I felt lost through some of the process, so I wanted to pass along a few words of advice and experience.  Hope this helps!

- Rising neurosurgery intern

General Advice on Neurosurgery:
- Let me first say that neurosurgery is absolutely the best field in medicine, and you have came to the right place!  (Kidding of course).  I really do think that neurosurgery is a unique specialty that most students just don’t have exposure to when career planning.  Since there is not I exposure to neurosurgery during med school, a lot of med students gain interest in the specialty late in the game (unless you already know that you want to pursue this field and make effort to gain more exposure).  I would venture to say that at least half of the students I met along the trial didn’t know they wanted to pursue neurosurgery until 3rd year.  I say this because, if this is you, its not too late!

- If you gain interest in the field and want to learn more, you need to get involved in your school’s department ASAP.  Since neurosurgery is such a SMALL field, everybody knows everybody.  And you need to know somebody. 

- Board scores, ah, that is what everyone wants to know.  Step 1 is HUGE.  I would say that Step 2 would not compensate for a bad Step 1.  The average this past year matched applicants average was 232, and unmatched 215.  That being said, there are applicants that match with scores below 220, they are just averages.  I know of applicants with 270s that didn’t match either.  Its not all just numbers.  If you have a lower score you need other areas in which you excel.

Research
- Since neurosurgery residency programs are all academic programs (with at least 1 year of research), having some sort of research interests in the field is almost a must.  I am not saying that you need to be published, I would say that most applicants are.  Talk to someone in the department, and they can try and find someway for you to get published, or at least get some research under your belt (clinical or basic science).  Getting published sounds like a huge task, but to be honest, its not all that difficulty (whether it be a case report, etc). 

- Its also good to have some research interest because you will likely have to give a grand rounds presentation on your neurosurgery rotations.  This also is a good conversation maker on your interviews.

Application:
- Since this is with the SF Match, it can be a really difficult and frustrating process.  Its partially electronic (meaning you type in the pdf and fax or email it back).  You really need to get all your application material in AS EARLY AS POSSIBLE.  I know the deadline is early (mid-August), so start working on it as early as you can.  You will be doing this process mostly alone, because the ERAS counterparts don’t have to start this early. 

- Call SF Match and bug them if needed to make sure your file is complete, and your app is sent out to the programs.  They have been known to make mistakes and it is ultimately your responsibility to make sure that everything has been done correctly.  They have made mistakes.  This year they dispatched applications to wrong schools, and I got invited for an interview to a school that I didn’t even apply to.

- How many to apply to?  I would say the average person applies to 20-30 programs.  I applied to 35 because I couldn’t make up my mind.  You can always make those narrowing down decisions when the interviews roll around.  PLEASE PLEASE PLEASE apply and interview to a variety of tiers of programs.  Just because you are a rock star, don’t apply to just the top 20 programs.  You need backups.

- ERAS, CAS, and NRMP, oh my!  OK so most neurosurgery programs are inclusive with the PGY-1.  No need to pay for the ERAS and do the application.  You only need to register with SFMatch (of course) and the NRMP.  Once you match, you will then rank your program #1 on the NRMP to match for the intern year.

- Send your rank list via fax EARLY.  Don’t wait until the last minute because, again, you want to make sure everything is received, etc.  I have heard horror stories.

Letters of Rec
- Ask for your letters of rec REALLY EARLY.  Don’t expect to ask for a letter and have it in a week.  This takes time, and ask for it a month or two early.  You can only submit 3 to CAS.  If you can get them all from neurosurgeons, that is great.  Have one from your programs chair.

- Most likely, there will be no time to get your away recs in time to submit to CAS. Still get one!!  Programs want to see that you are loved at other places too (your home program can brag on you, that’s great.  But in some ways, they almost HAVE to).  When you have these letters, you can do one of two things.  Ask to send it to all the programs you applied to (troublesome for the secretary, have some respect and address envelopes for them).  Or you can ask for the letter writer to send it to you, and you can dispatch them to the programs.  (I would suggest the latter).

Away Rotations:
- Bottom Line…..do one…..or two.  Of course you will do one at your home institution, which should be done in July. Do aways at places that you are interested in, and feel like you have a shot.  You can ask around and find out places that have good away rotations.  I would start looking in early March/April.  Spots fill.  See the letters of rec section regarding letters.

- Work your butt off on your aways.  This is your future, these 4 weeks are going to be like the rest of your life.  Work hard.  You dont have to be an expert of neurosurgery, and no one expects you to.  But people do expect you to work hard.  Help the residents out.  Know how to close.  Carry a Greenberg’s.  Dont be annoying.

Step 2CK:
- Don’t worry about having this done before the interviews.  There is no way you can have it in time to submit your score to CAS.  I can say if its not on your CAS application the first time, it will likely be overlooked.  I raced to have it done, and then emailed my score to all the programs, brought it to my interviews, etc.  Only 2-3 programs I interviews at even saw my score.  Like I said, no need to rush.

