The Insiders Scoop – Neurosurgery Residency

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Name: Bayard Wilson, M.D.

Specialty/Interests: Neurosurgery

Education: University of Pennsylvania (Biology B.A.), University of California, San Diego (M.D., M.A.S.)

Current Position: PGY-2 Resident at UCLA Neurosurgery

 

1 | What drew you to neurosurgery?

This is probably the easiest question to answer; put simply, I think it’s a lot of fun, and I find it to be a fascinating field.  Some people are excited by the cardiovascular system, others by the musculoskeletal system, etc.  For me, nothing compares to the nervous system.  And that’s not to say that I don’t enjoy learning about the rest of human physiology, but for me, the brain and spine are special.  I love studying them, learning about how they work, and pondering the mysteries surrounding all that we don’t yet fully understand.  And while both neurology and psychiatry provide many of the same intellectual opportunities with respect to learning about and understanding the nervous system, I found that the concrete nature and mindset of surgery were more suited to my personality.

 

2 | What advice do you have for pre-med and medical students interested in neurosurgery?

Be proactive. The field of neurosurgery is quite small, and faculty and residents are often very busy, so it’s not all that common to have scheduled opportunities to meet and greet people involved in the field. That’s something that certain departments are trying to remedy, and something that I hope changes in the future, but meantime I think that for those interested in the field (even if it’s just a casual interest for now) a good way to get some exposure is to reach out to faculty and residents.  Ask to visit a lab meeting, or to attend grand rounds, or to observe a surgery in the OR.  Ask to shadow a resident team on morning rounds.  Better yet, suggest a research project (though that’s a little harder early on in medical school).  These kinds of actions show initiative, and don’t take away from a surgeon’s already busy schedule.  Reading about the field is one thing, but there is no better way to gauge what working within the field entails than to rub shoulders with people in the field.

 

3 | What is a typical day like for you?

A typical day varies depending on your level of training and specific rotation, so a typical day for me now looks vastly different than a typical day for one of my more senior or junior residents.  For now, as a PGY-2, my entire year is spent at one hospital, working a three-day schedule that repeats for the entire year.  It’s a three-day schedule largely because each class is comprised of three residents (where I train), so this schedule allows us to cover the lion’s share of in-house call for the program.  The schedule is as follows:

On-Call

After morning rounds, the on-call resident is tasked with taking care of patients currently admitted on our service and seeing consults requested of the neurosurgery team. This frees up the remaining residents to operate. Each on call day can vary quite a bit, depending upon how many patients are on service and how many consults come in. There are days when you don’t have time to stop and eat, and there are days when you have sufficient time to stop in the operating room and assist in surgery, or work on research projects. Generally speaking, call days put a fair amount of pressure on a resident’s patience and time-management skills, if only because of the sheer number of items that need addressing on a given day.  Call days last approximately 28 hours; the on-call resident stays overnight in the hospital, so that issues overnight can be addressed, and consults can be seen. In-house call is necessary in neurosurgery largely because of the acute nature of much of the pathology in neurosurgery.  Call days end the following morning, when – after morning rounds – I pass the on-call duties off to a fellow PGY-2.  After ensuring that loose ends are tied up from the previous day, the on-call resident will go home.

Post-Call

As it sounds, the post-call day starts the day after a 28 hour call.  Generally, call days are sufficiently busy that residents tend to spent at least part of their post call day sleeping.  Where I train, the PGY-2 post-call resident is given the day off to catch up on sleep for the following day.  I tend to try to wake up by mid-afternoon to get a least part of this time to take care of personal stuff, socialize, study and read up for the following day’s surgeries

Operative

The third day in this rotation is exclusively operative.  Which is to say, after morning rounds the operative resident heads to the operating room for the entire day, and performs surgeries.  The day ends when those surgeries to which I am assigned are finished up, typically sometime between 5 and 7pm. At the end of an operative day, I try to make sure I get enough sleep to be up for a full day of call the next day.

 

4 | How much sleep do you get each night? What is your work load like week to week?

