Highest Paid Neurology Specialties

[123med321]

I was just wondering what are the highest paying specialties in neurology? Is it interventional neurology, pain medicine, or what?

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[sideways]

Have you looked into Neuroderm?

 

[123med321]

Have you looked into Neuroderm?

I'm guessing that was a joke. (After looking it up on google.)

 

[bustbones26]

Have you looked into Neuroderm?

Neurogynecology is a pretty hot field these days.

Okay, on a serious note, lets get back to the OP question at hand. There is no doubt that interventional neurologist can make some serious cash. Is it the highest paid neuro specialty? I don't know? I can't even tell you where to look this up and in my experience, most statistics based on physicians salaries in general tend to be inaccurate mostly because they are based on the "average" salary.

Overall, I am sure such a question has been asked here before, so go digging.

 

[neurologist]

Like every other specialty, it's any field in which a lot of procedures are performed:

EMG
Sleep
Interventional pain procedures
Interventional rads procedures

Stuff like neurobehavior, headache, movement d/o, etc, not so much.

This may change with health care "reform," but it's pretty hard to say in exactly what way. The most likely scenario is that everything goes down across the board.

Reliable salary figures for subspecialties are extremely hard to come by, so you probably won't find much, and what you do find I would take with a grain of salt.

FYI, I made $2_7,000 last year in a hospital-based group setting.

Much of that goes to taxes . . .

 

[indya]

strangely enough, I actually saw my dad studying a journal called "neurourology and urodynamics" yesterday.

 

[Eurosepsis]

If you had the patient base to support it, movement disorders neurologists can do botox injections (w or w/o emg guidance) for dystonias, which seems like a pretty efficient way to supplement one's income.

 

[neurolddoc]

If you had the patient base to support it, movement disorders neurologists can do botox injections (w or w/o emg guidance) for dystonias, which seems like a pretty efficient way to supplement one's income.

Not so much. The injection fee is modest and a limited EMG which is what you would bill for barely pays for the injection needle. Also you get paid about 1% above cost of the toxin so if you get stiffed on one reimbursement out of 20 you are screwed.

 

[neurolddoc]

Like every other specialty, it's any field in which a lot of procedures are performed:

EMG
Sleep
Interventional pain procedures
Interventional rads procedures
:

I would add:
EEG, particularly long term monitoring, either ambulatory or inpatient
Neurovascular ultrasound.

The interventional folks would have to pretty much be full time doing just that. Its not the sort of thing you could integrate into a broader practice, I wouldn't think.

 

[123med321]

I was reading that neurologists can be involved in deep brain stimulation. In what capacity are they involved? This seems like something that a neurosurgeon would definitely do.

 

[lanzarlaluna]

I was reading that neurologists can be involved in deep brain stimulation. In what capacity are they involved? This seems like something that a neurosurgeon would definitely do.

I did a movement disorder elective last year. At this institution there is a neurosurgeon in the neurology department who does nothing but DBS and baclofen pumps. Follow-up visits are done by the neurologist, who is in charge of all adjustments and medical management.

 

[typhoonegator]

Neurologists manage essentially everything other than the physical placement of the stimulator. They assess the patient for candidacy, they make the programming adjustments in clinic, and they modify the drug regimen after it is working (hopefully). The neurosurgeon performs the preoperative assessment, and is responsible for putting the stimulator(s) in the place they are supposed to go.

At many institutions, there is a multidisciplinary team that takes care of these patients, so the neurologist and the neurosurgeon can have a nice dialog about the patient and their candidacy. I think this is the best way to go, because everyone is clear on the plan from the get-go.

 

[neurolddoc]

Managing all the DBS patients post op may be intellectually stimulating but I don't think it is going to put you in the" highest paid" category of neurology.

 

[Capsaicin man]

FYI-there is a interventional pain fellowship spot Jan. 2011 that is still open at the Medical College of Georgia

 

[NRAI2001]

What about pain med?? I always hear of pain medicine as being pretty lucrative?

 

[Guero]

I'm currently finishing a *bing* first-author paper with an attending functional neurosurgeon at Vandy (wow was he generous, eh?) . Anyway, I've had the opportunity to shadow several of his DBS placements in treating patients suffering from PD. The neurologist's main task is intraoperative (averaging 4 hours of continuous assessment) and preoperative (averaging a few 15 minute meetings).

Intraoperatively, the neurologist assesses the implant’s efficacy as the team pin points the patient's optimal target for permanent placement of the electrode (several mm around the subthalamic nucleus) and fine tunes the impulse frequency. The neurologist elicits the patient's tremor (or other chief sign/Sx) and quantifies improvement throughout the trial and error process.

Unlike prior posts, the neurologist isn't as involved in post-op visits. Instead, s/he attends pre-op work ups during the candidacy assessment phase, basically integrating information collected by the neurosurgeon. It seems that Vandy values interdisciplinary dialogue while reserving most control and input for the neurosurgeon, which makes sense considering the circumstances. Once the neurologist assists in clearing the pt for surgery, the rest (including f/u) is up to the neurosurgeon. I kind of like that. I can’t stand superfluous hand-offs that tend to foster poor transitions of care.

