Is neurosurgery the most difficult surgical subspecialty out there?

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2NeRLyFsTyLE

    I know I'm only pre-med, but I've taken a liking towards neurosurgery. However, I heard lots and lots of "scary" things about it such as the insane hours they work, especially those in neurosurgical residency, the sleep deprivation they have to endure, the constant state of being on call, etc. etc. I was just wondering if it is possible to have atleast some personal time and family life if I go into neurosurgery or if it will be a full time constant dedication.

    Thanks
     

    barcalounger

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      "Difficult" in what sense? Technically? Endurance-wise? All surgery is demanding. The 80- (or 8:cool: hour work restriction has changed things somewhat. Ophtho and ENT have the reputation for being better lifestyle-wise, but you are going to work hard in any surgical residency. NSG gets a lot of trauma, which is why it is less predictable than others. But general surgery residents work very hard, also. You will get to find out all about the "scary stories" and whatnot when you do your third-year clinical rotations, and will be in a position to judge for yourself. By then, things may have changed. Who knows - perhaps there will be further work-hour requirements which will make this discussion moot.
       
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      2NeRLyFsTyLE

        "Difficult" in what sense? Technically? Endurance-wise? All surgery is demanding. The 80- (or 8:cool: hour work restriction has changed things somewhat. Ophtho and ENT have the reputation for being better lifestyle-wise, but you are going to work hard in any surgical residency. NSG gets a lot of trauma, which is why it is less predictable than others. But general surgery residents work very hard, also. You will get to find out all about the "scary stories" and whatnot when you do your third-year clinical rotations, and will be in a position to judge for yourself. By then, things may have changed. Who knows - perhaps there will be further work-hour requirements which will make this discussion moot.

        Yeah true I still have lots of time to decide and yes true also that becoming any type of surgeon will not come easily. Thanks for your input:thumbup:
         
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        Cody

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          My future plans are to become a neurosurgeon so I have done quite a bit of research. As hours are concerned, from what I understand during your residency things can get quite hairy. But, unless you go into like dermatology or something residency is going to be a wild ride. Neurosurgery is definitely something that requires SERIOUS devotion therefore is going to require long hours. But if you really want it then go for it, it's an amazing field.
           

          ddmo

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            The issue is not how much one works during residency because 1)It's a finite amount of time, 2)The 80 hour work week applies to all specialties. The issue is how much does an attending surgeon in the field work. Based on my experiences, ortho not nsg, neurosurgery attendings work some of the longest hours in the hospital throughout their career. Cardiothoracic is also up there.
             

            naegleria brain

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              The issue is not how much one works during residency because 1)It's a finite amount of time, 2)The 80 hour work week applies to all specialties. The issue is how much does an attending surgeon in the field work. Based on my experiences, ortho not nsg, neurosurgery attendings work some of the longest hours in the hospital throughout their career. Cardiothoracic is also up there.

              i don't agree completely with this.
              1) yes, it is a finite amount of time. but neurosurgery is 7 years; ortho, ENT, plastics, ophtho are all less. CT is the same.

              2) it applies, but not always followed. i've visited many different programs where as a medical student, working side by side with the residents, we easily surpassed 100 hrs a week. the "random" surveys they give out to ensure compliance is largely bs-ed to coverup the infractions, or during night-float where its possible to comply.

              3) ortho is tough too; at the highest volume centers, it can be as tough as, or possibly, longer than neurosurgery. in the vast majority of places i've seen, ortho is not quite as demanding as neuro. this may also be because neurosurg attendings are notoriously exacting, big-headed, and erratic in their behavior, whereas ortho attendings, though also exacting, are generally more sane. it's a tough call to make.
              my experience iwth CT is limited, so i can't divulge much as to that.

              in a word, yes, neuro is one of the hardest, and, at many hospitals, the hardest. however, general surgery, ortho, etc. are also very difficult. if you can do gen surg or ortho, i think you are perfectly capable of working a little harder in a neurosurgical residency.
               

              Mariah246

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                i don't agree completely with this.
                1) yes, it is a finite amount of time. but neurosurgery is 7 years; ortho, ENT, plastics, ophtho are all less. CT is the same.

                2) it applies, but not always followed. i've visited many different programs where as a medical student, working side by side with the residents, we easily surpassed 100 hrs a week. the "random" surveys they give out to ensure compliance is largely bs-ed to coverup the infractions, or during night-float where its possible to comply.

