orthoneuro

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Has anybody else had this dilemma?? I for one am interested in spine. I am well aware of the differences between the two specialties. I was just wondering if anybody else had a similar problem and how they came about their decision to ultimately pursue one specialty over the other...thanks
 

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orthoneuro said:
Has anybody else had this dilemma?? I for one am interested in spine. I am well aware of the differences between the two specialties. I was just wondering if anybody else had a similar problem and how they came about their decision to ultimately pursue one specialty over the other...thanks
My very peripheral understanding is that the majority of general private practice neurosurgery is spinal or peripheral nerve work and relatively less intracranial. If you finish 6-7 years of a decent residency you should feel comfortable doing spine work without a fellowship. Also keep in mind neurosurgeons are trained to work in the subdural space if need be. I think most orthospine docs would feel less comfortable with that.
Advantage Neuro.

Ortho residency ain't a walk in the park, but neurosurg residency is brutal.
If you ever burned out on spine work, I suppose you could do some general ortho work to help pay the bills, but with the astronomical salary that spine surgeons make, you should be able to just retire.
Advantage Ortho.

So ortho might seem the easier path, but how competitive are the ortho spine fellowships?

In the end would you rather be an orthopod or a neurosurgeon?

Just my two cents, which has depreciated 26% against the European currency within the last 3 years.
 
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orthoneuro

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hans19 said:
My very peripheral understanding is that the majority of general private practice neurosurgery is spinal or peripheral nerve work and relatively less intracranial. If you finish 6-7 years of a decent residency you should feel comfortable doing spine work without a fellowship. Also keep in mind neurosurgeons are trained to work in the subdural space if need be. I think most orthospine docs would feel less comfortable with that.
Advantage Neuro.

Ortho residency ain't a walk in the park, but neurosurg residency is brutal.
If you ever burned out on spine work, I suppose you could do some general ortho work to help pay the bills, but with the astronomical salary that spine surgeons make, you should be able to just retire.
Advantage Ortho.

So ortho might seem the easier path, but how competitive are the ortho spine fellowships?

In the end would you rather be an orthopod or a neurosurgeon?

Just my two cents, which has depreciated 26% against the European currency within the last 3 years.

I would be happy being an orthopod or neurosurgeon. Both fields appeal to me for different reasons. The fact that I find especially appealing for neurosurgeon is the many toys and cutting edge technology and future of minimally invasive endovascular surgery. However, the easier lifestyle and more family time of orthopedics is also very attractive as well. This is a very difficult decision indeed.
 

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Easier lifestyle and more family time in orthopedics? Not sure if I'd agree with that...there likely about equal. If you want surgery and more family time, try ENT, urology, ophthalmology...
 

Ace7

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Orthoneuro,

I'm in the same boat as you. This is my perspective from a lab rats stand point (I haven't done 3rd year yet so take my opinion with a grain of salt).

NS Pros:

Technology rich
Life/ Death outcomes
Very challenging
Plenty of research opportunities
Interesting pathology and anatomy
Prestigious, lucrative

NS Cons:

Personal lifestyle sacrifices
The "Death" part of the life/ death outcomes
Long training period
Malpractice

Ortho Pros:

Good patient outcomes, quality of life outcomes
Motivated patients
Technology rich
Multiple areas of specialization
Prestigious, lucrative
Positive personal experiences with Othropods

Ortho Cons:

Personal lifestyle sacrifices (My perspective is this would not be as bad as NS)
Not Life/ Death outcomes
Not sure I'm interested in the underlying basic science
Unsure of research opportunities
Malpractice


These are just some of the things I have thought about. What do you guys think? I have also looked in to ophthalmology, but that is another topic.

A
 

undecided05

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not sure by what you mean by neurosurgery having life/death implications, but not ortho spine. If you're going to be a spine surgeon (ortho or neuro), you're going to be doing the same procedures. If you're going to be doing cervical fusions, tumor resections, etc... there are the same risks with each.

