Vitreoretinal Surgery or Neurosurgery?

[Eye-eye]

I'm trying to figure out what I'd want to go into in medicine in the long run, and am having a hard time comparing all the factors of the two fields I'm most interested in (vitreoretinal and neurosurg) because I can't find a lot of reliable info out there. I've shadowed both, and enjoyed them both immensely, moreso than any other specialties I've been exposed to. Having never been much of a "blood and guts" guy, but much more interested in neuro and in sensory systems (e.g., vision), and wanting to be in a field where I can provide a treatment and cure or dramatically improve patients' conditions (i.e., surgery) seems to me like it would fit best with my personality. Shadowing in both was fascinating.

If I enjoy both, then I have to start considering a host of other factors impacting my lifestyle; I'm looking to start having kids in a few years, and I know that neurosurgery residency (and practice, from what it sounds like) is extremely intense. What I've heard is ~80 hours/week. And a 7 year residency. On the other hand, it sounds like neurosurg is a really small, tight-knit field, which I think I would really like. And I've heard average compensation (I'm guessing after 5-10 years from completing residency?) is like 700k, which would offset stress from debts and the long residency.

I know a lot less about the lifestyle of a vitreoretinal surgeon. I've heard of 40 hour workweeks, and somebody posted an average salary of around 600k (I'm also guessing after 5-10 years from completing residency?). However, these weren't from the same source, so I don't know if they're saying 80 hours/week for 600k and 40 for 300k or what. I'm assuming it's also a relatively small and tight-knit field, but I don't really know. I know you'd do a normal ophtho residency before the fellowship, which from what I understand isn't quite as crazy (or long) as neurosurg.

Basically, I'm just hoping people can chime in with their experiences and/or objective data from reliable sources to give me a better insight of what it's like to practice in each specialty. In the end, I can't exclude any of these factors or focus too much on any one. How competitive is each to get into (I know they're both very competitive, but compared to each other)? What's starting salary like for each (let's assume I go right into private practice)? What about after 5 years? After 15? How many hours will I be working to make that? How much am I on call (I'm guessing a lot, either way)? I'm trying to balance the goals of actually getting to know my kids with being able to provide for them, their colleges, etc, after my debt is taken out. Either way, I'm sure I'll be able to do that, and I think I'd love what I do, considering how it's fascinated me when I shadowed, and how much I like being constantly busy and overloading my plate (sounds like a requirement, at least for neurosurg). I'm just trying to get as good a sense of things as I can, from as many sources as I can.

Thank you, and sorry for the long post!

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[DrZeke]

Not to come down on you, but this is very intense and seems pointless at this stage in your career....

Do you have an acceptance to medical school at this time?


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[Eye-eye]

Not to come down on you, but this is very intense and seems pointless at this stage in your career....

Do you have an acceptance to medical school at this time?


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No, I totally understand. I do have an acceptance but am not yet in school.

I realize that it's very early, and also that most students change their minds as to what they think they want to practice. Even so, I've always been one to plan ahead and try to think about all the options far in advance. And from what I've seen poking around SDN, neurosurgery at least is one of the few fields in which a decent number seem to have known they wanted to go into it prior to med school. And since I'd really like my research in school (which I'd also like to start early) to be in my intended field if possible, especially since they're so competitive, I would like to at least give this as much thought as I can in my gap year, while things are less hectic.

I realize this may all change as I go through my clinicals in a few years, but as I said, I like to plan all the options ahead; it's just how I've always been. And it doesn't hurt to think about it and try to be prepared, I figure.

 

[ojoseco]

Nothing wrong with planning ahead and looking to the future even at your stage as long as it doesn't consume your focus and take away from the more pressing tasks at hand, namely enjoying what time you have before medical school and subsequently focusing on doing your best in your medical school coursework ---acceptance to medical school is an exciting time and you have a lot of great opportunities and choices ahead in the next few years!

That being said, it is quite difficult to choose a specialty at your stage. I thought i wanted to do primary care up till 4th yr of med school, ended up switching to ophthalmology. Shadowing before medical school is much different than being immersed in rotations in 3rd and 4th yr. also, your priorities and how much weight you give each priority can change through medical school---for example, I always valued Family and work/life balance, but even much more so after my son was born in medical school.

Since both Ophthalmology and Neurosurgery are very competitive, it will definitely not hurt you to start research in either field early in medical school---honestly i dont think it matters if you do lots of neurosurgery research but end up applying to Ophthalmology, this research will still help strengthen your application.

