Neurosurgery vs. Ortho

[KendallJennerSniperLady69]

Any attendings, residents, med students that struggled to decide among these two specialties? I believe am competitive for both in terms of grades (only had 1 HP in non med/surg clerkship), but am planning on a research year.

My considerations:
- I 100% want to do surgery, leaning heavily towards reconstructive surgeries that restore function (pro to ortho)
- I would rather be fixing a fracture than evacuating a hematoma in the middle of the night (pro to ortho). My neuro interests would be spine, functional/stereotactic, PNS (in practice I have never seen a peripheral nerve neurosurgeon though lol). My ortho interests are pretty much anything except foot/ankle, but more interest in spine and hand/upper extremity. As far as spine goes, I don't care to work intradurally I think, but I do ideally want access to minimally invasive training opportunities in the future (it seems like neurosurgeons get more of this).
- In terms of pathologies, I like the thought process of "localizing lesions" and understanding where a patient's functional/pain problem is coming from (pro to neuro, but ortho does this too), but again, I prefer that any surgical solutions be reconstructive surgery rather than "cut the problem out" (pro to ortho)
- don't mind long surgeries, but definitely would prefer not to have more short ones ideally (pro to ortho?). Definitely dislike the idea of painfully dissecting out a brain tumor for hours and hours (pro to ortho), but very much am fascinated by the science and the emotional/humanistic aspects of caring for brain tumor patients (pro to neuro). I find caring for cancer patients to be some of the most rewarding experiences in medicine, and I don't know if I want to give this up... I have not seen much of orthopedic oncology.
- My pre-medical school background is in neurobiology, and I love neuroscience (pro to neuro). I think my fantasy career would be studying and treating patients with neuroprosthetics, but this is such a niche field, and it seems like the only people that truly get to apply this are the functional/stereotactic neurosurgeons at the top of the field. I don't fare well with the hustle/politics of academia/research, and so I don't think this will be me realistically. Also, I did scrub a few stereotactic/functional cases, and actually observing those was admittedly much more boring than thinking/reading about them.
- Personally don't care for lifestyle at this moment, but am risk-averse and am inclined to choose a specialty where there are more options for lifestyle flexibility should I want them later down the road. Seems like the most flexible specialty in neurosurgery (spine) is also what many people consider one of the worse lifestyles in ortho (pro to ortho).

I think my biggest hang-up is just that I find the pathologies and science behind neurosurgery much more interesting, but I am not optimistic about the life-style and the actual satisfaction I would gain from treating neurosurgery patients. By far, my overall impression from the internet and from my MS3 rotations (rotated on both neurosurgery and ortho) that ortho surgeons are some of the happiest, easy going surgeons in the hospital, while the neurosurgeons (mainly the residents) just seemed like they've been grinded down by life or something and are just living day-to-day.

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[lanzhou_lamian]

Your ortho pros seem a lot stronger than your neuro pros. There also seem to be more avenues within ortho where you’d be happy. The neuro avenues you mention seem somewhat limited and niche.

 

[LucidSplash]

I think you like the idea of being a neurosurgeon rather than what being a neurosurgeon actually is. This list is all ortho but I suspect there’s something in the perceived prestige and coolness factor of imagining getting to tell people you’re a neurosurgeon that’s making you hang onto that idea.

 

[CJhooper123]

Welcome to ortho my friend

 

[SurfingDoctor]

Do you want to go on vacation or not?!

 

[operaman]

Agreeing with the others - everything you’re saying just screams ortho. Sounds like it will allow you to do everything you want to do and surely has the best lifestyle of the two.

Neurosurg is so brutal you really need to be a true believer who can’t imagine doing anything else to get through it. Your life as the ortho pgy2 will definitely suck, but after that should get better and stay that way. Out of curiosity, I just pulled up my OR board from work and guess who’s in the OR this lovely Saturday morning? Hint: it ain’t ortho.

 

[longhaul3]

you should do ortho based on your post. doesn't sound like there's a clear, realistic path through neurosurgery

brain tumor patients (gliomas and mets) all die and that's not going to change any time soon. the treatments are protocoled and minimally effective. there's not much humanism or neuroscience involved except you have to be good at telling people they're dying. skull base tumors are benign but bad actors and involve the most tedious of all surgeries in modern medicine, guaranteed

your hangup about reconstructive versus resective surgery is arbitrary and sounds naïve. the surgery a patient needs is the surgery he/she needs. if the patient has a malignant tumor, we cut it out...what should we reconstruct it with? spine fusions involve resecting the diseased joints and sometimes discs before reconstructing them. joint reconstruction involves cutting out the diseased joint before replacing it. it's all the same.

but, if you decide you really, really, definitely want to have a career as a spine surgeon, you should do neurosurgery

 

[KendallJennerSniperLady69]

if you decide you really, really, definitely want to have a career as a spine surgeon, you should do neurosurgery

Can you elaborate on why? I've heard this from my neurosurgery spine attendings before, but didn't really hear the opposite from my ortho spine attendings (although my neurosurgery attendings knew I was leaning towards ortho).

