Have you noticed a shift in interest towards inpatient neurology?

[deleted1208015]

I’ve been wanting to be a neurologist ever since I shadowed one back in 2013 as a freshman in college, and here I am as a PGY-1 in 2025 (wow oh my god that was painful to type out).

Back when I was in college I was interested in learning more about the landscape of neurology and it seemed like back then everyone was gearing towards outpatient neurology. I remember a statistic something like 90+ percent of neurologists are outpatient.

But now it seems like the interest in neurohospitalist is booming. Not sure if this is because Neuro IR is more attainable for neurologists now. Or whether it’s because neurologist run closed NCC units have become more common. Or if it has to do with pay structure with Medicare on a national scale? I’ve just noticed, anecdotally, that there’s been a massive shift in interest of people now wanting to pursue inpatient neurology.

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[Spinothalamic]

Anecdotally, yes.

Inpatient currently generally pays better. Inpatient is seen as “cooler” to many trainees (which is typically synonymous with higher acuity). No Inbasket/phone messages with inpatient. Finally, outpatient general neurology is too hard (partly because vast majority of neurology training is inpatient and then you are thrown to the wolves; partly because outpatient general neurology encompasses thousands of possible presentations/diagnoses.)

 

[s5260205]

Majority of students applying to neurology whom I've interviewed want to do stroke, NCC, or NIR. I think this is quite skewed due to students being mostly inpatient with limited exposure to other subspecialities within neurology.

When it comes times to residency, people are exposed to outpatient mostly through their resident clinic which unfortunately is filled with "leftover" patients after all the subspecialists pick out their own share of patients they want to see. These resident clinic patients would often have chief complaints that are vague and likely psychogenic. Many people then become quite jaded seeing these patients throughout residency. With the increase in purely inpatient neurohospitalist positions, especially the 7-on and 7-off schedule, people are naturally drawn toward inpatient.

I should say that as attending however, you will be able to see and manage many different neurologic conditions. Certainly, psychogenic complaints abound still, but there will be a plethora of other interesting patients you will encounter. For more general neurology positions, you won't be able to customize your patient panel. However, if you join a larger neurology practice, you will be able to do so. In large hospital-based or academic practice, you can even limit what chief complaints or diseases you will see. In short, outpatient is so much more rewarding being the primary neurologist managing your patients and following along throughout their disease course. This is in contrast to inpatient neurology where you are constantly under the pressure of all the hospital politics. There are pros and cons to each position, but I always like to tell residents that outpatient is not as bad as resident clinic experience.

 

[Aldertonghen]

- No inbasket messages, refills, and phone calls (which can take upto 10-20% of your clinic time per day)
- 7 days on, then 7 days in Hawaii sounds great to me in the middle of a gruelling residency
- Patients improve over days and you can see the improvement right away instead of waiting 3 months follow up.
- Less functional presentations, especially if neurocrit or NIR.
- more $$$ unless you’re doing pain, or sleep+EEG study outpatient.
- Resident clinic is a terrible wastebasket mostly for specialists to throw all functional patients into

 

[Neurogeneral]

There is no real “free lunch” no matter whether you do inpatient or outpatient. I did both for several years and they both come with their pitfalls. Having said that, over a year ago, I left my job and gave up inpatient completely and it has been liberating to say the least. In retrospect, I did not find inpatient neurology professionally satisfying. Seeing altered mental status patients became the bane of my existence. There has also been an explosion of new medications and treatment options but you hardly ever get to prescribe these as a neurohospitalist. In my clinic, I prescribe all kinds of AEDs, migraine meds, dopaminergic meds, MS drugs, amyloid beta monoclonal antibodies, etc.

Inpatient is great if you want to work real hard and make more money. You work more hours, see more patients, work weekends, take call, etc.

When I talk to my inpatients friends the weeks they are on, they are usually stressed and getting slammed. The seven days off course though is a huge plus for them and may be worth it. But I am usually done by 3:30 on weekdays and have my weekends completely off. I dont ever feel overwhelmed with seeing patients and doing notes. I don’t get called or paged outside of office hours.

And yes you are likely gonna see less functional patients as a neurohospitalist but you will not be spared this completely and you will often have to see these patients multiple days in a row for the duration of their hospitalization.

 

[Spinothalamic]

Anecdotally, yes.

