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The exact advice that was given to me as a beginning resident and I have tried to follow it.
Is 700-1 mill possible in neurology
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Always_Eating
Full Member
This is the most important take-away for those still in residency. If you want to be in the 90th-percentile of earners you either:
1) Are a partner, and you are taking your cut off the work of usually younger Neurologists. You assume the business risk and get the benefits.
2) Are working in the 90th-percentile of hours/RVUs. You are working harder than your peers in the 50th-percentile of earners.
3) Working a job that others find undesirable, be it by location or patient population or Admin reputation or other reason, so you command a premium.
There is no free lunch. Every graduating resident thinks he/she can land that unicorn job where he/she is working 9-5 with no overnight call in NYC or LA and making 600k seeing 8 patients a day. It does not happen. If you are making more then it is for a reason. Physician employment markets are quite efficient. If a job is great, someone will always do it for 1k less.
Numerous attendings here have described how you make 600k+: You are a partner/owner, you travel away from your home to do locums (usually where a position cannot find a permanent hire for whatever reason), or you do something like Tele in your off-service time.
There is no mystery as to how to make this kind of money. The question is whether or not you find the risk (partner), inconvenience (locums), or extra hours (tele) worth the extra money.
well said,
A few things that I want to clarify-
Being a partner is more common than you think. Being a partner does not necessarily mean you are riding the coattails of others....A group of 3 neuro-partners will not bring and share their MRI, EEG,EMG and other auxiliary revenue with an incoming doc who has not proven his mettle.
There is a misconception that high paying locums are only in undesirable locations, working an insane number of hours and seeing a gazillion patients. This is so far from the truth. I locumed in Seattle, Orlando, Phoenix and other major metros all paying a high high premium. I been paid $5k a day seeing 2-3 patients a day for 100 straight days. You just need to put in the work and find what works for you.
Finally, you are 100% correct that if you want to be in the 99%, you need to put in the work. I have not taken a sick day off since high school and I am darn proud of it (I did took 8 months off when i had my last baby a few years back but still made over 500k). no free lunches.
Best of luck folks.
PS. I am happy to see a financial discussion in this forum....when I was in residency I needed a light outside the tunnel to keep me going and knowing if I can work hard, I can indeed earn $500k....ask questions, educate your self about the finance of medicine, and prepare yourself for when is time to negotiate
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You've been paid this number for 2-3 patients a day? In a metro city? That's insane. So they're paying you 2k PER CONSULT, in a metro area?? Where do you find jobs like this?
Always_Eating
Full Member
I have also done very chill, high-paying locums, but to make residents think that 5k a day in a desirable location seeing 2-3 patients a day is the norm is misleading. I know many Neurologists that create their own locums contracts sans agencies, and in desirable locations they are almost always competing with other Neurologists for that per diem coverage, and the problem is that there is always another Neurologist that will do it for a dollar less. Desirable jobs fill. If an Admin is paying 5k a day for a chill job in a great location to see 2-3 patients per day, that Admin will be on the chopping block eventually. They are likely paying 50% more for physician service than they could. Also, 95% of physicians are not in a position where they can move elsewhere in the country for 100 days.
I set my contract as per day fee, not hourly. I get paid the same whether 1 or 10 pts.
Agree, no One should be expecting a $5k a day locum gig. A takes time and ability to negotiate to make this posible.....
The one thing I love about locum is the ability to work when Ever the heck I want. it is well documented here in this forum, for the last 4 or 5 years, that i work 100 straight days in the summer and I am off for the remaining of the year. I take my family with me, rent a luxury condo, and treat it as a 3 month vacation.
This works for me because my kids are off from schools in the summer. When we get back from locums, I get to take them to school, pick them up, eat dinner with them etc. this for me is priceless.
At any rate, folks currently in the trenches in residency should feel good about the chances of securing a decently paying job when they come out. Neurology is not FM or IM. focus on leaning neurology and the business of medicine and you should all be fine when you come out.
One last thing I want to say, especially for those interested in locums- when I say learn the business in medicine, what I mean to say is that you need to figure out how to increase your rate by doing non clinical duties.
Does the hospital/clinic needs a headache program? You offer to start one
Do they need help establishing a tele-stroke program? You offer to start one
Do they want to start an inpatient service line? You offer to start one.
Are they interested in becoming stroke certified..?
I have consulted and or completed every single one of the above. Obviously, you can’t write a checks you ass can’t cash and you really need to know what you are doing. But this goes a long way justifying your rate.
