“That Takes Stamina”: An Analysis into the Inner Workings of the Life of a Neurosurgeon
It is four in the morning and a medical student cranes her head and squints in the scanty dorm room light, tracing diagrams endlessly, mouthing out intricate terminology as she reads. Two years later, the same woman is standing in the OR as an intern, on a twenty-four hour shift, writing notes frantically beside the attending and staying awake using nothing but willpower. Five years later this intern is in the midst of her residency, running to the operating table from the on-call room for the tenth time that night, positioning her hand carefully onto a probe in a man’s brain and forcing herself to keep from shaking with exhaustion—which would inevitably kill the patient. Ten years pass, and this woman is a confident, fully-certified physician, apologizing to her husband for leaving their night out once again to go save a life. This is neurosurgery. This is what that medical student all those years ago was aspiring to. But was it all worth it? I believe so. Although it is an extremely arduous profession to attain and uphold, neurosurgery would be a rewarding and advantageous career for me.
Neurosurgeons are not “brain surgeons,” as the majority of the population believes. In fact, professionals of this field can be found operating on brains only a minority of the time. Eighty percent of neurosurgery operations are done on spines, a
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vital part of the neurological system, which neurosurgeons study intensively during their seven-year residency. This training is necessary because neurosurgeons are not only held responsible as experts of the brain, but they also receive the most spinal surgery training out of all specialties, and are the only doctors who treat the entire spinal cord. Neurosurgery is a highly specialized field; however, it is split even further into specific subspecialties if a physician wishes to be more than a general neurosurgeon. These areas include pediatrics, skull base, vascular/endovascular, spine, peripheral nerve, tumor (the most popular subspecialty), and functional. Skull base surgery is possibly the most complicated that exists. Few neurosurgeons in the world are qualified and trained enough to perform this sort of complicated procedure on the cranial nerves, located in the recesses of the brain. Functional neurosurgery is an intriguing field, working closely with neurophysiologic monitoring and locating abnormal brain functions in order to study and treat epilepsy and disorders such as Parkinson’s. The Spine and Nerve Center of Massachusetts General Hospital explains that peripheral nerve neurosurgeons apply “the surgical therapy of nerve entrapment such as carpal tunnel syndrome” (Spine and Nerve Center). The aspect of all specialties of neurosurgery (especially those related to the brain) that I find most appealing is the fact that they reside on the cutting edge of research. Neurological disorders—above all—are constantly being investigated in the hopes of finding minimally invasive and possibly non-surgical treatments. After all, physicians (and surely the patients) do not favor drilling open a skull unless absolutely necessary. This research has led to a boom of new technology and techniques such as radiosurgery, shunts, stents, lasers, and focused radiation. This new avenue of research,
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accompanied by the fact that the brain is the only true organ of “mystery” left to the scientific world, enchants many surgeons. Dr. Louw explains this captivation when he states, “Everything that’s interesting about humans, from a Bhram’s symphony to weapons of mass destruction, is a function of the brain. To delve in, to try and dissect the complexities of the mind without having a higher intelligence than we have, that’s formidable[…] Can you conceive of anything more fulfilling than trying to crack the code of the final frontier?” (Louw).
