Why you should consider neurosurgery - ask me anything

[phantasmo]

Derm and NSGY are so different from each other - what are you trying to do in biotech? It looks like you don't specifically care what the focus is and just want to get into biotech period, so no don't do neurosurgery that's asinine to do all that training, leave a piece of your soul behind, just to immediately leave into biotech.

don't know yet. need to spend the next years learning and gaining that domain knowledge. and nah im not a "need to get into biotech period" guy. I just want to do scalable ****, and biotech seems way more scalable. (but maybe this is inexperienced thinking)

You can do this in any specialty.

i mean regularly and for life. nsgy, working pp, I get the sense everything has to be planned/scheduled, and it's not that much vacation per year (and not much time to grind startups/business/side ventures).

my main question is does nsgy offer more in the way of having insane medical domain knowledge transferable to doing business related things, and is it scalable? because if not, I don't see a purpose to doing it (derm is paying 500k for half the residency years, half the residency hours, and 1.5x the free time as an attending).

I'm not a "yea I'd love to do nsgy to operate on people and make X dollars for each hour spent on surgery". more a question of "the big problems are really cool, and the insane domain knowledge of nsgy can transfer and make you valuable to pharma/device/etc companies or for building own startup"

I know im not choosing specialty here purely based on interest, and that's probably why you comment "derm and nsgy are so far from each other". they are. because I really cba which medicine I practice, medicine and greatness in the field of medicine is not my end goal (unless my thinking is wrong and fields like nsgy ARE in fact scalable, which in that case sure i'd dive right in).

thanks for the insightful response, let me know if I should reword anything. appreciate it.

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[LucidSplash]

I wouldn’t recommend doing a surgery residency if you don’t want to actually do surgery with your life. i’m not sure the time and effort it takes to learn to be a surgeon is worth it if you’re not planning to actually be a surgeon as your primary profession for at least 2 to 3 decades after finishing training.

I’m not quite sure what you mean by “insane domain knowledge”. Every specialty has their niche expertise about that specialty. Ortho has the lock on bones, neurology is your go to for that salad a deep understanding of neurologic pathophysiology, neurosurgery for interventions on the brain, vascular surgery for blood vessels, Cardiology for the heart. You get the idea.

If you want to get into biomedical stuff like designing devices, you should look into Cardiology and Vascular Surgery imho, but only if you have a background in this already. You won’t gain the knowledge about how to develop a device from idea to market from doing a residency in that area. in fact, one could argue that if you are really interested in these areas, you should just go into biomedical engineering in the first place, rather than medical school.

 

[phantasmo]

I wouldn’t recommend doing a surgery residency if you don’t want to actually do surgery with your life. i’m not sure the time and effort it takes to learn to be a surgeon is worth it if you’re not planning to actually be a surgeon as your primary profession for at least 2 to 3 decades after finishing training.

I’m not quite sure what you mean by “insane domain knowledge”. Every specialty has their niche expertise about that specialty. Ortho has the lock on bones, neurology is your go to for that salad a deep understanding of neurologic pathophysiology, neurosurgery for interventions on the brain, vascular surgery for blood vessels, Cardiology for the heart. You get the idea.

If you want to get into biomedical stuff like designing devices, you should look into Cardiology and Vascular Surgery imho, but only if you have a background in this already. You won’t gain the knowledge about how to develop a device from idea to market from doing a residency in that area. in fact, one could argue that if you are really interested in these areas, you should just go into biomedical engineering in the first place, rather than medical school.

how are physicians scaling their time/ability to make money. a lot of my writing here is born out of lack of knowledge. i don't know whether they're scaling in biotech/startups/devices or where.

which specialties are best for scaling and optionality. I threw derm out there because it provides insane capital for lower hours worked. to me that seems like a great deal to have all that time outside of outpatient clinic to grind a startup or whatever one feels passionate about.

do physicians/surgeons discuss this anywhere? I assume white coat investor but where on there if anyone knows?

idk if my question makes sense or im writing it wrong or what.

