Finishing up 2nd year as a neurosurgery attending, ask me anything

[TraumaBlonde]

So now that you've gotten that far- what things have you sacrificed in your personal life over the past few years? How many people are finishing neuro surg, that you started with (I mean how many people have stuck it out)?

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[mmmcdowe]

@mmmcdowe, first off, thanks for doing this. I'm a soon-to-be MS2, interested in NS or ENT (leaning towards the latter, assuming all scores are in place later on). What advice would you have for someone trying to decide between these two? Also, I've a bit nervous about my fine motor skills since I have a slight tremor and am not the most useful with tools, so to speak. Is this something to worry about? I guess we practice so much 3rd year and beyond that it will all become a lot easier?

I wouldn't worry about the motor skills, it has much more to do with repetition and motor learning. As far as choosing between the two, just spend as much time shadowing and interacting with both.

 

[mmmcdowe]

So now that you've gotten that far- what things have you sacrificed in your personal life over the past few years? How many people are finishing neuro surg, that you started with (I mean how many people have stuck it out)?

At my school I started off with 10 and it dropped to 3 and then went up to 7 or so after third year. I don't know if I have sacrificed so much as "thinned out". Meaning I still do the things I like with the people I like, but less frequently.

 

[TraumaBlonde]

I feel the same way! I kind of like that dynamic though, I guess that makes us perfect for this field

 

[Meningiyomama]

Thanks for doing this! Do you feel there are any special considerations programs take into account for female applicants? I know they technically can't ask, but things like age, marital status, kids etc?

 

[tiedyeddog]

Thanks for doing this! Do you feel there are any special considerations programs take into account for female applicants? I know they technically can't ask, but things like age, marital status, kids etc?

They aren't supposed to ask but at almost every single interview at least one person interviewing you will ask some of the questions above. Marital status came up pretty often for me, but I am not a female if it makes a difference.

 

[Meningiyomama]

They aren't supposed to ask but at almost every single interview at least one person interviewing you will ask some of the questions above. Marital status came up pretty often for me, but I am not a female if it makes a difference.

I guess I meant more along the lines of would they be worried about a female applicant wanting kids during residency, or already having kids and that leading to issues with schedules (especially since most classes are only 2 or 3 residents). The female NS residents that I know of are all single, no kids. I'm wondering if those questions are going to come up in the applicant ranking meeting.

 

[mmmcdowe]

I guess I meant more along the lines of would they be worried about a female applicant wanting kids during residency, or already having kids and that leading to issues with schedules (especially since most classes are only 2 or 3 residents). The female NS residents that I know of are all single, no kids. I'm wondering if those questions are going to come up in the applicant ranking meeting.

Yes this sort of this comes up, but for every program that is dubious about pregnancy issues there are two that are trying to actively recruit female applicants in order to avoid looking like the former. A resident going off line is a hardship on all the remaining residents (less so at bigger programs but still true), but ultimately the remaining residents have to band together and pick up the slack because things happen. I saw one neurosurgery resident go out of commission for months from an infection, another two from a trauma. The bottom line is that life happens, and it is certainly not an exclusively female purview. Residents that do elect to have children tend to aim for senior/elective years.

 

[ValentinNarcisse]

.

 

[clonoGnic]

Thoughts on the future of spine & reimbursements? Will the research supporting spine procedures withstand future scrutiny ("evidence based medicine", etc.)?

 

[sarahmed14]

.

 

[mmmcdowe]

Thoughts on the future of spine & reimbursements? Will the research supporting spine procedures withstand future scrutiny ("evidence based medicine", etc.)?

There is always a tendancy to overuse new metthods and medicines. Over time, the actual indications are shrunk and applied. I think spine surgery is going to face more pressure to demonstrate need but ultimately its for the better the patient.

 

[PL198]

Yes this sort of this comes up, but for every program that is dubious about pregnancy issues there are two that are trying to actively recruit female applicants in order to avoid looking like the former. A resident going off line is a hardship on all the remaining residents (less so at bigger programs but still true), but ultimately the remaining residents have to band together and pick up the slack because things happen. I saw one neurosurgery resident go out of commission for months from an infection, another two from a trauma. The bottom line is that life happens, and it is certainly not an exclusively female purview. Residents that do elect to have children tend to aim for senior/elective years.

