2022 Neurocritical care match

[theoneandonlyone]

hello y’all
starting a thread for the 2021-2022 NCC Match cycle (for positions in 2023). think it would be a good idea for a thread refresh for current and future applicants (since the last thread I saw chronicling different match related questions was from 2016) as different questions come along. Hopefully there are other applicants on SDN who can contribute.

i believe interviews typically happen between January and April? With invites to interview starting to go out in November?

do y’all think interviews will be live or virtual ?
how many programs are y’all applying to ?
how necessary is research in your cv for top spots ?

let’s have a conversation y’all!

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[riluzole]

Got matched for NCC fellowship last year for 2022-2024.
Last year all programs were virtual, I have not heard anything particular, my program is considering hybrid option if applicable.
Last year interviews started in early December and last interview i had was around mid march.
Apply to programs that you want to go for. People tend to get matched in their top 5 choices.
Research helps but connections and strong letter can get you a call from top program.

Best of luck for your match.

 

[theoneandonlyone]

Got matched for NCC fellowship last year for 2022-2024.
Last year all programs were virtual, I have not heard anything particular, my program is considering hybrid option if applicable.
Last year interviews started in early December and last interview i had was around mid march.
Apply to programs that you want to go for. People tend to get matched in their top 5 choices.
Research helps but connections and strong letter can get you a call from top program.

Best of luck for your match.

congrats!
what are some of your underrated programs ?

 

[theoneandonlyone]

wow, this thread is 💀
can we liven this up somehow.

anyone started applying ?
updates on any programs.

i’ve heard westchester is a new program under Mayer, but anyone have info on how the hospital runs etc

 

[3 %]

Submitted today. Anyone had any interview invites yet? With the timetable being new this year I don't know what to expect.

Also interested to hear about Westchester.

 

[thebobadoc]

Submitted my app on 1/19 to very selective programs based on location. Heard back from 2 so far.

 

[theoneandonlyone]

are y’all submitting lor from your PD to programs ?
is it required ?

 

[theoneandonlyone]

Submitted my app on 1/19 to very selective programs based on location. Heard back from 2 so far.

nice!
what’s your location preference ?

 

[thebobadoc]

nice!
what’s your location preference ?

West coast.

Anyone else got invites? Trying to gauge the new timeline.

 

[theoneandonlyone]

West coast.

Anyone else got invites? Trying to gauge the new timeline.

haven’t submitted apps yet. but i’m NE, MW preference

 

[thebobadoc]

haven’t submitted apps yet. but i’m NE, MW preference

Good luck! Keep us posted how things go. I'm glad I found this thread since there's so little info about NCC fellowship from an applicant's perspective. And now with the new timeline, I don't know what to expect.

 

[Number_7]

Hey guys, I submitted my application on 1/10, and got two offers so far. Some programs sent me an email saying that they don't start reviewing until March...

 

[3 %]

From responses I've got so far sounds like timelines are very variable between programs this year, with some starting in February and others saying they won't interview until late May.

 

[thebobadoc]

From responses I've got so far sounds like timelines are very variable between programs this year, with some starting in February and others saying they won't interview until late May.

May?! Oh my lord. Lol

 

[thebobadoc]

are y’all submitting lor from your PD to programs ?
is it required ?

Yes, one of my LORs is from my PD

 

[theoneandonlyone]

Submitted today. Anyone had any interview invites yet? With the timetable being new this year I don't know what to expect.

Also interested to hear about Westchester.

just submitted sunday.
any moves on interviews ?
none from my end

 

[sebastopublican]

Applied 1/30, not actually marked “complete” until 2/6…

Applying only to west coast (all programs) and my current east coast institution as a courtesy to my mentors here. Have to go back to family life.

So far, received invites from:
UCLA
USC
Cedars
UCSD

Awaiting responses from:
UCSF
Stanford
CPMC
UW
UC Irvine

Really hoping to get back to San Francisco area so please post to the thread if those programs have been inviting people.

Best of luck to you all, colleagues!

 

[ClassyBrass]

similar situation. applied at the beginning of January. I wish we had a sense of the timeline so that waiting wouldn't be so anxiety-inducing for the entire application cycle.

heard from:
ohsu
penn
utsw
ucla
usc

awaiting responses from:
all the other CA programs

would love to hear from others!

 

[theoneandonlyone]

any word from rush ?

 

[thebobadoc]

anyone heard from UCI, Stanford, UCSF, CPMC?

 

[sebastopublican]

I’ve now heard from Stanford and UW in addition to the above. Waiting on:

CPMC
UCSF
UCI

Please post if you have heard from these!

 

[ClassyBrass]

heard from stanford, still waiting for CPMC, UCSF, UCI too

 

[theoneandonlyone]

west coast is strong on this forum...
where our NE, MW folks ?

