Can you work fully remotely in neurology?

[deleted1081396]

Through doing only telemedicine or intraoperative monitoring? Or some other way?

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[AlternateSome1]

Yes. Telestroke, teleEEG, and IOM can all be fully remote.

 

[Aldertonghen]

Yes. EEG and stroke are best options for this, ICU can work too but more difficult.

 

[deleted1081396]

Yes. Telestroke, teleEEG, and IOM can all be fully remote.

How difficult is it to have this schedule with these things?

 

[curiousneuro]

I do telestroke full time, shift work, works well for me and my family. 15 shifts /month, options to pick up more of desired, have to do some nights /weekends though. Overall I would say good lifestyle and schedule, at least for me.

 

[Aldertonghen]

I do telestroke full time, shift work, works well for me and my family. 15 shifts /month, options to pick up more of desired, have to do some nights /weekends though. Overall I would say good lifestyle and schedule, at least for me.

Might be a stupid question, but do you think telestroke is perhaps vulnerable to encroachment by midlevels?

 

[curiousneuro]

Might be a stupid question, but do you think telestroke is perhaps vulnerable to encroachment by midlevels?

I actually think it's one of the least likely areas for midlevel encroachment in Neurology. One of the main selling points of telestroke /teleneuro is the idea of having a board certified specialist at your fingertips...networks would have a hard time recruiting clients if they used midlevels at all. In fact, I personally have never heard of midlevels being used for telestroke and acute teleneuro.

 

[Aldertonghen]

I actually think it's one of the least likely areas for midlevel encroachment in Neurology. One of the main selling points of telestroke /teleneuro is the idea of having a board certified specialist at your fingertips...networks would have a hard time recruiting clients if they used midlevels at all. In fact, I personally have never heard of midlevels being used for telestroke and acute teleneuro.

That makes sense, thanks!

 

[Phantom Spike]

I do telestroke full time, shift work, works well for me and my family. 15 shifts /month, options to pick up more of desired, have to do some nights /weekends though. Overall I would say good lifestyle and schedule, at least for me.

If I may ask, how many additional licenses did you have to get, and at how many hospitals are you credentialed? I have been contemplating a switch to teleneurology for a long time and most of the feedback I get from those who have done it is encouraging, but if there's one thing that continues to prevent me from taking the plunge, it's this aspect of it.

 

[ASA81QD]

If I may ask, how many additional licenses did you have to get, and at how many hospitals are you credentialed? I have been contemplating a switch to teleneurology for a long time and most of the feedback I get from those who have done it is encouraging, but if there's one thing that continues to prevent me from taking the plunge, it's this aspect of it.

Not OP but I took a solely telestroke job starting this summer. My position requires 4 state licenses, and ~12 hospitals for credentialing. The company requested a good amount of details up front, but they took care of all the licensing/credentialing and it's been smooth sailing so far with minimal input from my end. Hope this helps!

 

[Postictal Raiden]

Not OP but I took a solely telestroke job starting this summer. My position requires 4 state licenses, and ~12 hospitals for credentialing. The company requested a good amount of details up front, but they took care of all the licensing/credentialing and it's been smooth sailing so far with minimal input from my end. Hope this helps!

Are you fellowship trained? If so, in what?

Could you share a little about your job details (schedule, volume, types of cases)?

If you don’t mind, what is the pay like?

 

[chudat]

Love to know the pay as well

 

[curiousneuro]

If I may ask, how many additional licenses did you have to get, and at how many hospitals are you credentialed? I have been contemplating a switch to teleneurology for a long time and most of the feedback I get from those who have done it is encouraging, but if there's one thing that continues to prevent me from taking the plunge, it's this aspect of it.

Sorry about the late response. I'm with one of the bigger companies; >20 state licenses and a couple hundred hospitals. Company takes care of applying and maintaining credentials. While there is definitely some up front work to be done and some maintenance on my part, it's very minimal.

 

[ASA81QD]

Are you fellowship trained? If so, in what?

Could you share a little about your job details (schedule, volume, types of cases)?

