How come neurosx/ortho are so competitive despite "no jobs"?

[nekusis]

Seriously,

No spots are left over at the R-2 match. Why is that?

[cdnmaple]

Optimism.

.

[rmorelan]

Guess so. Operating is one of those things...when people want to do it, they'll do it.

 

Sure, and some people are just really interested in it. Plus for some of it it is hard to know what the job market will really be in 10 years (4 years MD, 5 years res, fellowship...).

[afsmak27]

There are jobs available, just probably not within your first choice location. Everyone wants a job in Vancouver/GTA/Calgary/Montreal, but that's just not feasible. There are many opportunities in the States, as well as "less appealing" cities in Canada (ie/ Regina).

[Mandibular]

There are jobs available, just probably not within your first choice location. Everyone wants a job in Vancouver/GTA/Calgary/Montreal, but that's just not feasible. There are many opportunities in the States, as well as "less appealing" cities in Canada (ie/ Regina).

 

 

 

In the last CMAJ, there was a short article as to how its getting more difficult for residents of a certain discipline to find permanent positions. So they created a section where they help resident find work. For Ortho, there was only one opening and it was in Shanghai...

[NLengr]

There are jobs available, just probably not within your first choice location. Everyone wants a job in Vancouver/GTA/Calgary/Montreal, but that's just not feasible. There are many opportunities in the States, as well as "less appealing" cities in Canada (ie/ Regina).

 

Not true for many specialties unfortunately. At least not enough to supply all the grads from residency or fellowship with a job every year.

[cdnmaple]

There are jobs available, just probably not within your first choice location. Everyone wants a job in Vancouver/GTA/Calgary/Montreal, but that's just not feasible. There are many opportunities in the States, as well as "less appealing" cities in Canada (ie/ Regina).

 

If only it were that simple. If only it were just a case of the city-folk not wanting to leave their metropoli.

 

I realize you were just grabbing at any old example, but Regina's a pretty bad one. A tertiary center, academic training site, well-supplied with nurses, anesthetists, assists, ICU, and a fairly well-stocked supply unit of arthroplasty parts, and a good number of local grads who think it's no great hardship to live there with their cheap car insurance, mom and dad's farm just an hour or two away, and keep cheering on their Riders.

 

But Regina's not exactly got a wide open door begging for neurosurgeons or orthopods. (They are currently hiring in urology, however.)

 

And as you start to get down smaller and smaller, you find there is no role for a neurosurgeon in most non-major communities. So no, it doesn't matter if you're willing to live there; you still can't work there.

 

And as for ortho, even most small communities have no OR time to give, assuming they can even support an ortho at all. That means catchment, nursing, and access to tools or implants or other subspecialty services such as nuc med. And this, the increasing shift of standard of care to rely on multidisciplinary units or specialized nursing, is the effect that's trickling into the other surgical specialties as well.

 

So the ones that might still occasionally pop up saying they're looking are often very remote. The Fort-whatevers. Which is a hard pill to swallow when you want to stay within a few hours travel (by air or by car) from aging family, or when your wife wants to stay employed. And even then there aren't enough.

[nekusis]

But if you look at UofT's recent neurosx graduates, a lot of them have been recruited by UofT, Mc, and UWO.

Heck, there's even a neurosx who's actually studied in Switzerland (Radovinic, I think) who's been recruited.

 

 

Honestly...neurosx is akin to rocket science...it's so prestigious. Maybe the most prestigious medical specialty out there.

[Riskbreaker]

As mentioned, we don't know the job situations available 10 years down the line, which leaves some hopefulness and uncertainty in the air. Speaking strictly for neuro, there were only 14 residency spots this year (English), which is a drop from previous years, so there is some adjustment.

 

As a neuro grad, your best option is always your home school. The "Big 3" of Toronto, Western and Calgary might afford additional opportunities down the line, and their residents are usually most visible as they have the most spots. The most recent Toronto grads ended up in Toronto and Sudbury for work, with others off for fellowship. It is the premier academic program and trains many successful surgeon-scientists. Western has the reputation for being a powerhouse for surgical skills training, and their last grad has a faculty position at the Cleveland Clinic. Calgary has a healthy mix of academic and skills training, and their last grad is now junior faculty.

 

Most opportunities available are in the USA, and I think new residents need to acknowledge that going in. Your best bet is still your home turf. Still, it's not all roses, as the most recent Edmonton grad is currently running the floor without any OR time, and Edmonton is an excellent training centre. Just have to be prepared.

[NewfieMike]

I've almost completely dropped the idea of doing Neurosx because of this.

 

I just can't rationalize spending that much time training only to maybe get a job... somewhere.

[NLengr]

I've almost completely dropped the idea of doing Neurosx because of this.

 

I just can't rationalize spending that much time training only to maybe get a job... somewhere.

 

Stick to the general stuff. Family, psych, GIM, General Peds and you'll be gold for ability to move around.

