I’m an MS-III with a couple of questions. I did an elective at my school and absolutely loved it and started thinking about it as a career option after that. But I have a few questions for which I can’t seem to find the answers. I’d really appreciate it if you guys can give me some input. And thanks for everyone contributing to this website. It’s pretty rockin’.

1. I came into med school thinking that I would practice some sort of socially responsible medicine. It seems like in NS, more specifically with tumors, you deal with a lot of bad outcomes and I can’t quite justify spending millions of dollars so that some dude would live a few more months. Am I wrong about this? How much can neurosurgeons affect the quality/quantity of life for a poor schmuck with something growing in their brain?

2. How brutal is the NS residency compared to the gen surg + fellowship pathway? They’re both 6-7 yrs and seems pretty brutal generally but it seems like a lot of NS programs have neurorads, neuropath, neuro plus research years built in to make it more palatable. But then the q2’s that I see the residents at my hospital take seem pretty bad too. Well, it seems to me that NS is more tolerable than gen surg + fellowship… well that is if you like brains and hate perirectal abscesses but then who doesn’t.

3. The residents I had were pretty awesome and were cool people in general but then some attendings were total assholes. How is the general landscape of neurosurgery residents? and how do you deal with the assholes?

4. How awesome is Harvey Cushing? (i guess this one doesn’t need an answer) The dude started a surgical field, discovered diseases and won the Pulitzer on the side. I live like 5 mins from his grave and I think that alone is making me smarter.

Well that’s a lot of stuff. I’d appreciate any input. Thanks.

a lot of good questions.  someone should write about this in the wiki, as these questions are frequently asked (hint hint).

1) yes, there are bad outcomes in neurosurgery because a lot of bad things happen.  it’s the nature of the specialty: malignant tumors, spinal cord injury, traumatic brain injury, brain hemorrhages, to just name a few.  some things you can’t help (just like stage IV liver or breast cancer, bad CHF… it’s everywhere in medicine).  but the things in which you can help are miracles for the patient.  functional surgery for pain, epilepsy, and movement disorders is taking off and these are extremely life-changing.  some people LOVe their spine surgeon.  currently, neurosurgeons are retreiving clots from MCA vessels and essentially reversing a devastating stroke.  there are bad things that are very bad, but the good things are very good.  if you’re into saving lives, check the field out.

2) residency is residency.  personally, i think neurosurgery residency is doable.  people do it all the time.  call can be hairy but at least you when it’s going to end.  and, work hour restrictions are slowly filtering their way into the field.  our post-call residents leave by 10AM (preposterous, i know).

3) most neurosurgery residents are cool people.  they can be driven, but are cool nonetheless.  as the field becomes more popular, the so-called assholes will be diluted out.  there are assholes in every field if you think about it.

definitely check it out as a career.  it’s hands-down the coolest, biggest, and fastest growing field out there.

most institutions with nsg residencies will clearly illustrate that the nsg residency is quite a bit tougher and “hairier” than a gen surg

your post about nsg vs. fellowship surgery tells me that you are very interested in surgery - that’s great.  you’re further along the process than I am (i’m only an MSII).  if all you want to do is cut people open, and don’t want to have a destructive residency, then gen surg is probably better (at least, that’s my experience at the institutions i’ve seen)

however if you really love neurosurgery, it’d be weak to say u didn’t do it because the residency was hell.  try to imagine yourself 30 yrs from now, doing surgery, but thinking what if you went the neuro path

i guess what i’m saying is...nsg residency is tougher, but people do it.  i see them succeed, and that motivates me to go for it.  i know an orthopedics residency would probably be a bit easier, but i know 30 yrs later as an orthopod, i’ll forever think...what if?

go for what you want, without regard to how bad residency is.  there’s an end to it, and people can do it.  if you can make it thru a nsurg sub-I, well, you probably have the capacity to push yourself a little harder for a little longer and get through it

Good questions.

I urge you to do what you love. Even if gen surg is easier (and I’m not sure it is), it will feel like twice the workload if it’s not what you really want to be doing. Personally, I really thought about doing gen + CT, and I’m a thousand times glad I didn’t. I just couldn’t deal with 5 years of t-tubes and bile ducts to get to what I wanted to do. I also sensed that the field was oversupplied, and the past 6 years of my residency have really borne that out.

The residents are generally really cool, but there are some pricks, just like any field. Don’t sweat that one. Academic attendings are a funny (read strange) bunch, and that’s why a lot of the bright young ones wash out in 3-5 years.

As for ‘socially-responsible’ medicine, well, let the politicians worry about that. If America thinks it’s worth $50,000 to take out a GBM and give someone an extra 3 months of life, who are we to argue? We provide a service.

But please don’t do something else just because you think it may be easier. It won’t be easier in the long run. There’s nothing more sad than seeing a 32-year-old FP going back into a surgical residency because that’s what he really wanted to do in the first place. To me, one of the greatest parts of NS is knowing that it really is the toughest residency, and I won’t ever look back and think I could have done something else if only I’d been more motivated.

This goes for anything in life.  Do some deep thinking, figure out what you want to do, and then go do it.  It really is that simple.  A lot of people end up being miserable taking other peoples advice and listening to their fears.  There is no perfect time to make a decision and pull the trigger on that decision.  Don’t get caught up with the people standing on the sidelines of life, giving their opinions on everything they haven’t done.  Ironically, they are usually the ones with the most to say.

Blaze your own path where you want to go.  If it is something that means a lot to you and you get a rush out of it - that is what will keep you going when things suck.  Money can come from many different routes, but there is only one route to extracting a tumor from someones brain in order to save their life (for example).