Interviews:
- How many to do?  Well, let me say that a lot of that wont be up to you.  There will be a lot of overlapping dates, and critical decisions will need to be made.  Stay organized.  I started out with 17 scheduled, and ended up with 14.  It would be in your favor to interview at least 10-12 places.

- Again, PLEASE interview at a variety of program tiers.  Don’t screw yourself.  Harvard, Hopkins, BNI are all awesome programs, but there is a limited amount of spots.  There are more rock stars than spots at those places.  You will be a neurosurgeon at any program you go to, and there are many great programs.

- I would schedule the interviews at places that you are really interested in at the MIDDLE of the interview season.  I felt like I was at my prime from my 4th – 8th interview, then I just got sick of it.

- Even if a programs spots are filled up on a particular day, take another day and be put on the wait list.  Hey, I matched at a place that I almost didn’t interview at (which ended up being my top choice).

- PLEASE CHECK YOUR EMAILS DAILY IF NOT HOURLY.  Once invitations roll in, all hell breaks loose.  Literally spots can be filled in just hours after invitations go out.  I sent an email trying to get an interview 3 hours after the email was sent out and it was full.  Again, stay organized!

- Not everyone reads your application, get over it.  I would say that at least half of the people I interviewed with did not read my app until I got in the room.  That’s your chance to show them who you are.  Be confident, don’t focus on your negatives.

- There will be some places that do things to mess with your head.  I placed the game Operation at Penn.  Spetzler at BNI asks people who play piano to play for him (he didn’t ask me to do any tricks, thank God).  Its all fun, and take it in stride.  Be calm.

- Send thank yous.  It doesn’t hurt, so do it.  As quickly after the interview as possible.  Most places rank the applicants immediately after the interview day.  Email or snail mail is fine.  You can send them to all the people you interviewed with (lengthy), or just to the program director and chairman.

MISC:
- Rank programs the way you want to match, not the way you think you will match.  Some programs call, some don’t.  Don’t let that influence your list.  Some people say don’t rank places you don’t want to go.  That is true, but always remember, would I rather go here, or not match at all?

- Gender issues – If you are female, remember, neurosurgery is for the most part still a man’s field (sadly).  There will be places that you will be the only female.  Don’t let this bother you.  You will get asked questions that you feel may be unethical.  If you are comfortable with yourself, this will show through.  Don’t be the one with a chip on your shoulder.  Things are changing in the field, for the better.

- The match is a crap shoot, there are always those stories you don’t want to hear.  Just be yourself, be comfortable, and apply to a variety of tiers.  There will be programs that you thought you may fit in, but don’t, and vice versa. 

- Second looks…..do some.  I would say go to your top 3 (if you didn’t rotate here).  You need to go there to see for yourself, and sometimes for them to see you.  Some places may say there is no need, but I would make time and go.  You don’t want to end up at a place that you don’t like for 7 years.  Interview days can be deceiving.

- To tell or not to tell?  I would say generally its not kosher to tell a program how you are ranking them.  Be discrete.  There are ways to get the point across without directly stating it.  However, some programs want to know if you are ranking them #1.  Its a toss up.

- Stereotypes.  There is the stereotype of the typical neurosurgeon.  Dont believe the hype. Its that way because a lot of people in the field are like that.  But again, it’s a stereotype.  I have met so many awesome, amazing people in this field.  You will meet so many amazing people on the trial.  Enjoy it!

- Early match has its benefits as well, while everyone else in your class is fretting over the match, you feel amazing in January.  Enjoy your 4th year!

GOOD LUCK!!!!

after that excellent advice, ill leave a comment just to agree with pretty much everything except for:
-didnt do any 2nd looks, but if you do would reiterate doing these only for your own rank list, not the programs’
-probably not a bad idea to let the program you have #1 know it, and maybe let the next 1 or 2 know they will be “whatever great way of saying ranked highly” that you feel comfortable with

-rising intern to where i wanted

Hey Sun, Spine thanks. The advice is really really good. One more question though guys. As far as letters of recommendation go, how many should we place in our application initially and how many can we add? I’m one of the kids ready to hand in an application in June.

Also, is there any way to retrieve demographic stats on different residency programs ???

Thanks a lot for all the advice, spine! I saved your post on my hard drive and can’t wait to read it again (particularly, the interview part) in a few years when I’m a seasoned medical student. Once again, thanks, and I appreciate the time you took to write it.

This stuff is great!  You should put it in our Wiki (hint hint).

As for letters of recommendation, I like three.  One from your home chairman, one from your away rotation chairperson, and a third one.  If you do more than one away rotation, you should get a letter from that chairman, without exception.  An away rotation without a letter from the chairman looks very suspicious.  And not to state the obvious, a letter from your non-neurosurgery family friend is worth squat, unless his name is Bill Frist or Dr. Phil…

How important is it to have a letter from your home chairman?

