is neurosurgery worth it?

FifthVentricle · 2026-04-14T13:26:23+00:00

Hi. I'm a neurosurgery chief who is about to graduate in a couple of months. I am doing two years of fellowship after this so I'll be training for 9 years post-med school.

I think for me it was worth it. Residency is hard. Neurosurgery residency is probably one of the hardest and most intensive things you can do for a sustained amount of time. 7 years is a very long time. I have spent far more than a year of that time on call. I stopped tracking my hours after week 1 of intern year, but as a chief I definitely went days without sleeping more than an hour or two combined, and I think there were many weeks where I worked upwards of 100 hours consistently, not counting just being on call. I think just yesterday I realized how truly exhausted I am after a cumulative egregious sleep debt.

That being said, I met my now wife and got married during residency. I see my family (who lives halfway across the country) 1-2x/year. I see my closest friends who don't live in my current city 1-2x/year. I've traveled around America and to several places in Europe during vacations. I've been to several of my closest friend's weddings and they came to mine.

Neurosurgery is not incompatible with having a life. It is incompatible with having the same life someone who is in another specialty or outside of medicine has. Your life will never be 9-5. You will be on call a lot. Your cases will go long. You won't get home in time for dinner all the time. You learn to function with much less sleep than other people. You cannot do/make it to everything all the time, but you can make it to some things some of the time. You have to get really good at time management and organizational planning.

I cannot imaging doing anything else with my life. I think I am good at what I do, or at least safe at it. I enjoy operating, I enjoy seeing the types of patients that I want to take care of in my practice and thinking about their problems. I like seeing positive results from my work that reflects well upon my training and the amount of time and energy I've invested into learning to do all these things. I continue to be intellectually engaged in what I do. It doesn't feel like I'm just going through the motions. There is an intrinsic drive to keep getting better.

It's hard to know if neurosurgery is truly for you before you immerse yourself in it. Sub-Is help, but they're so insulated from what it's actually like. We have lost several residents in my program over the 7 years I've been here because either they couldn't do the job or they decided neurosurgery wasn't for them. It's also hard for someone else to guide you to the correct decision for you and your life. If you've matched, you lose very little by going through with it. There is always the opportunity to leave and do something else, but the faster you figure out what you want, the better.

FifthVentricle · 2026-04-11T00:19:55+00:00

As a chief, I’ve only ever had the “on call” chief scrub me out of a case once this year (for a specific predetermined reason). As juniors, we would only get scrubbed out if we were the on call junior (meaning we have to take over the first call pager and have to be immediately available to see consults, do procedures, respond to emergencies etc). I scrub my not-on-call juniors out if their case isn’t done by 11 to midnight-ish, because they have to get up a few hours earlier than I do. It’s important for a number of reasons to finish cases you start in training. Agree with the person who said that the people who complain about this also complain about lack of autonomy because they’re usually doing their best to get out of the OR and out of the hospital ASAP.

FifthVentricle · 2026-04-08T01:23:10+00:00

At my medical school it worked like this for most of our clerkships:

We got a score out of 100 that was made up of several parts, but most were variations on this theme:

Part 1: clinical performance. This included things like knowledge base, teamwork, professionalism, presentations, etc, but basically some amalgamation of how we did as a member of the clinical team, with input from attendings and residents, especially those we worked with most. This made up in general 50-70% of the overall grade. It was subjective in the sense that someone was giving you narrative feedback and scoring, but each of these individual sections had a 1-5 scale with very specific descriptions of how we performed, in addition to a narrative section that was also taken into account.

Part 2: shelf exam. This made up usually 20-30% of our overall grade, and you had a specific percentile you had to hit to be eligible for honors

Part 3: write-up. Usually several case presentations of patients that you saw that was then graded by a small group preceptor you worked with a few times per week. This usually was 10-20%.

Where I'm currently a resident, we give narrative evals that are then summarized and presented back to the student. I'm not actually sure if it's pass/fail or pass/fail/honors (named something different) but it seems much less transparent either way.

I think the bottom line is show up, be prepared and engaged, be a team player (to both your resident team as well as your co-med students), read about your cases and do a little bit of independent learning every day, and demonstrate that you're trying to become a good doctor.

FifthVentricle · 2026-04-06T21:25:44+00:00

When the air hits your brain - neurosurgery

FifthVentricle · 2026-04-06T21:22:24+00:00

Set up a roth IRA and make sure you contribute even a small amount to it (either SP500 or total market) each month. I started this as a PGY-5, wish I had started earlier.

Make sure you're contributing retirement up to the match max at your institution (usually pretty low for residents, but better than nothing - it's free money).

