Average neurologist salary (non academic)

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Epic786

Epic786

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Can you guys mention about average neurologists salary in non academic outpatient/inpatient setting? Thanks
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Search the forum before posting something like this that's been discussed ad nauseum.
 
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300k-350k...

Not sure why neuro is not more competitive than it is. You are a specialist after just 4 years and salary is not too shabby either. Midlevel encroachment is not a big thing in neuro since the subject matter is very complex.
 
According to MGMA the median is $290k in the East coast, $307k in Midwest, $318k in the South, $296k West coast for general neurology and around $75k higher for stroke

You should also realistically expect to do a fellowship if you go into neuro. Around 80-90% of neuro grads these day do one
 
kirktodd0 said:
According to MGMA the median is $290k in the East coast, $307k in Midwest, $318k in the South, $296k West coast for general neurology and around $75k higher for stroke

You should also realistically expect to do a fellowship if you go into neuro. Around 80-90% of neuro grads these day do one
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Do people do the stroke fellowships as a one year to two year (one year research) ?
 
kirktodd0 said:
According to MGMA the median is $290k in the East coast, $307k in Midwest, $318k in the South, $296k West coast for general neurology and around $75k higher for stroke

You should also realistically expect to do a fellowship if you go into neuro. Around 80-90% of neuro grads these day do one
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Why should we expect to do a fellowship in neurology? Just curious because I am considering general neurology fairly heavily at the moment. Also, if we should expect to do this, how competitive are the different fellowship pathways in neurology and which are most in demand?

Thanks!
 
EmilKraepelin55 said:
Why should we expect to do a fellowship in neurology? Just curious because I am considering general neurology fairly heavily at the moment. Also, if we should expect to do this, how competitive are the different fellowship pathways in neurology and which are most in demand?

Thanks!
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Doing a fellowship is not a requirement at all. One of my upper classmates opted out on fellowship and was still able to get decent job offers in large metropolitan areas in the West.

One reason I see why most residents apply for fellowship is that residency is heavily inpatient focus while most subspecialties are outpatient based. One example is EMG. Unless you do few electives in neuromuscular or neurophysiology, you won’t have An adequate experience doing EMGs coming out of residency.

Another reason is the peer pressure. Most of your classmates will be applying to fellowships and you’ll feel “missing out” not doing the same, specially that most fellowships are short duration and easy to match into.

Also from my observation, there’s a disproportionately high number of neurology residents who want to do academia compared to other fields.

Finally some gig require fellowship training. Neuro critical care or stroke director positions come to mind.

Overall, people in neurology do fellowships because they want to, not because they need to. It’s not like radiology or pathology where unless you are fellowship trained you won’t find a job. It’s more like IM, where the field is very broad and doing a fellowship would help you focus on your area of interest.
 
EmilKraepelin55 said:
Why should we expect to do a fellowship in neurology? Just curious because I am considering general neurology fairly heavily at the moment. Also, if we should expect to do this, how competitive are the different fellowship pathways in neurology and which are most in demand?

Thanks!
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You don't have to do a fellowship. There was usually one person or so per class where I trained that didn't do one.

Off the top of my head, reasons to do a fellowship include: you will be more desirable if looking to join a large group, especially in popular/competitive metro areas; you want to do academics; you want to see less general neurology
 
Ibn Alnafis MD said:
One reason I see why most residents apply for fellowship is that residency is heavily inpatient focus while most subspecialties are outpatient based. One example is EMG. Unless you do few electives in neuromuscular or neurophysiology, you won’t have An adequate experience doing EMGs coming out of residency.
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Yes, this too. Good point.
 
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EmilKraepelin55 said:
Why should we expect to do a fellowship in neurology? Just curious because I am considering general neurology fairly heavily at the moment. Also, if we should expect to do this, how competitive are the different fellowship pathways in neurology and which are most in demand?

Thanks!
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You don't have to at all. You will have plenty of job offers regardless.

But even if you want to do general neurology, a fellowship offers a couple of advantages.

One: you get a chance to develop a billable skill. It's unusual to have enough training in residency to be able to perform EEG, EMG, botox, etc independently. Getting fellowship training in one or more of those areas ensures that you'll be able to be credentialed in them for hospitals and not run into as many problems with reimbursement for them, and as a bonus you get to learn how to do them competently (instead of just going off the extensive experience that some pharma-sponsored weekend workshop provides like many general neurologists do with botox). That allows you to do something fun and different from your regular clinic, and may also improve your bottom line.

