Fellowship salaries?

[bob38443]

Is there any data on salaries for example epilepsy vs neurocritical vs vascular?

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[kchan99]

Fellowship salaries don't vary by subspecialty. A first year fellow who completed an adult neurology residency would be paid at the PGY-5 level. Fellowship salaries vary slightly according to institution and geographic area because of the cost of living. Most fellows are able to moonlight though it would be more difficult in inpatient-heavy fellowships, such as stroke and neurocritical care.

 

[typhoonegator]

Yep, the only variance you're really going to see is by regional cost-of-living changes in PGY-level salaries. I don't know of any ICU programs that supplement salaries beyond the PGY level, because why would they? Also, ICU fellows at my institution are not permitted to moonlight outside the program because of their hours.

 

[NWwildcat2013]

Yep, the only variance you're really going to see is by regional cost-of-living changes in PGY-level salaries. I don't know of any ICU programs that supplement salaries beyond the PGY level, because why would they? Also, ICU fellows at my institution are not permitted to moonlight outside the program because of their hours.

What are the typical hours of a ICU fellow?

 

[neglect]

Yep, the only variance you're really going to see is by regional cost-of-living changes in PGY-level salaries. I don't know of any ICU programs that supplement salaries beyond the PGY level, because why would they? Also, ICU fellows at my institution are not permitted to moonlight outside the program because of their hours.

I see this prohibition as akin to slavery. Many legislatures agree, and prohibit any contract that restricts an employee from engaging in a lawful work outside their job (exceptions are made for folks who would want to work for a direct competitor, or a sales person taking clients with him, but these don't apply to an ICU fellow who wants to take call over a weekend at a local hospital).

What are the attendings afraid of, that the fellows might learn something?

 

[typhoonegator]

What? Moonlighting hours count towards the ACGME cap. Until recently, our fellows during their ICU blocks were up against the cap. Therefore, allowing moonlighting would risk them working over the duty hour cap. Now it isn't an issue any longer, but no one has asked.

Comparing employment terms governed by ACGME requirements to the institution of slavery is grossly hyperbolic.

 

[neglect]

What? Moonlighting hours count towards the ACGME cap. Until recently, our fellows during their ICU blocks were up against the cap. Therefore, allowing moonlighting would risk them working over the duty hour cap. Now it isn't an issue any longer, but no one has asked.

Comparing employment terms governed by ACGME requirements to the institution of slavery is grossly hyperbolic.

With respect, I disagree that comparisons to slavery is at all hyperbolic. Although you seem horrified by the idea, I reaffirm an employment situation that dominates an employee, treats them like they own them at work and outside of work, is, in my words, "akin to slavery"

But questions: Why do the fellows work 80 hours? Don't residents do anything? Even if this is the objection during a particularly bad month of ICU, then why prohibit them from moonlighting when they're on lighter rotations?

The nature of medical training sucks so much. Centers treat residents and fellows (especially unfair, since a fellow bills like an attending) like students when it comes to avoiding fair wages and work hours. Then they treat them like employees when it suits them, like non-compete contracts. In addition to some of this being unethical, non-compete laws that place employees at a disadvantage are facing more and more scrutiny, and in CA many of these agreements are illegal. Don't get me wrong, I wish I could hire highly qualified trial admins, coordinators, and support staff, then limit their ability to get better jobs and prevent them from advancing in pay and position. Again, the law recognizes that trade secrets are just that, and that Jim and Pam cannot take paper sale clients with them to another company, and Dwight can't moonlight for Office Depot. But if those things aren't in play, limiting an employee's ability to earn is - I think perhaps we can agree on the word - dubious.

 

[typhoonegator]

Fellows work hard these days because in many ways we have infantilized residents at programs where resources are abundant. If you have access to a fellow 24/7, then it suddenly seems "less safe" to have a resident covering an ICU overnight. This relegates residents to lesser roles, which means it takes longer for them to actually become proficient. There's always a sentinel event of some sort to support that line of thinking, so it is incredibly difficult to stem the tide. Before midlevels and support for nightfloat systems, fellows at big ICU programs traditionally worked very hard -- talk to someone who trained at Hopkins sometime; they lived there. I personally think midlevels have really improved both care and training in ICUs by streamlining operations. Our fellows don't typically work 80 hours a week anymore, and even when they did it wasn't all the time, but it is very difficult to legislate that into a moonlighting oversight system and guarantee adherence with limited resources to actually monitor activities.

The field has decided that the 80 hour work week is a red line, and programs face a lot of local and systemic pressure to toe the line. I personally agree that we should limit the restrictions we place on trainees to maximize their options to balance training and earning potential, but poorly funded mandates with repercussions that only swing in one direction have a way of limiting options for the very people the rules are supposed to protect. That's how you end up with internal moonlighting programs where it is far easier to regulate (a) the educational content of the moonlighting activity and (b) tracking of time spent moonlighting.

I don't fundamentally disagree with anything you are saying other than comparing someone who makes $54,000 a year in the US with someone who has their passport confiscated to live in a tent in Qatar for pennies a day with no way out.

 

[kchan99]

I'm not a neurocritical care fellow, but I should point out that there are neurocritical care fellowships out there that permit some sort of moonlighting. At the program where I did my residency, there was internal moonlighting for residents in which some neurocritical care fellows filled shifts during research months. Of course, no one was permitted to moonlight during ward months, regardless of training status.

 

[bob38443]

I may have phrased my question poorly but I meant to ask if there was data on the salaries of these subspecialities after finishing fellowship. I think its generally understood that you will be paid slightly above residents as a fellow.

 

[typhoonegator]

Ah, such a storm from a poorly written question. Subspecialty neurology salaries vary widely, depending on procedural load, inpatient/outpatient mix (and reimbursements), and how bad a department or practice wants someone with your skill set.

If a hospital in Wyoming needs a neurointensivist so they can go for Comprehensive Stroke Center accreditation, and they've done the math about how much that will bring in to the hospital just by having you around, then you salary could look pretty fantastic even if you aren't billing a lot. Office visits for epilepsy might not reimburse very well, but if you have 5 NPs seeing the patients while you read EEGs and LTMs, then suddenly the picture is rosier. So basically, there are major outliers in each.

 

[Nonphysiologic]

Curious, what is the 50-75th %ile for NICU?


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