Ask Me Anything: Dr. Michael McDowell, Pediatric Neurosurgeon

Last Updated on August 2, 2022 by Laura Turner

Dr. McDowell is a graduate of the Columbia University College of Physicians and Surgeons and the UPMC neurosurgery program. He undertook fellowships in endoscopic skull-based surgery and pediatric neurosurgery. Currently, Dr. McDowell is faculty at UPMC Children’s Hospital of Pittsburgh, specializing in skull base and cranial cervical junction disorders. He has research interests in non-invasive intracranial pressure monitoring. He is also a long-time moderator of the Student Doctor Networks forum community.

This interview has been condensed and lightly edited for clarity.

When did you first decide to become a physician and why?

So I’ve had a long, long history of wanting to be a physician. When I was a very young child, I wanted to be a veterinarian, but it became pretty clear early on that I was allergic to every animal besides people. So that kind of simplified that interest. I certainly had an interest in it as early as high school, but I guess I would say that while that interest existed, I kind of did the opposite of a lot of people and rather (than) running toward medicine. I ran away from it as much as I could really to try to justify my interest in it. So I explored a lot of different interests in college, hard sciences like chemistry and biochemistry, entomology, which is the study of insects and dance, which is something I got a degree in. So I really had it in the back of my mind, this interest in medicine, but spent a lot of time kind of validating it by excluding other fields of study.

How did you choose the medical school that you attended?

So this is a really critical question to consider. I’m a big proponent of attending a medical school based on fit. Fit is a multifaceted concept that can include a large array of topics, including financial security, going to a school that ensures you are not drowning in debt, and (being) able to also, kind of take care of responsibilities you may have for a family, for example, is something that should be considered into the fit category. So I was very interested in a school that was pass-fail for the preclinical years and a school that had a condensed preclinical curriculum and an extended clinical curriculum. And, I was interested in the school that had a very strong student culture and, in some ways, an esoteric culture.

And so that was really why I was attracted strongly to Columbia as kind of my top choice. I had the privilege of interviewing and being accepted at a number of other programs and they were all phenomenal programs ultimately, but really that strong student culture, as someone who had kind of spent a lot of time in non-medical interests, that was a huge draw for me, and I also wanted the experience of living in New York City. So Columbia was far and above my first or my first choice. I did write an intent letter there and fortunately I was lucky enough to be accepted.

Were you from the city, from a city growing up, or had you never lived in a city before?

I was a military brat. So I lived in a large number of places when I was very young, I lived in San Antonio, but for most of my childhood, I’ve never really lived in an urban environment, even San Antonio, we lived so far into the suburbs that I wouldn’t really call it an urban environment for my childhood. So where I came from before college was a town of 5,000 people.

Why did you decide to pursue your specialty, not just your surgical specialty, but specifically pediatric neurosurgery?

So a lot of people will tell you that you should only go into neurosurgery surgery if it’s the only thing that really excites you and interests you, I don’t really agree with that. I enjoyed a large number of specialties, both surgical and medical. A lot of things that I could have seen myself being content in. So for better or worse, the reason I was most attracted to neurosurgery was the people within it. I was very exposed to them very early in medical school. Columbia does a very nice job of getting all of the subspecialties involved in your preclinical education. And I was very much impressed by the general cultural attitudes within neurosurgery it’s a field that really values a high level of personal investments and commitments and integrity related to patient care.

It also has a very strong kind of perfectionism and work drive kind of culture. And I was attracted to those features of it. And that was a major reason why I ultimately applied into the field similar to college was I did spend much of my time in medical school trying to prove myself wrong. That wasn’t really what I wanted to do. So I spent a lot of time in other fields, including pediatric neurology, oncology, radiology, ER, pediatric ER. I encourage people not to shut themselves off just because they are convinced of what they want to be interested in. And I think you really owe it to yourself to prove it through exclusion my interest in pediatrics definitely exceeds the length of time that I had an interest in neurosurgery. I’ve always enjoyed working with children.

I did a lot of kind of child outreach in college related to education and I also used to be a magic enthusiast and have a fair number of magic tricks still from my earlier days as an amateur magician. So the things about pediatric neurosurgery that I like the most (is) there are a lot of, not necessarily hopeless cases in pediatric neurosurgery, but there are a lot of cases that can cause a certain amount of emotional turmoil in people taking care of them and things that are really either tragic or just situations that can really stir up strong emotions. But the flip side of that is nowhere out of pediatrics can you really feel like you’re making a difference in someone’s life than in a child.