Two: you can set up your clinic to have as much of a focus as you and your practice group want you to have. If you want to see everything but particularly enjoy, say MS, then you can see 50% or 75% general neurology and have your partners refer their surplus or more complex MS patients to you, perhaps on a dedicated day where you have staff set up to streamline MS things like cog testing or OCT. Same with epilepsy, etc. You can still have all the variety of a general neurologist but develop a particular expertise which can be satisfying not only intellectually, but in terms of building reputation in the community and in terms of feeling like you're really *good* at something.
 
I agree with many of the points above in regard to the advantages of doing a fellowship. I was interested in general neurology initially and have put in significant work during residency to make this happen (70 EMG during PGY3, reading most EEGs on our inpatients, taking initiative to follow clinic patients, reading a ton, etc).

That being said, I think most general neurologists coming out of fellowship are going to be incompetent at “doing it all”. I have wrestled with this question for some time now. Each field of neurology is getting so complex with increasing therapeutic options that becoming proficient in managing these drugs and associated complications is unrealistic for a generalist. Further, the rates of misdiagnosis and inaccurate interpretations of paraclinical testing in the community is concerning. Anecdotally we have all see patients harmed by this.

However, there are certainly skilled general neurologists who can do this competently, but they typically have had the luxury of being in the field over many years, where they can slowly adapt to new changes in the field.

I think that most graduates can go on to be effective pure neurohospitalists as long as they know when to send patients to higher levels of care and had excellent residency training. I also think that most neurologists who want to do outpatient medicine should strongly consider doing a fellowship. In fact, I have thought about having “tracks” in residency of inpatient versus outpatient as well since the split is becoming more definite in recent years.

I am curious to hear what you all think!
 
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Spinothalamic said:
Each field of neurology is getting so complex with increasing therapeutic options that becoming proficient in managing these drugs and associated complications is unrealistic for a generalist.
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This is certainly true to an extent. I think MS is a great example of this.

Thama said:
as a bonus you get to learn how to do them competently (instead of just going off the extensive experience that some pharma-sponsored weekend workshop provides like many general neurologists do with botox).
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Anyone who does EMG should also be able to do botox for spasticity. Also, botox for migraine is not difficult and a weekend course would suffice for learning it.

On the other hand, botox for things like cervical dystonia, hemifacial spasm, etc. requires some skill and extra training as part of a fellowship would definitely come in handy.
 
Agree with the BTX for migraine part. On the other hand, BTX for spasticity can get quite a bit more complex than for cervical dystonia, bleph, etc. The EMG guidance is just a checkpoint to know you're in the right muscle.
 
Spinothalamic said:
Further, the rates of misdiagnosis and inaccurate interpretations of paraclinical testing in the community is concerning. Anecdotally we have all see patients harmed by this.
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Agreed. The quality of neurodiagnostics can vary tremendously amongst non-fellowship neurologists.

Personally for me, my EMG/EEG fellowship allows me to do different things than just seeing patients non stop in clinic or on rounds day in day out. I can alos take of care of my patients in this regards, without having to refer them out for this. Fellowship also allows you to become more specialized and focus more on things that you like whether that be MS, movements disorders, headache, or even sleep. When I started early in my practice, I was not very comfortable with MS and would frequently refer these patients out. It has taken me some time to become more comfortable with all the new MS meds and therapies available. But when it still comes to the more aggressive cases that require infusions with biologics and/or monoclonal antibodies, I still refer these out to neuro-immunology.

All in all, I would definitely recommend a fellowship.
 
Neurogeneral said:
Agreed. The quality of neurodiagnostics can vary tremendously amongst non-fellowship neurologists.

Personally for me, my EMG/EEG fellowship allows me to do different things than just seeing patients non stop in clinic or on rounds day in day out. I can alos take of care of my patients in this regards, without having to refer them out for this. Fellowship also allows you to become more specialized and focus more on things that you like whether that be MS, movements disorders, headache, or even sleep. When I started early in my practice, I was not very comfortable with MS and would frequently refer these patients out. It has taken me some time to become more comfortable with all the new MS meds and therapies available. But when it still comes to the more aggressive cases that require infusions with biologics and/or monoclonal antibodies, I still refer these out to neuro-immunology.

