Path to becoming a neurosurgeon

[chemist_acs]

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I'm applying this cycle and have been fortunate enough to be admitted to several schools. My question is, does it matter which med school you go to in order to get into a neurosurgical residency? There is only around 200 spots in the country that have a 7 year neuro residencies and it's extremely competitive. Is this the only way to my goal? I keep hearing different opinions. Some tell me you have to go to a 7 year residency. While others say you can just go to a regular surgical residency to begin with.
Does it matter if hospital that's associated with med school I choose has a neuro residency?
I understand that I might change my mind during rotations but this is the goal right now.

 

[The Knife & Gun Club]

From what I've heard (full disclosure, I matriculate next year too), it's best to go to a med school that has a home neurosurgery residency program. That way you can get involved with the department early, do relevant research, and get a good understanding of what it takes to get into/complete a neurosurg residency.

 

[mimelim]

#1 There is no such thing as a "regular surgical residency". There are specific specialties. The only training paradigm in the US is to do an ACGME accredited residency in neurosurgery which are 7 years (I think there may be a couple of 6 year programs, but it isn't my area). You can not do general surgery and then become a neurosurgeon. You would need to switch to a neurosurgery program and start over. Some programs may give you some credit for time spent in other residencies, but rarely, if ever, is it more than a couple of months or a year of credit.

#2 Your home institution is the starting point for your application process. It is hard to believe that you know what neurosurgery is really like if you haven't spent time in their department working or rotating. If you are interested in something in particular, yes it is going to make a difference if your medical school has a neurosurgery department. A neurosurgery residency is also a perk because people like to take known quantities and if you are rotating on their service, it serves as an extended interview, which will help good students.

#3 Is it competitive? Yes. Just like any surgical subspecialty. Average step scores in the 240s. By the same token, of the 238 that applied for neurosurgery, 188 matched. Sure, there is a lot of self selection going, but of the people that tried to get into neurosurgery, more than 3/4 got in. Also, of those with step 1 scores between 211 and 230, 26/34 ended up at a neurosurgery program, so while you are expected to have strong scores, it isn't like EVERYONE does.

http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf

 

[Okazaki Frag Grenade]

I'm applying this cycle and have been fortunate enough to be admitted to several schools. My question is, does it matter which med school you go to in order to get into a neurosurgical residency? There is only around 200 spots in the country that have a 7 year neuro residencies and it's extremely competitive. Is this the only way to my goal? I keep hearing different opinions. Some tell me you have to go to a 7 year residency. While others say you can just go to a regular surgical residency to begin with.
Does it matter if hospital that's associated with med school I choose has a neuro residency?
I understand that I might change my mind during rotations but this is the goal right now.

I'm in no way disagreeing with the previous two posts, because I think your life will be much "easier" if your home program has a neurosurg department/residency. But if you matriculate at a school that doesn't have one, you are not screwed by any means. The MD program near where I live does not have a neurosurg residency program, but each year they match at least 1 student, if not 2. So it is still possible, just might take more administrative legwork to get your away rotations, find research, etc.

 

[chemist_acs]

I have been shadowing a neurosurgeon for the last 2 years in and out of surgeries. The doctor has been incredible explaining and teaching me during surgeries and going over results afterwards.
From several schools I've been accepted to so far I'm thinking either Rutgers or Tufts. Both have neurosurgical residencies available. I would prefer Rutgers because it's cheaper and closer to home. But Tufts is a much better school. Tufts is also know to pick their own students. I looked at their current neuro residents list and half of them are from Tufts. Couldn't find the same list for Rutgers. Would it matter which I pick in order to get into a 7 year neuro residency?

 

[mimelim]

I have been shadowing a neurosurgeon for the last 2 years in and out of surgeries. The doctor has been incredible explaining and teaching me during surgeries and going over results afterwards.
From several schools I've been accepted to so far I'm thinking either Rutgers or Tufts. Both have neurosurgical residencies available. I would prefer Rutgers because it's cheaper and closer to home. But Tufts is a much better school. Tufts is also know to pick their own students. I looked at their current neuro residents list and half of them are from Tufts. Couldn't find the same list for Rutgers. Would it matter which I pick in order to get into a 7 year neuro residency?

If you had to pick a school based on this, Tufts would be the better option of the two, but it is a pretty poor reason to pick a school to be honest. There are a lot of more important variables. The difference is marginal, but yes, you will have more resources in the sub-specialties at Tufts than at Rutgers. If this is the only reason to pick Tufts over Rutgers, I'd still do Rutgers.

