Neurologist compensation 2023: Salaries up overall, subspecialties see pay dip

By Shamard Charles, MD, MPH Published December 11, 2023

The rising prevalence of neurological diseases, especially amid an aging population, is straining an already stretched neurology workforce. Although demand for neurologists exceeds the supply, they rank among the lowest paid specialists in the US. Still, the field commands a reasonable salary, especially for doctors willing to work in rural areas or hospital-owned establishments.

This is the sixth in a series of MDLinx special reports examining doctor compensation trends, leveraging the most current data from the Medical Group Management Association (MGMA), among other sources. Here, we look at neurologists' salaries and the factors that affect their compensation.

The state of neurologist compensation

The demand for neurologists far surpasses the supply, with just over 11,000 full-time neurologists practicing in the United States.[1] Surprisingly, despite this shortage, neurology remains among the lowest paid medical specialties.

Neurology is more crucial than ever, given the prevalence of neurodegenerative conditions such as Alzheimer's disease and Parkinson's disease in the aging US population.

According to the latest MGMA research (based on 2022 data), the national median compensation for neurologists is $347,348, representing a 2.95% year-over-year increase from 2021 to 2022.[2]

national median compensation neurologist

Student loan burden

Many factors influence a neurologist’s compensation, including subspecialization, location, scarcity, and work environment, but the need to pay off student debt is especially significant.

In general, neurology salaries vary by subspecialty, with more years of training and board certification yielding higher salaries—thus, neurologists who specialize in neurocritical care or stroke medicine earn more than pediatric neurologists.

Like other specialists, neurologists go through extensive schooling. And the high cost of medical school forces many neurologists to carry a significant amount of debt, which can lead to financial strain, particularly in the early stages of their careers.

A report published by the Association of American Medical Colleges (AAMC) found that 73% of medical students graduate with debt totaling a whopping $202,453 on average, excluding premedical undergraduate and other educational debt.[3]

Consider that after medical school, new doctors who aspire to specialize in neurology start a 3-year internal medicine or pediatric residency program, which hardly pays enough to offset the debt they’ve accumulated. Upon graduation, physicians complete an additional 3-year neurology fellowship, meaning they must complete approximately 10 years of training before commanding their terminal salaries.

Geographic location

According to the latest MGMA research, neurologists' salaries range from a high of $462,535 in Illinois to a low $244,963 in Iowa. This wide salary range—primarily due to differences in supply and demand for neurologists in different states—underscores how scarcity affects compensation across the nation.

In addition, MGMA data shows that neurologists earn more in rural areas ($362,755) than metropolitan areas ($346,852), with lower cost of living and not having to pay state income tax playing a significant role in take-home pay.[2]

Subspecialization

Neurologists typically see an uptick in salary as they train and become more experienced. But neurology compensation with further subspecialization—a once lucrative means of increasing salary—has stagnated and even reversed in recent years.

MGMA data found the following major subspecialties saw a year-over-year decrease in median salary, per full-time employee, from 2021-2022:

Neurocritical care: $423,300 (–7.49%)
Stroke medicine: $373,289 (–4.73%)
Neuromuscular medicine: $298,395 (–0.24%)
Epilepsy/EEG: $298,264 (–10.36%)

Type of practice and ownership

Where a neurologist decides to work, whether in an academic medical center or private practice, plays a major role in their salary. In general, for-profit hospitals offer the highest earning potential for neurologists, primarily due to their ability to secure lucrative long-term contracts and reap sizable signing and volume-based bonuses, particularly in high-demand regions.

Neurology salaries tend to be lower in hospital-owned or other majority-owned practices relative to physician-owned practices. The median salary for neurologists in physician-owned practices is $369,694, compared with $343,725 in hospital-owned practices, and $315,000 in other majority-owned practices, according to MGMA data.

Experience and tenure

Neurologists with more experience and seniority earn more money, as evidenced by a linear relationship between years of experience and salary.