All in all, I would definitely recommend a fellowship.
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Are there any pros to being a general neurologist? I'm leaning towards no fellowship (assuming I match) for a few reasons, one large one is missing out on attending salary for a year. As a non-trad with boatloads of debt I can't help but factor that into things. One of mentors is a general neurologists at a smaller midwest city center and he is still able to do most things (from what he's told me). If you aren't trying to go big city living is it plausible? Thanks
 
Chibucks15 said:
Are there any pros to being a general neurologist? I'm leaning towards no fellowship (assuming I match) for a few reasons, one large one is missing out on attending salary for a year. As a non-trad with boatloads of debt I can't help but factor that into things. One of mentors is a general neurologists at a smaller midwest city center and he is still able to do most things (from what he's told me). If you aren't trying to go big city living is it plausible? Thanks
Click to expand...

As discussed above, you can still do a lot of general neurology but have a subspecialty focus with fellowship training. Keeping up with general neurology can add variety and be intellectually stimulating. The only pros to foregoing fellowship as far as I am concerned would be that first year of salary and I suppose if you didn’t want to have “expertise” in something so you could always throw your hands up and say “you’re complicated—you need to see a subspecialist.”

If you want to do general neurology and perform EMG/EEG without fellowship then in my opinion you should have months and months of experience during residency dedicated to neurophys and probably just focus on one of those disciplines. Otherwise, the chance of patient harm/unnecessary AED/misdiagnosis is too high the way I see it.
 
Chibucks15 said:
Are there any pros to being a general neurologist? I'm leaning towards no fellowship (assuming I match) for a few reasons, one large one is missing out on attending salary for a year. As a non-trad with boatloads of debt I can't help but factor that into things. One of mentors is a general neurologists at a smaller midwest city center and he is still able to do most things (from what he's told me). If you aren't trying to go big city living is it plausible? Thanks
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The pros are like you said you will not lose one year of attending salary and can still have a decent starting salary. I think that in smaller cities, the hospitals and/or systems will not be as picky in terms of wanting one to have a fellowship to do emg, Eeg, stroke call, etc.

However, I think that unless your residency allows you lots of flexibility in terms of taking lots of electives in terms of subspecialties and neurodiagnostics, it would be very difficult and frankly in my opinion, very impractical to gain enough experience to become competent enough to do neurodiagnostics (both emg and eeg). I mean, you can probably read routine EEGs but definitely not long term EEGs and I think you would be unlikely to be able to do EMGs competently.

At our program, we had outside resident rotators from DO neurology programs. There programs would not focus on inpatient neurology like most ACGME programs, giving them lots of clinic time and electives. But even their residents would tend to go into some type of fellowship.

I have also come across older community neurologists who have no fellowship training but through grandfathered experience exceptions, have been able to become boarded in clinical Neurophysiology, sleep medicine, vascular neurology, etc. But the conditions and circumstances of their training are usually different from how things are done now.
 
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Neurogeneral said:
However, I think that unless your residency allows you lots of flexibility in terms of taking lots of electives in terms of subspecialties and neurodiagnostics, it would be very difficult and frankly in my opinion, very impractical to gain enough experience to become competent enough to do neurodiagnostics (both emg and eeg). I mean, you can probably read routine EEGs but definitely not long term EEGs and I think you would be unlikely to be able to do EMGs competently.
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I agree. I'm only a PGY-2, but from what I'm observing not all EEGs are created equally. LTM/ICU/IO EEGs are a total different animal from your average routine spot EEG. Although my program is extremely inpatient heavy (more than two third of the residency is inpatient), we still have built-in EMU rotations. Still, my graduating seniors feel inadequate reading complicated EEGs. EMG is even worse. Zero exposure for it on the inpatient service and doing a couple months elective in it is simply not enough.
 
Agree with all of the above. If interested in neurodiagnostics, you should really do a fellowship. And you should pick either epilepsy or neuromuscular as clinical neurophysiology is a dying fellowship (for reasons stated in other threads).

For the very motivated resident, I think it's possible to come out of training and be competent at reading routine 2 hour outpatient EEGs or basic EMG studies (like carpal tunnel syndrome), but probably nothing more complicated then that. It's very easy to misdiagnose people when doing these tests if you don't know what you're doing.
 
In my opinion you do not need a fellowship to get a general neurologist job and if you residency is inpatient heavy you do not need a stroke fellowship either.

