What would compensation look like for an interventional neurologist who spend 60% of their time doing NIR/related procedures?

[someqsaboutstuff]

I apologize for asking such a direct q, but I recently learned that neurologists can do procedures which I find fascinating, and I began to wonder how that might affect compensation.

I understand that compensation is extremely variable and predicting compensation of future neurologists is a bit of a fool's errand. I also want to make clear that compensation isn't anywhere near the top priority for me. However, I am curious if the compensation of interventional neurologists who spend their time mostly (like 60%) doing procedures is higher than a general clinic-only neurologist?

I also understand that doing 60% procedures may not be realistic for an interventional neurologist, but if one were to do the arithmetic: revenue for most common NIR procedures x 60% of annual working time + revenue of clinic x 40% of annual working time - rough estimate overhead costs = how much in terms of a rough ball park?

The idea of neurology - which already has the most interest aspects of medicine to me personally - also being a procedural specialty is pretty interesting. I am hoping to shadow an interventional neurologist to learn more about the subspecialty but I was curious about compensation and thought this forum would be a better setting for a naiive question xD

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[Aldertonghen]

There are a fair number of interventional neurologists who do 40-50% procedures, and then 50% stroke/clinic in the community.

Compensation is very location dependent. I know a guy in central Alabama with that setup making $900k, and then another guy in Miami making $650k or so (miami guy just started this July after fellowship, Alabama guy is 2 years in). Potential to make $1m plus if you’re neurocrit trained too and cover the ICU more instead of stroke and work in a small city. And if you’re in academia, the salary in *Midwest* State University starts at $350-400k or so, although jobs are hard to find as academia likes to hire neurosurgeon/radiology trained people more unless you have a neuro trained NIR chief. Also, case mix matters- thrombectomies don’t yield as much RVUs (and can happen anytime at night) as scheduled aneurysm coiling.


Either way, it is much more than a general neurologist or subspecialty neurologist (a neurologist in Minnesota can earn around 350-400k in community; $230-250k starting salary in academia for most subspecialties in a state uni).

Another procedural field that neurologists can go into is interventional pain too if you’re aware of that.

 

[Darrow O'Lykos]

There are a fair number of interventional neurologists who do 40-50% procedures, and then 50% stroke/clinic in the community.

Compensation is very location dependent. I know a guy in central Alabama with that setup making $900k, and then another guy in Miami making $650k or so (miami guy just started this July after fellowship, Alabama guy is 2 years in). Potential to make $1m plus if you’re neurocrit trained too and cover the ICU more instead of stroke and work in a small city. And if you’re in academia, the salary in *Midwest* State University starts at $350-400k or so, although jobs are hard to find as academia likes to hire neurosurgeon/radiology trained people more unless you have a neuro trained NIR chief. Also, case mix matters- thrombectomies don’t yield as much RVUs (and can happen anytime at night) as scheduled aneurysm coiling.


Either way, it is much more than a general neurologist or subspecialty neurologist (a neurologist in Minnesota can earn around 350-400k in community; $230-250k starting salary in academia for most subspecialties in a state uni).

Another procedural field that neurologists can go into is interventional pain too if you’re aware of that.

I'm not doubting you on these numbers, but these sound extraordinarily high. Surely highly anecdotal and not suggestive of what's more plausible in most other situations? My understanding was that the vascular neurologists are some of the hardest worked docs in medicine in regards to total compensation vs hours spent on call. Is there that big of a step up comparing vascular neurology trained docs vs NIR? I worked for an academic neurology department before med school and one of the docs was vascular + neurocrit trained and it just seemed like he was drastically underpaid (albeit I get that goes in line with academia paying less).

I'll be the first to admit that despite working for years in vascular neuro that hearing how low the pay can be was one of my main motivations to look elsewhere once I started school.

- Signed, a lowly and possibly highly naïve MS2.

 

[scoopdaboop]

How many elective procedures do NIR people do? It surely can't be all thrombectomies on call that pay them so well...

 

[deathmerchant]

Not all physicians are paid by RVUs. That is not a good deal for many specialities/subspecialities. Esp for low supply fields like NIR. Because you could be "on call" for the whole weekend and do like 2 actual thrombectomies. You are mainly paid to be an indispensable part of a tertiary, referral, stroke center with a stroke ICU. Those and many other downstream things related to that are what bring money to the hospital.

For someone taking q2-q3 call in a mid-size city PLUS inpatient rounding and/or doing outpatient stroke f/u- 750k+ is feasible.

 

[deathmerchant]

How many elective procedures do NIR people do? It surely can't be all thrombectomies on call that pay them so well...

Its variable, but not a lot. I've seen some shady NIR guys doing many unnecessary cerebral angios for patients with stroke and any transient symptoms. Some times aneurysmal coiling, but its not super common as most people end up going to NES trained docs. An occasional WADA test in tertiary centers maybe. and few other rare procedures.

 

[Clean7795]

You may get supported by the hospital to take stroke call, which is how higher income numbers are obtained. If you do not get support from the hospital then you should probably run for the hills. With that support, the income is what you would expect for a neurosurgeon or hard-working radiologist.

