(04-10-2022, 07:01 AM)Focus Wrote: I can't speak for Al Mefty but Spetz practiced surgical skills in the anatomy lab all the way to the end of his career. My experience is that "hands" are an overrated concept that surgeons with good skills use to exceptional-ize themselves and surgeons with bad skills use to excuse themselves. Innate ability to use your hands is vastly secondary to the innate ability to drive yourself to practice. If you aren't doing rat vessel to vessel anastomoses and other microsurgical practice techniques and also justifying your microsurgical technical ineptitude via "hands" then you're full of it. I had a resident recently tell me that I made throwing vessel sutures under scope "look easy". It isn't easy, it is one of the most miserably fucking hard things to do and if I do it better than I once did it's because of the big pile of dead rats in the hospital garbage dump.
What is true is not every trainee has access to the practice opportunities that allow them to develop "hands".
Isn’t this an important barrier/distinction though? I feel like I don’t have the “hands” and I ALSO don’t feel the passion to spend hundreds of hours on top of a grueling neurosurgery schedule to practice suturing rat vessels. Let the people who LOVE cranial microsurgery do that and I myself can be a very good spine and general bread and butter cranial neurosurgeon. Why does everyone have to be the next Spetzler? There’s a reason almost all med students on the interview trail want to be cranial gods and then 70% of them become spine surgeons. This is likely one of them
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(04-10-2022, 11:40 AM)Guest Wrote: (04-10-2022, 07:01 AM)Focus Wrote: I can't speak for Al Mefty but Spetz practiced surgical skills in the anatomy lab all the way to the end of his career. My experience is that "hands" are an overrated concept that surgeons with good skills use to exceptional-ize themselves and surgeons with bad skills use to excuse themselves. Innate ability to use your hands is vastly secondary to the innate ability to drive yourself to practice. If you aren't doing rat vessel to vessel anastomoses and other microsurgical practice techniques and also justifying your microsurgical technical ineptitude via "hands" then you're full of it. I had a resident recently tell me that I made throwing vessel sutures under scope "look easy". It isn't easy, it is one of the most miserably fucking hard things to do and if I do it better than I once did it's because of the big pile of dead rats in the hospital garbage dump.
What is true is not every trainee has access to the practice opportunities that allow them to develop "hands".
Isn’t this an important barrier/distinction though? I feel like I don’t have the “hands” and I ALSO don’t feel the passion to spend hundreds of hours on top of a grueling neurosurgery schedule to practice suturing rat vessels. Let the people who LOVE cranial microsurgery do that and I myself can be a very good spine and general bread and butter cranial neurosurgeon. Why does everyone have to be the next Spetzler? There’s a reason almost all med students on the interview trail want to be cranial gods and then 70% of them become spine surgeons. This is likely one of them
People should pursue what they love. They'll be better at what they love. This isn't about me thinking more people should focus on microsurgery. The point is that it is absolutely nonsensical to believe you can't be a safe and effective microsurgeon if you don't have special hand powers (you also don't have to be world famous). A decade of medical study and training and yet we believe that after all of that our fate is solely due to "hands".
I liked cranial surgery coming in to residency. Realized that for me personally it's not worth it. You work twice as hard, have more urgent middle-of-the-night emergencies, get paid less, and have to compete twice as hard for patients. I love the surgeries but not enough to justify getting into the lab regularly on top of everything else, while making the financial sacrifice. And if i'm not willing to put in that work i felt it wasn't fair to my future patients.
Also wasn't willing to make the geographic sacrifice. Even if you come from a top residency the fellowships are insanely competitive nowadays. And even after that if you get one of the best fellowships there are very few job openings and you'll likely have little say on what area of the country or city you'll work in.
I also really enjoy spine surgery so even without those practical considerations i still might have switched.
(04-10-2022, 08:50 PM)Guest Wrote: I liked cranial surgery coming in to residency. Realized that for me personally it's not worth it. You work twice as hard, have more urgent middle-of-the-night emergencies, get paid less, and have to compete twice as hard for patients. I love the surgeries but not enough to justify getting into the lab regularly on top of everything else, while making the financial sacrifice. And if i'm not willing to put in that work i felt it wasn't fair to my future patients.
