deathmerchant

5+ Year Member
Feb 27, 2013
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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!
This thread and few other similar ones have had discussions, that are quite uptodate. Will be happy to answer any specific questions that you might have.

-Start looking about 12 months before graduation. May be bit prior if FMG.

-Easiest way is Recruiting companies. Saves you a lot of basic screening. Although if you have a general idea of the location, just cold calling the hospitals or talking to your past graduates/attendings who are doing the same gigs might work. Especially since more desirable jobs usually don't come through recruiters.

- Range is 250-350 for a moderately busy 7on-7off inpatient.

- Other than the usual stuff that you can find anywhere apt a job (No. of patients, EMR, Colleagues, Admin, Support staff and facilities, location, salary etc); one thing that might be very helpful is not being a primary admitting service. try to be a consult only. Also a place where you don't have to go in for every stroke/tpa or Seizure etc.
 

Telamir

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Dec 27, 2008
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^^^^ what he said.

I'll echo the consult only service. That makes your life that much easier. Also the ability to do telestroke after hours is important. Going in physically for every stroke will get very taxing, especially nowadays where every neuro symptom <24 hours old is called a stroke from the get-go.

Make sure if it's a busy place that you have 12 hour shifts (I.E. night coverage) otherwise it will be a miserable 7 days. If it's not too busy then this point isn't as important.
 
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Algor

10+ Year Member
Oct 11, 2009
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neurochica,
Thanks for sharing your great experience, I am glad you are able to negotiate directly with the hospitals and keep other middlemen out of the loop. I always feel that "home calls" a little sketchy, e.g. "benign vertigo" may become basilar artery occlusion and locked-in syndrome next morning and "encephalopathic patient" may turn out to be a stroke or meningitis. Most ER docs would call you to reduce their own liability. Most of the time you get a very superficial or unreliable exam from ER physicians or hospitalists on the phone, so liability becomes very significant unless you practice in very low liability states. E.g. how many ER physicians can reliably perform HINT exam? With extended 24 hours of endovascular stroke window, patients would require even more comprehensive evaluation with CT perfusion/CTA head and neck. Just wanted to hear your comments on those issues.
 
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Telamir

10+ Year Member
Dec 27, 2008
106
70
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Personally if I am taking home call and taking phone calls from E.D. docs I just practice more conservatively and CYA. If that vertigo patient is young and had recent trauma I'd get CTAs for example. If that same vertigo patient is older and has vascular risk factors I'd admit for an MRI.

It's true that they call you to reduce their own liability. It's also my preference to drop a small note on the chart of every phone call I get. "Called by Dr So and so for XYZ, on exam by Dr So and so findings are ABC....etc etc". The reason I do this is often times a phone call can be taken out of context. Example I recently had a patient who I recommended transfer to my hospital, and I later learned that he was just discharged home with PCP followup. I had a conversation with the E.D. doc. I don't know what he/she documented, but they could've easily said "neuro recommends outpatient followup" and done whatever they wanted. There's a note in the chart saying I recommended transfer, however.
 
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Algor

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Telamir,
Your set up is perfectly fine, and a lot of neurologists practice this way. However, let me just play a devil's advocate here solely for educational purposes. I want to make a disclaimer that I am not a lawyer and not giving legal advice.
First of all, let's finish the case described above. You admitted the patient for MRI and MRI showed cerebellar and brain stem infarction. Now what?
We all know about malpractice lawsuit criteria: duties, breach of duties, causation, damages. So, by taking phone calls a physician has duties.
Now, we need to discuss what would be a standard of care in such case. If the patient presented within 4.5 the standard of care would be to administer tPA and not to admit for MRI, if tPA was not given and MRI shows acute ischemic stroke, you are on the very shaky ground. Furthermore, 2018 has completely changed how neurology practice. Before 2018 if you get called and the patient is beyond 4.5 hr window, you are pretty much safe. However, after 2018 the stroke window is 24 hrs. It means significantly increased inpatient call burden for neurology.
Now, you can argue that you can order CTA and CT perfusion. How about the cases with acute or chronic renal failure? Are you going to make this call without seeing the patient, examining the patient and discussing the risk of IV contrast? Now, what if CTA is not-conclusive or shows some moderate stenosis here and there, you still need to correlate those findings with your exam to determine if those findings are symptomatic. What if the patient has a pacemaker and you cannot get MRI? What if MRI is not available after hours? What if this is not a stroke, but a myasthenic crisis? Or epidural abscess? Epileptic vs non-epileptic status? GBS vs cord compression? Migraine vs SAH or cerebral sinus thrombosis?
Now, even if you made the diagnosis, but there was a delay in care, you may get in trouble again.
Don't get me wrong, most of the neurologists taking phone calls will be fine in 9/10 cases, however, you need only one case to change your life significantly. Furthermore, if such case goes to a court, it will be presented in the way that you did not care to come to the hospital to examine the patient if you had any doubt in diagnosis. I am not sure if you can protect yourself by saying the ER physician gave you a pretty crappy exam, but it is very unlikely.
Realistically speaking, we all know it is impossible to come in for all those calls. However, you will be judged by people who do not know about all the burden of being on call for 24 hours.
 