Inpatient currently generally pays better. Inpatient is seen as “cooler” to many trainees (which is typically synonymous with higher acuity). No Inbasket/phone messages with inpatient. Finally, outpatient general neurology is too hard (partly because vast majority of neurology training is inpatient and then you are thrown to the wolves; partly because outpatient general neurology encompasses thousands of possible presentations/diagnoses.)

FYI, I was answering quickly with some of the perceived benefits of inpatient. The post above discusses some of the downsides pretty well. I will say that with outpatient it is extremely nice to have open weekends all of the time and never have to worry about missing things in the evenings!

 

[deathmerchant]

I’ve been wanting to be a neurologist ever since I shadowed one back in 2013 as a freshman in college, and here I am as a PGY-1 in 2025 (wow oh my god that was painful to type out).

Back when I was in college I was interested in learning more about the landscape of neurology and it seemed like back then everyone was gearing towards outpatient neurology. I remember a statistic something like 90+ percent of neurologists are outpatient.

But now it seems like the interest in neurohospitalist is booming. Not sure if this is because Neuro IR is more attainable for neurologists now. Or whether it’s because neurologist run closed NCC units have become more common. Or if it has to do with pay structure with Medicare on a national scale? I’ve just noticed, anecdotally, that there’s been a massive shift in interest of people now wanting to pursue inpatient neurology.

First, congrats on achieving your dream!! Next 2 years will likely be the worst, but it will improve rapidly after that, if you make the right decisions.
Some good points above. I do both inpatient and outpatient so my 2 cents-

Inpatient can be very busy and cause burnout fast if working at a busy stroke/tertiary center. It can also be very easy/relaxing if you pick the right job (like mine). Round for few hours and go home. Work 14 days/month and get paid well. No baskets/tasks/refill/patient calls. - I can also round whenever I want, some days I round in the evenings if I'm playing golf and service is not busy, other days early in the morning. The flexibility is very helpful when kids are involved too. I suggest if you are work hard/party hard type of person or not very social/patient/good listener or you feel like a weekend is not enough off time for you (like me). Pick inpatient.

Outpatient has a higher ceiling to make money, esp in certain sub-specialties. But, you have to see a lot more patients to make more than inpatient. Essentially you can control how much you make as outpatient to some extent. But by god its annoying. If you are in a subspecialty it might not be that bad. But by the time I see the 5th AD or migraine or dizziness patient, I don't have much left in me.

Bad analogy but outpatient is like you own a nice restaurant and patients are patrons. you have to satisfy them every time with good food and service and cost and wait times etc. Some are annoying and extra demanding and might even leave a bad review or keep calling afterwards as well. Inpatient is more like food delivery, you drop-off the food and you get out !!

 

[deleted1208015]

First, congrats on achieving your dream!! Next 2 years will likely be the worst, but it will improve rapidly after that, if you make the right decisions.
Some good points above. I do both inpatient and outpatient so my 2 cents-

Inpatient can be very busy and cause burnout fast if working at a busy stroke/tertiary center. It can also be very easy/relaxing if you pick the right job (like mine). Round for few hours and go home. Work 14 days/month and get paid well. No baskets/tasks/refill/patient calls. - I can also round whenever I want, some days I round in the evenings if I'm playing golf and service is not busy, other days early in the morning. The flexibility is very helpful when kids are involved too. I suggest if you are work hard/party hard type of person or not very social/patient/good listener or you feel like a weekend is not enough off time for you (like me). Pick inpatient.

Outpatient has a higher ceiling to make money, esp in certain sub-specialties. But, you have to see a lot more patients to make more than inpatient. Essentially you can control how much you make as outpatient to some extent. But by god its annoying. If you are in a subspecialty it might not be that bad. But by the time I see the 5th AD or migraine or dizziness patient, I don't have much left in me.

Bad analogy but outpatient is like you own a nice restaurant and patients are patrons. you have to satisfy them every time with good food and service and cost and wait times etc. Some are annoying and extra demanding and might even leave a bad review or keep calling afterwards as well. Inpatient is more like food delivery, you drop-off the food and you get out !!

Thanks for the response. Do you practice general or sub-speciality neurology?

 

[Zendo]

First, congrats on achieving your dream!! Next 2 years will likely be the worst, but it will improve rapidly after that, if you make the right decisions.
Some good points above. I do both inpatient and outpatient so my 2 cents-

Would you kindly elaborate on what kind of right decisions you mean? And general tips to gain maximum benefit from neurology residency? Thanks!

