There needs to be mandatory hospital disclosure of doctors/nurses/PA/NP salaries. The Dodd-Frank Act took a step in this direction in instructing SEC to require public corporations to disclose the ratio between the pay of the CEO and the avg employee; unfortunately, the SEC has not yet followed through with this. Greater knowledge about wage inequalities within hospitals and between hospitals can generate needed pressure on the hospitals (or at least those where disparities are greatest) to improve wages at the bottom (and perhaps to hold down salaries at the top)
Salary Survey
- Thread starter DocMom1
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1st post-fellowship job (2 years in). Child neurologist with subspecialty fellowship training.
Multi-disciplinary not-profit health group, hybrid private/academic model (mostly private sensibilities), joint appointment at the local medical school
Medium size neurology group
Base salary (guaranteed, not RVU based) - 300k, chance for production/quality measure bonus of 1-5% of base salary/yr
Mostly clinic based, 4 days clinic + 1 day admin is typical week for me.
60m for new visits, 30m follow ups, typically 10-13 patients per day.
Night call ~2-3x/month
Inpatient consult weeks (includes the weekend) ~ 1x every 2 months
Generous retirement, disability and life insurance packages
$1500/yr for CME/travel. Additional funds can be applied for if you are presenting at a meeting.
We have 2 child neuro residents per year (doesn't always fill)
About 70-80% of my practice is within the fellowship subspecialty, 20-30% is general child neurology
My patient numbers are probably slightly lower than some of my colleagues but I run several multidisciplinary clinics that are considered "flagship clinics" that raise the profile of my hospital. I'm not sure what my RVUs are but I imagine they are typical or slightly above average for my subspecialty. I also help with the residency program, resident/medical student education and educational outreach to local pediatricians/schools.
Addendum: The health group made all of us take a pay cut during COVID in 2020 and froze retirement contributions. Salaries and retirement contributions were returned to pre-COVID level after the new year and they maxed all our 2020 bonuses.
Multi-disciplinary not-profit health group, hybrid private/academic model (mostly private sensibilities), joint appointment at the local medical school
Medium size neurology group
Base salary (guaranteed, not RVU based) - 300k, chance for production/quality measure bonus of 1-5% of base salary/yr
Mostly clinic based, 4 days clinic + 1 day admin is typical week for me.
60m for new visits, 30m follow ups, typically 10-13 patients per day.
Night call ~2-3x/month
Inpatient consult weeks (includes the weekend) ~ 1x every 2 months
Generous retirement, disability and life insurance packages
$1500/yr for CME/travel. Additional funds can be applied for if you are presenting at a meeting.
We have 2 child neuro residents per year (doesn't always fill)
About 70-80% of my practice is within the fellowship subspecialty, 20-30% is general child neurology
My patient numbers are probably slightly lower than some of my colleagues but I run several multidisciplinary clinics that are considered "flagship clinics" that raise the profile of my hospital. I'm not sure what my RVUs are but I imagine they are typical or slightly above average for my subspecialty. I also help with the residency program, resident/medical student education and educational outreach to local pediatricians/schools.
Addendum: The health group made all of us take a pay cut during COVID in 2020 and froze retirement contributions. Salaries and retirement contributions were returned to pre-COVID level after the new year and they maxed all our 2020 bonuses.
Always_Eating
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I have a unique practice set-up so worth sharing I think.
Employed income: $30,000/year from full-time M-F 8-5 research gig from grants, employed at Top 20 U.S. News major research university. I have full health insurance, dental, vision. But I use these from my wife's insurance more than my own (better health system). No retirement matching. This is an 8-5 gig but given it is research it occupies much more of my time and mental capacity than that. I am more or less always "working".
Non-employed / 1099 / Independent-Contractor income: I work with two different TeleHealth companies, one being a very large national company and another being a smaller regional group. The pay structure is different for the two, but the overall hourly rates are similar. I take around 180 hrs of "call" a month, where much of those hours I am sleeping, and some of those hours I am getting a consult every 10 minutes. I really only do nights/weekends because of my day job, and I pick my own hours liberally. I only provide acute/emergency consult services, no follow-ups, no scheduled patients. It is eat-what-you-kill. No health insurance, no retirement. Some gentle CME money and tech reimbursement. This was approximately $370,000 this past year.
