Help me decide between Neurosurgery and Ortho

[NotAProgDirector]

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Does anyone have any insight on matching nsgy in the US? Does it help to get affiliated with a nsgy program/publish? Or can you match at places you've never worked with/never did a Sub-I there/no affiliations with them?

Neurosurgery is one of (if not the most) competitive fields. Reviewing your prior posts, you're in a state USMD program, have B's in your preclinical years, are "not the best test taker", are on an army HPSP scholarship, and are considering a DIY PhD if possible.

Getting a NS spot usually requires a stellar medical school performance, lots of research, and good connections with a NS department that can advocate for you. If we look at Charting Outcomes for NS, we see that: The average step scores are 250, mean number of pubs is 23, 40% of successful applicants are AOA, and 10% have a PhD. Unlike other specialties where the chance of matching strongly increases at around 5 ranks and peaks at 10, in NS the successful candidates start with 10 interviews and most have 16+.

You would first need to review your HPSP commitments and how that impacts your ability to apply. You would need to get involved with your local NS department and be cranking out research (without starting to fail courses). You'll need the best Step 2 score you can get. You will need multiple NS away rotations in 4th year. And you'll need a good dose of luck.

If Neurology would fit your needs, that's much less competitive and a much easier process.

 

[Lawpy]

mean number of pubs is 23

This is why separating out the abstracts from journal articles is so crucial

 

[deleted1132405]

Neurosurgery is one of (if not the most) competitive fields. Reviewing your prior posts, you're in a state USMD program, have B's in your preclinical years, are "not the best test taker", are on an army HPSP scholarship, and are considering a DIY PhD if possible.

Getting a NS spot usually requires a stellar medical school performance, lots of research, and good connections with a NS department that can advocate for you. If we look at Charting Outcomes for NS, we see that: The average step scores are 250, mean number of pubs is 23, 40% of successful applicants are AOA, and 10% have a PhD. Unlike other specialties where the chance of matching strongly increases at around 5 ranks and peaks at 10, in NS the successful candidates start with 10 interviews and most have 16+.

You would first need to review your HPSP commitments and how that impacts your ability to apply. You would need to get involved with your local NS department and be cranking out research (without starting to fail courses). You'll need the best Step 2 score you can get. You will need multiple NS away rotations in 4th year. And you'll need a good dose of luck.

If Neurology would fit your needs, that's much less competitive and a much easier process.

Hey there. Appreciate the feedback, I do not need anyone to try to tell me my chances of matching neurosurgery or try to discourage me from matching neurosurgery. I know myself best, not you.

 

[guytakingboards]

Hey there. Appreciate the feedback, I do not need anyone to try to tell me my chances of matching neurosurgery or try to discourage me from matching neurosurgery. I know myself best, not you.

Lol wut. Pragmatic feedback is bad? Okay guy.

It's like going to a restaurant and ignoring the waiter's advice not to get the fish. Proceed at your own peril.

 

[Lawpy]

Lol wut. Pragmatic feedback is bad? Okay guy.

It's like going to a restaurant and ignoring the waiter's advice not to get the fish. Proceed at your own peril.

I’ll be pretty interested if that person actually matches nsgy and comes back to prove SDN wrong.

 

[WheezyBaby]

I didn't read the whole thread. I'm an outsider. As an outsider, the ortho trainees I've worked with seem to be generally quite a bit happier than their neurosurgeon colleagues. Also, as someone who did not enjoy being in the OR, one of our neurosurgery attendings did a >24 hour case. I mean, my god. I thought my patient had died in the OR when they still weren't on my census the next day. Good for them, good for them, different type of person

 

[Oso]

I didn't read the whole thread. I'm an outsider. As an outsider, the ortho trainees I've worked with seem to be generally quite a bit happier than their neurosurgeon colleagues. Also, as someone who did not enjoy being in the OR, one of our neurosurgery attendings did a >24 hour case. I mean, my god. I thought my patient had died in the OR when they still weren't on my census the next day. Good for them, good for them, different type of person

Lol damn

 

[longhaul3]

I didn't read the whole thread. I'm an outsider. As an outsider, the ortho trainees I've worked with seem to be generally quite a bit happier than their neurosurgeon colleagues. Also, as someone who did not enjoy being in the OR, one of our neurosurgery attendings did a >24 hour case. I mean, my god. I thought my patient had died in the OR when they still weren't on my census the next day. Good for them, good for them, different type of person

Yeah. We did a case last week that was still going when I came in the next morning. Sadly that meant I had to round the whole service by myself.

