Day in the life of an Academic Subspecialty Neurologist

[90sportsfan]

Hi all,
Sorry if this topic has already been posted before (I didn't find it in my search), but I was wondering if any attendings or residents/fellows can describe what a basic day/week for an Academic Neurology Subspecialist is like?

a) I am mainly wondering how much protected research time you have and how does that look during the work-week (i.e. do you have a full day(s) off dedicated to research or is it a half day(s)?).

b) How much "teaching" do you do? Are you supervising residents/fellows for only a few days/rotations and mostly seeing patients without teaching or are you mostly working with residents/fellows?

c) Also, if you are in academics, how much general neurology do you do? I know that in PP, even those with a fellowship will very often still do a good amount of general neurology, but I'm curious how Subspecialists practice in an academic setting.

Thanks in advance.

---

Members don't see this ad.

 

[Thama]

A) This varies wildly. I've been at least 75% protected (minimum you need for a K award) since starting as faculty, and between 50-75% protected is common for faculty at major research institutions who have a strong track record of research productivity and are seeking independent funding right off the bat. This is always going to be a temporary thing until you get your own funding, and if you don't, you'll be expected to quickly take on a full clinical load. If you don't have a CV that says "I can get K or R funding within the next 2 years", then you aren't going to get this kind of package starting out. This kind of setup also generally comes with a very low starting salary (and often instructor rank) until you bring in money to pull your weight. Plenty, if not the majority, are primarily clinical. This tends to be between 75-85% clinical, with the rest as administrative and teaching responsibilities. Some who are primarily clinical will "buy" additional protected time by having a role in someone else's study, running a clerkship, etc.

B) Teaching can be residents, fellows, and students showing up to my clinic, teaching on the consult service or resident continuity clinic, or various lectures or workshops. I would say I teach residents several times more often than students, but it's mostly informal clinical settings (rounds, etc). Lectures and the sort are pretty uncommon, maybe a couple per year.

C) I don't do any general neurology as I don't have time, other than working with residents on the consult service. Many subspecialists I know who are primarily clinical will have a half-day or 2 of general neuro clinic. Academic departments are often desperate to hire general neurologists because they can't pay what other places do and the main advantages of academic work often don't apply to a general neurologist. Being willing to do some general clinic will make you attractive to academic departments as a clinician.

 

[Postictal Raiden]

General neuro clinic = half of your patients are neuropathy and the other half are pain (fibromyalgia, CRPS, radiculopathy)

 

[90sportsfan]

A) This varies wildly. I've been at least 75% protected (minimum you need for a K award) since starting as faculty, and between 50-75% protected is common for faculty at major research institutions who have a strong track record of research productivity and are seeking independent funding right off the bat. This is always going to be a temporary thing until you get your own funding, and if you don't, you'll be expected to quickly take on a full clinical load. If you don't have a CV that says "I can get K or R funding within the next 2 years", then you aren't going to get this kind of package starting out. This kind of setup also generally comes with a very low starting salary (and often instructor rank) until you bring in money to pull your weight. Plenty, if not the majority, are primarily clinical. This tends to be between 75-85% clinical, with the rest as administrative and teaching responsibilities. Some who are primarily clinical will "buy" additional protected time by having a role in someone else's study, running a clerkship, etc.

B) Teaching can be residents, fellows, and students showing up to my clinic, teaching on the consult service or resident continuity clinic, or various lectures or workshops. I would say I teach residents several times more often than students, but it's mostly informal clinical settings (rounds, etc). Lectures and the sort are pretty uncommon, maybe a couple per year.

C) I don't do any general neurology as I don't have time, other than working with residents on the consult service. Many subspecialists I know who are primarily clinical will have a half-day or 2 of general neuro clinic. Academic departments are often desperate to hire general neurologists because they can't pay what other places do and the main advantages of academic work often don't apply to a general neurologist. Being willing to do some general clinic will make you attractive to academic departments as a clinician.

Awesome info! Thanks for all of this! I would love to get a K award and get that protected research time, but I’m a little worried given how competitive they are and not having a PhD type background. I’ve done a fair amount of research as a med student and will try to get some good experience As a resident/fellow. Hopefully I can set myself up to have a chance to be competitive for a K. If not, I still see myself in an academic environment and will just lean more clinical.

 

[Thama]

General neuro clinic = half of your patients are neuropathy and the other half are pain (fibromyalgia, CRPS, radiculopathy)

Also a lot of functional and a lot of the sort of hospital follow ups where either there probably wasn't anything neurologically wrong with them but IM/EM insisted neuro "be on board" and "expedite neuro follow up", or there were a million things wrong but nobody ever figured out what they were.

General in academic settings is painful because all the real neurology is siphoned off by subspecialty clinics, and it doesn't really resemble general in private/community settings.

 

[Thama]

Awesome info! Thanks for all of this! I would love to get a K award and get that protected research time, but I’m a little worried given how competitive they are and not having a PhD type background. I’ve done a fair amount of research as a med student and will try to get some good experience As a resident/fellow. Hopefully I can set myself up to have a chance to be competitive for a K. If not, I still see myself in an academic environment and will just lean more clinical.

