private practice

[jok200]

Okay... I have been reading quite a few posts about the private and hospital practice but, I would like to read opinions on what is the successful private practice? By that I mean how to generate serious profit... I have decided to pursue a career in PM&R regardless if I make 150,000/year or 300,000 but if it is possible I would like to know. I also understand that I will have to work 70,80 and 100 hour weeks but I just need to know what the basic "framework" would be? Fellowships, I am still unsure because I have only recently started and my experience with pain management worries me about the types of patients I will be dealing with.

Thanks again for all the help.

---

Members don't see this ad.

 

[lobelsteve]

Okay... I have been reading quite a few posts about the private and hospital practice but, I would like to read opinions on what is the successful private practice? By that I mean how to generate serious profit... I have decided to pursue a career in PM&R regardless if I make 150,000/year or 300,000 but if it is possible I would like to know. I also understand that I will have to work 70,80 and 100 hour weeks but I just need to know what the basic "framework" would be? Fellowships, I am still unsure because I have only recently started and my experience with pain management worries me about the types of patients I will be dealing with.

Thanks again for all the help.

Starting by talking about money will get you nowhere.

Start with your training: List undergrad, med school, residency.
What are your personal statements like? What are your goals for a practice?
For $150-300- get a job on wall street. You can make more than that in PMR, but your intentions need to be to care for the patient first.

Aren't we doctors?

What are your clinical interests? If you hate patients and want to make a mint- just be a slick marketing dude and do EMG 5 days per week.

 

[jok200]

I have already been accepted into a pm&r program... I apologize for annoying anyone but I have a MASSIVE amount of loans from undergrad.. and I need a way a paying it off before it becomes impossible. I don't want 500,000 salary but around 300,000 would help to pay off loans and help care for my family.

Thanks again-

 

[jok200]

again sorry to upset anyone.

-Thanks

 

[SSdoc33]

if you are worried about your family, then dont work 100 hour weeks.

i cant imagine a position that would require that, or even want that of you.

if you are interested in making more money for more work, make sure that you are not on a strict alary, and there are reasonable incentives for increased productivity.

 

[RUOkie]

I for one am not in any way upset by your questions. I can see nothing wrong with being a good doctor and still being concerned about having a profitable business.

In this economy it is tough. Also, none of us can tell you what will happen in the next 5 yrs.

Interestingly the things that have made me financially sucessful are things that have next to nothing to do with medicine. I am a good doctor first, second, and last.

So what worked for me is this.

1. cater to your referral sources. I do inpt consults and some inpt rehab management because the PCP's, neurosurgeons, and Ortho docs ask me to. I don't like it but I do it anyway because that way they send me the good stuff (outpt MSK, and EMG)
2. Run a lean ship. My expenses are very low. I live in a semi-rural area. My wife owns my building, so I pay rent to her. We watch every penny. I am the only person in the practice who can sign checks.
3. Get involved in your medical and non medical community. Go to county/regional medical association meetings. Become an active member of your medical staff. Volunteer for boards of local charities. Show your patients and the other docs that you care about more than yourself.
4. Take advantage of opportunities. Our local docs built an imaging center and a small hospital. While they were risky investments, they have paid off by "joining the club" and getting increased referrals. That might mean joining the local country club and playing golf 1 day/wk. Those golfing buddies (or whatever the docs do in your community) will be loyal to you.

There is probably more, but I can't recall. Also, if ACOs really come about, I'm gonna be SOL

 

[PMRinDMkn]

In my opinion there is nothing wrong with asking about financial compensation in a specialty that interests you.

Although he did not state it as diplomatically, Steve Lobel is correct in that a love for treating patients is necessary and the money made is a by product. However, obtaining a pain medicine fellowship, which Steve did, is one of the surest ways to a financially lucrative practice, so chastising someone for asking about how lucrative a specialty can be is not necessary.

I am not a PM&R doc (yet). I work with a few physiatrists and orthopedic surgeons and will likely pursue PM&R following completion of med school. Rest assured if you are good at what you do, you will make good money, may be not surgeon money, but it will be lucrative ($150k is a low point and you can hit high six figures depending on the procedures you administer, EMGs as Steve stated, performing disability evaluations etc..)

