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Collections or take home pay
10% cms bump for office 2026
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According to what you guys are all saying, I guess all the HOPD docs are just schmucks for making so little $.......
And the biggest schmucks are hundreds of docs that must be making only 200K due to the mean MGMA pay being approx $490,000 to average out all those baller PP pain docs making 1-2 million per year?
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exactly, big difference
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Take home before taxes. Don’t shoot the messenger …
MGMA data probably is skewed a bit low. But yes there are certainly plenty of docs out there making much less than they could elsewhere. One of my fellowship colleagues took a position for $250k in Manhattan because that’s where he decided he absolutely had to live and work. Terrible job with ridiculous hours. Plenty of folks in big cities or academia settling for less, either in exchange for location or easier clinical burden (our fellowship attendings saw about maximum 20 patients per day on a busy day, and injections were probably about 15-20 per day; that volume is only going to cut it in academics).
PP can absolutely make more bank than anybody. You have to be very skilled, hard working, willing to take on the financial risk, and sociable. You’re going to work a lot more than HOPD. You can absolutely break 7 figures yearly working 4 8’s per week in the HOPD. You can make more than that and in a tax-advantaged way in PP. It’s not a shmuck move to decide that HOPD job is preferable to the extra work and risk associated with PP. Different strokes for different folks.
MGMA data gets screwed up very easy. I pay myself $400k a year W2. That number is probably what would get reported to MGMA.
I know this was definitely possible in the hay day of in house urine toxicology.
Everyone does well here also. But…. We all have c-arms in our offices.
I’ve said it so many times….almost as many as drusso does SOS….
Geography, geography, geography…
My former junior resident is making way over a mill pro fee before his exorbitant asc distribution..hotlanta..he’s been trying to get me to go there for years..
Alas balls and chains…
Geography, geography, geography…
My former junior resident is making way over a mill pro fee before his exorbitant asc distribution..hotlanta..he’s been trying to get me to go there for years..
Alas balls and chains…
Making money:
I wonder if we can open up a thread about making money relative to other responsibilities we individually have relatively speaking.
I took a hopd job because as the primary source of income in my family. That being said here’s my schedule:
Monday- procedures all day approaching 40(mostly bread and butter with rfa)
Tuesday - 40 all day clinic (730-4)
Wed - 7:30-12pm (20 patients) pick up kids, provide all child care till wife gets home at 5, she’s tired, dinner, I put both of them to sleep
Thursday- ditto of Wednesday
Friday- all day clinic- 30-35 patients
Monday and Friday I drive over an hour each way up at 5:30 am all week.
“Call” which is triage but for whole hospital system spine service, occasionally full weekends
46..kids are 7 and 3…live in NJ, a pack of gum here costs like $10..good times…
I’m tired as ****..
The dick swinging on this thread about 750
Or 1 million..
Let’s talk about what we go through to make any of this **** happen
I wonder if we can open up a thread about making money relative to other responsibilities we individually have relatively speaking.
I took a hopd job because as the primary source of income in my family. That being said here’s my schedule:
Monday- procedures all day approaching 40(mostly bread and butter with rfa)
Tuesday - 40 all day clinic (730-4)
Wed - 7:30-12pm (20 patients) pick up kids, provide all child care till wife gets home at 5, she’s tired, dinner, I put both of them to sleep
Thursday- ditto of Wednesday
Friday- all day clinic- 30-35 patients
Monday and Friday I drive over an hour each way up at 5:30 am all week.
“Call” which is triage but for whole hospital system spine service, occasionally full weekends
46..kids are 7 and 3…live in NJ, a pack of gum here costs like $10..good times…
I’m tired as ****..
The dick swinging on this thread about 750
Or 1 million..
Let’s talk about what we go through to make any of this **** happen
I am down to 25 total per day M-T, Friday off or 2 surgeries max (SCS/Kypho).
Getting better at welding, running. Latte art still sucks.
Kids 20 and 22. Golden retriever getting lots of gelato and pupcups.
Finishing wiring the 400v system for my car project in next few weeks.
I see over 200 clinic patients a week then most Fridays are at an ASC.
I appreciated what you wrote.
Life is not just about making money. I have a change coming to where I will work 4 days a week. I'll likely just drop under a seven figure income, but will have a much more balanced life.
There is so much more to life than money. Family, hobbies, fitness, friends, pets, travel, personal growth, etc.
what's the location?
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As you get older the outside obligations diminish. My kids are out of the house. I work 3 and 1/2 days. Take lots of time off. Make good money per time ratio. Home y five every day. Try and work out 3 nights a week. Hang out with spouse and or friends other times. Money matters but balance is better
Good thing about HOPD is that you get paid for the work you do rather than relying on billing departments and insurance BS.
