It can vary quite a bit, depending on the % of inpatient time, telemedicine, whether there is a stroke unit for post-tPA patients, how much neurosonology you can bill for, what you mean by "academic", etc. For someone just starting out, with a high clinical load, somewhere in the $140-200K range is probably accurate for true academic institutions where they essentially don't have to negotiate. Lower on the spectrum for Harvard-style places, higher on the spectrum for places that are trying to recruit more heavily. I'm assuming you are not negotiating a lab start-up or something like that, which changes things a bit, and that you are overwhelmingly clinical rather than research or administrative. It's not a very competitive salary compared to private practice, which is why people in academia are usually there for other reasons.
If you're asking how to reject an offer from the program you've trained at, it's no different from anywhere else. The best way is to do it objectively -- get an offer you like from somewhere else, and tell your home program about the the benefits of that offer over theirs, particularly if there are aspects you really like that they would never be able to match. Most programs are happy to see their trainees get positions they want.
