Physiatrist Salaries

[PMR2008]

I think I have a pretty good grip on what to expect for an average salary, but I know there are many different practice types in PM&R that change what you can expect to make.

What do you think the salary would be for a PM&R doc who was the medical director for the rehab unit of a moderate-sized hospital?

A lot of variables. Location, hospital system, experience, contract as employee or 1099, NP/PA support etc.
But in general I have seen 250k to 400k.

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[cowboydoc]

I think I have a pretty good grip on what to expect for an average salary, but I know there are many different practice types in PM&R that change what you can expect to make.

What do you think the salary would be for a PM&R doc who was the medical director for the rehab unit of a moderate-sized hospital?

Where? What is the demand in the area? How large is the unit?

the ranges above sounds about right.

 

[drg123]

Anyone have direct experience with salaries for physiatrists who do neuromuscular medicine (EMG/NCS/joint and peripheral injects?) In the AAPM&R report, they combine pain and neuromuscular, which definitely confuses things, since I suspect the majority of that higher salary is coming from the interventional pain folks.

I thought I was interested in pain, but beginning to reconsider whether I want to be a heavy interventionist. NM might be more my thing, but wonder how much salary I'd be giving up.

 

[runfastnow]

Anyone have direct experience with salaries for physiatrists who do neuromuscular medicine (EMG/NCS/joint and peripheral injects?) In the AAPM&R report, they combine pain and neuromuscular, which definitely confuses things, since I suspect the majority of that higher salary is coming from the interventional pain folks.

I thought I was interested in pain, but beginning to reconsider whether I want to be a heavy interventionist. NM might be more my thing, but wonder how much salary I'd be giving up.

Send me a message and can discuss my (somewhat) similar path with you.

 

[Sea Otter]

Anyone have ballpark numbers for how academic peds PM&R salary compares with academic adult PM&R salary?

 

[PMR2008]

This is from 2017. Median for general is 280k and Peds is 250k. In big cities it is lower.

Compensation Survey

 

[PMRDOC2019]

Any idea what academic PM&R pain is? Thanks.

 

[drg123]

Any idea what academic PM&R pain is? Thanks.

One can search state university salaries. I’ve seen from low 200’s to $400k. I think some states only show base and not bonuses and such. Also will likely depend on whether employed by anesthesiology or PM&R. Anesthesia salaries likely higher.

 

[cowboydoc]

One can search state university salaries. I’ve seen from low 200’s to $400k. I think some states only show base and not bonuses and such. Also will likely depend on whether employed by anesthesiology or PM&R. Anesthesia salaries likely higher.

This does not look very useful. I just looked at my state's data, which indicates the chair of neurosurgery made about $200k. There are obviously other revenue sources, and this must only the money that comes from tax payer dollars.

I'd take about a 50% pay cut to leave my employed position and take a job at the university across town. I'd guess the average is about 25%-33% less for an academic position.

The attached doesn't break down according to your questions, but is still a good reference.

 

[PMRDOC2019]

Thanks guys! Does anyone happen that has access to that 2017 AAPM&R Compensation survey, and if so, does it mention starting or median salaries are for academic pain PM&R docs?

 

[cowboydoc]

Thanks guys! Does anyone happen that has access to that 2017 AAPM&R Compensation survey, and if so, does it mention starting or median salaries are for academic pain PM&R docs?

https://www.aapmr.org/docs/default-source/career-center/808520_2017-compensation-survey-v06-ex-summary.pdf?sfvrsn=5bc2587c_0

 

[sweetxjules]

This is from 2017. Median for general is 280k and Peds is 250k. In big cities it is lower.

Compensation Survey

Anyone have an idea of difference between academic vs private for salary? I know private makes more but not sure by how much more.

 

[PMR2008]

50-100% more. Rough estimate.

 

[runfastnow]

Anyone have an idea of difference between academic vs private for salary? I know private makes more but not sure by how much more.

Anecdotal averages from recent grads/direct experience as starting offers:

Academic Inpatient / Non-Injectionist: $180-200k
Academic Injectionist: $220-240k
Private Inpatient: $200-350k (very heavy location bias)
Private Outpatient Non-Spine: $250k
Private Spine + Injectionist: $300-450k+ (location bias and depending on pain fellowship, pain pumps/stims vs ESIs only)

 

[Sea Otter]

Anyone here in academics? What made it worth the (very large) pay cut for you? What swayed you that way over private practice?

