Neurologists Near the Bottom of the Pay Scale but Still Happy

Megan Brooks

April 18, 2018

Neurologists rank near the bottom in terms of annual compensation for all physicians in Medscape's latest Physician Compensation Report, and but about 60% believe they are fairly compensated and most are happy in their chosen profession.

The overall Physician Compensation Report 2018 and the Neurologist Compensation Report 2018 were published April 18.  

Neurologists came in seventh from the bottom ($244,000) in annual compensation for patient care. That put them ahead of infectious disease specialists ($231,000), internists ($230,000), family physicians ($219,000), endocrinologists ($212,000), pediatricians ($212,000), and public health physicians ($199,000) and just behind rheumatologists ($257,000), physical medicine and rehabilitation physicians ($269,000), and allergists/immunologists ($272,000).

Plastic surgeons are the top earners ($501,000 annual pay), followed by orthopedists ($497,000) and cardiologists ($423,000).

2% Pay Drop

Compensation for neurologists decreased slightly this year (–2%). The biggest increases were seen among psychiatrists (+16%), plastic surgeons (+14%), and physiatrists (+13%). Decreases in earnings were evident in five other specialties this year, with general surgery (–9%) and urology (–7%) hardest hit.

Average annual compensation for US-trained neurologists ($245,000) is about the same as that reported this year for foreign-trained neurologists ($244,000). Neurologists who are employed earn less than their peers who are self-employed ($242,000 vs $304,000), presumably trading a higher salary for a steadier income and less time focusing on running a business.

Far more neurologists are employed than self-employed (68% vs 20%). This reflects a national trend toward physician employment, as hospitals and other entities have consolidated and absorbed private practices and younger physicians have sought a steadier income stream and more regular hours. However, there is some indication that the trend has plateaued, as hospitals reach staffing limits.

This year, as in previous years, male neurologists earn more than female neurologists ($250,000 vs $229,000). Part-time work does not account for this difference.

Sixty percent of neurologists believe they are fairly compensated, which placed them about in the middle among all physicians; 44% of neurologists feel they should be earning 11% to 25% more, and 31% believe they deserve an increase of 26% to 50%.

About 60% of neurologists report that they spend 30 to 45 hours each week seeing patients. More than one quarter spend more than 45 hours.  Most neurologists spend 13 to 24 minutes personally with each patient.

Rewards and Challenges

Bureaucratic tasks remain the primary driver of burnout among physicians, and nearly three quarters of neurologists (71%) report that they spend 10 hours or more a week on paperwork and administration.

What is most rewarding about being a neurologist? Relationships with and gratitude from patients top the list (36%), followed by making the world a better place (20%), being good at what they do/finding answers, diagnoses (19%), teaching (10%), and making good money at a job they like (8%). Very small percentages cited pride in their profession.

As is the case for other specialties, the most challenging part of being a neurologist is having to follow so many rules and regulations (31%), followed by having to work long hours (17%), dealing with difficult patients (16%), having to work with an electronic health record system (15%), and trouble getting fair reimbursement (10%). Few cited worry about being sued (5%). 

Despite the challenges, 80% of neurologists said they would choose medicine again and 86% would choose neurology again.

Other key findings from the neurologist compensation report are as follows:

  • Most neurologists are paid through an insurance carrier (89%). Roughly 30% are reimbursed on a fee-for-service basis (32%), with 21% paid through accountable care organizations. Only 5% have adopted the direct primary model, while 4% are in a cash-only practice and 1% in a concierge practice.

  • One third of neurologists participate in the Merit-based Incentive Payment System (MIPS) but only 8% participate in Alternative Payment Models (APMs).

  • A minority of neurologists (22%) report that they would drop insurers who pay poorly.

  • Most neurologists (71%) report they will continue to take new and current Medicare and Medicaid patients, 2% won't take new Medicare/Medicaid patients, and 22% have not yet decided.

  • Increases in the number of physicians who participate in health insurance exchanges have stabilized since their introduction in 2014. There is almost no change from last year's survey in the percentage of participating neurologists (27%). Over half, however, are unsure about whether they will participate (57%).

  • Anecdotally, physicians have complained about the effect of the Affordable Care Act on their incomes, but results from this year's surgery suggest that less than 10% of neurologists who participate in an exchange have experienced a decrease in income.

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