 

[Babble Heap]

The best piece of advice I received before embarking on sub-specialty surgical training was that surgical residency will **** up your life. It ruins relationships, kills hobbies, and slowly grinds you down, in service of a rewarding career. Six years in, I am not the same person I was when I started. I'm a better doctor and clinician, but I'm probably an inferior neighbor, husband, son, brother, father. Maybe I'll obtain better balance when I'm out, but hard to make reliable predictions about the future. The take-home is that you should only choose surgical training if you cannot imagine doing anything else. I love my job and would choose it again, but it has come at great personal sacrifice.

If quality of life is important to you, the decision between neurosurgery and orthopedic surgery is not the question you should be asking. The difference between 5 (or 6) years of hand and ortho trauma call versus 7 years of NSG trauma call is pretty marginal, at the end of the day. Between clinical and academic responsibilities, anyone in our position is burning the candle at both ends. Take a moment to disconnect from the narrative that to be successful you have to be in a competitive high-level specialty, and consider other procedural specialties where you will be rewarded handsomely for your work, will have time for all of your other interests, and where you can still help people who need it. You may arrive at the same conclusion, but I promise you that choosing to prioritize your quality of life is not a bad decision.

 

[Dr. Anonymouss]

The best piece of advice I received before embarking on sub-specialty surgical training was that surgical residency will **** up your life. It ruins relationships, kills hobbies, and slowly grinds you down, in service of a rewarding career. Six years in, I am not the same person I was when I started. I'm a better doctor and clinician, but I'm probably an inferior neighbor, husband, son, brother, father. Maybe I'll obtain better balance when I'm out, but hard to make reliable predictions about the future. The take-home is that you should only choose surgical training if you cannot imagine doing anything else. I love my job and would choose it again, but it has come at great personal sacrifice.

If quality of life is important to you, the decision between neurosurgery and orthopedic surgery is not the question you should be asking. The difference between 5 (or 6) years of hand and ortho trauma call versus 7 years of NSG trauma call is pretty marginal, at the end of the day. Between clinical and academic responsibilities, anyone in our position is burning the candle at both ends. Take a moment to disconnect from the narrative that to be successful you have to be in a competitive high-level specialty, and consider other procedural specialties where you will be rewarded handsomely for your work, will have time for all of your other interests, and where you can still help people who need it. You may arrive at the same conclusion, but I promise you that choosing to prioritize your quality of life is not a bad decision.

Thank you for this. This is something I am currently struggling with as an M3 and I think I am slowly getting driven further away from the surgical side of medicine because I realized I don't want to be "just" a doctor. Although you say you would have chosen your surgical sub-specialty again, what were some of the other specialties you were considering?

 

[Babble Heap]

Thank you for this. This is something I am currently struggling with as an M3 and I think I am slowly getting driven further away from the surgical side of medicine because I realized I don't want to be "just" a doctor. Although you say you would have chosen your surgical sub-specialty again, what were some of the other specialties you were considering?

I was very open during medical school and tried to consider each clerkship as a potential career. I liked OB, Psychiatry, and Family Med a lot. I wound up choosing the surgical sub in the last week of my third year. I’m super non trad and it was hard to imagine 7 years of additional training, but when I looked back at my life I realized I have always been all in on whatever I’m doing. I’ve never been good at balance.

I think in retrospect I probably should have tried rotating on Anesthesia or IR. They probably would have appealed to me, too, but ruined my life a little less.

