Neurocritical Care Salaries Surveyed

August 2007 Neurocritical Care Salaries Surveyed By Gene Sung MD, Wendy Wright MD, and Michael Diringer MD Annual Salaries of NCS Physicians Neurocritical care is a relatively new, but rapidly growing, discipline. Its practitioners come from a variety of backgrounds and practice in a variety of settings. None of the features of the practice and compensation of a neurocritical care physician have been examined in any systematic fashion. It would be expected that, in addition to patient care, different combinations of time commitments, such as teaching, research, and administrative activities be expected. This survey is an attempt to describe these aspects of the life of a neurointensivist in the U.S. in addition to gaining an understanding of financial compensation and its determinants. A survey was emailed to members of the Neurocritical Care Society. 106 members responded to the survey, but 20 neglected to include salary information (in an anonymous salary survey!!!), so only 86 responses could be used. Besides salary amounts, some of the information collected included primary appointment, practice setting, hospital type, geographic location, percent effort on clinical responsibilities, sources of income including salary incentives, patient population, board certification and subspecialty training, and whether they hold the position as ICU director. The mean salary of all respondents included in the final analysis (n=86) was $214,100 Source: Neurocritical Care Society Inside This Issue President s Corner P. 2 By Michael N. Diringer MD Note from the Editor P. 3 By Romergryko G. Geocadin MD ICP and Brain Monitoring Symposium P. 3 By J. Claude Hemphill III, MD, MAS Mapping Neurocritical Care Units P. 4 By Wendy L. Wright MD NCS 2007 Meeting Preview P. 5 By Cherylee W. Chang MD Intraventricular tpa Trial P. 6 By Matthew A. Koenig MD Featured Program: P. 7 Forsyth Stroke and Neurovascular Center By Cheré M. Chase MD Neurocritical Care Examination P. 8 By Cherylee W. Chang MD Neurocritical Care Classifieds P. 10 Continued on page 9

President s Corner NCS Leadership 2006-2007 Officers Michael N. Diringer MD, president Cherylee Chang MD, vice president Stephan A. Mayer MD, treasurer Gene Sung MD, secretary Directors Neeraj Badjatia MD Anish Bhardwaj MD J. Ricardo Carhuapoma MD William M. Coplin MD Jeffrey Frank MD Romergryko G. Geocadin MD Deborah M. Green MD Daryl R. Gress MD Christiana E. Hall MD Walter Haupt MD J. Claude Hemphill MD Andrew Kofke MD Edward M. Manno MD Marek A. Mirski MD Guy Rordorf MD Owen B. Samuels MD Wade S. Smith MD Thorsten Steiner MD Jose Suarez MD Paul M. Vespa MD Wendy Ziai, MD Administrative Director Janel Fick Neurocritical Care Society 5841 Cedar Lake Road, Suite 204 Minneapolis, MN 55416 Phone: (952) 646-2034 Fax: (952) 545-6073 Website: www.neurocriticalcare.org Email: info@neurocriticalcare.org Newsletter Advertising Display or Classified Contact: info@neurocriticalcare.org (952) 646-2034 By Michael Diringer, MD Despite the hot weather, work at the NCS has been fast and furious on several fronts. 1. The final program for the meeting is just about complete. I m certain that it will provide an exciting, educational and fun time for all those that attend. The two-day board review course is designed to help everyone gear up for December s exam. The Annual meeting will follow and promises to cover a broad range of important topics. For details see the article by Dr. Cherylee Chang on page 5 of this newsletter, or: http://neurocriticalcare.org/index.php?su bmenu=annualmeeting&src=gendocs&re f=annualmeeting_2007&category=main& PHPSESSID=e52c379ffac3c883ba937174 a6f0ea3b 2. The transition of the Journal publisher to Springer is going well. Based on that we are beginning negotiations to renew our contract with them. A main goal in these negotiations is to further enhance the income that the NCS gets from the journal. American Neurological Association 132 nd Annual Meeting Important Upcoming Dates 3. We are moving ahead on redesign of our website and have chosen vendors to update our on-line database and registration system. The site will also be redesigned to improve appearance, organization and functionality. Thanks to Romer Geocadin and the members of the Newsletter committee for taking a leadership role in this important job. 4. A salary survey was completed and has provided a lot of interesting and useful data. The preliminary result can be found beginning on page one of this newsletter. Thanks to everyone who participated. 