Orthopedic surgery vs. Neurosurgery

[MilesDavisTheDoctor]

I'm struggling with my decision between ortho and neurosurgery and was wondering if anyone else who was going through the same decision could chime in on what their thought process was in making a decision. I'm still kinda early on in medical school and have shadowed both specialties a bit but I think I might need to kinda start deciding soon because of how competitive these specialties are. I think a lot of people who are interested in the surgical subs have these two on their minds a lot. For me the main things that I'm thinking about in this decision are:

1) Outcomes: The main turn off for me in doing neurosurgery are the outcomes. There was a recent post on here by a neurosurgery resident that talked about how neurosurgery outcomes aren't actually that bad but idk how much I'm buying that lol. Brain trauma, aneurysms, strokes, and GBM. Idk if I'm emotionally cut out to deal with all of that stuff.

2)Coolness: Nothing in ortho so far get's me as excited as what I've seen in neurosurgery which is kind of a bummer. I'm hoping that this changes but replacing joints and fixing fractures (while very cool) is not as exciting to me as taking out brain tumors or implanting a DBS and immediately curing someone's Parkinson's disease.

3)Lifestyle outside of residency: I know a lot of neurosurgeons end up going into private practice and mostly do spines for the rest of their career and that can lead to a pretty decent lifestyle compared to the academic guys operating in the level 1 trauma warzones for the rest of their lives. At the same time, it's hard for me to imagine these PP spine guys have it as easy as most orthopedic surgeons.

If any of you guys were struggling between these two amazing fields lmk what you think!

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[Crassus]

In a similar situation, trying to figure out where I should direct my focus for this upcoming summer in terms of research and shadowing. I'm a little biased towards neurosurgery, though I suspect that's because I've spent more time shadowing and conducting research in the field compared to other fields while I was an undergrad. The academic neurosurgeons I worked with had a pretty good split between their clinical duties and research duties (imo). Haven't had as much exposure to ortho yet, looking forward to it.

 

[Gilakend]

I've always been so surprised that I see a lot of threads about ortho vs nsurg on SDN. Just from my limited experience with ortho and nsurg attendings/residents (at least where I am) they are two vastly different groups of people. I would say if possible with COVID try to shadow and spend time with the residents and attendings. For me at least, once I started spending time with different specialties it seems like most people can tell where they "fit" both in terms of personality (which can obviously change greatly by where you are) and the field itself.

I think traditional advice for someone early on would be "focus on step 1 and wait for your clinical rotations and you'll see what you're interested in" but given how competitive these are I would try and get a sense of which way you lean early so you can start research (even if you end up changing your mind, the research experience still looks good).

 

[Skullcutter69]

I'm struggling with my decision between ortho and neurosurgery and was wondering if anyone else who was going through the same decision could chime in on what their thought process was in making a decision. I'm still kinda early on in medical school and have shadowed both specialties a bit but I think I might need to kinda start deciding soon because of how competitive these specialties are. I think a lot of people who are interested in the surgical subs have these two on their minds a lot. For me the main things that I'm thinking about in this decision are:

1) Outcomes: The main turn off for me in doing neurosurgery are the outcomes. There was a recent post on here by a neurosurgery resident that talked about how neurosurgery outcomes aren't actually that bad but idk how much I'm buying that lol. Brain trauma, aneurysms, strokes, and GBM. Idk if I'm emotionally cut out to deal with all of that stuff.

2)Coolness: Nothing in ortho so far get's me as excited as what I've seen in neurosurgery which is kind of a bummer. I'm hoping that this changes but replacing joints and fixing fractures (while very cool) is not as exciting to me as taking out brain tumors or implanting a DBS and immediately curing someone's Parkinson's disease.

3)Lifestyle outside of residency: I know a lot of neurosurgeons end up going into private practice and mostly do spines for the rest of their career and that can lead to a pretty decent lifestyle compared to the academic guys operating in the level 1 trauma warzones for the rest of their lives. At the same time, it's hard for me to imagine these PP spine guys have it as easy as most orthopedic surgeons.

If any of you guys were struggling between these two amazing fields lmk what you think!

