Neuro-hospitalist contract

[therunningman]

Hey everyone,

I'm a neurology resident planning to do a neuro-hospitalist job. I have 2 contract offers thus far and I wanted to see what the typical compensation model is. I would also like to have some idea of what would be a fair base salary is, as I would be an area that is in need of neurology coverage. In addition, I would appreciate any advice on anything you wish you would've requested in your contract and things that I should look out for? Thanks in advance.

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[Cone774411]

There's like a million different compensation models depending on a host of factors. Instead of asking us a blanket question why don't you provide us some additional basic details?

 

[DocMom1]

Hey everyone,

I'm a neurology resident planning to do a neuro-hospitalist job. I have 2 contract offers thus far and I wanted to see what the typical compensation model is. I would also like to have some idea of what would be a fair base salary is, as I would be an area that is in need of neurology coverage. In addition, I would appreciate any advice on anything you wish you would've requested in your contract and things that I should look out for? Thanks in advance.

In underserved areas all of the full time neuro-hospitalists I know are making 500-775k depending on load of call. Academic centers will pay less (but this is changing as many centers are losing talent to industry/biotech). Make sure there are clear expectations regarding avg. consults per day, paid sick leave, vacation, healthcare coverage, malpractice insurance, and overtime.

 

[therunningman]

I was offered a base salary but I would like to add a RVU/production bonus on top of that. I'm not financially savvy by any means so I'm not even sure what would be a reasonable model for this. I have contacted a contract attorney to help me with this.

WiredEntropy - are these all RVU/production based positions or base + RVU/production bonus?

 

[Postictal Raiden]

In underserved areas all of the full time neuro-hospitalists I know are making 500-775k depending on load of call. Academic centers will pay less (but this is changing as many centers are losing talent to industry/biotech). Make sure there are clear expectations regarding avg. consults per day, paid sick leave, vacation, healthcare coverage, malpractice insurance, and overtime.

These salaries are much higher than ive seen. I hope you’re right 🙂

Most neurohospitalist jobs I’ve seen offer 275-350 base plus RVU (usually adds on another 30-50k).

 

[Telamir]

While I have seen folks make 500k+ this is usually with locums/telemedicine and a LOT of working/extra shifts.

It all depends on your area, and what the salary is quite honestly; and you haven't provided information on either. If you're offered let's say 280k salary seeing 8-9 patients a day with an odd stroke alert thrown in--that's cushy as hell, that'd be fine. On the other hand if you're offered 350k salary and you're seeing 15-20 patients a day, no procedures I'd say that's probably fair and you wouldn't make that much more on production anyway.

I have found anecdotally that production lends itself to weird practices, such as following a syncope patient ad nauseum to bill for a low level followup, or ordering more continuous EEGs than are necessary or seeing really stupid consults (syncope, transient dizziness, AMS w/ sepsis/UTI etc). I personally prefer to just be salaried, although in my case it's shift pay ($X per shift, Y shifts per year = total income). That way I'm not focusing on production which may make income a little unpredictable. I had a bunch of colleagues in other specialties who took a beating with COVID volumes because they were on production.

And oh yeah, benefits. Look at those too.

 

[therunningman]

I'm in the South, from the area so will plan on staying once hired - getting offered 330K base + plus directorship position (30K), 7 on 7 off

I was told by admin (no current neuro-hospitalists) by 1 hospital that the number of patients was 6-10/day. The second hospital is more in the range of 8-12/day per their current neurologists taking call.

Would like to stay with 12 hour shifts (7 am-7pm) with no night call. I wasn't sure if that was reasonable?

 

[Postictal Raiden]

I'm in the South, from the area so will plan on staying once hired - getting offered 330K base + plus directorship position (30K), 7 on 7 off

I was told by admin (no current neuro-hospitalists) by 1 hospital that the number of patients was 6-10/day. The second hospital is more in the range of 8-12/day per their current neurologists taking call.

Would like to stay with 12 hour shifts (7 am-7pm) with no night call. I wasn't sure if that was reasonable?

360 for 7/7 with no night responsibility and seeing less than 12 pts/day seems like a great deal imo. But then I'm a lowly, impoverished resident.

 

[DocMom1]

I'm in the South, from the area so will plan on staying once hired - getting offered 330K base + plus directorship position (30K), 7 on 7 off

I was told by admin (no current neuro-hospitalists) by 1 hospital that the number of patients was 6-10/day. The second hospital is more in the range of 8-12/day per their current neurologists taking call.