 

[DoYouEvenLiftBro]

Anecdotal averages from recent grads/direct experience as starting offers:

Academic Inpatient / Non-Injectionist: $180-200k
Academic Injectionist: $220-240k
Private Inpatient: $200-350k (very heavy location bias)
Private Outpatient Non-Spine: $250k
Private Spine + Injectionist: $300-450k+ (location bias and depending on pain fellowship, pain pumps/stims vs ESIs only)

I know academic injectionists more than tripling your numbers listed

 

[runfastnow]

I know academic injectionists more than tripling your numbers listed

Good to know for those out there interested what the upper brackets can look like. Certainly in the right compensation model (which is wildly variable regardless of practice type) you can get there once your patient load is full.

Just not my (or my peers') anecdotal experience - especially for new grads - to start in the $500-700s.

 

[PainRehabMD]

Good to know for those out there interested what the upper brackets can look like. Certainly in the right compensation model (which is wildly variable regardless of practice type) you can get there once your patient load is full.

Just not my (or my peers') anecdotal experience - especially for new grads - to start in the $500-700s.

Seen a single offer in low $500k's but it was for private practice part of a 2 year contract and the 2nd year had no guaranteed salary. Middle of nowhere town in extreme poverty. I don't know anyone in academic PM&R who makes anywhere near 500-700 (unless in a chair position and bringing in lots of research funding). Can't imagine RVU structure that nice in academia.

 

[sloh]

1099 Subacute Rehab Consulting: 4 days/week, 350k+

 

[Private_MD]

1099 Subacute Rehab Consulting: 4 days/week, 350k+

how many patients do you see daily generally speaking?

 

[sloh]

Kaiser outpatient W-2 with full benefits: 230-280k

 

[sloh]

how many patients do you see daily generally speaking?

I see around 35. I currently work 6 days/week. 4 of those days, I see 35 (~4 hr day). 2 days I see around 25-30 (~3 hr day). Mileage may vary depending on how efficient the physician is

 

[Private_MD]

I see around 35. I currently work 6 days/week. 4 of those days, I see 35 (~4 hr day). 2 days I see around 25-30 (~3 hr day). Mileage may vary depending on how efficient the physician is

i'm confused - i thought you said you work 4 days/week?
you work 6 days/week? so you do or you don't do subacute sorry i am not sure i get it. you see 35 patients in 4 hours? wow!
why do you work so much? is the 350k quoted for you or someone else who posted?

 

[sloh]

i'm confused - i thought you said you work 4 days/week?
you work 6 days/week? so you do or you don't do subacute sorry i am not sure i get it. you see 35 patients in 4 hours? wow!
why do you work so much? is the 350k quoted for you or someone else who posted?

4 days per week is what PM&R physicians usually work for SAR. 2 SNF’s, see patients twice per week. You can work more if you want. You can even work only 2 days per week if you want. I kind of want to hustle and achieve financial independence. And at 4 hours per day, I don’t feel I need much of a break wrt taking entire days off. Yes I currently do SAR work. I used to be a W2 doing outpatient MSK.

 

[Private_MD]

4 days per week is what PM&R physicians usually work for SAR. 2 SNF’s, see patients twice per week. You can work more if you want. You can even work only 2 days per week if you want. I kind of want to hustle and achieve financial independence. And at 4 hours per day, I don’t feel I need much of a break wrt taking entire days off. Yes I currently do SAR work. I used to be a W2 doing outpatient MSK.

so do you work at different facilities for a total of 6 days/week? or you just work 4 days per week total?

 

[sloh]

so do you work at different facilities for a total of 6 days/week? or you just work 4 days per week total?

I work at 3 SNF’s currently, see patients twice per week, which comes out to 6 days per week. I originally wrote 4 days/week because I felt it was more informative since that’s more the norm for PM&R physicians that do SAR work full-time

 

[Private_MD]

I work at 3 SNF’s currently, see patients twice per week, which comes out to 6 days per week. I originally wrote 4 days/week because I felt it was more informative since that’s more the norm for PM&R physicians that do SAR work full-time

so do you make 350k plus seeing patients 6 days/ week then?