If you don’t mind, what is the pay like?

Finishing up a vascular neuro fellowship this year. It is a 1099 job with one of the large companies, so the time on is quite flexible. You can commit to as little as 6 shifts/month, or up to 19 shifts/month (12 hours per shift). Volume is roughly one consult an hour. Most (80%) of cases will be acute stroke cases, though you are required to take care of all neuro emergencies (status, myasthenic flare, GBS, etc).

The pay is based on volume, though the average I was quoted is ~$400k. If you commit to 19 shifts/month it's more like $550k. Keep in mind this is a 1099 job so there's no employee 401k match, health insurance, and you'll have to pay the employer's share of SE tax as well.

 

[Phantom Spike]

Did they require that applicants be vascular trained?

 

[ASA81QD]

Did they require that applicants be vascular trained?

Either vascular or neurocritical care trained, yes. Although there were many telestroke jobs accepting gen neuro physicians when I was looking around!

 

[Need neuro]

Finishing up a vascular neuro fellowship this year. It is a 1099 job with one of the large companies, so the time on is quite flexible. You can commit to as little as 6 shifts/month, or up to 19 shifts/month (12 hours per shift). Volume is roughly one consult an hour. Most (80%) of cases will be acute stroke cases, though you are required to take care of all neuro emergencies (status, myasthenic flare, GBS, etc).

The pay is based on volume, though the average I was quoted is ~$400k. If you commit to 19 shifts/month it's more like $550k. Keep in mind this is a 1099 job so there's no employee 401k match, health insurance, and you'll have to pay the employer's share of SE tax as well.

Would you mind stating which company ? Interested in applying for full time telestroke but hearing mixed reviews of some of them. Telespecialists. SOC. Blue sky

 

[xenotype]

Either vascular or neurocritical care trained, yes. Although there were many telestroke jobs accepting gen neuro physicians when I was looking around!

Probably Blue Sky. Apparently ok with using midlevels to tele-round on patients by themselves though based on their website 'to help minimize cost of care'.

 

[elanmorin]

Finishing up a vascular neuro fellowship this year. It is a 1099 job with one of the large companies, so the time on is quite flexible. You can commit to as little as 6 shifts/month, or up to 19 shifts/month (12 hours per shift). Volume is roughly one consult an hour. Most (80%) of cases will be acute stroke cases, though you are required to take care of all neuro emergencies (status, myasthenic flare, GBS, etc).

The pay is based on volume, though the average I was quoted is ~$400k. If you commit to 19 shifts/month it's more like $550k. Keep in mind this is a 1099 job so there's no employee 401k match, health insurance, and you'll have to pay the employer's share of SE tax as well.

Did you do a comparison to an employed gig? From my understanding, the employer share comes out to an extra 7.65%. I think 401k match at most places is around 3% of salary. You'll also pay your own health insurance, but those premiums should be deductible for 1099 employees. Assuming you work from home, you can deduct a portion of your mortgage and utilities from your taxes as well. Plus some other deductions as well I'm sure. I assume the company at least covers your malpractice insurance. Overall, I estimate it would be about a 10% decrease from the quoted compensation figures compared to an employed gig for most people.

Btw, how many shifts per month do you expect to do to hit that average number?

 

[elanmorin]

Sorry about the late response. I'm with one of the bigger companies; >20 state licenses and a couple hundred hospitals. Company takes care of applying and maintaining credentials. While there is definitely some up front work to be done and some maintenance on my part, it's very minimal.

What do you mean by they "take care of applying and maintaining"? You don't have to do HIPAA training modules for a couple hundred hospitals?

 

[curiousneuro]

What do you mean by they "take care of applying and maintaining"? You don't have to do HIPAA training modules for a couple hundred hospitals?

Nope. They are able to minimize the paperwork and unnecessary garbage for the most part, although every now and then we are required to do something after credentialing, but that's fairly rare.

 

[Phantom Spike]

Assuming you work from home, you can deduct a portion of your mortgage and utilities from your taxes as well.

I had never heard that before. How much can you deduct?

