Neuro Salaries

[FutureDO2016]

Hi I was just wondering what are the average salaries for general neurologists compared to a neurologist who has completed a 1 year fellowship? How much more do you make if you complete one of the following fellowships:


Autonomic Disorders Balance Disorders
Behavioral neurology and neuropsychiatry Child Neurology
Clinical Research Cognitive disorders
Complementary Medicine EEG - Clinical Neurophysiology
EMG - Clinical Neurophysiology Epilepsy
Geriatric Neurology Headache medicine
Intervention neuroradiology Movement Disorders
Neural repair and rehabilitation Neuro-Oncology
Neuro-Ophthalmology Neuro-Otology
Neurocritical Care NeuroGenetics
Neurohospitalist Neuroimaging
Neuroimmunology (Multiple Sclerosis) Neuromuscular medicine
Neuropharmacology Other
Pain medicine Sleep Medicine
Vascular neurology (stroke)

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[FutureDO2016]

shameless bump!

 

[bustbones26]

Hi I was just wondering what are the average salaries for general neurologists compared to a neurologist who has completed a 1 year fellowship? How much more do you make if you complete one of the following fellowships:


Autonomic Disorders Balance Disorders
Behavioral neurology and neuropsychiatry Child Neurology
Clinical Research Cognitive disorders
Complementary Medicine EEG - Clinical Neurophysiology
EMG - Clinical Neurophysiology Epilepsy
Geriatric Neurology Headache medicine
Intervention neuroradiology Movement Disorders
Neural repair and rehabilitation Neuro-Oncology
Neuro-Ophthalmology Neuro-Otology
Neurocritical Care NeuroGenetics
Neurohospitalist Neuroimaging
Neuroimmunology (Multiple Sclerosis) Neuromuscular medicine
Neuropharmacology Other
Pain medicine Sleep Medicine
Vascular neurology (stroke)

I am not certain if some of these subspecialties would really earn you more? You have listed virtually every subspecialty so I cannot comment. I would only comment on what I know.

Neurophysiology? Meh, they just cut rates on EMG by 50%. Definitely useful to have the extra knowledge, but not sure if this is going to earn you more money.

Pain, well pain pays nicely for now. As I have complained in other posts, it seems as if some pain doctors can perform procedures with little barriers. It pays nice for now, but who really knows? What if medicare finds out that these doctors are making good money and slashes their specialty too? You just never know?

Interventional Neuroradiology? Well, look around this forum, you see all kinds of contravesial threads on interventional neurology.

Well, that's it. For the rest, do your research.

 

[mrcmedman]

Neurocritical care pays quite well but yeah it is not lifestyle friendly.

Sleep is still decent reimbursement wise despite encroachment from other specialties.

Like the above poster said about neurophys, doing a fellowship is not gonna add that much to your bottom line. If you want to be EMG certified, try to get the required number of readings done while in residency. On the other hand, If you are really passionate about EMG then for sure you should pursue this fellowship.

Having a stroke fellowship will help you market yourself better for neurohospitalist positions that have stroke call. So yeah, you could have a salary in the range of $200k to &350k+ depending on where it is being offered and other factors. Same goes for epilepsy fellowships and hospitals with EMU's.

NeuroIR is on shaky ground right now with recent studies showing worse outcomes for strokes than without any intervention. You currently get paid really really well. But how long that lasts in light of all this, I don't know.

Pain pays really well for now as well. But you got to be able to deal with a certain type of population and that may be off-putting to some. Procedures are just a fraction of your practice. In other words, you will have to dispense a lot of opiates.

 

[typhoonegator]

NCC can pay pretty well, but it's hard to work even 26 weeks/year because of burnout at most places. At some of the big centers, the attendings can work more weeks because there are fellows doing a lot of the work at the bedside and you aren't driving into the hospital at 3AM every day for an intubation or a line or a goals of care discussion.

Stroke can open up some administrative and QI doors which can net you some FTEs, but in my experience they don't make a whole lot more than other subspecialists as a rule -- YMMV depending on regional needs which may inflate the salaries of subspecialists in high demand. And in my experience, the pay and title for those administrative roles is never commensurate with the amount of extra work, so it better factor in to your long term career goals.

