bluedevilmike

This is a subjective answer, but a lot of folks would find brain surgery fairly boring. My dad (a cardiologist) likes the sense that he's working on something which is active and working. An orthopedic surgeon would probably miss the sawing and hammering. An ER doc would feel bored without the spontaneity of the event.

Litigators would miss the appeal of arguing before a jury; private equity investors would miss the necessity of "reading" the people around you; stock traders would miss the minute-by-minute changes. Professors would find that they didn't get to engage in lofty ideas, politicians would feel like they were only affecting one person at a time, and professional athletes would wonder what happened to the crowd.

There's a lot of folks out there who would think brain surgery is pretty boring.

Shrinkrap

Yeah. Some of us like actual relationships with our patients.

mhmm

does anyone know if you need (or should) have a neuroscience major in college to go the neurosurgeon route or can you do the whatever major to get into med school, and then decide to specialize?

PlusCrimeThink

I was wondering this also..

Bigredmed

Your college major doesn't matter to residency programs...although based on the way you phrased your question I'm not sure you fully grasp how one enters a specialty. If you do, I apologize for the following...

Med school is not where you specialize. Med schools is where you lay the basic foundation of science knowledge, clinical skills and general understanding to enter into any field. As a fourth year student, you'll select what field you'd like to enter and apply and interview at residency programs in that specialty. You do have some freedom as a 4th year in tailoring your rotations towards things you're interested in, but those don't count towards anything other than graduation. At graduation, you're officially a doctor (you have an MD or a DO degree conferred) but you're really only ready to begin your training.

To use myself as an example. I graduated on May 1st, have a diploma with my name on it, and could sign my name as Bigredmed M.D., I have a residency position in pediatrics beginning in July...but I'm not a pediatrician. If, at this point last year, I had decided to do anesthesia, I'd still be at the same spot I am now. My classmates are going into every thing from Neurosurgery to OB/GYN to Urology to Radiology. And while we've been exposed to a lot of different aspects of medicine (my neurosurg colleagues did a clerkship in pediatrics, I caught babies on OB/GYN, every one did 6 weeks of Psychiatry, etc), it's only in residency where we'll get the intensive training, experience and skill set to be a specialist in our chosen area. And for those of us, like myself, who wish to narrow our scope of practice even further, after our residencies are done, we'll enter fellowships. I want to do pediatric critical care and take care of really sick kids in the Pediatric ICU, one of my OB/GYN friends wants to do Reproductive Endocrinology and Infertility to help couples conceive, one of my Internal Medicine friends really hopes to go in Gastroenterology, a great friend who's going into radiology eventually wants to do interventional radiology, and we'll have to spend even more time in training to become those things.

asmallchild

Not an attitude that is welcomed in neurosurgery unfortunately

Princess'Dad

Hard to downen you first start out. But many are starting to work part time. But realize that you are not really "trained" when you finish your fellowship. The first couple of years are when you have the knife solely in your hand. The more experiance the better which means more hours

NSGYDoc

I am a neurosurgeon getting ready to start practicing on my own after residency and fellowship in 1 month.

I am astounded by the amount of uninformed information on this thread, even by those who clearly have knowledge of the world of medicine (the future pediatrician for instance)

So here is the scoop.

Is it really that difficult to become a neurosurgeon?

There are two parts to this question. First, what is the difficulty of matching into a neurosurgical residency (because you MUST do this in order to become a neurosurgeon)? Second, what is the difficulty of completing (surviving) a neurosurgery residency?

Timeline: (typical)

4 years of undergraduate education (college, take pre-med courses, MCAT)
4 years of medical school (generalized education, need high grades/USMLE/Research)
6-7 years of Neurosurgical Residency
1-2 years of Neurosurgery Fellowship (Optional)

Undergraduate: Just do whatever you would normally do to get accepted to medical school. Get good grades, good MCAT, extra curriculars, etc. Generally speaking it doesn't officially matter what medical school you end up attending... but realize that if you want to be a neurosurgeon you should go to a medical school that has a neurosurgical residency program. There are approximately 100 neurosurgical residency programs and approximately 150 medical schools.

