Hi guys, I'm a PGY4 graduating in July and wanted to hear experiences from those of you who have worked at Encompass Health before or heard from other physicians who have worked there- the good, the bad, the ugly.
Specific things I'm wondering about:
- How does compensation/workflow change if IM is primary/admitting versus if PMR is primary/admitting or the consulted physician?
- How many patient's are most of you usually seeing and how much are you earning with that number? I've heard pretty good salaries from some physicians like 500k for seeing ~20-25 patients daily and want to know if that's the normal at that number or a very high outlier
- How does vacation work? If you're an independent contractor, I'm assuming you can take as much vacay as you want. What happens if no one is there to cover you? Is it on you to find a physician to cover your patients or on Encompass to do so? Can that be negotiated in your contract that Encompass find a substitute when you're out?
- How does call work? I've heard that IM generally covers IM related issues and PMR covers PMR related calls. What if the IM attending is out? Is PMR then covering everything on call?
- How much does the CEO and medical director really affect your day to day flow? Do you see much of one another or mostly doing things independently (besides the medical director of course determining which patients come to rehab)
- Are beds usually at capacity and do you as PMR physicians generally have at least 18-20 patients to see per day?
- How does Encompass overall treat you if there are any big concerns?
Thanks so much guys, I know I wrote a lot of questions up there but any info is super helpful!
I'm not with Encompass, but I am an independent contractor so I can answer some of your questions. This turned out to be longer than I expected. Please forgive any grammar issues.
1) Workflow is dramatically different if you're primary vs IM. RNs have a tough time distinguishing who to call for a lot of things, so the default is to call the attending. Attending has to do the admit and dc med recs, which are quite time consuming. An initial H&P pays as well as an initial thorough consult note, so one could argue the consultant is getting paid more for likely less work. But on discharge it's hard to justify a high level progress note as a consultant, whereas the attending can bill more for a dc summary. It's also harder for a consultant to justify seeing a patient daily, so you may need to have a higher census if you only see folks 3x per week. If you're the attending, it's not hard to justify seeing patients everyday.
All in all, I'd say from a personal time management/financial standpoint, it's better to be a consultant (less calls, less work). But from a job satisfaction point, you'll always feel you're the patient's "real doctor" if you're primary. Also, PM&R being a consultant on our own rehab unit always sounded sad to me...
We're primary at our hospital. With good IM coverage, we've been happy.
2) Assume you'll make at $90/patient/day--I believe unless you have a poor payor mix you should make at least that. Maybe closer to $100 or even $120 with good payors (or if you bill aggressively). If you see 20 patients/day, 5d/week, 46 weeks/yr (lets assume 6w vacation), you're at $414k if you're at that $90 spot. Over $500k if you average 25 patients. That's without any weekend coverage or any stipends. Many docs are bringing in much more than $90/patient/day--part of that is based on where you live/Medicare reimbursement rates. We're more rural so we're on the lower end of things.
So $500k is reasonable if you're seeing 20-25 patients daily and have a stipend and doing some weekend/vacation coverage. But seeing 20-25 patients/day is tiring as well, so keep that in mind. You two biggest financial risks as a doc are divorce and burnout. But working hard your initial years is easier (often recent grads don't have kids, so they can work longer hours), and it's helpful in setting the stage for the future. Now that I went for a few years seeing 18-25/day, I find my life is so much nicer seeing less. I have the occasional vacation coverage to remind me what the busy years were like, but I don't miss them since I have a wife/kids to get home to. I think 14-15 is actually the ideal census for work-life balance--that still pays around $300k without stipends/weekend coverage, and I can say I'm much happier with $300k and a more relaxed schedule than I was with $500k and a busy one. Again--part of it depends on you and where you're at in life.
3) Vacation is hospital dependent. But you can't take time off if you have no one to cover you. So you find a partner who's willing to cover you (maybe you cover for them as well), or request Encompass pay a locums (keep in mind they can say no). It's easier to talk them into paying for a locums if you're the only doc on the unit. If there are a few of you, then you should all be covering for each other.
4) Call is totally depending on each individual hospital. Often IM covers IM issues 24/7 and PM&R covers PM&R issues 24/7, with the caveat that RNs often call whoever the attending is for things they're not sure of (or if they're just lazy). If IM is out, well, someone needs to cover. So unless IM has backup docs (we do--acute care IM covers if rehab IM is off-duty), then everything goes to PM&R--assuming PM&R is primary of course. If IM is primary, they can't be off.
5) I'm on a unit, so we have a program director instead of a CEO. Our director is very involved (in a good way--but I've heard of it being the other way around at other facilities) and we communicate often. But they don't dictate anything for me. We're more-or-less co-equals. They manage the unit/staff, I manage the patients.
When I was associate medical director we each individually assessed patients for admission based on the day, so really the medical director's impact on me was the same as a partner--if they were off it made a difference as I had to cover. But often a medical director will be the one reviewing all the patients for admission, assigning patients, making schedules, handling interpersonal doc disputes, etc. I'm medical director now and we've kept the same partner system in place where we review our own admissions, and I'm basically doing all the unit medical admin stuff, making our schedules, and generally have to pick up the slack if any exists (like if a covering weekend doc gets sick, etc.)
6) Our beds are typically at capacity, but this is also very hospital-dependent. Assume your beds won't be at capacity when working out your expected income/budget/etc. I see less than 18-20 patients/day, but I'm also the medical director and I'm covering weekends. 18-20 patients per day can get tiring as I said above, particularly if you're doing weekend coverage. I did handle it a lot easier when I was a fresh residency grad. Ironically, it took me a lot longer to see all the patients, but I didn't tire as much as I do now.
