Is a neurology fellowship worth it??

[95439]

I'm a PGY-2 in Neuro, and have started to think about career path. I'm waffling between general neurology, and numerous other subspecialties.

My main question is what does one get out of doing, say, a stroke fellowship? I assume it would make me more 'marketable', but the program I'm thinking about is 2 years, so I'd lose out on approximately $200,000 being a resident. Plus, money isn't my primary motivation.
If I want to do research, do I need a fellowship to do it?

I know there have been past threads that have discussed varying aspects of this, and I've read them, but they're all either ridiculously outdated or tangential.

Thank you guys as always!

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[neurologist]

I'm a PGY-2 in Neuro, and have started to think about career path. I'm waffling between general neurology, and numerous other subspecialties.

My main question is what does one get out of doing, say, a stroke fellowship? I assume it would make me more 'marketable', but the program I'm thinking about is 2 years, so I'd lose out on approximately $200,000 being a resident. Plus, money isn't my primary motivation.
If I want to do research, do I need a fellowship to do it?

I know there have been past threads that have discussed varying aspects of this, and I've read them, but they're all either ridiculously outdated or tangential.

Thank you guys as always!

If you plan to go into academics (which pretty much is what you mean by "doing research," unless you plan to go into pharma or some other industry); or if you plan to be hospital employed, you will almost definitely "need" a fellowship in the future because that's what those environments want. And pretty soon, those (and a few large independent groups) will be the ONLY employers. The reasons for this are several, including:

1. Large hospitals in general, and academic centers in particular, want (and in fact "need") to maintain a variety of dubious "certifications" (read: "marketing tools") that demonstrate "excellence" in a variety of areas, for example: "We're a Stroke Center of Excellence," or "We're a Level 1 Trauma Center" "We're an accredited sleep center," etc. Among the requirements for them to get these designations are having subspecialty trained physicians on staff and running those centers. You will be in a better position to get hired in these places if you can fill one of those roles.

2. Along the same lines, specialties (i.e, "neurology") are becoming increasingly balkanized into subspecialties i.e., "epilepsy," "sleep," "neuromuscular" etc), all of which, supposedly to "ensure physician competence" (but in reality "to propogate and enrich our sub-sub-specialty professional organization") are forcing practitioners to take subspecialty board exams. Pretty soon, if you want to read EEGs or do EMGs or give TPA, you will have to be subspecialty board certified. "General neurology" is going the way of the dinosaur, except maybe in very small community hospital or isolated private practice settings (in which settings you won't be doing a whole lotta research.)

3. Academic centers are required by the RRC to have a mix of subspecialists to maintain their residency programs.

4. Some (but not all) subspec trained neurologists (interventional, EMG, epilepsy, sleep) can still make more money for their groups because of their procedural base. I can guarantee you that it's my sleep study reading, not my headache clinic patients, that float the financial boat of my department.

Now, of course, you should focus on whatever subspecialty interests you, but I would definitely not stop at residency.

My 2 cents . . .

 

[95439]

If you plan to go into academics (which pretty much is what you mean by "doing research," unless you plan to go into pharma or some other industry); or if you plan to be hospital employed, you will almost definitely "need" a fellowship in the future because that's what those environments want. And pretty soon, those (and a few large independent groups) will be the ONLY employers. The reasons for this are several, including:

1. Large hospitals in general, and academic centers in particular, want (and in fact "need") to maintain a variety of dubious "certifications" (read: "marketing tools") that demonstrate "excellence" in a variety of areas, for example: "We're a Stroke Center of Excellence," or "We're a Level 1 Trauma Center" "We're an accredited sleep center," etc. Among the requirements for them to get these designations are having subspecialty trained physicians on staff and running those centers. You will be in a better position to get hired in these places if you can fill one of those roles.

2. Along the same lines, specialties (i.e, "neurology") are becoming increasingly balkanized into subspecialties i.e., "epilepsy," "sleep," "neuromuscular" etc), all of which, supposedly to "ensure physician competence" (but in reality "to propogate and enrich our sub-sub-specialty professional organization") are forcing practitioners to take subspecialty board exams. Pretty soon, if you want to read EEGs or do EMGs or give TPA, you will have to be subspecialty board certified. "General neurology" is going the way of the dinosaur, except maybe in very small community hospital or isolated private practice settings (in which settings you won't be doing a whole lotta research.)

