Help me decide between Neurosurgery and Ortho

[NSxortho]

I am a 2nd year med student in Canada and have been having a difficult time deciding on specialties. I have shadowed a lot of specialties, but only ortho and neurosurgery were the ones that I felt drawn to. Here is my experience with the two specialties:

Ortho: In general, I find myself to be a great fit in the ortho community. I somewhat fit the stereotypical bro image too (athletic, Muay Thai trained, work hard, play hard kinda dude), and most of my classmates already assume I am going into ortho. I found arthroplasty to be really fun, and the surgeons were hilarious. I could see myself going to work just to spend time with these people, it felt like a family. However, I found plain hip, knee, and shoulder replacements to be somewhat simplistic and not as intellectually stimulating. It lacked the kind of complexity and challenge I am interested in. I shadowed hand surgery and found it to be too delicate and micro for me.
However, ortho spine was a different story. I found it to be so exciting - the tech was mind blowing, the surgery was complex, challenging, and still macro which I like. Seeing the spinal cord made me literally euphoric. I couldn’t take my eyes off of it. I realized at that moment that my love for the brain outweighs my interest in MSK. There was also more medical management involved in spine, which I actually appreciate!

Overall I can see myself going into ortho spine and living a happy life. My concern is that I would have to do 5 years of ortho training in arthroplasty, hand, and foot, etc. I don’t mind it. I get along with ortho people. It is also easier than a neurosurgery residency. I also haven’t seen ortho trauma, oncology, or pediatrics which might be interesting too!

Neurosurgery: I am fascinated by neurology. It was undoubtedly my favourite block in med school. I also did very well in it. I remember studying for exams with enthusiasm, and going off tangent to look stuff up on YouTube/Google for my own curiosity, or excitedly telling my friends over drinks about the neuro disorders I thought were mind blowing. I only shadowed neurosurgery once, so my exposure is limited. But I found the surgery to be so fascinating, complex, and tech heavy. Again, I found myself to mesh well with the surgeons. I have no problem standing/not eating for 8h. Honestly, I secretly like that it challenges your stamina and resilience (not trying to sound like a masochist here haha)

If work and life balance was not a factor, I would choose neurosurgery in a heartbeat. I am fascinated by the field, and get a rush every time I’m in the OR. Even the bread and butter laminectomies were exciting. I think there is no other organ as mysterious and fascinating as the brain. But at what cost? I also value my time away from work. I’m doing well in med school, but I also strongly value my time with friends and family, my Muay Thai training, and skiing. Ortho residency would be less brutal, and shorter than a neurosurgery residency. I also do not care for research, I do it because I have to, but I do not want to do a masters or PhD and spend 9-10 years of my life in residency. I’m a slightly older student - I will be 30 when I graduate med school. I don’t want to be 40 when I finally start making money and having control over my schedule.

Any advice is appreciated. Thank you

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[Chelsea FC]

Have you taken step or the Canadian equivalent as yet? That might help make the decision for you. Also check out PM&R, little bit of neurology little bit of MSK from ortho. You would prob have to tune down the bro attitude (honestly I view this as a negative trait, you can be into fitness etc without being a bro).

 

[Matthew9Thirtyfive]

I think there is no other organ as mysterious and fascinating as the brain.

The most mysterious organ is the uterus. What it does and where it goes when it wanders the female body every month is a complete mystery.

 

[ACSurgeon]

I am a 2nd year med student in Canada and have been having a difficult time deciding on specialties. I have shadowed a lot of specialties, but only ortho and neurosurgery were the ones that I felt drawn to. Here is my experience with the two specialties:

Ortho: In general, I find myself to be a great fit in the ortho community. I am the stereotypical bro (athletic, Muay Thai trained, work hard, play hard kinda dude), and most of my classmates already assume I am going into ortho. I found arthroplasty to be really fun, and the surgeons were hilarious. I could see myself going to work just to spend time with these people, it felt like a family. However, I found plain hip, knee, and shoulder replacements to be somewhat simplistic and not as intellectually stimulating. It lacked the kind of complexity and challenge I am interested in. I shadowed hand surgery and found it to be too delicate and micro for me.
However, ortho spine was a different story. I found it to be so exciting - the tech was mind blowing, the surgery was complex, challenging, and still macro which I like. Seeing the spinal cord made me literally euphoric. I couldn’t take my eyes off of it. I realized at that moment that my love for the brain outweighs my interest in MSK. There was also more medical management involved in spine, which I actually appreciate!

Overall I can see myself going into ortho spine and living a happy life. My concern is that I would have to do 5 years of ortho training in arthroplasty, hand, and foot, etc. I don’t mind it. I get along with ortho people. It is also easier than a neurosurgery residency. I also haven’t seen ortho trauma, oncology, or pediatrics which might be interesting too!

