Full spectrum pmr

[AndyDufrane]

Hello
So I am considering a full spectrum pmr position, Where one is in an inpatient medical director role and outpatient msk, EMG, and interventional spine role. I have come across a salary of $400,000 at a hospital employed position in the Midwest. What would be a fair salary , I am thinking closer to $600,000 because it’s essentially 2 different jobs. Any insight would be appreciated? Or if one was going to do both inpatient medical director job and build an msk interventional practice on top, in private practice what can you expect?
Thanks in advance

---

Members don't see this ad.

 

[pmrmd]

How would you have the time to do both? Not enough money in the world to make me want to do what I do every day and then be in charge of a rehab facility.

 

[RangerBob]

Are they both separately full-time jobs? Or part-time? How many beds is the unit? Is it a free-standing rehab hospital or a unit?

$400k for an employed position sounds quite good if it's a full-time job in total. Most employed inpatient docs I knew were in the $200-300k range. $400k is often a hard salary to get to as an employee, though if you're doing a lot of spine interventions that obviously increases your potential.

If it's two full-time jobs then $400k is not a good deal. You can make that alone doing just inpatient rehab on a 14 bed unit (you can probably make quite a bit more than $400k doing that) as an independent contractor/fee-for-service physician working 5 days per week.

I don't know what private practice interventional MSK pays--but if you're doing a lot of spine injections under flouro, I do know it's a lot. Interventional pain/spine are typically the highest paid PM&R docs.

 

[runfastnow]

Only doing outpatient MSK/spine doing US, EMG, fluoro procedures (ESI, MBB/RF, SIJ without SCS) should get you around $400k if you are seeing 100 patients per week (80/20 clinic/fluoro) and know how to bill effectively.

Not sure how you'd do both with that volume without going insane after a few years. Only way I could see working would be having an NP that can handle pages and prep H&P/DCs for you. Plus - if you are doing that volume of outpatient + inpatient/med director work I would ask for $600k+ salary and/or demand some pretty favorable production incentive structure.

 

[AndyDufrane]

Thanks everyone for the input, I scenario I am thinking is 50% inpatient medical director (consulting model not admitting physician) and 50% outpatient msk in an orthopedic practice. For several year I did a gig where it was an inpatient medical director and consultant on inpatient rehab unit as an independent contractor, and it was a sweet gig ( hospital got bought out and they brought in employed physiatrist) but I couldn’t manage to do outpatient msk on top, so I am trying to figure out if a combo inpatient/outpatient gig is possible as a hospital employee physician

 

[AndyDufrane]

Also what is a fair salary to ask for if inpatient medical director for 14 bed unit only, and separate salary if outpatient msk physiatrist in in outpatient ortho practice doing fluoroscopy guided spine injections and EMGs. My gut also says same thing you all are stating , doing either inpatient or outpatient as an independent contractor is the most lucrative, the inpatient is easier to do as independent contractor, the outpatient a bit more moving parts to deal with

 

[Iamnew2]

Hello
So I am considering a full spectrum pmr position, Where one is in an inpatient medical director role and outpatient msk, EMG, and interventional spine role. I have come across a salary of $400,000 at a hospital employed position in the Midwest. What would be a fair salary , I am thinking closer to $600,000 because it’s essentially 2 different jobs. Any insight would be appreciated? Or if one was going to do both inpatient medical director job and build an msk interventional practice on top, in private practice what can you expect?
Thanks in advance

No one will pay you $600,00 SALARY - that I can pretty much guarantee. With that said, you can certainly make that and more with a well run program of doing both. The issue is that inpt rehab with a full unit takes time - there is no way you can do both. You can have a few days here and there of outpatient clinic, maybe if you hire some midlevels to write notes, etc but otherwise there's no way to do both. While salaries in the Midwest are higher, I think they will laugh at you if you ask for $600k. Just my two cents. The inpatient medical director stipend, without seeing clinical patients, is not that helpful and again in order to make it worth the hospital's while to cover even $400k, you'd have to be seeing a lot of patients. I think if you did two half days of outpatient at a busy clinic you can likely make an additional maybe 200k on top of 400-500 for med director AND seeing patients - but it would have to be an exceptionally well run operation with quite a bit of help - whether it would be midlevels, scribe, nursing staff to run your clinic, etc. Not an easy feat. Also it depends what kind of turf you are fighting for and hwere in the Midwest you are - Chicagoland, good luck, Idaho or Wisconsin, etc. maybe.

