Neurosurgery vs. General Surgery? HELP!

[Ezangjen]

Have/do any of you grapple with this question? I'm currently a 3rd year who can't do a neurosurgery rotation until 4th year but must decide on what away elective I want to do now (and pretty much what residency program I want to go into) b/c my school doesn't offer neurosurgery. Here are my current thoughts on both:

General Surgery 1) become a more well-rounded doctor, managing a wider variety of problems and being able to run codes, etc. 2) more hands on type of surgery, less need for precision 3) more applicable to possible overseas work, 4) less hours, less work.

Neurosurgery 1) enjoyed learning neurology more than other subjects during 2nd year, 2) I've got a background in neuro research, 3) I like technology (CT assisted surgeries, gamma knife, etc.) 4) it's a more focused field, thus you become more of an expert.

Can anyone confirm/refute any of my current beliefs? Are my current thoughts on neurosurgery enough that I'll most likely enjoy a career in it? I'd appreciate any thoughts or comments!

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[NSwannabe]

Have/do any of you grapple with this question? I'm currently a 3rd year who can't do a neurosurgery rotation until 4th year but must decide on what away elective I want to do now (and pretty much what residency program I want to go into) b/c my school doesn't offer neurosurgery. Here are my current thoughts on both:

General Surgery 1) become a more well-rounded doctor, managing a wider variety of problems and being able to run codes, etc. 2) more hands on type of surgery, less need for precision 3) more applicable to possible overseas work, 4) less hours, less work.

Neurosurgery 1) enjoyed learning neurology more than other subjects during 2nd year, 2) I've got a background in neuro research, 3) I like technology (CT assisted surgeries, gamma knife, etc.) 4) it's a more focused field, thus you become more of an expert.

Can anyone confirm/refute any of my current beliefs? Are my current thoughts on neurosurgery enough that I'll most likely enjoy a career in it? I'd appreciate any thoughts or comments!

Hi Ezangjen,

I was also grappling with the same question earlier this year. I have always wanted to do overseas work, and NS doesn't really lend itself to third world countries without the necessary resources.

However, I realized that there is no other system in the body I would enjoy working with as much.

But in the practical sense it came down to whether I would still find Gen Surgery as enjoyable as Neurosurg ten years down the road, and if I did decide on NS, would I still be willing to work the hours if I had a family. NS won for me.

 

[mysophobe]

Don't settle for general surgery because you have to pick your electives now. Schedule an elective at a place you'd like to go as well as a surgery sub-i or something at your home institution so you can cover yourself both ways. It sounds to me like you really want neurosurgery and you're tryin to justify not taking the plunge. I say go for it--you'll be much happier 10 years down the road.

 

[FatPigeon]

Can anyone comment on the uniformity of the programs w/ regard to progression through residency? It seems to me that neuro is broken up with months such as neurology, research years, and more manageable senior years (as compared with brutal PGY-2 and -3 years), whereas general surgery residents complain about doing the "exact same thing" throughout all 5 years.

Just wondering whether this is the case everywhere, or if it's specific to my school's programs.

 

[Habeed]

I want someone to address if there's a substantial difference in work hours between general surgery and neuro.

I've seen veiled references to the idea that neuro is one residency that simply doesn't care what the rules are, and that residents routinely work 100+ hours/week year round. While for general surgery, at least some programs try to comply and keep it down to 88 hours averaged between 2 weeks...

Since each additional hour becomes exponentially more difficult to work in a week, it seems like a rather significant difference.

 

[Winged Scapula]

I've seen veiled references to the idea that neuro is one residency that simply doesn't care what the rules are, and that residents routinely work 100+ hours/week year round. While for general surgery, at least some programs try to comply and keep it down to 88 hours averaged between 2 weeks...

Clarification: The 80 hours is averaged over 4 weeks not 2 weeks; neurosurgery programs can apply for the average to be 88 hours (again averaged over 4 weeks).

 

[FatPigeon]

I want someone to address if there's a substantial difference in work hours between general surgery and neuro..

