Can you work fully remotely in neurology?

[deathmerchant]

My 2 cents- Over the past 6 years I have worked with various permutations of inpatient/outpatient and Tele. Currently I do a little bit of everything.
I calculate my compensation based on actual time I work or the time I leave home to time I get back home. When I was a pure neuro-hospitalist, I was making over $400/hr plus benefits (although i'll admit that is a rare, low volume setup). As an employed outpatient, I made about $325/hr plus benefits. TeleStroke I get about $155/hr on average, the maximum I've been able to do with tele has been 260$/hr with bonus and seeing a lot of patients, definitely not sustainable. (Although I'm only part-time and don't have the option to get those extra bonus/$350 cases, also no benefits).

So Tele is clearly less money/time worked in my opinion. It definitely has some pros though, like working from home. Not dealing with aftercare issues, hospital issues. Most cases are super easy CYAs. You can work more shifts or see more patients to make more money or not.
On the other hand, to me it doesn't feel like you are a doctor, especially a neurologist who loves good neuro-exams and satisfying patient interactions. Also the remote logging in is a headache- every hospital is different. And you are stuck in front of a screen for 12 long hours, although you can take some short breaks. Feels like one of those 'cubicle office' jobs that I've always hated. Probably won't do it for long, but I can see how it works for some people.

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[Hockeyfan23]

My 2 cents- Over the past 6 years I have worked with various permutations of inpatient/outpatient and Tele. Currently I do a little bit of everything.
I calculate my compensation based on actual time I work or the time I leave home to time I get back home. When I was a pure neuro-hospitalist, I was making over $400/hr plus benefits (although i'll admit that is a rare, low volume setup). As an employed outpatient, I made about $325/hr plus benefits. TeleStroke I get about $155/hr on average, the maximum I've been able to do with tele has been 260$/hr with bonus and seeing a lot of patients, definitely not sustainable. (Although I'm only part-time and don't have the option to get those extra bonus/$350 cases, also no benefits).

So Tele is clearly less money/time worked in my opinion. It definitely has some pros though, like working from home. Not dealing with aftercare issues, hospital issues. Most cases are super easy CYAs. You can work more shifts or see more patients to make more money or not.
On the other hand, to me it doesn't feel like you are a doctor, especially a neurologist who loves good neuro-exams and satisfying patient interactions. Also the remote logging in is a headache- every hospital is different. And you are stuck in front of a screen for 12 long hours, although you can take some short breaks. Feels like one of those 'cubicle office' jobs that I've always hated. Probably won't do it for long, but I can see how it works for some people.

Where was this $400/hr inpatient gig? If you’re doing 10 hours that’s $4k. Feel these numbers would only happen in locums gigs.

 

[ProReduction]

Where was this $400/hr inpatient gig? If you’re doing 10 hours that’s $4k. Feel these numbers would only happen in locums gigs.

From his low volume remark, I'm guessing low volume = the denominator hr was low and the $ numerator was not extremely high at 4k. $1000 / 2.5 hrs per day is still $400/hr.

 

[Neurogeneral]

From his low volume remark, I'm guessing low volume = the denominator hr was low and the $ numerator was not extremely high at 4k. $1000 / 2.5 hrs per day is still $400/hr.

Yes thats what i interpreted it as well. Its not common but some hospitals are willing to pay a premium just to have a neurologist on the ground to see only a couple of consults.

 

[deathmerchant]

Where was this $400/hr inpatient gig? If you’re doing 10 hours that’s $4k. Feel these numbers would only happen in locums gigs.

Yea, I'm not doing 10 hrs/day. It was important to me to not work long shifts and have time for myself/family most days. I feel like after a 9-10 hour day, I cant do anything else. So my inpatient gig was 4-5 hours a day, Close to 30 hr/week. 7on/7off. Still pretty decent total comp and great benefits, although didn't have the option to scale unless I did more shifts.

That being said, currently I do a mix of neuro-hospitalist plus part-time outpatient plus part time Tele, still working well under 40 hours/week on average.

