Neurosurg vs Neurology

[DasNotRacist]

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Broad, high level question. Applies to other medical/surgical complementary specialties as well.

Assuming you’re equally interested in NS and neurology (and have the necessary score cutoffs & ok with training time, skillsets, salary diff, culture, etc), would you choose a bottom tier program in NS or a mid to top tier neurology program?

 

[SunBakedTrash]

Look deeper. They are so different that you must prefer one over another, even if it comes down to length of training.

 

[esob]

I agree, the specialties are too distinct from one another to make the ranking of one program over the other a decisive variable in what you do for the rest of your life

 

[OnePunchBiopsy]

What gets you more excited?

1. Pushing tPA
2. Cracking skulls

Because you definitely can’t do both at the same time.

 

[throwaway1000000]

Different fields.
Neurosurgery is probably more similar to another surgical field than it is to neurology.
Boils down to: do you like critical thinking about anatomy in the OR vs critical thinking about an undiagnosed patient and treatment plans once you diagnose them
If you like procedures but not enough to do neurosurgery, can do neurology and interventional neurology (not sure how hard it is to get that)

 

[CyrusHabs7695]

Different fields.
Neurosurgery is probably more similar to another surgical field than it is to neurology.
Boils down to: do you like critical thinking about anatomy in the OR vs critical thinking about an undiagnosed patient and treatment plans once you diagnose them
If you like procedures but not enough to do neurosurgery, can do neurology and interventional neurology (not sure how hard it is to get that)

You can go from Neurology --> Interventional Neurology??? I was under the impression that you can only get to interventional neuro from an IR residency or DR --> IR --> int neuro

 

[throwaway1000000]

You can go from Neurology --> Interventional Neurology??? I was under the impression that you can only get to interventional neuro from an IR residency or DR --> IR --> int neuro

You can. Some of the residents I worked with did. You do neuro then stroke then interventional. In fact at my institution which is a stroke center, interventional neuro is only done by neurologists.

 

[CyrusHabs7695]

You can. Some of the residents I worked with did. You do neuro then stroke then interventional. In fact at my institution which is a stroke center, interventional neuro is only done by neurologists.

Wow, super interesting il have to take a look into that, thanks!!!!

 

[Matthew9Thirtyfive]

You can go from Neurology --> Interventional Neurology??? I was under the impression that you can only get to interventional neuro from an IR residency or DR --> IR --> int neuro

One of the two interventional neurology faculty here went through the neuro route.

 

[sanfran256]

I have been told to only do surgery "if you can't see yourself doing anything else"

 

[CyrusHabs7695]

One of the two interventional neurology faculty here went through the neuro route.

@throwaway1000000

So I did a little reading on it and im a little confused on the path. So you do your Neurology residency (4 years) + 1 year of stroke/vascular fellowship and thats it? or is there another fellowship after that?

 

[Matthew9Thirtyfive]

@throwaway1000000

So I did a little reading on it and im a little confused on the path. So you do your Neurology residency (4 years) + 1 year of stroke/vascular fellowship and thats it? or is there another fellowship after that?

There is another fellowship after stroke in endovascular/interventional neurology.

 

[IMGASMD]

Broad, high level question. Applies to other medical/surgical complementary specialties as well.

Assuming you’re equally interested in NS and neurology (and have the necessary score cutoffs & ok with training time, skillsets, salary diff, culture, etc), would you choose a bottom tier program in NS or a mid to top tier neurology program?

Assuming you’re equally competitive in NS and Neurology, would you choose a million dollar career or a 300K career?

I am not being facetious. But there is a lot of self selection between your M1-M3 years. You don’t really have to worry about it. Do the best that you can. If you’re not at least top 10% or better of your class, the chance you get a NS spot doesn’t look good. If you cannot see yourself training for at least 7 years after med school, you should not get a NS spot.

Too many factors for you to worry now. Do all you can to preserve that choice.

Good luck.

 

[7331poas]

There is another fellowship after stroke in endovascular/interventional neurology.

Not always. There are programs that will accept straight out of stroke or NCC.

 

[Deecee2DO]

Assuming you’re equally competitive in NS and Neurology, would you choose a million dollar career or a 300K career?