5. I know that the application process was confusing and difficult to manage. I discussed with the UCNS a number of times how we might improve it. The position of the UNCS is that the people who respond to questions are not allowed to tell a caller if they do or do not meet the requirements; that is reserved for the Certification Council which only looks at completed applications. I don t anticipate that this will change; the UNCS is in charge of the process, not the NCS. After multiple reviews, the UCNS is preparing the final draft of the fellow training program requirements. Oct. 7-10, 2007 Washington, D.C. American Society of Anesthesiology Oct. 13-17, 2007 San Francisco, CA 2007 Annual Meeting European Society of Anaesthesiology June 9-12, 2007 Munich, Germany Neurocritical 3rd Annual Meeting Care Society Oct. 31-Nov. 3, 2007 Las Vegas, NV 5 th Annual Meeting 17 th Meeting of the European Neurological Society June 16-17, 2007 Rhodes, Greece Society of Critical Care Medicine Feb. 2-6, 2008 Honolulu, HI 37American th Critical Society Care Congress of Interventional & Therapeutic July 30-Aug. 3, 2007 Dana Point, CA Neuroradiology, 4 th Annual Meeting International Stroke Conference 2008 American Neurological Association Feb. 20-22, 2008 Oct. 7-10, 2007 New Orleans, LA Washington, D.C. American 132 nd Annual Academy Meeting of Neurology April 12-19, 2008 Chicago, IL 60 th Annual Meeting Neurocritical Care Society Oct. 31-Nov. 3, 2007 Las Vegas, NV 5 th Annual Meeting American Association of Neurological Surgeons April 26-May 1, 2008 Chicago, IL 76Society th Annual of Critical Meeting Care Medicine Feb. 2-6, 2008 Honolulu, HI 37 th Critical Care Congress European Neurological Society June 7-11, 2008 Nice, France 18International th Annual Meeting Stroke Conference 2008 Feb. 20-22, 2008 New Orleans, LA Page 2

From the Editor An Active Autumn Ahead for Neurocritical Care Quarterly Newsletter of the Neurocritical Care Society August 2007 Volume 2 - Number 3 Editor Romergryko G. Geocadin MD Baltimore, MD Editorial Board Stephan A. Mayer MD New York, NY Matthew A. Koenig MD Baltimore, MD Ashok Devasenapathy MD Hershey, PA Wendy L. Wright MD Atlanta, GA Robert G. Kowalski Ireland Janel Fick Minneapolis, MN By Romergryko G. Geocadin, MD As we say farewell to the summer, we start serious preparations for several important activities of the Neurocritical Care Society. Our annual meeting in Las Vegas is fast approaching. The meeting organizing committee is working hard to surpass the success of the Baltimore meeting last year. The 2007 meeting is packed with cutting-edge presentations and scientific discussions. Several new, exciting and enriching meeting-related activities would be introduced in Las Vegas that will include dedicated sessions for fellows, nurses and fellowship directors. Details of the meeting are provided in this issue. So, finalize your plans now and join us in Las Vegas. Another important evolution in the life of our society is the certification examinations that will be coming up in December 2007. The NCS Examination committee and the UCNS have worked hard to ensure that this be a success. The NCS has organized a pre-meeting CME session, the Neurocritical Care Review Course, to help members prepare for the test. More test-related updates are provided in this issue as well. The recurring sections of Currents continue to provide great materials, with the U.S. Neuro-ICU map, a feature on a community-based Neuro-ICU program in North Carolina, the expansion of a neurocritical care unit-based clinical trial the CLEAR-IVH phase 3, and a meeting report, this time from ICP 2007. I d also like to highlight the lead article on the NCS salary survey. This article is definitely an eye-opener. As the society continues to grow, effective communication becomes crucial. The newsletter committee has been tasked by the NCS leadership to take on the challenge and enhance the NCS website. I am so happy that our committee members responded with enthusiasm. At the present time, we are working with our administrative staff and NCS leadership to restructure the website. We have envisioned a website that will not only mirror the excitement of our society, but will also serve as a dynamic link to members, our patients, supporters and the world. The website will be run by ideas and contributions from the membership. If you are interested and willing to commit time and effort in this activity, contact us at info@neurocriticalcare.org Symposium Explores ICP Monitoring, Treatment Techniques By J. Claude Hemphill III, MD,MAS The 13 th International Symposium on Intracranial Pressure and Brain Monitoring, Mechanisms and Treatment (ICP 2007) was held in San Francisco from July 22-26, 2007. This international meeting occurs every three years and focuses on neurocritical issues relevant to ICP and advanced monitoring of cerebral blood flow and metabolism in traumatic brain injury, stroke, and other disorders. This year marks the 25 th anniversary of the first symposium in Hannover, Germany in July of 1972. Hosted locally by Drs. Geoff Manley and Claude Hemphill of UCSF, this year s meeting brought together a group of approximately 200 neurosurgeons, neurointensivists, and basic and clinical researchers during which over 60 platform sessions were presented along with over 100 oral poster presentations. Scientific highlights of ICP 2007 included a special consensus building session on Brain Tissue Oxygen Monitoring and Treatment. Panelists for this session included Claudia Robertson, Arun Gupta, Ross Bullock, Christopher Ang, Claude Hemphill, and Peter LeRoux. During this session issues such as nomenclature, monitoring indications, and treatment trials were discussed for brain tissue oxygen tension (P bt O 2 ). Other sessions included presentations by Peter Hutchinson regarding ongoing head trauma decompressive surgery trials, Marvin Bergschneider regarding normal pressure hydrocephalus, and Iain Chambers providing an update on the BrainIT informatics project. Throughout the scientific program a common theme was increased rigor of investigation into the