You know, when you take out a subdural from trauma in an older person that’s a good thing and that saves their lives and they go on and hopefully have a good remainder of their life. But when you do that in a two-year-old or a young child in general the infinity of possibilities that you’re giving them in their future to live a normal life, it’s just, it’s incomparable and it’s just a tremendous feeling of achievement.

Interviewer: I can tell how passionate you are about kids and like the idea of helping them, based on what you said.

Well, when you think of it is (that) children really are not accountable for the things that happen to them, right? No, a child didn’t smoke and get lung cancer or brain cancer so the things that happen to children really are beyond their control, and that, that innocence of accountability really, I think justifies what we call heroic measures when it comes to trying to treat children.

If you had to do it all over again, would you still choose pediatric neurosurgery? And if so, why or why not?

Yeah, I would not change any major part of the path that I’ve taken, and I think the reason for that really goes back to what I was saying earlier, which is you need to validate your interest by exploring other fields. So I don’t look at other fields with envy, and I see them going home earlier than me, or doing cool procedures because I did look at them before I made this decision. It was as to the greatest extent that a layman can achieve an informed decision, you can’t go through every one of these residencies and really dive, to the deepest possible level before you make a permanent decision. But you can spend a few weeks, on any given sub any specialty or subspecialty, and really ask yourself, is this what you really want to do with your life?

And I, I think I did that part by personal exploration and partially because of my curriculum, which as I said before, did expose me to a lot of specialties. And also it had essentially a minimum of one week of clinical rotations and essentially every specialty and so I think that was a tremendously useful experience, not only because it really, I think, let me convince myself of my choices, but also I think that every specialty has something to teach you, regardless of what you want to go into. And I think being exposed to as many of these specialties, as you can provide beneficial skills and knowledge that you’ll use for the rest of your career. The time I spent on neurology, for example, has had a significant impact in my ability to place foleys in the OR and manage urinary retention, postoperatively in terms of, other specialties, ENT, very useful in terms of having basic otoscopic skills, many, especially in pediatrics, many patients present with infections that arise in their ears. So whatever, whatever you end up in going and spending some time in these fields, you can learn things that will benefit you and justify the time expenditure. Neurosurgery, you don’t have to be interested in neurosurgery. The reality is a lot of specialties need to be able to do lumbar punctures, and nobody does as many lumbar punctures outside of maybe interventional radiology as neurosurgery. So learning how to do a neurosurgical lumbar puncture is a skill that can benefit you, even if you don’t wanna be a neurosurgeon.

Can you talk a little bit about what a typical day looks like for you?

Yeah I can touch on briefly just kind of the variances that can occur. Neurosurgery is a very broad field. You know, obviously, we have, sub-specialties like pediatrics, but we do everything from vascular and endovascular, functional and epilepsy, which is things like deep brain stimulation for Parkinson’s, tumor, spine, which we share with the orthopedic surgery world. But we also do radiation oncology and what we call radiosurgery. So we do things in various functional disorders like trigeminal neuralgia so you really have an opportunity to subspecialize a lot in your particular interest. The reality is most non-academic neurosurgeons primarily do spine as a pediatric neurosurgeon. The vast majority of pediatric neurosurgeons are affiliated with academic hospitals partially because pediatric neurosurgery being such a niche really doesn’t exist outside of a children’s hospital.

And you can confidently say most children’s hospitals are academic in nature because there’s very few of them, so there aren’t really that many (in) private practice, purely private practice children’s hospitals. So if you’re going into pediatric neurosurgery full time you’re really looking at an academic appointment if you’re looking to just do partially pediatric neurosurgery there are many private practice groups that do some pediatric neurosurgery that you could potentially fill that role, but it wouldn’t be a full-time job, so this year I’m finishing up my fellowship in pediatric neurosurgery, which is a one-year fellowship required in order to be a pediatric neurosurgeon. It cannot be done infolded, meaning it cannot be done in or during neurosurgery residency. And the reason for that is it is in fact, a separate specialty with the prerequisite being, doing a residency in neurosurgery.