Not surprisingly, MGMA data finds that neurologists see a 2.85% year-over-year increase in salary, and those who achieve seniority—that is, those who have 18 to 22 years of experience—earn an average median salary of $358,119, compared with $319,760 for entry-level physicians. Over time, incentive bonuses, ownership stake, administrative promotions, and other benefits may also increase total compensation.

Inadequate representation of minorities

The field of neurology continues to struggle with inadequate representation of racial and ethnic minorities. According to 2022 US census data, nearly one-third of all Americans identify as either Black/African American (13.6%) or Latino/Hispanic (19.1%).[4]

In contrast, only 4% of practicing oncologists self-identify as an underrepresented minority.[5]

While scant data on differences in pay between different ethnic and racial backgrounds for neurologists exists, research shows that White neurologists have the highest average salary, totaling nearly $272,245, compared with all other ethnicities, with Black oncologists bringing in the lowest average salary of $258,512.[6]

Black and Latino neurologists are particularly under-represented in leadership roles, with only 4.3% and 3.7% of all neurology residency program directors identifying as Black or Latino/Hispanic, respectively, which can lead to lower future salaries.[7] Even more, pays gaps remain within gender lines despite recent narrowing, with women making 87 cents on the dollar compared with men ($264,817 for men; $231,214 for women).[6]

Challenges

The retirement of neurologists, coupled with rising workplace demands and the absence of systematic succession planning, has exacerbated the neurologist shortage. Simultaneously, the increasing prevalence of neurological diseases, particularly among the aging demographic, who are requiring more care, has further strained the limited neurology workforce. As a result, patients experience lower quality care and worse outcomes, while neurologists’ career satisfaction erodes.

Burnout is also a major issue in this field, partially due to supply and demand imbalances. Factors that contribute to burnout include the following:

Long hours
Inadequate staffing
Administrative burdens
Workplace violence
High stress and general unhappiness in the workplace
Lower reimbursement rates
Racial, ethnic, and gender pay gaps

A recent Medscape survey revealed that about half of neurologists felt inadequately compensated.[8] This sentiment, coupled with increased administrative burdens and work environments that foster poor work-life balance, fuels career dissatisfaction among neurologists.

Underrepresentation and a sustained racial, ethnic, and gender pay gap further contribute to career dissatisfaction, ultimately underscoring the need for research that supports culturally competent care, equitable compensation, and better work-life balance.

Parting thoughts

Despite the relatively high salaries that neurologists command, they are experiencing high debt and burnout. Reducing student loan burden is one way to maximize salary. Achieving seniority and gaining experience also translates to higher salary; however, in the absence of adequate staffing and better work-life balance, feelings about career satisfaction remain mixed. Of note, working at a hospital tends to provide long-term stability and higher pay.

Geographical location/region and the size of the area in which one works seem to change compensation significantly, especially in high demand states such as Illinois and Oklahoma. All these factors, along with differences in organizational ownership, taxes, lower reimbursement rates, health insurance benefits, and rising inflation, must be considered when negotiating an employment package.

Importantly, gender and ethnic under-representation in the field of neurology has a detrimental impact on a number of factors important to the practice of medicine, including healthcare quality, research outcomes, patient treatment adherence, and compensation. However, further research is needed to fully understand the extent to which declines in these factors contribute to health disparities, and to develop tangible ways to improve representation—and, by proxy, patient health outcomes.

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Sources

US Bureau of Labor Statistics. Occupational Employment and Wage Statistics. 29-1217 Neurologists. May 2022.
Medical Group Management Association (MGMA) DataDive. 2021-2023 data.
Budd K. 7 ways to reduce medical school debt. AAMCNews. October 14, 2020.
United States Census Bureau. Quick Facts. United States. 2022.
Promoting Equity, Diversity and Inclusion in Academic Neurology. University of Maryland Medical Center. 2023.
Neurologist Demographics and Statistics in the US. Zippia. 2023.
Jordan MC, Tchopev ZN, McClean JC. Education Research: Diversity in neurology graduate medical education leadership. Neurology Education. 2023 June;2(2).
McKenna J. Medscape Neurologist Compensation Report 2022: Incomes Gain, Pay Gaps Remain. Medscape. May 13, 2022.