 

[101N]

"Although he did not state it as diplomatically"

Recurring theme.

 

[bronx43]

I for one am not in any way upset by your questions. I can see nothing wrong with being a good doctor and still being concerned about having a profitable business.

In this economy it is tough. Also, none of us can tell you what will happen in the next 5 yrs.

Interestingly the things that have made me financially sucessful are things that have next to nothing to do with medicine. I am a good doctor first, second, and last.

So what worked for me is this.

1. cater to your referral sources. I do inpt consults and some inpt rehab management because the PCP's, neurosurgeons, and Ortho docs ask me to. I don't like it but I do it anyway because that way they send me the good stuff (outpt MSK, and EMG)
2. Run a lean ship. My expenses are very low. I live in a semi-rural area. My wife owns my building, so I pay rent to her. We watch every penny. I am the only person in the practice who can sign checks.
3. Get involved in your medical and non medical community. Go to county/regional medical association meetings. Become an active member of your medical staff. Volunteer for boards of local charities. Show your patients and the other docs that you care about more than yourself.
4. Take advantage of opportunities. Our local docs built an imaging center and a small hospital. While they were risky investments, they have paid off by "joining the club" and getting increased referrals. That might mean joining the local country club and playing golf 1 day/wk. Those golfing buddies (or whatever the docs do in your community) will be loyal to you.

There is probably more, but I can't recall. Also, if ACOs really come about, I'm gonna be SOL

Can you expand on this a little bit? Thanks.

 

[Mattchiavelli]

Learning how to properly bill and code your visits is going to be very big on your being financially successful in private practice. Proper billing and coding will be the difference of, for the same visit, $25 vs $75 vs $125 and getting blasted for insurance fraud. It has 0 to do with pathophysiology and everything to do with the business of medicine. I think to be financially successful in medicine you have to be money conscious but never be money driven because I think your integrity as a physician takes a hit when you're money driven (like ordering diagnostics that will make you $$ but aren't needed). You're a highly trained professional that deserves to be justly compensated for the work you do, but don't take advantage of people that put their trust in you to use that training to do what is best for them.

Honestly, running a private practice is a business and it's best to hit the library and read up about entrepreneurship. You don't need a business degree to understand business, if you're smart enough to get through med school you're smart enough to pick up some business knowledge on your own or self-teach and skip some of the inherent BS in business school.

In general, with all specialties, the way reimbursement works is procedures pay more per unit time than cognitive work, and any fellowship that gives you access to more procedures (diagnostic or therapeutic) will increase your earning power. This is why getting into GI fellowship is cutthroat for IM (access to scope-based procedures) and not so much for, say, rheumatology. However, this reimbursement may or may not hold up indefinitely.

 

[lobelsteve]

"Although he did not state it as diplomatically"

Recurring theme.

Too many concussions when younger, too many PMR people who rollover and play dead, too many cups of coffee. I asked the same question when interviewing as an IM preliminary guy getting my PMR spot. Nothing wrong with asking just know it's distasteful and unneeded as there are many threads
On this forum that will get you all of these answers.

 

[jok200]

Hey everyone thanks for the info... this is what I was looking for exactly. I have been told so many varying things by many physiatrists as far as compensation that I was very unsure. I was told by one physiatrist that works over 70 hours a week is what it takes to make 300k and more and a boat load of EMG's, and injections.... others that work less time make less money for their own personal reasons. This is the main reason I asked my question. Again I apologize for upsetting anyone.

Thank you again everyone,
-

 

[PMR 4 MSK]

IMHO:

Every PM&R has the potential to make $400K+/year, most don't because of poor money management.

#1 cause of loss potential income - poor billing. Doctor doesn't know the codes -CPT and ICD-9. Person doing the billing doesn't know enough to go after what wasn't paid, or is not incentivized enough.

#2 cause of loss of potential income - high overhead. Too many employees, too high salaries or benefits, taxes not done well, rent too high, too much debt. Every dollar of OH is one dollar not in your pocket.

