Which fellowships are required vs optional to practice in the subspeciality?

[Guest]

Like you don't need a spine fellowship. But pediatrics is a hard requirement.

Is is possible to practice skull base, endovascular, neuro-onc, etc. without a fellowship?

[Guest]

there are enfolded INR, skull base, and onc fellowships at many programs. whether or not this gets you a job is market dependent.

[Guest]

The skull base job market is tough enough as it is, your prospects would only be worse without a fellowship. An enfolded one carries very little weight.

Neuro-onc you definitely don't need a fellowship. There aren't that many that exist anyway.

[Focus]

FWIW it depends. I can tell you that several major skull base programs' enfolded fellows have done very well establishing themselves without a post-grad fellowship. If your mentor vouches for you and is well known and has a history of churning out competent enfolded fellows you will be fine.

Ultimately, in the end despite people so what programs care about if you are good, make them money, and stay out of excessive trouble. Yes, a post-grad fellowship can help reassure programs that you fit those criteria but it isn't the only way to achieve that objective and lord knows a post-grad fellowship isn't a guarantee you aren't a dumpster fire surgeon.

[Guest]

You will not give privileges as a pedi neurosurgeon or for endo guy without the certificate. People do not care if it's enfolded for endo. Pedi has to be after graduation. Hard to call yourself a peripheral nerve neurosurgeon if you don't do one of the two fellowships (Mayo or WashU).

For skull base, the job market will be extremely tough regardless. Why make it worse by not doing a fellowship? It's one more person trying to find you a job. Tumor is less necessary. People I know think it helped when looking for jobs. They were sometimes more prepared when they got out. The people who are amazing after fellowship likely worked hard enough during residency that they were good after 7 years anyway. Enfolded tumor is meh. Functional is more of a grab bag - several fellowships are suspect already. Only a couple will help you get a job. You can probably do most of it by the end of 7 years, but I wouldn't let anyone who skipped fellowship do DBS or an open seizure focus resection on a family member.

Spine is whatever - you're doing the fellowship to get a final stamp, but if you train at a good program, you'll have 90+% of what you need for academic spine.

A sizable chunk of the people saying that fellowship is required did a fellowship. You're at an academic center surrounded by academic neurosurgeons who mostly did fellowships. Of course, they think you should do one. If you go into pp - no one will care once you have a reputation. If you go into academics - yes, we all judge each other based on where we did fellowship (petty but true). Most people will not be overly impressed by enfolded fellowships. Enfolded fellowships completely miss the point of going somewhere new. If you don't think that's valuable, then you don't think neurosurgery fellowships are worth the time.