 

I would have included gen Surg, but you need OR time for that so its not near as flexible. The other ones you can work out of a private office.

[futureGP]

But if you look at UofT's recent neurosx graduates, a lot of them have been recruited by UofT, Mc, and UWO.

Heck, there's even a neurosx who's actually studied in Switzerland (Radovinic, I think) who's been recruited.

 

 

Honestly...neurosx is akin to rocket science...it's so prestigious. Maybe the most prestigious medical specialty out there.

 

 

at times i think neurosurg might be overrated due to the fact that it's the "brain" omfg

 

i mean they do amazing work, but so do all other surgeons and physicians

[Flasses]

 

Honestly...neurosx is akin to rocket science...it's so prestigious. Maybe the most prestigious medical specialty out there.

 

If you're going to go by length of training, NeuroSx is ridiculously long. If you're going by hours, NeuroSx is quite possibly the single worst field out there (especially in residency). If you're going by salary per hour, lots of fields beat NeuroSx, which is bad especially when you account for years spent training.

 

Despite the "prestige", most people in the medical community just feel sorry for them.

[NLengr]

If you're going to go by length of training, NeuroSx is ridiculously long. If you're going by hours, NeuroSx is quite possibly the single worst field out there (especially in residency). If you're going by salary per hour, lots of fields beat NeuroSx, which is bad especially when you account for years spent training.

 

Despite the "prestige", most people in the medical community just feel sorry for them.

 

Damn right. Bad disease, not great treatments, long ORs, sick time consuming patients. That doesn't spell fun time to me.

[Lactic Folly]

One of their residents named "no poo" as a plus.

[LostLamb]

One of their residents named "no poo" as a plus.

 

I LOL'd!!!!!

 

Good point

[A-Stark]

One of their residents named "no poo" as a plus.

 

As someone consigned to wards that have the usual medical smell (Purell + slight sent of feces, interspersed with C. diff), I'd sooner have that than the scent of neuro breath. Ugh. And nothing says neurological impairment like fecal incontinence.

[bloh]

Despite the "prestige", most people in the medical community just feel sorry for them.

 

I always laugh at the "prestige"! Prestige is only relevant if you are around "less prestigious" individuals but when so much time is spent in the hospital around other physicians, where is it?

[spontaneouscombustion]

Its a fascinating field and I don't think there's any need to feel sorry for them, because most of them seem to love it despite the brutal work hours and lack of jobs. As long as they're involved in some way -whether it be through fellowships, research, etc., they seem to be happy.

[NLengr]

Its a fascinating field and I don't think there's any need to feel sorry for them, because most of them seem to love it despite the brutal work hours and lack of jobs. As long as they're involved in some way -whether it be through fellowships, research, etc., they seem to be happy.

 

Unfortunately, happiness doesn't pay the bills. If you are stuck doing fellowship after fellowship, you are losing hundreds of thousands of dollars.

 

I will double check with my bank on the dollar-happiness exchange rate. Maybe they've changed payment options

[spontaneouscombustion]

Happiness doesn't pay the bills, but fellowship stipends do. They aren't working for free, and when their hard work pays off they'll be doing a job they love for a very generous of pay.

 

Its not an ideal situation, but I can see why someone would chose it. Its the most fascinating area in medicine.

 

Its not a cush lifestyle, but not everyone is looking for cush.

[A-Stark]

Are you a neurosurgery resident or staff? Have you have spent time on a neurosurgery service as a clerk or off-service resident?

 

If not, I'd suggest you stop arguing with people who have actual experience in that respect. Don't get me wrong, the ORs were pretty cool, but that's probably because I avoided spine at all costs and never went to one of those 9-hour tumour resections that they do routinely. The complications are beyond awful and even among those patients who do well, many don't emerge on the other side entirely at their baseline. They also tend to be understaffed so staff end up doing the equivalent of junior resident call and senior residents routinely work post-call.

 

That's not to say I didn't enjoy elements of my rotation, but slogging it out to get in for rounds at 6am everyday and spending much of my time with off-service residents who *HATED* their life on that service did not endear me to the specialty. Later on while I was on plastics, one of the R4s told me that his neurosurg rotation had him on the phone to his parents telling them he was thinking of quitting medicine.

 

Now, for those who love it, it's great, I guess. But you have to love it more than almost anything else in life, and if the lifestyle gets better as staff (assuming you find a position), it's still very, very demanding. At least general surgeons can transition to doing hernias, elective choles, and scoping later in practice; there's nothing especially simple or low-risk about anything neurosurgeons do.

[NLengr]

Happiness doesn't pay the bills, but fellowship stipends do. They aren't working for free, and when their hard work pays off they'll be doing a job they love for a very generous of pay.

 

Its not an ideal situation, but I can see why someone would chose it. Its the most fascinating area in medicine.

 

Its not a cush lifestyle, but not everyone is looking for cush.

