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[Postictal Raiden]

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Residents in these medical specialties have the most regrets | American Medical Association

Does anyone of you have regrets?

 

[Telamir]

If you had asked me a few years ago I would've said undoubtedly yes. I recently got out of training and started practicing and am currently more satisfied, but I was very unhappy during training and this seemed somewhat common throughout my residency mates.

 

[deathmerchant]

Well looking at the bright side, that means More people who enter neurology despite all this, are the ones who are actually fascinated by Neuro.
Also I am not complaining about the high demand vs supply of neuro driving our salaries up. Because just based on RVUs, we are many times below most specialties.

P.S. No regrets!

 

[Postictal Raiden]

If you had asked me a few years ago I would've said undoubtedly yes. I recently got out of training and started practicing and am currently more satisfied, but I was very unhappy during training and this seemed somewhat common throughout my residency mates.

Glad to know.

I'm still in my prelim year but I have done a neurology rotation in my prospective program. I can tell, the hours are long (70+), patient are very sick, and the expectations are high. Although everyday I get closer to finishing my internship I get more excited about finally joining the field of my choice, I also become more dreadful of my PGY-2 year (3/4th of it will be inpatient!).

 

[Postictal Raiden]

Well looking at the bright side, that means More people who enter neurology despite all this, are the ones who are actually fascinated by Neuro.
Also I am not complaining about the high demand vs supply of neuro driving our salaries up. Because just based on RVUs, we are many times below most specialties.

P.S. No regrets!

Thanks for the positive response.

Speaking of RVU's, what's the average number of wRVU's a neurologist produces per year? How many patient encounters does it take to achieve that?

Also when you mention that salaries are higher than what they should be (based on RVU's), are you hinting that salaries are artificially (due to subsidies) inflated and that doing self-employment would mean lower income?

Thank you,

 

[deathmerchant]

Thanks for the positive response.

Speaking of RVU's, what's the average number of wRVU's a neurologist produces per year? How many patient encounters does it take to achieve that?

Also when you mention that salaries are higher than what they should be (based on RVU's), are you hinting that salaries are artificially (due to subsidies) inflated and that doing self-employment would mean lower income?

Thank you,

That is really hard to say- there is a wide range. Also, the RVU- $ conversion is different in every setting. And how much the insurance company finally pays is different too.

Just to give approximate averages (physician work RVUs, total RVUs billed by hospital are higher)- New patient 3.5, f/u 2, routine EEG 1.. etc (see attachment below). So if you see about 5 new and 5 f/u per day, 5 days a week, 46 weeks = Thats about 6000 RVUs. This is the moderate number of patient encounters for neurologists. Obviously there are people who see much less and people who see more than twice of that.
The average conversion is 40-60 per RVUs. So @$50 per RVU you are looking at 300K.

I know many of my GI and Cards friends who are easily doing >1000 RVUs per month and get paid 350-450K in similar settings. By that rate, neurologists shouldn't be making more than 200K, esp neurohospitalists, who work less than 26 weeks. So definitely, our salaries are artificially higher.

Self employment is tricky because you can potentially make more money if you see a lot of patients, but there is a lot of overhead and the worst part- dealing with insurance. In my hospital, insurance denies more than 50% bills (but usually the employer takes that damage). So with anything less than average number of patients, you will earn way less in private. Academics is the worst regarding money/work ratio.

Obviously, the above is a simple analysis and varies a lot. Also, I personally disagree with RVU system and believe we neurologists provide much more than is depicted by mere RVUs, that are biased towards procedures.

 

[Postictal Raiden]

That is really hard to say- there is a wide range. Also, the RVU- $ conversion is different in every setting. And how much the insurance company finally pays is different too.

Just to give approximate averages (physician work RVUs, total RVUs billed by hospital are higher)- New patient 3.5, f/u 2, routine EEG 1.. etc (see attachment below). So if you see about 5 new and 5 f/u per day, 5 days a week, 46 weeks = Thats about 6000 RVUs. This is the moderate number of patient encounters for neurologists. Obviously there are people who see much less and people who see more than twice of that.
The average conversion is 40-60 per RVUs. So @$50 per RVU you are looking at 300K.

I know many of my GI and Cards friends who are easily doing >1000 RVUs per month and get paid 350-450K in similar settings. By that rate, neurologists shouldn't be making more than 200K, esp neurohospitalists, who work less than 26 weeks. So definitely, our salaries are artificially higher.

Self employment is tricky because you can potentially make more money if you see a lot of patients, but there is a lot of overhead and the worst part- dealing with insurance. In my hospital, insurance denies more than 50% bills (but usually the employer takes that damage). So with anything less than average number of patients, you will earn way less in private. Academics is the worst regarding money/work ratio.

Obviously, the above is a simple analysis and varies a lot. Also, I personally disagree with RVU system and believe we neurologists provide much more than is depicted by mere RVUs, that are biased towards procedures.

Thank you, that's helpful.

 

[Telamir]

I am a recent grad and a neurohospitalist. Like I said, during training I was very burned out but coming out to practice has been much more enjoyable than residency for me so far. Regarding compensation it all depends on how you get paid (salaried, per shift + rvus, purely RVU etc).I am personally paid a flat salary that I think is quite generous and I am satisfied with.

I agree with Merchant's point about RVUs not favoring us. If you think of a stroke admitted to the hospital you may only build a comprehensive consult note however assuming TPA is given or thrombectomy is performed there is a lot more revenue that comes downstream from what you do (imaging ordered, EEGs, etc). Also, if it's a somewhat underserved area being able to provide a prompt opinion and outpatient followup may result in fewer days in the hospital which is also favorable from a DRM standpoint.