 

[sloh]

so do you make 350k plus seeing patients 6 days/ week then?

No it’s more than that. The 350k reflects 4 days/week.

 

[RangerBob]

You see 35 patients (including new consults), write orders, and notes in just 4hrs?

 

[PMR2008]

I used to work 6 days a week doing SAR early in my career. Since than I work 4/week and see about 30-35 patients. Probably 4-5 new/day. Rounding, notes and billing takes about 5-6 hours. A lot of follow ups are to monitor pain meds, rehab, discharge planning and can be 5-10/patient. Initial evals probably take 10-15 minutes. Notes take about 45-60 minutes and dictated. Billing an additional 10-15 minutes. I don't put orders in myself. I just tell the nurses and they input it into the EMR.
Some days I am hyper efficient but others it might take a a little longer. I cut down subacute to 4 days a week but added a outpatient clinic and admin/med legal. What @sloh is saying is achievable while providing good care. As a consultant I am not managing every medical issue but just focusing on rehab/msk/neuro/optimizing meds/discharge planning. Makes it a lot easier. 350k sounds about right.

 

[sloh]

You see 35 patients (including new consults), write orders, and notes in just 4hrs?

Yeah SAR consulting as PM&R is very different from Acute Inpatient Rehab. For acute inpatient rehab, I would get quite frazzled if my census went much above 15-18 patients per day. For SAR, we are consultants (not primary) and can focus more on functional, MSK, pain issues. I do not write or put in orders. I make recommendations in my notes and then will text/email/send those recs to the director of nursing so that it can be approved (or declined) by the primary physician.

On a typical day of 35 patients (let's assume 32 with 3 new ones), I will show up at 8:30 AM and touch base with the Director of Rehab to see if they have any patients with specific issues to address more urgently. This is typically maybe 3-5 patients. Then I will chart check and round on all the other patients in 1-1.5 hours. Documenting will usually take me about 1.5 hours, running up to 2 hours if including the new consults. Initial consults take 10-15 minutes per patient. The company I work for has coders/billers that take care of the billing/coding. I finish my notes, send them an email, and they take care of the rest.

 

[RangerBob]

Sounds like a really nice gig. We had no exposure to SAR in residency. I really enjoy IPR, but I’ll have to keep SAR as a backup option (or partial retirement option).

 

[PMR2008]

Most programs don’t even want to talk about it. I started in 2012 and I have no intention to leave this setup.

 

[PMR2008]

Subacute is not for everyone but those who like independence from hospitals and want flexibility it is hard to beat. It is not glamorous work but it is bread and butter physiatry. There is a place for both acute and subacute rehab and we need to be involved in the continuum of care and not look down on docs who take care of patients in any setting.

 

[MavFab]

Subacute is not for everyone but those who like independence from hospitals and want flexibility it is hard to beat. It is not glamorous work but it is bread and butter physiatry. There is a place for both acute and subacute rehab and we need to be involved in the continuum of care and not look down on docs who take care of patients in any setting.

What are the downsides of this setup aside from the 1099? It sounds almost too good to be true.

 

[sloh]

What are the downsides of this setup aside from the 1099? It sounds almost too good to be true.

Yes, from a compensation/hour standpoint, it is very good. I agree with PMR2008 that one of the biggest downsides is that it's not glamorous work. Although you should largely be consulting on and seeing patients getting subacute rehab (patients getting PT/OT/ST) with the goal of discharge home, you are seeing these patients in a SNF setting. You also have to kind of set your ego aside as a consultant. When you make recommendations, this can often times take longer to be implemented just due to the logistical inefficiencies in a SNF setting as well as approval from the primary physician.

It's also not unusual that patients who don't fulfill IPR criteria and go to SAR instead are just sicker overall and require a more protracted and less intensive rehab course. This is gradually shifting though. See below:

"Rehabilitation in the skilled nursing facility environment is rapidly emerging as the predominant level of inpatient rehabilitation care in the United States. The effects of the so-called 60% rule, level of care determinations by payers, and other restrictions on IRF rehabilitation, have led to a 25% decline in IRF cases between 2004 and 2013. More patients receive will their inpatient rehabilitation in a SNF today than in an IRF – and the trend is likely to continue."