In fact, many of the spine fellowships are open to either ortho or neurosurgery.
 

Ace7

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My life/ death comment is biased by the fact that most of my interactions with orthopods has delt with sports related injuries, and in my opinion these people are not on death's door. Can you shed more light on the differences between ortho spine and neuro spine. I have heard the guideline that Orthopods stay out of the dura, but with the combined spine fellowships is this still the case? Any information would be greatly appreciated.

A
 

medstudent123

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i guess a question you might ask yourself is, if you don't do any spines, would you be happier doing brain tumors or hip replacements for the rest of your life?
 

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undecided05 said:
not sure by what you mean by neurosurgery having life/death implications, but not ortho spine. If you're going to be a spine surgeon (ortho or neuro), you're going to be doing the same procedures. If you're going to be doing cervical fusions, tumor resections, etc... there are the same risks with each.

In fact, many of the spine fellowships are open to either ortho or neurosurgery.

I've never heard of a Ortho surgeon taking out an intradural intramedullary tumor like an ependymoma from the spine.

I would say, with the exception of metastatic disease to the epidural space, ortho surgeons do not resect spine tumors.

Here is how I see the differences (as a PGY4 NSGY resident)

NSGY residents spend 50% of their time or more during neurosurgical residency for 6 or 7 years doing spine surgery. That is a lot of freaking cases.

Ortho residents spend 20% or less of their time doing spine surgery during residency. This means they will likely need to do a spine fellowship following residency which is an additional year. Making a 5 year ortho residency now 6 or 7 years (some spine fellowships are 2 years). I'd say 85% of NSGY residents who go into private practice and do predominately spine do not need and do not do spine fellowships. It is an inherrent part of their training.

And besides that... they can operate in the brain :)

Lifestyle during residency similar to the point of making it moot.

Lifestyle after residency... well if both are doing almost exclusively spine... they will have essentially identical lifestyles after residency. It is only when a neurosurgeon does a lot of cranial procedures in private practice and trauma stuff that he hurts his lifestyle with comming in the middle of the night to suck out subdurals etc. Or having to deal with a lot of sick ICU patients.

Salary - neurosurgeons and ortho surgeons get paid exactly the same per spine case. So this is moot.

Difficulty to match: both residendencies comparably difficult to match into.

Oh and a lifestyle issue again, if you do decide to do trauma (ortho or neuro) there is NO QUESTION the ortho docs work much harder and more often doing Ortho trauma at all hours of the day and night than Neurosurgeons. I'd say it is 5:1 in favor of Ortho being busier with trauma at a major trauma center. So if covering trauma at night is part of your Call schedule in private practice... you'll likely have it worse as an Ortho guy.
 

orthospine

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(pasted from other forum)

I'm an ortho pg3 right now. Just finished my spine rotation (first of 2) and loved it, looking for fellowships right now. I'll give my meandering opinions of some of the things I've read here.

In college I thought I wanted to be a neurosurgeon. It seems glamorous, cool surgeries, operate on the brain (oooohhhh woww!). Then I got to med school and met some neurosurgeons. Probably the most miserable group of people I've ever met personally. Not that they weren't cool guys, many of them are. But they never leave the hospital and they get their dicks kicked in constantly while there, both from their attendings and their patients and families. Some people can tolerate that, I found I was not one of them. Then there is the whole "brain surgeon" thing. Unless you do academics, you won't be a brain surgeon. Almost all private practice neurosurgeons do a lot of spine to pay the bills while waiting for that next craniotomy to come around. If you don't like spine surgery, run from neuro or do it and go into academics. The other things I got tired of in neurosurg were: patients really sick, requiring lots of attention (i.e. not operating), patients frequently die as noted by others here, patients who are "successes" still fare pretty poorly as human beings they're just not dead in many cases.