efficacy of advanced neuromonitoring and the relevance of examining indices of autoregulation such as P rx and O rx. Perhaps the highlight of ICP 2007 was the keynote address by Dr. Tony Marmarou and the follow-up dinner and roast of Dr. Marmarou by colleagues old and new. The participation and attendance by neurointensivists and members of the Neurocritical Care Society was particularly encouraging. This emphasized that ICP 2007 was really a neurocritical meeting with issues of interest and relevance to NCS members. A talk on current approaches to hypothermia by Dr. Mauro Oddo helped highlight the value of multidisciplinary interchange as the field of brain monitoring moves forward. ICP 2010 will be held in Tübingen, Germany and ICP 2013 will be held in Singapore. We look forward to increased participation by neurointensivists and emphasize this meeting as a primary forum for high-level interchange in the field of neurocritical care. Page 3

Advocacy for the Neurointensivist Putting Neurocritical Care Units on the Map By Wendy L. Wright MD Everyone knows that we are growing in number. What has this done for our geography? As we gear up for the first round of neurocritical care boards, will there be enough board certified neurointensivists to make an impact across the nation? Part of the answer to that question depends on how you define neurointensivist, of course. Members of the Neurocritical Care Society are a diverse group, from many training backgrounds and many nations. Not all of us are fellowship trained. Some of the units have been around for so long that for the younger generation they just seem to have been. well, just Seattle, WA always BEEN. Portland, OR The question of where these units are is not esoteric. We need to have the ability to network and collaborate, for one San Francisco, CA Stanford, CA thing. And one important issue still at stake, the Los Angeles, CA notion of incorporating the presence of neurocritical care units into comprehensive stroke centers, is Honolulu, in part impacted HI by the geographic distribution neuro-icus. of For the sake of counting, let us consider the neurocritical care units that are currently running in the U.S. Let us further consider those that are being run by either fellowship-trained neurointensivists or those who founded the field (that is to say, those who have been around so long that they trained many of us). Forgive me, those of you members, who work in neurosurgical- or anesthesiology-based units. Of course, adding your fine units to this map would This section is provided to promote all aspects of advocacy for the practice of neurocritical care. For questions, comments or suggestions for future articles, email Wendy L. Wright MD at wendy.wright@emoryhealthcare.org. blanket more territory. But I want us to ponder this map for a moment, which reflects the fellowship-trained neuro-intensivist, as we have just embarked on the era of the UCNSguidelines for training. My list of fellowship-trained neurointensivists U.S. Cities with Neurointensive Care Units Staffed by Neurologists Fellowship Trained in Neurocritical Care Salt Lake City, UT Phoenix, AZ Minneapolis, MN St. Paul, MN Rochester, MN Milwaukee, WI Dallas, TX Houston, TX Chicago, IL Ann Arbor, MI Detroit, MI Cleveland, OH Cincinnati, OH Kansas City, KS Wichita, KS St. Louis, MO Charlottesville, VA Durham, NC Nashville, TN Winston- Salem, NC Memphis, TN Atlanta, GA Augusta, GA and the places they call home was generated from the NCS database members and from NCS Vice President Dr. Cherylee Chang s invaluable Pedigree presentation at last year s NCS meeting in Baltimore, combined with that ever-reliable all-knowing source of information - www.google.com. Of note, approximately 127 NCS members are working in 50 dedicated neuroicus, and an additional 18 NCS members are working as consulting neurointensivists in 15 hospitals. The dedicated NeuroICUs were located in 39 cities, spanning 25 states and the District of Columbia. Regrettably, this data does not include the 2007 graduating neurocritical care fellows, as I have not yet had time to track those members down. I assume I have left some neurologist-based units off the list, as my search method, which felt exhaustive, was certainly flawed. If your unit is not represented or if you are a 2007 fellowship grad, please email me at wendy.wright@emoryhealthcare.org (and include the following information: your name, where you did your neurocritical care Hershey, PA Not to scale Worcester, MA Baltimore, MD Bethesda, MD Washington, D.C. Charleston, SC Boston, MA New York, NY Newark, NJ Philadelphia, PA fellowship, who trained you, the name and location of your hospital and whether you are in academic or private practice). Another main source of error, I suspect, would be that some people have changed location since this data was collected, so if your old unit is now defunct but you suspect it is still on the map, let me know. Also, I would love to publish a similar map that shows where the fellowship-trained neurointensivist NCS members are practicing as consultants, so those of you reading this, send me that information as well. The point is, with the advent of the Neurocritical Care Certification Examination, we will now have a new labeling and tracking mechanism, however you may feel about the implications of board certification. The UCNS was expecting 75 applications, but received over 100. How will it change this map? Page 4

