Neurosurgery Vs Interventional Radiology

[libertyyne]

I think I’d still rather be a wealthy radiologist bored with his work than a pediatrician begging for scraps on the street.

There is no pediatrician begging for scraps in the streets. Pediatricians make 3-4x the annual median household income.

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[odyssey2]

There is no pediatrician begging for scraps in the streets. Pediatricians make 3-4x the annual median household income.

Yes it was a joke

 

[libertyyne]

Could anyone define the surgical itch? I am unsure if i really have it. I like throwing in sutures as much as the next guy, i got to problem solve with an attending during a surgery the other day for the first time and that felt like a lot of fun.

 

[efle]

Could anyone define the surgical itch? I am unsure if i really have it. I like throwing in sutures as much as the next guy, i got to problem solve with an attending during a surgery the other day for the first time and that felt like a lot of fun.

The way I've heard it described: At 3pm on Friday, you know you'd rather spend the next 6 hours in an OR than the next 2 hours at table rounds, or in a reading room, or in outpatient/clinic.

 

[longhaul3]

Could anyone define the surgical itch? I am unsure if i really have it. I like throwing in sutures as much as the next guy, i got to problem solve with an attending during a surgery the other day for the first time and that felt like a lot of fun.

It's not all about actually doing the surgery, and it's definitely not about suturing. Most of the time attendings in teaching hospitals are long gone by the time the needle driver comes out. It's about diagnosis, determining which patients/problems need surgery, problem-solving, honing a craft, and making an identifiable impact from skin to skin.

For me, it's also about staying busy, being engaged, pushing myself, and assuming responsibility. I also like the idea that the buck stops with our subspecialty service and we are the ultimate experts in our domain, despite not being experts at the finer points of general medicine. I am not the one you want on board the plane—I really respect all the docs in anesthesia, IM, EM, etc. who can manage a broader range—but when someone needs our help, nobody else can do it. Obviously this is the case in many non-surgical specialties like derm, psych, path, whatever, but it contributed a lot to that itch for me.

The way I've heard it described: At 3pm on Friday, you know you'd rather spend the next 6 hours in an OR than the next 2 hours at table rounds, or in a reading room, or in outpatient/clinic.

This is a pretty good one. Sadly you also have to include whether you'd rather come in at 7pm on the weekend for a 6 hour case a couple times a month than spend that time with family. I totally get why people don't like surgery.

 

[FindersFee5]

Could anyone define the surgical itch? I am unsure if i really have it. I like throwing in sutures as much as the next guy, i got to problem solve with an attending during a surgery the other day for the first time and that felt like a lot of fun.

For me, it was very based around how I felt coming out of the hospital at the end of the day. On surgery, I was excited, upbeat, wanted to talk about my day with my wife even if I had been at the hospital for 16 hours.

On my non-procedural rotations, I'll often get home and be so grumpy I don't want to talk or work for at least an hour until I've totally recharged, even if I'm getting out at 2 PM. Even after I veg out for a while I still usually was not that excited to talk about my day.

 

[HuskyMD Emeritus]

Have you thought about pulmonary-critical care? You have to know a lot of medicine and physiology (like everything you studied for in the Steps), you have ownership of the patient (neurosurg pts are often in the ICU--the surgeon operates but you manage the patient), and there are lots of procedures (lines, intubation, thoracentesis, chest tubes, pleural biopsies, PleurX catheters, bronchoscopies, LPs, paracentesis......)
There is also interventional pulmonology (thoracoscopy is done in the OR for those who likes to go there).
Technology is part of the game: EBUS, navigational bronchoscopy, LASER bronchoscopy.
If you want to follow patients longitudinally, there is clinic.
Lifestyle is not as harsh as neurosurgery. IR can be challenging. Where I work, they are often doing procedures late into the night and on weekends.

 

[efle]

For me, it was very based around how I felt coming out of the hospital at the end of the day. On surgery, I was excited, upbeat, wanted to talk about my day with my wife even if I had been at the hospital for 16 hours.

On my non-procedural rotations, I'll often get home and be so grumpy I don't want to talk or work for at least an hour until I've totally recharged, even if I'm getting out at 2 PM. Even after I veg out for a while I still usually was not that excited to talk about my day.

Which did the wife prefer, upbeat and home at 9pm or grumpy from 2-3pm?

 

[Gilakend]

I don't have much experience to offer for OP here as he has already gotten advice from people way more knowledgable than me, but just wanted to ask: Am I the only one who has been surprised by the hours of some of the surgical specialties?