 

[Giovanotto]

Anyone here actually happy doing tele? I'm thinking of trying it after graduation, and if after a year I get tired of it, going back to a more traditional set up. The ability to work from anywhere in the US is extremely appealing right now, especially since I don't have ties to any particular city/state, but at the same time, all the desirable areas have little openings for trad neurohospitalist.

 

[curiousneuro]

I love my job. Work for one of the big telestroke companies, have pulled >600k for the past 2 years. Being able to work from home is great. Work-life balance is awesome. Not sure why there is so much hate here about it. In order to make a comparable salary as neuro hospitalist locally here I would have to work about twice as hard as I do currently.

 

[Neurogeneral]

Anyone here actually happy doing tele? I'm thinking of trying it after graduation, and if after a year I get tired of it, going back to a more traditional set up. The ability to work from anywhere in the US is extremely appealing right now, especially since I don't have ties to any particular city/state, but at the same time, all the desirable areas have little openings for trad neurohospitalist.

Plenty of people are happy with teleneuro but my perspective is that its best suited for acute/telestroke consults than a routine consult for generalized weakness or cognitive decline.

 

[Aldertonghen]

Anyone here actually happy doing tele? I'm thinking of trying it after graduation, and if after a year I get tired of it, going back to a more traditional set up. The ability to work from anywhere in the US is extremely appealing right now, especially since I don't have ties to any particular city/state, but at the same time, all the desirable areas have little openings for trad neurohospitalist.

If you know what you’re doing it’s also possible outside of the US (living on a boat in Europe anyone?) with certain loopholes

 

[ProReduction]

Anyone here actually happy doing tele? I'm thinking of trying it after graduation, and if after a year I get tired of it, going back to a more traditional set up. The ability to work from anywhere in the US is extremely appealing right now, especially since I don't have ties to any particular city/state, but at the same time, all the desirable areas have little openings for trad neurohospitalist.

Would put it in the "it works for me right now" bin. As a full-time scientist, I only do 10 hours of clinical work per week and it is the only way that I can make 200k a year off clinical work built around my busy science schedule. My gripes with Tele are because I have been doing it for a long time and have seen negative changes over the years. Eight years ago I was mostly seeing acute stroke, status epilepticus, SAH, TBI, myasthenic crisis, and other emergencies and I felt I was making a big difference with a positive impact. Eight years ago I covered 20-30 hospitals and surprisingly built a personal relationship with the local doctors. It was nowhere near the respect and collegiality you would get from walking the same halls each day with those doctors, but it worked and you felt like a "real doctor."
Move forward 8 years and the average "STAT" consult is "Hey this is ED MD Smith . . . this patient's LKW was 6 days ago and Head CT shows a subacute stroke. I have no questions for you but the Hospitalist is blocking the admission for stroke work-up without a STAT Neuro consult from the ED." Or "Hey this is Hospitalist Smith and our local on-call Neurologist is refusing to see this Routine consult today so I am calling it to you as a STAT consult despite no real urgency." It is typical to cover 80+ hospitals now. Any respect or relationship with the local physicians has evaporated.
I am happy for anyone that is happy doing Teleneuro but it is simply not aligned with what many of us consider to be a "career" as a Neurologist. My advice to new grads would be to get an in-person job and to dip your toe into Tele with part-time work, which is the way that most Neurologists do it.

 

[Telamir]

You can even do it in your rocket all the way to the moon with all the money you’re making!

 

[Zendo]

Hypothetically speaking, is telestroke (vascular fellowship) or reading EEGs/IONM (CNP fellowship) better if someone's primary goal is to work from home? Better as in more opportunities, income, QOL etc.

 

[deathmerchant]

Anyone here actually happy doing tele? I'm thinking of trying it after graduation, and if after a year I get tired of it, going back to a more traditional set up. The ability to work from anywhere in the US is extremely appealing right now, especially since I don't have ties to any particular city/state, but at the same time, all the desirable areas have little openings for trad neurohospitalist.

