Is it possible

[rodamus prime]

Hey I'm new to this forum, but I've been juggling thoughts about PMR in my head for a long time. I like the field, but I also have a keen interest in being "financially secure". It's not all about the money, but I had a goal for myself to make at least $250+ 3-5 years out of my training. Is that possible in PMR? outpatiently speaking....

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[Karaoke]

I'll get us started on this thread. I'm a PGY3 in rehab medicine.
My understanding is that you can make that kind of money in
any discipline if you're willing to work hard enough for it. The
question is, how hard are you willing to work for it? I remember
doing a rotation in family medicine as an MS3 for a private
practitioner who was pulling down that much, but he was
working his little tushie off. Even dermatologists who make
that much money are working really hard, putting in long
hours from what I understand. And don't even get me started
on surgeons -- those people earn every penny and god bless'em
cuz I personally wouldn't ever want to do what they do.

As far as I can tell, the money you're looking for can be had
in rehab medicine, but you'll work hard for it. I've been told
that it's reasonable to expect 120-150k fresh out of residency
with no additional fellowship training. Your 3-5 year time frame
puts you on track to make partner with a group, at which point
you could conceivably break 200k. So 250k is within reach in
my mind, but only if you work hard. Or you could do a
fellowship in pain or sports & spine and increase your odds.

Folks, I'm one year into my residency, so I'm still full of
misconceptions. Please feel free to correct what I've said.

 

[rodamus prime]

thanks for the quick reply. What kind of a starting salary can you expect after a fellowship in Sport/Spine or Pain?

 

[axm397]

A lot of it depends on where you go(the more popular locations pay less), the type of practice(solo, group, multi specialty, VA, Kaiser type network, academic), and what you do(consults, inpt, outpt, procedures incl EMG, injections, etc.).

From what I have HEARD (so it's heresay - I did not see anyone's actual pay check or contract)

Most academic positions start 90-130K in big cities like NYC, Chicago, etc.(I heard as little ask 90K for "prestige" like Columbia/Cornell) For private practice, I've heard btwn 140-180K for general rehab straight out of residency. That 180K is for northern california where cost of living is high and it's not as saturated as southern california. If you do a fellowship starting ranges btwn 160-200K - with obviously a lot more as you get further into practice. Most practices lose money on you the first couple years - I've heard it takes 2-3 yrs for a practice to "break even" on you - so after that, you do better. Some of it depends on how efficient you are (productivity bonus) and whether you are willing to do certain procedures, consults, etc. And like the earlier post said, also depends on how much work you are willing to do. I shadowed a private practice attending in NJ making 400-500K - without fellowship - he had a private outpatient clinic, a nice inpatient unit of about 10-12 beds w a PA doing most of the day to day work, consulted at 2 different nursing homes/subacute rehabs including most Saturdays, and did 1/2 day EMGs per week. He was pretty much a solo practice although he shared his clinic space with his wife who was also a physician. So it really depends on your business skills. Also, your starting salary is not necessarily indicative of the long term earnings. Some practices will lure you in with a high starting salary then trap you with very little opportunities for future partnership, etc. Need to factor in things like benefits, tuition assistance for kids, loan repayment, mortgage help, pension plan, etc. I do think you can have a relatively cush lifestyle and still make over 200K in PM&R 3-5 yrs into practice.

that's my 2cents.

 

[Ligament]

You can easily reach your $250K goal in general pm&R if you are doing enough EMGs in particular. You can hit this in a couple years.

PM&R pays very well per hour worked.

 

[lobelsteve]

$250k, is that all you want?
I know a guy who tripled that this past year.

 

[rodamus prime]

$250k, is that all you want?
I know a guy who tripled that this past year.