The things I liked about ortho have already been noted: healthy patients in general, they get better in general, very problem focused (if it's broke fix it, if not then break it and fix it), lots of cool technology and toys to play with, the money is great, the lifestyle can be great.

Since I'm half way done with my residency I'll share some of the good and bad that I could not have known prior to matching in ortho.

Bad: people with orthopaedic problems hurt, and will use their voices/family/attorneys/work comp agents to hurt you. Contrary to some people's beliefs this is in NO way isolated to the spine clinic. Old people with arthritic hips complain and many continue to complain after they get a shiny new one. Athletes complain. I laugh my ass off at all these guys who drool over the opportunity to take care of athletes. If you want unrealisitic, noncompliant, whiny little pains in the ass in your clinic then pursue athletes as patients. They always expect their limb/joint to function as "new" in a very short time without putting forth all the rehab effort they should. Personally I have found these people to be very ungrateful and not fun at all to care for. Obviously not everyone feels this way.
All areas of ortho see the work comp/disability crap. You can't avoid it. You just have to decide if you're going to deal with it or not. You CAN flatly refuse to see work comp and simply refuse to do disability assessments. It's easy, just say no. Work comp pays really well though, so if you can tolerate those people then ring the cash register and buy that bigger boat you've been looking at.

Malpractice for ortho is terribly expensive and worsening in most geographic areas similar to neuro.


Good stuff: we are in huge demand and it is only going to increase in coming years. The supply of orthopedists has been tightly regulated for decades by some very savvy dudes, and the job market is incredibly good. There are opportunities virtually everywhere in the US.
The surgery is really fun. If you like anatomy and understanding how to reconstruct aberrant anatomy to near normal with all sorts of tools and implants, then you'd have fun in ortho.
If you like research, there is limitless opportunity for ortho research. The literature in ortho is relatively young with few good controlled trials to rely on in many areas. An interested researcher could go far easily.

As for spine:
There is a great deal of overlap in Neuro and Ortho spine practice. In general ortho guys don't go in the blue water balloon (there is nothing worth seeing in there any way). So if intradural tumors are your thing then don't do ortho. Ortho guys are generally more comfortable with instrumentation, at least at first, because of their background with hardware going into bones. But now most neuro residencies probably have spine guys doing a lot of instrumentation. Overall the difference in practice probably breaks down to: neuro does more tumor, ortho does the vast majority of deformity cases (scoliosis, spondylolisthesis, kyphosis, etc). If you're doing private practice this difference is negligible.

Some people point to "bread and butter" as the difference. I'm not sure that is true. Sure, if you are in a small group of orthopods and take call at a busy trauma center you'll have to do the occasional femur or washout in the middle of the night. But most community surgeons arent covering the war zone type ERs that we do in training. If you do a spine fellowship in ortho and join a group with a big enough referral base, you can distill down to almost 100% spine fairly quickly. Or if you like general practice with some spine you can do that. The more frequent complaint I have heard from guys is that once you are labeled as the spine guy you get all spine and your general practice dries up. I would say that post residency the lifestyles of NSG vs ortho are very close except in bigger cities with level I/II trauma centers. In those centers the private orthopedist can get spanked with trauma where the NSG would not.

One last thing. There is no question whatsoever that ortho residencies offer better lifestyles than Neurosurg. There will be isolated examples where that is not the case, but across the board neurosurg residents grab their ankles for 6 or 7 years. My own residency is very kind and gentle since the 80 hour thing. I am averaging in the 50s this year, but it has hurt our case experience some. That is a whole different topic.

Not sure if any of this was helpful, but I'm on call and bored.
 
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orthospine

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AlbertConstable said:
So it seems that you're saying that the NS residency is tougher than the Ortho residency but if you are aiming to be a spine guy, it doesn't matter after residency is over?
Pretty much. If you want to go in the dura for tumors, then NS is a must. If you want to do normal stuff on the spine in the community, or if you have interest in pediatric spine (scoliosis), then I'd recommend ortho.