For example, I came in interested in ortho, expecting the worst and realizing that even though I was interested in it that I wouldn't do it because I wanted a healthy family life. The more I've shadowed and talked to residents, the more I've actually been pulled towards it. I feel like the horror stories (at least from what I've seen) are pretty few and far between. Most of the residents said when not on trauma they'd be home between 3-6 and all of them that I talked to had multiple kids. And that's in residency. After residency, from what I understand, if you're fine with taking a pay cut, you can pretty much fit your schedule however you like. Obviously, I want to get a bigger sample size, but so far I feel myself being more drawn to it. I also feel like every resident/attending I've talked to has genuinely been a normal person which I have found is pretty rare in med school (please if there are other fields like this let me know).

It could also be that because the other fields I'm interested in seem to have a very doom and gloom outlook within the specialty *cough* EM *cough*. Still want to try out some of the other flexible surgery fields like ENT though, but I don't think I'll like it as much. Just wanted to see if anyone else had a similar experience.

 

[libertyyne]

Have you thought about pulmonary-critical care? You have to know a lot of medicine and physiology (like everything you studied for in the Steps), you have ownership of the patient (neurosurg pts are often in the ICU--the surgeon operates but you manage the patient), and there are lots of procedures (lines, intubation, thoracentesis, chest tubes, pleural biopsies, PleurX catheters, bronchoscopies, LPs, paracentesis......)
There is also interventional pulmonology (thoracoscopy is done in the OR for those who likes to go there).
Technology is part of the game: EBUS, navigational bronchoscopy, LASER bronchoscopy.
If you want to follow patients longitudinally, there is clinic.
Lifestyle is not as harsh as neurosurgery. IR can be challenging. Where I work, they are often doing procedures late into the night and on weekends.

I dont know if i would like ICU since i have not had the ability to rotate in ICU settings besides neurosurgery.
I am not sure if I am a fan of shift work, and this might be sampling error, but every intensivist i have met has been miserable/ unhappy compared to the neurosurgeon attendings that are relatively happy. I also dont like the nature of IM where they obsess over things that ultimately do not impact patient outcomes, like a trend of a lab value that is within the margin of error of the test itself. In my experience surgeons seem to cut out all of the background noise that does not impact the patient and focus on what matters in terms of getting the patient to the next step.

 

[libertyyne]

I don't have much experience to offer for OP here as he has already gotten advice from people way more knowledgable than me, but just wanted to ask: Am I the only one who has been surprised by the hours of some of the surgical specialties?

For example, I came in interested in ortho, expecting the worst and realizing that even though I was interested in it that I wouldn't do it because I wanted a healthy family life. The more I've shadowed and talked to residents, the more I've actually been pulled towards it. I feel like the horror stories (at least from what I've seen) are pretty few and far between. Most of the residents said when not on trauma they'd be home between 3-6 and all of them that I talked to had multiple kids. And that's in residency. After residency, from what I understand, if you're fine with taking a pay cute, you can pretty much fit your schedule however you like. Obviously, I want to get a bigger sample size, but so far I feel myself being more drawn to it. I also feel like every resident/attending I've talked to has genuinely been a normal person which I have found is pretty rare in med school (please if there are other fields like this let me know).

It could also be that because the other fields I'm interested in seem to have a very doom and gloom outlook within the specialty *cough* EM *cough*. Still want to try out some of the other flexible surgery fields like ENT though, but I don't think I'll like it as much. Just wanted to see if anyone else had a similar experience.

I was very much surprised at this as well. Dont get me wrong, the first three or so years of neurosurgery residency are going ot be miserable. But even then all the residents seemed to know what was going on in pop-culture, or had watched the witcher, or had families . The horror stories make it seem like things like that would not be possible. The attending hours are definately better, provided i dont see them come in to the hospital in the middle of the night. And a lot of the hours were self imposed like starting 8 hour elective cases at 3pm. on the flipside sometimes they are out of the hospital before noon.

 

[Dr G Oogle]

Could anyone define the surgical itch? I am unsure if i really have it. I like throwing in sutures as much as the next guy, i got to problem solve with an attending during a surgery the other day for the first time and that felt like a lot of fun.

the itch is the feeling of not being able to wait to go back to OR as your throwing the last stitch on your case, being excited to go to work every morning and perhaps most importantly the satisfaction of seeing your patients improve/do well through their initial meeting with you to the last postop visit. I just don’t think IR has a lot of that last part. To be sure there will always be grateful patients, but at the end of the day IR is a tertiary referral specialty without control or affiliation with any specific disease process and far fewer patients think of the IR as “their doctor” than they do the surgeon. IR definitely has their hero moments and I think the future is very bright for them and they will become a more known and respected specialty by lay people which also “scratches a certain itch” but a surgeon will always have a different place on the hierarchy, they bring in patients but IR, while providing a necessary service, do not.