The physiatrist's role in post-acute rehabilitation - McKnight's Long Term Care News

In the IRF environment, it is mandated by federal regulation that the rehabilitation physician performs several key functions. It is not specified that this doctor necessarily be a physiatrist, but only a physician with training and experience in rehabilitation. In the SNF environment, there is...

www.mcknights.com

 

[MavFab]

Yes, from a compensation/hour standpoint, it is very good. I agree with PMR2008 that one of the biggest downsides is that it's not glamorous work. Although you should largely be consulting on and seeing patients getting subacute rehab (patients getting PT/OT/ST) with the goal of discharge home, you are seeing these patients in a SNF setting. You also have to kind of set your ego aside as a consultant. When you make recommendations, this can often times take longer to be implemented just due to the logistical inefficiencies in a SNF setting as well as approval from the primary physician.

It's also not unusual that patients who don't fulfill IPR criteria and go to SAR instead are just sicker overall and require a more protracted and less intensive rehab course. This is gradually shifting though. See below:

"Rehabilitation in the skilled nursing facility environment is rapidly emerging as the predominant level of inpatient rehabilitation care in the United States. The effects of the so-called 60% rule, level of care determinations by payers, and other restrictions on IRF rehabilitation, have led to a 25% decline in IRF cases between 2004 and 2013. More patients receive will their inpatient rehabilitation in a SNF today than in an IRF – and the trend is likely to continue."

The physiatrist's role in post-acute rehabilitation - McKnight's Long Term Care News

In the IRF environment, it is mandated by federal regulation that the rehabilitation physician performs several key functions. It is not specified that this doctor necessarily be a physiatrist, but only a physician with training and experience in rehabilitation. In the SNF environment, there is...

www.mcknights.com

Did you or @PMR2008 do an interventional fellowship like pain or spine/sports? If so, how do you incorporate procedures into this setup? Thanks for the responses!

 

[PMR2008]

What are the downsides of this setup aside from the 1099? It sounds almost too good to be true.

I have heard that statement "sounds too good to be true" for 10 years now.
Downsides are below.
1) not enjoying the work or setting
2) SNFs are not run like hospitals. Can be very disorganized and can have frequent management changes
3) This work is non academic. You don't get to spend you day interacting with residents/students or other Physiatrist. But I do interact with the Primary care team daily and occasionally ortho or neuro if I need clarification regarding a patient. I sign off patients to local outpatient Physiatrists if the patient needs long term PM&R care
4) Typically there is no guaranteed salary and this can be very daunting for new grads to envision. I lot of new grads would rather take a significant pay cut that even consider the risk. I personally think the risk of not matching a guaranteed salary is very low. Unless you are doing interventional pain and are busy from the get go
5) There is no ownership in 1099 work. Some non SNF practices do offer partnership and long term they can be financially beneficial
6) You don't have the ability to order MRI's on every patient who has low back pain. Any imaging comes out of the pocket of the SNF's. I rely on good history and exam. if someone needs urgent workup they are sent back to the hospital.
7) You don't have a ton of support like you would in clinic. In my clinic I have the MA/RN that help get the patient in the room, draw up meds, assist with injections and documentation. But I do hate the prior authorization etc.
8) Occasionally you might get push back from the primary care team. Even though they are consulted prior to a Physiatrist starting but at times the decision to add Physiatry into a SNF is a corporate decision. Once they understand how we help them it can be a wonderful symbiotic relationship. Similar to any other practice.

In a nutshell don't just look at the compensation. That will be attractive for a short amount of time. You have to love the consulting Physiatrist role and be a little risk tolerant. When I started I wanted to give it a try for a year and I knew there would be plenty of jobs available if I decided it was not for me after a year.

 

[PMR2008]

Did you or @PMR2008 do an interventional fellowship like pain or spine/sports? If so, how do you incorporate procedures into this setup? Thanks for the responses!

Interventional spine/pain fellowship. In the SNF I am doing bedside ultrasound guided injections. Everything from nerve blocks, IA injections to trigger point injections. In my separate clinic I do spine injections. I did train how to do stims but decided I did not want that patient population in my clinic.