You have to really enjoy it to do it. The lifestyle is generally worse than the base specialties of neurosurgery, radiology, and neurology. You are typically on call for a week at a time, and stroke is a relatively common emergency unfortunately. The training is long, usually about 7-8 years in total. It is quite subspecialized so even though there can be a national demand for NIRs, it may still be difficult to find a job in your preferred locale. There are also ergonomic challenges that come with wearing lead that can cause people transitioning away towards the mid/late point of their career back to their base specialties. Of course, the procedures are interesting and it can be extremely rewarding with the impact you make! But I think medical students should be aware that it isn't very lifestyle-friendly, hence why even with 3 specialties entering the space we don't have NIRs running around everywhere.

In terms of procedures the bread and butter is going to be stroke/stenosis work and aneurysm work (many of which will be diagnostic cerebral angiograms). There are other case types but they are less common and it will depend on your center. Usually your time is split between weeks on interventional and weeks doing your base specialty (probably NCC or a stroke clinic for a neurologist)—the exact percentage will vary but doing ~50/50 is common around my area.

 

[Aldertonghen]

I'm not doubting you on these numbers, but these sound extraordinarily high. Surely highly anecdotal and not suggestive of what's more plausible in most other situations? My understanding was that the vascular neurologists are some of the hardest worked docs in medicine in regards to total compensation vs hours spent on call. Is there that big of a step up comparing vascular neurology trained docs vs NIR? I worked for an academic neurology department before med school and one of the docs was vascular + neurocrit trained and it just seemed like he was drastically underpaid (albeit I get that goes in line with academia paying less).

I'll be the first to admit that despite working for years in vascular neuro that hearing how low the pay can be was one of my main motivations to look elsewhere once I started school.

- Signed, a lowly and possibly highly naïve MS2.

Vascular+ neurocrit will get paid essentially like a neurocrit trained person (possibly with a small bonus if you’re the director of the stroke Center- that’s where the vascular fellowship comes in handy). In a Midwest academic place, the salary for that is around $280k ($250-260k for vascular with telestroke call); for private practice (which is brutal for either lifestyle wise)- we had a stroke fellow who recently signed for $400k at a private institution but the call is NOT great.

NIR is significantly more well paid than these two, but that’s because the risks you take while doing some of these intricate surgeries are enormous. Just 1 month of a stroke rotation as an intern was enough for me to rule out NIR as a potential fellowship lol- too many unnecessary complications leading to devastating deficits. Added to that is the fact that NCC+NIR is 4 years, so you’re doing 8 years of training- essentially neurosurgery like. And the call for NIR is the singular worst call of any specialty- imo just as bad as neurosurgery call, or a malignant OB gyn call schedule. Of course you’re gonna get paid a boatload to compensate for this. And it’s cool as hell, as endovascular is one of the fastest growing fields in neurosurgery right now, and functional neuroendovascular is just starting to blossom (and I think this will explode in the next 15 years).

I am merely an intern though, so take everything with a grain of salt.

 

[NeuroHopeful1]

Neuro trained NIR attending I was with said he was making a little over $1.2m. It's just him and two other attendings running NIR and the neuro ICU so call schedule is brutal. He's on call half the year and gets called in like 90% of the time.

 

[someqsaboutstuff]

Would it be possible to do NIR like 3 months a year and then do general neuro/some other outpatient subspeciality during the other 9 months?

 

[Telamir]

No.

No one will let you do that. The need for IR is too great.

Not to mention your numbers for procedures would be too low and that’s synonymous with worse outcomes.

 

[Aldertonghen]

Would it be possible to do NIR like 3 months a year and then do general neuro/some other outpatient subspeciality during the other 9 months?

No, closest to that that I’ve seen is NIR for 1 week (on call 24*7, does all procedures), then stroke clinic and telestroke (days only) coverage the other 2 weeks. So 33% NIR. Honestly I think that’s pretty chill- he gets called in at night 2-3 times the week he is on, and everything else happens during the day. So 2-3 times every 3 weeks which isn’t bad in your 30s and 40s

 

[someqsaboutstuff]

No, closest to that that I’ve seen is NIR for 1 week (on call 24*7, does all procedures), then stroke clinic and telestroke (days only) coverage the other 2 weeks. So 33% NIR. Honestly I think that’s pretty chill- he gets called in at night 2-3 times the week he is on, and everything else happens during the day. So 2-3 times every 3 weeks which isn’t bad in your 30s and 40s

In theory, could one do something that isn’t stroke related, like movement disorders, during the other two weeks? Or would the hospital/PP never want to agree to such a contract?

What factors allowed the individual you mentioned to do “1 on, 2 off”? Is that arrangement pretty difficult to negotiate for?

 

[someqsaboutstuff]

Also @Aldertonghen (sorry to blast you with questions 😅) but when you refer to “functional neuroendovascular” in an above comment - are you referring to stentrodes? I have seen one stentrode startup develop one that was able to decode brain activity for posting tweets (!) but I had the impression that the risk of implanting a stent for long term doesn’t make stentrodes more promising than DBS.

Or are there other functional neuroendovascular procedures being developed?