 

[AnatomyGrey12]

Which did the wife prefer, upbeat and home at 9pm or grumpy from 2-3pm?

Happy and home at 9 and it isn’t even close.

 

[Scrubs101]

Be me on a surgery rotation:
Anyone: “howd your day go?!”
Me: rants for 90mins about how cool it was to hold the leg being sawed off, hold retractors and observe, or merely just be present in the OR for a certain case

Be me on a non-surgical rotation:
Anyone: “howd your day go?!”
Me internally: *oh my god im drawing a blank what even happened today? Did i black out?*
me: “it was alright”

im assuming this is the itch? Or maybe im just being roofied on my non-surgical rotations idk

 

[Neopolymath]

Surgical itch would be better compared between how you feel on procedural services versus surgical services. Not liking clinic doesn't mean you have the surgical itch. It just makes you sane lol. You have to decide if operating is irreplaceable or it procedures would scratch the "do something" itch. If you didn't feel the difference then honestly it probably isn't there and you just hate non procedural specialties.

 

[HuskyMD Emeritus]

I dont know if i would like ICU since i have not had the ability to rotate in ICU settings besides neurosurgery.
I am not sure if I am a fan of shift work, and this might be sampling error, but every intensivist i have met has been miserable/ unhappy compared to the neurosurgeon attendings that are relatively happy. I also dont like the nature of IM where they obsess over things that ultimately do not impact patient outcomes, like a trend of a lab value that is within the margin of error of the test itself. In my experience surgeons seem to cut out all of the background noise that does not impact the patient and focus on what matters in terms of getting the patient to the next step.

Small sample size is a problem.
1. Most of my pulm-ccm colleagues are happy and brilliant clinicians with family life, hobbies and nonmedical interests.
2. The neurosurgeons I worked with are burned out to the point of leaving. We ended up not having neurosurgery in the hospital and have to refer away.
3. Not all pulm-ccm work is shift work, depends on your hospital and group. There is no shift work in clinic. I don't do shift work.
4. Doctor, not just IM, who obsess over minute details that have no impact on outcomes and irrelevant lab trends do not survive. I have seen this.
Not necessarily defending my specialty, just giving you another perspective from years in the field.
You have to do what you are interested in and I agree gut feelings are important too (my daughter chose gen surg!!).
Medicine is a great career choice. Good luck to all of you.

 

[Gilakend]

Small sample size is a problem.
1. Most of my pulm-ccm colleagues are happy and brilliant clinicians with family life, hobbies and nonmedical interests.
2. The neurosurgeons I worked with are burned out to the point of leaving. We ended up not having neurosurgery in the hospital and have to refer away.
3. Not all pulm-ccm work is shift work, depends on your hospital and group. There is no shift work in clinic. I don't do shift work.
4. Doctor, not just IM, who obsess over minute details that have no impact on outcomes and irrelevant lab trends do not survive. I have seen this.
Not necessarily defending my specialty, just giving you another perspective from years in the field.
You have to do what you are interested in and I agree gut feelings are important too (my daughter chose gen surg!!).
Medicine is a great career choice. Good luck to all of you.

Did you love IM going into residency? Or did you know you wanted to do pulm-ccm and IM was a means to an end?

 

[FindersFee5]

Which did the wife prefer, upbeat and home at 9pm or grumpy from 2-3pm?

She wants me to be excited about what I do. We have had a lot of conversations about family and how there will be times that it's really difficult and she'll essentially be a single parent. I can't predict the future - it could definitely become a source of friction. But me going into a field I'm less interested in could become a source of friction too. So we'll just try to keep our communication open and cross that bridge when we get to it.

 

[Splenda88]

I am 28 years out of medical school. 2 close friends/classmates who ended up in diagnostic radiology. Both rich. Both agree their job feels like “factory work”.

How so? These rad docs have arguably the best clinical job in the hospital. They are somewhat immune from the day-to-day BS that go on in the hospital while making 400-500k/yr with 8-10 wks vacation.

