Specialty: Decided, or How To Match In Neurosurgery (Hopefully)

I’ve decided to apply for a neurosurgery residency. (Readers: please feel free to ask me questions about my decision or my decisionmaking process)

Scary for me to even say, but there, I said it. Nothing like changing to an extremely competitive field late in your third year. So much to do: away electives, letters of recommendation, new research projects, just to be competitive.

Why so much stress? Well, according to the most recent (2011) Charting Outcomes in the Match, the average successful NSGY applicant has a Step 1 score of 239 (~0.75 SD above the mean), 3 research experiences, and 8 papers/abstracts/publications. 25% of successful applicants are AOA (no applicants who were AOA failed to match, giving it a LR of a kajillion).

Let’s talk about the Step 1 score game for a second. There’s a tendency for medical students to obsessively focus on Step 1 as though it is all that matters. Frankly, in neurosurgery that’s just not the case. Even those who had essentially average Step 1 scores (the 221-230 bracket) had just over an 80% chance of matching. Those are pretty good odds. It means that other factors are much more important in neurosurgery – like being AOA. Having a lot of publications, in and of itself,  doesn’t seem to make that much of a difference – but I’d bet that on an individual applicant basis, and at particular programs, it most certainly can.

Another interesting factoid, looking back over the 2009 and 2011 data: the number of contiguous ranks required to have a 90% chance of matching was ~17.5 in 2009, but declined to ~14.5 in 2011. Paradoxically, while only a third (56/215) of applicants ranked more than 16 programs in 2009, half of applicants (91/202) did so in 2011. Maybe applicants are applying more broadly, maybe top programs are being more generous so that top applicants get more interviews, who knows. But the matching curve is changing, and it was significantly worse to get <8 interviews last year (20-60% chance of matching) compared to two years ago (50-70% chance). My sense is that the overall understanding of the neurosurgery match game has improved particularly as the applicant pool has thinned out a bit.

So what does this all mean for me? Well, here are my strengths vs. weaknesses as an applicant:

Strengths: Step 1 score >250, 9 published papers (in neurology, lets say) before and during medical school, (supposedly) strong letters from home chairman, interview well (meaning that I am not a serial killer and people seem to like me rather than hate me on first impression)

Weaknesses: No neurosurgery publications, no home neurosurgery program (so I don’t have a true “back up”), came to neurosurgery late in life so I’m behind on the away rotation apps and such, couples matching (so we both have to somehow match into programs within 30 minutes of each other by car/train/helicopter)

For all of those reasons, I’m also afraid of “having” to go to a relatively poor program with little opportunity to advance in academic medicine, difficulty getting a fellowship, etc. etc. I have a few dream programs, and choosing neurosurgery only puts those farther and farther away (out of reach?).

So, onwards with away applications, shelf studying trying to grind out those last couple H’s, and so on and so forth. What else is there to say?

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8 Responses to Specialty: Decided, or How To Match In Neurosurgery (Hopefully)

  1. Pingback: Give the people what they want: Neurosurgery Match, July edition | Drinking From The Fire Hose

  2. Kelly says:

    nice link. i’m always on the lookout for reading about those interested in neurosurgery. for me, i take step one in about 3.5 months, and it feels epic. I have no publications, and am working on getting some TBI or DBS research starting third year rotations. any suggestions about board prep that worked for you? neurosurgery feels competitive, but not incredibly so…i feel like only those who love it will go into it, as it’s not a residency for the lighthearted. hope all is well.

    • Step 1 is epic. I am helping teach a Step 1 prep program now and even with a bit of added distance, it is far and away the most concentrated period of study and information acquisition/retention of my life. It’s not *as* important as it seems at the time, particularly once you are over a certain score, but the pressure of having to perform your best on one particular day can be high. The board prep formula is pretty simple: UWorld(x2) + First Aid + Goljan is a good base, then add whatever else you need to supplement. Make sure you are learning (i.e. assess yourself honestly) and not just reading or reviewing. No one will give you a good score because you read all of first aid, but RETAINING all of first aid will get you a great score. Relax, go to the gym, and try to enjoy your life outside of studying – it will make studying easier. Once you are in dedicated step 1 study mode it is not unreasonable to study 12 focused hours a day (i found more than that to be difficult). I used anki and made flashcards for everything, but there are other arguably better programs now.

      Re: research, if there is something that interests you, then really pursue that (once step 1 is done) and try to find something you can make your own (case series, small small experiment, etc).

      Neurosurgery is competitive – but not as competitive numerically as radonc/plastics/derm. My biggest surprise was finding such a large proportion of applicants who had been positioning themselves to do NS since undergrad and already built relationships in the field. it is an extremely small and politically connected world, and having advocates/mentors is very important (and something that I lack, at least compared to many).

      It sounds like you have acquired some inkling of what you’re in for in NS, which is important. It is the greatest privilege you can have as a physician, but as far as training programs go, no other trainee pays as dear of a price.

      As far as all being well, ask me next week.

  3. swear000 says:

    I have been working all my life towards a neurosurgery residency. It’s best not to advertise it until your license is in hand because a lot of “license review programs” want to rob you blind just because you don’t knew a few minor details. My true calling is Neurosurgery but I may have to do radiology because people will literally stab you in the back and bully all that you earned and deserve right out of your hand. The medical community as a whole is highly educated but ruthless. At the end of the day, it’s not what you know but who you know so find people who want you to succeed and move ahead and lot hold you back with their lies.

  4. Caleb says:

    What exactly is AOA? and how do you get in it?

  5. gassie32 says:

    It’s me once again….almost half way through third year and I’m once again figuring out if I should go with NS…I love it, but I’m worried about the match. my step scores are >240, but I have no research due to a later interest in NS than others. also, lifestyle….i think you can make a life, but it is definitely something i think about. in saying that, all i will have are great LORs and good board scores….is this still a possibility….?

  6. NMBE Steeeeperone says:

    All that matters is step 1. That’s all anyone cares about. You don’t need research, good LOR, or honors third year. Just step 1.

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