Neurosurgery: I am fascinated by neurology. It was undoubtedly my favourite block in med school. I also did very well in it. I remember studying for exams with enthusiasm, and going off tangent to look stuff up on YouTube/Google for my own curiosity, or excitedly telling my friends over drinks about the neuro disorders I thought were mind blowing. I only shadowed neurosurgery once, so my exposure is limited. But I found the surgery to be so fascinating, complex, and tech heavy. Again, I found myself to mesh well with the surgeons. I have no problem standing/not eating for 8h. Honestly, I secretly like that it challenges your stamina and resilience (not trying to sound like a masochist here haha)

If work and life balance was not a factor, I would choose neurosurgery in a heartbeat. I am fascinated by the field, and get a rush every time I’m in the OR. Even the bread and butter laminectomies were exciting. I think there is no other organ as mysterious and fascinating as the brain. But at what cost? I also value my time away from work. I’m doing well in med school, but I also strongly value my time with friends and family, my Muay Thai training, and skiing. Ortho residency would be less brutal, and shorter than a neurosurgery residency. I also do not care for research, I do it because I have to, but I do not want to do a masters or PhD and spend 9-10 years of my life in residency. I’m a slightly older student - I will be 30 when I graduate med school. I don’t want to be 40 when I finally start making money and having control over my schedule.

Any advice is appreciated. Thank you

If Ortho is five years fixing bones, neurosurgery is 7 years draining brain bleeds and picking at tumors… you’ll spend minimal time thinking about neurological pathways as a Neurosurgery resident and more time figuring out if someone needs a surgery and how to do that surgery….

Most Ortho patients do well post-op. Most brain surgery patients don’t. If showing up to the neuro ICU at 4 am to check on all the EVDs on patients with a GCS of 3-6t sounds appealing, have at it.

Your post seems like you really want to do Ortho.

Most importantly, don’t listen to me, talk to people in these specialties and spend time with them.

 

[ACSurgeon]

The most mysterious organ is the uterus. What it does and where it goes when it wanders the female body every month is a complete mystery.

The uterus stays in the pelvis until it’s ready to go in a bucket. There’s no mystery about where it goes…

 

[Matthew9Thirtyfive]

The uterus stays in the pelvis until it’s ready to go in a bucket. There’s no mystery about where it goes…

It was a medical history joke.

Wandering womb - Wikipedia

In the middle of the flanks of women lies the womb, a female viscus, closely resembling an animal; for it is moved of itself hither and thither in the flanks, also upwards in a direct line to below the cartilage of the thorax, and also obliquely to the right or to the left, either to the liver or the spleen, and it likewise is subject to prolapsus downwards, and in a word, it is altogether erratic. It delights also in fragrant smells, and advances towards them; and it has an aversion to fetid smells, and flees from them; and, on the whole, the womb is like an animal within an animal.

 

[NSxortho]

Have you taken step or the Canadian equivalent as yet? That might help make the decision for you. Also check out PM&R, little bit of neurology little bit of MSK from ortho. You would prob have to tune down the bro attitude (honestly I view this as a negative trait, you can be into fitness etc without being a bro).

Thank you for your response. I will be taking the Canadian equivalent some time in 3rd year but note that our score is irrelevant to residency competitiveness (just a pass is required). Matching is based on research, fit, and elective performance.

PM&R is an interesting specialty but I am sure that I want to do surgery - not medicine, or procedural specialties.

 

[Matthew9Thirtyfive]

Thank you for your response. I will be taking the Canadian equivalent some time in 3rd year but note that our score is irrelevant to residency competitiveness (just a pass is required). Matching is based on research, fit, and elective performance.

PM&R is an interesting specialty but I am sure that I want to do surgery - not medicine, or procedural specialties.

How competitive are spine fellowships in Canada? Because if you do an ortho residency and then can’t match a spine fellowship, you’re stuck doing ortho. You don’t need a fellowship to do spine as a neurosurgeon.

That said, I think what @ACSurgeon said is good advice.

 

[Chillbo Baggins]

It may be easier said than done, but you need to figure out what bread and butter stuff you'll be happy doing for the next 30 years. Obviously, I'm biased towards ortho and always advocate for it, especially given overall patient outcomes and relative work-life balance, but to each their own.

 

[mrbreakfast]

I am fascinated by neurology. It was undoubtedly my favourite block in med school. I also did very well in it. I remember studying for exams with enthusiasm, and going off tangent to look stuff up on YouTube/Google for my own curiosity, or excitedly telling my friends over drinks about the neuro disorders I thought were mind blowing.

So you like neurology. If you like the neurological pathways, cool neuro disorders, the neuro exam, etc, you should consider how much of that you'll actually do in neurosurgery (probably less than you think).

In my anecdotal experience people go into neurosurgery because they want to fix some of the sickest patients and do emergent procedures, at least while they're a resident.

 

[ACSurgeon]

So you like neurology. If you like the neurological pathways, cool neuro disorders, the neuro exam, etc, you should consider how much of that you'll actually do in neurosurgery (probably less than you think).

In my anecdotal experience people go into neurosurgery because they want to fix some of the sickest patients and do emergent procedures, at least while they're a resident.

The only neuro exam I’ve seen by neurosurgery is pinching the trauma patient’s chest until they bruise and yelling at them to open their eyes…

If the eyes open= no brain surgery needed
If the eyes don’t open= they’re too far gone for brain surgery to help them.

That’s the outside observer’s perspective anyways

 

[mrbreakfast]

The only neuro exam I’ve seen by neurosurgery is pinching the trauma patient’s chest until they bruise and yelling at them to open their eyes…

If the eyes open= no brain surgery needed
If the eyes don’t open= they’re too far gone for brain surgery to help them.

