PM&R Pain Salaries

[Dr. Ice]

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

---

Members don't see this ad.

 

[SC Tian]

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

nice observations, hand, sports are better.

 

[MitchLevi]

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

Several guys in my practice churn out ridiculous collections. I'm in the middle of the group probably.

 

[BobBarker]

Nothing compares to a prolific pain doc doing trials, implants in the ASC. It isn’t even debatable.

 

[MitchLevi]

Nothing compares to a prolific pain doc doing trials, implants in the ASC. It isn’t even debatable.

I'm not sure how I could see that many pts. In terms of ASC collections, I just don't see how.

 

[BobBarker]

On a per case basis. I agree though that volume is an issue with most. I don’t have enough volume anymore either.

 

[MitchLevi]

If you're fast, supported by 3-4 midlevels and have an endless supply of pts I can see it. I think that's a unique situation that most wouldn't be able to make work.

Multiple rooms. Midlevels close implants. Two implants per hr.

Multispecialty ASC would struggle with that if you've got other doctors same day doing high volume cases.

 

[Ducttape]

thats the key - someone has to feed the machine.

hire APPs or non pain MDs to see all the new patient evals and follow ups and then funnel all the procedures to 1 interventionalist.

 

[clubdeac]

thats the key - someone has to feed the machine.

hire APPs or non pain MDs to see all the new patient evals and follow ups and then funnel all the procedures to 1 interventionalist.

What a terrible, greedy model. Best way to guarantee poor patient outcomes at maximum cost. I know docs that practice this way

 

[nvrsumr]

I think this is a fairly common set up and becoming more so. Know of several practices that have shed pain docs and hired mlps to replace.

 

[SC Tian]

If you're fast, supported by 3-4 midlevels and have an endless supply of pts I can see it. I think that's a unique situation that most wouldn't be able to make work.

Multiple rooms. Midlevels close implants. Two implants per hr.

Multispecialty ASC would struggle with that if you've got other doctors same day doing high volume cases.

This is not typical orthopedic pain practice, imo, quality of care, the accuracy of diagnosis and efficiency, and safety of practice are equally important.

 

[Ducttape]

What a terrible, greedy model. Best way to guarantee poor patient outcomes at maximum cost. I know docs that practice this way

needle jockey, block shop, KOL.

This is not typical orthopedic pain practice, imo, quality of care, the accuracy of diagnosis and efficiency, and safety of practice are equally important.

au contraire.

this is the pattern of a typical successful orthopedic pain practice. $$$ rules.

 

[SC Tian]

The ortho practice is changing rapidly, the merging is ongoing and accelerating, sinc e Covid, there are three groups who joined the current practice, and pain practices there and ASCs become more standard and restrictive like multiple specialties centers, just my two cents of observation.

 

[afob100]

Ortho group pain doc here (hospital employed). We have 2 PMR non interventional, 2 spine NPs, 2 spine surgeon + their 2 spine surgery PAs.

All of these folks send their injections to myself and my partner within the group (at ASC).

Agree that quality of care does suffer somewhat and cost increases. One of the non spine NPs ordered a bilateral L3-4, L4-5, L5-S1 TFESI...I will usually just change the order to something more reasonable/covered by insurance.

However, access to care is improved since we offer same day or next day spine appointments. Eventually the patients do make it to the correct provider long term.

 

[GoBeers]

is it common for the interventional pain docs in the ortho groups to have to do med mgmt for all the ortho post-ops or non-ops?
i'm sure it's group specific but i fear that it would be so easy for the surgeons and their PAs to just punt to the pain doc

 

[SC Tian]

The Rothman Institute is a really world-class orthopedics group, their pmr pain is just as conservative as any other multi-specialty group.
I would not take over the med from the surgeons.

 

[Dr. Ice]

The Rothman Institute is a really world-class orthopedics group, their pmr pain is just as conservative as any other multi-specialty group.
I would not take over the med from the surgeons.

Lol…”world class”

 

[SSdoc33]

Lol…”world class”

i was about to say the same.

it really is doctor-dependent. i know some scrubs who work there

 

[SC Tian]

Fyi, Rothman model affects many orthopedic practice now.

