Brains and Beyond

Neurosurgeons need strong technical skills and a capacity for hard work

Neurosurgery is one of the most technically demanding specialties, but it also offers substantial clinical challenges.

Dr Mark Davies, president of the Neurosurgical Society of Australia, says he was initially attracted to the specialty because he enjoyed surgery, but was also fascinated by the nervous system and neurological diseases.

“I found it was as challenging as many medical specialties in terms of the clinical acumen required”, he says.

Dr Davies says it’s a specialty where the basic sciences, such as anatomy and physiology, continually come into play. He trains young doctors to think from first principles, using clinical signs and symptoms to try to determine the problem, before correlating their conclusions with imaging.

Another appealing aspect is the fact that neurosurgeons operate not only on the brain, but on the entire peripheral nervous system.

“From a surgery point of view, it’s a fairly unique specialty in that you get to operate all over the body”, Dr Davies says. “For instance, in Australia, about 70% of spinal surgery is performed by neurosurgeons.”

When Dr Davies started in the specialty 20 years ago there were “a lot of unknowns” about the brain and nervous system, which is still true today.

“That continues to be something that gets you up in the morning because you’re always learning things, there are new developments occurring all the time. People have outcomes that you don’t quite understand and people present in ways that are often not the textbook way”, he says.

Dr Terry Coyne, a neurosurgeon at BrizBrain & Spine in Brisbane, agrees that one of the most interesting aspects of the specialty is that it’s constantly evolving.

“It’s an ever-expanding field. I might be biased, but probably of all of medicine, neurosurgery is the area with the greatest growth potential.”

Dr Coyne says in the 25 years he’s worked as a specialist neurosurgeon he has seen huge advances in technology and treatments. These include computerised image guidance, stereotactic radiosurgery and deep brain stimulation for movement disorders.

“You need to be open to change and be willing to take advantage of all the advances that are occurring”, he says.

In addition to embracing change, neurosurgeons need to be able to cope with the emotional side of managing very sick patients, including those with major trauma. Neurosurgery is also high-stakes work, so while it can be life-changing it can also have disastrous outcomes when things go wrong.

“It can be emotionally draining and stressful … there are not always good outcomes. That’s probably the worst part”,

Dr Coyne says.He says budding neurosurgeons need the ability to be “brave without being reckless”, particularly when performing difficult operations such as complex spinal reconstructions or deep brain tumour operations.

The technical demands of the specialty, where much of the surgery is done under magnification, mean that neurosurgeons need “good hands”.

Neurosurgery is also a demanding specialty in terms of time management. Many neurosurgeons working long and antisocial hours, with procedures that can stretch up to 24 hours. Neurosurgeons therefore need to have a measure of stamina, both physically and emotionally.

There are only about 160 neurosurgeons practising in Australia and New Zealand. Dr Coyne says the small size of the specialty offers a number of advantages, such as opportunities to interact with international colleagues.

“Because there are not that many people in neurosurgery you get to know people from around the world. I’ve really enjoyed that aspect of it.”

The small size of the specialty also gives neurosurgeons the chance to really become experts in their area of specialisation.

Dr Coyne also appreciates the practice model at BrizBrain, which is a shared private practice of five neurosurgeons with different subspecialty interests. He says this model is becoming more common and allows practices to offer patients excellent care through access to neurosurgeons with different areas
of expertise.

Most neurosurgeons these days do subspecialise, says Dr Davies. Popular subspecialties include spinal surgery, paediatric neurosurgery, cerebrovascular neurosurgery and neuro-oncology. Because the specialty is small, many neurosurgical registrars choose their subspecialty based on the needs of the hospital they want to work in, he adds.

Many neurosurgeons are also actively involved in research (see “Medical mentor”, page C5) and the specialty enables doctors to pursue research to the extent they wish.

Similarly, neurosurgeons can often choose the mix of private and public work that suits their preferences.