 

[deathmerchant]

Thanks for the response. Do you practice general or sub-speciality neurology?

I am subspecialty trained but I do everything except sleep. Both Inpatient and outpatient.

 

[deathmerchant]

Would you kindly elaborate on what kind of right decisions you mean? And general tips to gain maximum benefit from neurology residency? Thanks!

I meant right decisions in a general sense- related to personal relationships, health, career, hobbies etc. These 'decisions' can be very different things for different people. Many neurologists/physicians are unhappy, not rich, divorced and burnt out by the time they hit 40.

For your specific question, it depends on what you see yourself doing for the rest of your life. Are you passionate about and want to subspecialize in a specific niche?- then do some early electives/rotations in that. Do you want to get into academics and climb the ladder?- get into research. Do you want to do pp or work as a generalist?- get exposure to every subspecialty and learn procedures like EEG/EMG/Botox/Sleep. Do you want to go into a high paying field like NIR?- do research/away electives and make connections etc. etc.

Really depends on what you want. If you know that part, people can advise you better.

 

[Telamir]

Among the limited cohort of neurology trainees I am exposed to (I work locums, after all) I think it's mixed. Some folks absolutely cannot stand inpatient neurology, and others seem to love it.

A lot of folks here seem to mention the 7 on 7 off. I think it's a great schedule, but honestly can be somewhat exhausting. When you're "on", you're really on, and depending on the night situation at any particular job you can be sleep deprived a good portion of those 7 days, rendering 2-3 of your "off days" as recovery days. As locums however I make my own schedule, and sometimes have 2-3 weeks off at a time. I'd love to say I do some exciting stuff during it, but mostly I'm just enjoying not living out of a hotel/moving across time zones/driving a rental car, and being home with my friends/loved ones and taking part in my hobbies.

I will say that I started doing inpatient exclusively because of how bad my clinic was. I went to a "brand name" place--my clinic was almost exclusively psych. Poorly defined vaguely neurologic complaints +/- pain/radic/neuropathy. As alluded to above, it was the leftovers of what the attending didn't want to see. That, combined with the inbox, the refills, the ****ty patient behavior, the callbacks, the occasional peer to peer, etc made me swear off clinic once I was done with residency. I'm aware it supposedly gets better, but I think we need to do something about how it's handled/structured.

 

[neophyte2008]

I can also share my views on this.

I am relatively fresh out of training, I did my residency training in an inpatient heavy program with a neuro ICU. I felt relatively comfortable with inpatient management by the end of it. But my clinic experience was anything but great at my program. I just wasn't a great multitasker and the refills; phone calls and messages were overwhelming. I respect outpatient folks for doing this, but I felt it wasn't my cup of tea.

Also did a vascular fellowship. Surprisingly, I had more outpatient time during my fellowship relative to other programs. It was fun, but we only see stroke patients, so you don't get psychosocially complex patients. But still, I liked inpatient more for certain. It is just that you have too many things to keep track of as an OP doc or at least I felt so.

My transition to attending was so simple because I chose an inpatient job. It was just like a continuation of residency/fellowship. The pros are

- The on and off schedule is great.
- No messages at all.
- No peer to peer, phone calls, paperwork.
- Doing same thing as training.

Cons
- Maybe 2-4 questionable TIAs and encephalopathies a day.
- Lack of variety of cases and lack of follow-up.

Don't think I will do OP in future unless its stroke clinic and is absolutely needed. I however do get the appeal of inpatient for folks.

Sometimes I wonder if the hospitalist market will get saturated with so many people opting inpatient.

 

[Neurogeneral]

Most neurology residencies are inpatient heavy with outpatient continuity clinic treated as something that is getting in the way. In this type of setting, it’s natural to feel overwhelmed by patient messages or a supervising attending laboriously checking all the reflexes on a migraine headache patient when you happen to be juggling that with rotating on the inpatient service simultaneously.

As an outpatient only neurologist, though, managing the inbasket does not feel burdensome. It’s just part of the job. I can devote my day completely to my clinic and still leave the office by 4 pm. Having said that, every once in a while, I will have the misfortune of having to take care of a disturbed, confrontational, and demanding patient, but I always try my best to remind myself that I do not have to take call and I do not have to work weekends.