I am not being facetious. But there is a lot of self selection between your M1-M3 years. You don’t really have to worry about it. Do the best that you can. If you’re not at least top 10% or better of your class, the chance you get a NS spot doesn’t look good. If you cannot see yourself training for at least 7 years after med school, you should not get a NS spot.

Too many factors for you to worry now. Do all you can to preserve that choice.

Good luck.

Pre clinical grades dont really matter though do they? I mean i could see if you dont have at least a 245-250+ Step 1 your chance doesnt look good but grades? Is AOA that important for NS

 

[Matthew9Thirtyfive]

Not always. There are programs that will accept straight out of stroke or NCC.

I was under the impression that you needed an endovascular neuro or interventional neuroradiology fellowship. And at least the programs I saw required a stroke or NCC fellowship prior.

 

[slowthai]

Pre clinical grades dont really matter though do they? I mean i could see if you dont have at least a 245-250+ Step 1 your chance doesnt look good but grades? Is AOA that important for NS

They don't matter. Yeah, this isn't top tier IM, lol. AOA is not going to be the determining factor in whether you match neurosurg or not. It's going to be everything else: steps, LORs, aways, and research.

 

[Deecee2DO]

They don't matter. Yeah, this isn't top tier IM, lol. AOA is not going to be the determining factor on whether you match neurosurg or not. It's going it be everything else: steps, LORs, aways, and research.

ok ya thats what i thought lol

 

[Matthew9Thirtyfive]

Looking at charting the outcomes, it looks like going to a top 40 school is one of the biggest things for nsg. Over 40% versus 10% matched and unmatched.

 

[7331poas]

I was under the impression that you needed an endovascular neuro or interventional neuroradiology fellowship. And at least the programs I saw required a stroke or NCC fellowship prior.

Programs generally want it, but there is no hard requirement by any governing body. I think the interventional neuro route isn't even ACGME accredited yet.

 

[CyrusHabs7695]

Not always. There are programs that will accept straight out of stroke or NCC.

@Matthew9Thirtyfive

So what are we looking at, 7 years post-grad? Why isn't this more popular for the people who want to go into IR but don't have the step score?

 

[slowthai]

@Matthew9Thirtyfive

So what are we looking at, 7 years post-grad? Why isn't this more popular for the people who want to go into IR but don't have the step score?

Because the lifestyle is crap and it's not full breadth IR

 

[Matthew9Thirtyfive]

@Matthew9Thirtyfive

So what are we looking at, 7 years post-grad? Why isn't this more popular for the people who want to go into IR but don't have the step score?

Like slowthai said, it’s limited to neurorads I believe, which I think most IR folks actually don’t want to do. Also I don’t think someone who wants to do something like IR typically falls into the camp of people willing to do a 4 year neurology residency and then a stroke fellowship first.

 

[throwaway1000000]

Assuming you’re equally competitive in NS and Neurology, would you choose a million dollar career or a 300K career?

I am not being facetious. But there is a lot of self selection between your M1-M3 years. You don’t really have to worry about it. Do the best that you can. If you’re not at least top 10% or better of your class, the chance you get a NS spot doesn’t look good. If you cannot see yourself training for at least 7 years after med school, you should not get a NS spot.

Too many factors for you to worry now. Do all you can to preserve that choice.

Good luck.

But lot of american med students don't choose that way.
If you look at the data, in absolute numbers, IM which is a low paid field has the most number of 250s and 260s step 1 scorers who can likely match to any field.
I agree with your advice to do well in school, but don't pick a field purely for the money unless you can at least mildly tolerate that field.

 

[Matthew9Thirtyfive]

But lot of american med students don't choose that way.
If you look at the data, in absolute numbers, IM which is a low paid field has the most number of 250s and 260s step 1 scorers who can likely match to any field.
I agree with your advice to do well in school, but don't pick a field purely for the money unless you can at least mildly tolerate that field.

IM is also the gateway to cards and GI, so you can’t really compare it like that.

 

[7331poas]

@Matthew9Thirtyfive

So what are we looking at, 7 years post-grad? Why isn't this more popular for the people who want to go into IR but don't have the step score?

neurorads guys have the worst lifestyle in the hospital. At least in neurosurg they can do elective spine cases in their off time.