 

[Splenda88]

I dont know if i would like ICU since i have not had the ability to rotate in ICU settings besides neurosurgery.
I am not sure if I am a fan of shift work, and this might be sampling error, but every intensivist i have met has been miserable/ unhappy compared to the neurosurgeon attendings that are relatively happy. I also dont like the nature of IM where they obsess over things that ultimately do not impact patient outcomes, like a trend of a lab value that is within the margin of error of the test itself. In my experience surgeons seem to cut out all of the background noise that does not impact the patient and focus on what matters in terms of getting the patient to the next step.

You definitely won't like IM... IM is the intellectual masturbation specialty where almost everyone is showing off their intellectual prowess in almost everything non surgical.

 

[nimbus]

How so? These rad docs have arguably the best clinical job in the hospital. They are somewhat immune from the day-to-day BS that go on in the hospital while making 400-500k/yr with 8-10 wks vacation.

They’ve made much more than that over the years. But it’s a high volume of not very stimulating work. One uses the “drinking from a fire hose” analogy.

 

[NeuResurgens]

The way I've heard it described: At 3pm on Friday, you know you'd rather spend the next 6 hours in an OR than the next 2 hours at table rounds, or in a reading room, or in outpatient/clinic.

Yep. Have this itch. Can confirm. If you like the OR and hate table rounding (or even worse: walk rounds with an attending), surgery could be a fit

 

[Chlorini]

@libertyyne...I relate to a lot of what you've written.

I agonized about my speciality selection for most of medical school (and tbh, I still agonize about it). I fluctuated between OB/GYN and ortho for most of the time and then picked rads at the end of MS3 after only shadowing for 3 days. I applied to DR and I plan on specializing in breast imaging. If I hate it, or if I don't get my procedural fix through mammo, I plan on doing IR. Luckily I don't have to decide until R2.

It took me a long time to figure out why I was hesitant to drop ortho and choose another field. It boiled down to a few things:

1). My ego. Being a radiologist isn't sexy. No one goes "wooooww" when you say you're a radiologist. Some people don't even know radiologists are physicians. I hate to admit it, but I imagined myself as a sexy badass ortho chick surgeon, chopping off legs, playing with power tools, etc. However, when I stepped away from that egotistical image of myself and how I wanted others to see me, and realized that idea was what was keeping me from another career I could enjoy just as much or even more, it seemed silly. I was able to let go of that--you may not. Sure, people WILL go "wow!" when you say you're a neurosurgeon. But then they'll go back to thinking about what they want for lunch. Make sure your desires to do neurosurgery are not rooted in ego alone.

2). I like the OR. I love procedures, I always will. But I don't LOVE the OR. When the clock hits 5 PM, I want to go home.

3). I value predictability. I want to know what my day will look like. I hated my MS3 year and not because I don't like medicine--I hated not knowing when I would get to go home. Will I get home in time to take my daughter to dance? Who will pick up my kids from school? Will I get to go to the gym? Am I going to be able to cook dinner? This led me to radiology and other shift-based fields.

4). I have two kids. I know I will never regret choosing them over ortho or another surgical sub-speciality. If I didn't have kids, I may have done ortho. But I do.

5). You will not find happiness from external means. I know this for a fact--I lived in Maui for 3 years after undergrad because I thought living on the beach would make me happy. I started my own business working from home because I thought that would make me happy. I had children early because I thought that would make my happy. I actually went to medical school because I thought that accomplishment would make me happy (hilarious now to think, lol). I expect to like my job, but I don't expect my job as a radiologist to define me or my happiness. I think a lot of people in medicine, esp in specialities like neurosurgery, need neurosurgery to be the source of their happiness/fulfillment. For a single man, I can see why they'd choose neurosurgery. For someone with kids, I really don't get it.

Sorry for the long post, but I think if you tease out the details of why you're deciding between these two fields, maybe the decision gets easier. I know it did for me.

 

[efle]

1). My ego. Being a radiologist isn't sexy. No one goes "wooooww" when you say you're a radiologist. Some people don't even know radiologists are physicians. I hate to admit it, but I imagined myself as a sexy badass ortho chick surgeon, chopping off legs, playing with power tools, etc. However, when I stepped away from that egotistical image of myself and how I wanted others to see me, and realized that idea was what was keeping me from another career I could enjoy just as much or even more, it seemed silly. I was able to let go of that--you may not. Sure, people WILL go "wow!" when you say you're a neurosurgeon. But then they'll go back to thinking about what they want for lunch. Make sure your desires to do neurosurgery are not rooted in ego alone.

