I’m at a crossroads where I’m not sure what to do. I love spine, cranial, and hell even vascular. But doing a spine fellowship (thinking MIS, deformity) along with endovascular and skull base (tumor and open vascular) doesn’t seem a good use of one’s time when ultimately you’ll be hired as the “vascular” or “spine” guy. Im worried if I pursue vascular for example I’ll hired on as mostly taking stroke call and in angio suite rather than doing open cases, especially spine. There is also the matter of turf wars among other attendings where it’s a big no no to “take” cases in their specialty whether it be spine , etc.
What do you guys think, am I trying to bite off more than I can chew when we live in an era of super sub-specialization?
There are definitely surgeons in hospital-employed positions or PP that do cases across multiple sub specialties. They typically work at non teaching hospitals that serve as a tertiary referral center for major health insurance systems. These can even be pseudo-academic; in the end there’s nothing stopping you from publishing your case series or operative videos, though you probably won’t be given the support or time away from the OR if you want to do something more rigorous. If I were you, I would market yourself as a cranial specialist (open vascular/skull base) and advertise that you’re very willing to do spine, god knows there’s plenty of that to go around and many non-academic places will expect you to do it anyways. I would not get endovascular training unless you really enjoy it, many of these positions need a surgeon to provide open support for their NIR groups anyways. If you want to be in academia, I think you’ll have to look at small programs with few faculty, your options would be fewer but still possible.
I have to agree with this sentiment. As neurosurgery evolves it will be increasingly important to learn the “minimally invasive” counterpart.
If you’re going into vascular, it’s essential you are trained in endo vascular
Doing big spine wacks? Learn MIS/perc techniques
Tumor? Learn Gamma knife, etc.
At a large academic center it’s unlikely that you would be able to do everything. However I know several endovascular trained specialist who went out into general practice and were able to do many different subspecialty cases including spine. I would not do both a spine fellowship and an endovascular fellowship. I would say if you want to be a generalist including vascular make sure you do the endovascular fellowship
If you want to be an academic vascular specialist, of course do endovascular, but if you want to be a jack of all trades who likes complex cranial and spine, then I think you’ll be happier without it. Having endovascular training will inevitably force you to do a lot of endovascular cases. Without it, open vascular cases will be a relative minority of your case load, but it sounds like you’re fine with that as you can fill your calendar with tumors and spine. Ultimately, you need a place that’s looking for the skill set that you want to offer. It won’t be at a premier neurosurgery institution given the trend to subspecialization, but if you’re ok with that, you can probably find the job you want.
you can do it all in academci county jobs.
You can still do simple spine stuff as a vascular guy. Not many vascular guys I've seen like it though. Don't expect to be a deformity surgeon without proper fellowship. Or else you will have a whole of explaining to do on your complications and PJFs on your oral boards.
I’ve seen a decent amount of functional guys doing a lot of spine (not just stimulators and pain pumps either). Really some of the most well rounded surgeons I know have some sort of mix between functional/pain doing stereotax stuff, simple tumors, epilepsy surgeries and LITT, gamma knife, MVDs, shunts, full spectrum of spine except large scoly cases
For majority of us our training leaves us well equipped for most spine cases. I agree don’t expect to go out in practice doing Shaffrey/Uribe type cases without additional training. Vascular guys in general don’t typically like spine, and quite frankly don’t have the time outside of their vascular practice to develops a high volume spine practice that will enable you to gain that valuable expertise early on as an attending.
Sounds like instead of 2 years of endo vascular training the better option is to do one year of spine (enfolded perhaps) and one year of complex cranial/skull base post grad to build your confidence and expertise in those domains. You’ll find yourself gravitating one way or the other as you develop your practice and find what cases you truly enjoy.
