When Dr. Richard Veyna, a board-certified neurosurgeon, revealed his educational journey in a viral Facebook video that garnered over 147,000 views, his answer left many stunned. "It's 15 years after high school," he explained, "or what I like to say was 27th grade."
This eye-opening statement reveals a truth that even many medical professionals don't fully appreciate: neurosurgery requires one of the longest training pathways in all of medicine.
Neurosurgeons diagnose and treat conditions affecting the brain, spine, and nervous system.
Dr. Veyna's path to becoming a neurosurgeon followed this trajectory (based on the standard U.S. model):
The extended timeline isn't arbitrary. Neurosurgery demands exceptional skill development across multiple domains:
Neurosurgeons must develop extraordinary manual dexterity, hand-eye coordination, and visuospatial awareness. They operate on the most delicate and vital structures in the human body, including the brain and spinal cord.
A neurosurgeon must cultivate excellent communication skills to manage relationships with colleagues, patients, and their families effectively.
The skill set of a neurosurgeon should also include a calm temperament and the ability to work well under pressure. It encompasses teamwork, problem-solving, diagnostic acumen, and ethical decision-making.
The American Board of Neurological Surgery (ABNS) sets strict requirements that shape neurosurgical training:
The educational program in neurological surgery must be 84 months in length
The year of fundamental skills (PGY-1) must be organized so that residents participate in clinical and didactic activities
The program must provide 54 months of clinical neurological surgery education at the primary clinical site or at an approved participating site. A minimum of 21 months of neurological surgery education must occur at the primary clinical site
Remaining time dedicated to neurological sciences, research, and elective rotations (e.g., critical care, neuropathology).
There must be a total of at least 500 major neurological surgery procedures at the primary clinical site per year for each resident completing the program
U.S. neurosurgery residents have been limited to an average of 80 hours per week, per ACGME rules since 2003. This schedule accelerates skill acquisition and case volume but demands sacrifices in work-life balance.
Neurosurgery is among the most competitive specialties in the United States. It has a match rate of roughly 56 to 60 percent, and successful applicants often score in the highest percentiles of the USMLE Step examinations.
Neurological surgery is a medical discipline and surgical specialty that provides care for adult and pediatric patients in the treatment of pain or pathological processes that includes the activity of:
the central nervous system (e.g., brain, hypophysis, and spinal cord)
the peripheral nervous system (e.g., cranial, spinal, and peripheral nerves),
the autonomic nervous system, and the supporting structures of these systems (e.g., meninges, skull and skull base, and vertebral column)
Treatment encompasses non-operative management (including prevention, diagnosis, image interpretation, etc) and operative management (including image interpretation, endovascular surgery, functional and restorative surgery, etc).
Dr. Veyna mentioned in the video that he once performed an 18-hour surgery. These marathon operations are not uncommon in neurosurgery, where precision under fatigue can mean the difference between life and death.
One goal of ACGME-accredited education is to educate physicians who seek and achieve board certification. One measure of the effectiveness of the educational program is the ultimate pass rate. The program director should encourage all eligible program graduates to take the certifying examination offered by the applicable American Board of Medical Specialties (ABMS) member board or American Osteopathic Association (AOA) certifying board.
In the U.S., women remain underrepresented in neurosurgery, though progress is accelerating. As per a report, the percentage of female neurosurgery residents over the years is as follows:
29.8% (included 71 females) in 2022
25.2% (included 58 females) in 2021
With a contrast of only 15.2% (included 34 females) in 2016 1
Organizations like Women in Neurosurgery (founded in 1989) work to address these disparities by attracting women to the field, providing mentorship, and recognizing accomplished female neurosurgeons who are innovative, competent, and deeply committed to patient care.
When Dr. Veyna casually mentioned "27th grade" to describe his education, he illuminated a reality that shocks even medical professionals: becoming a neurosurgeon requires 15 years of intensive post-high school training.
This extraordinary commitment reflects the immense responsibility neurosurgeons shoulder. They operate on the most complex organ in the human body, where their skills directly determine whether patients live or die, recover fully, or face permanent disability. It's a path of unparalleled rigor, but one that saves lives in ways few professions can match.
1. El Naamani, K., Reyes, M., Jreij, G., Ghanem, M., Abbas, R., Mounzer, M., Schunemann, V., Theofanis, T., Smith, M., Gooch, M. R., Rosenwasser, R. H., Jabbour, P. M., & Tjoumakaris, S. I. (2024). Women in neurosurgery: a cross-sectional demographic study of female neurosurgery residents in the United States. Journal of Neurosurgery, 140(6), 1785-1789. https://doi.org/10.3171/2023.9.JNS232080
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