RE: highest paid neuro specialties
I'm willing to bet that neuroimaging and neurocritical care are among the fastest growing positions and pay...could definitely be wrong, though. Any thoughts? I’d like to see this thread stay alive.

 

[doctorlarry]

I'm currently finishing a *bing* first-author paper with an attending functional neurosurgeon at Vandy (wow was he generous, eh?) . Anyway, I've had the opportunity to shadow several of his DBS placements in treating patients suffering from PD. The neurologist's main task is intraoperative (averaging 4 hours of continuous assessment) and preoperative (averaging a few 15 minute meetings).

Intraoperatively, the neurologist assesses the implant's efficacy as the team pin points the patient's optimal target for permanent placement of the electrode (several mm around the subthalamic nucleus) and fine tunes the impulse frequency. The neurologist elicits the patient's tremor (or other chief sign/Sx) and quantifies improvement throughout the trial and error process.

Unlike prior posts, the neurologist isn't as involved in post-op visits. Instead, s/he attends pre-op work ups during the candidacy assessment phase, basically integrating information collected by the neurosurgeon. It seems that Vandy values interdisciplinary dialogue while reserving most control and input for the neurosurgeon, which makes sense considering the circumstances. Once the neurologist assists in clearing the pt for surgery, the rest (including f/u) is up to the neurosurgeon. I kind of like that. I can't stand superfluous hand-offs that tend to foster poor transitions of care.

RE: highest paid neuro specialties
I'm willing to bet that neuroimaging and neurocritical care are among the fastest growing positions and pay...could definitely be wrong, though. Any thoughts? I'd like to see this thread stay alive.

Fastest growing does not necessarily equal higher pay. Turf wars are still an issue with Neuroimaging, neurology won't win that one, they've been trying for years. Don't know about neurocritical care, but haven't heard anything astounding.

Some would believe Neurointerventional radiology would be high paying. However, while cutting edge, such jobs in the private setting are few and far between. This usually limits one to academia (which does not pay well) or hospital-based practice (who own you), which are generally associated with less autonomy and potential than private practice. Plus, the only evidence-based procedure at the moment is aneurysm coiling. There aren't that many aneurysms to coil especially when there are still turf wars with neurosurgery. Carotid stents? good luck with that turf war (rads, vascular, cards, neurosurg, etc). Embolizing tumors/AVMs, interventional stroke, intracranial angioplasty/stent etc are still in clinical trial phase. Not to mention the 2am calls. At the end of the day, opportunities will likely involve you working as a stroke neurologist (not good pay/time) some percentage of the time, unlike radiology-trained specialist who can do neuroradiology (good pay) to fill their time. Perhaps at some point in the distant future, this subspecialty may be worth the extra years in training.

Electrophysiology (EMG) has some potential, but not great.

Among all subspecialties, on the average, Pain Medicine has the highest potential, and usually, starting base salaries run about 50-100K more than neurology. The potential after making partner, however, is leaps and bounds.

 

[Strokeguy]

Regarding DBS, just to clarify, a MD (movement disorder) neurologist is not involved in 'post-op' care but has a predominant role in clinical management post implantation. There are a few postop visits for the functional nsurgeon. But the entire post DBS implantation work, titrating the dose/frequency of stimulation with clinical response in conjunction with pharmacologic management is all done by the MD neurologist. This is similar to VNS for epilepsy. After placement there are a few post op visits and then it is again over to the epileptologist. Interestingly, the neuropace device in clinical trials is also along the same lines. So there is much more work overall for the MD or epileptologist.
Regarding neurointervention, very few pts with acute ischemic stroke require/benefit from endovasc therapy. If you look at the records of any major stroke center there are a large number of pts who receive and benefit from IV thrombolysis (also including telestroke) with a lot of supporting evidence compared to a much smaller number of those who go for endovasc therapy. Also a lot of research is being focussed on better selection of pts who could benefit from endovasc intervention which is sometimes overdone (look at the NINDS website). Stroke neurology is a full time job even in private practice. It is not possible for a neurologist to practice stroke and also do intervention because of the very small number of intervention cases.
Lets face it. The vast majority of INR cases come from neurosurgery. There are very few intracranial/extracranial vert art stenting cases with little supporting evidence. Secondly, all neurosurgeons who recently/currently trained as cerebrovasc surgeons are also training in endovasc neurosurgery. The 'interventional neurologist' has to depend on referrals from nsurg and they control INR. The bulk of INR work comes from SAH/aneurysms, avms and other pathology which is traditionally neurosurgical. In the real world, all such pts are admitted to a CV neurosurgeon who makes decisions, does angiograms and then clips or coils/embolizes. If he/she is busy in the OR, then those cases are done by a nonneurosurgeon. Most 'interventional neurologists', with very few exceptions are employed in neurosurg depts.
An article in AJNR analyzed workforce requirement for acute stroke intervention and concluded that for the small number of cases, there are already enough interventionalists.
Intra-arterial stroke therapy: an assessment of demand and available work force.Cloft HJ, Rabinstein A, Lanzino G, Kallmes DF.AJNR Am J Neuroradiol. 2009 Mar;30(3):453-8. Epub 2009 Jan 8. Review

