Surgical specialty
Neurological Surgery (Neurosurgery): Salary, Residency & Career Guide
Surgical care for brain, spine and peripheral nervous system disease.
Typical Training
7 years
Seven-year integrated neurological surgery training.
Attending Compensation
$829,161
Average Total Compensation
Employment outlook
Not isolated
Projected Job Growth
Relative Competitiveness Index
98 / 100
Highly Competitive
Start in Medical School
M1 to M4 Preparation
Practical experience, projects and rotation planning.
See the Medical School RoadmapAttending Compensation and State Wages
U.S. Attending Compensation
$829,161
Average Total Compensation
BLS does not publish a separately matched state wage series for this specialty.
Resident Pay by Institution
Seven-year integrated neurological surgery training..
2026–27 salaries, five published training-institution examples.
Selected institution
University of Michigan, Ann Arbor, MI
$77,049/ year
Pay varies by institution and postgraduate year.
Schedules and Work Setting
Schedule and Call
Operative cases, neuro ICU decisions and trauma consults make overnight coverage substantial in many programs. Seven years of training often includes research and variable graduated call.
Practice Settings
Neurosurgical operating rooms, neurocritical care, trauma centers and outpatient spine or cranial clinics.
Procedures and Clinical Work
- Craniotomy and tumor resection
- Spine surgery
- Cerebrovascular procedures
- Emergency neurosurgical consultation
Fellowship Training
Fellowship Expectation Index
4 / 5
Fellowship Options
Common Fellowship Duration: 1–2 year(s) beyond residency. Complex spine, functional neurosurgery and pediatrics are common further focuses.
An integrated neurosurgical residency provides broad specialty training, but academic cranial, functional, pediatric and spine careers can be strongly subspecialized.
Direct Practice
General neurosurgical practice where credentials and operative experience support it.
Specialized Practice
Pediatric neurosurgery and certain complex clinical roles often involve further fellowship training.
Choosing a Path
Consider whether you prefer broad community neurosurgery or a highly specialized tertiary practice.
Potential Fellowship Pathways
- Pediatric neurosurgery
- Cerebrovascular surgery
- Functional and epilepsy surgery
- Complex spine
Preparing in M1 Through M4
Follow a patient from neurologic deterioration through imaging, surgery, ICU management and rehabilitation. Neurosurgery spans the entire acute episode.
Research or QI
A spine outcomes registry, brain tumor trial, neurotrauma QI intervention or neurocritical care audit is relevant when you can explain your contribution.
Common Mistake
Equating neurosurgery with interesting operations. The seven-year training commitment and ICU or trauma call are equally consequential.
Preparation by Year
- 1Shadow operative cranial surgery and postoperative neurocritical care, then discuss the resident call schedule.
- 2Ask about research infrastructure and mentorship before starting a multi-year neurosurgical project.
Ask a resident this: What responsibilities do interns have in postoperative neuro ICU care, and when do residents gain operative autonomy?
MD vs DO Match Outcomes
204 of 297 matched to their preferred specialty
3 of 14 matched to their preferred specialty
MD vs DO difference: 47.3 percentage points
Applicant Considerations
Only a very small number of DO seniors preferred neurological surgery in the 2024 NRMP cohort. Percentages are unusually unstable; they should not be treated as a student-specific chance.
DO Application Strategy
Find a regional neurosurgeon who supervises a meaningful project or subinternship. Confirm program-level DO graduate history, exams accepted and audition opportunities.
Job Outlook
N/A
Projected Employment Growth
2025 to 2035, BLS occupational projection
No distinct employment forecast is published for this exact specialty.
AI and the Specialty
Potential Workflow Changes
Imaging segmentation, trajectory planning and monitoring may gain AI support; operative decisions remain surgeon-led.
Sources & Data Notes
Reviewed . National attending compensation uses Doximity's 2026 specialty survey (2025 pay) where available, then verified specialty-specific Medscape, Marit or Salary.com estimates. Doximity, Medscape and Marit report total compensation; Salary.com models base salary. Survey averages, modeled salaries and BLS wage medians measure different populations and must not be interpreted as identical metrics. BLS May 2025 state wages are shown separately and exclude self-employed physicians. The ophthalmology BLS category excludes pediatric ophthalmologists. State figures may be missing, top-coded, or suppressed. Job outlook uses BLS 2025–2035 occupational projections; it is not a local vacancy forecast. Resident stipend examples reflect published institutional scales for 2026 to 2027, by postgraduate year, not specialty. Stanford includes housing in its reported base salary; other institutions handle allowances differently.
The Relative Competitiveness Index uses a fixed score of 25 plus 1.75 times the 2024 U.S. MD preferred-specialty unmatched percentage, rounded, then applies the same 1.225 multiplier to every specialty. Neurological Surgery is 98/100; the score is not the applicant's chance of matching. It is not a 2026 estimate or DO-specific score. The MD and DO percentages compare different unadjusted applicant cohorts who ranked that specialty first. They do not account for application strategy, program selection, scores, or geography. Ophthalmology and urology have separate specialty match processes; other pathways may lack suitable NRMP cohorts.
The 1–5 Fellowship Expectation Index is an editorial assessment of customary career paths, not a measured participation rate or requirement. For residency profiles, compact training labels put specialty years before the clinical base or preliminary year; e.g. 3+1 means three specialty years and one clinical base year, even though the clinical year comes first. Fellowship-defined careers are presented in the separate fellowship explorer. Schedules, procedural scope, preparation suggestions, and potential AI effects depend on the program and practice setting; they are qualitative descriptions, not guaranteed outcomes or forecasts of physician replacement.
For Neurological Surgery (Neurosurgery): Doximity 2026, Average Total Compensation, reported under “Neurosurgery.” The national estimate must not be treated as a state-specific compensation figure.
Neurological Surgery (Neurosurgery): Editorial estimate of how fellowship shapes a career path. No observed fellowship uptake percentage is implied. Specialty-specific roadmaps describe illustrative activities, not mandatory publication, shadowing-hour, rotation, or skill requirements. Common fellowship routes: Complex spine, functional neurosurgery and pediatrics are common further focuses.