Neuro Critical Care Salary

[ProffesorOakDO]

Hello, just matched neurology! I was wondering if the NCC pathways offers a higher salary at the end of the fellowship; I love CC and neurology, but I wouldn’t do a 2 year fellowship if it didn’t pay significantly more… I have 300K in student loans here lol. There’s limited data on this; I found some saying 350,000; but I say for it to be worth it, the pay should be inline with Pulm/CC (350-450).

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[Telamir]

In all seriousness, offers I've seen are comparable to pulm crit. 450-500 typically.

 

[CnsCrit]

Pay is highly dependent on region and level of academia. Ranges are huge, you can easily be paid $200k or less at some highly academic places, or closer to $500 at nonacademic places in certain areas of the country. Getting paid more than 500 as a new fellowship grad is probably not possible, if it is you'd be pretty suspicious of how much you're going to be asked to work for that money.

New grads:
Hardcore academics in major cities: $200-250
Academics in smaller cities: $300ish
Privademic: Somewhere between $300-400
Private/nonacademic: 400-500 max -> places like this are for the most part going to be in smaller cities or less conventionally desirable cities (might still be great places to live).

Caveat being the above reflects the east coast, might be slightly different in midwest or west. I'm sure there are some exceptions but this is a rough guide based on my connections in the field.

 

[Postictal Raiden]

Pay is highly dependent on region and level of academia. Ranges are huge, you can easily be paid $200k or less at some highly academic places, or closer to $500 at nonacademic places in certain areas of the country. Getting paid more than 500 as a new fellowship grad is probably not possible, if it is you'd be pretty suspicious of how much you're going to be asked to work for that money.

New grads:
Hardcore academics in major cities: $200-250
Academics in smaller cities: $300ish
Privademic: Somewhere between $300-400
Private/nonacademic: 400-500 max -> places like this are for the most part going to be in smaller cities or less conventionally desirable cities (might still be great places to live).

Caveat being the above reflects the east coast, might be slightly different in midwest or west. I'm sure there are some exceptions but this is a rough guide based on my connections in the field.

How’s the job market?

 

[ProffesorOakDO]

That's not bad, though why does it seem less than Pulm/CC? The Neuro/CC docs I rotated with could do a whole lot of CC procedures.
I'm looking to practice in Ohio or Michigan. A can't fathom taking such a drastic pay cut for academics; esp if am giving two more years in academia up-front.

And If I can ask another question; how much competitive is the fellowship compared to say.. vascular? Like would I have to be doing a lot of research; I'm from a mid-tier program.

 

[Itsarainbow]

That's not bad, though why does it seem less than Pulm/CC? The Neuro/CC docs I rotated with could do a whole lot of CC procedures.
I'm looking to practice in Ohio or Michigan. A can't fathom taking such a drastic pay cut for academics; esp if am giving two more years in academia up-front.

And If I can ask another question; how much competitive is the fellowship compared to say.. vascular? Like would I have to be doing a lot of research; I'm from a mid-tier program.

As far as vascular jobs, there might actually not be a pay bump compared NCC. Not much benefit in terms of salary. Do it only if you really love stroke.

 

[randomguy514]

To provide additional perspective: here on the west coast in academics most NCC attendings start around $250k and as they progress through the academic ladder salaries tend to increase. Most of the mid career or senior NCC faculty make around $400k. This data is publicly available but doesn’t provide a breakdown of how much their salary comes from clinical work vs grant funding or other sources. From my experience, these attendings seem to work a 7 on 14 off schedule but their off time is filled with significant research or admin duties.

 

[CnsCrit]

How’s the job market?

Since I'm in the job market, I'll take a positive outlook. For years people have been saying the NCC market is becoming "saturated," I was even told this as a med student > 5 years ago. There may be some truth to it, but I think prospects are decent overall. Even though you have many divisions with full cohorts of attendings, you still have job openings when people leave for a better opportunity, cut back, or retire - same as any other field. Just from observing job listings and talking to people, I know several big academic places throughout my region have recently hired, It's just that you can't walk into any division you want and ask for a job anymore. 5 or 10 years ago it was easier to do that as even some highly academic places were still building their units from the ground up. Outside academics there are a lot of CSCs in larger community hospitals that are building/expanding NCC so I think those opportunities are decent as well.

