Neurology compensation

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This is just a thought but how busy can a neurohospitalist at a smaller hospital outside a big city really be? Its not like in residency where Neurology was an admitting service. Also, you can usually just do stroke over the phone and give the OK for TPA and follow up with the patient the next day.

@neurochica do your gigs also request that you read EEG's and/or EMG's ?
I only do EEGs and I tell them upfront.

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I would not worry about compensation in neurology for a while. Just make sure not to undersell yourself. You are in high demand. Focus on selecting a job or designing a job, like Neurochica, that will be most enjoyable for you. Longevity is what is important just as reaching financial freedom ASAP. Waking up in the morning and feeling good or excited to go to work is what you should look for.
 
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I would not worry about compensation in neurology for a while. Just make sure not to undersell yourself. You are in high demand. Focus on selecting a job or designing a job, like Neurochica, that will be most enjoyable for you. Longevity is what is important just as reaching financial freedom ASAP. Waking up in the morning and feeling good or excited to go to work is what you should look for.
Which specialties do you think are the most conducive to a practice model like the one you’re using?
 
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Which specialties do you think are the most conducive to a practice model like the one you’re using?

It’s been said before, and I’ll reiterate- practice the specialty that you are most passionate about. I love neurology and couldn’t imagine doing something else.
 
I want to bring this thread back up for some updates from current practitioners. I’m interested in stroke management.

If I want to earn 400-500K a year, how hard do I have to hustle with a stroke fellowship or with a stroke plus NIR fellowship?

I’m interested in hrs worked per week, # of vacation weeks, frequency of calls, and # of pts seen per day. I’m open toward working in the majority of the US with the exception of places like the Dakotas, Wyoming, or areas within that tundra region.
 
Why would someone want to make 400k-500k? That's a lot of money if you ask me...
There are 400-500k reasons for wanting to making that much money. I’m interested in the reason why one wouldn’t be.
 
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I want to bring this thread back up for some updates from current practitioners. I’m interested in stroke management.

If I want to earn 400-500K a year, how hard do I have to hustle with a stroke fellowship or with a stroke plus NIR fellowship?

I’m interested in hrs worked per week, # of vacation weeks, frequency of calls, and # of pts seen per day. I’m open toward working in the majority of the US with the exception of places like the Dakotas, Wyoming, or areas within that tundra region.

You don't have to do a stroke or NIR fellowship to make 400k-500k. You can make more than that by either working Locums( @10K-20K a week) Or as a hospitalist (7on-7off which will be 250k-350k depending on location) and supplement remaining(7off) time with locums. Some states you can do outpatient neurology clinic or group(250-400k) and pick up stroke calls/night shifts at nearby hospitals. And there are many other ways...
 
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You don't have to do a stroke or NIR fellowship to make 400k-500k. You can make more than that by either working Locums( @10K-20K a week) Or as a hospitalist (7on-7off which will be 250k-350k depending on location) and supplement remaining(7off) time with locums. Some states you can do outpatient neurology clinic or group(250-400k) and pick up stroke calls/night shifts at nearby hospitals. And there are many other ways...
If this is so, is there then any financial incentive/advantage to subspecializing? Would any fellowship(s) push one above the 400-500k threshold?
 
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That kind of income will be helped by having billable procedures (EEG, EMG, etc) but is mostly dependent on the practice setup. Specifically, having the kind of practice setup where patient care comes in a distant third to printing money with unnecessary testing owned by the practice (own your own MRI? Of course every MS patient needs an MRI every 3 months) and finding out just how far you really can push the billing lines before the feds charge you with Medicare fraud.
 
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You don't have to do a stroke or NIR fellowship to make 400k-500k. You can make more than that by either working Locums( @10K-20K a week) Or as a hospitalist (7on-7off which will be 250k-350k depending on location) and supplement remaining(7off) time with locums. Some states you can do outpatient neurology clinic or group(250-400k) and pick up stroke calls/night shifts at nearby hospitals. And there are many other ways...

Is there any advantage of a Vascular fellowship and a NIR fellowship afterward? I personally want to be the person that handles most of the work for vascular cases from start to finish.
 
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I want to bring this thread back up for some updates from current practitioners. I’m interested in stroke management.

If I want to earn 400-500K a year, how hard do I have to hustle with a stroke fellowship or with a stroke plus NIR fellowship?

