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

[afib123]

Thanks so much. Final questions, sorry for bothering you.
I have an elective where I will be doing 2 weeks of research for neurosurgery. Do you think it's a good idea to go in and do research in the work room? As a resident, would you think it's weird if a medical student is just sitting there all day doing research in the work room? I want to build relationships with the residents but at the same time I am wondering if it's a good idea or not to go in or if it's better to just work from home.
Also, what do you guys look for in medical students on rotations? I did an elective but not much was expected of since I was just trying it out. How do I prepare for cases and are there any textbooks you recommend I use to build my neurosurgery knowledge so I look better during my rotation?
Again thanks a lot for your help.

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[mmmcdowe]

Everything is contextual and I don't know the people or place you are working but unless that is the norm or you are invited to do so or they have a tremendous overabundance of work stations my gut feeling would be no. A lab perhaps. I look for medical students who are attentive and thoughtful and just generally pleasant to have tailing me for hours on end. The neurosurgery online atlas is a good place to start for case prep. Cohen also has a number of great 1 hour videos where he discusses cases with a famous neurosurgeon. learningradiology.com has some decent educational stuff on as if neuroradiology. radiopedia too. Neurosurgery rounds and the essential neurosurgery companion are good books.

Thanks so much. Final questions, sorry for bothering you.
I have an elective where I will be doing 2 weeks of research for neurosurgery. Do you think it's a good idea to go in and do research in the work room? As a resident, would you think it's weird if a medical student is just sitting there all day doing research in the work room? I want to build relationships with the residents but at the same time I am wondering if it's a good idea or not to go in or if it's better to just work from home.
Also, what do you guys look for in medical students on rotations? I did an elective but not much was expected of since I was just trying it out. How do I prepare for cases and are there any textbooks you recommend I use to build my neurosurgery knowledge so I look better during my rotation?
Again thanks a lot for your help.

 

[mmmcdowe]

Bump. It's that time again. Now finishing up PGY5, boards are done and I'm half way through an infolded skull base fellowship. AMA.

 

[Lucca]

Bump. It's that time again. Now finishing up PGY5, boards are done and I'm half way through an infolded skull base fellowship. AMA.

Yayyy, congrats! I thought NSG was 7 yrs, was the fellowship built into your residency program?

 

[Little Green Mensch]

What do you think about the ABNS decision to allow sub-specialty certification for enfolded fellowships completed in PGY-7?

 

[NeuResurgens]

Bump. It's that time again. Now finishing up PGY5, boards are done and I'm half way through an infolded skull base fellowship. AMA.

Thanks again, as always.

1. How difficult is it to become a tumor specialist in academic neurosurgery? I've heard lots of neurosurgeons enjoy doing tumors so it's difficult to build a practice and become a specialist in it. Does a neuro onc fellowship help?

2. how important is a year off in med school for research? A couple students in classes above me did it and one of the residents said it's important in matching at a good program. I'm already a bit older and would like to avoid this if possible, my board scores are good and I'm producing research so wondering if taking a year off would drastically increase my chances vs. only a little bit, if that makes sense?

 

[mmmcdowe]

Yayyy, congrats! I thought NSG was 7 yrs, was the fellowship built into your residency program?

Yes it is enfolded.

 

[mmmcdowe]

What do you think about the ABNS decision to allow sub-specialty certification for enfolded fellowships completed in PGY-7?

I am in favor of it as long as they can demonstrate efficacy in their graduates regardless of year of completion.

 

[mmmcdowe]

Thanks again, as always.

1. How difficult is it to become a tumor specialist in academic neurosurgery? I've heard lots of neurosurgeons enjoy doing tumors so it's difficult to build a practice and become a specialist in it. Does a neuro onc fellowship help?

2. how important is a year off in med school for research? A couple students in classes above me did it and one of the residents said it's important in matching at a good program. I'm already a bit older and would like to avoid this if possible, my board scores are good and I'm producing research so wondering if taking a year off would drastically increase my chances vs. only a little bit, if that makes sense?

1 I would say that my impression is that a vibrant tumor research lab has become a major part of getting and keeping an once practice. Fellowships and connections help for sure.

2. It will certainly help, as long as you are productive, but it is all relative to yourself not relative to others. Only you can value if it is worth it. For example if you have 50 pubs and take a year off for 10 more versus 0 pubs and taking a year off for 10 more. I found the nonpublication benefits were the biggest value to me as I was fairly well published. I learned statistics and some other skills that advanced me over the long term.

 

[moto_za]

What salary offers are common to work in non-academic settings?

 

[mmmcdowe]

What salary offers are common to work in non-academic settings?

I think it is highly variable by location and seniority and based in part on production. Most of the recent grads of my program have gone academic.

 

[cptsam]

with the upcoming merger for residencies, how do you think this will affect MD/DO's? Can you see more DO's matching into neurosurgery?

 

[ArdorAyurveda]

During medical school, did you pursue research or do activities to strengthen your app during holiday breaks?

How did you balance your schedule with non-work related tasks like keeping up with family?

Did you have time to date during medical school, and do you have time to date now during residency?

