couple of questions about neurosurgery...

[medheel]

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I'm a med student interested in neurosurgery, and I just had a couple of questions...

1. How much does taking a year off to do research in neurosurgery help for the match?

2. After neuro residency is completed, how much flexibility in schedule is there for private practice neurosurgeons (i.e. call, hours, etc.)?

Thanks. Any comments would be helpful.

 

[apma77]

research will only help if ur scores are deficient or u are shooting for a high powered program.

typical priv practice neurosurgeon works betwen 50-70 hrs a week and makes between $450k-1.5 mil depending on the practice

 

[Bull's eye]

Like my Dad (a neurosurgeon) says, " You can either run your practice, or it can run you."

 

[OwlMyste]

Originally posted by apma77
typical priv practice neurosurgeon works betwen 50-70 hrs a week and makes between $450k-1.5 mil depending on the practice

I've never heard of a neurosurgeon making 1.5 million dollars.....which practice would make them make that much?

 

[neurogeek]

Yep, they can make that much. I know an orthopod that has made more than 1.5 mil, 3 years in a row. It just takes a lot of work in a private practice.

 

[medheel]

when you say "your scores are deficient," what exactly do you mean? for example, are you saying that if you don't have aoa, then your scores are deficient? i know that the board average for neurosurgery matching students is usually 220-235, but i don't really know what the prevalence of aoa membership is.

thanks.

 

[lipoyl]

(1) Research is key for the top programs. More than a fifth of all matched applicants had Ph.D's this year, and another fifth were AOA. As the above poster said, taking a year off for research in the dep't is helpful to network if you are a borderline candidate, or if your a good candidate who wants to shoot for a top program. The average Step I score over the past 5-6 years has been stable (around 230-235;234 this year) . The best way to figure out what kind of candidate you are is to talk to your department's chairman, and honestly go over your credentials.

(2) You dictate your schedule in pirvate practice depending on where you practice, and depending on how much you want to make. I agree with the first poster's estimates re salaries, but with the caveat that most people make in the 350-500 range (ie the 1mill plus are outliers)

 

[deleted9493]

While they're a minority, I've heard of neurosurgeons making upwards of 3 million a year. I'm not sure what that Dr. Carson at Johns Hopkins makes...but I'm sure it's even more than that. My friend, a neurosurgeon, seems to have a pretty reasonable schedule w/ ~60 hr weeks...he's pulling around 600k...when last we spoke about it.

 

[Minimalist M]

I heard a rumor that Spetzler and the other 8 Barrow neurosurgeons collectively make 50 million a year, not sure if that's their personal take homes salaries or the amount they make for the entire BNI.

I'd agree with the above poster and say that most make between 300-400k annually. Although the guys at SFGH/UCSF give me the impression that they make about $50-60K!

 

[Blitzkrieg]

Originally posted by hudsontc
While they're a minority, I've heard of neurosurgeons making upwards of 3 million a year. I'm not sure what that Dr. Carson at Johns Hopkins makes...but I'm sure it's even more than that. My friend, a neurosurgeon, seems to have a pretty reasonable schedule w/ ~60 hr weeks...he's pulling around 600k...when last we spoke about it.

Carson only makes 500k from hopkins; Academia doesn't pay like it should. However, he is on the board of kellog, and a few other things, so he isnt hurting. FYI, the local nsurg makes upwards of 3-5 million; 60 Hr weeks with a family is *not* reasonable by most standards; I'm a bit torn between nsurg and another specialty, myself, for that very reason....

