movement disorders salary

[Jojo45]

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Is it true that it doesn't pay well. Whats the average salary? 200k for academics? I assume difficult to build a large practice outside of academics?

Also that botox and DBS programming are not well reimbursed.. Is this true as well?

 

[deathmerchant]

Is it true that it doesn't pay well. Whats the average salary? 200k for academics? I assume difficult to build a large practice outside of academics?

Also that botox and DBS programming are not well reimbursed.. Is this true as well?

Academic salary for fresh out of training movement disorders is between 150k-220k. The average being around 180k. Private practice movement disorders is probably 250-350k.

Actually Botox reimbursement is not that bad right now, compared to other things in Neuro. DBS is not bad either. Although, in academics you won't get paid extra for Botox or DBS. Its a lump sum pay.

 

[Jojo45]

What's the typical reimbursement for botox and dbs programming?

 

[RainbowYoshi]

Aside from intervential neuro is there that big a difference in compensation between specialties?

 

[Postictal Raiden]

subpecialty doesn’t directly affect salary. However certain subspecialties tend to generate more RVUs through volume and procedures than others. An initial encounter may consume half or third of time in general neurology/neurophysiology than in behavioral neurology, yet the reimbursement is the same. In the same time it takes to do a thorough H&P on a demented pt, you can 2-3 pts with cc of headache/carpel tunnel/radicular back pain/etc. similarly, you could do 4-limb EMG with NCS in less time than assessing someone’s memory and cognition. I don’t know the numbers off the the top of my head, but you can generate at least double the number of RVUs, and hence money, doing the earlier. Therefore subspecialties like behavioral neuro and movement disorders, which tend to do lengthy H&P, tend to generate less money than others.

This concept is the same across all specialties of medicine. Regardless of procedures, a dermatologist who breezes through 50 pts in the same time it takes a rheumatologist to see 20 pts is going to generate 2-3x the income.

 

[Thama]

Movement time per visit is more akin to neuromuscle than it is to dementia. There are the rare difficult patients but most PD, ET followups take 15-20 minutes, Botox appointments can be done in 10 with excellent reimbursement, and DBS programming is efficient as well. While in academics the salary is based on academic rank rather than subspecialty, most faculty practices have productivity bonuses which do vary. Also, what counts as full clinical time can vary based on how many RVUs are generated. Botox and DBS generate a LOT of RVUs so fewer clinic days are required to be considered full time without buying out protected research time.

 

[deathmerchant]

What's the typical reimbursement for botox and dbs programming?

Botox 'work RVU' is 1.2- 1.8 per limb (depending on no. of muscles injected) plus an additional 0.4 for using EMG guidance.

DBS is 3.5 RVUs for 1hour and then another 1.5 for additional time. A thorough Initial programming usually takes an hour or more.

As per medicare, 1 RVU is $37. But the rate per RVU is usually dependent on the hospital you are in. Range being 40-60. Keep in mind, the above are just physician 'work RVUs'. Total RVUs are apprx 2-3 times.

 

[deathmerchant]

Aside from intervential neuro is there that big a difference in compensation between specialties?

Not much in academics. In outpatient private practice, procedural specialties like Interventional pain, Sleep, Neuromuscular and Epilepsy can bill higher RVUs make, usually in that order.

 

[Cassowary]

Which neuro specialties lend themselves to the most volume per time? Neurophys?

subpecialty doesn’t directly affect salary. However certain subspecialties tend to generate more RVUs through volume and procedures than others. An initial encounter may consume half or third of time in general neurology/neurophysiology than in behavioral neurology, yet the reimbursement is the same. In the same time it takes to do a thorough H&P on a demented pt, you can 2-3 pts with cc of headache/carpel tunnel/radicular back pain/etc. similarly, you could do 4-limb EMG with NCS in less time than assessing someone’s memory and cognition. I don’t know the numbers off the the top of my head, but you can generate at least double the number of RVUs, and hence money, doing the earlier. Therefore subspecialties like behavioral neuro and movement disorders, which tend to do lengthy H&P, tend to generate less money than others.

This concept is the same across all specialties of medicine. Regardless of procedures, a dermatologist who breezes through 50 pts in the same time it takes a rheumatologist to see 20 pts is going to generate 2-3x the income.

 

[Postictal Raiden]

Which neuro specialties lend themselves to the most volume per time? Neurophys?

Yes. Pain. Headache.

 

[Epic786]

I heard neurocritical care has the highest RVU in terms of their notes and procedures. Reading EEG can generate about 4-6 RVU.

 

[deathmerchant]

I heard neurocritical care has the highest RVU in terms of their notes and procedures. Reading EEG can generate about 4-6 RVU.

Yes you can bill critical care time in NCC for over 60 minutes spent with a patient.

A routine EEG is only 1.08 physician work RVU. Although total is 11.

 

[doctorhopeful242]

To kind of piggy back on this, is there really much difference in income between subspecialties? In general does doing a fellowship make significantly more money or is it really just between whether you do private or academic work.

 

[Alcmaeon of Croton]

Movement time per visit is more akin to neuromuscle than it is to dementia. There are the rare difficult patients but most PD, ET followups take 15-20 minutes, Botox appointments can be done in 10 with excellent reimbursement, and DBS programming is efficient as well. While in academics the salary is based on academic rank rather than subspecialty, most faculty practices have productivity bonuses which do vary. Also, what counts as full clinical time can vary based on how many RVUs are generated. Botox and DBS generate a LOT of RVUs so fewer clinic days are required to be considered full time without buying out protected research time.

Just out of curiosity since I’m going into movement, what’s the average RVU number you typically need to achieve as a movement specialist to be considered full time? Ideally, I would love to do 2.5 days clinic and 2.5 research but not sure if this would be enough to reach Full Time Equivalent.

 

[Thama]

FTE isn't usually RVU based though there are often separate RVU targets. At academic places 80-85% clinical time is generally considered "full clinical", which is about 4 clinical days and 1 admin/academic day. If you want 2.5 research days you'll either need your department to support it or come with funding.

 

[scoopdaboop]

Yes. Pain. Headache.

So if I want the most money possible while working the least amount possible, I should do headache?

 

[Postictal Raiden]

So if I want the most money possible while working the least amount possible, I should do headache?

No that would be psychiatry

 

[Telamir]

So if I want the most money possible while working the least amount possible, I should do headache?

At the expense of your soul and sanity, sure.

 

[Captain_Falcon]

Any recent changes on the outlook of reimbursements that could limit the income of the various sub specialties like CNP or movement?

 

[Aldertonghen]

Any recent changes on the outlook of reimbursements that could limit the income of the various sub specialties like CNP or movement?

EMG reimbursement got a big cut a few years ago, and recently EEG too. CNP doesn’t make as much as they used to.