That’s the outside observer’s perspective anyways

Pretty accurate, at least in the trauma ICU. If you could quantify overall "neurology knowledge" as a score, there are plenty of neurosurgeons who would score around the average internist. If a neurosurgical patient has a neuro problem/change that isn't clearly surgery-related, it's a neurology consult. Not an insult to neurosurgeons, they have a vast wealth of surgical/anatomical knowledge and have more pressing things to worry about than lengthy exams and differentials. But you shouldn't do neurosurgery because you're interested in neurology, you should do it because you're interested in neurosurgery. The overlap between the fields isn't as tight as you might think.

 

[DarkHorizon]

Do what you’re interested in. I personally couldn’t do nsx. I’m Ortho so I am obviously biased. I also despise spine. Neurosurgeons by far have the most job security, and all of them really love what they do, from what I see. They all work harder than me and I am Ortho trauma, which tends to work harder than other orthos.

 

[MilesDavisTheDoctor]

Do what you’re interested in. I personally couldn’t do nsx. I’m Ortho so I am obviously biased. I also despise spine. Neurosurgeons by far have the most job security, and all of them really love what they do, from what I see. They all work harder than me and I am Ortho trauma, which tends to work harder than other orthos.

you say neurosurgeons have the most jobs security - is there some reason they have more job security than orthopedic surgeons?

 

[DarkHorizon]

you say neurosurgeons have the most jobs security - is there some reason they have more job security than orthopedic surgeons?

Yeah, there are less of them, and there’s a big need. Even in saturated urban areas. Most hospitals even in urban areas don’t have neurosurgery on call. They command the highest salaries by far. You won’t even see their compensation on usual salary surveys.

 

[Lawpy]

OP it sounds like ortho is best fit for you.

 

[curiousneuro]

The only neuro exam I’ve seen by neurosurgery is pinching the trauma patient’s chest until they bruise and yelling at them to open their eyes…

If the eyes open= no brain surgery needed
If the eyes don’t open= they’re too far gone for brain surgery to help them.

That’s the outside observer’s perspective anyways

Pretty accurate, at least in the trauma ICU. If you could quantify overall "neurology knowledge" as a score, there are plenty of neurosurgeons who would score around the average internist. If a neurosurgical patient has a neuro problem/change that isn't clearly surgery-related, it's a neurology consult. Not an insult to neurosurgeons, they have a vast wealth of surgical/anatomical knowledge and have more pressing things to worry about than lengthy exams and differentials. But you shouldn't do neurosurgery because you're interested in neurology, you should do it because you're interested in neurosurgery. The overlap between the fields isn't as tight as you might think.

As a neurologist (not a neurosurgeon), I can attest that this is most definitely the case. There really is very little neurology in daily neurosurgery practice at least from my experience; I would be consulted on anything that did not clearly fit a surgical issue.

 

[longhaul3]

Pretty accurate, at least in the trauma ICU. If you could quantify overall "neurology knowledge" as a score, there are plenty of neurosurgeons who would score around the average internist. If a neurosurgical patient has a neuro problem/change that isn't clearly surgery-related, it's a neurology consult. Not an insult to neurosurgeons, they have a vast wealth of surgical/anatomical knowledge and have more pressing things to worry about than lengthy exams and differentials. But you shouldn't do neurosurgery because you're interested in neurology, you should do it because you're interested in neurosurgery. The overlap between the fields isn't as tight as you might think.

There are some areas of neurology the details of which are not particularly relevant to neurosurgeons, like neuromuscular disorders, sleep, headache, etc. In those cases once we rule out neurosurgical pathology (for which we should not have been consulted in the first place) we recommend neurology consult. But to be a competent neurosurgeon you have to have a strong understanding of non-surgical neurologic problems. All of it comes up on our written and oral boards. To suggest that an internist has the same level of neurology knowledge as a neurosurgeon reflects a misunderstanding of neurosurgery. Neurosurgery residents are required to rotate with neurologists, but neurology residents do not rotate with neurosurgeons routinely. But, I completely agree with the overall point that neurosurgery is not surgery for people interested in neurology.

Sounds like OP should go into ortho - neurosurgery is not glamorous. The comment about ICU rounds and troubleshooting EVDs at 4am is spot on. Our patients tend to do poorly because they come in with real bad problems. The natural history of our pathology—gliomas, brain mets, aneurysms, TBI, spine trauma, spine tumors, spina bifida, degen spine, pain—is terrible across the board. Sometimes we make them less bad; sometimes we just keep them from getting worse - which IMO is often a fate worse than death.

Most of us love what we do though.

 

[MilesDavisTheDoctor]

There are some areas of neurology the details of which are not particularly relevant to neurosurgeons, like neuromuscular disorders, sleep, headache, etc. In those cases once we rule out neurosurgical pathology (for which we should not have been consulted in the first place) we recommend neurology consult. But to be a competent neurosurgeon you have to have a strong understanding of non-surgical neurologic problems. All of it comes up on our written and oral boards. To suggest that an internist has the same level of neurology knowledge as a neurosurgeon reflects a misunderstanding of neurosurgery. Neurosurgery residents are required to rotate with neurologists, but neurology residents do not rotate with neurosurgeons routinely. But, I completely agree with the overall point that neurosurgery is not surgery for people interested in neurology.

Sounds like OP should go into ortho - neurosurgery is not glamorous. The comment about ICU rounds and troubleshooting EVDs at 4am is spot on. Our patients tend to do poorly because they come in with real bad problems. The natural history of our pathology—gliomas, brain mets, aneurysms, TBI, spine trauma, spine tumors, spina bifida, degen spine, pain—is terrible across the board. Sometimes we make them less bad; sometimes we just keep them from getting worse - which IMO is often a fate worse than death.

