I don't really get it when people say that neurologists can't make any money. I guess it's because a lot of neurologists are more interested in academics, which, like academics in all specialties, doesn't pay that well. In my area a neurologist with a stroke fellowship can get hired for a neurohospitalist position at 275k + bonuses depending on how much extra stroke call they want to take. That's an awesome salary regardless of your specialty.
It is not that you cannot make money as a neurologist, you just will not "get rich" as a neurologist and have to work harder for it.
Now, I know that some will interpret my response as flaming other specialties; however, I would make the disclaimer that is not really the case.
Syncope:
Cardiology: Holter monitor, EKG, Stress Test = $$$$, all negative, so go see a neurologist
Neurology: Get and MRI (radiologist = $$$), Get an EEG maybe? = $$
Back pain:
Neurologist: EMG = $$, send to pain provider
Pain Provider: Do a nerve block, Do epidural, do radiofrequency ablation = $$$$
Headache:
Right now, insurances and medicare are making it very difficult to perform Botox for chronic migraine, You end up chasing your tail and no, you do not make money on it.
Again, this does not mean that it is impossible to make money, you just have to be savvy with your business and make sure that you are coding and documenting everything perfectly! For example, did you know that some insurances will pay for psychiatric screening at check in? Your documentation can be a template and if the insurance pays for the screening, we are talking and extra $50. Does not seem like much but adds up throughout the day.
Nerve blocks? There are a number of insurances companies that will outright deny occipital nerve blocks, but they will not deny trigger point injections? It is not inappropriate to perform a trigger point injection of the patient's upper cervical musculature and code for it. If you are performing said trigger point injection and "accidentally" block the greater or lesser occpital nerve, oh well
You will have to code 723.8 or 723.9, must document neck pain (and they have it), document that everything else that has been tried over the past 30 days had failed, etc. etc.
We undercode as well!! With the amount of documentation we do in our notes, ALL of our patients should be level 4s. We have this impression that we must document time in/time out but this is not true. There are guidelines out there with a map to follow. Vague and harder to find than a unicorn, but if you find them, you can always fight your case.
Now, are video EEG studies on the EMU and sleep studies still fairly good money generators? I would not know?
As much as I hate to say this, during residency, we focus so much on our education, because of course, we want to pass our board. After that me must learn how to document and code things appropriately and attend these courses at whatever conferences we attend for CME. These courses are just as if not more important than general education. Additionally commentary from the crowd is where you learn the most. You will ALWAYS learn something. The other unfortunate part, once you crack the code, it will change again