I don't hate Tele, but its not a great/satisfying full time gig for most. It feels like an office/cubicle job with long hours and money/hr worked is actually the lowest I've seen as mentioned in my previous post. But the ceiling can be high if you work a lot. Im not sure how much curiousneuro above works to pull >600k, gotta be atleast 250 hr/month of actual work or more (unless he has some exceptional setup). Even in a moderately busy neuro-hospitalist job, you will work under 150hrs/month; and many are well under that.

Also keep in mind traveling and doing Tele sounds easier than it actually is. You have to have a very reliable and elaborate setup/home office with multiple screens and you're not gonna want to haul it while traveling all the time. Also after a 12 hour shift, you barely have energy to do anything else.

Agree with ProReduction that it is a great side gig, at least to start with.

 

[deathmerchant]

Hypothetically speaking, is telestroke (vascular fellowship) or reading EEGs/IONM (CNP fellowship) better if someone's primary goal is to work from home? Better as in more opportunities, income, QOL etc.

You don't need any fellowship as of now, but if you had to, Telestroke would give you the most opportunities/job options today. If you are not sure about long term and might want to do other stuff or get into private practice etc And you feel comfortable managing acute strokes/neuro, do a CNP fellowship.

 

[curiousneuro]

Without giving too many details, I make about $225/patient on average, and I work about 20 days per month (on average). That comes out to be about 11 patients per day to clear 50k/month.

But I do completely agree with all of you that telestroke may not be quite as rewarding as other gigs, and you are essentially a "cog in the wheel", albeit a expensive one as the amount of time and money that it takes to fully credential and license each one of us is probably over 50K, which the company fully covers. Another thing to also keep in mind is that while I realize I make good money now, that could certainly change in a year from now depending on policy changes, price structure, etc. It is quite a fluid position to be in, and you have to be comfortable with that.

It works very well for me and my family, and I have lots of other side gigs that I do that have nothing to do with medicine, so this allows me that flexibility. I would never be able to have the time nor the latitude to be able to do my consulting work in a typical neuro hospitalist gig.

In terms of traveling, it's very easy. I bring my laptop and maybe an extra screen, and able to work essentially out of any hotel room with decent Wi-Fi.

I do essentially pure telestroke mixed with some acute teleneuro consults. I will be the first one to say that for anything else, teleneuro is certainly not as good as in-person neurology. So it can certainly get monotonous as well seeing stroke after stroke, but that's the trade-off with the gig.

 

[ProReduction]

Without giving too many details, I make about $225/patient on average, and I work about 20 days per month (on average). That comes out to be about 11 patients per day to clear 50k/month.

But I do completely agree with all of you that telestroke may not be quite as rewarding as other gigs, and you are essentially a "cog in the wheel", albeit a expensive one as the amount of time and money that it takes to fully credential and license each one of us is probably over 50K, which the company fully covers. Another thing to also keep in mind is that while I realize I make good money now, that could certainly change in a year from now depending on policy changes, price structure, etc. It is quite a fluid position to be in, and you have to be comfortable with that.

It works very well for me and my family, and I have lots of other side gigs that I do that have nothing to do with medicine, so this allows me that flexibility. I would never be able to have the time nor the latitude to be able to do my consulting work in a typical neuro hospitalist gig.

In terms of traveling, it's very easy. I bring my laptop and maybe an extra screen, and able to work essentially out of any hotel room with decent Wi-Fi.

I do essentially pure telestroke mixed with some acute teleneuro consults. I will be the first one to say that for anything else, teleneuro is certainly not as good as in-person neurology. So it can certainly get monotonous as well seeing stroke after stroke, but that's the trade-off with the gig.

I agree with everything said by curiousneuro. We are looking at the same glass, it is just that he is a glass half full, fun at parties kind of guy and I am a glass half empty, "honey don't make me sit next to him" kind of guy.

 

[curiousneuro]

I agree with everything said by curiousneuro. We are looking at the same glass, it is just that he is a glass half full, fun at parties kind of guy and I am a glass half empty, "honey don't make me sit next to him" kind of guy.