If you have a research background at this point and really want to pursue that long term, the right residency is helpful (ask specifically about R25 programs), but a high quality research oriented fellowship is much more important. That's really where you will accrue the skills, publication record, and preliminary data for grant applications, and the institution where you do fellowship is the most likely place for you to have success in the early career phase.

 

[xenotype]

General neuro clinic = half of your patients are neuropathy and the other half are pain (fibromyalgia, CRPS, radiculopathy)

Also a lot of functional and a lot of the sort of hospital follow ups where either there probably wasn't anything neurologically wrong with them but IM/EM insisted neuro "be on board" and "expedite neuro follow up", or there were a million things wrong but nobody ever figured out what they were.

General in academic settings is painful because all the real neurology is siphoned off by subspecialty clinics, and it doesn't really resemble general in private/community settings.

This exactly for 'academic general neurology'- getting dumped all the irritating cases no one else wants to see. You can still get students and often even IM/FM residents for teaching in many community places if desired and in a bigger group the majority of patients will be your subspecialty of interest anyways. IMO academics can have far more politics than many community settings as well (eg you and the ED doc/hospitalist/PCP/other specialists are all incentivized properly to make each other's lives easier in the community).

 

[Aldertonghen]

A) This varies wildly. I've been at least 75% protected (minimum you need for a K award) since starting as faculty, and between 50-75% protected is common for faculty at major research institutions who have a strong track record of research productivity and are seeking independent funding right off the bat. This is always going to be a temporary thing until you get your own funding, and if you don't, you'll be expected to quickly take on a full clinical load. If you don't have a CV that says "I can get K or R funding within the next 2 years", then you aren't going to get this kind of package starting out. This kind of setup also generally comes with a very low starting salary (and often instructor rank) until you bring in money to pull your weight. Plenty, if not the majority, are primarily clinical. This tends to be between 75-85% clinical, with the rest as administrative and teaching responsibilities. Some who are primarily clinical will "buy" additional protected time by having a role in someone else's study, running a clerkship, etc.

B) Teaching can be residents, fellows, and students showing up to my clinic, teaching on the consult service or resident continuity clinic, or various lectures or workshops. I would say I teach residents several times more often than students, but it's mostly informal clinical settings (rounds, etc). Lectures and the sort are pretty uncommon, maybe a couple per year.

C) I don't do any general neurology as I don't have time, other than working with residents on the consult service. Many subspecialists I know who are primarily clinical will have a half-day or 2 of general neuro clinic. Academic departments are often desperate to hire general neurologists because they can't pay what other places do and the main advantages of academic work often don't apply to a general neurologist. Being willing to do some general clinic will make you attractive to academic departments as a clinician.

Is it possible as an academic neurologist to supplement income by say doing telestroke or something on nights/weekends (unrelated to the main job)? Or does the contract prohibit that?

I’m very interested in this line (neuro modulation research) but badly need to pay some family loans when I get out of fellowship. Workload isn’t a concern.

 

[Thama]

Is it possible as an academic neurologist to supplement income by say doing telestroke or something on nights/weekends (unrelated to the main job)? Or does the contract prohibit that?

I’m very interested in this line (neuro modulation research) but badly need to pay some family loans when I get out of fellowship. Workload isn’t a concern.

You have to figure out what you want to do.

If you want to be an academic clinician, then of course telestroke is an option if you have vascular training. In fact, a lot of big academic centers are trying desperately to expand their telestroke networks and hire people to do telestroke, as it's a major revenue stream for them. Moonlighting outside the institution is very institution-dependent and often not allowed.

If you want to be a clinician-scientist and manage to get some protected time off the bat, then doing a bunch of extra clinical work is not going to be a good idea. Not only because you're basically taking the time that the department is covering for you where they're expecting you to successfully apply for grants, but also because that is effort you should be dedicating to your career advancement at this stage. I know a grand total of zero people who have successfully started a clinician-scientist career who work 8-5 and have time for a bunch of moonlighting. If you do, you're guaranteeing your own failure, especially when you first start out. You're always going to take a large relative financial hit by going into research compared to what you could make as a pure clinician.

 

[xenotype]

Is it possible as an academic neurologist to supplement income by say doing telestroke or something on nights/weekends (unrelated to the main job)? Or does the contract prohibit that?

I’m very interested in this line (neuro modulation research) but badly need to pay some family loans when I get out of fellowship. Workload isn’t a concern.

As Thama states this won't be possible. Academics generally has very restrictive contracts that will block you from moonlighting. If you aggressively negotiate you might be able to get rid of this contract language (very rare to be able to) in exchange for other downsides and bad blood, but you cannot do a high powered research career with lots of moonlighting for cash outside anyways- you won't have time. If you really need to hustle and earn money as your #1 priority, you should not go into academics at all. Private practice rewards you for hustling, seeing more volume, and taking more call, and can often easily be combined with multiple gigs as well. As with the theme in other posts you need to narrow your focus and figure out who you really want to be. If getting paid well is a necessity due to debt- you really need to avoid academics as the private practice pay if you are very busy is easily double an academic salary.

 

[Aldertonghen]

You have to figure out what you want to do.

