The human brain remains a mystery, so it’s no wonder many aspiring medical professionals are drawn to the allure of neurosurgery, captivated by the opportunity to make life-saving interventions. Yet, behind the allure lies a journey fraught with obstacles. At the core of the matter lies a fundamental question: “Is neurosurgery hard?” Understanding the journey to becoming a neurosurgeon is crucial as it allows you to delve into the myriad of challenges that accompany the pursuit of this noble profession. 

Buckle up and get ready to witness what makes this specialty one of the most demanding specialties in medicine. Join us and discover what awaits you when you take this formidable path. 

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What Is a Neurosurgeon?

Neurosurgeons are specialized medical doctors who diagnose and treat conditions that affect the nervous system – brain, spinal cord, and nerves. They diagnose and treat nervous system conditions through both surgical and non-surgical therapies. Some of the conditions they treat include:

  • Tumors in the brain, spine, and skull;
  • Cerebral aneurysms and strokes;
  • Head and spinal cord trauma;
  • Congenital anomalies, such as Spina bifida or hydrocephalus;
  • Vascular disorders, such as arteriovenous malformations (AVM);
  • Pituitary tumors and neuroendocrine disorders;
  • Movement disorders like Parkinson’s disease;
  • Infections of the brain or spine, such as meningitis, encephalitis, or epidural abscess;
  • Epilepsy;
  • Degenerative diseases of the spine, such as spinal disc herniation and spinal stenosis.

A key element to treating neurological disorders is radiology tools, such as:

  • Computed tomography (CT);
  • Positron emission tomography (PET);
  • Magnetic resonance imaging (MRI);
  • Magnetoencephalography (MEG).

By utilizing these imaging tools, neurosurgeons can perform both open surgery and minimally invasive surgical procedures, such as:

  • Conventional open surgery;
  • Endoscopic surgery;
  • Microsurgery;
  • Endovascular surgery;
  • Stereotactic radiosurgery;
  • Spinal neurosurgery;
  • Psychiatric neurosurgery.

Besides surgical procedures, neurosurgeons are responsible for:

  • Prescribing medications such as pain medication or antibiotics;
  • Ordering and interpreting medical laboratory tests;
  • Performing physical examinations;
  • Performing special neurologic maneuvers to examine whether the brain and cranial nerves function appropriately. 

How Hard Is It to Become a Neurosurgeon?

Becoming a neurosurgeon is one of the most challenging and demanding paths in the medical field. It requires a high level of dedication, physical stamina, and emotional resilience. Let’s explore the key factors that make this specialty challenging. 

How Hard is it to Become a Neurosurgeon

1. Educational requirements

Before stepping into an operating room, neurosurgeons must go on a long and grueling educational journey. First, they must earn a bachelor’s degree from an accredited institution. While there are no strict requirements regarding the major, a degree in biological sciences, neuroscience, or a related field can serve as a stepping stone toward a medical career. During their undergraduate studies, students are required to complete the prerequisite courses for medical school, such as biology, biochemistry, chemistry, physics, mathematics, and English. Additionally, students must take and pass the Medical College Admission Test (MCAT) before enrolling in medical school.

Medical school is a pivotal step on the journey to becoming a neurosurgeon. During medical school, students gain foundational knowledge in anatomy, pathology, pharmacology, biochemistry, etc. Moreover, they undergo clinical rotations in various specialties, including neurology and neurosurgery. 

During undergraduate studies and medical school, students must maintain high academic performance. Strong grades reflect a solid understanding of medical concepts and the ability to handle the rigors of medical education. Furthermore, they must participate in research projects or volunteer in healthcare settings to advance their medical knowledge and develop patient care skills. 

2. Residency training

Residency training in neurosurgery is exceptionally challenging, demanding, and equally rewarding. It prepares aspiring neurosurgeons to handle the complexities of their field, ultimately allowing them to provide the highest level of care to their patients. 

Neurosurgery residency is one of the longest medical residencies and takes seven years to complete. During the residency training, aspiring neurosurgeons gain hands-on training in all aspects of neurosurgery, including the cerebrovascular system, the spine and spinal cord, pediatric surgery, pain management, trauma, and tumors. Although the rotations and resident responsibilities vary depending on the program, in general, during the years, residents go through rotations in neurosurgical, critical care medicine, and neuropathology services. Moreover, they receive basic training in performing lumbar puncture, external ventricular drain placement, and intracranial pressure monitor insertions before moving to complex spinal procedures with meningiomas and posterior fossa surgery. 

The work hours during neurosurgery residency training are famously demanding. On average, residents work between 60 and 80 hours per week or 12 and 16 hours per day, including overnight shifts, weekends, and holidays.

