So, You Want to Be a Neurosurgeon
Zachary Litvack, MD’03

The field of Neurosurgery is probably the youngest and most rapidly evolving of the surgical sub-specialties. Neurosurgeons care for patients from all age groups – whether it be in utero surgery to repair Spina Bifida defects, or functional surgery to relieve the symptoms of neurodegenerative diseases which strike at the end of life. There are currently five sub-specialties within Neurosurgery: Tumor, Cerebrovascular, Skull-Base, Spine and Pediatrics. Furthermore, the specialties of Neurointerventional and Neuroradiosurgery are quickly becoming foci of entire careers. Most importantly, given the relative infancy of all these specialties, the “general” neurosurgeon may operate in any or all of these areas on any given day. Neurosurgery is a tertiary care specialty – it requires the support of many departments within a major medical center, and consults for nearly every other service in the hospital. I was drawn to Neurosurgery due to the system involved (the brain), my desire to remain in academic medicine, and my desire to enter a field where there is still a lot of good work left to be done. And, they have really cool toys in the operating room.

There is no core rotation in Neurosurgery, but you have to have completed Medicine and General Surgery before you are allowed to rotate on service. I therefore did Medicine Q2, and Surgery Q3. I actually rotated on service in May (end of Q4) after doing a radiology elective. I felt that this was adequate preparation for the rotation. If you are not confident in your pre-clinical knowledge of neurology, I would recommend a month of Neurology before rotating on service.

Away rotations in Neurosurgery are tremendously important. The field is small enough that nearly everyone knows everyone. So, the goal of the away rotation is to sell yourself to one or two programs to guarantee an interview when the time comes, and to obtain letter(s) of recommendation from Really Important Persons™. I did my rotation in June. I was planning on one for July, but I made a late request (May) and it didn’t go through. I would recommend planning your away rotations no later than March, if possible. The timing of the rotations is to get your letters by the middle of August.

The time-line for matching is different for Neurosurgery, as they participate in the San Francisco Match. (http://www.sfmatch.org) This match occurs at the end of January, and there is no Black Monday. Applications are accepted the last week of August, and SF Match provides a central application service. The forms are all available online. You can apply to 10 programs without extra charge. Most people apply to 20-30 programs, with the goal of getting 10-12 interviews. This year, the average number of interviews was 10. Invitations for interviews are sent out between September and November. All interviews occur on a Fri/Sat or Sun/Mon, with some exceptions. Unfortunately, trying to geographically co-ordinate interviews is next to impossible as the invitations seem to come at random. Rank lists are due the third week of January.

There are two major aspects of being a competitive applicant – grades/scores and research. On average, a matched applicant has Step 1 scores two standard deviations above the norm (>235). They are almost always Honors/AOA. As far as research goes, papers are nice, but spending a large amount of time in one lab over the course of medical school is probably more beneficial. This will provide you with a letter of recommendation from someone who knows you better than most of your letter writers, and can truly comment on your ability to do research (rather than your ability to write).

Once you’ve accomplished all these things, you will hit the interview trail. Like I said before, these are usually two day interviews. The first day is an informal introduction to the program, and then a nice dinner with the residents. Be Careful! The dinner is really reconnaissance to find out what you are like with your guard down. The next day is filled with tours and interviews (at least four). You will end up interviewing with the majority of the department, including research faculty. The most important interviews are the Chairman, and the Program Director. The others can help or hurt you. However, these two have veto-power over the other recommendations (for the most part).

I took a very pragmatic approach to my interviews/visits. I knew that the training was mostly the same, regardless of the programs at which I was looking. So, my priorities were : Do I like the hospital? Do I like the other residents? Could I see myself living in that city? Could I tolerate the characters of the faculty? Are the residents happy? Etc…

I hope this helps you with your decision of whether or not, or how to pursue a career in Neurosurgery. Feel free to look me up at Oregon Health Sciences to ask questions, or let me know if you’re coming to visit.

Zach Litvack MD
zlitvack@yahoo.com
Brown Medical School ‘03