By Panayiotis (Panos) N. Varelas, MD, PhD, FAAN, FNCS
Yes, There is Hope
We are in April and nature is slowly waking up from its white hibernation in the northern states. As I was writing this, I could not restrain myself from drawing a parallel with a major achievement of NCS, the second annual World Coma Day, which just occurred. I hope many of you joined us for the full day of content, but even the few hours of connecting were eye-opening for many of us. Even for providers who work in neuro-ICUs and encounter comatose patients every day, there was news: yes, there is hope! Many patients have a slow awakening and even after that moment there is an improvement, sometimes to complete normalcy, and returning back to their previous lives! There are even new signs of awakening we didn’t realize in the past! There are new treatment venues! And there is a lot to learn and a lot to do…
Some statistics as the dust is settling down: the number of registrants was 1,526, with 611 unique attendees, from 100 countries and the average number of participants per hour was 56 people; 150 media outlets responded including the Associated Press and the Boston Globe. What else can I say, but to congratulate and express my appreciation to World Coma Day co-chairs Keri Kim and Olivia Gosseries, Curing Coma Campaign co-chairs Claude Hemphill and DaWai Olson, and all our colleagues who put together this herculean endeavor!
It was a team’s work, as everything we achieve in our ICUs is a team’s work. And within the society, everyone should have opportunities to offer help, experience, serve. That brings us to the 2022 Get Involved Campaign. In this update you will find a link to submit your interest. Although the number of committees is much smaller than the number of applicants, we have a process in place to allow committee representation from any discipline, independent of gender, sex, race, training level, etc. We would love to see new and young people get involved with this society and become its future.
We also addressed this month the major issue in the news. The war in Ukraine. There are many angles to that and one could debate for hours what statement a medical society, like NCS, should put out and what would be its impact. But there is only one universal truth across all human history: any war is bad and innocent people suffer. We, as health care providers, send a humanitarian message to all, especially to our health care colleagues: we are here, we think and pray for you all and we will try to support you in whichever way we can!
We also had some developments from ACGME. Listening to our and others’ strong voices, they made some changes in the NCC Fellowship Program requirements, which you can find here: Common Program Requirements (acgme.org) A few of the major changes are: now the sponsoring institution should (previously must) also sponsor ACGME-accredited neurology and neurosurgery residencies. Also, now for core faculty, there is a grace period until July 2026 to allow neurosurgeons with completion of a neurocritical care fellowship to serve. However, after that date, they should meet this requirement via Neurocritical Care Recognized Focused Practice by the ABNS. This does not solve the problem we have because few have neurocritical care fellowship training. In the survey we’ve sent to current neurocritical care program directors, we received answers from 45 programs. In this sample, only eleven programs (24.4%) answered they have neurosurgeons with neurocritical care certification (most through UCNS or CAST). However, 28 programs (62%) are planning to apply within 12 months for ACGME accreditation, indicating that they are working with our neurosurgery colleagues and encouraging them to become neurocritical care certified.
Therefore, although there have been some positive advancements, the major hurdle with ACGME accreditation still remains for most programs. NCS will not stop here. We will continue our communication with ACGME and the Neurology/NS RCs to try to resolve this. Meanwhile, I would advise everyone to carefully read the requirements, and apply immediately if you meet them or work closely with our neurosurgeons to become certified.
It does not stop here. Three days ago, NCS became aware that since neurocritical care became an ABMS recognized subspecialty, only ACGME-accredited programs in neurocritical care would allow international medical graduates to get J-1 visas through ECFMG sponsorship. Based on the paragraphs above, our interpretation and concern is that very few, if any, programs may be able to train these IMG colleagues. NCS is collecting and interpreting information and examining how to respond and solve this new impasse in a timely fashion, since it may significantly compromise the care we provide in our ICUs and block many hardworking and bright colleagues from joining us. As I am writing these lines one thing is certain: we will stand behind our IMG colleagues and will try to resolve this new issue.
Just for a change, I would switch this month to share a Latin quote, by the greatest orator of Rome, Cicero. He was a statesman and proponent of the Republic and lived in tumultuous times during the transition through Cesar and Octavian from the Republic to the Imperium. Many of his quotes and writings have been saved, and this one “omnium enim rerum principia parva sunt” (the beginnings of all things are small) is one of my favorites (I wouldn’t say, though, Latin hour was my favorite in school). In this world and times we live, where everything moves with electron-speed, we forget this truth, that like a newborn baby, most evolve and grow with time. We sometimes seek immediate gratification or answers and we become impatient and unhappy. Rarely, do we live through a revolution, but in most instances, the small changes over time are the ones that cumulatively transform our lives …
Panayiotis (Panos) N. Varelas, MD, PhD, FAAN, FNCS
President, NCS Board of Directors
Professor of Neurology and Chairman, Department of Neurology
Albany Medical College