There's no doubt that a lot of patients with those problems can have challenging prognoses. I guess the point that I was trying to make is that those problems rarely make up a large proportion of your practice as an attending neurosurgeon (vs. a resident on service). Stroke is not a surgical disease and those patients are managed by neurologists. Sure, you can be called to do a suboccipital craniectomy for a PICA + stroke that swells (or I guess a mechanical thrombectomy if you happen to be on endovascular) but you're in essence providing a service to the primary team who then manages the patient. This is akin to the trauma wrecks that ortho gets who have DIC, cardiac tamponade, etc. and ortho gets asked to fix an acetabular fracture once the patient is stable. Those folks rarely do well but they're not patients you ever get in your elective practice - only occasionally during the weeks you take neurosurgery call. "Brain trauma" can result in suboptimal outcomes, but you'll be surprised by how well some subdural/epidural hematoma patients will bounce back after you save their life. Once again, those aren't cases you get referred to your clinic, you'll only have those during the weeks you're on call.

GBM is usually it's own thing, and folks who specialize in intra-axial tumors relish those cases (they usually employ cool things like brain mapping and fluorescence-guided surgery (you should look up "5-ALA brain tumor" in google images)). They also tend to have a heavy focus on basic science research (in an attempt to find a cure/treatment that improves outcomes). If you're interested in brain tumors/skull base, there's a whole host of problems, including meningiomas, metastases (for resection, gamma knife, or laser interstitial thermal therapy), acoustic neuromas, pineal tumors, pituitary tumors, etc. Even the vascular folks who definitely have tougher patients (due to their call having a proportionally greater number of SAH, ICH, etc.) have tons of AVMs, AVFs, carotids, Moya-Moya, etc. Most spine, functional, and pediatric patients do very well.

Don't get me wrong, I loved my ortho rotations as a med student. If I couldn't do neurosurgery, I'd undoubtedly do ortho because of the similar culture of no nonsense, let's get these cases done and get moving with our day, cool people, and some nice technologies. For me it was a clear choice because neurosurgery was simply way more interesting for me (both the pathology and the actual operative approaches, new technologies, variety, etc.) People who try and lump entire specialties by personality do themselves a disservice. There are many neurosurgery programs (like ours) that have tons of laid back, cool dudes. There are also ortho/ENT/uro/you name it specialty with weirdos and malignant residents (including neurosurgery).

I think that one of the best pieces of advice I ever got is to choose WHAT you want to do first (what will you still find interesting 30 years from now?) What will you like doing AFTER residency (which is when the vast majority of your career will take place). What do you actually enjoy reading about and studying? Is it Salter Harris fracture classifications or types of brain tumors? After that, you can decide WHERE to do it based on things you care about (programs that value your well-being, have cool, down to earth residents, etc.) The exact same advice applies, whether you want to do neurosurgery or ortho. If you're most interested in bones and joints, but you think you're shy and nerdy, you should absolutely do ortho, and *then* pick a program with residents who are most like you. If you're really broey but think operating on brains is more your thing then you should do neurosurgery, it's as simple as that.

Best of luck with your decision. You'll have an amazing and fulfilling career regardless of which one you pick.

 

[IMG69]

I was in a similar position but initially I was dead set on ortho until I watched my first lateral skull base approach and things changed. I asked both types of attendings (NSGY and ortho) from rotations which they think better suited me and every single one said NSGY. I suggest you do the same if you have a good relationship with your attendings even ones in other fields, the more perspectives you get the better.

 

[Tenk]

I think this all comes down to how much you can bench.

 

[Crassus]

Get your step score, then decide.

By the time many M1s (especially those at schools where steps are taken during/after third year) get a scored step (most likely Step 2), won't it be too late to decide? At that point, you're getting ready to fill out ERAS and all of the specialty-relevant research would have to be complete right?

 

[agiraffe999]

Skull Cutter said it best.

However, remember that after doing it 20 years, even DBS or AVM surgeries look "routine" for you. Which one is more fun? Fixing your 1000th femoral head fracture, or placing your 1000th burr hole?

A lot of PP spine guys also take call for general NSG (strokes are separate). I live near a level 2 trauma center that's pretty large, and their PP spine guys still have no issue evacuating a SDH in the middle of the night. Any PP ortho spine guys won't have to do that. Honestly, I think whatever pathology you like the most is the best. Lifestyle is flexible for both.