 

[Iamnew2]

Also what is a fair salary to ask for if inpatient medical director for 14 bed unit only, and separate salary if outpatient msk physiatrist in in outpatient ortho practice doing fluoroscopy guided spine injections and EMGs. My gut also says same thing you all are stating , doing either inpatient or outpatient as an independent contractor is the most lucrative, the inpatient is easier to do as independent contractor, the outpatient a bit more moving parts to deal with

I don't think you are looking at the whole picture - stipends for med directors run in the from what I have seen $80k or so on the lower end and $150k or so - plus billing from seeing patients. An inpt hospital won't have a built in fluoro type outpatient practice bc that's not their business model. You can certainly create your own outpatient MSK/EMG, etc clinic but the hospital I can assure you won't pay you for that - if anything it might not be profitable for quite a while. And certainly like I said an inpt unit won't have a fluoro suite, etc.

If anything you are looking at two jobs - inpt rehab director, plus seeing patients and outpatient clinic. I have yet to see outpatinet PM&R for ortho group that's part time, I have seen salaries for Ortho PM&R physician in the mid two's to 300-400 for full time, but I don't think ortho practices want part time generally.

And if you are a "part time" medical director and not at the hosptial all the time then no one is going to offer you a massive stipend - so if you are getting like $60k in stipend it makes it pointless in my opinion. I think you have to decide which one of the above you want more.

 

[Iamnew2]

Are they both separately full-time jobs? Or part-time? How many beds is the unit? Is it a free-standing rehab hospital or a unit?

$400k for an employed position sounds quite good if it's a full-time job in total. Most employed inpatient docs I knew were in the $200-300k range. $400k is often a hard salary to get to as an employee, though if you're doing a lot of spine interventions that obviously increases your potential.

If it's two full-time jobs then $400k is not a good deal. You can make that alone doing just inpatient rehab on a 14 bed unit (you can probably make quite a bit more than $400k doing that) as an independent contractor/fee-for-service physician working 5 days per week.

I don't know what private practice interventional MSK pays--but if you're doing a lot of spine injections under flouro, I do know it's a lot. Interventional pain/spine are typically the highest paid PM&R docs.

Out of curiosity how do you make 400k with seeing 14 patients for 5 days a week?

 

[RangerBob]

If you make ~ $90/patient/day (physiatrists in the Bay Area tell me they average closer to $120) from insurance/patient collections, that's about $300k/year with 4 weeks off. Then add the medical director stipend for running the unit, which can be $50-150k+, depending on the rate you negotiated--so I averaged and went with $100k. So ~400k total.

Most docs want more than 4 weeks off, but most will also average more than $90/patient/day. So $400k seems like a reasonable income if you're the director and see 14 patients/day. Perhaps $350 at the lower end if your stipend is on the smaller side, or $300 if you take a lot of time off.

 

[Iamnew2]

If you make ~ $90/patient/day (physiatrists in the Bay Area tell me they average closer to $120) from insurance/patient collections, that's about $300k/year with 4 weeks off. Then add the medical director stipend for running the unit, which can be $50-150k+, depending on the rate you negotiated--so I averaged and went with $100k. So ~400k total.

Most docs want more than 4 weeks off, but most will also average more than $90/patient/day. So $400k seems like a reasonable income if you're the director and see 14 patients/day. Perhaps $350 at the lower end if your stipend is on the smaller side, or $300 if you take a lot of time off.

On one of my other posts I mentioned about how frustrating it is when patients don't pay - I see 20+ patients and would say get from over 70 to 100 depending - but some patients that haven't met deductibles, etc and they don't pay I get $0 at times. But I understand your math, thanks! That helps.

 

[DMBandFan86]

Also what is a fair salary to ask for if inpatient medical director for 14 bed unit only, and separate salary if outpatient msk physiatrist in in outpatient ortho practice doing fluoroscopy guided spine injections and EMGs. My gut also says same thing you all are stating , doing either inpatient or outpatient as an independent contractor is the most lucrative, the inpatient is easier to do as independent contractor, the outpatient a bit more moving parts to deal with

I would think about 50k for a 14 bed unit per year for medical director. Depending on location may be higher or lower. That includes more than just signing preadmit screens and running off to clinic.

