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.