Would like to stay with 12 hour shifts (7 am-7pm) with no night call. I wasn't sure if that was reasonable?

Which area of the south are you in? Here in Florida these figures would be quite low for a place with no current neuro-hospitalists. Remember that beyond the RVUs and procedural/imaging/subspeciality referral income you generate for the hospital, your presence allows subspecialty neurologists to develop outpatient practices with less call responsibilities that in turn facilitates recruitment, reduces turnover and increases individual outpatient productivity and patient satisfaction scores.You are therefore a tremendous value add to the hospital (and might generate upwards of 2-3M/yearly at FTE), so don't be shy to negotiate for more. There are some interesting publications and data in press about revenue to compensation ratios of neurologists if you need for info to support you in negotiating. 🙂

 

[deathmerchant]

I'm in the South, from the area so will plan on staying once hired - getting offered 330K base + plus directorship position (30K), 7 on 7 off

I was told by admin (no current neuro-hospitalists) by 1 hospital that the number of patients was 6-10/day. The second hospital is more in the range of 8-12/day per their current neurologists taking call.

Would like to stay with 12 hour shifts (7 am-7pm) with no night call. I wasn't sure if that was reasonable?

I think these are reasonable numbers for a straight out of training job. In general, $180-200 per patient as a hospitalist is a very good number. Less than 150 per patient is a No-No. More than that is unlikely, there must be a catch (this is based off some calculations I had done). You can always ask for 5-10% more. Obviously the numbers change a little bit depending on location/setting.

I also agree that in general RVU based model is more stressful and people tend to follow patients unnecessarily and that sometimes is a reason for burnout. You also tend to accept every silly consult. 500k-700k is unlikely, as an employed 7on 7off neurohospitalist working 26 weeks. Its only possible if you are working more shifts and/or Locums and/or outpatient. Or may be seeing >20-25 patients every day inpatient.

The most important thing I would recommend is being consult only and ensuring the ER doesn't require you to come in for every stroke call and even tpa. Obviously also look at the whole benefit package.

 

[bigamygdala]

just curious, on those 350k to 500k, what % eventually comes as post-tax? rough estimate

 

[Postictal Raiden]

just curious, on those 350k to 500k, what % eventually comes as post-tax? rough estimate

Depends on where you live and your marital status.

350k for a family of 4 living in Texas nets you 270k of take home income

On the other hand if you are single making 350k in CA, you take home 207k.

Remember, we are not accounting for retirement savings, investment in HSA, or health insurance.

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[dave2626]

500-700k here - major metro southeast region. I see 20-30 pts per day consult only with EMG / EEG 7 on 7 off. Base is 300 - the rest of pay is wrvu bonus - it’s rough when I’m on but totally worth it.

 

[DocMom1]

500-700k here - major metro southeast region. I see 20-30 pts per day consult only with EMG / EEG 7 on 7 off. Base is 300 - the rest of pay is wrvu bonus - it’s rough when I’m on but totally worth it.

This figure strikes me as somewhat low for this patient load plus EMG & EEG, unless you're in an academic/university center? How many of the 20-30 are new vs follow-up?

 

[Neurologo]

500-700k here - major metro southeast region. I see 20-30 pts per day consult only with EMG / EEG 7 on 7 off. Base is 300 - the rest of pay is wrvu bonus - it’s rough when I’m on but totally worth it.

20-30 inpatient consults a day? I would get burned out in 6 months or less.

 

[dave2626]

This figure strikes me as somewhat low for this patient load plus EMG & EEG, unless you're in an academic/university center? How many of the 20-30 are new vs follow-up?

Usually 5-8 new consults and 15-20 follow ups with avg 0.5 EMG/day and 4-6 EEGs. $55/wrvu. I'm not primary - so very little scut. 12k wrvu last year. I definitely have a supportive spouse to help. Mid-career this just seems perfect to build the nest egg so that I can cut back eventually and have a nice clinic by the beach 8-4 Monday thru Thurs with no weekends and no call by age 45.

I'd prefer to grind harder early on rather than punch the clock every week and be stuck doing call until 65. Neurologo you are right on man. No way to keep this up in perpetuity - but its easier than residency.

 

[bigamygdala]

500-700k here - major metro southeast region. I see 20-30 pts per day consult only with EMG / EEG 7 on 7 off. Base is 300 - the rest of pay is wrvu bonus - it’s rough when I’m on but totally worth it.

you did a fellowship rite?