 

[AndyDufrane]

Thanks everybody for the great input, so for about 4 years early in my early career I was the medical director independent contractor for an 18 bed inpatient unit inside a rural hospital , med director stipend was 84K/year, and collections on average were 20-30K/month, and I tried renting an office at a local ortho practice and tried to do 1-2 half day clinics of msk/EMG and spine injections, I did feel it was a tough balance, but the position I am considering right now would be 100% hospital employee, and right now job is only outpatient ortho msk role, my concern is if I took job, and hospital knows I did inpatient medical director job in past and used to cover at hospital’s inpatient unit, if current inpatient medical director role becomes available, and hospital tries to make me do full spectrum PMR, do I tell them upfront if inpatient med director role opens up, then they can’t just make me do inpatient role on top of my ortho pmr msk role, would require renegotiation of initial contract , or how to have a favorable arrangement? My gut says would just them if inpatient becomes available and they expect me to do, then would have to provide mid level or I can’t do

 

[Iamnew2]

I would think about 50k for a 14 bed unit per year for medical director. Depending on location may be higher or lower. That includes more than just signing preadmit screens and running off to clinic.

Exactly. The money a rehab hospital spends on you has to be worth their time - inpatient rehab units that work well tend to have full time med directors (I have never myself seen a part time med director) who at the same time sees patients clinically and keep things running reasonably.

 

[Iamnew2]

Thanks everybody for the great input, so for about 4 years early in my early career I was the medical director independent contractor for an 18 bed inpatient unit inside a rural hospital , med director stipend was 84K/year, and collections on average were 20-30K/month, and I tried renting an office at a local ortho practice and tried to do 1-2 half day clinics of msk/EMG and spine injections, I did feel it was a tough balance, but the position I am considering right now would be 100% hospital employee, and right now job is only outpatient ortho msk role, my concern is if I took job, and hospital knows I did inpatient medical director job in past and used to cover at hospital’s inpatient unit, if current inpatient medical director role becomes available, and hospital tries to make me do full spectrum PMR, do I tell them upfront if inpatient med director role opens up, then they can’t just make me do inpatient role on top of my ortho pmr msk role, would require renegotiation of initial contract , or how to have a favorable arrangement? My gut says would just them if inpatient becomes available and they expect me to do, then would have to provide mid level or I can’t do

I don't think that this really is a consideration - for one you would be hired to do outpatient. so that's your gig, I don't see how they could force you to do an inpatient med director. I would imagine they would offer that to someone else. I dont think most people would be successful trying to do both. And I would be surprised if this ever became a request of you. why would the med director role become available btw? is the current med director wanting or planning to leave?

 

[AndyDufrane]

I don't think that this really is a consideration - for one you would be hired to do outpatient. so that's your gig, I don't see how they could force you to do an inpatient med director. I would imagine they would offer that to someone else. I dont think most people would be successful trying to do both. And I would be surprised if this ever became a request of you. why would the med director role become available btw? is the current med director wanting or planning to leave?

Yes current inpatient medical director retiring in the next 1-2 years

 

[RangerBob]

You can just say no if they ask you to do more than what's in your contract (which could be worded vaguely--so have a contract lawyer review). Worst case scenario is they could let you go for that, but that would seem unlikely--how many docs are there lining up to replace you to do two full-time jobs?

More likely is if you're an employee is they'll expect you to do some inpatient coverage (vacation, weekends, etc.). If they do expect that, make sure you're getting paid for it. And if you don't want to provide coverage, make sure that's in your contract (such as "will provide outpatient-only coverage in clinic at xx address").

Another potential is the medical director leaves, and they say "we need some help--can you help us out?" And a few weeks of coverage could turn into months/years depending how hard it is to fill the position. Not too many residents want to do inpatient these days, so it could be hard for them to find someone. Even if you're a nice guy and want to help, it might just be better/smarter to let them hire locums until they find a permanent medical director.

 

[AndyDufrane]

Thanks everyone for the input, I think I will spell it out in the contract that I will only be doing outpatient work in the contract, to make sure I don’t get suckered into doing inpatient duties

 

[megan1010]

Are they both separately full-time jobs? Or part-time? How many beds is the unit? Is it a free-standing rehab hospital or a unit?

$400k for an employed position sounds quite good if it's a full-time job in total. Most employed inpatient docs I knew were in the $200-300k range. $400k is often a hard salary to get to as an employee, though if you're doing a lot of spine interventions that obviously increases your potential.

If it's two full-time jobs then $400k is not a good deal. You can make that alone doing just inpatient rehab on a 14 bed unit (you can probably make quite a bit more than $400k doing that) as an independent contractor/fee-for-service physician working 5 days per week.

I don't know what private practice interventional MSK pays--but if you're doing a lot of spine injections under flouro, I do know it's a lot. Interventional pain/spine are typically the highest paid PM&R docs.

