Hi all, I'm an incoming MS1 who is interested in neurosurgery and orthopedics. I was wondering if there is any advice you guys would have on figuring out if either field is right for me and how to approach med school (ie. the type of research I might do) so that I'm set up to be a strong applicant for either field in my later years. I've thought that doing spine research might be the way to go because there is an overlap there between neurosurgery and ortho but would like to get your guys' take on anything else I might want to keep in mind.
(06-07-2020, 04:25 PM)Guest Wrote: Hi all, I'm an incoming MS1 who is interested in neurosurgery and orthopedics. I was wondering if there is any advice you guys would have on figuring out if either field is right for me and how to approach med school (ie. the type of research I might do) so that I'm set up to be a strong applicant for either field in my later years. I've thought that doing spine research might be the way to go because there is an overlap there between neurosurgery and ortho but would like to get your guys' take on anything else I might want to keep in mind.
how much can you lift?
(06-07-2020, 04:25 PM)Guest Wrote: Hi all, I'm an incoming MS1 who is interested in neurosurgery and orthopedics. I was wondering if there is any advice you guys would have on figuring out if either field is right for me and how to approach med school (ie. the type of research I might do) so that I'm set up to be a strong applicant for either field in my later years. I've thought that doing spine research might be the way to go because there is an overlap there between neurosurgery and ortho but would like to get your guys' take on anything else I might want to keep in mind.
Resist what MS1s normally do when considering different fields:
- Picking something just because a parent/friend/mentor/research boss tells you to
- Thinking that liking the subject matter means you will like practicing in the field (liking neuroscience doesn't mean you will like neurosurgery)
- Ignoring other specialties, including nonsurgical ones, that you might really enjoy, because you've pigeonholed yourself into ortho/neuro organizations early on in med school
My advice for med students is to go back to basics, because you will spend your entire residency and at least the first few years of your practice (no matter your subspecialty) doing general cases in your field of choice. That makes things simpler. Many, many neurosurgery patients are SICK, medically complex, and have poor outcomes. Many surgeries are nonelective. You will have to treat many vascular problems, tumors, cranial traumas, and shunts in addition to sweet spine cases. You will spend much more time in the ICU and actually have to understand what happens in there.
There are sick ortho patients too, but most ortho treatment is at least semi-elective. You can refuse to replace someone's knee until they lose weight or their medical issues are sorted; those allowances don't always exist for us. In the realm of spine, neurosurgery and orthopedics are growing closer. Ortho really pioneered many of the biomechanics principles that appear on neurosurgery boards. In general, neurosurgeons get much more spine diagnosis and surgical treatment during residency than orthopods get in 2 years of fellowship. And orthopods do not have the training in microsurgery or handling neural tissue that we do, so intradural work isn't something they do. That being said, there are plenty of truly fantastic ortho spine surgeons out there.
Bottom line: research is fine, but if you really want to be ahead of the curve, go see them in action. Make rounds with each service. Go to clinics. Talk to attendings. As an MS1 you are totally allowed to do this. Learn whether you ACTUALLY like spend hours in the OR (this is a rude awakening for many folks). See what kinds of patients they treat. See what kinds of people the fields attract. Can you see yourself in their shoes - 10 years, 20 years, 30 years from now? Do you want to spend your life thinking about the problems that these people see every day? Research is never going to answer that question for you, and if you're considering either of these fields, you should find out sooner rather than later.
(06-07-2020, 04:25 PM)Guest Wrote: Hi all, I'm an incoming MS1 who is interested in neurosurgery and orthopedics. I was wondering if there is any advice you guys would have on figuring out if either field is right for me and how to approach med school (ie. the type of research I might do) so that I'm set up to be a strong applicant for either field in my later years. I've thought that doing spine research might be the way to go because there is an overlap there between neurosurgery and ortho but would like to get your guys' take on anything else I might want to keep in mind.
Quite a few people in neurosurgery (including myself) were interested in ortho at some point or were deciding between the 2. I'm a PGY-4 and my older brother is an orthopod a few years out of training. I understand the appeal of the field: nice variety of surgery all over the body, overall happy/chill residents, and a seemingly good lifestyle (although this is misleading at the med student level for a number of reasons).
While the variety of cases sounds like a positive in ortho, I personally found both the anatomy and actual surgeries outside of spine and joints to be pretty boring. Bread and butter cases in hand, foot & ankle, sports, and peds are pretty lame, and I didn't feel like we were helping patients that much. Joints were cool in the beginning but their attendings literally do 2-4 surgeries the entire rest of their career: primary hip, primary knee +/- the 2 revisions. I'd be pretty bored 5 years out in practice. Spine is very comparable to neurosurgery and ortho has some huge names in the field (Lenke, Vaccaro, Todd Albert, etc.). We have several advantages though apart from doing more cases as residents. First, you can go intradural and do more complex cases like tumors and AVMs that orthopods can't do. These are definitely rare (almost no one can have an entire practice solely in spine tumor) but it adds more variety to your skill set. Also in private practice, a lot of hospitals combine head and spine trauma call together, which gives neurosurgeons a huge advantage for these types of jobs. The variety of intracranial pathology you get to treat as a neurosurgeon beats out ortho and gives you a more rare skill set that brings value to hospitals. Ortho is a shorter residency, but if you do an enfolded fellowship, it's only 1 extra year (7 vs. 6) since almost every orthopod does a fellowship.