If you want to be an academic clinician, then of course telestroke is an option if you have vascular training. In fact, a lot of big academic centers are trying desperately to expand their telestroke networks and hire people to do telestroke, as it's a major revenue stream for them. Moonlighting outside the institution is very institution-dependent and often not allowed.

If you want to be a clinician-scientist and manage to get some protected time off the bat, then doing a bunch of extra clinical work is not going to be a good idea. Not only because you're basically taking the time that the department is covering for you where they're expecting you to successfully apply for grants, but also because that is effort you should be dedicating to your career advancement at this stage. I know a grand total of zero people who have successfully started a clinician-scientist career who work 8-5 and have time for a bunch of moonlighting. If you do, you're guaranteeing your own failure, especially when you first start out. You're always going to take a large relative financial hit by going into research compared to what you could make as a pure clinician.

I see. I asked because there is a poster on here who makes ~400k/year doing telestroke on nights/weekends, while his main job is a 100% research one in a big academic institution that pays only $30k/ year (in electrical engineering/CS). I am not sure if this is an actual academic post or if he’s working as a research fellow. I can see myself in a similar role, as my interest in neuromodulation is less on the clinical side and more on the engineering side.

On a different note, as an academic neurologist with protected time, is it hypothetically possible to take extra telestroke shifts within the institution (assuming one has the right training) to supplement income? I know no one does it as they really need to be committed to research to climb up the academic ladder, but was just wondering.

 

[Aldertonghen]

As Thama states this won't be possible. Academics generally has very restrictive contracts that will block you from moonlighting. If you aggressively negotiate you might be able to get rid of this contract language (very rare to be able to) in exchange for other downsides and bad blood, but you cannot do a high powered research career with lots of moonlighting for cash outside anyways- you won't have time. If you really need to hustle and earn money as your #1 priority, you should not go into academics at all. Private practice rewards you for hustling, seeing more volume, and taking more call, and can often easily be combined with multiple gigs as well. As with the theme in other posts you need to narrow your focus and figure out who you really want to be. If getting paid well is a necessity due to debt- you really need to avoid academics as the private practice pay if you are very busy is easily double an academic salary.

Academics is a big part of what I love about this field, and I certainly cannot see myself in private practice right now. It’s just that I have financial obligations that I have to sort in the not too distant future (I will begin residency next year).

 

[Thama]

I see. I asked because there is a poster on here who makes ~400k/year doing telestroke on nights/weekends, while his main job is a 100% research one in a big academic institution that pays only $30k/ year (in electrical engineering/CS). I am not sure if this is an actual academic post or if he’s working as a research fellow. I can see myself in a similar role, as my interest in neuromodulation is less on the clinical side and more on the engineering side.

On a different note, as an academic neurologist with protected time, is it hypothetically possible to take extra telestroke shifts within the institution (assuming one has the right training) to supplement income? I know no one does it as they really need to be committed to research to climb up the academic ladder, but was just wondering.

I've never heard of a position like this. I can almost guarantee their day job isn't within any sort of clinician-scientist track (especially at that salary). That's basically lab tech/work at Target money.

As I mentioned previously, if you have protected research time then taking enough moonlighting shifts within your department to meaningfully increase your income will be seen as using your department support poorly and is likely to result in you being told to be full clinical or GTFO and stop wasting their time and support.

 

[Aldertonghen]

I've never heard of a position like this. I can almost guarantee their day job isn't within any sort of clinician-scientist track (especially at that salary). That's basically lab tech/work at Target money.

As I mentioned previously, if you have protected research time then taking enough moonlighting shifts within your department to meaningfully increase your income will be seen as using your department support poorly and is likely to result in you being told to be full clinical or GTFO and stop wasting their time and support.

I see. The type of job I referred to is in post #54 of this thread: Neurology Salary Survey

To quote: “
Employed income: $30,000/year from full-time M-F 8-5 research gig from grants, employed at Top 20 U.S. News major research university. I have full health insurance, dental, vision. But I use these from my wife's insurance more than my own (better health system). No retirement matching. This is an 8-5 gig but given it is bench research it occupies much more of my time and mental capacity than that. I am more or less always "working". All in silico modeling work, really more applied EECS than Neuroscience. I am a research fellow, hence the low salary.”

I do not have any interest in acquiring a high academic rank, I just want to do research, while earning well atleast for 4-5 years until I can pay off my loans, and this seems to be a very good way to do so. After I pay off my loans I’m quite happy to accept academic salary. It is very helpful to know that moonlighting is pretty discouraged if one has protected research time, I wasn’t aware of that.

 

[xenotype]

I see. The type of job I referred to is in post #54 of this thread: Neurology Salary Survey

To quote: “
Employed income: $30,000/year from full-time M-F 8-5 research gig from grants, employed at Top 20 U.S. News major research university. I have full health insurance, dental, vision. But I use these from my wife's insurance more than my own (better health system). No retirement matching. This is an 8-5 gig but given it is bench research it occupies much more of my time and mental capacity than that. I am more or less always "working". All in silico modeling work, really more applied EECS than Neuroscience. I am a research fellow, hence the low salary.”

