Job market for neuro

[Converted]

Hi guys, out of curiosity, what is the job market like for general neurologists? Assuming if you graduated from a middle tier university program in the mid west or west coast, would it be reasonable to easily get a job in SoCal working 40-50 hrs week in an outPt clinic making at least 150K?

Is it a buyer's market out there?

Thx

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[bustbones26]

Hi guys, out of curiosity, what is the job market like for general neurologists? Assuming if you graduated from a middle tier university program in the mid west or west coast, would it be reasonable to easily get a job in SoCal working 40-50 hrs week in an outPt clinic making at least 150K?

Is it a buyer's market out there?

Thx

150K for outpatient only is not unreasonable, but you will have to load up with a lot of patients during the day.

 

[donegal]

That sounds like a really low number
In am a neurology resident in the Midwest and the numbers I hear are usually in the 200-300 range depending on whether its academic vs private and the higher figures for small cities and towns,of course these numbers are for the Midwest

 

[danielmd06]

That sounds like a really low number
In am a neurology resident in the Midwest and the numbers I hear are usually in the 200-300 range depending on whether its academic vs private and the higher figures for small cities and towns,of course these numbers are for the Midwest

Remember, the OP is seeking opportunities that exclude inpatient responsibilities and (presumably) taking call.

 

[MLT2MT2DO]

Remember, the OP is seeking opportunities that exclude inpatient responsibilities and (presumably) taking call.

How does the number change if one is willing to take inpatient but would prefer not taking call (is this even possible?).

 

[danielmd06]

How does the number change if one is willing to take inpatient but would prefer not taking call (is this even possible?).

I couldn't guess about the numbers. I suppose anything is possible.

If you're okay with inpatient, then you could work as a neurohospitalist and see exclusively inpatient people with no clinic. You wouldn't be on-call per se, but would likely have to do shift work that covered nights and weekends.

 

[donegal]

I have been wondering about Neurohospitalist
The obvious perk is that you would be off for a substantial amount of time
I would find that appealing but just wonder how much you would be bogged into dealing with strokes codes and neuro critical patients,I would not want to be doing that all day especially if you are expected to put in lines etc
So what is a general description of a Neurohospitalist's duties ?Would a stroke fellowship be crucial? Do they get paid generally less ,the same or more compared to traditional neurologists.

 

[typhoonegator]

A neurohospitalist is not a neurointensivist. Just because you are seeing inpatients doesn't qualify you to be a critical care physician, any more than being an oncologist qualifies to you manage ventilators. In some systems that lack a neuroICU, neurology patients are admitted to a MICU or SICU, and in that case a neurohospitalist may be expected to round on these patients and comment on their neurologic workup, but they would not be expected to perform a thoracentesis and wean the ventilator. A neurohospitalist can have NCC training, but in that case your day-to-day would need to be clearly demarcated between disciplines. A stroke fellowship is not "crucial" for hospitalists. I know many neurohospitalists who have either no fellowship training or fellowship training in other neuro disciplines. However, it could be beneficial in some settings because it would be seen as an added value to your skill set and allow you to manage in house strokes in addition to your other duties. Frankly, depending on where you train, you may be comfortable doing this anyway -- stroke fellowship covers many topics that are not acute stroke.

In academic centers, neurohospitalists often end up with a large teaching role, since they are the primary point of contact with residents and medical students. This is something else to think about if you don't like residents being underfoot all the time. Finally, while you ostensibly have "free time" when you are not on service, all of the day-to-day responsibilities of a practicing physician pile up when you are in house all the time, so there can be a lot to do even when you aren't seeing patients. If you are part of a academic department, people will also look at this "free time" as an opportunity to offer you other responsibilities, like directorships of services or QA initiatives.

 

[Converted]

Thx for the input. So let me modify my question a bit. Is it at all possible to work 40 hrs week ONLY (averaged) everything included irrespective of in- or outpatient services to land a job in SoCal, preferably LA area and make around 200K?