Nope. They are able to minimize the paperwork and unnecessary garbage for the most part, although every now and then we are required to do something after credentialing, but that's fairly rare.

Do you mean the teleneurology companies have an understanding with the hospitals whereby they exempt you from the usual credentialing requirements that other physicians have to abide by?
How about all the mandatory CME for the dozens of state licenses? Each state has its own approved courses and requirements.
Also how do you get LORs for hundreds of hospitals? I can't imagine asking any of my colleagues to do that. I have a hard enough time asking them to write one LOR.

 

[curiousneuro]

I had never heard that before. How much can you deduct?

Do you mean the teleneurology companies have an understanding with the hospitals whereby they exempt you from the usual credentialing requirements that other physicians have to abide by?
How about all the mandatory CME for the dozens of state licenses? Each state has its own approved courses and requirements.
Also how do you get LORs for hundreds of hospitals? I can't imagine asking any of my colleagues to do that. I have a hard enough time asking them to write one LOR.

You can absolutely deduct home expenses, working with my accountant on that now (this is my first tax season with this). That's one of the major perks with this job and being 1099 over W2. Mortgage, home improvements, utilities, phone, etc.

In terms of the other questions: yes, at least at our company they have been able to really minimize physician work for hospital credentialing, and they handle nearly everything. Sometimes I need to sign something or do something but usually very minimal.

State licensure: when you start you sign a bunch of paperwork and fill out a very thorough internal app that essentially allows for the company to file for licensure on your behalf with again minimal input from the physician.

LOR: yeah this sucks especially in the beginning. Your LOR writers get a bunch of LOR requests which is annoying...doesn't seem like there's a way around that part 😔

 

[Phantom Spike]

Thanks for your very helpful replies. One more question, do you find that they keep pressuring you to get additional licenses and hospital privileges? Or do you stick with what you start out with? Can you decide how many licenses/privileges you are willing to get based on the number of shifts/month you sign up for?

 

[curiousneuro]

Sure thing! So at least at our shop the company continually adds licenses and hospital credentials as more places come on board. At least at our place that's expected, I don't think you can just stick with a few state licenses and hospital credentials, but that is probably company dependent and situation dependent. Some companies have you in "sectors" where you get x amount of licenses and credentials, so that's certainly a possibility.

 

[johnwandering]

I don't think IOM has been brought up here enough.

Close friend of mine does remote-IOM, doing nothing but peripherally keeping eyeballs on IOM cases while chillaxing in their pajamas at home (makes about 250-300K for first year, but vets in company are clearing ~400-500K). Don't have to speak to a single patient or do a neuro exam again (if you found out you hate these things).

Pros: Very easy low stress mindless work
Cons: Very easy low stress mindless work
(at least I think, I don't do it so I don't really know)

May not be for everyone, but its certainly a great choice for all of those who wish they did a more chill radiology instead. It's sort of the "hidden secret" in neurology if it interests you.


If this interests you it's a thing to keep in mind when you're making that confusing decision** between Epilepsy Fellowship vs Neurophysiology Fellowship. These are only available for the neurophysiology folks (fellowship required I believe).

 

[Phantom Spike]

Good point. Not every neurophysiology or epilepsy fellowship provides exposure to IOM, however. For example, although I am neurophysiology-boarded and am quite comfortable with EMGs and EEGs, I haven't had any IOM experience, so this is out for me. There are remote EEG/v-EEG jobs, but I am unsure how much one can make doing that, and I believe you would still need multiple hospitals and licenses (probably true of IOM as well). Tele-sleep is also open to neurologists with sleep certification, but competition for that is very fierce from pulmonary/IM.

 

[sloh]

I don't think IOM has been brought up here enough.

Close friend of mine does remote-IOM, doing nothing but peripherally keeping eyeballs on IOM cases while chillaxing in their pajamas at home (makes about 250-300K for first year, but vets in company are clearing ~400-500K). Don't have to speak to a single patient or do a neuro exam again (if you found out you hate these things).

