Tumor vs Functional

[dusk till dawn]

Currently interested in both tumor and functional... which one has more potential in the future? What are you guys' thoughts?

[Guest]

As a junior tumor attending, this is the wrong question to ask IMHO. The population is aging which increases incidence of both functional d/o and tumors. The number of functional procedures is expanding as are the indications. While the number of "tumor surgeons" is probably growing faster than the number of brain tumors being diagnosed, many patients are becoming wiser and going to those specialists for care. A huge number of my fellow tumor fellowship grads are going into private/employed/privademic practice and general neurosurgeons aren't going to be able to make the case that they should be doing tumors. Same goes for functional, a huge number of private places are looking to build programs. Like in other specialties, there aren't enough academic positions for the number of fellowship grads and so niches (even in private market) are going to narrow further. The real question is what kind of practice are you OK building, and where do you want to practice? You're going to have to adapt and learn to new techniques no matter which field you enter. Not many saw the interventional cardiology revolution coming, least of all CT surgeons. We're already battling neurologists and radiologists for IR. Who knows? Radiologists might fight to take FUS. Some new targeted therapy could cut brain tumor surgical volume. You'll have to roll with the punches.

[Guest]

Non fellowship trained neurosurgeons should not be doing tumors? What does that leave a general neurosurgeon? Trauma cranis and basic spine?

[Guest]

(04-20-2020, 03:28 PM)Guest Wrote: Non fellowship trained neurosurgeons should not be doing tumors? What does that leave a general neurosurgeon? Trauma cranis and basic spine?

Yep

[Guest]

(04-20-2020, 03:28 PM)Guest Wrote: Non fellowship trained neurosurgeons should not be doing tumors? What does that leave a general neurosurgeon? Trauma cranis and basic spine?

If you're in a bigger market, this is where things are heading...not to imply that fellowship makes you a better surgeon, but it does make you marketable. Not a big deal for those in practice for >10 years already, but will be a bigger deal in the future. Or we will move to neurosurgical hospitalists. Look @ what happened with general internal medicine or general cardiology.

[Guest]

(04-21-2020, 02:40 PM)Guest Wrote:

(04-20-2020, 03:28 PM)Guest Wrote: Non fellowship trained neurosurgeons should not be doing tumors? What does that leave a general neurosurgeon? Trauma cranis and basic spine?

If you're in a bigger market, this is where things are heading...not to imply that fellowship makes you a better surgeon, but it does make you marketable. Not a big deal for those in practice for >10 years already, but will be a bigger deal in the future. Or we will move to neurosurgical hospitalists. Look @ what happened with general internal medicine or general cardiology.

Not in the real world

[Guest]

(04-21-2020, 02:40 PM)Guest Wrote:

(04-20-2020, 03:28 PM)Guest Wrote: Non fellowship trained neurosurgeons should not be doing tumors? What does that leave a general neurosurgeon? Trauma cranis and basic spine?

If you're in a bigger market, this is where things are heading...not to imply that fellowship makes you a better surgeon, but it does make you marketable. Not a big deal for those in practice for >10 years already, but will be a bigger deal in the future. Or we will move to neurosurgical hospitalists. Look @ what happened with general internal medicine or general cardiology.

Seems hard to justify a 7 year residency for such limited practice.

[Guest]

(04-21-2020, 03:39 PM)Guest Wrote:

(04-21-2020, 02:40 PM)Guest Wrote:

(04-20-2020, 03:28 PM)Guest Wrote: Non fellowship trained neurosurgeons should not be doing tumors? What does that leave a general neurosurgeon? Trauma cranis and basic spine?

If you're in a bigger market, this is where things are heading...not to imply that fellowship makes you a better surgeon, but it does make you marketable. Not a big deal for those in practice for >10 years already, but will be a bigger deal in the future. Or we will move to neurosurgical hospitalists. Look @ what happened with general internal medicine or general cardiology.

Seems hard to justify a 7 year residency for such limited practice.

If your goal is primarily clinical practice without a lot of research then go to a program that allows you to enfold a CAST fellowship as a PGY-7.

[Guest]

(04-21-2020, 03:39 PM)Guest Wrote:

(04-21-2020, 02:40 PM)Guest Wrote:

(04-20-2020, 03:28 PM)Guest Wrote: Non fellowship trained neurosurgeons should not be doing tumors? What does that leave a general neurosurgeon? Trauma cranis and basic spine?

If you're in a bigger market, this is where things are heading...not to imply that fellowship makes you a better surgeon, but it does make you marketable. Not a big deal for those in practice for >10 years already, but will be a bigger deal in the future. Or we will move to neurosurgical hospitalists. Look @ what happened with general internal medicine or general cardiology.

Seems hard to justify a 7 year residency for such limited practice.

Which is why enfolded fellowships have become so popular

[Guest]

You really want your skull base meningioma or glioma taken out by a community surgeon who does one every 2-3 years? We've all seen our fair share of people out there doing part-time tumor or functional and what their outcomes can look like. It an be hit or miss.

Any person leaving training today and going into a community job in a mid to large metropolitan area is kidding themselves if they think they should be doing tumors without a fellowship. Have fun when the lawyers find you.