Critical care EEG fellowship?

[Aldertonghen]

I recently learned about this fellowship being offered at some places like Yale and Pitt. Could anyone tell me how this works in terms of the job opportunities available post fellowship (academic and private)? Is this usually combined with either a NeuroICU fellowship and/or epilepsy, or is it a standalone fellowship?

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[xenotype]

I would strongly recommend just doing a traditional CNP or epilepsy fellowship. ICU EEG is included with nearly all of those to great depth, and the EMU is actually much more challenging in terms of seizure semiology, sEEG planning, and localization. Cutting out the EMU would leave one incompetent at video EEG. Additionally, I don't believe neuroICU fellowships really provide enough EEG exposure on their own, a couple of dedicated months at most is not enough- there is so much critical care to learn that trying to pick up another skill on top of it would eat into something else. Six months with EEG call would be adequate if the volume is high assuming one understands EEG basics well from residency (not all programs ensure that- I read and reported >300 routine EEGs in residency alone by myself). To emphasize however routine EEGs in residency doesn't make one competent- I think in all of those there was only one with an actual seizure that I had no idea at the time how to describe. Then in fellowship half the running EEGs had seizures on the recording- big, big difference. Some people do one year epilepsy plus the usual 2 of neuroICU. Additionally being CNP boarded/ACNS or epilepsy boarded is valuable for job options and credentialing and doing a very non-standard fellowship would geopardize this.

 

[Aldertonghen]

I would strongly recommend just doing a traditional CNP or epilepsy fellowship. ICU EEG is included with nearly all of those to great depth, and the EMU is actually much more challenging in terms of seizure semiology, sEEG planning, and localization. Cutting out the EMU would leave one incompetent at video EEG. Additionally, I don't believe neuroICU fellowships really provide enough EEG exposure on their own, a couple of dedicated months at most is not enough- there is so much critical care to learn that trying to pick up another skill on top of it would eat into something else. Six months with EEG call would be adequate if the volume is high assuming one understands EEG basics well from residency (not all programs ensure that- I read and reported >300 routine EEGs in residency alone by myself). To emphasize however routine EEGs in residency doesn't make one competent- I think in all of those there was only one with an actual seizure that I had no idea at the time how to describe. Then in fellowship half the running EEGs had seizures on the recording- big, big difference. Some people do one year epilepsy plus the usual 2 of neuroICU. Additionally being CNP boarded/ACNS or epilepsy boarded is valuable for job options and credentialing and doing a very non-standard fellowship would geopardize this.

Thank you for putting it into perspective. What are the benefits of doing one year epilepsy (or CNP) plus the 2 years of NeuroICU? How does a combined practice work (in academia or private)? Do they run a mixture of ICU and EMUs, or do they also read ICU EEGs and EMGs (if doing a traditional CNP fellowship)- potentially increasing incomes?

 

[xenotype]

Thank you for putting it into perspective. What are the benefits of doing one year epilepsy (or CNP) plus the 2 years of NeuroICU? How does a combined practice work (in academia or private)? Do they run a mixture of ICU and EMUs, or do they also read ICU EEGs and EMGs (if doing a traditional CNP fellowship)- potentially increasing incomes?

The difference in practice would be reading your own ICU EEGs (competently, to ACNS standards). This makes you not dependent on an epileptologist to make major treatment decisions on your ICU patients (eg AED weaning, treatment of NCSE/HEBs, etc). You can also do EMU if you want.

EMG is a whole 'nother animal. You could try a 50/50 split at a CNP program for 6 months EEG and 6 months EMG- hard but not impossible to make that work. EMG would not plug in well to an NICU job.

 

[Aldertonghen]

The difference in practice would be reading your own ICU EEGs (competently, to ACNS standards). This makes you not dependent on an epileptologist to make major treatment decisions on your ICU patients (eg AED weaning, treatment of NCSE/HEBs, etc). You can also do EMU if you want.

EMG is a whole 'nother animal. You could try a 50/50 split at a CNP program for 6 months EEG and 6 months EMG- hard but not impossible to make that work. EMG would not plug in well to an NICU job.

I see. Would reading your own ICU EEGs boost your revenues compared to an NCC attending who doesn’t?

Also, on the flip side, won’t time being in the EMU reduce compensation (as it bills less than critical care)? ICU seems hectic on it’s own even without adding more duties on top of it.

Yeah, EMG won’t be a good option. When you mentioned CNP I automatically thought of the 6m/6m EMG/EEG fellowships when you probably meant a 1 year EEG fellowship.

 

[xenotype]

I see. Would reading your own ICU EEGs boost your revenues compared to an NCC attending who doesn’t?

Also, on the flip side, won’t time being in the EMU reduce compensation (as it bills less than critical care)? ICU seems hectic on it’s own even without adding more duties on top of it.

Yeah, EMG won’t be a good option. When you mentioned CNP I automatically thought of the 6m/6m EMG/EEG fellowships when you probably meant a 1 year EEG fellowship.

EEG used to be a money maker but not so much anymore after big cuts. Reading 2-4 cEEGs on top of ICU rounding isn't too bad. You might get offered a bit more if you can do EEG and ICU at select places. 6m/6m CNP fellowship would be adequate but I just question when you'd ever have time to keep EMG skills up.

 

[Aldertonghen]

EEG used to be a money maker but not so much anymore after big cuts. Reading 2-4 cEEGs on top of ICU rounding isn't too bad. You might get offered a bit more if you can do EEG and ICU at select places. 6m/6m CNP fellowship would be adequate but I just question when you'd ever have time to keep EMG skills up.

I knew EMG received big cuts a while ago but didn’t know EEG was on the chopping block too.

The CNP fellowship (epilepsy) would also help if someone wanted to reduce ICU weeks when they’re say 50, and transition towards EMU? I agree EMG doesn’t make sense though unless one is involved in outpatient clinics (imo defeats the purpose of doing icu in the first place).

 

[Telamir]

50 shades of GPEDs.

 

[Postictal Raiden]

50 shades of GPEDs.

More like 50 shades of triphasic

 

[Telamir]

Right. Meant to say "50 shades of GPDs with triphasic morphology"