Most of us love what we do though.

Do you ever wish you went into ortho or another surgical field? It sounds like from your comment that you think neurosurgery is pretty depressing.

 

[longhaul3]

Do you ever wish you went into ortho or another surgical field? It sounds like from your comment that you think neurosurgery is pretty depressing.

It can be depressing for sure. But we do what we can to help these patients who have terrible disease. Over time you realize that you didn't cause the patient's problem, and although a lot of what we do is swimming upstream, it can be very meaningful to patients and their families to help a father survive to walk his daughter down the aisle, help restore grandma's speech for her last few months, etc. Some well indicated spine surgeries in properly selected patients can be highly rewarding.

Neurosurgery and ortho are not very similar in the work we do. Much of our work is microsurgical, highly delicate, meticulous and sometimes tedious. Ortho in my experience is more rote, macroscopic, and mechanical. None of this is a value judgment but if you walk between two adjacent neuro and ortho ORs, you will see very different surgeries and skill sets.

I would not really be interested in ortho. I see my compadres (who I'm friendly with) reducing fractures in the shock room under portable XR and casting nonoperative fractures at 2am and don't find myself particularly interested in what they're doing. I read the op notes for our mutual polytrauma patients who have their pelvic ring repairs or IMNs or tib-fib fixations and it doesn't sound very exciting to me. If I weren't in neurosurgery I'd probably do radiology as imaging is the most important thing in our specialty outside of the OR and we become highly skilled in interpreting neuroimaging.

 

[NSxortho]

It may be easier said than done, but you need to figure out what bread and butter stuff you'll be happy doing for the next 30 years. Obviously, I'm biased towards ortho and always advocate for it, especially given overall patient outcomes and relative work-life balance, but to each their own.

What I do know is that I would get incredibly bored if I only did hip/knee/shoulder replacements for the rest of my life. I shadowed a hip guy, and saw his cases for the day (left hip, right hip, left hip, right knee, left knee, and on and on). I also didn't get that adrenaline rush in arthroplasty that I got in ortho spine, or neurosurgery. I find myself drawn to operations that keep the surgeon hyper focused and on their toes, knowing that there are profound consequences if the wrong decisions are made. I want some level of variety in my cases, and some level of adrenaline that keeps me on my toes. Perhaps, I would find ortho trauma and ortho oncology interesting as well.

So you like neurology. If you like the neurological pathways, cool neuro disorders, the neuro exam, etc, you should consider how much of that you'll actually do in neurosurgery (probably less than you think).

In my anecdotal experience people go into neurosurgery because they want to fix some of the sickest patients and do emergent procedures, at least while they're a resident.

My main priority is doing surgery. However, the content is also important to me. I find neuro more interesting than MSK. But I did like some of the MSK block, especially trauma content (avascular necrosis, nonaccidental pediatric traumas).

I understand that neuro is infamous for the poor outcomes, but aren't patients still grateful if you have given them a few more months to live? Or some improvement in their prognosis? Or is it more rare to find gratitude in neurosurgery?

 

[mrbreakfast]

I understand that neuro is infamous for the poor outcomes, but aren't patients still grateful if you have given them a few more months to live? Or some improvement in their prognosis? Or is it more rare to find gratitude in neurosurgery?

"Neuro = poor outcome" is a common misconception. The overwhelming majority of patients with neurological problems can be effectively treated, and the overwhelming majority of inpatients I see for a neuro consult will get better (from a neuro perspective, anyway). Viewing neurological diseases as having a grim prognosis is as over-simplistic a view as saying cardiology problems, for example, have a grim prognosis ("you have coronary atherosclerosis, so you'll eventually have a heart attack and die; you have heart failure, so your heart will eventually stop pumping and you'll die). Every medical student learns about the most horrific neurological diseases (HD, CJD, ALS) but those are a tiny percentage of what we see.

To try to include topics with neurosurgical overlap, you can diagnose painful, debilitating nerve compressions and fix them. You can treat or fix trigeminal neuralgia, a condition so painful that treating it is generally considered life-saving. Neurosurgeons can work with neurologists to implant deep brain stimulators, giving someone who can't use their limbs potentially decades of good life, or cure otherwise untreatable seizures with epilepsy surgery. Endovascular treatment of strokes can (sometimes) treat life-threatening large strokes, sometimes with no residual deficits. You can place drains or surgically clip/coil aneurysms to prevent or treat otherwise life-threatening intracranial bleeds. Etc.

The neuro-ICU can be a dark place. You see some of the most critically ill patients in the hospital. A lot of them will die. But with your skill and knowledge, you can take some people who will otherwise definitely die and watch them walk out of the hospital. I think a lot of people find that rewarding.

I think you should do more rotations in both to decide what you want to do. I think most neurosurgeons I know knew they wanted to neurosurgery from day 1; ortho is a popular preclinical choice, but many people switch to other surgical subspecialties (e.g. urology) or consider other things.

