Neurosurgery

[Akr]

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Might be getting ahead of myself here, but just wondering if anyone could tell me anything about neurosurgery, from the Navy HPSP standpoint? Like about the subinternship(s), application process, residency program, active duty opportunities, translation into civilian practice, or anything else? I'm finding hardly anything about it online; I have however talked to an Air Force neurosurgeon who seemed pretty satisfied with his career.
My impression so far is that there are 0 to very few spots per year for the Walter Reed/NCC program, and 0 to few civilian deferments per year. And some older posts here about unfortunately low caseloads in the military setting. So I'm definitely trying to think of other more realistic specialties for me as well, nonetheless I would like some more info & insight if possible.
Right now I'm early into M3. Step 1 score 247. Any responses appreciated!

 

[DeadCactus]

I have no insight or personal knowledge but keep in mind that the lack of spots and deferments may reflect a lack of interest. For a residency that long an a specialty that well-paying, there is a lot of motivation to just payback as a GMO and get out...

 

[DrMetal]

I have no insight or personal knowledge but keep in mind that the lack of spots and deferments may reflect a lack of interest. For a residency that long an a specialty that well-paying, there is a lot of motivation to just payback as a GMO and get out...

It's a good point. Don't do it in the mil. The training is ok at best (they will farm you out to other places to get better training, as this is a common theme in the surgical residencies). But the actual practice of it seems to be less than fulfilling in the military. If you can work it financially, I'd GMO and do it in the civilian world. If you've got numbers, you're likely to get a spot somewhere, as opposed to having to fight for the one spot at Walter Reed.

 

[Akr]

Thanks for the advice! It does make sense, what you're saying... Even the one military neurosurgeon I've talked to has his work somehow divided between civilian practice and military.

Well, hopefully I will figure out the best way for me to go about it. Within the next several months I want to have a pretty clear idea, as I line up 4th year rotations...

 

[Handsome1]

Navy is overmanned in neurosurgery but AF/Army are severely undermanned so the .mil is stretched somewhat thin. That being said, I personally know two Navy guys given straight through training deferments my year. There is 1 possible "in house" Navy slot (army has UF and UT-San Ant). Also keep in mind if you do NCC then you have added to your commitment as you now owe 7. If you are straight through person you'd be done with the military at 40 the earliest. If you do a GMO tour it could be longer. A deferment would be ideal in not adding. Not doing a fellowship right out might be an issue too. I don't really know about that. You could do a GMO tour and bounce depending upon your love for the miltiary but do not underrestimate how awful neurosurgery residency is and how much more awful it could be as you get older in life.... wife, kids, dealing with the absolute crap. Just do the best you can and make sure you know what you are getting into. I am not active duty so I have no real knowledge there about case load but it is rumored to be lower. I have no knowledge on transition out of mil.

I can say wholeheartedly that military neurosurgeons are some of the most dedicated
physicians I have had the honor of meeting. Honestly, inspiring. (....i have not completed my training yet and dont count myself amount them)

 

[Akr]

Navy is overmanned in neurosurgery but AF/Army are severely undermanned so the .mil is stretched somewhat thin. That being said, I personally know two Navy guys given straight through training deferments my year. There is 1 possible "in house" Navy slot (army has UF and UT-San Ant). Also keep in mind if you do NCC then you have added to your commitment as you now owe 7. If you are straight through person you'd be done with the military at 40 the earliest. If you do a GMO tour it could be longer. A deferment would be ideal in not adding. Not doing a fellowship right out might be an issue too. I don't really know about that. You could do a GMO tour and bounce depending upon your love for the miltiary but do not underrestimate how awful neurosurgery residency is and how much more awful it could be as you get older in life.... wife, kids, dealing with the absolute crap. Just do the best you can and make sure you know what you are getting into. I am not active duty so I have no real knowledge there about case load but it is rumored to be lower. I have no knowledge on transition out of mil.

I can say wholeheartedly that military neurosurgeons are some of the most dedicated
physicians I have had the honor of meeting. Honestly, inspiring. (....i have not completed my training yet and dont count myself amount them)

Thanks so much for your response!
Maybe Navy being overmanned in neurosurgery doesn't bode so well for my interest in it... Anyway, aside from that, I'm hoping that my next 2 rotations (gen surg followed by neurosurg) will really help me know what I'd be getting into and test how much I want to pursue it, like you advised.
I have not really considered the GMO-and-out route much before now. I will look into that some more as well, before I go all in on whatever decisions I make. Thanks again for the advice!

