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Non-Trad Becoming Competitive For Sub-Specialty Sx


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Hello all,

 

I am a medical student in Ontario (just finished first year) who has found an enormous passion for neurosurgery. I have spent many days in the OR (as many as an eager first year student can spend) shadowing different types of surgeons and have found a really strong connection with neurosurgery. I entered med school as a (very) non-trad student, and was always set on becoming a family physician. Over the course of the year, through both personal and professional experiences, I have done a great deal of realistic soul searching (with eyes wide open to lifestyle and career prospect challenges) and have decided that surgery - specifically neurosurgery - is something I would like to pursue as a career.

 

Partially full disclosure: I attend a 'newer' medical school in Ontario,  where opportunities for research, specifically in neurosurgery, are not as 'robust' shall we say, as they may be in other places.

 

Any perspectives on the following would be incredibly welcome:

1) how important is research in pursuing a neurosurgery residency?

2) does it all really come down to 4th year electives?

3) would spending a good deal of time in the OR in observerships during second year be helpful to these applications?

4) would writing STEP 1 be a good decision? 

 

Thank you!!

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I am not aware of neurosurgery per se and how important research may or may not be. Step 1 is not relevant. Observerships can be helpful if they result in a meaningful LOR, e.g., you also do electives with the same people. It comes down to electives, evaluations, LORs and lots of face time in my view.

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There are another 2 users on here that are very interest in NeuroSx. I wonder if they will see this, so that you can all share resources and commentary. There has been some conversation already about Step 1 on the forums, and the US options for NeuroSx, but there may be some licensing issues and cross practice ability etc...but that may just be something that warrants further research into technical details.

Definitely may be a good idea to take step 1, if you wanted to keep US residency options open - but like i said may be a caveat that, you could only practice in the US with the US neruosx residency etc. Not definitively known, something to research. 

If neuroSx is super competitive, and you would rather do that, but in the US, than do anything else in Canada (assuming you were unsuccesful in the Canadian match), then it is definitely a good idea to keep the USMLES in mind.

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1) Important enough I hear. NeuroSx isn't the most competitive specialty these days, but it's a research-heavy one. Particularly with the job market the way it is, significant research experience seems to border on being a necessity for eventual employment, even if it's not necessarily critical to landing a residency. I'd recommend getting some research experience, particularly if this is a path you're seriously considering, because research is likely to be a significant component of your career. If you find you really hate research in NeuroSx, it may not be as strong a fit as you believe it to be.

 

2) Not entirely, but that's the most important component, as it is with every specialty. You might be able to put yourself a little bit ahead (or behind) other candidates by what you do before your electives, but electives are the make-or-break time, rightly or wrongly.

 

3) Experience and connections never hurt. If your school doesn't have a NeuroSx program isn't not going to be quite ait s big of a benefit, but it's a reasonable use of time if you've got it free. Just spending the time there won't be the major gain though, on it's own it won't make much of a difference at all on your CV for example. It's more about developing your knowledge and familiarity (and maybe setting up a decent LOR).

 

4) Yes, do that.

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I think neurosurg in the US is more competitive than in Canada but they also have a better job market. Write step 2 during 4th yr med and step 3 during residency if you want to keep job options open.

There's also alot more NeuroSx spots in the US though.

 

About 210 spots with 256 US seniors applying(and a total of 354 applicants if you include IMG/FMGs), and 188 of the spots going to the US seniors. A Canadian MD with decent steps and research would probably be on comparable grounds with a US senior, minus the visa issue etc(which tend to be a non-issue for many places with $$). And there are definitely some "lesser" desirable programs that US seniors wouldn't rank as high etc, but would be happy to go to if rank list goes that low etc. 

 

If you're competitive for NeuroSx in Canada on the non-test attributes, probably a decent shot at US neuroSx with the appropriate clinical exposure and exam scores etc.  Definitely would help to cast that wider net. 

 

But again, going to want to look at the licensing and reciprocity of practice etc. 

 

Compare with Carms 2015:

 

22 applicants to NeuroSx, with only 12 solely applying to that discipline - for a total of 16 CMG spots, 2 going unfilled. 

 

Huge difference in sample sizes, with the Canadian pool of spots susceptible to more year-to-year variability of course, but overall it wouldn't be a big leap to assume similiar levels of competitiveness (or lack thereof). But also probably a lot of self-selection in these types of specialties, given the inherent lifestyle factors etc. 

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What I hear from people who matched to nsx and few nsx residents is that nsx itself in Canada is not that hard to match if you show interest with electives in 3rd and 4th year. Remember nsx is notoriously intense and they lose residents consistently, so it's a specialty where they'd rather unmatch than match someone who's half hearted. Rumor has it a PhD is pretty much required for academic nsx these days (is there even non-academic nsx?)

 

The US is a different story. You may want to check SDN instead.

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I think the drop out rate for Neurosurgery is one of the highest if not the highest of all residencies. Its one of the specialties where you typically need a PhD to find a job anywhere and it is pretty common residency for MD/PhD students to go into. 

 

 

With that being said research is pretty important, some students will work for profs at other schools during their summers if their own school has no neurosurg research. Also, keep in mind all research is good research, so it doesn't need to be ground breaking, as long as one neurosurgeon does some sort of research at your school that is good enough. 

 

You should probably write the Step 1 just in case, but I would not apply for neurosurg in the states, it is very competitive in the states because they earn the highest salary out of any specialty there and jobs are likely easier to come by. Your chances are much better in Canada. Also its very difficult to manage applying to residencies in two countries especially due to the fact that if Canada takes you, you are withdrawn from the US match automatically. 