So start in residency...as a resident I asked the stroke director to be part of the tele stroke program implementation team.... I sat down with docs who previously own their own practice etc.
Use you time wisely. I knew I was going to be a neuro-hospitalist but didn’t want to do an eeg fellowship.....so I spent lots of time there.
Good luck!
Does the hospital/clinic needs a headache program? You offer to start one
Do they need help establishing a tele-stroke program? You offer to start one
Do they want to start an inpatient service line? You offer to start one.
Are they interested in becoming stroke certified..?
I have consulted and or completed every single one of the above. Obviously, you can’t write a checks you ass can’t cash and you really need to know what you are doing. But this goes a long way justifying your rate.
So start in residency...as a resident I asked the stroke director to be part of the tele stroke program implementation team.... I sat down with docs who previously own their own practice etc.
Use you time wisely. I knew I was going to be a neuro-hospitalist but didn’t want to do an eeg fellowship.....so I spent lots of time there.
Good luck!
Unfortunately, great success stories like yours also make me feel that the job market would be too saturated once I graduate, or it
Success stories like yours is what makes me fear that the field will be saturated in the future and good jobs are hard to come by when i graduate.
Market has not change in the last 7 years. In in fact, salaries have increased. I can show you right now , just today, I received 5 recruiting emails all above $$400k, including one in NYC For $450k ( I doubt this is enough in NYC, but nevertheless).
You will be fine. You will need to find a balance between work and quality of life.
The overwhelming majority of neurologists do not.
Exceptions not the rule. For every one that makes 5k a day, there are 100 that make 1k a day. That’s is true not only for neurology, or medicine, but life in general.
Agree. But one thing I have noticed in SDN is that if you post that you are in the 99% percentile in your specialty in term of salary, many start assuming your are not providing proper care. The docs that are in the 99 percentile work really hard or they know how to negotiate, and negotiation skills is something that many physicians lack (N ~30).
I am IM and I thought I had to do a lucrative fellowship or work like a horse in order to make 400k+/yr, and to my surprise, I quickly realized that I don't need to do either to make that kind of salary. Not to blow my horn here: I had 6 offers and I took what I believe is the best one based on my conversations with people who work at these places.
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bigamygdala
Full Member
that's a very interesting and honest perspective. Thanks.
how long have you been practicing?
I been practicing for 8 years.
1 year in private practice with a large neurosurgery and neurology group. Dream location and schedule. Essentially I worked 7/7 9-5, no call $330k. 2 weeks vacation, 2 weeks CME. Thus, 20 weeks a year.
2 years in academics. 7/7 24 hour call, 85% stroke 15% seizures. Included research and teaching responsibilities and a medical student clerkship directorship. (Started a telemed program). Heavy load but had 2 NPs. $350k with about $85k in benefits.
5 years locums. Best decision ever. This decision was guided in having a child with disabilities. I needed to spend more time with my family. I used an agency my first time and learned that such agency was keeping 40% of profits. I started negotiating directly with hospitals until I hit my sweet spot of ~$5k a day ~110 days each summer. Child no longer has a disability and thriving. This reduce workload after thus summer.
Best
Always_Eating
Full Member
I'm trying to piece all of this together, as I can make 5k in a 24 hr shift doing Tele from home in shorts, but I am seeing 20+ patients for cash to do that. It makes sense to all parties involved from a business perspective. The hospitals save a ton of money on coverage, keep high reimbursing patients they otherwise would have to transfer, and I make more than I would doing a traditional in-person job and can also choose all my hours and I do not have to travel.
Are you going to great locations, only seeing 2-3 patients a day, and then basically the rest of the day is a vacation, while only working 100 days a year? Or are you "program building" and spending hours upon hours per day meeting with low-knowledge, big-ego doctors and admin while on these locums assignments to start headache clinics and telemed programs? The story keeps changing. It seems like it can't be both ways. Either you are grossly overpaid, seeing only 2-3 patients a day in a great location, by very inefficient Admin wasting money, in which case at any moment a major Telehealth organization will swoop-in and let their CEO and Medical Director know they can save 95% on their Neuro costs by simply buying a cart. They also offer program building services with Tele services.
Or are you truly offering something worth 5k a day, which could certainly be the case if you are program-building for these locums clients? I am not aware of anyone that would take-on that challenge of dealing with the leadership and personalities that would be stakeholders in these types of locums environments, so that could certainly command a premium.