Agreed, it's probably that I'm just too young to know all about the good old days 😊

But everything being said, telestroke certainly has its pros and cons. Just would recommend anyone thinking about doing it really evaluating both of those and deciding whether or not it's what they want out of their life. Just because it works with me doesn't mean for others...

My opinion is essentially all of medicine is becoming "widgitized", you just have to decide what kind of widget you want to be (I know, pessimistic view....)

 

[sloh]

I have lots of other side gigs that I do that have nothing to do with medicine, so this allows me that flexibility. I would never be able to have the time nor the latitude to be able to do my consulting work in a typical neuro hospitalist gig.

Can you elaborate more on your side gigs?

 

[curiousneuro]

Can you elaborate more on your side gigs?

Startups in the healthcare technology space (software development, etc).

 

[Portcullis]

Is there any possibility of living in Canada (Canadian citizen) and working a US teleneuro job? Hypothetically, say I have a US address and use a VPN to remotely connect to my US home network, would that be considered appropriate, or would it be unethical?

 

[Telamir]

lol

 

[deathmerchant]

Is there any possibility of living in Canada (Canadian citizen) and working a US teleneuro job? Hypothetically, say I have a US address and use a VPN to remotely connect to my US home network, would that be considered appropriate, or would it be unethical?

Its not a straight answer. I have looked into it. Its also a moving target and things are and will change more with time.

Biggest hurdle is that CMS laws explicitly forbids billing them for services provided outside of the US. So you can only see self pay or some private insurance patients for now. Or the Tele company bills the facility directly on their own terms, and they pay you on your terms. Or you can make your own Tele company and have a flat rate deal with the hospital without either billing the insurance for those services. You have sort of bypassed CMS. You could also use a VPN and not mention your location, but then technically this could be fraud. (Also typical VPNs are not fool proof; in case you have a case/complaint against you, they can find out where you were located at the time. And there are many other ways to figure out where you were at the time).

Now, is it likely that someone will complain or find out?- Unlikely. But more and more Tele companies are now disallowing this in their contracts.

 

[Clean7795]

Is there any possibility of living in Canada (Canadian citizen) and working a US teleneuro job? Hypothetically, say I have a US address and use a VPN to remotely connect to my US home network, would that be considered appropriate, or would it be unethical?

You need to be on US soil for finalizing cases remotely in my specialty. The penalty for being caught I believe is in the range of thousands of dollars per case fraudulently signed off. The risk is not worth it, even if the chance of being caught is low. There are some loopholes but it limits what jobs you can find.

In 20-30 years this may change as tele-work in multiple specialties grow.

 

[Aldertonghen]

Is there any possibility of living in Canada (Canadian citizen) and working a US teleneuro job? Hypothetically, say I have a US address and use a VPN to remotely connect to my US home network, would that be considered appropriate, or would it be unethical?

So I know someone who does tele stroke from a different continent and covers night shifts. The reason this works is because the guy never bills for any of these shifts- the daytime attending sees the patient in the morning and signs the note, but acute interventions are provided by the night person. In essence it’s being done so that the stroke group here can sleep at night and not have to take any call. But because the night guy never bills for anything- it’s not a problem from CMS perspective.

These kinds of jobs are rarer to get, pay less (you’d likely have to work on the side to make similar money), but it’s doable.

 

[Neurogeneral]

Is there any possibility of living in Canada (Canadian citizen) and working a US teleneuro job? Hypothetically, say I have a US address and use a VPN to remotely connect to my US home network, would that be considered appropriate, or would it be unethical?

Most companies forbid working outside of the US as they wont be able to bill the Medicare/Medicaid cases. And not sure if this applies to you but you need to have work authorization (US visa, PR, citizenship) to work directly with a US-based company even if it is done remotely.

Moreover, while you could use a VPN but its going to be hard to conceal that your living in Canada - where you will likely have to pay Canadian taxes and have to submit forms to your company and the IRS to avoid getting taxed by them as well. My point is that there will be a big paper trail of all of this.