 

[orbitsurgMD]

Thanks so much for your response!
Maybe Navy being overmanned in neurosurgery doesn't bode so well for my interest in it... Anyway, aside from that, I'm hoping that my next 2 rotations (gen surg followed by neurosurg) will really help me know what I'd be getting into and test how much I want to pursue it, like you advised.
I have not really considered the GMO-and-out route much before now. I will look into that some more as well, before I go all in on whatever decisions I make. Thanks again for the advice!

You should know that NS is one of the most difficult fields to match because of the extremely low number of available training slots in service. You might do better in outservice/ deferral, but even then, not easy. The single Navy slot was known to be beyond competitive, such that unless you were connected politically within the Navy (senior Admiral in the family) or were a stellar USNA grad, you weren't considered.

 

[Akr]

You should know that NS is one of the most difficult fields to match because of the extremely low number of available training slots in service. You might do better in outservice/ deferral, but even then, not easy. The single Navy slot was known to be beyond competitive, such that unless you were connected politically within the Navy (senior Admiral in the family) or were a stellar USNA grad, you weren't considered.

Thanks... I definitely want to know this before possibly investing my away rotations, etc. I'm not connected with Navy Admirals or from USNA...

I guess most people would do their 2 ADTs and then get 1 shot at a civilian away rotation, if they were also ranking deferment in whatever specialty? Depending on what their school allows. Seems like not much room for having backup plans :/

 

[redsquareblack]

It's a good point. Don't do it in the mil. The training is ok at best (they will farm you out to other places to get better training, as this is a common theme in the surgical residencies). But the actual practice of it seems to be less than fulfilling in the military. If you can work it financially, I'd GMO and do it in the civilian world. If you've got numbers, you're likely to get a spot somewhere, as opposed to having to fight for the one spot at Walter Reed.

I can tell you that the training at WR is excellent.

The level of autonomy is also impressive.

However, it is true that you will go to other places. They don't do a lot of trauma, so you'd be going to Shock Trauma. For tumors, you'd be going to NIH. I could think of worse places to fill in your training.

 

[DrMetal]

I can tell you that the training at WR is excellent.

I don't doubt that the training is good. But the question is, what comes after that? You'll train for 7 years, getting all of your necessary numbers. Then what are you gonna do for the next 20 years, when you hardly have enough casese (and a diversity of cases) to go around? You'll watch your skills atrophy away, you'll be disgruntled because you'll become a crappy, underpaid neurosurgeon. The Milmed can be a great place to practice certain specialties, but NS is not one of them, in my opinion.

The level of autonomy is also impressive.

I'm not so sure that 'impressive' is the right word. 'Dangerous' seems more like it. In my short time on the NS service at WR, I observed some very cavalier residents almost kill several patients because of gross surgical technique and poor floor management. Now, I know we expect most surgeons to be a little cavalier and bad at floor scutwork (tongue in cheek as i write this) . . .but these guys were especially bad , and their staff seemed to have no idea what was going on. I'm not sure if all NS departments are like that . . . i hope not.

 

[bustbones26]

I can tell you that the training at WR is excellent.

The level of autonomy is also impressive.

However, it is true that you will go to other places. They don't do a lot of trauma, so you'd be going to Shock Trauma. For tumors, you'd be going to NIH. I could think of worse places to fill in your training.

The level of autonomy in military surgical training is great; however, for neurosurgery, the problem is volume. I recall years ago that I had to do a month of neurosurgery as a resident. At that time, there was a reservist backfilling who happened to be an attending at a university based residency program. The other attending was bragging to an intern that during his chief year at WR he got to do 300 cases all by himself!! The reservist sort of chimed in, "Is that all, gee my residents do well over 1000 during their chief year".

That being stated, I will not bash WR. The I am sure that the training is solid and yes, the residents will be farmed out to sister institutions to enhance their training as needed.

 

[Akr]

Thanks for the comments!

