Neurology vs Internal Medicine lifestyle/salary comparison.

[2021acc117]

Just wondering about the salary and lifestyle of neurologists... and how its different from general IM?
I hear neurologists make generally 300k starting vs 220k general IM and the lifestyle is ok?

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[sharkbaitwhohaha]

The salary difference is negligible. 80k/yr extra in the wrong speciality will made you hate life. Do what you like more.

 

[Thama]

General neurology >>> IM primary care

IM has more diversity in fellowship training though, and there's no neurology equivalent to something like GI in terms of compensation/lifestyle.

 

[Splenda88]

IM outpatient: 220-280k (M-F 8-5pm)

Hospitalist: 220k-340k (7 days on and 7 off) 7a-7pm. There are some jobs out there where people can leave early.

Nocturnist: 280k-400k (7 nights on and 7 off)

As an IM hospitalist, I make 330k/yr working 7 days on/off,from 7:00 am to 6:15 pm. Some prefer to work M-F and have every weekend off. The 7 days on/off work better for me.


My guess is that lifestyle is similar but Neurologists probably make more on average.

 

[2021acc117]

General neurology >>> IM primary care

IM has more diversity in fellowship training though, and there's no neurology equivalent to something like GI in terms of compensation/lifestyle.

General neuro >> IM primary in what way, salary or lifestyle? just wondering

 

[Thama]

Salary and sanity. Being a PCP is a martyrs game in today's world.

And just to add my take on IM hospitalist to this discussion, it's a good gig in the short run but with an extremely high burnout rate if you do it more than a few years. I know vanishingly few hospitalists who are still practicing full time hospitalist medicine for more than a decade. You're at the mercy of any hospital policy change, dispo nightmares, surgical dumps, and have to come running to a dozen meetings at the behest of whatever assistant to the regional nurse manager is on the warpath that month. My spouse is in that world so I've gotten a view from up close, and it's definitely not something I would ever want for myself.

 

[2021acc117]

Salary and sanity. Being a PCP is a martyrs game in today's world.

And just to add my take on IM hospitalist to this discussion, it's a good gig in the short run but with an extremely high burnout rate if you do it more than a few years. I know vanishingly few hospitalists who are still practicing full time hospitalist medicine for more than a decade. You're at the mercy of any hospital policy change, dispo nightmares, surgical dumps, and have to come running to a dozen meetings at the behest of whatever assistant to the regional nurse manager is on the warpath that month. My spouse is in that world so I've gotten a view from up close, and it's definitely not something I would ever want for myself.

what do you mean by a martyrs game in today's world? just wondering what that means. does it mean working too hard?

 

[sloh]

Salary and sanity. Being a PCP is a martyrs game in today's world.

And just to add my take on IM hospitalist to this discussion, it's a good gig in the short run but with an extremely high burnout rate if you do it more than a few years. I know vanishingly few hospitalists who are still practicing full time hospitalist medicine for more than a decade. You're at the mercy of any hospital policy change, dispo nightmares, surgical dumps, and have to come running to a dozen meetings at the behest of whatever assistant to the regional nurse manager is on the warpath that month. My spouse is in that world so I've gotten a view from up close, and it's definitely not something I would ever want for myself.

Where do these hospitalists go after?

 

[Thama]

PCPs are dumped on by every angle - hospitals, EDs, insurance, etc. It's a combination of being overworked, underappreciated, and being expected to clean up everyone's mess. Specialists avoid a ton of this.

Burnt-out hospitalists frequently go back and do fellowship after a year or 3, and many others back off to part time work, find angles into administration, and some even leave medicine altogether. Some lucky few find their way into a setting where the environment is good, volume isn't crushing, and ancillary staff actually help you and thus make a real career out of it.

 

[Aldertonghen]

PCPs are dumped on by every angle - hospitals, EDs, insurance, etc. It's a combination of being overworked, underappreciated, and being expected to clean up everyone's mess. Specialists avoid a ton of this.

Burnt-out hospitalists frequently go back and do fellowship after a year or 3, and many others back off to part time work, find angles into administration, and some even leave medicine altogether. Some lucky few find their way into a setting where the environment is good, volume isn't crushing, and ancillary staff actually help you and thus make a real career out of it.

How is a neuro hospitalist different from IM hospitalist in terms of lifestyle and compensation?

For a GI lifestyle/compensation equivalent in neuro I do think Pain is an option (?) (patients aren’t easy in pain but I can’t stand GI patients), although anesthesia and pmr is the route to take if one wants pain.

 

[Thama]

Very few hospitals outside of academic centers have a "neurology service". Neurohospitalists are more often than not consultants that cover the hospital all the time. FWIW, that's also a gig that leads to a lot of burnout, though not having to deal with the social work side of medicine provides a bit of an insulating layer.

When comparing fellowship options, you'd be wise to stick to "core" fellowships. Pain isnt any more a core neurology fellowship than neuro ICU is a core EM fellowship - just because it's possible to apply doesn't mean it's a likely destination. I've yet to meet a neurology resident who went into pain, ever. And pain management is orders of magnitude more painful to deal with than GI - not comparable in any way.

 

[xenotype]

Very few hospitals outside of academic centers have a "neurology service". Neurohospitalists are more often than not consultants that cover the hospital all the time. FWIW, that's also a gig that leads to a lot of burnout, though not having to deal with the social work side of medicine provides a bit of an insulating layer.

