Neurology procedures (interventional neuro fellowship)

[JPSmyth]

Hi all,

I'm a medical student interested in the possibility of going into interventional neurology. I think minimally invasive stuff is very cool, and I have shadowed IR and interventional cards, but I am not familiar with interventional neurology.

I was looking on the SVIN site about procedures performed by interventional neurologists (Procedures - Society of Vascular and Interventional Neurology) and they seem interesting.

My questions:
Is it still common for fellowship trained neurologists to perform these procedures, or is there encroachment by endovascular neurosurgeons? Or IR docs?

How competitive are fellowships, and what is the job market like?

How is the salary compared to non-interventional neurologists? (I have a great deal of student debt so this is a concern for me)

Any input is greatly appreciated, thanks!

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[typhoonegator]

1. Common? Not that common, but the field is pretty small. And if anything, neurologists are the ones doing the encroaching. There are several programs that train neurologists.
2. Very competitive. Job market is theoretically wide open, but there are many caveats regarding suite time, call, referral base, etc. that affect the relative attractiveness of positions.
3. The salary is likely to be far higher than a non-fellowship trained neurologist. The delta will be significantly lower at academic centers overall.

 

[VeitVat]

Interventional neuroradiology is a radiology specialty. The techniques were invented, developed and polished by radiologists. Other specialties want a piece of the action and have been encroaching in it - mainly neurosurgery.

The lifestyle of interventional neurorads is pretty hellacious. The jobs are relatively few, as only very large city centers can sustain a practice.

 

[oopsy]

A fellowship trained neuroendovascular specialist is competent in the same neuroendovascular procedures, whether they be IR, neurosurgery, or neurology trained. It is literally the same fellowship and they are often co-fellows. The complement of their other skills is obviously very different. They all do aneursyms, thrombectomy, AVMs, diagnostic angio, etc. The referral base is dicey, with a likely murkier future for the radiologists as neurology and neurosurgery continue to take turf. Neurosurgery is in the driver's seat. They have the referral base for aneurysms, AVMs, etc, but neurologists are involved in those cases as well and bring expertise of vascular neurology/neurocritical care to the table. Depending on your practice and what they're bringing to the table (ie-stroke volume they're generating for the center), you could be working together or butting heads indefinitely.

Regardless, all procedures are fair game. There are some practices where neurologists are busy doing everything the rad/surgeon does (and maybe none of their medical practice ie-ICU/stroke), and other jobs where the neurologist is hired for stroke call and whatever rare things they catch on call, with the other members of the group (surgeons) taking all the elective aneurysm, avm, etc volume while the neurologist does other stuff. This is a problem intrinsic to the job, and not necessarily the specialty.

If you love the modality, neurosurgery is choice A, neurology probably choice B. That said, you have to a be a surgeon if you do neurosurgery, and it's a long run for a short slide to do a neurosurgical residency to basically be a radiologist. If you choose neurology, you'd do so because you have an interest in this subspecialty, but would also be happy spending a significant percentage of your time with stroke or ICU. They'll make about 1/2- 2/3s what the surgeon makes in the private market/academia, but you'll be a well paid neurologist at the cutting edge of stroke, and you don't have to deal with the rest of the surgical responsibilities.

 

[Phrasing]

A fellowship trained neuroendovascular specialist is competent in the same neuroendovascular procedures, whether they be IR, neurosurgery, or neurology trained. It is literally the same fellowship and they are often co-fellows. The complement of their other skills is obviously very different. They all do aneursyms, thrombectomy, AVMs, diagnostic angio, etc. The referral base is dicey, with a likely murkier future for the radiologists as neurology and neurosurgery continue to take turf. Neurosurgery is in the driver's seat. They have the referral base for aneurysms, AVMs, etc, but neurologists are involved in those cases as well and bring expertise of vascular neurology/neurocritical care to the table. Depending on your practice and what they're bringing to the table (ie-stroke volume they're generating for the center), you could be working together or butting heads indefinitely.