3. Academic centers are required by the RRC to have a mix of subspecialists to maintain their residency programs.

4. Some (but not all) subspec trained neurologists (interventional, EMG, epilepsy, sleep) can still make more money for their groups because of their procedural base. I can guarantee you that it's my sleep study reading, not my headache clinic patients, that float the financial boat of my department.

Now, of course, you should focus on whatever subspecialty interests you, but I would definitely not stop at residency.

My 2 cents . . .

Your 2 cents is worth a million dollars to me (which I don't have so don't ask please ;o) ). Thank you and please keep it coming people.

 

[Mattchiavelli]

if you want to read EEGs or do EMGs or give TPA

From what I understand, now if you want to do electrodiagnosis you have to do at least an electrophys fellowship to get boarded- people who finished residency earlier can get grandfathered in.

To OP, if you didn't want to do research you might find some 1 year stroke fellowships- most of the fellowships in areas I have looked have 1 year clinical and 1 year research. I know to sit for boards in vascular neuro only requires 1 year of fellowship but a lot of places tack on extra years for research, some optional and some mandatory.

 

[BlackFrancis33]

Ok, I think that is a skewed view. If you want to be in a large hospital system, particularly an academic institution, then fellowship training is often needed. What is in great demand is well-trained general neurologists to staff hospitals in middle-sized and smaller communities. The actual sway subspecialty certification may or may not have is speculative at best and will likely vary significantly by specialty and location. Many places in the US need neurologists who can do everything including doing emgs and taking stroke call.

I am in fellowship because of my academic proclivities. I don`t think subspecialty training will be an absolute for employment in the future. This is my opinion, of course.

 

[95439]

This is exactly the kind of information I was hoping to hear...I've heard varying opinions on whether to do a fellowship or not.
Is one a more attractive general neurologist applicant if they've done a fellowship in EMG, for example? I'd assume 'yes', but the question is does it make enough of a difference that it's worth doing a fellowship for?

 

[ProgramDirector]

This is exactly the kind of information I was hoping to hear...I've heard varying opinions on whether to do a fellowship or not.
Is one a more attractive general neurologist applicant if they've done a fellowship in EMG, for example? I'd assume 'yes', but the question is does it make enough of a difference that it's worth doing a fellowship for?

I'm a PGY-2 in Neuro, and have started to think about career path. I'm waffling between general neurology, and numerous other subspecialties.

My main question is what does one get out of doing, say, a stroke fellowship? I assume it would make me more 'marketable', but the program I'm thinking about is 2 years, so I'd lose out on approximately $200,000 being a resident. Plus, money isn't my primary motivation.
If I want to do research, do I need a fellowship to do it?

I know there have been past threads that have discussed varying aspects of this, and I've read them, but they're all either ridiculously outdated or tangential.

Thank you guys as always!

Hey, bblue! If you want to do academic neurology, the most likely successful path is a fellowship - one real key I believe to success in an academic track is to do the work to get either a NIH K grant or VA CDA so that you have a track record of funding when negotiating a position, and so you have enough protected time to actually perform research/publish. If you are going to go academic, this is really the smart move, even if in general neurology.

If you want to go into private practice as a general neurologist, technically you do not need a fellowship, and in fact there is very little real benefit at the moment in terms of renumeration for having done a fellowship on your CV. However, you will want to have some procedures that you are able to do well to help keep your revenue up, things like Sleep studies, EEG, EMG/NCV, etc. If you leverage your residency smartly, you can gain enough expertise in these areas to go direct to practice, but that takes some forethought and a lot of hustle on your part to make certain you are getting to do enough of them to feel proficient. On the other hand, a clinically oriented fellowship will give you plenty of time to acquire these skills, so in that respect may be worth the extra time.

 

[danielmd06]

I think almost all of us benefit from a fellowship regardless of academic or private practice aspirations.

First, most residency programs now are essentially training neurohospitalists. You see tons and tons and tons of inpatient work/admits/consults and your paltry 1/2 day of clinic per week is full of indigent, non-compliant people who often have heavy psychiatric overtones to whatever else they're complaining about. "Outpatient" elective months are often peppered with call, presentations, academic assignments, and are the only time you can interview, take vacation, or come up for oxygen from the grind of the inpatient services.

