Why is neurology a low paying field?

[FutureDO2016]

I'm just wondering why cardiologists make around 400 grand a year while neurologists make only 180 grand a year. Is there a reason why neurologists are poorly compensated? Granted cardiologists have 3 more years of advance training but do neurologists that do fellowships in stroke/vascular, headache/pain or other diseases make significantly more?

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[danielmd06]

I'm just wondering why cardiologists make around 400 grand a year while neurologists make only 180 grand a year. Is there a reason why neurologists are poorly compensated? Granted cardiologists have 3 more years of advance training but do neurologists that do fellowships in stroke/vascular, headache/pain or other diseases make significantly more?

The average for neurology is above 180K according to the MGMA data I have seen (more like 250k), but you are correct that we average less than surgical subspecialties and many medical subspecialties.

In my opinion, it boils down to lack of procedures (we are primarily a cognitive field like primary care), and that what procedures we do have are often also performed by other specialties like pulmonology and physiatry (and the market for these services gets split with other folks). EEGs do not really reimburse that much. The imaging that we so prolifically order is all swept up by radiologists (it is rare for neurologists to complete neuroimaging fellowships, own their own MRI/CT scanners, or bill in any way for interpretation of radiological studies). EMG reimbursements have recently been cut by about 50% (!), and home sleep testing (which will continue to grow in usage) is much cheaper than in-lab sleep testing. Bottom line? Salary is often based on income generation, and a neurosurgeon in the OR can make more in twenty minutes than we make all day.

However, the supply/demand ratio for neurologists strongly favors us in the job market, and this has resulted in more recent salary increases than what has traditionally been the norm. Other specialties are increasingly clueless about neurological medicine because they consult like crazy in their training programs, and hospitals need us for accreditation for their "centers of excellence" in epilepsy, stroke, etc.

 

[FutureDO2016]

So what do neurologists make in average if they practice general neurology or if they do a 1-2 year fellowship then what's their average pay?

 

[DIce3]

Do not be concerned about the current differences in income if you are a medical student as physician income will be lowered and normalized. Physicians from different specialties will likely earn nearly the same amount a decade from now. At a minimum, we will all earn less in inflation adjusted dollars.

 

[rafman]

Sorry to kinda divert the topic, but is there a saturation of neurologists in cities? Ie after I finish a neurology residency, what are the chances that I'm able to find a job in a city or suburb, such as Houston, Dallas, Austin, etc?

 

[neurologist]

In my opinion, it boils down to lack of procedures (we are primarily a cognitive field like primary care), and that what procedures we do have are often also performed by other specialties like pulmonology and physiatry (and the market for these services gets split with other folks). EEGs do not really reimburse that much. The imaging that we so prolifically order is all swept up by radiologists (it is rare for neurologists to complete neuroimaging fellowships, own their own MRI/CT scanners, or bill in any way for interpretation of radiological studies). EMG reimbursements have recently been cut by about 50% (!), and home sleep testing (which will continue to grow in usage) is much cheaper than in-lab sleep testing. Bottom line? Salary is often based on income generation, and a neurosurgeon in the OR can make more in twenty minutes than we make all day.

Yeah, but remember that there are "interventional" and "non-interventional" cardiologists. And BOTH of the them make more than us. I can see that for the interventional types, but what, really, does a "non-interventional" cardiologist have or do that we don't? EKG? Echos? Holters? Those are pretty much analogous to EEGs or EMGs in my mind (although I do admit I don't know how much they reimburse, I bet you don't get much for an EKG or a holter). They pretty much just manage meds like we do . . .

Sorry to kinda divert the topic, but is there a saturation of neurologists in cities? Ie after I finish a neurology residency, what are the chances that I'm able to find a job in a city or suburb, such as Houston, Dallas, Austin, etc?

The basic laws of supply and demand apply. There is a saturation of specialists in all desirable cities. You can still find jobs, but it may be a bit harder and they will probably pay less than in crappy cities where nobody wants to go.

