Neuroimmunology Job prospects and options

[ChocolateE21]

I'm about to start looking for jobs for after fellowship. I'm curious if anyone has tried a career half outpatient and half neuro hospitalist. My idea would be two weeks of clinic then two weeks off where I would help out for any shifts needed for the inpatient team. Up to 7 full shifts per month of inpatient work. This would look like 0.5 FTE outpatient and 0.5 FTE inpatient to hopefully make up a full 1.0 FTE. Is this feasible? Would it be attractive in a small to medium sized city (100k - 500k population) if there is currently no neurology clinic associated with the hospital? most full time clinicians I know only work 4 or 4.5 days per week so could I get away with 8 days of clinic per month and 7 days of neuro hospitalist work per month? Would it be rude/crazy of me to request a setup like this? If I thought out the general salary, most outpatient only attendings are making 300-350k in private practice, and most 7 on / 7 off neuro hospitalist make around 400k+. So could I expect closer to the 350-400k or how around what salary would you expect and try to negotiate?

My clinic would hopefully be mostly neuroimmunology patients but I don't mind seeing some Gen neuro. I'm proficient in outpatient procedures like Botox for spasticity, back often pump management, LPs, etc (not EMT/NCS unfortunately). And my inpatient skills are solid. I feel confident seeing anything, reading inpatient EEGs if necessary, and covering stroke.

Alternatively, what kind of setups have you guys got going on for neuroimmunology trained attendings in private practice?

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[CnsCrit]

Yes, lots of neurologists do part outpatient and part inpatient. Neuroimmunologists are needed pretty much everywhere as are neurohospitalists. You could probably negotiate a split however you want, and it'll also depend on the needs of each particular practice at a particular point in time. Something reasonable would be 12 weeks inpatient and 12+ weeks clinic to get to 1 FTE.

Most neurohospitalists are not making 400+, at least not anywhere near where I live. In academics you'll make 300 or less (maybe < 250), in hospital emyployed or privademic a little more, and in true private practice or true RVU based you might push 400 but I doubt it. This is for pure inpatient, not hybrid clinic and inpatient. It may not matter either way, as a lot of groups are paying neurologists more equitably regardless of specialty with some exceptions.

 

[Telamir]

Pure inpatient 7 on 7 off is typically depending on area around 350-400. Over 400 you’re going real rural or something about the job is undesirable.

As locums 7 on 7 off if it’s a good gig is around 450. That being said it’s no benefits and that’s with a lot of travel. I’ve made more, but life was miserable.

As always, your mileage may vary.

 

[deathmerchant]

I'm about to start looking for jobs for after fellowship. I'm curious if anyone has tried a career half outpatient and half neuro hospitalist. My idea would be two weeks of clinic then two weeks off where I would help out for any shifts needed for the inpatient team. Up to 7 full shifts per month of inpatient work. This would look like 0.5 FTE outpatient and 0.5 FTE inpatient to hopefully make up a full 1.0 FTE. Is this feasible? Would it be attractive in a small to medium sized city (100k - 500k population) if there is currently no neurology clinic associated with the hospital? most full time clinicians I know only work 4 or 4.5 days per week so could I get away with 8 days of clinic per month and 7 days of neuro hospitalist work per month? Would it be rude/crazy of me to request a setup like this? If I thought out the general salary, most outpatient only attendings are making 300-350k in private practice, and most 7 on / 7 off neuro hospitalist make around 400k+. So could I expect closer to the 350-400k or how around what salary would you expect and try to negotiate?

My clinic would hopefully be mostly neuroimmunology patients but I don't mind seeing some Gen neuro. I'm proficient in outpatient procedures like Botox for spasticity, back often pump management, LPs, etc (not EMT/NCS unfortunately). And my inpatient skills are solid. I feel confident seeing anything, reading inpatient EEGs if necessary, and covering stroke.

Alternatively, what kind of setups have you guys got going on for neuroimmunology trained attendings in private practice?

Many small to midsize hospitals will like someone who does both. Do inpatient rounds in the morning and outpatient in the afternoon. I have a similar setup. I've also had places offer 7on 7off inpatient plus some outpatient in the off weeks.
Remember it takes lot of manpower to run an outpatient clinic so you have to have enough hours to make it worthwhile for your employer. So it will be hard to find a job just doing 7-8 days of outpatient a month. You could come up with some locums options but that is suboptimal in other ways.