Haha... I'd take more if it was there, sure. Running a business (like a private practice) can be both risky and exhilirating. I'm trying to learn as much about it right now to ease the transition to adulthood (aka "finally making my own living"). My financial goals are just based on compensation for how much training we all have to do to get to where we want to be. Compared to our corporate counterparts, we won't be making a decent living until about 8 years after they do. My future plans mostly revolve around my career interests, but some regard does go to the financial growth potential. It seems to be the fact that if you are a good businessman (or woman) then you can achieve whatever you want (with grueling hard work). Still, most medical students don't get any exposure to the business side of medicine so we all have syncopal episodes when thinking about whats to come. Students see fields like Radiology or Anesthesia making tons of money right from the get-go and automatically target those fields. If only we got more medical business exposure.....

Lobelsteve!! who is this private practice doc that you know!? haha.. you could PM me if you want to keep it private.

 

[Louisville04]

$250k, is that all you want?
I know a guy who tripled that this past year.

Yeah but was that guy doing 100% injections?

 

[ampaphb]

thanks for the quick reply. What kind of a starting salary can you expect after a fellowship in Sport/Spine or Pain?

Here is an offer sheet I just received - it is at the higher end, but not unattainable

Base Salary
Year 1: range between $275k-$350k depending on BE/BC, training and experience.
Year 2: Range between $300k-400k depending on BE/BC, training and experience.

Production Incentive:
Year 1: 50 to 60% of net collections after subtraction of Salary, benefits, and all overhead/corporate expenses, which are allocated equally between all the physicians of the corporation (partners and salaried doctors)
Year 2: 60 to 70% of net collections after subtraction of expenses as noted above.

Moving Expenses:
Up to a maximum of $ 7,500.00 towards Physician’s actual expenses of moving self, family to begin practice.
​

 

[MSKalltheway]

I shadowed a private practice attending in NJ making 400-500K - without fellowship - he had a private outpatient clinic, a nice inpatient unit of about 10-12 beds w a PA doing most of the day to day work, and did 1/2 day EMGs per week. He was pretty much a solo practice although he shared his clinic space with his wife who was also a physician.

I don't mean to threadjack here, but I saw this and it would ideally be the kind of practice I'd like to set up. Is this easy to do? Would the admin for a small inpatient rehab unit accept a physiatrist rounding in the mornings and having his/her own practice in the afternoons? I ask because I have seen a case where the hospital has forced the internists working there to either give up their practice or to discontinue working the inpatient wards.

 

[axm397]

That example is not the only one I've seen for inpt physiatrists having clinic on top of their inpatient duties - Inpatient rehab is NOT as complex as inpatient internal medicine. Especially private community rehabs - the patients are not as sick and they really don't require 24hr physician care. Plenty of people have onsite and offsite clinics during the day after rounding on inpatients. I actually think it's a minority of physiatrists who solely do inpatient work.

Even in academic settings - look at RIC - almost all the inpatient attendings do clinic and some even do consults on top of their inpatient responsibilities and clinic. A few do botox, EMG, acupuncture, baclofen pump management, and other procedures as well. NPs and PAs can manage most day-to-day stuff and if patients truly become unstable, they will get transferred back to inpatient acute care or to the ED.

 

[OUsooner]

I know a PM&R (non fellowship trained) yanking in close to 7 figures. How does he do this? 4-5 EMG's a day, plenty of injections, along w/ some pvt research patients - pay very well. He's a one man wrecking crew - financially savvy but only does the least amount of testing needed to get the diagnosis - his patients appreciate the fewer pokes and the surgeons like how fast he gets them the consult note on EMG's. Basically works 50 hours a week or so with some talks for pharma worked in on weekends. Has a great life and is under 50. Anything is possible salary wise in rehab.

 

[Louisville04]

I know a PM&R (non fellowship trained) yanking in close to 7 figures. How does he do this? 4-5 EMG's a day, plenty of injections, along w/ some pvt research patients - pay very well.

Wow 4-5 EMG's a day! That's 80 to 100 EMG's/month. Does he work in a rural area where no one else does EMG's? 5 EMG's in a week is a good week for me.