I'm still in residency and have only started getting emails for jobs and peaking out of curiosity, but where are these inpatient acute rehab jobs that are around $400k? I like inpatient acute rehab, but most emails I see are around $220-240k which was a bit disappointing. There's a lot I have to learn about job options and salaries though.

 

[Iamnew2]

I'm still in residency and have only started getting emails for jobs and peaking out of curiosity, but where are these inpatient acute rehab jobs that are around $400k? I like inpatient acute rehab, but most emails I see are around $220-240k which was a bit disappointing. There's a lot I have to learn about job options and salaries though.

If salaried, 220-240 is typical, although many employed positions are in the 300k range now. as an independent contractor, wages go up significantly - so the 400k type is generally independent contractor. if med director that goes up to 450k plus depending on census.
the disadvantage with independent contractor gigs is that there are no benefits. so depends how much that matters to you. my hospital pays for my malpractice but generally you have to cover that, insurance, etc. if you have a spouse who gets insurance through their work for example, then it doesn't matter as much. I get my health insurance through my husband, so makes no difference to me. you typically get a 20% discount on your taxes for being independent contractor so that helps a lot with taxes also. obviously you have to be able to stomach the ups and down of collections which initially is very nerve wrecking.

 

[DMBandFan86]

Depends on location and benefits. Some places quote base salary, which can be low. But then add in bonus + productivity + retirement matching.

I’ve not seen 220-240 unless academic or competitive market. Look to rural and you will get paid more plus student loan repayment at times. There are places that are desperate for PMR.

BTW, 50% mgma is about 294k for PM&R.

SNF work and independent IPR quote 300-450 k per year. Depending on how much you work. For independent, That’s only if you do your own billing, collections and accounting. Otherwise you have to subtract all that out plus practice costs and funding retirement. For IPR need to see about 20 or more patients per day to make the higher end. Seems high as a resident, but more manageable with experience.

An example would be to look at encompass health physician postings. They have about a million hospitals opening and are all contractor based. Lower job security and no benefits, but potential to make a good amount of money and also do side work.

 

[RangerBob]

I'm still in residency and have only started getting emails for jobs and peaking out of curiosity, but where are these inpatient acute rehab jobs that are around $400k? I like inpatient acute rehab, but most emails I see are around $220-240k which was a bit disappointing. There's a lot I have to learn about job options and salaries though.

Both posters above gave really great answers.

I very much agree the ups and downs of collections is quite unnerving initially. It really freaked me out initially. But now I see an average of 14 patients/day (about 65-70/week) and am very happy with my income and hours. I'm kind of bummed I have to pay so much for healthcare, but I get to take all sorts of deductions (the pass-through deduction is particularly huge), and I can put about $61,000 into my solo 401k/year. And I'm my own boss.

 

[jsaul]

How are you able to put 61k into your solo 401k per year.
I assume you bill through your LLC and set up as an s corp for tax purposes and pay yourself a salary.

 

[RangerBob]

How are you able to put 61k into your solo 401k per year.
I assume you bill through your LLC and set up as an s corp for tax purposes and pay yourself a salary.

Sole proprietor with individual 401k.

 

[Momentum70]

An example would be to look at encompass health physician postings. They have about a million hospitals opening and are all contractor based. Lower job security and no benefits, but potential to make a good amount of money and also do side work.

Encompass has been searching for multiple positions for at least a few years all over, there is a big shortage of inpatient pmr docs. When i switched from outpatient to inpt practice about 4 years ago I go into contact with an encompass recruiter. She had multiple positions to review with me. I still see things posted all the time all over US.

This post is not entirely accurate though as encompass partners with some hospital groups so you are an employee of that hospital while working at Encompass. So you are W2 with benefits like any other physician with that group.

I work for one of those hospital groups and my place has been looking for 3rd pmr for the past 2 years. The pay is good but its more rural and it seems each time we interview someone they end up going for a bigger city position. A few months ago someone took the position and as they were doing their onboarding training accepted a job they had been going for in Dallas. Encompass is all about the RVU so depending on your desire to work you can do well. My first year I took time off for oral boards and wife had a baby. Throw in the fact in my residency we learned zilch about billing and my first year I was happy I had a guarantee. Since then I have made a lot more than the first year guarantee and plan on staying a while. It was a very big pay bump from outpatient which I did for 6 years before going inpatient.

