Why are neuro and spine docs paid so much?

[Ross434]

Okay, with mean salaries between 500-700k (edit - this is obviously private practice), what is allowing the market to be this favorable?

I DONT mean "Why should they be paid so much" .. i mean, why are they *actually* paid so much.. Insurance doesnt care how hard you work. Is it because the cases are more risky or involve more technology? Or is it just a supply issue? Particularly with regards to spine, as this is what is allowing ortho and neuro docs to make 7 figure salaries. Do you foresee reimbursement cuts?

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[dankev]

They do make a lot of money, but your numbers look pretty high.

Ortho (2003)-
Mean:335,800
Median:284,000
http://medicine.wustl.edu/~residenc/outside/spec/ORSinfo.html

Neurosurg (1998)-
Mean:275,200
Median:230,000
http://medicine.wustl.edu/~residenc/outside/spec/NS_info.html

The neuro is a few years old, but this is still a lot lower. Also, the medians are a lot better to look at, because the means are skewed by the few superstars who are making 500-700k.

 

[Ross434]

They do make a lot of money, but your numbers look pretty high.

Yeah, maybe check this out though http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

Or search for spine surgeon jobs? there's an awful lot of them out there advertised at 500k 1st year income guarantees.

You have to be careful about salary surveys cause a lot of them only survey people who are considered employees, and the base salary for "employed" surgeons is a lot lower (academia, HMO's) I'm specifically talking about private practice away from big cities.

(edit) Also, spine is a relatively small percentage of ortho docs, so, ortho surveys dont typically convey the higher pay they receive. Surveys of neuro salaries will also fail to convey their high private practice numbers because the majority of neurosurgeons probably work in academic centers or as salaried employees. Its safe to guess that a private ortho spine doc or a private neuro spine doc is making in the top quartile on "typical" salary surveys.

But i'm not here to debate absolute numbers, i'm just wondering why they are so far ahead.

 

[bigfrank]

Yeah, maybe check this out though http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

Or search for spine surgeon jobs? there's an awful lot of them out there advertised at 500k 1st year income guarantees.

You have to be careful about salary surveys cause a lot of them only survey people who are considered employees, and the base salary for "employed" surgeons is a lot lower (academia, HMO's) I'm specifically talking about private practice away from big cities.

I think all the salary surveys out there are all crap. They probably give information about salaries between specialties (relative salaries), but as far as numbers are concerned, forget about it. Quoting the above site:

"Survey includes base salaries, net income, or hospital guarantees minus expenses."

Hmmmmmm........that's what I call variability.

 

[Ross434]

I think all the salary surveys out there are all crap. They probably give information about salaries between specialties (relative salaries), but as far as numbers are concerned, forget about it. Quoting the above site:

"Survey includes base salaries, net income, or hospital guarantees minus expenses."

Hmmmmmm........that's what I call variability.

Okay, well, clearly they are the top paid docs, regardless of numbers. I'm not trying to debate how much money anyone makes, i'm just wondering what are the factors that are clearly (regardless of survey) causing these specialties to be at the top of the heap.

 

[UTCobra]

Why does it cost so much to have the transmission in your care rebuilt...because you can't do it can you?

 

[ddmo]

From what I understand, many of those reported salaries are sig. lower than what people are getting out there. A lot of doctors don't like patients and others knowing just how much money they are actually pulling in.

I know someone who is being offered 1mill a year for some cardiology positions just out of residency, but he is turning it down to do an interventional fellowship. Of course, he is an all-star.

 

[MeowMix]

I don't know where your numbers are coming from, but Iserson's says the top is cardio at $300,000 (after expenses, before taxes), with neuro way down below the mean at $170,000. These numbers come from the AMA 2000-2002 stats.

 

[Ross434]

I don't know where your numbers are coming from, but Iserson's says the top is cardio at $300,000 (after expenses, before taxes), with neuro way down below the mean at $170,000. These numbers come from the AMA 2000-2002 stats.

I dont know why you didnt see the link in my second post, and i dont know why people arent responding to my initial question.

 

[MeowMix]

I dont know why you didnt see the link in my second post, and i dont know why people arent responding to my initial question.

Too much work to go look at the link! But I did, and it's a commercial source with the above-mentioned disclaimer about variability - thus, it is not a reliable source for comparing. When you compare those numbers with the $300,000 above, there is about a factor of 3 difference.

As for the differences between specialties, Iserson's says it's because people are much more willing to pay for actual hands-on stuff i.e. surgery vs. more talking i.e. family practice. As accurately noted by the transmission comment above.

 

[fullefect1]

As for the differences between specialties, Iserson's says it's because people are much more willing to pay for actual hands-on stuff i.e. surgery vs. more talking i.e. family practice. As accurately noted by the transmission comment above.

People are willing to pay? I thought it is the insurance companies responsibility to decide how much the doctors get paid?

 

[fantasty]

My understanding is that it is related to the amount of malpractice insurance they have, which is also a function of the potential liability they have and the fact that numbers are so small (which results in a lack of ability to pool risks). The consequences of an error in surgery to the nervous system and spine can result in a lifetime of disability, which is very costly (I'm told that this is also the reason that OB/Gyn insurance is so high). But, coupled with the fact that so there are so few neurosurgeons to spread the risk across, they have very high premiums.

(I am kind of talking out of my a.. tho).

 

[cytoskelement]

I don't know where your numbers are coming from, but Iserson's says the top is cardio at $300,000 (after expenses, before taxes), with neuro way down below the mean at $170,000. These numbers come from the AMA 2000-2002 stats.

are you confusing neurology and neurosurgery. i highly doubt any neurosurgeon in the country makes less than 200K a year (unless they are a resident). neurosurgery in a minimum of 7 years of residency and then i would guess at least 1-2 years of fellowship for spine surgery. that's a lot of time for 170K.

