MSTP student interested in Neurology, doubts due to salary

[studentdoctornetwork]

I have been accepted into a few MD/PhD programs and was always very focused on pursuing a primarily research career. I am very interested in working with patients with rare genetic illnesses and optimizing therapeutics for these patients. One aspect that really motivates me is the lack of physicians with similar interests, since most will focus on the big neuro diseases/injuries, such as TBI, strokes, parkinson's, alzheimers. When there is a whole population whos needs are being unmet. Ideally, I'd like to be in a position like this:

http://www.chp.edu/find-a-doctor/service-providers/maria-escolar-123540

Although I have always been strongly committed to this plan, I was recently researching financial compensation and was... shocked to be honest. I always was aware that there is a financial sacrifice when pursuing research, but my assumption was that it would be something like making 200k instead of 300k.

However, I am coming across some extremely low numbers in academic pediatric neurology, such as a starting salary of 90k. I could honestly make that much money in 2-3 years due to my engineering background. I am not in this for the money, but I am the son of some very hard-working immigrants and have a family to support, some who are critically ill. I don't want to be in school for 15 years and come out and still be unable to support my entire family.

I was hoping for input from current residents and neurologists, especially those who are MD/PhD and pursuing academic careers. Are the salaries really that low? For those who are heavily involved in research, how much are you making and how much did you start out making?

I understand that there are many variables (location, sub-specialty, etc), but still cannot wrap my head around the 90k figure and I find it very demotivating from pursuing my intended path.

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[kchan99]

There are neurologists interested in rare genetic disorders. They are fellowship trained in various subspecialties. Neurogenetics is a loosely organized non-ACGME area. Some neurologists go into medical genetics fellowships, but others may be trained through movement disorders, neuromuscular, etc. Some clinician-scientists in this area are not necessarily neurologists. Please keep in mind that it can be difficult to recruit patients with rare diseases into research studies because the patients are rare, may not want to travel, may not be well enough to travel, may not have enough grant funding for international travel, etc.

 

[Hank Rearden]

You are going to be very hard pressed to get anyone to post their salary on here. As an academic neurologist I can give you some sense of the range in salaries. Keep in mind that I'm an adult neurologist, so I don't have a good sense of how much this changes for Peds. Starting salary for an academic neurologist at a high power center (this assumes 75% dedicated research time) is roughly $120k. In less high power centers that are perhaps in less desirable places to live that figure could go up to $150k or higher. When you make jumps from Assistant --> Associate Prof and from Associate --> full Prof you are generally getting about 30k more each time. Again, these are only ballpark figures. If you find a cure for Pelizaeus-Merzbacher disease your salary would shoot up to $300-400k when they make you head of the department.

Most of us in academics do other things to help supplement our salaries. Some do medical legal work, some pick up extra call shifts on the weekends, etc. You are actually in an envious position fincancially in that as an MSTP your med school will be paid for. You have no idea what an advantage that will be for you in the future. Those of with straight MDs in academics are walking around with huge debts that are difficult to pay off.

One strategy would be to find someone in med school with no research interests, going into derm or rads and marry them

 

[DokterMom]

Consider also who would be paying your salary and why. Orphan diseases are, by definition, rare, so the market for therapies and cures will be small. Problems that affect a larger number of [wealthier] people have the potential to attract funding from commercial as well as governmental sources... Free-market and all.

 

[deleted915325]

The physician you cited, Maria Escolar, is a neuodevelopmental pediatrician, not a child neurologist. She also is an MD and not an MD/PhD. If you would like to shadow her, reach out to her directly. She is always open to helping students and is happy to help guide you in your decision making process. As for salary, it is significantly higher than 80-90K, so I would not let that influence your choice

 

[oopsy]

There are rare rare birds in academia who are actually making 90,000. Those salaries are for folks who have minimal to no clinical time and are getting their labs off the ground. As your grants roll in, or you take on more clinical responsibility, your salary goes up. At the end of the day, no one is going to pay you just for being awesome. You have to generate your salary either via billing, grants, or both. Most academics who take jobs like the ones you saw (~90,000) are moonlighting on the side to make up the gap. Suffice to say, I know several residents who make more than 90k by their own moonlighting. I wouldn't assume this lowly salary is a foretold destiny.