Ischemic stroke is very different from MI/CAD. Every pt with cardiac ischemia goes to angio. If that were the case with stroke, we would have taken over INR by now. But most of our pts do not need it. The heart and brain are very different.
Regarding large artery occlusions, INR work is still investigational (look at ASA guidelines). There is a lot of research on other reperfusion therapies being funded by the NIH as well as the industry. Sonothrombolysis is one example. There are patients who do benefit from endovasc therapy, but we have to find which are those. At the same time other acute therapies are also evolving.
Despite CREST, carotid stenting is still not superior to CEA; is infact inferior in certain aspects. Read the entire article in NEJM as well as expert comments. Also carotid stenting is shared by by cardiology, IR, vasc surgery, INR so there is a lot of dilution.
INR is an amazing field, very promising, but the pathologies are traditionally neurosurgical. There is no way nsurg will lose control of their patients, just like stroke neurologists will never lose control over their stroke pts.
There is a lot of work in stroke neurology in academia or private practice. The income in private practice is also decent >200-250K.
But in the current healthcare climate it is also difficult to predict future incomes in all specialities.
It is important to know about the 'real world' of every subspeciality before making a career decision.

 

[Neurotic Guy]

Fastest growing does not necessarily equal higher pay. Turf wars are still an issue with Neuroimaging, neurology won't win that one, they've been trying for years. Don't know about neurocritical care, but haven't heard anything astounding.

Some would believe Neurointerventional radiology would be high paying. However, while cutting edge, such jobs in the private setting are few and far between. This usually limits one to academia (which does not pay well) or hospital-based practice (who own you), which are generally associated with less autonomy and potential than private practice. Plus, the only evidence-based procedure at the moment is aneurysm coiling. There aren't that many aneurysms to coil especially when there are still turf wars with neurosurgery. Carotid stents? good luck with that turf war (rads, vascular, cards, neurosurg, etc). Embolizing tumors/AVMs, interventional stroke, intracranial angioplasty/stent etc are still in clinical trial phase. Not to mention the 2am calls. At the end of the day, opportunities will likely involve you working as a stroke neurologist (not good pay/time) some percentage of the time, unlike radiology-trained specialist who can do neuroradiology (good pay) to fill their time. Perhaps at some point in the distant future, this subspecialty may be worth the extra years in training.

Electrophysiology (EMG) has some potential, but not great.

Among all subspecialties, on the average, Pain Medicine has the highest potential, and usually, starting base salaries run about 50-100K more than neurology. The potential after making partner, however, is leaps and bounds.

Let's take a mature step back. If you want real estimates of salaries, its not hard to find it on the web if you spend a few minutes searching. The key though is happiness in life, and you have got to do what you have a true passion for, especially when higher salary jobs often command higher risky procedures and possible rougher worker hours / work demand.

Having said that, I'll add my 2 cents: I agree that fastest growing does not necessarily equate with highest salary. But extremely high demand, especially for positions who can reimburse highly, does equate to higher salary.

I disagree with a lot of your post. Turf wars exist in a lot of subspecialties that are multi-disciplinary. You seem to be going into pain and seem to be placing pain in a brighter tone than other subspecialties of neurology. I'll play devils advocate with your post. Pain is a huge turf war itself. Even if you are a neuro-trained pain specialist from an ACGME accredited program, some academic pain depts in the country will not want neuro-trained pain specialists to join their group, esp if they have other anesthesia or PMNR job obligations that neuro guys cannot do (e.g. OR obligations, PMNR clinic obligations). Yeah, it's still a lucrative field now but the pain guys I know are all complaining about how reimbursements are dropping and that the future doesn't look bright, which is the case for essentially all medical specialties. Plus, the majority of neuro residents detest pain patients since many feel they can be a pain in the ***** and eventually cause the doctor himself/herself to get a headache, from listening to so many pain complaints. Some people can handle it, but a lot cannot.

Regarding the other specialties, you are somewhat ill-informed:
EMG still is the highest reimbursable procedure in general neurology and will continue to be so. Private practice jobs with heavy EMG demand can easily start at 250K and rise to well over 300-350 within a couple of years. I know because I get recruiters asking me to join groups all the time and these are the quotes I'm getting. Yeah, you'll work hard, but doesn't everyone in medicine?

EEG/IOP: Hot field, tons of jobs available right now. Avg salaries I'm seeing these days are starting around 250K and moving upwards of well over 350K in a couple of years. If you want to make over 400K, you can do it. I know at least 2 guys that are doing that, though they are working hard. I know of academic EEG/IOP guys making around 200-250K during the first 1 or 2 years out of fellowship. Not bad for an academic position. You also have the option of sitting at home and doing tele-EEGs and monitoring multiple OR procedures from home, which is very lucrative, though can get boring.

Neurocritical Care: Another hot field, also a lot of jobs available right now. Very multi-disciplinary. Most jobs are academic, and jobs mostly are starting around 200K, but some are definitely higher than that, in the 250K range. Private jobs start around 250-300K. I know of academic neurointensivists making well over 350K. These guys work hard, but the people doing it seem to love it. Some academic institutions still don't have neurointensivists, but it seems that in the future, all major academic centers will eventually have them.