 

[Radetzky]

What I do know is that I would get incredibly bored if I only did hip/knee/shoulder replacements for the rest of my life. I shadowed a hip guy, and saw his cases for the day (left hip, right hip, left hip, right knee, left knee, and on and on). I also didn't get that adrenaline rush in arthroplasty that I got in ortho spine, or neurosurgery. I find myself drawn to operations that keep the surgeon hyper focused and on their toes, knowing that there are profound consequences if the wrong decisions are made. I want some level of variety in my cases, and some level of adrenaline that keeps me on my toes.

Adrenaline rushes don’t sustain a career. What is an adrenaline rush now will become routine very quickly. Long term you will have to find a different form of satisfaction to sustain you.

 

[Skullcutter69]

A lot of the posters above clearly have a limited understanding of neurosurgery. Trauma surgeons are only going to see the disasters that come in on call who they share with the catching service. Saying that neurosurgery is all neuro ICU/EVD management is like saying all of ortho is ortho trauma. What are the people who aren’t on call (95% of the residency/attendings) doing?

This past week, I did 9 cases: 2 retrosigs for acoustic neuroma, 1 microvascular decompression for trigeminal neuralgia, a temporal lobectomy for epilepsy, 1 carotid endarterectomy, 1 crani for a parafalcine meningioma, an endoscopic transfrontal colloid cyst resection, a C2-T2, and a 2 level ACDF. All of my patients went home and I never saw a patient with a drain. Neurosurgery has incredible variety. As a junior resident, you'll definitely get your fair share of call/trauma admits (just like you'll be on OTS as an ortho junior). You'll also have a ton of time on functional, spine, elective vascular, tumor, peds, etc. If you love spine, neurosurgery makes sense in a lot of ways, since at many programs, 70% or more of your cases might be spine.

 

[Chillbo Baggins]

What I do know is that I would get incredibly bored if I only did hip/knee/shoulder replacements for the rest of my life. I shadowed a hip guy, and saw his cases for the day (left hip, right hip, left hip, right knee, left knee, and on and on). I also didn't get that adrenaline rush in arthroplasty that I got in ortho spine, or neurosurgery. I find myself drawn to operations that keep the surgeon hyper focused and on their toes, knowing that there are profound consequences if the wrong decisions are made. I want some level of variety in my cases, and some level of adrenaline that keeps me on my toes. Perhaps, I would find ortho trauma and ortho oncology interesting as well.

That is a fair criticism of joints, it can become very rote. But if you do joints, you can spice it up with revisions if that's your thing. Personally, spine was pretty mundane: TLIFs and ACDFs all feel the same to me and I would hate doing it for a career. In my opinion, trauma offers, in general, more variety than a lot of the ortho subspecialties. You operate on every extremity and the pelvis.

Adrenaline is typically something people look to *avoid* as they continue on in their career. The best cases are the ones that are boring and went exactly how you planned pre-op.

 

[DarkHorizon]

What I do know is that I would get incredibly bored if I only did hip/knee/shoulder replacements for the rest of my life. I shadowed a hip guy, and saw his cases for the day (left hip, right hip, left hip, right knee, left knee, and on and on). I also didn't get that adrenaline rush in arthroplasty that I got in ortho spine, or neurosurgery. I find myself drawn to operations that keep the surgeon hyper focused and on their toes, knowing that there are profound consequences if the wrong decisions are made. I want some level of variety in my cases, and some level of adrenaline that keeps me on my toes. Perhaps, I would find ortho trauma and ortho oncology interesting as well.



My main priority is doing surgery. However, the content is also important to me. I find neuro more interesting than MSK. But I did like some of the MSK block, especially trauma content (avascular necrosis, nonaccidental pediatric traumas).

I understand that neuro is infamous for the poor outcomes, but aren't patients still grateful if you have given them a few more months to live? Or some improvement in their prognosis? Or is it more rare to find gratitude in neurosurgery?

Yeah, I do Ortho trauma, and I enjoy the randomness of cases as well as the variety, but adrenaline riddled situations are not something I look forward to anymore. It was cool as a junior resident, but now I like to be in control and precise. Trauma is not for everyone because every fracture is different and you have to be creative, but after while, it’s no longer truly adrenaline inducing. My last adrenaline fuelled case was a guy who had a open midshaft femur fracture with laceration of femoral artery that came in with a tourniquet on. Nearly died. And Sure, we took care of him, but a case like that takes emotional toll and causes moral injury.

Anyway, from what you say, you should do neurosurgery.

 

[Dunkthetall]

So I hear that surgery programs can be pretty different, but on average, do neurosurgeons residents work longer hours than other surgery residents?
As a surgery resident are you going to be in the hospital may 4AM regardless so might as well pick what type of case you want to be there for?

 

[ACSurgeon]

So I hear that surgery programs can be pretty different, but on average, do neurosurgeons residents work longer hours than other surgery residents?
As a surgery resident are you going to be in the hospital may 4AM regardless so might as well pick what type of case you want to be there for?

Neuro has an ACGME exception to the 80 hour work week and there limit is 88. At least when I was in residency that’s what it was…

 

[NSxortho]

Neuro has an ACGME exception to the 80 hour work week and there limit is 88. At least when I was in residency that’s what it was…

I mean, if it’s just 8 hours extra that isn’t the end of the world. But I’m assuming 88 really means 100 for neurosurgery

 

[Matthew9Thirtyfive]

I mean, if it’s just 8 hours extra that isn’t the end of the world. But I’m assuming 88 really means 100 for neurosurgery

Trust me. 8 extra hours is a lot. 88 versus 80 is enough.