The neurointerventionalists here are doing ICU shifts in the day and endovascular at night. its insane.

 

[throwaway1000000]

IM is also the gateway to cards and GI, so you can’t really compare it like that.

Yeah but the avg of cards and GI is in the high 230s and low 240s. So not all the 250s and 260s are going into those fields.

UCSF match list: UCSF Fellowship Match 2018 | Department of Medicine
UCSF is one of the top 4 programs and all of them can get into cards or GI very easily if they desire it, but only about 50-60% go into cards or GI. The trend is likely similar for all top academic programs.

For lot of people, they need a job with a combination of passion and money. I for sure do. Would have gone into ortho or something with a guaranteed high paycheck than IM and fellowship if money is all that mattered. I was actually planning on going into NS for a long time but really disliked the rotations. I could have stuck with it and stayed unhappy but switching to IM which I enjoy is one of better decisions I made.

I think a lot of fields have the potential to make money so you don't need to necessarily sacrifice your passion for money. Try to find a combo that gives you both.

Even in neurology, you can do interventional neurology, finish in around 7 yrs (same as NS) and make similar money if you work as hard as a neurosurgeon does.

If lifestyle matters in this decision, then I think that's a different thing and you wouldn't be looking at neurology or NS both of which are pretty time consuming fields. Would look at derm or rads or urology or optho

 

[slowthai]

IM is also the gateway to cards and GI, so you can’t really compare it like that.

True, but interestingly, it's not all of the specialties you would expect with the highest number of 250s. What's crazy is that IM, EM, GS, and peds beat out derm, ENT, plastics, and neurosurg. (See chart.) The amount of people applying to these primary care fields is way higher than those applying to a field like plastics or derm, so you've got that in play as well. If they calculated the ratio of 250+ scorers to the total number of applicants in each respective field, we'd likely see all the highly competitive fields at the top.

IM wins out by far, partly because of the future cards/GI effect. Matching into a university/prestigious IM program maximizes your chances of matching cards or GI, which is in accordance with what Matthew said.

 

[7331poas]

True, but interestingly, it's not all of the specialties you would expect with the highest number of 250s. What's crazy is that IM, EM, GS, and peds beat out derm, ENT, plastics, and neurosurg. (See chart.) The amount of people applying to these primary care fields is way higher than those applying to a field like plastics or derm, so you've got that in play as well. If they calculated the ratio of 250+ scorers to the total number of applicants in each respective field, we'd likely see all the highly competitive fields at the top.



IM wins out by far, partly because of the future cards/GI effect. Matching into a university/prestigious IM program maximizes your chances of matching cards or GI, which is in accordance with what Matthew said.

I mean...the fields you listed are way bigger than neurosurgery. Like, way way bigger. Im surprised Family med isn't in the top 5 if you are going to use that argument.

 

[Matthew9Thirtyfive]

True, but interestingly, it's not all of the specialties you would expect with the highest number of 250s. What's crazy is that IM, EM, GS, and peds beat out derm, ENT, plastics, and neurosurg. (See chart.) The amount of people applying to these primary care fields is way higher than those applying to a field like plastics or derm, so you've got that in play as well. If they calculated the ratio of 250s scorers to the total number of applicants in each respective field, we'd likely see all the highly competitive fields at the top.

View attachment 306833

IM wins out by far, partly because of the future cards/GI effect. Matching into a university/prestigious IM program maximizes your chances of matching cards or GI.

Right. There are also way more people applying to IM than neurosurg and derm like you said, and there is a cards/gi effect I’m sure. The average step 1 for IM is a 233 and for cards is a 239, 235 for GI.

 

[slowthai]

I mean...the fields you listed are way bigger than neurosurgery. Like, way way bigger. Im surprised Family med isn't in the top 5 if you are going to use that argument.

What argument? I was discussing the various reasons for why we're seeing the numbers that we're seeing. Competitiveness, field-specific emphasis on step scores, fellowship plans, number of applicants, etc all play a part.

 

[throwaway1000000]

True, but interestingly, it's not all of the specialties you would expect with the highest number of 250s. What's crazy is that IM, EM, GS, and peds beat out derm, ENT, plastics, and neurosurg. (See chart.) The amount of people applying to these primary care fields is way higher than those applying to a field like plastics or derm, so you've got that in play as well. If they calculated the ratio of 250+ scorers to the total number of applicants in each respective field, we'd likely see all the highly competitive fields at the top.