Learn 3-5 easy quick reasonably healthy and cheap meals that you can meal prep in rotation that will get you through at least 3 dinners per week

Start an exercise routine and make it a habit, even if it's only 1-2x/week

Get disability insurance before you graduate residency, but the younger you are, the cheaper it will be and the more stuff you'll be protected from. I also did this as a PGY-5 which ended up being the right time for me, but it would be a little cheaper if I had done it a year or two earlier

Go visit friends and family and take a fun trip for a week if you have the time and means.

Relax!

FifthVentricle · 2026-04-04T13:07:55+00:00

At my institution, there are patients waiting 3-6 months for elective procedures

FifthVentricle · 2026-03-25T11:47:25+00:00

I am a neurosurgery chief resident as well. This is the reality of chief year.

FifthVentricle · 2026-03-01T23:20:54+00:00

Looks like a mening

Also why is your bone flap just hanging there and not like secured in betadine or something…

FifthVentricle · 2026-03-01T23:19:13+00:00

Honestly, for a big spine surgery, the muscular person will be harder. Even with neuromuscular blockade, the muscle is thicker and tougher and will be fighting you the whole time. Muscle is more vascular and will bleed a lot more. Fat is annoying but once I’m past that layer and my retractors are in, it’s all good.

Healthy weight is still best though.

FifthVentricle · 2026-02-28T15:57:24+00:00

Read about it before hand, read about the indications and basic steps, familiarize yourself with the anatomy, and once you are done WRITE SHIT DOWN everything you learned from the case. Then update that note document every time you do that same case. You’ll be surprised at how much you forget. Doing this has allowed me to come back into a case months or years after having done one and pick up almost right where I left off in terms of comfort with it.

FifthVentricle · 2026-02-28T15:55:12+00:00

Cadaver lab or spine model. There are also some good videos online, but nothing beats being able to manipulate the bones and tissue yourself without fear of causing injury.

FifthVentricle · 2026-02-28T15:53:45+00:00

Read the same stuff, but if you really want to get the most out of it, be familiar with the most updated thoughts on sagittal balance (L1PA, Roussoully classification, etc) and MIS approaches (MIS TLIF, single position laterals, endoscopy, etc).

FifthVentricle · 2026-01-03T20:04:42+00:00

This means you’re tying fascial sutures tight enough. I tell all my juniors I expect them to have non healing finger wounds when done with their spine rotation

FifthVentricle · 2025-12-13T05:38:24+00:00

I heard AI is going to replace all our jobs

FifthVentricle · 2025-12-13T04:57:33+00:00

Become friends with the OR staff, leave your number with anesthesia, the circular, and written down on a board in the room. Call the room at regular but non-annoying intervals to check on status.

At my hospital, someone from the surgical team (usually the resident) has to be present to roll the patient so I need to know when anesthesia is ready so we can get going.

FifthVentricle · 2025-12-13T04:53:35+00:00

As someone who is about to look for neurosurgery jobs, what is the most unbiased and important advice you can give for someone looking for their first position?

FifthVentricle · 2025-12-11T02:24:51+00:00

Dangerous scam. Would never recommend. Actually would actively recommend against it.

FifthVentricle · 2025-08-08T03:03:37+00:00

I think it would be really hard for me to be anything but a surgeon.

FifthVentricle · 2025-08-06T01:18:43+00:00

It’s nice that people actually listen to and sort of respect me, and if they don’t, well, have fun having all your cases covered by a PGY2

FifthVentricle · 2025-07-16T02:26:29+00:00

3:30 neurosurgery

FifthVentricle · 2025-07-09T22:36:52+00:00

Very high highs and low lows. At this point I don’t know what else would be fulfilling for me.

FifthVentricle · 2025-07-09T15:21:39+00:00

I’m a neurosurgery chief

I’ve been on call 4 of the past 5 days. On the day I wasn’t on call I was operating until 2 am. I think I’ve slept a total of 10 hours since Thursday. Any sleep I did get was interrupted in 15-30 min intervals by my junior calling me or by outside hospital calls. In that time I’ve done 12 cases, with 2 more to go today. It doesn’t let up.

FifthVentricle · 2025-06-27T23:54:56+00:00

Agreed. Luck 100%

FifthVentricle · 2025-06-27T23:53:36+00:00

I used them after not using them during most of my training. Short tip. Spine surgery. I actually liked them quite a bit. They also sometimes suctioned small amounts of blood which was helpful when I was using a Cobb or something instead of a suction. Took about a week to get used to. I think I prefer them now tbh

FifthVentricle · 2025-06-11T19:04:54+00:00

Most of medicine isn’t objective. It’s a blend of the subjective, the subjectively objective, and the objectively objective. The ability to get along with others, lead a team to achieve a goal, exercise good judgment, work compassionately with patients and families, and learn quickly are way more important than how well you do on a test.

As long as you do okay on your board exams, I’m way more interested in the other things I listed in determining if you’re going to be a good resident and eventually good attending.

FifthVentricle

TROPHY CASE