10% cms bump for office 2026
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I think this better reflects the kind of people the specialty attracts than the field itself.
The PMR contract I just signed is between rads and optho and I didn't particularly look too hard.
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I think it's pretty hard to make 7 figures doing PMR.
(which I have done the last 5 years in Pain, but yes I have worked hard).
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Humblebrag
That’s a pretty big range tho. 116k
Yeah upside is certainly much higher in pain if you're willing to grind.
I don't know any ophtho making that low.
They do 30 surgeries a day. They make a lot of money.
Every time I see an ophtho they put me in front of like 4 machines for various images and tests. All operated by techs. They all look like ATMs to me.
This will be the future of pain. Mark my words...
More of a refute to baron’s comment that straight PMR is preferable because the “pain ship is sinking”
That said, I expect Baron Samedi was also implying was that PMR pays a strong salary for a very cush job. I see his point, yet I still think that HOPD pain docs do better than that.
Several HOPD docs have posted before on this board that they make 750-800K..... working just 4 days a week. Those are better gigs than mine regarding work/life balance. Yes, I've made low 7 figures for the past 5 years, but I've also worked 5 days/week and 55 hours/week(including travel) for those 5 years. I'm sure there are a number of HOPD docs here who are paid more per hour than I am.
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I'd be the first to buy a portable MRI for the office...
Correct doing the hourly math I made about 700 plus an hour this year. HOPD. Easiest job I’ve ever had ….
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But we are gonna get cut 9% and what about the year after that…
I'm more curious about this whole ambulatory specialty model that they're proposing to start in 2027. From what I gather, it sounds like they're going to look at all the pain docs treating chronic back pain in a region, then compare their patient outcomes/costs. If you have above average outcomes/lower costs, you will get a bonus in 2029. If you have worse ones, you get a financial penalty. You're also apparently going to be required to do some BS screening crap like ensuring that patients have addressed needs re: transportation (how is this my problem?) and food security (again, how the hell is this my problem?).
At the end of the day, I'm curious how it will all pan out. I know that it's clearly going to be used to try and decrease reimbursement overall. That said, the carrot part is somewhat appealing as I'm fairly good at gaming the system.
At the end of the day, I'm curious how it will all pan out. I know that it's clearly going to be used to try and decrease reimbursement overall. That said, the carrot part is somewhat appealing as I'm fairly good at gaming the system.
understand, but its not just about how hard you work. certain parts of the country, you can work you butt off but still not hit those numbers. payor mix in PP where you live is a lot different that NYC, chicago, etc.
mazel tov on the $$$. you work hard and are good at your job, you should make bank.
The mindset seems to be that docs who accept Medicare are essentially federal employees and can be made to do whatever. Sigh.
I think if I get back into full time pain it will have to be HOPD. In office based PP we are getting crushed by insurers and MC cuts. One major carrier told us we could either accept three consecutive large rate reductions over the next 3 years or be ONN forever. Another one told us to pound sand when we asked for a rate increase to cover rising overhead costs. Zero bargaining power for small shops, whatsoever. I have patients calling every day complaining that MC won't cover telemed visits anymore.
The choice was whether to keep doing more work with more headache to maintain the same pay or cut my losses and pivot.
Making 7 figures is mostly right job than skill
Unless really PP, office based
Unless really PP, office based
Yes this is why I left pp and joined hopd. Only way to be pp where I live is go very lean, go oon and pray.
The large groups will make you eat it, low balling the pay and citing overhead issues.
This is the first list of specialty salaries I have seen that includes PM&R but not anesthesia.
And they never include pain
This ⬆️
We are doing great. I’m in charge. We have everything we need, most things we want, adequate staff. We are also willing to see plenty of patients. The other doctor had a procedure block that didn’t form up well for Monday. My wife, who is the office manager, rustled the troops and it is now filled with E&M’s. The staff would have been content to be done at 2:00. She knows she loses if he isn’t working.
Likely rare exception on this forum
I’d gather majority of 7 figure income earners are due to distribution of facility fees rather than pro fees here
Hard to do PP office setting and acquire tons of referrals from ortho practice or hospitals (as they will likely eventually get their own pain physician)
5 days/ week at 55h/week to hit 7 figures? Something isn't right. Are you doing all of your cases in an ASC?
I am part of a facility but that’s just extra.
We probably just have standard contracts. No effort has ever been spent trying to negotiate payment rates. How would I even go about that with a 2.5 year old practice? I think the thing that helps us the most is Medicaid pays a little more than Medicare for procedures and a little less for E&M’s but Medicaid is net better as the patients don’t have balances.
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You've found the Golden Ticket!
Stay out of saturated coastal and mountain cities is the best advice I never got when starting out.
How does MCD pay same as Medicare.
I’d be rich if that were the case
Yeah, definitely not the case in my state. Medicaid pays about 72% of Medicare rates here. My upside is that our commercial insurance contracts are quite good and pay significantly more than Medicare.
Our Medicaid (CA has Medicaid managed care contractors) pays Medicare rates, plus specialty access credit, and more recently also target rate adjustments as well, which make them our best payor. The downside is there’s very little private competition in our area, almost all Blue Cross, and their rates are garbage. For some things, lower than Medicare.
My last job 7 figures easy ALL PRO FEE, PP multi group, we did a lot of PI. Current job will also be 7 figures more traditional PP pain, that’s not including the ASC. The jobs are out there for sure. My other buddy hopd 750k doing 35 hours a week with 6 weeks off is pretty sick. Other friend is academic pain and he’s in the low 200s..
Not necessarily. In the 5 past years at my current gig I've made just under double (190%) of what the previous doc made annually for a decade. Skill, efficiency, personality, advanced procedures, and of course hard work, all make a difference.
California is rough in that a lot of the commercial payors will pay worse than medicare, yet you still have the same annoying hoops to go through for those commercial payors, vs easy medicare auths.
my post mentioned that I was in PP and working 55hrs a week "with travel". I'd say that I spend a consistent 50hrs a week actually at work in clinic or doing procedures.
I don't understand the comment about "something isn't right".
Except for heavy PI practices or solo shops (which provide major tax shelter benefits), how many pp pain docs do you see making over a million dollars a year?
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Every hard working PP pain doc I know is over 1 mil/year.
Im an R1 rads res, the local pp just threw a steak dinner and starts year 1s at 500+, partners high 6 low 7s. I dont trust these charts
What are your thoughts on a rads in pain, owning their imaging center and reading their images on top of doing pain?
I think that model has been tried and failed in our market twice.
What about a rad who did an official pain fellowship
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I think it was the imaging component that failed and then brought the rest of the business down.
Maybe in the Midwest.
I know quite a few hard working PP pain docs in various areas making less than 700K.
The mean MGMA Pain is 490K for a reason.
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Everyone in my group makes >1M due to distributions so I guess i take that as luck of my job
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Every PP doc I know makes over 1M (some without ASC ownership), and a few make around 2M with WC and PI added in there.
