Neurosurgery focuses on the central, peripheral and autonomic nervous systems. Practitioners diagnose problems through physical examination with the aid of such tools as MRI, CT scans and laboratory tests and frequently provide surgical treatment. Neurosurgery includes management of diseases of the skull, the brain, the pituitary and the spinal cord. Management of head and spinal injuries is a major challenge. As many head injuries and acute intracranial emergencies occur in off-hours, this is not a specialty for those who value lifestyle. It is, however, a very challenging and rewarding career. Neurosurgery as a discipline arose as a result of an increasing need for special expertise in the surgical and non-surgical treatment of various diseases affecting the nervous system and supporting structures. Therefore, it involves the ability to diagnose, and the technical expertise for the effective surgical treatment of congenital and acquired abnormalities. It also requires expertise in trauma and diseases affecting the nervous system that can be potentially prevented, alleviated or cured. This specialty requires the physician to be well-grounded in the principles of both neurosurgery and surgery in general.
Thus, the fully-trained resident must demonstrate proficiency and expertise in the:
- care of neurosurgical emergencies
- principles of pre- and post-operative general surgical care
- treatment of deep vein thrombosis
- management of fluid and electrolyte disturbances
- treatment of sepsis, the use of antibiotic therapy and an understanding of the
- implications of antibiotic prophylaxis
- understanding of vascular shock and its treatment
- an understanding of the diagnostic importance of disordered blood gas analyses and
- their treatment
- acute, subacute and chronic management of parenteral nutritional support
A neurosurgical resident must have knowledge, clinical ability and surgical skill as these apply to surgical diseases of the nervous system. They must have familiarity with, and knowledge of, the related disciplines of basic neuroscience, neurology, neuropathology, neuroimaging and neuropsychology.
Neurosurgical residents must also demonstrate a detailed knowledge of the normal structure and function of the nervous system and of the pathological processes that unbalance it. They must develop learning strategies to enhance their knowledge and expertise so as to maintain excellent and current standards of care. Interprofessional skills are imperative as they must become effective neurosurgical consultants with respect to patient care, education of colleagues and the provision of medical legal opinions. Finally, and most importantly, the neurosurgical resident is expected to demonstrate unequivocal high moral and ethical behaviour.
Upon completion of medical school, it takes an additional six years of RCPSC-approved training to become certified in neurosurgery. This period must include: 2 years of core training in surgery and 3 years of RCPSC-approved resident training in neurosurgery. Up to six months of this period may be spent in pediatric neurosurgery. It also requires 1 year of training that must include 3 months of residency in neurology, 3 months of residency in neuropathology, and 3 months of residency in neuroimaging.
The data contained in this profile has been extracted from the 2010 National Physician Survey (NPS), unless otherwise stated. A total of 35 neurosurgeons responded (for a response rate of 13%). For complete data tables for neurosurgery from the 2010 NPS, Click Here.
There are currently 293 neurosurgeons practicing in Canada. Of these 4% are under the age of 35, 58% are 35-54 and 35% are age 55 and older. 91% male and 9% are female.
According to CaRMS, there were 19 neurosurgery residency spots available to Canadian medical graduates in 2011. Surgical specialty residents in general most frequently cited intellectual stimulation/challenge as a reason for choosing a career in medicine (89%), followed by the doctor-patient relationship (65%) and the wide variety of clinical opportunities available (59%).
Most neurosurgeons (68%) work in an academic health sciences centre (AHSC), while 45% work in a university and 33% work in a private office/clinic.
Neurosurgeons work an average of 61 hours per week on professional activities (excluding on call). Much of this time (34 hrs/wk) is devoted to direct patient care, with or without a teaching component. An additional 7 hrs/wk is spent on indirect patient care, such as making appointments with specialists, charting, meeting a patient’s family, etc. and 5 hrs/wk is spent doing research.
26% receive 90+% of their income from fee-for-service, while a quarter receive it via salary. A further 18% receive their income through a blended source.
75% of neurosurgeons report that they are very or somewhat satisfied with their current professional life. 83% are very or somewhat satisfied with their relationship with their patients and with their relationship with specialist physicians. 65% and are very or somewhat satisfied with finding a balance between personal and professional commitments.