'which specialty provides the most ability to not be tied down working for a salary tied to X patients seen or Y surgeries done in the long run'. i'm ok sitting in derm clinic for the first 5-10 years of my career accruing capital and building things on the side (until I can totally fly away from sitting in that clinic meeting 1 patient at a time). is this possible in neurosurgery? that's basically my question.

or is a neurosurgeon's life basically either between academic research prestige ego 700-800k salary or private practice 1-1.5 mil salary, no scaling. are there examples of neurosurgeons that are putting their money to work for them (other than basic investing etf type ****)? i don't think it's a good deal to work 55-60 hrs a week 7:30-6 M-W TH-F 9-5 like skullguy69 said for entire life. that's just horrible once you consider that this starts at age 35 at the earliest and the early career will require a lot of hours to establish self.

 

[LucidSplash]

how are physicians scaling their time/ability to make money. a lot of my writing here is born out of lack of knowledge. i don't know whether they're scaling in biotech/startups/devices or where.

which specialties are best for scaling and optionality. I threw derm out there because it provides insane capital for lower hours worked. to me that seems like a great deal to have all that time outside of outpatient clinic to grind a startup or whatever one feels passionate about.

do physicians/surgeons discuss this anywhere? I assume white coat investor but where on there if anyone knows?

idk if my question makes sense or im writing it wrong or what.

'which specialty provides the most ability to not be tied down working for a salary tied to X patients seen or Y surgeries done in the long run'. i'm ok sitting in derm clinic for the first 5-10 years of my career accruing capital and building things on the side (until I can totally fly away from sitting in that clinic meeting 1 patient at a time). is this possible in neurosurgery? that's basically my question.

Most physicians that I know of aren’t scaling in medicine. They are doing “side gigs”. The most common is rental properties that I am aware of.

Most of us are just working and taking care of patients. While there are physician entrepreneurs, very few are doing the kind of thing you are describing.

Some end up getting into aesthetics like Botox and injectables, even those who are not in plastics or derm. But that’s pretty controversial, and many of those end up selling their license to mid levels, which many of us frown on and also puts you at substantial risk.

 

[phantasmo]

Most physicians that I know of aren’t scaling in medicine. They are doing “side gigs”. The most common is rental properties that I am aware of.

makes sense thanks for response. this makes sense. which specialty is best for this. rental properties are the safest way to scale which makes sense for physicians (and their self-selected personalities)

and which specialty best for actively building **** that can return more than just buying 2 or so rentals per year

 

[LucidSplash]

makes sense thanks for response. this makes sense. which specialty is best for this. rental properties are the safest way to scale which makes sense for physicians (and their self-selected personalities)

and which specialty best for actively building **** that can return more than just buying 2 or so rentals per year

There is no best specialty for rental properties. The more money you make, the more capital you have to invest in side projects. But you have to be good at the side projects.

 

[phantasmo]

Most physicians that I know of aren’t scaling in medicine. They are doing “side gigs”. The most common is rental properties that I am aware of.

Most of us are just working and taking care of patients. While there are physician entrepreneurs, very few are doing the kind of thing you are describing.

Some end up getting into aesthetics like Botox and injectables, even those who are not in plastics or derm. But that’s pretty controversial, and many of those end up selling their license to mid levels, which many of us frown on and also puts you at substantial risk.

good points in the last 2 new sentences. yes, this career seems very cringe for doing "physician+" stuff like was originally marketed. apparently the "+" just means sitting in ivory tower academia. which is boring and doesn't translate to money (or am I wrong)

 

[phantasmo]

There is no best specialty for rental properties. The more money you make, the more capital you have to invest in side projects. But you have to be good at the side projects.

makes sense. I like derm because so much free time, so much ability to scale (like you said just open botox clinics or what not), easy residency so can grind side stuff during it, and it's really fast. 1 easy transitional year, 3 not so hard advanced years. then done easy 500k a year by age 30.

then can take that money and put it to work.

how's the future of derm look, and why is their specialty so high-paying RVU-wise?

where does one learn about all this.

 

[LucidSplash]

makes sense. I like derm because so much free time, so much ability to scale (like you said just open botox clinics or what not), easy residency so can grind side stuff during it, and it's really fast. 1 easy transitional year, 3 not so hard advanced years. then done easy 500k a year by age 30.

then can take that money and put it to work.

how's the future of derm look, and why is their specialty so high-paying RVU-wise?

where does one learn about all this.

