BACKGROUND: A group of anesthesiologists practice as intensivists in neurointensive care units (NeuroICU). The current nature and implications of the role of anesthesiology-based neurointensivist remain unclear. The purpose of this survey was to assess today's practice environment of anesthesiology-based neurointensivists as a framework for future study. METHODS: During the period between January 2011 and March 2011, we identified anesthesiologists who provide patient care in specialized NeuroICUs in the United States. We used an online, 15-question survey to gauge the environment and their role in the delivery of care to critically ill patients admitted to NeuroICUs. RESULTS: Of the 104 NeuroICUs in the United States, 22 institutions include anesthesiology-based neurointensivists (n=41). With a response from 33 of 41 requested surveys, anesthesiology-based neurointensivists reported that background training and roles for providing patient care in the NeuroICU setting varied widely between institutions. In contrast, these practices were similar in providing 24-hour coverage (76%), working with neurosurgical (88%) and anesthesiology residents (85%), and having critical-care fellowship training (97%). Almost all surveyed individuals practice both neurocritical care and anesthesia in the operating room, and 76% reported satisfaction with their working environment in the NeuroICU relative to other responsibilities. CONCLUSIONS: Anesthesiology-based neurointensivists currently represent a small subgroup within the rapidly growing neurointensivist workforce in the United States and consider neurocritical care a valuable aspect of their career. Promoting subspecialty training in neurocritical care among anesthesiologists may provide an opportunity for new patient-care frontiers and address the increasing need for NeuroICU physicians.