 

[sloh]

So I know someone who does tele stroke from a different continent and covers night shifts. The reason this works is because the guy never bills for any of these shifts- the daytime attending sees the patient in the morning and signs the note, but acute interventions are provided by the night person. In essence it’s being done so that the stroke group here can sleep at night and not have to take any call. But because the night guy never bills for anything- it’s not a problem from CMS perspective.

These kinds of jobs are rarer to get, pay less (you’d likely have to work on the side to make similar money), but it’s doable.

How is he getting paid?

 

[Aldertonghen]

How is he getting paid?

My understanding is the stroke department pays him out of pocket so that they get to sleep at night. So it’s a pay cut for them, but the trade off is now they don’t take call at all at night so big QoL improvement.

As more stroke physicians get burned out- this is actually becoming slightly more popular.

 

[Portcullis]

Most companies forbid working outside of the US as they wont be able to bill the Medicare/Medicaid cases. And not sure if this applies to you but you need to have work authorization (US visa, PR, citizenship) to work directly with a US-based company even if it is done remotely.

Moreover, while you could use a VPN but its going to be hard to conceal that your living in Canada - where you will likely have to pay Canadian taxes and have to submit forms to your company and the IRS to avoid getting taxed by them as well. My point is that there will be a big paper trail of all of this.

That makes sense, I totally forgot about taxes lol

 

[xenotype]

My understanding is the stroke department pays him out of pocket so that they get to sleep at night. So it’s a pay cut for them, but the trade off is now they don’t take call at all at night so big QoL improvement.

As more stroke physicians get burned out- this is actually becoming slightly more popular.

Every hospital wants to be able to bill to recoup some of the cost of teleservices, so you will hardly see any of these jobs that are ok with overseas work.

Personally I think tele jobs are on the whole competitive with neurohospitalist jobs in terms of hours worked for pay. Most neurohospitalist jobs expect you to be on 24hr call the week you are on. Some jobs might fork out acute stroke at night to tele, but outside of this you'll still get called at night for everything else including status. Additionally, most NH jobs seem to expect at least 15-20 encounters per day which is realistically 9-12hrs of work depending on complexity and percentage of new consults vs f/u. Deathmerchant is in a rare good job with great pay for hours worked in a small hospital with easy call. My benchmarks for tele job will be 11-15 acute stroke cases per 12hr shift and most want 13-15 shift per month commitment for full time working out to around $320k to $380k depending on how fast one works. NH jobs are very much in the same range, unless someone knows otherwise. The real tradeoffs being having to work mostly weekends and some nights for tele with fewer days off in a row vs NH having week on week off but being on call 24hrs a day when one is on with some sleep disruption depending on how busy the hospital is. I think those quoting much higher numbers than this A) work a hell of a lot- 20 shifts a month is a crazy amount for tele, and including nights is an unsustainable schedule for most people. B) got really luck in a small company that is especially generous on pay, but probably take on increased liability with bursts of cases/volume they can't control well. These small companys can get eaten by the big tele companies due to not offering billing for services because the notes are too basic, not responding quickly enough on bedside times etc.

Most hospitals still having in person NH coverage will tend to be busy these days, because if they weren't they would just use tele coverage as it is cheaper. If my impression of the NH and tele market is wrong in terms of numbers and expected volume I'd love to hear it, because I think people are picking between two somewhat crappy options with tradeoffs for each, versus just doing outpatient and getting on the treadmill of chugging through stupid referrals and dealing with the outpatient inbox. I think $325/hr for outpatient is a crazy rate that most will only see thru locums, and even then that is a particularly desperate location or a place you just have a good relationship with and have cut out the staffing company middle man.

 

[Giovanotto]

Every hospital wants to be able to bill to recoup some of the cost of teleservices, so you will hardly see any of these jobs that are ok with overseas work.