I think, regardless, it’s important to choose a track - either do inpatient or outpatient. Trying to do both IMO can often lead to burnout.

 

[sharkbaitwhohaha]

Most neurology residencies are inpatient heavy with outpatient continuity clinic treated as something that is getting in the way. In this type of setting, it’s natural to feel overwhelmed by patient messages or a supervising attending laboriously checking all the reflexes on a migraine headache patient when you happen to be juggling that with rotating on the inpatient service simultaneously.

As an outpatient only neurologist, though, managing the inbasket does not feel burdensome. It’s just part of the job. I can devote my day completely to my clinic and still leave the office by 4 pm. Having said that, every once in a while, I will have the misfortune of having to take care of a disturbed, confrontational, and demanding patient, but I always try my best to remind myself that I do not have to take call and I do not have to work weekends.

I think, regardless, it’s important to choose a track - either do inpatient or outpatient. Trying to do both IMO can often lead to burnout.

Agree w above.
Inpatient is boring. AMS that is either toxic/metabolic or seizure or stroke or functional. Or a stable neurological condition consult that is "just to be on-board". Yes there are the rare interesting cases (NMDA encephalitis, etc).

Out patient: certainly a lot of migraine, seizures, diabetic neuropathy and dementia. But also longitudinal management of ALL the episodic and progressive neurological disorders (CIDP, MG, MS, PD, PSP, FTD, DLB, chronic migraine, refractory epilepsy, dystonia, other).

A well run outpatient clinic allows the neurologist to actually see and manage patients and pushes inbasket management to a midlevel or a well trained MA who "filters" 95% of the work. Outpatient private practice is NOT residency clinic even in the slightest. There is a lot of misinformation from neurohospitalist on this forum.

For example, I see about 20 pts a day and spend about 3-5mins a day w inbasket messages. I'm home every day by 430pm and never work ANY weekends and I've never missed ANY important family/kid event since starting private practice. Oh, and I make about 600k a year.

 

[ToastyPremed]

Agree w above.
Inpatient is boring. AMS that is either toxic/metabolic or seizure or stroke or functional. Or a stable neurological condition consult that is "just to be on-board". Yes there are the rare interesting cases (NMDA encephalitis, etc).

Out patient: certainly a lot of migraine, seizures, diabetic neuropathy and dementia. But also longitudinal management of ALL the episodic and progressive neurological disorders (CIDP, MG, MS, PD, PSP, FTD, DLB, chronic migraine, refractory epilepsy, dystonia, other).

A well run outpatient clinic allows the neurologist to actually see and manage patients and pushes inbasket management to a midlevel or a well trained MA who "filters" 95% of the work. Outpatient private practice is NOT residency clinic even in the slightest. There is a lot of misinformation from neurohospitalist on this forum.

For example, I see about 20 pts a day and spend about 3-5mins a day w inbasket messages. I'm home every day by 430pm and never work ANY weekends and I've never missed ANY important family/kid event since starting private practice. Oh, and I make about 600k a year.

How do you arrange your clinic to see 20 patients a day? 30 minutes a pt? 8-4am gives you 16?

 

[sharkbaitwhohaha]

How do you arrange your clinic to see 20 patients a day? 30 minutes a pt? 8-4am gives you 16?

15 min for follow up and 30 min for new. some overbooking to allow for no shows.

 

[CnsCrit]

You are right there is more interest in inpatient neurology, but much of it wanes by the time people graduate and go on to fellowship, most residents are still going into outpatient heavy fields, or are at least splitting their time with heavy outpatient time as attendings. Remember the other side of the coin - many residents are burnt out by their inpatient and NCC heavy residencies and would rather transition into something that seems less stressful to them.

NIR is an extremely small field, and the job prospects are not the best anymore. There are only so many CSCs and the barrier to entry is extremely high. NCC is also a small-ish field and again, there are only so many CSCs and job prospect are ok but not amazing. Neurohospitalist has less to do with those other 2. Simply, there's much more demand for neurologists to do inpatient consults and respond to stroke alerts.

This forum is heavily skewed towards folks who do locums and neurohospitalist, just keep that in mind. You will almost certainly make much, much less than 600k as an outpatient neurologist. Check out the physician side gigs forum database, look at published AAN and MGMA data for outpatient neurologists, it will be nowhere near that much. On the other hand, you won't make that as a neurohospitalist or NCC either. Just being realistic.