You can also stop calling it a "7 year neuro residency". For starters it is confusing because it is a neurosurgery program, not neurology (which is what is usually abbreviated to 'neuro') neurosurgery normally gets abbreviated to "neurosurg" or NSGY. And since they are all 7 years long, you don't need to keep specifying.

 

[bc65]

Go to the school you like better, overall. Despite your interest in neurosurgery now, you will still probably change you mind by the time you get through your 3rd year of med school. Shadowing is different from actually doing long cases in the middle of the night.

To clarify the "7 year " issue: Some surgical specialties require a full 5 or 6 year general surgery residency first as a pre-requisite, after which you apply to separate 2 year fellowship, eg vascular surgery, cardiothoracic surgery. Of those, a few programs combine the general surgery plus the fellowship into one admission process, but they still take 7 years. Neurosurgery is NOT one of those specialties. ALL of neurosurgery involve a single residency, usually 7 years long.

Urology, orthopedics, and ENT are single 5 year programs. You don't do a separate general surgery residency first. Plastic surgery is an exception, in that it does it both ways: Some 6 year residencies, and some where you do a full general surgery residency for 5 years, after which you apply for a separate 3 year plastic surgery program.

 

[ErbB1]

Just my two cents:

There are a couple other paths to being a "neurosurgeon"

For example, neurology residency then interventional neuroradiology fellowship. In the same vein, radiology residency then interventional neuroradiology fellowship.

Other paths besides the classical "7 year neurosurgery residency"

 

[typhoonegator]

Just my two cents:

There are a couple other paths to being a "neurosurgeon"

For example, neurology residency then interventional neuroradiology fellowship. In the same vein, radiology residency then interventional neuroradiology fellowship.

Other paths besides the classical "7 year neurosurgery residency"

No. Neurointerventionalists are not neurosurgeons. But some neurosurgeons are neurointerventionalists. I work every day with both, and no neuroIR person who trained in neurology or rads would call themselves a neurosurgeon.

 

[Mad Jack]

Just my two cents:

There are a couple other paths to being a "neurosurgeon"

For example, neurology residency then interventional neuroradiology fellowship. In the same vein, radiology residency then interventional neuroradiology fellowship.

Other paths besides the classical "7 year neurosurgery residency"

Interventionalists are not surgeons, they are proceduralists. They aren't neurosurgeons by a long shot.

 

[Affiche]

How important is it to attend a school with a home residency program? I don't have a strong interest in any field yet, but the school I'm likely going to attend doesn't have a home program for a few of the areas I'm possibly interested in.

Edit: not to derail the thread or anything! I'm hoping this applies to the OP, too

 

[The Knife & Gun Club]

How important is it to attend a school with a home residency program? I don't have a strong interest in any field yet, but the school I'm likely going to attend doesn't have a home program for a few of the areas I'm possibly interested in.

Edit: not to derail the thread or anything! I'm hoping this applies to the OP, too

I'm actually very interested in this as well!

 

[WedgeDawg]

Having a home program makes things easier because 1) you generally get some degree of favoritism 2) you have the opportunity to get more exposure than if you didn't have a home program 3) you have people in the field who will end up knowing you and can vouch for you (very important in the surgical subspecialties) 4) research opportunities will likely be better and/or easier to obtain

 

[chcash]

Just out of curiosity, what are some notable med schools WITHOUT neurosurgery programs? It seems the vast majority I've looked at have at least several neurosurgeons.

 

[Affiche]

Having a home program makes things easier because 1) you generally get some degree of favoritism 2) you have the opportunity to get more exposure than if you didn't have a home program 3) you have people in the field who will end up knowing you and can vouch for you (very important in the surgical subspecialties) 4) research opportunities will likely be better and/or easier to obtain

2) and 3) come with away rotations though, right?

 

[WedgeDawg]

Just out of curiosity, what are some notable med schools WITHOUT neurosurgery programs? It seems the vast majority I've looked at have at least several neurosurgeons.

UConn, UMass, EVMS, etc - it's usually programs with smaller hospitals. Most MD medical schools do have a home program though.

http://www.aans.org/Young Neurosurgeons/Medical Students/Residency Directory.aspx

 

[WedgeDawg]

2) and 3) come with away rotations though, right?

Yes, but for 2) your exposure is going to be a lot more brief. SubIs are only a month or so long. Compare that to 4-5 year longitudinal exposure to the specialty via your home program. You have the opportunity to shadow attendings and residents, go to Grand Rounds, take overnight call, attend presentations and meetings, etc. For 3) same thing - longitudinal exposure. Yes, you can absolutely get exposure and letters if you don't have a home program, it's just harder to do so.

 

[bc65]

Just out of curiosity, what are some notable med schools WITHOUT neurosurgery programs? It seems the vast majority I've looked at have at least several neurosurgeons.