Also, I take it that you're a college/pre-medical student. Honestly, you have no idea what you're going to want, so I wouldn't plan my life around your sub-sub-specialty interest at this phase. The decision is simple: if you're certain you want to do basic research, great, do the MD/PhD. I did, great experience and learning opportunity. If you're not, don't. If you end up a straight clinician, particularly in a private/privademic setting, it is a huge opportunity cost in salary that you forgo. That student loan you avoided looks good up front, but if you forgo 300k/year for several years....it'll pale in comparison. It's more of a general interest conversation now, regarding basic research, and if you're willing to take the opportunity cost in salary to do science. FYI, here's a dirty little secret none of your MSTP interviewers will tell you: <25% of graduates actually end up with a lab long-term. There are a thousand reasons for this, but just keep that in mind as you decide what to do.

 

[Nonphysiologic]

As one of my attendings used to say: "One piece of advice: MARRY A CLASSMATE!" lol.

 

[NeurologyHopeful2018]

I have been accepted into a few MD/PhD programs and was always very focused on pursuing a primarily research career. I am very interested in working with patients with rare genetic illnesses and optimizing therapeutics for these patients. One aspect that really motivates me is the lack of physicians with similar interests, since most will focus on the big neuro diseases/injuries, such as TBI, strokes, parkinson's, alzheimers. When there is a whole population whos needs are being unmet. Ideally, I'd like to be in a position like this:

Maria L. Escolar, MD, MS at Children’s Hospital of Pittsburgh

Although I have always been strongly committed to this plan, I was recently researching financial compensation and was... shocked to be honest. I always was aware that there is a financial sacrifice when pursuing research, but my assumption was that it would be something like making 200k instead of 300k.

However, I am coming across some extremely low numbers in academic pediatric neurology, such as a starting salary of 90k. I could honestly make that much money in 2-3 years due to my engineering background. I am not in this for the money, but I am the son of some very hard-working immigrants and have a family to support, some who are critically ill. I don't want to be in school for 15 years and come out and still be unable to support my entire family.

I was hoping for input from current residents and neurologists, especially those who are MD/PhD and pursuing academic careers. Are the salaries really that low? For those who are heavily involved in research, how much are you making and how much did you start out making?

I understand that there are many variables (location, sub-specialty, etc), but still cannot wrap my head around the 90k figure and I find it very demotivating from pursuing ..

 

[guylewis]

There is a saying that MD/PHD program is a paradox - why? Because MD/PhD students have the highest academic CV, yet these students are dumb as a rock without any common sense.

Anyone with a tincture of common sense and self-respect would realize after a mere few weeks working in the lab that basic science research career is a highly toxic, malignant and stressful environment with no prospect. Even if you are Einstein and your mentor loves you, luck still plays a major role in your success and failure. Scientists and PIs have largely become liars and cheaters making up data to make a living.

Ask any PhD student whether they rather be a blue collar worker with a union or slaving away at a lab...

That had to be one of the dumbest things I've ever read

 

[Writer1985]

The best source for salary ranges in academics is the AAMC Faculty Salary Survey. It's compiled yearly, subdivided by region and specialty, and your medical school library should have a copy of it. For 2016, the median salary for assistant professor of neurology nationwide was ~180k, with an IQR of 165k-190k-ish. I didn't look up the child neuro numbers when I was job-searching, but I have heard they are about 20-25% less.

 

[NeurologyHopeful2018]

The best source for salary ranges in academics is the AAMC Faculty Salary Survey. It's compiled yearly, subdivided by region and specialty, and your medical school library should have a copy of it. For 2016, the median salary for assistant professor of neurology nationwide was ~180k, with an IQR of 165k-190k-ish. I didn't look up the child neuro numbers when I was job-searching, but I have heard they are about 20-25% less.

Don't physicians earn additional income on top of that salary for clinical work billing?

 

[jd1031]

I have been accepted into a few MD/PhD programs and was always very focused on pursuing a primarily research career. I am very interested in working with patients with rare genetic illnesses and optimizing therapeutics for these patients. One aspect that really motivates me is the lack of physicians with similar interests, since most will focus on the big neuro diseases/injuries, such as TBI, strokes, parkinson's, alzheimers. When there is a whole population whos needs are being unmet. Ideally, I'd like to be in a position like this:

Maria L. Escolar, MD, MS at Children’s Hospital of Pittsburgh

Although I have always been strongly committed to this plan, I was recently researching financial compensation and was... shocked to be honest. I always was aware that there is a financial sacrifice when pursuing research, but my assumption was that it would be something like making 200k instead of 300k.

However, I am coming across some extremely low numbers in academic pediatric neurology, such as a starting salary of 90k. I could honestly make that much money in 2-3 years due to my engineering background. I am not in this for the money, but I am the son of some very hard-working immigrants and have a family to support, some who are critically ill. I don't want to be in school for 15 years and come out and still be unable to support my entire family.