I do not have any interest in acquiring a high academic rank, I just want to do research, while earning well atleast for 4-5 years until I can pay off my loans, and this seems to be a very good way to do so. After I pay off my loans I’m quite happy to accept academic salary. It is very helpful to know that moonlighting is pretty discouraged if one has protected research time, I wasn’t aware of that.

You can do research in private practice, or even in one of the larger telestroke companies but it will be small data collection projects at best. You aren't going to be able to reconcile high earnings and an academic job. Sorry, but that is reality. $400k is already the 75th percentile+ in private practice and you have to be quite busy seeing a lot of patients to hit that. Nobody walks out of fellowship into that unless they are crafty at negotiating locums jobs and not too picky on the location. Reality is going to hit you in the paycheck at some point whether you like it and accept it or not. 'Telestroke' is not a money printing machine either unless you really don't care about the quality of your work, and as I already said you won't be allowed a private practice telestroke gig along with an academic 'day job' 99.99% of the time. Again, you have to pick one or the other. You can always go back to academics later after the loans are managed, but an additional $100k of earning potential really cannot be underestimated.

 

[90sportsfan]

For me personally (still a med student looking in from the outside), there is a certain prestige about a tenure-track/ tenured academic neurologist who has gotten an NIH grant and has a decent amount of protected research time each week. Still getting to practice within your subspecialty, but not having the demands of seeing patients non-stop. You may not make a private practice salary, but you make good money, great benefits, and getting tenure and moving up the ranks to leadership positions within academics seems exciting. I’m sure with that comes lots of politics and hard work, but I personally think I would enjoy the academic lifestyle more than private practice.

 

[xenotype]

For me personally (still a med student looking in from the outside), there is a certain prestige about a tenure-track/ tenured academic neurologist who has gotten an NIH grant and has a decent amount of protected research time each week. Still getting to practice within your subspecialty, but not having the demands of seeing patients non-stop. You may not make a private practice salary, but you make good money, great benefits, and getting tenure and moving up the ranks to leadership positions within academics seems exciting. I’m sure with that comes lots of politics and hard work, but I personally think I would enjoy the academic lifestyle more than private practice.

Sure, if you really enjoy research. A lot of research is still seeing patients non-stop- just longer, more frequent visits for detailed clinical rating scales etc. Most people won't be able to get an NIH grant to give them that protected time so you'll be stuck with clinical work anyways. Prestige is vastly overrated, but teaching residents/students can be very rewarding. Neurohospitalist, tele, and especially locums come with much larger built in chunks of time off along with higher $ per hour. If you don't enjoy actually seeing patients/doing clinical neurology, then perhaps you are on the wrong track and should be in something else like radiology/pharma etc. My point for you specifically is don't go into neurology for prestige (or any field), and don't go into it if you don't like seeing patients for most of every work day. I am not trying to put down academics but people need to know what they are getting into and what the opportunity costs are when they sign any contract.

 

[90sportsfan]

Sure, if you really enjoy research. A lot of research is still seeing patients non-stop- just longer, more frequent visits for detailed clinical rating scales etc. Most people won't be able to get an NIH grant to give them that protected time so you'll be stuck with clinical work anyways. Prestige is vastly overrated, but teaching residents/students can be very rewarding. Neurohospitalist, tele, and especially locums come with much larger built in chunks of time off along with higher $ per hour. If you don't enjoy actually seeing patients/doing clinical neurology, then perhaps you are on the wrong track and should be in something else like radiology/pharma etc. My point for you specifically is don't go into neurology for prestige (or any field), and don't go into it if you don't like seeing patients for most of every work day. I am not trying to put down academics but people need to know what they are getting into and what the opportunity costs are when they sign any contract.

Oh yeah, I totally agree with you. I think everyone in medicine should enjoy and be comfortable seeing patients. If not, a PhD or other field would be better. That wasn’t what I trying to imply. I meant that getting a break to do other things during the week besides just seeing patients would be enjoyable for me personally. I like variety and while I expect the majority of my week will involve patient care, I think having some protected research and admin time for academic endeavors would be the added bonus of the academic setting.

Yeah, the prestige part about NIH funding was kind of tongue and cheek, lol. As you said, it’s so hard to get those and be in a tenure position anyway, so first and foremost, you have to enjoy patient care. I do think the ability to practice mainly in your subspecialty is another appealing thing about academics.

 

[Aldertonghen]

You can do research in private practice, or even in one of the larger telestroke companies but it will be small data collection projects at best. You aren't going to be able to reconcile high earnings and an academic job. Sorry, but that is reality. $400k is already the 75th percentile+ in private practice and you have to be quite busy seeing a lot of patients to hit that. Nobody walks out of fellowship into that unless they are crafty at negotiating locums jobs and not too picky on the location. Reality is going to hit you in the paycheck at some point whether you like it and accept it or not. 'Telestroke' is not a money printing machine either unless you really don't care about the quality of your work, and as I already said you won't be allowed a private practice telestroke gig along with an academic 'day job' 99.99% of the time. Again, you have to pick one or the other. You can always go back to academics later after the loans are managed, but an additional $100k of earning potential really cannot be underestimated.

