2022 Neurocritical care match

[ProReduction]

"Never say never", but it would take a real unicorn to pull it off and I am not aware of anyone that has done it of-late. If you have no prior research before NCC fellowship then as a MD post-doc after NCC fellowship you would be a post-doc in-name only and you would be functioning as an advanced undergraduate researcher. Even a first year PhD student would have more research experience. As such, you would not be as independent as a true post-PhD post-doc. You could certainly do a 3-6 year post-doc in this setting. A really extended T32 would probably be the only way to do this and avoid critical care skill atrophy.
Being an independent NIH funded basic science or translational science researcher with only a MD and no research experience prior to doing a post-doc after NCC fellowship would probably make you the only person ever to do this. Alternatively, to be competitive for clinical research funding you would need to really learn statistics, probability theory, the fundamentals of randomization and research, etc. This can be done by doing a Masters in Biostats or Clinical Research while doing a T32.
If you are an intern now I would not wait. Start getting involved in real research now in any capacity you can. Not case reports and reviews but real research projects.

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[jay-why]

Hey thanks for this comprehensive response. I’m a pgy-2 and will be applying to NCC next year. Currently I’m looking into clinical programs that are focused on heavy intensivist training (ie. an intensivist who does neuroicu rather than a neurologist who does intensive care). Do you have a list of programs that you think prioritizes this? So far I’ve got Emory, Maryland and Miller in that list but Columbia and UCSF are two dream schools that I’ve wanted to apply to. Also if anyone has any information on how UCSD is, I’d appreciate it. Love San Diego and would love to get a great work/life balance living there. Some others I’ve been wondering about are Yale, Northwestern and WUSTL.

Would appreciate anyone’s help!

Clinically heavy programs would include, in no particular order, Pitts, Emory, UT Houston, UMaryland, Mount Sinai, and UCLA. I heard UMiami is also busy, but I don’t know too much first hand. I don’t think UCSD has a comparable clinical volume to those programs.

 

[jay-why]

"Never say never", but it would take a real unicorn to pull it off and I am not aware of anyone that has done it of-late. If you have no prior research before NCC fellowship then as a MD post-doc after NCC fellowship you would be a post-doc in-name only and you would be functioning as an advanced undergraduate researcher. Even a first year PhD student would have more research experience. As such, you would not be as independent as a true post-PhD post-doc. You could certainly do a 3-6 year post-doc in this setting. A really extended T32 would probably be the only way to do this and avoid critical care skill atrophy.
Being an independent NIH funded basic science or translational science researcher with only a MD and no research experience prior to doing a post-doc after NCC fellowship would probably make you the only person ever to do this. Alternatively, to be competitive for clinical research funding you would need to really learn statistics, probability theory, the fundamentals of randomization and research, etc. This can be done by doing a Masters in Biostats or Clinical Research while doing a T32.
If you are an intern now I would not wait. Start getting involved in real research now in any capacity you can. Not case reports and reviews but real research projects.

I totally agree with this. But, as you noted, it happens rarely, where some fellows with unique interests end up getting grants during fellowship without that much research experiences, especially at big-name institutions. On the other hands, those with significant research backgrounds not uncommonly do post-doc or research fellowship, making fellowship length essentially 3 years before becoming an attending. But these get good academic jobs from what I’ve seen so far.

 

[ProReduction]

I totally agree with this. But, as you noted, it happens rarely, where some fellows with unique interests end up getting grants during fellowship without that much research experiences, especially at big-name institutions. On the other hands, those with significant research backgrounds not uncommonly do post-doc or research fellowship, making fellowship length essentially 3 years before becoming an attending. But these get good academic jobs from what I’ve seen so far.

We are in agreement, but I'd expand on two things you mentioned:

1) ". . . some fellows with unique interests end up getting grants during fellowship without that much research experiences, especially at big-name institutions."

This does happen, but it is usually because said academic institution has spare T32s sitting unused because more qualified PhDs or MD/PhDs or even MDs with significant research experience have not filled them. I know this because after fellowship I was awarded a T32 with only one prior pub (1st/2nd author) in a good journal. The director of the institution's T32 program even told me "You show a ton of promise, but these usually go to MD/PhDs or PhDs with 10+ pubs". It is one thing to be awarded a T32. It is an entirely different thing to get a K and multiple years of R/U funding that make a MD a true "independent investigator". This is extremely rare.

2) "But these get good academic jobs from what I’ve seen so far"

This all depends on how we define "good academic jobs". Yes, doing an extra research year after NCC fellowship can land you a job at "World's Best Medical Centers", but that does not mean that those new hires have anything close to legit protected research time. Most of the junior faculty at "big name" academic shops are clinical work horses so that senior clinical faculty with grants can do minimal on-service time. Junior faculty join thinking that they will one day be at the top of the pyramid with 90/10 research/clinical split. This almost never happens. You have to be aware that "research mentorship" is sparse once you are out on your own. You need to be K-ready at a minimum at this point in your career.

 

[Aldertonghen]

We are in agreement, but I'd expand on two things you mentioned:

1) ". . . some fellows with unique interests end up getting grants during fellowship without that much research experiences, especially at big-name institutions."

This does happen, but it is usually because said academic institution has spare T32s sitting unused because more qualified PhDs or MD/PhDs or even MDs with significant research experience have not filled them. I know this because after fellowship I was awarded a T32 with only one prior pub (1st/2nd author) in a good journal. The director of the institution's T32 program even told me "You show a ton of promise, but these usually go to MD/PhDs or PhDs with 10+ pubs". It is one thing to be awarded a T32. It is an entirely different thing to get a K and multiple years of R/U funding that make a MD a true "independent investigator". This is extremely rare.

2) "But these get good academic jobs from what I’ve seen so far"

This all depends on how we define "good academic jobs". Yes, doing an extra research year after NCC fellowship can land you a job at "World's Best Medical Centers", but that does not mean that those new hires have anything close to legit protected research time. Most of the junior faculty at "big name" academic shops are clinical work horses so that senior clinical faculty with grants can do minimal on-service time. Junior faculty join thinking that they will one day be at the top of the pyramid with 90/10 research/clinical split. This almost never happens. You have to be aware that "research mentorship" is sparse once you are out on your own. You need to be K-ready at a minimum at this point in your career.

Thank you for this advice. Another obstacle I have at this stage is that I am on a visa, and so I’m not eligible for many grants (including a K grant) even if I did manage to become heavily involved in research. I’m currently doing small retrospective chart reviews in my free time but these don’t matter at all in the grand scheme of things.