I think if I was 100% set on spine surgery, I would choose neurosurgery, but that's not the case. If I were to choose neurosurgery it'd be because I would not want to give up intracranial work.

 

[Kierkegaard's Bud]

Can you elaborate on why? I've heard this from my neurosurgery spine attendings before, but didn't really hear the opposite from my ortho spine attendings (although my neurosurgery attendings knew I was leaning towards ortho).

I think if I was 100% set on spine surgery, I would choose neurosurgery, but that's not the case. If I were to choose neurosurgery it'd be because I would not want to give up intracranial work.

Isn’t it obvious, your nsgy residency will give you more time with spine cases than replacing hip and knees.

 

[LucidSplash]

Can you elaborate on why? I've heard this from my neurosurgery spine attendings before, but didn't really hear the opposite from my ortho spine attendings (although my neurosurgery attendings knew I was leaning towards ortho).

I think if I was 100% set on spine surgery, I would choose neurosurgery, but that's not the case. If I were to choose neurosurgery it'd be because I would not want to give up intracranial work.

Many feel that overall neurosurgery does a better job with spine than ortho. As mentioned above, there is more dedicated time in training to the spine in neurosurgery residency than in orthopedic residency. That is not to say that there can’t be qualified and competent ortho spine surgeons, but I generally prefer to refer patients to neurosurgery when available, as I have witnessed more shady behavior and decision making from ortho spine than from neurosurgery.

 

[longhaul3]

Can you elaborate on why? I've heard this from my neurosurgery spine attendings before, but didn't really hear the opposite from my ortho spine attendings (although my neurosurgery attendings knew I was leaning towards ortho).

I think if I was 100% set on spine surgery, I would choose neurosurgery, but that's not the case. If I were to choose neurosurgery it'd be because I would not want to give up intracranial work.

We do probably an order of magnitude more spine cases than ortho in residency. Something like 70% of neurosurgery cases in the US are spine and I know you mentioned not being interested in intradural surgery but it teaches you skills that apply to spine surgery and microsurgery in general, especially complication management.

"General" neurosurgery still exists but is relatively rare. Not a lot of neurosurgeons regularly doing both complex spine and complex cranial surgery.

 

[Robin-jay]

My ortho interests are pretty much anything except foot/ankle,

Podiatry is vastly superior in foot and ankle anyway. I'm not sure you would see as many foot and ankle surgery cases even if you were interested, so it's probably good you're not.

Sounds like you're into ortho to me.

neurosurgery takes a very special person imo.

 

[lioneljohn]

both specialties are rewarding and impactful, and your choice should reflect where you see yourself being most satisfied and successful in the long run.

 

[VincentAdultman]

I think my biggest hang-up is just that I find the pathologies and science behind neurosurgery much more interesting, but I am not optimistic about the life-style and the actual satisfaction I would gain from treating neurosurgery patients. By far, my overall impression from the internet and from my MS3 rotations (rotated on both neurosurgery and ortho) that ortho surgeons are some of the happiest, easy going surgeons in the hospital, while the neurosurgeons (mainly the residents) just seemed like they've been grinded down by life or something and are just living day-to-day.

The pathology and science being interesting I don’t think is going to help you get through a very demanding residency nor is it going to outweigh the bread and butter stuff you’ll be doing on a day to day basis. If that makes sense.

I like ortho because I like replacing hips and knees and (occasionally) revising them. And fixing fractures. It’s not like I’m sitting here thinking about Endochondral ossification or the OPG/RANKL feedback mechanism.

As far as spine is concerned, I don’t disagree that you’d be better at via NSGY since it’s a numbers game. In a five year residency I did about 6 months of spine. That being said there isn’t a single orthopedic surgeon these days operating on a spine without having done a fellowship first. So that’s a year of being immersed in nothing but spine surgery.

Anyway obviously I’m biased so take fwiw

 

[KendallJennerSniperLady69]

The pathology and science being interesting I don’t think is going to help you get through a very demanding residency nor is it going to outweigh the bread and butter stuff you’ll be doing on a day to day basis. If that makes sense.

I like ortho because I like replacing hips and knees and (occasionally) revising them. And fixing fractures. It’s not like I’m sitting here thinking about Endochondral ossification or the OPG/RANKL feedback mechanism.

As far as spine is concerned, I don’t disagree that you’d be better at via NSGY since it’s a numbers game. In a five year residency I did about 6 months of spine. That being said there isn’t a single orthopedic surgeon these days operating on a spine without having done a fellowship first. So that’s a year of being immersed in nothing but spine surgery.

Anyway obviously I’m biased so take fwiw

appreciate the input and also I enjoy your profile picture lol

 

[VincentAdultman]

appreciate the input and also I enjoy your profile picture lol

It’s a self portrait.