 

[droliver]

Salaries are going to vary signifigantly by the type of practice you are in (spine, skullbased surgery, tumors, neurovascular, peripheral nerve, pain mangement, hand) . A friend of mine is junior faculty @ UCSF & he's paid pretty modestly. Salaries in academia can range substancially depending upon the relationship of the group to the university. Some groups are essentially full-time private practice guys with only the loosest of academic interest & tend to make in the upper 6 figures. Very few people are realizing salaries of more then $1 million dollars anymore as reimbursements have been cut into. Spine surgery (ortho & neuro) is one of the last real lucrative areas in insured medicine, but everyone sees the writing on the wall that it won't last much longer. The successful ones in private practice I know here routinely work more then 60 hrs a week & treat saturdays as another working day in the OR with 5-6 cases sometimes booked

 

[Blitzkrieg]

dr oliver,

wouldnt you say that ophthalmology still has potential for high 6 figure, maybe 7 figure, salaries on a regular basis?

All of these salaries I see on SDN...my local area must be a complete outlier, cos the gen surg I shadowed makes over 7 figures (he works 7 days a week, and lines up gall bladder surgeries like gangbusters), the nsurg makes 3-5 million, opthalmologists pull in over 7 figs, and ENT's make a good 500-700k. What's the dealio? Oh, and a rad onc friend of mine in LA pulls in 700k for a 40 hour work week. Dr?

 

[droliver]

The only opthamologists pulling those #'s these days (for the most part) are doing high-volume fee for service LASIK-type corneal surgeries & the like or fee for service oculoplastics. The rest of the field has become stagnant financially as fees have been reduced substancially. That's not to say that busy non-corneal opthamologic or oculoplastic surgeons don't make a good living, they do - on average they have one of the higher average salaries among physicians. Their profit margins however have shunk substancially on anything involving the third-party payer system. The competition for corneal surgeries is pretty fierce I understand, & graduating residents have told me that most of the desirable markets are already oversaturated for these high-paying procedures & there were few plum jobs around.

I too know of a general surgeon in a rural area of Kentucky who clears ~$1 million. To do that however, he works constantly with an inhumane pace in a unique situation (little competition in an area with a high % of insured patients). To earn that kind of salary is almost impossible in most places..... you just can't do enough procedures that add up even if you want to (only so many hours in the day & if you see what reimbursements are for the most common procedures it's a formidable thing to try to net that much)

Same principal applies for these other specialties. It has gotten so hard to earn some of the salary levels previously achieved because your reimbursements have been cut repeteadly, the # of uninsured patients has climbed, the penetrence of manged care in many areas, rising malpractice insurance, & steadily rising overhead in excess of most attainable increase in productivity.

I'll take your word on some of those salaries, but a Neurosurgeon still making $5 million just doesn't seem plausible anymore. There is only so many operations that you can physically do. Does he have some angle to achieve this (ie. owning his own outpatient surgery center or imaging machine)?

 

[Blitzkrieg]

Originally posted by droliver
The only opthamologists pulling those #'s these days (for the most part) are doing high-volume fee for service LASIK-type corneal surgeries & the like or fee for service oculoplastics. The rest of the field has become stagnant financially as fees have been reduced substancially. That's not to say that busy non-corneal opthamologic or oculoplastic surgeons don't make a good living, they do - on average they have one of the higher average salaries among physicians. Their profit margins however have shunk substancially on anything involving the third-party payer system. The competition for corneal surgeries is pretty fierce I understand, & graduating residents have told me that most of the desirable markets are already oversaturated for these high-paying procedures & there were few plum jobs around.

I too know of a general surgeon in a rural area of Kentucky who clears ~$1 million. To do that however, he works constantly with an inhumane pace in a unique situation (little competition in an area with a high % of insured patients). To earn that kind of salary is almost impossible in most places..... you just can't do enough procedures that add up even if you want to (only so many hours in the day & if you see what reimbursements are for the most common procedures it's a formidable thing to try to net that much)

Same principal applies for these other specialties. It has gotten so hard to earn some of the salary levels previously achieved because your reimbursements have been cut repeteadly, the # of uninsured patients has climbed, the penetrence of manged care in many areas, rising malpractice insurance, & steadily rising overhead in excess of most attainable increase in productivity.

I'll take your word on some of those salaries, but a Neurosurgeon still making $5 million just doesn't seem plausible anymore. There is only so many operations that you can physically do. Does he have some angle to achieve this (ie. owning his own outpatient surgery center or imaging machine)?