 

[ortnakas]

Which will satisfy you on the not-adrenaline filled days?

 

[IMG69]

Everyone has already answered it but as an M4 who's going into Neurosurgery here's my 2c, one of the last things on earth that interests me is ortho and my ortho attending was trying to get me into it. The only other thing that interests me is Radiology and potentially crit care. Neurology is also something i'd never even consider going into. There seems to be some very common themes/interests amongst Neurosurgeons at least all the ones i've rotated with.

Wait till your 3rd and 4th year so you get to experience what the specialties are actually like.

 

[NSxortho]

Everyone has already answered it but as an M4 who's going into Neurosurgery here's my 2c, one of the last things on earth that interests me is ortho and my ortho attending was trying to get me into it. The only other thing that interests me is Radiology and potentially crit care. Neurology is also something i'd never even consider going into. There seems to be some very common themes/interests amongst Neurosurgeons at least all the ones i've rotated with.

Wait till your 3rd and 4th year so you get to experience what the specialties are actually like.

I've come to realize that this is the best advice. I'm going to focus on research and being a good med student in general instead of pressuring myself into picking a specialty in 2nd year. I'll continue shadowing and hopefully figure it all out in 3rd year.

I'll keep this thread updated if anyone happens to care about my decision making process between ortho vs neuro (or even a different specialty).

 

[ortnakas]

I've come to realize that this is the best advice. I'm going to focus on research and being a good med student in general instead of pressuring myself into picking a specialty in 2nd year. I'll continue shadowing and hopefully figure it all out in 3rd year.

I'll keep this thread updated if anyone happens to care about my decision making process between ortho vs neuro (or even a different specialty).

The best advice I got and can pass on is:
Pick the specialty whose boring you like the most. If you pick for the zebras but don’t like the bread and butter, you won’t be happy overall.

 

[fleetfox]

If you are fairly set on Spine, figure out what you'd dislike more: knee scopes, arthroplasty, fracture reductions in the ED, vs rounding on sick patients in the neuro icu, cranial cases, head bleed consults in the ED, etc.

Outside of spine, where there is 95% overlap between neuro and ortho, they are radically different specialties.

I'm ortho spine. I love what I do but mostly liked the other stuff in ortho to some extent. Except hand. Hand sucks. Point being - I think it would be hard to go through either residency if the ONLY thing you like is spine. You don't have to love joints, scopes or ortho trauma but if you think you could find it at least somewhat interesting - I would do ortho since it's a shorter and generally easier residency than neurosurg. But it's not an EASY residency and if you think you'd prefer to be a "real doctor", rounding and operating on very sick patients, you'll have a more rewarding 7 yrs doing neurosurg than the 5 you'd spend in ortho.

 

[NSxortho]

Everyone has already answered it but as an M4 who's going into Neurosurgery here's my 2c, one of the last things on earth that interests me is ortho and my ortho attending was trying to get me into it. The only other thing that interests me is Radiology and potentially crit care. Neurology is also something i'd never even consider going into. There seems to be some very common themes/interests amongst Neurosurgeons at least all the ones i've rotated with.

Wait till your 3rd and 4th year so you get to experience what the specialties are actually like.

May you explain why you never had any interest in ortho?

And what are the very common themes/interests that you see among neurosurgeons?

 

[NSxortho]

The best advice I got and can pass on is:
Pick the specialty whose boring you like the most. If you pick for the zebras but don’t like the bread and butter, you won’t be happy overall.

If you are fairly set on Spine, figure out what you'd dislike more: knee scopes, arthroplasty, fracture reductions in the ED, vs rounding on sick patients in the neuro icu, cranial cases, head bleed consults in the ED, etc.

Outside of spine, where there is 95% overlap between neuro and ortho, they are radically different specialties.

I'm ortho spine. I love what I do but mostly liked the other stuff in ortho to some extent. Except hand. Hand sucks. Point being - I think it would be hard to go through either residency if the ONLY thing you like is spine. You don't have to love joints, scopes or ortho trauma but if you think you could find it at least somewhat interesting - I would do ortho since it's a shorter and generally easier residency than neurosurg. But it's not an EASY residency and if you think you'd prefer to be a "real doctor", rounding and operating on very sick patients, you'll have a more rewarding 7 yrs doing neurosurg than the 5 you'd spend in ortho.

I don't *mind* the bread and butter of ortho. Yesterday, I did arthroplasty clinic and really liked how healthy and grateful the patients were. Even when I did hand, I appreciated the immediate outcomes. Seeing the trigger finger patients so happy to extend their fingers right after leaving the OR was pretty awesome. I can see the ortho patient population giving me fulfillment, even with the bread and butter. However, I still found spinal/cranial surgery just outright fascinating and out of this world. I still can't stop thinking about the spine case I saw (just a laminectomy + TLIF, so not a zebra case).

I haven't seen neurosurgery clinic yet, so I think that will really help shape my opinion. I'm scheduling full clinic and and call days with a neurosurgeon, so hopefully that'll help. I'll update.

 

[Skullcutter69]

May you explain why you never had any interest in ortho?

And what are the very common themes/interests that you see among neurosurgeons?