Total income comes to around 400k a year. I will likely be scaling back clinical work to transition full-time to industry and other non-clinical consulting/research gigs, which pay less but I find more interesting.
Employed income: $30,000/year from full-time M-F 8-5 research gig from grants, employed at Top 20 U.S. News major research university. I have full health insurance, dental, vision. But I use these from my wife's insurance more than my own (better health system). No retirement matching. This is an 8-5 gig but given it is research it occupies much more of my time and mental capacity than that. I am more or less always "working".
Non-employed / 1099 / Independent-Contractor income: I work with two different TeleHealth companies, one being a very large national company and another being a smaller regional group. The pay structure is different for the two, but the overall hourly rates are similar. I take around 180 hrs of "call" a month, where much of those hours I am sleeping, and some of those hours I am getting a consult every 10 minutes. I really only do nights/weekends because of my day job, and I pick my own hours liberally. I only provide acute/emergency consult services, no follow-ups, no scheduled patients. It is eat-what-you-kill. No health insurance, no retirement. Some gentle CME money and tech reimbursement. This was approximately $370,000 this past year.
Total income comes to around 400k a year. I will likely be scaling back clinical work to transition full-time to industry and other non-clinical consulting/research gigs, which pay less but I find more interesting.
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Wow that's impressive. 370k just doing Telehealth
I've seen similar numbers. Teleneurology for around 15 12hr shifts a month or 180hrs per month- no benefits, Range seems to be $300-450k depending on how fast you can see consults. Involves nights and weekends obviously, and a lot of acute stroke. Granted this is indepedent contractor for these companies- much higher taxes.
Always_Eating
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Yes, more recently (over the last 4-6 months) it averages around 200/hr, which works out to around 430k a year. That said, you are not "working" 180 hours a month. I usually only get woken-up once overnight where my sleep is disrupted, so the hourly rate for the hours where I am actually seeing patients is much higher than 200/hr. The taxes are heavily dependent on which state you live in, but I pay no more in taxes vs if I made the same income via W2s, since my joint-filing AGI is so high anyway. There are many legal tricks (LLC, S-Corp) that I do not personally exploit to shelter the 1099 income, but that many other ICs do. The set-up works for me since I have a very atypical job set-up. I live in a major metro area where pay is lower for employed gigs than the national average. I am not aware of any local job in my area where I would be able to make as much as I do as an IC doing Tele, even with the tax structure. I could easily clear 600k a year if I did it full-time and had open hours M-F 8-5.
This is fascinating. Thanks for sharing. So day job is research? Basic, translational, clinical? Running a lab or working as part of a research team? The telehealth salary is phenomenal. Did you have to find the telehealth options on your own or did your institution help you? This is unconventional but in a really good way.
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I enjoy seeing the variety of income for neurologists. However, I'm disappointed that you need to support yourself outside of your 9-5 reseach time. You seem like a very passionate researcher. If only to would be appropriately compensated for it....
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That seems unfairly low unless your volume is also very low.
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Sounds reasonable for the first 1-2 years if in private practice. After that, you could ask for more production % share. Being on call for your clinic is built-in the that pay and unavoidable in most cases. Being on call for inpatient should always be extra pay.
Always_Eating
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Very basic. All in silico modeling work, really more applied EECS than Neuroscience. I am a research fellow, hence the low salary. Tele work all on my own.
varies widely by practice setting; many neuro-oncologists work within academic medical centers, and most academic medical centers are known to collude to massively suppress salaries of their neurologists who often don't know that they could be making 3x+ more outside of the ivory tower.
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Fair point! Then again can you really put a price on getting to call yourself "assistant professor"?
Is it fair to assume that in a private practice setting (if such a thing exists for neuro-onc) the salaries would be commiserate with traditional heme/onc trained physicians?