 

[7331poas]

with the upcoming merger for residencies, how do you think this will affect MD/DO's? Can you see more DO's matching into neurosurgery?

Why more? Wouldn't you expect less DOs matching?

 

[mmmcdowe]

with the upcoming merger for residencies, how do you think this will affect MD/DO's? Can you see more DO's matching into neurosurgery?

I see less or the same number matching truthfully.

 

[mmmcdowe]

I did research from home during some breaks but also spent time with family. I basically set specific goals for family in terms of how much contact per week and I stuck to it religiously. It wasn't much but it was sacred. I was engaged during medical school and it was long distance. Ironically I kept it up all through medical school only for it to collapse right before match. I spent a lot of time during a research year with her working remotely. In some ways long distance is an easier relationship because the time committment is lower but long term distance does not make the heart grow fonder I've dated throughout residency. It has been healthier as my work schedule has lightened throughout residency to allow more flexibility to squeeze in time for a SO.

During medical school, did you pursue research or do activities to strengthen your app during holiday breaks?

How did you balance your schedule with non-work related tasks like keeping up with family?

Did you have time to date during medical school, and do you have time to date now during residency?

 

[NontradCA]

Do you make north of 7 figures now?

 

[7331poas]

Do you make north of 7 figures now?

As a PGY5? Someone get my congressman on the phone

 

[TXEMC344]

Could you do a "Day in your life" summary? From waking up, going to the hospital and your routine?

 

[mmmcdowe]

Do you make north of 7 figures now?

With moonlighting in make about 80k before taxes.

 

[Little Green Mensch]

How does one moonlight as a neurosurgery resident? I'd always thought that surgery residents generally aren't able to do so

 

[NontradCA]

With moonlighting in make about 80k before taxes.

Ballin’. Heh I thought you were done cuz the thread was made in 2015 but realize it was edited

 

[mmmcdowe]

Could you do a "Day in your life" summary? From waking up, going to the hospital and your routine?

Well I am at the VA so it isn't a very typical rotation but it is perhaps an interesting day in the life nonetheless. So the VA is the last bastion of old school resident autonomy. You are in many ways treated more like a fellow. You are able to see clinic patients independently, book cases, and can sign in and mark patients and also do the time out. An attending still has to be present in the hospital for cases however. I operate Tuesdays and Fridays and half of every Wednesday. I have clinic all Monday and every Wednesday afternoon. Attending participation is variable and not mandatory. You also serve as the consultant for the regional VAs. So for example each Wednesday I show up at 7 and check in one small general anesthesia case (a microdisc, a stimulator, etc) or two moderate sedation cases ( carpal tunnel, battery change, etc). While the OR is setting up I go get starbucks and see any in patients that I may have (usually one or two at most). I then go fo the cases and wrap up around 10 and go to clinic. I'll see 10 patients or so and dictate. Usually finish around one or two. Then I review a week's worth of consults from other VA hospitals and pick which I want to see in person versus giving recs for nonoperative management. Maybe 30 cases. If I have consults I'll see them and then head to afternoon conference at the main hospital from 4 to 7 then home. Tuesday and Friday I do no clinic and two or three general anesthesia cases. Monday no cases just longer clinic.

 

[LebronManning]

So for example each Wednesday I show up at 7 and check in one small general anesthesia case (a microdisc, a stimulator, etc) or two moderate sedation cases ( carpal tunnel, battery change, etc).

Neurosurgery does carpal tunnel surgery? Always thought that was in the domain of hand surgeons.

 

[mmmcdowe]

How does one moonlight as a neurosurgery resident? I'd always thought that surgery residents generally aren't able to do so

It is program specific and something worth asking about when you interview. We have internal moonlighting where senior residents get paid to take 5 hours of call a night to allow better transitions between day and night teams.

 

[mmmcdowe]

Neurosurgery does carpal tunnel surgery? Always thought that was in the domain of hand surgeons.

Nope we do a fair amount. Not as much as we used to because spine reimburses better but they're quite satisfying. I would also argue neurosurgeons are better suited for truly distinguishing Central and peripheral neurological problems, which offsets our lower frequency of doing then to some extent.

 

[LebronManning]

In the community, what's the competition like in spine surgery especially with ortho spine surgeons also in the mix? Do you find that patients often prefer a neurosurgeon?

 

[mmmcdowe]

In the community, what's the competition like in spine surgery especially with ortho spine surgeons also in the mix? Do you find that patients often prefer a neurosurgeon?

There may be some selection but I think the reality is it isn't nsg vs ortho it's you vs everyone else else.

 

[lagbydesign]

Neurosurgery does carpal tunnel surgery? Always thought that was in the domain of hand surgeons.

You don't need to be a hand surgeon to do carpal tunnels. General ortho, PRS, and NSG are trained to do them. If you think about it, the overlap makes sense. Neurosurgeons are surgeons of the central and the peripheral nervous system, including hand and brachial plexus. Since upper extremity/hand surgery is under the purview of ortho and plastics, it makes sense that they do carpal tunnels too.

 

[Bonejorno]

Whether confirmable or just rumors, what’s the reputation of the neurosurgery program at Tulane that you’ve heard?