#3 cause of loss of potential income - poor insurance contracts (HMOs, e.g.)and/or payor mix. PM&R in particular tends to have a bad payor mix - many of our patients are disabled = Medicare and/or Medicaid.

 

[ml2001]

IMHO:

Every PM&R has the potential to make $400K+/year, most don't because of poor money management.

#1 cause of loss potential income - poor billing. Doctor doesn't know the codes -CPT and ICD-9. Person doing the billing doesn't know enough to go after what wasn't paid, or is not incentivized enough.

#2 cause of loss of potential income - high overhead. Too many employees, too high salaries or benefits, taxes not done well, rent too high, too much debt. Every dollar of OH is one dollar not in your pocket.

#3 cause of loss of potential income - poor insurance contracts (HMOs, e.g.)and/or payor mix. PM&R in particular tends to have a bad payor mix - many of our patients are disabled = Medicare and/or Medicaid.

Sounds like a lot of money (400K+/yr ) for people just getting ready to graduate from the residency as we mostly hear about below 200K or even 150K (in case of inpt) through out the residency, but I guess one could achieve those numbers if what PMR4MSK highlighted above.

The number one rule in Medicine is always "Patient care comes first" and money will always follow you if you stick to this rule.

-ML

 

[bronx43]

IMHO:

Every PM&R has the potential to make $400K+/year, most don't because of poor money management.

#1 cause of loss potential income - poor billing. Doctor doesn't know the codes -CPT and ICD-9. Person doing the billing doesn't know enough to go after what wasn't paid, or is not incentivized enough.

#2 cause of loss of potential income - high overhead. Too many employees, too high salaries or benefits, taxes not done well, rent too high, too much debt. Every dollar of OH is one dollar not in your pocket.

#3 cause of loss of potential income - poor insurance contracts (HMOs, e.g.)and/or payor mix. PM&R in particular tends to have a bad payor mix - many of our patients are disabled = Medicare and/or Medicaid.

This is probably true for all outpatient based medical specialties.

Ruokie never explained the comment about the ACO and PMR docs being SOL. Do you know what he is referring to with that statement? Thanks.

 

[Paddington]

I was crunching some numbers and it seems hard even to get to $200,000.

Let's say you see 15 return patients in a day. The billing for that would be $30-$100 or so. We'll presume $50 to be conservative. You also see 4 new patients billing $100 for each. You do 2 NCS/EMG. I'm not as sure about the billing for those, but will presume $200 each. Multiple total by 5 days then 50 weeks.

That works out to about $270K in total billings. Let's say you have 50% overhead. So your income then is only around $135K. To boost that up to a $200K would require a lot of "stretching" in terms of improving insurer mix (easier said than done, especially for a young doc joining any new practice and taking on new cases that prolly other folks don't want), cramming in more patients each hour, working longer hours, taking on an inpatient load/rounding on weekends, etc.

I just don't see the path to $400K for regular PM&R outpatient. I know people who probably make that kind of money, but they are very old and senior partners in big groups with lots of underlings.

 

[bronx43]

I was crunching some numbers and it seems hard even to get to $200,000.

Let's say you see 15 return patients in a day. The billing for that would be $30-$100 or so. We'll presume $50 to be conservative. You also see 4 new patients billing $100 for each. You do 2 NCS/EMG. I'm not as sure about the billing for those, but will presume $200 each. Multiple total by 5 days then 50 weeks.

That works out to about $270K in total billings. Let's say you have 50% overhead. So your income then is only around $135K. To boost that up to a $200K would require a lot of "stretching" in terms of improving insurer mix (easier said than done, especially for a young doc joining any new practice and taking on new cases that prolly other folks don't want), cramming in more patients each hour, working longer hours, taking on an inpatient load/rounding on weekends, etc.

I just don't see the path to $400K for regular PM&R outpatient. I know people who probably make that kind of money, but they are very old and senior partners in big groups with lots of underlings.

How does that work out to $270k? (15 * 50 + 4* 100 + 2 * 200) * 250 days = 387,500.

