When E. Sander Connolly, MD, chair of neurological surgery at Columbia University and surgeon-in-chief at NewYork-Presbyterian/Columbia University Irving Medical Center, talks about what separates a good neurosurgery department from an elite one, he points to one quality: the ability to create a collaborative team.
Dr. Connolly connected with Becker’s about how he leads a New York City-based team recognized in the top five in U.S. News & World Report’s Best Hospitals 2026-27 rankings for neurology and neurosurgery.
A culture built on collaboration
Dr. Connolly is direct about the fact that collaboration has to be built deliberately, and it takes time.
“It’s just as easy to be in a competitive environment as it is to be in a collaborative environment,” he said. “Building that, and leaning on each other when cases are better treated by somebody else, is important.”
He said the effort to provide quality patient care starts with the people behind the product.
“The product is only as good as the people providing it, and so we really focus on putting our staff, our surgeons, first. If we do that, then the patients really get world-class treatment.”
In practice, that means Dr. Connolly’s own clinical work is cross-disciplinary. He operates jointly with endovascular colleagues, neuro-ICU specialists, tumor surgeons, pediatric neurosurgeons and, on occasion, spine surgeons — bringing in an epilepsy surgeon, for instance, when a vascular case also involves a seizure disorder.
“That’s one of the ways that you do it,” he said. “Another thing is just incredible open lines of communication. Cellphones on all the time, no questions are stupid, share everything. Let us know what’s going on. There’s really no barriers to communication, up and down the lines of leadership.”
Building the next generation
For Dr. Connolly, sustaining a department at that level is not something that starts at residency. It starts years earlier, with the pipeline that eventually produces a residency class.
“We have high school students working in the department,” he said. “We have undergrads working in the department. Many of us serve on the admissions committee here, so we’re critically involved in the input function to the medical school. Which, really, is the beginning of our team, if you will.”
Not every resident comes through Columbia’s own medical school, he noted, but a steady pipeline does — helped by the department’s own reach into the field.
“We’ve trained a lot of neurosurgical chairs and faculty across the country, and so they will then send some of their medical students to us to rotate,” he said.
Once residents are in the department, Dr. Connolly said the priority shifts from recruitment to individualized development.
“It’s all about tailoring the experience to them, making sure that they’re getting what they need,” he said. “Everyone learns a little bit differently, has a different idea about how they want to practice, and brings different intellectual skills and interests.”
He said the department will bring in world-class surgeons midcareer when the right fit presents itself. But he estimated that the vast majority of the department — and, he suspects, most elite academic neurosurgery programs — is self-grown.
“Without a robust residency, it would be hard to keep repopulating ourselves,” he said.
Innovation balanced with the economics
When deciding which innovations are worth pursuing, Dr. Connolly asks a simple question: Does it actually solve a problem for the patient?
“All the innovation that we’re engaged with starts with the patient,” he said. “If there’s not a significant problem, or it’s not solving a real need, then it’s probably adding expense, which ends up degrading access and affordability. We’re really looking for things that are pushing the field forward — either making it safer or allowing us to treat unmet needs of our patients.”
Notably, he said it is not just up to leaders to decide what counts as innovation. Each surgeon and resident is largely responsible for tracking innovation in their own area.
“Some are more conservative. Some are more hard-charging, if you will. Some really gravitate towards randomized clinical trials. Others not so much,” he said. “The critical thing in all of these elite departments is that there’s a critical mass of people actively engaged in innovation, and it just kind of creates a culture where that is seen as positive.”
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