 

[theoneandonlyone]

update with interview experiences so far.
please post to assist with future incoming applicants, as we do not have a current thread. sure all y'all benefited from prior threads

1. Emory - strong program, 4 fellows per year. month block rotations, including other ICUS's where you are primary but no elective time first year. second year functions like attending with one week on /off. Faculty seems very down to earth and it seems like Emory retains and takes care of its people. But did not get a good vibe when i asked about NIR. seems there is current drama ongoing. Able to moonlight second year. Unsure if fellows write notes

2. UCLA - super strong program with lots of toys (microdialysis etc). Heavy trauma (fellows show up to trauma alert and sign out if no ICH). Strong r/s with NSGY. Procedurally heavy doing everything (including EVD's, CT etc). Multimodal monitoring. Strong faculty.
Call schedule really busy tho. One week long call (q24 hr M/W/F/Sun), then next week research / elective, then next week short call (q24 hr Tu/Th/Sa), then next week day NCCU (vs elective second year). 2 fellows per year. signout 6am.
2 week vacation / year. Forgot to ask about moonlighting.
Fellows write minor notes, sometimes no notes at all

3. Mt Sinai- 2 week schedule style, days vs night float (7-7) no 24 hours. strong program but not that procedurally heavy from my impression. No trauma at Main campus but can go to Elmhurst on electives where you'll work with NSGY doing trauma and EVD etc. No fancy multi modal monitoring "MMM", but overall autonomous flexible program with lots of elective time (about 2 weeks / month - 6 months total during fellowship).
several tracts per fellow with good mentorship. incoming fellow doing combined NCC/ NIR tract. Fellows write minor notes.
PD and faculty really down to earth. Feel like you'll have freedom to pursue your tract.
cant remember but i think 2-3 weeks vacation / year

4. Uni of Maryland Shock trauma- busy hands on program in two week block schedule style. The name speaks for itself, so good exposure to trauma, POCUS, and procedures (but no EVD/ bolt - nsgy does but can ask). Lots of federal military grant money for neurotrauma research. One month orientation at the beginning of the fellowship. 2- 3 fellows per year (depending on if military applicant). Able to moonlight. Good number of elective time (they have a block schedule example on their website). I feel procedurally similar to UCLA, with multimodal monitoring. But not as big program as UCLA so wont be a small fish in big pond. Good mentorship. Fellows write minor notes
3-4 week vaca / year, cant remember exactly

All programs are still UCNS. None have applied to ACGME currently.

Will update with pending interviews- Upenn, Miami, Rush.

 

[jay-why]

update with interview experiences so far.
please post to assist with future incoming applicants, as we do not have a current thread. sure all y'all benefited from prior threads

1. Emory - strong program, 4 fellows per year. month block rotations, including other ICUS's where you are primary but no elective time first year. second year functions like attending with one week on /off. Faculty seems very down to earth and it seems like Emory retains and takes care of its people. But did not get a good vibe when i asked about NIR. seems there is current drama ongoing. Able to moonlight second year. Unsure if fellows write notes

2. UCLA - super strong program with lots of toys (microdialysis etc). Heavy trauma (fellows show up to trauma alert and sign out if no ICH). Strong r/s with NSGY. Procedurally heavy doing everything (including EVD's, CT etc). Multimodal monitoring. Strong faculty.
Call schedule really busy tho. One week long call (q24 hr M/W/F/Sun), then next week research / elective, then next week short call (q24 hr Tu/Th/Sa), then next week day NCCU (vs elective second year). 2 fellows per year. signout 6am.
2 week vacation / year. Forgot to ask about moonlighting.
Fellows write minor notes, sometimes no notes at all

3. Mt Sinai- 2 week schedule style, days vs night float (7-7) no 24 hours. strong program but not that procedurally heavy from my impression. No trauma at Main campus but can go to Elmhurst on electives where you'll work with NSGY doing trauma and EVD etc. No fancy multi modal monitoring "MMM", but overall autonomous flexible program with lots of elective time (about 2 weeks / month - 6 months total during fellowship).
several tracts per fellow with good mentorship. incoming fellow doing combined NCC/ NIR tract. Fellows write minor notes.
PD and faculty really down to earth. Feel like you'll have freedom to pursue your tract.
cant remember but i think 2-3 weeks vacation / year

4. Uni of Maryland Shock trauma- busy hands on program in two week block schedule style. The name speaks for itself, so good exposure to trauma, POCUS, and procedures (but no EVD/ bolt - nsgy does but can ask). Lots of federal military grant money for neurotrauma research. One month orientation at the beginning of the fellowship. 2- 3 fellows per year (depending on if military applicant). Able to moonlight. Good number of elective time (they have a block schedule example on their website). I feel procedurally similar to UCLA, with multimodal monitoring. But not as big program as UCLA so wont be a small fish in big pond. Good mentorship. Fellows write minor notes
3-4 week vaca / year, cant remember exactly

All programs are still UCNS. None have applied to ACGME currently.

Will update with pending interviews- Upenn, Miami, Rush.

I recently matched and largely agreed with your impressions.