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To a degree...but at the same time volume of “regular” cancer far outweighs volume of brain cancer or brain mets
Doubtful you'll do much better in neuro-onc than just doing general neurology. Many onc settings seem like they need someone doing EEG, EMG, and managing AEDs much more than someone to hand out temodar and avastin all day. The actual day to day practice is more morbid than ALS clinic personally- crushingly depressing. You tend to only see neuro-onc in big centers because a local heme-onc can easily manage first line therapy themselves.
Heme-onc has had some major advances in the past decade that have genuinely extended what they are able to do for patients. There really hasn't been anything for glioblastoma, which is still the majority of neuro-onc clinic, and still a complete and terrible death sentence after immunotherapies really failed to add anything in recent trials.
Heme-onc has had some major advances in the past decade that have genuinely extended what they are able to do for patients. There really hasn't been anything for glioblastoma, which is still the majority of neuro-onc clinic, and still a complete and terrible death sentence after immunotherapies really failed to add anything in recent trials.
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How are things looking for fresh grads now that we're closer to the end of residency/fellowship? Seeing any discrepancies from historical figures? Also wondering if covid has had an effect
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Medscape usually drastically underreports in my experience talking to mentors and the average on the comp report 2021 went up almost 20k from a few years ago. So that's pretty reassuring
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With the concerns of the residency glut that has been talked about in the other thread, and the EM situation, I wanted to provide my approach to a lasting opportunity. In the other thread, I wrote the following:
I signed a couple months ago for my first job out of fellowship. We also need to have some sort of template to have better, more-direct comparisons (unfortunately I understand many will not disclose certain parts due to privacy reasons).
Location: Major Metro (Top 5). Same city as my current program.
Day to day:
Inpatient/Outpatient - 3 weeks clinic (q6-7 night call, can be taken from home) with one week Neuro hospitalist M-F days.
Will be the only in my sub-specialty at the group. In a specialty with good procedures.
Outpatient days - 45 min New, 20 min follow-up.
Inpatient - consult only. 10-15 census. 5 new consults. 1 NP to help.
Employment Details/Compensation
- Partnership track - 1 year. Private group with ~15 partners. Excellent track record of new hires making partner.
- Noncompete - not too restrictive, would be able to practice on the other side of the
- Salary: 275K + fairly aggressive bonus based on collections
- Signing bonus 10K
- CME 5K
- Standard benefits: health, dental, malpractice (no tail coverage), disability, etc.
- 3 weeks PTO
In general, jobs were plentiful if looking for general neurology. For certain specialties, they were much more restrictive on city OR there was the option to start with general neurology and build your own collection of subspecialty. EMG needs seemed pretty high on the outpatient side versus other procedures.
I signed a couple months ago for my first job out of fellowship. We also need to have some sort of template to have better, more-direct comparisons (unfortunately I understand many will not disclose certain parts due to privacy reasons).
Location: Major Metro (Top 5). Same city as my current program.
Day to day:
Inpatient/Outpatient - 3 weeks clinic (q6-7 night call, can be taken from home) with one week Neuro hospitalist M-F days.
Will be the only in my sub-specialty at the group. In a specialty with good procedures.
Outpatient days - 45 min New, 20 min follow-up.
Inpatient - consult only. 10-15 census. 5 new consults. 1 NP to help.
Employment Details/Compensation
- Partnership track - 1 year. Private group with ~15 partners. Excellent track record of new hires making partner.
- Noncompete - not too restrictive, would be able to practice on the other side of the
- Salary: 275K + fairly aggressive bonus based on collections
- Signing bonus 10K
- CME 5K
- Standard benefits: health, dental, malpractice (no tail coverage), disability, etc.
- 3 weeks PTO
In general, jobs were plentiful if looking for general neurology. For certain specialties, they were much more restrictive on city OR there was the option to start with general neurology and build your own collection of subspecialty. EMG needs seemed pretty high on the outpatient side versus other procedures.
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If you don’t mind sharing, what’s your subspecialty?
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May I ask what companies these are? I understand if you can't tell us.
These figures are very encouraging and suggest that telehealth is a very viable full-time career path. As someone thinking of making the transition from an employed position, this is good to hear. Of course, if this is all one does (I know in your case it is not) you'd have to pay your own health insurance, and as an independent contractor, you'll be responsible for the self-employed income taxes (which are substantial) and making quarterly estimated taxes (for which you probably need a CPA). In the end the taxes might not be too much worse than what's withheld from a W-2 employee, hopefully. And you could open a solo 401(k) for retirement funds.
