PM&R Pain Salaries

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To add to this, is there significant variability of salary for those with ACGME Pain fellowship training, but different primary specialities? in other words, does PM&R Pain typically make less than Anesthesia Pain overall? TIA
 
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Geographically dependent as well as hopd vs not. Too many variables to make accurate commentary. From what I continue to see over years of practice is so much of private practice depends on the culture (multifactorial), and more importantly contracts with payors. The latter having mass effect on the former
 
Short answer is yes, in my experience gas-trained pain docs can sometimes start off a bit higher than others but it's not a widespread practice and not a significant dollar difference. As others said, there are tons of variables and it's highly-practice dependent.

But as a more general comment, don't look past the importance of $/pt seen. Earning a higher $/pt often correlates with a more tolerable work environment and also provides you with a better financial cushion to absorb potential changes in the future that can put your income at risk (ie decreasing reimbursement, decreased staffing, etc) and/or also motivate you to work harder and see more patients.
 
I think the last actual data I saw, had PMR pain higher however. Some anesthesia pain probably have anesthesia call still so that is quite a bit of money to be had if you are willing to do that.
 
BobBarker said:
No, not for the same procedure. I could see PMR more frequently nerding out with a U.S. guided procedure that takes 15 min, uses $15 in disposable, and reimburses $60 than anesthesia trained docs. That would be a reason for lower salary.
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pinstriped1992 said:
I have heard that two placed where pay can vary significantly is in VA jobs where PM&R is paid lower and within Kaiser systems (but not sure why). Are there instances where PM&R would be reimbursed differently than an anesthesiologist doing the same procedures?
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Bob is correct. In an eat what you kill model, the anesthesia pain doc gets paid the same for an epidural as a PMR/Pain doc.

Some pain docs are more procedure focused than others. PMR docs tend to do more peripheral joint work, including the accurate example bob gave of spending all day on a MSK US guided procedure that pays peanuts. Anesthesia tends to be more spine focused which pays better. But there are plenty of spine focused PMR/Pain docs as well.

Only in the military and Kaiser, is PMR specifically paid lower for doing the same work. Otherwise, you get paid the same for the work, same CPT codes, etc.
 
pinstriped1992 said:
I’ve read a lot about anesthesia pain position salaries, I was hoping any PM&R trained pain docs could comment on their salary/region and type of practice their in. Very interested on how the current market looks and what the positions look like.
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Last I knew, VA paid PM&R base specialty less than anesthesia. Other than that it's all over the place. AMGA has consistently listed "non-anesthesia pain" as earning more than anesthesia pain. Probably because the PM&R docs work harder and are better looking.

Variability between jobs/region etc is probably a far larger spread than any consistent difference in pay between the 2 base specialties. For the most part, your review of local anesthesia pain salaries are a good estimate for PM&R pain in the same region. The anesthesia data is probably a better representation based on the number of responses, as there are far more anesthesiologists than physiatrists.

The market looks great where I am. We could use more good docs. If you want to be in NYC/west coast or decent parts of Florida, you'll probably take a serious hit financially.

My anesthesia friend tried to get me to join his private group, but I didn't think the relative autonomy was worth a 40% pay cut. (This was likely more related to SOS hospital-based employment and a potential low-ball offer than specialty.)

Of course, anesthesia can take call, etc. and make more in their base specialty than most of what PM&R could make peripherally. Work comp/medicolegal can be a headache, but pays me more per hour than everyday "Pain" work.

I often describe my practice as 75% the same as my anesthesia colleagues. I quit doing EMGs a few years ago. I have a few legacy SCI patients (who see a partner for general issues). I still do amputee care because no one else around here will, and those patients end up getting a lot of injections. I was a director at rehab facility (2-4 hrs/week) for several years until it wasn't worth the time away from the office. I probably do more U/S than most, but don't fall into the diagnostic circle jerk described above.
 
cowboydoc said:
Last I knew, VA paid PM&R base specialty less than anesthesia. Other than that it's all over the place. AMGA has consistently listed "non-anesthesia pain" as earning more than anesthesia pain. Probably because the PM&R docs work harder and are better looking.

Variability between jobs/region etc is probably a far larger spread than any consistent difference in pay between the 2 base specialties. For the most part, your review of local anesthesia pain salaries are a good estimate for PM&R pain in the same region. The anesthesia data is probably a better representation based on the number of responses, as there are far more anesthesiologists than physiatrists.

The market looks great where I am. We could use more good docs. If you want to be in NYC/west coast or decent parts of Florida, you'll probably take a serious hit financially.

My anesthesia friend tried to get me to join his private group, but I didn't think the relative autonomy was worth a 40% pay cut. (This was likely more related to SOS hospital-based employment and a potential low-ball offer than specialty.)