Regardless, all procedures are fair game. There are some practices where neurologists are busy doing everything the rad/surgeon does (and maybe none of their medical practice ie-ICU/stroke), and other jobs where the neurologist is hired for stroke call and whatever rare things they catch on call, with the other members of the group (surgeons) taking all the elective aneurysm, avm, etc volume while the neurologist does other stuff. This is a problem intrinsic to the job, and not necessarily the specialty.

If you love the modality, neurosurgery is choice A, neurology probably choice B. That said, you have to a be a surgeon if you do neurosurgery, and it's a long run for a short slide to do a neurosurgical residency to basically be a radiologist. If you choose neurology, you'd do so because you have an interest in this subspecialty, but would also be happy spending a significant percentage of your time with stroke or ICU. They'll make about 1/2- 2/3s what the surgeon makes in the private market/academia, but you'll be a well paid neurologist at the cutting edge of stroke, and you don't have to deal with the rest of the surgical responsibilities.

So what are the chances of securing a fellowship coming from a neurology background? Seems like they are pretty slim from what I have read.

 

[typhoonegator]

So what are the chances of securing a fellowship coming from a neurology background? Seems like they are pretty slim from what I have read.

If you're a very high quality applicant from a good residency who has done a stroke fellowship or NCC fellowship at a highly respectable place, then you have a decent chance.

 

[Phrasing]

If you're a very high quality applicant from a good residency who has done a stroke fellowship or NCC fellowship at a highly respectable place, then you have a decent chance.

So I'm trying to understand what constitutes a "good residency" would somewhere like Miami or wake be good enough?

 

[typhoonegator]

So I'm trying to understand what constitutes a "good residency" would somewhere like Miami or wake be good enough?

We're talking continuous variables here. Miami or Wake would be fine if you can get good research done and build relationships with some endovascular leaders, and if you can parlay your residency experience into a stroke/ICU fellowship at MGH/JHU/Columbia/Duke/Pitt/Penn/UCLA/UCSF or something like that.

Look, you can do anything from anywhere, and I'm sure someone can find a guy from Wayne State that is now a brilliant endovascular surgeon at Mayo or whatever. But to put yourself in the best position, then you have to play the percentages, which tends to favor those with 1) prestigious training experience, and 2) personal relationships with people invested in their success. This is especially true when coming from neurology going into neuroendovascular, because there are a lot of people who want to get into the field, and not very many spots at neurology-friendly programs (or even overall, honestly).

 

[TUGM]

To answer some questions, from someone currently applying.

NIR is dominated by neurosurgery at this point in time. Neurology probably second. Many old school/west coast and respectable programs still radiology run, but most accept neurologists, save a few exceptions (UTSW, Mallinkrodt/WUSTL, UCSF). It all depends on what spots fill and what spots remain open, which can vary from year to year.

It is tough to get into NIR from neurology - definitely still an uphill battle. As mentioned before, you have to go to a residency and stroke/ICU fellowship somewhere prestigious enough to network with the big names. There are several small programs opening up, but only a few programs that are neurology-friendly program that really provide great training (Pitt, NYU, Mt. Sinai, UCLA, Miami, etc). The key is volume and hands-on experience.

Job Market is okay, most people find jobs they like. Starting salaries typically 350+ in academics, 450+ in private/community settings.

Can't speak about Wake, but Miami has matched every person that wanted to do endovascular for as long as I know (the last 10 years or so).

 

[Alakazam123]

If you're a very high quality applicant from a good residency who has done a stroke fellowship or NCC fellowship at a highly respectable place, then you have a decent chance.

Can I do a neurophysiology fellowship AND a neuro IR fellowship (if I spend extra time during residency sharpening my skills on vascular techniques?)

 

[typhoonegator]

Can I do a neurophysiology fellowship AND a neuro IR fellowship (if I spend extra time during residency sharpening my skills on vascular techniques?)

Tell me what a week of your practice would look like after training.

 

[Alakazam123]

Tell me what a week of your practice would look like after training.

Could I do: Monday, Wednesday, and Friday for Neuromuscular, and Tuesday, Thursday, and the weekends for Neuro IR?

 

[typhoonegator]

Could I do: Monday, Wednesday, and Friday for Neuromuscular, and Tuesday, Thursday, and the weekends for Neuro IR?