 

[PMR2008]

Finally if anyone wants to talk more about this privately please PM me. I have helped a lot of docs including @sloh over they years. If you are a resident reading this and want to get exposure find out if your local SNF has a Physiatrist and spend some time with them on a post call or vacation day. It is tricky with COVID since most facilities are not letting residents/students shadow. None of my facilities in the Chicagoland area have issues with shadowing.

 

[sloh]

Finally if anyone wants to talk more about this privately please PM me. I have helped a lot of docs including @sloh over they years. If you are a resident reading this and want to get exposure find out if your local SNF has a Physiatrist and spend some time with them on a post call or vacation day. It is tricky with COVID since most facilities are not letting residents/students shadow. None of my facilities in the Chicagoland area have issues with shadowing.

Yeah, if it weren't for PMR2008's DM responses to my questions and posts on SAR over the years on this very forum, I would have never taken the plunge. He has been very helpful! I did not get any exposure to this in residency.

 

[callosum]

Subacute is not for everyone but those who like independence from hospitals and want flexibility it is hard to beat. It is not glamorous work but it is bread and butter physiatry. There is a place for both acute and subacute rehab and we need to be involved in the continuum of care and not look down on docs who take care of patients in any setting.

You mentioned the care continuum, have you seen any progress being made with model 2 below from AAPMR, integrating physiatry into acute care? I've worked in occupational therapy for the past eight years, was a director of rehab in SNFs for 4 years, treating neuro/ortho/trauma cases in acute hospital for the past 2 years now.

I just got accepted to medical school and am very eager to use my background in rehab. I see a huge potential for difficult cases where hospitalists, neurologists, trauma, and ortho put PT/OT/SLP in their A/P, yet there is no physiatry involved with these complex cases. Thoughts on this? Is there a way to fit into this niche and make a living comparable to sub/post-acute? perhaps a case-mix of acute/post-acute/OP caseloads? I would love a case-mix with some acute care included

I was also under the impression that a fellowship in brain or SCI would be more geared towards medical directorship and/or consulting, but it seems interventional works just as well? with brain/SCI, would you be equipped to provide bedside US guided injections as well?

Thanks!

Rehabilitation Care Continuum Practice Area

 

[Private_MD]

You mentioned the care continuum, have you seen any progress being made with model 2 below from AAPMR, integrating physiatry into acute care? I've worked in occupational therapy for the past eight years, was a director of rehab in SNFs for 4 years, treating neuro/ortho/trauma cases in acute hospital for the past 2 years now.

I just got accepted to medical school and am very eager to use my background in rehab. I see a huge potential for difficult cases where hospitalists, neurologists, trauma, and ortho put PT/OT/SLP in their A/P, yet there is no physiatry involved with these complex cases. Thoughts on this? Is there a way to fit into this niche and make a living comparable to sub/post-acute? perhaps a case-mix of acute/post-acute/OP caseloads?

I was also under the impression that a fellowship in brain or SCI would be more geared towards medical directorship and/or consulting, but it seems interventional works just as well? with brain/SCI, would you be equipped to provide bedside US guided injections as well?

Thanks!

Rehabilitation Care Continuum Practice Area

View attachment 320300

Outside of academia brain or SCI fellowships are not very helpful as it’s very hard to find an exclusive gig in either those fields. Those fields are geared more towards academics or VA which are rather far away from consulting. I would say pain/regen would be far more helpful in that regards.

 

[callosum]

Outside of academia brain or SCI fellowships are not very helpful as it’s very hard to find an exclusive gig in either those fields. Those fields are geared more towards academics or VA which are rather far away from consulting. I would say pain/regen would be far more helpful in that regards.

Thanks for the feedback. How far out does regenerative neuro seem to be from clinical application, and will this be a skill set you can practice/explore with a pain fellowship? I'm guessing the most applicable setting for this would be outpatient, post-IPR. I don't want to hi-jack this thread, so if anyone wants to really discuss neuro-based regenerative medicine, the literature, and applications for TBI, stroke, SCI (outside of salary) please see below. Trying to get a better picture of career opportunities with pain fellowship and a strong neuro-rehab interest.