After completing residency training, some neurosurgeons choose to complete an additional fellowship in a particular specialized area of study, such as:

  • Skull base surgery;
  • Neurovascular surgery;
  • Neuro-oncology;
  • Functional neurosurgery;
  • Spinal surgery;
  • Traumatology. 

3. Licensing and certification

A crucial step for neurosurgeons to practice medicine is obtaining a medical license. It involves passing the United States Medical Licensing Examination (USMLE) for allopathic physicians (M.D.s) or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) for osteopathic physicians (D.O.s). Both USMLE and COMLEX are divided into three stages, usually taken:

  • USMLE Step 1 or COMLEX Level 1: At the end of the second year of medical school;
  • USMLE Step 2 or COMLEX Level 2: During the third or fourth year of medical school;
  • USMLE Step 3 or COMLEX Level 3: During the first or second year of residency.

After completing residency training, neurosurgeons can seek certification through the American Board of Neurological Surgery (ABNS). The primary purpose of this certification is to evaluate an applicant’s education, training, and practice qualification through written and oral examinations. Written exams test knowledge across neurosurgery in neuropathology, clinical neurology, critical care/fundamental clinical skills, neuroanatomy, neurosciences, and more. While the written examination explores an applicant’s knowledge in various relevant disciplines, the oral examination examines knowledge and judgment in clinical neurological practice. This includes questions regarding the preoperative evaluation, intraoperative technical and decision-making issues, postoperative management, and appropriate treatment of complications.

To maintain certification, neurosurgeons are required to engage in continuing medical education (CME) throughout their careers. This involves participating in seminars and enrolling in courses to remain up-to-date with the latest developments in the field. 

4. Skills and knowledge

Lastly, becoming a neurosurgeon requires advanced skills and knowledge, such as:

  • Technical skills: Neurosurgeons perform delicate and precise brain, spinal cord, and peripheral nerve surgeries. Therefore, they must possess excellent hand-eye coordination to manipulate surgical instruments safely within these sensitive areas. They also must possess fine motor skills to make minute movements without damaging surrounding tissues.
  • Extensive knowledge: Neurosurgeons must also have extensive knowledge of neuroanatomy to navigate the nervous system during surgery and diagnose neurological conditions accurately. They must also have advanced knowledge of neurology to understand neurological diseases, their presentations, and non-surgical management.

Neurosurgery is an ever-evolving field. Therefore, neurosurgeons must participate in continuous learning to keep up-to-date with the latest developments, surgical techniques, and technological innovations. Continuous learning enables them to hone their skills and deepen their understanding of the field, allowing them to provide the highest level of care to their patients. 

How Long Does It Take to Become a Neurosurgeon?

The journey to becoming a neurosurgeon is a lengthy and rigorous process that typically takes about 15 years after high school. The education and training needed to become a neurosurgeon involves:

  • Graduating from an accredited four-year undergraduate degree;
  • Completing four years of medical school;
  • Completing a seven-year neurosurgical residency program that is accredited by the American Council on Graduate Medical Education (ACGME).

Furthermore, fellowship programs in a subspecialty of neurosurgery typically take one to two years to complete.

The path to becoming a neurosurgeon demands a significant investment of time, dedication, and hard work. However, for those genuinely passionate and committed to the field, this odyssey leads to a rewarding career where they can profoundly impact the lives of their patients. 


Becoming a neurosurgeon is undeniably one of the most challenging paths in the medical field. From rigorous educational requirements to intense residency training, neurosurgeons must excel in a highly competitive environment, constantly honing their skills to meet the profession’s standards. Despite the challenges, many neurosurgeons find immense satisfaction and fulfillment in their profession. They thrive in a field where they can make life-changing and life-saving differences for their patients. 

If you’re passionate about becoming a neurosurgeon and want to work at the cutting edge of medical science, you’ll find that neurosurgery makes a uniquely fulfilling career. The road ahead may be challenging, but with dedication and resilience, becoming a neurosurgeon is within reach. 

Frequently Asked Questions

What is the difference between a neurologist and a neurosurgeon?

The main distinction between a neurologist and a neurosurgeon lies in their scope of practice: neurosurgeons address surgical issues related to the brain and spine, while neurologists deal with non-surgical neurological problems.

Can a neurosurgeon treat without surgery?

Although they primarily perform complex surgeries, neurosurgeons can employ a variety of non-surgical treatments like medications, steroid injections, and physical therapies before recommending surgery. 

At what age do most neurosurgeons retire?

The most common age range for planned retirement for neurosurgeons is 65 to 69

What is the shortest time to become a neurosurgeon?

The shortest time to become a neurosurgeon is 15 years after high school. This timeline encompasses four years of undergraduate studies, four years of medical school, and seven years of residency training.

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