NueroICU vs MICU Cases

[ProffesorOakDO]

Hi, I’m a PGY-1 Neurology resident. It’s going pretty well so far, I’m enjoying my internal medicine and neurology blocks. I finished my MICU rotation and I really liked the acuity and the variety of cases. My question is, how much “MICU problems” can a NeuroICU physicians competently manage. How are the patients different?

Don’t get me wrong, I don’t want to be be managing s/p cardiac arrest or ECMO patients. But it would be nice to have some variety and see like a septic shock or EtOH withdrawals, status, meningitis, drug overdose mixed in with the s/p tPA and post of NGSY patients, and other bread and butter issues.

What do y’all think?

---

Members don't see this ad.

 

[Aldertonghen]

At certain programs the NCC attendings when on call manage all critical care patients- not just neuro ones- I think UPMC is one of them. Some private hospitals here do so too. The stuff you mention we take care of in neuroICU too- status and meningitis

 

[SpacemanSpifff]

Hi, I’m a PGY-1 Neurology resident. It’s going pretty well so far, I’m enjoying my internal medicine and neurology blocks. I finished my MICU rotation and I really liked the acuity and the variety of cases. My question is, how much “MICU problems” can a NeuroICU physicians competently manage. How are the patients different?

That's going to depend on where they trained and the exposure they had during fellowship. Very few neurocritical care programs adequately prepare their graduates to manage complex, sick medical patients, because that's not the population they treat. Certainly their patients can develop these issues after being admitted for neurologic issues (i.e. aspiration leading to ARDS, hospital acquired sepsis, withdrawal, etc.), but the average neurocritical care fellowship is not geared towards these problems. Multidisciplinary CC fellowships, which are uncommon, are perhaps the exception.

 

[CnsCrit]

Yes, neurointensivists can treat common MICU diagnoses. It's important to realize that every intensivist has their strengths. NCC is not equal to trauma crit care which is not equal to MICU or anesthesia crit care. We all share common skills, but we have our strengths and weaknesses. At a certain point, everyone has their own interests and preferences for how they like to practice. If a neurointensivist has a special interest in cardiology or ID and chooses to somehow build their skills, they'll have that niche. Same is true for medical intensivists who are interested in neuro. Fellowship matters to a certain extent but so does your own motivation and interests. A career lasts a long time and fellowship is just the starting point.

I can admit I am not as good a MICU doc as someone trained in pulm/crit, but I can promise you that all critically ill patients develop septic shock, ARDS, menigitis, renal failure, GI bleeding, respiratory failure, complications of cancer, whatever - and they don't care what ICU they're boarding in.

 

[CCM-MD]

In addition to asking whether you can handle it, you need to ask: whether you can find someone willing to hire you to do it and/or whether or not you want the liability. You can probably handle some low acuity non-neurological patients but these are the minority. Anyone will tell you that the sickest patient population in the hospital is in the MICU. This is a start contrast to the acuity in the neuro ICU, which contains some of the most metabolically and hemodynamically stable ICU patients. A large portion of them being post op neurosurgical patients. I wouldn't want a neurologist managing a decompensated cirrhotic with combined septic, hemorrhagic and cardiogenic shock with ongoing GI bleeding and a prosthetic valve infection with wide open MR. Nor would a CT surgeon be comfortable with a neurologist managing their post op patient with biventricular Impellas, CRRT and multiple vasoactive agents . Its much easier to flex a IM/EM/Anesthesia trained physician with a multidisciplinary Critical Care Fellowship across these patient populations. NCC will never be seen under that same light. Regardless of what the gungo ho NCC koolaid drinkers will tell you, its just not the same.

Bottom line, if you're going the neurology/neurocrit route, expect to work in an academic neuro ICU or the minority of very large community hospitals that have dedicated neurointensivists. Some non-neuro patients may come your way in these practice settings, but they will be a small minority. If that's enough to get you your fix, great. Otherwise, you're still a PGY1, it may be worth considering an alternative path to Critical Care Medicine with exposure to a broader patient population via a multidisciplinary fellowship and a residency in IM, EM or anesthesia.

 

[Splenda88]

As @CCM-MD mentioned above, It appears that your interests align more with IM/CCM than neuro. These are the things I manage in a semi open ICU (non vented patients) on daily basis as a hospitalist.

I would be happy if neuro at my shop co-manage these patients w/ me, but they don't want the liability.

 

[mrbreakfast]

I will say that, as a neurohospitalist, I treat meningitis, alcohol withdraw, status, drug overdose, etc, in various ICUs all the time. I'm obviously not adjusting the vents or pressors or ordering antibiotics, etc. That's the distinction. You can still get a broad diversity of presentations and care as a neurohospitalist; the question is whether you want to be the one calling the shots "below the neck," so to speak.