Neurosurgery

[Guest satsumargirl]

Anyone with any experience in neurosurgery on this board?

 

What is a typical day/week like?

What is the lifestyle of residency and afterward like?

Can you still have a life and be a neurosurgeon?

 

What are the pros? What are the cons?

 

Oh do surgeons tend to have shorter careers than other specialties (ie as vision and hand steadiness etc...worsens with age)

 

Thanks

Sats

[Guest UWOMED2005]

I didn't do any neurosurgery electives nor did I apply to the program.

 

I do know that neurosurgery has become increasingly unpopular the last few years as med school grads are becoming more interested in "lifestyle" - and neurosurgery is felt to be one of the toughest lifestyles for a specialty. Everything I've heard suggests neurosurgeons work some of the longest hours. . . and because fee for service tends to renumerate best for short procedures and neurosurgical procedures tend to take a long time, neurosurgeons have traditionally been underpaid relative to other surgical specialties.

 

Interestingly enough, the following CMAJ article came up in a post in the moderator's corner:

 

Neurosurgical Depression

 

I had two classmates who were interested enough in neurosurgery to do electives. Neither ended up applying for neurosurg programs at all.

 

Both were turned off by the lifestyle.

 

And one made the following point. . . surgical specialties are often attractive for the ability to "fix" someone. Taking an appendix out of a healthy 25 year old often saves their life. Hip replacements give years of much greater quality of life. Same for cataracts. But many neurosurgical procedures don't have quite the same outcome. . . in many (not all) cases there isn't a high quality of life even after the surgery. . . and my friend argued in a few cases things were possibly worse.

 

AND to top it all off there are rumours that the last few years Canadian neurosurg grads have had trouble finding jobs. . . many of the current surgeons aren't quite retiring, the government doesn't like funding new spots since neurosurgery is so expensive, and there really hasn't been any new high volume neurosurgery procedures to increase demand.

 

But there COULD be a huge need in a few years when all the current surgeons do start retiring. . .

 

But don't take my word for it. . . this is all 2nd hand info, you're better off finding out for yourself.

[Guest Kirsteen]

Hi there,

 

I second the above post re: lifestyle choice. I did my MSc research in an area of neurosurgery and heard that the residency is quite taxing in terms of hours. (I'd read somewhere that neurosurgery residents top all other residents in terms of average hours worked per week.) Also, I believe it was this past year that the US closed its doors to Canadian neurosurgery graduates. I know one faculty guy who moved down to the US to open a private practice prior to this gate crashing and snagged himself a very nice neurosurgery salary (upwards of $700K US).

 

I, myself, was interested in neurosurgery whilst researching in the field. Even now, I quite enjoy neurology and some of the surgical solutions to those types of problems. However, some of the above factors and speaking with one of my general surgery mentors about why he didn't consider neurosurgery as a career made me think twice. His comment: "I just couldn't do surgery where, if I made a mistake, I would be responsible for altering someone's personality."

 

Cheers,

Kirsteen

[Guest UWOMED2005]

Kirsteen - you might be interested to know one of the two classmates mentioned above ended up choosing neurology instead. . .

[Guest marbledust]

Not to be rude, but it should be noted that it was later revealed in the CMAJ (by the author himself, a neurosurgeon) that the article above was in fact written as a piece of fiction--something he neglected to mention when it was first published. I don't have the reference (too lazy), but it should be easy to find, (should anybody care )

 

However, that is not to say that the neurosurg lifestyle cannot be a rather brutal one. My own extremely limited experience with neurosurgery attendings and residents was during a summer unit clerk job. I only worked a few shifts on the unit, but it seemed they were ALWAYS in the hospital; I think probably more hours than the general and trauma surgery guys. The residents, in particular, worked insane hours due to the length of procedures and a nasty call schedule even in their 5th and 6th years of training. But interestingly, many of them found the time and were active participants in hardcore hobbies such as mountain climbling, triathalons, marathons etc. Of course that may have come at the expense of a family life because a person only has so much time and when you spend 90+ hours a week at the hospital...

[Guest UWOMED2005]

No worries Marbledust - you're not being rude!

 

I didn't know that about the article. I probably wouldn't have posted the link if I'd realized that. . .

[Guest marbledust]

UWOMED2005:

 

I think it is a good article and worth posting on a site like this--however, it would have been a much better article had the author admitted up front that it was a work of fiction. I remember when I first read it I was stunned. Then a few months later I read the "retraction" and was a little disappointed by the author.

 

But having said that, I have looked up the reference and here is the link. While the original article and his follow-up letter raise some very important issues about mental health and physicians, his admission that he feels like a "fraud" after recieving numerous letters from people concerned about him is quite a little gem. I don't want to use the word "idiot"--oops I just did

 

btw: how goes ob at the RockyHorror?

