anesthete Posted April 5, 2016 Report Share Posted April 5, 2016 Hi all I have developed a passion for neurology (always had one to be honest, but never approached it from the clinical side before.. always more of general "neuroscience"). I have had the great opportunity to spend time with both neurologists and neurosurgeons... which are, needless to say, very different fields. Has anybody here ever felt torn between neurology vs neurosurgery? I like the lesion localization and diagnostic challenge of neurology but feel that the clinical practice or neurology is a bit slow paced with limited curative potential... I do feel that neurosurgery is more my thing. It is more fast paced and more "curative" (though not always, and nor always in as dramatic ways as one would like). I have however been dissuaded by both my colleagues, the job market, and what appears to be the complete lack of work life balance in this specialty, though. I also have very little interest in practically any other types of surgery. Wishful thinking perhaps, but has anybody been through these feelings before, and come out on the other side? Is there perhaps some magic "middle of the road" specialty? Neuro - critical care and interventional Neuro Radiology, perhaps? Any thoughts? Thanks! Link to comment Share on other sites More sharing options...
shikimate Posted April 6, 2016 Report Share Posted April 6, 2016 Are you sure nsx is not more "palliative" than "curative"? just my $0.02 Link to comment Share on other sites More sharing options...
NLengr Posted April 7, 2016 Report Share Posted April 7, 2016 Have you spent time in the OR yet? If not, that will probably make your decision for you. It's usually a case of absolutely loving or hating the OR. You need to ask yourself, do I love the OR so much, I would be willing to wake up in the middle of the night multiple times per month to operate on someone, then work the following day. Link to comment Share on other sites More sharing options...
Edict Posted April 12, 2016 Report Share Posted April 12, 2016 I'm in a similar position as you actually although i'm debating between cardiology and cardiac surgery. Its difficult to really say, but i don't get the whole love or hate the OR thing. I like the OR, but i don't love it, i like cutting things and i'm a "seeing is believing" kind of person and love surgery, but i'm certainly not obsessed with the sterile field for example and the myriad of rules that i'm sure i'll get used to eventually. Link to comment Share on other sites More sharing options...
NLengr Posted April 12, 2016 Report Share Posted April 12, 2016 You quickly adapt to the rules and sterile technique. It becomes second nature and you don't even think about it anymore. Kinda like shifting when you drive a manual transmission. It's more of a question of do you like the actual surgical process The reason liking the OR is a big deal is because that's your primary role as a surgeon. It'll dominate your life. You are going to spend your life getting called to the OR at all hours to perform surgery and you have to do it even if it's Xmas morning. It's also incredibly stressful to perform surgery. Being a surgeon will consume your life. It's not something you can go into and kind of have an interest in. You'll quickly swap out to a non surgical specialty (happens all the time in reaidency). Link to comment Share on other sites More sharing options...
ACHQ Posted April 12, 2016 Report Share Posted April 12, 2016 I'm in a similar position as you actually although i'm debating between cardiology and cardiac surgery. Its difficult to really say, but i don't get the whole love or hate the OR thing. I like the OR, but i don't love it, i like cutting things and i'm a "seeing is believing" kind of person and love surgery, but i'm certainly not obsessed with the sterile field for example and the myriad of rules that i'm sure i'll get used to eventually. Agree with NLengr, the flip side to that is, do you like Cardiology/Internal Medicine and its mindset/process? Do you like complex medical problems, problem solving and figuring out whats going on with a patient? Do you like interpreting test results (for cardio it would be echos, ECGs, caths, stress tests etc...). For residency can you sit through talking about differentials, pathophysiology, treatment and management plans? Can you deal with possibly never "curing" a patient (but often times helping them feel better). Do you like multiple practice models including inpatient, consultative and outpatient practice styles? Also you have to like Internal medicine (imo) to some degree, cause the first 3 years will be a lot of call and if you don't like it you will hate your life just to get to cardiology. Also there are no guarantees you will get cardiology in the R4 match. Tbh it shouldn't be a major struggle to decide since they are pretty different. Once you get to clerkship your core medicine rotation and surgery rotation should help clarify things for you. I had a good friend who loved the heart period. He was thinking cardiac surgery early on in med school (first year), but was very dissuaded by the job market. He started thinking cardiology, but I knew deep down he wouldn't like medicine (given the type of person he was). Once he started clerkship (luckily had surgery and medicine early on) he decided he was going to cardiac surgery and not even consider medicine. He said the pace was too slow and not enough was happening. That being said if you still do like the two fields equally, I would go with the medicine field over the surgical field, due to a generally better lifestyle. Link to comment Share on other sites More sharing options...