2). I like the OR. I love procedures, I always will. But I don't LOVE the OR. When the clock hits 5 PM, I want to go home.

3). I value predictability. I want to know what my day will look like. I hated my MS3 year and not because I don't like medicine--I hated not knowing when I would get to go home. Will I get home in time to take my daughter to dance? Who will pick up my kids from school? Will I get to go to the gym? Am I going to be able to cook dinner? This led me to radiology and other shift-based fields.

5). You will not find happiness from external means. I know this for a fact--I lived in Maui for 3 years after undergrad because I thought living on the beach would make me happy. I started my own business working from home because I thought that would make me happy. I had children early because I thought that would make my happy. I actually went to medical school because I thought that accomplishment would make me happy (hilarious now to think, lol). I expect to like my job, but I don't expect my job as a radiologist to define me or my happiness. I think a lot of people in medicine, esp in specialities like neurosurgery, need neurosurgery to be the source of their happiness/fulfillment. For a single man, I can see why they'd choose neurosurgery. For someone with kids, I really don't get it.

Don't have kids, but otherwise I grok every one of these. Well put.

Especially #5 - I'm realized I'm very content at baseline, and the only time in my life I've felt unhappy and stressed was during the life-consuming blocks like Medicine and Surgery and Dedicated.

None of the lifestyle specialties are sexy like surgery, but ego will never replace loved ones and friends and hobbies.

 

[Splenda88]

Neurosurgeons can make 800k to 1 mil... Can IR docs make that much?

If you are undecided about 2 specialties, choose the one with better pay and lifestyle? After a few years, everything becomes routine anyway...

 

[Dr G Oogle]

Neurosurgeons can make 800k to 1 mil... Can IR docs make that much?

If you are undecided about 2 specialties, choose the one with better pay and lifestyle? After a few years, everything becomes routine anyway...

Yes IR docs can make that much if they hustle

 

[slowthai]

Just addressing #2 for other people reading this, but for a lot of the surgical subspecialties leaving at 5pm isn't a crazy concept. As an attending you might do 7am to 5pm five days a week (50hrs) plus call. Many subspecialists do 2 days OR, one day procedure clinic, 2 days clinic (some may do 3-1-1). On clinic days you are definitely out by 5pm and most OR days will end on time. I've met many female residents who have multiple kids (some they had during their senior residency years) and aren't worried about the balance. I have mentors who are fathers that make it home to be with their kids at least 5/7 days of the week

General surgery, neurosurgery, vascular, CT, and maybe trauma are the big ones that won't follow that schedule and would be more difficult. Residency is more hectic hourwise than attendinghood, but that's the same for residency in most specialties. Being an attending is a different story

I have always heard that it takes a while to get to this point though, whether in academia or private practice. You have to "build your practice" before you can enjoy those hours.

 

[Dr G Oogle]

I have always heard that it takes a while to get to this point though, whether in academia or private practice. You have to "build your practice" before you can enjoy those hours.

i can’t speak for PP but in academics your hours are much better while you’re building your practice because you don’t have casesto do and patients to see. When i started I was seeing like 8-10 patients a day and my first surgery wasn’t until a few weeks after I started. Now I’m seeing between 20-30 patients per day with 2-5 procedures in clinic and have 1.5 OR days doing between 3-8 surgeries. My hours are worse now . But I still get home by 630 at the latest. There maybe some places that make you take more call while you’re building but I think that’s pretty rare as it would be unfair to the new junior attending.

you can make your schedule however you want work less and make less or work more and pay more

 

[TheVagüs]

That's got ortho written all over it bro.

I just wanted to follow up on this, as after getting more exposure during my surgery rotation I'm now 100% in on ortho. So you nailed it lol.

Note to all the undecided MS1, MS2, and MS3, always keep an open mind. Ortho wasn't even on my radar until 3rd year, and I didn't really get the exposure I needed until my 4th rotation.

 

[DeucesHigh3]

Someone who can grind through that many Anki reviews has what it takes to do DR. The job involves rapid-fire retrieving diverse medical knowledge at random all day nonstop.

No joke. I have an Anki deck of ~5000 cards, specific to rads and which I've created myself, that I still rotate through as a 4th year Radiology resident even after the board exams. If you like crushing a deck (particularly if they are image-rich!), this is the field for you.

 

[Chlorini]

No joke. I have an Anki deck of ~5000 cards, specific to rads and which I've created myself, that I still rotate through as a 4th year Radiology resident even after the board exams. If you like crushing a deck (particularly if they are image-rich!), this is the field for you.