 

[PMR2008]

Most outpatient(w/o fluro guided injections) private practice physicians I know see 7-10 followups, 3-4 new patients and do either 2-3 halfs days of EMGs a week. In you calculation you are not including injections(trigger point, joints, botox, phenol etc), ultrasound guided injections and PRP . Most outpatient attendings also do IMEs which can pay a lot. EMGs easily pay from 300 to up to 1500 for workman comp cases. So hitting the $200,000 is easy even with a 50% overhead. There are some docs out there that do 3 days a week of EMGs and make upwards of 300,000.

I was crunching some numbers and it seems hard even to get to $200,000.

Let's say you see 15 return patients in a day. The billing for that would be $30-$100 or so. We'll presume $50 to be conservative. You also see 4 new patients billing $100 for each. You do 2 NCS/EMG. I'm not as sure about the billing for those, but will presume $200 each. Multiple total by 5 days then 50 weeks.

That works out to about $270K in total billings. Let's say you have 50% overhead. So your income then is only around $135K. To boost that up to a $200K would require a lot of "stretching" in terms of improving insurer mix (easier said than done, especially for a young doc joining any new practice and taking on new cases that prolly other folks don't want), cramming in more patients each hour, working longer hours, taking on an inpatient load/rounding on weekends, etc.

I just don't see the path to $400K for regular PM&R outpatient. I know people who probably make that kind of money, but they are very old and senior partners in big groups with lots of underlings.

 

[Paddington]

How does that work out to $270k? (15 * 50 + 4* 100 + 2 * 200) * 250 days = 387,500.

 

[RUOkie]

Can you expand on this a little bit? Thanks.

sorry, been off the board for a few days.

Nobody knows how ACOs are really going to translate into real payments, but the thought is that the hospitals are going to hold the upper hand. The system (as it appears) seems to reward hospital employed physicians, or large multispecialty groups.

If this system (again, as it appears) is created, it will be the death knell for the solo practitioner. I cannot do a cash only practice in my community. Likely I would need to join an IPA with the other small groups in the community in order to have some bargaining power with the hospitals.

 

[bronx43]

sorry, been off the board for a few days.

Nobody knows how ACOs are really going to translate into real payments, but the thought is that the hospitals are going to hold the upper hand. The system (as it appears) seems to reward hospital employed physicians, or large multispecialty groups.

If this system (again, as it appears) is created, it will be the death knell for the solo practitioner. I cannot do a cash only practice in my community. Likely I would need to join an IPA with the other small groups in the community in order to have some bargaining power with the hospitals.

Thanks for the response.
It seems like if ACOs' biggest threat is forcing physicians to join larger groups, then the hurdle isn't insurmountable and you wouldn't be SOL. Even currently, wouldn't being in a larger multispecialty group make life easier for you?

 

[RUOkie]

Thanks for the response.
It seems like if ACOs' biggest threat is forcing physicians to join larger groups, then the hurdle isn't insurmountable and you wouldn't be SOL. Even currently, wouldn't being in a larger multispecialty group make life easier for you?

absolutely not. The advantage I have in my current community is to watch costs. This allows me to spend more time with patients. Also, my wife is my office manager and owner of my office. Neither would fly in a MS group practice. Right now my expense ratio is close to 20% (excluding salaries-since we are paying ourself). Try doing that in any group practice.

 

[Finally M3]

Most outpatient(w/o fluro guided injections) private practice physicians I know see 7-10 followups, 3-4 new patients and do either 2-3 halfs days of EMGs a week. In you calculation you are not including injections(trigger point, joints, botox, phenol etc), ultrasound guided injections and PRP . Most outpatient attendings also do IMEs which can pay a lot. EMGs easily pay from 300 to up to 1500 for workman comp cases. So hitting the $200,000 is easy even with a 50% overhead. There are some docs out there that do 3 days a week of EMGs and make upwards of 300,000.

Unless you have gold-plated insurance contracts, this is wildly optimistic on 10-14 patients a day. I see 10-14 patients a half day.

Whatever you calculate (patients, collections/patient), multiply by .70 and you may be a bit more realistic.

