Neurology vs Cardio?

[Techmonkey]

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Here's a question.

If neurosurgeon compensation is comparable to their counterparts in cardiovascular why are neurologists paid significantly less than cardiologists?

I'm sure that it has to do with the superior efficiency/effectiveness of diagnosis and treatment. Not saying that cardiologists are superior to neurologists on this board of course but merely that due to the nature of the brain, diagnosis and treatment is often more difficult.

Do you think neuros will ever be able to catch up to cardiologists in terms of compensation and efficiency of diagnosis and treatment? When will technology and discovery allow neuros to understand and manipulate the neuro field to the degree that cardios have over their field?

 

[automaton]

very simple, neurologists don't have as many procedures for their bread and butter cases like the cardiologists. cardiologists get trained to read echos, place pacemakers, catheterizations + angioplasty + stent, etc, which are all used with people who have coronary artery disease and its complications. CAD is of course the bread and butter of the cardiologists. neurologists, as far as i know, do not get paid to read their own CT or MRI, and rarely get to intervene procedurally for things like stroke, dementia, MS, etc.

 

[new_avatar]

CT Surgery has fallen on hard times...

http://ats.ctsnetjournals.org/cgi/content/abstract/78/5/1523

Their cardiology (medical) colleagues have defended their turf well and have come out better in terms of pay, opportunities and procedures. IR and statins have helped to reduced opportunities for CT surgery also.

It remains to see if interventional neurology will remain an oxymoron or will neuro blossom to do more procedures.

 

[Bonobo]

Interventional neurology is coming. There will need to be two ingredients to make this happen:

1) A new breed of neurologists who are aggressive, willing to endure many years and long hours of training, and demonstrate and practice good procedural skills.

This is starting to happen, more at some residency programs than others. To see how vascular neurology compares to cardiology, imagine a 3 year combined stroke and critical care fellowship program. Such a 3-year fellowship can then allow a vascular neurologist to specialize in interventional procedures, imaging (ultrasound and CT/MRI), research/clinical trials, neurocritical care, or general stroke/hospitalist neurology. The first two specializations might require an additional year or two of training. Except for the additional year in general neurology, the total training time would be equivalent for both cardiology and vascular neurology. The main difference would be future income, but this is improving (though a lot depends on the turf battles between neurology and neuroradiology, I think that if step 2 happens, neurology will have no problem managing the interventional turf, and probably even some of the stroke imaging turf also....)

2) Clinical trials proving the efficacy and safety of interventional procedures and imaging methods (including ultrasound, maybe functional MR?) for acute stroke beyond the 3 hour time window and other neurovascular diseases.

Some of this has already happened. IV rtPA is standard of care. TCD is also the standard of care for monitoring patients for vasospasm following SAH. ICP monitors are becoming commonplace in most neuroICU's. But there isn't much more medicare reimbursement for diagnostic and therapeutic procedures in vascular neurology yet. The IMS-2 trial might prove the efficacy of IA tPA. The Multi MERCI (2) trial appears to show pretty good grounds for using the MERCI retrieval device in large artery occlusive stroke. Stenting is now being looked at as well for intracranial occlusions. Jugular pulse oximetry, microdialysis, and continuous EEG are all potentially important advances in the neuroICU. The development of a "brain stress test" is not too far with multiple studies looking at vasoreactivity measured by ultrasound as a marker for decided how and whether to treat. Etc.

My conclusion, belief and hope is that both 1 and 2 will happen and make vascular neurology nearly as lucrative as cardiology is today. 1 requires us to push the field ahead. I see this happening in some places, and we have great leadership, as well as the baby boomer generation who are going to create a very strong political basis for stroke neurology to mature over the next decade. 2 is bound to happen given the number of trials out there.

It really is just a matter of time. So all of you considering cardiology over neurology, consider how much regret you will have 10-20 years from now when you realize that you could be doing the same job, but be dealing with the beautiful brain instead...

B

 

[automaton]

the brain is beautiful indeed and those who want to advance the field should do neurology. but if you are considering financial rewards down the line, remember that 10-20 years of a huge salary difference will put the cardiologist in an insurmountable lead over a neurologist. suppose a neurologist makes 180k/yr now, and a cardiologist makes 360k/yr. that's 180k/yr for 10-20 yrs, or 1.8 to 3.6 million in raw salary, somewhat less assuming neurology compensation increases, however could be balanced out by compound interest. all this for a balance of salary that may or may not happen.

 

[Zoom-Zoom]

the brain is beautiful indeed and those who want to advance the field should do neurology. but if you are considering financial rewards down the line, remember that 10-20 years of a huge salary difference will put the cardiologist in an insurmountable lead over a neurologist. suppose a neurologist makes 180k/yr now, and a cardiologist makes 360k/yr. that's 180k/yr for 10-20 yrs, or 1.8 to 3.6 million in raw salary, somewhat less assuming neurology compensation increases, however could be balanced out by compound interest. all this for a balance of salary that may or may not happen.

That's true, but some of us won't be practicing for ~10 yrs. 😉

 

[cortexking]

Hey all,

When you join IM, can you say for sure that you will get cardio? 😛

I think it is easier to get Neuro and then vascular neurology fellowship. (may not down the road)

Cardiology is also facing some problems because of internal competition. 👎

can any one tell me places where one can do Interventional Neurology fellowship? 🙂

 

[bustbones26]

go to the AAN website, click on the "students and residents" tab, go to "fellowships" and then browse what's out there.

Last note, if anybody here goes into cards because it pays more than neuro, or goes into neuro to do interventional because its easier than getting a cards fellowship, I think they will be disappointed.

 

[mysophobe]

I'm interested in interventional neuro, but I'm curious as to how often they actually get to do procedures. I don't care about the salary difference/easiness-to-get-into-factors so much as the getting-to-do-stuff-I-find-fascinating factor.