 

[Dr. Anonymouss]

I was very open during medical school and tried to consider each clerkship as a potential career. I liked OB, Psychiatry, and Family Med a lot. I wound up choosing the surgical sub in the last week of my third year. I’m super non trad and it was hard to imagine 7 years of additional training, but when I looked back at my life I realized I have always been all in on whatever I’m doing. I’ve never been good at balance.

I think in retrospect I probably should have tried rotating on Anesthesia or IR. They probably would have appealed to me, too, but ruined my life a little less.

Thank you! I am currently leaning heavily towards anesthesiology as I think it will give me balance between procedural medicine and a decent lifestyle. In terms of practicing medicine I think orthopedics appeals to me the most, but there are many draw downs that come with it and I just don't think I can make those sacrifices.

 

[NSxortho]

Thought I would update this post with where I'm at now and share my excitement in moving forward with pursuing ortho!

Being an M3 now, and having gone through most rotations, I am certain that the enjoyment I get in the OR is unparalleled to all of my other experiences. I've gone through 26h call shifts, and while absolutely draining, I can't understate the joy and reward I got in the OR. I've made lots of connection in the ortho community, with residents and some staff and I genuinely feel that it's the right fit for me. I mesh really well with them and find myself just being happy even when I come home after long days. I never felt this way in my easier rotations. I felt miserable in psych and family, even when I ended my days at 2PM - I'd come home feeling tired and drained. I'd feel flustered most of the day thinking this isn't why I went to med school.

I know this doesn't translate to residency and staff life - I can only imagine how difficult my life is going to be doing an ortho residency for 5+ years, but I feel resolute in my passion for it. I'll have a tough road ahead, but there is someone drawn to every specialty and I think ortho is that for me. I'm a Canadian, where ortho doesn't pay as much as some of the other surgical specialties (unlike the US where it is the highest paid), so this decision truly isn't about the income for me. There are still days where I consider doing family and just focus on other parts of my identity which I hold dear to myself, but thinking back to my family/peds/psych rotations and remembering how unmotivated and drained I felt makes me feel that I ought to do what makes me feel most rewarded.

Neurosurgery will always be so fascinating to me and a part of me will be sad to not pursue it, but I don't find myself a good fit among them. I sensed more collegiality, happiness, and brightness in ortho compared to NSx, which was the deciding factor for me between the two specialties. I also like that ortho offers such a diverse field where you can pursue something delicate and plastic-ish like hand surgery, or something just like neurosurgery like spine. Also, there is greater variety in lifestyle considerations in ortho than there is neurosurgery. At this moment, I personally think ortho is the best specialty, and seeing how I was interested in it since day 1 of med school and despite all the experiences I've had in M1,M2, and M3 I am still drawn to it is testament to how strongly I feel about it.

I will continue to stay open-minded through M3, and if anything else gives me a nudge towards a different direction, I'll follow it and update you all. But I'm really happy to have made up my mind. Picking a specialty is a damn hard thing to do.

 

[Miles Gloriosus]

Thought I would update this post with where I'm at now and share my excitement in moving forward with pursuing ortho!

Being an M3 now, and having gone through most rotations, I am certain that the enjoyment I get in the OR is unparalleled to all of my other experiences. I've gone through 26h call shifts, and while absolutely draining, I can't understate the joy and reward I got in the OR. I've made lots of connection in the ortho community, with residents and some staff and I genuinely feel that it's the right fit for me. I mesh really well with them and find myself just being happy even when I come home after long days. I never felt this way in my easier rotations. I felt miserable in psych and family, even when I ended my days at 2PM - I'd come home feeling tired and drained. I'd feel flustered most of the day thinking this isn't why I went to med school.

