Has anyone else read that article by Lawton in the current Neurosurgey looking for characteristics that predict whether people go into academics vs. private.  For a “academic” training program like UCSF, only half end up in academia. 

There is an interesting discussion on views towards academics vs. private in training programs.  It should be of interest to people here since it seems all medical students claim they want to go academic, but the reality is most do not at the end of it all.

By the same token, flip to the back and look at the jobs advertised.  Most positions out there are in private practice.  The reality is that there are not enough academic positions out there to accomodate even a third of the trainee graduated each year.  So are chairmen and PD’s really just deluding themselves when they claim they only want to train academic neurosurgeons?

great article by mike lawton.  for you medical students out there, check out the table on the stats of students who sucessfully matched at UCSF for neurosurgery.

any residents/attendings/students want to comment on the article?

This article is great. To be more generalizable to the neurosurgical applicant pool it would have been beneficial to have profiled more programs. It definitely isn’t what you’d expect though. Thanks Ken (looks like it’s from Neurosurgery).

here’s the reference:

Lawton, Michael T. M.D.; Narvid, Jared M.D.; Quinones-Hinojosa, Alfredo M.D.  PREDICTORS OF NEUROSURGICAL CAREER CHOICE AMONG RESIDENTS AND RESIDENCY APPLICANTS. Neurosurgery. 60(5):934-939, May 2007.

On a non-related note, Lawton is a chair in the making and may be one of the most technically gifted neurosurgeons in the world. When he operates, it’s like watching Mozart compose or Lang Lang play the piano.

It’s good an article like this is available also b/c it kind of erases the notion that a lot of kids know what they’d like to sub-specialize in once done training.

Guest - 08 May 2007 05:21 PM

On a non-related note, Lawton is a chair in the making and may be one of the most technically gifted neurosurgeons in the world. When he operates, it’s like watching Mozart compose or Lang Lang play the piano.

I prefer to say like Ron Jeremy in a porno

I think the value of this article is that it comes from a highly academic program.  In effect, they are stating that even in a residency that places such emphasis on academics, only half of their graduates end up in academics.  This article does not seem self serving, but maybe should be an eye opener to programs as to the realities out there.

Training is long.  People’s family situations, needs, and wants will change over time.  Training programs should recognize that.  As a recent graduate, when I was looking at jobs, the mention of going into private practice was if not looked at with disdain by the faculty, at least you were treated as a second class citizen.  Chairmen and PD’s like to see their trainees go into academia because it propagates their legacies.  This may not be the best interest of the trainee though. 

The emphasis on academia is hypocritical of neurosurgery.  On one hand the senior leadership wants to have their trainees go into academia.  On the other, they do not want general/trauma surgeons to do emergent cranis for trauma.  So unless they open more academic centers out there, how are neurosurgeons supposed to meet the needs of the population. 

In the end, there are many more private positions out there are academic.  For that matter, most academic practices are becoming more like private practices.  When you get to the negotiation stage of looking for jobs, they will talk to you about targets for number of cases you do and billings.  Things like teaching and research will get little attention.  So in the end, many of these academic centers ask you to have the same practice you would have in private, but require you to work longer hours and pay you less.

Until residencies accept the realities of the communities needs and the market, applicants for residencies are expected to present a uniform picture that in no way reflects what comes out at the end of training.  In my opinion this does not reflect any disingeniuos intentions on the students part as much as it does delusions on the training programs.

The above post is correct in pointing out that applicants are expected to be interested in academia, or at least undecided about academia vs private practice.  However I met a number of fellow applicants this year who knew very clearly that they wanted to go into private practice, and were certainly open with their fellow students about the fact that, as far as any of their interviewers were concerned, they were 100% determined to go into academia.

Several of them matched at top academic programs.

It’s certainly possible that they will change their mind over the course of residency and end up in academia.  But contrary to the above poster’s impression, there is quite a bit of disingenuous behavior about this issue on the trail.

I think that both of the above 2 posts are right in many ways. Assuming UCSF only matches people with a strong and explicit interest in academics, this excellent article shows that over half of their residents lied or changed their minds. I’m sure there’s some of both going on, as there is in every program.

It is sort of a paradox about the interview circuit that we sit in lobbies and talk to each other about private practices, or more likely, how we’re completely undecided because we’re 4th year med students and haven’t had any exposure to PP at all. Then we go in to the chairman’s office and tell him we want to sit in his chair someday.

It’s really a shame that more chairmen and PD’s aren’t open to candidates’ preferences during the interview. During my interviews I would have loved to sit there and say that I will probably be one of the 85% of NS grads to go into private practice. I think there are several forward-thinking chairs and PD’s that are happy with a mix of residents, and it’s the mark of a well-rounded program that can put competent people into PP or academics.