(Neurosurg) Realistic advice about job prospects

[Jack Marcos]

Hello all, 

I’m really interested in doing neurosurg, have been doing research and shadowing and still think I could really enjoy it despite the insane hours and poor life quality that will happen during residency and after. I honestly don’t care about having a high salary, I just really enjoy the field so far. I also don’t mind doing a PhD, and will definitely plan on doing a fellowship(s) However, after looking at many forums it really seems like getting a job is hardest part of the whole journey. I’ve talked to some people in the scene and it seems like they also echo this sentiment. So 1) I’m wondering realistically what are the chances of finding a job in Canada upon finishing residency+PhD+fellowships? 2) Should I just write usmle step 1 etc and try and make it in the states? 
 

Thanks guys

[dooogs]

Have you tried to look for actual job postings? It seems that a few do come up every year or other year if you are flexible with location across canada

[Snowmen]

12 hours ago, dooogs said:

Have you tried to look for actual job postings? It seems that a few do come up every year or other year if you are flexible with location across canada

The overwhelming majority of jobs in medicine never get announced anywhere.

Regarding jobs, pretty much all the the surgical fields have terrible job markets and as far as I know, cardiac and neurosurgery are even worse.

One thing you also have to ask yourself is whether or not you will really like it. There's a huge difference between enjoying something when you're shadowing for a day with an attending who's trying to make it like the best thing in the world and liking it at 3 am when you're doing the work nobody wants to do after 3 years of brutal hours with 1-in-3 call.

[blah1234]

I've seen this many times with students and I really want to convey that what you may love as a student you may not love as a resident or attending. People's priorities change as their life situation changes (e.g. marriage, children, illness, etc.).

I'm not saying you won't love it forever, but the road is very long and the payoff may not be as immediate as some of your peers.

[offmychestplease]

job market is absolutely terrible after 9-10 very difficult years of training post medical school (6 years of residency + fellowships + graduate degrees), and if you eventually find a job...hours are terrible for the rest of your life. Not to mention a few million in lost opportunity cost if you chose a diff medical field so you'll be 45+ years old until you break even. GG

[neurologist19]

Do you need a PhD to be a neurosurgeon? I don't understand the PhD part.

[offmychestplease]

To be able to get a job as a neurosurgeon in Canada, you need to get a PhD during your training (usually residency) yes due to the very academic nature of the field, and also because of the extreme shortage in jobs. 

Same thing applies for Cardiac surgery. 

[Naruto]

Be prepared to go to the US.

[offmychestplease]

18 minutes ago, Naruto said:

Be prepared to go to the US.

Canadian NSx residency is not equivalent to the US due to number of years, and other factors

[Jack Marcos]

5 hours ago, offmychestplease said:

Canadian NSx residency is not equivalent to the US due to number of years, and other factors

Yep, I guess the only thing is I could try and get into a US NSGY residency so I could become board certified, but it’s quite hard to get into US NSGY residency.

[neurologist19]

14 hours ago, offmychestplease said:

To be able to get a job as a neurosurgeon in Canada, you need to get a PhD during your training (usually residency) yes due to the very academic nature of the field, and also because of the extreme shortage in jobs. 

Same thing applies for Cardiac surgery. 

PhD takes on average 5.5 years to complete for students who are full-time PhD students. How is it possible to get a PhD during your residency? The residency would take over 10 years then at the very least if you work very efficient. Why would someone choose to become a neurosurgeon? I did a quick search and it doesn't seem they earn more than a specialist. Could your PhD be in anything or is there any specific topic to get a PhD in? Like is it a PhD in Surgery?

[offmychestplease]

1 hour ago, neurologist19 said:

PhD takes on average 5.5 years to complete for students who are full-time PhD students. How is it possible to get a PhD during your residency? The residency would take over 10 years then at the very least if you work very efficient. Why would someone choose to become a neurosurgeon? I did a quick search and it doesn't seem they earn more than a specialist. Could your PhD be in anything or is there any specific topic to get a PhD in? Like is it a PhD in Surgery?