Can you share it?

 

[libertyyne]

No joke. I have an Anki deck of ~5000 cards, specific to rads and which I've created myself, that I still rotate through as a 4th year Radiology resident even after the board exams. If you like crushing a deck (particularly if they are image-rich!), this is the field for you.

can you pm me this deck ? would like to be prepared for my elective coming up.

 

[Ho0v-man]

No joke. I have an Anki deck of ~5000 cards, specific to rads and which I've created myself, that I still rotate through as a 4th year Radiology resident even after the board exams. If you like crushing a deck (particularly if they are image-rich!), this is the field for you.

can you pm me this deck ? would like to be prepared for my elective coming up.

Can I get on this train?

 

[Scrubs101]

No joke. I have an Anki deck of ~5000 cards, specific to rads and which I've created myself, that I still rotate through as a 4th year Radiology resident even after the board exams. If you like crushing a deck (particularly if they are image-rich!), this is the field for you.

Gonna jump on this train. Sauce plz

 

[Cognovi]

How much would you pay for a rads anki deck?

 

[libertyyne]

How much would you pay for a rads anki deck?

Approximately zero dollars.

 

[Neopolymath]

How much would you pay for a rads anki deck?

About tree fiddy but I absolutely want one as well

 

[Ho0v-man]

How much would you pay for a rads anki deck?

I will pay in likes. I will now extend a down payment.

 

[redsox93]

I downloaded one I found on reddit. It’s way over my head but I’ll find the link and post it

 

[redsox93]

 

[TheVagüs]

I just wanted to follow up on this, as after getting more exposure during my surgery rotation I'm now 100% in on ortho. So you nailed it lol.

Note to all the undecided MS1, MS2, and MS3, always keep an open mind. Ortho wasn't even on my radar until 3rd year, and I didn't really get the exposure I needed until my 4th rotation.

just kidding fam. I couldn't let neurosurgery go. If it doesn't work out then so be it, but I would regret it forever if I didn't try to do what I loved the most. see you on the trail (or whatever we're calling it this year) libertyyne

 

[slowthai]

just kidding fam. I couldn't let neurosurgery go. If it doesn't work out then so be it, but I would regret it forever if I didn't try to do what I loved the most. see you on the trail (or whatever we're calling it this year) libertyyne

What made you decide to go back to neurosurgery?

 

[TheVagüs]

What made you decide to go back to neurosurgery?

A few things. I agonized for a long time about the commitment, but I realized:

1) Ortho residency is hard too. If I'm willing to grind out a residency in ortho, then working a bit more each week in something I find a lot more interesting is a no-brainer.

2) I had multiple mentors tell me recently I can have a happy life with my family as a neurosurgeon, as long as I make it a priority. I don't have a ton of hobbies. I keep a small circle of friends. When I imagine my life as just family and work I'm happy with that outcome. Like libertyyne mentioned though, the junior years will suck ass no matter what. I've accepted that.

3) Some of the initial shine/newness of orthopedics wore off, and I find neuroanatomy and pathophys much more interesting than MSK. Always have. I tried checking out the ortho literature regularly, but I just couldn't get into it. I also just couldn't get behind the aggressive disinterest some of the pods had with respect to being doctors. I don't want to forego all my medicine. I don't want to be a hyperspecialized technician (no offense to my ortho bros/gals, it's just what I've seen here)

4) Lastly, gut feeling played a big role. I wasn't excited putting my 4th year together for ortho. I didn't feel the butterflies in my stomach when I envisioned residency and beyond. I just didn't have the fire in my belly like before, and I was dragging my feet. The minute I started thinking nsurg again I felt awake and started making moves.

In the end, I spent a long time trying to convince myself I would be happy with anything else, and I just couldn't do it. Don't get me wrong, I'm as terrified as I am excited for residency, but it feels right

Ask me again in a few years when I'm juggling call and an infant with a resident spouse lol

That was probably more than you wanted, but those are my thoughts.

 

[NeuResurgens]

A few things. I agonized for a long time about the commitment, but I realized:

1) Ortho residency is hard too. If I'm willing to grind out a residency in ortho, then working a bit more each week in something I find a lot more interesting is a no-brainer.

2) I had multiple mentors tell me recently I can have a happy life with my family as a neurosurgeon, as long as I make it a priority. I don't have a ton of hobbies. I keep a small circle of friends. When I imagine my life as just family and work I'm happy with that outcome. Like libertyyne mentioned though, the junior years will suck ass no matter what. I've accepted that.