Personally I think tele jobs are on the whole competitive with neurohospitalist jobs in terms of hours worked for pay. Most neurohospitalist jobs expect you to be on 24hr call the week you are on. Some jobs might fork out acute stroke at night to tele, but outside of this you'll still get called at night for everything else including status. Additionally, most NH jobs seem to expect at least 15-20 encounters per day which is realistically 9-12hrs of work depending on complexity and percentage of new consults vs f/u. Deathmerchant is in a rare good job with great pay for hours worked in a small hospital with easy call. My benchmarks for tele job will be 11-15 acute stroke cases per 12hr shift and most want 13-15 shift per month commitment for full time working out to around $320k to $380k depending on how fast one works. NH jobs are very much in the same range, unless someone knows otherwise. The real tradeoffs being having to work mostly weekends and some nights for tele with fewer days off in a row vs NH having week on week off but being on call 24hrs a day when one is on with some sleep disruption depending on how busy the hospital is. I think those quoting much higher numbers than this A) work a hell of a lot- 20 shifts a month is a crazy amount for tele, and including nights is an unsustainable schedule for most people. B) got really luck in a small company that is especially generous on pay, but probably take on increased liability with bursts of cases/volume they can't control well. These small companys can get eaten by the big tele companies due to not offering billing for services because the notes are too basic, not responding quickly enough on bedside times etc.

Most hospitals still having in person NH coverage will tend to be busy these days, because if they weren't they would just use tele coverage as it is cheaper. If my impression of the NH and tele market is wrong in terms of numbers and expected volume I'd love to hear it, because I think people are picking between two somewhat crappy options with tradeoffs for each, versus just doing outpatient and getting on the treadmill of chugging through stupid referrals and dealing with the outpatient inbox. I think $325/hr for outpatient is a crazy rate that most will only see thru locums, and even then that is a particularly desperate location or a place you just have a good relationship with and have cut out the staffing company middle man.

The trend I saw on my interview trail is that more and more NH positions are offering positions with no acute stroke, no overnight. I wouldn't take any job that has you take primary for starters, and definitely no overnight obligation. I have coworkers who also signed into NH positions that are "7-5pm". I would rather do outpatient than deal with overnight coverage; few things in life are more important to me than sleep, and work is definitely not one of them. Of course, if you throw enough money at me, I'd be singing a different tune, but I would definitely only consider a 24 hour work day with compensations north of 500k.

 

[Neurogeneral]

Every hospital wants to be able to bill to recoup some of the cost of teleservices, so you will hardly see any of these jobs that are ok with overseas work.

Personally I think tele jobs are on the whole competitive with neurohospitalist jobs in terms of hours worked for pay. Most neurohospitalist jobs expect you to be on 24hr call the week you are on. Some jobs might fork out acute stroke at night to tele, but outside of this you'll still get called at night for everything else including status. Additionally, most NH jobs seem to expect at least 15-20 encounters per day which is realistically 9-12hrs of work depending on complexity and percentage of new consults vs f/u. Deathmerchant is in a rare good job with great pay for hours worked in a small hospital with easy call. My benchmarks for tele job will be 11-15 acute stroke cases per 12hr shift and most want 13-15 shift per month commitment for full time working out to around $320k to $380k depending on how fast one works. NH jobs are very much in the same range, unless someone knows otherwise. The real tradeoffs being having to work mostly weekends and some nights for tele with fewer days off in a row vs NH having week on week off but being on call 24hrs a day when one is on with some sleep disruption depending on how busy the hospital is. I think those quoting much higher numbers than this A) work a hell of a lot- 20 shifts a month is a crazy amount for tele, and including nights is an unsustainable schedule for most people. B) got really luck in a small company that is especially generous on pay, but probably take on increased liability with bursts of cases/volume they can't control well. These small companys can get eaten by the big tele companies due to not offering billing for services because the notes are too basic, not responding quickly enough on bedside times etc.