 

Fellowship stipends aren't anything to write home about when you have a boatload of debt and are aging (I.e. burning through time to save for retirement). They can even be less than pay during senior resident years. If you are lucky, staff will throw you some call days or something, but that's highly dependent on your staff being willing to give up money (by handing off call).

 

They also need to find a job. Which isn't easy.

[spontaneouscombustion]

Are you a neurosurgery resident or staff? Have you have spent time on a neurosurgery service as a clerk or off-service resident?

 

If not, I'd suggest you stop arguing with people who have actual experience in that respect. Don't get me wrong, the ORs were pretty cool, but that's probably because I avoided spine at all costs and never went to one of those 9-hour tumour resections that they do routinely. The complications are beyond awful and even among those patients who do well, many don't emerge on the other side entirely at their baseline. They also tend to be understaffed so staff end up doing the equivalent of junior resident call and senior residents routinely work post-call.

 

That's not to say I didn't enjoy elements of my rotation, but slogging it out to get in for rounds at 6am everyday and spending much of my time with off-service residents who *HATED* their life on that service did not endear me to the specialty. Later on while I was on plastics, one of the R4s told me that his neurosurg rotation had him on the phone to his parents telling them he was thinking of quitting medicine.

 

Now, for those who love it, it's great, I guess. But you have to love it more than almost anything else in life, and if the lifestyle gets better as staff (assuming you find a position), it's still very, very demanding. At least general surgeons can transition to doing hernias, elective choles, and scoping later in practice; there's nothing especially simple or low-risk about anything neurosurgeons do.

 

I just finished a 4 week rotation as a clerk on neurosurgery. Off-service residents have nothing to do with it, I'm talking about the ones that are there because they want to be.

[Blake]

I will complete my neurosurgery residency this year and I wanted to add my 2 cents to this topic.

 

Personally I am happy with my career choice and I wouldn't do it anything else (even if offered derm/ENT/rad/ophtho). I thought neurosurgery was the coolest thing as a 3rd year med student, and I still think it is the coolest thing now that I've actually dissected and clipped aneurysms, instrumented lots of spinal columns and evacuated a bunch of hematomas. I'm overall satisfied with the care we provide to patients with debilitating conditions, and honestly I feel that we help out people 95% of the time. People tend to focus on the terrible outcomes, and neglect the forest behind the tree.

 

About the prestige thing, well I guess that depends on the individual. Pretty sure none of my neighbours ever found out what I did for work, and I can't pull the neurosurgeon card on my wife to get what I want so I guess tough luck for me, haha. Over the years, I have seen plenty of premed, med students, residents and staff with ginormous egoes, so I don't think that this is exclusive to our field. I just like being chill and courteous to everyone. Call it good manners, I guess. I am not a deity, nor the president of the USA or NASA's top astronaut, so keeping the ego to a minimum is only reasonable.

 

Not sure where A-stark had his neurosurgery experience, but that is different from mine. Most of our craniotomies here for GBM/mets take 3-4 hours, and I haven't been that often in 9 hours surgeries. Again I see a comment about poor outcomes and how patients don't return to their baseline. Not trying to sell you on neurosurgery, but let's be honest, there is absolutely no way that we would still be allowed to practice if there was no overall patient care benefit to our field. By the way, there are plenty of low risk procedures in neurosurgery. Not trying to toot my own horn, but I don't stress at all whenever I do most shunts, bur holes, lumbar + cervical laminectomies, ACDFs, lumbar microdiscectomies, convexity meningiomas, frontal or temporal pole tumors, acute SDH evacuation, etc. The bread and butter of neurosurgery is fairly easy to do, honestly. There are still a few things I wouldn't want to do often such as ruptured giant aneurysms, glioma resection in the motor strip, thoracotomies and retroperitoneal approaches for multilevel spinal decompression + fusion, endonasal resection of chordomas, brainstem cavernoma resection, etc but only a few guys in the whole country have such complex practices.

 

As for fellowships, it is my understanding that fellows do get to bill as surgical assistants and so on, provided they pass the FRCSC exam. I expect to make some decent change next year, and this was clearly discussed in my fellowship interviews.

 

I like neurosurgery a lot, but it did not stop me from having a life. I think my wife and family would agree. I may have been in a unusual position though, and I don't chat that often with guys in other programs so maybe I've had it way easier than the rest of my colleagues. All I know is I've gone through residency relatively easily, without any major fuss. I didn't sacrifice that much in my personal life (I got married to an amazing woman, I still read the news and watch sports, I have watched every episode of Game of Thrones, and I can still kick ass at videogames), I've developed some pretty amazing skills over the years, I have cared for thousands of patients and I bet most of them are thankful. I am not worried for a job after my fellowship (I will leave it at that), and my dream car list is only getting bigger.

 

So yea, don't feel too sorry for me as I am exactly where I wanted to be.