Show points ranking of top five with columns representing the points, the height of which is proportional to their ranking(like bar graphs). Refer to spread sheet and use the total points in each category Neurosurgery candidates are top students, with very high Step 1 and Step 2 scores, generally only a few points below the average dermatology orplastic surgery matriculants. But what truly sets ,neurosurgery applicants apart is their research.The average matriculant in 2018 pumped outover 18 publications, abstracts, or presentations by the time they applied to residency. In comparison, plastic surgery and dermatology were at 14 with orthopedic surgery at 10. Most other specialties didn 't even break 7.

Why the focus on research in neurosurgery?Neurosurgery is a highly academic field, likely due to the fact that there is so much room to

improve outcomes in patients. Residencies want to train surgeon scientists who will advance

the field. While treatment modalities and

outcomes have improved drastically in the past 20-30 years, there are several pathologies with bleak outcomes. For example, glioblastom a multiforme, or GBM for short, had an average prognosis of about 5 months over a century

ago. Despite all the technological advancement since, these days, even after aggressive surgery,radiation and chemotherapy, median survivalhas improved to only 14-16 months Medical students that end up applying to neurosurgery are a unique bunch and are a self-selecting group. They take the meaning of work a holicto the next level. The award for most brutal and rigorous residency, even amongst surgical residencies, is usually reserved for neurosurgery.Despite the 80 hour work week restrictions enacted by the ACGME, it 's not uncommon to see neurosurgery residents exceeding these limits repeatedly. The good news is that as anattending, the days of working 90 hour weeksare now behind you, but that won 't always bethe case in residency.

After completing residency, you can practiceas a general neurosurgeon, or choose to

sub-specialize further with fellowship.

Skull-base is primarily concerned with tumors that grow along the base of the skull, which is not oriously high end real estate. It's a shrinking field, mainly because less invasive options like

radiosurgery and end ovascular procedures are becoming more sophisticated and appealing for patients, but it's still an appealing subspecialty.Those with the best hands and stamina for 18hour-plus surgeries go here. It's a young man's game.

Neurovascular is highly technical, dealing with aneurysms, hemorrhagic strokes, and

by passing blockages in the brain. Call schedule is brutal, attracting those who are gluttons for punishment.

Outcomes can sometimes be particularly grim,which can take a toll over the course of one's career. You'll need а strong stomach.

Functional and stereotactic surgery deals with modulating the electrical circuitry of the brain.These are the nerds of the nerds, usually with PhD's after their name or computer science backgrounds.

Spine is for the jocks and ortho bros. There's a great deal of bony work, thus requiring а higher degree of strength and on average less finesse than other aspects of neurosurgery.

Pediatrics is for the neurosurgeons who are best at dealing with parents. A strong stomach is prerequisite as children needing neurosurgical intervention generally don 't have rosy outcomes.Peripheral nerve is perhaps the smallest subspecialty within neurosurgery, partly because it's not exclusive to neurosurgeons (you can get there through orthopedics or plastic surgery).It's for surgeons who enjoy operating all over the body, since the peripheral nervous system exists everywhere outside of the brain and spinalcord.

Surgical neuro-oncology tends to attract

surgeons with an interest in tumor biology.These surgeons may spend up to half of their time in the research lab, studying additional methods for tumor treatment beyond simple surgical resection. This 1S because а large subset of brain tumors don't respond to just surgical resection (like GBM).

Trauma/neurocritical care is for those surgeons who wish to focus on the multi-disciplinary

treatment of patients with traumatic neurological injuries. Beyond performing life saving surgeries, these folks are interested in the longer-term post-operative recovery process for patients suffering from TBI, spinal cord injury,a neurysm rupture or hemorrhagic stroke.

As а neurosurgeon, you'll be working on

arguably the most fascinating and mysterious organ of the body the brain. Psychiatrists

and neurologists deal with the brain as well, but in a non-surgical capacity. You 'll get to touch,change, and augment the central nervous system right in front of you, in real time.

It's a highly innovative field, particularly the subspecialty of functional neurosurgery, where the line is blurred between what is you and

what 1s hardware. It raises questions about free i will, consciousness, and other questions that are bound to keep you up late at night.