Most hospitals still having in person NH coverage will tend to be busy these days, because if they weren't they would just use tele coverage as it is cheaper. If my impression of the NH and tele market is wrong in terms of numbers and expected volume I'd love to hear it, because I think people are picking between two somewhat crappy options with tradeoffs for each, versus just doing outpatient and getting on the treadmill of chugging through stupid referrals and dealing with the outpatient inbox. I think $325/hr for outpatient is a crazy rate that most will only see thru locums, and even then that is a particularly desperate location or a place you just have a good relationship with and have cut out the staffing company middle man.

I did teleneurohospitalist for a few months. Volume was about 18-19 patients for 8 to 9 hr shifts. Pay was about $173 per hour.

I also do outpatient locums (locally) and I get about paid $210 per hour for 8 hr shifts. I see about 5 to 6 patients daily on average. There is some inbasket work but nothing major.

Obviously, I stopped doing the tele job cause i was working much harder for less pay.

 

[deathmerchant]

Every hospital wants to be able to bill to recoup some of the cost of teleservices, so you will hardly see any of these jobs that are ok with overseas work.

Personally I think tele jobs are on the whole competitive with neurohospitalist jobs in terms of hours worked for pay. Most neurohospitalist jobs expect you to be on 24hr call the week you are on. Some jobs might fork out acute stroke at night to tele, but outside of this you'll still get called at night for everything else including status. Additionally, most NH jobs seem to expect at least 15-20 encounters per day which is realistically 9-12hrs of work depending on complexity and percentage of new consults vs f/u. Deathmerchant is in a rare good job with great pay for hours worked in a small hospital with easy call. My benchmarks for tele job will be 11-15 acute stroke cases per 12hr shift and most want 13-15 shift per month commitment for full time working out to around $320k to $380k depending on how fast one works. NH jobs are very much in the same range, unless someone knows otherwise. The real tradeoffs being having to work mostly weekends and some nights for tele with fewer days off in a row vs NH having week on week off but being on call 24hrs a day when one is on with some sleep disruption depending on how busy the hospital is. I think those quoting much higher numbers than this A) work a hell of a lot- 20 shifts a month is a crazy amount for tele, and including nights is an unsustainable schedule for most people. B) got really luck in a small company that is especially generous on pay, but probably take on increased liability with bursts of cases/volume they can't control well. These small companys can get eaten by the big tele companies due to not offering billing for services because the notes are too basic, not responding quickly enough on bedside times etc.

Most hospitals still having in person NH coverage will tend to be busy these days, because if they weren't they would just use tele coverage as it is cheaper. If my impression of the NH and tele market is wrong in terms of numbers and expected volume I'd love to hear it, because I think people are picking between two somewhat crappy options with tradeoffs for each, versus just doing outpatient and getting on the treadmill of chugging through stupid referrals and dealing with the outpatient inbox. I think $325/hr for outpatient is a crazy rate that most will only see thru locums, and even then that is a particularly desperate location or a place you just have a good relationship with and have cut out the staffing company middle man.

I agree with most of what you said. A busy Neuro-hospitalist job and a Telestroke job are probably somewhat similar on the whole with some pros and cons for each.
That being said, you can still find a light (3-4 hour of actual work/day) or moderately busy (6-8 hr/day) neurohospitalist job and make 300-350k. Also for an efficient person, with the right contract, outpatient can make a lot of money. I currently make over $300/hr in my outpatient gig. (Again not a lot of total hours, but ability to increase as needed). As an anecdote, I had a busy day recently with inpatient rounding and a full clinic day. Made over $4300 in under 10 hours of work (RVU based).

 

[xenotype]

I agree with most of what you said. A busy Neuro-hospitalist job and a Telestroke job are probably somewhat similar on the whole with some pros and cons for each.
That being said, you can still find a light (3-4 hour of actual work/day) or moderately busy (6-8 hr/day) neurohospitalist job and make 300-350k. Also for an efficient person, with the right contract, outpatient can make a lot of money. I currently make over $300/hr in my outpatient gig. (Again not a lot of total hours, but ability to increase as needed). As an anecdote, I had a busy day recently with inpatient rounding and a full clinic day. Made over $4300 in under 10 hours of work (RVU based).

