Friday, September 29, 2023
Neurologist Compensation Report 2013
Is your income up or down? How is your practice changing? Are you drowning in paperwork, and would you do it all over again? Nearly 22,000 physicians gave answers to these and other intriguing questions about what it means to be a doctor these days and where their earnings are going.
Captions by Neil Chesanow, Senior Editor, Medscape Business of Medicine
Neurologist Compensation in 2012
Physicians have done well in 2012, and that includes neurologists, who earned a mean income of $217,000. They rank near the middle of all medical specialties. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.
Historically, neurologists have ranked in the lower half among the specialties in Medscape's surveys, and their compensation rank has barely budged over time. In our 2012 report, neurologists ranked 18th from the top, while in the previous year they were slightly higher, in 16th place.
Over 20% of neurologists earn $300,000 or more; about 15% earn $100,000 or less.
For employed physicians, compensation includes 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 fees, speaking engagements, and product sales). Compensation in this chart includes only that for physicians working full-time.
Note: Totals in slideshow may not add up to 100% due to rounding. "Not applicable" (N/A) responses were not included in the charts and graphs.
Neurologist Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been very little movement in earnings for neurologists. In 2012, 45% of respondents said that their compensation remained the same from the previous year, compared with 41% in 2011.
Similarly, in 2012, 27% of neurologists said that they earned more than they earned in 2011, and 28% earned less. In 2011 compared with 2010, 35% saw an earnings increase; 25% lost money.
Do Men or Women Earn More?
Male physicians earn more than female physicians, regardless of specialty. Overall, male physicians earn 30% more than their female counterparts. In neurology, however, that gap is 20%, less than in many other specialties.
One contributing factor involves women's choice of specialties. There are fewer women in some specialties, which skews the overall percentages. For example, 29% of neurologist survey respondents were women, whereas in pediatrics, 53% of respondents were women; for family medicine, it was 36%.
Neurologist Compensation by Geographical Region
Neurologist compensation varies significantly by region. Doctors in the South Central region, with the highest compensation (a mean of $250,000 in 2012), earn 29% more than their colleagues in the Mid-Atlantic region, with the lowest compensation (a mean of $194,000 in 2012).
In 2011, the spread was nearly identical. Neurologists earned the most in the Southeast region and the least in the Southwest.
Neurologist Compensation by Setting
Among different work settings, neurologists in single-specialty group practices earned the highest amount, $251,000. Coming in second among that group were physicians in multispecialty group practices, and then neurologists in solo practice.
Looking at various work situations, partners earned the most, at $253,000, followed by owners of solo practices ($209,000). Both earned more than employed neurologists. ($192,000).
Do Neurologists Feel Fairly Compensated?
About 46% of neurologists feel fairly compensated vs 59% who believe that they are underpaid, and this represents a gradual erosion in feelings about earnings fairness. In 2010, about 50% of neurologists felt fairly compensated. In 2011, that number had dropped to 43%.
Compared with all physicians, a higher-than-average percentage of neurologists feel underpaid. Among all physicians, only 48% of doctors are satisfied with their pay.
If You Had to Do It All Over Again, Would You...
The changing healthcare environment appears to have affected neurologists as it has affected other doctors, and the number of neurologists who would choose medicine again as a career has declined slightly. Only 48% would do so in 2012 vs 50% in 2011.
However, neurologists seem to be relatively content with their specialty. About 44% of neurologists would choose the same specialty again, compared with 42% of physicians overall.
There were strong signs of discontent about practice setting. In 2012, only 19% of neurologists said that they would choose the same practice setting, compared with 25% in 2011.
Neurologist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Neurologists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 7% of neurologists either participated in an ACO or planned to join one in the coming year. This year saw a huge jump, to 23%.
Concierge practices and cash-only practices are not a large factor in neurology practices. Very slightly more neurologists have opted for concierge medical practices (2% vs 1%) and cash-only practices (2% vs 1%) in 2012 than in 2011, although the percentage is still small.
Will You Stop Taking Medicare or Medicaid Patients?
Many doctors, worried about potential low levels of Medicare reimbursement, are making the decision to stop taking those patients.
Among neurologists, 11% plan to stop taking new Medicare or Medicaid patients, and 2% plan to stop seeing current Medicare or Medicaid patients. Another 31% are undecided.
That number (who will stop taking new Medicare or Medicaid patients) is somewhat higher for the primary care specialties of internal medicine (11%) and family medicine (15%). Be that as it may, 56% of neurologists are not conflicted.
Will You Drop Insurers That Pay Poorly?
Most practice management experts advise doctors to review their payments by insurers on a yearly basis and be ready to drop those who are paying the worst or creating the most denials and problems.
In 2012, more than a third of neurologists (34%) were planning to take this advice, or perhaps they do it already. But 18% were planning to keep all insurers because they felt that even poor payers represent revenue. Another 17% felt that dropping insurers that pay poorly was inappropriate behavior.