A few pointers here though. I think the big decision point for your clinical training is who is doing intubations. Yes, all NCC programs will have some sort of OR-anesthesia rotations to teach you how to do intubations, but intubating during codes is a completely different animal. The default at some program is to call an airway team for any intubation, and if so, fellows have to ask around to get a chance to try intubating their own patients. This is fine for similarly structured, well-resourced institutions, but you would have to decide on this on your own. Other procedures such as EVDs, bolts, running your own RRTs, etc. are cool, but always think about what you’ll really be doing as a neurointensivist, as only a relatively small number of jobs will actually require or even allow you to do those. Similarly, pay attention to the patient demographics in each unit, as it could vary significantly to your surprise. One unit that is super strong in vascular may not be the strongest in seizures or meningoencephalitis. A unit that is geared toward seizures may not afford as many trauma patients. This is because the location of each unit and its network, resources, etc. all play a key role in determining the patient population, which then feeds into growing/maintaining relevant expertise, and it is very difficult to change that cycle dramatically. Also, even though a program has a really strong research in a disease process X, there may be a mismatch in terms of their day-to-day patient demographics. This is admittedly rare, but I certainly recommend talking to the fellows and get their impression in terms of case composition, patient demographics, support system, and “what if’ situations as you see fit.

About the programs you mentioned thus far:
Emory — They have a very strong clinical NCC training program, period. Yes, there was some drama between EUH side and Grady side for endovascular, but still it shouldn’t affect your rank list too much, unless (1) you are sure you want to do endovascular and (2) another program is offering you a combined spot. There is a current endovascular fellow, following his NCC fellowship. It is also unique that their fellows are counted as “staffs” that patients are admitted and discharged with their names, and with greater power comes greater responsibility. This is one of the best places for SAH without a doubt.

Mt Sinai — This is a quite procedurally-heavy program as they do all of their own intubations, lines, POCUS, TCDs, bronchs, and even trach/PEG program is coming for the fellows, if I remember correctly. There is a procedure room within the unit with US and fluoroscopy guidance for PICC lines too. They have some of the biggest endovascular presence, and the patient demographics in their units reflect that with a lot of vascular cases, if that’s your thing. Manhattan in general has fewer trauma cases, as high-speed motorway accidents are rarer than other areas of US, but Elmhurst affords a good trauma volume in comparison to other NY programs, I heard.

 

[theoneandonlyone]

I recently matched and largely agreed with your impressions.

A few pointers here though. I think the big decision point for your clinical training is who is doing intubations. Yes, all NCC programs will have some sort of OR-anesthesia rotations to teach you how to do intubations, but intubating during codes is a completely different animal. The default at some program is to call an airway team for any intubation, and if so, fellows have to ask around to get a chance to try intubating their own patients. This is fine for similarly structured, well-resourced institutions, but you would have to decide on this on your own. Other procedures such as EVDs, bolts, running your own RRTs, etc. are cool, but always think about what you’ll really be doing as a neurointensivist, as only a relatively small number of jobs will actually require or even allow you to do those. Similarly, pay attention to the patient demographics in each unit, as it could vary significantly to your surprise. One unit that is super strong in vascular may not be the strongest in seizures or meningoencephalitis. A unit that is geared toward seizures may not afford as many trauma patients. This is because the location of each unit and its network, resources, etc. all play a key role in determining the patient population, which then feeds into growing/maintaining relevant expertise, and it is very difficult to change that cycle dramatically. Also, even though a program has a really strong research in a disease process X, there may be a mismatch in terms of their day-to-day patient demographics. This is admittedly rare, but I certainly recommend talking to the fellows and get their impression in terms of case composition, patient demographics, support system, and “what if’ situations as you see fit.

About the programs you mentioned thus far:
Emory — They have a very strong clinical NCC training program, period. Yes, there was some drama between EUH side and Grady side for endovascular, but still it shouldn’t affect your rank list too much, unless (1) you are sure you want to do endovascular and (2) another program is offering you a combined spot. There is a current endovascular fellow, following his NCC fellowship. It is also unique that their fellows are counted as “staffs” that patients are admitted and discharged with their names, and with greater power comes greater responsibility. This is one of the best places for SAH without a doubt.

Mt Sinai — This is a quite procedurally-heavy program as they do all of their own intubations, lines, POCUS, TCDs, bronchs, and even trach/PEG program is coming for the fellows, if I remember correctly. There is a procedure room within the unit with US and fluoroscopy guidance for PICC lines too. They have some of the biggest endovascular presence, and the patient demographics in their units reflect that with a lot of vascular cases, if that’s your thing. Manhattan in general has fewer trauma cases, as high-speed motorway accidents are rarer than other areas of US, but Elmhurst affords a good trauma volume in comparison to other NY programs, I heard.

Very nice additional points... it’s nice seeing what a fellow thinks in hindsight.
Your point on intubations is very high yield!

 

[3 %]

Time to confirm rank list is fast approaching

How much do people think 'prestige' or going to one of the big name programs matters when it comes to future job prospects? It seems some of the 'smaller' name programs actually give greater educational & research opportunities to their fellows compared to some of the big names.

 

[theoneandonlyone]

Time to confirm rank list is fast approaching

How much do people think 'prestige' or going to one of the big name programs matters when it comes to future job prospects? It seems some of the 'smaller' name programs actually give greater educational & research opportunities to their fellows compared to some of the big names.

what kind of programs do you consider as big name ?
and which small ?

 

[Neurocrit]

Time to confirm rank list is fast approaching

How much do people think 'prestige' or going to one of the big name programs matters when it comes to future job prospects? It seems some of the 'smaller' name programs actually give greater educational & research opportunities to their fellows compared to some of the big names.