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neurochica

10+ Year Member
Aug 31, 2009
132
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neurochica,
Thanks for sharing your great experience, I am glad you are able to negotiate directly with the hospitals and keep other middlemen out of the loop. I always feel that "home calls" a little sketchy, e.g. "benign vertigo" may become basilar artery occlusion and locked-in syndrome next morning and "encephalopathic patient" may turn out to be a stroke or meningitis. Most ER docs would call you to reduce their own liability. Most of the time you get a very superficial or unreliable exam from ER physicians or hospitalists on the phone, so liability becomes very significant unless you practice in very low liability states. E.g. how many ER physicians can reliably perform HINT exam? With extended 24 hours of endovascular stroke window, patients would require even more comprehensive evaluation with CT perfusion/CTA head and neck. Just wanted to hear your comments on those issues.
You hit it right on the money!

I am a very conservative neurologist, open minded and aggressive when going after pathology when I need to be.

When I first start a gig, I’ll go in for anything. It is my license and I only trust myself. However, I get to know the ER folks and learn who is good and who is not and thus this determine whether I go in or not. I have met some ER docs who are way better than neurologist who are on call once a month.

The reality for me is that I only work 16-20 weeks a year and thus I work hard when I am on…..in fact, I am on call 24/7 for 16 weeks straight. The first few weeks are harder as I am getting to know who is good, training nurses when to page (hate the 2am call for meds) etc-- and I am ok going in whenever I need too. However, when the 16 weeks are up, I get to go home and take 8 months off, so its easier to swallow for me, as a locum doc. Harder to maintain for a full time doc.

The scenarios you presented are real and encountered every day in the life of an inpatient neurologist. From early on, I learned to document EVERYTHING. I cant tell you how many times my notes saved my ass from accusations from nurses, ER, IM, Cards etc. I am very DILIGENT with my notes. I have always pride myself of providing world class neurology and my reputation is all I have….I work hard in maintaining it with documentation.
 

Algor

10+ Year Member
Oct 11, 2009
26
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Neurochica, thanks again for sharing your experience. I am really impressed with your set up. I am happy to see there are docs who can fight the system and get the lifestyle they want and deserve. I have many friends who left their first job because of too much pressure from the administration. Usually, it starts gradually, then they try to push more and more work on you for the same salary. But we are highly educated professionals and should know our value. I am pretty much like you, can do anything, stroke, vascular, EMG/EEG, clinic, MS, etc, so thinking about switching to locums, maybe will start with agencies. The most concerning part for me is getting privileges in multiple hospitals, licences in multiple states, etc. It is kind of PITA.
Please keep posting here. Your posts are very inspiring. Good luck!
 
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neurochica

10+ Year Member
Aug 31, 2009
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Neurochica, thanks again for sharing your experience. I am really impressed with your set up. I am happy to see there are docs who can fight the system and get the lifestyle they want and deserve. I have many friends who left their first job because of too much pressure from the administration. Usually, it starts gradually, then they try to push more and more work on you for the same salary. But we are highly educated professionals and should know our value. I am pretty much like you, can do anything, stroke, vascular, EMG/EEG, clinic, MS, etc, so thinking about switching to locums, maybe will start with agencies. The most concerning part for me is getting privileges in multiple hospitals, licences in multiple states, etc. It is kind of PITA.
Please keep posting here. Your posts are very inspiring. Good luck!
Exactly, it always start with something….more meetings, more research and all of the sudden you are the medical student clerkship director and asking yourself how did I get here? More work with more responsibility and less pay. I DO NOT miss that hospital rat race at all.

Doing locum work should be a lot easier now with IMLC. It took 3 DAYS to get licenses in AZ, WA, CO. Days, not weeks or months, DAYS.

Create a credentialing file/folder. I have 1 folder that has all my licenses, previous hospital information etc. I email that one file to the hospital that I am currently credentialing, and usually, they send back the application for me to signed…..painless. I have credentialed in 1 month do being prepared. Organization is key!

Or you can hire your wife, pay her benefits or talk to your accountant how to maximize her. Make sure you have a good business plan. Some hospital will not deal directly with you, per their policy, but will work directly with your company. Create a corp.

You can easily start locums with agencies at $2600 a day, $18k a week. Stick to your guns and don’t accept anything less.
 

