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Academic neurosurgery
#1
Hey guys. I am interested in a different field, but have had an interest in nsg at some point which prompted me to lurk forums like this and I still read it occasionally. I find many things relevant to nsg to be projectable to other fields. I am trying to understand one thing that seems to be quite unique to nsg, and am hoping it will let me understand some general concepts of different models of medical practice. What I think is unique about nsg is the special place academia has in it. I yet have to see the field that is more academic, in a broad sense. Fields like neurology, or say hem/onc, that one can think are just pure academia in their essence, are not exactly like that in reality. I don't have the actual statistics in hand, but I get the impression that majority of people in those fields use academia as a step to private practice at best. As opposed to that, at least by reading this forum, I am getting the impression that academic neurosurgery is a niche that people very thoughtfully choose for themselves and stick to it.  I realize that most often people do go to academia because they are genuinely interested in advancing their respective field. However it just does not completely fit my understanding of human nature -- committing to something that by definition brings almost twice as little money and arguably more work. Even if we are talking about highly intelligent people that go to nsg, it is hard for me to believe that people choose harder work for less money over lighter hours and higher pay. Is the situation more complex than I see it? Is there something else to it that makes academia appealing to people? One another way to phrase my question: how is the life of an academic neurosurgeon working at a busy trauma center and running a basic science lab for 500k better than the life of 8-6 spine guy in private practice making 800k? Is it JUST the interest/talent/altruism that drives the guy number one? And drives him so much that he makes an informed decision to not make those extra 300k, which could have made a significant impact on the lifestyle (I am not talking Ferraris, I am rather talking sending kids to college, which might be an issue if you have more than 1 or 2).
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#2
(05-19-2017, 09:57 PM)Guest Wrote: Hey guys. I am interested in a different field, but have had an interest in nsg at some point which prompted me to lurk forums like this and I still read it occasionally. I find many things relevant to nsg to be projectable to other fields. I am trying to understand one thing that seems to be quite unique to nsg, and am hoping it will let me understand some general concepts of different models of medical practice. What I think is unique about nsg is the special place academia has in it. I yet have to see the field that is more academic, in a broad sense. Fields like neurology, or say hem/onc, that one can think are just pure academia in their essence, are not exactly like that in reality. I don't have the actual statistics in hand, but I get the impression that majority of people in those fields use academia as a step to private practice at best. As opposed to that, at least by reading this forum, I am getting the impression that academic neurosurgery is a niche that people very thoughtfully choose for themselves and stick to it.  I realize that most often people do go to academia because they are genuinely interested in advancing their respective field. However it just does not completely fit my understanding of human nature -- committing to something that by definition brings almost twice as little money and arguably more work. Even if we are talking about highly intelligent people that go to nsg, it is hard for me to believe that people choose harder work for less money over lighter hours and higher pay. Is the situation more complex than I see it? Is there something else to it that makes academia appealing to people? One another way to phrase my question: how is the life of an academic neurosurgeon working at a busy trauma center and running a basic science lab for 500k better than the life of 8-6 spine guy in private practice making 800k? Is it JUST the interest/talent/altruism that drives the guy number one? And drives him so much that he makes an informed decision to not make those extra 300k, which could have made a significant impact on the lifestyle (I am not talking Ferraris, I am rather talking sending kids to college, which might be an issue if you have more than 1 or 2).

Just throwing out a guess here since a student too. I think you're partially correct. To some extent it is the interest/talent/altruism that drives them. On the other hand, it's probably also a bit of ego. Just look at all the ppl here on this forum talking about these academic guys like they're gods. "You guys hear "X" is resigning from "Y" program". "So and so big academic guy is taking over as chair at so and so program". Being a big academic person gives you the name/title/fame in the field. Some people are very hungry for that. 
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#3
True, there is something really stimulating about the constant influx of energy, questioning, teaching that goes on with the mentor/mentee relationship in academia. The research can be exciting, and there are industry spin-offs too.