There are reasons for this beyond the scope of what I wanted to briefly say. Yes, there are exceptions I know...I'm just saying the situations I describe represented the rule when I interviewed and talked to other residents in fellowship interviews and has been confirmed by practicing neurologists I know now.

Second, fellowship adds the true flavor of private practice (and niche academic) neurology that you will really need in my opinion to excel in either environment. For instance, neurophys training goes farther in preparing you for really taking care of neuromuscular and epilepsy patients than residency ever would.

My free advice. Good luck.

 

[95439]

However, you will want to have some procedures that you are able to do well to help keep your revenue up, things like Sleep studies, EEG, EMG/NCV, etc. If you leverage your residency smartly, you can gain enough expertise in these areas to go direct to practice, but that takes some forethought and a lot of hustle on your part to make certain you are getting to do enough of them to feel proficient. On the other hand, a clinically oriented fellowship will give you plenty of time to acquire these skills, so in that respect may be worth the extra time.

Hmmm....I may have to PM you if this gets too personal (threads should be beneficial for all), but how does one leverage their residency smartly?

I know I'll get a lot of hands on experience reading EEGs, and do get to work on EMGs as well, but how much is enough to be able to perform it on your own in private practice? There seems to be some differing opinions on here as to whether you need a Neurophys fellowship to perform EEG/EMGs after residency..

Thank you again for the info, you guys are awesome.

 

[bustbones26]

From what I understand, now if you want to do electrodiagnosis you have to do at least an electrophys fellowship to get boarded- people who finished residency earlier can get grandfathered in.

To OP, if you didn't want to do research you might find some 1 year stroke fellowships- most of the fellowships in areas I have looked have 1 year clinical and 1 year research. I know to sit for boards in vascular neuro only requires 1 year of fellowship but a lot of places tack on extra years for research, some optional and some mandatory.

If you do six months of EMG during residency and document a numnber of preceptored EMGs, you can sit for the american board of electrodiagnostic exam for EMG. This is not affiliated with the ABPN and this is usually the test that PM&R docs that in order say that they are "certified" in EMG. There is nothing to stop you from doing EMG in private practice. I did not do fellowship, but I will do EMG for simple things such as carpal tunnel versus radiculopathy, etc. If I think a patient has say muscular dystrophy, ALS, myasthenia, etc, then no, I refer these out to somebody that is fellowship trained in neuromuscular or neurophys with EMG concentration.

Same does for EEG. There is no reason as to why you cannot do and read simple 30 minute routine sleep deprived EEGs in the office. However, long term video ambulatory monitoring?? No, I send this out to the epilpetologist.

 

[95439]

If you do six months of EMG during residency and document a numnber of preceptored EMGs, you can sit for the american board of electrodiagnostic exam for EMG. This is not affiliated with the ABPN and this is usually the test that PM&R docs that in order say that they are "certified" in EMG. There is nothing to stop you from doing EMG in private practice. I did not do fellowship, but I will do EMG for simple things such as carpal tunnel versus radiculopathy, etc. If I think a patient has say muscular dystrophy, ALS, myasthenia, etc, then no, I refer these out to somebody that is fellowship trained in neuromuscular or neurophys with EMG concentration.

Same does for EEG. There is no reason as to why you cannot do and read simple 30 minute routine sleep deprived EEGs in the office. However, long term video ambulatory monitoring?? No, I send this out to the epilpetologist.

Ahhh the debate continues! My attending actually took me to the ABPN website yesterday and showed me the requirements. But I guess there is this american board of electrodiagnostic exam as well...what are the differences? If you wanted to get hired based on your 'EMG prowess', would a hospital/practice accept the american board of electrodiagnostic exam??

 

[Fencer]

The following comments are about Neurophysiology type fellowships:


As a PD in Clinical Neurophysiology, I have been involved in the development of several policies at our accrediting groups. It is my opinion, that in 20 yrs, the non NBMS boards will be extinct with, perhaps the exception of UPN accredited small fellowships. The "old" EEG, EMG, and Sleep boards will not exist. These were the "black belts" for academicians. The ABPN sponsored boards: CNP, Neuromuscular, Sleep and Epilepsy will be the only ones that matter for hospitals and payers. For private practitioners, a one-year CNP will be preferred, but for academicians, it will be expected to have two-year fellowship with CNP and one subspecialty (NM, Sleep, Epilepsy) board certification.