Vascular Neurology (Stroke): Still hot in the job sector, with tons of hospitalist jobs out there starting salaries around 250K in the private sector and maybe around 200K in the academic sector. Become partner with a group and that will rise. Outpatient jobs with heavy stroke clinic are numerous out there and in the same broad range of salaries.

A lot of other fields that are interdisciplinary are in the range of salaries above, or well above that, including sleep, neurorehab, neuro-onc. The key is whether you want to do academic or private practice, and this ends up determining a large portion of your salary. Next, if you are academic, and you want to do only 20% clinical and 80% research, you're not going to command the salaries listed above unless you're already famous in your field. So expect to do more clinical time so you can bring in more $ to the institution, which will then keep your salary up. Though salaries in all these fields are lower in the academic sector, the gap has been closing for many years as reimbursements have been declining (which affects the private guys way more than the academic guys).

Bottom line though, is that if you like the brain, there's probably a niche for you in one of the subspecialties that will make you happy by allowing you to do what you love while also having a decent lifestyle and most importantly helping some patients! For a detailed list of the enormous list of fellowships in neurology, go to http://www.aan.com/education/fellowships .

 

[doctorlarry]

Let's take a mature step back. If you want real estimates of salaries, its not hard to find it on the web if you spend a few minutes searching. The key though is happiness in life, and you have got to do what you have a true passion for, especially when higher salary jobs often command higher risky procedures and possible rougher worker hours / work demand.

Having said that, I'll add my 2 cents: I agree that fastest growing does not necessarily equate with highest salary. But extremely high demand, especially for positions who can reimburse highly, does equate to higher salary.

I disagree with a lot of your post. Turf wars exist in a lot of subspecialties that are multi-disciplinary. You seem to be going into pain and seem to be placing pain in a brighter tone than other subspecialties of neurology. I'll play devils advocate with your post. Pain is a huge turf war itself. Even if you are a neuro-trained pain specialist from an ACGME accredited program, some academic pain depts in the country will not want neuro-trained pain specialists to join their group, esp if they have other anesthesia or PMNR job obligations that neuro guys cannot do (e.g. OR obligations, PMNR clinic obligations). Yeah, it's still a lucrative field now but the pain guys I know are all complaining about how reimbursements are dropping and that the future doesn't look bright, which is the case for essentially all medical specialties. Plus, the majority of neuro residents detest pain patients since many feel they can be a pain in the ***** and eventually cause the doctor himself/herself to get a headache, from listening to so many pain complaints. Some people can handle it, but a lot cannot.

Regarding the other specialties, you are somewhat ill-informed:
EMG still is the highest reimbursable procedure in general neurology and will continue to be so. Private practice jobs with heavy EMG demand can easily start at 250K and rise to well over 300-350 within a couple of years. I know because I get recruiters asking me to join groups all the time and these are the quotes I'm getting. Yeah, you'll work hard, but doesn't everyone in medicine?

EEG/IOP: Hot field, tons of jobs available right now. Avg salaries I'm seeing these days are starting around 250K and moving upwards of well over 350K in a couple of years. If you want to make over 400K, you can do it. I know at least 2 guys that are doing that, though they are working hard. I know of academic EEG/IOP guys making around 200-250K during the first 1 or 2 years out of fellowship. Not bad for an academic position. You also have the option of sitting at home and doing tele-EEGs and monitoring multiple OR procedures from home, which is very lucrative, though can get boring.

Neurocritical Care: Another hot field, also a lot of jobs available right now. Very multi-disciplinary. Most jobs are academic, and jobs mostly are starting around 200K, but some are definitely higher than that, in the 250K range. Private jobs start around 250-300K. I know of academic neurointensivists making well over 350K. These guys work hard, but the people doing it seem to love it. Some academic institutions still don't have neurointensivists, but it seems that in the future, all major academic centers will eventually have them.

Vascular Neurology (Stroke): Still hot in the job sector, with tons of hospitalist jobs out there starting salaries around 250K in the private sector and maybe around 200K in the academic sector. Become partner with a group and that will rise. Outpatient jobs with heavy stroke clinic are numerous out there and in the same broad range of salaries.

A lot of other fields that are interdisciplinary are in the range of salaries above, or well above that, including sleep, neurorehab, neuro-onc. The key is whether you want to do academic or private practice, and this ends up determining a large portion of your salary. Next, if you are academic, and you want to do only 20% clinical and 80% research, you're not going to command the salaries listed above unless you're already famous in your field. So expect to do more clinical time so you can bring in more $ to the institution, which will then keep your salary up. Though salaries in all these fields are lower in the academic sector, the gap has been closing for many years as reimbursements have been declining (which affects the private guys way more than the academic guys).

Bottom line though, is that if you like the brain, there's probably a niche for you in one of the subspecialties that will make you happy by allowing you to do what you love while also having a decent lifestyle and most importantly helping some patients! For a detailed list of the enormous list of fellowships in neurology, go to http://www.aan.com/education/fellowships .