I was hoping for input from current residents and neurologists, especially those who are MD/PhD and pursuing academic careers. Are the salaries really that low? For those who are heavily involved in research, how much are you making and how much did you start out making?

I understand that there are many variables (location, sub-specialty, etc), but still cannot wrap my head around the 90k figure and I find it very demotivating from pursuing my intended path.

From what I've seen, Writer1985 is right. It's about 150-190k. There's a lot of variables though, including location, institution, clinic vs research responsibilities. Any sort of "Director" position generally pays more. Maybe about 50k more (Don't quote me on this exact number, this is from what I've seen). Also, the more research funding you bring in, the more you generally make as well.

But you're right. Community practice does pays significantly more, around 100k a year greater (or even more than that in some circumstances).

 

[kchan99]

Any sort of "Director" position generally pays more.

As long as not everyone in the department is some kind of director

 

[curiousneuro]

From what I've seen, Writer1985 is right. It's about 150-190k. There's a lot of variables though, including location, institution, clinic vs research responsibilities. Any sort of "Director" position generally pays more. Maybe about 50k more (Don't quote me on this exact number, this is from what I've seen). Also, the more research funding you bring in, the more you generally make as well.

But you're right. Community practice does pays significantly more, around 100k a year greater (or even more than that in some circumstances).

There's a huge discrepancy between academic and private practice salaries, with most private practice salaries in my area starting at 300k+. Makes it very hard to seriously consider an academic career...

 

[Postictal Raiden]

There's a huge discrepancy between academic and private practice salaries, with most private practice salaries in my area starting at 300k+. Makes it very hard to seriously consider an academic career...

Which part of the country is this?

 

[curiousneuro]

Which part of the country is this?

Southwest.

 

[Postictal Raiden]

Southwest.

Thank you

 

[curiousneuro]

Thank you

I think you'll find that number in most areas of the US, except for places like NYC, etc.

 

[jd1031]

As long as not everyone in the department is some kind of director

LOL

 

[Postictal Raiden]

I think you'll find that number in most areas of the US, except for places like NYC, etc.

I live in SoCal (will be moving to AZ for residency), and both neurologists I worked with made a lot more than 300k. I know a of one group in LA that is recruiting now and offering high 200s plus benefits for two years, and after that full partnership.

Howvwe, people keep telling me that these are outliers and point me to surveys like medscape, which shows that the average salary is 244k.

 

[NeurologyHopeful2018]

I live in SoCal (will be moving to AZ for residency), and both neurologists I worked with made a lot more than 300k. I know a of one group in LA that is recruiting now and offering high 200s plus benefits for two years, and after that full partnership.

Howvwe, people keep telling me that these are outliers and point me to surveys like medscape, which shows that the average salary is 244k.

Its not just Medscape - but also MGMA and AMA data.

There are anedoctal outliers for every specialty. I also know at least one family physician making 500K.

 

[Postictal Raiden]

Its not just Medscape - but also MGMA and AMA data.

There are anedoctal outliers for every specialty. I also know at least one family physician making 500K.

MGMA and AMA are on par with the anecdotal data (~300k). Medscape is significantly lower.

 

[curiousneuro]

I think the main reason there is a skew is because so many neurologists go into academics, which pays significantly lower.

 

[Postictal Raiden]

I think the main reason there is a skew is because so many neurologists go into academics, which pays significantly lower.

I wonder if you happen to know anything about working for the VA. What is the starting salary like? Are these gigs chill as people say (40hrs/week, rarely covering nights or weekends)?

 

[Student's T]

I wonder if you happen to know anything about working for the VA. What is the starting salary like? Are these gigs chill as people say (40hrs/week, rarely covering nights or weekends)?

Can't speak specifically to neurology, but I know an IM resident in a large mountain west metro area who just took a VA job for ~$210k + some loan repayment for 8 AM - 5 PM primary care clinic (30 minute appointments) with no call of any type ever and 5 weeks of vacation.

 

[Postictal Raiden]

Can't speak specifically to neurology, but I know an IM resident in a large mountain west metro area who just took a VA job for ~$210k + some loan repayment for 8 AM - 5 PM primary care clinic (30 minute appointments) with no call of any type ever and 5 weeks of vacation.