 

[FutureDO2016]

What about movement disorders?

So would you say a stroke, pain or NCC fellowship would boost your income to $300K or more?

 

[barrelcortex]

Don't do neurology for the money, or anything else for that matter.

If you need encouragement, there are about 20 offer emails stuck to a blackboard in our dept. with minimum starting salaries at 325 and some up to 450, especially for stroke fellowship. This is what we are getting sent quite consistently and some of these offers are <30mins from major metropolitan areas. I would say as a plain neurohospitalist out of residency, 250 is a typical offer. Of course, academic centers will low ball you, but that's the same for every specialty.

I think neuro, especially stroke is in very high demand, as I have talked to several graduating residents and its pretty easyto find decent well paying jobs at this point. As the # of neurologists in training increases they might keep up with demand, but I doubt the salaries for stroke will go down anytime soon. Plus (just to piss some ppl off ) we are going to start getting reimbursed for reading CTs and MRIs soon..... ok maybe not soon, but eventually.

 

[Strokeguy]

Agree with barrelcortex. There are lot of jobs post stroke fellowship available. At meetings incl ISC the fellows get lot of options incl geographic locations etc. A lot has to do with penetration of telemedicine and as said below it isn't going to stop or slow down anytime soon. Regarding reimbursing for CT / MRI I am doubtful, but you can clain a modifier on your consult/admit note.
What you can do and bill for are TCDs and carotid dopplers (do them and bill for them like radiology does). Another aspect is that 'there are no turf wars in stroke/vascular practice'? You don't have to lock horns with nsurgeons or radiologists or pulm criticalcare folks for anything.
Managing and running a stroke program is now a fully specialized job when it comes meeting JCAHO requirements, etc. Apart from metrics on acute stroke, there are goals in outpt and inpt care as well. So the 'stroke director' at a hospital does get paid extra (depending on the place $25-50k over the base salary). Another part of practice is running 'screening clinics for kids with sickle cell dis'. You screen them every 6 months with TCDs untill adulthood. This is done in collaboration with pedi or pedi neuro.

 

[mrcmedman]

What about movement disorders?

So would you say a stroke, pain or NCC fellowship would boost your income to $300K or more?

I would that would be the case for NCC and pain for sure. People will still low ball you in saturated markets (i.e. very large cities).

I thought that post-stroke fellowship pay was variable. But according to the posters above, I guess it is also on the upside these days, which is great news! 350k is doable, just not front and centre in Chicago, San fran, NY, etc.

As for movement disorders, it is primarily outpatient based. More likely you will be practising in an academic setting, where you can build up your patient base through referrals but at the same time will have to do hospitals rounds and research - just like any other neuro faculty. You pay will accordingly be below 200k.

 

[danielmd06]

What about movement disorders?

So would you say a stroke, pain or NCC fellowship would boost your income to $300K or more?

Sleep medicine would boost your income to that level, also.

 

[Acherona]

movement has the best lifestyle, patients are nice, and there are good treatments. beats getting up in the middle of the night to give a placebo. i don't mind being paid less to not have to do that.

 

[FutureDO2016]

How much does movement on average get paid?

 

[DD214]

You are barking up the wrong tree. Medicare has been slashing all of the neurology reimbursement with a vengeance and things will likely be very depressing by the time you are ready to bill for your first patient encounter. One arbitrary decision from Medicare can completely destroy your business model and our professional societies can do very little to nothing about it.

 

[FutureDO2016]

Then why are other fields like orthopedic surgery and cardiology still paying well? Why is Medicare aiming these cuts at neurology and not other more lucrative specialties?

 

[TUGM]

You are barking up the wrong tree. Medicare has been slashing all of the neurology reimbursement with a vengeance and things will likely be very depressing by the time you are ready to bill for your first patient encounter. One arbitrary decision from Medicare can completely destroy your business model and our professional societies can do very little to nothing about it.

This just sounds so depressing...

 

[Silent Cool]

Then why are other friends like orthopedic surgery and cardiology still paying well? Why is Medicare aiming these cuts at neurology and not other more lucrative specialties?

Hasn't CMS already cut Cardiology?