NSx residency is 6 years long in Canada, one can usually use 1 year to start their PhD and then spend 2 years full-time at PGY-7 and PG-8 to complete. So, in total PhD's completed during surgical training are much shorter than classic PhD's and they are arguably "less intense". Completing of a PhD during NSx surgery is not usually to become a researcher but to check off a box to get an academic job (basically all NSx jobs in Canada). The PhD is generally done in a neurosurgery or neuroscience related field. Fellowships would then be 1-2 years long after that PGY-9 and PGY-10. It's not an exaggeration to say that NSx/Cardiac total training after medical school is 10 years and that is assuming you didn't take any breaks/leaves and finished your training on time. A Neurosurgeon told our class to "book off a decade after medical school" if you want to get into this field. If someone gets into med right after undergrad...that is 18 years of university in total. 

Secondly, many fields actually make more than NSx (Derm, Cosmetic Plastics, Rads, Cards to name a few) in Canada. And not only do they make more they do it with less time, less brutal training, better hours, and much better jobs (even Cards which has poor jobs of the ones I listed...the NSx market makes cards look good). Even the hard plastics residency is not as hard as NSx. You could even make more money in FM if you do the right things, and work hard the same hours....but do it 8 years earlier with way better jobs, way easier training, no call, etc.

But let's use FM to compare time.... you are literally 8 years behind income wise since FM is get-in-and-get-out in 2 years. Hence my earlier comment saying you would be 45+ to break even money-wise.

Every year only maybe 1-3 max students from each medical school class of about 150 apply to NSx for reasons mentioned above...so basically anyone wanting NSx has to really really really love it (more than anything in life, literally). 

[Jack Marcos]

19 minutes ago, offmychestplease said:

NSx residency is 6 years long in Canada, one can usually use 1 year to start their PhD and then spend 2 years full-time at PGY-7 and PG-8 to complete. So, in total PhD's completed during surgical training are much shorter than classic PhD's and they are arguably "less intense". Completing of a PhD during NSx surgery is not usually to become a researcher but to check off a box to get an academic job (basically all NSx jobs in Canada). The PhD is generally done in a neurosurgery or neuroscience related field. Fellowships would then be 1-2 years long after that PGY-9 and PGY-10. It's not an exaggeration to say that NSx/Cardiac total training after medical school is 10 years and that is assuming you didn't take any breaks/leaves and finished your training on time. A Neurosurgeon told our class to "book off a decade after medical school" if you want to get into this field. If someone gets into med right after undergrad...that is 18 years of university in total. 

Secondly, many fields actually make more than NSx (Derm, Cosmetic Plastics, Rads, Cards to name a few) in Canada. And not only do they make more they do it with less time, less brutal training, better hours, and much better jobs (even Cards which has poor jobs of the ones I listed...the NSx market makes cards look good). Even the hard plastics residency is not as hard as NSx. You could even make more money in FM if you do the right things, and work hard the same hours....but do it 8 years earlier with way better jobs, way easier training, no call, etc.

But let's use FM to compare time.... you are literally 8 years behind income wise since FM is get-in-and-get-out in 2 years. Hence my earlier comment saying you would be 45+ to break even money-wise.

Every year only maybe 1-3 max students from each medical school class of about 150 apply to NSx for reasons mentioned above...so basically anyone wanting NSx has to really really really love it (more than anything in life, literally). 

Not sure if you know the answer to this, but you seem to have pretty good insight. So I’ll ask anyways lol
1) do you know how US residencies view Canadian medical students? What would be the most important things to focus on to get into a US residency? is it really possible to get US residency coming from Canada?
 

2) I know some recent Canadian neurosurgeons who moved to the US but like you said they cannot become board certified if they did a Canadian residency, so what are the major limitations without being board certified? Is it harder to do academic or private practice without board certification.

[offmychestplease]

I believe that US MD programs would view Canadian MD grads as equivalent but the issue is that if you do not have an American visa the residency programs have to sponser you which not all programs are willing to do - but if you are an exceptional candidate this is probably less of a problem. USMLE Step 1 score was the most important factor to get looked at by NSx programs (240+ but ideally 250+ if possible) but now it is P/F fail so I am not sure what they will use instead. Many medical schools in the US still use grades to an extent, class rank, honours etc but again as a Canadian we don't have those. Getting good refs from NSx electives is important too (if you can somehow arrange electives at US programs, even better). Research is very important to NSx...so getting NSx research and pubs is almost-a must. I don't know other specifics if anyone else can chime in. Essentially what it used to be until this year: High Step 1, NSx pubs, and good reference letters from NSx electives is what you needed. So maybe now that Step 1 is gone, they will pay more attention to research and electives (like our system in Canada)? You can probably read many conjectures on American med forums. 