 

[OUsooner]

He's in a mid sized city in the midwest. From what I have seen the money is in cities sized between 500k to 2 mil or so. Think Oklahoma City, St. Louis, Kansas City, and other similarly sized cities. I've lived in the midwest so that's where my expertise (if you can call it that) lies. If you want to live in Chicago or New York you will not make over 200k without really busting your a$$ or getting really lucky. If you want to be in a city like Chicago you need to work in the 'burbs to get good numbers. Also when you go at in pvt practice you have to realize that early on you may not make the money but in the long run you'll be better off - assuming you have some business savvy and are good at what you do. People skills and business knowledge go a long ways once you're finished.

 

[WaterAvatar]

where can one acquire this business knowledge?

 

[OUsooner]

Different ways to do it. It helps to have an interest in it in the first place. Personally I was a business major in undergrad but I know others just take initiative and read on their own. A lot if it is common sense. Sadly common sense isn't that common these days.

 

[Xardas]

I don't mean to threadjack here, but I saw this and it would ideally be the kind of practice I'd like to set up. Is this easy to do? Would the admin for a small inpatient rehab unit accept a physiatrist rounding in the mornings and having his/her own practice in the afternoons? I ask because I have seen a case where the hospital has forced the internists working there to either give up their practice or to discontinue working the inpatient wards.

I would think it depends on where your clinic is located; also if your patients need inpatient down the line the expectation may be to admit those patients to that hospital.

The more potential business you bring in or how effective you are gives you power in how your employer sees you.

As far as the attending in New Jersey making 400-500K, was that *gross* income or take home?

I don't doubt this guy was making a lot of money, but I figure a PA makes 80-90K and if this guy only does 1/2 day of EMG's he must be making a lot doing other stuff i.e. medicolegal, injections, etc.

Otherwise I have a hard times seeing how an inpatient guy with only 10-12 beds as his base source of income can make that much even if he is getting a high turnover every day.

As far as the last post about business sense -- you learn a lot of that with experience, and there is no substitute. Common sense helps a lot. But most of all thinking outside the box...

 

[axm397]

As far as the attending in New Jersey making 400-500K, was that *gross* income or take home?

Gross - He was working pretty much at least one weekend day every week doing consults 2x wk at subacute/nursing facilities. plus, he was med director at the 10-12bed facility.

 

[Disciple]

Here is an offer sheet I just received - it is at the higher end, but not unattainable

Base Salary
Year 1: range between $275k-$350k depending on BE/BC, training and experience.
Year 2: Range between $300k-400k depending on BE/BC, training and experience.

Production Incentive:
Year 1: 50 to 60% of net collections after subtraction of Salary, benefits, and all overhead/corporate expenses, which are allocated equally between all the physicians of the corporation (partners and salaried doctors)
Year 2: 60 to 70% of net collections after subtraction of expenses as noted above.

Moving Expenses:
Up to a maximum of $ 7,500.00 towards Physician’s actual expenses of moving self, family to begin practice.
​

What city-size and region of the country?

if you don't mind me asking.



Partnership tract?

 

[Disciple]

I know a PM&R (non fellowship trained) yanking in close to 7 figures. How does he do this? 4-5 EMG's a day, plenty of injections, along w/ some pvt research patients - pay very well. He's a one man wrecking crew - financially savvy but only does the least amount of testing needed to get the diagnosis - his patients appreciate the fewer pokes and the surgeons like how fast he gets them the consult note on EMG's. Basically works 50 hours a week or so with some talks for pharma worked in on weekends. Has a great life and is under 50. Anything is possible salary wise in rehab.

4-5 EMGs per day. Are these strictly nerve entrapment/radic screens or does he do EMGs for Neuromuscular disease?

Regarding injections, I'm assuming you mean fluoro guided spinal injections in addition to peripheral joint injections, etc.

Office C-Arm?

 

[OUsooner]

The EMG's are mixed between screening for CTS and such vs. dx neuromuscular disorders. He has no c-arm. Does botox injections for contractures etc. Also has patients see him for private pain research companies which pay well per visit - just a matter of being meticulous in record keeping. Also he has two pain docs who work in the adjacent office who send him plenty of referrals because they do not do any diagnostic work or injections of their own. All adds up well.