For every 66,000 people in the country, there is one neurosurgeon. This fact seems unrealistic, even ridiculous, but it is true. And it is not surprising. After eight years of college, less than one percent of fourth-year medical students go into neurosurgery. The field is challenging and formidable, not to mention the constant shortage of
internship program spots available to applicants, leading to intense competition between students, especially in the over-achieving activities, such as “off-the-clock” research and
publication. Dr. Katrina Firlick describes this frustration when she states that “savvy medical students do all they can to bolster the research side of their résumés[…]often to the detriment of their already tenuous social lives. Fear, in addition to savvy, is a factor here, too, as there are always more applicants than spots, similar to musical chairs. Neurosurgeons were those kids who always managed to grab hold of a chair” (34). If a medical student is lucky enough to be accepted into an internship program and survive the year of intense training, the real work begins. A five to seven year-long residency awaits, with challenges to overcome at every turn. The American Board of Neurological Surgery mandates that training physicians need to complete the following requirements in
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their residency in order to become certified: a year obtaining fundamental skills, sixty months in the neurological sciences (twelve of which must be spent as chief resident), three months in clinical neurology, six months in neurology training, and twenty-one to twenty-four months in other neurology-related specialties (such as neuroradiology, extra neurosurgery, or neuropathology). The ACGME (Accreditation Council for Graduate Medical Education) supervises this process and regulates it, enforcing its many rules (such as that requiring eighty hour work weeks for the entire length of the residency). For the few who survive this hellish training period, the work slackens slightly in the traditional areas, but increases by a large percent in others, ruining the notion that one is able to “get your life back” after residency. A neurosurgery attending on a reputable student-doctor network website states that “Neurosurgery is not an easy life. […] Who do you think the resident calls at 2am for an emergency crani? Who will have to staff the OR at 7am, regardless of what you were doing at 3am? Who has to round on patients on the floor or the unit EVERYDAY when they are on service? […] Weekends and holidays, the hospital must be staffed by an attending, period. That means somebody who is already out of residency and ‘living their life’ is tied to that pager and must be ready to come into the hospital if the need arises. Toss in the research requirements of an academic neurosurgeon and you’ve got a serious 100 hour week until you retire” (Lifestyle of a Neurosurgeon). Neurosurgery is not just a job; it is a lifestyle. And a student must love and understand this lifestyle before they even consider the prospect of living it.
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Neurosurgery is living proof of how hard work pays off—literally. After fourteen years of extreme working conditions and pay averaging around that of a waiter’s, the earnings are impressive. In 2006, a survey of in-practice neurosurgeons around the country revealed an average salary of $541,000—with the lowest reported being $354,000, and the highest at $936,000. This might seem disproportionably high, considering that the average salary of a general surgeon was found to be $291,000, and that of a family practice doctor only $204,000. However, one must take into account the malpractice insurance of neurosurgeons ($25,000 per year, compared to the family doctor’s $5,000), the actual pay per hour neurosurgeons receive (considering that they have the most demanding schedules out of all specialties), and the extra years a neurosurgeon must train as a resident, thus delaying their full pay (those in family practice only need a residency of three years). Once these factors are added into the equation, the difference between specialties considerably shrinks, leaving neurosurgeons still with a small advantage. This can be accredited to the shortage of medical students entering the field today—WIN states that, “The total number of residents in the United States is about 785” (What is Neurosurgery?) — and the greater cost to the patient for a neurological surgery compared to a regular “check-up” at the family doctor.
Neurosurgery is the most male-dominated medical specialty in the United States today. Only 5% of certified US neurosurgeons are female, a sizable improvement— considering only eight women encompassed the founding membership of Women in
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Neurosurgery in 1989. Nevertheless, the statistics are startling. As shown in Fig. 1, in the medical field—where female doctors have become a norm—female neurosurgeons remain a novelty, with only
180 currently certified. There is however, a rational explanation for this conundrum.
Neurosurgery has always been a very challenging field in the amount of time which must be spent at the hospital. In the past, females have been viewed as the homemakers of the family, and thus would be inclined to choose careers more suited to spending time at home. Thus, men filled up the neurosurgery boards and organizations, becoming accustomed to their one-gender field. This led to a “glass ceiling” in the specialty in recent years, when women have become more interested in the field. Bonnie Darves, in her article for the New England Journal of Medicine, explains, “Although women physicians are far more common in the OR and the ER than they once were, they are still a minority — if a visible one — in the boardroom, the executive suite, and the upper echelons of academia” (Darves). Although this problem results partly from notorious, impenetrable “men’s clubs” in the higher levels of the medical hierarchy, it also can be attributed to the short number of years women have spent in the field. Many of the female neurosurgeons today are known for being the first female graduate of their
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college’s neurosurgery program; perhaps it is up to the next generation to break through the higher barriers. We are progressing, slowly but surely.