So there’s really no way to kind of get out of that continuum of education, which is a seven-year neurosurgical residency and one-year pediatric neurosurgery fellowship. The nice thing about pediatric neurosurgery fellowships is many, if not, most of them do provide you with faculty privileges, meaning that you are able to practice as an independent surgeon. And it is more of what we call a finishing school, where other surgeons will provide input and suggestions while you and your residents kind of perform the majority of the cases by yourself. So at my institution, I wake up around 5:30 have some coffee review charts that may have occurred overnight and then I arrive at around 6:30 at the hospital. The residents at that time have already kind of prepared a list chart review on all of the patients the senior most resident, which we call the chief resident, will then present to me very briefly, the events of the patients, as well as any new patients overnight, provide me with the plans that they recommend.

I’ve already looked at most of the films at that point, but I’ll review anything that I may have missed and then provide any editing of those plans based on my own personal preferences and experience. We’ll then usually around 6:45, go and see all the patients on the service, which is usually about a half hour I spent most of my time talking to families and distracting them while the residents actually do the kind of nitty-gritty examinations, which can be sometimes distressing for families to watch. So that kind of helps to reduce the level of anxiety because they’re kind of talking to me about the plan and me asking them any questions they may have or concerns they may have and, after that, usually around 7:15, I go down to the preoperative page sign in any patients that we may have and then operate throughout the day until we’re done.

Some days are long, some days are short; usually, I’ll round in the afternoon briefly on primary neurosurgical patients a second time just to check in I try to do it very early between cases around noon, just so that there’s time to kind of modify any issues that they may be having and once the surgical day is done, I just, I go home and residents will call me with any urgent consults or questions that they might have overnight and I’m kind of on what we call backup or backup call most nights where they’ll call me if there’s a concern or an operative problem and everything else, they kind of just manage autonomously.

Interviewer: So you’re in the surgical suite every day, basically.

Yeah. At least five days a week. It can be all seven. It depends. I do, I do take time off. It’s not (bad) – it sounds more brutal than it is. The great thing for the sake of children, at least just pediatric neurosurgery is rare. So it’s not like we’re getting 20, 30 new cases a day. It tends to be a fairly sleepy specialty compared to other aspects of neurosurgery. So, I get plenty of sleep and that’s not really been an issue and I take about two weekends off a month, essentially. I tend to take ’em just one day at a time because I’m from Pittsburgh. I did my residency there, so that’s where my family is. So I’m not running around trying to go visit family in another city or a spouse that’s not with me, I’m a full-time member of the Pitt community and I’m staying here long term.

“I had the pleasure of spending some time with one of the greatest neurosurgeons of kind of the last generation Robert Spetzler. And even in his seventies near his retirement, Robert Spetzler at the end of his operative days would go up to the anatomy lab and practice his surgical technique on cadavers. And that’s how he became Robert Spetzler. He wasn’t born an extraordinarily gifted aneurysm surgeon. He forced himself to become through rigorous study and practice.”

Dr. Michael McDowell

What were the most important factors for you in choosing your residency at UPMC?

So I went to Columbia for medical school which was a phenomenal experience. And (though) my experience with the neurosurgical field through Columbia was great, and I have lifelong mentors there, Columbia is what you might call a boutique program. You know, it’s obviously in a very competitive city with a lot of neurosurgeons and it has a very powerful academic name associated with it. And so it tends to be a more academic experience where you spend a lot of time early on getting lots and lots of kind of didactic education. And your operative experience kind of comes after you’ve done a lot of didactic education. This is the kind of program that tends to destroy the neurosurgical written boards, for example, they’ve really very frequently hit the 99th percentile of that because the core of their early education really does revolve on classical neurosurgical papers and review. And they do a great job in that. I do not consider myself a naturally skilled surgeon, I don’t in general, the more that I’ve trained and the more that I have been exposed to different surgeons, I’ve gradually lost faith in that concept at all. People often talk about having good hands or he’s got good hands, they don’t have good hands. My experience has been having been involved with about 30 neurosurgical trainees as well as 30 neurosurgical attendings is that is an excuse that bad surgeons use to justify their inability, to do certain extremely technical aspects of neurosurgery. And it is a mythology that is propagated by those who have, in order to exceptionalize themselves. I think 99% of surgical skill is through training study and practice.