Only a few specialties truly save people 's lives.

Neurosurgery is one of them. At a

moment 's notice, you may be called in and rush to the hospital to save someone's life. While the surgeries may become routine, the feeling of saving someone 's life never will.

Trauma and emergency medicine are some other specialties that share this aspect.

Neurological surgery is a highly academic field,satisfying even the most intellectually curious.You'll be surrounded by driven and truly

impressive colleagues cut from the same cloth.

To quote my neurosurgery friend, not to say we're better than everyone, but we are." He's joking of course, but only a little.

As a doctor, you normally need to choose

between honing surgical expertise and foregoing medical management, or vice versa. That' s one thing I didn't enjoy about plastic surgery. I wasn't managing patients medically so much,just more SO surgically. As a neurosurgeon,you'll be handling the medical side of things quite intensivelytitrating sedatives to adjust for intracranial pressure abnormalities, adjusting ventilator settings, and reading EEG's to see if someone is seizing. You won 't quite be a cardiothoracic surgeon, who are the most badass in terms of medical management while being surgeons, but you won 't miss the medical side of med1c1ne .

In medical school, I rotated on orthopedic

surgery, plastic surgery, and neurosurgery,the three specialties I was considering most

seriously. One thing I loved about neurosurgery were the personalities. Some of the funniest

and coolest surgeons I worked with were

neurosurgeons.

This isn't uncommon. The field is very

humbling, and despite the stereotype,

neurosurgeons are faced daily with the reality that they are not god. You can 't take yourself too seriously and you' ll need to learn to laugh at yourself, otherwise you won 't last.

There were two main factors that pushed me away from neurosurgery, despite my love for neuroscience and fascination with the brain.

First, think about the types of patients that need neurosurgical intervention. They're very sick and can often have poor outcomes.

Many of your patients will succumb to immense

suffering or death. That may not sound so bad right now, but day after day, year after year, that sort of heaviness will weigh on you.

The other thing that pushed me away from

neurosurgery was learning that it wasn't

as precise and meticulous as I would have expected brain surgery to be. Certain aspects are highly precise, like skull-base, but much of neurosurgery is surprisingly crude and more similar to orthopedic surgery than something like plastic surgery.

But wait, there 's more. Neurosurgeons face one of the most challenging life styles of any

specialty, even beyond residency. That's because in addition to scheduled cases,

you 'll need to take neurosurgery trauma call. In medicine,we say that neurosurgeons make the most money, but don 't have any time to enjoy it. Themedian salary is $680,000 per year, and they 're consistently number 1 or number 2 1n terms of highest paid specialty, duking it out with orthopedic spine surgeons.

The field is 92% men. While not as bad as orthopedic surgery, it'S one of the most male dominated specialties, although that is slowly changing.

The neurosurgeon stereotype comes with good and bad. For online dating apps, it's great, but beyond that, the stereotype is difficult to deal with in the hospital. Others expect you to have а god complex, to be an asshole, egotistical,emotionless, or even sociopathic.

At this point, you'll know whether or not

neurosurgery is right for you. It's a highly self-selecting group of people. Obviously, you need to enjoy the practice of surgery and have deep intellectual curiosity for the brain and mind.But beyond that, you need to really want it

more than anything else. You'll need incredible stamina to endure a brutal 7 year residency and continue to work challenging and unpredictable hours as an attending.

The stakes are high, and there's a consistently high sphincter tone and level of vigilance.

That 's because, so often, patients with

neurological injuries can be incredibly

hard to monitor. A patient in acute organ failure, mid-heart-attack, or exsanguinating during a trauma can be hard to ignore. But

in neurosurgery, potentially devastating

neurological complications - such as а stroke or а brain bleed - can occur with scary subtlety.Being on top of the ball is a must.

If you' re all about that, you' 'll certainly get theexcitement and rush from the unpredictabilityof trauma. You'll also get the highly technicalaspect of something like plastic surgery.

If you take deep pride in your work and have perfectionistic tendencies, neurosurgery may be a good fit.​​​​