 

[danielmd06]

Yeah, but remember that there are "interventional" and "non-interventional" cardiologists. And BOTH of the them make more than us. I can see that for the interventional types, but what, really, does a "non-interventional" cardiologist have or do that we don't? EKG? Echos? Holters? Those are pretty much analogous to EEGs or EMGs in my mind (although I do admit I don't know how much they reimburse, I bet you don't get much for an EKG or a holter). They pretty much just manage meds like we do . . .

Well, they certainly do a lot of volume where I am. Echos ain't cheap, and they'll read a stack of them at a time. Don't forget carotid dopplers, which they also do. Plus you've got AICD's and pacers for the EP folks. Other cardiologists may do vascular work (particularly the legs) and not be taking acute MI call (though I guess you can consider them "interventional"). And, in private groups, you may find people who are seeing and medically managing patients all day, so that the interventional people are in the cath lab all day (and hence, making the major money of the practice). So when the finances are distributed, the work division is taken into account and the non-interventional people may be "over" compensated on purpose for their work floating the interventional arm of the group.

 

[danielmd06]

Sorry to kinda divert the topic, but is there a saturation of neurologists in cities? Ie after I finish a neurology residency, what are the chances that I'm able to find a job in a city or suburb, such as Houston, Dallas, Austin, etc?

Exactly what neurologist said. When I was hunting for jobs, I saw tons and tons of prospects, including in all major cities.

Still, you have to factor in that more desirable areas are usually proportionally more saturated than less desirable areas, and this may thus possibly have effect upon the overall salary, call schedule, and payor mix that you can expect. Supply and demand.

I bet you could find a neurology job in practically any location, though. Provided you weren't too picky about salary. This being said, the lowest paying jobs I saw were always at least 180k.

 

[typhoonegator]

This being said, the lowest paying jobs I saw were always at least 180k.

You've obviously never shopped for a job at a Harvard hospital. You need an R01 to make 180K there.

Hyperbole...a little.

 

[vistaril]

Yeah, but remember that there are "interventional" and "non-interventional" cardiologists. And BOTH of the them make more than us. I can see that for the interventional types, but what, really, does a "non-interventional" cardiologist have or do that we don't? EKG? Echos? Holters? Those are pretty much analogous to EEGs or EMGs in my mind (although I do admit I don't know how much they reimburse, I bet you don't get much for an EKG or a holter). They pretty much just manage meds like we do . . .

Cardiologists who don't do interventional still do a lot of procedures.

 

[Handsome88]

Maybe because it takes 6 years to do cardiology while only 4 years to do neurology?

 

[danielmd06]

You've obviously never shopped for a job at a Harvard hospital. You need an R01 to make 180K there.

Hyperbole...a little.

My condolences.

 

[GalenWoman]

The average for neurology is above 180K according to the MGMA data I have seen (more like 250k), but you are correct that we average less than surgical subspecialties and many medical subspecialties.

In my opinion, it boils down to lack of procedures (we are primarily a cognitive field like primary care), and that what procedures we do have are often also performed by other specialties like pulmonology and physiatry (and the market for these services gets split with other folks). EEGs do not really reimburse that much. The imaging that we so prolifically order is all swept up by radiologists (it is rare for neurologists to complete neuroimaging fellowships, own their own MRI/CT scanners, or bill in any way for interpretation of radiological studies). EMG reimbursements have recently been cut by about 50% (!), and home sleep testing (which will continue to grow in usage) is much cheaper than in-lab sleep testing. Bottom line? Salary is often based on income generation, and a neurosurgeon in the OR can make more in twenty minutes than we make all day.

However, the supply/demand ratio for neurologists strongly favors us in the job market, and this has resulted in more recent salary increases than what has traditionally been the norm. Other specialties are increasingly clueless about neurological medicine because they consult like crazy in their training programs, and hospitals need us for accreditation for their "centers of excellence" in epilepsy, stroke, etc.

MGMA median salary for neuro is 268K

 

[med321]

Maybe because Neurology treatment is slow and less popular.