Im a current fellow who has not yet started to apply to jobs but based on my senior fellows experience the name of the program has opened a lot of doors for them. That being said, having done residency at a program with a less prestigious ICU I can confirm that clinical training and competence does not necessarily correlate with prestige.

The doors that were opened by the prestige were academic positions and highly desirable metro areas. The job market is good and if you have no geographic preferences you’ll be fine and won’t need that extra bump. I had recruiting interest before even starting fellowship from new community based neuro ICUs.

 

[Neurocrit]

what kind of programs do you consider as big name ?
and which small ?

When I think of top programs the following comes to mind:

Columbia (easily the best reputation)
Hopkins
MGH
UCLA (fellows did not seem happy though)
UCSF (the whole “neurovascular” service setup is strange to me)
WashU
Emory

I think Yale is underrated on the East Coast and UCI is underrated on the West Coast.

 

[Neurocrit]

Also, if you want neuro IR it might be wise to keep it on the down low. I knoe that some programs feel used as a stepping stone/placeholder. I think it’s a fair concern for some programs that want to produce the next generation of academic neuro ICU leaders.

 

[theoneandonlyone]

When I think of top programs the following comes to mind:

Columbia (easily the best reputation)
Hopkins
MGH
UCLA (fellows did not seem happy though)
UCSF (the whole “neurovascular” service setup is strange to me)
WashU
Emory

I think Yale is underrated on the East Coast and UCI is underrated on the West Coast.

I see.
You don’t think Upenn, Mt sinai are top programs ?

 

[Neurocrit]

You don’t think Upenn, Mt sinai are top programs ?

I know less about them and didn’t apply to Sinai (didn’t want to live in NYC if it wasn't going to be for Columbia) but they fall in the upper tier as well.

I think Columbia is first followed by a gap and then Hopkins, UCLA, MGH, UCSF and then another gap followed by the rest of the good programs in no specific order.

UTSW and Rush are underrated as well. Those are my non coastal dark horses.

 

[ClassyBrass]

anyone have an idea of how many programs applicants usually rank in order to feel a sense of ensuring a match?

 

[theoneandonlyone]

anyone have an idea of how many programs applicants usually rank in order to feel a sense of ensuring a match?

Depends. I think ~7-10.

 

[theoneandonlyone]

Goodluck!.
We all know we benefited from prior posts, so i hope y’all take a moment to post feedback after we match to help future applicants.

 

[Neurocrit]

Unfilled vacancies posted. Some suprises in here.

SF Match - Residency and Fellowship Matching Services

www.sfmatch.org

 

[Aldertonghen]

Unfilled vacancies posted. Some suprises in here.

SF Match - Residency and Fellowship Matching Services

www.sfmatch.org

Which of these would be considered close to top tier? Emory, UCLA, WashU, Rush, UMiami?

 

[PureMedical]

I am honestly surprised that multiple so called “big names” went unmatched and in total there are 37 vacancies. The notable ones are below:

1. Duke
2. UCLA
3. Emory
4. University of Pittsburg
5. Rush
6. UMiami
7. WashU
8. Tufts medical center
9. Thomas Jefferson

In my opinion, the top tier in the east coast for NCC are: Columbia/Cornell, Hopkins, Harvard, Yale, UPenn, and Duke; I think Duke is the underdog since it lacks multimodality monitoring.

Extra Thoughts:
Unfortunately, UPenn and Harvard are still making their fellows write notes and place orders like super seniors. From what I recall from the interview trail the following programs allowed moonlighting: Yale, UPenn, and Duke. One UPenn graduating fellow said they didn’t feel comfortable intubating so that was a red flag.

Columbia: is fellow driven so you learn from other fellows and have a lot of autonomy, arguably still the best overall deal because: clinical/procedural training, pgy salary 93k, really nice friendly attending invested in career development of their fellows (they go on to do what they want), research galore, location, and prestigious.

Hopkins is a second best as it strikes an excellent balance between research and clinical with great exposure to procedures. Trauma can be done at Maryland as an elective so that’s not a shortcoming. Con is Baltimore. Pgy salary is low for the current cost of living in Maryland.

Third has to be Harvard given similar features as the above two but con is Boston which is expensive and again not enough pay for cost of living. Fellows are still being treated like super residents because of the unwillingness of this program to change its ways.

Yale is arguably the best overall package; location close to NY, $86k pgy salary w/ affordable housing, good secondary schools near by if you have kids (unlike Hopkins, UPenn) ample research opportunities, moonlighting opportunities, good mix of clinical and elective; no 24 hour shifts (Hopkins has q3h 24 hours shifts on clinical weeks) instead has night shift, allows EVD etc good procedure training, multimodal modalities, and prestige.

Lastly, I will say that picking a fellowship is a deeply personal decision based not just on prestige or rankings; ultimately you have to look inwards to seek your long term goals. The decision should be based on many factors: where you want to be, how they treat the fellows, how good is the clinical and procedural teaching, research, salary, housing affordability, location desirability, moonlighting, number of 24 hour shifts (Maryland makes fellows do six 24 per month) and personal long term goals.

Congratulations to those of you who matched where they wanted to! And good luck to the future applicants who will be seeking to begin on this exciting journey!

 

[NGTY1991]

Theres not much discussion on applicant stats/if anyone from peds neuro matched onto an adult NCC match. Is everyone who matched comfortable sharing their stats?