That's not bad, though why does it seem less than Pulm/CC? The Neuro/CC docs I rotated with could do a whole lot of CC procedures.
I'm looking to practice in Ohio or Michigan. A can't fathom taking such a drastic pay cut for academics; esp if am giving two more years in academia up-front.

And If I can ask another question; how much competitive is the fellowship compared to say.. vascular? Like would I have to be doing a lot of research; I'm from a mid-tier program.

I don't necessarily think salaries are less than pulm crit. Remember these numbers are for new fellowship grads - who knows how much salaries go up with time for veteran attendings. The drastic pay cut you take with academics holds true for any field. You can be a neurohospitalist in the community and make a lot more than NCC in the right scenario. You can do NM in the community and make more than an academic neurohospitalist, etc.

Competitiveness is on par with vascular. Neurology fellowships (with exception of endovascular and pain) are not particularly competitive overall. It's more dependent on you and where you're willing to move after 4 long years of residency. You don't need a ton of research for fellowship but your interviewers will still try and gauge your interest in the field, research is just one way. Stroke definitely doesn't make more than NCC, but again, its more dependent on region and academia than anything else.

 

[ProReduction]

To provide additional perspective: here on the west coast in academics most NCC attendings start around $250k and as they progress through the academic ladder salaries tend to increase. Most of the mid career or senior NCC faculty make around $400k. This data is publicly available but doesn’t provide a breakdown of how much their salary comes from clinical work vs grant funding or other sources. From my experience, these attendings seem to work a 7 on 14 off schedule but their off time is filled with significant research or admin duties.

Unless you run the show at UCLA and make over $1,000,000: 'Paul Vespa' search results | Transparent California

 

[415kid]

Unless you run the show at UCLA and make over $1,000,000: 'Paul Vespa' search results | Transparent California

View attachment 368159

WTF... how?

 

[Aldertonghen]

Since I'm in the job market, I'll take a positive outlook. For years people have been saying the NCC market is becoming "saturated," I was even told this as a med student > 5 years ago. There may be some truth to it, but I think prospects are decent overall. Even though you have many divisions with full cohorts of attendings, you still have job openings when people leave for a better opportunity, cut back, or retire - same as any other field. Just from observing job listings and talking to people, I know several big academic places throughout my region have recently hired, It's just that you can't walk into any division you want and ask for a job anymore. 5 or 10 years ago it was easier to do that as even some highly academic places were still building their units from the ground up. Outside academics there are a lot of CSCs in larger community hospitals that are building/expanding NCC so I think those opportunities are decent as well.



I don't necessarily think salaries are less than pulm crit. Remember these numbers are for new fellowship grads - who knows how much salaries go up with time for veteran attendings. The drastic pay cut you take with academics holds true for any field. You can be a neurohospitalist in the community and make a lot more than NCC in the right scenario. You can do NM in the community and make more than an academic neurohospitalist, etc.

Competitiveness is on par with vascular. Neurology fellowships (with exception of endovascular and pain) are not particularly competitive overall. It's more dependent on you and where you're willing to move after 4 long years of residency. You don't need a ton of research for fellowship but your interviewers will still try and gauge your interest in the field, research is just one way. Stroke definitely doesn't make more than NCC, but again, its more dependent on region and academia than anything else.

This is very helpful, thanks for the insight.

I’m a PGY-1 currently, loved my MICU rotation recently, and am strongly considering doing NCC after residency as a result. However, in my case I kind of have to pay some hefty family loans pretty soon (because of which I was previously considering other high paying fields like pain in the past), and so I’ll probably have to work for 3-4 years as a neurohospitalist in the boonies after residency. If I decide to do NCC after that, would this 3 year hiatus significantly affect my chances to get into a top NCC program (with good research opportunities)? I am eventually looking to get into academics, so this would be important for me.

 

[ProReduction]

WTF... how?

Not sure. But a lucky guess would be the following. Credential your fellows as "Instructors" to bill for critical care time maxed out at 1 hour per patient on a full unit daily, that way you get to bill and capture RVUs for all their notes as the attending, keep a full unit with no empty beds ever (likely have many patients in the unit that do not need to be there), record continuous 24 hour EEG on many patients that do not need it (and make sure the ICU team not epilepsy gets the RVU for the reads), have advanced monitoring, A-lines, and CVLs on every single patient in the unit and "bill" for it as if you were actually there during the critical portion of the procedure. Be "on-service" most of the year. Do all of this and in the era of eat what you kill RVU incentivized UC health system compensation, you too can make 7 figures in NCC. Check your ethics at the door.