 

[mmmcdowe]

Whether confirmable or just rumors, what’s the reputation of the neurosurgery program at Tulane that you’ve heard?

I haven't heard really anything other than it seems like they've had some vacancies in the residency recently.

 

[Detailfanatic]

I’m an incoming MS1 at Miami Miller. Whats the general reputation of their neurosurgery residency? I want to balance my desire of staying in Miami for residency but also want to get good training. Thanks for this thread by the way!

 

[mmmcdowe]

I’m an incoming MS1 at Miami Miller. Whats the general reputation of their neurosurgery residency? I want to balance my desire of staying in Miami for residency but also want to get good training. Thanks for this thread by the way!

I think you'll get good training there overall. Similar to Pitt before we went to four a year I think their volume is a bit overwhelming for their resident numbers and so I think if research is a big factor for you it may not be the most conducive.

 

[Detailfanatic]

I think you'll get good training there overall. Similar to Pitt before we went to four a year I think their volume is a bit overwhelming for their resident numbers and so I think if research is a big factor for you it may not be the most conducive.

Thanks!

 

[LebronManning]

Does a neurosurgeon who wishes to do Neuro IR have to complete a fellowship in it? And is enfolded fellowship often enough?

 

[FutureDoctor06]

Do you mind PMs?

 

[mmmcdowe]

Does a neurosurgeon who wishes to do Neuro IR have to complete a fellowship in it? And is enfolded fellowship often enough?

Yes going forward you'll need CAST certification. Two year enfoldeds may still count but one years will not based on recent rule changes

 

[mmmcdowe]

Do you mind PMs?

I don't mind PMs for sensitive issues but obviously the goal of the thread is to answer as many questions openly as possible.

 

[moto_za]

Can you give a typical schedule / hours / salary of an attending starting out in a non-academic environment?

 

[mmmcdowe]

Can you give a typical schedule / hours / salary of an attending starting out in a non-academic environment?

I can't because there isn't a typical one. Each is unique. I've hear of offers ranging from 500 to 800 but there's a lot more to it because that salary is usually only a gauruntee for the first two years or so and then you have to make your own money. 700k sounds great unless it comes as part of a practice where the market is saturated and you don't get any production bonuses and there's no commitment from your partners to help you build your practice. That sounds like you're just there to take call for them and then be booted for the next guy.

 

[LebronManning]

From any experience you may have with working with orthos or having friends that have matched in it, how would you compare the competitiveness of neurosurgery vs. orthopedic surgery to match?

 

[mmmcdowe]

From any experience you may have with working with orthos or having friends that have matched in it, how would you compare the competitiveness of neurosurgery vs. orthopedic surgery to match?

I think they are pretty comparable but the one thing about Ortho is that there are a lot more spots available.

 

[Davidfromcali]

How does the pediatric population differ from adults in terms of the types of procedures done? What is considered bread and butter in the pediatric world? How has your experience been treating pediatric patients?

 

[mmmcdowe]

How does the pediatric population differ from adults in terms of the types of procedures done? What is considered bread and butter in the pediatric world? How has your experience been treating pediatric patients?

Well CSF diversion is a major portion of pediatrics. Probably about a third or more depending On your practice. Endoscopic third ventriculostomies and shunts mostly. Peds is a mixed bag and tends to be less specialized. Some neurosurgeons do scoliosis but that's is Ortho dominated in peds. Common surgeries include posterior fossa tumors, spasticity procedures like pumps and rhizotomies, myelomeningice and associated spinal dysraphism repairs, epilepsy procedures, chiari decompressions, and craniosynostosis surgeries. I love it but most residents don't because it tends to be a more needy population (mostly families rather than the patients) and other services tend to be more high strung, resulting in a lot of inappropriate consultations.

 

[Dr. Mike Trout]

Odd question. But how often do you have to get your eyes tested for vision?

 

[mmmcdowe]

Odd question. But how often do you have to get your eyes tested for vision?

There is no time where your vision is tested as a requisite for your employment here if that's what you mean. I get them tested annually for my own health and to ensure my loopes are well focused. Ultimately if you're going blind the attendings will figure it out pretty quickly. I've heard of urology and ophtho programs screening for monoculsar vision loss in applicants but I doubt that is wide spread.

 

[Detailfanatic]

Do you know what the average starting salary is for academic neurosurgeons?

 

[Skindoc83]

I can't because there isn't a typical one. Each is unique. I've hear of offers ranging from 500 to 800 but there's a lot more to it because that salary is usually only a gauruntee for the first two years or so and then you have to make your own money. 700k sounds great unless it comes as part of a practice where the market is saturated and you don't get any production bonuses and there's no commitment from your partners to help you build your practice. That sounds like you're just there to take call for them and then be booted for the next guy.

Hi, are the major markets as saturated with neurosurgeons as they are for other fields?

 

[mmmcdowe]

Do you know what the average starting salary is for academic neurosurgeons?

Variable by location and subspecialty but probably averages in the 400 to 600 k range

 

[mmmcdowe]

Hi, are the major markets as saturated with neurosurgeons as they are for other fields?

Define major markets for me please.