Neurologist Income Up 5%, But Most Still Unsatisfied

Megan Brooks

April 04, 2016

Neurologists continue to rank below the mean in terms of compensation for all physicians in Medscape's latest Physician Compensation Report, and fewer than half feel they are fairly compensated.

The overall Physician Compensation Report 2016 and the Neurologist Compensation Report 2016 were published April 1.

Neurologists came in ninth from the bottom ($241,000) in compensation for patient care (they were eighth from the bottom in 2015 at $229,000), ahead of pediatricians ($204,000), family physicians ($207,000), endocrinologists ($206,000), and internists ($222,000) and just ahead of rheumatologists ($234,000). The top earners in 2016 are orthopedists ($443,000), cardiologists ($410,000), dermatologists ($381,000), and gastroenterologists ($380,000).

Neurologists had a 5% increase in income this year, below the middle among all physicians. Most neurologists attributed their increases to increased patient volume and/or working more hours. Others said they received cost-of-living or merit-based raises or changed jobs or positions. Some cited supplemental income from speaking engagements and consulting, while a few mentioned stipends per call for on-call work or improved employer or practice efficiency and productivity.

Gender Pay Gap Continues

The highest-earning neurologists practice in the North Central region ($269,000), the Southeast ($261,000), and the Great Lakes ($252,000), while the lowest-earning practice in the Southwest ($205,000) and Northeast ($211,000).

The top-earning neurologists work in multispecialty group practices ($277,000) and healthcare organizations ($267,000). Last year, the top earners were in single-specialty and multispecialty groups ($279,000 and $271,000, respectively).

This year, as in all previous years of the report, male neurologists continue to earn more than their female counterparts ($251,000 vs $214,000), a difference of $37,000.

Being employed or self-employed may play a role in the gender disparity in salary. Earnings for self-employed female neurologists are $258,000, which is 92% of men's ($280,000), and employed female neurologists' compensation is $205,000, which is 86% of their male counterparts' ($238,000).

Despite increasing attention, cash-only and concierge practices are still not significant payment models for any physicians, including neurologists. This year, only 4% of neurologists were in concierge practices and only 3% were in cash-only, compared with 4% and 6%, respectively, last year.

Neurologist participation in accountable care organizations (ACOs) had been rising dramatically from year to year, but this year it increased only from 30% to 34%; moreover, only 5% of neurology respondents expect to join an ACO this year. Just under one third of neurologists (30%) have seen an influx of patients due to the Affordable Care Act (ACA).

Less than half (47%) of neurologists believe that they are fairly compensated, but they are not the most dissatisfied physicians. Those who feel most underpaid are urologists (42%) and allergists and endocrinologists (both 43%). As in every year's survey since 2012, those who felt most fairly paid are dermatologists (66%), who are also the third highest earners this year. Pathologists (63%) and emergency medicine physicians (60%) followed in satisfaction, even though their earnings were toward the middle range among physicians.

Not surprisingly, regardless of specialty, those who made more were more likely to feel fairly paid than those who made less. Neurologists who believed that they were fairly paid made $59,000 more than their peers who believed that their compensation was unfair.

Two thirds of employed male neurologists and 85% of employed female neurologists believe that they are paid fairly, compared with only 32% and 14%, respectively, of their self-employed counterparts.

Patient Relationships Most Gratifying

Five years ago, in the 2011 Medscape report, 68% of neurologists said they would choose medicine again and 63% would select their own specialty. This year, slightly fewer neurologists (65%) would choose medicine, and far fewer (46%) would select their own specialty.

To determine the level of general career satisfaction, Medscape averaged the percentage of neurologists who again would choose medicine, those who would choose their own specialty, and those who thought they were fairly compensated. At 53%, neurologists ranked slightly below the middle among all physicians. In the 2015 report, at 51%, they ranked closer to the bottom. According to the calculation, this year, the least satisfied physicians are nephrologists (47%) and internists (48%). The most satisfied are dermatologists (65%), followed by oncologists (59%) and psychiatrists and pathologists (both at 58%).

Forty-two percent of neurologists spend 30 to 45 hours per week seeing patients, and slightly more than half (51%) spend more than that. Among neurologists responding to this year's survey, 61% of those who are self-employed and 69% of their employed peers spend 10 hours or more per week on paperwork and administrative tasks.

Among all physicians, 41% of men spent 17 minutes or more with their patients compared with 49% of women. The difference is about the same among neurologists: 81% of men and 89% of women spent 17 minutes or more with patients.

Thirty-nine percent of neurologists believe that being good at what they do is the major reward of the job, and 30% find relationships with patients to be most gratifying. These answer choices garnered the most votes by far. Only 12% cited "making the world a better place," 8% "making good money in a job that I like," and 4% "being proud of being a doctor."

Three percent of neurologists found nothing rewarding. In the comments section included with this survey question, helping others and teaching were frequently mentioned as rewards of the job.

Nearly 19,200 physicians in over 26 specialties responded to this year's Medscape compensation survey.

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