                3) ortho is tough too; at the highest volume centers, it can be as tough as, or possibly, longer than neurosurgery. in the vast majority of places i've seen, ortho is not quite as demanding as neuro. this may also be because neurosurg attendings are notoriously exacting, big-headed, and erratic in their behavior, whereas ortho attendings, though also exacting, are generally more sane. it's a tough call to make.
                my experience iwth CT is limited, so i can't divulge much as to that.

                in a word, yes, neuro is one of the hardest, and, at many hospitals, the hardest. however, general surgery, ortho, etc. are also very difficult. if you can do gen surg or ortho, i think you are perfectly capable of working a little harder in a neurosurgical residency.

                out of curiosity, are you currently a med student/resident/attending?

                if student, are you planning to go into neurosurgery?
                 

                naegleria brain

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                  MS3, and with luck, yes. ive dabbled in many different surgical subspecialties (i've always known i was going to be some kind of surgeon) so i know a bit about many different specialties.

                  neurosurgery match seems to be the most interesting in my opinion. i've posted about it here before, and you can get a taste of the "characters" involved if you go to uncleharvey.com. good luck to you!
                   
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                  Blake

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                    MS3, and with luck, yes. ive dabbled in many different surgical subspecialties (i've always known i was going to be some kind of surgeon) so i know a bit about many different specialties.

                    neurosurgery match seems to be the most interesting in my opinion. i've posted about it here before, and you can get a taste of the "characters" involved if you go to uncleharvey.com. good luck to you!
                    I wouldn't generalize based on nsmatch/uncleharvey. Most of the folks I've met on the trail were great people.
                     

                    Vermian

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                      As a resident in neurosurgery (about to marry a resident in orthopedic surgery), I can say that it takes a lot of time commitment for any surgical field. Not that this makes it impossible to have a life, but it does get in the way sometimes. When looking at going into neurosurgery, one has to realize that it will BE their life on occasion. However, if you are in a program where everyone works together, most things get done and you go home at the end of the day. People tend to try to follow the 80 hour rules, but we are all still surgeons and like to be around to take care of business as it arises. It is one of the longest specialties, as it has the longest residency prior to any fellowship time. Of course, one may do close to the same amount of time in other fields once everything is said and done. It has to be about what you like.
                       

                      naegleria brain

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                        blake: im getting into the rush now and am meeting several gettin ready to apply. you are right, many are great people. but i think we all share a little bit of that same insistent-motivation; its something pretty unique i find in people who lead lives in busy, demanding specialties.

                        dizzyorange - some of it is nonsense though. the general repeated sentiments i believe do have truth to them, but there are other posts that make little-to-no sense whatsoever.

                        vermian - congrats to you! youre kids are going to inherit some amazing genes.
                         

                        Malftap

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                          I second what Vermian said. I'm a 3rd year resident and I can tell you from first hand NSGY is a very demanding residency. The length of the residency can be fustrating (especially when you see classmates about to finish is fields like ER and I still have another 4 yrs to go). But I will say this...there is no other field of medicine I would go into and I would do it all over again.
                          Also I just want to say there are other fields that work very hard. I'm at a level I trauma center and the ortho guys here get slammed when they are on call. Gen surgery also since they handle the trauma. Whatever field you choose you are going to feel the demands of that specialty.
                           

                          mpp

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                            Also I just want to say there are other fields that work very hard. I'm at a level I trauma center and the ortho guys here get slammed when they are on call. Gen surgery also since they handle the trauma. Whatever field you choose you are going to feel the demands of that specialty.

                            I think that the big difference for neurosurgery is the few number of people involved and the constant "always on" challenges of the specialty. At most places ortho residents out number neurosurgery residents by at least 2 or 3 times and so the pain is spread a bit more. For general surgery residents there is also the increase numbers but also a variety of rotations. That trauma surgery call is typically but just a few months out of their 5 or 6 years.
                             

                            youngin

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                              Can anyone comment on life after residency? I hear horror stores about divorces, burnout, ectt.. but I wonder if it is mainly during residency. Do the hours still far exceed other fields?
                               