You talk alot about Family in your post---as someone who prioritizes family as my #1, I would strongly suggest you think twice about Nuerosurgery---would be quite challenging to start a family in residency or early in your career, though im sure people have done it. Ophthalmology in general affords more opportunities for a family friendly lifestyle if this is your priority, though it certainly varies by subspecialty and practice setting...

$$ will be fine in either field if you budget appropriately, vitreoretinal tends to be the highest paying subspecialty in Ophthalmology and the most taxing call schedule---salary data can be found in medscape surveys (small sample) or MGMA data, though it is quite variable. Your questions in these areas are very specific but the answers are dependent on a number of factors and are not the same for all practitioners in that specialty, so you need to bear this in mind when looking at the data.

Ophthalmology is also a very small, tight knit community of which vitreoretinal surgeons make up a small percentage. Im sure you can google the total number of currently practicing physicians in each specialty.

OK to plan ahead and will certainly benefit you to start research in either field early in medical school, dont stress about which field to do research in---just try to get plugged into good clinical projects that will get published (talk to people at your med school to see who good mentors are). Remember, Ophthalmology and Neurosurgery are similarly competitive and scoring well on your USMLE Step 1 will be vital for each, so doing well in your pre-clinical coursework and subsequently this exam should be your focus in order to keep your options open. Please relax and enjoy your time before medical school, things will get busy quickly.


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[Eye-eye]

Nothing wrong with planning ahead and looking to the future even at your stage as long as it doesn't consume your focus and take away from the more pressing tasks at hand, namely enjoying what time you have before medical school and subsequently focusing on doing your best in your medical school coursework ---acceptance to medical school is an exciting time and you have a lot of great opportunities and choices ahead in the next few years!

That being said, it is quite difficult to choose a specialty at your stage. I thought i wanted to do primary care up till 4th yr of med school, ended up switching to ophthalmology. Shadowing before medical school is much different than being immersed in rotations in 3rd and 4th yr. also, your priorities and how much weight you give each priority can change through medical school---for example, I always valued Family and work/life balance, but even much more so after my son was born in medical school.

Since both Ophthalmology and Neurosurgery are very competitive, it will definitely not hurt you to start research in either field early in medical school---honestly i dont think it matters if you do lots of neurosurgery research but end up applying to Ophthalmology, this research will still help strengthen your application.

You talk alot about Family in your post---as someone who prioritizes family as my #1, I would strongly suggest you think twice about Nuerosurgery---would be quite challenging to start a family in residency or early in your career, though im sure people have done it. Ophthalmology in general affords more opportunities for a family friendly lifestyle if this is your priority, though it certainly varies by subspecialty and practice setting...

$$ will be fine in either field if you budget appropriately, vitreoretinal tends to be the highest paying subspecialty in Ophthalmology and the most taxing call schedule---salary data can be found in medscape surveys (small sample) or MGMA data, though it is quite variable. Your questions in these areas are very specific but the answers are dependent on a number of factors and are not the same for all practitioners in that specialty, so you need to bear this in mind when looking at the data.

Ophthalmology is also a very small, tight knit community of which vitreoretinal surgeons make up a small percentage. Im sure you can google the total number of currently practicing physicians in each specialty.

OK to plan ahead and will certainly benefit you to start research in either field early in medical school, dont stress about which field to do research in---just try to get plugged into good clinical projects that will get published (talk to people at your med school to see who good mentors are). Remember, Ophthalmology and Neurosurgery are similarly competitive and scoring well on your USMLE Step 1 will be vital for each, so doing well in your pre-clinical coursework and subsequently this exam should be your focus in order to keep your options open. Please relax and enjoy your time before medical school, things will get busy quickly.


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Of course! I'm super excited, and since my med school's cirriculum has a decent amount of unstructured time in the first year, I plan to start off with research and heavier shadowing as soon as I can. Just trying to decide if I should continue with retinal research (as I've been doing in my gap year) or try something new...

I guess my biggest questions is how crazy VR really gets compared to neurosurgery. I've heard some people saying VR is a very busy surgical specialty, and then I saw someone who said he does like 35-40 hours a week (9-5 schedule) in an all-retina group and still makes 800k... which seems like it must be a huge outlier, but I don't really know. Of course, that was supposedly due to a lot of laser treatments (PRP, etc), whereas what I saw when I shadowed was mostly using instruments inserted through the pars plana, if I remember correctly. But maybe I didn't see enough variation in the VR field just from shadowing him?