Neurorehabilitation, neurology, and regenerative medicine

Looking for opinions/thoughts/evidence for regenerative medicine with SCI, TBI, and stroke. For example, the use of PRP, scaffold proteins, bioengineering of polymer templates for healing, enzymes, bone marrow aspirate concentrate, and other approaches. Does this seem like something that will...

forums.studentdoctor.net

 

[Private_MD]

Thanks for the feedback. How far out does regenerative neuro seem to be from clinical application, and will this be a skill set you can practice/explore with a pain fellowship? I'm guessing the most applicable setting for this would be outpatient, post-IPR. I don't want to hi-jack this thread, so if anyone wants to really discuss neuro-based regenerative medicine, the literature, and applications for TBI, stroke, SCI (outside of salary) please see below. Trying to get a better picture of career opportunities with pain fellowship and a strong neuro-rehab interest.

Neurorehabilitation, neurology, and regenerative medicine

Looking for opinions/thoughts/evidence for regenerative medicine with SCI, TBI, and stroke. For example, the use of PRP, scaffold proteins, bioengineering of polymer templates for healing, enzymes, bone marrow aspirate concentrate, and other approaches. Does this seem like something that will...

forums.studentdoctor.net

Highly unlikely. I think personally that any type of neuro based regen medicine is decades away if ever, and pain is mostly spine with the occasional peripheral joint - not neuro. Stem cells are the closest thing to regen in terms of outside joints and even that is iffy and really no current good data/evidence that stem cells truly are effective. So don't think you'd be able to practice any neuro rehab.

Practice is divided into 2 essential components - academics, which is slower, for those who like to teach, do research, and pay is less, stress is less, etc.
Private practice - much higher volume, better compensation, less focus on "academic" type of practice and more real life/world practice, more stress.
With private practice, $ is not monopoly money as is frequently in academics - it's real life people with insurance or lack therefore, copays, denials, etc. which academics really doesn't deal with nearly as much.

 

[ScawtyDawg]

Apologies if this has been answered before (I tried looking it up but found nothing recent):

Does anyone have an idea of salaries for the V.A.? I am aware of some basics around their salary structure (the way I think of it: Gen Med primary care = tier 1 salary (lowest), PM&R = tier 2, Anesthesia = tier 3) but I was hoping someone could provide more details and/or correct me if I am wrong.

Specifically I am curious about how interventional fellowship training could increase income at the V.A. (either sports/spine or NASS ISMM or ACGME pain / sports etc). I understand that technically, even having done the same ACGME pain med fellowship training as our Anesthesia counterparts, PM&R as a speciality is tiered lower than Anesthesiology and thus our base salary will not be as high as Anesthesia even having completed the same pain fellowship (does that sound right?)

I know the extra benefits and pension are great, but I was also hoping to learn more about opportunities for bonus pay (productivity based?) if that exists.

Thanks for your time. Responses very much appreciated!

 

[ThereIsNoErfLevel]

Anyone know what salaries look like for NASS interventional spine? Haven't been able to find any good data about it

 

[cowboydoc]

Anyone know what salaries look like for NASS interventional spine? Haven't been able to find any good data about it

That data doesn’t exist. Most valid data is probably MGMA and AMGA numbers for “non-anesthesia pain” with PM&R for reference.

 

[9732doc]

Do we have any recent updates on PM&R salaries from MGMA?
Anyone care to share some numbers on a practice that is mostly MSK medicine with procedures +/- EMG?

 

[rehabresident16]

Anyone know what salaries look like for NASS interventional spine? Haven't been able to find any good data about it

Recent graduate from ACGME pain fellowsihp here, spoke with several folks who went the NASS route. In private practice they see it pretty much the same - they care about whether you're comfortable doing the procedures they want you to do and prescribing meds. My sense (may not be true) was that people who went the NASS route wanted to avoid medical management but >95% of pain jobs out there require at least some medical management. It's exceptionally hard to find 100% pure interventional jobs unless you have a lot of leverage like a rural location or willing to take a pay cut.

If you are willing to do interventional and medical, the pay tracks pretty similarly to pain jobs you see on job boards or the "non anesthesia pain" MGMA numbers.