Preview: 5 th Annual Neurocritical Care Society Meeting By Cherylee W. Chang MD This year the annual meeting takes place in Las Vegas on Friday and Saturday, November 2 and 3. In preparation of the first-ever Neurocritical Care Certification Examination administered through the United Council of Neurological Subspecialties in December, the annual meeting will be preceded by a pre-session review course October 31 st and November 1 st. The course will be comprehensive and intense with 21 faculty members presenting topics in both general critical care and neurocritical care. Visit www.neurocriticalcare.org to view the details of the programs. In addition to the oral abstracts, the Annual Meeting features 22 distinguished faculty members presenting topics in Sessions: 1) Translational Neurocritical Care, 2) Neurocritical Care in the Combat Zone, 3) Spinal Cord Resuscitation, 4) Pediatrics and Neurocritical Care, 5) Neuroimaging 6) A Pro and Con debate of PbrO2, Microdialysis and continuous EEG monitoring in the ICU. This year we are featuring two Walk- Abouts with the Professor with refreshments during the Poster Sessions. The meeting will be opened by Cecil Borel, MD with Neurocritical Care in 2007. The Society Lecture: Neurotrauma: Roles for Neurocritical Care and Neurosurgery will be delivered by David Adelson, MD, the Vice-President of the Congress of Neurological Surgeons and the Chair for the AANS/CNS Section on Neurotrauma and Critical Care. Friday evening s reception and dinner is Upcoming Awards at the 2007 NCS Meeting Young Investigator Award An award, supported by The Medicines Company, will be given at the 2007 meeting for the outstanding abstract submitted by a junior member of the society (student, resident, or fellow). Please note that one must be a member of the Neurocritical Care Society at the time the abstract is reviewed. The recipient is expected to attend the annual meeting. Outstanding Abstract Award An award, supported by PDL BioPharma, will be given at the 2007 meeting to the best scientific abstract submitted by an individual (open to all members). Please note that one must be a member of the Neurocritical Care Society at the time the abstract is reviewed. The recipient is expected to attend the annual meeting. "Challenging Case Study in Neurocritical Care" Awards A "Challenging Case Study in Neurocritical Care" Competition Sponsored by The Medicines Company, junior members of the society (student, resident, or fellow) are invited to submit a 500 word or less case summary of an interesting case to info@neurocriticalcare.org by September 30, 2007. Three cases will be selected. Those three nominees will receive a $500 travel grant to present their 10-minute case, which should include highlights of pathophysiology and treatment on October 31st at The Medicines Company-supported event, "Building the Future of Neurocritical Care." One winner will be chosen at that time to receive free registration to the next year's meeting. The winner of this competition will also present their case during the Oral Abstracts Session, Friday, November 2. sponsored by PDL Pharma. Eelco Widjicks, MD will be delivering the evening keynote address: Coma in Hollywood and on Television. The Codes (Drs. Gary Bernardini, David Crippen, Michael DeGeorgia, and Stephan Mayer) who debuted at last year s meeting, will provide an encore performance later that evening. Other highlights include an Outstanding Scientific Abstract Award in addition to the Young Investigator Award. A new case competition will be offered and be held during the first evening of the pre-session Review Course at a fellow- and young faculty- focused satellite sponsored by The Medicines Company: Building the Future of Neurocritical Care. During lunch on Saturday, another first offering will be a Nurses Corner, a Fellows Corner and a Fellowship Directors Corner. These facilitated lunch discussions will provide a forum to discuss issues and concerns for NCS members. The Annual Meeting Program committee invites you to visit the website for details and to join us for the 5 th Annual NCS Meeting and the pre-session Certification Review Course! The Annual Meeting Program Committee is composed of Cherylee W. J. Chang, MD, Chair; Carmen Graffagnino, MD; J. Claude Hemphill III, MD; Geoffrey S. F. Ling, MD, PhD; Ed Manno, MD; Bart Nathan, MD; Lori Shutter, MD; Gene Sung, MD; and Thorsten Steiner, MD. Page5