I had originally planned on doing clinic side work a few half days a week but I am so busy I never started. I added inpt consult service to my job at the hospital we are associated with so no time. The other PMR doc is medical director and does clinic 3 days a week 10-12 EMGs only. The clinic is in the hospital so would be easy if I ever wanted to do that or if the 3rd person we eventually ever hire wants to do it.

 

[sloh]

Encompass has been searching for multiple positions for at least a few years all over, there is a big shortage of inpatient pmr docs. When i switched from outpatient to inpt practice about 4 years ago I go into contact with an encompass recruiter. She had multiple positions to review with me. I still see things posted all the time all over US.

This post is not entirely accurate though as encompass partners with some hospital groups so you are an employee of that hospital while working at Encompass. So you are W2 with benefits like any other physician with that group.

I work for one of those hospital groups and my place has been looking for 3rd pmr for the past 2 years. The pay is good but its more rural and it seems each time we interview someone they end up going for a bigger city position. A few months ago someone took the position and as they were doing their onboarding training accepted a job they had been going for in Dallas. Encompass is all about the RVU so depending on your desire to work you can do well. My first year I took time off for oral boards and wife had a baby. Throw in the fact in my residency we learned zilch about billing and my first year I was happy I had a guarantee. Since then I have made a lot more than the first year guarantee and plan on staying a while. It was a very big pay bump from outpatient which I did for 6 years before going inpatient.

I had originally planned on doing clinic side work a few half days a week but I am so busy I never started. I added inpt consult service to my job at the hospital we are associated with so no time. The other PMR doc is medical director and does clinic 3 days a week 10-12 EMGs only. The clinic is in the hospital so would be easy if I ever wanted to do that or if the 3rd person we eventually ever hire wants to do it.

Do you mind divulging your gross income?

 

[Iamnew2]

Do you mind divulging your gross income?

My one question is - why are so many of these hospitals built in such rural/ non urban areas?

 

[PMR2008]

Less competition. No one wants to compete against the Shirley Ryan’s of the big cities.

 

[Iamnew2]

Less competition. No one wants to compete against the Shirley Ryan’s of the big cities.

That's a valid point. although Shirley Ryan does have the hospital in Herrin, IL which is middle of nowhere for example.

 

[DMBandFan86]

I am considering getting a different gig soon.

If you become a 1099 employee what would you expect for the following costs of practice? Most of these are already paid for by my employer. I put in some numbers that I had from the past, but don't know how up to date they are, especially with inflation over the last 1-2 years making everything more expensive.

Billing and collections (6-8%)
malpractice insurance ($7000-8000 annually)
+ / - accountant fees: 1-2% ?
market health insurance:
disability, life insurance:
CME, ABPMR fees, licensing fees, AAPMR: 2000 - 10000 per year
Retirement:
Loss from uncollected bills:
Anything else worthy of mentioning besides small expenses?

What tax benefits do you get and are there any changes with upcoming legislation?

 

[RangerBob]

I am considering getting a different gig soon.

If you become a 1099 employee what would you expect for the following costs of practice? Most of these are already paid for by my employer. I put in some numbers that I had from the past, but don't know how up to date they are, especially with inflation over the last 1-2 years making everything more expensive.

Billing and collections (6-8%)
malpractice insurance ($7000-8000 annually)
+ / - accountant fees: 1-2% ?
market health insurance:
disability, life insurance:
CME, ABPMR fees, licensing fees, AAPMR: 2000 - 10000 per year
Retirement:
Loss from uncollected bills:
Anything else worthy of mentioning besides small expenses?

What tax benefits do you get and are there any changes with upcoming legislation?

Biller fees are very variable (as is competence). I pay 6.5% of collections right now.

Malpractice costs me $4,000, but I'm in CA which has a cap on non-economic damages and results in low malpractice premiums.

I used to have an accountant just for taxes (I'm a sole proprietor). Depending on the accountant costs were $800-$2000. Would obviously be more if you're having them do payroll, etc. I opted to just do my own taxes since, as they're fairly simple to do with my set up.

For a family of 3, one of the top health insurance plans via Obamacare costs me $1600/month. I could've gone with a cheaper plan, but this way I get to deduct the costs and I get less nervous about whether or not we could have a big medical bill (we have a few medical issues).

Disability and life are really variable, and cost more if you're older. I can only tell you we pay almost $500 combined for life for both my wife and I, and a so-so disability policy. I can't really say what others will cost.