Just pursue what seems interesting to you, and you'll thank yourself later.

 

[Telamir]

This forum is heavily skewed towards folks who do locums and neurohospitalist, just keep that in mind.

I agree! As a full time locums neurohospitalist I wholeheartedly agree. People need to take the schedules and "salaries" presented with a grain of salt, as there is a lot of (not-so-humble) bragging going on, an who knows if some embellishing.

 

[deathmerchant]

Agree that answers in online forums should be taken with a grain of salt. But I also want to encourage you about salaries, if that is important to you. Most specialties that make a lot of money are either able to see a lot of patients fast and/or do quick procedures. Either way they are working a lot for it. You can do the same in neurology. Lot of online data is also from academic or VHCOL setups which skews lower.

Inpatient has a ceiling but outpatient can be very lucrative. ( I personally do both and prefer inpatient for reasons mentioned above)

Y'all need to find a job that pays the standard $60/RVU ($55-65 is the range). Seeing a new patient in 30 min and follow up in 15 is key. That will get you around 8 RVUs/hr if billed correctly. Work 36 hours/week. That's close to 300 RVUs/week x $60 = $18000/week. Working 42 weeks/year gets you 750k.
If you want an easy schedule with $55/RVU and maybe working 4 days/week, still gets you close to 600k.

Obviously this is excluding procedures which can add on more.

 

[MC47]

Agree that answers in online forums should be taken with a grain of salt. But I also want to encourage you about salaries, if that is important to you. Most specialties that make a lot of money are either able to see a lot of patients fast and/or do quick procedures. Either way they are working a lot for it. You can do the same in neurology. Lot of online data is also from academic or VHCOL setups which skews lower.

Inpatient has a ceiling but outpatient can be very lucrative. ( I personally do both and prefer inpatient for reasons mentioned above)

Y'all need to find a job that pays the standard $60/RVU ($55-65 is the range). Seeing a new patient in 30 min and follow up in 15 is key. That will get you around 8 RVUs/hr if billed correctly. Work 36 hours/week. That's close to 300 RVUs/week x $60 = $18000/week. Working 42 weeks/year gets you 750k.
If you want an easy schedule with $55/RVU and maybe working 4 days/week, still gets you close to 600k.

Obviously this is excluding procedures which can add on more.

300 RVU/week x 42 weeks= 12600 RVU....
I am only averaging 5500-6000 RVU a year doing clinic work.

 

[deathmerchant]

300 RVU/week x 42 weeks= 12600 RVU....
I am only averaging 5500-6000 RVU a year doing clinic work.

You are doing great, that is slightly above average for neurology! So about 125 RVUs/week. I am guessing you are seeing 12-15 patients/day which is on the lower end for non academic.

 

[DrSatan]

I'll give another perspective here:

• Privademics model, outpatient only gig
• $285k salary (must reach >5000 RVUs/year)
• If RVUs >5300, additional $60 per RVU added to salary
• 10% bonus guarenteed + extra 2% for miscellaneous tasks
• 4.5 work days per week
• Clinics located in nearby suburbs of a major coastal city
• 60 minute new, 30 minute follow up times (8 to 12 patients/day)
• New patient appointments 4-6 months, follow up appointments 3-4 months with emergency slots available for my extra sick patients
• Can hyperfocus 100% on any subspecialty if desired.
• RNs and MAs inbasket support.
• Call ~3x per year consisting of every other night general neurology coverage for multiple EDs and hospitals x2 weeks. 1 major holiday every 1-3 years. No additional pay. No need to go in (though theoretically this could happen)

 

[s5260205]

I'll give another perspective here:

• Privademics model, outpatient only gig
• $285k salary (must reach >5000 RVUs/year)
• If RVUs >5300, additional $60 per RVU added to salary
• 10% bonus guarenteed + extra 2% for miscellaneous tasks
• 4.5 work days per week -- in at 750am, leave by 430pm, almost never have to chart or prep late
• Clinics located in nearby suburbs of a major coastal city
• 60 minute new, 30 minute follow up times (8 to 12 patients/day)
• New patient appointments 4-6 months, follow up appointments 3-4 months with emergency slots available for my extra sick patients
• 1/4 time dedicated movement disorders, remainder is general neurology (minus neuroinflammatory, complex headache, chronic pain, and epilepsy)
• 1/2 day per month for dedicated functional neurologic disorder clinic
• RNs and MAs help with inbasket, but I end up doing most of it
• Ready access to most all neurology subspecialties
• Call ~3x per year consisting of every other night general neurology coverage for multiple EDs and hospitals x2 weeks. 1 major holiday every 1-3 years. No additional pay. No need to go in (though theoretically this could happen).