Anyway, thank you for the advice! I definitely appreciate the availability of attendings and residents on this site to be there for the little guy!

 

[Trichromatic]

I don't think you'll find anyone here that'll vote for neurosurgery. I was actually going into neurosurgery and switched at the end of MS3. More than a few neurosurgeons I talked to said that if they could go back they'd consider ophthalmology instead, and I'm sure some of them would have done retina (though one told me cornea). I don't think liking both is surprising, but they are miles apart in practice. VR can get crazy, but it's still a clinic-based specialty like all of ophthalmology. My medical school was affiliated with a PP group and those VR surgeons had a great lifestyle (and salary as you mentioned). The academic surgeons I saw in med school and see now are quite busy, especially at trauma/tertiary referral centers. If you're working in academics, particularly at a busy program, many of the late night cases/emergencies will be sent your way. I know a fellow at top retina program, and the hours there were similar to a general surgery resident. As echoed above, I also considered family life when deciding between neurosurgery and ophtho, and there is really no comparison. In any case, it is early but not overly so. I waited until the end of 1st year to find research, and ended up doing neurosurgical/stroke research for the next 2-3 years which was a lot of fun and different than what most ophtho programs see on CVs. Cheers.

 

[Eye-eye]

I don't think you'll find anyone here that'll vote for neurosurgery. I was actually going into neurosurgery and switched at the end of MS3. More than a few neurosurgeons I talked to said that if they could go back they'd consider ophthalmology instead, and I'm sure some of them would have done retina (though one told me cornea). I don't think liking both is surprising, but they are miles apart in practice. VR can get crazy, but it's still a clinic-based specialty like all of ophthalmology. My medical school was affiliated with a PP group and those VR surgeons had a great lifestyle (and salary as you mentioned). The academic surgeons I saw in med school and see now are quite busy, especially at trauma/tertiary referral centers. If you're working in academics, particularly at a busy program, many of the late night cases/emergencies will be sent your way. I know a fellow at top retina program, and the hours there were similar to a general surgery resident. As echoed above, I also considered family life when deciding between neurosurgery and ophtho, and there is really no comparison. In any case, it is early but not overly so. I waited until the end of 1st year to find research, and ended up doing neurosurgical/stroke research for the next 2-3 years which was a lot of fun and different than what most ophtho programs see on CVs. Cheers.

Thank you; this is definitely helpful. Do you think there's as much of a bias in VR toward having ophtho research as there seems to be in neurosurgery for having neurosurg research?

 

[pasquals]

Thank you; this is definitely helpful. Do you think there's as much of a bias in VR toward having ophtho research as there seems to be in neurosurgery for having neurosurg research?

You don't need ophtho research to get into an ophtho residency but you'll need good retina research to match retina fellowship. You probably just need some sort of research to match neurosurgery. You're comparing a fellowship to a residency... it doesn't really work...


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[Eye-eye]

You don't need ophtho research to get into an ophtho residency but you'll need good retina research to match retina fellowship. You probably just need some sort of research to match neurosurgery. You're comparing a fellowship to a residency... it doesn't really work...


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Fair enough. I admittedly know very little about applying for fellowships. When are you supposed to find time for significant retina research during residency, though? Or do most people practice as an attending for a year or two before applying for a retina fellowship?

 

[DrZeke]

You don't need ophtho research to get into an ophtho residency but you'll need good retina research to match retina fellowship. You probably just need some sort of research to match neurosurgery. You're comparing a fellowship to a residency... it doesn't really work...


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The research for A retina fellowship doesn't have to be impressive. I'm at a program with a retina fellowship and many of our matched people have no publications.


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[DrZeke]

Oh and this thread makes me feel inadequate.


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[Eye-eye]

The research for A retina fellowship doesn't have to be impressive. I'm at a program with a retina fellowship and many of our matched people have no publications.


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Interesting. Out of curiosity, are we talking medical retina or surgical retina? If I understand correctly, you can do a fellowship in either, though don't quote me on that... I certainly don't know all the subspecialties of ophtho by any means.

 

[Eye-eye]

Oh and this thread makes me feel inadequate.


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Lol, how so? You guys are all a bunch of ophtho residents talking to a pre-med. I don't see what you have to feel inadequate for in this thread...

