question about fellowships...

[anxietypeaker]

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to operate on the brain, is it the de fact standard to have completed fellowship in something like epilespy/etc? If so, do neurosurgeons without a fellowship do any brain surgery TYPICALLY?

thanks

 

[sga814]

residency: general training within a field
fellowship: specific training within a field

someone who's completed a neurosurgery residency should be able to perform any neurosurgery, while a neurosurgeon who in addition to residency had a fellowship in "epilepsy" correction, or what have you, should be REALLY REALLY good at dealing with those types of patients, but should still be able to manage anything else.

 

[anxietypeaker]

i realize the residency vs fellowship comparison. Neurosurgeons without fellowships can TECHNICALLY do brain surgery but do they actually do it? (ive heard from someone they dont: neurosurgeons without fellowship in some type of brain surgery tend NOT to do direct brain surgery).

For example, technically you can legally prescribe medicine after only an internship. But that isnt the norm prolly (they do an actual board residency).

I guess what it comes down to is this: Are there surgeries involving DIRECT contact with the brain that ARE (not "technically can be") carried out by neurosurgeons without fellowships?

 

[njbmd]

i realize the residency vs fellowship comparison. Neurosurgeons without fellowships can TECHNICALLY do brain surgery but do they actually do it? (ive heard from someone they dont: neurosurgeons without fellowship in some type of brain surgery tend NOT to do direct brain surgery).

For example, technically you can legally prescribe medicine after only an internship. But that isnt the norm prolly (they do an actual board residency).

I guess what it comes down to is this: Are there surgeries involving DIRECT contact with the brain that ARE (not "technically can be") carried out by neurosurgeons without fellowships?

Hi there,
It is quite obvious that you DO NOT understand the difference between residency and felloship. Anyone who has completed a neurosurgery (read neuroSURGERY!) residency can operate on the brain. A fellowship beyond the neurosurgery residency is not required to OPERATE on the brain. Neurosurgery fellows have extra specialization and experience in areas of brain surgery but all neurosurgeons are trained to operate on the brain if they wish. (I have operated on the brain as a PGY General Surgery resident!)

Any resident, regardless of completing internship, can legally prescribe medications. Once you have received a residency DEA number, you can legally prescribe medications in the United States.

njbmd 🙂

 

[robotsonic]

Neurosurgeons without fellowships can TECHNICALLY do brain surgery but do they actually do it?

Why the hell would someone complete a 6-year neurosurgery residency and then not actually do surgery?

 

[anxietypeaker]

the justification for his reason was this: academia medical centers are where brain surgery occurs. To be on faculty, you pretty much have to have a fellowship. Therefore, a fellowship is a de fact requirement for brain surgery.

Now that is i guess what confused me. Any of you SDN gods care to enlighten me? thanks

 

[Telemachus]

the justification for his reason was this: academia medical centers are where brain surgery occurs. To be on faculty, you pretty much have to have a fellowship. Therefore, a fellowship is a de fact requirement for brain surgery.

Now that is i guess what confused me. Any of you SDN gods care to enlighten me? thanks

A neurosurgeon at a community hospital will still be touching brain regularly......

what's the major malfunction here?

by the way, the term is "de facto"

 

[1SwtWrld]

i realize the residency vs fellowship comparison. Neurosurgeons without fellowships can TECHNICALLY do brain surgery but do they actually do it? (ive heard from someone they dont: neurosurgeons without fellowship in some type of brain surgery tend NOT to do direct brain surgery).

Are you kidding me!!!!!! Thats like saying Gen Surg residents dont do surgery they just sit around all day after performing a 6 year residency. Fellowships are not mandatory.

 

[1SwtWrld]

I guess what it comes down to is this: Are there surgeries involving DIRECT contact with the brain that ARE (not "technically can be") carried out by neurosurgeons without fellowships?

Yes....it happens every day in most hospitals.

 

[velo]

Why the hell would someone complete a 6-year neurosurgery residency and then not actually do surgery?

ha, 6 years if you do the fast track

 

[emack]

Why the hell would someone complete a 6-year neurosurgery residency and then not actually do surgery?

That's what I was thinking. What would they do instead? Sit around and not operate?

 

[MattD]

I think his question was simply whether non-fellowship trained neurosurgeons in the community typically did brain operations in their day-to-day practice (not emergencies), or if those cases typically went to fellowship trained surgeons and the general NS would up doing more non-brain related procedures, like spine and everything else (sorry not too versed in NS). He seemed very aware of the fact that they COULD legally do it, just not whether it was typical. It wasn't a scope of practice question, but a reality of practice question. Naive question? maybe. Stupid question? doesn't seem like it to me!

geez, be nice

 

[fullefect1]

the justification for his reason was this: academia medical centers are where brain surgery occurs. To be on faculty, you pretty much have to have a fellowship. Therefore, a fellowship is a de fact requirement for brain surgery.

Now that is i guess what confused me. Any of you SDN gods care to enlighten me? thanks

Where did you hear that you need to have a fellowship to be a neurosurgery faculty?