Not the original poster, but I was definitely torn between ortho and neurosurgery as a med student. Just like you, I really enjoyed the camaraderie, overall fun/supportive culture, and variety in ortho. As I explored both and looked more critically, I realized that I liked the content of neurosurgery so much more. I loved spine in both, but quite honestly found hand, peds, sports, and foot/ankle to be really boring. When studying for my Sub-Is, I liked reading about fluorescence-guided brain tumor surgery a lot more than memorizing the Salter Harris classification.

Fortunately, as I got further along in med school and got to do away rotations/interviews, I was incredibly relieved to find out that there was a huge range of programs. Some neurosurgery programs had a fun/broey/ortho esque culture and great lifestyle, while others had mean people and worked you to death (same with ortho). I realized that you actually have control over the types of people you work with, program setup (white collar/blue collar/call schedule), and location. What you couldn't control was the content (what you're operating on, studying, etc. on a day to day basis).

To that end, I have zero regrets. I was lucky to train at an amazing program with a totally reasonable call schedule. I got to enfold a spine fellowship (many neurosurgery programs will allow you to move your chief year to PGY-6 so that you can do a post-chief fellowship and graduate without losing an extra year). I'm lucky to have an amazing job next year, in a desirable metro with Q8 call as an attending. If you love complex spine and are interested in cool cases on the side, you can develop a niche and/or take cranial call (in private practice, the 2 are often combined and highly sought after).

Best of luck with your decision.

 

[IMG69]

May you explain why you never had any interest in ortho?

And what are the very common themes/interests that you see among neurosurgeons?

Well to keep it simple, i'm the stereotype for ortho 100% (gym, sports etc) so M1 and early on I wanted to do it before i'd ever actually had any Ortho experience or any clinical experience at all tbh. Ortho is just a bit boring in my opinion, the cases aren't interesting, you have to focus on one joint for the rest of your life. Don't get me wrong they are some of the nicest docs i've ever worked with but even I can see how bored they are. Sure there's camaraderie etc but the case to case work seems rather mundane in my opinion.

I did my rotation with one of the most established Neurosurgeons in Europe and it's just so hard to explain, the best example I can give is like Marco Pierre White on Masterchef (you can youtube him if you're interested) to be honest, that's probably the best possible way to describe what this particular one was like. Marco's quote about making Gordon Ramsey cry seems to sum up all the Neurosurgeons that i've worked with 'I didn't make Gordon cry, it was his choice to cry'. All the others i've worked with have been less intense versions of this essentially and i've felt much less embarrassed when I don't know something. Everything is beneath them but everything they do is easy.

In regards to their interests the ones i've worked with have all been the typical older 'gentleman' type, cardigan, wine, classical music etc. Unfortunately I haven't worked with any residents or younger Neurosurgeons.

This is just my experience so N=1, of course you can't just give blanket statements about a group of people but there were just certain personality traits that were recurring which may be a by-product of getting through the intense training. Neurosurgeons have been the specialty with the most homogeneity in my experience. The reality is you'll make your own decision on what you like and want to do because each surgeon could be different, each training program could be different. Pick whatever specialty makes you happiest.

 

[sylvanthus]

Whats your bench press + usmle score?

 

[NSxortho]

Just wanted to update after finishing MS2.
I shadowed lots of neurosurgery the past couple of months. I think I still find the specialty fascinating, the surgeries are complex, delicate, and challenging. My absolute favourite was watching a GBM resection while the lights are dimmed, with classical music in the background, and the staff and his fellow just work in tandem without speaking to resect the tumour.

Clinic on the other hand was no fun. There were some grateful, happy patients. But the majority were either very sick, aggressive, or depressed. Some patients with severe deficits that you can’t do anything about. The worst was seeing patients whose outcomes were worse post-up. I don’t know if I can handle this type of work for the rest of my life.
I also found the environment very very intense and serious. The docs are all quite intense, rarely make jokes or smile. Quite the opposite vibe I got from ortho.

I’m no longer sure about neuro. I can’t rule it out yet because I enjoyed my experience overall. But I would say I had a more fun time in ortho. I think I can see myself doing ortho if I can put up with my lack of interest in MSK.

Alternatively I’m looking into radiology because after doing 4 days of doing neuro and ortho OR, I realized standing all day might not be my vibe LOL

 

[Dr. Anonymouss]

Just wanted to update after finishing MS2.
I shadowed lots of neurosurgery the past couple of months. I think I still find the specialty fascinating, the surgeries are complex, delicate, and challenging. My absolute favourite was watching a GBM resection while the lights are dimmed, with classical music in the background, and the staff and his fellow just work in tandem without speaking to resect the tumour.

Clinic on the other hand was no fun. There were some grateful, happy patients. But the majority were either very sick, aggressive, or depressed. Some patients with severe deficits that you can’t do anything about. The worst was seeing patients whose outcomes were worse post-up. I don’t know if I can handle this type of work for the rest of my life.
I also found the environment very very intense and serious. The docs are all quite intense, rarely make jokes or smile. Quite the opposite vibe I got from ortho.

I’m no longer sure about neuro. I can’t rule it out yet because I enjoyed my experience overall. But I would say I had a more fun time in ortho. I think I can see myself doing ortho if I can put up with my lack of interest in MSK.

Alternatively I’m looking into radiology because after doing 4 days of doing neuro and ortho OR, I realized standing all day might not be my vibe LOL

lol and the switch to radiology has begun

 

[deleted1132405]

Which specialty is more physically taxing, as in requires more strength to do the surgeries? I'm in the same boat. Love the brain and adult reconstruction.