Either way, I would not exactly broadcast being paid 5k a day to see 2-3 patients a day if it really is the ultra-chill former situation. The Admin that approved that would be in boiling hot water (and probably fired) if the ED Medical Director at your locums, who has been in an 18 month hiring freeze and had to cut ED MD hours and pay, finds out about your arrangement.
Major point to trainees is that if you are making 5k a day, you are working for it. You are not seeing 2-3 patients a day on average without offering something beyond the clinical services, unless you are consistently finding Administrators that do not know what they are doing. Even low volume, chill locums seeing 2-3 patients a day that are self-contracted max out in the high 3k range.
@Always_Eating
I don’t know if you are implying I am lying- if you have a question please ask, don’t assume. I have share my contracts with a few members here and I don’t appreciate you coming at me without knowing the ins and outs of my practice.
I don’t go year to year seeing 3 pts a day. How I negotiate my contracts is by offering 24/7 service for 100 days, open ended schedule. The clinic\hospital size determine how many pts I see, plus I will come In for anything emergent overnight.
Because of my outrageous rate, and when in conversation with the CEO/Neuro team, we discuss process improvement, program building etc to justify my rate. If there is nothing to improve and nothing to add, then they just have to pay the rate for my clinical service. I don’t care about what happens to admin- we which include the CEO, admin, and hospital attorneys hash out a contract and that is that. I honor my end and expect them to honor their end.
In 2017, when I build an inpatient service line, I saw an average of 3 pts a day. I don’t always see 3 patients a day and I am not always in big cities. In Seattle I saw 15....in Ohio I saw 5.
my incoming contract includes 7/7 24/7. Nothing more, nothing less. $5k plus $3K living stipend. Inpatient/outpatient blend. Census of 8-13.
this is not rocket science. I been doing this for 5 years. Sometimes I work 100 days in the summer, others i come in during spring break anor other holidays. Not all contracts are the same.....
ps- I am all in with with telemed-all stakeholders win, especially when offering tele-stroke. BTW, if I have to see 20 pts to earn $5k, then I see 20 pts a day, knowing I am off for the rest of the year.
please let me know if I can clarify anything for you.
cheers
I don’t know if you are implying I am lying- if you have a question please ask, don’t assume. I have share my contracts with a few members here and I don’t appreciate you coming at me without knowing the ins and outs of my practice.
I don’t go year to year seeing 3 pts a day. How I negotiate my contracts is by offering 24/7 service for 100 days, open ended schedule. The clinic\hospital size determine how many pts I see, plus I will come In for anything emergent overnight.
Because of my outrageous rate, and when in conversation with the CEO/Neuro team, we discuss process improvement, program building etc to justify my rate. If there is nothing to improve and nothing to add, then they just have to pay the rate for my clinical service. I don’t care about what happens to admin- we which include the CEO, admin, and hospital attorneys hash out a contract and that is that. I honor my end and expect them to honor their end.
In 2017, when I build an inpatient service line, I saw an average of 3 pts a day. I don’t always see 3 patients a day and I am not always in big cities. In Seattle I saw 15....in Ohio I saw 5.
my incoming contract includes 7/7 24/7. Nothing more, nothing less. $5k plus $3K living stipend. Inpatient/outpatient blend. Census of 8-13.
this is not rocket science. I been doing this for 5 years. Sometimes I work 100 days in the summer, others i come in during spring break anor other holidays. Not all contracts are the same.....
ps- I am all in with with telemed-all stakeholders win, especially when offering tele-stroke. BTW, if I have to see 20 pts to earn $5k, then I see 20 pts a day, knowing I am off for the rest of the year.
please let me know if I can clarify anything for you.
cheers
Just to clarify you work 100 days straight 24/7? Or during the 100 day you work 7 on 7 off?
Yes, I set my contracts 100 days straight 24/7. This is what works for me and my family and won’t work for everyone.
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Don’t you get burned out though working 100 days in a row? That is very impressive
And here I am working 14 hours on nightfloat seeing 6-10 pts (including stroke alerts) while making $200 per shift. Haha
Cant wait till I’m on the other side
Cant wait till I’m on the other side
Of course....but I am off for the remaining of the year.
Also, I’ll come in at 8 or 9 and leave when I am done rounding.
2-3 hours on weekends.
again, this is what works for me and my family.
A small sacrifice on my part to be with my kids all year long.
