Question for the Neurosurgery residents

[fORe!]

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Given that so much of what is said about neurosurgery appears to be second-hand or lower info; it makes you wonder whether the specialty truly is self-torture with no hopes for a normal life like everyone seems to make it out to be. Can anyone in the know please elucidate what exactly makes neurosurgery so terrible??
1) Is it the frequent calls in residency; if so, how much more frequent is the call than for other surgical residencies? I
2) Is it the lengthy residency; because isn't it only one or two years longer than ENT, uro, gen surg?
3) Is it the long cases? (ENT, chest, ortho cases can all be extremely long)
4) How true is it that neurosurgeons are all divorced/have marriages in shambles/have a terrible family life?? Is it truly unheard of to have a good family life?

Thanks for your replies

 

[md_student10021]

Originally posted by fORe!
Given that so much of what is said about neurosurgery appears to be second-hand or lower info; it makes you wonder whether the specialty truly is self-torture with no hopes for a normal life like everyone seems to make it out to be. Can anyone in the know please elucidate what exactly makes neurosurgery so terrible??
1) Is it the frequent calls in residency; if so, how much more frequent is the call than for other surgical residencies? I
2) Is it the lengthy residency; because isn't it only one or two years longer than ENT, uro, gen surg?
3) Is it the long cases? (ENT, chest, ortho cases can all be extremely long)
4) How true is it that neurosurgeons are all divorced/have marriages in shambles/have a terrible family life?? Is it truly unheard of to have a good family life?

Thanks for your replies

Ok, I'm not a neurosurgery resident. Let's just assume that someone working 100 hours a week doesn't have time to reply. This is based on what I have heard/read, so take it with a grain of salt, unless you have hypertension...

(1) call is very frequent. remember that neurosurgery programs are very small (typically 1-2 residents per year per program, a few have 3/year). With fewer residents, you necessarily have frequent call.
(2) yes, the lengthy residency is tough. noone said residency in general surgery, ENT, or urology, was easy either. adding 1-2 years to an already painful 5 is a sacrifice many cannot or do not want to make.
(3) again, long cases are not specific to neurosurgery. a long case in CT, ortho, etc., is very demanding as well. But also remember that if a neurosurgeon makes a mistake, you may very well leave your patient paralyzed, aphasic, or worse.
(4) family life is rough for just about every surgical specialty (except perhaps ENT and uro). This is of course a generalization, because there are plenty of happily married, family-type surgeons out there. The thing is that as a resident you are not in control of your hours, which are awful, and make it difficult to have any semblance of a normal personal life. In practice, it will probably be easier (assuming you are in a large group with less call), but you will still have rough hours, emergencies that can't wait until morning, and cases that unexpectedly go on for hours later than you'd anticipated.

I know you really wanted to hear from a resident; my answers are pretty accurate, though (as far as I know).

 

[neurogeek]

I'm not a NS resident either, but I have spent time with a neurosurgeon that does enjoy a family life. He has a great marriage and does fun things with his kids. He works A LOT, but when he's not working he really spends good time with his family. So, it can be done.

The post by md_student10021 sounds accurate to me.

 

[CutIt]

I'm not a NS resident; although I recently had a brief discussion with one who surprisingly said that "things will be a lot different" when the 80-hour rule goes into effect. When I asked for clarification she insinuated that the residents wouldnt have to work as long as previously. Has anyone else heard of anything like this?

 

[Idiopathic]

My concern is that no matter what the "rules" say, no resident is going to jeopardize his/her status in an ultra-competitive program by squealing about a +100-hr work week. The way I see it, surgery programs may not feel compelled to stick to the letter of the law when it comes to the new rules. I know that I am not necessarily planning on a sub-80 hour week. This has nothing to do with neuro specifically, but it does show just a little bit of the seedy side of competitive programs (neuro, CT, ortho, etc). Anyone who reports violations can pretty much kiss that choice of career goodbye. Am I far off base here?

 

[aram]

How much money do neurosurgeons make?

 

[apma77]

Some general surgery programs are sticking to the 80 hr week but ince neuro only takes 1 or 2 residents a year there will be many plcaes either shut down or put on probation by acgme for violations..thats pretty much obvious!

 

[phil123]

APa,
You've pretty much said it all. In fact, the Univ of Chicago Neurosurgery program has already been notified of its probationary status, and some of the attendings are anticipating the worst so they are actively looking for openings at other institutions. applicants should in general steer clear of unstable programs, to ensure that a residency program exists throughout their training.

