One of those pesky MS3’s here. I have read essentially every post on this site. My app looks pretty decent on paper: 260+ boards, mix of honors and high-pass for clinicals, 1-2 neuro-ish papers, so this isn’t one of those “will I match” questions. I can probably match well in neurosurgery, radiology, or neurology. Which brings me to…

I am planning on applying to the neurosurgery match in a few months, and have my subi’s all lined up already. I have been attracted to neurosurgery for years: I am currently reading Greenberg and am hanging on every word. I love the technicality of the field, the difficulty, and most of all - the fact that the brain is the most special place in the universe. But there are other fields aside from neurosurgery that deal with the brain.

For those of your more advanced in your experience, who has thought something like, “Man, I really should have done radiology, where I can read films from my garden while watching my kids play.” I remember reading about the chairman of a neurosurgery department beginning a radiology resident as PGY-2.

As a neurosurgery resident, when you’re Q2 for two weeks straight and haven’t seen your wife awake during that time, do you ever look with despair to the future where being an attending still means pulling 80+ hour weeks? Or do you relish all the pain, knowing that it will make you a better surgeon?

Do you regret that you’ll rarely be able to visit Florence, or go hiking, or visit the Met, or see your favorite bands? Maybe I’m painting a bleak picture, but as much as I love the concept of neurosurgery, I was just wondering how many of you have have second thoughts about spending most of your active life in the hospital…

Thanks.

You’ll get 100 different answers to this, but one view is that yes--neurosurgeons are not robots who eschew the finer things in life.  We do miss relaxed schedules, freedom to catch the ballgame whenever we want, and the ability to hit the gym 5 times a week.  We all have varied interests and uniformly agree that we wish we had more time to engage in them.  So you aren’t unique in having these concerns.

Where it gets personal for you--and no one can help you with this--is whether or not you enjoy neurosurgery enough to make the sacrifices required, and I don’t mean this consdescendingly.  While work weeks get restricted and society’s general view of hard work is changing dramatically, neurosurgery stays pretty much the same in what it asks of those ultimately responsible for patients (attendings)--some long days, some unexpected cases, high stress.  The reward is joining a wonderful profession which really is ascendant in medicine.

Do your sub-is and evaluate during and after.

Choose neurosurgery if you would prefer to operate rather than eat, sleep, or have sex.

I chose this field a long time ago, early in med school, for the erudite scientific interest and desire to make a difference.  At the time, I was naive to the malpractice part, as nobody would ever discuss that stuff, and I foolishly assumed that, if we did a good job and didn’t show up to the hospital drunk, we all avoid the attorneys.........WRONG!!!!!  Had I know NS was far and away the most expensive ins (2X OB/Gyn), I may have done Otology or something like that.  Nowadays, it’s something you MUST consider.  Also, I was single when I matched, and could throw myself into work, and you just can’t do that when you are a parent...always feel torn in different directions.  I am also sickened to see radiologists I know making much more than I do, mostly because they own all these MRI centers and get all that passive income.  It’s much simpler for them to own the MRI centers, as they don’t have the same compliance issues that we do, vis a vis issues of self-referral of pts to something you own.  The rads just crank them thru and say thank you.

The above poster is just garbage.  I’m a resident and I know radiologists who wished they had stuck their guns and done NS.  I love it and don’t regret it at all.

This is a good question, and I’m glad you’re thinking about this. The short answer is, if you think you could enjoy radiology or neurology, you should probably do that instead. Make no mistake, this is a field which can and does make some miserable. But a lot of us love it.

So why do it? Neurologists can’t fix anything, just diagnose and observe (from the surgeon’s POV). Same for rads, except interventional, but then you have a surgeon’s lifestyle anyway. I wouldn’t give this up. However, something has to give. In my case, I just interviewed for a (staff) job that offers 9 weeks vacation a year. To me that’s the perfect mix of “work hard, play hard.”

The other thing: nobody who is psychatrically intact likes junior residency, so don’t hang your hat on a miserable junior. It sucks. That’s all there is to it. But it only lasts a few years. You just keep your head down and do it.

Guest - 06 June 2007 10:48 AM

The above poster is just garbage.  I’m a resident and I know radiologists who wished they had stuck their guns and done NS.  I love it and don’t regret it at all.

You’re entitled to you opinion, but I’ve been an attending for >10 years, so I do know something about life after residency.