I don't get why it's considered unacceptable for programs to frown on people that are going to have kids.. Like as you said, it directly hurts the other residents and forces them to do more. Therefore if preferable, a residency would not want to go through that situation. God forbid life decisions have choices that negatively effect a candidate.

 

[Meningiyomama]

I don't get why it's considered unacceptable for programs to frown on people that are going to have kids.. Like as you said, it directly hurts the other residents and forces them to do more. Therefore if preferable, a residency would not want to go through that situation. God forbid life decisions have choices that negatively effect a candidate.

I wasn't trying to argue against the validity of a program not wanting baby-machine residents, I've read through the Maternity Leave thread in the General Residency Issues Forum. I just wanted to know if it was going to be held against an applicant if they fall into a particular profile (female, married, family started or of the typical family-starting age). I have no issue playing by the rules when I signed up to play the game. I don't want to derail this thread, I only asked about how an applicant would be viewed (firmly screws lid back on can of worms).

 

[PlasticBag]

Did you take a year off for research during med school? How common/necessary is it?

 

[mmmcdowe]

Did you take a year off for research during med school? How common/necessary is it?

Yes I did. About 30% of applicants do. It isn't absolutely required but the general wisdom is that for major academic programs it can improve your chances substantially if you are productive. I wouldn't recommend it to anyone except if you want to do it for your own interest/improvement of your ability. It wasn't until that year that I began to feel competent enough to generate novel hypotheses and projects. I ended up winning some grants late during fourth year as well that I took with me to residency. That's what I value more than anything. You can be impressively productive without a research year with motivation and a good mentor. One of my co-residents published 80+ papers without a research year. He's the absolute extreme outlier, but ultimately a research year for him wouldn't have necessarily helped his resume, though he may have benefitted in ways like I did.

 

[PL198]

I wasn't trying to argue against the validity of a program not wanting baby-machine residents, I've read through the Maternity Leave thread in the General Residency Issues Forum. I just wanted to know if it was going to be held against an applicant if they fall into a particular profile (female, married, family started or of the typical family-starting age). I have no issue playing by the rules when I signed up to play the game. I don't want to derail this thread, I only asked about how an applicant would be viewed (firmly screws lid back on can of worms).

yeah I wasn't trying to like attack what you said, I was just questioning OP about why they think that viewpoint exists, when it seems perfectly illogical for it to.

 

[soccerman93]

Piggybacking on the research year question, outside of your research year when were you involved in research? Anything in addition to summer after M1?

 

[mmmcdowe]

yeah I wasn't trying to like attack what you said, I was just questioning OP about why they think that viewpoint exists, when it seems perfectly illogical for it to.

Because it has been deemed to be a form of discrimination, especially since it is about the potential for something to occur in the future rather than the fact. You are being denied a job because you may get sick some day, may die in ten years, may get pregnant, etc. There is an understandable vein of pragmatism in medicine, you want to ensure the maximum output of committing to train someone for close to a decade. You want people who are going to reduce the work of the team, etc. It conflicts with more liberal points of view.

 

[mmmcdowe]

Piggybacking on the research year question, outside of your research year when were you involved in research? Anything in addition to summer after M1?

I was involve during all of my years from 2 months in until the last month of med school.

 

[PL198]

Because it has been deemed to be a form of discrimination, especially since it is about the potential for something to occur in the future rather than the fact. You are being denied a job because you may get sick some day, may die in ten years, may get pregnant, etc. There is an understandable vein of pragmatism in medicine, you want to ensure the maximum output of committing to train someone for close to a decade. You want people who are going to reduce the work of the team, etc. It conflicts with more liberal points of view.

that's a joke and I'm surprised nsurg allows that viewpoint to be accepted. like yeah I get mommy track if it's not a hardcore surgical specialty, but if it is and someone is trying to take mommy track, that's taking the spot from someone else that actually is going to use it and not screw everyone else

 

[mmmcdowe]

that's a joke and I'm surprised nsurg allows that viewpoint to be accepted. like yeah I get mommy track if it's not a hardcore surgical specialty, but if it is and someone is trying to take mommy track, that's taking the spot from someone else that actually is going to use it and not screw everyone else

If neurosurgery was left to its own devices it would probably still be all white guys, the government doesn't give surgeons a choice on this and no one wants to make the news over a discrimination suit.