When comparing fellowship options, you'd be wise to stick to "core" fellowships. Pain isnt any more a core neurology fellowship than neuro ICU is a core EM fellowship - just because it's possible to apply doesn't mean it's a likely destination. I've yet to meet a neurology resident who went into pain, ever. And pain management is orders of magnitude more painful to deal with than GI - not comparable in any way.

Program specific. In certain programs 1-2 people do pain a year out of each class, and I happen to know several that do pain. It has a nice 8-5 M-F no call schedule, a properly setup practice can get rid of most of the headache inducing patient referrals up front, and the income at least for now is a lot better than you could do in neurology outside of locums. Picking a program that has a track record of getting people into pain makes it an option. That isn't to say pain isn't facing headwinds long term from reimbursement cuts, oversupply/competition to CRNAs trying to do it. Someone matching to a program with no history of putting someone into pain is probably not going to get a spot, as their local anesthesiology department has no incentive to help them and will view a neurology resident as an extraterrestrial. I advocate for anyone who thinks they have an inkling of doing pain to ask about this in interviews, and exclude/downrank programs that never place people into pain successfully (eg an area where a name brand program can actually hurt you as the neuro dept has no ownership over pain, no one goes into it, and no one really wants to help you get into it). It can be a 'core' fellowship if your program actually owns a chunk of interventional pain and rotates residents in it.

As for whether pain or GI is more 'painful to deal with'- sticking cameras up poorly prepped butts is not a good experience versus needles in backs.

 

[90sportsfan]

From my perspective, the big difference is that as an Internist you are primarily trained as a generalist whereas as a Neurologist, you are trained as a specialist from the start. Even in many IM subspecialties, you will still conduct a thorough physical/ general exam. I went to an Endocrinologist a few years ago, and had one of the most thorough physical exams I’ve had. As a neurologist, our exams are specialized.

Depending on how you are viewing “lifestyle,” some may prefer the specialized nature of neurology vs being trained as a generalist if you don’t sub specialize after IM.

 

[Aldertonghen]

Program specific. In certain programs 1-2 people do pain a year out of each class, and I happen to know several that do pain. It has a nice 8-5 M-F no call schedule, a properly setup practice can get rid of most of the headache inducing patient referrals up front, and the income at least for now is a lot better than you could do in neurology outside of locums. Picking a program that has a track record of getting people into pain makes it an option. That isn't to say pain isn't facing headwinds long term from reimbursement cuts, oversupply/competition to CRNAs trying to do it. Someone matching to a program with no history of putting someone into pain is probably not going to get a spot, as their local anesthesiology department has no incentive to help them and will view a neurology resident as an extraterrestrial. I advocate for anyone who thinks they have an inkling of doing pain to ask about this in interviews, and exclude/downrank programs that never place people into pain successfully (eg an area where a name brand program can actually hurt you as the neuro dept has no ownership over pain, no one goes into it, and no one really wants to help you get into it). It can be a 'core' fellowship if your program actually owns a chunk of interventional pain and rotates residents in it.

As for whether pain or GI is more 'painful to deal with'- sticking cameras up poorly prepped butts is not a good experience versus needles in backs.

I agree completely with you on pain. My perspective is limited, but I feel in certain programs, pain is certainly not as outlandish as an EM guy doing neuroICU. At USF, from my interview with them, they have multiple residents going into pain every single year.

Unrelated to OP’s post, but I was wondering if you could tell me about some of the other programs with good pain exposure. I know USF is one, I interviewed there and really liked it, but I don’t really know about the others.

 

[Thama]

If you are digging deep to find a residency where anyone goes into a particular fellowship, that isn't a core neurology fellowship. I have no idea who these supposed neurologists are who are lining up to deal with fibromyalgia patients, as they surely have zero in common with any neurologist I've known at a variety of departments.

 

[xenotype]

If you are digging deep to find a residency where anyone goes into a particular fellowship, that isn't a core neurology fellowship. I have no idea who these supposed neurologists are who are lining up to deal with fibromyalgia patients, as they surely have zero in common with any neurologist I've known at a variety of departments.

1. Fibromyalgia is screened out of many pain practices up front. The pain forum has entire threads on this, and you seem to have a flawed impression of the average pain practice if you think seeing fibromyalgia is a significant portion of the practice. I think you are speaking from ignorance here as you don't do interventional pain, and apparently don't know anyone that does it either.
2. Searching for a neurology residency that successfully places people into pain fellowships is no different than finding one that successfully places people into NIR fellowships. Sure it isn't a 'core' fellowship by your definition but going to a residency that doesn't own a chunk of a home program in either of these if this is what one's interest is, is a big mistake regardless of any 'prestige' factor as these are very competitive fellowships that are hard to get regardless of one's background.
3. Saying these 'neurologists lining up to deal with fibromyalgia patients' have zero in common with any neurologist you've known is ridiculous as you also admitted you don't know a single one that does pain. I can tell you as I actually know several that they are neurologists just like you and me that happen to enjoy doing a lot of procedures.
4. Advocating against neurologists holding turf in areas like pain, NIR, NCC is short sighted for the long term growth of the field and fellowship opportunities for everyone. Perhaps your department needs to be more open minded.