Couldn't agree more with your post regarding the importance of enjoying what you do. Can't really put a price on that. On the other hand, having gone through the process of job interviews, etc., from a financial perspective (the OP's focus), pain medicine starts at a higher salary (250K-450K) with plenty of demand and potential (400-600K depending on locale). Would be hard pressed to find that in the other neuro subspecialites. And it hasn't been difficult at all finding jobs as a neurologist in interventional pain medicine, joining anesthesia, ortho or neurosurgery groups. There are TON of opportunities with no neuro call. Declining reimbursements, as you say, will occur in all specialities, but proportionately, pain will always be better. Headaches with pain pts, headaches with psychogenic nonepileptiform seizures, headaches with psychogenic movement disorders, headaches with psychiatric overlay, headaches with 2am stroke codes. Its a large part of neurology. Like you say, pain isn't for everyone.

 

[Neurotic Guy]

Couldn't agree more with your post regarding the importance of enjoying what you do. Can't really put a price on that. On the other hand, having gone through the process of job interviews, etc., from a financial perspective (the OP's focus), pain medicine starts at a higher salary (250K-450K) with plenty of demand and potential (400-600K depending on locale). Would be hard pressed to find that in the other neuro subspecialites. And it hasn't been difficult at all finding jobs as a neurologist in interventional pain medicine, joining anesthesia, ortho or neurosurgery groups. There are TON of opportunities with no neuro call. Declining reimbursements, as you say, will occur in all specialities, but proportionately, pain will always be better. Headaches with pain pts, headaches with psychogenic nonepileptiform seizures, headaches with psychogenic movement disorders, headaches with psychiatric overlay, headaches with 2am stroke codes. Its a large part of neurology. Like you say, pain isn't for everyone.

Accurate, but you need to specify the sector you are talking about...the salaries you mention are for the private sector. The handful of private pain specialists I know who are private do make in the range of what you state above. The academic guys that I know who are doing pain, on the other hand, make in the range of 250-400K, and they get a lot of offers for higher salaries from the private sector but they choose to stay in academics because they love the research and the lifestyle of academics in comparison to private practice. The critical thing to keep in mind is that once you get into the private sector, it is a business. You can take so many different subspecialties of neurology as well as other medical specialties and make a killing because it is essentially a business. For example, a general neurologist (no subspecialty training) can make the range of salaries you mention if they run a multi-partner practice group and essentially own the office and equipment. Heck, I know of general practitioners running a nice lucrative multi-person practice making the range of salaries that you mention above. A business is business, and you have to know what brings in the most reimbursements in this era. If you don't own anything and you are lowly employee of a practice, there is no way you'll be making 600K doing epidurals all day for $100-200 per epidural (not counting the overhead costs), which is what Medicare reimburses. So you could do epidurals all day, or you could do IOP on pts in the OR for much more, or do a MERCI retrieval device or coil an aneurysm for a heck of a lot more, or do a bunch of EMGs or EMG-guided botox injections, or do a bunch of ICU procedures and get much more from Medicare. Bottom line is whether you want to do private practice or academics. If research rocks your boat, how much exactly? Not to mention administrative sector being lucratice since we all know that chairmen of large academic departments can make well over the 400-600K that you mention above, though yeah it takes many years before one can become a chairman. So you just have to choose what rocks your boat. When anyone quotes an annual salary, its best to mention whether it is for private or academic, and what portion of their time is for clinical and research. Then one can determine if it fits their interests, which goes back to what you and I agree upon, you have to do what interests you the most, academic vs private, procedures vs no procedures, lifestyle, salary, etc...

 

[doctorlarry]

Accurate, but you need to specify the sector you are talking about...the salaries you mention are for the private sector. The handful of private pain specialists I know who are private do make in the range of what you state above. The academic guys that I know who are doing pain, on the other hand, make in the range of 250-400K, and they get a lot of offers for higher salaries from the private sector but they choose to stay in academics because they love the research and the lifestyle of academics in comparison to private practice. The critical thing to keep in mind is that once you get into the private sector, it is a business. You can take so many different subspecialties of neurology as well as other medical specialties and make a killing because it is essentially a business. For example, a general neurologist (no subspecialty training) can make the range of salaries you mention if they run a multi-partner practice group and essentially own the office and equipment. Heck, I know of general practitioners running a nice lucrative multi-person practice making the range of salaries that you mention above. A business is business, and you have to know what brings in the most reimbursements in this era. If you don't own anything and you are lowly employee of a practice, there is no way you'll be making 600K doing epidurals all day for $100-200 per epidural (not counting the overhead costs), which is what Medicare reimburses. So you could do epidurals all day, or you could do IOP on pts in the OR for much more, or do a MERCI retrieval device or coil an aneurysm for a heck of a lot more, or do a bunch of EMGs or EMG-guided botox injections, or do a bunch of ICU procedures and get much more from Medicare. Bottom line is whether you want to do private practice or academics. If research rocks your boat, how much exactly? Not to mention administrative sector being lucratice since we all know that chairmen of large academic departments can make well over the 400-600K that you mention above, though yeah it takes many years before one can become a chairman. So you just have to choose what rocks your boat. When anyone quotes an annual salary, its best to mention whether it is for private or academic, and what portion of their time is for clinical and research. Then one can determine if it fits their interests, which goes back to what you and I agree upon, you have to do what interests you the most, academic vs private, procedures vs no procedures, lifestyle, salary, etc...