Well, first you have to match in Derm, pretty much in the top of all specialties in competitiveness.

The reimbursement is high due to the relatively short period of time it takes for office based procedures, so you can see a lot of patients in one day, the fact that most of those office based procedures don’t have long global periods, and the availability of cash based procedures for cosmetic interventions.

 

[JeremiahJohnson]

Some end up getting into

Why Derm and NSGY when you could be a hospitalist? 3 years of residency rather than 4 or 7+, week on week off schedule allowing for lots of dedicated time to your side projects rather than being an evening or weekend warrior. And can still make plenty of income (300k+) to start off. If you're really "scaling" the amount of base income wont matter in the long run and you'll be out a year sooner with more time to afford to these ventures.

NSGY you'll be behind by years, and you just wont have the time unless you want to throw away all that grind (a great neurosurgeon has a LOT to learn after residency and don't often pull back the hours for a while).

And NSGY residency is hell if you don't absolutely love it, and if you do it's just a different circle of hell.

 

[phantasmo]

Why Derm and NSGY when you could be a hospitalist? 3 years of residency rather than 4 or 7+, week on week off schedule allowing for lots of dedicated time to your side projects rather than being an evening or weekend warrior. And can still make plenty of income (300k+) to start off. If you're really "scaling" the amount of base income wont matter in the long run and you'll be out a year sooner with more time to afford to these ventures.

NSGY you'll be behind by years, and you just wont have the time unless you want to throw away all that grind (a great neurosurgeon has a LOT to learn after residency and don't often pull back the hours for a while).

And NSGY residency is hell if you don't absolutely love it, and if you do it's just a different circle of hell.

makes sense - derm because it's like 1 extra year for higher base pay, and I feel the cosmetic scaling is a good floor if other side stuff just doesn't pan out. have already come so far, what's 1 extra year for the ability to scale in that way. also I'm not a huge fan of inpatient. I really like the idea of at some point opening a bunch of clinics (once have the capital which should be fast and after like 5-10 years of initial practice not having to see patients anymore)

nsgy, what you said makes a lot of sense. I saw the barrow nsgy's doing some sort of collaboration with neuralink. is that common? is it lucrative, and are there other examples of this? like are there commonly known anecdotes of any nsgy's scaling, or is it really a specialty for those that just want to go in and do surgeries for their whole life.

what are the top academic nsgy's doing? i assume research? I feel like in some way or form they have equity in what's produced but maybe I'm wrong? surely they're not just sitting there looking at blots and reading papers for the pure fulfillment

thanks so far for all the responses and insight to you both

 

[JeremiahJohnson]

derm because it's like 1 extra year for higher base pay,

They just have nicer schedules. Derm doesn't make that much more than hospitalists unless you're running your practice (which will take away from your other scalable ventures) or do something like MOHS. Otherwise Derm typically makes about the same as a hospitalist, working Mon to Fri or Mon-Thurs with packed schedules, so you'd be in the same position financially you'd just have more weekends. Personally, when I'm working on a project I don't like saving it for the evenings and weekends I like having dedicated time to it.


If you're not a huge fan of inpatient then fair, Derm will pay more than PCPs pound for pound


And I can't answer your NSGY questions, my colleagues who are neurosurgeons are still in training or just got out and grinding to get more cases under their belt to work on their craft.

 

[phantasmo]

They just have nicer schedules. Derm doesn't make that much more than hospitalists unless you're running your practice (which will take away from your other scalable ventures) or do something like MOHS. Otherwise Derm typically makes about the same as a hospitalist, working Mon to Fri or Mon-Thurs with packed schedules, so you'd be in the same position financially you'd just have more weekends. Personally, when I'm working on a project I don't like saving it for the evenings and weekends I like having dedicated time to it.


If you're not a huge fan of inpatient then fair, Derm will pay more than PCPs pound for pound


And I can't answer your NSGY questions, my colleagues who are neurosurgeons are still in training or just got out and grinding to get more cases under their belt to work on their craft.

thanks for this perspective. a lot. this is good insight.

if anyone else can weigh in i appreciate.