Neurologist Income Up 3%, but Many Unsatisfied With Pay

Megan Brooks

April 12, 2017

Neurologists ranked in the lower third in terms of compensation for all physicians in Medscape's latest Physician Compensation Report, and only about half feel they are fairly compensated.

The overall Physician Compensation Report 2017 and the Neurologist Compensation Report 2017 were published April 12.

Neurologists came in eighth from the bottom ($249,000) in compensation for patient care, down from a position of ninth from the bottom in 2016 at $241,000. That put them ahead of pediatricians ($202,000), family physicians ($209,000), endocrinologists ($220,000), and internists ($225,000), and just ahead of psychiatrists and rheumatologists (both at $235,000).

The top earners in 2016 are orthopedists ($489,000), followed by plastic surgeons ($440,000), cardiologists ($410,000), and urologists ($400,000).

Neurologists saw a 3% boost in income this year compared with 5% last year, which was below the middle among all physicians. The specialties seeing the largest increase in income were plastic surgeons (24%) and allergists (16%). Pediatricians were the only specialists who reported a decrease in income this year, at −1%.

Self-Employment Pays

Average compensation for foreign-trained neurologists exceeds that of their US-trained peers by 3% ($254,000 vs $246,000).

The top-earning neurologists practice in the South Central region ($270,000), the North Central region ($262,000), and the West and Southeast (both at $254,000), whereas the lowest earners practice in the Southwest ($235,000), the Mid-Atlantic ($239,000), and the Northeast ($247,000).

Self-employed neurologists earn 17% more than their employed peers ($277,000 vs $237,000). This year, as in all previous years' reports, full-time male neurologists reported higher earnings than their female counterparts ($264,000 vs $212,000), a difference of $52,000.

About three quarters of neurologists say they receive employer-subsidized health insurance (77%) and liability coverage (73%); about two thirds have paid time off (67%) and employer-subsidized dental insurance (66%). Only 9% said they receive no benefits.

Only 50% of neurologists feel they are fairly compensated, ranking them below the middle among all physicians. At the bottom of the list, just 41% of nephrologists feel fairly compensated, followed in dissatisfaction by endocrinologists (44%). Emergency medicine physicians, at 68%, were the most likely to report that they feel fairly compensated.

This year, in addition to asking respondents whether they are satisfied with their compensation, the Medscape survey asked those who were not satisfied how big an increase they feel they deserve. Thirty-nine percent of neurologists think they deserve to be earning between 11% and 25% more, whereas 12% believe their current income should be increased by more than 75%.

Participation in Healthcare Exchanges Up

This year, neurologists' participation in accountable care organizations (ACOs) increased to 35%, up from 34% in 2016, whereas 4% had either concierge or cash-only practices.

Of all specialties, neurologists were among the least likely to say they expect to participate in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which went into effect on January 1, 2017, at 40%.

Seventeen percent of neurologists said they would drop insurers who pay poorly, and 46% said they would not. The question was not applicable to 37% of neurologist respondents, most likely because they were employed by hospitals or other organizations.

More than one third (36%) of neurologists said they have seen an influx of new patients during the past year as a result of the Affordable Care Act (ACA) compared with 30% in 2016. Most neurologists (72%) said they will continue to take new and continue to treat current Medicare and Medicaid patients. Only 4% intended to stop taking new patients, and just 1% will drop current patients with Medicare or Medicaid; 11% have not decided.

This year saw a notable increase in the percentage of all Medscape survey respondents who say they are participating in healthcare exchanges, up to 37% from 19% in 2016. Among neurologists, 30% said they plan to participate in exchanges, up from 17% last year, whereas 21% do not plan to participate, down from 25%.

This year, 84% of neurologists said they regularly or occasionally discuss the cost of treatment with patients; 48% do so occasionally and 36% regularly. Thirty-five percent of neurologists in solo practices say they charge patients for appointments missed without notice, as do 37% of those in single-specialty group practices and 21% of those in multispecialty groups.

More than one third (38%) of neurologists surveyed report spending more than 45 hours each week seeing patients, down from 47% last year. Most office-based neurologists (58%) spend between 13 and 24 minutes with each patient; 35% spend 25 or more minutes per patient.

Rewards, Challenges

According to this year's Medscape Lifestyle Report, bureaucratic tasks remain the chief cause of physician burnout, with 56% of all physicians surveyed spending 10 hours or more each week on paperwork and administration, up from 35% in the 2014 report. Exceeding the overall rate, 67% of neurologists said they devote 10 or more hours to such tasks each week.

What is rewarding about being a neurologist? One third (33%) said being good at what they do and doing it well, and 30% cited relationships with and gratitude from patients as the most rewarding aspect of their jobs. Only 3% found nothing rewarding about their jobs.

What is the most challenging part of being a neurologist? A little more than one quarter (26%) chose the number one response, "having so many rules and regulations." Longer hours for less pay placed second, at 22%, followed by having to deal with difficult patients, at 15%.

When asked this year whether they would still choose medicine if they had to do it over again, 71% of neurologists said they would, ranking them lowest among all physicians. Of those who would choose medicine again, neurologists ranked fifth from the bottom, with 76% saying they would choose their own specialty again.

A total of 19,270 physicians in more than 27 specialties responded to this year's Medscape compensation survey.

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