EMGs are a goldmine, but;
1) You need an awesome referral base (I'm happy with 8-10 a week, and I'm the only PMR with 11 orthos)
2) You need to check your ethics at the door to make a ton; One of my competitors likes to do 3 limb EMG/NCV/F & H waves on unilateral mononeuropathy patients. Always helpful results as well (mild, chronic C5-8 radic, mild peripheral neuropathy, LS plexopathy, bilateral CTS). For medicare, this will probably reimburse $1000. Unethical IMHO and unnecessary.
3) If you're like me, 3 full days of EMG a week, and I will blow my brains out. CTS ad nauseum gets really repetitive.

Great patient care will bring more people to your door. But that's only half the battle. Knowing how to code E&M patients COLD is crucial. Keeping up on CPTs is very important (27096 w/ 77003 v. 20610 is a $50+ difference for SI injections IF you include arthrogram findings).

Most academic programs won't be able to teach you this, so the onus is on you.

 

[lobelsteve]

Unless you have gold-plated insurance contracts, this is wildly optimistic on 10-14 patients a day. I see 10-14 patients a half day.

Whatever you calculate (patients, collections/patient), multiply by .70 and you may be a bit more realistic.

EMGs are a goldmine, but;
1) You need an awesome referral base (I'm happy with 8-10 a week, and I'm the only PMR with 11 orthos)
2) You need to check your ethics at the door to make a ton; One of my competitors likes to do 3 limb EMG/NCV/F & H waves on unilateral mononeuropathy patients. Always helpful results as well (mild, chronic C5-8 radic, mild peripheral neuropathy, LS plexopathy, bilateral CTS). For medicare, this will probably reimburse $1000. Unethical IMHO and unnecessary.
3) If you're like me, 3 full days of EMG a week, and I will blow my brains out. CTS ad nauseum gets really repetitive.

Great patient care will bring more people to your door. But that's only half the battle. Knowing how to code E&M patients COLD is crucial. Keeping up on CPTs is very important (27096 w/ 77003 v. 20610 is a $50+ difference for SI injections IF you include arthrogram findings).

Most academic programs won't be able to teach you this, so the onus is on you.

If you do a SIJ without fluoro I will cut off your little finger. I know you always do it that way, and were just using the major joint code as an example.

 

[axm397]

I average 13-17 patients/half day(about 1/3 new 2/3 follow ups), do 4-8 EMGs/week, and 10-15 injections/procedures per week but my overhead is 60+%. Our payor mix is fair, and our contract sucks because I am in a saturated area. IMEs vary by state and Texas has state designated fee schedules for DD exams and MMI/IR visits.

$$ depends on: where you are, what your overhead is, what your payor mix is, how busy you are (referral source), how good your contracts are (depends on area and whether you can afford to go out of network - we can't), and how ethical you are.

 

[101N]

I average 13-17 patients/half day(about 1/3 new 2/3 follow ups), do 4-8 EMGs/week, and 10-15 injections/procedures per week but my overhead is 60+%. Our payor mix is fair, and our contract sucks because I am in a saturated area. IMEs vary by state and Texas has state designated fee schedules for DD exams and MMI/IR visits.

$$ depends on: where you are, what your overhead is, what your payor mix is, how busy you are (referral source), how good your contracts are (depends on area and whether you can afford to go out of network - we can't), and how ethical you are.

"and how ethical you are."

1+

 

[Finally M3]

If you do a SIJ without fluoro I will cut off your little finger. I know you always do it that way, and were just using the major joint code as an example.

yeah it was just an example. I need my pinkies to do my Dr. Evil impersonation.

 

[PMR 4 MSK]

If you use Medicare as your base for proformas, you can get decent numbers being conservative.

Say you are working full time 8 - 5 M-F. <shudder>

You do 10 hours/week of EMG @ $500/hr = $5000/wk

You do 10 hour per week of injections under fluoro or US @ $250/hr = $2500/wk

You do 20 hours of clinic patients 1/2 new, 1/2 f/u. $60/f/u and $150 per new. = $600 + $1500/week = $2100/week.

