The Neurology Rate & Negotiation Toolkit

What's Inside

Not "a PDF." Six specific tools:

1. Rate Benchmark Database

   Neurology rates by state and setting — urban hospital and rural/critical access — at the 25th, 50th, 75th, and 90th percentile. Fifty states. Includes stroke center type premium data and telestroke contract rate ranges.

2. Recruiter Call Scripts

   Word-for-word. The exact sentences:

   • The opening anchor when you've received a below-market offer
   • The vascular neurology premium script — how to price stroke certification value explicitly
   • The telestroke hybrid script for facilities offering remote coverage arrangements
   • The counter when they say "this is our neurology standard rate"
   • The leverage script for Appalachian and Deep South stroke desert assignments
   • The renewal script when they try to roll your old rate forward
3. Neurology Leverage Points

   The specific neurology credentials and coverage capabilities that justify a higher rate:

   • Vascular neurology board certification commands 20–25% above the general neurology rate at Joint Commission stroke centers — this premium is consistent and real, but it is not priced automatically
   • Joint Commission's 4-tier certification system creates tiered demand; higher certification requires more neurologist coverage hours, and the rate premium increases with certification level
   • Neurocritical care capability pushes rates to $267–289/hr at academic and tertiary centers — a distinct coverage tier from general neurology locum placements
   • EEG reading and epilepsy monitoring capability expands assignment eligibility beyond acute stroke to epilepsy monitoring units — a separate billable service that should be priced separately
4. Contract Red Flag Checklist

   Stroke activation response time, call volume without census ceiling, telestroke technology provision, weekend differential language, and tPA liability coverage scope. Response time expectations are the clause most likely to cause post-signing disputes. One page, annotated.

5. Agency Markup Framework

   Neurology locum coverage carries high agency margins because the specialty pool is small. Understanding the bill rate structure changes how you respond to rate ceilings.

6. Locum Tax Framework

   The 1099 math: S-corp threshold, Solo 401(k) gap, and the effective net rate after malpractice and tax in the highest-paying states for neurology coverage.

What It Looks Like on the Call

When a recruiter quotes $208/hr for a stroke center assignment in the South, this is the sentence from Section 2:

"The regional neurology median for stroke center coverage is $225/hr. I'm vascular neurology boarded, which at a Joint Commission-certified stroke center typically commands 20–25% above the general neurology rate. I'd expect to be in the $265–275 range for this type of assignment. Is there flexibility before we get into logistics?"

You change the numbers to match your state. You say it. That is the product.

Who Built This

For years I took every rate I was offered without pushing back. Not because I was naive. I didn't have the data to know whether I should. Neither did anyone I trained with. I built this because the information existed in federal wage surveys, peer-reviewed research, and 50 years of negotiation science, and it wasn't assembled anywhere a physician could use it before calling a recruiter back.

I started with surgery. Then I built the same data model and negotiation framework for the 22 specialties with the highest locum demand. The leverage points in each toolkit come from specialty-specific research. The scripts and the data are the same framework I use myself.

The agency has this organized. Now you do too.

— General Surgery MD

Verify the Premise Before You Buy

Call three locum agencies and ask what their bill rate is for neurology. Write down how many give you a number.

That is the problem this PDF solves.

The Research Behind It

The economic analysis in this toolkit is grounded in Nobel Prize-winning research:

• Akerlof (1970, Nobel 2001): In markets where one side has better information, the uninformed party is systematically underpriced, not because they're naive, but because the market is structured that way.
• Spence (1973, Nobel 2001): Credentials only move your rate when the agency prices them. This toolkit shows you how to make that happen.
• Nash (1950, Nobel 1994): The fair split in any negotiation assumes equal information and equal skill. Neither assumption holds on a recruiter call.

The negotiation psychology section cites 17 peer-reviewed sources. This is not a blog post formatted as a PDF.

What It Costs in Context

• Consulting an attorney to review your locum contract: $350–$500/hr.
• Hiring a negotiation consultant: $3,000–$5,000.
• This toolkit: $99. One successful negotiation at a stroke center adds $10,000+ annually.

One Honest Limitation

This will not help you if you are already negotiating above the 75th percentile for your specialty and state. If you don't know what percentile your current rate is, that is the problem this solves.

About the Data

Sourced from BLS OEWS public data and CMS geographic adjustment factors, processed through a locum-adjusted model. Not derived from agency-reported data.