It kind of sucks that my engineering friends can make 150K working these hours while sacrificed considerably less. I know the privilege to heal others is a gift in itself, but still...

 

[Vader]

Thx for the input. So let me modify my question a bit. Is it at all possible to work 40 hrs week ONLY (averaged) everything included irrespective of in- or outpatient services to land a job in SoCal, preferably LA area and make around 200K?

It kind of sucks that my engineering friends can make 150K working these hours while sacrificed considerably less. I know the privilege to heal others is a gift in itself, but still...

I would say this is pretty unrealistic. Most neurologists in the L.A. area work quite a bit more than that to make around 200k. In the future, expect to have to work even more to stay even, given the changes coming in medical delivery and reimbursement.

 

[Vader]

A neurohospitalist is not a neurointensivist. Just because you are seeing inpatients doesn't qualify you to be a critical care physician, any more than being an oncologist qualifies to you manage ventilators. In some systems that lack a neuroICU, neurology patients are admitted to a MICU or SICU, and in that case a neurohospitalist may be expected to round on these patients and comment on their neurologic workup, but they would not be expected to perform a thoracentesis and wean the ventilator. A neurohospitalist can have NCC training, but in that case your day-to-day would need to be clearly demarcated between disciplines. A stroke fellowship is not "crucial" for hospitalists. I know many neurohospitalists who have either no fellowship training or fellowship training in other neuro disciplines. However, it could be beneficial in some settings because it would be seen as an added value to your skill set and allow you to manage in house strokes in addition to your other duties. Frankly, depending on where you train, you may be comfortable doing this anyway -- stroke fellowship covers many topics that are not acute stroke.

In academic centers, neurohospitalists often end up with a large teaching role, since they are the primary point of contact with residents and medical students. This is something else to think about if you don't like residents being underfoot all the time. Finally, while you ostensibly have "free time" when you are not on service, all of the day-to-day responsibilities of a practicing physician pile up when you are in house all the time, so there can be a lot to do even when you aren't seeing patients. If you are part of a academic department, people will also look at this "free time" as an opportunity to offer you other responsibilities, like directorships of services or QA initiatives.

Agree completely... both private practice neurohospitalists work hard and academic neurohospitalists work hard. I'd personally prefer the academic version since I love the academic environment, research and teaching. In any environment, as alluded to, it is important to understand one's role and limitations. I would say that if you trained in a strong stroke-centric residency, fellowship in vascular neurology is probably unnecessary and that other areas would provide more value-added benefit, i.e. critical care or clinical neurophysiology fellowship. But it really depends on what you want to do and want to bring to the table. For example, neurovascular fellowship would be valuable if you intend on attaining a stroke directorship at a private hospital or plan on being an academic strokologist. If you like reading EEGs, doing IOM, running an EMU, using continuous video EEG, and/or treating status epilepticus as part of an inpatient career, clinical neurophysiology or epilepsy would make sense. If you like stabilizing and managing critically ill patients including neurotrauma, stroke, severe neuromuscular disease, post-neurosurgical patients, etc, then NCC is for you. I would also suggest neuroimmunology as an exciting area which may give targeted expertise in treating inpatient disease using the many newer immunomodulatory and steroid-sparing agents available.

Ideally, in any given academic (or private) neurohospitalist group, there would be people trained in and comfortable with a variety of these areas to provide breadth and depth of expertise.

 

[Silent Cool]

Thx for the input. So let me modify my question a bit. Is it at all possible to work 40 hrs week ONLY (averaged) everything included irrespective of in- or outpatient services to land a job in SoCal, preferably LA area and make around 200K?

It kind of sucks that my engineering friends can make 150K working these hours while sacrificed considerably less. I know the privilege to heal others is a gift in itself, but still...

That sucks. Why do people want to go into Neurology?

 

[typhoonegator]

That sucks. Why do people want to go into Neurology?

