Career Pathways in Neurosurgery
Your roadmap to becoming a neurosurgeon -- anywhere in the world.
Career Progression
MBBS
5.5 years (4.5 + 1 year internship)
NEET PG
Qualify for MS General Surgery or direct MCh entry
MS General Surgery
3 years (required for most MCh seats)
NEET SS / INI SS
Qualify for MCh Neurosurgery superspeciality
MCh Neurosurgery
3 years (or 6 years direct post-MBBS at select centres)
Fellowship
Spine, Vascular, Pediatric, Skull Base, or Functional Neurosurgery
Entry Pathway
NEET PG qualifies you for MS General Surgery or, at select centres, direct 6-year MCh Neurosurgery programmes. Most candidates complete a 3-year MS General Surgery before appearing for NEET SS or INI SS to secure MCh Neurosurgery seats.
Key Exams
NEET SS (NBE), INI SS (AIIMS/NIMHANS/PGIMER/JIPMER), individual institute entrance exams. Some centres like NIMHANS and SCTIMST conduct their own DM/MCh entrance tests.
Duration
MCh Neurosurgery is 3 years after MS General Surgery. Direct (post-MBBS) programmes are 6 years and available at AIIMS, NIMHANS, and a few other centres.
Top Institutes
AIIMS New Delhi, NIMHANS Bangalore, PGIMER Chandigarh, CMC Vellore, SCTIMST Trivandrum, SGPGIMS Lucknow, NIMS Hyderabad, KEM/Grant Medical College Mumbai.
Fellowships
Spine surgery, cerebrovascular/endovascular, pediatric neurosurgery, skull base surgery, functional and stereotactic neurosurgery, neuro-oncology. Many pursue international fellowships (UK, USA, Japan, Germany) after MCh.
Career Progression
Pre-Med / Undergraduate
4 years -- Bachelor's degree with pre-med coursework (biology, chemistry, physics, organic chemistry)
Medical School (MD / DO)
4 years -- Earn Doctor of Medicine or Doctor of Osteopathic Medicine degree
USMLE Exams
Step 1 (during/after medical school), Step 2 CK (clinical knowledge, before graduation)
Neurosurgery Residency
7 years -- Matched via NRMP (National Resident Matching Program); includes 1-2 years dedicated research at most programs
USMLE Step 3
Taken during PGY-1 or PGY-2; required for independent medical licensure
ABNS Board Certification
Written and oral examinations by the American Board of Neurological Surgery after residency completion
Fellowship (Optional)
1-2 years in spine, vascular/endovascular, pediatric, functional, skull base, or neuro-oncology
Entry Pathway
After completing a 4-year undergraduate degree and 4-year medical school (MD or DO), graduates apply for neurosurgery residency through the NRMP Match. Neurosurgery is among the most competitive specialties, with ~250 positions filled annually from ~400+ applicants. Strong USMLE scores, research publications, and clinical clerkship evaluations are critical for matching.
Key Exams
USMLE Step 1 (now pass/fail since January 2022, but score still reported for older applicants), USMLE Step 2 CK (scored, increasingly the primary screening metric), USMLE Step 3 (licensure). After residency: ABNS Written Board Exam (primary certification) and ABNS Oral Board Exam (within 5 years of completing written boards). Board-certified neurosurgeons must maintain MOC (Maintenance of Certification) through the ABNS.
Duration
Total training from college entry to independent practice: approximately 15-16 years (4 years pre-med + 4 years medical school + 7 years residency). With a fellowship, add 1-2 years. Most programs include 1-2 years of dedicated research time built into the 7-year residency (so-called Folding or Enfolded research years).
Top Programs
UCSF, Johns Hopkins, Columbia/NewYork-Presbyterian, Massachusetts General Hospital (Harvard), Barrow Neurological Institute, University of Michigan, Duke, University of Pittsburgh, Cleveland Clinic, NYU Langone, Mayo Clinic, Stanford, University of Pennsylvania, Washington University (St. Louis), UCLA.
Fellowships
Spine surgery (complex/deformity), cerebrovascular and endovascular neurosurgery (CAST-accredited, 2 years with dedicated endovascular training), pediatric neurosurgery, functional and stereotactic neurosurgery (DBS, epilepsy surgery), skull base surgery, neuro-oncology, peripheral nerve surgery, and neurocritical care. Endovascular neurosurgery is increasingly popular with its own CAST-accredited fellowship track.