No! First, you can't work every day every week. Second, why would you want to sit in neuromuscular clinic when your RVU generation would be much higher doing IR procedures? When are you going to have neuroIR clinic? On Tuesdays? Are you really only going to do one day in the suite each week, on Thursdays? You aren't going to be doing elective cases over the weekend. How are you going to build up your neuroIR referral base with only one day seeing patients and one day doing procedures per week? Are your practice partners in IR going to be OK taking call for you every monday, wednesday, and friday so you can sit in neuromuscular clinic?

 

[Alakazam123]

No! First, you can't work every day every week. Second, why would you want to sit in neuromuscular clinic when your RVU generation would be much higher doing IR procedures? When are you going to have neuroIR clinic? On Tuesdays? Are you really only going to do one day in the suite each week, on Thursdays? You aren't going to be doing elective cases over the weekend. How are you going to build up your neuroIR referral base with only one day seeing patients and one day doing procedures per week? Are your practice partners in IR going to be OK taking call for you every monday, wednesday, and friday so you can sit in neuromuscular clinic?

I apologize if I have upset you. But can you please explain to me how I could get do multiple subspecialties? If it is possible? Bc I really like both.

 

[typhoonegator]

I'm not upset at all! You can do all the fellowships you want, but the reason you don't see people everywhere practicing multiple subspecialties is for the reasons I included in my previous post. People occasionally will practice in related subspecialties that have a lot of overlap, like neuroICU and epilepsy or vascular. But for essentially surgical specialties like neuroendovascular, people neglect to consider the business-side of the equation that governs suite time, referrals, pre-procedure and longitudinal follow-up, acute stroke and SAH call burden, etc. Furthermore, the opportunity-cost of sitting in clinic when you could be building your case-load or doing procedures is substantial. Most neuroendovascular practices or academic divisions are not looking to hire someone part-time, which is essentially what you would be offering them. And I can tell you that if you walked into an endovascular fellowship interview talking about doing both neuromuscular and neuroendovascular, they wouldn't think you were serious enough about your endovascular career. Finally, coming into endovascular from neurology, you're almost certainly going to need to do either an ICU or vascular fellowship first, so now you're talking about three fellowships, with a very long period of time between when you finish residency and when you begin to generate income as an attending -- yet another substantial opportunity-cost.

 

[Alakazam123]

I'm not upset at all! You can do all the fellowships you want, but the reason you don't see people everywhere practicing multiple subspecialties is for the reasons I included in my previous post. People occasionally will practice in related subspecialties that have a lot of overlap, like neuroICU and epilepsy or vascular. But for essentially surgical specialties like neuroendovascular, people neglect to consider the business-side of the equation that governs suite time, referrals, pre-procedure and longitudinal follow-up, acute stroke and SAH call burden, etc. Furthermore, the opportunity-cost of sitting in clinic when you could be building your case-load or doing procedures is substantial. Most neuroendovascular practices or academic divisions are not looking to hire someone part-time, which is essentially what you would be offering them. And I can tell you that if you walked into an endovascular fellowship interview talking about doing both neuromuscular and neuroendovascular, they wouldn't think you were serious enough about your endovascular career. Finally, coming into endovascular from neurology, you're almost certainly going to need to do either an ICU or vascular fellowship first, so now you're talking about three fellowships, with a very long period of time between when you finish residency and when you begin to generate income as an attending -- yet another substantial opportunity-cost.

I understand. Okay, here's the thing, and I might as well be honest. I apologize in advance for sounding like a money grub. However, I want to shoot to make more than 300K in neurology. I have read in many places this is more than possible in a semi-medium to small size cities (Cleveland, Rochester, Madison, etc.). Neuro IR, with all of its procedures is very lucrative AND is of great interest to me because my grandfather suffered a stroke recently and it's made me interested in going into that field. I am interested in neuromuscular because I am personally afflicted with a peripheral neuropathy called Parsonage Turner Syndrome. So I definitely have personal motivations for this beyond just money. However, I want to make a good sum of money. My parents will have grown old by then, and I want to look after them and make sure they are okay. Or at least be able to help pay off their bills and such. I've heard that procedures like EMG and EEG are on the "chopping block" and do not pay as high as they used to, which is why I wanted to do multiple sub-specialties within neurology. I was told in a previous post that I made, that it is possible to be a neuromuscular neurologist and take vascular/stroke calls as well.