I’m interested in hrs worked per week, # of vacation weeks, frequency of calls, and # of pts seen per day. I’m open toward working in the majority of the US with the exception of places like the Dakotas, Wyoming, or areas within that tundra region.

To make this much you very much need to hustle! To generate the income needed for a salary of 400, you need to account for about 50% overhead. Even in the hospital. That means you need to generate billing of 700-1,000K. Good luck with that doing clinical neurology and not: killing people, going insane, sleeping (because you won’t be).

It is totally possible to do this BTW, but you’ll be working very hard. One way to increase your salary after a stroke fellowship is by entering an agreement with a hospital in which you will be awarded a stipend for covering call. At 500 a night, that’s 130K a year and depending on how things are structured you can keep that free of overhead. But because most hospitals don’t like writing checks, good luck staying independent. Usually they will just give you a salary and if it is high, then they will expect you to work for it.

That’s why locums pays so well BTW. This is the one area where supply and demand economics plays out in medicine. Hospitals are desperate to keep the stroke patients in house and not lose them to another system. So they will dip into their funds from DRG (always remember that for every 250 dollar admit you do, the hospital stands to generate thousands of dollars from the DRG, you bill separately for your professional component. Always remember this if you are negotiating with a hospital admin, who creates NO VALUE, about your salary. You can bring in well over millions of dollars to a hospital system in admissions, imaging, labs, but they will pay you ONLY based on professional billing. While this might be fair as that money pays nurses, machines, techs, it is something to chew on). Anwya, the need starts a bidding war because honestly, how many of us want to cover a hospital in Nebraska over a February-March? But you might want to! Or you might want to cash that check.

You don't have to do a stroke or NIR fellowship to make 400k-500k. You can make more than that by either working Locums( @10K-20K a week) Or as a hospitalist (7on-7off which will be 250k-350k depending on location) and supplement remaining(7off) time with locums. Some states you can do outpatient neurology clinic or group(250-400k) and pick up stroke calls/night shifts at nearby hospitals. And there are many other ways...

Exactly. “There are many other ways.” There are TONS of things you can do to build income streams if you are in private practice. 30 years ago you could have bought or leased an MRI, now those numbers look bad. These days you can: hire extenders, build ancillary services like infusions, legal cases - disability, malpractice, and other civil suits, long term EEG monitoring (even if you don’t read them, there are services that will do it), build PT, home health services, home sleep studies. Personally, I’ve been doing clinical trials which are rewarding in many ways OTHER than financially, but, yes, also financially. Without getting personal, I’ve begun to border on, and even push above the thresholds listed above.

Also: @W19 makes a good point, which got a bit of pushback. After a certain point, what difference does it make? It doesn’t actually matter how much you make (after 150 or so), it matters how much you keep. I know plenty of stressed out docs who do not live modestly, who are waking up at 5 AM to get to work asap, not spending time on fun forums, burning through their health and youth. Why? Pay off loans, buy a modest but nice house/car, enjoy your mornings and evenings, enjoy the work - or at least some aspects of the work, take vacations, save for your kid’s college, stay married, have a hobby, work out. I also recommend recycling and using sunscreen.

If this is so, is there then any financial incentive/advantage to subspecializing? Would any fellowship(s) push one above the 400-500k threshold?

Nothing guaranteed. Ten years ago it was neuro-muscular because NCV’s paid so much. Then the powers that be killed it (but stupidly for our field the number of NCV’s didn’t drop - again, supply and demand don’t apply to false markets in medicine). Sleep is anticipating huge hits. EEG is surely next on the chopping block. Meanwhile spine surgeons make north of 10K per surgeries that have been shown, at best, to minimally help people.

Who knows what’s going to happen in the future? Will MS doctors start making mad money because they are going to infuse everyone with biologics? Will HA docs be able to adjust VNS all day while their MA handles calls over telemedicine? Ditto movement and DBS? I have no clue.

The best way to ensure this sort of salary is to get out of clinical medicine. After about 10 years in pharma, for example, you will probably be around there with the various stock options and other schemes. Or identify a need, then start a business to fill it.
 
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If this is so, is there then any financial incentive/advantage to subspecializing? Would any fellowship(s) push one above the 400-500k threshold?

Is there any advantage of a Vascular fellowship and a NIR fellowship afterward? I personally want to be the person that handles most of the work for vascular cases from start to finish.