 

[Gilakend]

I think I can see myself doing ortho if I can put up with my lack of interest in MSK.

I realized standing all day might not be my vibe LOL

I don't know if I've ever seen 2 more surefire signs not to do ortho. The best ortho surgeons I saw were the ones who truly mastered the anatomy and physiology of the MSK system and also had at least a someone deep understanding of biomechanics. This seems like it would be horrible to try and accomplish if you aren't in love with ortho/MSK. Additionally, ortho is probably the most physically demanding specialty in all of medicine. As someone at the end of their med school journey, I'll give you a quick synopsis of my specialty decision, and maybe it will help you.

I think ortho is a great field, it's the only surgical field I would consider and I was full bore ortho from essentially undergrad-M3/M4. I have a very similar background and personality to you. But while I loved some aspects of the specialty (most of the people, most of the personalities, the hardware), I realized I only liked ortho overall. It was considerably more meticulous than what many think and much less of the "human carpentry" I thought it was. Which as someone who would more than likely have gone to a trade school if I didn't go to med school, was a huge drawback.

I liked ortho and I think I could be happy in it, but it wasn't the "bone broke, me fix" specialty I had built up in my mind. I realized it was a better option for me to go into a specialty I like at least as much (probably more, but honestly it is hard to say as a med student) and give myself considerably more time outside the hospital to be with family, workout, train, and do the things I enjoy that I thought ortho would give me at work (wrenching on stuff, building things, etc.).

I guess the whole point is, don't be afraid to explore other options, especially so early on in med school (it's great you are already realizing you might also enjoy rads). I had a completed ortho application and it has been a little bit of a hassle to change everything at the end of med school. If I was a little more open-minded as I went along things probably would have been a lot smoother.

 

[deleted1132405]

I don't know if I've ever seen 2 more surefire signs not to do ortho. The best ortho surgeons I saw were the ones who truly mastered the anatomy and physiology of the MSK system and also had at least a someone deep understanding of biomechanics. This seems like it would be horrible to try and accomplish if you aren't in love with ortho/MSK. Additionally, ortho is probably the most physically demanding specialty in all of medicine. As someone at the end of their med school journey, I'll give you a quick synopsis of my specialty decision, and maybe it will help you.

I think ortho is a great field, it's the only surgical field I would consider and I was full bore ortho from essentially undergrad-M3/M4. I have a very similar background and personality to you. But while I loved some aspects of the specialty (most of the people, most of the personalities, the hardware), I realized I only liked ortho overall. It was considerably more meticulous than what many think and much less of the "human carpentry" I thought it was. Which as someone who would more than likely have gone to a trade school if I didn't go to med school, was a huge drawback.

I liked ortho and I think I could be happy in it, but it wasn't the "bone broke, me fix" specialty I had built up in my mind. I realized it was a better option for me to go into a specialty I like at least as much (probably more, but honestly it is hard to say as a med student) and give myself considerably more time outside the hospital to be with family, workout, train, and do the things I enjoy that I thought ortho would give me at work (wrenching on stuff, building things, etc.).

I guess the whole point is, don't be afraid to explore other options, especially so early on in med school (it's great you are already realizing you might also enjoy rads). I had a completed ortho application and it has been a little bit of a hassle to change everything at the end of med school. If I was a little more open-minded as I went along things probably would have been a lot smoother.

What specialty did you choose? Would you say the OP has any surefire signs to not do nsgy?

 

[Gilakend]

What specialty did you choose? Would you say the OP has any surefire signs to not do nsgy?

Obviously they can choose to do whatever they please. I’m sure some people who ended up becoming orthopedic surgeons had similar concerns and are happy with their choice. I’m just reiterating much of the advice I got which was you really need to love it.

I ended up choosing anesthesia.

 

[longhaul3]

Which specialty is more physically taxing, as in requires more strength to do the surgeries? I'm in the same boat. Love the brain and adult reconstruction.

Ortho requires greater strength in terms of applying force to instruments, bones, etc.

Neurosurgery requires greater stamina—10-12+ hour surgeries happen daily and require constant focus under the microscope, often standing. I am biased but I will say it is very physically taxing.

 

[longhaul3]

Standing whole day is not bad as long as you are the one doing something. Shadowing someone else doing the operation might make you feel tired since you are just observing on the side. But if you are the one operating, “standing whole day” will be the least of your concern trust me.

I don’t operate on people but my job requires me to do 10 hour shifts while standing with only half an hour of lunch break, but it has never bothered me or any of my colleagues because our mind is occupied by work.

Operating on people is a different ballgame, especially when it's the brain. It is taxing. Trust me.

 

[deleted1132405]

Does anyone have any insight on matching nsgy in the US? Does it help to get affiliated with a nsgy program/publish? Or can you match at places you've never worked with/never did a Sub-I there/no affiliations with them?

 

[Dr. Anonymouss]

Obviously they can choose to do whatever they please. I’m sure some people who ended up becoming orthopedic surgeons had similar concerns and are happy with their choice. I’m just reiterating much of the advice I got which was you really need to love it.

I ended up choosing anesthesia.

I am between orthopedics and anesthesia 50/50. It sounds like we have very similar mindsets, so it will be interesting to see if I decide to pull the trigger on anesthesia.