Neurohospitalist beds

[PecanPie1984]

Hi all,

I'm in early stages of accepting a neurohospitalist position.

for people who are presently working as neurohospitalists.. how many beds does your hospital have.

Not sure if a hospital needs to have a certain size/beds to supply enough volume to pay a 2 person neurohospitalist team.

I am concerned that the position that I apply to may or may not have enough volume. I got some conflicting reports from people who currently work there.

So, if I don't end up meeting the minimum rvu requirement, I may have to end up working outpatient as well to meet their RVU threshold.

Thank you

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[Postictal Raiden]

I know a 300-bed hospital that generates 12 neuro consults per 24-hr period. On the other hand, a nearby 400+ bed hospital barely generates 8 consults a day. So it may vary

Most of the NH jobs I interviewed for are requiring only one neurologist on per week. Bed size ranged 300-500, and some were CSC. A friend of mine interviewed for one in TX that needs 3 NHs on at any given time. Size is 1500ish.

 

[PecanPie1984]

My current job is just under 300 bed and generates only about 2 to 5 new consults per day, but we're primarily outpatient now.

Guess the IM.docs would be more inclined to place neuro consults if they see an in-house neurohospitalist.

 

[Neurogeneral]

A +300 bed hospital should have enough consults to justify one dedicated neurohospitalist. If you have two working at the same time sharing consults, you would need 600 beds if generated RVUs are a concern to justify compensation.

 

[Neurogeneral]

Guess the IM.docs would be more inclined to place neuro consults if they see an in-house neurohospitalist.

For sure. If they know neuro is in house (and not leaving for clinic), the hospitalists will be more inclined to consult. Even the ER docs will be more inclined to ask the neurologist to come in and assess patients before discharging them home.

It can also depends on how accessible you make yourself. If you want consults and network with all the referring hospital staff, they will consult you more and you will make more RVUs.

 

[deathmerchant]

My current job is just under 300 bed and generates only about 2 to 5 new consults per day, but we're primarily outpatient now.

Guess the IM.docs would be more inclined to place neuro consults if they see an in-house neurohospitalist.

My hospital is little over 300 beds. I get on average 2-3 new 2-4 f/u and 1-2 EEGs per day. We are 2 neurologists week on week off. Get to bit over 3000 RVUs. Ive been doing this job for 5 years and haven't seen much increase in volume-maybe 10-15% more. Partly because my other attending is a bit "rough on the edges"!

If this is just an RVU based job, then I would reconsider and ask for a fixed salary or call based pay (like 1500/day or something). Because with that volume you will get to 3200-3600 RVUs/year and @ 50 per Rvu that's 180k.

 

[PecanPie1984]

My hospital is little over 300 beds. I get on average 2-3 new 2-4 f/u and 1-2 EEGs per day. We are 2 neurologists week on week off. Get to bit over 3000 RVUs. Ive been doing this job for 5 years and haven't seen much increase in volume-maybe 10-15% more. Partly because my other attending is a bit "rough on the edges"!

If this is just an RVU based job, then I would reconsider and ask for a fixed salary or call based pay (like 1500/day or something). Because with that volume you will get to 3200-3600 RVUs/year and @ 50 per Rvu that's 180k.

Thanks all .


Oh wow

Around 3000 rvu is low for a neurohospitalist.
Are you doing outpatient as well.

Need to hit atleast 5000 plus to reach the 300k plus mark

 

[Postictal Raiden]

My hospital is little over 300 beds. I get on average 2-3 new 2-4 f/u and 1-2 EEGs per day. We are 2 neurologists week on week off. Get to bit over 3000 RVUs. Ive been doing this job for 5 years and haven't seen much increase in volume-maybe 10-15% more. Partly because my other attending is a bit "rough on the edges"!

If this is just an RVU based job, then I would reconsider and ask for a fixed salary or call based pay (like 1500/day or something). Because with that volume you will get to 3200-3600 RVUs/year and @ 50 per Rvu that's 180k.

This is a 1 in a million job you got there. I’m envious

 

[elanmorin]

My hospital is little over 300 beds. I get on average 2-3 new 2-4 f/u and 1-2 EEGs per day. We are 2 neurologists week on week off. Get to bit over 3000 RVUs. Ive been doing this job for 5 years and haven't seen much increase in volume-maybe 10-15% more. Partly because my other attending is a bit "rough on the edges"!

If this is just an RVU based job, then I would reconsider and ask for a fixed salary or call based pay (like 1500/day or something). Because with that volume you will get to 3200-3600 RVUs/year and @ 50 per Rvu that's 180k.

Do you provide ED and/or stroke coverage? 2-3 consults/day seems quite low.

 

[deathmerchant]

Thanks all .


Oh wow

Around 3000 rvu is low for a neurohospitalist.
Are you doing outpatient as well.

Need to hit atleast 5000 plus to reach the 300k plus mark

Yes with the volume you described, you are looking at around 3500 RVUs. To get to 5000 RVUs, you need 200 RVUs/week. Which comes to about 29 per day. You need close to 14-15 encounters a day for that number. Ask for call pay.