 

[CnsCrit]

This is very helpful, thanks for the insight.

I’m a PGY-1 currently, loved my MICU rotation recently, and am strongly considering doing NCC after residency as a result. However, in my case I kind of have to pay some hefty family loans pretty soon (because of which I was previously considering other high paying fields like pain in the past), and so I’ll probably have to work for 3-4 years as a neurohospitalist in the boonies after residency. If I decide to do NCC after that, would this 3 year hiatus significantly affect my chances to get into a top NCC program (with good research opportunities)? I am eventually looking to get into academics, so this would be important for me.

One option is to go straight through NCC fellowship and take a nonacademic job which will pay better than neurohospitalist anyways, then go back to academics. Working as an attending for a couple years shouldn't disadvantage your fellowship app, but in neurology it's unusual so you'd want to have some kind of explanation. Remember there are a lot of great fellowships so if you're flexible geographically you should be fine.

If you have student loan debt and your goal is academics, your best financial move is to go straight through fellowship and not take a job just to pay down debt. You would have 6 years of PSLF payments by the end of fellowship, and you make the rest during the first 4 years of attendinghood and be done with it.

 

[Aldertonghen]

One option is to go straight through NCC fellowship and take a nonacademic job which will pay better than neurohospitalist anyways, then go back to academics. Working as an attending for a couple years shouldn't disadvantage your fellowship app, but in neurology it's unusual so you'd want to have some kind of explanation. Remember there are a lot of great fellowships so if you're flexible geographically you should be fine.

If you have student loan debt and your goal is academics, your best financial move is to go straight through fellowship and not take a job just to pay down debt. You would have 6 years of PSLF payments by the end of fellowship, and you make the rest during the first 4 years of attendinghood and be done with it.

Thanks for the explanation. Like you said it is unusual but I do have a reason (my loans are more family loans- and they’re a lot more than my student loans unfortunately- although not sure if I’d say that in a fellowship iv). I’m not restricted geographically, although I would prefer a warmer place.

 

[mid|ine]

That's not bad, though why does it seem less than Pulm/CC? The Neuro/CC docs I rotated with could do a whole lot of CC procedures.
I'm looking to practice in Ohio or Michigan. A can't fathom taking such a drastic pay cut for academics; esp if am giving two more years in academia up-front.

And If I can ask another question; how much competitive is the fellowship compared to say.. vascular? Like would I have to be doing a lot of research; I'm from a mid-tier program.

Let me know if you would be interested in talking about a spot in Cincinnati. You can DM me.

 

[oopsy]

NCC fellowship is a buyers market. I dont remember what this year's numbers were, but last year, many programs left with empty slots. I mean like 10-20% of slots open.

Job environment is encouraging, not like stroke/general neuro, but you can be in whatever big city you want to be in if location is #1. If you want academic plus particular city, that can be challenging. But private opportunities abound.

Pay: Academic pay varies, but most academic jobs I looked at pay 275-325/year (~16-20 weeks). Private pay ~400-425/year start new grad (26 weeks).

Lifestyle: Plus and minus with shift work and being on for the whole week, but keep in mind, unlike stroke/neurohospitalist, you dont have to take any **** ED phone calls and you are generally working with APPs as first tier of defense. I stopped taking stroke/ED call (so painful) once we developed an ICU-moonlighting role at our institution.

 

[Postictal Raiden]

NCC fellowship is a buyers market. I dont remember what this year's numbers were, but last year, many programs left with empty slots. I mean like 10-20% of slots open.

Job environment is encouraging, not like stroke/general neuro, but you can be in whatever big city you want to be in if location is #1. If you want academic plus particular city, that can be challenging. But private opportunities abound.

Pay: Academic pay varies, but most academic jobs I looked at pay 275-325/year (~16-20 weeks). Private pay ~400-425/year start new grad (26 weeks).

