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What should you expect?




The majority of AOA Neurosurgery Resident Graduates have gone into private practice, with the remainder entering academic practices, industrial practices, fellowships or research opportunities throughout the country and world. To see current Neurosurgery salaries on click here.


Before you consider the first position of your career, answer a few questions from the Ideal Neurosurgery Career Questionnaire submitted by Dr. Javed Siddiqi.


1)                Do  you already have a preference for a type of practice :

a.     Private

                                                       i.      Solo

                                                     ii.      Group

b.     Public

                                                       i.      County Hospital

                                                     ii.      University Hospital

                                                  iii.      Veterans Hospital

c.      HMO (eg. Kaiser)

d.     Combination of the above:

e.      Not sure yet


2)                Do you want to practice all of neurosurgery (A general neurosurgery practice in which you do a mix of cranial and spinal surgery)?

a)                 Comprehensive general neurosurgery practice

b)                Focused subspecialist neurosurgery practice


3)                Do you expect to need guidance and mentorship in the early stage of your career?

a)                 Yes

b)                No


4)  What is your highest priority for your first job (right out of fellowship training)?

a)                 Type of practice (group vs. solo)

b)                General neurosurgery vs. sub-specialist practice

c)                 Mentorship & Guidance

d)                Educational Environment (to teach and help pass boards)

e)                 Money

f)                  Location

g)                 Quality of life


5)    What are your financial goals?

a)     Get rich quick (financial home run)

b)    Build Income (one base at a time)


6)  What kind of educational environment do you prefer?  One in which, there is…

a)       regular learning/teaching sessions & grand rounds/board exam preparation

b)      no regular teaching (you get your education on your own)


7)    What is your idea of financial success?

a)        being in the top 1% income bracket in the country

b)       being in the top 5% income bracket in the country

c)        being in the top 10% income bracket in the country

d)       being in the top 20% income bracket in the country

e)        being in the top 33% income bracket in the country

f)         being in the top 50% income bracket in the country


8)    Quality of life:

a)     Important: I would rather give up some other priorities than be worked to death

b)     Not important: I want to work ceaselessly for a few years, and then relax into a better lifestyle


9)      Geographic priorities. 

a)     I want to work near friends & family

b)    East coast

c)     West coast

d)    Mid-West

e)     Northern USA

f)      Southern USA

g)     Location is irrelevant to me


10)    Practice Evolution:  I want to be in a practice that…

a)     continues to evolve, offering new opportunities

b)    remains predictable and constant


11)    Do you want to work in a type of practice in which you treat all patients, irrespective of ability to pay?

a)     Yes (Some patients do not pay)

b)    No (you have a purely elective practice of exclusively paying patients)


12)    Do you want to take ER call? (Do you want to treat conditions that present as emergencies— SAH, trauma, seizures (secondary to AVM, tumor)

a)              yes

b)             no


13)    How much call is reasonable?

a)                 1:1 (Daily)

b)                1:2

c)                 1:3

d)                1:4

e)                 Equal amount with other associates in group


14)    How much vacation do you want per year?

a)                 2 wks

b)                3 wks

c)                 4 wks

d)                5 wks

e)                 6 wks

f)                  National average for neurosurgeons


15)    Do you prefer to be:

a)                 Salaried (thus having some financial certainty)

b)                Eat what you kill (Financial uncertainty--only get paid what you bill/collect, understanding that in a first job, the first collections may take 6-18 months from the time of billing)

c)                 other: ___________________________________


16)    Do you prefer to:

a)                 build your own practice from scratch

b)                join an established practice

c)                 both (a) and (b) simultaneously


17)    Competition: how much is acceptable?

a)                 only compete with other neurosurgeons in the community

b)                compete with others within your group

c)                 no competition


18)    How important is trust in, and respect for, your colleagues?

a)                 very important

b)                minimally important

c)                 not important


19)    How important is it for you to respect the clinical and technical skills/judgment of your colleagues?

a)     very important

b)    minimally important

c)     not important


20)    How important is it to know the people you work with:

a)                 very important (I need them to watch my back, & vice versa)

b)                minimally important (Can get to know them later)

c)                 not important (It’s just a business relationship)


21)    When out of town, what do you expect from your colleagues?

