UT Houston:
Very large program with a high volume, clinical focus. The fellows are interdisciplinary, including neurologists, ED physicians, etc. Attendings are also multi-disciplinary. Kiwon Lee was the director when I interviewed, someone farther up in the thread said he has since left, I have no primary information about this. Regardless, this is a great clinical training program. They have an insane referral network and patient base (they have 5 air ambulances that land on top of the hospital to get trauma/acute patients in quickly), tons of trauma and vascular cases (I think they quoted something ~300 SAH/yr), and a ridiculous volume on service. The ICU has ~40 beds on one contained unit, split into 2 teams. I don’t remember the details of the call schedule, but it did not seem absurd. I think they have 3 fellows, an army of NP/PA, and neurosurgery residents that they work closely with. The training model is intensivist first, then neurology. They train straight-up intensivists. It is a closed unit, and you are doing all of your own procedures. The unit itself does not seem to be particularly academically inclined. Graduates often go into private practice.
They have a very impressive stroke program (Jim Grotta leads it) and are at the forefront of clinical stroke research. The deal-breaker for me was that they have a stroke team rounding in the unit and leaving recs regarding stroke management. That was a problem for me, but for others who would not mind that, then this is a great place to train. Houston is a great town, very affordable, and cosmopolitan. While you will live in Texas, the culture within the city is very different from when you get beyond.
Duke:
The program leadership is extremely nice and supportive, the work atmosphere seems collegial, and the training seemed superb. The staff is interdisciplinary, including a few anesthesia and mostly neurologists. The program itself is in an amazing clinical research environment, the Duke Clinical Research Institute is a major player. Duke is obviously the premier institution in its locale, but there are certainly centers throughout the Carolinas trying to take in some volume. The unit is 22-24 beds and has a model of an attending run service with the fellow and then a separate service largely run by the senior fellow (I think I’m remembering this right). I don’t remember the SAH volume numbers, but it seemed comparable with other major centers. They have an army of NPs/PAs who are very experienced. The fellowship schedule is essentially tailored to the fellow, so they really do build your training around you. In general, you spend a fair amount of time getting intensivist training in other ICUs, but most of your time in the neuroICU. They do most of their own procedures, they get trained on transcranial dopplers, and they carve out time for you to do research. You also run all of the codes on the neurology floors (across the hall and downstairs; you are their code team). One peculiarity of the program is that you spend a couple weeks as a consultant at a nearby satellite hospital, which I think is to pay for your salary (not sure, don’t remember). If doing minimal neurohospitalist coverage is a deal-breaker, FYI.
The fellows seemed to be genuinely happy with their training experience—I did not get a sense of burnout at all. Graduates go into academia versus private practice, probably more of the latter. That said, the culture of the program seems to be shifting more academic. Finally, the triangle (Chapel Hill, Raleigh, Durham) is a wonderful place to live. It’s very affordable, beautiful, and walkable in those particular college towns. The hospital opens up onto the Duke quad, and you have access to great stuff in Durham and the surrounding areas. You’re 2 hours from the coast, 2 hours from the mountains, and 3-4 hours from Shenandoah up in VA. Amazing place to live. I didn’t end up going here purely for family proximity reasons, but I would’ve been extremely happy to train here.
Emory:
Great program with a focus on intensivist training. The program is spent between Emory University Hospital (EUH, main campus, on the university campus) and Grady Hospital (<20% of the time, public hospital, downtown ATL, major stroke center). Emory also has or is opening up an ICU at a privademic like hospital called Emory Midtown--I don’t think fellows are going there but I can’t remember. All in all, it’s something like 70!! ICU beds. The city is divided between ischemic and hemorrhagic stroke. Ischemic (LVO) mostly goes to Grady, hemorrhagic (aneurysm) mostly goes to EUH. This is an extremely high volume center. 300-350 SAH/year, 300+ thrombectomies a year. There’s a major population base in Atlanta and really bleeding out into neighboring states, and not a lot of other players to compete with. The program leadership is nice and firmly grounded in a hardcore intensivist model of practice. The relationship with neurosurgery is excellent, built on the relationship between the neuroICU director and the head surgeons. NeuroICU is a division of neurosurgery at Emory, not neurology, and your training reflects that. Fellows told me that they were comfortable doing all the routine ICU procedures, as well EVDs, lumbar drains, etc, and the neurosurgeons were happy to be left to operate and let you run the show in the unit. The program is vascular heavy for sure. The vascular neurosurgeons are very prominent (Barrow is the chair), and they have a very high profile endovascular program for both SAH (Jacques Dion, first ever coil) and ischemic stroke (Raul Nogueira, DAWN trial, etc). The director is Owen Samuels who is a well-known leader in ICU, and I got along with everyone I met there and found everyone to be personable and interested in whether this was a mutually good fit.
The training model is intensivist heavy—the first year you spend mostly not in the neuroICU (renal, ID, SICU, etc) and the second year you run as a junior attending with your own service that you then discuss with the attending. Emory itself has a huge critical care presence, the president of the critical care society is an intensivist at Emory. They’re apparently a major liver transplant center (#2 in country), so you work with a lot of liver complications, ie hyperammonia with edema, coagulopathy complications, etc. Grady is the major trauma center for the region so the trauma volume comes through there. There’s a huge patient population to work with in terms of research, and an opportunity to get really into clinical trials. The stroke and neurosurgery groups are very active in research. The ICU culture is less academic in comparison but you won’t be on an island. Clinical research infrastructure at Emory includes a major public health school and the CDC literally next door.
Fellows go into both private practice and academia and seemed like normal people (this is not a given at all places) who enjoyed their experience there. I enjoyed hanging out with them at the dinner. Atlanta is a great place to live, big city in the South, affordable, pretty good weather most of the time, and you get all the perks of living in a major city. You can live a suburban lifestyle, or in-town living in walkable neighborhoods, whatever suits you, on the cheap. And while you will live in Georgia, the culture within the city is very different from when you get beyond.