Neuromuscular Salaries (2020)

[9732doc]

I've recently begun to consider Neuromuscular as a career option. I like the pathology, the emphasis on diagnosis, the outpatient setting (predominantly) and research options. I like EMG/NCS as well. Before this, I was considering pain fellowship. I still care about pain as a problem, and NM sees lots of neuropathic pain, but the difference is that I wouldn't be nearly as interventional as if I did a pain fellowship. One thing I'm thinking about is salary. I haven't seen any numbers for average NM salary reported anywhere. I know pain has high earning potential. That is not my primary motivation but it's something to consider if I'm going to make a pretty big shift in my plans.
So would anyone be willing to share some first hand knowledge about NM salaries? And also, what kinds of procedures besides EMG/NCS can a NM specialist do to (1) help patients, (2) bolster revenue?

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[GuillainMollaret]

It's going to be in line with most outpatient neurologists. It will be higher if compared to a non-procedural neurologist. Typical range can be anywhere from 250 to 350+ depending on a host of factors such as location, practice type, patient load, etc etc.

Other procedures besides EMG: skin biopsies, Botox. I also know some that do steroid injections for carpal tunnel. There's also neuromuscular ultrasound, typically done in conjunction with EMG, but the reimbursement isn't much.

 

[Neurogeneral]

You can do the usual EMG, Botox, punch nerve biopsies, etc. Some can do steroid injections for CTS but you would need to find someone to train you in this (doesn’t seem too hard to learn though).

However, you will have a hard time generating the kind of revenue a pain physician can as a neurologist. That is unless you have a very high volume practice. EMGs used to be a cash cow for neurologists but then NCS reimbursement was cut by half by CMS. Unless you are able to do a EMG/NCS study quickly (and still maintain good quality) you can probably generate more money seeing more clinic patients. I do EMGs cause I like doing them and doing clinic all the time would be exhausting for me but they don’t necessarily add much more revenue to my bottom line. Whereas with pain, the reimbursements are higher for their procedures, they can be quicker to do, you usually have to spend less time with patients overall, and you spend less time documenting.

 

[Telamir]

 

[kevinbrainy]

I've recently begun to consider Neuromuscular as a career option. I like the pathology, the emphasis on diagnosis, the outpatient setting (predominantly) and research options. I like EMG/NCS as well. Before this, I was considering pain fellowship. I still care about pain as a problem, and NM sees lots of neuropathic pain, but the difference is that I wouldn't be nearly as interventional as if I did a pain fellowship. One thing I'm thinking about is salary. I haven't seen any numbers for average NM salary reported anywhere. I know pain has high earning potential. That is not my primary motivation but it's something to consider if I'm going to make a pretty big shift in my plans.
So would anyone be willing to share some first hand knowledge about NM salaries? And also, what kinds of procedures besides EMG/NCS can a NM specialist do to (1) help patients, (2) bolster revenue?

There are several factors, what I understand is that you should try to have at least 1 full day of EMG (at least 10 studies per week) to maintain a salary at the 75 percentile. Also you should try to do also the NCS part, so a tech is not needed. In private practice this is the most imp factor. In academia if there are others doing EMGs they can probably afford to pay a tech to do NCSs (for the whole week). Most techs do not do EEGs as well which is what makes them specific to the EMGer.

 

[9732doc]

Thanks for the replies all. This is very useful. I understand salary will not be equivalent to a productive pain practice, but the differences aren't so huge that the decision to pursue NM vs. Pain is totally inadvisable. I'm also envisioning a possible hybrid practice, where I'm mostly neuromuscular, but do some straightforward procedures for the patients who have pain a primary symptoms, like radiculopathy or small fiber neuropathy.

 

[Epic786]

285K in PA.

 

[sdnuser001]

Hate to say it but you should just have gone into pm&r and done a pain/spine fellowship, the majority of pm&r pain docs I know in surgical groups do both spinal injections and NCS/EMG

 

[DrSatan]

Hate to say it but you should just have gone into pm&r and done a pain/spine fellowship, the majority of pm&r pain docs I know in surgical groups do both spinal injections and NCS/EMG

Too bad they can't do an EMG/NCS worth sh it though

 

[Postictal Raiden]

Too bad they can't do an EMG/NCS worth sh it though

Heck we see so many **** reports generated by general neurologists, let alone non-neurologists

 

[Thama]

Heck we see so many **** reports generated by general neurologists, let alone non-neurologists

Sometimes you even see them drop the classic "please correlate clinically" after their vague, near meaningless findings.

PMR EMGs are occasionally useful for carpal tunnel (though the surgeons at my center will insist on a real neuromuscular physican repeating the EMG before operating), and never useful for anything else.