Medical School: This is the important step. You need to perform minimum in the top 25% of your class (if you school does class rank and grades such as Honors, High Pass, etc), generally speaking neurosurgeons were in the top 10% of their med school classes and many were AOA elected. You should think of 235 as the average USMLE board score for students who match into neurosurgery. Remember for scores less than 235 you will likely need to balance the low board score with some other area of your application that makes you stand out (and it is VERY tough to stand out against other medical students trying to get into neurosurgery). You will want to do research and really need to work on getting some publications while a medical student. You need to excel on the neurosurgical rotation and get great lettors of recommendation. Eventually, you will need to apply to neurosurgical residencies, get offered interviews, attend the interviews, and then match into the residency program. Approximately 75%-85% of US senior medical students who complete the application process will match into neurosurgery. This may seem like a high match rate... but compared to other specialties like internal medicine and pediatrics it is actually a low matching rate. It is not the hardest residency to match into... there are others that are harder numerically like Derm. Remember however, there is a self selection process going on too... many medical students who might be interested in neurosurgery but don't think they are competitive for the match (poor board scores or grades etc) won't even apply. So you are competing for those positions with those who think they have a real shot at matching. Additionally, unlike IM or Peds which may have 5-12 positions at each residency training program where you will interview, neurosurgical residencies usually only have 1 or 2 positions available at each residency. If you go on 8 interviews for IM residency with 10 positions open at each interview site, you are effectively trying to match into one of 80 spots. If you are applying to neurosurgical residency and you go on 8 interview you will likely be interviewing for 1.5 positions per interview and will be effectively trying to match into one of 12 spots (compared to 80 spots for the IM residency, with identical # of interviews) All of this plays into the difficulty of matching.

Residency (surviving):

Most programs require 1 year of general surgery internship followed by 6 years of neurosurgical residency (of which 2 years is usually devoted to research or elective time). Some programs do 1 year of general surgery internship followed by 5 years of neurosurgical residency (total of 6 years instead of 7 years) but only require 1 year of research instead of 2. So in the end the amount of clinical training in neurosurgery (and the time spent in the OR) is identical between 6 and 7 year neurosurgical residency programs. About 80% are 7 years long and about 20% of programs are 6 years long.

Generally, you will work between 80-100 hours per week and for most neurosurgical residency programs are required to average 88 hours per week or less over a 4 week period.

You will typically carry a patient census that is much larger than your IM or Peds counterparts. Typical census lists for me when I was a junior residency in neurosurgery was 40-60 patients per day shared between 2 junior residents. That means you are responsible to round on 20-30 patients per day typically. Most IM residents are only responsible for 5-12 patients per day. Additionally, you will usually be in the operating room from 7:30 am until 6-8pm daily (M-F) and still need to find time when you are not in the operating room to see your patients, follow-up studies, write notes, etc

The tolerance for errors and mistakes is very low, because a small mistake can have large unsalvageable consequences when dealing with the brain and spinal cord.

It is a stressful, high risk, high reward specialty.

And there are rewards.... it is an extremely interesting and challenging specialty. You will have to work hard, probably harder than any other specialty during and after you residency (with a few exceptions) but then again the financial rewards are also good.

I will be starting at $600,000 per year guaranteed salary as an academic neurosurgeon without any pay-back obligations following my fellowship in one month.

NSGYDoc

btw, you are trained when you finish your fellowship. There is nothing I feel uncomfortable doing surgically. I will obviously improve with time and experience. But that is different than saying someone is not fully trained. I've spent 8 years training for neurosurgery after medical school. Of the common neurosurgical procedures I've done hundreds. Overall, I've done close to 3000 neurosurgical operations. I routinely do the entire surgery myself as a chief resident (previous to fellowship) and during fellowship with the attending neurosurgeon either not scrubbed at all, sitting on a chair across the room (who is watching the microscope video of my surgery) or who is scrubbed in assisting me (not me assisting him).

Shrinkrap

"I will be starting at $600,000 per year guaranteed salary as an academic neurosurgeon "

Wow! Do you have to may your own med mal? How much its it for a neurosurgeon?...Also, am I wrong abort the relationship thing??

J'adoube

NSGYDoc: Thanks for the excellent posts.

RileyJohn

NSGYDoc, you are amazing.

But yes, $600,000 a year? Wonderful. How much would someone in Internal Medicine be making after their residency?

asmallchild

Too general a question. It depends if the resident pursued fellowship training. It depends what area of medicine the physician practiced (outpatient clinic only? academics? hospitalist?). It depends on the location of the physician.

All those factors accounted for, I will acknowledge it's rare to find someone in pure internal medicine coming close to a neurosurgeon. (The caveat being it's generally easier to get into IM, easier to survive the IM residency, and will generally enjoy better hours as an IM attending. Yes, exceptions do exist to all the above)

bluedevilmike

If you just came straight through IM, it'd probably be, what, $150K? Maybe less at an academic center.

ND's $600K sounds high to me; maybe he's at a center that's exceptionally profitable or something. Not that $600K is outlandish for a neurosurgeon; it seems a little high to me but not ridiculousl.

What surprises me is that I had thought that most neurosurgeons take major pay cuts to be in academics; I would have expected him to make much less than half of that, especially as a starting salary.

This is definitely not my field of expertise, but you can color me very surprised.

NSGYDoc

My fellowship is in an area of neurosurgery that is currently highly sought after. There is a limited supply of people trained in what I do, and the average neurosurgeon isn't trained to do the types of cases I can do. That is why I can get more from an academic center than a neurosurgeon without that training. I'd say I'm at the upper end of what you can get as a starting salary at an academic center. The low end for someone with my specialized area of training at an academic center would be about $400k

$150k is about right for IM