 

[jay-why]

I know less about them and didn’t apply to Sinai (didn’t want to live in NYC if it wasn't going to be for Columbia) but they fall in the upper tier as well.

I think Columbia is first followed by a gap and then Hopkins, UCLA, MGH, UCSF and then another gap followed by the rest of the good programs in no specific order.

UTSW and Rush are underrated as well. Those are my non coastal dark horses.

Well, as a recent graduate of one of so-called “top” programs, I don’t think it is nowhere close to being that clear cut when it comes to fellowships. All of those programs have different strengths and weakness, ranging from research, mentorship, procedural training, work schedules, cultures, patient demographics, etc. As one of the most recent posts suggested, I think fellowship decision should be individualized and tailored to each person, and there is no such a thing as “the singular best program” imho, not to mention there is no perceivable gap between those so-called top programs, and a top program for one person may not be a top choice for another depending on his/her career goals. For future applicants, don’t be afraid to look for the best fit for you.

 

[ClassyBrass]

is anyone out there possibly facing the disappointment of getting passed over by their home program?

 

[oopsy]

Well, as a recent graduate of one of so-called “top” programs, I don’t think it is nowhere close to being that clear cut when it comes to fellowships. All of those programs have different strengths and weakness, ranging from research, mentorship, procedural training, work schedules, cultures, patient demographics, etc. As one of the most recent posts suggested, I think fellowship decision should be individualized and tailored to each person, and there is no such a thing as “the singular best program” imho, not to mention there is no perceivable gap between those so-called top programs, and a top program for one person may not be a top choice for another depending on his/her career goals. For future applicants, don’t be afraid to look for the best fit for you.

Totally agree. The initial comment about here are the top 7 east coast programs is ludicrous. I went to medical school and trained at half of that list and couldn’t disagree more.

There are blue chip programs that have national cache, and there are tons of programs that will deliver excellent clinical training, exposure, and job placement. For instance, mythologizing Yale and Duke (neither of which are blue chip programs in my mind) and not mentioning shock trauma or UPMC (which does more tbi than both combined, more aneurysms than each, more strokes than each) is wild. Similarly, if you want to take care of post ops and esoteric fourth referrals while doing tons of research, then Hopkins is great, but I don’t know any other top tier program that has to farm out their general icu (trauma) experience to the local competition with nearly 10x the referral base and patient flow. This isn’t to diss any of those 3 programs, I ranked two of them within my top 3 (and I didn’t rank Maryland, despite all the above). Even crazier is that some others are listing consultant icu programs in the top tier, where you’re not even primary. To each their own, but hard pass for me.

The point is that it is easy to pigeonhole a program based on name (or lack thereof) alone. So while I’m glad the author enjoyed these top 7 or so programs, fellowship decisions are multifactorial and I guarantee you that your consensus “top 10” is not mine or anyone else’s.

Just be honest with yourself, are you really going to be an R01 researcher? Do you want to live in this region or that? Are you going to be a private practice physician? Do you want to be a general intensivist who happens to be in the neuro icu (do your own chest tubes/PEG/Trach/etc), or do you want to do some icu while you mostly focus on neuro stuff? Are you going to be primary or consultant?

The hot or not list is not going to help you figure this out and find a good fit for your training or career. These are among the questions you need to ask yourself and navigate re programs, not is it top 5-10?

However, for a rare subset of applicants, it does matter, a lot. Blue chip programs have a substantively different track record and capacity to get your research career going. If you’re serious (I don’t mean, I’m going to start research as a fellow, I mean you’ve got a track record of research, publishing, etc), looking for a mostly research time job, etc, then absolutely prioritize this, it matters. Go to the places where the attendings spend most of the time investigating because it makes a huge difference in your research training and progress. Rounding 26 weeks a year is tough to do and get an R01.

But if not, and that’s >95% of applicants, there are a ton more options for outstanding clinical training and no one is served by saying you can’t have excellent clinical training without being at these few sites.

And finally, this is not a diss on research (I’m personally all in on it for my own career), but this conflation of research and clinical training as the same thing is endlessly confusing to applicants and frustrating to watch now that I’m on the other side.

 

[Aldertonghen]

Totally agree. The initial comment about here are the top 7 east coast programs is ludicrous. I went to medical school and trained at half of that list and couldn’t disagree more.

There are blue chip programs that have national cache, and there are tons of programs that will deliver excellent clinical training, exposure, and job placement. For instance, mythologizing Yale and Duke (neither of which are blue chip programs in my mind) and not mentioning shock trauma or UPMC (which does more tbi than both combined, more aneurysms than each, more strokes than each) is wild. Similarly, if you want to take care of post ops and esoteric fourth referrals while doing tons of research, then Hopkins is great, but I don’t know any other top tier program that has to farm out their general icu (trauma) experience to the local competition with nearly 10x the referral base and patient flow. This isn’t to diss any of those 3 programs, I ranked two of them within my top 3 (and I didn’t rank Maryland, despite all the above). Even crazier is that some others are listing consultant icu programs in the top tier, where you’re not even primary. To each their own, but hard pass for me.