Pros: Very easy low stress mindless work
Cons: Very easy low stress mindless work
(at least I think, I don't do it so I don't really know)

May not be for everyone, but its certainly a great choice for all of those who wish they did a more chill radiology instead. It's sort of the "hidden secret" in neurology if it interests you.


If this interests you it's a thing to keep in mind when you're making that confusing decision** between Epilepsy Fellowship vs Neurophysiology Fellowship. These are only available for the neurophysiology folks (fellowship required I believe).

Do they have to be present during the surgery, therefore working nights and weekends?

 

[johnwandering]

Good point. Not every neurophysiology or epilepsy fellowship provides exposure to IOM, however. For example, although I am neurophysiology-boarded and am quite comfortable with EMGs and EEGs, I haven't had any IOM experience, so this is out for me. There are remote EEG/v-EEG jobs, but I am unsure how much one can make doing that, and I believe you would still need multiple hospitals and licenses (probably true of IOM as well). Tele-sleep is also open to neurologists with sleep certification, but competition for that is very fierce from pulmonary/IM.

Yes that is true, IOM experience is something that has to be sought out (our neurophysiology fellows had 2 weeks standard experience but not the case with everyone). But from what I know, a lot of the companies will train you in IOM (you dont necessarily need experience before, although it helps), they just need that valuable Neurophysiology board certification. My friend got a job just out of neurophysiology fellowship with only TWO weeks of peripheral shadowing experience in IOM, so theyre not looking for a lot.

IOM is rarely ever present, and for the remote positions that is 0% of the time (hence the remote). Youll live anywhere and monitor for several different states. From what I know he monitors one weekend every month.

 

[Drhappyface]

Yes that is true, IOM experience is something that has to be sought out (our neurophysiology fellows had 2 weeks standard experience but not the case with everyone). But from what I know, a lot of the companies will train you in IOM (you dont necessarily need experience before, although it helps), they just need that valuable Neurophysiology board certification. My friend got a job just out of neurophysiology fellowship with only TWO weeks of peripheral shadowing experience in IOM, so theyre not looking for a lot.

IOM is rarely ever present, and for the remote positions that is 0% of the time (hence the remote). Youll live anywhere and monitor for several different states. From what I know he monitors one weekend every month.

Is it a M-F gig?

 

[Phantom Spike]

IOM is rarely ever present, and for the remote positions that is 0% of the time (hence the remote). Youll live anywhere and monitor for several different states. From what I know he monitors one weekend every month.

He makes $250-300K doing one weekend a month? I'm sure I'm missing something here.
I suppose that for someone who has done neurophysiology and is reasonably comfortable with EEGs and EPs, it shouldn't take too long to learn IOM. It's good to know they are willing to consider those with little to no experience.
Also, IOM is usually used in elective surgeries, so I would assume that availability is probably needed most during business hours rather than nights/weekends.

 

[johnwandering]

He makes $250-300K doing one weekend a month? I'm sure I'm missing something here.
I suppose that for someone who has done neurophysiology and is reasonably comfortable with EEGs and EPs, it shouldn't take too long to learn IOM. It's good to know they are willing to consider those with little to no experience.
Also, IOM is usually used in elective surgeries, so I would assume that availability is probably needed most during business hours rather than nights/weekends.

Sorry for the miscommunication. She works Mon-Friday + one weekend a month.

Different companies do it differently from what I heard. Some do shift work, some regular mon-friday. Otherwise everytime I talk with my friend about her work she always says how fantastically relaxed it is.

 

[xenotype]

Sorry for the miscommunication. She works Mon-Friday + one weekend a month.

Different companies do it differently from what I heard. Some do shift work, some regular mon-friday. Otherwise everytime I talk with my friend about her work she always says how fantastically relaxed it is.

Fantastically relaxed till you get sued. IOM is high liability work with many factors beyond your control. Also, I don't think letting one's brain slowly turn to jello is good for long term job prospects.

 

[Phantom Spike]

Fantastically relaxed till you get sued. IOM is high liability work with many factors beyond your control. Also, I don't think letting one's brain slowly turn to jello is good for long term job prospects.