The good:

• I see the cases I want.
• Schedule flexibility -- could do dedicated telehealth days and procedure days.
• I have time to deep dive every single patient if desired. I review every single chart in great detail and personally review all the relevant imaging.
• I have time to address more than 1 concern.
• I have time to use my neurologic examination when needed without sacrificing too much time for clinical history.
• More time spent with the patients = better care. I won't believe otherwise, especially with neurodegenerative dementing/movement disorders and functional neurologic disorder. Patients who see me as a 2nd or 3rd opinion invariably stay with me.

The bad:

• Probably underpaid. My colleagues make way more than me but pump out RVUs.
• Support staff regularly leave as they are underpaid.
• Poor inbasket assistance.
• Less PTO than colleagues who crush RVUs because of procedures, but I take ~4-5 weeks including conferences.

By 3x per year of every other night coverage, do you mean a total of 6 weeks per year? That is just horrendous with no extra call pay, especially considering the lower salary already with even an RVU goal on top of it (do they deduct pay if you go under 5000 RVUs?). Our hospital historically has issue recruiting because of the call requirement. With neurohospitalists being increasingly popular, along with tele-neurology, these hospitals need to stop taking advantage of doctors who do call "just because" with no extra pay.

Another downside is this being a multi-subspecialty neurology clinic but still only 1/4 time dedicated to movement disorders and needing to see general neurology for a big portion of your time. I would think people take a pay cut by working in academic (or privademic) so that they can tailor what patients they want to see (something like 80% movement if not more).

 

[deathmerchant]

I'll give another perspective here:

• Privademics model, outpatient only gig
• $285k salary (must reach >5000 RVUs/year)
• If RVUs >5300, additional $60 per RVU added to salary
• 10% bonus guarenteed + extra 2% for miscellaneous tasks
• 4.5 work days per week -- in at 750am, leave by 430pm, almost never have to chart or prep late
• Clinics located in nearby suburbs of a major coastal city
• 60 minute new, 30 minute follow up times (8 to 12 patients/day)
• New patient appointments 4-6 months, follow up appointments 3-4 months with emergency slots available for my extra sick patients
• 1/4 time dedicated movement disorders, remainder is general neurology (minus neuroinflammatory, complex headache, chronic pain, and epilepsy)
• 1/2 day per month for dedicated functional neurologic disorder clinic
• RNs and MAs help with inbasket, but I end up doing most of it
• Ready access to most all neurology subspecialties
• Call ~3x per year consisting of every other night general neurology coverage for multiple EDs and hospitals x2 weeks. 1 major holiday every 1-3 years. No additional pay. No need to go in (though theoretically this could happen).

The good:

• I see the cases I want.
• Schedule flexibility -- could do dedicated telehealth days and procedure days.
• I have time to deep dive every single patient if desired. I review every single chart in great detail and personally review all the relevant imaging.
• I have time to address more than 1 concern.
• I have time to use my neurologic examination when needed without sacrificing too much time for clinical history.
• More time spent with the patients = better care. I won't believe otherwise, especially with neurodegenerative dementing/movement disorders and functional neurologic disorder. Patients who see me as a 2nd or 3rd opinion invariably stay with me.

The bad:

• Probably underpaid. My colleagues make way more than me but pump out RVUs.
• Support staff regularly leave as they are underpaid.
• Poor inbasket assistance.
• Less PTO than colleagues who crush RVUs because of procedures, but I take ~4-5 weeks including conferences.

I appreciate neurologists like you who are passionate and understand the importance of neuro exams and take their time and I think your setup is great if it works for you!

I say this because I want all of us to be united. Because that is how mid-levels have been able to increase their salaries. If we all demand the same things, it is better for everyone.

For certain patients I understand, but do we really need 60 minutes for an RLS or neuropathy or essential tremor or migraine patient. And do we really need 30 minutes for a f/u of stable epilepsy or even PD, MS or any of the above patients? Remember 'Parkinson's Law'.
Also like mentioned by above poster, don't take call for free. Neurology is one of the highest in-demand specialty both for inpatient, outpatient, locums and tele. Use this leverage well.

