I think once you get into residency (or further into residency if you currently are) and see the careers of endo and functional it might make more sense why we don’t see endo+functional. Everything Drstrange said is true. If you want to try to make it a thing best of luck, lots of hurdles in the way that make it very complicated to do. I do not know of any personally. I believe the “time to stick” at stroke centers will make it nearly impossible. Plus, if you’re doing an awake DBS and you get called for a stroke, good luck explaining to the awake patient “brb don’t move” and walking out
There’s a solution here. Do endovascular and do research/tailor your career to endovascular neuro modulation (e.g, stentrode). Boom.
Why does functional plus spine work well together?
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Spine and functional work because both spine and functional are elective + normal amount of call. You're putting an elective style of practice with another elective focused practice. Then you add general neurosurgery call on top of that - which everyone has to do. There is a certain basket of skills that you need to successfully manage an elective practice and you get a lot of crossover by combining these things together.
Adding in stroke call (which again, will have to be done separately from your other call due to CSC requirements and what your hospital will almost certainly write into your contract) is a big burden on top. People have said do research - look at what the endo guys are doing. I am not sure how anyone thinks you'll be doing the level of research that is typically expected of the functional guy at most programs.
There is another important consideration - a lot of stage 1s are still done awake. Have fun telling your elective cranial patient why you weren't in the room for two hours while you were making your fifth pass on a thrombectomy. Patients absolutely notice this and a fraction of those will care. Since they're elective, they will tell their neurologist if there was an issue. Then that person questions referring patients to you. And while yes, the proportion of asleep DBS will continue to increase, most neurologists prefer awake for testing and SE profiling. That isn't going to change - the new generation is even more attached to it than the old from my experience.
I understand the knee-jerk "just because it hasn't been done before" but there are structural reasons for this. At the start of residency, you want to believe that you can do everything well. By the end, you will see that you need to pick the area where you excel and that you enjoy. In 2022 the field is advanced enough that you cannot be good at everything, especially if you want to care about academics at all.
What about peds + complex spine ? I came in loving spine but I just can't get enough of peds
(04-23-2022, 10:45 PM)Guest Wrote: What about peds + complex spine ? I came in loving spine but I just can't get enough of peds
There are a few pediatric neurosurgeons that specialize in spinal deformity and scoliosis. Mostly orthopedic peds do it but it's possible. There's also no shortage of complex tethered cords.
(04-24-2022, 05:00 AM)Guest Wrote: (04-23-2022, 10:45 PM)Guest Wrote: What about peds + complex spine ? I came in loving spine but I just can't get enough of peds
There are a few pediatric neurosurgeons that specialize in spinal deformity and scoliosis. Mostly orthopedic peds do it but it's possible. There's also no shortage of complex tethered cords.
If looking for peds scoli and really want neurosurg > Amir Samdani at Shriners in Philly is one of the bigger ones. But yeah, scoli surgery was born in ortho and for that reason they still dominate it
(04-24-2022, 06:36 AM)Guest Wrote: (04-24-2022, 05:00 AM)Guest Wrote: (04-23-2022, 10:45 PM)Guest Wrote: What about peds + complex spine ? I came in loving spine but I just can't get enough of peds
There are a few pediatric neurosurgeons that specialize in spinal deformity and scoliosis. Mostly orthopedic peds do it but it's possible. There's also no shortage of complex tethered cords.
If looking for peds scoli and really want neurosurg > Amir Samdani at Shriners in Philly is one of the bigger ones. But yeah, scoli surgery was born in ortho and for that reason they still dominate it
It doesn't necessary have to be scoli. I was thinking general peds (shunts, chiari, tumors, tethered cord, etc.) + complex spine (includes your bread and butter adult ACDF, lamis, TLIF, etc. as well as some complex cases here and there, both adult and kids).
This would be a best of both worlds for me but my mentors are telling me to choose between the adult or pediatric patient population and not to do both
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Yes you can do peds + general spine neurosurgery. Complex spine is, functionally, scoli surgery. Rare in academics (Vanderbilt, maybe one of the St. Jude's surgeons too) to be able to sync peds + adult scoli, but outside of the academic world there is definitely the opportunity to do so. Lots of smaller children's centers/hospitals where you might be able to supplement your peds practice with general neurosurgery.
(04-24-2022, 07:33 AM)Guest Wrote: (04-24-2022, 06:36 AM)Guest Wrote: (04-24-2022, 05:00 AM)Guest Wrote: (04-23-2022, 10:45 PM)Guest Wrote: What about peds + complex spine ? I came in loving spine but I just can't get enough of peds
There are a few pediatric neurosurgeons that specialize in spinal deformity and scoliosis. Mostly orthopedic peds do it but it's possible. There's also no shortage of complex tethered cords.
If looking for peds scoli and really want neurosurg > Amir Samdani at Shriners in Philly is one of the bigger ones. But yeah, scoli surgery was born in ortho and for that reason they still dominate it
It doesn't necessary have to be scoli. I was thinking general peds (shunts, chiari, tumors, tethered cord, etc.) + complex spine (includes your bread and butter adult ACDF, lamis, TLIF, etc. as well as some complex cases here and there, both adult and kids).
This would be a best of both worlds for me but my mentors are telling me to choose between the adult or pediatric patient population and not to do both
Complex spine is like skull base or peds brain tumors —> you shouldn’t do one every now and then. You should either do it and do it well, or only do general spine. If you do complex cases only a couple of times a year or even 1-2 cases a month, you’re not going to be great at them and the only thing you’ll ensure is a bad outcome for the patient. Community surgeons who dabble in this stuff are why you have people at academic surgeons with practices focused on revision. If you want to be a generalist that is totally ok and the field 100% still needs them, but only do general cases. Don’t be a generalist who masquerades as an expert and hurts people
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