The lifestyle of ortho residents is much better than NS in general, as I've noted already. I have a bias obviously, but I find the non-spine work in ortho to be much more interesting and rewarding than neurosurgery. Ortho residents spend more time in the OR than NS in my somewhat limited exposure to NS. We don't have the nearly dead patients in the ICU always demanding our attention.
 

NSGYResident

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orthospine said:
Pretty much. If you want to go in the dura for tumors, then NS is a must. If you want to do normal stuff on the spine in the community, or if you have interest in pediatric spine (scoliosis), then I'd recommend ortho.

The lifestyle of ortho residents is much better than NS in general, as I've noted already. I have a bias obviously, but I find the non-spine work in ortho to be much more interesting and rewarding than neurosurgery. Ortho residents spend more time in the OR than NS in my somewhat limited exposure to NS. We don't have the nearly dead patients in the ICU always demanding our attention.
This is a classic response from someone who doesn't understand what neurosurgeons do. First, how busy a resident is can depend heavily on the hospital where they train. At my hospital the ortho residents are pretty freaking busy with all kinds of ortho trauma. I take 2 saturday calls per month, no calls during the week as a PGY4. You will almost definitely need to do a spine fellowship as an ortho resident to then go practice spine because you will likely only do about 20% spine as a resident, where as a neurosurgery resident does about 60-75% spine during their residency and a spine fellowship is typically, thought not always, optional.

Secondly, we don't take care of "dead" patients in the ICU. The vast majority of the patients we take care of in the ICU are non-spine cases dealing with intracranial anuerysm rupture and the consequences of subarachnoid hemorrhage. While they may be sick patients, most grade 1 and grade 2 SAH patients will eventually recover to completely normal. Also, not every brain tumor operated on has a malignant tumor etc. We actually learn how to manage ICU issues and are better doctors for it. We typically only manage ICU patients as pgy2, and during the later, heavy OR years typically spend all day in the OR and don't deal with any of the ICU issues directly (the lower level residents deal with them).

It essentially comes down to this... If you want to fix bones/joints as a resident and the focus on spine when you are done, go into Ortho. Your residency is likely very comparable to a NSGY residency as far as how busy you are. It is not like we are comparing NSGY to derm here. If you want to learn how to deal with tumors in the spine, and how to operate on the brain (think of it as a challenge), and do much more spine work during your residency, the NSGY is for you. As a neurosurgeon you will learn how to be part vascular surgeon, part ortho surgeon, part oncologist, etc, because you learn how to deal with multiple aspects of the nervous system including its bony confines, its vasculature, its intricate and dynamic anatomy.

There is no right or wrong answer, go work along side several Ortho guys and Neuro guys and then decide.
 

Ace7

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NSGYResident and orthospine,

While we are on the subject of spine surgery, could you give us a feel for what the patient population is like and if their are differences between the patients seen by a NS and those seen by an orthopod (I know you guys have talked about tumor issue, but beyond that are there differences)? Specifically, what are the typical problems people present with (I would guess lower back pain/ disc problems would be at the top), are the surgeries successful (not the technical aspect, but the ultimate outcome) or do you have a lot of repeat "customers", and is chronic pain management a large part of the practice? Any other information would be greatly appreciated.

Thanks

A
 

coolhandluke

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How much harder would you consider a NS residency when compared to an ortho residency followed by a spine fellowship? By "harder" I am referring to not so much the hours but rather the thinking aspect of it. I am a pretty hard worker and I do well in school--honors in most classes--but I do not consider myself to be brilliant by any means. Im your typical bright guy but hard worker. I guess what I am trying to get at is the brain power necessary for NS residency a lot more than what is needed for ortho spine.

Thanks for your help.
 

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orthospine said:
(pasted from other forum)

I'm an ortho pg3 right now. Just finished my spine rotation (first of 2) and loved it, looking for fellowships right now. I'll give my meandering opinions of some of the things I've read here.

