IOM Jobs: In-House Or With A Contractual Neuromonitoring Company: Pros And Cons

With the amount of people looking to get into neuromonitoring, and some of the larger companies slowing down their hiring till the dust settles on these billing issues, it seems like most people would “take what they can get.” And I’ve shown those people how to search out a neuromonitoring company or hospital department to get their foot in the door.

But it may not be the same story for those fortunate enough to have experience in the field, and studied hard enough to get their CNIM and/or DABNM. I see people on Linked in changing companies all the time, as well as recruiters looking for new hires. So there is plenty of activity for those looking for an IOM job opportunity. [UPDATE: Since I wrote this in 2013, I’ve moved on to my second company. If you know me, then you know that is not typical of my personality. But I’ve been fortunate enough that opportunities presented themselves.)

I’ve had the good fortune to work for both a contractual company and in-house neuromonitoring department. While my experience is limited to these places, I’d thought I’d share some of the pros and cons of each.

IOM Contractual Company vs In-House

Let’s start with the 3 most important factors…

 “How many hours am I going to work, how much am I going to be traveling and how much am I going to make?”

The Hours

My experience with the contractual group had me leaving my house at 5:00 am one morning, and 2:00 pm the next. On days I wasn’t scheduled, I still couldn’t leave my phone or my equipment. So although I was technically not working, I was really limited as to what I could do. I had to be always ready to go when they needed me.

At the in-house job, I start at 6:30 am Mon-Fri. I rotate emergency call, which means I’ll be here till 3:00 pm at the earliest, but usually till 5-7pm on my call days. On the days I’m not taking that call, I’m out of here at 3 pm.

So overall, the in-house is more hours, but at least I can plan for things on my non-call days. It makes a difference to have some days where you know you won’t be working. But then again, being able to sleep in once in a while was nice too.

The Travel

If you’re with a contractual neuromonitoring company, get ready to drive and/or fly. And if you’ve got a gas guzzler for a car, it’s time to rethink your ride. The government says you can factor in about $0.56 per mile on average. That number drops down to about $0.41-$0.45 if you’ve got a prius, scion tA, honda fit, etc. But that jumps up into the $0.60’s when you start moving into the trucks and SUV’s.

When you talk to the other people that are working for that company in that territory, ask them how much they drive a week or month. Say you average 20 miles a day at the local hospital, and 40 miles for the contractual company. That’s another $10/day in cost to you (really about $12 after you factor in after-tax dollars).

But I seemed to work fewer days at the contractual company. Sure, those days I worked were all over the place, and sometimes long hours, but at least my car was parked. So if I worked 4 days a week on average, that’s less than what I work at the in-house (guaranteed mon-fri, occasional weekend).

In-house = $3080 (5.5 days/wk for 50 weeks, 20 miles per day, $0.56/mile)

Contractual = $4,480  (4 days/wk for 50 weeks, 40 miles per day, $0.56/mile)

Cost = $1,400 more with contractual company (really $1,680 after tax cost). .

HOWEVER: Most contractual companies will have some traveling expenses they will cover. That can significantly eat into that difference. As a matter of fact, you might end up with more money covering cost from the contractual company. It all depends on those variables of distance, cost of gas, type of car you drive, regular commute distance, etc.

neuromonitoring company car

choose your car wisely if working for a contractual neuromonitoring company

The Pay

Speaking of salary, the general consensus seems to be that you earn more working for a contractual group. While that’s on a case-by-case, I’d agree that overall, that might have some truth to it. But you’ll need to find out for yourself, because who cares what the trends say if you’re getting different offers.

All the other perks, like 401K, health insurance, etc are pretty similar. Maybe not so with a smaller contractual company.


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The Day-To-Day

With an in-house group, it REALLY helps if you like the people you’re working with. There’s down time where you’re sitting around with these people. It’s hard to escape. With a contractual group, you can pretty much stay away from most people if you want. I only saw some people once a year at the holiday party (all good people and friends of mine, that’s just how it was).

In-house IOM job

Working at an in-house neuromonitoring group means you’re on staff at the hospital, so other people in the room see you as “one of them.” It’s been a lot easier getting scheduling to keep you updated, TIVA from anesthesia and keeping psycho nurses at bay if you’re not wearing that red cap that screams “keep an eye on this dirtbag, s/he’s here to sell you stuff.” And forget those morning visits to biomed, where you sit around waiting for a green sticker while your patient is getting wheeled into the room. You know everyone, they know you, and things are just more routine.

Did I mention you know everyone and they know you? Well, that’s not always a good thing either. You’ll be right smack in the middle of all the hospital gossip and drama. It’s near impossible to avoid.

The Responsibility

Speaking of less communication, that also means that you’re more “on your own.” That’s both good and bad. You have more freedom to “call the shots” and make decisions in your case without someone breathing down your neck, but you better make sure you’re doing the right thing. With fewer checks and balances, it’s way less annoying, but probably easier to mess things up or pick up bad habits (although my guess is that this is getting to be less and less with the amount of remote monitoring that’s going on these days). [UPDATE: If you didn’t know, I started with a group that hires mostly doctors that interpreted thier own cases. The field has shifted away from that model, and those companies are becoming less and less common. Now, you’ll have oversight on all your cases even if you are working in a contractual neuromontoring company. This is because insurance pays that way, hospitals demand it and companies want to cover their butts.]

The Exit

When that time comes to move on to your next place of employment, it’s a real PITA leaving a contractual company. Lawyers, or at least the threat of getting them involved, seem to be the norm. Must require an extended notice to terminate your contract, can’t work in this large geographic area for long periods of time, etc. Just starting with a contractual company usually doesn’t offer the best exit strategy, so in-house might be a better choice for that person looking for more of a “non-permanent” gig.

The Conclusion

I really don’t know which I liked better. That’s not the final answer you probably want to hear, but that’s all I got for you.

How about you? Is there one you would never go back to doing?

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Joe Hartman DC, DACNB, DABNM

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