Most of what I am referring to is an academic facility, yes. But, I have been at two community hospitals, one with two attendings staffing is serving 350k people, and one with three attendings staffing it serving 500k. Both places also did not have in house neurosurgery attendings. Either they had a PA seeing consults for them, or they had ER docs/trauma docs calling them in for emergencies. 

A close acquaintance of mine in neurosurgery did moonlighting at a small community hospital during his fellowship taking call. Even then, he did not stay in house. That’s not tenable for neurosurgeons because there aren’t enough of us. Nobody signs up for it. There is not a general surgery trauma attending model for neurosurgery. 

The small town guys got paid more because they were typically private practice and got significant bonus pay from the hospitals they worked at due to the need to be on primary trauma call more often. So with the extra call comes some reward.