I started couple of half days of clinic only in my on week. I will be trying to negotiate extra pay for that once the volume picks up.

 

[deathmerchant]

Do you provide ED and/or stroke coverage? 2-3 consults/day seems quite low.

Yes I am On 24 hours and provide ED and Stroke coverage. I probably get called once or twice from ED after-hours. I think one of the reasons its not that busy is because we have 2 similar competing hospitals within 15 minutes of each other and there are tertiary centers within an hour in each direction. Also we have a good hospitalist group who don't consult me much for nonsults and many times will just curbside me or text me for straight forward issues. I don't care because I'm on a fixed salary. Its a good job for sure.

 

[deathmerchant]

This is a 1 in a million job you got there. I’m envious

There are pros and cons man. I am in a relatively small town, plan was to leave after few years. But now have roots here and got a chill job. Definitely miss seeing complex patients/academia/research sometimes, but not so much There are definitely other similar jobs out there.

 

[xenotype]

I know a 300-bed hospital that generates 12 neuro consults per 24-hr period. On the other hand, a nearby 400+ bed hospital barely generates 8 consults a day. So it may vary

Most of the NH jobs I interviewed for are requiring only one neurologist on per week. Bed size ranged 300-500, and some were CSC. A friend of mine interviewed for one in TX that needs 3 NHs on at any given time. Size is 1500ish.

Local hospital culture varies a whole lot in terms of generating consults. Some hospitalist groups will not admit a patient from the ED with syncope without a neurology consult first, other groups will admit a stroke from the ED sight unseen, do an entire stroke work up without a neurologist, and occasionally a stat consult comes when patient gets worse/nurse figures out something is being grossly missed. Number of beds is not so reliable- some 300 bed places can generate a list of 15 while others will have a list of 4 consistently. Tele at a lot of places now carves out the entire ED in terms of consults as well as any inpatient stats- anyone getting bombarded with volume can use either leaving or pushing some of that volume to tele contractually as a tool to decrease how busy it is especially if other hospitals in the system already have an existing contract with one of the big tele groups. Weekend coverage in smaller places can even be done entirely with tele to get a hospitalist job into a M-F.

 

[PecanPie1984]

Local hospital culture varies a whole lot in terms of generating consults. Some hospitalist groups will not admit a patient from the ED with syncope without a neurology consult first, other groups will admit a stroke from the ED sight unseen, do an entire stroke work up without a neurologist, and occasionally a stat consult comes when patient gets worse/nurse figures out something is being grossly missed. Number of beds is not so reliable- some 300 bed places can generate a list of 15 while others will have a list of 4 consistently. Tele at a lot of places now carves out the entire ED in terms of consults as well as any inpatient stats- anyone getting bombarded with volume can use either leaving or pushing some of that volume to tele contractually as a tool to decrease how busy it is especially if other hospitals in the system already have an existing contract with one of the big tele groups. Weekend coverage in smaller places can even be done entirely with tele to get a hospitalist job into a M-F.

Great point.

 

[deathmerchant]

Local hospital culture varies a whole lot in terms of generating consults. Some hospitalist groups will not admit a patient from the ED with syncope without a neurology consult first, other groups will admit a stroke from the ED sight unseen, do an entire stroke work up without a neurologist, and occasionally a stat consult comes when patient gets worse/nurse figures out something is being grossly missed. Number of beds is not so reliable- some 300 bed places can generate a list of 15 while others will have a list of 4 consistently. Tele at a lot of places now carves out the entire ED in terms of consults as well as any inpatient stats- anyone getting bombarded with volume can use either leaving or pushing some of that volume to tele contractually as a tool to decrease how busy it is especially if other hospitals in the system already have an existing contract with one of the big tele groups. Weekend coverage in smaller places can even be done entirely with tele to get a hospitalist job into a M-F.

Yea Tele is definitely an option. Although many hospitals/ED attendings/patients Hate Televisits, esp for acute issues. At least that was the reason this hospital hired me (from what they told me) because for these volumes, tele was a much cheaper option for them. Obviously many hospitals don't have that option due to physician shortage in these areas and have to go to Tele.
In addition, more and more neurologists/doctors want to do Tele, which would further cause shortage of in-house physicians. This would encourage more midlevels and Tele support. In my opinion, this will be a race to the bottom for us neurologists in the long term, because we have less volumes/admissions/procedures in general. Our major advantage is being able to provide a service to a hospital.

 

[PecanPie1984]

Agree that many IM docs hate dealing with tele, but that's where things are headed now

I personally love this division of labor between stroke and non stroke neurologists- works for both of us

Stroke specialists who like to just see strokes and not AMS, seizures, Gbs etc.
Best way for them to see strokes exclusively is to do tele- stroke.

Non stroke neurologists like me hate doing stroke codes . ,so I'm happy to do all consults, read my EEGs, status etc and leave the strokes to telestroke.

Also, strokes are easy to do on tele, no touching the patient required

Some neuro consults are almost impossible on tele, GBS for instance, only a neurologist can reliably pickup on absent reflexes or a changing day to day exam.


Me personally would never opt to do teleneuro for inpatient(non stroke) consults.