Agree with you again regarding potential of Private practice in all specialites of medicine. However, on the average, MGMA standards are considerably higher for pain than for neurology. I agree with the ownership thing, except the same applies for Pain.

For academics, based on the many academicians I know, Pain salaries are almost always higher than Neurology, that's just the way it is. Like I said earlier, you'll be hard pressed to make a living doing JUST IOP, ICU procedures, or neurointervention, even in academics. A chunk of your time will be doing general neurology, which pays okay, I guess. Keep in mind, in most scenarios, you see more Medicare pts in academia than in private practice. Yes the chairman thing takes a long while to get there, and usually, a SLOW and painful ladder to climb with only academic pay along the way. The same rules generally apply to Pain Medicine.

Regarding procedures, epidurals are only a subset of reimbursable procedures in Pain Medicine. Today, doing many short procedures in a given day tends to be more lucrative/efficient than the RARE merci clot retrieval or aneurysm coil, or even EMG. On average, each EMG (CMS Medicare Fee schedule 2 limb $113.31, 4 limb $176.96) reimburses less than an epidural (CMS Medicare Fee schedule $359.44), which takes about 5-10 minutes. Additionally, most EMG's are not 4 limb studies. Additionally, many Pain practices incorporate EMG/NCS in their clinics. Neurologists or neuromuscular specialists aren't appropriately trained to do interventional pain treatments.

Of course, there are always going to be exceptions to the rule, however, we're talking averages here. The original poster was asking about the most lucrative neurology subspecialities. Everyone here already knows (or should know) to choose what they really like.

 

[Guero]

Let's try to clarify the difference between a clinician educator's salary and a clinician scientist's salary, two different academic positions. It seems obvious that a clinician educator would command a higher salary than a clinician scientist since the scientist usually performs about 20% clinical and 80% research. I think neurosurgery is the only exception, where clinician scientists usually perform 80% clinical and 20% research—correct me if I'm misguided. However, just knowing that one type of physician makes more than the other doesn't really give me a good idea of what to expect in choosing either path. Does anyone know a ballpark figure of these physicians' median salaries in general neurology, consult neurology, (the emerging field of) hospitalist neurology, and general or functional neurosurgery?

 

[typhoonegator]

Why does it seem obvious that a clinician educator would make more than a clinician scientist?

Teaching doesn't bring a lot of money into the department -- actually it often loses money since those hours are not billable and the medical school probably isn't paying much. The clinician scientist has to bring in grant money or else she/he cannot justify her/his salary.

The percentage of time devoted to clinical care vs. research can only be determined by the chair relative to the needs of the department...the more highly placed and funded the researcher, the less clinical care is "required". That being said, many clinician scientists enjoy spending time on the clinical side, and would not want to give it up entirely. High profile researchers actually have a hard time balancing their time...a 1% effort on a colleague's grant doesn't seem like much until you look at how much of your time is already spoken for.

 

[Guero]

Why does it seem obvious that a clinician educator would make more than a clinician scientist?

Teaching doesn't bring a lot of money into the department -- actually it often loses money since those hours are not billable and the medical school probably isn't paying much. The clinician scientist has to bring in grant money or else she/he cannot justify her/his salary.

The percentage of time devoted to clinical care vs. research can only be determined by the chair relative to the needs of the department...the more highly placed and funded the researcher, the less clinical care is "required". That being said, many clinician scientists enjoy spending time on the clinical side, and would not want to give it up entirely. High profile researchers actually have a hard time balancing their time...a 1% effort on a colleague's grant doesn't seem like much until you look at how much of your time is already spoken for.

It seemed obvious because they spend more time on the wards. But, that's why I carefully chose to use "seems" rather than make a definitive statement. I wasn't sure.

I love research and teaching, but like you said, wouldn't want to lose a huge fraction of my clinical duties to grant-writing. That's why I'm trying to evaluate the pros and cons of these paths early on. I was told once you choose one or the other, you're pretty much stuck. I just hope by the time I graduate there are positions available with slightly more equitable research/teaching and clinical responsibilities.

All of the clinician scientist PIs I've worked under spend an inordinate time writing grants to maintain that steady flow of departmental funding. I just can't imagine staying cooped up in an office 80% of the year, hoping that the NIH will choose my proposal over thousands of other competitors and fearing for my job if my proposal is rejected. Just the thought of that lifestyle makes me lean toward a clinician educator role. But at the same time, I have no experience in that realm. I'm planning to shadow a med-peds clinician educator this month to get a better idea of what that role is like.