Clinical Trials Monitor Intraventricular tpa Trial Seeks New Sites for Phase III Study By Matthew A. Koenig MD Investigators for the Clot Lysis Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR-IVH) trial are seeking additional centers for a phase III study of intraventricular tpa for removal of IVH. This double-blind, multi-center, placebo-controlled trial is an extension of prior safety and dosefinding trials conducted over the last 8 years. The principle investigator for the trial is Daniel Hanley, MD, the Division Director of the Brain Injury Outcomes Service (BIOS) at the Johns Hopkins Hospital. To date, intracerebral hemorrhage (ICH) and IVH continue to have mortality rates between 40 and 80% at most centers and no single therapy has been rigorously proven to improve outcomes. Recent failures of recombinant factor VII in the FAST trial and surgical clot resection in the STITCH trial have led to pessimism about the ability to alter outcomes in these patients. Phase I and II data from the CLEAR-IVH study have generated renewed hope for treatment of IVH through minimally invasive techniques. This is important to neurocritical care research because it is the first comprehensive program to be carried out primarily in the neurocritical care unit environment. The FAST trial was carried out primarily in the ED environment and was found to be lacking as far as significance goes. This may be because we have underestimated the value of sustained neurocritical care and the value of removal of the IVH, says Dr. Hanley. The CLEAR-IVH study enrolls patients with IVH associated with a small (<30 cc) ICH who have undergone placement of an external ventricular drain (EVD). Patients <75 years of age who have occlusion of the third and fourth ventricle are eligible for enrollment if they are screened within 12 hours of onset. Patients must demonstrate stability of clot size by a second head CT more than 6 hours after the first scan in order to receive the study drug and tpa must be administered within 48 hours of onset. According to the study protocol, 1 mg of tpa or placebo is administered via the EVD every 8 hours for up to 96 hours (12 doses). The EVD will be clamped for 1 hour after each drug administration, then re-opened for drainage. Patients will be followed with daily head CTs and the study protocol will be discontinued when the third and fourth ventricle clear and mass effect from lateral ventricular clot resolves. Patients and investigators will be blinded to patient assignments. The primary endpoint of the study is modified Rankin scale at 6 months. Secondary endpoints include multiple functional outcome assessment scales, mortality, duration of ventricular drainage, and interval to clot resolution. The investigators will monitor for adverse events including, EVD tract hematoma, hemorrhage expansion, and ventriculitis. The prior study phases demonstrated acceptable safety and a low incidence of adverse events at the present dose and frequency of administration. The phase III study is seeking 75 centers in the United States, which would each be expected to enroll 2-4 patients per year. The total planned enrollment is 500 patients, half of whom will be Page 6 randomized to each arm. In order to participate in the study, prospective centers must have at least 80 annual admissions for ICH and must screen at least 11 patients every 90 days. Centers must also treat patients in an intensive care unit where patients are actively managed by a neurologist or neurosurgeon and the site investigator must have ICU privileges. To date, 30 centers are enrolling patients and CLEAR-IVH just received funding for a planning grant from the NINDS to recruit and train 20-45 additional centers over the next year. This planning grant will be followed by This is important to neurocritical care research because it is the first comprehensive program to be carried out primarily in the neurocritical care unit environment. The FAST trial was carried out primarily in the ED environment and was found to be lacking as far as significance goes. This may be because we have underestimated the value of sustained neurocritical care and the value of removal of the IVH. - Daniel Hanley, MD,..Principle investigator of the CLEAR-IVH trial an NINDS R01 application to fund the phase III study which will be submitted in October. The 5-year study is budgeted to cost nearly $17 million. Interested centers can find additional information at the website http://clearivh.com/default.aspx. Site expansion is progressing at a good pace, as investigator enthusiasm is high. We have novel online and telephonic training of site personnel including coordinators, investigators, and surgeons, says Dr. Hanley. As an approved planning grant, we have overcome the biggest hurdle and are now sure that this is a study program that is relevant to the mission of NINDS.

Neuro-Intensive Care Featured Program Forsyth Stroke and Neurovascular Center Winston-Salem, N.C. By Cheré M. Chase, MD As a neurointensivist, building a neurocritical care program is a tremendous challenge. Developing best practices and protocols, recruiting highly trained neurocritical care physicians and nurses and implementing programs to effectively diagnose, treat and prevent devastating neurological disability in the community were all goals of mine. As the medical director of Stroke and Neurocritical Care for the Stroke and Neurovascular Center at Forsyth Medical Center in Winston-Salem, N.C., I have been able to meet and exceed those goals within a community-hospital setting. When I joined the Forsyth Stroke and Neurovascular Center in July 2003, Forsyth Medical Center was considered a regional leader in the treatment of neuroscience patients and had the second-largest stroke patient load in the state of North Carolina. However, the Forsyth had no formal neurocritical care program. My first year at Forsyth Medical Center was extremely demanding. In August 2004, Dr. Cheré M. Chase is medical director of Stroke and Neurocritical Care for Forsyth Stroke and Neurovascular Center in Winston-Salem, N.C. Dr. Chase obtained her