Career Progression
Medical School
5-6 years -- MBBS/MBChB degree (5 years standard or 6 years with intercalated degree; 4 years for graduate-entry medicine)
Foundation Programme (FY1-FY2)
2 years -- Rotations across medical and surgical specialties; provisional then full GMC registration
Core Surgical Training (CT1-CT2)
2 years -- Broad surgical training; pass MRCS examination (Parts A and B)
ST3 National Selection
Highly competitive entry into neurosurgery specialty training; portfolio, interview, and clinical assessment
Specialty Training (ST3-ST8)
6 years -- Run-through neurosurgery training at regional neuroscience centres; ISCP portfolio and ARCP reviews
FRCS(SN) Exit Exam
Fellowship of the Royal College of Surgeons in Surgical Neurology -- taken in final years of training
CCT and Consultant Appointment
Certificate of Completion of Training; eligible for NHS Consultant posts or fellowship abroad
Entry Pathway
After medical school and the 2-year Foundation Programme, trainees complete 2 years of Core Surgical Training (CT1-CT2) before applying for ST3 entry into neurosurgery via National Selection. Entry at ST3 is extremely competitive, with approximately 15-20 posts available each year for 100+ applicants. Selection is based on a structured portfolio (publications, courses, audits, teaching), a clinical scenario station, and a management/interview station.
Key Exams
MRCS (Membership of the Royal Colleges of Surgeons) -- Part A (MCQ) and Part B (OSCE), required during or before Core Surgical Training. FRCS(SN) -- Fellowship of the Royal College of Surgeons in Surgical Neurology, the exit exam taken in ST7-ST8. The FRCS(SN) has a written section (SBA/EMI papers) and a clinical/viva section. Passing FRCS(SN) is mandatory for award of CCT.
Duration
Total from medical school entry to Consultant: approximately 15-16 years (5-6 years medical school + 2 years Foundation + 2 years Core Surgical + 6 years ST3-ST8). Out-of-programme experiences (OOPE) for research, fellowships, or overseas training may extend this by 1-3 years. The training pathway is governed by the Joint Committee on Surgical Training (JCST) and monitored through the Intercollegiate Surgical Curriculum Programme (ISCP).
Top Centres
The National Hospital for Neurology and Neurosurgery (Queen Square, London), Addenbrooke's Hospital (Cambridge), King's College Hospital (London), John Radcliffe Hospital (Oxford), Royal London Hospital (Barts Health), Salford Royal Hospital (Manchester), Leeds General Infirmary, Walton Centre (Liverpool), Institute of Neurological Sciences (Glasgow), Bristol Royal Infirmary.
Fellowships
Post-CCT fellowships in spine surgery, skull base surgery, vascular/endovascular neurosurgery, paediatric neurosurgery, functional neurosurgery (DBS, epilepsy surgery), and neuro-oncology. Many UK-trained neurosurgeons pursue international fellowship years (commonly in the USA, Canada, France, or Japan) before taking up Consultant posts. Fellowships are typically 1-2 years.
Career Progression
Medical School
5-6 years -- Undergraduate medical degree (varies by country; often integrated with clinical years)
Common Trunk / Junior Surgical Training
1-2 years -- General surgical rotations (required in Germany, France, Spain; varies elsewhere)
Neurosurgery Specialty Training
5-6 years -- Structured residency (Facharzt in Germany, DES in France, MIR in Spain)
National / European Board Exam
Country-specific board certification; optional EANS/UEMS European examination
Specialist Registration
National registration as a neurosurgery specialist (e.g. Facharzt, Spécialiste, Especialista)
Fellowship (Optional)
1-2 years subspecialty fellowship at a major European or international centre
Entry Pathway
Pathways vary significantly across European countries. In Germany, after the Approbation (medical licence), trainees apply directly to departments for Assistenzarzt positions and complete 6 years of Weiterbildung to achieve Facharzt für Neurochirurgie status. In France, medical graduates take the EDN (Epreuves Dématérialisées Nationales, replacing the former ECN) to enter the DES de Neurochirurgie (5 years). In Spain, the MIR exam determines entry into a 5-year neurosurgery residency. The EANS (European Association of Neurosurgical Societies) and UEMS (European Union of Medical Specialists) work toward harmonising training standards across the EU.
Key Exams
Country-specific: Germany -- Facharztprüfung (specialist oral exam administered by the Ärztekammer). France -- Validation of DES competencies and thesis defence. Spain -- MIR national ranking exam for residency entry. Pan-European: The EANS Written Board Exam and UEMS Section of Neurosurgery assessment offer voluntary European-level certification that is increasingly valued for cross-border mobility under EU directive 2005/36/EC.
Duration
Typically 11-14 years from medical school entry to independent specialist practice. Germany: 6 years after Approbation (~12 years total). France: 5 years DES after 6 years medical school (~11-12 years total). Netherlands: 6 years residency. Italy: 5-year Scuola di Specializzazione after 6 years of medical school. Fellowship training adds 1-2 years.