One issue that does come to mind is that if one does not have "face-to-face" patient encounters for extended periods of time, it might become problematic if you then want hospital privileges or apply for locum/telestroke work. Most institutions are asking for patient logs these days.

Interesting point about high liability in IOM. Is there much data on that? Is there a greater likelihood of getting sued than, say, doing high volumes of telestroke?

 

[deleted1081396]

I don't think IOM has been brought up here enough.

Close friend of mine does remote-IOM, doing nothing but peripherally keeping eyeballs on IOM cases while chillaxing in their pajamas at home (makes about 250-300K for first year, but vets in company are clearing ~400-500K). Don't have to speak to a single patient or do a neuro exam again (if you found out you hate these things).

Pros: Very easy low stress mindless work
Cons: Very easy low stress mindless work
(at least I think, I don't do it so I don't really know)

May not be for everyone, but its certainly a great choice for all of those who wish they did a more chill radiology instead. It's sort of the "hidden secret" in neurology if it interests you.


If this interests you it's a thing to keep in mind when you're making that confusing decision** between Epilepsy Fellowship vs Neurophysiology Fellowship. These are only available for the neurophysiology folks (fellowship required I believe).

You absolutely need to do a neurophys fellowship to do remote IOM?

 

[Aldertonghen]

Fantastically relaxed till you get sued. IOM is high liability work with many factors beyond your control. Also, I don't think letting one's brain slowly turn to jello is good for long term job prospects.

Which subspecialty/ fellowship has the least chances of getting sued?

 

[Postictal Raiden]

Which subspecialty/ fellowship has the least chances of getting sued?

maybe cognitive neurology, but that's a guess.

 

[curiousneuro]

maybe cognitive neurology, but that's a guess.

Yeah probably not going to get sued for a delayed Alzheimer's diagnosis...

 

[curiousneuro]

Yup I have a family friend that does this as well - has been doing it for about 6 years and absolutely loves it.

 

[Phantom Spike]

Yup I have a family friend that does this as well - has been doing it for about 6 years and absolutely loves it.

Are they fellowship trained in Clinical Neurophysiology? Did they have a lot of IOM experience before starting? Or did they get a lot of training from the company?

 

[xenotype]

One issue that does come to mind is that if one does not have "face-to-face" patient encounters for extended periods of time, it might become problematic if you then want hospital privileges or apply for locum/telestroke work. Most institutions are asking for patient logs these days.

Interesting point about high liability in IOM. Is there much data on that? Is there a greater likelihood of getting sued than, say, doing high volumes of telestroke?

Neurology is not in general high risk- the main risk in the hospital is not giving tPA when someone should have gotten it. IOM is a different ballgame where your risk of litigation becomes directly tied into the surgeons (eg- why they order neuromonitoring to begin with). Spine surgeons get sued a whole lot.

 

[ASA81QD]

Would you mind stating which company ? Interested in applying for full time telestroke but hearing mixed reviews of some of them. Telespecialists. SOC. Blue sky

I'll PM you the company; interviewed at most of them and can give you a brief rundown.

Did you do a comparison to an employed gig? From my understanding, the employer share comes out to an extra 7.65%. I think 401k match at most places is around 3% of salary. You'll also pay your own health insurance, but those premiums should be deductible for 1099 employees. Assuming you work from home, you can deduct a portion of your mortgage and utilities from your taxes as well. Plus some other deductions as well I'm sure. I assume the company at least covers your malpractice insurance. Overall, I estimate it would be about a 10% decrease from the quoted compensation figures compared to an employed gig for most people.

Btw, how many shifts per month do you expect to do to hit that average number?

You hit the nail on the head. The biggest negative factors are the 7.65% employer share SE tax, more complex taxes, buying your own health insurance, lack of 401k match, and no paid vacations. Upsides include great tax deductions; work-related expenses (mortgage/rent if setting up a home office, white coats, computer/tech, etc) on schedule C, health insurance plan, HSA contributions, individual 401k contributions, and of course choosing your own benefits.

