It is clear that the consensus amongst posters on this site is that neurosurgery is not an ideal field for a physician-scientist.  Indeed, there are some who vehemently believe a desire to be a neurosurgeon and basic scientist is downright ridiculous.  Even sympathizers of the career choice are quick to point out the difficulty of such a path, the disadvantages, and the possible handicaps that result.  Yet even oponents quickly remark, for example, that “your PhD will help you come match time...”

So, will anyone offer an opinion as to why having both degrees helps one match?  Is it simply that we are viewed as hard workers--individuals proven to remain committed to long training protocols?  Or do academic centers really want academically driven trainees with a committment to research?  Are there any who think that the current ruling generation of this field will be replaced by individuals who place less value on the dual degree?

An informative discussion would be much appreciated.

the point is not that neurosurgery isn’t an ideal field for the physician-scientist.  the point is that as neurosurgery as a field increases in breadth and scope, it is becoming increasingly difficulty to stay active and productive in both arenas.  in our field, there are surgeons who are primarily surgeons and there are surgeons who are primarily researchers.  the majority dabble in both but to find someone who is top gun in both is fairly rare.  to develop the technical expertise and clinical acumen seen in surgeons with “gifted hands” requires a high volume of cases.  to get a high volume of cases, you need to have lots of clinic patients, which means lots of clinic time.  if you have an R01 that requires you to be in the lab more than 50% of your week, it will be hard to build that high-volume practice.  again, this is describing the so-called “traditional” model of the surgeon-scientist who prefers to publish in journals such as science and nature.

that being said, there are plenty of surgeons who conduct clinical research or even translational research in conjunction with their high volume practice.  in this day and age of global corporate partnerships, one way to easily succeed is to partner with someone else: another surgeon, a PhD to help run the lab, etc.  everyone’s got their own specialty that they do well.  the breadth of cases your typical general neurosurgeon does is trending smaller.  subspecialists are taking over the field.  the underlying theme in all of this is that you can’t really do it all yourself anymore.

SO, to answer your question, PhDs are helpful for two reasons: 1) institutions still want to recruit surgeons who are primarily scientists.  by bringing your experience in the OR to the lab will allow you to answer questions and see things in differently than regular PhDs.  2) the assumption that MD PhDs students are generally of higher pedigree than single degree applicants.

i have a few theories

1) youve been in school for so long that you are now a true academician.  youre the type of person who’ll probably end up turning 7 years of training into 9 with a couple more years of fellowships and advanced skills.  the institution can really “milk” a lot out of you

2) given the extra years getting the PhD and now those fellowships stated in 1), youre probably very much less likely to go into private practice.  this means if you turn out awesome, there’s a good chance that the institution can keep you on as faculty where you bring further patients and glamour to the institution.

3) now because of 1 and 2, you’re on as faculty.  well the institution realizes they have a number of great surgeons.  out of the pool, only a few can probably produce some good research, and among them, the phd’s are probably better suited for that sort of thing.  so they can tell you to operate less and write more NIH grants and bring even more money to your department, increasing the glamour factor.

4) a guy who didnt get in the first time around and decided to go back and get a phd or just got a phd to “improve their application” tells me they really freakin want to be a neurosurgeon, and if i take him on my team, i can be relatively certain he wont be a dropout.

so, you see, a phd can be pretty versatile - they can operate or research.  not everyone is an extremely gifted cutter, but it doesnt necessarily require a unique “gift” to do research; having a phd shows youve got experience doing it and are probably pretty proficient at it.  and every program loves to produce the research and get the grant money while they wait for a few golden-gloved cutters to rise up and string them along in their department.  if youve got gifted hands, a keen research mind, and a phd, youre golden, but someone like that rarely ever occurs.  in terms of supply, youve got a lot of cutters, less cutters with phds, less very gifted cutters, and very few phd gifted cutters.  the majority are just cutters, whereas the phd cutter variety is rarer, making you look more desirable.  plus, there’s aways a chance you got the gift-factor too that may crop up during your training, putting you in the golden category.

but in the end, those that have it all tend to focus either on research, or patient-care.  the fact that each operation takes 4+ hours, and the followup is extensive doesnt really allow you to limit your patient hours, but research is always “limitable”, and in the end, research suffers.  think, when faced iwth the choice of injecting your rats or operating on a dying patient, most would make the ethical argument for the latter.  hence, we see a growing number of departments who hire just phds to conduct their neuroscience research while the surgeons do the cutting, and hope for some magical interplay between the two entities.  can’t really comment on whether its working, but im noticing it more and more.
i guess a phd surgeon could help on that interplay, but dont count on it.

however, many neurosurgeons are active clinical research publishers, putting things out almost monthly.  well, when you operate that much, its just a matter of hiring a nurse or finding a few med students (ie me) to put it together for you.  this doesnt really require a phd, and is an entirely different discussion.