That = $9600/week. Take 4 weeks off per year and you have $460,800. Then take out OH.

Your mileage may vary.

 

[RUOkie]

If you use Medicare as your base for proformas, you can get decent numbers being conservative.

Say you are working full time 8 - 5 M-F. <shudder>

You do 10 hours/week of EMG @ $500/hr = $5000/wk

You do 10 hour per week of injections under fluoro or US @ $250/hr = $2500/wk

You do 20 hours of clinic patients 1/2 new, 1/2 f/u. $60/f/u and $150 per new. = $600 + $1500/week = $2100/week.

That = $9600/week. Take 4 weeks off per year and you have $460,800. Then take out OH.

Your mileage may vary.

Those are great numbers for examples. And from a business perspective that is why I live where I do. It is far easier for me to control the overhead side than the collections side without compromising ethics.

 

[jok200]

sorry, what does OH mean?

 

[RUOkie]

sorry, what does OH mean?

OverHead

 

[jok200]

gracias-

 

[101N]

A recurring theme here is volume: 15pts/half day. This is the number we all want to keep our clinics busy and our procedure suits busy with ethical work.

And this is where ACOs are going to hurt the independents - like me - because there will be incentives to keep these patients in the fold & not refer out, if there is a shared savings/earnings.

 

[bedrock]

If you use Medicare as your base for proformas, you can get decent numbers being conservative.

Say you are working full time 8 - 5 M-F. <shudder>

You do 10 hours/week of EMG @ $500/hr = $5000/wk

You do 10 hour per week of injections under fluoro or US @ $250/hr = $2500/wk

You do 20 hours of clinic patients 1/2 new, 1/2 f/u. $60/f/u and $150 per new. = $600 + $1500/week = $2100/week.

That = $9600/week. Take 4 weeks off per year and you have $460,800. Then take out OH.

Your mileage may vary.

Agree with PMR4MSK regarding the medicare baseline rates for clinic and EMGs but injection $/hr is a bit low. This certainly depends on your site of service, as you make the most doing procedures in the office. I can do a lumbar TFESI every 15 minutes, which even at medicare rates of $233 yields just over $930/hr.

EMGs are a goldmine, but;

For you PMR/pain guys out there, how close is your $/hr for EMGs compared to $/hr for procedures?
Maybe I'm more efficient with procedures or just slow with my EMGs. I figure that on average(considering all insurance carriers) I bring in $750-900/hr doing EMGs and 30% more doing in-office interventional procedures.

 

[Finally M3]

I do procedures in an ASC, so my hourly is like $400-450/hr going every 15 minutes.

EMGs, I can do 2 an hour, so hourly is like $700-900 (bilateral UE being the most lucrative). Some insurances pay so far above Medicare that I've received $600 for one CTS screen.

 

[ghost dog]

I do procedures in an ASC, so my hourly is like $400-450/hr going every 15 minutes.

EMGs, I can do 2 an hour, so hourly is like $700-900 (bilateral UE being the most lucrative). Some insurances pay so far above Medicare that I've received $600 for one CTS screen.

I don't know how saturated things are in the U.S. , but in Canada insurance based MVA / IMEs pay very well.

However, they aren't terribly rewarding clinically. If you've done 10, you've pretty much done them all.

So what have you taken for pain ?

"Uh... tylenol and advil."

Have you seen your family doc since the MVA?

"Yeah...once"

And you've had 19 months of physio????

Ok........

 

[bedrock]

I do procedures in an ASC, so my hourly is like $400-450/hr going every 15 minutes.

How do you get them to turn the room over every 15 minutes? I do a 2 half-days a month at an ASC for procedures that need IV sedation, and I've really hounded them about efficiency but can't get them to turn the room over that fast. I end up scheduling procedures q 30 minutes or longer at the ASC. I can get them down to q20 minutes for a lumbar interlaminar ESI which takes me 2 minutes and them 18 minutes to turn the room over, but most procedures take 30 minutes or longer at the ASC.

I don't know how saturated things are in the U.S. , but in Canada insurance based MVA / IMEs pay very well.