Also wasn't willing to make the geographic sacrifice. Even if you come from a top residency the fellowships are insanely competitive nowadays. And even after that if you get one of the best fellowships there are very few job openings and you'll likely have little say on what area of the country or city you'll work in.
I also really enjoy spine surgery so even without those practical considerations i still might have switched.
Incoming pgy1 here: do you feel this only applies to skullbase, tumor, and open vasc or would you include endovascular and functional/pain/epilepsy in that statement? I’ve seen a few endovasc + spine and functional + spine types I was hoping to emulate.
(04-10-2022, 08:50 PM)Guest Wrote: I liked cranial surgery coming in to residency. Realized that for me personally it's not worth it. You work twice as hard, have more urgent middle-of-the-night emergencies, get paid less, and have to compete twice as hard for patients. I love the surgeries but not enough to justify getting into the lab regularly on top of everything else, while making the financial sacrifice. And if i'm not willing to put in that work i felt it wasn't fair to my future patients.
Also wasn't willing to make the geographic sacrifice. Even if you come from a top residency the fellowships are insanely competitive nowadays. And even after that if you get one of the best fellowships there are very few job openings and you'll likely have little say on what area of the country or city you'll work in.
I also really enjoy spine surgery so even without those practical considerations i still might have switched.
Do you get to do any cranial cases as a spine attending? How's the pay for spine PP?
(04-14-2022, 03:15 AM)Guest Wrote: (04-10-2022, 08:50 PM)Guest Wrote: I liked cranial surgery coming in to residency. Realized that for me personally it's not worth it. You work twice as hard, have more urgent middle-of-the-night emergencies, get paid less, and have to compete twice as hard for patients. I love the surgeries but not enough to justify getting into the lab regularly on top of everything else, while making the financial sacrifice. And if i'm not willing to put in that work i felt it wasn't fair to my future patients.
Also wasn't willing to make the geographic sacrifice. Even if you come from a top residency the fellowships are insanely competitive nowadays. And even after that if you get one of the best fellowships there are very few job openings and you'll likely have little say on what area of the country or city you'll work in.
I also really enjoy spine surgery so even without those practical considerations i still might have switched.
Do you get to do any cranial cases as a spine attending? How's the pay for spine PP?
For both questions it depends on the hospital and geographic location.
Just as an example, here in NYC our spine attendings only do cranial trauma, infection, or emergency shunt failures if they are on general call. All other cranial cases go to the appropriate subspecialty. This may differ from other places but we are very subspecialized.
In regards to PP pay, I'm sure you can get mid-to-high 6 figure salary, and there will be places where you could make over 1 million (maybe not the first few years, but eventually).
The difference in pay between academics and hospital employed/private can be staggering. Plenty of people who like academics end up choosing not to do it because a 400k a a year or so difference is a lot of money. Not something people like to talk but certainly not inaccurate.
(04-14-2022, 10:38 AM)Guest Wrote: (04-14-2022, 03:15 AM)Guest Wrote: (04-10-2022, 08:50 PM)Guest Wrote: I liked cranial surgery coming in to residency. Realized that for me personally it's not worth it. You work twice as hard, have more urgent middle-of-the-night emergencies, get paid less, and have to compete twice as hard for patients. I love the surgeries but not enough to justify getting into the lab regularly on top of everything else, while making the financial sacrifice. And if i'm not willing to put in that work i felt it wasn't fair to my future patients.
Also wasn't willing to make the geographic sacrifice. Even if you come from a top residency the fellowships are insanely competitive nowadays. And even after that if you get one of the best fellowships there are very few job openings and you'll likely have little say on what area of the country or city you'll work in.
I also really enjoy spine surgery so even without those practical considerations i still might have switched.
Do you get to do any cranial cases as a spine attending? How's the pay for spine PP?
For both questions it depends on the hospital and geographic location.
Just as an example, here in NYC our spine attendings only do cranial trauma, infection, or emergency shunt failures if they are on general call. All other cranial cases go to the appropriate subspecialty. This may differ from other places but we are very subspecialized.
In regards to PP pay, I'm sure you can get mid-to-high 6 figure salary, and there will be places where you could make over 1 million (maybe not the first few years, but eventually).
500K for PP spine? NYC pay seems to be on the lower end.
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