The Role Of A Neurosurgeon
Neurosurgeons are involved in the diagnosis, assessment and surgical treatment of conditions relating to the nervous system. The nervous system can be split into the central nervous system and peripheral nervous system; the central nervous system consists of the brain and spinal cord, while the peripheral nervous system includes nerves and neuromuscular junctions outside the brain and spinal cord.
What patients do neurosurgeons see and what conditions do they diagnose/treat?
Neurosurgeons see patients of all ages. Cases span a wide spectrum from acute, life-threatening emergencies to chronic debilitating conditions. Some of the common conditions they diagnose and treat may include the following: 
Tumours in the brain, spine and skull
Head and spinal cord trauma
Degenerative spinal conditions
Cerebral aneurysms and strokes
Movement disorders – e.g. Parkinson’s disease
Congenital conditions e.g. Spina bifida
Pituitary tumours and neuroendocrine disorders
Surgical management of pain
Mix of medical, surgical, imaging, interventional work
A Neurosurgeons job entails many different procedures to treat the conditions mentioned above. Examples of surgical procedures include craniectomy and craniotomy, stereotactic radiosurgery and neuroendoscopy. There have been many technological advances in neurosurgery, including interventional radiology and minimally invasive surgical techniques etc.
Use of imaging procedures is vital in neurosurgery in order to identify brain structures and assess brain function for surgery.
Neurosurgeons work alongside other members of the multidisciplinary team including specialist doctors, nurses and anaesthetists. They work very closely with neurologists, who usually provide the management plan for the patient, while the neurosurgeon carries out surgery.
Other main specialist doctors they work closely with include radiologists, oncologists and pathologists. They are also supported by healthcare professionals including occupational therapists, physiotherapists, speech and language therapists and social workers.
Proportion of men/women
Neurosurgery is a predominantly male specialty. Data from NHS Hospital and Community Health Service (HCHS) workforce statistics shows that in 2017, there were 679 males and 151 females in neurosurgery, meaning 82% of neurosurgeons are male.
Desired skills, aptitudes, traits
Neurosurgery is a very demanding specialty which requires good decision making under stress. Desired skills and traits include but are not limited to good manual dexterity, effective time management and organisation, confidence and caution, physical stamina and emotional strength.
Advantages and Disadvantages
Neurosurgery is no doubt a very challenging specialty and one that involves long hours, many on-call duties and a high degree of risk. However, it can also be very rewarding as successful surgery can greatly improve a patient’s quality of life. Neurosurgery is at the forefront of medical, surgical and technological advances.
The Life Of A Neurosurgeon
Typical day and working hours
Surgery is the main responsibility of a neurosurgeon; however evaluation of patients in clinics, emergency departments and ward rounds are also part of the job. Neurosurgery is a challenging specialty with long hours. Days can vary widely. For example, a typical day starts around 07:50 gathering patient lists and preparing for ward rounds.
There is a handover meeting discussing patients and reviewing imaging. If a theatre list is available, pre-checks would be done and the list of patients would be discussed. There can be ward rounds and surgeries throughout the day, and teaching for trainees. The day generally ends at 18:30 or 20:30 depending on the shift. Further, night shifts are common, as head or spinal trauma can occur at any time.
On call commitments
Out of hours commitments, including weekends, are common. This includes on call for adult and paediatric emergencies. Consultants are usually on call on a one in eight or one in nine rota. Even as a consultant, neurosurgeons have many on call duties due to the nature of the specialty; accidents are unpredictable and traumatic situations can be clinical emergencies.
Elective procedures can be cancelled at short notice due to emergencies. Operations can range from long and complex such as removing a difficult brain tumour (taking 10-11 hours), or simple and straightforward such as putting in an intracranial pressure monitor (30 minutes).
The Route To Neurosurgery
In order to become a neurosurgeon, one must first complete a degree in medicine (MBBS/MBChB or equivalent) and then be registered with the General Medical Council (GMC). After completion of a two-year UKFPO-affiliated foundation programme, one can apply directly to a ST1 neurosurgical training post.
Neurosurgery training is a ‘run-through’ programme lasting 8 years (ST1-8). An alternative pathway to neurosurgery includes two years of core surgical training (CT1 and CT2) followed by entrance to ST3 in neurosurgery – however this route is even more competitive.
Competition is extremely high; in 2019, competition ratios for ST1 and ST3 training posts were 6.54 and 7.00 respectively.
The training pathway is outlined below:
- 1 - Core neuroscience training
- 2+3 - Initial neurosurgical training
- 4+5 - General neurosurgical training
- 6+7 - Final neurosurgical training
- 8 - Specialty training
The Membership of the Royal College of Surgeons exam (MRCS) is required for progression to ST3. It consists of a 5 hour MCQ exam and an OSCE. The Fellowship of the Royal College of Surgeons exam (FRCS (Neurosurgery)) is the exit exam which includes a portfolio. It includes both a written exam and a clinical and oral exam.
Upon completion of ST1-8 and the FRCS, you will be awarded a Certificate of Completion of Training (CCT). Consultant roles can be applied for six months prior to achieving the CCT.
Tips for success
Given how competitive neurosurgery is, it is important to be active in developing skills and expressing interest in surgery from an early stage. Additional related qualifications including intercalated degrees (e.g. BSc, BMedSci), attendance at Basic Surgical Skills and ATLS courses, audits and research are all desirable.
Neurosurgery is a small surgical specialty. In January 2020, there were 349 neurosurgeons in England out of a total of 9,784 surgeons, meaning neurosurgeons make up only 3.6% of surgeons. This trend is also seen in Scotland, with 30 consultants.
There are many subspecialties available within neurosurgery, including the following:
Skull base surgery
Opportunities for research or an academic career
Those interested in an academic career may begin from an early stage entering the Academic Foundation Programme, although this is not essential. An Academic Clinical Fellowship (ACF) with progression to a Clinical Lectureship (CL) are the more advanced stages of an academic career.
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
There is also potential to enhance NHS earnings from private practice, earning up to an additional £79,199 per annum according to 2008 study.
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
Additional Information & Resources
Youmans Neurological Surgery and Schmidek and Sweet: Operative Neurosurgical Techniques are textbooks for those who may be keen to get a head start on neurosurgery and for those already working in the specialty.
The National Hospital for Neurology and Neurosurgery (NHNN) in London is the UK’s largest dedicated neurological and neurosurgical hospital. It is a major international centre for both research and training alongside its neighbour, the UCL Queen Square Institute of Neurology.
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