3) Some of the initial shine/newness of orthopedics wore off, and I find neuroanatomy and pathophys much more interesting than MSK. Always have. I tried checking out the ortho literature regularly, but I just couldn't get into it. I also just couldn't get behind the aggressive disinterest some of the pods had with respect to being doctors. I don't want to forego all my medicine. I don't want to be a hyperspecialized technician (no offense to my ortho bros/gals, it's just what I've seen here)

4) Lastly, gut feeling played a big role. I wasn't excited putting my 4th year together for ortho. I didn't feel the butterflies in my stomach when I envisioned residency and beyond. I just didn't have the fire in my belly like before, and I was dragging my feet. The minute I started thinking nsurg again I felt awake and started making moves.

In the end, I spent a long time trying to convince myself I would be happy with anything else, and I just couldn't do it. Don't get me wrong, I'm as terrified as I am excited for residency, but it feels right

Ask me again in a few years when I'm juggling call and an infant with a resident spouse lol

That was probably more than you wanted, but those are my thoughts.

#1 and 2 are what I tell people about neurosurg too. 7 years of training, woah! But look at other specialties. Cardio is at least 6 years. GI likely too. And pulm/CC. Then if you subspecialize within those it's more training. Most GS residencies have lengthened to 7 years by now, and if you want academics you'll have to do a fellowship on top of that anyway. CT surgery takes a while. Hell even IM subspecialties are at least 5 years for the more medically inclined ones (rheum, allergy, etc). Training really isn't as short in other specialties as people make it.

Residency is more brutal for 7 years though, for sure. But once you're an attending you have more leeway over what you want your lifestyle to look like than people think. In any case glad you've joined the train, there's nothing quite like those nsgy butterflies when you feel it

 

[slowthai]

That was probably more than you wanted, but those are my thoughts.

No, it was great. Thanks for your thoughts.

 

[sovereign0]

Struggled with a lot of the same things people have been discussing in this thread throughout medical school, bouncing between DR/IR, NSG, vascular, and anesthesia. I matched neurosurgery this year.

The one thing I'll add is that there is a LOT of difference among neurosurgery training programs in philosophy and lifestyle. Let me be clear - no neurosurgery training program is going to be easy. You will likely be the first in the parking lot and the last one to leave for 7 years. With that said, there's still a lot of differences between programs. The "old way" of q2-3 call with no post-call day and covering multiple hospitals still exists, but it is now the minority. There's only a handful of places like that left, but believe it or not they're actually pretty sought-after residency spots because their reputations mean that their graduates are very well-regarded in academics. Most other programs are a lot more reasonable in what their residents do during training - q4-6 call with a true post-call day, midlevel support to help with managing consults, ancillary support to minimize scut work, etc. The notion of work without proportional educational value is a bit stranger than perhaps it once was.

 

[Minimal Charge Disease]

OP, consider Vascular surgery.

Broad anatomy (neck to toes) where you’d have to be a maestro of dissection for open cases and a wizard for endo techniques. Hybrid options in the works as we speak.

tons of opportunity to get involved in device/industrial/imaging research and you control the gate when it comes to seeing patients as there are no medical counterparts.

If you like trauma, find a residency with interventional cardiologists but you will deal with emergent trauma like situation such as intra-op consults.

income, were one of the top (4th) paid specialties based on surveys in the last two years. You don’t have to worry bout job opportunities.

Lifestyle, it can get real crazy but you have the option to tone down and do dialysis access/veins albeit taking a good pay cut ( still pretty freaking good money).

 

[TheVagüs]

A few things. I agonized for a long time about the commitment, but I realized:

1) Ortho residency is hard too. If I'm willing to grind out a residency in ortho, then working a bit more each week in something I find a lot more interesting is a no-brainer.

2) I had multiple mentors tell me recently I can have a happy life with my family as a neurosurgeon, as long as I make it a priority. I don't have a ton of hobbies. I keep a small circle of friends. When I imagine my life as just family and work I'm happy with that outcome. Like libertyyne mentioned though, the junior years will suck ass no matter what. I've accepted that.