 

[neurodoc]

I disagree that Neuro is "a low paying field." Compared to what? GP/FP, IM, Peds, or Psychiatry? The median salary for Neuro is higher than those. Compared to the higher paid IM subspecialties like Cards and GI it is lower. Compared to some other IM subspecialties, like Rheum, it is higher. The surgical specialties do have higher median incomes, but that's to be expected given the longer training requirements and higher reimbursement rates for procedures. I certainly do not begrudge neurosurgeons, orthopedists, or cardiothoracic surgeons who earn much more than I do.

There are more specialists (and MDs in general) in urban areas. The fact is that the number of Board Certified Neurologists is still fairly low compared to the "primary care" physicians or Psychiatrists (the other ABPN-certified specialists).

The need for Board Certified Neurologists is increasing due to advances in the treatment of acute stroke, epilepsy, Alzheimer Disease, MS, and even HA. The old joke that Neurologists can diagnose everything but treat nothing no longer even has a kernel of truth.

Neurology residency offers several subspecialty fellowship opportunities for those who wish to extend their practice and gain ABPN certification, e.g. Clinical Neurophysiology, Sleep Medicine, Pain Management, and Addiction Medicine. All of these subspecialties are in demand, and Third Party reimbursement increasingly requires Board Certification.

So, I don't think Neurology is a low paying field at all.

 

[typhoonegator]

I disagree that Neuro is "a low paying field." Compared to what? GP/FP, IM, Peds, or Psychiatry? The median salary for Neuro is higher than those. Compared to the higher paid IM subspecialties like Cards and GI it is lower. Compared to some other IM subspecialties, like Rheum, it is higher. The surgical specialties do have higher median incomes, but that's to be expected given the longer training requirements and higher reimbursement rates for procedures. I certainly do not begrudge neurosurgeons, orthopedists, or cardiothoracic surgeons who earn much more than I do.

So, I don't think Neurology is a low paying field at all.

Thank you for saying this.

You want a guaranteed $400K a year job when you get out? Go to a top 10 law school or become an interventional cardiologist. Like neurology and want to treat neurologic disorders? Be content that you will still be making more money than the vast majority of people you pass on the street. This is not to belittle the real problems in private practice neurology today, but I get so tired of the idea that we somehow should be making more money than other specialties that train longer and/or do more procedures than we do.

 

[danielmd06]

I disagree that Neuro is "a low paying field." Compared to what? GP/FP, IM, Peds, or Psychiatry? The median salary for Neuro is higher than those. Compared to the higher paid IM subspecialties like Cards and GI it is lower. Compared to some other IM subspecialties, like Rheum, it is higher. The surgical specialties do have higher median incomes, but that's to be expected given the longer training requirements and higher reimbursement rates for procedures. I certainly do not begrudge neurosurgeons, orthopedists, or cardiothoracic surgeons who earn much more than I do.

It's all relative. The MGMA data speaks for itself. It's a shorter list to name specialties that make less than us, compared to more. That's all I was saying. I don't begrudge other doctors, either. I love neurology.

 

[Acherona]

There are much fewer physicians within the specialties that make more. So overall, we probably make about average or above the average physician.

 

[neurodoc]

There are much fewer physicians within the specialties that make more. So overall, we probably make about average or above the average physician.

Exactly. Check the national state-by-state listings that show the numbers of ABMS-certified specialists in each field. the big numbers are in IM, FP, Peds, and Psych. and even Gen Surgery. Neuro has relatively low numbers, and lower still in the ABPN subspecialties. All in all the employment prospects are good for salaried jobs.

And another thing, mentioned in a previous post, it seems that a lot of other physicians, including those in IM/FP, don't feel very confident diagnosing and treating neurological problems. I'm not sure why, but in my experience this is quite true, and seems more true today than it was when I was in medical school in the 1980's.

 

[FutureDO2016]

There must be some fellowships neurologists can complete to earn more?