 

[typhoonegator]

1) If you're covering a smaller hospital without a vascular neurologist, you could be a general neurologist/neuromuscular neurologist and take stroke call. That isn't very lucrative and can be a lot of work, but if you enjoy the case-mix then that's fine. But there is a huge difference between determining whether someone is eligible for tPA and what you're talking about with a career in endovascular neurosurgery/neuroIR.
2) Endovascular procedures reimburse well currently, with a lot of variation therein depending on practice model, RVU-reimbursement at the hospital/PO level, seniority, and referral base. But there is a lot more to neuroIR than stroke, and being an endovascular specialist is hard work compared with just about every other neurologic specialty, often with frequent and unpredictable call to serve as an offset for the remunerative benefits of the specialty.
3) Everything is on the chopping block, and changes to Medicare reimbursement are very difficult to predict, particularly over the long term. Do not pick your life's work based on whether someone thinks Medicare is going to reimburse less for a NCS than they do currently.
4) There is a limited amount of time in the day. You are very unlikely to future-proof your reimbursement scheme through diversification.

 

[Alakazam123]

1) If you're covering a smaller hospital without a vascular neurologist, you could be a general neurologist/neuromuscular neurologist and take stroke call. That isn't very lucrative and can be a lot of work, but if you enjoy the case-mix then that's fine. But there is a huge difference between determining whether someone is eligible for tPA and what you're talking about with a career in endovascular neurosurgery/neuroIR.
2) Endovascular procedures reimburse well currently, with a lot of variation therein depending on practice model, RVU-reimbursement at the hospital/PO level, seniority, and referral base. But there is a lot more to neuroIR than stroke, and being an endovascular specialist is hard work compared with just about every other neurologic specialty, often with frequent and unpredictable call to serve as an offset for the remunerative benefits of the specialty.
3) Everything is on the chopping block, and changes to Medicare reimbursement are very difficult to predict, particularly over the long term. Do not pick your life's work based on whether someone thinks Medicare is going to reimburse less for a NCS than they do currently.
4) There is a limited amount of time in the day. You are very unlikely to future-proof your reimbursement scheme through diversification.

So is there any real possibility of making over 300K/yr as a neurologist without being a Neuro IR? Do neurohospitalists make that much in medium cities?

 

[Postictal Raiden]

So is there any real possibility of making over 300K/yr as a neurologist without being a Neuro IR? Do neurohospitalists make that much in medium cities?

From my interaction with PP neurologists and neurology residents, 300k is the floor in PP settings in a nonsaturated geography. I know of two academic places that start neurologists at 300k+.

You could also do locum. @neurochica claims that she pulls ~3k/day. If you do that all year long, you could potentially make close to seven figures.

 

[CarlosDanger]

So is there any real possibility of making over 300K/yr as a neurologist without being a Neuro IR? Do neurohospitalists make that much in medium cities?

A couple of anecdotes. I rotated at a community hospital about a 15 min drive from a major city. The physician recruiter told me he has been desperately trying to hire neurohospitalists, offering 350, and they can't fill the positions. I could tell from my rotation that there are administrative frustrations that could make the job less than ideal, and there could be other negatives related to call schedules and patient load that I just wasn't privy to as a med student. Overall though, it didn't seem like a bad gig.

I've also been told by an attending that many neurointensivists can make roughly the same as endovascular attendings, so theres that. We have a real live neurointensivist here, so they can speak to that if they want. NeuroICU is still a similar lifestyle to endovascular from my experience - patients are actively tanking, you're in a lot of high pressure situations, you're still doing a lot of procedures (albeit smaller ones), and hours are very long when you're on.

So there are 2 situations where you could make over 300. My impression is that it's doable, but its not the norm. You have to be ready to work hard and compete for competitive fellowships. I think you can technically still do interventional pain (sounds miserable to me), or any other practice where you've found a nice procedure and enough patients. I'd like to make tons of money too, but if that doesn't pan out at least I'll be doing something where the patients, the research, the cases, and the science are stimulating.