Of course, anesthesia can take call, etc. and make more in their base specialty than most of what PM&R could make peripherally. Work comp/medicolegal can be a headache, but pays me more per hour than everyday "Pain" work.

I often describe my practice as 75% the same as my anesthesia colleagues. I quit doing EMGs a few years ago. I have a few legacy SCI patients (who see a partner for general issues). I still do amputee care because no one else around here will, and those patients end up getting a lot of injections. I was a director at rehab facility (2-4 hrs/week) for several years until it wasn't worth the time away from the office. I probably do more U/S than most, but don't fall into the diagnostic circle jerk described above.
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Where are you located @cowboydoc ?
 
My anesthesia pain colleagues made significantly more but now, as anesthesia is not being reimbursed for spine procedures, and in our area, out of network for anesthesia is dwindling, the pay is almost equal
 
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Hello anyone have the RVU clinic and procedure data for pain?
 
Pmr pain salaries range from $350k at the VA to $1.5 million if you’re a mover and shaker. The variance is wide and most of us fall somewhere in the middle
 
Any suburban site close to nyc is gonna pay low end. Most pain practices in northern New Jersey (my state) are still riding out of network train. They are getting paid 2k for a lumbar epidural and living the life. For years I was hearing out of network is dead or dying, but I can assure you it’s alive and well. They see 20 patients a day and clear over a mill easily. It’s the only setup in my opinion that is better than hopd employment
 
pinstriped1992 said:
Would you be able to explain how out of network reimbursement works?
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No cause I’m the ******* that’s still in network. My cursory understanding is they charge whatever they want and get paid it, because the insurance companies have no way of tracking non contractural agreements so it’s a massive loop hole
 
The VA added a table designation of "interventional pain", independent of primary specialty, a few years ago. The max pay is something like 385k. If someone is an anesthesiologist, there would be flexibility in using that title instead, with a max of 400k.

These are MAX pay and it's very rare people get that. The same is true with all specialties at VA. Orthopods and radiologists are in the 350-400k range.
 
hyperalgesia said:
The VA added a table designation of "interventional pain", independent of primary specialty, a few years ago. The max pay is something like 385k. If someone is an anesthesiologist, there would be flexibility in using that title instead, with a max of 400k.

These are MAX pay and it's very rare people get that. The same is true with all specialties at VA. Orthopods and radiologists are in the 350-400k range.
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For those of us paid via a K1/1099 the VA is a great resource for an acceptable salary with the rest being distributions.
 
BobBarker said:
No, not for the same procedure. I could see PMR more frequently nerding out with a U.S. guided procedure that takes 15 min, uses $15 in disposable, and reimburses $60 than anesthesia trained docs. That would be a reason for lower salary.
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You are giving me PTSD flashbacks of me being forced to watch military PM&R docs doing 60 minute pre-surgical diagnostic ultrasounds for the Ortho Sports docs followed by a comprehensive "gait analysis". Super critical that we visualize and name every ligament in the ankle and foot.
 
I recently started Pain fellowship and am looking at jobs back home in the NW. I haven't seen too many numbers, but I'm wondering if being a pain doc at the VA right out of fellowship is the right call. PSLF ( and EDRP at the VA would be nice) or loan repayment is a high priority for me, but I'm concerned that the VA won't have the volume/diversity of procedures and the pay won't hold up with a hospital based job.

If anyone could provide their opinion I'd appreciate it
 
DrLefty said:
I recently started Pain fellowship and am looking at jobs back home in the NW. I haven't seen too many numbers, but I'm wondering if being a pain doc at the VA right out of fellowship is the right call. PSLF ( and EDRP at the VA would be nice) or loan repayment is a high priority for me, but I'm concerned that the VA won't have the volume/diversity of procedures and the pay won't hold up with a hospital based job.

If anyone could provide their opinion I'd appreciate it
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yes to all of your concerns.

Your skills will atrophy and the VA pay will be 1/3 that of a HOPD pain job.

Pay your loans off yourself by making bank, not by depending on the government.
 
DrLefty said:
I recently started Pain fellowship and am looking at jobs back home in the NW. I haven't seen too many numbers, but I'm wondering if being a pain doc at the VA right out of fellowship is the right call. PSLF ( and EDRP at the VA would be nice) or loan repayment is a high priority for me, but I'm concerned that the VA won't have the volume/diversity of procedures and the pay won't hold up with a hospital based job.

If anyone could provide their opinion I'd appreciate it
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If I’m not mistaken, your loan repayment is valid at a non-profit or government employer.

https://studentaid.gov/pslf/employer-search/search-tool

Many would pay better than va, and if you still qualify, best of both worlds.
 
cowboydoc said:
If I’m not mistaken, your loan repayment is valid at a non-profit or government employer.

https://studentaid.gov/pslf/employer-search/search-tool

Many would pay better than va, and if you still qualify, best of both worlds.
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Yeah a hospital based system would be loan eligible, and VA if EDRP eligible would allow me to double dip in the forgiveness category, I just don't know if the pay cut/procedural limitations would be worth it vs community based hospital setting.