Guest - 06 June 2007 06:08 AM

I chose this field a long time ago, early in med school, for the erudite scientific interest and desire to make a difference.  At the time, I was naive to the malpractice part, as nobody would ever discuss that stuff, and I foolishly assumed that, if we did a good job and didn’t show up to the hospital drunk, we all avoid the attorneys.........WRONG!!!!!  Had I know NS was far and away the most expensive ins (2X OB/Gyn), I may have done Otology or something like that.  Nowadays, it’s something you MUST consider.  Also, I was single when I matched, and could throw myself into work, and you just can’t do that when you are a parent...always feel torn in different directions.  I am also sickened to see radiologists I know making much more than I do, mostly because they own all these MRI centers and get all that passive income.  It’s much simpler for them to own the MRI centers, as they don’t have the same compliance issues that we do, vis a vis issues of self-referral of pts to something you own.  The rads just crank them thru and say thank you.

There is no reason why NSG can’t own an MRI center. I know two that co-own 5 MRI centers (they are outside of their local area- a requirement if the town you live in is over a certain size) and they use to make a killing off of them. Now with pre-cert and reductions in reimbursement across the board a lot of MRI centers and radiologist are taking HUGE pay cuts. BCBS did recently increase reimbursements a little but radiology is slowly making less and less money. The Aussies and Indians are more than happy to read our scans at night also.

Guest - 06 June 2007 01:57 PM

Guest - 06 June 2007 06:08 AM

I chose this field a long time ago, early in med school, for the erudite scientific interest and desire to make a difference.  At the time, I was naive to the malpractice part, as nobody would ever discuss that stuff, and I foolishly assumed that, if we did a good job and didn’t show up to the hospital drunk, we all avoid the attorneys.........WRONG!!!!!  Had I know NS was far and away the most expensive ins (2X OB/Gyn), I may have done Otology or something like that.  Nowadays, it’s something you MUST consider.  Also, I was single when I matched, and could throw myself into work, and you just can’t do that when you are a parent...always feel torn in different directions.  I am also sickened to see radiologists I know making much more than I do, mostly because they own all these MRI centers and get all that passive income.  It’s much simpler for them to own the MRI centers, as they don’t have the same compliance issues that we do, vis a vis issues of self-referral of pts to something you own.  The rads just crank them thru and say thank you.

There is no reason why NSG can’t own an MRI center. I know two that co-own 5 MRI centers (they are outside of their local area- a requirement if the town you live in is over a certain size) and they use to make a killing off of them. Now with pre-cert and reductions in reimbursement across the board a lot of MRI centers and radiologist are taking HUGE pay cuts. BCBS did recently increase reimbursements a little but radiology is slowly making less and less money. The Aussies and Indians are more than happy to read our scans at night also.

You are correct that you CAN own an MRI if you’re a NS, but it is more complex to maintain compliance with Stark laws than it is for a radiologist, because your own pts will get referred.  A lot depends on the local marketplace.  In my metro area, the radiologists have a near monopoly on outpt centers.  They also have many more people in their groups who don’t have to contribute as much to acquire ownership.  Make no mistake, it is a risky endeavor.  There may be some rads groups who allow NS to purchase stock, but this carries with it more attorney’s fees to make it compliant, so the margins are less.  Also, if a NS were to open an MRI in our market, it would really piss off the rads, who are very powerful, due to large #s (just like anesthesia), and may control the medical staff leadership positions at your hospitals, as a result.  Then you have to find someone outside the area to read the films, etc.  It’s quite complex.

Kraney - 06 June 2007 04:39 PM

Enough derailment, keep the posts focused on what the OP was asking.

Point well taken.  http://uncleharvey.com/index.php/forums/viewthread/393/

Enough derailment, keep the posts focused on what the OP was asking.

as someone who thoroughly enjoys sleeping and hobbies and such, i spent a lot of time in medical school trying to find another specialty that i could do.  obviously, the answer was no, although i did look at radiology.  you’re right in that compromises and sacrifices will have to be made to become a neurosurgeon.  most people also assume that the hellish hours that you pull during residency continue after you graduate, which is not necessarily the case.  your priorities are your priorities and if it’s having a successful academic career and being the most bad ass brain surgeon out there, then other parts of your life will get less attention.  it’s no different for an olympic athlete or rock star or investment banker.  if you want to spend time with your family or travel, there is absolutely no reason that you can’t.

don’t get me wrong: residency sucks ass.  nobody likes it.  nobody enjoys q2 (i used to think i did but now i’m much better).  every resident thinks about quitting at some point.  residency sucks ass, but it only sucks ass for a couple of years.  there are only a number of bad years in residency; the rest of it you spend learning to operate and trying to push the field.  i haven’t taken in-house call for a year now and never will again (unless dr burchiel has something to say about it).  the two years before that i was only on call q8 (better than some neurology residencies, i think).  there are good years and there are bad years but it all ends.