Algor

10+ Year Member
Oct 11, 2009
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neurochica,
Great plan! Thanks again! Very smart move with corp, definitely can save a lot on taxes! Lots of people are making money on us, recruiters, hospitals, managers, etc. Your set up is very efficient!
 

deathmerchant

5+ Year Member
Feb 27, 2013
186
104
New York City
Status
Attending Physician
Telamir,
Your set up is perfectly fine, and a lot of neurologists practice this way. However, let me just play a devil's advocate here solely for educational purposes. I want to make a disclaimer that I am not a lawyer and not giving legal advice.
First of all, let's finish the case described above. You admitted the patient for MRI and MRI showed cerebellar and brain stem infarction. Now what?
We all know about malpractice lawsuit criteria: duties, breach of duties, causation, damages. So, by taking phone calls a physician has duties.
Now, we need to discuss what would be a standard of care in such case. If the patient presented within 4.5 the standard of care would be to administer tPA and not to admit for MRI, if tPA was not given and MRI shows acute ischemic stroke, you are on the very shaky ground. Furthermore, 2018 has completely changed how neurology practice. Before 2018 if you get called and the patient is beyond 4.5 hr window, you are pretty much safe. However, after 2018 the stroke window is 24 hrs. It means significantly increased inpatient call burden for neurology.
Now, you can argue that you can order CTA and CT perfusion. How about the cases with acute or chronic renal failure? Are you going to make this call without seeing the patient, examining the patient and discussing the risk of IV contrast? Now, what if CTA is not-conclusive or shows some moderate stenosis here and there, you still need to correlate those findings with your exam to determine if those findings are symptomatic. What if the patient has a pacemaker and you cannot get MRI? What if MRI is not available after hours? What if this is not a stroke, but a myasthenic crisis? Or epidural abscess? Epileptic vs non-epileptic status? GBS vs cord compression? Migraine vs SAH or cerebral sinus thrombosis?
Now, even if you made the diagnosis, but there was a delay in care, you may get in trouble again.
Don't get me wrong, most of the neurologists taking phone calls will be fine in 9/10 cases, however, you need only one case to change your life significantly. Furthermore, if such case goes to a court, it will be presented in the way that you did not care to come to the hospital to examine the patient if you had any doubt in diagnosis. I am not sure if you can protect yourself by saying the ER physician gave you a pretty crappy exam, but it is very unlikely.
Realistically speaking, we all know it is impossible to come in for all those calls. However, you will be judged by people who do not know about all the burden of being on call for 24 hours.

The sword of lawsuits is always hanging on every doctors neck. Its a necessary evil, I believe.
Just sharing this here as Information and may be some helpful tips.

 
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Max E Million

7+ Year Member
Jul 5, 2010
55
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@neurochica do you travel with your family when on locums assignments, or do they have a separate home base? Do you ever get tired of moving around so much or not being able to see family for weeks (if they don't travel with you)?
 

neurochica

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Aug 31, 2009
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@neurochica do you travel with your family when on locums assignments, or do they have a separate home base? Do you ever get tired of moving around so much or not being able to see family for weeks (if they don't travel with you)?
I only work, travel, when kids are not in school Ie summer, spring break etc. This is the only way it works for me. Essentially it’s a vacation for them everytime I work.
I have a home and my husband and kids go with me when ever i work. I leaned to maximize my earnings, lately in the $3600-$4800 a day range, so mostly I work around 100 days in the summer.
 

Ibn Alnafis MD

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I only work, travel, when kids are not in school Ie summer, spring break etc. This is the only way it works for me. Essentially it’s a vacation for them everytime I work.
I have a home and my husband and kids go with me when ever i work. I leaned to maximize my earnings, lately in the $3600-$4800 a day range, so mostly I work around 100 days in the summer.
I’m counting the days...
 
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Algor

10+ Year Member
Oct 11, 2009
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I only work, travel, when kids are not in school Ie summer, spring break etc. This is the only way it works for me. Essentially it’s a vacation for them everytime I work.
I have a home and my husband and kids go with me when ever i work. I leaned to maximize my earnings, lately in the $3600-$4800 a day range, so mostly I work around 100 days in the summer.
You would be a good swimmer, your efficiency and drag minimizing skills are very impressive lol
 

neurochica

10+ Year Member
Aug 31, 2009
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You would be a good swimmer, your efficiency and drag minimizing skills are very impressive lol
I was actually a decent swimmer back in High school and college. I’ll be honest, it’s been easier to master the business of medicine than swimming 3 miles everyday. Business is booming!
 
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neurochica

10+ Year Member
Aug 31, 2009
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What is the typical housing solution for your gigs?
Sorry I missed this question. I rent a luxury condo and live it up. I been able to get a travel stipend of about $3k a month in addition to my daily rate. I also have a nice motor home that we take on shorter trips-I get to keep most of the stipend when i take the rig.
 
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liquidshadow22

Junior Member
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Jun 23, 2006
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Neuro Chica, how often will hospitals balk at working with you and insist on finding their locums through an agency instead?
 
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