Lifestyle: Plus and minus with shift work and being on for the whole week, but keep in mind, unlike stroke/neurohospitalist, you dont have to take any **** ED phone calls and you are generally working with APPs as first tier of defense. I stopped taking stroke/ED call (so painful) once we developed an ICU-moonlighting role at our institution.

Do these jobs require taking stroke alert calls (usually via tele)? Are you completely off when off?

I am a neurohospitalist, and though I like my job, I sometimes contemplate the idea of going back and doing a NCC fellowship to escape these undifferentiated, nebulous weakness/dizziness/encephalopathy consults.

 

[CnsCrit]

Do these jobs require taking stroke alert calls (usually via tele)? Are you completely off when off?

I am a neurohospitalist, and though I like my job, I sometimes contemplate the idea of going back and doing a NCC fellowship to escape these undifferentiated, nebulous weakness/dizziness/encephalopathy consults.

Usually no stroke call or teleneuro required. Because you're working at CSCs for the most part, dedicated stroke teams are already in place. Off when off depends on the job, but usually yes. The caveat is that most people are working towards gaining protected time through research or leadership roles so they may be voluntarily doing other stuff in order to get that time. Even in academics in a lot of places its ok if you're full time clinical, but most people eventually want to transition to other roles that give some fraction of FTE. If you are pure private practice or nonacademic hospital employed then obviously yes, off when off always - but NCC is fairly academic overall and although there are private jobs they are a little less common.

I will say the neurohospitalist job market seems overall better than NCC and I think the pay is pretty similar, but in terms of pathology/interesting cases its hard to beat NCC.

 

[ProReduction]

Usually no stroke call or teleneuro required. Because you're working at CSCs for the most part, dedicated stroke teams are already in place. Off when off depends on the job, but usually yes. The caveat is that most people are working towards gaining protected time through research or leadership roles so they may be voluntarily doing other stuff in order to get that time. Even in academics in a lot of places its ok if you're full time clinical, but most people eventually want to transition to other roles that give some fraction of FTE. If you are pure private practice or nonacademic hospital employed then obviously yes, off when off always - but NCC is fairly academic overall and although there are private jobs they are a little less common.

I will say the neurohospitalist job market seems overall better than NCC and I think the pay is pretty similar, but in terms of pathology/interesting cases its hard to beat NCC.

Not that @CnsCrit was saying differently, but the mode for faculty members with even a single U/R award in academic Neurocritical Care divisions is Zero. Many of the largest academic NCC divisions in the U.S. have no R/U awardees on faculty. The number of Neurointensivists with consistent funding is even smaller. Buy-down time with research is very rare in NCC. Most buy-down time is via administrative duty: Clerkship director, Fellowship program director, Medical Director, etc. To have a long career in NCC you really need to be clinically focused and enjoy seeing patients.
In terms of interesting pathology you have to also remember that for every super interesting case you will admit 9 stinkers: 3 Neurosurgery post-ops needing a sitter, 1 transiently hypotensive neuro floor patient, 2 post-TNK stroke patient with an average NIHSS of 1, 1 pseudoseizure status patient . . . better than a Neurohospitalist list but it is not all severe TBI, high grade SAH, complicated SCIs.

 

[Telamir]

It's all hydroponics.

 

[Aldertonghen]

Not that @CnsCrit was saying differently, but the mode for faulty members with even a single U/R award in academic Neurocritical Care divisions is Zero. Many of the largest academic NCC divisions in the U.S. have no R/U awardees on faculty. The number of Neurointensivists with consistent funding is even smaller. Buy-down time with research is very rare in NCC. Most buy-down time is via administrative duty: Clerkship director, Fellowship program director, Medical Director, etc. To have a long career in NCC you really need to be clinically focused and enjoy seeing patients.
In terms of interesting pathology you have to also remember that for every super interesting case you will admit 9 stinkers: 3 Neurosurgery post-ops needing a sitter, 1 transiently hypotensive neuro floor patient, 2 post-TNK stroke patient with an average NIHSS of 1, 1 pseudoseizure status patient . . . better than a Neurohospitalist list but it is not all severe TBI, high grade SAH, complicated SCIs.

It’s not the patient list that’s bothersome though- I mean that list sounds pretty good. Cleaning up NeuroIR and neurosurgery’s mess is in my institution a far bigger problem.