Yes, definitely there are advantages

1. You will be the expert in your field. Like you said, you can take care of the patient from start to finish.
2. You will get to do procedures, if thats your thing
3. NIR will get you much higher salaries by itself( you won't have to hustle/do extra shifts/locums or any of the things mentioned previously; although you might work equally hard for same salary).

I got an email last week from a hospital in Rochester, NY offering 900K for Endovascular trained neurologist (I am not endovascular trained)

4. But, as many people above mentioned- it sounds cliche but after a point money does not matter and you will know it once you start working. Also future of reimbursements is highly unpredictable.
Who knows someone will come up with a new thrombolytic that will render thrombectomy obsolete. So do what interests you, you can make money many ways.
 
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Congrats on your residency placement!

I worked 24 weeks this year. Made little over $600k. I was supposed to work less than 20 weeks this year but something came up and I was forced me to work 4 extra Weeks. I been off since mid September I won’t work until middle of April however.
 
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I’m on the same page as Ibn Alnafis MD. $57k working 49 weeks with benefits (well partial benefits that mostly get deducted from that salary). I guess it’ll get better someday!
 
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Congrats on your residency placement!

I worked 24 weeks this year. Made little over $600k. I was supposed to work less than 20 weeks this year but something came up and I was forced me to work 4 extra Weeks. I been off since mid September I won’t work until middle of April however.
Maybe I should look for a PGY-2 neuro spot :p...
 
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How is this possible? Are you working locums in places that no other human wants to frequent (no offense intended, I prefer these places myself :)).

Not necessarily, I worked in Seattle and in Milwaukee this past year. Now that I think about it, perhaps Seattle and Milwaukee are that list . I wouldn’t live there myself.
 
Anybody else killed it this year?

Congrats on your residency placement!

I worked 24 weeks this year. Made little over $600k. I was supposed to work less than 20 weeks this year but something came up and I was forced me to work 4 extra Weeks. I been off since mid September I won’t work until middle of April however.

This is terrific, congratulations. You should note if you pay for any overhead, including malpractice, and include 401K, pension, options, health insurance, et al in total compensation - just FYI. Salary isn’t the same as total compensation.

Although I came close to you on pure salary, you win! Congratulations! Yet I also think I killed it this year. I’m particularly proud of a few killer rides on an awesome mountain bike. I got to go to a few national parks. I explored a few new interests. Professionally I think my best moment was obtaining informed consent from an under-represented minority who was going to refuse a trial. I enrolled dozens of others into various other trials. I had many good moments where I provided clarity and candor and direction to struggling families. I think some of them got rid of amyloid and clots in their brains. I made some good hiring decisions, and some less good. My kids are growing up, getting smarter and better and staying healthy. I published zero papers. I got to hang out with old and new friends. I deleted Facebook.

It was a great year. Not quite dead with one month to go - still got some miles to ride and beers to drink and diagnoses to disclose. But if it ended tomorrow, I’d say that I killed it.
 
This is terrific, congratulations. You should note if you pay for any overhead, including malpractice, and include 401K, pension, options, health insurance, et al in total compensation - just FYI. Salary isn’t the same as total compensation.

Although I came close to you on pure salary, you win! Congratulations! Yet I also think I killed it this year. I’m particularly proud of a few killer rides on an awesome mountain bike. I got to go to a few national parks. I explored a few new interests. Professionally I think my best moment was obtaining informed consent from an under-represented minority who was going to refuse a trial. I enrolled dozens of others into various other trials. I had many good moments where I provided clarity and candor and direction to struggling families. I think some of them got rid of amyloid and clots in their brains. I made some good hiring decisions, and some less good. My kids are growing up, getting smarter and better and staying healthy. I published zero papers. I got to hang out with old and new friends. I deleted Facebook.

It was a great year. Not quite dead with one month to go - still got some miles to ride and beers to drink and diagnoses to disclose. But if it ended tomorrow, I’d say that I killed it.

That’s awesome! You are absolutely right. Killing it means a different things to different people. Kids, time spent with the family is the most important thing. In fact, that’s the reason I went the locum route. I have a young and growing family and i wanted to spend more time with them.

I don’t pay for malpractice- I ask all of my gigs to pay for it, including tail. I pay for my health insurance and benefits. However, the best thing about my gig is that i am paying taxes in the 15% range- I feel that I am working smarter, not harder. +$600k was my total gross income under my s Corp.