 

[doctorlarry]

Regarding neurointervention, very few pts with acute ischemic stroke require/benefit from endovasc therapy. If you look at the records of any major stroke center there are a large number of pts who receive and benefit from IV thrombolysis (also including telestroke) with a lot of supporting evidence compared to a much smaller number of those who go for endovasc therapy. Also a lot of research is being focussed on better selection of pts who could benefit from endovasc intervention which is sometimes overdone (look at the NINDS website). Stroke neurology is a full time job even in private practice. It is not possible for a neurologist to practice stroke and also do intervention because of the very small number of intervention cases.
Lets face it. The vast majority of INR cases come from neurosurgery. There are very few intracranial/extracranial vert art stenting cases with little supporting evidence. Secondly, all neurosurgeons who recently/currently trained as cerebrovasc surgeons are also training in endovasc neurosurgery. The 'interventional neurologist' has to depend on referrals from nsurg and they control INR. The bulk of INR work comes from SAH/aneurysms, avms and other pathology which is traditionally neurosurgical. In the real world, all such pts are admitted to a CV neurosurgeon who makes decisions, does angiograms and then clips or coils/embolizes. If he/she is busy in the OR, then those cases are done by a nonneurosurgeon. Most 'interventional neurologists', with very few exceptions are employed in neurosurg depts.
An article in AJNR analyzed workforce requirement for acute stroke intervention and concluded that for the small number of cases, there are already enough interventionalists.
Intra-arterial stroke therapy: an assessment of demand and available work force.Cloft HJ, Rabinstein A, Lanzino G, Kallmes DF.AJNR Am J Neuroradiol. 2009 Mar;30(3):453-8. Epub 2009 Jan 8. Review

Ischemic stroke is very different from MI/CAD. Every pt with cardiac ischemia goes to angio. If that were the case with stroke, we would have taken over INR by now. But most of our pts do not need it. The heart and brain are very different.
Regarding large artery occlusions, INR work is still investigational (look at ASA guidelines). There is a lot of research on other reperfusion therapies being funded by the NIH as well as the industry. Sonothrombolysis is one example. There are patients who do benefit from endovasc therapy, but we have to find which are those. At the same time other acute therapies are also evolving.
Despite CREST, carotid stenting is still not superior to CEA; is infact inferior in certain aspects. Read the entire article in NEJM as well as expert comments. Also carotid stenting is shared by by cardiology, IR, vasc surgery, INR so there is a lot of dilution.
INR is an amazing field, very promising, but the pathologies are traditionally neurosurgical. There is no way nsurg will lose control of their patients, just like stroke neurologists will never lose control over their stroke pts.
There is a lot of work in stroke neurology in academia or private practice. The income in private practice is also decent >200-250K.
But in the current healthcare climate it is also difficult to predict future incomes in all specialities.
It is important to know about the 'real world' of every subspeciality before making a career decision.

Ditto Strokeguy. Couldn't agree more.

 

[RAD345]

MS is another sub that at private practice could earn high revenue through Tysabri and Solumedrol infusions, and EMG, Botox injection for spasticity.

 

[Ilovelamp]

How does neuro-oncology pay?

 

[Guero]

How does neuro-oncology pay?

According to "Neurotic Guy," who posted earlier in the thread, about $250k in the private sector and around $200k in academia.

 

[rockydoc]

How does neuro-oncology pay?

Is that something you go into via Neurology or Hem/Onc or either??

 

[Guero]

Is that something you go into via Neurology or Hem/Onc or either??

You can definitely end up at the same point via either discipline—that's certain. However, I think the difference will lie in your fundamental understanding and treatment modality (e.g., via neuro, you'll be more concerned with how the process specifically affects the cerebrum and how it manifests symptomatologically; whereas via onc, you'll probably be more concerned with the carcinogenesis and pathological vicissitudes).

Admittedly, I'm not a fellow, resident, or even a med-student yet; so take that with a grain of salt. It just seems like the logical answer from what I've learned from my attending, fellow, and resident colleagues...

 

[rockydoc]

EMG still is the highest reimbursable procedure in general neurology and will continue to be so. Private practice jobs with heavy EMG demand can easily start at 250K and rise to well over 300-350 within a couple of years. I know because I get recruiters asking me to join groups all the time and these are the quotes I'm getting. Yeah, you'll work hard, but doesn't everyone in medicine?

A lot of other fields that are interdisciplinary are in the range of salaries above, or well above that, including sleep, neurorehab, neuro-onc. http://www.aan.com/education/fellowships .

question for neurotic guy or others who are informed. I keep hearing that practices heavy on EMG have more earning potential. But what exactly does "heavy" mean? Would your day be almost entirely EMGs? 50/50 with normal consults? I dont think I could do only EMGs and lose other consults.

Secondly, I kind of already asked this, but neuro-onc intrigues me. I've had an interest in both hem/onc and neuro...but more experience with neuro. I've just never heard of neuro-onc specifically. Does anyone have more info on this field? (how you get there, what they do day to day, etc).

thanks

 

[neurolddoc]

question for neurotic guy or others who are informed. I keep hearing that practices heavy on EMG have more earning potential. But what exactly does "heavy" mean? Would your day be almost entirely EMGs? 50/50 with normal consults? I dont think I could do only EMGs and lose other consults.

I can't speak for other practices but in our group, everybody does their own EMG's. Therefore, you have to see the patients in consultation or follow-up that need the EMG (or EEG, doppler, sleep study, etc). I would imagine it is rare to have a private practice settting where you just sit there and do EMG's that are fed to you all day long.

 

[neurolddoc]

MS is another sub that at private practice could earn high revenue through Tysabri and Solumedrol infusions, and EMG, Botox injection for spasticity.