And I had the pleasure of spending some time with one of the greatest neurosurgeons of kind of the last generation Robert Spetzler. And even in his seventies near his retirement, Robert Spetzler at the end of his operative days would go up to the anatomy lab and practice his surgical technique on cadavers. And that’s how he became Robert Spetzler. He wasn’t born an extraordinarily gifted aneurysm surgeon. He forced himself to become through rigorous study and practice. And so that was something that was very important to me was I wanted to go to a program that was gonna immerse me in as much rigorous practice as I could get. And so I focused very heavily on what are called operative powerhouse programs, places like the Barro Neurological Institute, Mayo Clinic, Indiana, and of course, UPMC.

What I liked about UPMC is while it had this strong history of extraordinary operative volume and training, it also had very strong academic ties and infrastructure for people interested in pursuing an academic career, particularly for people who are interested in technology because of their very strong relationship with Carnegie Mellon University which is kind of tied together with an institution called the Pitt Innovations Institute. And they focus heavily on technological applications and commercialization led by physicians and scientists. And so I don’t know exactly how many papers and book chapters I published during residency, but it was about, or more than 60. And I won a number of grants and major trainee awards during that time. So I still had that opportunity to explore academics and build myself up as an academic (since) I knew I was going into pediatric neurosurgery, so I knew I needed to be an academic, but I also was flooded with operative cases. The average trainee logs about 1400 surgeries during their residency. I focused in skull base which is a fairly lengthy surgery so we’re talking about often just one surgery a day lasting 10 plus hours. But even with that sub-specialization, I logged about 2,500 cases, which is about two standard deviations above, my co-residents, who’ve focused on spine and endovascular, the endovascular guys logged 4,000 cases because endovascular cases are very quick, but the spine guy logged over 30,000. So that just, that was very important to me. That’s why I chose UPMC, but there’s, there’s always a price, right? You don’t get to publish dozens of papers and do a massive number of cases and go party every night or sleep 20 hours a day.

There’s a finite limit. There’s no perfect program. And so I encourage people when they’re looking at programs is don’t be, first of all, don’t be seduced by prestige, if you need prestige, do a fellowship, it’s much shorter, much less painful, but you look at the pros and cons of a program and ask yourself, are these the pros that are most important to me? And are these the cons that are least important to me? I was single, I wasn’t super concerned about having lots and lots of free time. And to me, the exceptional operative and academic opportunities were worth the busy workload and that doesn’t mean I was smiling and, and giddy when I was finishing a 26-hour surgery, right? Which I have done several during residency, but I recognized the value of that and I never regretted the commitment that I made to get that value.

Did you complete any enfolded fellowships during residency?

Yes, I did a endoscopic and open skull base fellowship. One of the other nice things about the UPMC program is it has the longest kind of amount of elective time allowed by the AC GME, which is 18 months for neurosurgery. And so alright, so excuse me, 21 months, 21, months by the ACB. And so I spent those 21 months doing exclusively endoscopic and open skull base procedures that’s an extraordinarily rare field in pediatrics, so I didn’t do that fellowship with the idea that I would exclusively be doing pediatric endoscopic skull base surgery. I’d have to do the whole world’s in pediatric endoscopic skull base surgery to be a full-time practitioner of that. But I did value the microsurgical techniques that are so important in skull base and the, just the technical complexity It unquestionably my mentor through hours of torture and tearing out my sutures and otherwise giving me gray hair, he made me a much better surgeon and many of the techniques that I learned in the skull base, I have now transitioned into pediatric surgery, and I’ve been able to really kind of find some unique applications of those to the point of even patents for, for new tools specific to the pediatric world to kind of take those techniques and apply them to my current profession so that was a great use of my time.

It also taught me some other valuable skills. First of all, it taught me the value of cadaver surgical dissection. And, I took thousands of kind of high-quality, 3D photos of different cadavers that I dissected over the years doing a number of classical surgical approaches and also attempting to innovate with some new ones, one of which is in the process of being published now. And the other thing that it taught, we’ve video(ed) everything in skull base because skull base has a lot of complications, frankly, and it’s good to have those videos to be able to review and understand which you could have done better, but the side value of doing all of those videos is that I now have a personal resume, a video resume of my own procedures that I did on camera, which I can then pull up for talks, I can pull up for interviews, whatever it may be. That has been an enormous resource for me, especially as I started looking for jobs and being involved in kind of the forefront of academic neurosurgery.

