What are some of the downsides of being a neurosurgeon?

There are few aspects that many neurosurgeons love about the field but that those it exploring it as a potential specialty can use to differentiate it from others.

(1) Patient acuity. Neurosurgeons, even in a community setting, deal with many high acuity patients: penetrating trauma, severe TBI, spinal cord injury, spinal fractures, intracranial hemorrhages. Some of these things must be taken care of emergently to avoid further disability or death. This acuity translates to a worse lifestyle than some other surgical subspecialties due to call frequency and burden. The parallel to acuity is...

(2) Patient Outcomes. While most community neurosurgeons do a large proportion of their work in degenerative spine disease, there are very few who do not deal with some element of adult and/or pediatric trauma, tumors, and cerebrovascular. For many of these pathologies the long term prognoses are poor; for others the short-term mortality rates are high; and for many of these patients, even with excellent surgical care, mild to moderate disability would be considered a “good” outcome. Put another way, many patients meet their neurosurgeon (or their families do) in what will end up being the worst day of their lives. One of our jobs is to help patients and families navigate these terrible circumstances. It can be psychologically draining and emotionally exhausting - the same is true for other high acuity fields like trauma surgery. That said, it is one of the most rewarding aspects of the profession. When asked by medical students, “what about Neurosurgery did you not expect as a medical student”, I respond that I didn’t anticipate how many discussions I would have to have telling patients and families the worst possible news. You come to own it, take the time to do it right, and take pride in helping people through but it is tough each time, even now. And, even in elective spine Surgery complications happen, which leads to...

(3) Complications. You will strive to do your best every day and be faced with your falability. But unlike other specialties, when you make a mistake with nerves, spinal cord, or brain the consequences are dire and you must own them. You are mortal, you will make mistakes, and in Neurosurgery that means even when you do your best possible work, a wrong decision under pressure or slight missed movement of the hands can mean disability, paralysis, or even death. You have to be able to work past this and that can be too much for some. Not to mention...

(4) Litigation. When you do have a complication, and you hopefully are beating yourself up and researching what you could’ve done differently to maybe change the outcome, the prospect of ligation is always there.

may leave someone. Spine surgery is the #1 specialty for lawsuits (1 in 7 per year face litigation in average). Litigation rates are high because outcome can be poor even when everything is done perfectly and are apparent when something may have gone wrong. Litigation is present in all fields but it is a stressor that can weigh on you.

There are many other little things that people will cite. The bottom line is it’s not for everyone but I can’t imagine doing anything else.

There are three good memoirs listed below to get a taste. But, shadowing as a medical student is the best way. Neurosurgeons guard the specialty fiercely but once we see that you’ve caught the bug, most of us will happily encourage and guide you into the field. Best of luck!

1)Training Requirements:

One of the potential disadvantages of becoming a neurosurgeon is the training requirements involved. Before you can start working as a neurosurgeon, you must go through a number of years of intense training. You have to start out in a pre-med program and then get into medical school. Medical school usually takes another four years to complete. After medical school, you must go through a surgical residency to become a neurosurgeon. This takes several more years to complete. By the time you become a neurosurgeon, you have spent many years in school and made a large financial investment.

2)Responsibility:

Another potential disadvantage of working as a neurosurgeon is the responsibility that comes with it. When you work as a neurosurgeon, you are dealing with people's spines and brains. One slight mistake could potentially cause major damage for your patient and could result in paralysis or death. This means that if you do not perform well every single day, you could end up hurting someone and their family significantly. This is one of the highest pressure jobs available in the medical field.

3) Schedule:

Even though most neurosurgeons strive to work on a particular schedule, this rarely can be adhered to. When you become a neurosurgeon, you are part of a very select group of surgeons. When someone needs surgery in this area, you can be called at any time day or night. This often results in the need to work many more hours than you would like to work. Working so many hours can put a strain on your personal life as well as your health.

4) Continuing Education

Another potential disadvantage of working as a neurosurgeon is the need to engage in continuing education. Since you are counted on to provide excellent care in this area, you have to keep up with the latest technology and medical advances. This often requires you to take extra courses and training in the proper areas. You also must read many medical journals and other documentation to stay up-to-date on these advances. This can consume a lot of your time.