View attachment 306833

IM wins out by far, partly because of the future cards/GI effect. Matching into a university/prestigious IM program maximizes your chances of matching cards or GI, which is in accordance with what Matthew said.

Would be interested to see the absolute numbers if someone wants to calculate them. Just curious.
How many 250+ are going into low-moderately competitive fields like IM, Peds, GS, FM, neurology, pathology, psych, and OB,Gas. Can exclude the 250s that end up going to Cards or GI if that is distorting the numbers.

Would think these absolute numbers would be more than the 250s going into very competitive fields like derm, plastics, ortho, NS, ENT, Optho, Uro, Vascular, IR

Not including rads, I think it is a very strange field. It has all the characteristics of a competitive field like derm or optho, but strangely is not that competitive. Most likely because of the number of spots but will still exclude it. Actually thinking about it, most of these competitive fields are competitive primarily because of the number of spots. IM and Peds would also be extremely competitive if the spots are reduced to a number like ortho or derm. Cut your supply=stay competitive

 

[longhaul3]

Neuro and neurosurgery attract opposite people. They're complementary and basically nonoverlapping. It's unusual to find a neurologist who would be happy as a neurosurgeon and vice versa.

Neurosurgery is extremely competitive. Don't be fooled. I believe the US match rate was the lowest of all categorical-only (i.e. not CT, IR, PRS, other fields that have pathways other than categorical) specialties this year. It's also probably the most competitive overall because other fields may have slightly higher Step 1 score, etc., but neurosurgery requires extensive commitment to the field through research which is time-consuming.

It's also one of the two or three smallest surgical specialties, if not the smallest. There are more than twice as many PGY-1 positions offered in IM every year as there are neurosurgeons in the entire US.

 

[CherryRedDracul]

Neurosurgeons are crazy people. Are you a crazy person? Then consider neurosurgery.

 

[detritus]

Neuro and neurosurgery attract opposite people. They're complementary and basically nonoverlapping. It's unusual to find a neurologist who would be happy as a neurosurgeon and vice versa.

Neurosurgery is extremely competitive. Don't be fooled. I believe the US match rate was the lowest of all categorical-only (i.e. not CT, IR, PRS, other fields that have pathways other than categorical) specialties this year. It's also probably the most competitive overall because other fields may have slightly higher Step 1 score, etc., but neurosurgery requires extensive commitment to the field through research which is time-consuming.

It's also one of the two or three smallest surgical specialties, if not the smallest. There are more than twice as many PGY-1 positions offered in IM every year as there are neurosurgeons in the entire US.

One question I have about competitiveness is: if you know early what you want, should competitiveness really be that big of a consideration? I’m assuming most students at US MD schools are capable of matching a competitive field like NSGY if they work from Day 1 with this goal in mind and/or take a Research year. Maybe I’m naive but I think if you want it bad enough, no one’s going to stop you.

 

[7331poas]

One question I have about competitiveness is: if you know early what you want, should competitiveness really be that big of a consideration? I’m assuming most students at US MD schools are capable of matching a competitive field like NSGY if they work from Day 1 with this goal in mind and/or take a Research year. Maybe I’m naive but I think if you want it bad enough, no one’s going to stop you.

Not true. A ton depends on if you have a home program, whether your school has the juice to get you a spot, etc.

 

[longhaul3]

One question I have about competitiveness is: if you know early what you want, should competitiveness really be that big of a consideration? I’m assuming most students at US MD schools are capable of matching a competitive field like NSGY if they work from Day 1 with this goal in mind and/or take a Research year. Maybe I’m naive but I think if you want it bad enough, no one’s going to stop you.

The thing that makes neurosurgery so competitive is that yes, you can plan for it from day 1, have 30 lines on your CV by fourth year, whatever, but then you still have to do well on Step 1, and then survive/be likable on your sub-i's. The average score for matched applicants is around 250. The people matching with scores below that are people with PhD-level research backgrounds—nsg also has the highest percentage of PhDs after path and maybe rad onc, I think—so good luck competing with that. (Also, I don't have any data in front of me on Step 1 score creep, but since MSTP students usually take it around 5 years before applying, an MD/PhD with a lower absolute score may have been perfectly average for neurosurgery at the time.)

