Neurosurg Vs Ortho

[Guest]

(04-03-2021, 11:52 AM)Guest Wrote: Spine fellows at my institution told me they wished they had done ortho. Why bother with the extra effort on cranial and being crushed with call?

Cranial call is a fucking joke compared to spine or ortho trauma

[Guest]

(04-03-2021, 01:21 PM)Guest Wrote:

(04-03-2021, 11:52 AM)Guest Wrote: Spine fellows at my institution told me they wished they had done ortho. Why bother with the extra effort on cranial and being crushed with call?

I think it just depends on what you're interested in. Most of the spine attendings here genuinely enjoy general neurosurgery and taking neurosurgery call, even though their elective practice is all spine. While I ended up going into spine, I actually really liked taking out meningiomas and doing MVDs in residency. I would hate to put casts and splints on people on call. There's also huge variation in the types of neurosurgery/ortho programs. I rotated at Vanderbilt as a Sub-I when I was a student, and their ortho residents were getting destroyed, working every Saturday and taking 25-30 consults/night on call, with no postcall days. 


Someone above made a really nuanced point that's impossible to know or appreciate as a med student or junior resident. There's a sizable advantage to being a neurosurgery-trained spine recruit in private practice, since a lot of places seeking level II trauma accreditation in the community can group cranial/spine call by taking you. The actual work isn't very tedious (bunch of calls about small IPHs, non-op subdurals, etc.) but you provide a ton of value for the hospital, even in desirable areas (- NYC, LA, etc. obviously). Ortho call is a dime a dozen, and can be done by any random sports guy.

Thank you so much for this insight. What are some of the spine heavy residency programs? I would like to go to a place with loads of Spine ie like a 70-30 split

[Guest]

PGY6 nsgy resident here going into spine. Agree with all the other posts above. I chose Nsgy over ortho bc we can do *everything* in spine from intramedullary tumor resections to large deformity corrections and now we're moving into pediatric deformity. Most of neurosurgery training is spine and if you end up at a known spine program you will be extremely well trained in all spine. Plus the other aspects of nsgy are just awesome. Ortho has a culture of pt dumping and lack of ownership which is generally the opposite of nsgy. At the places i've rotated at, ortho can't take care of pts in the ICU, which is not appropriate in my opinion. How can one do a huge surgery requiring the pt to be in the ICU and you can't take care of them? Nsgy takes care of the pt from beginning to end. Nsgy is an amazing field and I'm very happy i chose it. It's an incredible amount of work but the rewards are huge. The microsurgical training and cranial work in nsgy only help with spine surgery. Many of the Ortho spine surgeons are good but tend to be sloppier and less meticulous than nsgy spine surgeons. (just things i've noticed).

[Guest]

(04-03-2021, 08:51 AM)Guest Wrote: I had the same dilemma you did and chose neurosurgery and I’ve been very glad I did, even when I was in the middle of PGY-2 year. If I were you I’d use your high stats and mentors to try and match at a program where you can enfold a spine fellowship PGY-7 year. That way your total training is only 1 year longer. The main difference is that if you like spine, you’ll be doing what you enjoy during most of your training (I’ve probably been doing 65-70% spine) and get a lot more autonomy early on (mid-way through PGY-3 year, most attendings stopped scrubbing with me for all decompressive bone work and scrubbed but just watched me do screws), which makes residency infinitely better. Like you, I also thought that joints and spine were cool, but I hated foot&ankle, hand, peds, random sports stuff, etc. that had short cases but was really boring. Yes, some of the ortho personalities were awesome to work with, but neurosurgery programs have a wide range of people and you’ll be able to target places with more chill, down to earth people. Overall, I knew I’d be much more satisfied with a complex spine practice (that included tumor work) with some cranial call than anything in ortho, for only 1 year more of training (that will likely be a research break in between anyway). The skillset is more valuable and the money is also better. Good luck in your decision! Both are awesome specialties.

What are some of the spine heavy programs

[Guest]

(04-11-2021, 12:21 PM)Guest Wrote:

(04-03-2021, 08:51 AM)Guest Wrote: I had the same dilemma you did and chose neurosurgery and I’ve been very glad I did, even when I was in the middle of PGY-2 year. If I were you I’d use your high stats and mentors to try and match at a program where you can enfold a spine fellowship PGY-7 year. That way your total training is only 1 year longer. The main difference is that if you like spine, you’ll be doing what you enjoy during most of your training (I’ve probably been doing 65-70% spine) and get a lot more autonomy early on (mid-way through PGY-3 year, most attendings stopped scrubbing with me for all decompressive bone work and scrubbed but just watched me do screws), which makes residency infinitely better. Like you, I also thought that joints and spine were cool, but I hated foot&ankle, hand, peds, random sports stuff, etc. that had short cases but was really boring. Yes, some of the ortho personalities were awesome to work with, but neurosurgery programs have a wide range of people and you’ll be able to target places with more chill, down to earth people. Overall, I knew I’d be much more satisfied with a complex spine practice (that included tumor work) with some cranial call than anything in ortho, for only 1 year more of training (that will likely be a research break in between anyway). The skillset is more valuable and the money is also better. Good luck in your decision! Both are awesome specialties.

What are some of the spine heavy programs

Mayo
Barrow
Pitt
Miami
Rush
UCSF
UW (trauma spine mostly)
Duke (increasing 2/2 Shaffrey arriving)
WashU probably gonna increase, but historically an ortho-dominant program

[Guest]

(04-11-2021, 03:04 PM)Guest Wrote:

(04-11-2021, 12:21 PM)Guest Wrote:

(04-03-2021, 08:51 AM)Guest Wrote: I had the same dilemma you did and chose neurosurgery and I’ve been very glad I did, even when I was in the middle of PGY-2 year. If I were you I’d use your high stats and mentors to try and match at a program where you can enfold a spine fellowship PGY-7 year. That way your total training is only 1 year longer. The main difference is that if you like spine, you’ll be doing what you enjoy during most of your training (I’ve probably been doing 65-70% spine) and get a lot more autonomy early on (mid-way through PGY-3 year, most attendings stopped scrubbing with me for all decompressive bone work and scrubbed but just watched me do screws), which makes residency infinitely better. Like you, I also thought that joints and spine were cool, but I hated foot&ankle, hand, peds, random sports stuff, etc. that had short cases but was really boring. Yes, some of the ortho personalities were awesome to work with, but neurosurgery programs have a wide range of people and you’ll be able to target places with more chill, down to earth people. Overall, I knew I’d be much more satisfied with a complex spine practice (that included tumor work) with some cranial call than anything in ortho, for only 1 year more of training (that will likely be a research break in between anyway). The skillset is more valuable and the money is also better. Good luck in your decision! Both are awesome specialties.

What are some of the spine heavy programs

Mayo
Barrow
Pitt
Miami
Rush
UCSF
UW (trauma spine mostly)
Duke (increasing 2/2 Shaffrey arriving)
WashU probably gonna increase, but historically an ortho-dominant program

I largely agree with this list. I would also add Cleveland Clinic (massive spine volume, chair/PD both spine attendings), and UT Memphis. Bear in mind that many of the above are also amazing in cranial, but would enable you to make it more spine heavy if that were your interest.

[Guest]

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