In terms of lifestyle, most ortho programs are larger so the call is more spread out, but they still get destroyed at most programs with trauma (this obviously varies depending on the exact place just like in neurosurgery). In neurosurgery, you're in house for 2 years a lot of the time (vs just PGY-2 in ortho) but they also get 25 consults/night and are woken up all the time. I remember when I did an ortho Sub-I back in med school the joints residents would pre-round at like 4:30, so it's honestly not that different - all surgical fields get worked during training. As an attending, you can choose whatever job you want. Most neurosurg residents don't end up doing vascular with Q3 stroke call. My brother who's a joints attending gets worked and does 6-7 cases/day (comes in at 6 AM, done around 9 PM) with Q4 call. Yes, neurosurgery acuity on call is often greater, but most neurosurgeons aren't covering the warzone ERs they do during residency. The ortho hand surgeons you hear about in med school working at the VA from 9-5 are sacrificing 70% of their salary.
tl;dr I liked spine, but thought that brain tumors, aneurysms, head trauma, ICU care were much cooler and satisfying than fixing ACLs and tenosynovitis. Number of years in training and lifestyle in residency (and even after) is not *that* different. You can choose a program that fits your needs in terms of personality, call, etc.
Good luck!
(06-07-2020, 06:47 PM)Guest Wrote: (06-07-2020, 04:25 PM)Guest Wrote: Hi all, I'm an incoming MS1 who is interested in neurosurgery and orthopedics. I was wondering if there is any advice you guys would have on figuring out if either field is right for me and how to approach med school (ie. the type of research I might do) so that I'm set up to be a strong applicant for either field in my later years. I've thought that doing spine research might be the way to go because there is an overlap there between neurosurgery and ortho but would like to get your guys' take on anything else I might want to keep in mind.
Quite a few people in neurosurgery (including myself) were interested in ortho at some point or were deciding between the 2. I'm a PGY-4 and my older brother is an orthopod a few years out of training. I understand the appeal of the field: nice variety of surgery all over the body, overall happy/chill residents, and a seemingly good lifestyle (although this is misleading at the med student level for a number of reasons).
While the variety of cases sounds like a positive in ortho, I personally found both the anatomy and actual surgeries outside of spine and joints to be pretty boring. Bread and butter cases in hand, foot & ankle, sports, and peds are pretty lame, and I didn't feel like we were helping patients that much. Joints were cool in the beginning but their attendings literally do 2-4 surgeries the entire rest of their career: primary hip, primary knee +/- the 2 revisions. I'd be pretty bored 5 years out in practice. Spine is very comparable to neurosurgery and ortho has some huge names in the field (Lenke, Vaccaro, Todd Albert, etc.). We have several advantages though apart from doing more cases as residents. First, you can go intradural and do more complex cases like tumors and AVMs that orthopods can't do. These are definitely rare (almost no one can have an entire practice solely in spine tumor) but it adds more variety to your skill set. Also in private practice, a lot of hospitals combine head and spine trauma call together, which gives neurosurgeons a huge advantage for these types of jobs. The variety of intracranial pathology you get to treat as a neurosurgeon beats out ortho and gives you a more rare skill set that brings value to hospitals. Ortho is a shorter residency, but if you do an enfolded fellowship, it's only 1 extra year (7 vs. 6) since almost every orthopod does a fellowship.
In terms of lifestyle, most ortho programs are larger so the call is more spread out, but they still get destroyed at most programs with trauma (this obviously varies depending on the exact place just like in neurosurgery). In neurosurgery, you're in house for 2 years a lot of the time (vs just PGY-2 in ortho) but they also get 25 consults/night and are woken up all the time. I remember when I did an ortho Sub-I back in med school the joints residents would pre-round at like 4:30, so it's honestly not that different - all surgical fields get worked during training. As an attending, you can choose whatever job you want. Most neurosurg residents don't end up doing vascular with Q3 stroke call. My brother who's a joints attending gets worked and does 6-7 cases/day (comes in at 6 AM, done around 9 PM) with Q4 call. Yes, neurosurgery acuity on call is often greater, but most neurosurgeons aren't covering the warzone ERs they do during residency. The ortho hand surgeons you hear about in med school working at the VA from 9-5 are sacrificing 70% of their salary.
tl;dr I liked spine, but thought that brain tumors, aneurysms, head trauma, ICU care were much cooler and satisfying than fixing ACLs and tenosynovitis. Number of years in training and lifestyle in residency (and even after) is not *that* different. You can choose a program that fits your needs in terms of personality, call, etc.
Good luck!
great write up, thank you!
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