I work at Bellevue. It is a HUGE hospital with every specialty available. Given that it is the flagship HHC Hospital of New York City, the patient population is just as diverse as NYC is. The majority of the patients are underprivileged and many are lacking health insurance. Most of the patients have not kept up with their own primary care and have multiple comorbidities that we must deal with, in addition to their acute medical care. Despite not speaking English, there is a very good translation service that can help you with pretty much any language you need (I once had trouble finding a zulu speaker though, when I had a zulu patient who came straight to Bellevue from JFK airport).
We see so many different cases; there is always the bread and butter stroke case; but the pathology we deal with is very diverse. More often than not, we will take care of at least 10 neurocystercercosis cases every year. We have a lot of neuroonc. exposure, brain bleeds, seizures, dementia, intractable back pain, etc.
Usually the patient load on the neuro. inpatient service is about 15-20 pts. There is a senior resident and two junior residents in charge of the patients' care. There are daily attending rounds (except weekends) however Bellevue is unique in that it is pretty much a resident run hospital and therefore, as a resident, there is much leeway in how you want to care for the patient.
The neurology consult service at Bellevue, however, is VERY busy. It is run by one senior and two junior residents as well. The neurology department at NYU has a good reputation, and the neurology consultations that we provide are taken into great consideration by whichever primary service we help. Bellevue is a stroke center, so we often push tPA when pts. with acute strokes come within the window. However, there is no interventional service to do angiograms and more aggressive measures such as stenting of the intracranial vessels, coiling of aneurysms, etc.
Neurology is not in charge of the neurocritical care unit at Bellevue, however, and critical care is not a main focus of the neurology residency program. However, if persons are interested in neuro. critical care, there is ample time to do electives with our colleagues in neurosurgery who run the neurocritical care unit. BTW, we have a great relationship with neurosurgery and help each other out with patients when help is needed.
The neurology wards have a decent ancillary staff. Of course being a city/public hospital, some ancillary services such as phlebotomy, needs some improvement, but it really isn't too bad. The nursing care is decent (depending on the nurse). In terms of efficiency, Bellevue can be somewhat slow. For example, pts. with acute strokes usually cannot get an MRI until 1-2 days after admission. Echocardiograms (transesophageal) are sometimes difficult to arrange and require the resident to call 2-3 people in order to push for it to be completed expeditiously. The average length of stay for patients is usually about 3-5 days. There are a lot of social issues which keep pts. in the hospital and discharge planning sometimes can be a major headache.
Overall though, I feel the training I receive while in Bellevue is outstanding. Residents and attendings get along very well. We are all a part of a family, in many ways. The neuropathology department is amazing and you'll see cases you've never seen before, only read about in texts. I must give compliments to the whole NYU neurology program as I feel that the training I receive while there will be second to none, especially given my goal of being an outstanding general adult neurologist.
