Neurocritical care

[Floss]

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I was wondering if anyone has any input on this field, I was wondering about whether the training is on par with medicine critical care and whe sort of job prospects exsist...

 

[typhoonegator]

Neurocritical care training varies widely from fellowship to fellowship. There are some NCC programs that function more as consultants, and are therefore less procedure-oriented. Other programs, like UCSF and Hopkins, are very critical-care oriented, and their fellows spend a lot of time in the SICU, MICU, and TICU. They place lines, do bronchs, intubate, and generally act like ICU physicians. Some NCC programs offer exposure to advanced neuroimaging (PET, Xenon-CT) and neuromonitoring technologies (Licox, cerebral microdialysis, continuous EEG) while others are more conservative.

In my humble opinion, a well-trained neurointensivist should be able to provide systemic critical care that is on-par with an anesthesiologist or pulmonologist, but with a better understanding of, and focus on, what is going on above the neck than the majority of people in these specialties can provide.

Well-trained NCC physicians are in relatively high demand. NeuroICUs have become in vogue, and can be a profit center for a neurology department which otherwise tends to lose money on inpatients.

 

[BlondeDocteur]

Agree with above. My program is very strong on neuro-critical care, and the fellows are top-notch. They are perfectly comfortable in all intensivist procedures and are much more competent than other critical care-trained fellows in things above the neck. Most graduate to run neuro-ICUs some place. A select few decide to become interventionalists, though that is less popular due to the additional training, bad hours and time away from the bedside.

 

[Aspalgarry]

Neurocritical Care is one of the most exciting fields in neurology. If you like doing procedures and don't mind taking care of sick patients is one of the best fellowship options out there in terms of job opportunities/exciting research and a much better salary than other areas of neurology (even in the academic setting)

I am a doing a two year neurocritical care fellowship at Cleveland Clinic and I am very happy about my fellowship choice.

The key is looking for a program that has a close unit and the ICU team is either primary or co-primary. We do all our intubations, lines, and take care of all the critical care problems (ARDS, sepsis, cardiogenic shock....).

I also think the outside rotations in the MICU, SICU, CCU and Trauma unit are an important part of the fellowship. You can always learn how things are done in other units and gain valuable experience.

The mix of patients is also important. You don't want a unit that is full of stroke patients. You need to know how to take care of neurosurgical patients which are often sicker (SAH). Ideally you want a mix of Stroke, S/P interventions, post surgical, SAH, ICH, GBS, MG and status epilepticus

The field is moving towards goal directed therapy and advanced neuromonitoring with cerebral blood flow, lycox monitor and continuous EEG and several studies have shown that mortality and ICU length of stay was improved when a neurointensivist was involved

Lifestyle is better than I anticipated since most attendings work one or two weeks block follow by some time doing research and/or teaching. Having good fellows and residents can make a big difference

There are opportunities in academic and lately in increasing number of positions in private practice

I hope the overview helps

 

[Floss]

Thanks for the replies, would you say that someone with a neurocritical fellowship wold be as qualified to run a MICU as someone with one year crtic care and 2 years ID/Renal?

 

[halopecia]

The answer is NO ! if one wants to run a MICU train in Critical care, for a NeuroICU train in Neurocritical care. the emphasis of domain of training is different. While a neurointensivist manages critical care there is enough he doesnt see in daily life and training that is required in MICU - pacing, dialysis, chest tubes, bronchoscopies etc, unless trained in a handful of NICUs in the country where one may learn this..

 

[neurologist]

The answer is NO ! if one wants to run a MICU train in Critical care, for a NeuroICU train in Neurocritical care. the emphasis of domain of training is different. While a neurointensivist manages critical care there is enough he doesnt see in daily life and training that is required in MICU - pacing, dialysis, chest tubes, bronchoscopies etc, unless trained in a handful of NICUs in the country where one may learn this..

I wholeheartedly agree. When my time comes and I'm gorked out in the unit with sepsis, ARDS and whole-body organ failure, the last person I want near me is a friggin' neurologist. I want a hard core internal med flea with critical care-fellowship training.

If you need neuro input in an ICU, get a neuro consult. While neurologists give good consult and arguably can run a specific "neuro" ICU, no way should they be running a general med/surg ICU.

 

[Aspalgarry]

I wholeheartedly agree. When my time comes and I'm gorked out in the unit with sepsis, ARDS and whole-body organ failure, the last person I want near me is a friggin' neurologist. I want a hard core internal med flea with critical care-fellowship training.

If you need neuro input in an ICU, get a neuro consult. While neurologists give good consult and arguably can run a specific "neuro" ICU, no way should they be running a general med/surg ICU.

The same could be said about a MICU doctor trying to taka care of patients in a Neurocritical Care unit. Without any knowledge about vasospasm, Reading a CT scan, interpreting EEG, brain oxygen tension monitoring changes in a head trauma patient, treating a pt with GBS (the list continues...) having a Neurointensivist running a NICU makes a difference in patient care and there is data to support it. (Improve mortality, length of state...) if you have doubts just look it up. I am sure a well trained Neurointensivist can cover some shifts in the MICU just like a good Int Med intensivist can do in the NICU but obviously the have a different set of skills and expertise.

 

[Vader]

What is the typical salary level for a neurointensivist in academics? In private practice?

 

[Aspalgarry]

Depends of the setting:

Academics 190-250 a year

Private practice 250-350 a year

In the latest survey by the neurocritical care society the median salary for a neurointensivist was 215 year (mostly because most neurocritical care practioners are in academic practice)

 

[donesoon]

Does anyone currently training in NCC have thoughts on non-neurologists (ie., IM, EM, anesth, gen surg) doing a fellowship in NCC? Or are these open only to neurology/neurosurgery-trained residents?