 

[neo]

well, i think there will at the very least be alot of pressure from peers and attendings to "fudge" the 80 hour work week at least. it might not be openly stated, but i think there is this unsaid ethic in surgery, when stuff hits the fan, someone has to do the work to preserve good patient care and if that makes me go over my 80 hour work week, im fine with that.

and i think if some resident complains about how s/he's working more than 80 hours a week, unless they're being worked way more than everyone else and its significantly more than 80 hours a week, most people in surgery are gonna label them as weak. now if the resident is being singled out and overworked or is working far in excess, well, that's of course wrong.

i think the 80 hour work week is a great idea because it will have programs working towards more humane and safer workloads for residents but i kinda doubt it will be adhered to right down to the letter at many places.

 

[lipoyl]

I matched in neurosurgery this past year...I'll try and answer your questions based on my observations during my sub-i's, etc.


(1) The calls vary dramatically. Larger programs have more residents, so the call schedule is more evenly distributed. It is certainly possible to find programs with Q5-Q-6 call. I would say the average is Q4. I have not seen worse than Q3 call (except for chiefs, who just operate and leave). Of course your call nights will be busier than that of a medicine or peds resident, but that goes without saying.

(2) The residency is between 6 and 8 years long depending on the program. Most programs are 7-years. The residency incorportates atleast one (and in most cases two) years of mandatory research. During your research years, your schedule will be easier, and you'll have time to see if academic neurosurgery apeals to you. Some programs even allow you to pursue fellowships during the research time. Overall, when you consider that you will be subspecialty trained, 7 years isn't too bad, even compared to other subspecialties.

(3) The cases vary in length. You do things like resecting an acoustic schwanoma which can take 8+ hours, or do a sural nerve biopsy which takes 15 minutes. The beauty of neurosurgery is the spectrum of cases your involved in.

(4) Many neurosurgeons are divorced, but many are happily married too. Really this factor is as much a reflection of you and your relationship as it is the field. You can certainly have a good family life, but as with anything else, if you want a ton of money, your gonna have to work.

 

[CutIt]

good post, Lipoyl. If you don't mind, could you expound on your reply #4? Are you saying that the fact that one's spouse is a neurosurgeon is not at all related to the divorce rate for neurosurgeons? Also, could you please comment on what you know about how the 80 hour work week is going to impact NS residency? Also (sorry, last question!) what specialties were you considering in your latter stages of med school before deciding to choose NS, and what factors led you to do so?

Thanks!

 

[lipoyl]

Lifestyle is more of a factor in neurosurgery than most other residencies (including other surgical subspecialties). This could account partially for the divorce rate. However, neurosurgery also tends to attract more focused and driven applicant pool, many of whom put work ahead of family life. I've met a number of neurosurgeons who are happily married. It depends on your priorities I guess...if you want to make a ton of money, or become a chairman by the time you turn 45, you will have to make sacriifces on the family side. Many people are able to balance the two areas just fine.

The 80-hour week is very controversial among academic programs. I interviewed at programs (Baylor, Barrow, UCSF), which were quite upfront in stating that they wouldn't comply. Other programs (Brigham, Hopkins) were already within the 80-hour limit. Overall I would say that the rule will benefit residents in n-surg, but not dramatically. Still expect to work 100-110 hours. This is especially true in smaller programs where you don't have the man-power to pick up the slack.

I knew fairly early that I wanted to do neurosurgery. If it hadn't been an option I would've considered either ENT or rad. onc. (my interest is in tumors).

 

[GeorgeC97]

hi lipoyl -

could you share more details about the application process? take away the top tier programs, but does everyone out on trail have publications? for neurosurgery, how much of the process is a number game - meaning, all honors / AOA / board scores -- or is really about getting great letters of recommendation (obviously a combo of all of the above). also, perhaps you know some who have matched who have decided later in 3rd year that they want to do NS -- the question is, how do they compare to the other students who have decided long back and have 3-5 pubs under their belt?

any help on the process would be great

thanks for the help

 

[lipoyl]

In my opinion, the applicant pool was competitive (granted, most the programs I interviewed at were upper-tier). There are a significant number of Ph.D's who apply (about a fifth of all matched applicants had Ph.D's this year), so publications certainly are important. Even if you don't have a graduate degree, being involved in research shows people that you are academically inclined, which is always helpful. Although they do ask about AOA, I tend to think that grades as a rule were not as big a selection criteria as people like to say (there is so much variability in the way different schools do grades)

Letters are KEY...make sure you get to know your department's chairman well--a strong endorsement from him (ie a phone call) can make your app. as strong as someone with stellar numbers or a Ph.D

As far as numbers go, the mean Step I score was 234, with considerable variability. Many Ph.D's tended to have lower step I scores and were buoyed by fabulous research. Conversely, many traditional applicants tended to have higher scores. I personally had a score that was >250, and met many applicants with comparable numbers.