I've never done them. Sounds boring but solid $.

Anybody here do IMEs and what do you make per hour doing them?

 

[RUOkie]

How do you get them to turn the room over every 15 minutes? I do a 2 half-days a month at an ASC for procedures that need IV sedation, and I've really hounded them about efficiency but can't get them to turn the room over that fast. I end up scheduling procedures q 30 minutes or longer at the ASC. I can get them down to q20 minutes for a lumbar interlaminar ESI which takes me 2 minutes and them 18 minutes to turn the room over, but most procedures take 30 minutes or longer at the ASC.



I've never done them. Sounds boring but solid $.

Anybody here do IMEs and what do you make per hour doing them?

I do a fair # of IMEs. If you want to do them, take a course (they suck) to become CIME (american college of disabiltiy examiners) and you will get more than you want. I try to limit to 1 each week.

Most of the $ is from the record review/report generation. I will not post my hourly rate on a forum. But my IME rates are not that high (reasonable but not ridiculous) but I charge a butt load for testimony and depositions (especially if video, since your depo can be used in lieu of testimony in court). Testimony is a minimum of 4 hrs and is billed portal to portal PLUS expenses (gas/hotel/meals). That discourages having to testify.

 

[bedrock]

I do a fair # of IMEs. If you want to do them, take a course (they suck) to become CIME (american college of disabiltiy examiners) and you will get more than you want. I try to limit to 1 each week.

Most of the $ is from the record review/report generation. I will not post my hourly rate on a forum. But my IME rates are not that high (reasonable but not ridiculous) but I charge a butt load for testimony and depositions (especially if video, since your depo can be used in lieu of testimony in court). Testimony is a minimum of 4 hrs and is billed portal to portal PLUS expenses (gas/hotel/meals). That discourages having to testify.

Thanks, that is helpful as I wasn't clear on those points.
I do worry about the hassle factor with IMEs, and I'd rather not spend time testifying.

I understand if you don't want to post specifically how much/hr you make doing IMEs, but can you indicate if you generally make more or less than the $/hr for EMGs listed by finally M3 and myself a couple posts up?

 

[cbest]

Ghostdog,

Fellow Canuck here doing PM&R in the US and planning on doing a Pain fellowship. How good a pay are we talking about for IME/MVA/Work Comp? Just curious

 

[ghost dog]

Ghostdog,

Fellow Canuck here doing PM&R in the US and planning on doing a Pain fellowship. How good a pay are we talking about for IME/MVA/Work Comp? Just curious

Worker's comp work absolutely sucks.

Insurance based IMEs:I charge between
$1050 - 1200 at 300 / hour.

However these are "lawyer's hours".

I say it takes about 2 - 2.5 hours for
these reports.

 

[goosemac]

Need help with some abbreviations please, what do:

ACO
SOL
ASC
IME

stand for?

 

[bedrock]

Insurance based IMEs:I charge between
$1050 - 1200 at 300 / hour.

However these are "lawyer's hours".

I say it takes about 2 - 2.5 hours for
these reports.

Lawyer's hours, now I understand....

 

[PMR2008]

ACO: Accountable care organization
SOL: S@!t Out of Luck. This one you should have known.
ASC: Ambulatory Surgery Center
IME: Independent medical examination

Need help with some abbreviations please, what do:

ACO
SOL
ASC
IME

stand for?

 

[SSdoc33]

How do you get them to turn the room over every 15 minutes?

what do you mean "turn the room over". take off old sheet, put on new sheet -- done. thats the problem with ASCs. they are so used to mini-surgeries, that they are often not equipped for the quick procedures we do.

i do 4/hour as well. the more you can control about EXACTLY how things run, the more efficient you can be.

 

[ghost dog]

Lawyer's hours, now I understand....

1. These reports are a PITA.

2. In my area , demand for assessors exceeds supply.

3. You think lawyers
are billing for the actual # Of hours performed ?
Yeah, right.

Understand now?

 

[RUOkie]

Thanks, that is helpful as I wasn't clear on those points.
I do worry about the hassle factor with IMEs, and I'd rather not spend time testifying.