The point is that it is easy to pigeonhole a program based on name (or lack thereof) alone. So while I’m glad the author enjoyed these top 7 or so programs, fellowship decisions are multifactorial and I guarantee you that your consensus “top 10” is not mine or anyone else’s.

Just be honest with yourself, are you really going to be an R01 researcher? Do you want to live in this region or that? Are you going to be a private practice physician? Do you want to be a general intensivist who happens to be in the neuro icu (do your own chest tubes/PEG/Trach/etc), or do you want to do some icu while you mostly focus on neuro stuff? Are you going to be primary or consultant?

The hot or not list is not going to help you figure this out and find a good fit for your training or career. These are among the questions you need to ask yourself and navigate re programs, not is it top 5-10?

However, for a rare subset of applicants, it does matter, a lot. Blue chip programs have a substantively different track record and capacity to get your research career going. If you’re serious (I don’t mean, I’m going to start research as a fellow, I mean you’ve got a track record of research, publishing, etc), looking for a mostly research time job, etc, then absolutely prioritize this, it matters. Go to the places where the attendings spend most of the time investigating because it makes a huge difference in your research training and progress. Rounding 26 weeks a year is tough to do and get an R01.

But if not, and that’s >95% of applicants, there are a ton more options for outstanding clinical training and no one is served by saying you can’t have excellent clinical training without being at these few sites.

And finally, this is not a diss on research (I’m personally all in on it for my own career), but this conflation of research and clinical training as the same thing is endlessly confusing to applicants and frustrating to watch now that I’m on the other side.

If someone is interested in research, then what would you consider are the programs to target? Is that previous list relevant then (in terms of the rank order)?

 

[theoneandonlyone]

Totally agree. The initial comment about here are the top 7 east coast programs is ludicrous. I went to medical school and trained at half of that list and couldn’t disagree more.

There are blue chip programs that have national cache, and there are tons of programs that will deliver excellent clinical training, exposure, and job placement. For instance, mythologizing Yale and Duke (neither of which are blue chip programs in my mind) and not mentioning shock trauma or UPMC (which does more tbi than both combined, more aneurysms than each, more strokes than each) is wild. Similarly, if you want to take care of post ops and esoteric fourth referrals while doing tons of research, then Hopkins is great, but I don’t know any other top tier program that has to farm out their general icu (trauma) experience to the local competition with nearly 10x the referral base and patient flow. This isn’t to diss any of those 3 programs, I ranked two of them within my top 3 (and I didn’t rank Maryland, despite all the above). Even crazier is that some others are listing consultant icu programs in the top tier, where you’re not even primary. To each their own, but hard pass for me.

The point is that it is easy to pigeonhole a program based on name (or lack thereof) alone. So while I’m glad the author enjoyed these top 7 or so programs, fellowship decisions are multifactorial and I guarantee you that your consensus “top 10” is not mine or anyone else’s.

Just be honest with yourself, are you really going to be an R01 researcher? Do you want to live in this region or that? Are you going to be a private practice physician? Do you want to be a general intensivist who happens to be in the neuro icu (do your own chest tubes/PEG/Trach/etc), or do you want to do some icu while you mostly focus on neuro stuff? Are you going to be primary or consultant?

The hot or not list is not going to help you figure this out and find a good fit for your training or career. These are among the questions you need to ask yourself and navigate re programs, not is it top 5-10?

However, for a rare subset of applicants, it does matter, a lot. Blue chip programs have a substantively different track record and capacity to get your research career going. If you’re serious (I don’t mean, I’m going to start research as a fellow, I mean you’ve got a track record of research, publishing, etc), looking for a mostly research time job, etc, then absolutely prioritize this, it matters. Go to the places where the attendings spend most of the time investigating because it makes a huge difference in your research training and progress. Rounding 26 weeks a year is tough to do and get an R01.

But if not, and that’s >95% of applicants, there are a ton more options for outstanding clinical training and no one is served by saying you can’t have excellent clinical training without being at these few sites.

And finally, this is not a diss on research (I’m personally all in on it for my own career), but this conflation of research and clinical training as the same thing is endlessly confusing to applicants and frustrating to watch now that I’m on the other side.

very thorough response!
thanks for keeping this thread going as it will benefit future applicants.

 

[oopsy]

If someone is interested in research, then what would you consider are the programs to target? Is that previous list relevant then (in terms of the rank order)?

It depends on what you’re interested in. Multimodal monitoring? Stroke trials? Prognostication? TBI? Vasospasm? Neuro imaging stuff? Etc.

Different centers have different points of emphasis. If you’re not sure what you’re interested in, but want to do some research in general, you’re probably not seriously looking at an 80-20 career. And that’s PERFECTLY FINE and the boat that most academics are in, including me as an NCC applicant.

But if you’re passionate about this niche, have been actively working on it, want to refine your expertise etc, and see yourself rounding like literally <10 weeks a year, then yes, I think it’s very reasonable to target centers with mentors in your areas/modalities of interest.

So for instance, if you wanted to be a neuroimmunology investigator focusing on encephalitis, etc, it would much more sense going to UPenn than the classic Columbia/MGH/UCSF conversation. If you were interested in coma recovery, then there are specific mentors and modalities at many of those sites. If you want to focus on DCI/spasm, I would say that list is less overlapping and you will be more surprised to see where those leaders are. The point is, go where the mentors you need are, and that may or may not be a blue chip program. This is the advice I was given and have found it helpful thus far.