In college I thought I wanted to be a neurosurgeon. It seems glamorous, cool surgeries, operate on the brain (oooohhhh woww!). Then I got to med school and met some neurosurgeons. Probably the most miserable group of people I've ever met personally. Not that they weren't cool guys, many of them are. But they never leave the hospital and they get their dicks kicked in constantly while there, both from their attendings and their patients and families. Some people can tolerate that, I found I was not one of them. Then there is the whole "brain surgeon" thing. Unless you do academics, you won't be a brain surgeon. Almost all private practice neurosurgeons do a lot of spine to pay the bills while waiting for that next craniotomy to come around. If you don't like spine surgery, run from neuro or do it and go into academics. The other things I got tired of in neurosurg were: patients really sick, requiring lots of attention (i.e. not operating), patients frequently die as noted by others here, patients who are "successes" still fare pretty poorly as human beings they're just not dead in many cases.

The things I liked about ortho have already been noted: healthy patients in general, they get better in general, very problem focused (if it's broke fix it, if not then break it and fix it), lots of cool technology and toys to play with, the money is great, the lifestyle can be great.

Since I'm half way done with my residency I'll share some of the good and bad that I could not have known prior to matching in ortho.

Bad: people with orthopaedic problems hurt, and will use their voices/family/attorneys/work comp agents to hurt you. Contrary to some people's beliefs this is in NO way isolated to the spine clinic. Old people with arthritic hips complain and many continue to complain after they get a shiny new one. Athletes complain. I laugh my ass off at all these guys who drool over the opportunity to take care of athletes. If you want unrealisitic, noncompliant, whiny little pains in the ass in your clinic then pursue athletes as patients. They always expect their limb/joint to function as "new" in a very short time without putting forth all the rehab effort they should. Personally I have found these people to be very ungrateful and not fun at all to care for. Obviously not everyone feels this way.
All areas of ortho see the work comp/disability crap. You can't avoid it. You just have to decide if you're going to deal with it or not. You CAN flatly refuse to see work comp and simply refuse to do disability assessments. It's easy, just say no. Work comp pays really well though, so if you can tolerate those people then ring the cash register and buy that bigger boat you've been looking at.

Malpractice for ortho is terribly expensive and worsening in most geographic areas similar to neuro.


Good stuff: we are in huge demand and it is only going to increase in coming years. The supply of orthopedists has been tightly regulated for decades by some very savvy dudes, and the job market is incredibly good. There are opportunities virtually everywhere in the US.
The surgery is really fun. If you like anatomy and understanding how to reconstruct aberrant anatomy to near normal with all sorts of tools and implants, then you'd have fun in ortho.
If you like research, there is limitless opportunity for ortho research. The literature in ortho is relatively young with few good controlled trials to rely on in many areas. An interested researcher could go far easily.

As for spine:
There is a great deal of overlap in Neuro and Ortho spine practice. In general ortho guys don't go in the blue water balloon (there is nothing worth seeing in there any way). So if intradural tumors are your thing then don't do ortho. Ortho guys are generally more comfortable with instrumentation, at least at first, because of their background with hardware going into bones. But now most neuro residencies probably have spine guys doing a lot of instrumentation. Overall the difference in practice probably breaks down to: neuro does more tumor, ortho does the vast majority of deformity cases (scoliosis, spondylolisthesis, kyphosis, etc). If you're doing private practice this difference is negligible.

Some people point to "bread and butter" as the difference. I'm not sure that is true. Sure, if you are in a small group of orthopods and take call at a busy trauma center you'll have to do the occasional femur or washout in the middle of the night. But most community surgeons arent covering the war zone type ERs that we do in training. If you do a spine fellowship in ortho and join a group with a big enough referral base, you can distill down to almost 100% spine fairly quickly. Or if you like general practice with some spine you can do that. The more frequent complaint I have heard from guys is that once you are labeled as the spine guy you get all spine and your general practice dries up. I would say that post residency the lifestyles of NSG vs ortho are very close except in bigger cities with level I/II trauma centers. In those centers the private orthopedist can get spanked with trauma where the NSG would not.