a)                 to look after your patients with the same degree of diligence that you would offer yourself

b)                cross-coverage sharing with other neurosurgeons in the community

c)                 nothing; you will discharge all patients before you go out of town


22)    When taking a job, how much freedom do you want to quit?

a)                 complete freedom:  quit without notice; do whatever you want, whenever you want without regard for burning bridges

b)                moderate freedom:  quit only after giving contractually-agreed upon notice  of 6-12 months

c)                 minimal freedom: quit only after giving contractually-agreed upon notice of more than one year


23)    How important are the following medical malpractice issues:

                    a)       Tail insurance:      high            moderate              low

                    b)      Co-liability:           high            moderate              low

                    c)       Capped damages: high            moderate              low

                    d)      Cost:                    high            moderate              low


24)    What kind of hospital do you want to do your neurosurgery in?

a)                 university hospital

b)                VA hospital

c)                 HMO-owned hospital

d)                Community hospital

e)                 Tertiary care center


25)    Emergency care—what kind of hospital do you want to be associated with?

a)                 trauma center

b)                not a trauma center


26)    Ideally, how long do you want to anticipate your first job to last?

a)                 1-2 years

b)                3-5 years

c)                 More than 5 years

d)                Entire career


27)    How do you want to do your complex brain and spine surgeries?

a)                 alone

b)                assisted by a referring family physician

c)                 assisted by a neurosurgeon colleague


28)    Type of employment: do you want to be...

a)                 self-employed

b)                employed by a hospital

c)                 employed by a group


29)    Do you have any interest in research?

a)                 none

b)                clinical research only, on a voluntary basis

c)                 lab research only


30)    Do you have any interest in publishing papers or giving presentations (e.g. at ACOS, AOA, CNS, AANS meeting)

a)                 none

b)                yes, on a voluntary basis (Only when I want)

c)                 yes, on a mandatory basis (Publish or perish)


31)    When considering a group practice, what kind of leadership is important:

a)                 founder’s leadership- does not change

b)                rotating leadership, couple of years at a time

c)                 complete equality


32)    How do you expect to deal with hostility towards you and your practice (from other competing services, from aggressive competing neurosurgeons)?

a)                 on your own

b)                with the help of a good, expensive, lawyer

c)                 with the backing of a strong leader & team

d)                with the support of the AOA & other professional organizations

e)                 with the support of other neurosurgeons in the community


33)    What do you wish to emphasize at the start of your career?

a)                 developing clinical & technical skills, and a personal style of practice

b)                becoming the leader of your own group

c)                 purchasing an office building

d)                hiring your own staff and billing service

e)                 pursuing business education, by getting an MBA in the evenings and on weekends

f)                  quality of life


34)    How important is early board certification preparation to you?

a)                 very important—need to do it as soon as possible

b)                moderately important—will get it done whenever possible, but no rush

c)                 minimally important—will get it done by the end of the allowed number of years

d)                unimportant—don’t care about board certification


35)    How important is peace of mind to you when it comes to practicing conscientious medicine, treating all who need your services, working with colleagues that watch your back?

a)                 very important

b)                moderately important

c)                 minimally important


36)    Taking into consideration your own education only, do you see any personal benefit in training residents, such as learning by teaching:

a)                 yes

b)                no


         37)           Do you think having residents improves the quality of life of their Attendings?

a)     yes

b)    no


38)    Taking into consideration your workload only, do you see any personal benefit in having residents?

c)     yes

d)    no


          39)    Taking into consideration osteopathic neurosurgery as a profession, and your place in it, do you see any personal benefit in training residents?

a)       yes

b)      no


40)    Do you feel any special obligation to represent the osteopathic profession generally, and osteopathic neurosurgery specifically?

a)                 yes

b)                no


41)    Do you feel any special obligation to train the next generation of osteopathic neurosurgeons?

a)                 yes

b)                no


42)    When on call, what would you prefer:

a)                 take first call alone

b)                take first call with backup neurosurgeons

c)                 take second call (with resident on first call)

d)                take second call (with physician assistant on first call)

e)                 take second call (with nurse practitioner on first call)


43)    What kind of call schedule do you prefer:

a)                 a rigid one in which the schedule is made 3 months in advance, and there is no easy way to make revisions

b)                a flexible one, made one or two months in advance, but in which the colleagues cover each other when necessary