"Are there any who think that the current ruling generation of this field will be replaced by individuals who place less value on the dual degree? “

I think this is interesting.  if i were chairman and could build my own dept as i saw fit out of 10 people, i’d try to get 6-7 excellent cutters, one in each specialty.  i’d make sure more than a few are very proficient in spine to maximize money input (spine is still most lucrative), but id make sure i have a great endovascular guy, a top notch skull base, etc.  i’d encourage them to stay within their field, but i’ll also allow some degree of freedom to operate outside their level of expertise, not only to keep them happy, but promote a sense of team spirit and unity.  it’ll help teaching residents too when everyone is involved - it takes a village to raise a child.

the other 3 would be PhD’s.  hopefully its a grad school i’m working at, and these PhD’s would attract some grad students to help with the labwork.  med students would obviously show up too, esp those interested in neurology/nsg.  theyd be my main research guys getting the big NIH grants.  the MD cutters would be in charge of getting clinical articles out to JNS, etc. 

now, when i look at new applicants coming in, you bet i’m going to look favorably on the MD/PhD guys because im willing to bet theyll stick it through and all the above reasons i mentioned above.  so although i personally may not see a huge benefit to having them on board, except for facilitating MD cutters with PhD researchers, i would love to take them on as residents.  during their research years of training, they could prove pretty valuable to my department and i could really get some great grant money out of them.

i guess in my functional department, i wont see a huge need for them, but in an applicant pool, theres an undeniable advantage in my eyes.  its only a logical consequence than in my actual department, therefore, i’ll have several MD/PhD’s available for hire.  so no, i dont think theyll ever really go away/be replaced, just because theyre favored in the match and PhD degrees dont disappear 20 years later when theyre working as full-fledged surgeons

Thank you for the feedback, gentlemen.  I would like to throw a hypothetical out for discussion.  This is by no means what I see myself doing, but…

What if a neurosurgeon did want to devote 80% of her time to research (indeed, many NIH grants mandate this much)?  Let’s say she is the director of basic science research for the department (many are PhDs without an MD).  Now the department has a basic sciencest that can share the call load, cover colleagues clinics when they are away and has the flexibility to teach and mentor students.  In addition to benefiting the clinical side of the department, such an arrangement would enhance basic science endeavours by creating an avenue by which translational research could affectively occur.  By understanding the challenges faced by the surgeon and patients first hand, the needs of both will be properly addressed at the bench. 

Just a thought.  Enlightening discussion is much appreciated.

I met a neurosurgeon at a conference last year who works for the NIH (NINDS). His name escapes me at the moment but I remember he was trained at MGH. He told me he does elective neurosurgeries only one day of the week. He spends the rest of his time in the lab (brain tumors). He said he doesn’t make any money from the surgeries since the NIH provides pro bono treatment. His income is derived from his grants. He said he doesn’t make nearly as much as your average neurosurgeon but that he was happy since he has a modest place to live, is able to provide for his family and basically work 9 to 5. I’m trying to google his name. If I find it I’ll let you guys know. Although his situation is the exception, I think this adds some substance to what others have already suggested on this site - that once you get out of residency you can really tailor your lifestyle and research interests to suit your own needs. However, something has to be sacrificed - either your time or your income.

You are probably referring to John Park at NIH--trained at the Brigham and now is at NINDS as head of surgical and molecular neuro-oncology there.

ID - 10 June 2007 06:30 AM

You are probably referring to John Park at NIH--trained at the Brigham and now is at NINDS as head of surgical and molecular neuro-oncology there.

YES. Thanks! Here’s a little blurb about him:

http://neuroscience.nih.gov/Lab.asp?Org_ID=492