Some people like that more than waiting to get the extra coins later.
Where in Jersey?
Whats the comp for a workload like that with your group?
I'm realizing this in my mid 30s already that I dont want to trade my precious time in my prime for extra dollars to spend in my 60s.
Take home >1 M everyone, most >1.4 before taxes
Geography is not ideal but works for me since family is close by and I have children that are young
I agree, dying field though. We’re about to get screwed in next few years.
I only do about 120 patient encounters a week (90 procedures, 30 clinic visits)- 1 OR day/month for implants, etc.
mostly esis and facets
All I’m saying is I’m not particularly skilled- just the job I have. My first job out of fellowship I made less but was working harder marketing, caring more, etc. this job is dummy proof as of now. Likely those making less here on the forum are skilled, just not have right opportunities due to geographic constraints
Geography is not ideal but works for me since family is close by and I have children that are young
I agree, dying field though. We’re about to get screwed in next few years.
I only do about 120 patient encounters a week (90 procedures, 30 clinic visits)- 1 OR day/month for implants, etc.
mostly esis and facets
All I’m saying is I’m not particularly skilled- just the job I have. My first job out of fellowship I made less but was working harder marketing, caring more, etc. this job is dummy proof as of now. Likely those making less here on the forum are skilled, just not have right opportunities due to geographic constraints
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I’m employed working 5 days per week in NE PA/NJ region. 40s with 3 kids under 5. Wife also works.
Monday 24 procedures 8-3
Tuesday 30-40 patients in clinic
Wednesday 24 procedures 8-3
Thursday 27 patients 8-4
Friday 17 patients 7-12
Long days and short weeks. Workout 5 days per week and still try to cook 3 days per week at least. Not quite at 750+. Have been interested in pp but standard of living is fixed and still have loans/daycare bills. Opportunity cost of starting my own pp or joining another group does seem daunting but the itch is there.
That’s great..how do you have time to work out 5 days a week? When do you do it? You guys have family help or hired help?
Feel like I barely have time to take a **** with everyone’s wants and needs all day long
No help. I just make time in the mornings before work and kids. Was driving to the gym before we finally got some equipment at home. Now that saves some time as well.
Under a million.
Home gym
I’m out the door before 7am home around 6pm, plus pick ups from kids activities, helping with dinner, kids homework, bedtime etc. able to squeeze in 20 to 30 minute workout after work most days. Kids have a TV and other play stuff in the same area as my gym equipment ….helps to balance it all
do you have a mid-level working with you? what are your hours on tuesdays?
Same as you except kids are 6 and 3
minus the wiring for car, im wiring for smart switches in the house
monday 830 to 230. 25 procedures
tuesday 830 to 400... 35 pts, 1/2 procedures
wednesday same as tuesday
thursday 7 EMGs, 18 patients
friday 8-2, 30 pts.
i usually work thru lunch or work out during lunch. exercise 6 days a week one way or another
kids 11, 13, 15. there is more down time as they get older.
live in a high COL area in northeast.
i do an obscene about of RVUs/year, but the $/RVU is so embarrassingly low that i cant bring myself to even share that number.
i find that i do a pretty piss poor job on a lot of patients but i keep doing so to keep the remuneration reasonable.
tuesday 830 to 400... 35 pts, 1/2 procedures
wednesday same as tuesday
thursday 7 EMGs, 18 patients
friday 8-2, 30 pts.
i usually work thru lunch or work out during lunch. exercise 6 days a week one way or another
kids 11, 13, 15. there is more down time as they get older.
live in a high COL area in northeast.
i do an obscene about of RVUs/year, but the $/RVU is so embarrassingly low that i cant bring myself to even share that number.
i find that i do a pretty piss poor job on a lot of patients but i keep doing so to keep the remuneration reasonable.
Monday 7-3 consults 30 min and follow ups 15 min - 45 min lunch
Tuesday 9-5 procedures 15 min for most and 30 for RFA - 1 hr lunch
Wednesday 8-4 procedures - 1 hr lunch
Thursday 7-12 consults/follow ups 12:45-3 ultrasound procedures - 45 min lunch
Friday 7-8 consults 8-3 procedures - 30 min lunch
2 kids
resistance exercise after work at least once per week, usually twice - office building has full gym facility!
coach son's lacrosse team
above MGMA median for total comp, much more favorable $/wrvu value this year (finally)
Tuesday 9-5 procedures 15 min for most and 30 for RFA - 1 hr lunch
Wednesday 8-4 procedures - 1 hr lunch
Thursday 7-12 consults/follow ups 12:45-3 ultrasound procedures - 45 min lunch
Friday 7-8 consults 8-3 procedures - 30 min lunch
2 kids
resistance exercise after work at least once per week, usually twice - office building has full gym facility!
