I see. So even in an academic setting, salary is linked to RVUs and the specialties you mentioned above (icu, NIR, pain) have a higher potential income than the other fields, correct?
I'm just graduating movement fellowship at a prestigious academic center so the job advertisement emails have been rolling in for 2 years.
There is SO MUCH variability to neurology salary it is mind boggling. There are basically no rules.
You can work every other week as a neurohospitalist in Alaska and make 500k. You can work every day 9-5 as a cognitive outpatient doc in a big california city at a prestigious academic center and make 160k.
As other people have said, there is so much more to consider than dollars per hour. What stage are you at? You shouldn't even be thinking about this until you're atleast a R2.
I'll try and break down the factors that go in to salary,
Practice type: private, employed, locums. Private, typically you get paid for what you do in RVUs. This is where procedure heavy specialties win out (reading EEG, injections, EMG). Employed- you work for a hospital/clinic, managed care organization, VA, something like that. You get a set salary for whatever %time you work. Often the salary is tied to an RVU goal, especially for outpatient providers. Hospitals aren't dumb and they set an RVU goal based on about what amount of work they think you should do for that time and for what you're doing. The RVU goal therefore requires a certain amount of work for your salary, but also provides bonus opportunity if you get very fast or efficient at what you do. Some places don't have an RVU goal (Kaiser, for example, other community operations) and they're basically paying you to just see people and for your availability. What that salary is that you are working towards is highly variable based on location (more remote == more money), academic or not (academic == less money), and private/public (this can be a mixed bag, with county hospitals in some area paying more than academic public universities, etc). Locums you're basically a free floating neurologist for hire, though often people will stay at one place for potentially longer times. Payment is typically shift or hourly, with some room for bonus/productivity. Per hour, locums probably actually pays the most, because these hospitals are so desperate for any kind of neurology coverage and they need it NOW. It seems like you're perhaps interested in research? Unfortunately, your plan to maximize dollars on a few days a week to "free up" time for research doesn't really work. If you're going to do research in any real way you need to be at an academic institution. You can't really just elect to work 2 days/week at a high paying specialty and like be freewheeling the rest of the time. Basically you sign up for a full time position, lets say it pays $210k, and then you come up with ways to pay that salary. Initially a department might offer 210k for 3 days of clinic and 2 days of research, but those 2 days of research will eventually have to be paid by grant money. It's not like you get paid 210 for 3 days of work and the rest is volunteering. So eventually you get a grant and pay for X% of 210k with that, and if the number is not 100% you and your department negotiate what work you need to do to fill the space.
Work setting: outpatient/inpatient. This primarily determines your work schedule, and less your reimbursement, as alot depends on the factors above. But it is vital to consider in terms of what you're willing to do for the money. Outpatient is typically 3-5 clinic days a week 9-5. Many subspecialty academic practices do 3 days full time clinical work and then 2 days research. Many busy big hospitals might say the "week" is 4 clinic days long with a day for admin. Most inpatient people work 7 days on/then 7 days off, with variability around whether you take night/weekend call.
Location: Anything not in metropolitan California or the east coast big cities will pay about 30-50% more in any situation I'd say.
Specialty or general: Because often specialists work in the more academic centers, specialists do not necessarily make more money than generalists. Quite the opposite sometimes. I guess if you have a private specialty clinic there is opportunity to make people pay out of pocket, and in lots of places there is quite a lot of demand.
Here are some examples:
1. Stroke specialty, fellowship trained. Prestigious academic center in metropolitan CA. Many patients are in the ICU. 10 weeks of service, taking overnight call. 2 clinic half days/week. Teaching responsibilities, manage a neurology resident team. Residents handle all pages. First job out of fellowship. 190k, 10k signing bonus. This compares to the non-academic hospital in the same city, which would have required more like 15-20 weeks of service with you being the first call for strokes,
2. Movement specialty, fellowship trained. Prestigious academic center in metropolitan CA. Outpatient, 3 days of clinic/week. Attainable RVU goal. 2 days of research/week, with expectation to get funding for this portion in 2-3 years. No call. 210k, 25k signing bonus.
3. Neurohospitalist, fellowship trained. Large county hospital in metropolitan CA. On every other week M-F. Consult, working with medicine residents. Often take work home until midnight. On call overnight during those days. All weekends off. The other week, 2 days of clinic. No expectations the other 3 days that week. 306K, 36k built in bonus
4. Neurohospitalist, not fellowship trained. Medium community hospital in urban NM. 7 on/7off. 7-7am. No calls overnight. 330K
5. General neurologist: Outpatient at Kaiser. 4.5 clinic days/week. A little bit of phone call for a few hours here and there. No weekends. $244K.