Make no mistake neurologists are in demand and I believe that will continue to be the case for many years to come, especially if you're good at what you do. While we may get paid higher than our RVU count may suggest it also depends on how good you are at documentation and billing, especially inpatient (I'm still trying to get better at this).

https://www.merritthawkins.com/uplo...ins/Content/Pdf/mhawhitepaperneurology(1).pdf

I found that article from Merritt Hawkins on recruiting neurologists pretty insightful.

 

[Postictal Raiden]

I am a recent grad and a neurohospitalist. Like I said, during training I was very burned out but coming out to practice has been much more enjoyable than residency for me so far. Regarding compensation it all depends on how you get paid (salaried, per shift + rvus, purely RVU etc).I am personally paid a flat salary that I think is quite generous and I am satisfied with.

I agree with Merchant's point about RVUs not favoring us. If you think of a stroke admitted to the hospital you may only build a comprehensive consult note however assuming TPA is given or thrombectomy is performed there is a lot more revenue that comes downstream from what you do (imaging ordered, EEGs, etc). Also, if it's a somewhat underserved area being able to provide a prompt opinion and outpatient followup may result in fewer days in the hospital which is also favorable from a DRM standpoint.

Make no mistake neurologists are in demand and I believe that will continue to be the case for many years to come, especially if you're good at what you do. While we may get paid higher than our RVU count may suggest it also depends on how good you are at documentation and billing, especially inpatient (I'm still trying to get better at this).

https://www.merritthawkins.com/uplo...ins/Content/Pdf/mhawhitepaperneurology(1).pdf

I found that article from Merritt Hawkins on recruiting neurologists pretty insightful.

Thank you for the generous contribution

 

[Postictal Raiden]

To neutralize some of the negativity in the report of the original post, I’m going to post this one here:

PracticeLink Magazine - FALL 2018

Go to page 44 and see which fields have the highest demand.

Every few months, PracticeLink release a new report. For the past few years, neurology has shown to be most in demand. Moreover, the demand is increasing. Last report the ratio of candidates per jobs was 0.94. This new report the ratio is 0.87. Neurology is the only field where number of jobs outweighs number of candidates.

 

[neglect]

Residents in these medical specialties have the most regrets | American Medical Association

Does anyone of you have regrets?

Way back when I was a resident, I think I had misgivings and long moments of abject burnout, but I never really had regrets. Brain diseases are always interesting, even if the vast majority are not as interesting as the case reports that got me fascinated as a medical student.

In many ways, neurology has a long way to go. There remain horrific brain diseases which no good treatments. In other ways, look at seizures, migraine, MS, sleep, movement, vascular and neuromuscular: tons of great treatments that are helping people every day. You can really make a difference in neurology, add a ton of value, but you’ve got to steel yourself for the cases where you don’t and can’t. Not every stroke patient walks out of the hospital. It can get you down. But I see it as an opportunity to make things better - my way is to develop better treatments.

As far as the job opportunities - please. Any market would have corrected this supply (too few neurologists) and demand (infinite patients) by making neurology a top paying field. But the false market of Medicare/insurance doesn’t allow that, so fewer people go into it. Even if our stupid system of public/private payers create ways for neurologists to make more money (and there’s evidence this is happening: although they slashed EMGs and EEGs look like a sickly lamb far from the flock, check out some of the new codes for dementia), it’ll take decades or more for enough spots to be filled. In the meantime, how many cases of stroke, dementia, headache will go undiagnosed or misdiagnosed for want of expertise?

 

[GuillainMollaret]

Fourth year resident here.

Neurology residency can be incredibly difficult and burnout is common.

Long hours with countless nights and weekends; dispo battles with the emergency department; endless stream of terrible consults and an average of 5-6 stroke alerts per day where you have to drop everything and run to the ED and over half the time it’s a demented patient with a UTI and no focal deficits or something of that flavor; complex social issues on the inpatient side that you have little control over; terribly sick patients with horrible disability or death; etc. These are the things that directly contribute to burnout IMO.

But at the end of the day, as much as residency is a slog, it is temporary. And my life as a fellow next year and then an attending, doing primarily outpatient neurology, is going to be significantly different and much better.

I still love neurology. There’s still nothing else in medicine that I think I would enjoy as much or be nearly as good at. I still love how important the neurological exam is and how elegant neurologic localization can be. We make amazing diagnoses that no one else can make and treat a plethora of problems that physicians in other fields have probably never heard of or haven't thought about since med school. The job market is great and the demand for our services is ever increasing.

I have no regrets.

 

[HueySmith]

 

[Dr. Bruce Banner]

It was a concern. Until interviews started and I realize just how much programs are now focusing a lot of attention on reducing burnout and improving wellness, and I realize I rather be in a specialty where people recognize burnout and have plans to deal with it, vs a specialty where they BELIEVE people don't burn out and therefore pay no attention to the subject

 

[deleted978973]

To neutralize some of the negativity in the report of the original post, I’m going to post this one here:

PracticeLink Magazine - FALL 2018

Go to page 44 and see which fields have the highest demand.

Every few months, PracticeLink release a new report. For the past few years, neurology has shown to be most in demand. Moreover, the demand is increasing. Last report the ratio of candidates per jobs was 0.94. This new report the ratio is 0.87. Neurology is the only field where number of jobs outweighs number of candidates.

In other words it's a fairly easy specialty to get into and there's no reason why a fresh graduate shouldn't be able to leverage a contract with the hours. location and lifestyle they want.

 

[Postictal Raiden]

In other words it's a fairly easy specialty to get into and there's no reason why a fresh graduate shouldn't be able to leverage a contract with the hours. location and lifestyle they want.

Pretty much.

If money is not a concern, you could have the best lifestyle doing outpatient neurology