neuro call-life after residency & concerns

[uclakid07]

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hey guys,

i'm an ms3 considering neurology. i had read a few posts about family/work balance in neuro.

however, after looking through current job openings for neurologists, it looks like call averages 1:3 or 1:4 in most groups which seems not much different from neuro residency (i've included a sample below).

so for an overage neuro position (non-academic practice w/o residents) like the one below, what would an average call night be like? would you expect to be called in > 50% and work as a PGY-4 or is it usually not quite that bad compared with other specialties.

is academic neurology really the only option if one wants more family/work balance? i really like neuro and the patient/doc relationship and understand call is part of the responsibility, but would be concerned if sleepless nights would be the norm every other day or so.

thanks for the input.

Private single specialty group of 2 in beautiful St. Louis suburb, seeking well rounded neurology candidate to become third associate - open to fellows on a case by case. Group works from two offices and two hospitals with call 1:3. Potential option for partnership. Comprehensive financial package includes salary-income guarantee, excellent benefits, CME, relocation expenses, potential for signing/commencement bonus, and potential for medical education debt assistance. If you are interested in this opportunity, please email your inquiries and CV to [email protected]; or fax to 1-877-878-1970 attn: Julie Kramer. Find more opportunities online or register for free at www.staffpointe.com.

 

[Fencer]

In general, Private Neurologists and Academicians work about 60 hours + call (there are AAN surveys about this). Some situations with high income require you to work 90 hours. That is also true but rare for some academicians. The difference between Private and Academic neurologists is flexibility. You might want to be working on that paper or grant between 11 pm and 3 am, and then get to the lab at 9 am, but you were able to coach your kid at the 6 pm soccer game in 8 out 12 weeks. A private neurologist has patients to see at that time, and is rarely productive between 11 pm and 3 am. In addition, on-call duties obviously are also less burdensome for academicians. That is why hospitals have a hard time recruiting neurologists to cover their ER.

Academicians also have to cover their salaries. If you have no grants, it means more clinical workload. There is no free lunch!

 

[synmaster]

I was told that junior attendings in neurology in Chicago was only paid by 80k-90k/per year. How can these academician survive in Chicago (90k is enough but...) after medical school, residency and fellowship?

 

[neurochica]

Academicians also have to cover their salaries. If you have no grants, it means more clinical workload. There is no free lunch!

Fencer,
how much of my salary can I cover with grants. For example, if you bring in a 300k grant, do you keep 10%? How does your salary works in academic?

Regards

 

[Fencer]

Fencer,
how much of my salary can I cover with grants. For example, if you bring in a 300k grant, do you keep 10%? How does your salary works in academic?

Regards

Salary + benefits (~30%) are taken off grants. The maximum salary cap for NIH grants is close to 200K (+ benefits). The percentage of time that you charge to your grant is declared when you submit your NIH or VA grant. Depending upon the type of research, you will justify/charge 5-25% of your salary per grant. Salary is negotiated with your chairman based on prior year productivity, institutional guidelines, seniority, AAMC salary scales for specialty, and other factors. I previously posted the AAMC median salary at different levels.
I hope this helps you.

 

[neurochica]

Thanks fencer-

Now does this include hospital salary? For example Salary + benefits (~30%) from grants and 90-120k from the academic institution?

Also, have you or anyone from your circle reached the NIH salary cap of 200k?

thanks in advance

 

[uclakid07]

thanks fencer for the response. sorry but i don't think you answered my first question completely. are overnight calls for attendings working in group practices any different from that of the resident's call? as i had posted, most jobs seem to require 1:3 or 1:4 in most groups which seems not much different from neuro residency.

although i am aware call is everyone's responsibility, i am concerned about finding family balance in a career of neurology with potentially frequent overnight responsibilities. would appreciate comments from private practice neurologists. thanks.

 

[Phantom Spike]

thanks fencer for the response. sorry but i don't think you answered my first question completely. are overnight calls for attendings working in group practices any different from that of the resident's call? as i had posted, most jobs seem to require 1:3 or 1:4 in most groups which seems not much different from neuro residency.

although i am aware call is everyone's responsibility, i am concerned about finding family balance in a career of neurology with potentially frequent overnight responsibilities. would appreciate comments from private practice neurologists. thanks.

Well, in my experience, one major difference is that at most hospitals, Neurology is a consult-only service, meaning that you won't be admitting patients. Therefore, for the most part, unlike in residency, you won't be called into the hospital in the middle of the night to see that stable TIA or syncope or migraine ... the hospitalist service generally admits, and you'll only see the patient the next morning. In fact, if you have an answering service or work out an arrangement with the floors, you will probably only be notified of the consult the next morning, meaning very few overnight phone calls anyway. Of course, you will be called, and may need to come in, for STAT issues like tPA, status epilepticus, etc., but that's definitely not something that will happen every night. It's a good idea to ask a neurologist in a group you're interested in how busy their calls are, rather than how frequent, since that will determine whether you need to come in after hours, and therefore, how bearable they are.

 

[uclakid07]

thanks phantom spike for sharing your insight! it was very helpful.

 

[neurologist]

thanks fencer for the response. sorry but i don't think you answered my first question completely. are overnight calls for attendings working in group practices any different from that of the resident's call? as i had posted, most jobs seem to require 1:3 or 1:4 in most groups which seems not much different from neuro residency.

although i am aware call is everyone's responsibility, i am concerned about finding family balance in a career of neurology with potentially frequent overnight responsibilities. would appreciate comments from private practice neurologists. thanks.

Call frequency varies tremendously depending on the size of the group and number of hospitals covered. Even a very large private group may have frequent call if they have to split up between half a dozen hospitals.

I am in a call pool of about 10 neurologists, and we cover only 2 geographically close hospitals. Thus, my call averages about 2 weeknites a month and a weekend every 8 weeks or so. That's pretty damn nice and yes, it was a big factor in my taking this job. My feeling is that since I didn't even have to take q3 call as an intern, there's no way in hell I'm going to do it now.

As PhantomSpike describes, our group works as consultants, not the primary admit service, so usually the night calls are not too onerous. The hospitalists handle the admit and basic stuff. Plus, as Spike also points out, there are, in real life (as opposed to residency, where everything is a "teaching experience"), really very few emergencies where the physical presence of a neurologist truly adds value, so other than TPA and refractory status, I'm generally not running in to the hospital in the middle of the night. Occasionally you get a call where you just have no idea what the referring doc is talking about so it's the better part of valor to go in and see for yourself, but this is pretty rare. My weekend days can be busy with new consults, but weekend nights generally taper off by about 9 or 10.

 

[Phantom Spike]

Plus, as Spike also points out, there are, in real life (as opposed to residency, where everything is a "teaching experience"), really very few emergencies ...

Oh, yes, the educational value of being called in to see a chronic low back pain patient requesting narcotics in the ER at 2 a.m. is invaluable!

I'm so glad I'm not a resident anymore.