I listed a $3-5 million range because I have heard both figures; This guy actually has 3 months of vacation a year; He was my cousin's surgeon for multiple surgeries, but has completely awful family life. I'm not sure how he does this, but I do know that he is a mudphud, hasnt been in practice *too* long, yet owns a mountain out west with an observatory and airstrip, and flies one of his several private jets out there often. Family time is a creeping turn off in my mind to nsurg, but I hvae heard that some manage it well, so I havent ruled it out. Wouldn't you say, with the rising elderly population, that optho's heyday will come again? Add in the diabetes epidemic, and you have a recipe for greatness. Think salaires of 400k+ are feasible in most areas of the country if one works 5 days a week in optho?

 

[Aaargh]

Originally posted by droliver
Salaries are going to vary signifigantly by the type of practice you are in (spine, skullbased surgery, tumors, neurovascular, peripheral nerve, pain mangement, hand) . A friend of mine is junior faculty @ UCSF & he's paid pretty modestly.

Well, I know spine is considered lucrative but what about the rest? Which are lucrative and which not?

And what does "pretty modestly" mean?

 

[JasonDO]

Originally posted by Blitzkrieg
I listed a $3-5 million range because I have heard both figures; This guy actually has 3 months of vacation a year; He was my cousin's surgeon for multiple surgeries, but has completely awful family life. I'm not sure how he does this, but I do know that he is a mudphud, hasnt been in practice *too* long, yet owns a mountain out west with an observatory and airstrip, and flies one of his several private jets out there often. Family time is a creeping turn off in my mind to nsurg, but I hvae heard that some manage it well, so I havent ruled it out. Wouldn't you say, with the rising elderly population, that optho's heyday will come again? Add in the diabetes epidemic, and you have a recipe for greatness. Think salaires of 400k+ are feasible in most areas of the country if one works 5 days a week in optho?

well..I think the days of 5 days/week for 500k/year in ophtho are pretty much over unless you are in a set up practice, established, have your own ASC and are a high volume surgeon...if you fit all of these criteria...it's possible to gross 3-4mil/year...alteast that's what my father had done back in the late 80s and early 90s...but times they sure have changed...and unfortunately for the worse😱 I have no complaints though...I don't need a Bentley Arnage Red Label...a Mercedes SL55 AMG will do...Dr. Kelman the inventor of what is modern day phacoemulsification makes upwards of 15mil/year.........but that is primarily due to passive income he gets from inventing that damn machine...hey that's more than JaRule and DMX made in 2002 according to VH1...Marshal Mathers made 29mil last year...he's got a place in Manalapan, FL...I believe Don King lives there as well

 

[Blitzkrieg]

Originally posted by JasonDO
well..I think the days of 5 days/week for 500k/year in ophtho are pretty much over unless you are in a set up practice, established, have your own ASC and are a high volume surgeon...if you fit all of these criteria...it's possible to gross 3-4mil/year...alteast that's what my father had done back in the late 80s and early 90s...but times they sure have changed...and unfortunately for the worse😱 I have no complaints though...I don't need a Bentley Arnage Red Label...a Mercedes SL55 AMG will do...Dr. Kelman the inventor of what is modern day phacoemulsification makes upwards of 15mil/year.........but that is primarily due to passive income he gets from inventing that damn machine...hey that's more than JaRule and DMX made in 2002 according to VH1...Marshal Mathers made 29mil last year...he's got a place in Manalapan, FL...I believe Don King lives there as well

jason,

what is a more realistic outlook for the current optho salary, and the future of optho?