“Neurosurgery is not a hand holding field and ultimately people aren’t gonna have a lot of sympathy for you if you don’t put in the work.”

Dr. Michael McDowell

What is your advice for a current first-year medical student who wants to pursue a neurosurgery residency without a home program?

The hard truth is that’s a tough position to be in. It’s not an impossible position by any means, but it does require additional initiative on your part. The issue is, is neurosurgery is a small field that really hasn’t grown much. It’s been about 3,000 providers for the last 20 years. And that means that the movers and shakers of neurosurgery all know each other very well. And it is a tight community of interpersonal communication and networking. So you, you really need to find yourself a mentor and a pseudo-home institution to really kind of help bolster your chances. So I would look up the closest neurosurgical departments, academic neurosurgical departments, and really reach out to them and reach out to your student advisors to see what you can do within the confines of your curriculum to spend as much time interacting with that kind of home department that you can, because it’s, frankly it’s hard.

Most neurosurgical research is clinical. There is some basic science, but regardless basic science or clinical, it’s very hard to do that when you’re not in a hospital system, right. Even clinical research requires chart review, which requires access. It’s very hard to be handed a project that has everything done, except for stuff you can do at a computer in the middle of a desert. It’s just the reality of the situation. So, considering taking a year off at that program, certainly doing as many elective rotations researcher, otherwise, as you can at that program, that really is your best opportunity to develop a rapport with people who then will go to bat for you and write you good letters that other people that know them throughout the country will read and value, so that would be my advice – it does require a little bit of proactive work on your part. It’s certainly not an impossible battle, but it is a little bit of an uphill one that does require initiative and effort, but it certainly I’ve seen many students without home programs would be very successful in the match but the onus is on you. No, one’s gonna hold your hand. neurosurgery is not a hand-holding field and ultimately people aren’t gonna have a lot of sympathy for you if you don’t put in the work.

What do you like most about being a physician and what do you like least?

Well, I will say, specifically in my field, the thing that I love to do most and that I take the most satisfaction (in) is doing spinal cord tumors. Taking out a spinal cord tumor is as close to feeling, near to God as I’ve ever felt in my life, it’s truly an extraordinary experience. When some, you do a surgery on an area that’s only at most a half inch wide and the patient wakes up and they’re moving their arms and legs. It’s just an extraordinary sense of satisfaction and accomplishment to be able to safely remove one of those, especially in a child, and for them to be able to walk around and eat and drink and use the restroom and have no real consequences for working on something that really up until a few decades ago was just inconceivable (to) people. There’s still echoes of it nowadays in neurosurgery, but people have forgotten over the last 50 years that being sent to a neurosurgeon in the 1950s was considered a death sentence.

The mortality rates were as high as 50/50, and the morbidity rates were equally high. And so when, when people talk about the stereotype of a neurosurgeon being arrogant and aggressive and extraordinarily nitpicky, there’s a reason for those things. Those are what I call functionally dysfunctional traits. They are terrible outside of the OR, if you can’t turn them off at the end of the day, and don’t make us any friends, but the reality is in the operating room they, like that meticulousness, that absolute insistence on perfection it paid off it slowly chipped away at that extraordinarily high mortality and morbidity rate and allowed us to turn neurosurgery into a field that people for all intents and purposes can expect, very, fairly regularly, to wake up and be normal after. And that’s a great achievement.

So, that’s things like that, like spine surgery is what I’d like most. And then more, more generally, I like the saves, I like the tremendous wins when someone comes in and if you don’t operate on them, they’re gonna die. And then you save their life and they wake up normal and they go on and have a normal life. As I had said before, doing that for a three-year-old, you’re giving them an infinite number of futures, and that’s just an immensely satisfying experience to know that this person would have ceased to exist if you hadn’t operated on, and it may, may or may not be the most complex surgery you do, but in terms of what it provides and what it gives to another human being, there are few things in life that you can say have given someone 80 years of future.