Edict Posted April 12, 2016 Report Share Posted April 12, 2016 Agree with NLengr, the flip side to that is, do you like Cardiology/Internal Medicine and its mindset/process? Do you like complex medical problems, problem solving and figuring out whats going on with a patient? Do you like interpreting test results (for cardio it would be echos, ECGs, caths, stress tests etc...). For residency can you sit through talking about differentials, pathophysiology, treatment and management plans? Can you deal with possibly never "curing" a patient (but often times helping them feel better). Do you like multiple practice models including inpatient, consultative and outpatient practice styles? Also you have to like Internal medicine (imo) to some degree, cause the first 3 years will be a lot of call and if you don't like it you will hate your life just to get to cardiology. Also there are no guarantees you will get cardiology in the R4 match. Tbh it shouldn't be a major struggle to decide since they are pretty different. Once you get to clerkship your core medicine rotation and surgery rotation should help clarify things for you. I had a good friend who loved the heart period. He was thinking cardiac surgery early on in med school (first year), but was very dissuaded by the job market. He started thinking cardiology, but I knew deep down he wouldn't like medicine (given the type of person he was). Once he started clerkship (luckily had surgery and medicine early on) he decided he was going to cardiac surgery and not even consider medicine. He said the pace was too slow and not enough was happening. That being said if you still do like the two fields equally, I would go with the medicine field over the surgical field, due to a generally better lifestyle. Thanks for responding guys! I've shadowed a bit of general internal medicine and honestly it didn't interest me. I felt like I couldn't do much for patients, felt the pace was too slow and dealt with too much minutiae most of it was uncertain. Often you couldn't confirm anything without performing labs and tests and the diagnosis would not be easy to come by. In terms of pace GIM was too slow for me. Cardiology clinic again is not exactly my cup of tea either, I find that trying to convince patients to stay on life long medications that have small but significant benefits is not exactly what I want to do for the rest of my life, I know I don't want to do general cardiology either. However, I do like the interventional side of cardiology and the operations themselves. The only things that I could possibly say are putting me off cardiac surgery would be the perception that somehow I feel like cardiac surgery wants the perfect person who is very bright, gets things the first time and never forgets it, doesn't make mistakes and is always go go go and never really needs to sleep. Its that sort of perception that I feel like I can meet some but not all of those criteria and i'm not sure if I can go at that pace for the rest of my life. If someone told me that Cardiac Surgeons didn't need to be that perfect I would have settled on it already. I definitely don't mind long hours during residency, I love staying up at night but I think for me to settle down on something as intense as cardiac surgery I feel I would need to really spend a good 3 weeks in surgery which I am planning on doing this summer. I feel like that will really tell me whether or not I want to live the surgery life and if so I will continue with it and if not I will think about alternatives. Does that sound reasonable? I'm actually seeing some of what you said about your friend in me. Would it be possible to see if he's willing to talk to me and give me some advice? Thanks! Link to comment Share on other sites More sharing options...
Edict Posted April 12, 2016 Report Share Posted April 12, 2016 You quickly adapt to the rules and sterile technique. It becomes second nature and you don't even think about it anymore. Kinda like shifting when you drive a manual transmission. It's more of a question of do you like the actual surgical process The reason liking the OR is a big deal is because that's your primary role as a surgeon. It'll dominate your life. You are going to spend your life getting called to the OR at all hours to perform surgery and you have to do it even if it's Xmas morning. It's also incredibly stressful to perform surgery. Being a surgeon will consume your life. It's not something you can go into and kind of have an interest in. You'll quickly swap out to a non surgical specialty (happens all the time in reaidency). I like the tools, the technology, the cutting and the idea of a real fix for patients and the pretty good outcomes and serious nature of cardiac surgery. I feel like cardiac surgery really improves QoL for patients and has so much room for growth in terms of research (i.e. minimally invasive and regenerative). I like working the long hours at least for now and I want to make an impact in some form eventually (while also being happy as a clinician if things don't work out in that way). Career is definitely important to me and all these things make me like it, but theres still the concern of thinking this but not actually being able to handle the long hours and I feel like I get so many more warnings from my seniors and peers about cardiac surgery than I would if I told them about cardiology that I feel like they are seeing something in me that I am not realizing which is contributing to my self doubt. I hear stories of people liking surgery but then thinking their manual dexterity is not good enough then going into medicine and being happy, obviously the stories of people who go into surgery then switch into something else are abound which makes it very difficult for me to settle on cardiac surgery. I feel like 8/10 people who like surgery eventually drop out somewhere along the path and I feel like you need to be that perfect human being to make it (smart, athletic, hard working, humble yet confident) and that is the one thing that makes me feel like maybe I need to either backup or get out of a field because I don't feel perfect enough to do it. Link to comment Share on other sites More sharing options...