Are you also a locum?
 
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That’s awesome! You are absolutely right. Killing it means a different things to different people. Kids, time spent with the family is the most important thing. In fact, that’s the reason I went the locum route. I have a young and growing family and i wanted to spend more time with them.

I don’t pay for malpractice- I ask all of my gigs to pay for it, including tail. I pay for my health insurance and benefits. However, the best thing about my gig is that i am paying taxes in the 15% range- I feel that I am working smarter, not harder. +$600k was my total gross income under my s Corp.

Are you also a locum?

Not locum, just very fortunate.

Given the price point that you control, I'd consider doing locums, except it would distract me away from doing what I like. As you know, past a certain point (and I supposed below another point) money just becomes a number, a point of pride and a way of keeping score.
 
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That’s awesome! You are absolutely right. Killing it means a different things to different people. Kids, time spent with the family is the most important thing. In fact, that’s the reason I went the locum route. I have a young and growing family and i wanted to spend more time with them.

I don’t pay for malpractice- I ask all of my gigs to pay for it, including tail. I pay for my health insurance and benefits. However, the best thing about my gig is that i am paying taxes in the 15% range- I feel that I am working smarter, not harder. +$600k was my total gross income under my s Corp.

Are you also a locum?
Can you comment in the job market for neurologists? Is it still booming?
 
Can you comment in the job market for neurologists? Is it still booming?
If you look at the data released by PracticeLink, you’ll see that neurology is the only field right now where job openings exceed candidates. Also, the ratio of candidates per positions has progressively fallen from 1 to 0.97 to 0.94 over the past 12 months
 
I got killed this year. Hopefully it’s better next year. Btw thought you had a permanent placement?

No permanent placement. However, my contracts are for 1 year. After 1 year, I find another 1 yer contract.
 
I’m stuck in between ob, EM and neuro. Y’all make it seem neuro can make more than an ob doc. How’s that?
 
No permanent placement. However, my contracts are for 1 year. After 1 year, I find another 1 yer contract.

Thank you for your time with this valuable info. I am finishing my fellowship in one of general neurology subspecialties (nm), contemplating this locum tenens option upto 3 years to pay off my loans asap then move into academics. Therefore, high pay would be the most priority.

1. May I ask where would be good place to search for such positions without going through agents ?

2. If I find myself very flexible with no preference in location/life style/timing or 24 hrs shifts and want to maximize the earning, would it be good idea to apply for state license in almost all 50 states ?

3. Which states have the best offers (as I will start to apply for license in these states first)

4. For neuro-ICU patients, I would serve as a consult rather than admitting/primary. right ?

5. Would it be ok for me to send you a private message ?

Thank you
 
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I’m stuck in between ob, EM and neuro. Y’all make it seem neuro can make more than an ob doc. How’s that?

I don't know the market for OBGYN. However, I know of an EM Doc absolutely killing it doing locums. He lives in FL on his $500k "boat" that of course is part of his business. There is a locum doc in the EM forum who gets 500hr for 12 hours shifts. Works 5-9 shifts per month.
Also, please note that my income is as an independent contractor, not as employed.
 
Thank you for your time with this valuable info. I am finishing my fellowship in one of general neurology subspecialties (nm), contemplating this locum tenens option upto 3 years to pay off my loans asap then move into academics. Therefore, high pay would be the most priority.

1. May I ask where would be good place to search for such positions without going through agents ?

2. If I find myself very flexible with no preference in location/life style/timing or 24 hrs shifts and want to maximize the earning, would it be good idea to apply for state license in almost all 50 states ?

3. Which states have the best offers (as I will start to apply for license in these states first)

4. For neuro-ICU patients, I would serve as a consult rather than admitting/primary. right ?

5. Would it be ok for me to send you a private message ?

Thank you

1. This is always the hardest question to answer because there is no hard answer or website that will tell you where to look. How I do it is I figure out where I want to go and I start cold calling. In Seattle, I was in a major academic institution and other times I will be the only neurologist on staff. The majority of my assignments are with hospitals that are not looking for locums per se, they are looking for permanent candidates. This is where good negotiations skills are needed the most.