And that’s one of them. So that’s my favorite thing. And the thing that’s the least is the, is what I use those cases to brace myself for, which is the extraordinarily tragic losses. I had a child who passed away because of an accident involving their parent, who was directly responsible for ending their life by accident. I mean, I can’t think of anything more tragic or painful for a parent to go through than knowing that you by, (through) no intent of your own, resulted in the end of your child’s life like that. That’s heartwrenching, no matter who you are, watching someone go through that agony is just a truly terrible thing. And so you have some of the worst moments in medicine, in pediatrics, and in children.

And you have to learn get through those. And I use the successes to hold myself through those, but sometimes you get a bunch of those cases in a row and it can get really, really burdensome on you, just bad situation after bad situation, after bad situation. And you just really are hoping for a win. One of those wins too, I’ve had children who I saved, and they could have woken up and gone and lived normal lives, but they ended up having other issues that in the process of getting to them to that point, they developed that were life ending. And then you had a child whose mind you saved, but whose body you couldn’t and watching the family go through the the grieving process of allowing their child comfort measures.

That’s really hard when you’ve invested potentially months of effort trying to turn the tide and ultimately, failing to provide a long-term survivable outcome. So that’s the worst part. And as I said, everyone deals with it in different ways. I’ve found that most people who go into pediatric neurosurgery don’t have children at the time that they make that decision. It seems like people who have children when they consider pediatric neurosurgery as a field, it tends to be a little harder to separate your home life from what you’re seeing, and certainly, that’s not an absolute truth, but that’s been my experience.

How do you balance work in your hobbies? Do you have hobbies that you participate in and that you spend time on?

I definitely am not just an infinite work machine, I have other interests. I do have hobbies. We’ll get to this, but (I have) other interests, like, for example, I’m in a hotel room right now because I have a lot of interest in technology and technology development. I’ve spent a lot of time working on new technologies to make neurosurgery better. And one part of that is finding a company that will make what you’ve developed. And so I spent a lot of time in the startup area or some startup arena. I don’t personally have a lot of interest in running startups, but kind of working through the process of taking an idea, making a prototype, validating it, and then getting it made by somebody and ultimately picked up by a major manufacturer, that’s kind of a side interest of mine that I spend a fair amount of time on. Hobbies are very important in neurosurgery. And outside interests (are important), neurosurgery is an infinitely overwhelming field. You could work forever and never be done. There’s no end – there are very few neurosurgeons. That’s intentional politically to kind of maintain a strong reimbursement model by our major political bodies, but the reality is, for example, in my field or in my residency, there were four residents per year. And we’d have up to 18 to 20 ORs a day throughout the system up to 100 to 150 patients on the list. And then you look at general surgery and they would have the same patient numbers but have 3, 4, 5, 6 times the residents.

So it can be a lot of work. I’ve developed this perception that there’s kind of a cutoff in terms of long term, not talking about residency, but in terms of long term about the amount of time you can spend in the OR and still revert to a seemingly normal personality outside of the OR. I call it the 350 rule, which is just, that if you’re doing more than 350 cases a year, you go a little crazy. The number, the number is just an estimate. It’s different for everyone. And obviously, there are short cases and long cases, but that’s kind of been my general profession or, a perception that the surgeons that I’ve seen that go way over that number, they tend to be a little rougher around the edges because you spend almost every moment of your life awake in an environment that you essentially have absolute control over you are the master and commander of your OR, and that can be hard to turn off when you’re spending 98% of your life in the OR. I found that the most important thing in neuro or in residency was to anchor myself on repetitive and often simple activities to kind of keep myself sane.

So during junior residency that involved every week on my day off, I would go to a different restaurant. I would literally sometimes fall asleep at these restaurants, right. It didn’t matter <laugh> it was what was important was the repetition, the separating myself from the hospital, doing a human activity with other people interacting on, on a non-hospital level. That kept me sane when I was older. I had a dog I would walk that dog didn’t matter what time I got home, or when I went in every morning, every night that dog got a long walk by the river, and yes, I had a dog walker. Don’t worry. The dog was getting a walk during the day too. But that was important. That was extremely important to my sense of well-being in terms of now; I continue my interest in dance, my wife and I do, a smattering of different jazz and Latin dances.