In outpatient setting you cannot see general neurology patients forever. About 50% patients are functional or have underlying anxiety or psych issues.

Our department is asking Neuro Hospitalist to be fellowship trained in stroke and in that case a fellowship does come handy.

in terms of salary, can anyone comment if 285k is a good starting salary for north east for outpatient ?
 
Splenda88 said:
300k-350k...

Not sure why neuro is not more competitive than it is. You are a specialist after just 4 years and salary is not too shabby either. Midlevel encroachment is not a big thing in neuro since the subject matter is very complex.
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i agree. Same thing with allergy which has the same pay as neuro and the allergy lifestyle is honestly rivaled by very few
 
Epic786 said:
in terms of salary, can anyone comment if 285k is a good starting salary for north east for outpatient ?
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There's alot you need to consider before determining if this is favorable. Academic or not? Rural or urban? Employed or private with partnership track? How much admin time? How much call?

Any production based incentive beyond your base salary? If so, then collections vs RVU? If RVU, then you need to look at $/wRVU and wRVU threshold you need to cross before you get into bonus territory.

Overall, 285 is a little below average, but it could be a good offer depending on all the other variables above.
 
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GuillainMollaret said:
There's alot you need to consider before determining if this is favorable. Academic or not? Rural or urban? Employed or private with partnership track? How much admin time? How much call?

Any production based incentive beyond your base salary? If so, then collections vs RVU? If RVU, then you need to look at $/wRVU and wRVU threshold you need to cross before you get into bonus territory.

Overall, 285 is a little below average, but it could be a good offer depending on all the other variables above.
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No call, weekends off.
 
Epic786 said:
No call, weekends off.
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Is the initial salary completely guaranteed? And for how long? How many patients are you expected to see on daily/weekly basis? What is your compensation for each wRVU generated? Is this in a large metro or small city/town?
 
Epic786 said:
In my opinion you do not need a fellowship to get a general neurologist job and if you residency is inpatient heavy you do not need a stroke fellowship either.
Click to expand...

Agreed. We recently had a chief get an academic hospitalist job (at a less prestigous place) right out of residency. I would say you should do a stoke fellowship mainly if you a) are very interested in stroke and want to do academics, or b) are interested in being a stroke director somewhere.

I don't know what community salaries are for neuro-hospitalists right out of residency, but I have some friends graduating from medicine at the end of the month and starting out around $330K for 7 on/7 off, 7a-5p inpatient gigs with no call/nights

Chibucks15 said:
Are there any pros to being a general neurologist? I'm leaning towards no fellowship (assuming I match) for a few reasons, one large one is missing out on attending salary for a year
Click to expand...

Lots of community hospitals have small/very small neurology departments and would likely happily take you. You can do a consult-only job - the happiest inpatient neurologists I've met have been consult-only. If you want to manage your own general neurology inpatient service, that's probably a different matter.

Spinothalamic said:
In fact, I have thought about having “tracks” in residency of inpatient versus outpatient as well since the split is becoming more definite in recent years.
Click to expand...

This is actually already a thing, de facto anyway. On the interview trail I was struck by the enormous variation in inpatient vs outpatient workloads between programs, and realized there are there are moderately big-name academic neurology programs that do not have general inpatient services. At my program, we spend about 20% of our total time managing the inpatient general and inpatient VA services; one program I interviewed at without those services was majority-outpatient every year of residency.


For me personally (early on in residency) I'm also weighing a general (inpatient) neurology career against doing a fellowship. We have two months each of EEG/EMU and EMG and about 6 months of elective, and I'm planning on spending a few of those months on additional EEG/neurophys rotations.
 
mrbreakfast said:
Agreed. We recently had a chief get an academic hospitalist job (at a less prestigous place) right out of residency. I would say you should do a stoke fellowship mainly if you a) are very interested in stroke and want to do academics, or b) are interested in being a stroke director somewhere.

I don't know what community salaries are for neuro-hospitalists right out of residency, but I have some friends graduating from medicine at the end of the month and starting out around $330K for 7 on/7 off, 7a-5p inpatient gigs with no call/nights



Lots of community hospitals have small/very small neurology departments and would likely happily take you. You can do a consult-only job - the happiest inpatient neurologists I've met have been consult-only. If you want to manage your own general neurology inpatient service, that's probably a different matter.