Thanks for the insight. Regarding the pay of academic jobs, I realise it’s somewhere in the ballpark of $200-240k per year for most subspecialties. Is this also the range if one has 50% protected research time, or would that be lower because you’re generating less revenue? Would it be half of that ($120k or so)?

Also, how difficult is it to enter academics after 3 years of private practice post fellowship?

 

[drg123]

Thanks for the insight. Regarding the pay of academic jobs, I realise it’s somewhere in the ballpark of $200-240k per year for most subspecialties. Is this also the range if one has 50% protected research time, or would that be lower because you’re generating less revenue? Would it be half of that ($120k or so)?

Also, how difficult is it to enter academics after 3 years of private practice post fellowship?

Sadly, I think, starting out, it's more on that lower end (low-mid 100's). But likely very dependent on institution, department, and how bad they want you and see you as a sure bet. Nervtheless, pay cut is deep.

 

[Thama]

Sadly, I think, starting out, it's more on that lower end (low-mid 100's). But likely very dependent on institution, department, and how bad they want you and see you as a sure bet. Nervtheless, pay cut is deep.

Instructor can be anywhere from high 5 figures to mid 100s. That only really applies if you're research track with major protected time at a major center. Assistant professor is typically 170-200 starting at major centers, often higher at places where they are more desperate.

 

[Aldertonghen]

Instructor can be anywhere from high 5 figures to mid 100s. That only really applies if you're research track with major protected time at a major center. Assistant professor is typically 170-200 starting at major centers, often higher at places where they are more desperate.

Is 170-200k the figure for assistant professors with protected research time? Or is it for a more 3.5-4 days clinical+ 1 day admin type of work?

 

[Thama]

Academic departments usually have standard salaries for an academic rank, though its often easier to hit incentive targets if you're all clinical. But if you have most of your time protected for research and don't have funding to cover it, you probably aren't getting hired at the assistant professor level.

 

[xenotype]

Just so those with substantial debt can understand how deep the academic paycut is- community practice in a major desirable city is probably average 250-300k. A lot of neurohospitalist jobs in somewhat desirable regions like smaller coastal cities can be had for 300-350k- tele jobs will be in this range as well for full time depending on productivity- the national average for new contracts in neuro hovers between 300-320 ("50th percentile" of busy). 400k is possible in an undesirable area, very high volume neurohospitalist/tele("75th percentile"), or a partner practice that is busy with a lot of procedures but most people won't be able to do any this straight out of fellowship except going somewhere no one wants to go. Locums can go much higher than any of these if one is savvy.

One thing I would emphasize is if you wind up doing almost entirely clinical/teaching (which for most of you wanting to do 'research' is what you'll be forced into one way or another anyways)- do it at a place that is not brand name and pays a reasonable wage. Most places that aren't ivy league will pay $200-220k and give you a slightly more reasonable schedule and volume than a busy community practice will have and the benefits tend to be much better at academic centers (particularly state institutions and ++VA) so that can make up for the low income somewhat with a livable schedule long term. I'd recommend just thinking about where you want to live/raise kids and pick State University Medical Center with a juicy retirement plan/401k match. Often these places you can't really be sued easily in a lot of states either so the liability is another major advantage over community practice (sovereign immunity, qualified immunity, caps on reimbursement).

 

[Aldertonghen]

Just so those with substantial debt can understand how deep the academic paycut is- community practice in a major desirable city is probably average 250-300k. A lot of neurohospitalist jobs in somewhat desirable regions like smaller coastal cities can be had for 300-350k- tele jobs will be in this range as well for full time depending on productivity- the national average for new contracts in neuro hovers between 300-320 ("50th percentile" of busy). 400k is possible in an undesirable area, very high volume neurohospitalist/tele("75th percentile"), or a partner practice that is busy with a lot of procedures but most people won't be able to do any this straight out of fellowship except going somewhere no one wants to go. Locums can go much higher than any of these if one is savvy.

One thing I would emphasize is if you wind up doing almost entirely clinical/teaching (which for most of you wanting to do 'research' is what you'll be forced into one way or another anyways)- do it at a place that is not brand name and pays a reasonable wage. Most places that aren't ivy league will pay $200-220k and give you a slightly more reasonable schedule and volume than a busy community practice will have and the benefits tend to be much better at academic centers (particularly state institutions and ++VA) so that can make up for the low income somewhat with a livable schedule long term. I'd recommend just thinking about where you want to live/raise kids and pick State University Medical Center with a juicy retirement plan/401k match. Often these places you can't really be sued easily in a lot of states either so the liability is another major advantage over community practice (sovereign immunity, qualified immunity, caps on reimbursement).

Somewhat unrelated but I’m curious… are Ivy League appointments actually hard to get or is the compensation/work life balance so low that few people want them? Only very few end up joining them and I wonder why.

 

[Thama]

Somewhat unrelated but I’m curious… are Ivy League appointments actually hard to get or is the compensation/work life balance so low that few people want them? Only very few end up joining them and I wonder why.

First, Ivy league means little to nothing in medicine or in neurology specifically. For all the doximity rankings, USNWR rankings, etc, the metric that academic departments care about is NIH funding. The 2 most successful departments in this metric (Wash U, USCF) have nothing to do with the Ivy League, and meanwhile nobody much cares what Brown neurology does (I have no idea if Dartmouth even has a med school).

