DoctwoB

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As an MS1 considering neurosurgery, I was wondering if current neurosurgeons were worried about encroachment from other fields and ending up in a state similar to CT surgery now.

I've heard of encroachment from:

Neurologist/Radiologists for Interventional neuroradiology work
Orthos for spine work
Radiation Oncology for Pain/Palliative/Cancer work

Will this significantly impact demand for neurosurgeons in the future?
 

mpp

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Maybe, but not as much as the other way around.

Interventional radiologists need the nerosurgeons to take care of the patients. They can do the procedure but have no desire to take care of the patient before and after nor can they handle some of the complications. The number of interventionalists coming through neurosurgery (who are trained in both endovascular and open methods) is growing quickly; it's quickly becoming the most popular fellowship choice. This is becoming a part of the neurosurgeon's skill set (this is where the CT surgeon's made their error in not training in endovascular procedures...they could and in some regards SHOULD be the ones doing both the open and endovascular work).

Twenty years ago most neurosurgeons did very little spine practice and now it is the majority of their work. No worrries in that regard. There is consideration of having spine surgery as a completely separate entity with it's own board. With Obamacare on the horizon, spine surgeons may be forced to limit some of their current elective practice.

Radiation oncologists do not do procedures apart from giving radiotherapy. Ablative procedures with radiotherapy are few and none work very well. Neurosurgeons are usually involved anyways because of frame placement, some of the dose planning, an more importantly, the referrals. Not too many PCPs will refer direct to a rad onc for trigeminal neuralgia. Some anesthesiologists are doing pain procedures. This is a very limited set of procedures and not in the the scope of most neurosurgeon's practice. Many neurosurgeons would be happy to be rid of it. On the other hand there are many pain procedures that would only be in the realm of the neurosurgeon (DREZ, myelotomy, cortical stimulation, etc.) so this is not going to be taken over by other specialities.

Just like all specialists, just adapt to what is going on and you will be in demand.