Across the board, I doubt you'd find on average that neuro residents were working more than general surgery. I found on my rotations that the general surgery patients had many more issues to manage, and there always tended to be more of them in the hospital at a given time...meaning extra time rounding in the AM as well as in the evening. Nor have I seen neurosurgery patients to be more prone to complications and emergent craniotomies than are general surgery patients to emergent laparotomies. I really don't understand (at least not yet) why neuro has this monstrous reputation for being so brutal....in my opinion, it couldn't possibly be more brutal than general. Take this with a grain of salt since my experience is limited (2 months of surgery and 1 of neuro).

 

[Habeed]

Hmm.

+End residency in itself, fellowship not semi-mandatory
+More 'cerebral' a specialty
+Pay scale the highest average for nearly all physicians

- Harder to match than general surgery
- Takes longer to do cases which makes for a worse lifestyle as attending

If the work hours were the same, and one had the grades for either, it seems kind of like a no-brainer (hehe)

 

[klooless]

In applying in neurosurgery, away elective experience is not optional (whereas away general surgery electives are definitely optional). This is to say that any neurosurgery program is going to expect that you've done at least one away elective in neurosurgery. So I say use your "away" time as an opportunity to fulfill that neurosurgery "requirement" as well as an opportunity to become better acquainted with the field.

 

[BlondeDocteur]

Hi Ezangjen,

I was also grappling with the same question earlier this year. I have always wanted to do overseas work, and NS doesn't really lend itself to third world countries without the necessary resources.

I won't comment on your internal struggle, but I WILL say that neurosurgery is increasingly applicable overseas. There is a burgeoning movement to adapt the so-called "highly technical specialties" to developing country settings. I personally know a handful of residents and attendings who do neurosurgical missions abroad, mainly in Africa. It's nice to know you can contribute without having to airlift people out to the States at great expense... and best of all, you can train in-country surgeons in basic neurosurgical care, which leaves a much more profound mark than one person operating furiously for a week and then leaving ever could.

 

[John Stanhope]

My advice to you may be, to not got involved in Neuosurgery
unless its really what you want to do. you either hate it or you
love it, Also i feel like its it more scientific than Gen. surgery,
(not speaking on precision) Its hard for me to balance my career
because of how busy i am sometimes.

John Stanhope,MD/MP,B.s.c.,F.n.p.r.
chief of medicine,
CAPM (dept. of cognitive neurosurgery)

 

[maxheadroom]

General Surgery 1) become a more well-rounded doctor, managing a wider variety of problems and being able to run codes, etc. 2) more hands on type of surgery, less need for precision 3) more applicable to possible overseas work, 4) less hours, less work.

Codes seem very exciting in medical school, but out in the real world, the codes are run by the "code team" nurses and either the in-house Anesthesiologist or ICU doc.

 

[Bombrainiac]

First of all, let me begin by applauding your interest in surgery and taking steps to gather as much information as possible before committing yourself.

General surgery, in my opinion, is the last thing on Earth that I would want to be doing. I think general surgeons these days are NOT the same breed or caliber of general surgeons of yesteryear, and that is why you see a lot of them subspecializing. The times of the true GENERAL general surgeon are mostly over. And learning how to run a code, and learning general medicine is even more important in a field like neurosurgery than you would think. In fact, the first piece of advice I got before going into neurosurgery was from an old, retiring neurosurgeon who told me to learn all of medicine and to know it better than the other guys. Why? Because the level of acuity that brain surgery patients present with is unsurpassed--your patients will be the sickest in the hospital and you have to be very capable not only in neurosurgery, but also in general medicine. For instance, something as simple as fluid management becomes extremely complex in a neurosurgical patient.

In short, a comparison between neurosurgery and general surgery is almost laughable. There is no contest. Neurosurgery is a self-selective field, and is practiced in a fashion that is completely opposite to general surgery. What has happened to general surgery is a tragedy. I'm not saying to do neurousurgery--I'm just saying, for the love of all that is holy, don't do general surgery unless you plan on specializing. And even then, if you had the choice of general surgery with a specialization versus neurosurgery (meaning you are good enough to match into neurosurgery and have an interest in it), then why in the world would you not do neurosurgery. Coolest cases, coolest toys, ridiculous money and opportunities for device development, etc, etc. And don't worry about lifestyle stuff--just love what you do and you'll never have to worry about it.