Then based on what you said and the following source, Neurology at VA should pay at least that much.

https://www.va.gov/OHRM/Pay/2018/PhysicianDentist/PayTablesRev.pdf

 

[MedicalDoge]

The best source for salary ranges in academics is the AAMC Faculty Salary Survey. It's compiled yearly, subdivided by region and specialty, and your medical school library should have a copy of it. For 2016, the median salary for assistant professor of neurology nationwide was ~180k, with an IQR of 165k-190k-ish. I didn't look up the child neuro numbers when I was job-searching, but I have heard they are about 20-25% less.

Thank you for this information. Sorry to hijack this thread, but is there any way you could tell me how much neuropathologists make according to the survey?

 

[tortuga87]

You will actually be making less than 90K because they make you do college (4 years) + MD/PhD (7-9 years) + residency (3-4 years) + research fellowship (1-2 years) + instructor (1-2 years) before they hire you as an assistant professor with a K award

So you will be making 60K after 15 years of education when you are in fellowship (in 2018 dollars)

You will not be able to support your extended family with this salary

 

[deleted915325]

Thankfully, you do not have to do an MD/PhD to be a physician-scientist. An MD will do

 

[dl2dp2]

• You will actually be making less than 90K because they make you do college (4 years) + MD/PhD (7-9 years) + residency (3-4 years) + research fellowship (1-2 years) + instructor (1-2 years) before they hire you as an assistant professor with a K award
  
  So you will be making 60K after 15 years of education when you are in fellowship (in 2018 dollars)
  
  You will not be able to support your extended family with this salary

I know very well this career track, and have several personal friends who are neurologists in that track. The above is accurate.

You cannot really support extended families being a physician scientist in a cognitive specialty for at least until well into your 40s (i.e. with an R01 in hand). Thankfully, the likelihood of you ending up there is statistically in the single digits.

So one might ask, why would people still compete for non existent positions that pay comparatively very little? First, you can make it work if it's a household of two working adults. Second, a lot of physician scientists (and just scientists in general) who survive the training and getting grants game come from relatively affluent backgrounds. People with low access to resources typically start to drop out of this track somewhere between residency and fellowship. Thirdly, as a physician scientist, your salary support is adjusted based on that of an equivalent employee (i.e. a straight PhD scientist), and their salary is in the 90k-150k range.

 

[Hank Rearden]

I'm not a clinician scientist (straight MD who mostly does research), but I think MD/PhD's are not on the same pay scale as straight PhD scientists. As a faculty member at a research university, your pay is typically based on a certain percentile of the AAMC Faculty Salary Survey described above. The thing about the AAMC survey is that it has one number for clinical faculty salary and another for research faculty within the same department. The clinical faculty salaries are quite a bit higher. It makes no sense to me that an MD/PhD would be paid on the lower scale, as many still do ~25% clinical work. The department shouldn't really care as long as they're pulling in enough grant money to cover the remaining 75% of the higher salary.

For those lamenting the long time spent in MD/PhD programs I want to reiterate that your med school is free. I know that doesn't compare to lost wages if you were a straight clinician for those extra years, but it's a huge benefit.

 

[NTF]

I was recently researching financial compensation and was... shocked to be honest. I always was aware that there is a financial sacrifice when pursuing research, but my assumption was that it would be something like making 200k instead of 300k.

However, I am coming across some extremely low numbers in academic pediatric neurology, such as a starting salary of 90k. I could honestly make that much money in 2-3 years due to my engineering background. I am not in this for the money, but I am the son of some very hard-working immigrants and have a family to support, some who are critically ill. I don't want to be in school for 15 years and come out and still be unable to support my entire family.

I was hoping for input from current residents and neurologists, especially those who are MD/PhD and pursuing academic careers. Are the salaries really that low? For those who are heavily involved in research, how much are you making and how much did you start out making?

I understand that there are many variables (location, sub-specialty, etc), but still cannot wrap my head around the 90k figure and I find it very demotivating from pursuing my intended path.

I finished my job search for pediatric neurology 5 months ago. Indeed there are some "elite" academic institutions that have very low starting salaries for assistant professor/clinical instructor positions. I didn't see or hear about any as low as 90k but there was at least one that started at 110k. I guess you're paying for the prestige and privilege of working at their institution. Most research-oriented academic positions I inquired about started in the 150-175k range but there were others that started in the 200-225k range. But like most things, the higher the salary the more strenuous, your clinical responsibilities. The lower paying academic jobs expected 60% or less clinical time with the idea that you are using the extra time to develop your research endeavors and generate R or K awards. These institutions also tended to have more attendings so there's more people to divide call and service time with. They also often have residents/fellows that buffer call and service. At the higher salary academic sites 70-80% clinical was the minimum. They often had more strenuous call duties/service expectations and may or may not have any buffering by residents/fellows. I train at a large academic pediatric center and some of our attendings do supplement their income with industry or legal consulting work. I believe my institution starts new attendings in the 160-175k range and 60% clinical unless you have active grants. My institution also has Young Investigator Grants that fund you to be 80% research/20% clinical for two years but my assumption is competition is high for these awards.