Sleep depends largely on whether or not I’m on call.  On call days, I can get anywhere from no sleep to about 4 hours, though the sleep I do get is rarely uninterrupted.  On post-call days, I typically try to sleep for at least 4 hours during the day and wake up so that I can enjoy at least part of the afternoon/evening. I’ll then try to get to bed in time for 6 hours of sleep before the following day (operative day).  On operative days, I’m generally home before 8pm, and also try to get a minimum of 6 hours of sleep.  When it comes to getting >6 hours of sleep, I’d say I’m successful about 50% of the time.

For more senior residents, and those taking “home call” (where a resident gets to go home but answers pagers from home) as opposed to “in-house call”, sleep can come even less predictably.  Getting to bed at a reasonable hour is a challenge, but there’s no guarantee that before the next day’s surgeries you don’t get called in to operate on an emergent basis.  In such cases – unlike the in-house on-call resident – senior residents have to stay the following day to complete their assigned surgeries.  In some ways, therefore, the sleep schedule of a senior resident is more difficult.

Regarding work hours, ACGME regulations dictate a maximum allowable number of hours that a resident can work per week.  Averaged over a month, residents are not supposed to work more than 80 hours per week; which is to say that in one month a resident may work 90 hours one week, 70 the next, 85 the next, and 75 the next – just not >80 hours every week. Residents are also required to get one day off per week, averaged over a month.  My program makes a real effort to respect these rules, though there have been times when clinical volume has been high enough to require me (and my colleagues) to work over the work-hour maximum.  It happens frequently enough to be frustrating – both for me and those people close to me outside of work – but it also happens for reasons that generally don’t leave me resenting the field I chose.  Lastly, we get four weeks of vacation per year.

 

5 | How do you maintain the work-life balance as a busy neurosurgeon?

Generally speaking, we spend more time in the hospital than most specialties in medicine; sufficiently hard to preclude having too many interests and hobbies outside of work.  But not prohibitively hard; while residency in neurosurgery does require putting on hold some things otherwise permitted by a 40-hour work-week, managing work-life balance is about prioritizing those things you enjoy most outside of work in your limited free time.  Personally, I try to prioritize two things outside of work: 1) regular exercise, and 2) my personal life.  Everything else that I get to enjoy besides that is gravy.  Having such a short list of priorities – and for so many years during residency – is perhaps the greatest sacrifice that we as neurosurgery residents make.  Dwelling on just how much time the job “steals away” from your life outside of work can drive a person insane.  As such, it’s not really sustainable to look at residency in neurosurgery just a job, nor to focus on the fact that it’s only temporary.  I find that one must enjoy, or at least take pride in, the immersive experience that is residency, and recognize that it’s an awesome opportunity to learn and sharpen a set of skills that few others ever get a chance to learn.

 

6 | What has been one of your most fulfilling professional experiences?

About a month ago, I was stopped outside of work by what I thought was a complete stranger. A middle-aged man approached me and asked if I knew where he could find a neurosurgeon.  He had a smirk on his face, and I figured given his question he had some kind of agenda, and must have known who I was or seen the label on my jacket or something along those lines.

He began explaining himself, and didn’t get more than ten words out before he broke down in tears and came forward to grab my hand and give me a hug. Turns out he had been a patient of mine; he had come to the hospital with a life-threatening emergency several months prior, and had been treated by our team for about six weeks.  Neither of us recognized one another, but he mentioned that his wife had noticed me walking by, and told him that I was part of the team of doctors who helped save his life.  He all but dragged me around the corner to see her, standing with their son; I recognized her right away.  I had been the resident on call when he had arrived, and since he had not been conscious, I spent several hours that day and night speaking with her and walking her through each step of his condition and treatment.  I also performed a life-saving procedure at 3am the night he arrived.  I saw her nearly every day for the remainder of his hospital stay, until he was eventually discharged to a rehab facility to continue recovering from his injury.

The three of us spent the next little while recounting his time in the hospital and celebrating his remarkable recovery. Their gratitude towards me and my team was immense, and while I have been thanked by patients before, this was different.

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