2) no idea 

[neurologist19]

1 hour ago, offmychestplease said:

NSx residency is 6 years long in Canada, one can usually use 1 year to start their PhD and then spend 2 years full-time at PGY-7 and PG-8 to complete. So, in total PhD's completed during surgical training are much shorter than classic PhD's and they are arguably "less intense". Completing of a PhD during NSx surgery is not usually to become a researcher but to check off a box to get an academic job (basically all NSx jobs in Canada). The PhD is generally done in a neurosurgery or neuroscience related field. Fellowships would then be 1-2 years long after that PGY-9 and PGY-10. It's not an exaggeration to say that NSx/Cardiac total training after medical school is 10 years and that is assuming you didn't take any breaks/leaves and finished your training on time. A Neurosurgeon told our class to "book off a decade after medical school" if you want to get into this field. If someone gets into med right after undergrad...that is 18 years of university in total. 

Secondly, many fields actually make more than NSx (Derm, Cosmetic Plastics, Rads, Cards to name a few) in Canada. And not only do they make more they do it with less time, less brutal training, better hours, and much better jobs (even Cards which has poor jobs of the ones I listed...the NSx market makes cards look good). Even the hard plastics residency is not as hard as NSx. You could even make more money in FM if you do the right things, and work hard the same hours....but do it 8 years earlier with way better jobs, way easier training, no call, etc.

But let's use FM to compare time.... you are literally 8 years behind income wise since FM is get-in-and-get-out in 2 years. Hence my earlier comment saying you would be 45+ to break even money-wise.

Every year only maybe 1-3 max students from each medical school class of about 150 apply to NSx for reasons mentioned above...so basically anyone wanting NSx has to really really really love it (more than anything in life, literally). 

Thanks for your complete and insightful answer. It does make sense if someone wants to become a professor, as MD/PhD is starting to become  the norm as a part of the requirements for hiring clinical scientist faculty members. So if you are interested in becoming a clinical scientist, that might be a good route. However, getting a PhD just so that you can be able to find a job as surgeon... that doesn't make sense to me

[offmychestplease]

12 minutes ago, neurologist19 said:

Thanks for your complete and insightful answer. It does make sense if someone wants to become a professor, as MD/PhD is starting to become  the norm as a part of the requirements for hiring clinical scientist faculty members. So if you are interested in becoming a clinical scientist, that might be a good route. However, getting a PhD just so that you can be able to find a job as surgeon... that doesn't make sense to me

no worries, getting a PhD to be more competitive for limited surgery jobs especially if you want to have a chance at Toronto/Vancouver/Montreal/Calgary surgery positions (if they open up) is the harsh reality in Canada. This is mostly true for NSx/Cardiac/Ortho which have extremely poor markets. This does not include doing fellowship(s) too btw because no one is gonna have a chance for a surgery job with no fellowship when you have people who did 2-3 fellowships hungry for the job.....for other surgery fields like Gen Surg + ENT etc a MSc + fellowships might be good enough. You can do reading on this issue in various threads. Surgery wasn't that competitive to find a job 15-20+ years ago but it has been a disaster for many years...hence the old adage "if you can see yourself doing absolutely anything else in medicine, go for that instead of surgery." The time, effort, grind, lifestyle, job opportunities lost income etc to be a surgeon in Canada is really not worth it at all unless surgery is your life. 

Here is a video of a Canadian who did 2 years of Gen Sx residency and dropped out a few months ago to go into FM (smart choice)...he explains what I said above pretty well : 

https://www.youtube.com/watch?v=2P9dZPLSVpM

or

https://www.youtube.com/watch?v=sKK_d7lTU5g  

 

 

[neurologist19]

27 minutes ago, offmychestplease said:

no worries, getting a PhD to be more competitive for limited surgery jobs especially if you want to have a chance at Toronto/Vancouver/Montreal/Calgary surgery positions (if they open up) is the harsh reality in Canada. This is mostly true for NSx/Cardiac/Ortho which have extremely poor markets. This does not include doing fellowship(s) too btw because no one is gonna have a chance for a surgery job with no fellowship when you have people who did 2-3 fellowships hungry for the job.....for other surgery fields like Gen Surg + ENT etc a MSc + fellowships might be good enough. You can do reading on this issue in various threads. Surgery wasn't that competitive to find a job 15-20+ years ago but it has been a disaster for many years...hence the old adage "if you can see yourself doing absolutely anything else in medicine, go for that instead of surgery." The time, effort, grind, lifestyle, job opportunities lost income etc to be a surgeon in Canada is really not worth it at all unless surgery is your life. 

