Nursing home physiatrist

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RIT

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I am considering taking a position as a Physiatrist in a nursing home. I am looking for someone who is currently working in this setting. I would essentially be a consultant for patients on the skilled unit. I am wondering how many days/week you round and if you get a stipend from the nursing home in addition to what you bill.

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I am considering taking a position as a Physiatrist in a nursing home. I am looking for someone who is currently working in this setting. I would essentially be a consultant for patients on the skilled unit. I am wondering how many days/week you round and if you get a stipend from the nursing home in addition to what you bill.

What do you do as a nursing home physiatrist?
 
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I am considering taking a position as a Physiatrist in a nursing home. I am looking for someone who is currently working in this setting. I would essentially be a consultant for patients on the skilled unit. I am wondering how many days/week you round and if you get a stipend from the nursing home in addition to what you bill.

I dabbled with it a couple years ago - mainly it fulfills a need to NH/rehab facility has - usually thats why a NH wants a physiatrist - so they can bill as a rehab unit. The patients get better at an even slower pace than inpt rehab, or just bide their time until a bed opens up on the non-rehab ward.

The pay sucks for the time involved - medicare rates. I would round 1-2x/week, took up most of an afternoon, and I could see more patients in the clinic, plus travel was an issue - I had NHs on opposite ends of town. Stipends were in the upper 3 digits per mo. Again, not worth it.
 
I dabbled with it a couple years ago - mainly it fulfills a need to NH/rehab facility has - usually thats why a NH wants a physiatrist - so they can bill as a rehab unit. The patients get better at an even slower pace than inpt rehab, or just bide their time until a bed opens up on the non-rehab ward.

The pay sucks for the time involved - medicare rates. I would round 1-2x/week, took up most of an afternoon, and I could see more patients in the clinic, plus travel was an issue - I had NHs on opposite ends of town. Stipends were in the upper 3 digits per mo. Again, not worth it.

I too am "dabbling" right now...I totally agree...a lot of the time you dont even get paid for doing consultations. It might be a function of the population being in the "YO" and all. I actually look for medicare numbers on the face sheet just so I know that I will get something for taking the time. Commuting is also an issue for me...its kind of a distance from my office location. Not really worth it.

On the other hand...its not exactly rocket science, and doesnt take all that long to knock out...
 
Dude, what haven't you done?

Inpt SCI or TBI since residency. A fellowship. Implants. High cervical ESI's. Eagled a par 5.

Other than that, not much, I think.

I spent my first 2 years out of residency running a small general rehab unit (12 bed) in a small hospital - yeah, Director right out of residency (don't try this yourself kids...), while starting an outpt clinic that developed into a full time pain clinic. The clinic grew as the hospital and the economy moved away from inpt rehab being important, so I switched to full time outpt pain, where I learned I'm good at pain and being a doctor, but not so good at being a business owner.

I tired several different things with it including having counseling, PT, and even accupunture and chiropractic all at the same office - short story was everyone wanted things done, as long as they didn't have to pay for it, and as long as the they recieved their monthly opioid Rx. I burned out on both opioid Rx'ing and running a business.

I closed shop, moved closer to what used to be home, joined a thriving ortho/multi-specialty clinic. Now I do outpt spine/pain and some general outpt rehab, about 1/3 clinic, 1/3 EMG and 1/3 injections. About half the injections are diagnostic - injecting gad for MRI arthrograms (we have 2 MRI units in our office - 1 full size, 1 mini), such as hip and shoulder, as well as hip and shoulder injections under fluoro diagnostically (lido +/- steroid) for the ortho's e.g. "is this joint causing the patient's pain and would they be a good candidate for joint replacement." I do some spasticity treatment.

Along the way I've tried out a number of other opportunities, including nursing homes. We were pimped out to several during residency - nursing homes collectively paid for 1/2 or a residency position that year, Chair was trying to be financially creative. I used to f/u some of my inpt rehab pts in the NH in my old practice.

Then, shortly after coming here, while still building my practice, I was approached by 2 NHs almost simultaneously that were opening rehab units, looking for physiatrists to see their pts, to fulfill state requirements. It turned out not to be worthwhile to me professionally or monetarily. I rounded, wrote notes, made recommendations that may or may not be enacted (everything I ordered came out of the pocket of the NH/rehab facility - they got paid per diem, no FFS). It took too much of my time and paid too little. They could not afford enough of a stipend to make up for the money I would lose from not being in the clinic.

I've found letting others do what they are trained for, and doing my thing makes a lot more sense and money than trying to be everything to everyone. I've now found a nice little well-paying niche for myself, and it's a comfy little niche.

My next plan is to go down to 4 day work-weeks. I only see patients for about 30-32 hours per week as it is, so I'm trying to re-create my schedule to have either Mondays or Fridays off, maybe both every other week.
 
are there plenty of job opportunities in pmr? I'm worried about getting out and not being able to find a job because I don't know if there is a lot of demand. Thanks!
 
Inpt SCI or TBI since residency. A fellowship. Implants. High cervical ESI's. Eagled a par 5.

Other than that, not much, I think.

I spent my first 2 years out of residency running a small general rehab unit (12 bed) in a small hospital - yeah, Director right out of residency (don't try this yourself kids...), while starting an outpt clinic that developed into a full time pain clinic. The clinic grew as the hospital and the economy moved away from inpt rehab being important, so I switched to full time outpt pain, where I learned I'm good at pain and being a doctor, but not so good at being a business owner.

I tired several different things with it including having counseling, PT, and even accupunture and chiropractic all at the same office - short story was everyone wanted things done, as long as they didn't have to pay for it, and as long as the they recieved their monthly opioid Rx. I burned out on both opioid Rx'ing and running a business.

I closed shop, moved closer to what used to be home, joined a thriving ortho/multi-specialty clinic. Now I do outpt spine/pain and some general outpt rehab, about 1/3 clinic, 1/3 EMG and 1/3 injections. About half the injections are diagnostic - injecting gad for MRI arthrograms (we have 2 MRI units in our office - 1 full size, 1 mini), such as hip and shoulder, as well as hip and shoulder injections under fluoro diagnostically (lido +/- steroid) for the ortho's e.g. "is this joint causing the patient's pain and would they be a good candidate for joint replacement." I do some spasticity treatment.

Along the way I've tried out a number of other opportunities, including nursing homes. We were pimped out to several during residency - nursing homes collectively paid for 1/2 or a residency position that year, Chair was trying to be financially creative. I used to f/u some of my inpt rehab pts in the NH in my old practice.

Then, shortly after coming here, while still building my practice, I was approached by 2 NHs almost simultaneously that were opening rehab units, looking for physiatrists to see their pts, to fulfill state requirements. It turned out not to be worthwhile to me professionally or monetarily. I rounded, wrote notes, made recommendations that may or may not be enacted (everything I ordered came out of the pocket of the NH/rehab facility - they got paid per diem, no FFS). It took too much of my time and paid too little. They could not afford enough of a stipend to make up for the money I would lose from not being in the clinic.

I've found letting others do what they are trained for, and doing my thing makes a lot more sense and money than trying to be everything to everyone. I've now found a nice little well-paying niche for myself, and it's a comfy little niche.

My next plan is to go down to 4 day work-weeks. I only see patients for about 30-32 hours per week as it is, so I'm trying to re-create my schedule to have either Mondays or Fridays off, maybe both every other week.

I like this. :thumbup:
 
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