 

[Eyefixer]

Most private practice retina docs don't have "crazy schedule". It's clinic and occasional (depending on the set up) after hours emergencies. A full partner in a busy good retina group can certainly pull in 800k or more. Reimbursements have been going down through and had hit retina particularly hard this year, so the numbers are fluid. Neurosurgery is a completely different animal. Not family friendly, tough schedule, operating at night (unless you do spine only and even then- hospital rounding, etc). But, at least for now, you can write your own ticket with neurosurgery. They only graduate 140 residents per year and demand is huge. 800k is pretty much a starting salary for them and goes way up after that.


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[Eye-eye]

Most private practice retina docs don't have "crazy schedule". It's clinic and occasional (depending on the set up) after hours emergencies. A full partner in a busy good retina group can certainly pull in 800k or more. Reimbursements have been going down through and had hit retina particularly hard this year, so the numbers are fluid. Neurosurgery is a completely different animal. Not family friendly, tough schedule, operating at night (unless you do spine only and even then- hospital rounding, etc). But, at least for now, you can write your own ticket with neurosurgery. They only graduate 140 residents per year and demand is huge. 800k is pretty much a starting salary for them and goes way up after that.


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They START at 800k? Geez, how much higher could it really go? I can't imagine you could really make more than a million in a year, unless you're doing something crazy specialized. Besides, isn't their malpractice huge? I thought I saw somewhere it being like 100-300k. As for how many there are, is VR really any bigger of a field? I would think neurosurgery is more needed (and thus would theoretically have more doctors) than VR surgeries. Again I could be completely wrong as to all of this, though...

 

[Eyefixer]

I know a few neurosurgeons and set ups vary of course. Academics will be less, but life style is better with fellows and what not. Busy private practice especially with surgery center ownership and heavy spine may generate way over a million.


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[DrZeke]

Interesting. Out of curiosity, are we talking medical retina or surgical retina? If I understand correctly, you can do a fellowship in either, though don't quote me on that... I certainly don't know all the subspecialties of ophtho by any means.

Surgical retina. Mostly They operate 1 day a week with some add ons.


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[Eye-eye]

I know a few neurosurgeons and set ups vary of course. Academics will be less, but life style is better with fellows and what not. Busy private practice especially with surgery center ownership and heavy spine may generate way over a million.


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Then again, if you never have time to enjoy it, what's the point of making that much...

In the end, I think it will just come down to figuring out which I fall in love with in clinicals. You guys have helped put to rest some of my fears about needing to immediately decide what kind of research I need to do, at least. Looks like I have some time... Not to say that more info isn't always appreciated, of course.

 

[Trichromatic]

Edit

 

[Eye-eye]

Do whatever research you find interesting. I was choosing between neurosurgery and ophtho, and I joined a neurosurgical/stroke research lab at the end of MS1. I enjoyed the animal surgeries, learning how to write, critically appraise manuscripts, and it was much different than most research that programs see on CVs. I did ophtho clinical stuff in MS3. I should say, however, that when interviewing at less research-oriented programs, I was asked about my 2 ophtho clinical products in lieu of my translational work which was much more complicated, productive, and time-intensive. So it goes. VR in private practice is fine: 1-2 days OR, 3-4 clinic, minimal emergencies (my med school was affiliated with such a group). The real busy VR surgeons are at academic eye centers because all the community cases get shunted to them off hours, as well as more complex cases in general. Neurosurgery is extremely interesting, but I found most of them to be unhappy, overworked, their cases with worse outcomes, etc. Ophtho was a very easy choice in the end, and I'll probably apply to surgical retina (diverse pathology, interesting surgeries, and great research opportunities).

Thank you. I think I'll just try to immerse myself in both as much as I can, both in research and clinicals, and see which I like better. I imagine that once I get there, it will probably be an easy decision for me as well; I just wanted to get as much info on lifestyles, etc., as possible, as soon as possible. Thanks again!

 

[Trichromatic]

Thank you. I think I'll just try to immerse myself in both as much as I can, both in research and clinicals, and see which I like better. I imagine that once I get there, it will probably be an easy decision for me as well; I just wanted to get as much info on lifestyles, etc., as possible, as soon as possible. Thanks again!

That's a good attitude. I realized I said the same thing essentially twice, my apologies. I'm delirious from intern year-not an uncommon occurrence.

 

[Eye-eye]

That's a good attitude. I realized I said the same thing essentially twice, my apologies. I'm delirious from intern year-not an uncommon occurrence.

No worries; I got some new info each time.