Here is a video of a Canadian who did 2 years of Gen Sx residency and dropped out a few months ago to go into FM (smart choice)...he explains what I said above pretty well : 

https://www.youtube.com/watch?v=2P9dZPLSVpM

or

https://www.youtube.com/watch?v=sKK_d7lTU5g  

 

 

Thank you so much. For the record, I never had an interest in surgery. I have a masters in genetics and want to eventually go down the path the path of becoming a medical geneticist. I don't mind getting a PhD in medical genetics sometime but the issue is that PhDs and Fellowships pay peanuts unfortunately.  Also thanks for the YouTube videos,  I enjoyed the videos very much and actually found that Youtuber pretty cool too.

[DrOtter]

6 hours ago, offmychestplease said:

no worries, getting a PhD to be more competitive for limited surgery jobs especially if you want to have a chance at Toronto/Vancouver/Montreal/Calgary surgery positions (if they open up) is the harsh reality in Canada. This is mostly true for NSx/Cardiac/Ortho which have extremely poor markets. This does not include doing fellowship(s) too btw because no one is gonna have a chance for a surgery job with no fellowship when you have people who did 2-3 fellowships hungry for the job.....for other surgery fields like Gen Surg + ENT etc a MSc + fellowships might be good enough. You can do reading on this issue in various threads. Surgery wasn't that competitive to find a job 15-20+ years ago but it has been a disaster for many years...hence the old adage "if you can see yourself doing absolutely anything else in medicine, go for that instead of surgery." The time, effort, grind, lifestyle, job opportunities lost income etc to be a surgeon in Canada is really not worth it at all unless surgery is your life. 

Here is a video of a Canadian who did 2 years of Gen Sx residency and dropped out a few months ago to go into FM (smart choice)...he explains what I said above pretty well : 

https://www.youtube.com/watch?v=2P9dZPLSVpM

or

https://www.youtube.com/watch?v=sKK_d7lTU5g  

 

 

Oh wow I've been following him for some time too. Surprised but also not surprised with his decision

Impressed with his insights and courage too!

[offmychestplease]

46 minutes ago, DrOtter said:

Oh wow I've been following him for some time too. Surprised but also not surprised with his decision

Impressed with his insights and courage too!

agreed. I think medical schools could do a better job in sharing the realities of surgery I mentioned above with students. If you don't do your own research about the harsh realities you're going to get burned. My friend went to a ortho talk and the PD tried to make it seem like there were jobs for everyone....later it was found out when he meant "jobs" he meant everyone got a fellowship...which is great all but not what people meant. If students know the reality that you have ortho grads doing 2-3 years of fellowships after 5 years ortho residency to hopefully be able to land a part-time temp locum position then their perspectives would change. This site is very useful to get informed about truths that you may not have access to...

[JohnGrisham]

1 hour ago, offmychestplease said:

agreed. I think medical schools could do a better job in sharing the realities of surgery I mentioned above with students. If you don't do your own research about the harsh realities you're going to get burned. My friend went to a ortho talk and the PD tried to make it seem like there were jobs for everyone....later it was found out when he meant "jobs" he meant everyone got a fellowship...which is great all but not what people meant. If students know the reality that you have ortho grads doing 2-3 years of fellowships after 5 years ortho residency to hopefully be able to land a part-time temp locum position then their perspectives would change. This site is very useful to get informed about truths that you may not have access to...

I think classes in the last few years are more aware -  most people i knew who went into surgical fields were very well aware of the poor job prospects, but just couldn't see themselves doing other fields...and were fine with doing masters and fellowships to get their desired work.  Multiple close friends in Ortho as an example who knew they needed to keep options open if they wanted to get work and be flexible, many nights spent over beer trying to convince them to do otherwise...but that was their passion, and I dont blame them for it.  