 

[neurochica]

I dont know if this is the thread to discuss this, but when i was in private practice, I knew of an MS doc billing $90k-$120k a MONTH working 4 days a week. I have no idea how much she was collecting from this billing, but even if she was collecting 50%, she was making a good living, minus overhead cost. This was a 7 person neurology group-they hated clinic and thus, I was working the inpatient setting...I always wonder how they could afford me paying me an employed salary of about $350K working 20 weeks (26 contracted work, minus 4 weeks vacation, minus 2 weeks of CME. They were killing it at the clinic. I used to get emails about our productivity every month, and she was not the only one pulling these kind numbers.

 

[Alakazam123]

I dont know if this is the thread to discuss this, but when i was in private practice, I knew of an MS doc billing $90k-$120k a MONTH working 4 days a week. I have no idea how much she was collecting from this billing, but even if she was collecting 50%, she was making a good living, minus overhead cost. This was a 7 person neurology group-they hated clinic and thus, I was working the inpatient setting...I always wonder how they could afford me paying me an employed salary of about $350K working 20 weeks (26 contracted work, minus 4 weeks vacation, minus 2 weeks of CME. They were killing it at the clinic. I used to get emails about our productivity every month, and she was not the only one pulling these kind numbers.

Have you heard of neurohospitalists making that much? Like neuromuscular docs who take a lot of cases, etc.

 

[neurochica]

Hypothetically, if you are willing to work during your week off, then yes, you can make additional income. Everywhere I been employed I been asked if I wanted to do additional Clinic, which for me has always been a no.

 

[Alakazam123]

Hypothetically, if you are willing to work during your week off, then yes, you can make additional income. Everywhere I been employed I been asked if I wanted to do additional Clinic, which for me has always been a no.

So if you're willing to work over time, like, on the weekends, then you have a chance of making that much? Furthermore, how can I do this whole "taking stroke calls" while also being a neuromuscular physician? How do I ask the hospital for that opportunity? Furthermore, aren't there bonuses you can get as well on top of additional hours?

 

[neurochica]

Neurology is a dinosaur field. Most neurologist are old white and hate clinic. The new bread of neurologist enjoy the fast pace inpatient side of neurology. Most Clinic neurologist still take call. Depending on where you go, you can ask to be part of the stroke or call rotation for additional pay. I seen some groups charge hospitals $500-$700 a night just for being on call, plus you get to some rvus. Remember that inpatient work is a pipeline for your Clinic practice ie you see someone with a stroke inpatient and schedule him/her for a follow up with you.
I don’t know many neuromuscular docs doing stroke call. There is plenty of money to be made if you learn the business side of neuromuscular or just being a good physician.

 

[Alakazam123]

Neurology is a dinosaur field. Most neurologist are old white and hate clinic. The new bread of neurologist enjoy the fast pace inpatient side of neurology. Most Clinic neurologist still take call. Depending on where you go, you can ask to be part of the stroke or call rotation for additional pay. I seen some groups charge hospitals $500-$700 a night just for being on call, plus you get to some rvus. Remember that inpatient work is a pipeline for your Clinic practice ie you see someone with a stroke inpatient and schedule him/her for a follow up with you.
I don’t know many neuromuscular docs doing stroke call. There is plenty of money to be made if you learn the business side of neuromuscular or just being a good physician.

Can you pick your hours for "on-call" work? Like, if you finish up neuromuscular or whatever at 5 pm, then offer to work from 6 pm till 12 am every day?

 

[neurochica]

This is something you need to Ask within your group or negotiate in your contract.

 

[typhoonegator]

Can you pick your hours for "on-call" work? Like, if you finish up neuromuscular or whatever at 5 pm, then offer to work from 6 pm till 12 am every day?

Not usually. Most call schedules are set for either the week, the 24h, or the overnight. Some groups do weird things, though. But I don't know anyone who starts their call at midnight when you want to go to sleep. Some groups have just call nights for the week, where several practices or just a single group designates someone to take call for all the providers after hours. So you could get done seeing patients at 5, then start an overnight pager call until the following AM. Do that for a week. You get to pick your on-call weeks/shifts to some degree, but you're not going to be able to avoid all the holidays and summer weekends, etc.