Having a program doesn't just mean that the schools have neurosurgeons. They mean that they have a residency program in neurosurgery. So, the residency director of your program will have more credibility when they recommend you rather than just some random neurosurgeon.

 

[mimelim]

Go to the school you like better, overall. Despite your interest in neurosurgery now, you will still probably change you mind by the time you get through your 3rd year of med school. Shadowing is different from actually doing long cases in the middle of the night.

To clarify the "7 year " issue: Some surgical specialties require a full 5 or 6 year general surgery residency first as a pre-requisite, after which you apply to separate 2 year fellowship, eg vascular surgery, cardiothoracic surgery. Of those, a few programs combine the general surgery plus the fellowship into one admission process, but they still take 7 years. Neurosurgery is NOT one of those specialties. ALL of neurosurgery involve a single residency, usually 7 years long.

Urology, orthopedics, and ENT are single 5 year programs. You don't do a separate general surgery residency first. Plastic surgery is an exception, in that it does it both ways: Some 6 year residencies, and some where you do a full general surgery residency for 5 years, after which you apply for a separate 3 year plastic surgery program.

While diverging from the primary topic, this is incorrect or misleading.

#1 General surgery (GS) programs are 5 years long, not 5 or 6. People may do research years as a part of any pathway, but GS is 5 years.
#2 The programs that combine GS and fellowship are called early specialization programs (ESP), they are almost universally 6 years, not 7.
#3 There are more trainees in integrated vascular surgery than there are in the traditional pathway. These are 5 year MS4 -> vascular surgeon programs, also known as the 0+5 programs.
#4 Cardiothoracic programs are known as i6 programs and they are 6 years long.
#5 The standard examples of surgical sub-specialties only accessible via general surgery would be Colorectal or Pediatric surgery.

Just my two cents:

There are a couple other paths to being a "neurosurgeon"

For example, neurology residency then interventional neuroradiology fellowship. In the same vein, radiology residency then interventional neuroradiology fellowship.

Other paths besides the classical "7 year neurosurgery residency"

Just because you put a words in quotation marks doesn't mean you can just make up a definition for it. Otherwise, my medical school/residency training is a path to being a "fireman".

 

[WedgeDawg]

In addition to what mimelim said above, the other "big" specialties that are only accessible through general surgery are transplant and surgical oncology. However, as a caveat, I believe that if you want to do heart transplants, you have to do a specific heart transplant fellowship. Additionally, many other surgical specialties have oncology fellowships (neurosurgery in particular has a neuro-onc fellowship) and doing a surg onc fellowship isn't always necessary to do onc procedures (see: Whipple - at major centers, you'll usually have a fellowship trained surgeon doing these, but at more remote centers, you'll see regular general surgeons doing them). CT is interesting in that the i6 program, according to some of the CT surgeons at my school, isn't for everyone and you don't get to be double-boarded in GS and CT, and if you're aiming for an academic position, some argue that it's actually better to do the traditional 5+3 pathway than the i6. There's also thoracic track CT that focuses more on lungs than heart, but that's another issue entirely.

Sorry to diverge, but just wanted to help demonstrate that general surgery is a convoluted field when it comes to specializing.

In terms of neurosurgery, you have to do the 7 year residency program and then you can do 1-2 year fellowships (either infolded during your research years of which there are generally 2 or after you're done) in things like pediatric neurosurgery, neurotrauma, the aforementioned neuro-oncology, cerebrovascular, skull base, etc, but these specializations are really just further training within a certain area of neurosurgery that all neurosurgeons will be familiar with anyway and aren't an entirely separate field like CT might be considered compared to general surgery.

(actual surgeons - please shout if any of this is incorrect)

 

[typhoonegator]

Agree with above except neurosurgical tumor fellowships aren't typically called neuro-oncology, because neuro-oncology is a fellowship for neurologists or oncologists specializing in medical management of brain tumors. Also, not every neurosurgery residency allows fellowships to be folded in, or at least they don't allow everyone to do it. At some centers, it's the exception rather than the norm -- those research years are there for a reason, not just vacation time you can use to improve your earning potential. Some need both; I know several that did endovascular fellowships during their residency, and still took a year to do dedicated skull base and/or vascular neurosurgery fellowships after residency to build their chops. For academics, it can be a bit of a catch-22 because you want to get really well-trained clinically, but you also want to have the research credibility to get a great academic job, and you can't do both at once. There's a whole neurosurgery forum on this site, and those interested should feel comfortable asking well-informed questions on that board as well. There used to be Uncle Harvey's forum (for Harvey Cushing) on another site, but not sure if that is still around anymore.