Many point to neurosurgery is the most demanding specialty, which is why it requires the longest amount of training of any medical speciality.  Unlike other parts of the human body, the nervous system does not tolerate mistakes well. Errors in judgement or technique can have very serious consequences for patients.

Following college, some neurosurgeons complete up to 14 years of training:

  • Four years of medical school (MD or DO).
  • Seven years in a neurosurgery residency.
  • One to three years in a fellowship. Some neurosurgeons complete a one-year fellowship. Others complete an open and endovascular fellowship, which can be up to three years.

Aside from the training, neurosurgeons also complete a rigorous board certification process.

After the first year of residency, neurosurgeons must take and pass an neuroanatomy written online test. Before starting the chief residency years (years six and seven, neurosurgeons must pass a written neurosurgery test.   

A neurosurgeon must collect 125 cases over a six-month stretch in the first three years after graduating from residency.  (Other medical specialties may only require 30 cases.) The cases are submitted to the American Board of Neurological Surgery (ABNS), and then the neurosurgeon must sit for oral boards, which make up the third and final test.

The oral boards review a neurosurgeon’s submitted cases as well as other cases. After passing neuroanatomy, written and oral boards, a neurosurgeon is then certified by the ABNS.

Board certification does not end with the initial certification; neurosurgeons must complete ongoing board requirements, including an intense re-certification process every 10 years.

The maintenance of certification (MOC) requirements include:

  1. An annual letter from the department chair stating that the neurosurgeon has hospital privileges and is completing the mortality/morbidity (MM) conference on a regular basis.
  2. At least 20 continuing medical education (CME) hours each year.
  3. Actively completing the ABNS learning module each year.
  4. Participating in at least a quarterly MM conference, which includes the neurosurgeon’s own cases.

These ongoing requirements must be completed by December 31 of each year. Failure to do so results in the neurosurgeon being required to re-take the oral boards.

Neurosurgeons also complete a major re-certification exam every 10 years, and this includes the written exam (the MOC cognitive exam). In addition, a practice performance assessment is completed (the evaluation and improvement of a neurosurgeon’s clinical practice, often through case logs or peer review).