 

[ChocolateE21]

Many small to midsize hospitals will like someone who does both. Do inpatient rounds in the morning and outpatient in the afternoon. I have a similar setup. I've also had places offer 7on 7off inpatient plus some outpatient in the off weeks.
Remember it takes lot of manpower to run an outpatient clinic so you have to have enough hours to make it worthwhile for your employer. So it will be hard to find a job just doing 7-8 days of outpatient a month. You could come up with some locums options but that is suboptimal in other ways.

Hmm, I would assume I could be placed in another multi specialty clinic. My current university has a clinic that has neurology on Tuesday/Thursday and acts as a Gen peds clinic MWF. The staff are the same for both.

I've also been warned by my mentor against inpatient rounds in the AM and clinic in the PM. Especially if you're still taking calls/consults in the afternoon. I think it sounds like a quick way to burnout.

I also think a 7on/7off is already full time and it would take a lot extra to get me to work that plus clinic on my off weeks. The point of me wanting to do clinic 2 weeks then 1 week of inpatient is so that I could still enjoy some of the benefits of extra time off that comes with 7on/7off.

 

[Spinothalamic]

Just something to keep in mind even though it kind of “bursts the bubble”: if you run a general neurology clinic with predilection for neuro-immunology patients, your two weeks of inpatient/“off” time unfortunately will not be without answering a lot of chart messages/telephone encounters about your active outpatients. Even if you are in a group and have partners to help while you are on service or “off” they will defer the actual management questions to you, especially anything that is close to resembling your subspeciality.

 

[CnsCrit]

Correct - 7 on/off is already full time, so you wouldn't want to agree to do more outpatient on top of that. Just remember that a week of inpatient is not the same as a week of outpatient. Say you work 7 days inpatient per month (call it 84 hours), that would equal at least 2 weeks of outpatient time (4 clinic days). So in nonacademic practice they probably would want you to work at least 1 week inpatient and 2 weeks outpatient per month in that scenario. In academics you might be able to carve admin or research time. You can see where it just depends on your practice context and the needs of your specific employer.

Just remember that a lot of salaries discussed on this site are by people who do locums or who have above average salaries in LCOL areas. Most neurologists are not full time locums. Also keep in mind what the benefits situation is - what health insurance and what retirement accounts you have access to. As an example, if your employer matches 10% of your salary that translates into more compensation than if you don't have access to a match or a crappy match.

 

[Telamir]

Agreed. I always post that I do locums as a disclaimer. That being said 7 on 7 off employed at a busy hospital in a mid sized city was 380k/yr for me. It always goes down the bigger/more saturated the area is.

 

[deathmerchant]

Hmm, I would assume I could be placed in another multi specialty clinic. My current university has a clinic that has neurology on Tuesday/Thursday and acts as a Gen peds clinic MWF. The staff are the same for both.

I've also been warned by my mentor against inpatient rounds in the AM and clinic in the PM. Especially if you're still taking calls/consults in the afternoon. I think it sounds like a quick way to burnout.

I also think a 7on/7off is already full time and it would take a lot extra to get me to work that plus clinic on my off weeks. The point of me wanting to do clinic 2 weeks then 1 week of inpatient is so that I could still enjoy some of the benefits of extra time off that comes with 7on/7off.

Yes that's what I do, I work 8 half days/month using the staff from another clinic; only during my On week. I get paid extra for this work on top of my 7on 7off inpatient.
But yes, this depends on how busy your inpatient is. I'm in a small hospital so we don't get that many Code Strokes and I typically have 2-3 new consults/day so I'm done with inpatient in few hours. Also my outpatient office is across the hall from ED if I have to go in to eyeball a patient which happens rarely.
There are many other people I know who do both inpatient and outpatient on the same day.

 

[Neurogeneral]

Combining outpatient and inpatient is doable but there are some headaches and possible burnout to deal with. When you are doing inpatient and taking call, your outpatient MS patients will still be calling/messaging you. You will also still have timely deadlines to deal with in regards to appeals/peer to peers for denied imaging and treatments. By trying to do both, you are also giving up many of the lifestyle benefits of a typical inpatient schedule (7 on/off) vs outpatient schedule (weekends off and no overnight call).