CME is free if you use UpToDate
ABPM&R wants $200/year
My CA license is $920 every two years
AAPMR costs like $800 or $900. I bought the online education module this year (haven't used it...), so my cost was closer to $900.
I subscribe to a few journals as well, for CME

I max out retirement each year. As a 1099 contractor with solo 401k, I can put $61,000 into my 401k for 2022. And you can do another $6k for you and your spouse into a backdoor Roth.

No idea on what the loss is from uncollected bills. It's so common I just know what we collect on average per patient per day. You typically can't write off uncollected bills though, unless you use a non-standard accounting basis. Which is totally legit, but my accountant said it's a lot more complicated and probably costs a fair amount more overall.

Tax benefits are great!
Write of all business expenses. So many things qualify for a deduction. If you work at more than one site you can claim a home office and write off all your miles.
The pass-through deduction is huge. I max out my solo 401k so I can optimize it, as you start to get phased out at a taxable income over ~$326,000. My solo 401k contributions, health insurance costs, business costs, and if I'm not mistaken even personal deductions all factor to that. If you're taxable income is going to be well under $326k, sometimes you're better off putting your 401k money into your roth 401k-- WhiteCoatInvestor had a post about that some time ago. The main reason is because you're lowering your pass-through deduction when you reduce your income further below $326k.

I think the pass-through deduction is supposed to fade away ~2025, but who knows what politicians will do at that time, because letting it expire is the same as giving a lot of people a big tax increase, and no politician wants to be known for that (usually).

 

[Iamnew2]

I am considering getting a different gig soon.

If you become a 1099 employee what would you expect for the following costs of practice? Most of these are already paid for by my employer. I put in some numbers that I had from the past, but don't know how up to date they are, especially with inflation over the last 1-2 years making everything more expensive.

Billing and collections (6-8%)
malpractice insurance ($7000-8000 annually)
+ / - accountant fees: 1-2% ?
market health insurance:
disability, life insurance:
CME, ABPMR fees, licensing fees, AAPMR: 2000 - 10000 per year
Retirement:
Loss from uncollected bills:
Anything else worthy of mentioning besides small expenses?

What tax benefits do you get and are there any changes with upcoming legislation?

Billings and collections vary, I pay 10%.
Same with malpractice but around 10k
I don’t pay anything in account fees
Medical licensing, aapmr fees, CME will vary but 2-5k probably
If you are a 1099 you can do solo 401k (I do that) which varies by year but I think this year you can sock away about 61k I think
As a 1099 you also get 20% discount on your income i forget what it’s called but I talked to my accountant about it and her software takes it off automatically so it’s a great savings
Loss in Billings will vary, some places are better than others in collections
If you have part of your home exclusively dedicated to work you have a certain amount you can discount too from your income
Health insurance can also be discounted

You have to get a knowledgeable accountant to help you with all the above

 

[DMBandFan86]

Well if democrats are in power I assume the pass through tax will go away, as it primarily helps wealthier people (middle class) pay less taxes. At least the current policy is to take those away. Anyways...



I've done comparison calculations several times before to try to compare a 1099 vs employed and I just wanted to compare again and see if any data has changed. I basically find a close equivalence between an employed position being paid at 50% MGMA (with added benefits such as pension, CME reimbursement) being about the same as a 1099 independent contractor collecting about 390K per year. However, the tax incentives would give the upper hand to the 1099 (for now at least).

The one thing I see with taking the 1099 job, is that if you don't do the MD or associate MD role, then you really are left with seeing a lot of people to make up for that or adding in SNF consults/outpatient, etc. I guess that's why people are covering 2 hospital IPRs. So if I end up only collecting 350k per year then probably not worth it.

 

[Iamnew2]

Well if democrats are in power I assume the pass through tax will go away, as it primarily helps wealthier people (middle class) pay less taxes. At least the current policy is to take those away. Anyways...



I've done comparison calculations several times before to try to compare a 1099 vs employed and I just wanted to compare again and see if any data has changed. I basically find a close equivalence between an employed position being paid at 50% MGMA (with added benefits such as pension, CME reimbursement) being about the same as a 1099 independent contractor collecting about 390K per year. However, the tax incentives would give the upper hand to the 1099 (for now at least).

The one thing I see with taking the 1099 job, is that if you don't do the MD or associate MD role, then you really are left with seeing a lot of people to make up for that or adding in SNF consults/outpatient, etc. I guess that's why people are covering 2 hospital IPRs.

It really depends how many people are at your hospital. I"m the only PM&R at my hospital, and I see typically 20-27 patients, depending on census, etc. Having the medical director/associate medical director roles though help significantly in terms of income though you are absolutely right.