However, even on the non-altruistic side, academia does buy you relief from the relentless nature of 1st in line call and allows you to do more complex stimulating cases, with significant resident/ICU/collaborating services support. Most academic guys are protected by that buffer of residents and fellows. None of my private practice friends like to admit to the hospital a complex patient that will keep them up all night and bring them into the hospital for a ventric change, etc. My observation has been that even the most aggressive private neurosurgeons right out of residency (I can clip that aneurysm, I can take out that skull base tumor), find that the energy required to keep it up year after year starts to wear on them and their family. Hence, most private practice is 85% spine.
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#4
(05-19-2017, 09:57 PM)Guest Wrote: Hey guys. I am interested in a different field, but have had an interest in nsg at some point which prompted me to lurk forums like this and I still read it occasionally. I find many things relevant to nsg to be projectable to other fields. I am trying to understand one thing that seems to be quite unique to nsg, and am hoping it will let me understand some general concepts of different models of medical practice. What I think is unique about nsg is the special place academia has in it. I yet have to see the field that is more academic, in a broad sense. Fields like neurology, or say hem/onc, that one can think are just pure academia in their essence, are not exactly like that in reality. I don't have the actual statistics in hand, but I get the impression that majority of people in those fields use academia as a step to private practice at best. As opposed to that, at least by reading this forum, I am getting the impression that academic neurosurgery is a niche that people very thoughtfully choose for themselves and stick to it.  I realize that most often people do go to academia because they are genuinely interested in advancing their respective field. However it just does not completely fit my understanding of human nature -- committing to something that by definition brings almost twice as little money and arguably more work. Even if we are talking about highly intelligent people that go to nsg, it is hard for me to believe that people choose harder work for less money over lighter hours and higher pay. Is the situation more complex than I see it? Is there something else to it that makes academia appealing to people? One another way to phrase my question: how is the life of an academic neurosurgeon working at a busy trauma center and running a basic science lab for 500k better than the life of 8-6 spine guy in private practice making 800k? Is it JUST the interest/talent/altruism that drives the guy number one? And drives him so much that he makes an informed decision to not make those extra 300k, which could have made a significant impact on the lifestyle (I am not talking Ferraris, I am rather talking sending kids to college, which might be an issue if you have more than 1 or 2).

As mentioned above, it's all about ego. Look at the thread "chairs shuffling", it's all about ego and reputation. And this board doesn't represent reality in many ways, there are plenty of neurosurgery grads going into private practice.
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#5
My main motivations for heading towards academics are two fold. The first has been sorta covered above -- I want to do the crazy cases, don't particularily like spine, etc. Second, I like teaching and I want to be closely involved with a residency program.

As a side note, I get the sense that I'd be a shit businessman and I'll take being a salaried employee over self-employed any day (take that american dream). I'll take the pay cut so I don't have to think about overhead costs, hiring support staff, maintaining an infrastructure, etc.
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#6
(05-20-2017, 08:14 AM)Guest Wrote: My main motivations for heading towards academics are two fold. The first has been sorta covered above -- I want to do the crazy cases, don't particularily like spine, etc. Second, I like teaching and I want to be closely involved with a residency program.

As a side note, I get the sense that I'd be a shit businessman and I'll take being a salaried employee over self-employed any day (take that american dream). I'll take the pay cut so I don't have to think about overhead costs, hiring support staff, maintaining an infrastructure, etc.

Agreed, as an academic physician you get to:
- Take challenging interesting cases
- Work on interesting problems
- Be a part of an organized effort to realize the already predetermined future of human health
- Work with smart people who have also been thinking about those problems
- Work with young and hungry trainees 
- Do a variety of tasks as part of your job

It's not for everyone, but if you value teaching and learning it's a spectacular gig. If I'd wanted to hustle for cases/clients to make $900k and go home at 6pm I would have gone into finance. (It's not too late!)

I'd note that this bit about "thinking about overhead costs, hiring support staff, maintaining an infrastructure, etc." pretty much perfectly describes running a lab. I don't think anybody ever got into an academic career to *avoid* administrative bullshit. So caveat emptor. (But, yeah, I hear you, there are lots of ways to be an academic that don't involve running a lab...)

- TT
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#7
Most neurosurgeons do not have an academic affiliation

Most academic neurosurgeons do not run an active lab

Most academic neurosurgeons with lab do not do the heavy research lifting themselves, they rely on PhDs and post-docs

There are markets where large private hospital systems draw a larger volume of complex cases than the local academic center.

There are academic neurosurgeons who are terrible in the OR-- or only are proficient within their subspecialty (not always a bad thing at tertiary referral center).

Academic medicine used to be insulated from financial pressures. However, many departments are now converting reimbursement from salary/seniority based payment to RVU based payment.

Academic medical centers need to move toward cost containment and efficient operations to survive. These goals may come at the cost of the educational/research component of their mission

Patient referrals are determined more by insurance coverage/in-network status than by the draw of academic prestige. John Doe will go to the in-network private hospital for his complex tumor resection (For better or worse) if the academic center is not contracted with his insurance.
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