 

[9732doc]

Hate to say it but you should just have gone into pm&r and done a pain/spine fellowship, the majority of pm&r pain docs I know in surgical groups do both spinal injections and NCS/EMG

Actually I am a PM&R resident. I always thought I'd do pain, but after doing NM, I am now less certain. I like the heavy emphasis on diagnostics in NM. I like the pathology, which overlaps well with my research interests. And I still care about pain and NM problems often do present with pain. So I'm trying to see if I could occupy some niche where I see NM patients but when possible, instead of referring out to pain management, I can handle some stuff on my own. I'll get a good amount of EMG/NCS during residency, and would get a lot more in NM fellowship if I did it. Hopefully I can rise above the perception of PM&R's EMG/NCS (or lack of) expertise.

 

[Bostonspine]

Actually I am a PM&R resident. I always thought I'd do pain, but after doing NM, I am now less certain. I like the heavy emphasis on diagnostics in NM. I like the pathology, which overlaps well with my research interests. And I still care about pain and NM problems often do present with pain. So I'm trying to see if I could occupy some niche where I see NM patients but when possible, instead of referring out to pain management, I can handle some stuff on my own. I'll get a good amount of EMG/NCS during residency, and would get a lot more in NM fellowship if I did it. Hopefully I can rise above the perception of PM&R's EMG/NCS (or lack of) expertise.

..At the institution where I did my PMNR residency (NYU) I spent 6 months doing EMG/nerve conduction studies with the neurophysiology fellow's same cases same method. the fellow spent 4 months or 8month depending on the concentration. I've seen plenty of crappy EMG/NCS for Neurology and PM&R quality is about individual skills and report generation. for the PM&R resident unless you want to treat Neurodegenerative conditions or do muscle biopsy and/or research there is no value in a fellowship. for those who don't know PM&R residents do 2-300 EMG/ncs from start to finish and there is no great mystery on life to a carpal tunnel study lol.

 

[Thama]

..At the institution where I did my PMNR residency (NYU) I spent 6 months doing EMG/nerve conduction studies with the neurophysiology fellow's same cases same method. the fellow spent 4 months or 8month depending on the concentration. I've seen plenty of crappy EMG/NCS for Neurology and PM&R quality is about individual skills and report generation. for the PM&R resident unless you want to treat Neurodegenerative conditions or do muscle biopsy and/or research there is no value in a fellowship. for those who don't know PM&R residents do 2-300 EMG/ncs from start to finish and there is no great mystery on life to a carpal tunnel study lol.

I wouldn't trust an EMG from a CNP-trained neurologist that much more than from PMR, honestly. Unless it's a so-easy-a-caveman-could-do-it carpal/cubital tunnel question, I'm 100 times out of 100 going to refer to a real neuromuscular specialist for electrodiagnostics.

 

[Postictal Raiden]

I wouldn't trust an EMG from a CNP-trained neurologist that much more than from PMR, honestly. Unless it's a so-easy-a-caveman-could-do-it carpal/cubital tunnel question, I'm 100 times out of 100 going to refer to a real neuromuscular specialist for electrodiagnostics.

Hence why these fellowships are phasing out. They only train you to become a technician. If you want to truly understand the pathophys of your findings you need to do a dedicated fellowship in the corresponding field (epilepsy, NM, or sleep). At least that’s what I’ve been told by some of my attendings

 

[Thama]

Hence why these fellowships are phasing out. They only train you to become a technician. If you want to truly understand the pathophys of your findings you need to do a dedicated fellowship in the corresponding field (epilepsy, NM, or sleep). At least that’s what I’ve been told by some of my attendings

Yes. EMGs are an extension of the physical exam, and thus expertise in the disease not just the technique is required to produce useful results. An EMG that ends with vague findings and "please correlate clinically" is worse than useless and nobody should be allowed to bill for it.

 

[sloh]

I wouldn't trust an EMG from a CNP-trained neurologist that much more than from PMR, honestly. Unless it's a so-easy-a-caveman-could-do-it carpal/cubital tunnel question, I'm 100 times out of 100 going to refer to a real neuromuscular specialist for electrodiagnostics.

I’m PM&R, trained at a pretty well regarded academic institution with robust EMG/NCS, and can confirm that outside of straightforward carpal tunnel, cubical tunnel, radic, PM&R really shouldn’t be performing these studies. Knowledge of the rarer conditions is absolutely essential.

 

[9732doc]

Found this very interesting academic MGMA table from UAMS while doing some research on this topic

Academic 2017 MGMA data for total compensation

https://jfr.uams.edu/help_docs/46.xlsx

Median academic NM compensation is $234,000 in 2018, and 90th percentile $317,000. So that's the ceiling in academia it looks like. Since it's compensation, I'm assuming this includes benefits, so salary likely lower.