What Steps Do You Take to Become a Brain Surgeon?

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The brain and nervous system control the rest of the human body, so when they're not functioning properly the results can be debilitating or life-threatening. Neurological surgeons are responsible for treating conditions affecting the brain and nervous system, and brain surgery is one of the neurosurgeon's core responsibilities. Given the brain's importance, it's not surprising that neurosurgeons face one of the medical profession's longest training periods.


Medical careers begin with an undergraduate premedical degree. Any major is acceptable as long as the course work meets the prerequisites for medical school. Those usually include courses in mathematics and the humanities, basic physics, biology and chemistry, and more advanced work in organic chemistry or biochemistry. Students also take the Medical College Admissions Test, or MCAT, before their senior year. After earning a bachelor's degree, students go on to spend four years in medical or osteopathic college. The first two years are primarily classroom instruction, learning medical ethics and the science of medicine. The third and fourth years are spent in clinical rotations, working with experienced physicians and gaining hands-on exposure to the major branches of medicine.

Residency and Primary Examination

After graduation from medical school, the new doctor must earn a position in a residency program accredited by the Accreditation Council for Graduate Medical Education, or ACGME. The first year is spent in general surgery. The remaining five or more years focus on neurological surgery, which includes procedures treating the peripheral nervous system, central nervous system and spine as well as brain surgery. Residents exercise increasing levels of responsibility and independence, as they demonstrate their competence, judgment and growing skills. During this period, residents can take the Board of Neurological Surgery's primary examination. Once they've passed the exam and completed their residency, they're eligible for certification.

Board Certification

Surgeons are considered board-eligible for a period of five years after completing their residency. They must pass the Board of Neurological Surgery's certification exam during that period, or take additional training to restore their eligibility. Candidates must first pass the primary examination, provide a letter from their residency program that vouches for their competence, and document all cases in the preceding year -- a minimum of 100 -- in which the applicant was the responsible physician. The certification exam itself is an oral examination, with a panel of experienced neurological surgeons posing questions designed to assess the surgeon's clinical and decision-making skills. Those who pass become board-certified neurosurgeons.

The Career

Neurosurgeons use a variety of techniques for brain surgeries. Traditional open surgeries, with the skull opened and the brain exposed, are still performed for some conditions. Less-intrusive endoscopic and catheter-based procedures use miniature instruments threaded through a thin tube and into the brain, performing repairs from inside the patient's skull or blood vessels. Neurological surgeons are among the highest-paid of all physicians. A 2012 survey performed by the American Medical Group Association reported a median salary of $656,250 for neurosurgeons, second only to the $710,556 earned by orthopedic spinal surgeons.