Seriously? 40 hours a week is not much time in ANY specialty. Do you think dermatologists just walk into clinic at 9AM and walk out at 5pm and print money? Surgeons work more than 40 hours. Interventionalists work more than 40 hours. You might only see patients for 8 hours a day, but there is so much ancillary work that goes on "off the books" for running a practice, charting, getting reimbursed, etc. that a pure 40 hour work week is pretty unrealistic, whatever your specialty of interest.

8 hours a day, no weekends? Who would want to hire you? Maybe as a senior partner you could swing that...

Also, comparing across medical/non-medical fields is fallacious. High school dropouts can make 30 billion dollars, but most don't. Engineers at a big firm can top out at 150 maybe, but that isn't the average. There is so much upward mobility in medicine that if you're willing to make the right sacrifices, you can hang a big number in essentially any specialty.

 

[Jorje286]

Seriously? 40 hours a week is not much time in ANY specialty. Do you think dermatologists just walk into clinic at 9AM and walk out at 5pm and print money? Surgeons work more than 40 hours. Interventionalists work more than 40 hours. You might only see patients for 8 hours a day, but there is so much ancillary work that goes on "off the books" for running a practice, charting, getting reimbursed, etc. that a pure 40 hour work week is pretty unrealistic, whatever your specialty of interest.

8 hours a day, no weekends? Who would want to hire you? Maybe as a senior partner you could swing that...

Also, comparing across medical/non-medical fields is fallacious. High school dropouts can make 30 billion dollars, but most don't. Engineers at a big firm can top out at 150 maybe, but that isn't the average. There is so much upward mobility in medicine that if you're willing to make the right sacrifices, you can hang a big number in essentially any specialty.

I hear psychiatry is the exception.

 

[michaelrack]

I hear psychiatry is the exception.

yes, because psychiatry clinics can be low overhead.

 

[Dusn]

That sucks. Why do people want to go into Neurology?

I'm ophtho and that's a pretty typical starting salary for comprehensive ophtho in SoCal as well, if you can even find a job there - so these low salaries are not neuro specific. A neuro-ophtho fellowship could probably get you an 8-5 job, all outpatient, if that's what you're looking for.

 

[Silent Cool]

Seriously? 40 hours a week is not much time in ANY specialty. Do you think dermatologists just walk into clinic at 9AM and walk out at 5pm and print money? Surgeons work more than 40 hours. Interventionalists work more than 40 hours. You might only see patients for 8 hours a day, but there is so much ancillary work that goes on "off the books" for running a practice, charting, getting reimbursed, etc. that a pure 40 hour work week is pretty unrealistic, whatever your specialty of interest.

8 hours a day, no weekends? Who would want to hire you? Maybe as a senior partner you could swing that...

Also, comparing across medical/non-medical fields is fallacious. High school dropouts can make 30 billion dollars, but most don't. Engineers at a big firm can top out at 150 maybe, but that isn't the average. There is so much upward mobility in medicine that if you're willing to make the right sacrifices, you can hang a big number in essentially any specialty.

PMR, Allergy, Psych, Path, Derm, and Pain Medicine--many people in these fields work 4-5 days per week and earn a lot more than 200K. Likewise, in many other fields if one is working significantly more than 40 hrs, they would earn way more than 200K. From the sounds of this thread, one will clear about 200K for 'busting their butt every week.' in neurology. I'd rather bust my butt in a different field and earn double or 2.5 times that--that's what I'm saying. Especially now with some of the ridiculous neurology cuts that were announced recently. The science of neurology is cool, but not that cool.

 

[Silent Cool]

To put it in perspective, here's a post I cam across a while back while researching pediatrics. It's a quote from a pediatric dentist on a dental forum re: the relatively low pay of a peds doc. As it turns out, the number is pretty close to the 200k mark talked about in this forum.

"Dude - I don't know if I could live on that as a bachelor let alone with three kids (which instantly means mucho life insurance, disability, etc), a wife (nuff said) and a dog (who currently may need bilateral ACL repair by the orthopedic specialist), education and business loans. I'm not even including the second house, the boat, Harley etc. (Just kidding about that last sentence).