i have plenty of friends in radiology and emergency medicine who work much less with less stress and make much more.  i could look at professional athletes or CEOs of corporations who probably work less and sleep more and will make more money in a year than i will ever see in my life.  if that’s your priority in life, then do that, not this.

as for seeing your favorite bands, you should read this: click here.  i’ve traveled all the way to fiji, go to hawaii once a year, and have summitted Mt St Helens, all during my neurosurgical residency.  I have a 20 month old son at home who thinks i’m the shit.  I logged over 600 cases my PGY5 year, hold the institutional speed records for clipping a (ruptured) PCOMM aneurysm (incision to clip: 37 minutes; skin to skin: 71 min) and a single level ACDF (skin to skin: 43 minutes, including waiting for staff), and waste time on this website.

i was a fairly average applicant.  just think what you superstars will be able to do.

I think this is an excellent question, one that everyone has or should have asked themselves at some point.  You asked if anyone had had regrets, so I hope the following is a helpful illustration.

I grew up in an artsy family.  Not only am I the only doctor, but my parents and brothers are all muscians, art historians, teachers etc.  I studied abroad in Florence during college and learned to speak italian.  I didn’t think I would end up in medicine.

As a medical student I tried hard to convince myself to do emergency medicine, with no success.  An eight hour shift in the ED seemed to go on forever, and 36hrs straight on the neurosurgery service flew by for me.  In the end, even though some of the neurosurgeons I knew best were complete assholes, I had to do what made me happiest.

Residency was difficult, but exciting.  Sure I had regrets at times, and sometimes I was miserable.  Strangely, I remember the good times best.  Some of my best friends are the guys I trained with, and my best stories are about them and the times we had.

I am now an attending.  My life is good, certainly better then I deserve.  Who knows, soon we may have universal health care and I may earn 80K a year.  There are a lot of reasons to be apprehensive.  I work harder then most people in medicine and don’t get paid as well as some.

BUT, bottom line: I still love my job. I love taking care of sick patients.  I love saving lives.  I love operating on the brain.  I came home grinning yesterday to tell my wife about the giant aneurysm we clipped and how well the patient is doing.  I enjoy working with good partners, fellows, and residents.

Oh, and on the way back from a conference in Europe this autumn my wife and I are spending a week in Florence.

Make your own decision.  You would be a fool not to consider lifestyle, and you should be very afraid of the committment you are considering and the inevitable regrets you will have.

For me, even if neurosurgery somehow goes to shit next year, I dodged a bullet.  If I had done anything else, I would have a huge regret.  Lots of people have jobs that they really don’t enjoy.  None of us know the future, but in general, you are better off doing what you love doing.

Kenny, you have a beautiful family. All the best to you and them.

I used to be a musician, and when in the middle of creating a song, I would sometimes enter a state of flow where the linear march of time would morph into a much more fluid entity (no, there really were no drugs involved)… I hear many surgeons speak in similar terms about the state of mind they’re in when they’re operating, but that’s something that’s really hard to get a sense of as a student. It’s hard to get in a flow when you’re retracting. If I can experience that on a regular basis when operating, then I will be forever hooked, and I think I can find the inner strength to put up with the extreme stamina involved, the demands on time, the malpractice, etc.

Radiology is a great specialty, but it’s much more of a job than a life’s calling. Why do people climb Everest, when they could be relaxing poolside or by a warm fire? Something is calling upon them to do this, from which each climber can derive great satisfaction. I think that nothing offers the personal satisfaction of having the privilege of operating regularly on Brains and Spines. Life really is about choosing the best compromises: Radiology can lead to a comfortable and satisfying life, but I really don’t think it can compare to knowing that you can climb Everest.

My original question could have been rephrased: “Does the inner joy and satisfaction of being a neurosurgeon outweigh the reality of becoming and being a neurosurgeon?” Malpractice, 100 hour weeks, and limited family life are not a joy to anyone of normal mental health.

Steve Martin, Kenny, Clipsncoils, and the other attendings and residents: thanks so much for your thought-provoking and insightful comments (I’m the original poster).

Keep em coming…

Guest - 07 June 2007 04:18 PM

Why do people climb Everest, when they could be relaxing poolside or by a warm fire?

Because relaxing poolside or by a warm fire is like watching grass grow with your finger on the speed dial for the suicide hotline…

I would much rather be on Everest - winds whipping, low vis, and a few good buddies.