I also believe that those society boards will continue surviving with retooling their exams for MOC and continue to provide the In-service examinations.

I agree with comments from "neurologist" and "ProgramDirector".

 

[95439]

The following comments are about Neurophysiology type fellowships:


As a PD in Clinical Neurophysiology, I have been involved in the development of several policies at our accrediting groups. It is my opinion, that in 20 yrs, the non NBMS boards will be extinct with, perhaps the exception of UPN accredited small fellowships. The "old" EEG, EMG, and Sleep boards will not exist. These were the "black belts" for academicians. The ABPN sponsored boards: CNP, Neuromuscular, Sleep and Epilepsy will be the only ones that matter for hospitals and payers. For private practitioners, a one-year CNP will be preferred, but for academicians, it will be expected to have two-year fellowship with CNP and one subspecialty (NM, Sleep, Epilepsy) board certification.

I also believe that those society boards will continue surviving with retooling their exams for MOC and continue to provide the In-service examinations.

I agree with comments from "neurologist" and "ProgramDirector".

To summarize, in your opinion, if one is interested in doing Neurophys, they should do at least a 1 year fellowship if considering prviate practice, but a 2 year fellowship if one is considering 'academics'.

To which I pose an unintelligent question - what exactly is the difference between 'private practice' and 'academics'?

 

[Mattchiavelli]

The following comments are about Neurophysiology type fellowships:


As a PD in Clinical Neurophysiology, I have been involved in the development of several policies at our accrediting groups. It is my opinion, that in 20 yrs, the non NBMS boards will be extinct with, perhaps the exception of UPN accredited small fellowships. The "old" EEG, EMG, and Sleep boards will not exist. These were the "black belts" for academicians. The ABPN sponsored boards: CNP, Neuromuscular, Sleep and Epilepsy will be the only ones that matter for hospitals and payers. For private practitioners, a one-year CNP will be preferred, but for academicians, it will be expected to have two-year fellowship with CNP and one subspecialty (NM, Sleep, Epilepsy) board certification.

I also believe that those society boards will continue surviving with retooling their exams for MOC and continue to provide the In-service examinations.

I agree with comments from "neurologist" and "ProgramDirector".

I appreciate you clearing that up as I keep hearing different things from different people

 

[Fencer]

To summarize, in your opinion, if one is interested in doing Neurophys, they should do at least a 1 year fellowship if considering prviate practice, but a 2 year fellowship if one is considering 'academics'.

To which I pose an unintelligent question - what exactly is the difference between 'private practice' and 'academics'?

1. Yes. 2-year fellowships allow you time to do research, which prepares you for an academic career. It takes time to generate data at the new place, and for that period, you still might be able to publish your data from fellowship.

2. Private - you eat what you kill. No preference on the killing (as long as it pays the overhead). Your subsidy is at most a year. Academic - you cost the department until you develop the subspecialty. You eventually must make your salary (with often less good of patient payer mix but also lower salary target). The timeline is longer and might be 3 or 4 years depending upon the system.

 

[95439]

1. Yes. 2-year fellowships allow you time to do research, which prepares you for an academic career. It takes time to generate data at the new place, and for that period, you still might be able to publish your data from fellowship.

2. Private - you eat what you kill. No preference on the killing (as long as it pays the overhead). Your subsidy is at most a year. Academic - you cost the department until you develop the subspecialty. You eventually must make your salary (with often less good of patient payer mix but also lower salary target). The timeline is longer and might be 3 or 4 years depending upon the system.