What kind of people become neurosurgeons? This is a question skirted around on many informational websites. They go in depth into the intense training, the long hours, and the wealth of knowledge and earnings that result, but few address what many contemplative medical students must be asking themselves: “Could I be a neurosurgeon?
Am I truly cut out for this career?” Ultimately, it seems, the answer lies in the hard facts. The road to neurosurgery contains the following obstacles: training spanning at least fourteen years, operating for hours on end, making decisions and standing by them in life-or-death situations, working eighty hours a week, keeping up with the most cutting-edge medicine throughout your career, sacrificing social and family time constantly, communicating effectively with patients concerning complex surgical procedures, and dealing with the stress and challenges of overseeing critically and commonly fatally ill patients. The organization Women in Neurosurgery (WIN), calls for students with “intellectual curiosity and ability,” “personal and physical stamina,” and “a strong desire to be an interventionist” (Who Should Become a Neurosurgeon?). But what does this mean? Beyond being the top of their class, the best of the best, what is a neurosurgeon’s personality like? What sort of person can take on this profession? My best answer can be found in an interview with certified neurosurgeon, Dr. Louw, when he states, “It’s not just about scholarship. People don’t realize the strenuous physical demands of the job. It’s common to put in long hours in the OR, standing very still, performing delicate technical tasks with every ounce of dexterity you can muster. That takes stamina” (Louw). So there
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is the key. Neurosurgeons do not only have to be intellectually gifted, but they also must pull strength from within, and allow themselves to face these grievances of the job
straight on. They rise to the challenge, and they overcome. There are few who are able to achieve this. But I believe I can.
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Works Cited
Arkins, Audrey. “The Brains Behind the Brain Surgery.” Salary.com. 2005. 10 Dec 2007
<http://www.salary.com/careers/layouthtmls/crel_display_Cat10_Ser131_Par231.
html>.
“Congress of neurological surgeons – neurosurgical training.” Congress of Neurological
Surgeons 2007. Congress of Neurological Surgeons. 27 November 2007.
<http://www.cns.org/public/whatIs/nTraining.asp>.
“Congress of neurological surgeons – the role of a neurosurgeon.” Congress of
Neurological Surgeons 2007. Congress of Neurological Surgeons. 27 November
2007. <http://www.cns.org/public/whatIs/role.asp>
Darves, Bonnie. “Women in Medicine Force Change in Workforce Dynamics.” The New
England Journal of Medicine. April 2005. 10 Dec 2007
<http://www.nejmjobs.org/career-resources/women-in-medicine.aspx>.
Ellenbogen, Richard. “So, you want to be a neurosurgeon?.” Women in Neurosurgery
2007. 27 November 2007. <http://www.neurosurgerywins.org/career/index.html>.
Firlik, Katrina. Another Day in the Frontal Lobe. New York City: Random House, 2006
“What is neurosurgery?.” So, You Want to Be a Neurosurgeon? 2007. Women in
Neurosurgery. 27 November 2007.
<http://www.neurosurgerywins.org/career/whatis.html>.
“Lifestyle of a Neurosurgeon” Online posting. 27 October 2003. Student Doctor Network Forums: GasForums. 09 Dec 2007. <http://forums.studentdoctor.net/showthread.php?t=83852>.
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“Skull-Base Surgery.” Tri-State Neurosurgical Associates-UPMC . 12 March 2003. 17 Dec 2007 <http://www.josephmaroon.com/base.htm>.
“Spine and Nerve Center.” Neurosurgical Service. 2006. Massachusetts General Hospital. 17 Dec 2007 <http://neurosurgery.mgh.harvard.edu/spine/default.htm#PeripheralSurgeons>.
“Who should become a neurosurgeon?.” So, You Want to Be a Neurosurgeon? 2007.
Women in Neurosurgery. 27 November 2007.
<http://www.neurosurgerywins.org/career/whoshould.html>.
“Women in neurosurgey.” So, You Want to Be a Neurosurgeon? 2007. Women in
Neurosurgery. 27 November 2007.
<http://www.neurosurgerywins.org/career/neurological_training.html>.