 

[CnsCrit]

Not that @CnsCrit was saying differently, but the mode for faculty members with even a single U/R award in academic Neurocritical Care divisions is Zero. Many of the largest academic NCC divisions in the U.S. have no R/U awardees on faculty. The number of Neurointensivists with consistent funding is even smaller. Buy-down time with research is very rare in NCC. Most buy-down time is via administrative duty: Clerkship director, Fellowship program director, Medical Director, etc. To have a long career in NCC you really need to be clinically focused and enjoy seeing patients.
In terms of interesting pathology you have to also remember that for every super interesting case you will admit 9 stinkers: 3 Neurosurgery post-ops needing a sitter, 1 transiently hypotensive neuro floor patient, 2 post-TNK stroke patient with an average NIHSS of 1, 1 pseudoseizure status patient . . . better than a Neurohospitalist list but it is not all severe TBI, high grade SAH, complicated SCIs.

I completely agree. I don't have the numbers but I think in my neck of the woods there must be more than average pursuing research time. Overall though, most are more successful through the admin/leadership route. And some are doing research in their off time just because they want to and have the time, but don't necessarily have a big grant. I don't think it's particularly different than any other field, a lot of people want protected time regardless of inpatient or outpatient. Some would say to have a long career you need some time to do other things given how demanding service can be, but plenty of people are also happy to be very clinically focused, I think everyone is different and I've met both types of people.

I got good advice once from a mentor that in any subspecialty you should think of the most mundane cases and make sure you're ok seeing that patient. If thinking about that makes you wanna pull your hair out then you should probably move on.

 

[ProReduction]

I got good advice once from a mentor that in any subspecialty you should think of the most mundane cases and make sure you're ok seeing that patient. If thinking about that makes you wanna pull your hair out then you should probably move on.

Absolutely brilliant advice

 

[xenotype]

There is a trend in medium sized community hospitals (200-400 beds) of trying to build out comprehensive centers and neuroICU is part of that. The stroke call can be completely and totally handled by teleneuro- usually big outside company like SOC, access, TS, blue sky etc and these hospitals greatly tend to prefer this, especially since larger hospital conglomerates may own a piece of or have strategic agreements with these companies now. There will be some growth in community opportunities but several caveats: bread and butter as others say is majority babysitting cases. These hospitals have a very low threshold for ICU admission as it bills better and want to keep the unit full, so even complete BS patients with BP 200 and headache might get foisted on you (HCA, for example).

As for pay 300k in academics is obviously better than 220k. In the community it is going to be more like 350k for neurohospitalist/busy outpt/vascular vs 400k for neuroICU, a smaller gap but probably still a little bit better for about the same amount of work. The downside will be that the outpatient neurologist can find a job literally anywhere, the market will have a lot fewer choices for neuroICU, and some of these may force you to be the neurohospitalist too if the unit is too small/not busy. I will say I think the job market for neurohospitalist work has tightened significantly as teleneuro has scooped up 100% of the smaller hospitals, and even larger ones are back and forth about whether they want to pay someone in house or just have teleneuro cover everything. A lot of neuroICU folks have ended up doing teleneuro anyways, and they don't get paid any differently than anyone else doing it. Obviously if you combine teleneuro with off weeks from the ICU you can make massive amounts of money, but this is a terrible lifestyle I'd never be willing to do.

 

[mcribbits]

I recently completed my job search. I looked at the west coast and east coast, and looked at private and privademic jobs.

At least for the first job as a junior attending, both private practice and privademics on either coast within 1.5 hours rush hour commute from a major metro paid around 350-365k base salary with much wider variations in bonus structure. If you went out into more rural areas further away from a major metro, that’s where I saw base salary reach 400k+

What I ended up getting was around 350k with the potential to make up to around 40-60k extra based on various targets. Also got other things like a signing bonus, relocation allowance, training stipend and some loan repayment assistance.

I will say I think the job market is tighter than I thought it would be. Big cities are mostly saturated, and the big city jobs I did find came with some sort of catch. Rural jobs are the most prevalent, and there are still a very healthy amount of jobs is smaller metros and more suburban areas. I ultimately am living in a big metro but commuting out a decent ways for the time I’m on service to get to work in a suburban/smaller metro setting.