Leslie Kane, MA
Executive Editor,
Medscape Business of Medicine
Disclosure: Leslie Kane, MA, has disclosed no relevant financial relationships.
Compare Compensation Across 25 Specialties
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In 2011, neurologists earned a mean income of $184,000 --somewhat less than the previous year. They are among the lower-earning physicians, in the bottom half of the 25 specialties we surveyed. About 22% of neurologists earned $200,000-$249,000, the same as in last year's survey. About 14% earned more than $300,000, and 2% earned over $500,000. About 1 in 5 neurologists earned $100,000 or less.
For employed neurologists, compensation covers salary, bonus, and profit-sharing contributions. For partners, compensation includes earnings after tax-deductible business expenses but before income tax. Compensation excludes non-patient-related activities (eg, expert witness services, speaking engagements, and product sales).
Compensation for neurologists has remained stable. About 41% of neurologists we surveyed saw virtually no difference in income between 2011 and 2010, slightly less than in last year's survey and slightly less than for physicians in all specialties. Another 25% of these respondents saw a decrease in their earnings. More than one third of neurologists said that their income increased between 2010 and 2011.
Male neurologists made 24% more than female neurologists. Males reported mean compensation of $198,000 as compared with $160,000 mean earnings for women. In last year's survey, the gap was slightly less. Overall, male physicians across all specialties earned 40% more than their female counterparts. According to Tommy Bohannon, divisional vice president of Merritt Hawkins (a physician recruitment firm), more female physicians work part-time, which contributes to an overall lower income.
As in 2010, neurologists in the Southeast region (Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, South Carolina, and Tennessee) earned the most in 2011. Their mean income was $209,000. The next-highest earners were physicians in the Great Lakes region, at $201,000 – very close to the amount from the previous year. Neurologists in the Southwest earned the least, at a mean income of $155,000.
Neurologists who are members of office-based multispecialty group practices earned the most, at a mean income of $227,000 -- up somewhat over the previous year. Members of single-specialty groups came in second, at $224,000. Solo neurologists earned $195,000, a decrease since 2010. Physician employees of hospitals and academic/government groups earned the least.
Physicians across all specialties are nearly evenly split about whether they feel fairly compensated. Neurologists are more dissatisfied. A majority (57%) said they are unfairly compensated, compared to 51% last year, and 8 percentage points more than for physicians overall. Of the 22 specialties tabulated in Medscape's survey, neurologists rank about midway in feeling fairly compensated.
The vast majority of physicians don't consider themselves to be rich, and that's true for neurologists as well. Although the public may perceive most physicians as wealthy, only 10% of neurologists agree with that characterization. Some 48% said they don't feel rich because their income is no better than that of many nonphysicians, while 42% feel that way because of so many debts and expenses.
The largest percentage (25%) of neurologists spends 30-40 hours per week seeing patients, slightly more than in last year's report. Fourteen percent of neurologists spend 41-45 hours per week seeing patients, and another 14% spend 46-50 hours. One in 5 neurologists spends less than 30 hours seeing patients -- slightly more than the previous year.
Patient care in neurology is time-intensive, and the length of patient visits reflects this. About 47% of respondents spend 25 minutes or more with each patient on average -- down from 55% last year. One in 5 neurologists spends 16 minutes or less per patient visit, a higher proportion than in 2010.
The amount of time per patient visit excludes the patient's time with a nurse practitioner, physician assistant, or medical assistant; it measures only time spent in the presence of a physician.
One third of neurologists spend 10-14 hours per week on paperwork and administrative tasks, up from 25% in the previous year. One tenth of physicians in all specialties spend the same amount of time on these tasks. Another 23% of neurologists spend more than 20 hours, while only 10% spend 4 hours or less.
Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors across all specialties. Whereas in 2010, more than two thirds of neurologists told us that they would still choose a career in medicine if they could do it all over again, only 50% felt that way in 2011. Less than half of neurologists said they would choose the same specialty; last year, 63% would do the same. Only 25% would choose the same practice setting in 2012.
Despite the interest in alternative patient-care delivery models, only a small percentage of neurologists are currently involved. About 3% participate in Accountable Care Organizations (ACOs), but 4% say they plan to do so in the coming year. Only 1% of neurologists have concierge practices, and 1% have cash-only practices. Typically, such practices are more often found in primary care than in specialties.
An ACO is a type of payment and delivery model that ties provider reimbursement to quality metrics and reduction in the total cost of care for an assigned patient population. An ACO may initiate bundling of payments for various clinical outcomes. A majority (53%) of neurologists we surveyed believe that ACOs will cause either a large or slight decline in income (compared with 46% of physicians in all specialties), while 10% say they will have little or no effect on income. About 37% said it's too soon to tell.
Elements of healthcare reform entail following treatment and quality guidelines set by insurers and Medicare for shared savings programs, but physicians are clearly skeptical that they will improve patients' quality of care. One quarter of neurologists said these measures will lead to better patient care – the same as the percentage for physicians across all specialties. A majority (52%) of neurologists believe the guidelines and quality measures will have a negative effect, while 22% said they will have no impact on the quality of patient care.
Almost one half of the neurologists we surveyed said that they have no intention of reducing the amount of tests, procedures, and treatments they perform because they believe that the quality guidelines and cost-containment measures aren't in patients' best interests. Close to half (43%) of all physicians agree. Another 20% of neurologists said they won't change their routine because of the need to practice defensive medicine. About one quarter of these physicians said that they would reduce the number of tests and procedures because the guidelines are valid. Another 7% would reduce tests and procedures because the guidelines will affect their income.
About 45% of neurologists said they occasionally discuss cost of care issues if patients raise the subject (compared with about 46% of physicians overall). A very similar proportion of neurologists said they regularly discuss cost issues with patients. Some 7% never discuss the issue because they themselves don't know the cost of the treatments, while 6% said they never discuss it because they don't believe it's appropriate to do so.
Captions written by:
Mark Crane, Freelance writer, Brick, New Jersey
Disclosure: Mark Crane has disclosed no relevant financial relationships.