If your goal is a research-oriented career at a large academic institution, I think 200k is certainly attainable but your ideal job in today's market (9-11 years from now, who knows?) would likely start in the 150-175k range.

That being said the range of salaries in pediatric neurology is broader than I expected prior to my job search. I fielded offers from 160k (academic) to 375k (non-profit health group). There were private practices where pediatric neurologists were making close to 500k 2 years out from training.

But given that you just only got into medical school, I'd urge you to keep an open mind about your career. I think less than half of my classmates in medical school ended up in the specialties they thought they wanted when they started. I started out wanting to be a general pediatrician and to get out into private practice as fast as possible with no desire to do research. 9 years later, I'm about to start fellowship after 5 years of residency and have a job lined up in an academic setting.

Best of luck to you.

 

[Jah402]

I finished my job search for pediatric neurology 5 months ago. Indeed there are some "elite" academic institutions that have very low starting salaries for assistant professor/clinical instructor positions. I didn't see or hear about any as low as 90k but there was at least one that started at 110k. I guess you're paying for the prestige and privilege of working at their institution. Most research-oriented academic positions I inquired about started in the 150-175k range but there were others that started in the 200-225k range. But like most things, the higher the salary the more strenuous, your clinical responsibilities. The lower paying academic jobs expected 60% or less clinical time with the idea that you are using the extra time to develop your research endeavors and generate R or K awards. These institutions also tended to have more attendings so there's more people to divide call and service time with. They also often have residents/fellows that buffer call and service. At the higher salary academic sites 70-80% clinical was the minimum. They often had more strenuous call duties/service expectations and may or may not have any buffering by residents/fellows. I train at a large academic pediatric center and some of our attendings do supplement their income with industry or legal consulting work. I believe my institution starts new attendings in the 160-175k range and 60% clinical unless you have active grants. My institution also has Young Investigator Grants that fund you to be 80% research/20% clinical for two years but my assumption is competition is high for these awards.

If your goal is a research-oriented career at a large academic institution, I think 200k is certainly attainable but your ideal job in today's market (9-11 years from now, who knows?) would likely start in the 150-175k range.

That being said the range of salaries in pediatric neurology is broader than I expected prior to my job search. I fielded offers from 160k (academic) to 375k (non-profit health group). There were private practices where pediatric neurologists were making close to 500k 2 years out from training.

But given that you just only got into medical school, I'd urge you to keep an open mind about your career. I think less than half of my classmates in medical school ended up in the specialties they thought they wanted when they started. I started out wanting to be a general pediatrician and to get out into private practice as fast as possible with no desire to do research. 9 years later, I'm about to start fellowship after 5 years of residency and have a job lined up in an academic setting.

Best of luck to you.

Thanks for sharing about your job search. I am planning to apply Child Neurology this cycle and was also surprised by the range of salaries you were offered. An attending recently mentioned to me that General Peds makes more than Child neuro and that Child Neurologists will often supplement income with working in Gen Peds. Have you found this to be true? Were the private practice/higher salaries in certain areas of the country?

 

[NTF]

Thanks for sharing about your job search. I am planning to apply Child Neurology this cycle and was also surprised by the range of salaries you were offered. An attending recently mentioned to me that General Peds makes more than Child neuro and that Child Neurologists will often supplement income with working in Gen Peds. Have you found this to be true? Were the private practice/higher salaries in certain areas of the country?

Very few people supplement income with general peds work. (I've only heard of one and they worked in a remote rural area and did this instead of having to do adult neurology work). You'd be better off using some your vacation time doing a locums as a peds neuro. Just out of curiosity (because I literally get several emails and calls a week asking for help to fill locum tenens needs) I asked a recruiter what typical compensation is for child neuro locum tenens and they said for any work that involves some inpatient work generally $2000 per day, $1700 per day if outpatient only. $350-500/hr for any overtime hours. They pay malpractice, hotel lodging, travel and car. They don't cover health insurance.

Child neurology is still in a critical shortage. If you're doing general peds work, your employer is not utilizing your time or compensating you appropriately. You should only do general peds work if this happens to be a particular passion.