I met some people who didn't decide on neurosurgery until later...for the most part their success was dictated by their numbers, med school reputation, and grades...I don't think any program would deny a fabulous applicant just because they decided on n-surg late.

 

[GeorgeC97]

lipoyl -

thanks for your responses. they are invaluable. What's your opinion on letters of recommendation? how many total? how many from neurosurgeons and how many from your 'core' clerkships / non-neurosurgeons.

our dean was saying 2-3 letters from neurosurgeons and 1 from a core clerkship / outside. but i heard from some residents just get 4-5 neurosurgery letters.

oh yes, questions 2 is about the personal statement - did you write simply why you want to go into the field? any comments or suggestions?

thanks again for all your help. congrats to you on your match

 

[lipoyl]

You'll need 3 letters of rec minimum for CAS. Barring extenuating circumstances (ie research with a world famous scientist) they should all be from neurosurgeons. More letters would be a beneficial, provided they are substantive (ie more than just a 'good-guy' letter).

Put whatever you want in your personal statement. Try and be as general as possible (ie don't declare yourself a future pediatric neurosurgeon unless you have a legit reason for wanting to do so), but strongly state your desire to go into academic neurosurgery. Avoid resume dropping as much as possible, since most of that info is in your CAS.

 

[duramaterdoc]

I agree that all 3 letters should be from neurosurgeons.


I DISAGREE that you need to state that you want to do academics. I clearly stated that I wanted to do private practice and I was PRAISED HEAVILY at almost all of my interviews for my honesty.

 

[lipoyl]

If you want a shot at one of the top program (UCSF, Virginia, Hopkins) you have to declare atleast an interest in academic neurosurgery. Saying that you are going into private practice would preclude you from those programs. I think that most people would agree with that.

 

[neurogeek]

I'm able to do a NS elective at a top-tier program (although I have no real chance of matching there), and I'm very interested in another program. My question is: would it be most beneficial to first do a month at the top program and then go to the program I am interested in (i.e. I would potentially gain some experience and such before going to the program I'm interested in), or would it be better to just go to the program I'm interested in? I will only have one month of elective time before I have to submit my app, and I'm hoping to get a LOR from that elective. Is that realistic, and would it be better coming from the chair of the program I'm interested in or from the top school?

Of course, I'm going to apply to a lot of programs.

Thanks

 

[apma77]

sometimes u can shoot yourself in the foot by doing an elective at a place u wanna go!
just keep that in mind

 

[synapse_rules]

Originally posted by lipoyl
If you want a shot at one of the top program (UCSF, Virginia, Hopkins) you have to declare atleast an interest in academic neurosurgery. Saying that you are going into private practice would preclude you from those programs. I think that most people would agree with that.

Lipoyl ~ Great posts! Congrats on your match !

I have a question: I am an IMG currently getting my phd in neurobiology and want to take up neurosurgery later on after my phd.
Granted that NS is quite competitive, especially for IMGs, do you think that good scores with this PhD should enable me to take a fair shot at the NS match, at a mid-level program ?? I know that going for the top tier as an IMG, even with a PhD, is a little unrealistic.

Also, is it worthwhile to go through the route of appling to a competitive prelim Gen surg program and then get a PGY-2 in NS later ? Does this make the NS application stronger.

Any feedback would be highly appreciated - Thanks !

 

[neurogeek]

I'd be interested to hear an answer to synapse's question.

 

[Minimalist M]

I think I remember reading about an IMG matching at Barrows for neurosurgery. They're pretty much as top tier as you can get.

 

[neurogeek]

Bump this up . . .

 

[samsoccer7]

bump this up....

what's the least # of hours an NS can work and still be considered full-time, make pretty good money (over 250) and have little call? obviously this is a terrible question, but I'm curious if it's even possible. I hear stories that sound too good to be true, but you never know...

 

[RADRULES]

Geez man, I have never heard the words "neurosurgery" and "family life" used in the same sentance.

They do some really cool stuff, but if family life is what you are looking for, I really think NS is not the way to go.

 

[Minimalist M]

I jumped into an extensive discussion about family life and neurosurgery on this thread:

Neurosurgery and Family Life Thread

Family life and neurosurgery isn't totally incompatible, but it's certainly not the best choice if family life (or any kind of private life) is a major priority.