coach son's lacrosse team
above MGMA median for total comp, much more favorable $/wrvu value this year (finally)
Monday: off. Usually will go play basketball for a couple hours and go to lunch at my daughter’s school
Tuesday: Procedures, 7:30-3. Usually 3 injection days per month and 1 larger case day. About 35-40 on an injection day (ESI/MBB/RFA) or 8-ish on an SCS/SI fusion/kypho/MM/MILD day
Wednesday-Friday: clinic, 8-4. About 35-40 per day. Once or twice a week I will usually go over to the hospital to do a kypho or SCS trial during lunch.
On pace to go over 16k RVU this year which would put me into 7 figures for the first time.
Got a 5 year old and then my 2nd (and final) kid due next month.
HOPD employed at a small hospital in the rural south. Commute about 45 minutes each way from a larger metro. Usually spend that time listening to sports talk radio and playing radio call-in contests (just won tickets to Trans Siberian Orchestra doing so last week 😂)
Tuesday: Procedures, 7:30-3. Usually 3 injection days per month and 1 larger case day. About 35-40 on an injection day (ESI/MBB/RFA) or 8-ish on an SCS/SI fusion/kypho/MM/MILD day
Wednesday-Friday: clinic, 8-4. About 35-40 per day. Once or twice a week I will usually go over to the hospital to do a kypho or SCS trial during lunch.
On pace to go over 16k RVU this year which would put me into 7 figures for the first time.
Got a 5 year old and then my 2nd (and final) kid due next month.
HOPD employed at a small hospital in the rural south. Commute about 45 minutes each way from a larger metro. Usually spend that time listening to sports talk radio and playing radio call-in contests (just won tickets to Trans Siberian Orchestra doing so last week 😂)
@mdo1738 you need a new keyboard and lead. That collar is pretty much jacked.
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Tuesday hours are 8-6. By choice. I like having half days on fridays to get stuff done. Just got a mid level this past year but the numbers posted were for me only.
You can eat lunch with your kid at school? That's pretty cool!
Yep, taking advantage of it while she still thinks it’s cool and not embarrassing 😂
That is starting to sound more like a salaried position!
I’ll see about 25 on Mondays 8 to 4.
Tuesday and Wednesday half-day procedures (~17) in the morning, clinic in the afternoon until 3:30–4. 7 new or 12 f/u on avg.
Thurs 12-3. 7 new pts. I will come in a bit earlier and do Fluoro for 2 hours if I’m getting behind (4th quarter).
Friday 8:30-12. 12-14 pts. If I don’t have somewhere else to be, I’ll stay later and catch up on paperwork/medicolegal.
I could certainly be more efficient. With medical legal work, bringing in about $750k/yr. I coach too many kids sports, occupying 4 nights a week and games weekends. Modest physical activity at practice is the closest thing to exercise I see. I anticipate far less coaching and increased physical activity in the coming years. Spending more time on the real estate side hustle…
Good thread! I'm split anesthesia/pain.
2 days pain clinic: ~20 patients, one day about 8-4 with lunch (usually can go home for an hour - workout or see my wife) and one day 8-3 or 9-3
1 day procedures: ~16, 8:30-3 with 1 hour + lunch
2 days anesthesia: 7am start, finish anywhere from noon to 4pm. Usually I do one weekend call per month in house including overnight. Lucky for now it is often chill and I can workout and sleep through majority of the time.
Obviously not very efficient. I'm in academics. I tried fighting for more efficient schedule but stopped and basically take long lunches and call in patients to finish early.
I take the kids to/from school (9, 7, 4) about twice a week. Wife usually cooks dinner and we both split putting them to sleep.
As exercise I play tennis twice a week. I try to get the kids out on the trampoline or bikes most days. We have a regular babysitter come twice during the week. I tried to convince my wife for us to look into having an au pair to no avail. Kids are exhausting as **** and a whole lot more energy than I give at work.
I do lunch at kids' school once a month. I really enjoy it.
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The first million is easy. The second million is hard. I work 5-9.
Cool thread. Very informational.
I'm PM&R sports/spine in ortho multi-specialty private practice. Mid-COL mid-south college town. Used to be team physician for D1 school in town that added about 30 hours of after work duties on top of below. Very happy to not be doing that now and as such practice has shifted much more to spine care.
Take home low to mid-400s without counting benefits (close to $500k if you count them). ASC should start paying next year that would add another ~$50k+ per year. Would be nice to be 10-15% busier or make 10-15% more money but lifestyle is more important right now.
