stroke vs. neurocritical care

[pituitary]

I really need some help in deciding which fellowship to apply for. I kinda like everything in Neurology, and I enjoy working in both outpatient and inpatient settings. I have narrowed down to 2 choices: Stroke, Neurocritical Care and may be Neurophysiology.

Stroke is probably what I enjoy the most, however, the problem with stroke is that the work hours can be quite demanding and you don't really acquire any extra "skills" with this specialty. Most general neurologists can do a relatively good job in taking care of stroke patients and you probably don't earn too much more after a stroke fellowship. Perhaps some of the stroke fellows can answer, what made them decide to enter this fellowship? What do they find most attractive about stroke fellowship (besides interest)?

Neurocritical care is also an attractive fellowship for me, but once you apply for jobs, you will be forced to work in highly specialized hospitals--most likely big academic centers (this may be desired by some). Although it seems to be a growing specialty, we currently don't have too many hospitals in the country that have a dedicated Neuro-ICU. Changing jobs for whatever reason may equate to drastic geographical relocation. For those doing neuroCC fellowship, could you please comment on the lifestyle in this specialty in terms of work hours etc. Also, at times it seems like the neurointensivists are 'subordinates' to neurosurgeons--Is this something that's institution-specific or can it be generalized?

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[AznTrojan]

I really need some help in deciding which fellowship to apply for. I kinda like everything in Neurology, and I enjoy working in both outpatient and inpatient settings. I have narrowed down to 2 choices: Stroke, Neurocritical Care and may be Neurophysiology.

Stroke is probably what I enjoy the most, however, the problem with stroke is that the work hours can be quite demanding and you don't really acquire any extra "skills" with this specialty. Most general neurologists can do a relatively good job in taking care of stroke patients and you probably don't earn too much more after a stroke fellowship. Perhaps some of the stroke fellows can answer, what made them decide to enter this fellowship? What do they find most attractive about stroke fellowship (besides interest)?

Neurocritical care is also an attractive fellowship for me, but once you apply for jobs, you will be forced to work in highly specialized hospitals--most likely big academic centers (this may be desired by some). Although it seems to be a growing specialty, we currently don't have too many hospitals in the country that have a dedicated Neuro-ICU. Changing jobs for whatever reason may equate to drastic geographical relocation. For those doing neuroCC fellowship, could you please comment on the lifestyle in this specialty in terms of work hours etc. Also, at times it seems like the neurointensivists are 'subordinates' to neurosurgeons--Is this something that's institution-specific or can it be generalized?

i'm a senior neurocritical care fellow currently looking for a job.. there are plenty of jobs across the country.. many aren't advertised and are through word of mouth.. there are plenty of academic jobs as well as private practice jobs..

as for private practice.. i've seen anything from shift work (e.g 15-16 shifts per month) to overnight call to just consulting.. i've seen open as well as closed units..

as far as being a subordinate to neurosurgeons.. i definitely don't feel that way.. at least the places i've seen.. they really want a neurointensivist because pulmonary/surgical/medical intensivists aren't on the same page as a neurosurgeon in dealing with neuro patients..

lastly.. individuals who do neurocritical care can always go back and do stroke (acute stroke management isn't really all that hard).. stroke people on the other hand can't do neurocritical care.. the best part of doing neurocritical care is never having to do a clinic ever again

 

[Terpskins99]

i'm a senior neurocritical care fellow currently looking for a job.. there are plenty of jobs across the country.. many aren't advertised and are through word of mouth.. there are plenty of academic jobs as well as private practice jobs..

lastly.. individuals who do neurocritical care can always go back and do stroke (acute stroke management isn't really all that hard).. stroke people on the other hand can't do neurocritical care.. the best part of doing neurocritical care is never having to do a clinic ever again

When you split shifts or call-days as a neurointensivist, are you likewise expected to look after the non-neuro patients at most institutions? Or do most places always have a separate medicine-intensivist available to address those other patients?

I'm actually interested in neurocritical care as well, but as I only had one year of medicine internship I know I would be very rusty when it comes to managing the garden variety sepsis/VDRF patients that frequent most ICU's. Do most neurocritical care fellowships provide sufficient training such that you would feel comfortable looking after those non-neuro patients?

 

[typhoonegator]

While I feel comfortable managing a variety of pulmonary and general critical care issues, particularly as they pertain to neurologic or neurosurgical patients, I would never pretend that I could manage ARDS in the setting of IPF in a burn patient on ECMO as well as a pulm/CC doc can. The training is simply very different. While we rotate on SICU and MICU services during training, it certainly wouldn't qualify me as a pulm/CC doc, any more than having them stop by and rotate in the NCCU would make them savvy with managing SAH vasospasm. Could we get by for most things? Sure, and in fact at places where there is no NCCU, the pulm/CC and anesthesia/CC folks do just that.

While nothing that either of us do is really that romantic or that hard, the devil is in the details, and we each are better at managing the stuff we are extensively trained in. I know NCCU physicians that moonlight in community hospital "MICUs" that are more akin to step down units, but pretty much anywhere big enough to have a dedicated NCCU with neurocritical care trained staff is going to have a separate MICU/SICU/TICU/CCU each with their own staffs.

As far as not remembering medical issues from internship, well, that is a big part of fellowship. You need to re-learn sepsis goal directed therapy, diagnosis of malignant arrhythmias, how to effectively run a code, how to do CVVH, lines, thoras, paras, etc. All part of the fun.