 

www.cmaj.ca/cgi/content/f.../12/1774-a

[Guest UWOMED2005]

That is the first time this reply has come to my attention.

 

Unfortunately, I can't seem to find the time to read EVERY CMAJ article.

 

Hmm. . . on reading that reply, I'm not sure "fraud" is the term I'd used for the essay. Yes, Dr. Bernstein should have made it more clear the work was fictitious. But I think the point of this fictitious work is to point some of the downsides of his career and how they could lead to burnout. In that regard, I think he is successful and it does apply to the point of this thread.

 

Obs at the RockyHorror is good - two weeks to go. I've actually been doing low-risk Obs the last two weeks at the Pretty-Long-Carride with one of the family groups that does obstetrics.

 

I've had a number of your classmates helping me out as clerks. Any chance you'll be rotating through the RockyHorror?

 

(For the record, if anybody is interested in doing obs as a GP, Calgary has a fantastic setup. The majority of the deliveries both at the PLC and RGH are done by family docs. . .)

[Guest marbledust]

H

mm. . . on reading that reply, I'm not sure "fraud" is the term I'd used for the essay. Yes, Dr. Bernstein should have made it more clear the work was fictitious. But I think the point of this fictitious work is to point some of the downsides of his career and how they could lead to burnout. In that regard, I think he is successful and it does apply to the point of this thread.

 

Don't you think there is something ethically unsettling the first piece? Not a huge deal, of course. Greater sins are committed in medicine than this. But, from my own undergrad ethics courses, something like this wouldn't fly in mainstream journalism, I'm sure.

 

I think the doctors who took the time, and were obviously concerned enough about him, to write to him might consider him a fraud. Like I said, both pieces of writing help address some very important issues. But I think many people who read the article took it at face value (obviously both you and I did), when it isn't true. I don't think that it would have been any less effective had he put a small disclaimer saying "oh, by the way, I made this up--but this could happen to neurosurgeons." If nothing else, he did paint a very realistic portrait of depression.

 

One interesting aspect from me was that other doctors apparently opened up to him about their own battles with depression. That is a positive thing. But, on the flip side, I actually think something like this, perhaps not this specific case, could cause offense and might actually discourage people from disclosing their own problems.

 

Just my two cents...

 

I will be at the Rocky Horror in Sept. And, by the way, I think the Pretty Long Car-Ride might be my favorite hospital. Hate the FMC with a passion, unfortunately don't have the patience for the ACH, and haven't been at the Rocky Horror enough yet to form an opinion, although I have thrice visited the ED as a patient there (long stories) and wasn't too impressed :lol

[Guest UWOMED2005]

I gotta admit my preference is the RockyHorror. Maybe it was just my rotation experience (another long story) at the PLC that biased me, but I feel pretty attached to RockyHorror after that.

 

As to the article. . . reading it again. . . in the original, nowhere does the author suggest HE is the subject of the essay. The author intended this as a creative writing piece, one which highlights some of the pitfalls of the profession.

 

The problem is that the article hasn't been appropriately labeled. Isn't that the responsibility of the CMAJ editors, not the author?

 

So I don't think the author was being unethical at all. It was just a mixup in labelling.

 

But I will agree that the way the article was presented I assumed he was writing about his own experiences. . . which left me a bit uncomfortable.

 

I think we're on a bit of a tangent. . . anybody have addditional reliable info on neurosurgery?

[Guest marbledust]

As to the article. . . reading it again. . . in the original, nowhere does the author suggest HE is the subject of the essay. The author intended this as a creative writing piece, one which highlights some of the pitfalls of the profession

 

Not to prolong this, but yes, he didn't suggest he was the subject--but it looks like people (logically) assumed that he was. I know it's a creative writing piece--but in other medical journals the "fiction" is clearly labeled as such.

 

I'm not suggested he did something unethical on purpose, but obviously he felt compelled to write a followup and admit what was going on. Whether it was up to him or the editors to label it a fiction, (or "creative" if you want) I guess it doesn't matter because they both missed the boat with it. But given that he has done a fairly impressive amount of writing, including other works of fiction in other journals, I think he might have been a bit more careful.

 

That is all...

[Guest satsumargirl]

thanks for the replies.

 

I was hoping that neurosurgery would be less demanding than general in terms of call and hours since there are so many other organs the general surgeons take care of.

Lifestyle is pretty important to me, so maybe neruosurgery isnt' the best option. I do want something neuro-related though. Hmm...

