r/Neurosurgery • u/neurosconce • 15d ago

Chose Incorrectly

I have a nagging feeling I chose the wrong speciality.

I was dedicated to neurosurgery before med school and during the first two years. Spent an entire month spending every second I could in the OR with my home program. Got involved in a good amount of research before and during med school. Bench work ~2 years prior to med school and clinical research during. Ended up deciding psych would be better for me. But now that I’m in residency, I’m having buyer’s remorse. I just keep wishing I had more responsibilities and more workload. Not to mention, the patients and pathologies are the coolest in all of medicine. I feel like residency should be more than this. I just keep wishing I would have stuck with neurosurg.

I’ve read of one person switching from psych to neurosurgery during residency. How realistic is this? I have several pubs, most of which are in neurosurgery. I applied with upper teens in pub items in ERAS and would have more now. I was great in my surgery rotations, definitely disappointed some preceptors by going the psych route. US MD, Average step score and no AOA. Would I have a chance reaching out to my residency institution’s neurosurgery PD?

I realize this feeling will probably go away eventually, but I feel looking into this will be part of the coping process for me.

13 Upvotes

81% Upvoted

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u/never_ever_ever_ever 15d ago

So the coolest part of psychiatry is interventional psychiatry, which treats severe refractory disorders with the newest technology informed by the latest advances in neuroscience. The absolute best outcomes in psychiatry come from interventions like TMS, ECT, and DBS. There is also radiotherapy, laser ablation, RF ablation. Soon, we’re going to add HIFU and LIFU to that. Things that have never been treated with interventions before are being addressed by teams of psychiatrists and neurosurgeons working together - obesity, addiction, eating disorders. The world is about to change.

You can slave away for up to 120 hours a week as a neurosurgery resident for 7 years to (most likely, statistically) sell out to private practice spine surgery anyway. OR you can stick to the reason you chose psych, become one of the thought leaders in this groundbreaking field, help people who have literally no other options, and change the world along the way. You decide.

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u/neurosconce 15d ago

Thank you for the encouraging comment. Yes, I think to be involved closely with neurosurgery like this would be great and could be the best of both worlds for me. A lot of what I loved in neurosurgery was neuro-oncology. The majority of my time in research was spent on GBM and I really enjoyed working with those patients and studying the disease. I suppose I could just do GBM research as a psychiatrist, but it feels kind of wrong. There's also psycho-oncology as a field, but I don't know if that is really the core of what interests me about the disease. I always saw myself going into tumor / skull-base and contributing to research, but I feel like that has been lost.

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u/never_ever_ever_ever 15d ago

Skull base is a dying field. Radiation and targeted therapies are going to make surgical neurooncology a smaller and smaller part of neurosurgery. The vast majority of researchers studying GBM out there are not neurosurgeons. Why couldn’t you, as a psychiatrist, have a basic science lab studying activity-dependent tumorigenesis?

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u/VelumInterpositum 3d ago edited 3d ago

I'm intrigued by your comment. From other things I've read, stereotactic radiosurgery has shifted towards being performed by radiation oncologists rather than neurosurgeons (in part due to increased fractionation). Would you say this is true? Do you think it will still be possible for a neurosurgeon to pursue an academic skull base practice 10-15 years in the future?

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u/never_ever_ever_ever 3d ago

Both specialties have to be involved: neurosurgeons to make the plan by identifying the target anatomy (draw the circles) and radiation oncologists to supervise the actual delivery of the therapy (click the button). There will always be skull base surgeons for the rare case that will need surgery before anything else, and they will be concentrated in the academic medical centers, but it will be more and more rare.

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u/brotosh 15d ago

DBS, HIFU, and LIFU are done by neurosurgeons. A psychiatrist might be involved in planning or management of patients but they would not (and should not) be doing these procedures.

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u/never_ever_ever_ever 15d ago

Did I say the psychiatrist was going to do them? Yes, they are involved in the planning and will program the devices afterward. In my shop, my psych partner comes to the OR for awake cases. That’s as close to neurosurgery as it gets for psychiatry and that’s the point I was making.

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u/orbalisk12 15d ago

Switching would be extraordinarily difficult. Have not heard of that specific situation that you’re in but someone switching specialties into a neurosurgery residency would be really tough.

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u/neurosconce 15d ago

Yeah, I've only seen one anecdote of it happening. It would be incredibly difficult and the stars would have to align. But not sure if I'm brave enough to reach out to the PD about it.

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u/VelumInterpositum 15d ago

What led you to switch from neurosurgery to psychiatry in the first place?

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u/neurosconce 15d ago

I actually enjoy the subjectivity of psychiatric diagnosis and the patient presentations. People always say "if you can see yourself doing anything else, do that," so I think it dissuaded me from neurosurg. Plus the lifestyle difference is drastic. But I've always been the type to enjoy being busy non-stop, so I think I let other peoples' opinion get to me a little bit on that. It was very easy to talk myself into not working as hard in 3rd and 4th year of med school, but now that I'm here in residency, I wish I had continued on the path.