Academic jobs aren't all that hard to get at big name institutions if you want to do pure clinical work and they have a need at the time you're applying, especially if you're willing to be a general neurologist. To land a research-centered position is a completely different thing and can be very difficult.

 

[xenotype]

So people understand getting the NIH to give you a grant is the bottleneck. Endowed positions, etc are also possibilities along with start up funding but a major university is only going to give you start up money if you have some kind of a track record that suggests the NIH will fund you or an impressive publication track record. Once you have an R01 you can really go to whatever university you want, as long as you keep getting that R01 renewed which will be a major ongoing professional stressor.

Industry funding can allow one to do research on pivotal trails without dealing with grants. You'll get less control and managing FDA compliance is the main challenge (and a big challenge). Make yourself a big enough name with a big sub-specialty patient population and the drug companies will come to you before designing any trials. Many departments at lesser known universities are flush with cash from industry funding and you can easily fit this clinical research into practice with no paycut or worries about grant funding. You can even do industry funded trials in private practice quite profitably as long as you can supply the patients and handle the rigorous compliance required (eg you have 1000 MS patients in your practice panel).

There is no such thing as a free lunch. Academic neurology departments are mostly concerned about managing their budget, churning out publications, and keeping as many funding sources as possible open. Clinical work in some cases is literally done at a loss many places (payor mix, low productivity, high case complexity, inefficient systems compared to a private practice). Many go into academic neurology straight out of training, bright eyed and expecting protected time to pursue their own interests and are then disappointed with a crushing clinic schedule, productivity expectations, and internal politics/being dumped on (guess who is going to be on call for all the holidays...). The real world has a ton of patients that need to be seen at St. Elsewhere Regional MC, and they'll pay you double for it.

 

[Aldertonghen]

First, Ivy league means little to nothing in medicine or in neurology specifically. For all the doximity rankings, USNWR rankings, etc, the metric that academic departments care about is NIH funding. The 2 most successful departments in this metric (Wash U, USCF) have nothing to do with the Ivy League, and meanwhile nobody much cares what Brown neurology does (I have no idea if Dartmouth even has a med school).

Academic jobs aren't all that hard to get at big name institutions if you want to do pure clinical work and they have a need at the time you're applying, especially if you're willing to be a general neurologist. To land a research-centered position is a completely different thing and can be very difficult.

Which places would you rate as having a top 5 neurology department in the country? I managed to find a list of neurology departments according to NIH funding, would you agree with this list (attached with this post). It doesn't seem to have Harvard, Mayo etc which is weird.

For academic jobs, do you mean jobs at the instructor level? Or assistant professor and above (based on pubs/experience)?

Thank you for your explanations, they're really insightful for relatively naive students like myself.

 

[Aldertonghen]

So people understand getting the NIH to give you a grant is the bottleneck. Endowed positions, etc are also possibilities along with start up funding but a major university is only going to give you start up money if you have some kind of a track record that suggests the NIH will fund you or an impressive publication track record. Once you have an R01 you can really go to whatever university you want, as long as you keep getting that R01 renewed which will be a major ongoing professional stressor.

Industry funding can allow one to do research on pivotal trails without dealing with grants. You'll get less control and managing FDA compliance is the main challenge (and a big challenge). Make yourself a big enough name with a big sub-specialty patient population and the drug companies will come to you before designing any trials. Many departments at lesser known universities are flush with cash from industry funding and you can easily fit this clinical research into practice with no paycut or worries about grant funding. You can even do industry funded trials in private practice quite profitably as long as you can supply the patients and handle the rigorous compliance required (eg you have 1000 MS patients in your practice panel).

There is no such thing as a free lunch. Academic neurology departments are mostly concerned about managing their budget, churning out publications, and keeping as many funding sources as possible open. Clinical work in some cases is literally done at a loss many places (payor mix, low productivity, high case complexity, inefficient systems compared to a private practice). Many go into academic neurology straight out of training, bright eyed and expecting protected time to pursue their own interests and are then disappointed with a crushing clinic schedule, productivity expectations, and internal politics/being dumped on (guess who is going to be on call for all the holidays...). The real world has a ton of patients that need to be seen at St. Elsewhere Regional MC, and they'll pay you double for it.

So if I understand this correctly, one can be part of an academic institution, yet be involved in trials/research with funding from industry?

For NIH grants, is it necessary to get into a big name residency to have a chance in the future? Or is it the fellowship that has a greater role in this?

Regarding academic neurology, I understand that 3.5-4 days clinical+ 1 day administrative/teaching work would be considered as a full time job for outpatient departments. But for something like neurocritical, it seems that 12 weeks or so of ICU seems to be enough for clinical, and the rest of the time is spent on research or teaching or administration. So does this mean that it would be easier to do research in such a field compared to a traditional outpatient job without necessarily having protected time, as your clinical weeks are sort of fixed?

 

[drg123]

For NIH grants, is it necessary to get into a big name residency to have a chance in the future? Or is it the fellowship that has a greater role in this?