[Guest Kirsteen]

Hi there,

 

If you're interested in a specialty that's neuro-related (and not neurosurgery) then the most obvious choice will be neurology. However, although the subject matters within the two specialties are intimately connected, one factor that you should consider is that the approach that each specialty takes in tackling clinical issues is quite different. Another option, if you are interested in a hands-on approach to clinical problem solving that incorporates neuroscience is neural interventional radiology, that is, a sub-sub-specialty of radiology. Increasingly, interventional radiologists are becoming more specialised, especially within the big urban centers, where neuro interventionalists are found alongside their vascular and cardiac colleagues, etc.

 

Cheers,

Kirsteen

[Guest cracked30]

I guess I hope that some people do become interested in neurosurgery.

 

It would suck to get an intercranial tumour and not have anyone around who would try to remove it.

 

That's the problem with the politicization of publicly funded medicine. It's just not on the public's radar screen and it gets marginalized.

 

We may slag on them for accepting a horrible lifestyle, but when we need them, we are glad for their dedication to their training.

[Guest satsumargirl]

Thanks Kirsteen,

 

I will look into interventional neuroradiology, it sounds interesting and I don't really know that much about it.

 

I know the obvious choice for me is neurology, especially since I am already published in this field. The thing is I am concerned that over time neurology may become depressing since so many neuro problems are progressive (e.g Parkinson's, most of the dementias) and while they can be managed they can't be cured. (but I have to admit that in my current work the 2 dementia units I work on are my favourite...I know most people would think I was crazy, but I can be having such a bad day and a conversation with one of the pts can just make me smile again). I guess the appeal to neurosurgery was that if someone had a tumour or some foreign object lodged in their brain, I could take it out and have some tangible result. Unfortunately, I know that I would not want to sacrifice my outside interests to work the hours it seems the neurosurgeons do.

 

Off to research interventional neuroradiology!

 

Thanks again

Sats

[Guest Ian Wong]

Neuroradiology is a fascinating subspecialty within Radiology. A decent lifestyle is well within possibility for practitioners of diagnostic neurorads (a 1-2 year fellowship following the 5 year Radiology residency). Lifestyle is infinitely better than the neurosurgeons, and probably better than most neurologists too, especially those neurologists that maintain hospital priviledges and therefore take call, admit, and see inpatients.

 

On the other hand, if you want interventional neurorads, that's usually 1-2 years more following a diagnostic neurorads fellowship (which followed the Radiology residency). Interventional radiology has a pretty crummy lifestyle, definitely worse than most neurologists, although not as bad as the neurosurgeons, who almost certainly are the most overworked residents and attendings in the hospital.

 

I'm doing a neurorads rotation right now. It's way cool. The images of the brain and spine that you obtain on modern MRI's and CT's are jaw-droppingly clear, and are only getting better with each year. In order to take advantage of this though, you need to know your neuroanatomy cold. Neuroanatomy is incredibly complicated, and usually the nemesis of most medical students. I think a lot of the people who head into the neurological specialties do so because of their interest in it, however.

 

Today, I saw or dictated out an MRI of what looks like a glioblastoma multiforme, a motorcycle accident which included an epidural hematoma, a second motorcycle accident with hemorrhagic brain contusions and shear injury along with a fracture of the occipital condyle (basically where your neck joins the bottom of the skull), an MRI of the lower spine with multiple herniated discs, an MRI of the upper spine with a herniated disc matching the patient's presenting symptom of a C6 radioculopathy, and a number of evolving strokes on MRI and CT.

 

Everytime we make a call (or don't make a call, for that matter), it can dramatically affect the treatment course of that patient by the clinical team. As the neuroradiologist, you get to see the most interesting and complicated cases managed not only by the neurosurgeons and neurologists, but also the cases coming from the ER or internal medicine teams who, based on your call, will then decide whether they need to get neurosurgery or neurology involved.

 

I realized it's a phenomenally long way away, but neuroradiology is a field heavily based in neuroanatomy and neuropathology. You will become the expert at diagnosing neurological diseases through imaging, which includes basically all sorts of brain tumours, every sort of brain trauma you can envision, and any sort of vascular lesion (before starting clot-busters for an acute stroke, it's invariably a radiologist who clears the head-CT first; neurovascular imaging through both invasive [eg. catheter angiograms] and non-invasive [eg CT angiograms or MR angiograms] are also radiology's domain). With the advent of PET scanning, a lot of the degenerative diseases like Alzheimer's may potentially be imaged in the future as well, and this will likely be an area dominated by neuroradiologists as well as radiologists with cross-training in nuclear medicine, a closely-related imaging field.

 

Not to get too high on myself, but both Neurology and Neurosurgery are incredibly reliant on imaging, and as a diagnostic neuroradiologist, you are positioned in a very important niche in helping those two specialties out. If you want to treat patients yourself, you can go on to do a neurointerventional radiology fellowship and do all sorts of endovascular procedures to treat patients.

 

Ian