I know this doesn't translate to residency and staff life - I can only imagine how difficult my life is going to be doing an ortho residency for 5+ years, but I feel resolute in my passion for it. I'll have a tough road ahead, but there is someone drawn to every specialty and I think ortho is that for me. I'm a Canadian, where ortho doesn't pay as much as some of the other surgical specialties (unlike the US where it is the highest paid), so this decision truly isn't about the income for me. There are still days where I consider doing family and just focus on other parts of my identity which I hold dear to myself, but thinking back to my family/peds/psych rotations and remembering how unmotivated and drained I felt makes me feel that I ought to do what makes me feel most rewarded.

Neurosurgery will always be so fascinating to me and a part of me will be sad to not pursue it, but I don't find myself a good fit among them. I sensed more collegiality, happiness, and brightness in ortho compared to NSx, which was the deciding factor for me between the two specialties. I also like that ortho offers such a diverse field where you can pursue something delicate and plastic-ish like hand surgery, or something just like neurosurgery like spine. Also, there is greater variety in lifestyle considerations in ortho than there is neurosurgery. At this moment, I personally think ortho is the best specialty, and seeing how I was interested in it since day 1 of med school and despite all the experiences I've had in M1,M2, and M3 I am still drawn to it is testament to how strongly I feel about it.

I will continue to stay open-minded through M3, and if anything else gives me a nudge towards a different direction, I'll follow it and update you all. But I'm really happy to have made up my mind. Picking a specialty is a damn hard thing to do.

You made the right decision.

Ortho gives you way more options as you mentioned. Most non academic neurosurgeons do spine surgery anyway. Why go through a hard lengthy, intense residency when you could do spine as an ortho instead.

Also, when taking call, what would you rather do, nail a femur or do an emergent crani?

 

[nbever01]

Not the original poster, but I was definitely torn between ortho and neurosurgery as a med student. Just like you, I really enjoyed the camaraderie, overall fun/supportive culture, and variety in ortho. As I explored both and looked more critically, I realized that I liked the content of neurosurgery so much more. I loved spine in both, but quite honestly found hand, peds, sports, and foot/ankle to be really boring. When studying for my Sub-Is, I liked reading about fluorescence-guided brain tumor surgery a lot more than memorizing the Salter Harris classification.

Fortunately, as I got further along in med school and got to do away rotations/interviews, I was incredibly relieved to find out that there was a huge range of programs. Some neurosurgery programs had a fun/broey/ortho esque culture and great lifestyle, while others had mean people and worked you to death (same with ortho). I realized that you actually have control over the types of people you work with, program setup (white collar/blue collar/call schedule), and location. What you couldn't control was the content (what you're operating on, studying, etc. on a day to day basis).

To that end, I have zero regrets. I was lucky to train at an amazing program with a totally reasonable call schedule. I got to enfold a spine fellowship (many neurosurgery programs will allow you to move your chief year to PGY-6 so that you can do a post-chief fellowship and graduate without losing an extra year). I'm lucky to have an amazing job next year, in a desirable metro with Q8 call as an attending. If you love complex spine and are interested in cool cases on the side, you can develop a niche and/or take cranial call (in private practice, the 2 are often combined and highly sought after).

Best of luck with your decision.

You may not see this now but as a med student considering neurosurgery I would love to know what suggestions you have as far as neurosurgery programs with relatively better culture/lifestyle/call schedule, or how you went about finding the programs that did

 

[scubaboy]

For some insight, I am a current PGy1 in ortho and was between both specialties because I like a spine. You will do way more bread and butter spine as an nsx resident, but a 1-year fellowship in spine isn't bad at all, and I love fixing bones, so it depends; think about if you didn't do spine, what would make you happier doing.

 

[nibhighfootballrules]

@scubaboy hey as a recent M4 I was wondering your perspective on rotating ortho Sub-I's now that you have successfully made it to the other side. I am currently doing aways and am concerned about the process. I have received solid feedback that is promising from my home program but am constantly wondering if I am doing enough. It seems like the overwhelming majority of my interactions are with the residents which have all been positive but it seems like your ability to make a true impact as an M4 is limited. Outside of being available, working hard and trying to do the little things to make the resident's lives easier there isn't a whole lot of ways to differentiate yourself. I feel like my exposure to attending's is limited to the OR which often times translates to no meaningful conversations considering they are busy at work and the occasional opportunity at clinic to get more face time in a low stakes environment. Is this the norm and I am unnecessarily stressing myself out? Or do you feel like successful applicants find a way to make more solid connections during their rotations that go beyond just doing a good job and helping out the residents?

