Ruling Out Neurosurgery

I recently attended a dinner where I spoke with a neurosurgeon. Over the course of our meal I told him I am interested in ophthalmology, but as a second year medical student, I am not married to the first field that has piqued my interest in school. He challenged me to consider neurosurgery as a specialty, and proceeded to describe the variety of surgeries and technologies that make his career rewarding.

There seemed to be an all encompassing reverence for the brain throughout his appeal. He described the research and engineering potential of the brain to be on the verge of a scientific revolution. He cited big data analyses that are being championed by academic institutions, venture capitalist, and even Facebook. It seems to be at the forefront of people’s interests with backgrounds in medicine, technology, and business.

I have heard of many surgeons becoming disillusioned by their fields because they become specialized to the extent that they are performing the same few surgeries every day for decades. My conversation partner explained that he does around 12 different types of surgeries in his practice, while the average orthopedist performs around 4. He admitted that learning the procedures is not the hardest aspects of the job; as if once you surpass the learning curve, you are maintaining a skill that plateaus in difficulty. He said that the variety and interest even amongst those 12 routine procedures are more varied than any other surgical specialty. I’m willing to bet that as a neurosurgeon at an academic institution, there are plenty of complicated cases that provide sufficient challenge to avoid boredom.

I proposed several of my reasons for why I preferred ophthalmology to neurosurgery from my nascent stage of career development. He had counters for many of my points, which are paraphrased below.


Me: I like the idea of making blind people see. I was raised Catholic, and Jesus was a pretty decent influence.

Neurosurgeon: Most of the visual pathway is in the brain. The eye is certainly necessary for sight, but most of the phenomenon is in occurring within the brain.


Me: I want to affect more patients and have the largest impact as a surgeon.

Neurosurgeon: Sure as an ophthalmologist you may affect more patients, but probably not many more than a neurosurgeon. If you really want to have an expansive impact on society, go into public policy.


Me: I want to do research in biostatistics because I see all the big data that is being generated by novel technologies. There is infinitely more information than people who are able to make sense of it.

Neurosurgeon: Sure those are great skills, but you can get help from a biostatistician at the end of the day. Engineering and computer coding are the way to lean in research. These proficiencies are exceedingly rare in medicine. Figure out a way to apply engineering training as a physician researcher to truly set yourself apart from all the other applicants. They’ll all have equally as impressive or better test scores than you.


Neurosurgeon: As an ophthalmologist, your surgical domain is limited. The brain has so much more wonder to it, both in the lab and the operating room.

Me: You’re not wrong.


Neurosurgeon: No one can dismiss you as a neurosurgeon. At the end of the day the pulmonologist, the nephrologist, and the cardiologist’s care plans are all superseded by the neurosurgeon (in the case of a conflict). There’s rarely any point in keeping a brain-dead patient alive with pristine lung, kidney, and heart function. The neurosurgeon most commonly upends the care plans of ER docs. But it is best to be respectful and foster good relationships amongst colleagues as often as possible.


Neurosurgeon: No one can complain to you. You work 100-120 hours per week sometimes. Sometimes another specialist will tell you they can’t do something for your patient’s care because they need to sleep. As a neurosurgeon, you never have sympathy for those appeals, and everyone in the hospital knows it.


Neurosurgeon: In neurosurgery, there is a mentality that if there is a choice between what is easier and what is more difficult, the more difficult option is usually the correct choice. If you need MRIs before a surgery and radiology has not sent you the images, it is your responsibility to get the scans. You can’t let radiology stop you from caring for your patient. Along those lines, the 80 hour work limits are not feasible to successfully complete a neurosurgery residency program. You have to work over that regularly. And if any resident mentions anything about work hour limits, they are immediately perceived as weak. There are no formalities, but it is a cultural violation in neurosurgery to complain about hours logged.


Towards the end he went so far as to challenge the relevance of other surgical subspecialties in comparison to neurosurg. I find it amusing that physicians and surgeons from all fields need to question the validity of each other’s career choices, especially when high quality care takes an enormous team to deliver. It seems most doctors think their path is the most important. Egos are big in medicine. Go figure.

During the following days, I kept having the strange feeling that a small part of me may be possibly considering neurosurgery as a career. I wasn’t entirely convinced to shift gears towards becoming a brain surgeon, but I was inspired to spend a few hours researching the field instead of studying for boards.

At the end of my internet perusing, I was left with a reaffirmation of my initial sentiments: I do not want to live the unbalanced life of a neurosurgeon. It seems to me that if I were to become a neurosurgeon, I would be transformed into an incredibly high-tech piece of hospital equipment, which belongs in the hospital. And is to be rarely seen outside the hospital.

Neuroscience research does seem to be a possibility though. Time and time again I hear that the brain is the “final frontier” in medical research. And the technological integration of neurosurgery and neuroscientific research does have an undeniable sexiness to it, coming from an engineering background.


Interesting Links

Love, Life and Neurosurgery

Of the pieces I read, this was the most effective at conveying the existence of a neurosurgeon through the lens of a normal person. It seems if you ask a neurosurgeon what it’s like to be a neurosurgeon, they give you a very neurosurgeoney description that is full of technical information and innate fascination with the brain. Charlene Petitjean gives an insightful description of what it’s like to be married to a neurosurgeon.

AMA Neurosurgery Resident

Nothing like a firsthand account of neurosurgery from a fifth year resident.


Sources

Life, Love and Neurosurgery

IamA Neurosurgery Resident

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