 

[danielmd06]

There must be some fellowships neurologists can complete to earn more?

Historically these would be pain medicine and sleep medicine. Although they have their own foibles and problems, also. Neurointerventional seems to be in a rocky place at the moment, but both it and neurocritical care involve procedures that can elevate your reimbursement.

 

[kumar28]

are sleep fellowships even worth it now??

 

[danielmd06]

are sleep fellowships even worth it now??

In my opinion? Yes.

 

[kumar28]

can u elaborate...as far as reimbursement issues etc..

Thanks

 

[danielmd06]

can u elaborate...as far as reimbursement issues etc..

Thanks

Um, yeah. The field is interesting and the money is still okay. I still will be doing in-lab studies. Just not as much. The PSG's will pay less. The HST reimburses a smaller amount. But there are still tons and tons and tons of patients out there with sleep disordered breathing that really benefit from a trained sleep specialist. I am needed where I am and have great job security.

My clinic is booked solid for over three months out and I am in desperate need of a second sleep medicine physician.

Yeah, I'll make potentially less money than I would have five years ago. Who won't be? It's still a wonderful subspecialty that I wouldn't trade for any other in medicine.

 

[michaelrack]

Um, yeah. The field is interesting and the money is still okay. I still will be doing in-lab studies. Just not as much. The PSG's will pay less. The HST reimburses a smaller amount. But there are still tons and tons and tons of patients out there with sleep disordered breathing that really benefit from a trained sleep specialist. I am needed where I am and have great job security.

My clinic is booked solid for over three months out and I am in desperate need of a second sleep medicine physician.

Yeah, I'll make potentially less money than I would have five years ago. Who won't be? It's still a wonderful subspecialty that I wouldn't trade for any other in medicine.

The problem with HST is that the payment to the physician is approximately the same as a level 3 return outpt visit, and it takes approximately the same amount of time as a level 3 outpatient visit to read. Without a lot of relatively high pay PSG interps, sleep medicine pays about the same as non-procedural neurology or psychiatry...

 

[danielmd06]

The problem with HST is that the payment to the physician is approximately the same as a level 3 return outpt visit, and it takes approximately the same amount of time as a level 3 outpatient visit to read. Without a lot of relatively high pay PSG interps, sleep medicine pays about the same as non-procedural neurology or psychiatry...

Hey Mike.

I still expect to pull more than I would as a general neurologist. You are correct about the HST's, but I still seem to have plenty of patients who qualify for in-lab studies. Maybe it's the patient population where I am? I work for a cardiology practice, so many of my people have heart failure (for instance) and get a full PSG. Also, neurology patients (we also have a full time general neurologist) have more medical qualifications to get them an in-lab.

Financial motives aside, I still love the subject matter, and personally find the patients in adult sleep clinics to be gratifying and fun to take care of. I never enjoyed my neurology clinics as much as I do sleep. So that was a strong motivating factor for me as well.

 

[michaelrack]

Hey Mike.

I still expect to pull more than I would as a general neurologist. You are correct about the HST's, but I still seem to have plenty of patients who qualify for in-lab studies. Maybe it's the patient population where I am? I work for a cardiology practice, so many of my people have heart failure (for instance) and get a full PSG. Also, neurology patients (we also have a full time general neurologist) have more medical qualifications to get them an in-lab.

Financial motives aside, I still love the subject matter, and personally find the patients in adult sleep clinics to be gratifying and fun to take care of. I never enjoyed my neurology clinics as much as I do sleep. So that was a strong motivating factor for me as well.

HST plays a very small role in Mississippi, so I do make much more than a general psychiatrist.
Hopefully the situation in MS won't change too fast.
I think I would probably like seeing psychiatry inpatients/outpatients more than a general sleep clinic. I do sleep clinic about 1.5 days a week and essentially no psychiatry except for some weekend locums coverage of an inpt unit; I couldn't imagine doing a sleep clinic 4-5 days a week. I do like my current balance of clinic/procedures (reading sleep studies)