Neurology

Michael A. Rubin, MD
Second year fellow, Neurocritical Care Division
Washington University
St. Louis, Missouri

One can take many paths to become a neurointensivist.  Neurocritical care certification is controlled by the United Council for Neurologic Subspecialties (UCNS), which allows people to enter a neurocritical care fellowship from many different Accreditation Council for Graduate Medical Education (ACGME) residencies:  neurology, neurosurgery, internal medicine, anesthesia, surgery, emergency medicine, or pediatrics.  Consequently, after completion of medical school, one could choose to enter any of these fields before entering the fellowship.  Although the field is dominated by neurologists, many established programs have strong contributions from a variety of fields.
 
The fellowship is two years in duration with most of the time devoted to neurologic intensive care unit (ICU) exposure as well as rotations in ICUs of other disciplines.  On completion of the fellowship, the practitioner is trained in managing both neurosurgical patients (aneurysmal subarachnoid hemorrhage, traumatic brain injury, postoperative tumor resection, etc.) as well as neurology patients (status epilepticus, neuromuscular failure, large vessel stroke, etc.).

As the field is still developing, there is significant opportunity for career development.  Some choose to work only in the ICU while others manage stroke or other neurology patients on the general ward in addition to the ICU.  The list of topics available for clinical research is extensive, and support for such research grows as the field does.  The field has reached a critical mass of trainees, allowing staffing of neurologic-specific ICUs not only at large academic centers but other hospitals that previously managed this patient population in either a medical or general surgical ICU.