It's a great setting since you barely work on weekend and you make a boatload of $$$. Win-win in my book.
To OP, yes it is possible. If you are not resourceful, then you must work harder to make beyond the average $320k - $450k as explained by others above. If you are resourceful and know how to find or negotiate a right contract to your advantage, you can achieve it without having to sacrifice too much of your life or quality of your patient care or resorting to shady or fraudulent activities as evidenced by Neurochica. It is very hard to do so, if not impossible, while employed by a hospital. Easier to do so as an independent contractor, practice owner/partner or employed at a private practice with production based pay with appropriately supervised midlevels' support.
For the question of need of stroke fellowship to become skillful enough to handle all types of strokes, it is nice to add that 1 more year of residency with low pay but not absolutely necessary. Your experience at a comprehensive stroke center with full neurosurgery and neuro ICU services while catching up on key updates every 2-3 months should more than suffice to provide an excellent top notch stroke care that people deserve. Obviously you should be able to review and glean detailed information from CT, CTA, CTP, MRIs independently because often there may not be any neuro-radiologist in your future facility. If you are lazy and sloppy and do not regularly update your knowledge base, it does not matter whether you did a fellowship 8 yrs ago. You are still outdated.
As several people have pointed out, I would focus on enjoying your work, learning to work well with others and understanding your professional market value. My neighbor colleague sees about 35-40 patients daily in clinic with one midlevel and likely collects around $1.3 mil minus expences. That is not so resourceful way to do it, and I would not want that. But each of us has varying degree of tolerance levels and meaning of "overwork."
For the question of need of stroke fellowship to become skillful enough to handle all types of strokes, it is nice to add that 1 more year of residency with low pay but not absolutely necessary. Your experience at a comprehensive stroke center with full neurosurgery and neuro ICU services while catching up on key updates every 2-3 months should more than suffice to provide an excellent top notch stroke care that people deserve. Obviously you should be able to review and glean detailed information from CT, CTA, CTP, MRIs independently because often there may not be any neuro-radiologist in your future facility. If you are lazy and sloppy and do not regularly update your knowledge base, it does not matter whether you did a fellowship 8 yrs ago. You are still outdated.
As several people have pointed out, I would focus on enjoying your work, learning to work well with others and understanding your professional market value. My neighbor colleague sees about 35-40 patients daily in clinic with one midlevel and likely collects around $1.3 mil minus expences. That is not so resourceful way to do it, and I would not want that. But each of us has varying degree of tolerance levels and meaning of "overwork."
Completely agree and well stated.
It seems your gigs are not long-term. So you will have to find new clients once the contract is over. How do you find clients?
There is flexibility but you usually have to commit to doing a certain number of shifts per month. Within that, a certain number of shifts have to be overnight and on the weekend. During your off days, you are usually spending a decent chunk of your time filling out the credentialing and on boarding paperwork for the ever growing list of hospitals you will be covering.
Once doc in MS and one in FL did go to prison for this.
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Lots of neurologist in my community have mid-levels to skim off of.
To answer the original question, definitely doable if that's a priority. I worked ~24 weeks this year, and on my off weeks, do telemed service (not direct services) part-time, >650k this year, first year out. I live in a major city and work at a large academic center. I'd make quite a bit more if I went across the street to the private hospital. If salary is important, you can hustle with sided gigs or private setups, or double dip service and physician fees with infusion centers, etc. There are plenty of very wealthy neurologists. That said, you can do the same as a spine surgeon and far outstrip a neurologist, so if the magnitude matters that much to you, you will definitely earn more elsewhere with similar vigor/hustle. They are simply paid more per unit of time. I will say that at some point, your needs and wants are reasonably covered, and time is the single most important commodity. I make plenty of money, but I'm never going to pull in 1.5 million a year like my spine surgery colleagues can---but they're never going to have half the year off. No one is going to pay you to just be awesome, you've gotta hustle for those RVUs with time and sweat.