I would strongly caution you NOT to say, hey I kind of like the idea of doing research, haven’t published much if anything, and then living and dying on the idea of training at Columbia and MGH. This happens so often (read: all the time) and it’s often more about chasing a name than carefully considering a career. So while there are exceptions to every rule, the reality is that you’re not going to start from a pretty basic research understanding/experience and become a competent (junior) investigator in a busy two year fellowship.

Fellowship research time is more to help you launch based on a skill set and foundation you should already have by then, it’s not to start from scratch.

Just be honest with yourself in terms of who you are. If you’re PGY3-4 and haven’t really committed a lot of time to research, do you really suddenly envision committing most of your time in your career to something that you haven’t chosen to prioritize thus far? Or do you want to be a clinician who works at an academic center, does some academic stuff, but is definitely clinician first? There’s nothing wrong with being a great doctor, it’s ok to be honest with yourself about what you want, and the decision will shake out accordingly.

 

[jay-why]

It depends on what you’re interested in. Multimodal monitoring? Stroke trials? Prognostication? TBI? Vasospasm? Neuro imaging stuff? Etc.

Different centers have different points of emphasis. If you’re not sure what you’re interested in, but want to do some research in general, you’re probably not seriously looking at an 80-20 career. And that’s PERFECTLY FINE and the boat that most academics are in, including me as an NCC applicant.

But if you’re passionate about this niche, have been actively working on it, want to refine your expertise etc, and see yourself rounding like literally modalities of interest.

So for instance, if you wanted to be a neuroimmunology investigator focusing on encephalitis, etc, it would much more sense going to UPenn than the classic Columbia/MGH/UCSF conversation. If you were interested in coma recovery, then there are specific mentors and modalities at many of those sites. If you want to focus on DCI/spasm, I would say that list is less overlapping and you will be more surprised to see where those leaders are. The point is, go where the mentors you need are, and that may or may not be a blue chip program. This is the advice I was given and have found it helpful thus far.

I would strongly caution you NOT to say, hey I kind of like the idea of doing research, haven’t published much if anything, and then living and dying on the idea of training at Columbia and MGH. This happens so often (read: all the time) and it’s often more about chasing a name than carefully considering a career. So while there are exceptions to every rule, the reality is that you’re not going to start from a pretty basic research understanding/experience and become a competent (junior) investigator in a busy two year fellowship.

Fellowship research time is more to help you launch based on a skill set and foundation you should already have by then, it’s not to start from scratch.

Just be honest with yourself in terms of who you are. If you’re PGY3-4 and haven’t really committed a lot of time to research, do you really suddenly envision committing most of your time in your career to something that you haven’t chosen to prioritize thus far? Or do you want to be a clinician who works at an academic center, does some academic stuff, but is definitely clinician first? There’s nothing wrong with being a great doctor, it’s ok to be honest with yourself about what you want, and the decision will shake out accordingly.

I wholeheartedly agree with this. I couldn’t have said it any better than this.

By the way, I also got the same advice when applying to fellowship(s) that one should be honest with oneself and find a program with the best fit and mentor for what I was truly interested in.

UPenn vs. other brand name programs is so true too. They have so much more encephalitis patients in their NCCU, which is certainly notable. There are many great programs other than MGH/Columbia, especially depending on which disease/patient demographics you’re interested in.

As a future academic neurointensivist, applicants should also think about their niche and what they could add to the field. That’s how you decide which is the right program, and vice versa. It makes the whole interviewing and matching processes much smoother and more natural without adding more unnecessary stress.

 

[popeyespinach]

Totally agree. The initial comment about here are the top 7 east coast programs is ludicrous. I went to medical school and trained at half of that list and couldn’t disagree more.

There are blue chip programs that have national cache, and there are tons of programs that will deliver excellent clinical training, exposure, and job placement. For instance, mythologizing Yale and Duke (neither of which are blue chip programs in my mind) and not mentioning shock trauma or UPMC (which does more tbi than both combined, more aneurysms than each, more strokes than each) is wild. Similarly, if you want to take care of post ops and esoteric fourth referrals while doing tons of research, then Hopkins is great, but I don’t know any other top tier program that has to farm out their general icu (trauma) experience to the local competition with nearly 10x the referral base and patient flow. This isn’t to diss any of those 3 programs, I ranked two of them within my top 3 (and I didn’t rank Maryland, despite all the above). Even crazier is that some others are listing consultant icu programs in the top tier, where you’re not even primary. To each their own, but hard pass for me.

The point is that it is easy to pigeonhole a program based on name (or lack thereof) alone. So while I’m glad the author enjoyed these top 7 or so programs, fellowship decisions are multifactorial and I guarantee you that your consensus “top 10” is not mine or anyone else’s.

Just be honest with yourself, are you really going to be an R01 researcher? Do you want to live in this region or that? Are you going to be a private practice physician? Do you want to be a general intensivist who happens to be in the neuro icu (do your own chest tubes/PEG/Trach/etc), or do you want to do some icu while you mostly focus on neuro stuff? Are you going to be primary or consultant?