Anyone who can score >240 on Step 1 can match in neurosurgery with enough research, but then again, that's pretty much true across the board. Your reasoning should also apply to ortho, derm, PRS, etc., but in those cases it's probably a little easier, since coming in with 20 lines on your CV will blow 90% of the other applicants out of the water, while it's about average in nsg.

 

[throwaway1000000]

The thing that makes neurosurgery so competitive is that yes, you can plan for it from day 1, have 30 lines on your CV by fourth year, whatever, but then you still have to do well on Step 1, and then survive/be likable on your sub-i's. The average score for matched applicants is around 250. The people matching with scores below that are people with PhD-level research backgrounds—nsg also has the highest percentage of PhDs after path and maybe rad onc, I think—so good luck competing with that. (Also, I don't have any data in front of me on Step 1 score creep, but since MSTP students usually take it around 5 years before applying, an MD/PhD with a lower absolute score may have been perfectly average for neurosurgery at the time.)

Anyone who can score >240 on Step 1 can match in neurosurgery with enough research, but then again, that's pretty much true across the board. Your reasoning should also apply to ortho, derm, PRS, etc., but in those cases it's probably a little easier, since coming in with 20 lines on your CV will blow 90% of the other applicants out of the water, while it's about average in nsg.

Are you a neurosurgery resident?
I was interested in NSG a while and it is competitive but certainly similar or even less than the other competitive ones like derm and ortho. 2018 average step 1 score was 245, less than all the other competitive fields.
The caveat being needing research. But I would say you can match with a good step score and with a research portfolio similar to any other competitive speciality.
Only 1 person above a 250 step 1 didn't match in 2018. Safe to say with strong step scores and some BS research publications, you will likely match.
I don't know what the match rate was for this prior year, maybe it was lower than everything else but those things are always cyclical and random and you can never predict which year will have a lot of applicants. There are years where ENT went unfilled with next year being the complete opposite.

TLDR: get a score near 250, find an attending to publish some BS, work hard and you will match into any competitive speciality. neurosurgery is not an exception. If anything you can get by with a lower step score and supplement with more BS research.

 

[WedgeDawg]

Are you a neurosurgery resident?
I was interested in NSG a while and it is competitive but certainly similar or even less than the other competitive ones like derm and ortho. 2018 average step 1 score was 245, less than all the other competitive fields.
The caveat being needing research. But I would say you can match with a good step score and with a research portfolio similar to any other competitive speciality.
Only 1 person above a 250 step 1 didn't match in 2018. Safe to say with strong step scores and some BS research publications, you will likely match.
I don't know what the match rate was for this prior year, maybe it was lower than everything else but those things are always cyclical and random and you can never predict which year will have a lot of applicants. There are years where ENT went unfilled with next year being the complete opposite.

TLDR: get a score near 250, find an attending to publish some BS, work hard and you will match into any competitive speciality. neurosurgery is not an exception. If anything you can get by with a lower step score and supplement with more BS research.

These past two cycles were fairly brutal for neurosurgery. People with strong CVs from top schools and good scores did not match. Plenty of people with scores <240 matched. Who vouches for you and how much matters. Research, like everything else, is necessary but not sufficient.

 

[throwaway1000000]

These past two cycles were fairly brutal for neurosurgery. People with strong CVs from top schools and good scores did not match. Plenty of people with scores <240 matched. Who vouches for you and how much matters. Research, like everything else, is necessary but not sufficient.

Maybe. Would be interesting to see that data. 2018 and 2016 matching outcomes both show pretty similar level of competitiveness to all other competitive specialities.

 

[WedgeDawg]

Maybe. Would be interesting to see that data. 2018 and 2016 matching outcomes both show pretty similar level of competitiveness to all other competitive specialities.

I’m sure the official data will come out soon

 

[Groy]

What gets you more excited?

1. Pushing tPA
2. Cracking skulls

tPA, BABY!
1.) Noncon CT,
2.) Neuro exam + NIHSS + ASPECTS +/- MMSE
3.) R/o contraindications
4.) PUSH, PUSH, PUSH

WHAT A RUSH