As per title, is it still possible to have a sustainable complex cranial practice similar to Liu, Morcos, Couldwell, etc.? Not particularly interested in endovascular and also I feel that once you go that route you’re stuck with stroke call despite snagging the occasional open CV case, but to me seems it would be hard to build a strong tumor practice when labeled the endo guy. That’s also 2 years dedicated to non-microsurgery... On the other hand, not doing endo I would likely have to supplement heavily with spine as a junior attending and am overall less marketable than endo trained neurosurgeons. Appreciate what others think
Probably not. Who would refer to someone who doesn’t treat a lot of aneurysms by a good minimally invasive route? It’s like trying to start a gallbladder practice without learning to do laparoscopic surgery.
People still occasionally get hired to do these sorts of jobs, at least on paper. In the cases I'm aware of in recent years these folks have almost always given up any open vascular practice as time has gone on. It's important to think about how your practice will fit in the wider context of the group. Almost all complex cranial jobs are in academic settings or in otherwise highly subspecialized groups. Why would your dual-trained colleagues want to share the shrinking pool of open vascular cases with you? Why would a department want to hire a vascular neurosurgeon who can't take stroke call? Why would a tumor program want to hire a complex cranial person without an endoscopic skill set, which you likely won't really have unless you stack multiple fellowships? Similarly, why would your tumor colleagues want to share cases with someone who spends half their time in the angio suite? That's not to say these jobs don't occasionally crop up in the exact right circumstances, but I think it's poor planning to put yourself in such a corner.