There’s a fairly robust community in Pittsburgh for that. I also have a long-standing love of Chinese Shar-Pei. I have a Chinese Shar-Pei puppy named Sushi, who is about one year old now, she is a show dog. And we haven’t decided if we’re actually going to take her and do competitions, but she is of a new champion bloodline and she’s kind of been prepared for that. What people don’t realize about dog shows is they’re not sports, they’re breeding conventions. So in order, so in order to participate, your dog has to be viable as a reproductive animal. And so they can’t be spayed or neutered, so she’s currently not spayed, but that really is kind of what we’re debating, in terms of competing versus having her spayed and her just being a family dog. And I have a lot of interest in, kind of vintage menswear and I’m a clothing enthusiast, we’ll say.

How active is the pediatric neurosurgical research field?

It’s very active. To be clear, there are only about 300 pediatric neurosurgeons in the United States. So it’s a super small field. So when I say a few, I’m talking about a dozen or two, but there are a few surgeons who are genuine scientists. I am not a scientist. I’m a surgeon who does science. It’s a very big distinction, but I have two partners who are NIH RO1-funded scientists, and they also do surgery, but they’re real scientists. So yes, there is a lot of research activity on specifically brain tumors and functional epilepsy disorders in children. Clinically. There’s lots of research going on. The problem is it’s a very small field and it’s a very rare field. So it’s very hard to generate level one evidence on anything because it’s very hard to do randomized controlled trials on surgical topics, especially when you’re talking about things that maybe there are only a few hundred in the whole country per year.

So there is a lot of quality improvement research that goes on and there are you, but it tends to be multi-center institution based because it’s very hard for any center no matter how famous or how focused to a crew enough patients on any specific topic to generate level one evidence. So it’s a, it’s a highly collaborative field. There are tons of registries and multi-center studies that have different focuses on hydrocephalus or spasticity, but as a basic science true your research field there are only a few, probably a dozen practitioners that I would say are actual scientists.

What are your thoughts on the emergence of neurosurgery pre-residency programs?

So I’m gonna presume that when we’re talking about pre-residency programs, we’re talking about programs that you do after you graduate. But before you apply successfully to the match. Ultimately any successful route into neurosurgery is a successful route. I worry that many of the pre-residency programs out there by the definition that I’ve (seen) do not have great outcomes in terms of the percentage of people that ultimately end up in neurosurgery. Now we’re talking about programs like NYU, where you apply into medical school, and you basically are guaranteed a neurosurgery program spot in that program when you finish medical school, that’s great too. I think that that’s totally a reasonable route into neurosurgery, but I worry that a lot of these pre-residency programs tend to have people in them that spend a lot of time in the field and then don’t end up in neurosurgery.

Now they are often a necessity for non-US applicants because it’s very hard for someone coming from a different country to match into neurosurgery unless they’ve spent a number of years doing research and engaging in neurosurgery in this country. So for them, it is often the only viable option, but I would be hesitant to recommend someone devote multiple years of postgraduate time without reimbursement or with little reimbursement without a strong prospect in terms of an eventual residency position. You’re gonna graduate minimum when you’re like 34. So you, you really need to factor in, that you don’t get a coupon, to relive your life after the end of this.

What advice do you have for students interested in pursuing medicine in general or neurosurgery specifically?

So my advice is to pursue interests and activities within, or without medicine that truly you’re passionate about. I’m not a fan of resume padding, and there’s a lot of pressure to do that kind of thing in highly competitive fields, such as neurosurgery. I explored a lot of weird interests, including as we talked about early entomology, those have had applications in my life since becoming a neurosurgeon, I think being a diverse person and having diverse interests and diverse perspectives, ultimately results in unique insights and applications within a field. And I would much rather talk to somebody who was a competition weightlifter, about, well, how, what’s your, like what muscles most important in weightlifting. I’d rather hear about them telling me about their calves and their diet of broccoli and chicken that they’re, they spent, time and they invested, their passion and than listening to tell someone, tell me about the thousand hours they washed bedpans in the ER; unique and interesting activities that you enjoy talking about ultimately are going to reflect more positively on you.

---

Want to know more about neurosurgery? Check out our additional interviews with neurosurgeons:

• 20 Questions: Brian Walcott, MD, Neurosurgery
• Q&A with Dr. James Doty, Neurosurgeon, CCARE Director
• Q&A with Suzanne Tharin, MD/Ph.D., Neurosurgery