For me - 5 minutes holding a pole sucker in an open abdomen is infinitely more painful than doing back to back 100hr+ week Neurosurgery sub-I’s.  I am not exaggerating!  I loved my neurosurgery sub-I’s and am so fired up about starting residency in July that I can hardly wrap my brain around it.  Someone is going to let me train to do what I want to do.  I would pay money to train in brain surgery - but they are going to pay me.

I hope whatever you choose will fire you up the way neurosurgery has me.

Best wishes, and when someone tells you how hard something is, that’s probably a clue that you should check it out.

thank you all for your responses. they’ve all been insightful. i really agree with most of what’s been said here. i don’t mind the workload and challenges associated with NS but it’s just so hard to know if you’ll really love it in 30 yrs and if you’re hating it… you’ll be hating most of your waking hours. i guess you’ll never know with certainty and it’ll always be a leap of faith.

but i do have another question. how are the research/elective years like? from what i hear, they take up ~2 yrs of the 7 yr program but i don’t really know how they work. i have a good idea about the years on the neurosurg service from my elective but how is the year in the lab? is it chill like a 9-5 with weekends off or like working long hours in labs or kinda boring waiting to be back in the OR?

once again, thanks for the responses

I’d just add that I think the frequency of bad outcomes, while personally challenging and perhaps giving an aura of futility, is really an opportunity for growth of the field.  For example, it wasn’t all that long ago that most everyone who had a heart attack didn’t survive it, but thanks to years of focused, dedicated research, many people can now return to a normal life after an MI.  At this point a lot of neurosurgical conditions still carry a death sentence, and without continuing to attempt treatment and try novel therapies, it’s not likely the prognoses will improve.  While it may be a somewhat morbid outlook, today’s failures should lead toward tomorrow’s successes, and that opportunity for progress is one of the things I like about the field.

David Weingarten - 04 March 2007 04:57 PM

Dr. Hfuhruhurr - 27 February 2007 03:16 PM

There’s nothing more sad than seeing a 32-year-old FP going back into a surgical residency because that’s what he really wanted to do in the first place.

I agree with pretty much everything that’s been said in this thread so far, but I just had to comment on this.  It both depresses me and makes me laugh that you think 32 is old…

-- David

I don’t think it’s old at all, especially now that I’ve left 32 behind. My point is that it’s sad that they don’t figure it out, or admit what they really want, when they’re 26 or 27 and finishing med school. It’s sad that they spend years doing something that they didn’t really want to do in the first place.

David,

I can’t disagree with you there. I did go straight through, but I had the good sense to take 5 years for college and do some extensive traveling before and after medical school. In a way, I envy the guys who have the time to do other (non-medical) things like you did. In fact, most of the people I’ve worked around would agree that military guys wind up making the best residents. And the FP’s and internists really are the doctors, and we are technicians in a way. My only point was that it’s sad when people try to take the easy way out and wind up hating it. Life is too short to blow a few years doing something you don’t like, no matter how young you are.

Anyway, best of luck to you in your new undertaking. We’re about the same age, but I’m at the other end of the pipeline. I think you’ll find it rewarding and challenging like nothing else. Congratulations on matching.

Dr. MH.

I just want to add my two cents to the thoughts here. I am an MS3 now and will be 32 when I start my internship - assuming I match the first time around. In between college and med school (seven years), I lived and worked in Europe, traveled extensively (some of it by bicycle too, hmmmm), worked in IT, and supported myself as a musician. I like to think that I have gained some depth of experience and perspective from all that - it’s important to remember too that the first pants you try on don’t always fit the best.

By the way, this board is an amazing resource. Thanks to Kenny for putting it all together and for everyone for sharing their thoughts.

tachytea - 05 March 2007 05:39 AM

I just want to add my two cents to the thoughts here. I am an MS3 now and will be 32 when I start my internship - assuming I match the first time around. In between college and med school (seven years), I lived and worked in Europe, traveled extensively (some of it by bicycle too, hmmmm), worked in IT, and supported myself as a musician. I like to think that I have gained some depth of experience and perspective from all that - it’s important to remember too that the first pants you try on don’t always fit the best.

By the way, this board is an amazing resource. Thanks to Kenny for putting it all together and for everyone for sharing their thoughts.

36 at the start of my internship… s/p military and other things.

I enjoyed the pants analogy.  I have worn some great pairs, but these are the last ones I will put on - which is what I promised my wife… I really can’t imagine a better pair to put on.

I would also agree with this board being a great resource, and thanks to everyone for keeping it constructive.  It will certainly save future applicants significant time.

here’s my two cents…

i’m on the much younger end of the spectrum - early 20’s, hoping to jump right in
i know there are many things in the world that i’m going to miss out on by going in so early, but in the end i end up in something i love

if you ask a blind man - would he rather be born blind, or been struck blind, there are two answers:
1) born blind - i’ll never know what vision is
2) struck blind - at least i know the beauty of the world

for people who jump right, they probably have the mentality of number 1.  i’m the #2 camp.
it makes me question what i’m doing that much more, but i feel that i’m too far along the process, and i’d never endanger my chances by putting several years off and then having to compete with the rest of the straight-outta-med school guys.

exploring the world would have been great before medical school, not after.  that ship has sailed, and this is now the lesser of two evils.
well, it’s actually two good, with a little setback mixed in, and i’m hoping im choosing the lesser of the setbacks.
you get what i mean?

i sort of just found myself in med school; if you ask what drove me to come here, i really don’t have an answer.  i was very VERY fortunate to find that i loved this field so dearly, or else i would have been very miserable. 
sometimes life just works out with little successes along the way.

PJ-NSurg - 27 February 2007 04:06 PM

I would pay money to train in brain surgery - but they are going to pay me.

This is exactly how I feel!