 

[marstonne]

Thanks for doing this @mmmcdowe

I'm finishing up my neuroscience course and found that I really enjoyed the clinical aspects of it. Localizing CNS lesions and relating the exam findings back to the anatomy was a lot of fun. To be honest though I wasn't too enthralled with the "basic neuroscience" aspect of the course (lots of graphs of spike potentials and monkeys hooked up to electrodes). It may have been the short time I had to process it all, but who knows.

Is there a lot of basic neuroscience in the day to day of neurosurgery? Is this dichotomy I feel more common in surgeons vs. neurologists?

 

[cs24]

One of my co-residents published 80+ papers without a research year.

In medical school alone? This is a typo right?...right???

 

[mmmcdowe]

Thanks for doing this @mmmcdowe

I'm finishing up my neuroscience course and found that I really enjoyed the clinical aspects of it. Localizing CNS lesions and relating the exam findings back to the anatomy was a lot of fun. To be honest though I wasn't too enthralled with the "basic neuroscience" aspect of the course (lots of graphs of spike potentials and monkeys hooked up to electrodes). It may have been the short time I had to process it all, but who knows.

Is there a lot of basic neuroscience in the day to day of neurosurgery? Is this dichotomy I feel more common in surgeons vs. neurologists?

In functional neurosurgery there is a higher prevalence of neuroscience, but not as a whole. There really isnt much neuroscience used in neurology day to day either, so I wouldn't exclude that for this reason.

 

[mmmcdowe]

In medical school alone? This is a typo right?...right???

Nope, not a typo. Like I said, extreme outlier.

 

[Dredge]

Nope, not a typo. Like I said, extreme outlier.

This might be a dumb question but I was wondering, how many publications (and what kind if you know i.e. case reports, journal articles, etc) does the average, successful neurosurgery residency applicant have?

 

[AnonymousD.O.]

Where do you see the field of interventional neurology going? This is a field many pre meds etc may not be aware of. Do you think this field will grow for neurologists or will the playing field shift more towards interventional rads and neurosurgeons

 

[mmmcdowe]

This might be a dumb question but I was wondering, how many publications (and what kind if you know i.e. case reports, journal articles, etc) does the average, successful neurosurgery residency applicant have?

Not dumb at all. Id stay the top group of applicants averages 5 to 10, but the average is probably 1 to 2. You can check out tracking outcomes in the match data, but realize that they dont differentiate between pubs, abstracts, posters, talks, etc.

There is also more to a top applicant than publications.

 

[Dredge]

Not dumb at all. Id stay the top group of applicants averages 5 to 10, but the average is probably 1 to 2. You can check out tracking outcomes in the match data, but realize that they dont differentiate between pubs, abstracts, posters, talks, etc.

There is also more to a top applicant than publications.

Awesome! thanks for the advice!

 

[mmmcdowe]

Where do you see the field of interventional neurology going? This is a field many pre meds etc may not be aware of. Do you think this field will grow for neurologists or will the playing field shift more towards interventional rads and neurosurgeons

i think that neurosurgeons have and will maintain a strong presence in the field by virtue of versatility. A neurologist who has a endovascular procedure that needs to convert to open cannot do it. They cant do any surgeries on the side nor can they take operative call that might be needed at places with endovascular abilities but not the volume for full time neuro ir guys.

 

[grt398]

How many sub-I's did you apply for vs actually completed (feedback from tiedyeddog welcome too)? I'm in the process now having applied for 3 locations for 2 aways and wondering if I should add more now or wait till I hear back from everyone. I don't want to turn down any offers since I'm told it would reflect poorly come interview season, but I also don't want to get to June/July and not have aways lined up and scramble to find anything available.

 

[mmmcdowe]

How many sub-I's did you apply for vs actually completed (feedback from tiedyeddog welcome too)? I'm in the process now having applied for 3 locations for 2 aways and wondering if I should add more now or wait till I hear back from everyone. I don't want to turn down any offers since I'm told it would reflect poorly come interview season, but I also don't want to get to June/July and not have aways lined up and scramble to find anything available.