I have a pediatrician friend who works 60-70 hours a week for that $180K plus benefits. Two weekends ago she had 26 emergencies while on-call and was basically in the office all day Saturday and Sunday. I have other friends who are tradesman who work less, owe less and make more than she does. It's not all about money but that's an awful lot of work, time and energy for that pay. How many of you could afford to stay in pediatric dentistry if that happened to you?"

http://www.dentaltown.com/MessageBo...2&f=136&t=168136&g=1&st=pediatrician bachelor

 

[Converted]

Seriously? 40 hours a week is not much time in ANY specialty. Do you think dermatologists just walk into clinic at 9AM and walk out at 5pm and print money? Surgeons work more than 40 hours. Interventionalists work more than 40 hours. You might only see patients for 8 hours a day, but there is so much ancillary work that goes on "off the books" for running a practice, charting, getting reimbursed, etc. that a pure 40 hour work week is pretty unrealistic, whatever your specialty of interest.

8 hours a day, no weekends? Who would want to hire you? Maybe as a senior partner you could swing that...

Also, comparing across medical/non-medical fields is fallacious. High school dropouts can make 30 billion dollars, but most don't. Engineers at a big firm can top out at 150 maybe, but that isn't the average. There is so much upward mobility in medicine that if you're willing to make the right sacrifices, you can hang a big number in essentially any specialty.

I'm not thinking about making bank, but rather to have the option of living in LA working 40 hrs week (even if that is considered part-time) and make a reasonable living that corresponds to the amount of sacrifice I have made (when others were going out getting drunk in their early 20s, I was at home studying).

I thought private practice neurologists have the option of working in an outpatient setting since it's not a procedural specialty and that may allow you to work in an office seeing patients Mon to Friday.

I think other specialties allow you to control your hours, too. Like EM where you get paid hourly (something like 200 per hr) or in surgery where you can work part-time and operate maybe 2 days / week and be in clinic 2 days / week.

 

[Silent Cool]

I'm not thinking about making bank, but rather to have the option of living in LA working 40 hrs week (even if that is considered part-time) and make a reasonable living that corresponds to the amount of sacrifice I have made (when others were going out getting drunk in their early 20s, I was at home studying).

I thought private practice neurologists have the option of working in an outpatient setting since it's not a procedural specialty and that may allow you to work in an office seeing patients Mon to Friday.

I think other specialties allow you to control your hours, too. Like EM where you get paid hourly (something like 200 per hr) or in surgery where you can work part-time and operate maybe 2 days / week and be in clinic 2 days / week.

Based on what you are looking for, I would say that your best bet in Neurology is a pain fellowship.

 

[Silent Cool]

Seriously? 40 hours a week is not much time in ANY specialty. Do you think dermatologists just walk into clinic at 9AM and walk out at 5pm and print money? Surgeons work more than 40 hours. Interventionalists work more than 40 hours. You might only see patients for 8 hours a day, but there is so much ancillary work that goes on "off the books" for running a practice, charting, getting reimbursed, etc. that a pure 40 hour work week is pretty unrealistic, whatever your specialty of interest.

8 hours a day, no weekends? Who would want to hire you? Maybe as a senior partner you could swing that...

Also, comparing across medical/non-medical fields is fallacious. High school dropouts can make 30 billion dollars, but most don't. Engineers at a big firm can top out at 150 maybe, but that isn't the average. There is so much upward mobility in medicine that if you're willing to make the right sacrifices, you can hang a big number in essentially any specialty.

Not everyone in medicine wants to kill themselves for their career. One of my favorite posters on SDN, Taurus, said it quite well:

"I'll be very happy sitting in my Aeron chair, drinking my latte, talking into my dictaphone, working 9-5."