RE: telestroke / teleneuro coverage. If the ED only called about acute stroke for ED-teleneuro coverage, then the argument re: only stroke neurologists should cover is reasonable. I've covered multiple teleneurology/telestroke pagers, they're always abused as a acute neuro consult. Sadly, it's a <10-20% hit rate for the ED consult being an acute stroke.....like it always has been for ED consults. You're so much more likely to get called about headaches, functional, gen neuro, etc than an acute stroke <24hrs, much less <4.5hrs. Does that mean stroke doctors shouldn't be involved? Didnt think so. This is frankly not a very reasonable position to hold and is more advertising of who is taking the call than substance of who is delivering the care. I agree that ideally you want the pool to be neurologists enriched in acute stroke / acute neurology expertise (hospitalists, ICU, etc) to manage the panoply of neurologic emergencies that can happen, but say that the ED can only be covered by stroke neurologists is absurd. In reality, there are <5% of hospitals in the country that can have both a neurologist on call and separately, a stroke neurologist on call for the ED. Most are happy to get anyone at all.
And let me be very clear, this is not because I have any financial interest in covering that pager. In fact, you can have the damn ED pager. I'm not doing it again after the first few months I signed up for. Not worth it. I'll stick to my unit.
RE: telestroke / teleneuro coverage. If the ED only called about acute stroke for ED-teleneuro coverage, then the argument re: only stroke neurologists should cover is reasonable. I've covered multiple teleneurology/telestroke pagers, they're always abused as a acute neuro consult. Sadly, it's a <10-20% hit rate for the ED consult being an acute stroke.....like it always has been for ED consults. You're so much more likely to get called about headaches, functional, gen neuro, etc than an acute stroke <24hrs, much less <4.5hrs. Does that mean stroke doctors shouldn't be involved? Didnt think so. This is frankly not a very reasonable position to hold and is more advertising of who is taking the call than substance of who is delivering the care. I agree that ideally you want the pool to be neurologists enriched in acute stroke / acute neurology expertise (hospitalists, ICU, etc) to manage the panoply of neurologic emergencies that can happen, but say that the ED can only be covered by stroke neurologists is absurd. In reality, there are <5% of hospitals in the country that can have both a neurologist on call and separately, a stroke neurologist on call for the ED. Most are happy to get anyone at all.
And let me be very clear, this is not because I have any financial interest in covering that pager. In fact, you can have the damn ED pager. I'm not doing it again after the first few months I signed up for. Not worth it. I'll stick to my unit.
D
deleted1081396
What percentage of that income comes from your main job and what percentage from your telemed side gig? How many hours per week are you working at each with this setup? What region of the country are you in and what is your subspecialty? Or can this be done just as a general neurologist with no fellowship?
I'm surprised the academic center that employs you allows you to do outside telemed work. Was it something you had to negotiate contract-wise?
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I dont provide direct telemedicine services, more like document review. Take great pains to not actually do telemedicine. That said, as long as I stayed more than X miles away from my center, there's nothing in my contract that precludes me from doing it.
I work in a top 10 metro in a desirable place to live. My side gig was about 40-45% of my income last year. I work a little less than every other week in the ICU. The side gig takes about 10-20 hrs a week, it's gig work and it fluctuates. This gig can be done as a non-fellowship trained specialist. There are many like it, I've just stayed with it for years now.
Remarkable that you were able to make ~240-260k on side gig.
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deleted1081396
What does document review entail and how do you make that your primary role without much actual patient communication? Are you a neurocrit specialist or did you not do a fellowship?
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I am fellowship trained in NCC, but the document review service has nothing to do with my clinical services and doesnt care about my fellowship training at all.
My recommendation is to review White Coat Investor and Physician on Fire if this sounds appealing to you. There are lots of folks who make much more money than I did with side gigs (or primary gigs). There are a lot of folks there with side gig experiences that vary from medical experts, document review for 2nd opinion services, workers comp, telemed, etc. I'm just pointing out that you can have a job with an on/off schedule, and side gigs that supplement your career and income in different ways and still maintain a quality of life.
My recommendation is to review White Coat Investor and Physician on Fire if this sounds appealing to you. There are lots of folks who make much more money than I did with side gigs (or primary gigs). There are a lot of folks there with side gig experiences that vary from medical experts, document review for 2nd opinion services, workers comp, telemed, etc. I'm just pointing out that you can have a job with an on/off schedule, and side gigs that supplement your career and income in different ways and still maintain a quality of life.
There aren't... Making >650k/yr put you in 99%+ percentile.
Foe someone who is mid-to-late career and looking to work part time in a medical but non-patient care setting (perhaps such as document review, peer review, research oversight, etc.) what would the best way to find such positions be? I understand that these positions, even if they are obtainable, will likely not match a clinical salary, but hopefully provide enough income to meet living expenses while allowing investments to grow for another 5-10 years in preparation for actual retirement.