I'm a little confused about eating what I kill lol. I assume you're referencing the fact that the patients you see are the ones that you bring to your practice yourself? But what sort of subsidy does one receive in private practice?
Also, are you saying that in academics, you're really not doing the department any good until you have a subspecialty, which is the reason to do a fellowship?
Sorry for my confusion..I'm post-call (that's my excuse for everything lol)

 

[neurologist]

I'm a little confused about eating what I kill lol. I assume you're referencing the fact that the patients you see are the ones that you bring to your practice yourself? But what sort of subsidy does one receive in private practice?
Also, are you saying that in academics, you're really not doing the department any good until you have a subspecialty, which is the reason to do a fellowship?
Sorry for my confusion..I'm post-call (that's my excuse for everything lol)

You eat what you kill = you make money by seeing patients. More work = more money. Less work = less money

Private groups will often "subsidize" a new doc by paying a predetermined salary for the first year or two, regardless of how much or how little $ you generate, because it will often take time to integrate you as a fully functioning member of the practice (i.e., there is a lag between the time you actually start seeing patients and the time you are a full productive member of the practice and the insurance payments are rolling in on a regular basis). After that, you salary will at least in part (how much depends on the practice setup) be determined by how many patients you see and what you generate in billing.

(The more cynical flip side of this is that the practice could also work you like a dog for a couple years and actually pay you less than the $ you generate . . . )

In academics, your salary may at least in part be supported by grant money that you are expected to win. That takes time to work up to. So until you get to the point of being able to generate grants, the dept will pay you from some other source of $.

Also in academics, the scenario is similar to private practice - it takes time to get you to the point of being a regular income generator on the clinical side as well.

 

[95439]

You eat what you kill = you make money by seeing patients. More work = more money. Less work = less money

Private groups will often "subsidize" a new doc by paying a predetermined salary for the first year or two, regardless of how much or how little $ you generate, because it will often take time to integrate you as a fully functioning member of the practice (i.e., there is a lag between the time you actually start seeing patients and the time you are a full productive member of the practice and the insurance payments are rolling in on a regular basis). After that, you salary will at least in part (how much depends on the practice setup) be determined by how many patients you see and what you generate in billing.

(The more cynical flip side of this is that the practice could also work you like a dog for a couple years and actually pay you less than the $ you generate . . . )

In academics, your salary may at least in part be supported by grant money that you are expected to win. That takes time to work up to. So until you get to the point of being able to generate grants, the dept will pay you from some other source of $.

Also in academics, the scenario is similar to private practice - it takes time to get you to the point of being a regular income generator on the clinical side as well.

Wow, thank you Neurologist, this is the information that is essential but is dififcult to find.
I was talking with a fellow resident yesterday and they said that the private practice general neurologist is a dying field, and the average salary is (and will be) app. 100-150k per year.
Unfortunately, if money weren't an issue, I'd like to do general neurology private practice, but 100k makes it hard to pay off 250k in loans! Does anyone know the validity of the above statement??

 

[bustbones26]

Wow, thank you Neurologist, this is the information that is essential but is dififcult to find.
I was talking with a fellow resident yesterday and they said that the private practice general neurologist is a dying field, and the average salary is (and will be) app. 100-150k per year.
Unfortunately, if money weren't an issue, I'd like to do general neurology private practice, but 100k makes it hard to pay off 250k in loans! Does anyone know the validity of the above statement??

Currently transitioning out of the military so looking at options. I did not do fellowship simpy due to my military committments (they twice refused to let me do one). Anyways, I am going into a general neurology practice and my contract is much more than 150K.

Here is the deal, you cannot go into saturated market. If you go to an exceptionally large city, you are not alone and you are not unique, and there are plenty of other hired guns in town.

People tend to be picky on their geographic locations. I am finding out just how muchin demand we neurologist are if you are willing to look. If you go to were you are in demand, you can generate sizeable cash flow!! Of course, there is always the moral ethical dilemma of being a good doctor versus being a good business person.

 

[danielmd06]

Wow, thank you Neurologist, this is the information that is essential but is dififcult to find.
I was talking with a fellow resident yesterday and they said that the private practice general neurologist is a dying field, and the average salary is (and will be) app. 100-150k per year.
Unfortunately, if money weren't an issue, I'd like to do general neurology private practice, but 100k makes it hard to pay off 250k in loans! Does anyone know the validity of the above statement??

I spent the last year and a half looking at various private practice setups in locations throughout the Midwest and Southeast. I also was peppered (and unfortunately still am) by offers from the West Coast, Northeast, Mid-Atlantic and wherever else.

