Intraoperative Neurophysiology as a Career

What is a Neurophysiologist? - Neurophysiologists study or examine the nervous system. Clinical Neurophysiologists are critical members of a surgical healthcare team that treats the nervous system and disorders that affect it. They are acknowledged experts on the care team when it comes to electrophysiological function of the nervous system, and as such, they are frequently consulted in highly acute and critical matters that can have a dramatic effect on patient outcome.

What is the work like? - Clinical Neurophysiologists work with surgeons to protect the patient from neurological damage during surgery. The Clinical Neurophysiologist's work place is the operating room (OR) as a member of the surgical team. The workday usually begins early in the morning and ends in the afternoon. Because so much of the workday is tied to the operating room schedule, there is tremendous variability in the day-to-day hours of the job. Surgical procedures typically last from two hours to five hours. However, once a surgical procedure is begun, it cannot be stopped until completed and occasionally complex procedures can go on for 12 or more hours. Much of that time is routine; however, problems can develop that produce high levels of stress in all of the surgical team members.

Clinical Neurophysiologists arrive at the hospital before surgery is scheduled  to begin. The typical sequence is: review the patient's medical record, confirm the surgical procedure planned, dress in scrubs for the OR, set up the monitoring equipment, and connect the patient using thin needle electrodes to the monitoring system. 

Prior to the surgical procedure, the Clinical Neurophysiologist coordinates with the Anesthesiologist to balance the need to anesthetize the patient with required level of medication to insure accurate readings for monitoring. At times, there may be conflicts between the perception of the Clinical Neurophysiologist and the Anesthesiologist since both are concerned with different aspects of the patient's care. This requires good verbal skills, comprehensive knowledge of monitoring requirements and pharmacology, as well as diplomacy.

The Clinical Neurophysiologist's primary responsibility is to warn the surgeon when some aspect of the procedure begins to affect a sensory or motor pathway. This responsibility requires the Clinical Neurophysiologist to have confidence in his or her knowledge and skill and the ability to communicate clearly and quickly.

Work Week - An average workweek is often 45-55 hours with the majority of the time spent in the operating room. Time is also spent completing reports on procedures, following up on patients, and maintaining equipment and supplies. Additional responsibilities may include teaching of resident hospital staff or Neurophysiology students or supervision of junior staff.

Salary - Salary in the field of Neurophysiology is somewhat variable. In a 2003 ASET survey, the average annual income for individuals with the technologist-level CNIM credential was $55,642 plus benefits. For those electing to practice at the advanced degree with DABNM credential-level, recent salary offerings ranged from $66,000 to $109,000 plus benefits.  Often the salary will reflect additional duties or work load such as teaching. These figures are based on 50-hour work-weeks.

Training - As the complexity of IOM grows, the standard for professional practice for the field is becoming a master's degree, supervised internship/proctorship, and board certification. Clinical Neurophysiologists must possess knowledge of neuroanatomy, pharmacology, anatomy, physiology, neurophysiology, and neuropathology. The successful student and Clinical Neurophysiologist will enjoy science, mathematics, computer science, and most of all, medicine.