Posts 12 and 18 from this thread summarize it well:

http://forums.studentdoctor.net/showthread.php?t=553242

 

[clement]

I hear psychiatry is the exception.

this is true. it's not exceedingly uncommon to work part-time (3-4 days a week) in psychiatry. I know someone making >150K right out of residency doing just that.
Demand is high, overhead is low, some say possibly the last frontier for private practice, liability is lower, burnout is generally lower, and it's easy to work in a different setting every day of the week (research, outpatient, inpatient, ERs, consulting in hospitals, companies, schools). You can break 300K if you're willing to work 6-7 days a week on the two coasts vs work less and make that same amount in the midwest. It really isn't for everyone when compared to the rest of the medical specialties, and perhaps that's a ginormous consideration factor. That said, I've seen some neurologists get creative and dabble in "psychiatry-like" practices.

 

[danielmd06]

Not everyone in medicine wants to kill themselves for their career. One of my favorite posters on SDN, Taurus, said it quite well:

"I'll be very happy sitting in my Aeron chair, drinking my latte, talking into my dictaphone, working 9-5."

I agree with typhoonegator.

Working 40 hours a week or less and still expecting over 200k per year as a base salary is a pretty high expectation outside of the highest paying specialties. I guess opportunities like this exist. Even then, I wouldn't be surprised to hear that more work is expected.

True, not everyone wants to "kill" themselves for their job, but working 40-60 hours per week is a pretty common expectation in medicine. And I suppose what "kills" you is relative.

I would suggest you look into emergency medicine. Your work hour to dollar ratio there is favorable.

 

[Lacktherof]

I feel like a 40 hr week is a pretty light workload, and 50-60 hrs is certainly not killing oneself. I think you really start to feel the burn at 65+ per week, but I guess everyone has their limits. I think expecting 200K for 40 hrs of work or less is a little entitled though

 

[Converted]

EM, work 30 hrs a week for 200$ per hour (I heard average salary is 250$ per hr), 4 weeks per month, 10 months a year (with 2 months vacation) = 240K
EM is a shorter residency than neuro.
EM is not more intense than Neuro stroke or NCC.
On the free market, EM should not be in much greater demand than Neuro.
I really don't understand the rationale behind all those reimbursement BS

 

[Silent Cool]

EM, work 30 hrs a week for 200$ per hour (I heard average salary is 250$ per hr), 4 weeks per month, 10 months a year (with 2 months vacation) = 240K
EM is a shorter residency than neuro.
EM is not more intense than Neuro stroke or NCC.
On the free market, EM should not be in much greater demand than Neuro.
I really don't understand the rationale behind all those reimbursement BS

Converted, you are clearly wise.

Wanna add a little (or a lot of) insult to injury? Why don't you check out becoming a CRNA. Or a specialty PA--who are earning almost as much in many cases. What about Pain? Or PMR? Or Allergy? Or Ophtho? Or for chrissakes, why not be a Psychiatrist? Earning 200K in medicine for about 40 hours per week is not unreasonable--especially when a lot of lesser trained health care staff are earning as much for the same or fewer hours and less responsibility.

What's going to be next? "Yeah, it's only 70 hours--It's not too bad. I mean, yeah, the CRNAs earn about the same for a good ol' 40 per week but, you know, I'm a doctor so, whatever. I'm tough."

This is why physicians are being taken to the cleaners--because they won't take a stand and complain...it makes them 'weak' or some such nonsense. "Work harder," is the mantra. Eventually I'm going to say "stick it" when education puts me 500K in debt to earn less than a f****** CRNA. Ridiculous.

There is a reason that neuro is one of the least competitive specialties. This thread sums it up nicely.

 

[typhoonegator]

30 hours a week is not a career -- it's essentially locum tenens. Are you going to complete all of your billing during your shift? Dictations? All of your CMEs too? All of your administrative responsibilities? Staff meetings? Interviews? Annual admin staff reviews? Teaching? Lunch? That's one heck of a 30 hour week.

It turns out that in the real world there are a lot of non-billable requirements of being a professional physician. Those eat in to your work week. No one here is arguing that you need to see patients 12 hours a day, 6 days a week to make any money, just that most practices or faculty positions expect a little more from their physicians than showing up at 10AM and clocking out at 4, doing nothing but seeing patients during that time.

I think the readers of this thread can reach their own conclusions on what, exactly, this thread sums up.