First, general neurology is probably the single most common skill set alot of the places I went to wanted. Followed by stroke, neurophys, etc. Practicaly everybody wants you to do some general neuro (either because the patient base demands it or because the older members of the group want to practice exclusively within their sub-sub-sub specialty..or at least not take new general neuro patients).

But general neurology is indeed in a dynamic time. Many practicioners are turning their backs on inpatient neuro in lieu of their outpatient practices (creating a new and interseting schism between neurohospitalists and outpatient neurologists). Many people want to exclusively practice within the scope of their subspecialty fellowship training (ie stroke or neurocritical care or sleep). But back to your question of salary...

Starting offers ranged anywhere from $180,000 (also something the academic places seemed to offer as a start) all the way up to $350,000. Nearly everything I seriously looked at was at a minimum $250,000 plus bonus potential. If you go to a more rural place, a place with a more dire need, or a place that needs your unique (ie FELLOWSHIP) skills...the ante can be upped considerably from a starting offer. It also helps if you are able to mesh well with a potential patient base and professional group. The highest *emailed* offers I saw topped $400,000.

 

[95439]

Currently transitioning out of the military so looking at options. I did not do fellowship simpy due to my military committments (they twice refused to let me do one). Anyways, I am going into a general neurology practice and my contract is much more than 150K.

Here is the deal, you cannot go into saturated market. If you go to an exceptionally large city, you are not alone and you are not unique, and there are plenty of other hired guns in town.

People tend to be picky on their geographic locations. I am finding out just how muchin demand we neurologist are if you are willing to look. If you go to were you are in demand, you can generate sizeable cash flow!! Of course, there is always the moral ethical dilemma of being a good doctor versus being a good business person.

Thank you so much for the info Bustbones 26.
Can you give an idea of what the range of salaries you received for a general neurology practicioner were? Don't want to invade privacy too much, but it's great to finally get some good info on this topic by people who actually know..

 

[95439]

I spent the last year and a half looking at various private practice setups in locations throughout the Midwest and Southeast. I also was peppered (and unfortunately still am) by offers from the West Coast, Northeast, Mid-Atlantic and wherever else.

First, general neurology is probably the single most common skill set alot of the places I went to wanted. Followed by stroke, neurophys, etc. Practicaly everybody wants you to do some general neuro (either because the patient base demands it or because the older members of the group want to practice exclusively within their sub-sub-sub specialty..or at least not take new general neuro patients).

But general neurology is indeed in a dynamic time. Many practicioners are turning their backs on inpatient neuro in lieu of their outpatient practices (creating a new and interseting schism between neurohospitalists and outpatient neurologists). Many people want to exclusively practice within the scope of their subspecialty fellowship training (ie stroke or neurocritical care or sleep). But back to your question of salary...

Starting offers ranged anywhere from $180,000 (also something the academic places seemed to offer as a start) all the way up to $350,000. Nearly everything I seriously looked at was at a minimum $250,000 plus bonus potential. If you go to a more rural place, a place with a more dire need, or a place that needs your unique (ie FELLOWSHIP) skills...the ante can be upped considerably from a starting offer. It also helps if you are able to mesh well with a potential patient base and professional group. The highest *emailed* offers I saw topped $400,000.

Whoa whoa whoa...that's really impressive. Those salaries are for a 'non-fellowship trained general neurologist'?
So general neurology offers: $180k to 350k
Fellowship neurology (subspecialty) offers: $250 to 400k?

I really am NOT in it for the money. But I don't want to struggle my entire life and there's a lot of fear-mongering about the current trend in medical compensation, which makes it hard to know what's true. It's like trying to predict a political climate from Fox News.

Thank you again Daniel MD, awesome information!!

 

[bustbones26]

Whoa whoa whoa...that's really impressive. Those salaries are for a 'non-fellowship trained general neurologist'?
So general neurology offers: $180k to 350k
Fellowship neurology (subspecialty) offers: $250 to 400k?

I really am NOT in it for the money. But I don't want to struggle my entire life and there's a lot of fear-mongering about the current trend in medical compensation, which makes it hard to know what's true. It's like trying to predict a political climate from Fox News.

Thank you again Daniel MD, awesome information!!

