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Functional neurosurgeon compensation
I'm still in training but I've heard functional pays really badly. Does anyone know what people in PP and academics who have functional make up a substanial part of their practice are making?
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(07-11-2020, 07:15 AM)Guest Wrote: I'm still in training but I've heard functional pays really badly. Does anyone know what people in PP and academics who have functional make up a substanial part of their practice are making?

It's a hard question to answer because it depends on so many factors. What kind of functional cases are they doing, primarily DBS/epilepsy/pain? Plenty of functional neurosurgeons supplement their practice with spine cases, how many of those are they doing? Do they have a basic science lab they spend 25% of their time in? What kind of industry ties do they have?

Typically if you're talking young, academic functional guy likely around 400-600k. Again, depends on how much spine they do but in my personal experience functional guys don't exactly enjoy grinding out TLIFs.
OP here: I'm honestly unsure of what even is the average breakdown in terms of spine/functional at academic places is. When I made the post I was mainly thinking about DBS surgery but I guess I would be happy doing epilepsy/pain procedures too. I'm fine doing lots of spine but I think I'd like at least half of my time to be doing functional cases and I don't think I'll be running a basic science lab but I'd like the idea of maybe collaborating with basic scientists. How much would you make in that sort of situation and do these sorts of jobs even exist outside the top of acadamia?
Functional neurosurgery is often described as the "what's left" subspecialty. A number of procedures in neurosurgery were kind of lumped together and put into one category. This means that a majority of people just take a slice of it. Having been in the field and being friends with a number of these people, I've seen a handful of strategies. Note that almost all of these occur in academics.
- Epilepsy with tumor. A natural combination to merge the functional mapping of epilepsy with tumors.
- DBS with some spine. Amount of spine is dependent on research funding and appetite of the individual for $$$.
- Pain (MVDs, Chiari) +/- peripheral nerve +/- minimal DBS.

There are a few exceptions to the "academics only" rule. For instance, two of the busiest guys in the country are in Florida and Colorada; both grinding out huge numbers of DBS cases. In both situations, cases are done asleep with anatomical targeting (imaging-based). Neither does intra-op MRI. One is the go-to for Mazor training. They are in the top 20 centers in the country by the number of installed systems (>50/yr) per my reps.

Now, your question is compensation. That's entirely dependent on location, volume, payer mix, and what you supplement with. You're going to be on the lower end of neurosurgeons. If that's not for you, then so be it. Even at name-brand places that make you take a pay cut for the honor of working there (e.g. MGH, UCSF, etc.), you'll make >$300k. I would agree with the $400-600 ballpark. If you're not happy with that, then you are an unhappy person at baseline, and making more money is unlikely to fix your outlook.
@drstrange thanks a lot for the great response. 400k-600k sounds totally reasonable to me and I'd be totally fine griding some spine and don't really plan to be working at a place like MGH or UCSF (not because I don't want to lol). I'm going to start thinking about applying to fellowships soon. How reasonable is it for me to go into doing a functional fellowship with the plan of eventually getting one of these "DBS with some spine" jobs in the NYC region (I'm going to have to be around one of these places due to my partner's job, wouldn't have to necessarily work in NYC but would have to live close).
Dude you're clearly not a "resident about to apply to fellowships", but okay
NYC? You're going to have to make a compromise somewhere. With jobs, I would say there are a ton of different considerations but they boil down to three things:
1) location
2) money
3) practice style (call, midlevel support, amount of spine, etc)

Pick 2. Even then, you're going to need the perfect job to open up at the perfect time. If you 100% have to live in NYC so that your IBanking SO can keep their job, then something is going to have to give.

The first strategy is to be the number one applicant on the job market with the top fellowship (either Lozano or Starr/Larson), a good K grant application, a well-connected PD who will make calls, high impact publications during residency/fellowship, and luck. The second strategy is to get the best fellowship you can and then take any job you can in NYC. Get into the market and then find a way to start carving out DBS cases.

It's a brutal environment to break into due to oversaturation and competition. Many major metro areas are that way.
(Med student question) How common of a model is functional + spine? There's one attending at my institution that does that and from private conversations with residents they are admittedly not quite strong in either, but unsure if that is because of weak residency training or insufficient volume in either subspecialty to make them shine
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