But for the most part, these don't pay very well. Taking a private group call is usually unpaid and everyone just has to do their part a few weeks a year, fielding "emergencies" and refill requests. Now, if you're covering a hospital, then there might be a little per diem, and you'll make some billing money if you go in to the hospital to see consults or admits, etc. There is better money in telestroke, eICU, and in-house call/overnight hospitalist, but for those things its less of a "call" and more of a "shift" where you might be up all night. You wouldn't want to do that and then have a full schedule of patients the next day.

Finally, if there is a good money/work ratio, then any call schedule will get filled pretty easily and no one is going to want to take food off their table to give you more shifts just because you want to make a lot of money. The best way to work the system is to find places where there is no one around to do the work, or if you're a sadist, calls where the work is awful but the money is good. But again, you can't cover a 40 hospital telestroke network every night and expect to be useful at work every day.

 

[Alakazam123]

Not usually. Most call schedules are set for either the week, the 24h, or the overnight. Some groups do weird things, though. But I don't know anyone who starts their call at midnight when you want to go to sleep. Some groups have just call nights for the week, where several practices or just a single group designates someone to take call for all the providers after hours. So you could get done seeing patients at 5, then start an overnight pager call until the following AM. Do that for a week. You get to pick your on-call weeks/shifts to some degree, but you're not going to be able to avoid all the holidays and summer weekends, etc.

But for the most part, these don't pay very well. Taking a private group call is usually unpaid and everyone just has to do their part a few weeks a year, fielding "emergencies" and refill requests. Now, if you're covering a hospital, then there might be a little per diem, and you'll make some billing money if you go in to the hospital to see consults or admits, etc. There is better money in telestroke, eICU, and in-house call/overnight hospitalist, but for those things its less of a "call" and more of a "shift" where you might be up all night. You wouldn't want to do that and then have a full schedule of patients the next day.

Finally, if there is a good money/work ratio, then any call schedule will get filled pretty easily and no one is going to want to take food off their table to give you more shifts just because you want to make a lot of money. The best way to work the system is to find places where there is no one around to do the work, or if you're a sadist, calls where the work is awful but the money is good. But again, you can't cover a 40 hospital telestroke network every night and expect to be useful at work every day.

Dang, all this is so complicated. Wish I could just say, "Hey, I want to work more hours. I'll work on the weekend too." And I am referring more towards working for a hospital, and not a private practice.

 

[Alakazam123]

Not usually. Most call schedules are set for either the week, the 24h, or the overnight. Some groups do weird things, though. But I don't know anyone who starts their call at midnight when you want to go to sleep. Some groups have just call nights for the week, where several practices or just a single group designates someone to take call for all the providers after hours. So you could get done seeing patients at 5, then start an overnight pager call until the following AM. Do that for a week. You get to pick your on-call weeks/shifts to some degree, but you're not going to be able to avoid all the holidays and summer weekends, etc.

But for the most part, these don't pay very well. Taking a private group call is usually unpaid and everyone just has to do their part a few weeks a year, fielding "emergencies" and refill requests. Now, if you're covering a hospital, then there might be a little per diem, and you'll make some billing money if you go in to the hospital to see consults or admits, etc. There is better money in telestroke, eICU, and in-house call/overnight hospitalist, but for those things its less of a "call" and more of a "shift" where you might be up all night. You wouldn't want to do that and then have a full schedule of patients the next day.

Finally, if there is a good money/work ratio, then any call schedule will get filled pretty easily and no one is going to want to take food off their table to give you more shifts just because you want to make a lot of money. The best way to work the system is to find places where there is no one around to do the work, or if you're a sadist, calls where the work is awful but the money is good. But again, you can't cover a 40 hospital telestroke network every night and expect to be useful at work every day.

Also, how do you set up a tele-neurology service. If you are licenced to practice in more than one state, can you accept calls from those states too?

