How to make oneself competitive for nsx

[Mathmaximum]

Hi guys,

I'm an incoming M1 and am really drawn to the field of neurosurgery based on my shadowing experiences and academic interests. I was wondering if any of you (neurosurgery residents/fellows/staff preferrably) are able to offer advice on how to become competitive for the field come CaRMS? I think it is in the middle of the pack based on match rate data. I want to hit the ground running coming into med school so what kind of activities would you guys recommend to bolster my CV for NSx in particular? Thanks!

[NLengr]

Probably shadow the hell of out of it in year one. 

It's a tough field. Long hours, bad outcomes, not the most collegial atmosphere, no jobs, multiple fellowships. Make sure you know what it's like before you commit a ton of energy to bolstering an application.  

[ploughboy]

And when NLengr says "shadow the hell out of it", he means it.  Don't just wander into the OR a few times, say "ohmigod, it's somebody's *brain* that's so cool" and then knock off early for lunch.  At some point in M1 see if you can do a weekend of call.  Not that you'd have any responsibility, but be there for rounds at 0-dark-30, watch (and help as able with) the ER consults, the constant ward pages, the middle-of-the-night ORs,, meet with the verklempt families, then round again with the team the next morning.

Then imagine doing that every day for the next seven years, with a low chance of getting a job at the end of it.

 

 

[JohnGrisham]

Neurosurgery isnt particularly competitive, there is a lot of self selection. The ones who go for it, make themself competitive. Theres much less half hearted applicants to it.  Most people self select themselves out due to the brutal nature of the field.

 

Take all the above advice, work hard and if you still like it after clerkship apply broadly. 

[Riskbreaker]

I would say it's very true that there is a lot of self-selection among medical students. Competitiveness has gone up a smidge in recent years for truly unknown reasons, but applicants who make it to the interview tend to make themselves competitive by nature.

Honestly, neurosurgery is certainly interesting with a lot of amazing surgeries and cool moments, but I have not seen another specialty so deftly chew out interested M1 and M2's. There were 10-12 interested in my first year class, and 2 at graduation who actually matched. In residency, we get multiple interested students, and we enjoy bringing them to clinic and the OR, or getting them involved in projects. However, once they hit M3 and experience actual clinical rotations, that usually does them in.

So, yes, do some shadowing and get a sense of the field. However, it's not until your elective/selective when you're on service and you realize what the lifestyle and patient population is actually like. This is generally true of many surgical specialties.

General things you can do to make yourself competitive, really for any surgical specialty, is be a nice normal human. Show interest, show up on time, work hard. It's always good to get involved in a project, get an abstract or publication. It doesn't make a difference if you're applying for neurosurgery and have 2 publications in general surgery; it's the fact that you participated in a project and were able to see it to completion. We don't care about how many clubs you were a part of, or if you were class president. The fact that you climb mountains may be interesting to bring up in an interview, but having a laundry list of extracurriculars isn't an asset (to be fair, it's not detrimental). Pretty much everything rides on your electives and how you act and come across. It is literally, only about the Golden Rule: treat others with respect as you wish to be treated. You'd be surprised, amazed even, at how often that gets overlooked, and how often it tanks an applicant's chances.

Finally, there are no Canadian neurosurgery jobs. Literally. And it's not going to get any better. That is an inordinate time investment (residency + 1 or 2 fellowships + MSc or PhD) to gamble a career on.

[NLengr]

12 hours ago, Riskbreaker said:

Finally, there are no Canadian neurosurgery jobs. Literally. And it's not going to get any better. That is an inordinate time investment (residency + 1 or 2 fellowships + MSc or PhD) to gamble a career on.

To me, this right here says don't do it no matter how much you love it. Hell at this point, given my experience, I would think long and hard about any surgical specialty. 

My advice: Do something where there is jobs and minimal hospital requirements. Finish training. Move to where you want to live. Be happy.

If you absolutely have to do surgery, make sure you are able to move to the USA and set yourself up to do so (USMLE's, American boards etc.).

[HailmadeMode]

Everyone from our year who applied to NSx, GOT NSx, because only the folks truly passionate for it applied (at least in my class, N = 4). Even the not-so-great personalities got in. You should be fine, if you know NSx is what you want to do for the rest of your life, so youll do whats necessary to get in. 