undergraduate degree from Brown University, her master s of health finance and management from the Johns Hopkins School of Public Health and her medical degree from the University of Maryland School of Medicine. She completed an internship in internal medicine at the University of Pittsburgh School of Medicine, a neurology residency at Case Western Reserve School of Medicine and a fellowship in neurosciences critical care at the Johns Hopkins School of Medicine. under my direction, our inter-disciplinary team established Forsyth Medical Center as the first hospital in North and South Carolina to receive Primary Stroke Care Certification from the Joint Commission on Accreditation of Healthcare Organizations. As the only primary stroke center in the region at that time, community outreach was essential. Our team applied for and received a $2.6 million, multi-year grant from the U.S. Department of Health and Human Services to implement and coordinate Medial Staff of the Forsyth Stroke and Neurovascular Center A Community Based Neurocritical Care Unit free stroke risk assessments and provide individualized stroke prevention education to underserved residents in the community. Our other primary mission during that first year was to create a neurocritical care unit. Previously, the hospital grouped neurosciences patients together in one area of the medical/surgical ICU, but we wanted to create Page 7 - Ashok Devasenapathy, MD, Section Editor an independent unit with evidence-based neurosciences pathways and protocols in place. Originally just two beds, this unit has now grown to be a 10-bed department that cares for the hospital s critically ill neurology and neurosurgery patients. The success of our program has resulted in such growth that we are now developing a 10-bed neuro-progressive care unit for patients who require specialized neurological care in an intermediate setting. Like academic medical center-based neurocritical care units, while each of our patients has a primary neurocritical issue, we also treat patients with multiple medical issues. In fact, the hospital s medical/surgical/cardiac ICUs routinely transfer patients that develop neurological issues to the neuro ICU as soon as possible, which I believe speaks to the comprehensive strength of our program. As our unit has grown, so, too, has our staff. During my first two years at the Forsyth Stroke and Neurovascular Center, I was the only neurointensivist on staff. Today, we have a second neurointensivist, Diana Greene-Chandos, M.D., who also trained at Johns Hopkins hospital; two physician assistants; a nurse practitioner; a nurse clinician; a nurse manager; two assistant nurse managers; a stroke coordinator; a stroke navigator; and more than 40 neuroscience specialized nurses many, of whom are Certified Neuroscience Registered Nurses (CNRNs). Typically we have a one-to-two nurse-topatient ratio. Our nurses participate in rounds every morning. At the Forsyth Stroke and Neurovascular Center, we believe that the nurses who are at the patients bedsides have and need to know clinically detailed information about their patients. That s why we invite them to be part of the decision-making process with regards to treatment. Continued on page 8

Neurocritical Care Certification Examination Finalized By Cherylee W. Chang MD The road to the United Council of Neurologic Subspecialties (UCNS) Neurocritical Care cerification began during the Second Annual Meeting of the Neurocritical Care Society held in San Diego in February, 2004. At that time, long debate resulted in the decision to initially pursue UCNS rather than ACGME certification. UCNS membership was granted to Neurocritical Care in October, 2005 with the support of the Society of Neurosurgical Anesthesia and Critical Care, the American Academy of Neurology, and the Neurocritical Care Society. Although a preliminary certification examination committee had been formed by the NCS in 2004, in 2005 the UCNS approved an examination committee of 10 individuals ACGME Board-certified and representing disciplines in: critical care medicine, anesthesiology, neurology and neurosurgery. The Neurocritical Care Society Examination Committee is composed of Cherylee W. J. Chang, MD, Chair; Jose I. Suarez, MD, Vice-Chair; Neeraj Badjatia, MD; Perry A. Ball, MD; Walter J. Koroshetz, MD; Edward M. Manno, MD; Paul Nyquist, MD; Javier Provencio, MD ; Michael Souter, MD ; John Terry, MD. For the exam committee, the last 18 months have included review of the content guidelines and core curriculum, training in item writing, question-writing and grueling meetings to finalize 200 questions. This August, the test has been finalized on the Pearson VUE testing system. Eventually the UCNS will be accrediting training programs, however, until that time, candidates should have reviewed the Practice Track and have applied for the examination by July 15, 2007. Pearson Professional Centers across the United States will offer the Neurocritical Care examination December 10-14, 2007. We offer congratulations to those candidates who have elected to sit for the examination. As all practitioners in neurocritical care, you continue to be the trail-blazers in a young and growing subspeciality. Good luck! Community Based Neurocritical Care at Forsyth Stroke and Neurovascular Center Continued from