I guess my point is, i dont think at least in recent times, there is much left of "oblivious ms4 applying to X surgical field without knowing there is less job prospects". Certainly still are some who are blind but i think the average person is aware enough of at least part of the pathway that lays ahead of them (as much as you really can as a medical student or resident).

[offmychestplease]

47 minutes ago, JohnGrisham said:

I think classes in the last few years are more aware -  most people i knew who went into surgical fields were very well aware of the poor job prospects, but just couldn't see themselves doing other fields...and were fine with doing masters and fellowships to get their desired work.  Multiple close friends in Ortho as an example who knew they needed to keep options open if they wanted to get work and be flexible, many nights spent over beer trying to convince them to do otherwise...but that was their passion, and I dont blame them for it.  

I guess my point is, i dont think at least in recent times, there is much left of "oblivious ms4 applying to X surgical field without knowing there is less job prospects". Certainly still are some who are blind but i think the average person is aware enough of at least part of the pathway that lays ahead of them (as much as you really can as a medical student or resident).

oh I agree that most MS4's are aware of the many challenges of a career in surgery and the ones that go into it clearly are ok with the many cons. In some cases, it takes actually doing a couple of years of residency to really comprehend the brutal reality and to switch asap (like the guy in the videos posted above). What I'm trying to say is that MS1's and (MS2's for the most part) are mostly shielded from the harsh reality. At all these surgery talks, PD's sugarcoat the jobs part of the presentation and don't focus on the reality ... or even the lifestyle and how brutal the residency is, etc.

So unless you are a MS1/MS2 who is doing your due diligence researching the realities of a surgical career on websites you are not getting the truth at these "interest group talks/presentations". I have heard a "theory" that PD's want have a vested interest in not showing the harsh truth about surgery because they need residents for call lol I don't know how accurate that is, but it makes sense why PD's would want to paint their field in a good light. What makes it worse for MS1/MS2's is that profs in medical school are usually very far removed from the realities of employment for various fields so they may also "underrate" the jobs issue for surgery. And for many people who don't have family in medicine, and only gaining their info from interest group talks/profs and not looking things up on their own, it's not surprising that they don't discover the "truth" until late in medical school...or from some people not until a couple years into surgical residency itself.

Moral of the story- do your own research and think critically the motivations why someone may tell you something  

And just a bonus interesting bit ... I find most premeds have no idea about the surgical job market and for some reason many think there is a "shortage of surgeons" .... not sure where that myth came about in the general public lol 

[blah1234]

1 hour ago, offmychestplease said:

And just a bonus interesting bit ... I find most premeds have no idea about the surgical job market and for some reason many think there is a "shortage of surgeons" .... not sure where that myth came about in the general public lol 

Probably from the long surgical wait lists. They don't understand we don't have the capacity to pay for more OR time for underemployed surgeons. I don't like how the government just portrays the surface level issues when it's really a huge funding problem at the core.

[MasterDoc]

On 2/3/2021 at 10:07 AM, offmychestplease said:

Canadian NSx residency is not equivalent to the US due to number of years, and other factors

Since US Neurosurg is PGY-7, can't you become board certified if you do PGY-6 + fellowship?

[Jack Marcos]

8 hours ago, MasterDoc said:

Since US Neurosurg is PGY-7, can't you become board certified if you do PGY-6 + fellowship?

Unfortunately, no. Any individuals who completed training after 1997 in Canada can no longer become certified in the United States, doesn’t matter how many fellowships you do. http://www.neurosurgeryschools.com/faqs/index.htm
 

You can still practice in the United States though.

[1D7]

On 2/15/2021 at 11:30 AM, Jack Marcos said:

Unfortunately, no. Any individuals who completed training after 1997 in Canada can no longer become certified in the United States, doesn’t matter how many fellowships you do. http://www.neurosurgeryschools.com/faqs/index.htm
 

You can still practice in the United States though.

It's up to the hospitals to decide if they want to accept your Canadian certification, and you'll be dependent on a visa. Probably not something you want to necessarily depend on but more of an option to consider if things continue to look dire in Canada if you reach your seniors years of NSx residency.