2. It takes a good amount of leg work to start on your own. I wouldn’t get 50 licenses. I would focus on securing one good hospital and contracting for a year. Try to configure the contract as open ended. Secure the schedule that you want with the availability to come in as often as you want. This year, I had the opportunity to earn more than a million dollars if I wanted to work the entire year (9 months) because of the way I structured the contract…I took advantage of working a few extra weeks, but my priority at this point in my life, is time spend with family. So, one license per year is what I recommend.

3. Don’t know. I have a daily rate and we try to sell it, regardless of the state.

4. It all depends in the hospital setting. Sometimes you be consults only, other times you be admitting and managing and other times you be doing tele-medicine. A few years back I was brought in to establish an inpatient service line. It was great because I set it up as a consult service and because it took time to roll it out, I worked 2-4 hours a day the entire summer. Again, how I like to set up the contracts, especially when only doing inpatient, is that I will be on call 24/7. However, I set my hours. I’ll come in and round at 10 or 11am, see consults, and go home. Sometimes I’m out by 2 others by 4. I’ll come in for a stroke or any emergency etc.

5. Shoot.

6. Keep in mind that you can command a great rate, at least I have, doing outpatient only. I did it early this year. Office hours was 8-4. I prefer the inpatient setting however.

7. What would be a good rate for you?


Good luck
 
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One can make a very decent salary if you can find a private practice that owns it on emg and eeg equipment and you either did a neurophys fellowship or had a very good residency program where you learnt these procedures well. Also seeing multiple migraine and neuropathy patients a day is not very hard or time consuming although can get very monotonous. Learn the business of medicine well and you can figure out your real worth and not settle for less.
 
Can new attendings or soon to graduate residents provide some figures on what one should expect as a starting salary in PP and as a neurohospitalist? Probably depends on location and the practice, but just curious on what you all are receiving from recruiters. I know neuro salary averages from surveys hover around 250-300k but after how many years of work would one reach those numbers?
 
Can new attendings or soon to graduate residents provide some figures on what one should expect as a starting salary in PP and as a neurohospitalist? Probably depends on location and the practice, but just curious on what you all are receiving from recruiters. I know neuro salary averages from surveys hover around 250-300k but after how many years of work would one reach those numbers?

It really depends on where, what hospital, what call schedule, etc. It can be as low as ~150 at high end academic centers. I've seen offers up to 500 for incredibly sketchy sounding positions with q2 or q3 call at hospitals with awful reputations. Generally speaking you should probably expect somewhere in the 200 to 300 range depending on location and call requirements.
 
I don't know the market for OBGYN. However, I know of an EM Doc absolutely killing it doing locums. He lives in FL on his $500k "boat" that of course is part of his business. There is a locum doc in the EM forum who gets 500hr for 12 hours shifts. Works 5-9 shifts per month.
Also, please note that my income is as an independent contractor, not as employed.
Damn that’s really enticing. I really feed off people so if I’m around a bunch of people who are pissed off, that’s how I’m going to be. That’s kind of what has turned me off of EM. I didn’t ever experience that in ob, everyone was always so happy and I liked that.
 
Can new attendings or soon to graduate residents provide some figures on what one should expect as a starting salary in PP and as a neurohospitalist? Probably depends on location and the practice, but just curious on what you all are receiving from recruiters. I know neuro salary averages from surveys hover around 250-300k but after how many years of work would one reach those numbers?

My first year out of residency I came out earning $~$330k as a neurohospitalist for 26 weeks a year. They offered 4 weeks vacation and 10 days cme, essentially cutting it down to 20 weeks. This was my dream practice, everything I wanted in a practice, city etc. Unfortunately, i left for a short stint in academia.
 
My first year out of residency I came out earning $~$330k as a neurohospitalist for 26 weeks a year. They offered 4 weeks vacation and 10 days cme, essentially cutting it down to 20 weeks. This was my dream practice, everything I wanted in a practice, city etc. Unfortunately, i left for a short stint in academia.
Why did you decide to leave for academia? And would you mind talking about why you didn’t enjoy working in academics?
 
AAMC has publicly available data on academic job salaries. The cost is $1125 but your residency/ fellowship PD should have it.


Sent from my iPhone using SDN mobile
 
I'm curious as to what locum companies are good to work with to maximize pay. I know that the bigger firms may be more streamlined and looking for smaller firms to work with. I'm about to finish a neurocritical care fellowship, and it seems challenging to find out how to navigate this work. I'm looking for neurology/stroke and neurocritical care locums around the country, without any restriction to location at this time. Anyone have any good leads to companies , let me know, thanks.
 