The VA I rotate through for training basically only does ESI/MBB/RFA. There's some other random stuff, but they don't do any SCS trials/implants/Kypho/PNS or anything. I'm worried I'll be severely limiting myself if I head to the VA and have the limited volume compared to other settings, but IDK, I'm also wouldn't really mind having a relatively easy job compared to non-VA
 
DrLefty said:
I'm also wouldn't really mind having a relatively easy job compared to non-VA
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PP or HOPD, and pay your loan off in < 3 yrs while still having a high QoL and job satisfaction.

A "relatively easy" job will not make you a good pain doctor.
 
DrLefty said:
This was one of my primary concerns. Thanks for the input.
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It's a real concern, but for some people the trade off may be worth it.

Not everyone wants to do stimulators and kyphos and "cool" procedures, and you'll find out real quick the vast majority of what you'll be doing for a living is ESI/MBB/RFA/joint injections. In fact, the implant I'm doing today at lunch time I really don't want to do...

Those advanced procedures only pencil out financially for you if you're good at them. That's the dirty secret BTW.

If all I did was offer traditional pain procedures (ESI/RFA, etc), I'd make plenty of money and have a line out my door a mile long.
 
MitchLevi said:
It's a real concern, but for some people the trade off may be worth it.

Not everyone wants to do stimulators and kyphos and "cool" procedures, and you'll find out real quick the vast majority of what you'll be doing for a living is ESI/MBB/RFA/joint injections. In fact, the implant I'm doing today at lunch time I really don't want to do...

Those advanced procedures only pencil out financially for you if you're good at them. That's the dirty secret BTW.

If all I did was offer traditional pain procedures (ESI/RFA, etc), I'd make plenty of money and have a line out my door a mile long.
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you don't own asc, that will be a completely different story 🙂
 
IMG_2600.jpeg
 
SC Tian said:
@MitchLevi one implant even with
Medicare comparable to 20 epidurals 😉
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If you're in a busy ASC and your implants are taking forever you'll get bumped by faster doctors.

Like I said, implants aren't for everyone, neither are trials or kyphos for that matter. MILD isn't for everyone. All the sexy new pain procedures aren't for everyone.

If you have a hand/wrist surgeon or a guy doing totals and you take 3 hrs for an implant you'll get bumped out of the ASC and into a clinic space.

We have several physicians in my group that you simply can't compete with in terms of collections, and they'll get the room before you.

As someone who makes money off the ASC, of you gave me a choice between another pain doctor or an ortho surgeon, I know who I'm picking.
 
MitchLevi said:
If you're in a busy ASC and your implants are taking forever you'll get bumped by faster doctors.

Like I said, implants aren't for everyone, neither are trials or kyphos for that matter. MILD isn't for everyone. All the sexy new pain procedures aren't for everyone.

If you have a hand/wrist surgeon or a guy doing totals and you take 3 hrs for an implant you'll get bumped out of the ASC and into a clinic space.

We have several physicians in my group that you simply can't compete with in terms of collections, and they'll get the room before you.

As someone who makes money off the ASC, of you gave me a choice between another pain doctor or an ortho surgeon, I know who I'm picking.
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good point from your practice, however this does not apply to other models, our interventionists here make comparable money to hand surgeons if not more by large. but you are right, my implant time is 1-1.5 hours on average. this morning before intracepts, it was a one-hour in and out of the implant.
 
SC Tian said:
good point from your practice, however this does not apply to other models, our interventionists here make comparable money to hand surgeons if not more by large. but you are right, my implant time is 1-1.5 hours on average. this morning before intracepts, it was a one-hour in and out of the implant.
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We have 5 or 6 guys in my group that are high producers. One hand guy at the end of July had done just under 700 cases, and that's just in our ASC. One total jt guy nearly 200 totals in our ASC end June. They do cases at the hospital too.

This also goes to contract negotiation. If you have a group of senior partners who do totals, the contracts will reflect that.

If our contracts are amazing for totals, and we can do a lot of them, I'd much rather have that doctor in our ASC than a pain guy.

Prob not the norm though.
 
The tide may have turned from office based to asc for procedures with declining physician fees and increasing facility fees. I don’t have enough stim cases to pencil out asc ownership personally
 
I have been told pain has better margins than Ortho for asc. The ortho implants cost too much. I guess if you are hand and doing 20 carpal tunnel releases a day the margins are positive. Total joint are great if the joint guys are cranking out volume too. Much depends on external factors like demographics, population health etc
 
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