Junior year resident interested in skull base. I’m equally uninterested in academics because of the general inefficiency and lack of motivation in house staff, which I’ve heard from friends is a fairly universal problem.
I know the skull base market is shit right now but has there ever been a market for private practice skull base? I’d be okay mixing in some spine to fill in the gaps but would like to have skull base as my primary focus. Thanks in advance, don’t want to ask around the department as PP tends to be looked down upon to here.
Realistically it is very difficult for a variety of reasons but there are a few examples of them. You either need to already be very established and then break apart (Dan Kelly) or join a very large healthcare system that refers all cases to you (impractical, hard to find). The reality of it is, skull base is not friendly when you consider RVU/hour, so PP groups are not encouraged to crank out the numbers. Pituitary cases do not bill well. Simple meningioma all PP surgeons do, not just the 'skull base' guy. So whats left are the big/nasty 6+ hour cases. So you'll spend most of your operative day to get 70ish RVU for your acoustic while your partner next door hammered out 4-6 ACDF with flip rooms and made well over double your RVUs. Then theres the problem of, do your partners want to cover your patients? Say you join a group of 10 neurosurgeons in PP and most of them are the general cases kind of people. You do a large petroclival meningioma with some cranial nerve deficits after, maybe CSF leak or hematoma... Do you think your partners are going to like working with you when they are on call getting called about this stuff?
I do not want to discourage you, but theres a reason most if not all high volume skull base people are in academic centers... Also, skull base neurosurgeons need a team. You need strong ENT, RadOnc, Oncology etc. Its rare to have some, certainly never all, of those components in a PP setting, even the massive ones like Atrium or Kaiser.
Hope this sheds some insight, good luck
I mostly agree with the person above. There are definitely fewer skull base jobs in the community. However, it is certainly possible. You want to look at very large systems with large catchment areas. There was recently a good job posted that was 100% skull base at Kaiser in San Diego. Kaiser has a larger footprint and PCP referral base than any academic center in California, so they're able to produce the appropriate volume. There was also a comparable job at OhioHealth and a few other systems.
I wouldn’t call Kaiser a “good job” given shitty salary, Kafkaesque style of the organization, and incentives to do as little surgery as possible, but it is a nonacademic skull base job that exists. If you see those things as benefits, like knowing your schedule far in advance or you don’t like operating, then great, go for it.
Respectfully disagree. I actually interviewed there. The salary was over 900,000, and there are other benefits like incentive pay and no interest loans for housing. Kaiser Northern Cal has a completely different pay structure from Soutern Cal. I challenge you to find *any* job in San Diego or another extremely desirable place to live that pays that much (UCSD academics pays like 300-400K). They send all their acoustics/CPA stuff and pituitaries to that campus, so the volume they showed was decent (200-250 cases/year). Kaiser San Diego isn't a trauma center, so the call is really light. Sure, you could take a shitty academic job in Nebraska and take Q3 level I trauma call for 500K/year, and do lots of shunts and wound washouts to have high case numbers. There are definitely some issues with Kaiser, especially if you want to do spine (Kaiser is it's own insurer and obviously doesn't want to pay for expensive implants so it's hard to have a busy practice). But with the combination of money, lifestyle, location, and actually getting to practice your subspecialty, it's hard to not see it as a good private cranial job. There's a reason tons of residents in good Cali programs want those jobs.
^ I second this. Was a resident in a good Cali program. Kaiser jobs are desirable. Also, Kaiser will 100% pay more than academics, its not even close. 800k+ starting. You wont find that anywhere in the country for academic skull base to start. Kaiser certainly has its problems, but its certainly a decent place to end up
How much is 900k in Cali after taxes? 450?
Unfortunately. Orange County and San Diego county are great places to live…until you have to pay the tax bill
Can't imagine being in academics making 450k with those taxes.
The bigger the name the bigger the side hustle. Everyone who’s anyone has a bunch of disclosures to make at the beginning of their CME presentations. That salary is what UC pays you, but it won’t be your only income if you make it.