I'm not sure what to make of it all... Overmanned status in Navy, but undermanned across the military in general, yet also low caseload at WR (and also in active duty?)... Hopefully I will also be able to judge for myself the quality of the training experience there, should I be so lucky to get to the point of neurosurg sub-I for my ADT (on that note, any ideas on how difficult or selective it is to get an MS4 rotation there? Or how many students go through per year?)

 

[tiredmildoc]

Thanks for the comments!

I'm not sure what to make of it all... Overmanned status in Navy, but undermanned across the military in general, yet also low caseload at WR (and also in active duty?)... Hopefully I will also be able to judge for myself the quality of the training experience there, should I be so lucky to get to the point of neurosurg sub-I for my ADT (on that note, any ideas on how difficult or selective it is to get an MS4 rotation there? Or how many students go through per year?)

Military Neurosurgery followed closely by CT surg is perhaps the worst surgical sub in the military. The case loads and complexity and astoundingly poor. I have made it clear to my coworkers that they will be transferring me to a civilian institution if I ever need my head cracked.

 

[Akr]

Military Neurosurgery followed closely by CT surg is perhaps the worst surgical sub in the military. The case loads and complexity and astoundingly poor. I have made it clear to my coworkers that they will be transferring me to a civilian institution if I ever need my head cracked.

:/ That bad eh? Thanks for the response though. I have been seriously considering other specialties more closely, in part because of comments like these... I'll still follow through with my upcoming neurosurg elective and talk it over with some advisors in person before scrapping the idea.

Just out of curiosity, do you say that based on experience/anecdotes from more than 1 facility or branch? Any more details or example that you could give about it?

 

[DrMetal]

:/ That bad eh? Thanks for the response though. I have been seriously considering other specialties more closely, in part because of comments like these... I'll still follow through with my upcoming neurosurg elective and talk it over with some advisors in person before scrapping the idea.

Just out of curiosity, do you say that based on experience/anecdotes from more than 1 facility or branch? Any more details or example that you could give about it?

If you're serious about it, in addition to doing an audition tour at Walter Reed during your 4th year, I'd also rotate at some civilian programs. Then you might be able to make a contrast between military and civilian NS departments (my guess is that the latter would be far more superior, in terms of #/diversity of cases, quality of the staff in terms of surgical techniques, knowledge and patient management . . . that's just my guess though, i have no hard evidence to back that up). You could then apply to civilian programs (thus asking for a civilian deferment). It's difficult to say whether you'll get it or not (the WR spot, or a deferment for a civilian program). If you're a single guy/gal without any strings and don't care about the pay cut, I'd shoot for the civilian route.

 

[tiredmildoc]

:/ That bad eh? Thanks for the response though. I have been seriously considering other specialties more closely, in part because of comments like these... I'll still follow through with my upcoming neurosurg elective and talk it over with some advisors in person before scrapping the idea.

Just out of curiosity, do you say that based on experience/anecdotes from more than 1 facility or branch? Any more details or example that you could give about it?

Army, and Navy, several institutions.

Don't get me wrong - I am not implying military Neurosurgeons are poor but the low volume, lack of anesthesia and post op support sets them and more importantly their patients up for poor outcomes. I've never ever met a military neuro or CT surgeon who was happy with their practice environment. As of yet, I have never worked with a Neurosurgeon who stayed beyond their commitment.

The one CT surgeon I saw stay was referred to as having "hands of stone".

 

[DrMetal]

Army, and Navy, several institutions.

Don't get me wrong - I am not implying military Neurosurgeons are poor but the low volume, lack of anesthesia and post op support sets them and more importantly their patients up for poor outcomes. I've never ever met a military neuro or CT surgeon who was happy with their practice environment. As of yet, I have never worked with a Neurosurgeon who stayed beyond their commitment.

The one CT surgeon I saw stay was referred to as having "hands of stone".

Well said. I as well don't mean to disparage military NS/CT surgeons. We just have to accept the fact that the military is not a good place to practice certain specialties (these being some of them . . . others are very-much debatable).

 

[Akr]

Army, and Navy, several institutions.