Are there many positions that still do not offer tail coverage? To me that's a significant concern, almost a deal-breaker. One would expect the group to pick up tail after a couple of years of serving with them, at least.
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Sorry, I’m otherwise pretty open, but I am one of the very few in this subspecialty graduating this year.
To be honest with you, I’m not sure. The really big places I interviewed (corporate) had tail coverage. I also interviewed at a couple places that had 2 or less docs (they didn’t offer it). At this job, they said they simply don’t offer it.
Some teleneurology groups will provide benefits, but IC is usually the structure from what I've seen.
No tail coverage is a complete deal breaker for me, anywhere. If the group is too small or too cheap to pay for this, then let them find someone else. Major reason to avoid 'top 5 cities' with poor salaries, VHCOL, and nonsense like no tail coverage. Hope your job is worth it but thats below average pay, a lot of call, and for average volume especially with procedures. How much is the 'buy in' for partnership? A lot of these local groups in competitive areas complete screw over the new guy at buy in or when it comes time for contract renewal- seen it locally here.
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I have a job in a major city. My contract looks very similar to his. I don't think lack of tail coverage should be a deal-breaker, we're not a surgical sub-specialty. It's not outrageously expensive.
Not everyone wants to live "1.5 hours from 'X' city".
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I can tell that you and I have different outlooks on neurology over the next 10 years (based on the Residency Position thread). Maybe I am overpreparing, but with how fast things are changing in medicine, I have a hard time seeing how I haven't put myself in an adaptable position (at the cost of sacrificing some salary).
I made sure not to over commit to anything, and that the deal would be OK to walk away from at the end of 1 year if I need to leave.
- Non-compete - I can practice in the remaining 75% of the metroplex
- No tail coverage? Will only matter if I plan on leaving (after 1 year if no partnership is offered). I leveraged that with the signing bonus not needing a specific X year commitment. I dont have to pay back anything if I leave after 1 year. That will offset a good chunk of that cost.
- Q 6-7 call/home call too much? I kind of disagree with you. Again, I think it is critically important to "Offer a niche, but stay broad overall."
- One of the other docs is up for partnership this year, and his buy in looks to be extremely reasonable.
Nothing you have said is wrong, but I find it unrealistic that you have been able to have everything you wanted in a job without making any compromises.
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Teleneurology groups that offer benefits generally want you to commit to a certain number of hours/shifts, including overnights/weekends, making them like regular 8-5 jobs with significant call, and, at least from what I've seen, you get paid per shift regardless of number of patients seen. That certainly provides job security, but limits income (like any employed W-2 job, I guess).
And I agree that tail coverage is extremely important when I evaluate any job. If you regularly attend acute strokes or deal with status epilepticus, for example, Neurology is hardly low-risk. Not to mention that psychologically, the fact that you have to pay tail to cover not just yourself but the employer you're leaving acts as a huge deterrent that might keep you with a group you'd otherwise be better off parting ways with. The longer you stay with them, the larger that payment becomes. I'll take tail coverage over a sign-on bonus any day.
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The opposite from my experience- pay is mostly dependent on volume with a base. I personally don't care about weekends- only about total number of days per year worked, $ per hour, and hours per day. I don't have kids so M-F does not matter to me.
Buying into a partnership is the bottom end of adaptable. You are totally committed to a specific, popular metro city and a specific partnership which can easily get bought out by a hospital system or forced out of business by insurers as are the major trends. Your sign on bonus covers less than half of tail coverage cost in most states. Your salary is below average but your clinic schedule is average amount of busy with above average call expectations (many outpatient practices have no call these days). Sure the call will 'keep your sharp' but exposes you to plenty of liability if it includes acute stroke- especially if by telephone and in a high liability state. Home call with a packed clinic the next day is hell to me, unless your hospital coverage is so small that they only call you once on average at most overnight.
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Are you referring to a teleneurology position with benefits?
That sounds very attractive ... if you are able, would you be willing to tell us the company? (If not, no worries, I understand.)