We have just run the numbers on setting up an infusion center and it indeed will make you some money but I would hold off on ordering the yacht. Tysabri infusions are relatively lucrative, though not as much as IVIG. Solumedrol infusions are barely a break even proposition.

You get a moderate injection fee for the Botox but make no money at all on the toxin itself. A limited EMG study for injection purposes pays relatively little.

 

[bbake87]

Interventional

 

[sytar]

What about neuropathologists? What's their pay like? What are their prospects? What is the future of the field?

 

[Guero]

What about neuropathologists? What's their pay like? What are their prospects? What is the future of the field?

Yeah, I'd love to hear an answer to that question, too. That path is based in the department of pathology and would involve doing a general pathology residency followed by a fellowship in neuropathology, right?

 

[Enkidu]

I noticed in the FAQ neuropathology is listed as a fellowship after neurology. I was a little skeptical of this fact, so I looked into some neuropathology fellowship programs and found that some do accept neurologists.

Here is a quote from the MGH neuropathology website:

Applicants must have completed two years of Anatomic Pathology training or be eligible for certification in AP, AP/CP, Neurology or Neurosurgery

Even so... This still doesn't seem right to me. Do neurologists actually do this? Can they sign out pathology cases and do general neurology as well? I have a sense that it would take more than a couple of years to be a competent neuropathologist. What do you guys think?

 

[Guero]

I noticed in the FAQ neuropathology is listed as a fellowship after neurology. I was a little skeptical of this fact, so I looked into some neuropathology fellowship programs and found that some do accept neurologists.

Here is a quote from the MGH neuropathology website:

Even so... This still doesn't seem right to me. Do neurologists actually do this? Can they sign out pathology cases and do general neurology as well? I have a sense that it would take more than a couple of years to be a competent neuropathologist. What do you guys think?

Yeah, I totally agree. Just think of the meticulous dissection methodology one masters during a pathology residency--a neurologist's experience in dissection probably harkens back to the anatomy days of med school...very interesting indeed. *pedantically stroking my beard* Maybe they offer remediation to neurologists, as humiliating as that may be.

 

[Ilovelamp]

Whats the future of interventional neurology? I know currently they are doing AVMs, aneurysms and vertebroplasties. Anything else? Anyone heard of any other procedures that they are possibly developing?

 

[95439]

I think it's great that out of 39 posts there is actually 1 that answers the question. Oh wait, make it 40 posts.

 

[neurolddoc]

On average, each EMG (CMS Medicare Fee schedule 2 limb $113.31, 4 limb $176.96) reimburses less than an epidural (CMS Medicare Fee schedule $359.44), which takes about 5-10 minutes.

One small but important point should be clarified with respect to doing "EMG's". The reimbursement is not just for the EMG; more income actually comes from the motor/sensory/F studies that are done in conjunction with the EMG. Another factor is that one can have a tech doing the nerve conductions on one patient while you do the EMG on the prior one.

The best answer that I can come up with for the "highest paid specialty" question is to have ownership interest in a group with multiple testing modalities performed by technologists that can leverage the physician's time.

 

[bronx43]

This probably belongs in a separate thread, but here's the current MW compensation survey stats for medical specialties.
http://www.merritthawkins.com/compensation-surveys.aspx

It looks like neurology has made some heavy strides in the past couple of years.

Neurology
2009/10 $180,000 $281,000 $460,000
2008/09 $180,000 $258,000 $375,000
2007/08 $150,000 $230,000 $325,000
2006/07 $170,000 $234,000 $275,000

For low/avg/high, I don't know if all of this is due to more neurologists using procedures like EEG/EMG, but a 50k upswing in two years' span is pretty impressive.

 

[Strokeguy]

Whats the future of interventional neurology? I know currently they are doing AVMs, aneurysms and vertebroplasties. Anything else? Anyone heard of any other procedures that they are possibly developing?

Look at my post above. Will answer all your questions. 'Interventional Neurology' is another bubble (no offence intended). It is more a subspeciality of neurosurgery, nrad than neurology.

 

[doctorlarry]

One small but important point should be clarified with respect to doing "EMG's". The reimbursement is not just for the EMG; more income actually comes from the motor/sensory/F studies that are done in conjunction with the EMG. Another factor is that one can have a tech doing the nerve conductions on one patient while you do the EMG on the prior one.

The best answer that I can come up with for the "highest paid specialty" question is to have ownership interest in a group with multiple testing modalities performed by technologists that can leverage the physician's time.

That could work, but please don't let techs do NCS. Anesthesia made this analagous mistake with CRNA's. Give them an inch, they'll lobby and take a mile...woudn't do it for the patient or physician's sake.

 

[neurolddoc]

That could work, but please don't let techs do NCS. Anesthesia made this analagous mistake with CRNA's. Give them an inch, they'll lobby and take a mile...woudn't do it for the patient or physician's sake.

Well...It actually does work and has been doing so for the last 20 years or so. As far as "letting techs do NCS", this is something that has been going on for nearly as long as EEG techs have been doing the technical parts of EEG's. In any event, you should worry more about primary care docs who have PT's come into their offices and do NCS's. Of course the patients will come to see you to determine the meaning of their abnormal test.