 

[Smurfette]

I think his question was simply whether non-fellowship trained neurosurgeons in the community typically did brain operations in their day-to-day practice (not emergencies), or if those cases typically went to fellowship trained surgeons and the general NS would up doing more non-brain related procedures, like spine and everything else (sorry not too versed in NS). He seemed very aware of the fact that they COULD legally do it, just not whether it was typical. It wasn't a scope of practice question, but a reality of practice question. Naive question? maybe. Stupid question? doesn't seem like it to me!

geez, be nice

Why would a general neurosurgeon be allowed to operate on the spine without a spine fellowship?!! *sarcasm*

There are fellowships in just about everything. People do fellowships for any number of reasons. It does not mean that a fellowship trained individual is better than one who is not. Lord knows if you do an endocrine surgery fellowship it does not mean you can't do an appendectomy. If that was true then there's no point in doing a residency and you should just skip to the fellowship. Also, some people graduate from a residency program with enough numbers of a procedure to have completed the relevant fellowship (like a gen surg program heavy in trauma; they may graduate with enough trauma cases to have completed a trauma fellowship, despite not actually doing a formal fellowship).

 

[MattD]

Why would a general neurosurgeon be allowed to operate on the spine without a spine fellowship?!! *sarcasm*

There are fellowships in just about everything. People do fellowships for any number of reasons. It does not mean that a fellowship trained individual is better than one who is not. Lord knows if you do an endocrine surgery fellowship it does not mean you can't do an appendectomy. If that was true then there's no point in doing a residency and you should just skip to the fellowship. Also, some people graduate from a residency program with enough numbers of a procedure to have completed the relevant fellowship (like a gen surg program heavy in trauma; they may graduate with enough trauma cases to have completed a trauma fellowship, despite not actually doing a formal fellowship).

Thank you for the sarcasm, it fills my heart with the spirit of the holidays! But you still missed the point. It's not a matter of CAN they do it, it's a matter of whether in the real world of community practice, do the fellowship trained (are there even fellowships in 'brain'? I certainly don't know, I'm just asking a question) surgeon's "snap up" the brain cases leaving all the other stuff to the non fellowship trained types, or do the cases get spread around? Obviously if there's no fellowship trained individual in the area, the case is done by someone without a fellowship, I'm not doubting their qualification to do it. My impression of the OP's question was that he's very interested in brain cases, and wanted to know if not doing a fellowship would cause him to lose those cases that he's really interested in to other docs who did do a fellowship. (or she, don't mean to be sexist...)

Sorry, it just bugs me when people rip on someone just for asking a question, and then proceed to demonstrate that they didn't even know what question was being asked in the first place. There was a time when you didn't know everything (I bet you still don't...) and to get information... you ask questions! Why can't people either just answer questions civilly, or ignore the question, instead of attacking and insulting people? Is it an internet phenomenon or are people just becoming this spiteful and mean? But whatever, it wasn't even my question in the first place. I hope you dug a valid answer to your question out of all the snide comments anxietypeaker.

Happy Holidays!
(By which I mean Merry Christmas!)

 

[Blake]

I'm not even sure you can be a ''general'' neurosurgeon nowadays. It's now all about fellowships or specializing in vascular, spine, peripheral, tumoral, epilepsy, functional, trauma, etc... I think the answer to your question is that any neurosurgeon can operate the brain and the nervous system, but they mainly choose to do what they're most comfortable with. I've seen general surgeons with fellowships perform brain surgery, but that's really rare so I wouldn't bet too much on being able to do it these days.

 

[kenmc3]

Ok, I think I will actually try and answer the question:

1) Many neurosurgeons in private practice do NOT have fellowships. Yet they perform a wide variety of neurosurgery on a VERY regular basis including spinal work and craniotomies (working inside the skull on the brain or vessels). They are fully qualified to perform most neurosurgery procedures and they usually have enough demand in their practice area.

2) Any neurosurgeon can perform craniotomies (i.e. removing tumors, trauma, cerebrovascular surgery, draining abscesses, epilepsy, etc) and spinal surgeries (herniated discs etc) all a fellowship does is give you extra training give you more experience at a particular type of surgery.

3) Training and fellowships are usually not what limits a neurosurgeon in a private setting, it is usually the facilities and resources. For example, epilepsy surgery requires a good neurology service and expensive equipment which many private hospitals don’t have. So even though the neurosurgeons are able to perform the procedures, they may not have the needed support. Another limitation is time, most private practice neurosurgeons don’t want to spend 7 hours operating on a patient with Parkinson’s disease – it usually isn’t worth their time, so they let the academic docs do it. Also difficulty plays a role. If the tumor is in a very scary place where most neurosurgeons don’t want to cut – a private neurosurgeon may refer the patient to some world renown academic who is an expert in tumors in that location etc.

Lets use for example a private neurosurgery practice I know well: there are 4 neurosurgeons here.

1) Fellowship in Vascular neurosurgery
2) Fellowship in spine
3) No Fellowship
4) No Fellowship

All 4 of them do the exact same procedures – there is virtually no difference. However the 2 docs which are fellowship trained tend to operate on their respective areas more frequently and may also take the more difficult cases. But they also do general procedures as well – and the non-fellowship trained docs to spine and vascular cases. So fellowships don’t really matter – they just give you more experience in a field you want to concentrate on.

 

[kenmc3]

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