 

[JasonDO]

realistically...coming out of residency into a practice as an employee and not a partner is between 140-180k base salary...obviously as a partner the salary is higher and is all dependent on how established a practice you go into but can range from 500-800k total cash compensation...fellowship trained surgeons might be paid more initially to lure you into a practice...but partners make the same regardless of being fellowship trained or not...if you want to make a conservative living within in the high end of ophthalmology...I'd do a fellowship in either occuloplastics or retina...if you want to be a high volume LASIK surgeon...the sky really is the limit depending upon how good you are at marketing your services and being in the right location to offer your services...but be forewarned...the surgeons who have achieved this status will literally do everything within their power to make sure you don't take a piece away from their cake

 

[Blitzkrieg]

Originally posted by JasonDO
realistically...coming out of residency into a practice as an employee and not a partner is between 140-180k base salary...obviously as a partner the salary is higher and is all dependent on how established a practice you go into but can range from 500-800k total cash compensation...fellowship trained surgeons might be paid more initially to lure you into a practice...but partners make the same regardless of being fellowship trained or not...if you want to make a conservative living within in the high end of ophthalmology...I'd do a fellowship in either occuloplastics or retina...if you want to be a high volume LASIK surgeon...the sky really is the limit depending upon how good you are at marketing your services and being in the right location to offer your services...but be forewarned...the surgeons who have achieved this status will literally do everything within their power to make sure you don't take a piece away from their cake

Sounds nice. Define your line about "if you want to make a conservative liviing within the high end of opthal..."..What do you see as conservative? And what do you see as the lifestyle/hours for either an occuloplastics, retina, or neuro-opthalmologist? How long does it usually take one to make partner? Occuloplastics and retina both sound good; I'm sure that one could also throw in some botox expertice in order to get some more dollars flowing in. I know what you mean about surgeons covering turf..However, I may have a few ins, so that would be nice...hmm...are you going into optho? Also, I see you're in south FL..at nova? Thanks for the responses, keep the good ones coming...

 

[Minimalist M]

A friend of mine is junior faculty @ UCSF & he's paid pretty modestly.

🙂

 

[JasonDO]

Originally posted by Minimalist M
Hey Dr Oliver,

Is this junior faculty member Dr JM? I worked with an MD/PhD from Cornell who did his residency at UCSF and then became an attending at UCSF (I think about 2-3 years ago) and he went to U KY for undergrad!

JM's a great guy down to earth guy who loves his churizos from El Farlito in the Mission district! I loved operating with him because he would get me involved in the cases!

He runs a full blown neurotrauma research lab (pretty amazing stuff), and is a damn fine surgeon (I still remember that monster menigioma 18 hour case...which ended with a churizo at El Farlitos!) In fact, he and the Chief of Service at SFGH (M.H.) inspired me to go into neurotrauma!

M

notwithstanding the obvious downsides for being a neurosurgeon...how happy are you with what you are doing? if you could do it all over again would you have travelled down the same career path? in other words have the rewards far outweighed the sacrifices you've made?

 

[Minimalist M]

Some of the nsu residents I've spoken to about whether they have regrets or not have said that they should have gone into different fields, the hours take a toll on their family life and emotional health. In fact, I've heard of more than a few nsu residents who left their programs, such as the infamous one at UCSF about 4 yrs ago left and went into real estate, UCSF is still short one PGY 5 thanks to her. I met this anesth PGY4 who did 3 years of NSU at St Louis/Washington, a great NSU program, who left and pursued anesth at UCSF. So for sure, nsu is not a field for everybody and those who are will to sacrifice anything (I should repeat ANYTHING in capitals for emphasis) may still have regrets after achieving their goals.

 

[GeorgeC97]

I have heard however that UCSF is one of the more malignant programs out there - meaning that the residents there are quite unhappy. I had a friend interview there this year, and she said all (ok ok most) of the residents she met were very unhappy and overworked. They would consistently leave the hospital after 10 PM and just didn't seem like they were enjoying the field so much. Also, the reputation is hardcore benchwork/research.

However, i have heard stories of other residents in other programs really liking their residencies - and are happy that they achieved somewhat of a 'balance' with neurosurg and personal life.

Does anyone know if the "80-hour" rule will apply to neurosurgy? or should i refrase, will neurosurg programs be making any attempts to achieve these goals?

 

[Minimalist M]

🙁