Rather not say but this gig is not hard to find and will be exploding going forward, especially since outpatient has barely been scratched for teleneurology post pandemic. The gigs now are stroke/EEG/inpatient neurology focused. I think this will broaden going forward somewhat. I don't think everything will 'go back to normal' post-pandemic because televisits are so convenient patients will demand them from insurers, or pay more to get them.
Are you working for a private group?There isn't a lot of transparency regarding salary/benefits for those on the neurology job search. This allows employers unfair advantages in contract negotiations due to information asymmetries (see Ramachandran, Gowri. "Pay transparency." Penn St. L. Rev.116 (2011): 1043; Estlund, Cynthia. "Extending the case for workplace transparency to information about pay and benefits." UC Irvine L. Rev. 4 (2014): 781]. I saw this style survey in another thread and thought it could help shed light on norms for those entering the job search
Anyone on the job search or currently working, please post salary info and job setup.
Here's my recent situation (recent residency graduate from mid-tier program, not fellowship trained, recently changed positions after a competing hospital recruited me)
Base $435,000 [neurohospitalist 7 on 7 off, Central Florida]; no night call; no outpatient clinic.
4 weeks vacation
Productivity bonus can be worth $50-100,000 depending on RVUs generated, I am on target to earn a 75K bonus.
Benefits include malpractice insurance, medical & dental insurance, $2000 CME; 2.5% 401k match
Earlier in the year I did 2 weeks of locums neurohospitalist work in a neighboring state that was exceptionally lucrative, generating $38,000 over the two weeks of inpatient call.
On target with paying off my medical school loans by 2/2021
New England, salaried, non academic, no bonus RVUs. outpatient 10-12 pts/day, inpatient (consultation only) 5-10 pts/day, weekend call every 6-7 weeks, weekday night call 3-4 per mo (phone call consults). 365k plus 10-15k total for calls throughout year. average day 8am -4:30pm. 8 weeks pto
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Are you doing both inpatient and outpatient simultaneously then? Do you see the inpatient consults before clinic, after clinic, or in between?
Pay is solid for amount of work/time
No not simultaneously, usually 3/4 weeks outpatient, 1/4 week inpatient.
It's amazing how our brain works. Before graduating residency, I thought 7k net pay every 2 wks would be good enough, but now as an attending I am thinking 10k would be ideal.
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This is true. My first job out was like that. Now i realize how much they were making off of me and left.
Aren’t they do it everywhere…
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Anyone have any recent data for neurohospitalists specifically? Average salaries, patient census, pay for night call coverage, etc.? Feel like this data is non-existent.
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There is data available through MGMA. 50th percentile for Stroke medicine was 375k and 90th percentile 650k in 2020.
I don't know if there are any exact numbers because it varies by location and other things. Based on my assessment, average/mean salaries for neurohospitalists would be close to 325 (SD 50K) for wRVU - 5000 (SD 1000), which would approximately be 100 encounters a week for 26 weeks/year.
Pay for night call coverage is not common in less busy/small hospitals, esp where its a home call. But in places where they do it can be 750-1500k. Someone correct me if I'm wrong.
Those 'average' $375k stroke jobs I guarantee have a substantially worse QOL than the average non-stroke neurohospitalist job with significant busy call, phone tPA questions, and administrative work maintaining PSC/CSC accreditation. Sure there are unicorns but they aren't common and are subject to change. The 90th percentile guys take insane liability and like OP in another thread basically work all the time. Also, tele is straight volume. Can't average a stroke alert in 20 minutes flat safely? You won't make $400k without working a substantial amount extra. Everyone needs to understand there is no such thing as a free lunch. $800k locums beats everything if you are willing to travel and work 23 days a month, and many here would be quite surprised at the patient volume for that amount of money, but you have to be willing to travel and aggressively negotiate.
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We do four to five weekends per year of home call for clinic patients needing urgent med refills, breakthrough seizure, etc. 0 to 5 calls per weekend on average.
We don't do any hospital call.
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yup there are no free lunches. You have to find the sweet spot of location/practice setting/workload/salary. And it will be different for everyone. Just make sure you are not getting taken advantage of.