                              Vermian

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                                Although I am just in my 5th year and still have 2 left before graduation, I might be able to shed a little light on your question. This actually comes from watching good friends of mine from other programs and listening to the multitude of staff I have been fortunate to work with over the past six years (yes I said six because I did a pre-residency year). Divorce rates are high in the US as a whole. What makes them higher in surgical specialties? I would have to say a lack of communication. We are in a field where there are time we will just have to be in the hospital to the exclusion of everything else. Patients don't choose when to have a problem that needs to be addressed before imminent death. There are times you can just let the work engulf you to the exclusion of everything else. This is what you need outside (and inside) support to avoid when feasibly possible. When having a spouse, that person has to understand what they got themselves into with their partner. As a physician (and especially a resident) there will be days or weeks you are just physically and emotionally drained. They have to be aware of that and be most supportive during those times. This is not always the case, but I have quite a few friends who are doing quite well on the marriage front. I, myself, am about to marry an orthopedic resident. It is rough at times, but we understand that and adjust for the times when it is not. As for burn-out, that would entirely depend on why you went into whatever surgical field you did. I was fortunate to have a very wise chief resident during my fake 2nd year. He said - "you have to figure out what drives you - it cannot be the surgery, because surgery is just a technical skill that once you master becomes dull - figure out why you like what you are doing and do it for that reason - not because you get to operate - a monkey can be taught to operate." Any job can wear on you, and medicine more so than others. You will see patients that just don't want your help, do things to undermine their health, or don't get better no matter what you do. That can be frustrating, and even more so if you decide to carry the weight on your shoulders. You are obligated to do the best you can for your patients, but in the end - they are responsible for their health as much as if not more so than you are. Do your best and know you did your best and that is all you can do. The hours get better (or so my friends claim), but I think that depends on the kind of practice you have and the kind of money you want to make. Obviously, more hours = more money. You have to find a practice that "fits" what you want out of life. There may be sacrifices early on there, but you cannot lose sight of what your life goals are. Being a workaholic will kill you in the end. Keeping a balance will temper the burn-out some people feel. Realize that you will even get a burn-out during residency if you take this path (most of us hit it our 4th or 5th year). You are paying an extraordinary price just going into medicine. Most of your friends will graduate, get jobs, start families, make money, take fabulous vacations long before you ever realize there is a city outside your hospital. This is my two cents, I hope it helps some. Good luck with your goals.
                                 
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                                youngin

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                                  Although I am just in my 5th year and still have 2 left before graduation, I might be able to shed a little light on your question. This actually comes from watching good friends of mine from other programs and listening to the multitude of staff I have been fortunate to work with over the past six years (yes I said six because I did a pre-residency year). Divorce rates are high in the US as a whole. What makes them higher in surgical specialties? I would have to say a lack of communication. We are in a field where there are time we will just have to be in the hospital to the exclusion of everything else. Patients don't choose when to have a problem that needs to be addressed before imminent death. There are times you can just let the work engulf you to the exclusion of everything else. This is what you need outside (and inside) support to avoid when feasibly possible. When having a spouse, that person has to understand what they got themselves into with their partner. As a physician (and especially a resident) there will be days or weeks you are just physically and emotionally drained. They have to be aware of that and be most supportive during those times. This is not always the case, but I have quite a few friends who are doing quite well on the marriage front. I, myself, am about to marry an orthopedic resident. It is rough at times, but we understand that and adjust for the times when it is not. As for burn-out, that would entirely depend on why you went into whatever surgical field you did. I was fortunate to have a very wise chief resident during my fake 2nd year. He said - "you have to figure out what drives you - it cannot be the surgery, because surgery is just a technical skill that once you master becomes dull - figure out why you like what you are doing and do it for that reason - not because you get to operate - a monkey can be taught to operate." Any job can wear on you, and medicine more so than others. You will see patients that just don't want your help, do things to undermine their health, or don't get better no matter what you do. That can be frustrating, and even more so if you decide to carry the weight on your shoulders. You are obligated to do the best you can for your patients, but in the end - they are responsible for their health as much as if not more so than you are. Do your best and know you did your best and that is all you can do. The hours get better (or so my friends claim), but I think that depends on the kind of practice you have and the kind of money you want to make. Obviously, more hours = more money. You have to find a practice that "fits" what you want out of life. There may be sacrifices early on there, but you cannot lose sight of what your life goals are. Being a workaholic will kill you in the end. Keeping a balance will temper the burn-out some people feel. Realize that you will even get a burn-out during residency if you take this path (most of us hit it our 4th or 5th year). You are paying an extraordinary price just going into medicine. Most of your friends will graduate, get jobs, start families, make money, take fabulous vacations long before you ever realize there is a city outside your hospital. This is my two cents, I hope it helps some. Good luck with your goals.

                                  Wow great. Thanks for the input.
                                   

                                  Vermian

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                                    Thanks Vermian for your view of things.

                                    (by the way, did you notice the enter key, it's to the right of the apostrophe :) )

                                    Sorry if that was a bit much to swallow - I live with a little bit of stream of conscious thinking - especially now with the ABNS primary exam on the 29th. Hopefully, future responses will be a little more coherent.
                                     
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