In my case, my home institution does not have neurosurgery residency, so I plan on doing 3 away electives. I don’t know the chairman very well, but I do have a much closer relationship with another neurosurgery faculty who offered to write me a letter (after I have been on a few cases with him while on other rotations).

Thanks for your help!

tachytea - 19 April 2007 12:39 AM

How important is it to have a letter from your home chairman?

In my case, my home institution does not have neurosurgery residency, so I plan on doing 3 away electives. I don’t know the chairman very well, but I do have a much closer relationship with another neurosurgery faculty who offered to write me a letter (after I have been on a few cases with him while on other rotations).

Thanks for your help!

It would be very important to have a letter from your chairman whether or not there is a residency program.  Your chairman may not know you but can consult with the other faculty to write your letter.  It’s just one of those things that are necessary.

Mark - 18 April 2007 10:37 PM

This stuff is great!  You should put it in our Wiki (hint hint).

I just added it to the wiki, after much struggle to figure out how to add a file.  =(

Mark - 18 April 2007 10:37 PM

As for letters of recommendation, I like three.  One from your home chairman, one from your away rotation chairperson, and a third one.  If you do more than one away rotation, you should get a letter from that chairman, without exception.  An away rotation without a letter from the chairman looks very suspicious.  And not to state the obvious, a letter from your non-neurosurgery family friend is worth squat, unless his name is Bill Frist or Dr. Phil…

What do you suggest for mudphuds that do two away rotations?  Clearly a letter from one’s PI is necessary.  Should four letters be sent or would leaving out one of the Sub-I chairmen be okay under these circumstances?

MS2.5 - 24 April 2007 10:24 AM

Mark - 18 April 2007 10:37 PM

As for letters of recommendation, I like three.  One from your home chairman, one from your away rotation chairperson, and a third one.  If you do more than one away rotation, you should get a letter from that chairman, without exception.  An away rotation without a letter from the chairman looks very suspicious.  And not to state the obvious, a letter from your non-neurosurgery family friend is worth squat, unless his name is Bill Frist or Dr. Phil…

What do you suggest for mudphuds that do two away rotations?  Clearly a letter from one’s PI is necessary.  Should four letters be sent or would leaving out one of the Sub-I chairmen be okay under these circumstances?

Unless your PI is a neurosurgeon, no one cares abot a letter from some guy in basic science or some other specialty.  Chair letters (in NS) trump these easily.  Your publications will speak of your research abilities.

MuDPhuD - 25 April 2007 08:42 AM

Unless your PI is a neurosurgeon, no one cares abot a letter from some guy in basic science or some other specialty.  Chair letters (in NS) trump these easily.  Your publications will speak of your research abilities.

Interesting.  I had been told quite the contrary (i.e. lack of a letter from someone I worked with for years would be a red flag); thanks for the perspective.  Do others agree with this view?

As a general rule of thumb, a letter of recommendation from a neurosurgeon is much more valuable than a letter from any other person who may know you.  It’s hard to imagine that anyone reviewing your application will consider a non-neurosurgeon as qualified to evaluate your qualifications to be a neurosurgeon.

In this field, as you already know, letters from chairs are gold to the applicant (if they’re good/great). If you can, you BETTER get a really good LOR!!!

That’s harder to answer.  My opinion is that a letter from your family friend would probably be useful at the program where they were previously chair, and probably also at programs where surgeons they trained are currently chairmen/program directors/full professors.

FWIW, I sent a total of five letters when I went through the process and no one seemed to complain.  My first three letters were from the neurosurgeons at my medical school and were sent early with the match package.  I then got a letter from Dr. Spetzler (actually written by his then chief Jeff Henn) and a letter from Dr. Sampson after I did my sub-I’s in Phoenix and Dallas.  Those later letters I asked the secretary/coordinator to send to my undergrad alma mater’s career office, since they offer the service of being a repository for letters of recommendation.  They were willing to copy and promptly forward those to the individual programs that I requested, and they also allowed me the option of waiving my right to review the letter myself and included a statement to that effect with the letters.

I also applied to nearly 40 programs, scheduled 17, made it to 16, and spent nearly $10k.  It’s tough to guess where you’ll end up liking, but for what it’s worth, my early favorite was also my last interview (in January) and was where I ended up matching.  In retrospect I think I could have pared down my interview schedule by removing the programs that had a famous university name attached to them, but weren’t really much to talk about from a neurosurgical perspective.  I also could have been more honest with myself about what kind of place I was willing to live in.

For me, interviewing was really alot of fun.  Much better than interviewing for med school.  And it was great to meet many wonderful people on the trail as well as some neurosurgical celebrities.  Enjoy it, it shows if you’re comfortable and having fun.