“It’s supposed to be hard. If it were easy, everyone would do it.” - Tom Hanks in A League of Their Own
"What begins as a failure of the imagination ends as a market inefficiency: when you rule out an entire class of people from doing a job simply by their appearance, you are less likely to find the right person for the job." - Michael Lewis in Moneyball
I am actually not a huge baseball fan but these two quotes resonate when thinking about my career choice. A career in neurosurgery is not for the meek, especially for women, who account for 6% of active board-certified neurosurgeons. When I interviewed for residency, I was usually the only woman in a sea of men. Like some of the baseball players in Moneyball, I didn’t have the “look” but I had the skills and the intellect. While the path to enter the neurosurgery world is challenging and the practice of neurosurgery humbling, being a neurosurgeon is pretty amazing!
Why choose neurosurgery?
1. Neuroscience is fascinating. The nervous system finesses chemistry and electricity into incredible, elegant processes that make us who we are. Language, visual perception, memory, imagination, athletic prowess are all reliant on our functioning nervous system. When these systems stop working properly, the diagnostic puzzle is not as easy as looking at an xray or a lab test. Solving these puzzles through history and exam is incredibly satisfying. So why not be a neurologist? True, neurologists are some of the brightest physicians, and most clever of diagnosticians. That brings us to #2.
2. You love operating. For those of us who are less patient, the interventions of neurology are not as gratifying as surgery. Like many others have noted, there are those who feel at home in the operating room with their hands inside someone else’s person and those who would rather work from the outside. The operating room is my favorite place to be (actually a three-way tie with my bed and enjoying a meal with my family). The camaraderie of the team, the focus on solving one problem, the satisfaction of physically removing a tumor, or disc, or relieving compression of the spinal cord all make my day. I feel most relaxed in my OR. Now, one of the techs in the OR and a PA recently told me that, SOMETIMES, the OR staff will humor the surgeon to make the day go smoothly. For years I was under the impression that everyone loved working in my room and that all my jokes were funny! Given the choice between a day in the OR or a day in the clinic, it is a no-brainer, so to speak. While I really enjoy my patients, I still find the clinic to feel like what my general surgery colleague calls the “penalty box.”
3. It is thrilling when a neurologic deficit improves after surgery. When a patient could not raise her leg off the hospital bed before surgery, then raises it in the recovery room, I want to do a backflip. (This in not wise, however, as my gymnastics days ended decades ago.) A long slog of a clinic day can completely turn around when a person brings in a list of the things he can do now that I have taken the pressure off his spinal cord.
4. The neurosurgery community is small, creating a unique sense of fellowship. When neurosurgeons get together we can do a “Six degrees of Kevin Bacon” game to find colleagues we have in common. This creates a great platform for collaboration. True we are the nerdiest of the nerds, but it is good to have a tribe.
Bad reasons to choose neurosurgery:
1. Lifestyle. Neurosurgery is not a lifestyle specialty. Period. You can believe that after the grueling residency is over that it will be a piece of cake. This is false. It does get easier as you practice longer, because as you work through many complex life-threatening situations and lost causes, your comfort level improves. No matter how many years in practice, though, some days you will end up operating on people who have little chance of surviving and delivering devastating news in the wee hours of the morning to families who do not deserve it. And then you will carry on with the next day’s schedule. Call tends to go on until retirement and this can interfere with sleep, holidays, weekends, soccer matches, homework, and conversations with your spouse. Without stars on the items in the positive column above, this can be relatively taxing on the soul.
2. Money. Neurosurgeons are compensated very well for doctors. There are many specialists who would find that unfair. However, see number one. “If it were easy, everyone would do it.” There are probably easier ways to improve your bank account, such as investment banking, law, working for Microsoft (these people seem to make us Washington neurosurgeons seem decidedly middle class). Yes, the compensation is good, but if you do not love what you are doing, the intensity will quickly generate burnout.
3. You want to impress people. Honestly, once I tell someone I am a neurosurgeon, they are not sure what to say. I often just tell people “I am a surgeon,” or “I work at the hospital,” or “I cut hair”. Among other women, there is some distancing that happens when you disclose that you are a neurosurgeon. I am not exactly sure the explanation for this. My best girlfriends are either other medical people or became my friends before they knew what I do for a living.
Once you’ve decided on neurosurgery, all I can say is dive in. Immerse yourself completely. Embrace the experience of the training. It is long, but it may be some of the best years, or at least most memorable years of your life. How to secure a residency spot and how to get through training are topics for another day, but I would love to expand on them for anyone interested. After training I went through about a year of euphoria, having reached delayed adulthood. Since then I have managed to ride the rollercoaster that is practicing neurosurgery while going through the other things that many women do. I have an amazing husband who is in support of my habit and, even better, works as a software engineer. My residency chairman told me recently that the key to a woman succeeding in neurosurgery is to have a Matt. I have found raising two daughters to be as challenging and gratifying as neurosurgery residency but longer. I do have a life outside work that includes being on the soccer boosters, cycling many miles, helping with homework, learning piano, and date nights. The key to this is being an absolute control freak with my time!
It is a rollercoaster, but I prefer the roller-coaster to the merry-go-round.
Barbara Lazio, MD, FAANS