I'm curious as to what locum companies are good to work with to maximize pay. I know that the bigger firms may be more streamlined and looking for smaller firms to work with. I'm about to finish a neurocritical care fellowship, and it seems challenging to find out how to navigate this work. I'm looking for neurology/stroke and neurocritical care locums around the country, without any restriction to location at this time. Anyone have any good leads to companies , let me know, thanks.
I am interested in neurocritical care. Can I ask how is the job market is for new grads and why are you looking for locums, is there shortage of well paying jobs or did you prefer to start with locums?
 
1. This is always the hardest question to answer because there is no hard answer or website that will tell you where to look. How I do it is I figure out where I want to go and I start cold calling. In Seattle, I was in a major academic institution and other times I will be the only neurologist on staff. The majority of my assignments are with hospitals that are not looking for locums per se, they are looking for permanent candidates. This is where good negotiations skills are needed the most.

2. It takes a good amount of leg work to start on your own. I wouldn’t get 50 licenses. I would focus on securing one good hospital and contracting for a year. Try to configure the contract as open ended. Secure the schedule that you want with the availability to come in as often as you want. This year, I had the opportunity to earn more than a million dollars if I wanted to work the entire year (9 months) because of the way I structured the contract…I took advantage of working a few extra weeks, but my priority at this point in my life, is time spend with family. So, one license per year is what I recommend.

3. Don’t know. I have a daily rate and we try to sell it, regardless of the state.

4. It all depends in the hospital setting. Sometimes you be consults only, other times you be admitting and managing and other times you be doing tele-medicine. A few years back I was brought in to establish an inpatient service line. It was great because I set it up as a consult service and because it took time to roll it out, I worked 2-4 hours a day the entire summer. Again, how I like to set up the contracts, especially when only doing inpatient, is that I will be on call 24/7. However, I set my hours. I’ll come in and round at 10 or 11am, see consults, and go home. Sometimes I’m out by 2 others by 4. I’ll come in for a stroke or any emergency etc.

5. Shoot.

6. Keep in mind that you can command a great rate, at least I have, doing outpatient only. I did it early this year. Office hours was 8-4. I prefer the inpatient setting however.

7. What would be a good rate for you?


Good luck
Thanks for all the reply .. is neurology really that depressing as ppl make it and can you really improve the patients quality of life ..and why are most neurologist depressed !! Just a ms1 here :)
 
Thanks for all the reply .. is neurology really that depressing as ppl make it and can you really improve the patients quality of life ..and why are most neurologist depressed !! Just a ms1 here :)
Interesting. I fail to see how neurology can be more emotionally taxing than critical care medicine where more than half of your patients die on you regarding of how much work you do, pediatrics where you witness neglected/abused pts on daily basis, psychiatry and delving into the darkness of human mind, and list goes on...
 
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Interesting. I fail to see how neurology can be more emotionally taxing than critical care medicine where more than half of your patients die on you regarding of how much work you do, pediatrics where you witness neglected/abused pts on daily basis, psychiatry and delving into the darkness of human mind, and list goes on...

Yeah, this is what I don't get about the reputation of neurology in the general medical world. Neurological diseases as a whole are every bit as treatable as what internal medicine does. The only thing either specialty actually cures is infectious disease, the rest is management of chronic conditions. The most common things we see are highly treatable in most cases - migraine, epilepsy, acute stroke, MS, Parkinson's... the only major area where we still have nothing to offer is dementia.

There are many areas that I would find much more sad than your typical neurology practice: critical care, neurosurgery, anything in pediatrics dealing with abuse or congenital/genetic syndromes, psychiatry - hell, my IM hospitalist friends see every bit as much tragedy and untreatable cases as I ever have.

That said, I'm not sure why this line of discussion ended up on an income thread...
 
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Reviving this thread for those currently in the job market. Current PGY3 looking to go into neurohospitalist career. I am originally from the suburbs of Chicago and am looking to return following residency. How soon should I be looking for jobs? What is the best way to go about searching and connecting with practices? What range of salary/benefits should I be looking for? Any other advice from those who have recently one through the process would be very helpful! Thank you!
 
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