I understand if you don't want to post specifically how much/hr you make doing IMEs, but can you indicate if you generally make more or less than the $/hr for EMGs listed by finally M3 and myself a couple posts up?

In actual time spent DURING THE WORK DAY, the compensation is very similar to EMG's. BUT, I do all my record review/video watching/report generation on the weekends, usually while a sporting event of some type is on in the background (well not if it is a video). The actual per hour rate of EMG's is better than anything else a physiatrist will do. But try doing 10 EMG's a day. Even EMG guru's like Jeff Strakowski have branched out into other things (he now does lots of US). There is only so much of that business to go around. In my extended community (20mile radius) there are 4 electromyographers and one orthopod that uses a mobile service . I do the IMEs to supplement income (basicly they pay for my vacations)

The best IMEs have massive amounts of records (I figure it takes 1hr to review 1" of records) AND a surveillance video (since you can watch it in 2x speed but bill for the length of the video). They are a pain in the ass, but they are cash money (no $, no report)

 

[PMR 4 MSK]

Agree with PMR4MSK regarding the medicare baseline rates for clinic and EMGs but injection $/hr is a bit low. This certainly depends on your site of service, as you make the most doing procedures in the office. I can do a lumbar TFESI every 15 minutes, which even at medicare rates of $233 yields just over $930/hr.

I base mine on about $125 per pt medicare for ILESI - I just checked and it's actually closer to $135 if we get the co-pays. So for me, 2/hr = $250.

Yeah, I'm slow, due to ASC - see below. I do 2/hour, with 15 min of playing on my phone b/w pts.

For you PMR/pain guys out there, how close is your $/hr for EMGs compared to $/hr for procedures?
Maybe I'm more efficient with procedures or just slow with my EMGs. I figure that on average(considering all insurance carriers) I bring in $750-900/hr doing EMGs and 30% more doing in-office interventional procedures.

I can make much more per hour doing EMGs.

what do you mean "turn the room over". take off old sheet, put on new sheet -- done. thats the problem with ASCs. they are so used to mini-surgeries, that they are often not equipped for the quick procedures we do.

i do 4/hour as well. the more you can control about EXACTLY how things run, the more efficient you can be.

Our ASC does a full clean of the room - spraying down the table and equiptment. Changing sheets, getting supplies ready. If I stood there, lit a fire under their @$$es and even helped out, I can cut it down from 15 min to maybe 10.

 

[Finally M3]

How do you get them to turn the room over every 15 minutes? I do a 2 half-days a month at an ASC for procedures that need IV sedation, and I've really hounded them about efficiency but can't get them to turn the room over that fast. I end up scheduling procedures q 30 minutes or longer at the ASC. I can get them down to q20 minutes for a lumbar interlaminar ESI which takes me 2 minutes and them 18 minutes to turn the room over, but most procedures take 30 minutes or longer at the ASC.

Old sheet, wipe down table, new sheet while I yap/examine/fill out paperwork for next patient.

The procedure is the easy part, as you know.

 

[ghost dog]

In actual time spent DURING THE WORK DAY, the compensation is very similar to EMG's. BUT, I do all my record review/video watching/report generation on the weekends, usually while a sporting event of some type is on in the background (well not if it is a video). The actual per hour rate of EMG's is better than anything else a physiatrist will do. But try doing 10 EMG's a day. Even EMG guru's like Jeff Strakowski have branched out into other things (he now does lots of US). There is only so much of that business to go around. In my extended community (20mile radius) there are 4 electromyographers and one orthopod that uses a mobile service . I do the IMEs to supplement income (basicly they pay for my vacations)

The best IMEs have massive amounts of records (I figure it takes 1hr to review 1" of records) AND a surveillance video (since you can watch it in 2x speed but bill for the length of the video). They are a pain in the ass, but they are cash money (no $, no report)

That's interesting; I think I have only had 1 -2 IMEs with video files attached to them, and have must done at least 200 -300 hundred IMEs over the years. Weird.

I've thought to myself , on more than a few occasions , that some cases would have "benefited" from video surveillance.