Top Centres
Germany: Charité (Berlin), University Hospital Heidelberg, LMU Munich, University Hospital Freiburg. France: Hôpital Pitié-Salpêtrière (Paris), Hôpital Lariboisière (Paris), CHU de Montpellier. Netherlands: Amsterdam UMC, Erasmus MC Rotterdam. Italy: Istituto Besta (Milan), Humanitas (Milan). Spain: Hospital 12 de Octubre (Madrid), Hospital Clínic (Barcelona). Switzerland: Inselspital Bern, University Hospital Zurich (technically non-EU but closely integrated in EANS).
Fellowships
Subspecialty fellowships are available across Europe in spine, vascular/endovascular, skull base, paediatric, functional (DBS, epilepsy surgery), and neuro-oncology neurosurgery. The EANS Training Courses and Observership programmes facilitate cross-border training. Many European centres also host WFNS-sponsored fellowships. Mobility between EU countries is facilitated by mutual recognition of specialist qualifications under EU law.
Career Progression
Medical School
4-6 years -- MBBS or MD (4 years graduate-entry or 5-6 years undergraduate-entry)
Intern Year (PGY1)
1 year -- Mandatory supervised internship for general medical registration with AHPRA
Prevocational Training (PGY2+)
1-3 years -- Gain surgical experience, build portfolio; many complete Basic Surgical Training (BST) rotations
SET Selection
Competitive application to SET (Surgical Education and Training) Program in Neurosurgery; CV, referee reports, structured interview, exam
SET Program in Neurosurgery
Minimum 7 years -- Accredited by the Neurosurgical Society of Australasia (NSA); rotations across multiple centres
FRACS Examination
Fellowship of the Royal Australasian College of Surgeons -- written (Generic Surgical Science Exam + Clinical Exam) and viva components
Fellowship (Optional)
1-2 years subspecialty training in Australia or internationally
Entry Pathway
After medical school and internship, candidates apply for the SET Program in Neurosurgery, administered by the Neurosurgical Society of Australasia (NSA) under the Royal Australasian College of Surgeons (RACS). Entry is extremely competitive, with approximately 4-6 positions offered annually across Australia for 50+ applicants. Selection criteria include clinical experience, research output, referee assessments, and a structured interview. Having passed the Generic Surgical Science Exam (GSSE) component of FRACS before applying is advantageous.
Key Exams
GSSE (Generic Surgical Science Examination) -- anatomy, physiology, pathology; typically attempted in the first 2 years of SET. Clinical Examination -- surgical-scenario-based assessment in the later years of SET. FRACS (Fellowship of RACS) -- awarded upon passing all examination components and satisfying all training requirements. The NSA also requires completion of a research project and various mandatory courses (EMST, CCrISP, ASSET).
Duration
Total from medical school entry to specialist: approximately 13-17 years (4-6 years medical school + 1 year internship + 1-3 years prevocational + minimum 7 years SET). The SET program itself is a minimum of 7 years, though some trainees may take longer due to research leave or additional training opportunities. Fellowship adds 1-2 years.
Top Centres
Royal Melbourne Hospital (Melbourne), Westmead Hospital (Sydney), Royal Prince Alfred Hospital (Sydney), Alfred Hospital (Melbourne), Royal Adelaide Hospital, Royal Brisbane and Women's Hospital, Sir Charles Gairdner Hospital (Perth), Princess Alexandra Hospital (Brisbane), Macquarie University Hospital (Sydney -- private).
Fellowships
Post-FRACS fellowships in spine, cerebrovascular/endovascular, paediatric neurosurgery, skull base, functional neurosurgery, and neuro-oncology. Many Australian neurosurgeons pursue international fellowships (commonly in North America or Europe) before returning to public or private practice. The NSA also supports travelling fellowships and exchange programmes with international neurosurgical societies.
Career Progression
Pre-Med / Undergraduate
3-4 years -- Bachelor's degree (some Québec programs accept CEGEP graduates)
Medical School (MD / MDCM)
4 years -- Doctor of Medicine degree at a Canadian medical school
MCCQE Part I
Medical Council of Canada Qualifying Examination Part I -- taken during or after medical school
Neurosurgery Residency
6 years -- Matched via CaRMS (Canadian Resident Matching Service); structured rotations, research, and progressive responsibility
Royal College Examination
FRCSC -- Fellowship of the Royal College of Physicians and Surgeons of Canada; written and oral components
MCCQE Part II (NAC OSCE)
Clinical OSCE exam; required for full LMCC (Licentiate of the Medical Council of Canada)
Fellowship (Optional)
1-2 years subspecialty training in Canada or abroad
Entry Pathway
After completing an undergraduate degree and 4-year MD program, graduates apply to neurosurgery residency through CaRMS (Canadian Resident Matching Service). Canada has approximately 12-14 neurosurgery residency positions per year across all programs, making it one of the most competitive specialties. Strong research, clinical evaluations, and elective performance at target programs are important for matching. IMG (International Medical Graduate) positions are very limited.
