Tumor vs Functional

[Guest]

Say goodbye to those. Has to be in your chief year now and good luck making that work if you're at a one a year program or even two a year.

Honestly doing an enfolded fellowship often completely defeats the purpose of a fellowship. Most people do fellowships to learn a new skill or see how others do things. Spending slightly more time with your mentor probably isnt going to teach you something you didnt learn from them after your first 300+ cases with them.

[Guest]

(04-21-2020, 05:34 PM)Guest Wrote: Say goodbye to those. Has to be in your chief year now and good luck making that work if you're at a one a year program or even two a year.

Honestly doing an enfolded fellowship often completely defeats the purpose of a fellowship. Most people do fellowships to learn a new skill or see how others do things. Spending slightly more time with your mentor probably isnt going to teach you something you didnt learn from them after your first 300+ cases with them.

Actually say hello to more programs with PGY6 years

[Guest]

(04-21-2020, 05:11 PM)Guest Wrote: 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.

What about relatively simple tumor cases like convexity meningiomas or gliomas in superficial non-elegant locations?

Have any residents successfully petitioned their program to start offering enfolded fellowships?

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(04-21-2020, 05:34 PM)Guest Wrote: Say goodbye to those. Has to be in your chief year now and good luck making that work if you're at a one a year program or even two a year.

Honestly doing an enfolded fellowship often completely defeats the purpose of a fellowship. Most people do fellowships to learn a new skill or see how others do things. Spending slightly more time with your mentor probably isnt going to teach you something you didnt learn from them after your first 300+ cases with them.

Perhaps that is the original or better reason to do a fellowship, but it sounds like now many residents are choosing to do them for medicolegal or resume boosting purposes. The program's I have visited that offer enfolded fellowships have virtually 100% participation. So they are definitely popular among residents.

[Guest]

(04-21-2020, 05:34 PM)Guest Wrote: Say goodbye to those. Has to be in your chief year now and good luck making that work if you're at a one a year program or even two a year.

Honestly doing an enfolded fellowship often completely defeats the purpose of a fellowship. Most people do fellowships to learn a new skill or see how others do things. Spending slightly more time with your mentor probably isnt going to teach you something you didnt learn from them after your first 300+ cases with them.

Goodbye to those? Enfolded fellowships are more common now than ever before. A lot more programs are adopting the Miami/Duke 6 + 1 model, where you move your chief year to PGY-6, and move 1 elective year to the PGY-7 slot. This not only gives you the chance to be CAST accredited but also allows you to do something like skull base, which you wouldn't have otherwise had the skill set to do as a PGY 4 or 5.

Going to another institution would be ideal, but if your home program is strong in something an enfolded fellowship could be worthwhile. No-one is comfortable doing far laterals, bifrontal transbasal approaches skin to skin during your standard residency rotations, even with your mentor.

[Guest]

Is functional going to be the next big thing, even bigger than tumor?

[Guest]

(04-21-2020, 11:33 PM)Guest Wrote: Is functional going to be the next big thing, even bigger than tumor?

If you enjoy your surgeries consisting of drilling burr holes.

[Guest]

I think this notion, for tumor (not functional), that if you didn't do a fellowship you shouldn't be doing them in practice is misguided. If you are a junior tumor attending that did a fancy fellowship in it then obviously that will be your opinion, as it should. And I doubt many community guys/gals are doing awake craniotomy or going for glory on nasty skull base tumors. But for cases like frontal lobe gliomas, most meningioma, some acoustics, there are certainly private practice guys doing these cases, and it is far more than 1-2 a year. The majority of private practice will be basic spine because that is the most in demand, and if they are efficient it maximizes their returns. But that absolutely does not mean that a good surgeon in private practice 'can't' take out a tumor. If a patient wants to do some research and then get on a plane and go to MD Anderson then they will. But if they don't want to uproot their lives and just have the tumor taken out by a reputable local surgeon, then they can do that too. For functional, its a huge startup cost to have the equipment, and it doesn't bill as much, so the private guys/gals have less incentive unless they actually just like it.

Please don't make people think that if you don't have a tumor fellowship you can't do brain tumors. Seven years of residency gets you ready for the basic stuff. Certainly some types of tumors are better treated in high volume academic centers, but there is no unofficial rule that private practice surgeons cant take on these cases too. Its all about personal comfort. There are some insanely skilled private practice surgeons too.

[Guest]

Soon spine fellowships will be mandatory to do spine

[Guest]

(04-22-2020, 11:41 AM)Guest Wrote: Soon spine fellowships will be mandatory to do spine

Again, this is a baseless comment and makes no sense. It might be true in some very small parts of the country, but in no way will the average community private practice neurosurgeon have to do a dedicated spine fellowship to do their job.

[Guest]

(04-22-2020, 10:57 AM)Guest Wrote:

(04-21-2020, 11:33 PM)Guest Wrote: Is functional going to be the next big thing, even bigger than tumor?

If you enjoy your surgeries consisting of drilling burr holes.

Probably can't make a living just on DBS. You would need to include a considerable amount of spinal cord stimulation, DRG stim, and epilepsy surgery too.