What compensation can you expect?
One question on everyone’s mind when they are looking at a neurology opportunity is, how much will I earn? Lots of factors go into determining both a neurology starting salary and what someone will make at 5 years out, 10 years out and beyond.
Below is information regarding neurology compensation ranges. If you have questions, please send us an email at firstname.lastname@example.org, call us at 216-906-8188 or request information using this form and we’ll contact you!
The factors that influence an offer
Typically, practices start formulating an offer using the most recent national neurology compensation benchmarking data such as Sullivan-Cotter and MGMA, and then go up or down from there depending on:
- Type of Practice: (Academic, Hospital-Employed Community Practice or Independent Private Practice)
- Geographic region
- How easy or hard it is for the practice to attract candidates
- How strongly the need to hire is
- Candidate experience
- Call responsibilities,
- Leadership responsibility
- Protected administrative time
- Protected time for research and research support package
Type of Practice and Subspecialty Can Impact Compensation
The type of practice you join (i.e. academic, hospital-employed community practice or independent private practice) makes a difference in determining your starting offer, as well as your long-term compensation. Hospitals are usually able to offer higher guaranteed salaries, and yet neurologists in some efficiently-run private practices with opportunities often earn more in the long-run than many hospital-employed neurologists.
Your subspecialty can also dramatically influence the amount of your offer and your long-term compensation. Interventional neurologists and neurocritical care specialists usually receive much higher offers than the norm. Neurohospitalists often command a higher guaranteed base salary with less emphasis on productivity, since neurohospitalists have less control over how many patients they see. A dramatic shortage of pediatric neurologists has resulted in dramatically increasing compensation in pediatric neurology. In recent years, MS neurologists and Movement Disorder neurologists were in particularly high demand and short supply, and were therefore able to get higher offers. From year to year, the “hot” specialties may vary, and starting offers are likely to vary along with supply and demand.
Location Impacts Compensation
The popularity of a location makes a difference. Locations that are in high demand are able to offer lower salaries because it is easy to attract candidates. Locations that are less popular need to pay more to attract people to those areas. If you are looking at a position in an area that needs to work harder to recruit candidates, you may consider asking for:
- A salary on the higher end of the starting salary benchmarking data,
- RVU-based and Quality-based bonuses,
- A Medical Directorship with a stipend to develop your subspecialty or to lead the stroke program
- A signing bonus,
- Student loan forgiveness, and/or
- A training stipend, if you are in residency or fellowship
Compensation Benchmarking Data
Academic medical centers, hospitals, and private practices all rely on annual compensation benchmarking data. Different surveys will show different data and it is important to understand which surveys the hospital or practice is using. Some stick with one survey, and some use a blend of several surveys. We believe that the Medical Group Management Association (MGMA) data most accurately reflects what we are seeing in the market, but even this excellent data is always relying on information from the past data year, not the present, and so it may not reflect the current market.
The survey data is a great place to start. It does not, however, help with a lot of data regarding how your subspecialty in neurology is likely to impact your compensation. For example, if you want to know about compensation specifically for a neurohospitalist, a neurointensivist, a stroke neurologist, or any other type of subspecialist, you may have to rely on anecdotal data or talk about the market with people who have seen recent offers in that subspecialty. There is some national benchmarking data available for some subspecialties, but such data has not been consistently provided by the major compensation benchmarking companies. We are always happy to let you know if recent surveys have reported benchmarking data in your subspecialty area, and perhaps more importantly, we can share our team’s experience with recent offers in your subspecialty in similar practices and locations.
Type of Practice: Academic, Hospital Employed and Independent Practice
The type of practice you are interested in will impact your starting and long-term income. Academic neurology tends to pay lower than other types of practices (although there are always exceptions!) due to the fact that your research time may take away from clinical productivity, and also due to simple supply and demand—there are often more candidates interested in academic jobs. Hospital employment will generally offer the highest starting salaries (hospitals have deeper pockets than independent private practices) and conversely, private practices usually offer lower salaries (particularly if the doctors are paying for the new hire out of their own pockets). However, private practice neurologists often think their autonomy is worth the tradeoff, and neurologists in private practice have the ability to supplement their income with income from testing, real estate, or other ancillary sources, and sometimes end up with higher earning potential over-all.
