Neurologist Compensation and Productivity From 2013 to 2023 in the United States

BACKGROUND AND OBJECTIVES: There are significant differences in compensation between medical specialties. In this study, we analyzed neurologist compensation in the United States compared with other medical specialties and in relation to productivity metrics. METHODS: We evaluated data from the 2013-2023 editions of the SullivanCotter Physician Compensation and Productivity Survey, which collects compensation and productivity metrics directly from hospitals, hospital systems, and medical groups. We compared neurologists with 8 other specialties (internal medicine, pediatrics, family medicine, radiology, emergency medicine, neurosurgery, orthopaedic surgery, and interventional cardiology). The primary outcome was median compensation, defined as base salary and incentive pay, after being inflation-adjusted to 2023 dollars. The secondary outcome was median work relative value units (wRVUs), adjusted for modifiers and excluding technical components. The tertiary outcome was compensation per wRVU. Outcomes were standardized to a full-time effort equivalent. RESULTS: From 2013 to 2023, the average yearly number of physicians and neurologists in our cohort was 37,443 and 2,280, respectively. Inflation-adjusted median neurologist compensation started at $313,315 in 2013 and increased by 1.6% to $318,284 by 2023. In comparison, pediatrics remained the lowest compensated specialty, increasing by 4.9% from $258,073 to $270,666 and neurosurgery was the highest compensated, increasing by 5.0% from $790,336 to $829,527. Median neurologist wRVUs started at 4,475 in 2013 and increased by 12.3% to 5,024 by 2023. In 2023, neurologists received less compensation per wRVU ($65/wRVU) than neurosurgery ($90), orthopaedic surgery ($76), or interventional cardiology ($68), but more than pediatrics ($48), family medicine ($50), internal medicine ($54), radiology ($55), or emergency medicine ($56). Over time, neurologist compensation became less varied by geography of practice location or hospital vs medical group employment. Among neurologists, compensation increased for neurohospitalists and vascular neurologists, whereas it declined for those in epilepsy, neuromuscular, multiple sclerosis, and neurocritical care. DISCUSSION: Despite a 12% increase in wRVUs, inflation-adjusted neurologist compensation has remained stable since 2013. Compensation differences between neurologists and other medical specialties are not solely due to variance in wRVU generation. Future studies should explore factors contributing to these findings, including reimbursement models and governmental policies.