The Future of Neurosurgery: A Resident’s Perspective

Change is a reality in all aspects of life and all fields of medicine. Neurosurgery residents are being trained in responsibility and patient care, however, the system itself is changing almost continuously. Understanding these dynamics is crucial to endure a career in medicine. Challenges include the intersection of technology and health care, understanding and modulating the “business” of medicine, and getting control of the medical-legal system.

To start, it is important to recognize that patients are better versed about their health care and diseases these days, thanks to public advocacy and the internet. Vanishing are the days when the “doctor knows best.” Today, patients shop for their physician, looking for the most cutting edge surgeons, performing “minimally invasive” procedures while remembering their names. These highly sophisticated patients are raising the bar for physicians, encouraging them to stay ahead of the times in their field. In the same vein, technology has become increasingly intertwined with patient care. Be it the medical records system, vital sign telemetry, functional non-invasive imaging or computer guided surgery, the marriage of medicine and machines is evident. Residents exposed to this early on will acquire the skill sets necessary to work in this environment. Physicians who embrace this technology will be rewarded through more efficient and thorough patient care.

The business of neurosurgery is constantly changing, usually with more restrictions and decreased reimbursement. Given the recent legislature, it seems that our nation is on its way to “universal healthcare.” Whether equal health care to all US residents becomes a reality is a different issue. Judicious spending and electronic records can facilitate this possibility. However, without addressing malpractice law and tort reform, the solution will never be achieved.

As a result of economic and training constraints, it is clear that the field of medicine has shifted from generalists to specialists with an emphasis on “Centers of Excellence” and multidisciplinary efforts in patient care. This allows more efficient and cost effective delivery of health care by more experienced specialists. Conversely, specialists in the community are focusing more on bread and butter cases and are occasionally criticized when they go “above and beyond” their institution’s capabilities. For example, fewer patients with aneurismal subarachnoid hemorrhage or severe brain injury are treated in community hospitals. This centralization of medicine will be essential in maintaining the highest level of care available to Americans at a relatively affordable cost.

The complexities and inequities of the health care system have deterred many people from entering the field, compared to previous decades. As a result, the remaining physicians are more motivated and willing to work in this environment. As we graduate from residency, it will be on us to change our field. Embracing technology promoting efficient informatics and inter-physician communication will be key. Equally as important is communication with our patients, not only articulating diagnoses, risks, and surgical interventions, but also encouraging tort reform and legislation change. Of course, the underlying tenet of improving quality while reducing cost will guide our progress. Ultimately, putting the patient before everything else is the recipe for success.

Garni Barkhoudarian, MD
Department of Neurosurgery, UCLA


  1. Frank Stalitz says:

    The resident training hours are being reduced. I am getting less real experience. What are everyone’s suggestions for gaining more experience?

  2. Frank, that is a good question, which is relevant to many residents in different countries. Just like airline pilots, well developed simulators may be a good way to start your first surgeries. However, such technology is not immediately available.

    I think one solution lies in using the hours that are available as good as possible, but this depends on how busy your clinical work schedule is. For example, you may visit surgeries that are performed, just to watch other people doing the surgery.

    Another solution could be to do a fellowship after finishing your residency. Although I think that one keeps improving “on the way”, also as a staff member. Most important is that you learn to manage the emergencies. More “chronic stuff” can be discussed with colleagues during daytime, which lets you benefit from their experience.

    And soon we will have a forum on this website, where you can discuss cases and surgerical technologies with colleagues from all over the world!

    Best regards,

    Pieter Kubben
    Maastricht, The Netherlands

  3. Evan Bascom says:

    I am finished my residency one year ago in the USA. I went into practice in a group and it did not work for me. I was doing complicated cases but had good results. my partners sent me more complex cases while they did more simple ones. Eventually the hospital said my cases were costing more than the average. I had to look for another place to go. I am more suited to academia but jobs are nit easy to find. any suggestions from others who have had a similar experience?

  4. Adnan says:

    Being a neurosurgeon isn’t easy. It’s extremely demanding on a physician, but at the same time it’s very rewarding. This specialty in medicine involves diagnosing and treating conditions affecting the spinal cord, the brain, peripheral nerves and all of their supporting and surrounding structures. Doctors in neurosurgery jobs operate in these areas of the body, while also providing care to patients. Some even teach medical students or give lectures to residents. Hospitals offering Neurosurgery in Germany

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