This is actually already a thing, de facto anyway. On the interview trail I was struck by the enormous variation in inpatient vs outpatient workloads between programs, and realized there are there are moderately big-name academic neurology programs that do not have general inpatient services. At my program, we spend about 20% of our total time managing the inpatient general and inpatient VA services; one program I interviewed at without those services was majority-outpatient every year of residency.


For me personally (early on in residency) I'm also weighing a general (inpatient) neurology career against doing a fellowship. We have two months each of EEG/EMU and EMG and about 6 months of elective, and I'm planning on spending a few of those months on additional EEG/neurophys rotations.
Click to expand...
That is a very generous salary for a hospitalist. I am a PGY2 (IM) and just started to test the job market (not actively looking for a job yet) and the hospitalist salaries I have seen are between 220-280k. 220 in major cities and 280k in small town. Your friend found a nice gig if this 330k is actual salary and not compensation.

One thing I am noticing in medicine is that we let employers fool us by using compensation instead of salary. I have noticed many of the PGY3 (except for a few) in my program would say they will be making x amount of $$$ per year, but when you dig deeper, you realize they are talking about total compensation, not salary.

I have never heard people in other industry (except finance) use their yearly compensation when they are actually talking about salary.
 
Splenda88 said:
That is a very generous salary for a hospitalist. I am a PGY2 (IM) and just started to test the job market (not actively looking for a job yet) and the hospitalist salaries I have seen are between 220-280k. 220 in major cities and 280k in small town. Your friend found a nice gig if this 330k is actual salary and not compensation.

One thing I am noticing in medicine is that we let employers fool us by using compensation instead of salary. I have noticed many of the PGY3 (except for a few) in my program would say they will be making x amount of $$$ per year, but when you dig deeper, you realize they are talking about total compensation, not salary.

I have never heard people in other industry (except finance) use their yearly compensation when they are actually talking about salary.
Click to expand...


can u explain the difference between salary and compensation?

Is salary the starting point and compensation the net income(pretax)?
 
Splenda88 said:
300k-350k...

Not sure why neuro is not more competitive than it is. You are a specialist after just 4 years and salary is not too shabby either. Midlevel encroachment is not a big thing in neuro since the subject matter is very complex.
Click to expand...
Very little exposure in medical school could contribute.
 
Neurogeneral said:
Is the initial salary completely guaranteed? And for how long? How many patients are you expected to see on daily/weekly basis? What is your compensation for each wRVU generated? Is this in a large metro or small city/town?
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12 patients per day. Based on RVU but it is easily manageable. It is a small town.
 
chocomorsel said:
Very little exposure in medical school could contribute.
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I agree... I was between neuro and IM. My school had only 2 wks outpatient neuro and did not like the rotation. I did an away inpatient neuro rotation in 4th year (July) and liked it, but I thought it was too late to put a neuro application together. I like IM but kind of regret not picking neuro over IM.
 
Prehealth1011 said:
Is Pain Medicine still unpopular among Neuro grads? I know it's historically been a Anes/PMR speciality but wondering if things have changed at all.
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Three of my colleagues went into or are going into pain, but you really have to be proactive about it - with multiple pain electives, research publications, networking, etc. The department is usually controlled by anesthesia And you really have to sell yourself to them, but with time they are becoming more open minded with accepting other residents besides pmr - especially because of the whole focus on the multidisciplinary approach to pain and not necessarily just focusing on becoming a “needle jockey“.

So, pain is an option for neurologists but it’s not easy as just practically walking into a clinical Neurophysiology fellowship. One other thing, once you get into pain, the jobs typically are with pain groups - meaning that you will likely have to leave the vast majority of neurology behind. I mean, there are some set ups that are open to you doing some neuro, but they are not the norm.
 
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Dumb question, but when they say "stroke medicine" is that just a neurohospitalist? Or is that interventional neurology?
 
Splenda88 said:
300k-350k...

Not sure why neuro is not more competitive than it is. You are a specialist after just 4 years and salary is not too shabby either. Midlevel encroachment is not a big thing in neuro since the subject matter is very complex.
Click to expand...
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How about them apples?
 
kirktodd0 said:
According to MGMA the median is $290k in the East coast, $307k in Midwest, $318k in the South, $296k West coast for general neurology and around $75k higher for stroke

You should also realistically expect to do a fellowship if you go into neuro. Around 80-90% of neuro grads these day do one
Click to expand...
There is a cultural tendency to do fellowship, but there doesn’t seem to be a NEED to do one.
 
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