The professional practice of intraoperative monitoring (IOM) has evolved over the past 30 years. This report describes the field's current state and how site of service affects practice.A survey queried American Academy of Neurology IOM neurologist members about their IOM volume, case type, duration, numbers of simultaneous cases, and location of the monitoring physician.Physicians located locally typically monitored fewer cases annually and simultaneously compared to physicians who monitored from remote locations. Physicians at remote locations monitored proportionally more spine procedures, whereas physicians who monitored locally monitored more intracranial procedures and a greater variety of cases.The remote monitoring practice model is different from local models in annual volume, simultaneous cases, work per case, and types of cases.