I applied 3 and got 3 (including home). I'd ask someone to call on your behalf.

 

[M.MD]

I've heard research is mandatory in most neurosurgery residencies. Is this true? What about as an attending? I like the idea of neurosurgery but I don't have much of a passion for bench work, and clinical research has been hit or miss thus far.

 

[mmmcdowe]

I've heard research is mandatory in most neurosurgery residencies. Is this true? What about as an attending? I like the idea of neurosurgery but I don't have much of a passion for bench work, and clinical research has been hit or miss thus far.

No it isn't, but at some programs it is, ask about publication requirements. As an attending, it depends on what kind of job you want. There are some jobs at major academic centers that don't focus on research professorships, but more frequently there are satellite hospitals where many of the non-academic attendings operate. If you are in private practice, obviously research expectations are much less frequent.

 

[TheRobin]

I lack a home neurosurg. program. Would this be a significant disadvantage should I choose to go for neurosurgery?

 

[mmmcdowe]

I lack a home neurosurg. program. Would this be a significant disadvantage should I choose to go for neurosurgery?

People without home programs still match, but it is important for you to make an impression elsewhere so take sub is very seriously. You should also consider doing research at a neurosurgery program in your relative area during the summer and try to keep in touch for case reports/reviews afterwards.

 

[PhillyMed777]

I would like to ask you how much sleep you manage to get? I am concerned with whether i can be fully functional with less sleep. To be clear, I don't mind hard work at all, but I definitely love good sleep.

 

[mmmcdowe]

I would like to ask you how much sleep you manage to get? I am concerned with whether i can be fully functional with less sleep. To be clear, I don't mind hard work at all, but I definitely love good sleep.

Anywhere from 4-8 hours, average 6-6.5 this year

 

[clonoGnic]

^ Does that include time for some outside interests, eating, etc.?

 

[Merely]

Its been covered many times: the general consensus is to not go into Nsurg unless you have a true passion for the field. While there may be a possibility for a decent lifestyle when you're an attending, don't go into it expecting a 9-5 job or anything close. Go into it knowing that you may have to make sacrifices and if you are still set on it despite those sacrifices then it might be a good fit.

 

[clonoGnic]

Its been covered many times: the general consensus is to not go into Nsurg unless you have a true passion for the field. While there may be a possibility for a decent lifestyle when you're an attending, don't go into it expecting a 9-5 job or anything close. Go into it knowing that you may have to make sacrifices and if you are still set on it despite those sacrifices then it might be a good fit.

True, though it's different if he's always eating on the go, goes straight to bed and immediately falls sleep after work, and that's 6-6.5 vs. he goes home, spends an hour doing something else (like sitting down to eat a meal, read something, or take an extra shower, or whatever) and then sleeps 6-6.5. That's what I was interested in clarifying. In the first case, you literally run out of hours in the day, in the second case you willingly sacrifice some sleep to do one or two personally important things to keep yourself sane.

 

[mmmcdowe]

^ Does that include time for some outside interests, eating, etc.?

Sometimes the former sometimes the latter.

 

[Hustler101]

Is it possible to have a private practice with 50 hour work weeks keeping logistics in mind?

 

[mmmcdowe]

Is it possible to have a private practice with 50 hour work weeks keeping logistics in mind?

yes but it may affect your income.

 

[CholeCystems]

If you wouldn't mind, what were your Step scores and number of publications/posters? If you don't want to posit it to keep your anonymity, a PM would be greatly appreciated!

 

[gators21]

Why is it so hard to pat you head and rub your belly at the same time? I figured a neurosurgeon would probably be the best person to ask

 

[mmmcdowe]

Why is it so hard to pat you head and rub your belly at the same time? I figured a neurosurgeon would probably be the best person to ask

Magnets

 

[mmmcdowe]

If you wouldn't mind, what were your Step scores and number of publications/posters? If you don't want to posit it to keep your anonymity, a PM would be greatly appreciated!

Between 250-265 and 10-20 papers. Posters are a dime a dozen, I only put the ones I was first or second author on.

 

[imadome]

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