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I hope you're willing to go to the states.  In Canada, a neurosurgery job generally requires a 6-year residency + at least 1 fellowship + 1 grad degree.  Talk to some surgeons to get a sense of the road ahead.   Will you still love it after the novelty wears off and you're 10 years postgrad without a job?

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  • 4 weeks later...

I hope you're willing to go to the states.  In Canada, a neurosurgery job generally requires a 6-year residency + at least 1 fellowship + 1 grad degree.  Talk to some surgeons to get a sense of the road ahead.   Will you still love it after the novelty wears off and you're 10 years postgrad without a job?

 

 

This is just an anecdotal experience, but the neurosurgeon I did research with did his residency and two fellowships in Canada, but got his graduate degree from an Ivy League university.  He wasn't a staff surgeon then and I don't believe he's one yet, but I heard he completed another fellowship.  Perhaps working on a fourth?  He's also a professor and graduate supervisor, but I'm not sure what role that plays.

 

If that's any reflection of the Canadian job market for staff neurosurgeons, that's pretty terrible. 

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  • 4 weeks later...

I'll give you my perspective as a current, intermediate-level neurosurgery resident, by addressing both your questions and other relevant topics.

 

1) how important is research in pursuing a neurosurgery residency?

- Canadian medical students applying for neurosurgery (and most surgical residencies) have a lot of anxiety when it comes to productivity in research. To be honest, the "amount" of research you've done accounts for little, nor is the subject matter important. It's my opinion that showing an interest in research is important, and this can be accomplished by finding a mentor and getting involved in a project, be it basic or clinical science. Demonstrating willingness to pursue and follow-through with a project is more important than number of abstracts/papers published, as different people are exposed to different opportunities. Do not fret that neurosurgery research is not available at your institution, find something else interesting and pursue that. Skills such as performing a literature review, statistics and writing are transferable. In previous years, we've interviewed candidates with as few as none and as high as almost 20 publications; this matters very little compared to how you come across during your elective and interview. The caveat to this statement is that research is very important for an academic job, and likely necessary to secure a job at most Canadian institutions. As such, those who are exposed earlier and have a greater familiarity will be more likely to publish. Most institutions are very supportive of projects during residency; however, the leg work will be up to you, and you have to balance this with the demands of your residency training.

 

2) does it all really come down to 4th year electives?

- To put it bluntly, yes. Even if you've worked with a single neurosurgeon since MS1, or gotten to know one or two residents, it's a panel decision made by every staff and (for most institutions) all the residents. Thus, the elective is important to have face-time with as many faculty and residents as possible. And really, it's very simple to be an elective student: show up on time, do the work that's asked of you, don't be an asshole. That's it. Major red flags that are all too common include arrogance and call-hogging. No one cares that you're doing 1-in-2 call, and it comes across as petty and try-hard. Your level of knowledge is not crucial, as we know you're here because you're interested and in the process of learning. You should know very basic concepts, such as accurately identifying gross brain regions on CT/MRI, or knowing the GCS score. Basic neurosurgical concepts include trauma and ICP management, which is a good set of core knowledge that will help you understand more during rounds and on-call. If I push you a bit more and ask what the branches of the external carotid are, or what the diagnostic criteria of NF1 are, I'd be impressed if you knew, but I don't care if you don't. However, if I ask you two days later and you still don't know, well, that's another issue.

 

3) would spending a good deal of time in the OR in observerships during second year be helpful to these applications?

- The only role of an observership is to help you make a decision whether or not the procedural work is interesting. In no way are these helpful for applications, because they don't represent the surgical lifestyle or day-to-day management. I've had MS1 and MS2s ask to shadow me on-call, and some MS3s during off-weekends. Often, this is more interesting to the student because they see a lot of scut, trauma, EVDs, etc. Again, the benefit is adding to your perspective of the specialty.  At worst, doing numerous observerships may be counter-productive. However, if doing an observership leads to a productive relationship with a surgeon, and perhaps a research project or letter of recommendation, then that is a useful endeavor.

 

4) would writing STEP 1 be a good decision? 

I would say writing all the USMLEs is essential, for different reasons. If you want to keep the doors open for residency in the USA, then you'll need a 240 minimum, likely higher. That will take time and effort, and is something you need to consider in the summer of MS1 or MS2. Otherwise, having all your USMLEs is essential for fellowship and employment opportunities in the USA. For these, you only need to pass (which still requires money, time and effort). There are certain ways in certain states to get around this requirement, but save yourself the headache and plan to write them.

 

Finally, I'll be blunt and say that you need to consider other career paths. Numerous MS1s become interested because of the procedures, but the reality is long hours, lots of call, incredibly poor patient outcomes, and poor work-life balance. As a non-traditional grad (which I'll take to mean a mature student), you'll spend 6-7 years in residency, 1-2 years in fellowship and perhaps 1-5 years obtaining an advanced degree for very poor job prospects in Canada. That's a long time for a lot of uncertainty. Jobs are more numerous in the USA, but you are no longer eligible to be board-certified (mostly removes private practice opportunities). There's an extraordinarily high drop-out rate across all years, relative to other programs. Finally, Canadian spots are in the process of being reduced due to the high supply and low demand. Quebec has been hit hardest, and other provinces will follow. Despite these warnings, Neurosurgery is having a boom year for applicants; the 2014 and 2015 numbers were a bit skewed, but this year, next year, and it looks like the year after as well were and will be quite competitive. 

 

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