ACHQ Posted April 12, 2016 Report Share Posted April 12, 2016 Tbh you sound like the surgery type. Check it out in the summer and see how it goes. I feel like every specialty wants that with their trainee, so I wouldn't stress too much about not being "perfect". Also Cardiac surgery training is intense for sure, and although have a lot of call, most of the call shouldn't be too rough given there's very few cardiac surgery emergency (aortic dissection, maybe acute MR, otherwise?, post op bleeding/complication). Most of their really sick patients are in the CVICU handled by the intensivist team which will deal with everything/anything not requiring an OR. From what I've seen most cardiac surgery teams/centre's have NP's covering their ward patients, so they can focus on the OR, and will check in with them if anything is concerning. Its mostly the long hour days (~16) and the stress of operating on someones heart (especially if its an elective procedure). I feel the staff surgeons have it a bit better since they wont be in OR all the time (maybe 2 max 3 times a week, and some weeks they wont be on), but the stress is probably still there and the long days when they are in OR. I'll ask my friend and PM if he says ok. Thanks for responding guys! I've shadowed a bit of general internal medicine and honestly it didn't interest me. I felt like I couldn't do much for patients, felt the pace was too slow and dealt with too much minutiae most of it was uncertain. Often you couldn't confirm anything without performing labs and tests and the diagnosis would not be easy to come by. In terms of pace GIM was too slow for me. Cardiology clinic again is not exactly my cup of tea either, I find that trying to convince patients to stay on life long medications that have small but significant benefits is not exactly what I want to do for the rest of my life, I know I don't want to do general cardiology either. However, I do like the interventional side of cardiology and the operations themselves. The only things that I could possibly say are putting me off cardiac surgery would be the perception that somehow I feel like cardiac surgery wants the perfect person who is very bright, gets things the first time and never forgets it, doesn't make mistakes and is always go go go and never really needs to sleep. Its that sort of perception that I feel like I can meet some but not all of those criteria and i'm not sure if I can go at that pace for the rest of my life. If someone told me that Cardiac Surgeons didn't need to be that perfect I would have settled on it already. I definitely don't mind long hours during residency, I love staying up at night but I think for me to settle down on something as intense as cardiac surgery I feel I would need to really spend a good 3 weeks in surgery which I am planning on doing this summer. I feel like that will really tell me whether or not I want to live the surgery life and if so I will continue with it and if not I will think about alternatives. Does that sound reasonable? I'm actually seeing some of what you said about your friend in me. Would it be possible to see if he's willing to talk to me and give me some advice? Thanks! Link to comment Share on other sites More sharing options...
A-Stark Posted April 22, 2016 Report Share Posted April 22, 2016 Also Cardiac surgery training is intense for sure, and although have a lot of call, most of the call shouldn't be too rough given there's very few cardiac surgery emergency (aortic dissection, maybe acute MR, otherwise?, post op bleeding/complication). Most of their really sick patients are in the CVICU handled by the intensivist team which will deal with everything/anything not requiring an OR. From what I've seen most cardiac surgery teams/centre's have NP's covering their ward patients, so they can focus on the OR, and will check in with them if anything is concerning. Well there are Type A dissections, emergency CABGs, emergency chest re-openings in CVICU, post op bleeding, tamponade, pericardial windows... The call will not be easy. In fact I think it's ridiculous to suggest that call won't be "too rough". Cardiac surgery is one of the more challenging surgical careers around and the training is not for the faint of heart. That can be said about most surgical specialties but especially so for cardiac and neuro. If you can't imagine life without the OR and also love everything about the heart to the exclusion of anything else (e.g. family, friends, hobbies), then it might be the right choice. I don't think comparisons to cardiology are all that helpful. I'm also not sure that pre-clerkship students can have a lot of insight into these careers from shadowing. Link to comment Share on other sites More sharing options...
ploughboy Posted April 23, 2016 Report Share Posted April 23, 2016 Cardiac surgery is one of the more challenging surgical careers around and the training is not for the faint of heart. ISWYDT Link to comment Share on other sites More sharing options...
NLengr Posted April 23, 2016 Report Share Posted April 23, 2016 Well there are Type A dissections, emergency CABGs, emergency chest re-openings in CVICU, post op bleeding, tamponade, pericardial windows... The call will not be easy. In fact I think it's ridiculous to suggest that call won't be "too rough". Cardiac surgery is one of the more challenging surgical careers around and the training is not for the faint of heart. That can be said about most surgical specialties but especially so for cardiac and neuro. If you can't imagine life without the OR and also love everything about the heart to the exclusion of anything else (e.g. family, friends, hobbies), then it might be the right choice. I don't think comparisons to cardiology are all that helpful. I'm also not sure that pre-clerkship students can have a lot of insight into these careers from shadowing. Neurosurg is notoriously brutal for call. Best surgical specialties for call are optho, ENT and plastics. Gen. Surg, ortho, neurosurg, vascular and cardiac are all very busy. Urology is somewhere in the middle. Best is a relative term here. If you don't wanna be busy on call during your career become an e rheumatologist or a public health officer or something. Link to comment Share on other sites More sharing options...
anesthete Posted April 23, 2016 Author Report Share Posted April 23, 2016 These are all fantastic perspectives everybody. Thank you all so much for sharing! At present I cannot imagine life without the OR and I love working long hours, and love the brain and spine more than most other things... But I'm not sure that I'll feel similarly in 15 years' time. Lots more exploring to do in months ahead! Link to comment Share on other sites More sharing options...
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