As I am in the process of starting up my own practice, I was talking to a practice manager in this town who of course manages other physicians. I was informed that the one neurologist in this town never takes home less than 40K per month after he has paid all of his bills, overhead, etc and he is booked out 3.5 months. (Bear in mind, this is before he pays taxes on that figure). As well, he is severely overworked!!!

My salary guarantee for my first year in practice is 240K, and this does not include the signing bonuses.

I have not had any serious offers under 220K as a general neuologist.

Now how did I manage this? I am taking this deal in an area with a shortage of neurologists that is about an hour away from the nearest major city. Oh well, I will have to drive an hour for the city excitement. Other opportunities that I have looked into were similar situations.

At the end of the day, I would not seek the holy dollar or be driven by this. Do what makes you happy. If you want to do fellowship, go and do fellowship, and will make you more marketable. However, if you are a person like me who just did not have the opportunity to do a fellowship or life circumstances have prevented it, then there I am here to tell you that there is still hope to make a very generous salary. Be careful, seek advice of your peers, be business savy, and be professional at all times.

Also,

 

[danielmd06]

At the end of the day, I would not seek the holy dollar or be driven by this. Do what makes you happy. If you want to do fellowship, go and do fellowship, and will make you more marketable...

Be careful, seek advice of your peers, be business savy, and be professional at all times.

I agree with this.

All of it. Good luck!

 

[95439]

As I am in the process of starting up my own practice, I was talking to a practice manager in this town who of course manages other physicians. I was informed that the one neurologist in this town never takes home less than 40K per month after he has paid all of his bills, overhead, etc and he is booked out 3.5 months. (Bear in mind, this is before he pays taxes on that figure). As well, he is severely overworked!!!

My salary guarantee for my first year in practice is 240K, and this does not include the signing bonuses.

I have not had any serious offers under 220K as a general neuologist.

Now how did I manage this? I am taking this deal in an area with a shortage of neurologists that is about an hour away from the nearest major city. Oh well, I will have to drive an hour for the city excitement. Other opportunities that I have looked into were similar situations.

At the end of the day, I would not seek the holy dollar or be driven by this. Do what makes you happy. If you want to do fellowship, go and do fellowship, and will make you more marketable. However, if you are a person like me who just did not have the opportunity to do a fellowship or life circumstances have prevented it, then there I am here to tell you that there is still hope to make a very generous salary. Be careful, seek advice of your peers, be business savy, and be professional at all times.

Also,

Thank you VERY much for your input. You have no idea how much it means, it might change my life (and others') so thank you.
My last question, is there a resource to find out what the current offers are in various areas? (i.e. is there a national recruiting agency that would be willing to talk with a PGY-2?).

 

[danielmd06]

Whoa whoa whoa...that's really impressive. Those salaries are for a 'non-fellowship trained general neurologist'?
So general neurology offers: $180k to 350k
Fellowship neurology (subspecialty) offers: $250 to 400k?

I really am NOT in it for the money. But I don't want to struggle my entire life and there's a lot of fear-mongering about the current trend in medical compensation, which makes it hard to know what's true. It's like trying to predict a political climate from Fox News.

Thank you again Daniel MD, awesome information!!

Slight correction - I'd say that fixed salaries and general salary ranges for both general neuro and fellowship trained neuro are roughly equal just like others are saying. My own experience was what I quoted to you. I'm sure others have had better or worse as applicable, too.

But fellowship can certainly make you more competive in selected situations. Remember the concept of supply and demand? If a group has an epileptologist, a neuromuscular guy, an MS gal etc and they REALLY need a stroke or neurocritical care person then the fellowship training can really up the ante for you. Sure they may need general neuro coverage too, but the fellowship can really be the icing on the cake and put you at the top of the candidate list.

And if your job has bonus potential based on productivity or RVU generation then a fellowship in an area with diagnostic testing (like EMGs or sleep studies) can boost your income far more than seeing your umpteenth clinic patient.

And if you seek academic employment then fellowship training would practically be a must have for your application - just as stated more eloquently above.

But to recap, I personally sincerely think that the extra training is worth its weight in gold in the long term for the great majority of residents. If you just plan on doing plain old general neuro, then I would recommend a fellowship in clinical neurophysiology.