Understanding not only the starting salary, but how subsequent years’ compensation is likely to be determined is incredibly important not only to avoid an unexpected drop in income, but also to understand what is possible at a particular practice.
Typical neurology compensation falls into 4 bands:
$200,000 - $250,000
Some academic practices and some private practices (where they may start you lower and provide you with the opportunity to earn more as you get busier). Practices and programs paying in this range may have trouble competing for candidates with higher-paying employers.
$250,000 - $300,000
Typical starting salary for most community practices, with private practices generally offering lower salaries than hospitals
We are routinely seeing offers from $300,000 - $350,000 as starting salaries for fully-inpatient neurohospitalists, as well as outpatient neurologists being recruited to less popular locations where practices need to pay more to attract candidates. We also see starting salaries in this range for neurocritical care neurologists.
Interventional neurology compensation, neurocritical care compensation, and compensation for leadership roles in neurology practices is often in the range of $350,000 or more…sometimes substantially more! We have seen offers in excess of $600,000 in interventional neurology. Other subspecialties which are in particularly high demand and short supply at any given time may also command a starting salary over $350,000. Which subspecialties are particularly “hot” at any given time can change from year to year.
Compensation Models and Fair Market Value
The most common ways to compensate neurologists are:
Base Salary plus RVU Production Bonus: Hospitals and most academic centers use this model. The hiring practice understands that you will need time to build a practice and ramp up. They will give you time to do this by guaranteeing you a base salary for a period of time (most common is 1-3 years). They will also pay you a bonus based on how productive you are. The bonus will have two components: the RVU threshold (i.e. the amount of RVUs you need to produce before you start earning a bonus) and the per dollar amount they will pay per RVU once the threshold is reached. You should ask what the threshold and dollar/RVU numbers are based on and how many patients the practice expects you to see, as well as how much volume you can expect to come from the practice itself and how much outreach to referring physicians you will need to do, so you know what the expectations are. Many practices will provide a pro-forma that will include the number of patients they expect you to see and any other productivity requirements (e.g. procedures or testing) in order to be able to start earning a productivity bonus. In most hospital-employed positions, a new base salary is set at the end of the contract term using a formula set by the institution.
Salary Plus Bonuses for Quality, Citizenship, and/or Academic Productivity: Some types of positions, such as research-focused positions or purely inpatient positions, are often compensated using a straight salary plus other types of bonuses for things like quality, citizenship, or academic productivity. This is common when the primary value for the role is not determined by the volume of patients seen.
Pure Productivity: After the guaranteed salary period ends, many practices will move you to a pure production model in which you are paid based on the RVUs produced or revenue collected minus expenses. A “collections minus expenses” model is common in private practice, but much less common in hospital-employed arrangements where the neurologists do not control the collections nor the expenses of the practice and have less control over which patients they see.
Fair Market Value (FMV) and why it matters
Even if a hospital really, really wants to hire you, it can’t just pay you anything it thinks you are worth. Why not? Federal regulations require that hospitals keep physician compensation within “Fair Market Value” if it takes payments from government programs, including Medicaid or Medicare. If a hospital pays its physicians more than “Fair Market Value,” the hospitals can face very serious consequences with respect to these federal programs, and be charged with violating the Anti-Kickback Statute (42 U.S.C. 1320a-7b) and the False Claims Act (31 U.S.C. 3729). Not-for-profit hospitals can even lose their tax-exempt status. So, no matter how badly a hospital wants to hire you, it is important to understand that it isn’t free to pay you whatever it would like. However, many hospitals might be able to pay you significantly more than the national benchmarking data median would suggest if the hospital can make a strong individual case to support your compensation as being within “Fair Market Value.” It may be helpful to the legal compliance team if you are able to share evidence that the compensation you are asking for is justified in your particular situation, such as if you have competing job offers, a W-2 reflecting that you are already earning close to what you are asking, and your individual productivity information.
Questions? Thoughts? We would love to help! Please fill out the form below and we’ll contact you or call 216-906-8188 or email bdery@rosmansearch.