 

[ClaudiaPipkens]

It is a residency. It's the longest of all of them, at 8 years. They have no training in general surgery beyond the rotations through it in medical school and internship.Some neurosurgeons do a fellowship after residency, usually for 2-3 years.

 

[hotlikebutter]

have you ever been scrubbed in on a colon resection? there is never enough bowel prep to get rid of that smell. im an olfactory oriented person.

on a serious note, dont be in a rush to make up your mind. let your rotations guide you. you will soon see that you have the personality of a general surgeon or a neurosurgeon.

good luck

 

[thethom]

And don't worry about lifestyle stuff--just love what you do and you'll never have to worry about it.

LOL I love that last quote, in essence, be prepared not to have a life outside of the hospital...

The chief of neurosurgery at one of the hospitals I rotated at LIVED in the hospital...I'm quite serious, he had an apartment at the top of the tower that housed the physicians offices...Pretty crappy if you ask me...

You need to decide if you want your work to be your life, or you want your life to be your work...

-T

 

[Bombrainiac]

LOL I love that last quote, in essence, be prepared not to have a life outside of the hospital...

The chief of neurosurgery at one of the hospitals I rotated at LIVED in the hospital...I'm quite serious, he had an apartment at the top of the tower that housed the physicians offices...Pretty crappy if you ask me...

You need to decide if you want your work to be your life, or you want your life to be your work...

-T

This is exactly the kind of stuff that family medicine docs worry about. No offense, but you just don't get it. There is no doubt that neurosurgeons work very hard, but there is also no doubt that their love for the field is really unmatched by most, if not all, other fields of medicine. If you want a job, then congratulations on spending half of your life training. If you have a passion and a drive that is deeper than just "going to work," then congratulations on spending half of your life to having a profession and not just a job. Lifestyle is an issue for those who make it an issue. You need to decide why you're a doctor and what kind of a family life you will be able to achieve with a demanding schedule. There is a lot of hype about how surgeons, and neurosurgeons especially, don't have a life. Don't listen to the hype. Figure out what is going to lead to happiness. I certainly didn't work all my life to have a job and start my life once I'm out of the hospital. I absolutely love what I do and I'd do it in my free time. My wife loves what I do and comes to the hospital to hang out with me all the time. And, frankly, I have plenty of personal time and energy. It's all about how you approach things. Docs and medical students have become soft over the years--the old breed of "in-the-trenches," balls-out doctors is over. Neurosurgery is not for everyone, and some people figure that out during residency. If you want to be a neurosurgeon, it's best you not take advice from family docs. They are a totally different breed--not worse, not better, just different and well-suited to what they do.

 

[Kiroro]

Have/do any of you grapple with this question? I'm currently a 3rd year who can't do a neurosurgery rotation until 4th year but must decide on what away elective I want to do now (and pretty much what residency program I want to go into) b/c my school doesn't offer neurosurgery. Here are my current thoughts on both:

General Surgery 1) become a more well-rounded doctor, managing a wider variety of problems and being able to run codes, etc. 2) more hands on type of surgery, less need for precision 3) more applicable to possible overseas work, 4) less hours, less work.

Neurosurgery 1) enjoyed learning neurology more than other subjects during 2nd year, 2) I've got a background in neuro research, 3) I like technology (CT assisted surgeries, gamma knife, etc.) 4) it's a more focused field, thus you become more of an expert.

Can anyone confirm/refute any of my current beliefs? Are my current thoughts on neurosurgery enough that I'll most likely enjoy a career in it? I'd appreciate any thoughts or comments!

If you like GenSurg and Neurosurg equally, I would go for GenSurg. It's shorter training and much easier to much. That's a lot less hustle for both 4th year and residency years. You'll probably be happy no matter which one you end up doing.

I also feel that most of the Neurosurg applicants make up their mind about the field much earlier in the game to prepare for research and rapport etc... Which would be another barrier for you.

If I were you, I would stick with General and try to match to a higher tier program or in a nice city, which would be hard to accomplish in neurosurg unless you have rockstar stats