page 7 Also, because the neurocritical care nurses are trained in stroke codes, they can go to other areas of the hospital to help assess patients and determine if someone is having a stroke, thus starting the process of diagnosis and treatment of in-hospital strokes much sooner than was previously possible. Perhaps our biggest strengths, however, are the technology that we use every day to treat patients with severe neurosciences conditions and the unique services that we offer to patients and their families. For example: The design of our neurocritical care unit allows us to reach the head of the patient s bed without moving equipment. The room s monitoring devices are on large, moveable arms. This allows us to change the direction of the patient while still attending to their needs. Thus, many procedures including tracheotomies, feeding tubes and PICC line placement can occur at patients bedsides. We utilize two imaging systems PACS and STENTOR that allow us to review patients films anywhere in the hospital or at home. Our neurointensivists personally manage ventilator patients and have an excellent consultative relationship with the pulmonary intensivists for prolonged ventilation patients. We have the capacity to monitor intracerebral pressure from all monitors. We offer 24/7 neurosurgical and neurointerventional radiology access for our patients who require interdisciplinary assessments. Although our unit s visiting hours are very liberal, we do have quiet time from 2-4 p.m. daily, during which visitors and medical procedures are halted to give patients time to rest. Our daily stroke education classes teach patients and family members about stroke risk Content of UCNS-approved Neurocritical Care Exam Content Area Percentage of Questions I. Neurological Disease States 48% (96) II. General Medical Critical Care 47% (94) III. Procedural Skills 5% (10) factors, treatment, rehabilitation processes and the various tests that patients may experience while in the neurocritical care unit. We also offer a caregivers support group called A Time for You that gives family members an opportunity to raise questions or concerns away from patients. The group also gives caregivers an opportunity to connect with other stroke families and build their own support network. Our Stroke Navigator complements the case manager to help patients navigate the hospital system. In addition to helping schedule appointments, the Navigator also connects families with resources in the community when financial problems strike to ensure they have a place to live, food to eat, medication to control disease and transportation to and from the hospital for treatment and/or rehabilitation at discharge. Although we have an open unit model and the patient s primary attending remains the attending of record, the critical decisions around patient care are the responsibility of the neurointensivist on duty. As one of the few community-hospital based stroke and neurovascular centers in the nation to have a neurocritical care unit run by a neurointensivist, Forsyth Stroke and Neurovascular Center is breaking new ground. Previously, the diagnosis and treatment of critically ill neuroscience patients were reserved for academic, tertiary care, referral centers. Now, the people of North Carolina s northwest counties can rely on our center to provide evidence-based standardized care overseen by neurointensivists. As neurointensivists continue to improve the lives of the critically ill across the country, I hope they will consider extending our expertise to community hospitals. Page 8

Neurocritical Care Physician Salary Survey Wide Range of Regional and Practice Differences Continued from page 1 and the median was $200,000, with the range from $100,000 to $550,000. The mean salaries for academic physicians ($201,400) was, unsurprisingly, lower than for private practitioners ($258,600). There were 31 neurologists who served as ICU directors, and salaries differed if their primary appointment was in a neurology department (n=25, mean salary $207,900), or a neurosurgery department (n=6, mean salary $247,500). The 4 ICU directors who were not neurologists had a mean salary of $323,500. Most respondents spent at least some time working on consults, research, or administrative duties. The majority of respondents (n=37%) practice in the northeast (mean salary=$221,100; n=32), but mean salaries were highest in the southwest ($264,200; n=6). The information gathered in this survey enhances the understanding of the current practice of neurocritical care throughout the United States. This data may be valuable to neurointensivists during contract negotiations, to hospital administrators trying to assess the feasibility of hiring a neurointensivist, and to neurologistsin training as a way of generating interest in neurocritical care as a career choice. These are some of the preliminary results, seen in the accompanying graphs and tables. More complete results will be presented at the annual meeting in Las Vegas. After seeing the results, some of our members may feel the need to supplement their incomes by gambling! Page 9