And I have heard that Ortho is on the chopping block.

Likewise Radiology has been cut and, geez, check out the Pathology forums *shudder*

 

[FutureDO2016]

well all the fields in medicine will see cuts except probably primary care like IM and FM but doctors will always be paid well since we go through so many years of schooling and have so much debt that no one will work for cheap

 

[DD214]

NPs practicing independently will work for cheap. Ask any hospital administrator. No one at Medicare gives a rat's ass how much you sacrificed, how hard you work or how much risk you take in performing as a physician. Private payers index all of their reimbursement to Medicare, so it royally screws over everyone when they slash reimbursement at a moment's notice like they did last year with EMGs.

 

[Mattchiavelli]

thankfully, private insurance companies have also been feeling the pinch recently.... Oh wait....... but I digress

Seriously reimbursements are labile enough that I think if you're going down a path solely for highest earning potential you may wind up pretty PO'ed halfway through your fellowship, there is a big range of earnings within a subspecialty that depend on a lot of things not unique to the subspecialty it's self. For example, how much procedural stuff vs non and how much time your encounters actually take compared to what you're being paid for them. Example- movement disorders, find a nice crop of older healthier people with good insurance and well documented botox-responsive conditions and you can have a sweet setup. You also could have a clinic with poor access to social work and have a bunch of huntington's patients for med management so all your visits are 90 minutes and you document poorly so you get a lvl2 for your visit.

A lot of people think the way it works is you pick the perfect subspecialty and then money rains upon you. It's really more about how hard you work to earn it and how hard are you are working to monetize your professional efforts.

 

[danielmd06]

A lot of people think the way it works is you pick the perfect subspecialty and then money rains upon you. It's really more about how hard you work to earn it and how hard are you are working to monetize your professional efforts.

Yes.

 

[FutureDO2016]

haha I've heard that before. A really wealthy dentist said it's less about the routine checkup and more about the added procedures that they can bill insurance companies for or have the patient pay out of pocket like teeth whitening, deep cleaning, and other dental procedures.

Ultimately, medicine is a business and people have to pay the bills and pay back their loans somehow.

 

[barrelcortex]

You are barking up the wrong tree. Medicare has been slashing all of the neurology reimbursement with a vengeance and things will likely be very depressing by the time you are ready to bill for your first patient encounter. One arbitrary decision from Medicare can completely destroy your business model and our professional societies can do very little to nothing about it.

This just sounds so depressing...

Actually, AAN just managed to get the EMG cuts all reversed. They also successfully defended cuts to EEG. So, this post above is out of date.

 

[neglect]

Actually, AAN just managed to get the EMG cuts all reversed. They also successfully defended cuts to EEG. So, this post above is out of date.

Reference?

I haven't heard this, but this is excellent news.

 

[Thama]

Reference?

I haven't heard this, but this is excellent news.

https://www.aan.com/public-policy/capitol-hill-report/current-capitol-hill-report/

The AAN is declaring victory (for now) on EEG cuts, and apparently managed to raise some EMG codes as well. No change on NCS, however.

 

[TUGM]

Yes recently heard this from some attendings on the interview trail. Excellent news! NEURO VICTOR!

 

[Vader]

If you look at the Medicare RVU/dollar amounts of 2014, you will see that indeed in terms of professional component, there have been some increases for EMG and holding pattern for EEG. However, the technical components of these tests which comprise the bulk of the reimbursement, have still sustained significant cuts. So I wouldn't be so quick to declare victory, especially for EMGs, which tend to be done by individual providers. If you were in a situation where you only collected the professional component anyway, this might be considered a "victory". Overall, I would consider it an important step, but the AAN and all of us must continue to reinforce to Congress, CMS, etc the impact of neurologic disease and the significance of neurology in helping patients with these disorders.

 

[DD214]

The AAN was probably on the verge of losing >50% of its membership if the EEG cuts went through. As I understand it, the EEG cuts were only part of a more widespread plan by CMS to cut nonfacility fees which was abandoned at the last minute. Private practice neurology is still very much struggling with the significant cuts to the NCS codes and the "victory" regarding the slight increase in EMG reimbursement means you get an extra $20 for 2 limbs.