 

[oopsy]

If you want to make 300K, you can do that in a non-major city area (ie-suburbs, or 90% of the country) taking exactly zero call and doing 100% clinic in a private practice, and depending on the locale, perhaps 4 days a week. You don't need to do a high-paying and demanding subspecialty if you've already expressed an interest in living in a smaller/less-dense community. Residents can show you. I literally get emails every day ranging from 250-350k (rarely in the 400s) starting salary for 100% clinic jobs, no stroke, no call, no weekends. Sub-specialty fellowship training not required. If that's what you're looking for (and that's totally fine and what the VAST majority of practicing neurologists are doing), no need to jump through extra hoops. Just do that.

 

[Postictal Raiden]

If you want to make 300K, you can do that in a non-major city area (ie-suburbs, or 90% of the country) taking exactly zero call and doing 100% clinic in a private practice, and depending on the locale, perhaps 4 days a week. You don't need to do a high-paying and demanding subspecialty if you've already expressed an interest in living in a smaller/less-dense community. Residents can show you. I literally get emails every day ranging from 250-350k (rarely in the 400s) starting salary for 100% clinic jobs, no stroke, no call, no weekends. Sub-specialty fellowship training not required. If that's what you're looking for (and that's totally fine and what the VAST majority of practicing neurologists are doing), no need to jump through extra hoops. Just do that.

Thank you for this post.

I was wondering if this type of lifestyle/income necessitates certain fellowships (neurophys/MS/etc...). I’m on the older side and have family to support. The idea of having to do more years of training and delayed gratification is bothering me. On my interview trail, I noticed that most residents end up pursuing fellowships. This compels me to wonder if having a fellowship training will soon become a must have like it is in other fields (rads, path, GS)

 

[Freeinfinity]

Thank you for this post.

I was wondering if this type of lifestyle/income necessitates certain fellowships (neurophys/MS/etc...). I’m on the older side and have family to support. The idea of having to do more years of training and delayed gratification is bothering me. On my interview trail, I noticed that most residents end up pursuing fellowships. This compels me to wonder if having a fellowship training will soon become a must have like it is in other fields (rads, path, GS)

Yep, when I interviewed last year many people seem to go on doing fellowships. This seems to be more of the norm now. However, there are still people that go on directly into private practice. The fellowships are usually just an extra one to two years so it isn't that much longer of a wait. Now if you're telling me an additional 3-4 yrs of fellowship, that's a significant difference, and I wouldn't even consider it unless I really love the subspecialty.

 

[Alakazam123]

If you want to make 300K, you can do that in a non-major city area (ie-suburbs, or 90% of the country) taking exactly zero call and doing 100% clinic in a private practice, and depending on the locale, perhaps 4 days a week. You don't need to do a high-paying and demanding subspecialty if you've already expressed an interest in living in a smaller/less-dense community. Residents can show you. I literally get emails every day ranging from 250-350k (rarely in the 400s) starting salary for 100% clinic jobs, no stroke, no call, no weekends. Sub-specialty fellowship training not required. If that's what you're looking for (and that's totally fine and what the VAST majority of practicing neurologists are doing), no need to jump through extra hoops. Just do that.

If I want to work in a place like Cleveland, and am willing to do stroke or tele-neurology along with neurophys clinic, etc, can I make salary in the low 400,000s? Working in a hospital that is, not at a private practice. I am someone who doesn't mind putting in leg work, and like staying busy.

 

[typhoonegator]

One has to be licensed in all states that they provide telemedicine services. Bit of a bummer as it is a lot of money and paperwork.

 

[MH94]

If I want to work in a place like Cleveland, and am willing to do stroke or tele-neurology along with neurophys clinic, etc, can I make salary in the low 400,000s? Working in a hospital that is, not at a private practice. I am someone who doesn't mind putting in leg work, and like staying busy.

The starting salary for neurohospitalists at a major academic program in one of the biggest cities in the US is 300k, plus benefits etc. they share call on weekdays, so if there's 10 of them, they have one half day of call per week. Call can be busy. Evening/night call taken from home unless tPA, then you have to go in. Round on your patients M-F. Weekend call 3-4 times a year, really busy because you round on everyone's patients.
If you want to make more money in neurology, learn procedures such as EMG, and Botox for headache. Those will bring in a lot of money once you have a patient base. Also, if you like working from home, intra operative monitoring can be quite lucrative.