As @xenotype said above, the bottleneck to having a research career is getting NIH to fund you. This is no trivial feat. You need a track record of demonstrated productivity in the form of high quality publications. On top of that you need to be in an environment that is conducive to doing your work, with the infrastructure and resources to execute. And perhaps most importantly, you need time. Just going to a top residency is no guarantee. The residency will matter to the extent that there are resources and established researchers there that can give you the opportunity to be productive, but the name alone matters only a little. It's about what you do.

During neurology residency, time is hard to come by for protected research. People do it, but it's hard. And if you don't already have research skills (MS, PhD, an extended time during med school during which you did research), you will need to get that time, which will mean a research fellowship/post-doc after residency. So in short, it's not about the name or title of where you get your clinical training. It's about your ability to carry out research and demonstrate your potential for ongoing research productivity, so that you can get your first extra-mural grants. Usually this is a K award as you transition to independence, and then for the rest of your career, it'll be R awards.

And even if you do all these things and you are fortunate to get NIH funding, you will still likely take some kind of pay reduction compared to your full time clinical colleagues.

 

[xenotype]

So if I understand this correctly, one can be part of an academic institution, yet be involved in trials/research with funding from industry?

For NIH grants, is it necessary to get into a big name residency to have a chance in the future? Or is it the fellowship that has a greater role in this?

Regarding academic neurology, I understand that 3.5-4 days clinical+ 1 day administrative/teaching work would be considered as a full time job for outpatient departments. But for something like neurocritical, it seems that 12 weeks or so of ICU seems to be enough for clinical, and the rest of the time is spent on research or teaching or administration. So does this mean that it would be easier to do research in such a field compared to a traditional outpatient job without necessarily having protected time, as your clinical weeks are sort of fixed?

First sentence yes- at the right institution. Some institutions are very anti-industry, which I don't personally agree with. Someone has to pay for the phase III trials and they are risky and very, very expensive.

Second sentence- names help for NIH grants, and being at an institution with a lot of people with grants that have the support structure to get you into a good project to get published well helps but you still have to A) get lucky and B) do a lot of hard work, with help from natural talent and luck to get a big grant. Plenty of projects are nearly unpublishable dead ends with a lot of man hours and little to show for it.

Last paragraph- I am extremely doubtful you could get a 'full time' academic job for 12 weeks neuroICU per year with no added clinic weeks or other demands.

 

[Aldertonghen]

First sentence yes- at the right institution. Some institutions are very anti-industry, which I don't personally agree with. Someone has to pay for the phase III trials and they are risky and very, very expensive.

Second sentence- names help for NIH grants, and being at an institution with a lot of people with grants that have the support structure to get you into a good project to get published well helps but you still have to A) get lucky and B) do a lot of hard work, with help from natural talent and luck to get a big grant. Plenty of projects are nearly unpublishable dead ends with a lot of man hours and little to show for it.

Last paragraph- I am extremely doubtful you could get a 'full time' academic job for 12 weeks neuroICU per year with no added clinic weeks or other demands.

Regarding the last sentence, the neuroICU attending I met during the interview trail told me that he worked 12 weeks of neuroICU (he would be on 24x7 during those weeks), but in the remaining weeks he had 2.5 days of clinic/admin work per week. I didn’t poke further of course but in my mind that seemed pretty good for having time off for research (even though I’m currently not interested in neuroICU at all).

Thank you for clearing that up about NIH grants! Really helps me plan my long term future as well as my RoL for the match in the short term

 

[90sportsfan]

So if I understand this correctly, one can be part of an academic institution, yet be involved in trials/research with funding from industry?

For NIH grants, is it necessary to get into a big name residency to have a chance in the future? Or is it the fellowship that has a greater role in this?

Regarding academic neurology, I understand that 3.5-4 days clinical+ 1 day administrative/teaching work would be considered as a full time job for outpatient departments. But for something like neurocritical, it seems that 12 weeks or so of ICU seems to be enough for clinical, and the rest of the time is spent on research or teaching or administration. So does this mean that it would be easier to do research in such a field compared to a traditional outpatient job without necessarily having protected time, as your clinical weeks are sort of fixed?

As someone who has a cousin who is a PhD (non MD) at a medical school, NIH grants are super competitive. He was lucky to get a K grant and an R01, but he said was a brutal process and many PhDs aren't successful and move on to industry. Your grant application is scored with the hundreds of others and only the top 10-20% are funded. Many MDs aren't successful either, but it's not a huge deal because they just shift to more clinical work. That's why there are few pure MD clinician scientists. Although, as the other MDs on here have stated, it is possible as a clinician with good research training and a supportive institution that can prepare you well. But I think they are trying to stress to us that this route (a clinician-scientist with NIH grants and protect research time) is not an overly common or easy route for most neurologists.

 

[Thama]

As someone who has a cousin who is a PhD (non MD) at a medical school, NIH grants are super competitive. He was lucky to get a K grant and an R01, but he said was a brutal process and many PhDs aren't successful and move on to industry. Your grant application is scored with the hundreds of others and only the top 10-20% are funded. Many MDs aren't successful either, but it's not a huge deal because they just shift to more clinical work. That's why there are few pure MD clinician scientists. Although, as the other MDs on here have stated, it is possible as a clinician with good research training and a supportive institution that can prepare you well. But I think they are trying to stress to us that this route (a clinician-scientist with NIH grants and protect research time) is not an overly common or easy route for most neurologists.