3) Some of the initial shine/newness of orthopedics wore off, and I find neuroanatomy and pathophys much more interesting than MSK. Always have. I tried checking out the ortho literature regularly, but I just couldn't get into it. I also just couldn't get behind the aggressive disinterest some of the pods had with respect to being doctors. I don't want to forego all my medicine. I don't want to be a hyperspecialized technician (no offense to my ortho bros/gals, it's just what I've seen here)

4) Lastly, gut feeling played a big role. I wasn't excited putting my 4th year together for ortho. I didn't feel the butterflies in my stomach when I envisioned residency and beyond. I just didn't have the fire in my belly like before, and I was dragging my feet. The minute I started thinking nsurg again I felt awake and started making moves.

In the end, I spent a long time trying to convince myself I would be happy with anything else, and I just couldn't do it. Don't get me wrong, I'm as terrified as I am excited for residency, but it feels right

Ask me again in a few years when I'm juggling call and an infant with a resident spouse lol

That was probably more than you wanted, but those are my thoughts.

...aaaaaand a couple months after this heartfelt post I am back considering rads. I am all tee'd up to apply neurosurgery, but I am struggling to finally commit. I have been reading up and speaking to my mentors, and nobody has been in the position I am in: married, likely to have kids as a junior resident (can't wait much longer due to my age and wife's age), spouse also in medicine and will start residency a year behind me, and coming from a place with no home program so unlikely to control matching in my hometown with family. Either folks had a stay at home spouse or spouse with a chill job, or they had kids after or late in residency, or they were young and single during training. Never all of the above, and my mentor was telling me the people he knew who did have kids in the middle of training struggled to stay afloat and went straight to private practice when they finished, which is not what I am interested in. Training is not what it was, but it is concerning to me that I can't find anyone who had as many things to juggle as I will during residency. I love neurosurgery the most, but I don't want to burn my family and relationships down over those 7-8 years.

I've established that the CNS is my favorite. I am considering going the rads->neurorads->neurointerventional route. It gives me the freedom during residency to start my family, and I can ramp my career back up later down the pipe while still working with the diseases and treatments I am interested in.

I think what has been so agonizing is this is truly the first time in my life I have had to consider genuine compromise regarding a major life decision. Being a neurosurgeon has been my primary career goal for about 10 years, and untangling that from what I want for my life big picture is difficult.

I am a little embarrassed posting this given all my back and forth, but maybe someone later on will read this and it will help them with their own decisions.

 

[TheVagüs]

Also, s/o to libertyyne for letting me occasionally hijack his thread with my bull****. Cheers

 

[DrOrthoSpineMD]

...aaaaaand a couple months after this heartfelt post I am back considering rads. I am all tee'd up to apply neurosurgery, but I am struggling to finally commit. I have been reading up and speaking to my mentors, and nobody has been in the position I am in: married, likely to have kids as a junior resident (can't wait much longer due to my age and wife's age), spouse also in medicine and will start residency a year behind me, and coming from a place with no home program so unlikely to control matching in my hometown with family. Either folks had a stay at home spouse or spouse with a chill job, or they had kids after or late in residency, or they were young and single during training. Never all of the above, and my mentor was telling me the people he knew who did have kids in the middle of training struggled to stay afloat and went straight to private practice when they finished, which is not what I am interested in. Training is not what it was, but it is concerning to me that I can't find anyone who had as many things to juggle as I will during residency. I love neurosurgery the most, but I don't want to burn my family and relationships down over those 7-8 years.

I've established that the CNS is my favorite. I am considering going the rads->neurorads->neurointerventional route. It gives me the freedom during residency to start my family, and I can ramp my career back up later down the pipe while still working with the diseases and treatments I am interested in.

I think what has been so agonizing is this is truly the first time in my life I have had to consider genuine compromise regarding a major life decision. Being a neurosurgeon has been my primary career goal for about 10 years, and untangling that from what I want for my life big picture is difficult.

I am a little embarrassed posting this given all my back and forth, but maybe someone later on will read this and it will help them with their own decisions.

I dont know if youre still considering ortho but a quick plug for lifestyle. Apart from trauma, the hours arent that bad. I met my wife during residency (shes non healthcare) and we obviously got married and started a family. All while I was in residency. I was able to moonlight, I was able to travel, I was able to see my wife most days for dinner minus trauma or some random long days (and of course call).
All of the ortho attendings I know love their job and have pretty good lifestyles. Most PP ortho have atleast 1/2 day a week of protected time to catch up on notes/clinic. Most academics have 1 day "academic" day for research or notes. As a resident you operate a lot but as an attending its not that common to operate more then 2 days a week (again outside of call stuff). PP call I've seen average around 1/6-7. Academic call is way less from what I've seen.

Good luck!