Key Exams
MCCQE Part I -- Medical Council of Canada Qualifying Examination (MCQ and CDM format, taken in final year of medical school or post-graduation). MCCQE Part II (NAC OSCE) -- clinical skills assessment. Royal College Examination in Neurosurgery -- written (MCQ, short-answer) and oral (clinical scenarios, operative planning) components; passage is required for FRCSC designation. FRCSC certification is mandatory for independent neurosurgical practice in Canada.
Duration
Total from undergraduate entry to independent practice: approximately 14-15 years (3-4 years undergraduate + 4 years medical school + 6 years residency). With fellowship, add 1-2 years. Some programs include dedicated research years within the 6-year program. Practice-ready assessment (PRA) routes exist for internationally trained neurosurgeons but are highly restricted.
Top Programs
University of Toronto (Toronto Western Hospital, SickKids), McGill University (Montreal Neurological Institute), University of British Columbia, University of Alberta, University of Ottawa (The Ottawa Hospital), University of Calgary (Foothills Medical Centre), Western University (London, ON), Université de Montréal, Dalhousie University (Halifax).
Fellowships
Subspecialty fellowships in complex spine, cerebrovascular and endovascular neurosurgery, paediatric neurosurgery, functional and stereotactic neurosurgery, skull base surgery, neuro-oncology, and peripheral nerve. The Montreal Neurological Institute and Toronto Western Hospital are particularly renowned for epilepsy surgery, functional neurosurgery, and neuro-oncology fellowships. Many Canadian neurosurgeons also pursue fellowship training in the USA or Europe.
Career Progression
Medical School
6 years -- MBChB at University of Auckland or University of Otago (only two medical schools in NZ)
Intern Year (PGY1)
1 year -- Supervised training for provisional general registration with MCNZ (Medical Council of New Zealand)
Prevocational Years (PGY2+)
1-3 years -- Gain surgical experience and build portfolio for SET application
SET Selection
Apply to SET Program in Neurosurgery via NSA/RACS; combined Australia-NZ selection process
SET Program in Neurosurgery
Minimum 7 years -- Training rotations across NZ and Australian centres; accredited by NSA under RACS framework
FRACS Examination
Fellowship of the Royal Australasian College of Surgeons -- same exam pathway as Australia
Specialist Registration
Register on MCNZ vocational scope of practice in neurosurgery; eligible for Consultant posts in NZ
Entry Pathway
New Zealand shares its neurosurgery training pathway with Australia under the Neurosurgical Society of Australasia (NSA) and RACS framework. After medical school at either the University of Auckland or University of Otago, graduates complete an intern year and prevocational training before applying for SET. NZ-based positions in the SET program are extremely limited -- typically only 1-2 training slots are available in New Zealand at any given time, and trainees often rotate through Australian centres as part of their training.
Key Exams
The examination pathway is identical to Australia: GSSE (Generic Surgical Science Examination) in the early years of SET, followed by the Clinical Examination in the later years. Successful completion of all FRACS examination components, along with a research requirement and mandatory courses (EMST, CCrISP), is needed for fellowship. The MCNZ then grants vocational registration based on FRACS qualification.
Duration
Total from medical school entry to specialist: approximately 15-17 years (6 years MBChB + 1 year internship + 1-3 years prevocational + minimum 7 years SET). The pathway length is effectively the same as the Australian system, as the training program is shared. Trainees should expect to spend significant time training in Australia due to the limited number of NZ-based training positions and the need for exposure to high-volume centres.
Top Centres
Auckland City Hospital (Grafton, Auckland) -- the largest neurosurgical centre in NZ and the primary training site; Wellington Regional Hospital; Christchurch Hospital. Due to the small number of neurosurgeons in NZ (approximately 25-30 practising specialists nationally), trainees rotate through major Australian centres (Royal Melbourne, Westmead, RPA) as part of their SET program.
Fellowships
Post-FRACS fellowships follow the same pattern as Australia. Given the limited subspecialty volume in NZ, most New Zealand neurosurgeons seeking fellowship training do so in Australia, North America, or Europe. Common fellowship areas include spine, paediatric, vascular/endovascular, and skull base neurosurgery. The small NZ neurosurgical community means most specialists practise broadly rather than in narrow subspecialties.