 

[ddmo]

I don't know where your numbers are coming from, but Iserson's says the top is cardio at $300,000 (after expenses, before taxes), with neuro way down below the mean at $170,000. These numbers come from the AMA 2000-2002 stats.

If you read my post, I explained why those figures you are getting can often times be deflated. As for the source, it's straight from the horse's mouth, as I mentioned.

 

[TripleDegree]

I don't know where your numbers are coming from, but Iserson's says the top is cardio at $300,000 (after expenses, before taxes), with neuro way down below the mean at $170,000. These numbers come from the AMA 2000-2002 stats.

You must be talking about neurology, not neurosurgery

 

[monkeyarms]

it's pretty safe to say the numbers from the rand mcnally survey are very representative of what docs make. the other surveys undershoot. i know plenty of practicing docs in several specialties and the $ they make....as to the other surveys, my guess is that smart business people would rather not clue everybody in to how much they're actually making, particularly people publishing their info to the public.

NOW as to the original question, i believe the movie young frankenstein handles this topic most eloquently:

MEDICAL STUDENT: But wasn't that the whole basis of your grandfathers work, sir...? the re-animation of component parts?
FRANKENSTIEN: My father was a sick man.
MEDICAL STUDENT:But aren't you the least bit curious about it, Doctor? Doesn't the secret of life hold any intrigue for you?
FRANKENSTIEN: You are talking about the gibberish ravings of a lunatic mind.
MEDICAL STUDENT: Yes, but, sir... if it could be accomplished, wouldn't that eliminate disease from the human frame and render man invulnerable to any but a violent death?
FRANKENSTIEN: How old are you, young man?
MEDICAL STUDENT: Nineteen, sir.
FRANKENSTIEN: Nineteen! My dear young man...once the human organism has eased
to function, nature has deemed that creature to be dead.
MEDICAL STUDENT: But look at what's been done with hearts and kidneys!
FRANKENSTIEN: HEARTS AND KIDNEYS ARE TINKER TOYS! I'm talking about the Central Nervous System!!!

 

[Ross434]

it's pretty safe to say the numbers from the rand mcnally survey are very representative of what docs make. the other surveys undershoot. i know plenty of practicing docs in several specialties and the $ they make....as to the other surveys, my guess is that smart business people would rather not clue everybody in to how much they're actually making, particularly people publishing their info to the public.

NOW as to the original question, i believe the movie young frankenstein handles this topic most eloquently:

MEDICAL STUDENT: But wasn't that the whole basis of your grandfathers work, sir...? the re-animation of component parts?
FRANKENSTIEN: My father was a sick man.
MEDICAL STUDENT:But aren't you the least bit curious about it, Doctor? Doesn't the secret of life hold any intrigue for you?
FRANKENSTIEN: You are talking about the gibberish ravings of a lunatic mind.
MEDICAL STUDENT: Yes, but, sir... if it could be accomplished, wouldn't that eliminate disease from the human frame and render man invulnerable to any but a violent death?
FRANKENSTIEN: How old are you, young man?
MEDICAL STUDENT: Nineteen, sir.
FRANKENSTIEN: Nineteen! My dear young man...once the human organism has eased
to function, nature has deemed that creature to be dead.
MEDICAL STUDENT: But look at what's been done with hearts and kidneys!
FRANKENSTIEN: HEARTS AND KIDNEYS ARE TINKER TOYS! I'm talking about the Central Nervous System!!!

Haha, thats awesome.

 

[orthospine]

As for how much spine/neuro actually make, I'm looking for jobs right now and can give you some real info. The surveys available on the web are suspect in some ways. If reported by the surgeon, they probably are telling you what is on their w2 at the end of the year. That is not all they get. Private groups have sophisticated tax management strategies that tend to hide much of their physicians compensation. That being said, one of the groups I interviewed with showed me some very interesting numbers.

There exists survey data from practice managers that are published yearly in books, but are not available on the web to my knowledge. I don't have it in front of me, but I think I remember for ortho spine the medians were in the mid 500k range. General ortho was in the 300-400 range depending on region and subspecialty (foot, hand, etc). I personally know spine surgeons taking home over 700k a year (I've seen their pay spreadsheets), and they don't work any harder than the other surgeons. Some of that is supply and demand. There are relatively few spine surgeons out there, and insurance companies make money by signing up patients. If they can't offer certain specialties to their patients, then they won't have subscribers to their plans for long. The relatively scarcity of the service gives negotiating power to the surgeons who offer services that not many can. That is one mechanism by which they get higher reimbursement.

The answer to why spine gets more lies in how their operations are currently coded. A femur nail has one (maybe two) CPT code that gets billed. A multi level spine fusion and decompression gets a code for the decompression (one for each level), the arthrodesis (one for each level), and the instrumentation (bundled for numbers of levels 1, 2-3, 4-7, 8-12, etc). These all add up very quickly. Not to mention that the RVU assigned by medicare is relatively high for each code. So a four hour ortho trauma case may get you 2000 bucks, but a three level decompression and fusion will get you much more for about the same amount of time in the OR.

That is the how. As for why, that is complicated. The mechanism by which CMS assigns RVUs to particular CPT codes is something I don't totally understand. Apparently representatives from different specialties get to argue their case to get their slice of the pie. Unfortunately, the pie isn't getting bigger so we are always fighting each other to make our piece the biggest. Thus far spine surgeons are enjoying a good reimbursement schedule, which may be justified by our higher malpractice risk and cost. Obviously these reimbursement schedules continuously change, so the good salaries of spine surgeons are not guaranteed to stay that way.