One last thing. There is no question whatsoever that ortho residencies offer better lifestyles than Neurosurg. There will be isolated examples where that is not the case, but across the board neurosurg residents grab their ankles for 6 or 7 years. My own residency is very kind and gentle since the 80 hour thing. I am averaging in the 50s this year, but it has hurt our case experience some. That is a whole different topic.

Not sure if any of this was helpful, but I'm on call and bored.
great post. :thumbup:
 

triquetras

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These are just some of the things I have thought about. What do you guys think? I have also looked in to ophthalmology, but that is another topic.

A
Ace-
I am also interested in NS, ortho and ophtho. what is your opinion on ophtho?
 

Ace7

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triquetras,

I'm doing an ophthalmology rotation in October so I will have better answers for you then. But this is how I see things now and remember this is just from my investigations (forums, talking to docs, etc.). I think it combines a lot of the things I like about surgery while minimizing some of the things I don't. It seems that you get to use cool equipement and your patients are better off after they see you, no pun intended. Furthermore, the lifestyle seems to be more flexible than other surgical specialties. However, I'm worried that I will feel limited to only working on the eye and feel isolated from the larger medical community. I'm also worried about the expansion of non-MDs into the field. I don't want to invest in my training only to have to fight with other for patients. I the end I'm looking for a field that I feel "fits" me and I have set up my rotation schedule so that I will have early exposure to ortho, NS, and ophtho. I hope this helps and I would like to hear what you think about the fields.

A
 

triquetras

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Ace7 said:
triquetras,

I'm doing an ophthalmology rotation in October so I will have better answers for you then. But this is how I see things now and remember this is just from my investigations (forums, talking to docs, etc.). I think it combines a lot of the things I like about surgery while minimizing some of the things I don't. It seems that you get to use cool equipement and your patients are better off after they see you, no pun intended. Furthermore, the lifestyle seems to be more flexible than other surgical specialties. However, I'm worried that I will feel limited to only working on the eye and feel isolated from the larger medical community. I'm also worried about the expansion of non-MDs into the field. I don't want to invest in my training only to have to fight with other for patients. I the end I'm looking for a field that I feel "fits" me and I have set up my rotation schedule so that I will have early exposure to ortho, NS, and ophtho. I hope this helps and I would like to hear what you think about the fields.

A
Ace-
Before starting medical school I wanted to do neurosurgery. I had done research in neurology/neurosurgery and had shadowed multiple neurosurgerons in the OR and the clinic. I continued my interest by doing neuro research in medical school, but i was also introduced to ophthalmology and ortho. I want to do research in my career and I love neuroscience, so i was looking for a field where i could operate and be a neuroscientist. My likes and dislikes about ophtho are the same as yours. I strayed away a little from neurosurg because of the lifestyle. I didn't and still don't know if i want to give so much of my life to my job. the crazy hours wont end with residency. my mentor still works crazy hours. Ortho came into play because i love anatomy and i really enjoyed learning about the interplay of muscles, nerves and bones. Hand surgery and spine really appeal to me, however most of the research done in ortho relates to bones (duh) and not much neuro. I am taking a year off starting in july to do research in ophthalmology (retina) but I am definitely shadowing some ortho and neuro residents and attendings/private practice docs. I guess in the end it depends on where you fit like you said and also which type of everyday casework still keeps you interested. I mean aside would you rather spend most of your doing hip replacements or low back pain or cataracts.... I think my personality fits best with ortho, but i might find that ophtho blends my research interests with my lifestyle/patient population desires. Both ophtho and ortho has patients that love you once you are done with the surgery especially if it is quality of life issues, like seeing better or walking better...
just my two cents :)