Very happy with proposed increase to office reimbursement for 2026.
Take kids to school, get home in time to exercise in the home gym to stay competitive with Olympic lifting while the kids play outside, have time/energy to help with meals, putting down kids at night, involved with church, etc.
Monday - Wednesday Clinic 8ish-4ish: 20-30 patients with a mix of new, f/u, EMG, US procedures, PRP, etc.
Thursday ASC Procedures: 10-15 mix of cervical ESIs, RFA, PNS, MILD
Friday in office fluoro procedures: 15-20 ESI, RFA, SIJ, etc.
I'm PM&R sports/spine in ortho multi-specialty private practice. Mid-COL mid-south college town. Used to be team physician for D1 school in town that added about 30 hours of after work duties on top of below. Very happy to not be doing that now and as such practice has shifted much more to spine care.
Take home low to mid-400s without counting benefits (close to $500k if you count them). ASC should start paying next year that would add another ~$50k+ per year. Would be nice to be 10-15% busier or make 10-15% more money but lifestyle is more important right now.
Very happy with proposed increase to office reimbursement for 2026.
Take kids to school, get home in time to exercise in the home gym to stay competitive with Olympic lifting while the kids play outside, have time/energy to help with meals, putting down kids at night, involved with church, etc.
Monday - Wednesday Clinic 8ish-4ish: 20-30 patients with a mix of new, f/u, EMG, US procedures, PRP, etc.
Thursday ASC Procedures: 10-15 mix of cervical ESIs, RFA, PNS, MILD
Friday in office fluoro procedures: 15-20 ESI, RFA, SIJ, etc.
Do you fly airplanes as well? If so, how do you balance working more (for a bigger plane of course lol) and making time to actually fly it?
My wife is the pilot. It's mostly does she sleep enough to safely fly with our youngest causing chaos. I am the financier of the endeavor and passenger prince/extra hands for the radios/nav. We have too many kids to all fit in the Grumman Cheetah in the picture but we can't seem to part with it.
When the ASC starts paying out we will upgrade to a Cessna 210 or Bonanza or five seat Cirrus. The possibilities to waste money in general aviation are endless!
I outlined mine in a different thread recently, but will throw in my hat here.
I'm 4 days a week, HOPD. I currently get $/RVU plus some compensation for the charts that I sign of my PA. Ends up being around $50k/year income from PA oversight. Have increased each of the past 4 years since fellowship, started at $400k and now on pace for $820k or so.
Mon: 28 patients (morning clinic, afternoon procedures)
Tue: 28 patients (either full procedures or half and half. alternates every other week)
Wed: 28 patients (full procedures)
Thur: 28 patients (full clinic)
Morning 0800 - 1130, afternoon 1300 - 1600. Eat a quick lunch then work on precharting for later in the week.
I often double book a few, with clinic often having 1-2 more, and procedures having maybe 2-4 more. I'm planning on just increasing my procedure days to mid-30's by default.
I don't know how some of you can see 40+ in clinic. I see 4 an hour, mostly new. If was seeing 5-6 per hour, I feel that, for me, some aspect of the quality of the visit would have to give. And I'd be extremely stressed about keeping on schedule.
Exercise 6 days a week, in the morning, at my home. Adjustable dumbbells to 90 lbs, pullup bar, and bench. Wake up 4:15, eat, exercise 5 - 6:30.
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That’s an amazing schedule for 820,000. Good for you!
About 11.5k
Those of you who are working super hard and bringing in bank but are stressed/unhappy, what is motivating you?
Are you working on generational wealth?
Are you working on generational wealth?
Who is stressed or unhappy in PP? I think if you are doing well in PP and making bank then you live what you do. Hard to do all of that when unhappy
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I’m not unhappy at all. Taking care of the patients for me isn’t stressful. Office mgmt can be the biggest challenge. Yes, I’m trying to build generational wealth but my clinical practice is just part of that. Patent pending on my real chance for that.
Only crappy part is office politics/nursing politics. Love the patient treatment.
Generational wealth is pointless, maybe for next two generations have something in place but even largest of wealth is divided out and past 7 generations.
I also don’t work hard at my job. 4.5 days, out by 4 pm.
I guess when I mean generational then I mean my kids and future grandkids. I probably won’t live long enough to make much of an impact in great grandkids life unless a child and grandchild have kids too early.
You are able to generate 70 procedures a week but you only see 56 patients a week? How many patients does the PA see? Do you trust this person that much?
Good point.
If the docs here making 7 figures are doing that because of PAs sending them procedures, then they are selling their soul for gold because PAs ordering procedures is not good medicine, and I doubt you would want that for your mother.
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