencies. Many of these top programs are barely known outside the profession, like Barrow...

I think when listing a desire about wanting to become an NS, it is pivotal to list why you wanted to become one. So what was your reason? For me, I am mainly interested in the academic part. I don't care as much about patient outcomes as understanding the brain in general for all patients. I am already heavily involved in brain research/brain injuries. Sure, the procedures I use are very invasive and could be viewed as more interesting than dealing with humans, but you know, there are very few people out there who even like to do this at this stage (electrophysiology). It can take over 11 hours to collect data from ONE animal and yes, you're still dealing with "goo." Does this exclude the probability that I might change my mind about going into NS? Of course not. But at least I know that I have a lot of interest in the brain and might be willing to do some laminectomies just to have the privilege of the occasional, more involved procedures. This is just like in the lab - most of the time it's business as usual and nothing too exciting. But sometimes you do get that eureka moment, especially during data analysis...

Do you want to see a field that is truly depressing? Check out pediatric neurology. Doctors go from one room to the next and prescribe pills (sometimes the same) full well knowing that they are not going to get better and not even being sure exactly what's the problem. I even wondered what is the reason that specialty exists. Seems to be just for psychological comfort. Very depressing.

I think that as far as life is concerned, there are two very interesting phenomena. The first is our universe and the mysteries of the physics behind it. Why do we exist? The second is our brain. Why do we perceive the universe as we do? And guess what? The next breakthrough about the hands on functionality of the brain is going to be done by a neurosurgeon. Those are the only people who get such an enviable access to the human brain. The field is in its immaturity because we can't exactly practice on humans, but some animals serve as a good analog. And I often wonder what experiments are possibly going on behind the closed doors of the FBI.

How can patient outcomes not be in the forefront of your mind if you're in the hospital for 80 hrs a week, dealing with some of the bleakest cases?

 

[Excelsius]

How can patient outcomes not be in the forefront of your mind if you're in the hospital for 80 hrs a week, dealing with some of the bleakest cases?

Patient outcomes are very important. What I am trying to convey is that the outcome of individual patients is not as important as the overall information that the given outcome yields to help the next patient and learn about the brain in general. The OP seems to be disillusioned because of some individual outcomes he saw, but I think that that's the wrong approach. If I am collecting data from rat brains, is every animal going to yield good data for me? Of course not. But the most important part is to learn from the bad outcomes. If you are doing something only because you want to get the results you want, you are setting yourself up for disappointment. That should not be the primary goal. I also saw several people here complaining about lack of challenge in NS. Just think about it. Is that really true? Or is the truth more like that NS is so challenging that you often have no idea what you're doing? It is the latter. And instead of complaining that you can't do anything about your patients, challenge yourself to learn what you can do to help. I think that more than any other field, NS has so much potential for advancement. Potential that you are not going to be taught during your seven years of residency, but potential that you will have to uncover through your own research and experiments. You might be surprised how many patients in severe conditions would be willing for you to try experimental treatments even if the outcome could be unsuccessful. Why? Because some of these people live such painful, crippled lives that even death is a better outcome for them. (Then they ask Dr. Kevorkian to end their lives and the doctor goes to jail because the government wants to decide whether you should live or not.)

 

[agranulocytosis]

In my humble opinion, neurosurgery offers some of the best rewards for patients imaginable. From craniectomies that relieve intracranial hemorrhage to placing nerve stimulators that decrease essential tremors, the results are nearly instantaneous.

That, combined with some of the coolest surgical tools and operative techniques, is probably what drives people to go into neurosurgery. At least that's what I think.

 

[hotlikebutter]

people always said that to me before my rotations. bad outcomes, big egos, financially driven blah blah.

the truth is once in a hospital your title means nothing. IM docs hate getting dumped on, ER docs are 5th medical students, Gen surgs hate Neuro surg and vice versa and so on. everyday is a battle between services in the resident training environment.

and for the financial aspect post grad wise, ask any recent grad about the job market and they will tell you it's a lot harder to find that kind money you hear about and the competition among existing neurosurgeons is like the mafia almost.

sure outcomes can be bad, but they can be truly amazing too. if you want good outcomes all the time dont go into any branch of medicine. our very existence is to deal with land mines and disasters of health. prevention medicine is like communism, it looks great on paper but human nature makes it fail.

 

[no name please]

I am a practicing neurosurgeon at a VA and I think there are a lot of misconceptions on this website.

I went into neurosurgery because I crave the "rush" you get when your intervention saves someone or makes their life better. Every benign brain tumor with a gross total resection and no residual deficit (I do at least 1 or 2 of these a week) is like a slowly given shot of endorphin. Every epi/subdural that takes a patient from GCS 3 to walkie/talkie is even more so. I got hooked in med school and never looked back.