Nominations Sought for New Neurocritical Care Society Board Members The Neurocritical Care Society is accepting nominations for new members of the organization s board of directors. Eight positions on the board are becoming vacant. Nominations should be made by emailing: mailto:info@neurocriticalcare.org by Sept. 4, 2007. The society wishes to express its appreciation for the dedication of board members whose terms are expiring in 2007: Jeffrey I. Frank, MD, University of Chicago; Daryl R. Gress, MD, University of Virginia, Charlottesville; Walter F. Haupt, MD, University of Cologne, Germany; J. Claude Hemphill III, MD, University of California at San Francisco; Marek A. Mirski, MD, PhD, Johns Hopkins University, Baltimore; Jose I. Suarez, MD, Baylor College of Medicine, Houston; Gene Sung, MD, University of Southern California, Los Angeles; and Paul M. Vespa, MD, University of California, Los Angeles. Neurocritical Care Classifieds Neurointensivists Faculty Position - Emory Contact: Owen Samuels, M.D. Director of Neurosciences Critical Care Emory University Hospital Department of Neurosurgery Job #206466 1365 Clifton Road, Suite B6200 Atlanta, GA 30322 Phone: 404-778-3752 Fax: 404778-4472 Email: owen.samuels@emoryhealthcare.org Critical Care Neurologist/Neurointensivist Cleveland Clinic Contact:Joe Vitale Director of Physician Recruitment Office of Professional Staff Affairs Email: vitalej@ccf.org Neurointensivist Faculty Position-Cedars-Sinai- CA Contact: Cameron Blount Academic Services Specialist 8711 W. Third Street Los Angeles, CA 90048 Fax: 310-423-0345 Email: cameron.blount@cshs.org NEURO-ICU Director - MGH Contact: Anne B. Young, MD, PhD Chief, Neurology Service Massachusetts General Hospital 55 Fruit Street -VBK915 Boston, MA 02114 Email: young@helix.mgh.harvard.edu Neurocritical Care/Stroke position Washington University, St. Louis, MO Contact: Michael Diringer, M.D. Professor of Neurology, Neurosurgery and Anesthesiology Director, Neurology/Neurosurgery Intensive Care Unit Department of Neurology, Campus Box 8111 Washington University 660 S Euclid Ave St Louis, MO 63110 Phone: 314-362-2999 Fax: 314-362-0215 Email: diringerm@neuro.wustl.edu Neuro-Intensivists - Henry Ford Hospital Contact: Panayiotis N. Varelas, MD, PhD Director NICU, Depts of Neurology and Neurosurgery Henry Ford Hospital 2799 West Grand Boulevard Detroit, MI 48202-2689 Phone: 313-916-8662 Email: varelas@neuro.hfh.edu Neurointensivist - Oregon Health & Science University Contact: Anish Bhardwaj, M.D., F.A.H.A., F.C.C.M. Professor of Neurology, Neurological Surgery, Anesthesiology/Peri-Operative Medicine Director, Neurosciences Critical Care Program Department of Neurology, School of Medicine Oregon Health & Science University (OHSU) 3181 SW Sam Jackson Park Road, L-226 Portland, OR 97239-3098 Phone: 503-418-1472 Fax: 503-418-1495 Email: bhardwaj@ohsu.edu Neurointensivist - Lehigh Valley Health Network Contact:Debra.Perna@LVH.com Phone: 610-969-0216 Website at www.lvh.org. Vascular Neurologist Sutter Health - CA Contact:Sutter Health, SSR Physician Recruitment Phone: 800-650-062 5Fax: 916-643-6677 Email: develops@sutterhealth.org Website: http://www.sutterhealth.org Neuro-Intensivist - University of South Carolina Contact:Sunil Patel, MD, Clinical Chair, Department of Neurosciences, E-mail: patels@musc.edu; or Julio Chalela, MD, Neuro-Intensive Care and Stroke, Medical Director NSICU E-mail: chalela@musc.edu. Neurointensivist - UT Southwestern Medical Center Contact: Wengui Yu, MD, PhD. Assistant Professor of Neurological Surgery and Neurology Chief, Division of Neurological Critical Care Departments of Neurological Surgery and Neurology UT Southwestern Medical Center 5323 Harry Hines Blvd Dallas, TX 74390-8855 Phone: 214-648-8513 Fax: 214-648-0341. E-mail: wengui.yu@utsouthwestern.edu Neurocritical Care / Neurointensivist - Tyler, TX Contact: Bill Kohut Trininty Mother Frances Health System Tyler, TX Phone: 888-226-5349 Fax: 208-255-2013 Email: kohutb@tmfhs.org Website: http://www.tmfhs.org Academic Neurocritical Care-Rush University Medical Center Contact: Richard E. Temes, M.D., M.S. Director, Neurological Intensive Care Rush University Medical Center Department of Neurological Sciences Section of Cerebrovascular Disease and Critical Care 1725 W. Harrison Street Suite 1117 Chicago, Illinois 60612-3824 Phone: 312-942-4500 Fax: 312-563-3495Or Email: Richard_E_Temes@rush.edu Neurointensivist Sutter Health - CA Contact:Sutter Health, SSR Physician Recruitment Phone: 800-650-0625Fax: 916-643-6677 Email: develops@sutterhealth.org Website: http://www.sutterhealth.org Neurointensivist - Sacred Heart Medical Center Williamette Valley, Oregon contact: Nancy Dunlap, CMSR Manager Physician Resource Planning Phone: 866-469-8162 Fax: 541-349-8036. Email: ndunlap@peacehealth.org Academic Neurointensivist Columbia University Medical Center Contact:Stephan A. Mayer, MD Division of Stroke and Critical Care The Neurological Institute 710 West 168th Street New York, NY 10032 Email: sam14@columbia.edu Neuro-Hospitalist - Marshfield Clinic Contact:Sandy Heeg, Physician RecruiterMarshfield Clinic 1000 N Oak AvenueMarshfield, WI 54449 Phone: 1-800-782-8581, extension 19781 Fax: 715-221-9779 Email: heeg.sandra@marshfieldclinic.org Website: www.marshfieldclinic.org/recruit Assistant/Associate Professor for Neuro-ICU Boston University School of Medicine Contact: Carlos S. Kase, MD BUSM Department of Neurology 715 Albany St., C-329 Boston, MA 02118 Phone: 617-638-5102 Email: cskase@bu.edu Page 10