Don't get me wrong - I am not implying military Neurosurgeons are poor but the low volume, lack of anesthesia and post op support sets them and more importantly their patients up for poor outcomes. I've never ever met a military neuro or CT surgeon who was happy with their practice environment. As of yet, I have never worked with a Neurosurgeon who stayed beyond their commitment.

The one CT surgeon I saw stay was referred to as having "hands of stone".

Wow... that is terrible.

If you're serious about it, in addition to doing an audition tour at Walter Reed during your 4th year, I'd also rotate at some civilian programs. Then you might be able to make a contrast between military and civilian NS departments (my guess is that the latter would be far more superior, in terms of #/diversity of cases, quality of the staff in terms of surgical techniques, knowledge and patient management . . . that's just my guess though, i have no hard evidence to back that up). You could then apply to civilian programs (thus asking for a civilian deferment). It's difficult to say whether you'll get it or not (the WR spot, or a deferment for a civilian program). If you're a single guy/gal without any strings and don't care about the pay cut, I'd shoot for the civilian route.

Yeah... I'd basically have to apply civilian in any case, right? If I wanted more chances than just the one WR position to match into neurosurgery. The question would be whether to rank deferment at the top or not - you all are making a pretty good case for ranking deferment higher (if neurosurgery at all)! Also, I don't really know how slim my chances will be either way.

Again, thanks for all the comments.

 

[C5H9NO4]

MilMed Neurosurgery Mentor? Anyone?

Hi all,

I am in need of a mentor who knows a thing or two about MilMed Neurosurgery.

I am a non-traditional pre-med interested in neurosurgical training and military medicine. I was accepted to USUHS and some schools in Boston and California. In order to evaluate these options, I would like to talk to someone who is a neurosurgeon in the military.

Can someone put me in contact with a military neurosurgeon so that he/she can share his thoughts about his career in the military and opinions on my options?

Thank you for your attention,

Cheers!

 

[DrMetal]

MilMed Neurosurgery Mentor? Anyone?

Hi all,

I am in need of a mentor who knows a thing or two about MilMed Neurosurgery.

I am a non-traditional pre-med interested in neurosurgical training and military medicine. I was accepted to USUHS and some schools in Boston and California. In order to evaluate these options, I would like to talk to someone who is a neurosurgeon in the military.

Can someone put me in contact with a military neurosurgeon so that he/she can share his thoughts about his career in the military and opinions on my options?

Thank you for your attention,

Cheers!

By any chance, did you read any of this thread that you bumped?! If you're pre-med, meaning you haven't gone to medical school yet, and you're dead set on neurosurgery....your best bet is to pursue the civilian route. Come into the military after you're done with residency.

 

[psychbender]

If you are set on being a neurosurgeon, and not already committed to the military through USUHS or HPSP, then it would be in your best interest to train as a civilian, then join later (via FAP) or become a GS contract physician, if you are still interested in serving our soldiers. The training pathway is very long for a neurosurgeon, and that will commit you to a very long payback period, in which you will not see the volume or acuity that you likely want and need to see. Very few MTFs have neurosurgeons, and those that do can still barely justify having neurosurgeons, as the referral volume for surgical cases (aside from lower-acuity back surgery) is just not there. The surgeons where I did residency operated rarely, and were moonlighting extensively, to augment both their skills and their income. If you have other options, take them, and leave the sole military NS residency spot for those unfortunate souls that are already in the system and decided that they can only be happy as neurosurgeons.

 

[HighPriest]

Just echoing the above. I only have experience with Army NS, and I have worked with three. Two wanted to do intracranial cases, but simply didn't have the volume and spent most of their time doing spine. One essentially doesn't want to do cranial cases at all, and only does spine. If you want to do neurosurg in the Army, just do Ortho Spine. You'll be happier. Some of the issue was case volume, but a lot of it was poor support from anesthesia or the ICU (being uncomfortable caring for these patients, which basically goes back to case numbers.) Of course, one of those neurosurgeons I mentioned went to the clink for 90 days on an assault charge, so that may muddy the anecdotal water a bit.

 

[C5H9NO4]

Thanks for the advice, guys. I appreciate that you took your time to reply and share your opinions. Wish you all the best in your careers, and if you come across a military neurosurgeon that reads/posts stuff on SDN, let me know.

Cheers!