Hey y’all, I’m a 3rd year Med student at a top 25 medical school currently torn between Ortho be Neuro. I have good stats, research and strong mentors and will probably match well in either specialty. I have completed rotations in both specialty. However, with application season coming up soon, I need to make a decision and comit within the next week?. I like basic neurosurgery ie subdural evacuation etc but the more complex things don’t interest me ie tumor. I feel like if I go into neurosurgery, I’ll end up in spine. With ortho, I don’t mind doing THAs and Placing femoral nail. The main reason I’m still considering ortho is because it’ll make a spine surgeon faster than neuro. Has anyone here faced a similar situation. If so why did you choose Neuro over Ortho
(04-02-2021, 09:21 PM)Guest Wrote: Hey y’all, I’m a 3rd year Med student at a top 25 medical school currently torn between Ortho be Neuro. I have good stats, research and strong mentors and will probably match well in either specialty. I have completed rotations in both specialty. However, with application season coming up soon, I need to make a decision and comit within the next week?. I like basic neurosurgery ie subdural evacuation etc but the more complex things don’t interest me ie tumor. I feel like if I go into neurosurgery, I’ll end up in spine. With ortho, I don’t mind doing THAs and Placing femoral nail. The main reason I’m still considering ortho is because it’ll make a spine surgeon faster than neuro. Has anyone here faced a similar situation. If so why did you choose Neuro over Ortho
Since your interests are balanced in both, I'd say go for ortho. 2 years shorter residency is a huge plus.
If all you want is to be a private practice guy pumping out ACDFs, PCDFs, lamis and TLIFS, and you're looking for lifestyle you go ortho. Residencies are larger so call is able to be split up more, the cases outside of spine are much shorter, the total time in residency is 2 years less, and the personalities are much more pleasant on average.
If you're talking spine training though neurosurgery is superior IMO. We spend 7 years with around 50% being spine, they spend 5 years with around 10-20% being spine + 1 year fellowship. My institution has a well respected ortho spine fellowship, i've done multiple joint cases with ortho spine fellows, i would say they're usually at the level of a mid-year PGY-3. In the long run it likely evens out, there's definitely excellent orthopedic spine surgeons out there, but there's a huge difference in the training.
Another consideration is ortho spine doesn't set you up for much intradural work, so if you're interested in spinal dAVF, IDEM, IDIM resections, really any intradural work those are usually left to neurosurgery. IMO those are the best cases, that was the difference for me.
I had the same dilemma you did and chose neurosurgery and I’ve been very glad I did, even when I was in the middle of PGY-2 year. If I were you I’d use your high stats and mentors to try and match at a program where you can enfold a spine fellowship PGY-7 year. That way your total training is only 1 year longer. The main difference is that if you like spine, you’ll be doing what you enjoy during most of your training (I’ve probably been doing 65-70% spine) and get a lot more autonomy early on (mid-way through PGY-3 year, most attendings stopped scrubbing with me for all decompressive bone work and scrubbed but just watched me do screws), which makes residency infinitely better. Like you, I also thought that joints and spine were cool, but I hated foot&ankle, hand, peds, random sports stuff, etc. that had short cases but was really boring. Yes, some of the ortho personalities were awesome to work with, but neurosurgery programs have a wide range of people and you’ll be able to target places with more chill, down to earth people. Overall, I knew I’d be much more satisfied with a complex spine practice (that included tumor work) with some cranial call than anything in ortho, for only 1 year more of training (that will likely be a research break in between anyway). The skillset is more valuable and the money is also better. Good luck in your decision! Both are awesome specialties.