Have You Started Offering New Ancillary Services?
We asked doctors whether they have started providing additional medical services that were previously not considered standard offerings for their specialties, in order to increase income.
An above-average number of neurologists said yes. Across all specialties, only 19% of doctors said that they had begun to do so. The percentage of neurologists offering ancillary services (21%) was similar to the percentage of physicians overall offering such services. By contrast, 22% of dermatologists, 19% of endocrinologists, and 29% of plastic surgeons (the second highest percentage) added ancillary services.
Do You Discuss Cost of Treatment With Patients?
Cost of treatment is a big issue, particularly when there are options for different treatments. Given the increasing number of high-deductible health plans, treatment choices may be influenced by cost.
In 2011, 43% of neurologists said that they regularly discuss cost with patients, and another 45% said that they occasionally discuss costs, if a patient brings it up. In 2012, those numbers declined; 37% said that they regularly discussed the cost of care with patients, and 41% would discuss cost if the patient brought it up.
In contrast, among all doctors, 30% regularly discussed the cost of treatment with patients in 2012, another 38% did so if the patient brought it up, and 6% deemed costs inappropriate to discuss with patients.
Hours Spent Seeing Patients per Week
The largest percentage of neurologists spends 30-40 hours per week seeing patients. The percentage of doctors who put in that amount of time has remained constant. In 2012, 26% of neurologists worked 30-40 hours per week; in 2011, 25% did. In the previous year, about 23% worked those hours. In contrast, among all physicians, the greatest percentage (30%) worked a 30- to 40-hour week in 2012.
Along the majority of the time continuum, the number of hours worked were similar from one year to the next. In 2012, 21% of neurologists worked less than 30 hours per week (the same as in 2011); 13% worked 41-45 hours (in 2011, it was 14%). About 10% of neurologists saw patients for 60 hours or more per week; in 2011, it was about 11%.
Number of Patients per Week
The sweet spot for neurologists is 25-49 patient visits per week. That accounted for 28% of neurologists in both 2012 and 2011 and over a third in 2010. The next largest group -- 25% in both 2012 and 2011, and just under a third in 2010 -- see 50-75 patients per week. Patient loads in excess of 100 patients per week aren't common in neurology. Only 14% of neurologists saw that many patients in 2012, down from about 19% in 2011.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, neurologists spend more time with each patient than do many other types of doctors. For the largest percentage of neurologists -- 42% in 2012 -- a mean of 25 minutes or longer was the norm per patient visit.
That percentage represents a slight decline in the number of neurologists who saw patients for that long in recent years. In 2011, 47% of neurologists saw patients for 25 minutes or longer; in 2010, that number was 55%.
For the third year in a row, the category with the second highest percentage is 17-20 minutes. In 2012, 24% of neurologists spent that amount of time with patients; in 2011 it was 19%, and in 2010 it was about 15%.
Hours Spent Seeing Patients in the Hospital
Neurologists, because of so much their specialty practice is office-based, don't spend a large portion of their time in the hospital with patients. Only 14% spend 25 hours or more per week seeing patients in the hospital. A full 46% spent 4 hours or less per week seeing patients in the hospital.
Other specialists who spent a considerable amount of time seeing patients in the hospital were cardiologists (24% spent more than 25 hours a week in the hospital) and critical care physicians (72%). Among internists that number was 29%, and among family physicians it was only 5%.
Hours Spent per Week on Paperwork and Administrative Activity
Most jobs entail paperwork and cumbersome chores. Neurologists were also bogged down with such tasks.
Nearly a third of neurologists (30%) spent 10-14 hours on paperwork and administration each week, and another 23% spent 5-9 hours. About 12% of neurologists spent 1-4 hours a week on paperwork. But a significant number -- 21% -- had 20 hours or more of paperwork per week.
However, that's in line with the time spent by other specialists with heavy paperwork loads. For family physicians, only 17% had 1-4 hours of paperwork a week, and another 17% had 20 hours or more. Oncologists were also on the higher end of the paperwork continuum: Only 10% had 1-4 hours of paperwork per week, and 20% had 20 or more hours.
The Most Rewarding Part of Your Job
No matter what the public thinks, it's not all about the money. For neurologists, there are clearly plenty of emotional rewards that still have a strong impact. Being good at the practice of medicine was the paramount reward for 43%. For physicians overall, that percentage was less: 34%.
For 31% of doctors overall, relationships with patients ranked next on the list in 2012. Among neurologists, 27% felt the same, and it ranked second as a factor in career satisfaction.
When it came to pride in being a doctor, 9% of neurologists considered "being proud of being a doctor" as the greatest career reward, compared with 7% for physicians overall.
Good compensation ranked fifth in importance, with 7% of neurologists citing it in 2012 compared with 9% for physicians overall.
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