Re:

Since you are in the hospital doing surgery two or three times a night, for two weeks, isn't there something that is an offshoot of medicine that you are passionate about?

Good question

Not really

The medical space is so filled - it honestly doesn't feel like a space for innovation. People talk a lot but the regulatory environment and intense competition for resources to support well established labs makes it hard to make progress.

I enjoy spending time in the hospitals, learning about stuff. The cases have a beginning and an end (move on to the next one), the learning is challenging. Using skills and making decisions where I am accountable is terrific. While there is always room for improvement and tons of input from folks all over the hospital - doctors largely make autonomous decisions where there are real outcomes. Nothing fake or intangible. And it feels like a merit-based place in the sense that the gossip and politics are secondary to the patient care (and not the primary drivers of it). There is also no cult of a supreme leader or head of state that makes emotional and often all encompassing decisions (unless it is God). I like neurology and neurosurgery both and I plan to continue to carve out a cool hybrid role that manages both specifically with expertise in trauma and cerebrovascular pathology since that is where I have lots of training and experience.

There are a ton of really cool research questions that no one will fund. I'm not sure even how to answer the questions but if they were provable, they would be game changing. I've tried to get research grants but basically unless you are doing genomics or degenerative disease - there really isn't much to qualify for. Setting up a lab is also a bogus operation since you don't really need all the space/people but the university needs that to keep funding flowing. So the "dean's tax" is a huge barrier too.

There is an offer on the table in the private sector at a big hospital here called here they want me to run their vascular fellowship and be a neurosurgical hospitalist (neurology + neurosurgery inpatient only, no clinic). But it is a real commitment and so bureaucratic/academic - not creative and a step in a direction that I am not keen to take.