This is all truth. K awards are typically funded at about a 25% rate for clinician-scientists, and remember that most people submitting K awards are already people with enough research productivity to actually write a K, which is quite a bit. R awards are generally more competitive than that, generally somewhere between 5 and 15% funded depending on funding mechanism, institute, topic. The majority of people I've known that have tried to go down a clinician-scientist pathway have washed out to pure clinical practice within a few years, and this is at one of the most well-funded departments in the country that's known for nurturing junior faculty into research careers. At a mid-tier program, it's even more rare to find success in this pathway.

 

[Dormouse]

This is all truth. K awards are typically funded at about a 25% rate for clinician-scientists, and remember that most people submitting K awards are already people with enough research productivity to actually write a K, which is quite a bit. R awards are generally more competitive than that, generally somewhere between 5 and 15% funded depending on funding mechanism, institute, topic. The majority of people I've known that have tried to go down a clinician-scientist pathway have washed out to pure clinical practice within a few years, and this is at one of the most well-funded departments in the country that's known for nurturing junior faculty into research careers. At a mid-tier program, it's even more rare to find success in this pathway.

K08 success rate for all institutes was 41% last year (53% at NIMH, 31% at NINDS), and 44% the year before, which doesn't seem terrible? But I guess like you said, the applicants are from a very self selecting group...
Is there any institutional funds/grants at your institutions to support early career clinician scientists who want to go down that pathway?
As a medical student I'm trying to understand more about this- why is it more rare to find success in this pathway at a mid-tier program? Is it the lack of departmental resources and support or...?

Industry funding can allow one to do research on pivotal trails without dealing with grants. You'll get less control and managing FDA compliance is the main challenge (and a big challenge). Make yourself a big enough name with a big sub-specialty patient population and the drug companies will come to you before designing any trials. Many departments at lesser known universities are flush with cash from industry funding and you can easily fit this clinical research into practice with no paycut or worries about grant funding. You can even do industry funded trials in private practice quite profitably as long as you can supply the patients and handle the rigorous compliance required (eg you have 1000 MS patients in your practice panel).

If you don't mind me asking, how do you make yourself a big enough name with a sub-specialty patient population? Through publications? Word-of-mouth/connections? Wouldn't you have to be rather well established to be approached by industry for these types of roles? Is this specific to a particular subspecialty or common in neurology?

 

[Thama]

You're right - I was referring to NINDS which is the most common institute for neurologist grants to be assigned to. That's usually around 25-30%. Other institutes can be more forgiving like NIA and NIMH, but still quite competitive. You aren't just competing against clinician scientists but against PhDs who have usually done 1 or more post docs and have no clinical training or responsibilities to divide their time. You get some leeway as a clinician scientist, but not enough to compensate for the demands on your effort.

To answer the question about high vs mid tier departments, just peruse the faculty page for UCSF and then do the same for a random state school. See how many clinician scientists you can find. The first obstacle to a scientific career is finding good mentorship, so going somewhere where a lot of people are successful in doing science immediately makes it more likely you'll find someone good to work with. It's also a strong indicator of how many resources a department is willing/able to put into clinician scientist development - the big boys have these resources, and most of the kids table doesn't. As someone who has been through the academic job search with research in mind, departments are nowhere close to being created equal here, even among programs with name recognition. Expertise tends to accumulate in certain places in a snowball effect, because it's between hard and impossible to just go somewhere random and start a lab until you're at a pretty advanced stage in your career.

 

[Dormouse]

To answer the question about high vs mid tier departments, just peruse the faculty page for UCSF and then do the same for a random state school. See how many clinician scientists you can find. The first obstacle to a scientific career is finding good mentorship, so going somewhere where a lot of people are successful in doing science immediately makes it more likely you'll find someone good to work with. It's also a strong indicator of how many resources a department is willing/able to put into clinician scientist development - the big boys have these resources, and most of the kids table doesn't. As someone who has been through the academic job search with research in mind, departments are nowhere close to being created equal here, even among programs with name recognition. Expertise tends to accumulate in certain places in a snowball effect, because it's between hard and impossible to just go somewhere random and start a lab until you're at a pretty advanced stage in your career.

How did you figure out which departments have the resources and mentorship? By their total NIH funding? By R25 funded residency programs? Or did you have to individually peruse each clinician scientist's records and see where their trainees ended up?
Also what you said implies that you're expected to stay where you are as a fellow/resident if you get a K grant? Wouldn't that be very difficult at a top institution?
I really appreciated your explanations!

 

[Thama]

Rankings help. NIH funding, USNWR, Doximity. But once you've used those to narrow your search, it comes down to looking at records for clinician scientists in fields you're interested in, seeing how many trainees they've had and what they've gone on to do, etc. Even among prestigious departments, some are drastically better at particular areas than others. Wanting to be a neuroimaging person vs doing basic neuroimmunology work will have a huge impact on what departments are best for you. There's no guide to this. You have to do the leg work yourself.