The hot or not list is not going to help you figure this out and find a good fit for your training or career. These are among the questions you need to ask yourself and navigate re programs, not is it top 5-10?

However, for a rare subset of applicants, it does matter, a lot. Blue chip programs have a substantively different track record and capacity to get your research career going. If you’re serious (I don’t mean, I’m going to start research as a fellow, I mean you’ve got a track record of research, publishing, etc), looking for a mostly research time job, etc, then absolutely prioritize this, it matters. Go to the places where the attendings spend most of the time investigating because it makes a huge difference in your research training and progress. Rounding 26 weeks a year is tough to do and get an R01.

But if not, and that’s >95% of applicants, there are a ton more options for outstanding clinical training and no one is served by saying you can’t have excellent clinical training without being at these few sites.

And finally, this is not a diss on research (I’m personally all in on it for my own career), but this conflation of research and clinical training as the same thing is endlessly confusing to applicants and frustrating to watch now that I’m on the other side.

Hey thanks for this comprehensive response. I’m a pgy-2 and will be applying to NCC next year. Currently I’m looking into clinical programs that are focused on heavy intensivist training (ie. an intensivist who does neuroicu rather than a neurologist who does intensive care). Do you have a list of programs that you think prioritizes this? So far I’ve got Emory, Maryland and Miller in that list but Columbia and UCSF are two dream schools that I’ve wanted to apply to. Also if anyone has any information on how UCSD is, I’d appreciate it. Love San Diego and would love to get a great work/life balance living there. Some others I’ve been wondering about are Yale, Northwestern and WUSTL.

Would appreciate anyone’s help!

 

[ProReduction]

It depends on what you’re interested in. Multimodal monitoring? Stroke trials? Prognostication? TBI? Vasospasm? Neuro imaging stuff? Etc.

Different centers have different points of emphasis. If you’re not sure what you’re interested in, but want to do some research in general, you’re probably not seriously looking at an 80-20 career. And that’s PERFECTLY FINE and the boat that most academics are in, including me as an NCC applicant.

But if you’re passionate about this niche, have been actively working on it, want to refine your expertise etc, and see yourself rounding like literally <10 weeks a year, then yes, I think it’s very reasonable to target centers with mentors in your areas/modalities of interest.

So for instance, if you wanted to be a neuroimmunology investigator focusing on encephalitis, etc, it would much more sense going to UPenn than the classic Columbia/MGH/UCSF conversation. If you were interested in coma recovery, then there are specific mentors and modalities at many of those sites. If you want to focus on DCI/spasm, I would say that list is less overlapping and you will be more surprised to see where those leaders are. The point is, go where the mentors you need are, and that may or may not be a blue chip program. This is the advice I was given and have found it helpful thus far.

I would strongly caution you NOT to say, hey I kind of like the idea of doing research, haven’t published much if anything, and then living and dying on the idea of training at Columbia and MGH. This happens so often (read: all the time) and it’s often more about chasing a name than carefully considering a career. So while there are exceptions to every rule, the reality is that you’re not going to start from a pretty basic research understanding/experience and become a competent (junior) investigator in a busy two year fellowship.

Fellowship research time is more to help you launch based on a skill set and foundation you should already have by then, it’s not to start from scratch.

Just be honest with yourself in terms of who you are. If you’re PGY3-4 and haven’t really committed a lot of time to research, do you really suddenly envision committing most of your time in your career to something that you haven’t chosen to prioritize thus far? Or do you want to be a clinician who works at an academic center, does some academic stuff, but is definitely clinician first? There’s nothing wrong with being a great doctor, it’s ok to be honest with yourself about what you want, and the decision will shake out accordingly.

This advice is everything. NCC fellowship is frequently where research careers for MD/PhDs go to die, and it is simply out of the question for any applicant without a PhD or multiple serious 1st/2nd/final author publications as a MD (very, very few MDs) to think that he/she can start their research journey during NCC fellowship. Very few Neurointensivists have independent labs anymore. Junior faculty at a few big name institutions usually grind away as a junior member in a more senior PI's lab. Even "academic" Neurointensivists mostly get by through clinical service and teaching. Research other than case reports and reviews is not even expected at most centers anymore.
The best hope I've seen for MD/PhDs is to have a ton of momentum from prior research during his/her PhD and hopefully some momentum carried through residency that can springboard things into a K from NCC fellowship.

 

[Aldertonghen]

This advice is everything. NCC fellowship is frequently where research careers for MD/PhDs go to die, and it is simply out of the question for any applicant without a PhD or multiple serious 1st/2nd/final author publications as a MD (very, very few MDs) to think that he/she can start their research journey during NCC fellowship. Very few Neurointensivists have independent labs anymore. Junior faculty at a few big name institutions usually grind away as a junior member in a more senior PI's lab. Even "academic" Neurointensivists mostly get by through clinical service and teaching. Research other than case reports and reviews is not even expected at most centers anymore.
The best hope I've seen for MD/PhDs is to have a ton of momentum from prior research during his/her PhD and hopefully some momentum carried through residency that can springboard things into a K from NCC fellowship.

Is it feasible for a neuro resident without prior research experience to make it as an NIH funded researcher in NCC? What if they were willing to spend multiple years as a post doc fellow after the NCC fellowship?