The company pays for malpractice insurance (occurrence policy), I believe most of them do. Rule of thumb for a 1099 vs W2 job is 10-20% higher salary, though this varies widely on the specific jobs, location, and above factors. To hit $400k is ~14 shifts/month, and working like a dog can hit $800k if so desired. Choose your balance 🙂

WCI has some great resources if anyone is interested: 1 2 3

 

[Phantom Spike]

I'll PM you the company; interviewed at most of them and can give you a brief rundown.

Would you be willing to PM me this information as well, please?

 

[deleted1081396]

I'll PM you the company; interviewed at most of them and can give you a brief rundown.


You hit the nail on the head. The biggest negative factors are the 7.65% employer share SE tax, more complex taxes, buying your own health insurance, lack of 401k match, and no paid vacations. Upsides include great tax deductions; work-related expenses (mortgage/rent if setting up a home office, white coats, computer/tech, etc) on schedule C, health insurance plan, HSA contributions, individual 401k contributions, and of course choosing your own benefits.

The company pays for malpractice insurance (occurrence policy), I believe most of them do. Rule of thumb for a 1099 vs W2 job is 10-20% higher salary, though this varies widely on the specific jobs, location, and above factors. To hit $400k is ~14 shifts/month, and working like a dog can hit $800k if so desired. Choose your balance 🙂

WCI has some great resources if anyone is interested: 1 2 3

Can you PM me as well?

 

[Giovanotto]

Interested in telestroke. What are the chances I need that stroke fellowship?

 

[Aldertonghen]

Interested in telestroke. What are the chances I need that stroke fellowship?

There is a post above saying either a vascular or NCC fellowship is very helpful, but not absolutely necessary at all.

 

[ASA81QD]

Interested in telestroke. What are the chances I need that stroke fellowship?

Stroke/NeuroICU fellowship are required for most of the big companies, though absolutely not required in general. You do get a competitive edge if you’re already experienced with telestroke from said fellowships however.

 

[elanmorin]

I'll PM you the company; interviewed at most of them and can give you a brief rundown.


You hit the nail on the head. The biggest negative factors are the 7.65% employer share SE tax, more complex taxes, buying your own health insurance, lack of 401k match, and no paid vacations. Upsides include great tax deductions; work-related expenses (mortgage/rent if setting up a home office, white coats, computer/tech, etc) on schedule C, health insurance plan, HSA contributions, individual 401k contributions, and of course choosing your own benefits.

The company pays for malpractice insurance (occurrence policy), I believe most of them do. Rule of thumb for a 1099 vs W2 job is 10-20% higher salary, though this varies widely on the specific jobs, location, and above factors. To hit $400k is ~14 shifts/month, and working like a dog can hit $800k if so desired. Choose your balance 🙂

WCI has some great resources if anyone is interested: 1 2 3

Would appreciate the same PM/info as I'm interested in your experiences.

Also, I overstated the impact of the taxes, as the social security portion (6.2% rate) is only applied on the first 147k for 2022 (which totals ~9k and is also the same cap for the employee share). Medicare portion is uncapped and 1.45%. If you're hitting 400k+, this effectively comes to about 3.5% total rather than 7.65%. Not too bad.

 

[Postictal Raiden]

Would appreciate the same PM/info as I'm interested in your experiences.

Also, I overstated the impact of the taxes, as the social security portion (6.2% rate) is only applied on the first 147k for 2022 (which totals ~9k and is also the same cap for the employee share). Medicare portion is uncapped and 1.45%. If you're hitting 400k+, this effectively comes to about 3.5% total rather than 7.65%. Not too bad.

Is this additional cost easy to offset with deductions, pass through policy, and other skillful tax saving tactics?

 

[elanmorin]

Is this additional cost easy to offset with deductions, pass through policy, and other skillful tax saving tactics?

Short answer is yes, but you'll have to apply it to your personal situation. For example, you can deduct business expenses (including the cost of your home office if working remotely and cost of commuting if you also have a hospital office), health insurance premiums, HSA contributions, 401k contributions, CME expenses, etc.

If you don't have those expenses, it might not be beneficial compared to being employed via W2.