 

[DrSatan]

By 3x per year of every other night coverage, do you mean a total of 6 weeks per year? That is just horrendous with no extra call pay, especially considering the lower salary already with even an RVU goal on top of it (do they deduct pay if you go under 5000 RVUs?). Our hospital historically has issue recruiting because of the call requirement. With neurohospitalists being increasingly popular, along with tele-neurology, these hospitals need to stop taking advantage of doctors who do call "just because" with no extra pay.

It's a total of 3 weeks call spaced out over 6 weeks with separate tele-stroke coverage. Average <5 calls per night, mostly medication refills <10pm. The call is a requirement and baked into compensation.

Yes, if I underperform with RVUs they can lower my FTE and salary.

Another downside is this being a multi-subspecialty neurology clinic but still only 1/4 time dedicated to movement disorders and needing to see general neurology for a big portion of your time. I would think people take a pay cut by working in academic (or privademic) so that they can tailor what patients they want to see (something like 80% movement if not more).

I could move to 100% movement if desired, but I like the easy cases that I do not have to follow up with indefinitely. I also generally like all of neurology.

For certain patients I understand, but do we really need 60 minutes for an RLS or neuropathy or essential tremor or migraine patient. And do we really need 30 minutes for a f/u of stable epilepsy or even PD, MS or any of the above patients? Remember 'Parkinson's Law'.
Also like mentioned by above poster, don't take call for free. Neurology is one of the highest in-demand specialty both for inpatient, outpatient, locums and tele. Use this leverage well.

60 minute appointments are only occasionally a waste of time for me for new patients. Rarely do I end my 30 minute follow up appointments early. If I do, then graduate them from clinic or push follow up to 6 to 12 months. Regardless, patients are late and roomed slowly. I only ever have ~15-20 minutes to actually see them for follow up when you subtract this out.

 

[deathmerchant]

It's a total of 3 weeks call spaced out over 6 weeks with separate tele-stroke coverage. Average <5 calls per night, mostly medication refills <10pm. The call is a requirement and baked into compensation. If I refuse then I am fired. This is a giant health care system in a prime location.

Yes, if I underperform with RVUs they can lower my FTE and salary. I am in the bottom percentile of RVU producers at my institution, but I readily hit my RVU target. My salary would be considered good for academic centers, and so I'm ultimately not too bothered by it as I effectively work as an academic neurologist without the need for research or residency mentoring (yet).


I could move to 100% movement if desired, but I like the easy cases that I do not have to follow up with indefinitely. I also generally like all of neurology.


Most of my consultations are not ever just RLS, neuropathy, or migraine. There is almost always more with the patient that can be addressed if time is available. The simple cases I discharge from clinic, see yearly, or push back to their primary care. 60 minute appointments are only occasionally a waste of time for me for new patients. Rarely do I end my 30 minute follow up appointments early. If I do, then graduate them from clinic or push follow up to 6 to 12 months. Regardless, patients are late and roomed slowly. I only ever have ~15-20 minutes to actually see them for follow up when you subtract this out. It may be that I am still too early in my work to have obtained a patient panel that is "stable." I bill all my patients by time and thus compensate by billing everyone as a level 5 (as I do in fact spend the required time to cross this threshold).

Most of my patients are overjoyed to see me every 3-4 months to make minor adjustments. Motor symptoms in PD are only the tip of the iceberg. The amount of non-motor symptoms ignored by my non-movement colleagues is astouding. My essential tremor folks I see sparingly because I often do not treat tremor. I like the 30 minutes so that we can follow up and occasionally ensure they have no converted to PD with a full UPDRS.

Like I said, I appreciate neurologists like you. I am movement trained myself so I know the importance of time and thorough history and exam. Maybe you get more complex patients. I would say 60%-70% of my patients are either stroke f/u, neuropathy, vertigo, migraines, tremor, RLS or stable epilepsy, PD, MS or Dementia etc. Occasionally I have a situation where I wish I had more time with a patient, but most days I am good. I have not had any negative feedback and most of my patients are happy with the care. I am 6 months booked out.

I think you have an overall decent setup and more importantly if you are happy with your practice, that's awesome! This is a marathon not a sprint and many physicians who try to work too much and too hard burnout earlier!