You want poor outcomes and hard to treat chronic diseases go round with a pediatric oncologist, pulmonologist, endocrinologist, neurologist.... That is not my life.

Ego and salary have nothing to do with it.

 

[no name please]

Every single graduating neurosurgery resident that I personally know has picked the city where they want to live when they are done, and then gotten at least 2 job offers in that city. Harvard people have no advantage over alumni from other programs.

 

[Excelsius]

Every single graduating neurosurgery resident that I personally know has picked the city where they want to live when they are done, and then gotten at least 2 job offers in that city. Harvard people have no advantage over alumni from other programs.

Thank you for clarification. The person who made the claim of regional limitation did not answer my question about his reasoning. I did not see a reason why an NS should be so limited about where he/she wants to practice. Even here in SoCal, where there supposedly should be an oversaturation of doctors, I have heard what a big event it is when a hospital hires a new NS - large starting bonuses and a lavish party of "welcome." That wouldn't be the case if the hospital wasn't really trying to woo the doctors.

 

[no name please]

Thank you for clarification. The person who made the claim of regional limitation did not answer my question about his reasoning. I did not see a reason why an NS should be so limited about where he/she wants to practice. Even here in SoCal, where there supposedly should be an oversaturation of doctors, I have heard what a big event it is when a hospital hires a new NS - large starting bonuses and a lavish party of "welcome." That wouldn't be the case if the hospital wasn't really trying to woo the doctors.

You are correct. Hospitals love neurosurgeons because every 100 cases done by a neurosurgeon brings 1 million in revenue (on average) to that hospital. Most neurosurgeons do between 250 and 600 cases a year.

 

[Yamen1q]

I will not be repeating the same things and facts previous members have stated as they have said enough.
To answer your question very briefly: No, "people" do not go into Neurosurgery for big egos and money.
But don't mix up super-ego with pride and confidence, they have pride, Neurosurgeons generally feel proud about themselves and very satisfied with what they have achieved which is not little, No they don't get to be arrogant, not because they are Neurosurgeons but because of the fact that no body should have such attitude of feeling superior than others by all means, but hell they get to be very confident and satisfied about themselves and its only natural after all they go through from learning to training.
And obviously thats not to say any other physicians work less, but odds are that a Neurosurgeon would work much longer hours than any other surgeon, and again thats not to make any other speciality sounds less important, as all specialists work very hard to get where they want and be pleased with their career.

 

[dmniarb]

I ask this question because this is basically what I have taken away from my experiences (shadowing and working).

As a resident in neurosurgery, I can tell you from my own experience that plenty of people go into all medical fields for the prestige and money. Neurosurgery is no different. When I was a medical student rotating on urology, the urologist said to me, "What's the best thing about being a neurosurgeon? - Telling people you're a neurosurgeon." My response, "Well it's almost worth it just for that." However, as many of the other posters put it, you could have just as much prestige and money from many other fields of medicine without having to work as hard, so there has to be something more to it.

For me, I like the lifestyle. I don't mind working hard and long hours, because I find the work interesting. While it's true that we have a high rate of sad and hopeless cases, we also have a good number of happy endings. When people have epidural hematomas that are continuing to bleed and expand, taking them to the OR not only saves their life, they usually go home absolutely fine in a day or two. When someone hits their head in car accident or from a fall, sometimes they need us to remove part of their skull (decompressive craniectomy) so their brain can expand during the acute phase of edema. After the swelling goes down, we replace the skull (cranioplasty). These are simple surgeries that take an hour or two, but really make a difference. It's not all GBM resections.

As far as microdiskectomies and laminectomies, sometimes we are able to take a person who is in chronic severe pain, and alleviate that pain by removing the herniated disk or decompressing a stenosed spine. Granted, often our patients are chronic pain patients who continue to have issues, but I have had many patients be able to stop taking pain meds after these types of surgeries.

We also help babies who are born with intraventricular hemorrhage who subsequently develop hydrocephalus by removing the excess cerebrospinal fluid. Some of these babies grow up to be relatively normal - and if left untreated, many would have died.


My advice to you is simple:
1. If you are interested in neurosurgery, you should meet and shadow as many people in the field as possible to get a more accurate picture of what they do, their lifestyle (private, academic, etc), how they balance their personal life, etc.
2. Because neurosurgical training is long and the lifestyle is unique in its severity, it's usually best left to those who can't see themselves doing anything else. Although I wanted to be a neurosurgeon since before I started college based on little more than I thought it would be interesting, I tried to keep an open mind in medical school and experience each specialty with the thought that is this something I could see myself doing. But, rotation after rotation, only confirmed that this was the only field for me. Keep an open mind. At my med school they told us that picking a specialty is liking falling in love. It's not always logical. You'll feel it when it happens. And the feeling has to be mutual.

Good luck!