Turf Wars

[Guest]

Are there any turf wars that are currently occurring or some that might occur in the future? Which pose the biggest threat to neurosurgery? On a scale from 1-10, how safe is neurosurgery from their turf being yanked from beneath them?

[Guest]

Endovascular is the obvious choice here. 3 specialties feeding into the field, each with their own training programs, churning out a ton of INR folks. The recent thrombectomy trials mean that every podunk hospital in the US will want to be a stroke center and therefore needs INR trained folks, and there just aren't enough neurosurgeons out there to foot the bill.

Spine is the other, although NSGY is now doing a better job of training fellows in the orthopedic ways of thinking (Even started appearing on boards recently). The inevitable formation of a spine-specific residency & board is coming soon.

I'll also throw in acoustics, which are often being managed by ENTs and rad onc guys without ever seeing a neurosurgeon. Especially in rural areas. We'll just be left with the gigantic ones that come in thru the ER.

[Guest]

So what will neurosurgeons be left with?

[Guest]

(07-08-2018, 03:35 PM)Guest Wrote: So what will neurosurgeons be left with?

Everything else that neurosurgeons do...

Brain and spine tumors (ortho guys won't touch anything intradural); vascular malformations like AVMs and some aneurysms that can't be done endovascularly; all the functional procedures like DBS, SCS, baclofen pumps, temporal lobectomies, vagal nerve stimulators etc; Shunts/ETVs; head/spine trauma (not a small number of cases by any means); all of the peripheral nerve surgeries (not just carpal tunnels); all this stuff in Pediatrics.... this is assuming spine surgeries completely go to ortho and IR takes over all aneurysms, which is not the case.

Spine is a massive, massive amount of cases. Even if it's split down the middle between ortho and neurosurgery there's still enough to go around. 

Endovascular is also another area where neurosurgeons are becoming more involved. There's becoming an increasing amount of neurosurgeons trained in both endovascular and open vascular procedures who can treat aneurysms both ways which if you ask me is the ideal surgeon for the job.

In summary, there's a whole lot left for neurosurgeons to do, and the demand for them will always be high. The only thing you need to worry about is if you have your heart set on clipping aneurysms then you're kind of shit out of luck.

[Guest]

if spine was its own specialty, more than half the people on this forum would be doing that

[Don]

Spine is an inherent part of our training, and the major revenue-maker for most of our programs. We get trained for 7 years with at least 60-70% of our cases in our ACGME case log being spine cases. And with an aging population in the US, spine is here to stay.

Saying spine is going to be taken from neurosurgeons and becoming a separate specialty is like saying joint replacement is going to leave orthopedics and become its own specialty.

If you like spine (or endovascular), train in them and excel in them. There is no comparison between someone who is trained for 7 years in spine surgery (and usually with a 1-year in-folded or post-residency fellowship) and someone who does 6 months during his/her residency and then 1-2 years of fellowship after.

Similarly, for endovascular, there is no comparison between someone who can treat a stroke patient as he enters the hospital via a thrombectomy, treat its complications:
- edema: decompressive craniectomy (with cranioplasty later on)
- hydrocephalus: EVD and later on shunt, if needed
- ICH: evacuation
.....etc, and anyone else who can only do a thrombectomy

Any hospital that wants to be a stroke center, will still need a neurosurgeon to be able to fully address the full spectrum of stroke and other vascular complications. For aneurysms, you will have the luxury of choice between endovascular and open vascular depending on the specific needs of the patient. Other specialties doing INR can't claim this.

We are in a privileged specialty, and we need to stop worrying about others taking our jobs, because they can't. Let's focus on being more efficient and patient-oriented.

[Guest]

You cannot have a level 1 trauma center without a neurosurgeon. Period

[Guest]

I have also heard that neurosurgeon pay,in general, will decrease. Why will this happen and how low will it go?

[Guest]

^^^
I have the same question. Looking for an answer as well...