These are unicorn jobs that are not easy to find, in places that people don't want to live, or you have to be exceedingly efficient (or fraudulent/unsafe in bare bones documentation in many cases). If one is a neurologist that writes the assessment as just 1. Dizziness and has an autopopulated MRI order underneath it as the meat of a note, you can see 40 patients a day giving this kind of care but it is not how I practice, nor does it give much protection against lawsuits writing crappy or heavily autopopulated notes. There is a local guy that triple books his clinic, writes absolutely garbage notes, and occasionally has major misses. He makes a lot of money, but I could simply never practice this way. Some people are just naturally quite fast and efficient with good care but this is not the majority of practicing neurologists. Its not to say that going fast and seeing a lot of patients is inherently wrong, but $300/hr for outpatient is well beyond the 90th percentile in pay, and most realistically are looking at $150-200/hr in private practice and significantly less than that for academics. Making well beyond those rates generally entails crazy productivity (and either high natural ability for efficiency or straight unethical practices), working somewhere nobody wants to work like small town in Michigan during the winter, or having relationships with regular locums opportunities where you can bypass the middle man companies to capture all of the hospital's rate without getting lowballed by that hospital group. As an example average productivity for emergent stroke cases would typically be 1.2 patients per hour via telemed, but there are a small percentage of people that can do 2x, very rarely 3x that speed. Based on my experience it is likely that they are skipping time consuming parts of the exam like visual fields (very time consuming with most RNs not knowing how to do it) yet fraudulently documenting this was done and their notes are generally extremely barebones without much meat to save them if a patient later sues about thrombolytics being offered or not offered. Tele companies love these high productivity people however because of the throughput/profit and don't have much concern for lawsuits. There is no such thing as a free lunch.

 

[deathmerchant]

These are unicorn jobs that are not easy to find, in places that people don't want to live, or you have to be exceedingly efficient (or fraudulent/unsafe in bare bones documentation in many cases). If one is a neurologist that writes the assessment as just 1. Dizziness and has an autopopulated MRI order underneath it as the meat of a note, you can see 40 patients a day giving this kind of care but it is not how I practice, nor does it give much protection against lawsuits writing crappy or heavily autopopulated notes. There is a local guy that triple books his clinic, writes absolutely garbage notes, and occasionally has major misses. He makes a lot of money, but I could simply never practice this way. Some people are just naturally quite fast and efficient with good care but this is not the majority of practicing neurologists. Its not to say that going fast and seeing a lot of patients is inherently wrong, but $300/hr for outpatient is well beyond the 90th percentile in pay, and most realistically are looking at $150-200/hr in private practice and significantly less than that for academics. Making well beyond those rates generally entails crazy productivity (and either high natural ability for efficiency or straight unethical practices), working somewhere nobody wants to work like small town in Michigan during the winter, or having relationships with regular locums opportunities where you can bypass the middle man companies to capture all of the hospital's rate without getting lowballed by that hospital group. As an example average productivity for emergent stroke cases would typically be 1.2 patients per hour via telemed, but there are a small percentage of people that can do 2x, very rarely 3x that speed. Based on my experience it is likely that they are skipping time consuming parts of the exam like visual fields (very time consuming with most RNs not knowing how to do it) yet fraudulently documenting this was done and their notes are generally extremely barebones without much meat to save them if a patient later sues about thrombolytics being offered or not offered. Tele companies love these high productivity people however because of the throughput/profit and don't have much concern for lawsuits. There is no such thing as a free lunch.

Fair points. 30 mins for a new patient and 15-20 mins for f/u patients are more than enough (for most patients). That usually gives you 8 new patients and about 15 f/u for a full day, which is over $300/hr typically @55-60/wRVU. I sometimes will have few overbookings on top of that.
I am 5 months booked out and so are most other neurologists within an hour of me. Seeing high volumes like that is not my preferred choice but is it better than those patients being treated by Primary care midlevels- I don't know? So I stretch myself taking abovementioned risks to help those patients. (that's my primary intention anyway, not making more money)