I had a similar decision to make, and chose neurosurgery. Spine experience during ortho residency is minor, and most require a fellowship anyway, which brings the training experience to 6 years, as opposed to the 7 of neurosurgery (and neurosurgery doesn’t need a fellowship). But the real decisive factor for me was seeing how over saturated the ortho field is becoming. Salaries are going down, and jobs are getting scarce except in undesirable areas. Neurosurgery regulates its numbers well, and jobs are plentiful. Average neurosurgeon salaries are vastly higher than average ortho salaries (obviously changes with a strictly ortho spine practice)
Completely agreed with the above three posters. Recently matched to NSGY after having the same internal debate of ortho vs. NSGY spine. ACGME graduate statistics ( https://acgme.org/Data-Collection-System...Statistics) and this publication looking at the comparison (Daniels et al 2014 doi: 10.2106/JBJS.M.01562) both support the notion that you do more cases in NSGY residency (which makes sense given NSGY is 7yr vs 5yr for ortho). For the most recent year w/ available data, the comparison is 77 total adult spine procedures for ortho ( https://acgme.org/Portals/0/PDFs/260_Nat...8-2019.pdf) to 475 for NSGY with an average of 379 as lead. That means you'd need to doing an additional ~300 cases over the next two years. Easily feasible, but that is why ortho people generally have to do spine fellowship. Also, what isn't conveyed in these statistics is what you are doing during those cases. Ortho doesn't give a breakdown, so you could just be doing skin/incision for half of those 77 cases, whereas the fact that 379 NSGY cases are as "lead resident" means you are supposed to be involved in the critical portion of the case during those cases. Also, what isn't covered in the discussion of the fellowship is that: 1) you can get CAST accreditation in spine @ a lot of programs now (e.g., Rush, Hopkins, Miami, Pitt, Mayo) that will continue even with the new rules changes since they do PGY6 chief year, and 2) orthopaedic spine fellowships are widely variable in operative experience. Some have "heavy" clinical research components and "heavy" outpatient clinic components, so you may only be in the OR 3 of the 5 days of the week, which makes it tough to close the aforementioned 300 case gap. Lastly, at my institution the ortho guys don't close their own durotomies and don't do anything intradural. If they get into dura, then they immediately do a intraoperative neurosurgery consult. I recognize that may not be true everywhere, but I personally did not want to risk feeling that I could only do the procedure if everything went right.
Also, like the above said re: private practice/academics, it seems like a lot of ortho spine guys go private practice, and for the academic jobs, it seems that ortho dominance is more in NYC (columbia ortho + HSS + NYU langone) and LA (cedars sinai + USC), whereas NSGY is increasingly dominant elsewhere (e.g., Pitt, Duke, Mayo, Miami, Baylor, NW, Michigan, OSU, UW). You can be successful both roots, but it's definitely easier to be academically successful if you're working in a department that already has big names.
Keep in mind you're asking on a neurosurgery forum, there will obviously be some selection bias
Spine fellows at my institution told me they wished they had done ortho. Why bother with the extra effort on cranial and being crushed with call?
(04-03-2021, 11:52 AM)Guest Wrote: Spine fellows at my institution told me they wished they had done ortho. Why bother with the extra effort on cranial and being crushed with call?
From what I have heard, ortho trauma call is more brutal than neurosurgery call.
(04-03-2021, 11:52 AM)Guest Wrote: Spine fellows at my institution told me they wished they had done ortho. Why bother with the extra effort on cranial and being crushed with call?
I think it just depends on what you're interested in. Most of the spine attendings here genuinely enjoy general neurosurgery and taking neurosurgery call, even though their elective practice is all spine. While I ended up going into spine, I actually really liked taking out meningiomas and doing MVDs in residency. I would hate to put casts and splints on people on call. There's also huge variation in the types of neurosurgery/ortho programs. I rotated at Vanderbilt as a Sub-I when I was a student, and their ortho residents were getting destroyed, working every Saturday and taking 25-30 consults/night on call, with no postcall days.
Someone above made a really nuanced point that's impossible to know or appreciate as a med student or junior resident. There's a sizable advantage to being a neurosurgery-trained spine recruit in private practice, since a lot of places seeking level II trauma accreditation in the community can group cranial/spine call by taking you. The actual work isn't very tedious (bunch of calls about small IPHs, non-op subdurals, etc.) but you provide a ton of value for the hospital, even in desirable areas (- NYC, LA, etc. obviously). Ortho call is a dime a dozen, and can be done by any random sports guy.
|