To your question specifically, research is highly valued in the field. Most large programs expect a phd to be completed (particularly in basic science) during your residency (if you havent already completed one before hand). Im certain you already know this given your interest, but I wanted to remind you on the importance of research. So get involved in research projects that are meaningful and related to NSx. Maybe some of the staff you shadow as an M1 will have projects for you. Entrepreneural activities seemed to be lauded as well, so try your hand on that. Ultimately, use these and your shadowing experiences to see if this is TRULY what you want to do. Everyone in my year who wanted NSx before med school, did not go for NSx by CaRMS. Everyone who did apply, found their way into NSx eventually a year or two into med school. Mine is only a small anecdotal example of course (at least 4 people), but keep this in mind. 

Good luck dude! Youll do awesome   

[BernieMac]

-

[GH0ST]

2 hours ago, YesIcan55 said:

It honestly blows my mind why someone would want to go into a field where there are no jobs AFTER 6 years of a very gruelling long residency + 2 years of fellowship + 1 year Masters + 3-4 years PhD post medical school (12-13 years)....is the clout of being a surgeon really that important to some people..?

Some people like what they do? 

Who's to say they like the clout of being a surgeon over the actual work? 

- G 

[BernieMac]

On 7/14/2019 at 1:55 PM, GH0ST said:

Some people like what they do? 

Who's to say they like the clout of being a surgeon over the actual work? 

- G 

-

[GH0ST]

1 hour ago, YesIcan55 said:

yes, I understand that. I just can't comprehend how after years and years of gruelling work, lost time with family/friends you can't get back, and the very really fact that after all of those sacrifices you may not even get a job / get a job in a place you don't want to be at is secondary to "enjoying the work." 

What can I say... people do pretty surreal things for what they care about (not to say they don't care about family or friends) 

People like to think they are the exception... we always like to think we're different, we're the exceptional ones, we won't face the same problems ... 

- G

[1D7]

1 hour ago, YesIcan55 said:

yes, I understand that. I just can't comprehend how after years and years of gruelling work, lost time with family/friends you can't get back, and the very really fact that after all of those sacrifices you may not even get a job / get a job in a place you don't want to be at is secondary to "enjoying the work." 

1. Exceptionalism like GH0ST mentions. Most medical students have been overachievers and to make it into medical school means beating out the odds in the first place. Most don't think they'll be the ones who have to do fellowship after fellowship without a job.

2. Most students applying to surgical specialties seem to face less negative pressure from finances & dependents. Every peer in my class who applied to a surgical specialty seemed to be a child of a physician or something of a similar level. None had young children or dependents they had to take care of. Those who had to face these issues self-selected themselves out of surgical specialties early on.

3. The priorities for people in their 20s is generally different from those in their 30s and later since children and infirm parents/siblings are usually not in the picture at that point.

Rarely do I think people actually apply for the prestige, though it certainly does shape how students perceive the specialty.

[GrouchoMarx]

On 7/14/2019 at 12:27 PM, NLengr said:

To me, this right here says don't do it no matter how much you love it. Hell at this point, given my experience, I would think long and hard about any surgical specialty. 

My advice: Do something where there is jobs and minimal hospital requirements. Finish training. Move to where you want to live. Be happy.

If you absolutely have to do surgery, make sure you are able to move to the USA and set yourself up to do so (USMLE's, American boards etc.).

This is the best advice.

If you're going to do neurosurg, ace the USMLEs and apply to the states.

 

Otherwise I would recommend avoiding any hospital based fields. Instead, consider psych, derm, family, emerg, or something along those lines. Do not consider surgeries or pathology, and be wary of rad onc.

[anonymouspls]

5 hours ago, GrouchoMarx said:

This is the best advice.

If you're going to do neurosurg, ace the USMLEs and apply to the states.

 

Otherwise I would recommend avoiding any hospital based fields. Instead, consider psych, derm, family, emerg, or something along those lines. Do not consider surgeries or pathology, and be wary of rad onc.

what about radiology? 

[GrouchoMarx]

53 minutes ago, ysera said:

what about radiology? 

Should be safe

[NLengr]

12 hours ago, GrouchoMarx said:

Should be safe

rmorlean should be able to provide more info on the state of the radiology market.

[hamham]

On 7/13/2019 at 11:54 PM, Riskbreaker said:

Finally, there are no Canadian neurosurgery jobs. Literally. And it's not going to get any better. That is an inordinate time investment (residency + 1 or 2 fellowships + MSc or PhD) to gamble a career on.

Is Toronto hiring? They just lost a neurosurgeon after he brutally murdered his wife.

[duckduckgoose18]

I'd imagine that even if a job (or several) opened up, newly minted grads (i.e., people entering med now) wouldn't be eligible b/c there'd be so many people ahead of you--I can only assume no matter how talented, hard-working, and brilliant you are, there's someone who has all the same traits + an extra fellowship/degree.