Maybe it is program dependent and you can do more at different places on your sub-i's or at the end of the day is the away rotation just to A) see that you are a harder worker/ normal and B) one piece of the puzzle alongside grades, LOR and your interview? Sometimes it seems like you are just physically there but adding no value which I get, I do not expect to be the center of attention at all but want to just make sure that I am not passively rotating through and under-performing. Thank you in advance for your advice.

 

[scubaboy]

@scubaboy hey as a recent M4 I was wondering your perspective on rotating ortho Sub-I's now that you have successfully made it to the other side. I am currently doing aways and am concerned about the process. I have received solid feedback that is promising from my home program but am constantly wondering if I am doing enough. It seems like the overwhelming majority of my interactions are with the residents which have all been positive but it seems like your ability to make a true impact as an M4 is limited. Outside of being available, working hard and trying to do the little things to make the resident's lives easier there isn't a whole lot of ways to differentiate yourself. I feel like my exposure to attending's is limited to the OR which often times translates to no meaningful conversations considering they are busy at work and the occasional opportunity at clinic to get more face time in a low stakes environment. Is this the norm and I am unnecessarily stressing myself out? Or do you feel like successful applicants find a way to make more solid connections during their rotations that go beyond just doing a good job and helping out the residents?

Maybe it is program dependent and you can do more at different places on your sub-i's or at the end of the day is the away rotation just to A) see that you are a harder worker/ normal and B) one piece of the puzzle alongside grades, LOR and your interview? Sometimes it seems like you are just physically there but adding no value which I get, I do not expect to be the center of attention at all but want to just make sure that I am not passively rotating through and under-performing. Thank you in advance for your advice.

Hey, great question! It can be hard to feel that you are differentiating yourself on aways, but the reality is that working hard and being "normal" is truly half of the battle. You would be shocked about how unmotivated some students are, but you will always feel that you are comparing yourself to others, so don't worry. In addition, yes, the reality is that most of the interactions you will have are with residents, so work mostly on making good connections with them. Also, you can ask them about their perspective on making connections with the attendings they feel may have a say, and many of them will help you out. Trust me, it may seem your work goes unnoticed, but as busy as everyone is, people notice when you do a good job. The last thing you want to do is make your presence known in a bad or annoying way. Keeping your head down, being normal, and making their lives easier is the sweet spot. It sounds like you are doing exactly what you need to be doing, but don't be afraid to ask for feedback and advice from the residents! I felt the same way as you; I was never doing enough, but the feedback I got was that I did all the right things and didn't overextend myself in my role as a medical student!

 

[nibhighfootballrules]

Hey, great question! It can be hard to feel that you are differentiating yourself on aways, but the reality is that working hard and being "normal" is truly half of the battle. You would be shocked about how unmotivated some students are, but you will always feel that you are comparing yourself to others, so don't worry. In addition, yes, the reality is that most of the interactions you will have are with residents, so work mostly on making good connections with them. Also, you can ask them about their perspective on making connections with the attendings they feel may have a say, and many of them will help you out. Trust me, it may seem your work goes unnoticed, but as busy as everyone is, people notice when you do a good job. The last thing you want to do is make your presence known in a bad or annoying way. Keeping your head down, being normal, and making their lives easier is the sweet spot. It sounds like you are doing exactly what you need to be doing, but don't be afraid to ask for feedback and advice from the residents! I felt the same way as you; I was never doing enough, but the feedback I got was that I did all the right things and didn't overextend myself in my role as a medical student!

Got it, thank you for the advice I really appreciate it!