 

[Strokeguy]

You cannot compare EM work to stroke or NCC. They may do shift work but even their night shifts are physically exhausting and overall the level of acuity can be intense (dealing with trauma/burns/cardiac arrest/shock.. - all tumbling into the ER at the same time). This doesn't mean the acuity is not in stroke or NCC, but the frequency can be much less. During the 8 hr shift they are on their feet and continuously active. Many times they don't get the chance to complete documentation when the shift is over (so the 30 hrs can be much longer if you account for the time to document).
EM docs also work hard to get paid what they do.

 

[bustbones26]

30 hours a week is not a career -- it's essentially locum tenens. Are you going to complete all of your billing during your shift? Dictations? All of your CMEs too? All of your administrative responsibilities? Staff meetings? Interviews? Annual admin staff reviews? Teaching? Lunch? That's one heck of a 30 hour week.

It turns out that in the real world there are a lot of non-billable requirements of being a professional physician. Those eat in to your work week. No one here is arguing that you need to see patients 12 hours a day, 6 days a week to make any money, just that most practices or faculty positions expect a little more from their physicians than showing up at 10AM and clocking out at 4, doing nothing but seeing patients during that time.

I think the readers of this thread can reach their own conclusions on what, exactly, this thread sums up.

I would like to echo TN's statement. It is possible, I believe to find an outpatient only neurology jobs that is 40 hours per week. That being stated, whenever I say 40 hours, I mean 40 hours of face to face patient time. Patients book from 9 to 5.

As TN points out, yes, indeed, there is a great deal of administrative stuff that will keep you at work until after 5PM. Dictating and/or writing notes is just one thing. Keep in mind, we are now trending to EMR and this CREATES more work. As an example, we now have to order entry our labs in the EMR and it is quite a pain!! There are many things that will slow you down!!

I currently am running my own private practice. There is one week per month where I am doing call at two hospitals. I have to start my day an hour late and end by 2PM everyday or else I would never get home!! I get killed with inpatient consults during that particular week!! If you are working at a practice that permits you to do outpatient only, you WILL be booked from the minute the doors open until the doors lock!

Yeah, EM works in shifts, but I have seen many EM doctors staying after shift to tidy up their notes and admin.

This happens frequently to IM/FP hospitalists as well.

 

[danielmd06]

There is a reason that neuro is one of the least competitive specialties. This thread sums it up nicely.

Not all that glitters is gold.

Clinical work might be more complicated than you surmise. For instance, I do full time adult sleep medicine. I do strictly outpatient work (in the clinic seeing patients) for *only* 2.5 to 3.5 days a week. The balance of my time is reading portable and in-lab sleep studies (rather like a radiologist). I don't take call in the traditional sense (I am available each and every night for my labs, though), I don't work holidays, and I don't have to go in on weekends if I don't desire. Sounds cushy, right? I should easily finish a work week in under 40 hours, right?

Guess what? A week that is 40 hours or less for me is an extreme rarity. Maybe in two years, it's happened once or twice when the workload was light.

When I first started and things were new, I would clock in 80-90 hours in a week. I always clock in at least 50-60 hours, even now when I'm much faster than I used to be. My clinic days are quite long, really. And beyond that, there is just too much else to do. Dictations, editing my electronic notes, calling patients with problems, calling doctors, clearing up orders with DME companies, calling pharmacies to straighten out medicines I've ordered, paperwork related to insurance requests/denials for testing on my patients, arguing with CMS or insurance companies over drugs I can get for a narcoleptic patient, VA paperwork (for disability requests), questions my techs have about scoring or medical knowledge, meetings with other doctors in the practice, meetings with techs about their performance, and researching patients' notes prior to seeing them in clinic to help the work flow more smoothly. And this is *not* including vacation or fun-type responsibilities like continuing CME, or attending lectures/reading/studying to keep up on sleep medicine.

My point is that there is more to even the most seemingly simple, straightforward, outpatient job than may be readily apparent. And these traits may make a true 40 hour work week a bit unrealistic for most clinicians.