By nearly any measure, Rothman Orthopaedic Institute is a world leader in the field of orthopaedics. Year after year, we have been ranked among the nation’s best in orthopaedic providers and the best in Greater Philadelphia, according to U.S. News & World Report. Our “Top Docs” are repeatedly ranked by Castle Connolly for providing superior and affordable orthopaedic care to patients, both locally and nationally.

 

[Dr. Ice]

Fyi, Rothman model affects many orthopedic practice now.

By nearly any measure, Rothman Orthopaedic Institute is a world leader in the field of orthopaedics. Year after year, we have been ranked among the nation’s best in orthopaedic providers and the best in Greater Philadelphia, according to U.S. News & World Report. Our “Top Docs” are repeatedly ranked by Castle Connolly for providing superior and affordable orthopaedic care to patients, both locally and nationally.

Great marketing, some really good but mostly average docs. How’s the world class label affecting how you compete against hss. Not really working out too well I imagine. FYI, I used to work there, I know the game…

 

[GoBeers]

can anyone talk about what this rothman model is and what's so good about it

 

[Dr. Ice]

can anyone talk about what this rothman model is and what's so good about it

typical Ortho model. Their docs don’t do any narcs. Pyramid system of payment. Top down model. Ortho will dump their failed joints on pain docs and say “it’s coming from your back” when it clearly isn’t. I’ve heard it’s become more geographically specific though as each territory has become its own microcosm of culture which I guess can be a good thing depending on where you wind up. The head of their pain department who is actually a really solid dude and former fellowship brethren just left for another gig…

 

[MitchLevi]

Those US News things are total BS.

I've been offered spots in those magazines too. I've turned them down because I don't want to pay them for the ad spot.

Literally just another large ortho group in a large city. These are everywhere.

 

[Dr. Ice]

There are way too many docs being “castle Connolly” for the advertised top 7% of board certified docs. I think I’ve been a member since 2019 or 2020..and every time I look at the sheer number of docs on there, I often wonder who the hell isn’t a castle Connolly doc?!

Also it doesn’t count if your oversized practice makes you all vote for each other. Then it’s really not merit based at all is it?

 

[Ducttape]

True story. I was told I was a Top Doc by the Connelly Group (as long as I paid), 1 month before I started working.

 

[SSdoc33]

i think rothman is actually pretty good for ortho.

problem is, we are not orthopedic surgeons. cant claim credit for another specialty's prowess...

 

[Dr. Ice]

True story. I was told I was a Top Doc by the Connelly Group (as long as I paid), 1 month before I started working.

Never had to pay for anything for the “distinction”

 

[drusso]

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

"Site of service arbitrage." It's the oldest trick in the book.

Obamacare favored facilities over physicians. Elections have consequences.

 

[afob100]

Our ortho group doesn't manage chronic opioids. I will help with opioid mgmt for 1 month postop for complex patients/big surgeries. But then I punt them to local pill mill if they want to stay on opioids.

 

[Forwho]

from my experience, ortho groups are the worst deal for compensation. i know two people who told me their base salary at rothman was sub 250k, i think closer to 220 if i recall. not sure what their take home was after bonusing but can't imagine it being too much. hard to believe there are people who will accept that.

another large ortho group I interviewed for, spoke to one of their pm&r docs, he was pretty open with everything and told me they max out just under 400k and that's if they're pretty busy

these positions were not in any of the major northeast cities either

 

[Dr. Ice]

from my experience, ortho groups are the worst deal for compensation. i know two people who told me their base salary at rothman was sub 250k, i think closer to 220 if i recall. not sure what their take home was after bonusing but can't imagine it being too much. hard to believe there are people who will accept that.

another large ortho group I interviewed for, spoke to one of their pm&r docs, he was pretty open with everything and told me they max out just under 400k and that's if they're pretty busy

these positions were not in any of the major northeast cities either

They will exploit their favorable geographic area, their name and their contracts which are not talked about with new employees. They also love new grads who are wet behind the ears. They have good contracts of course and the salary is based on hidden overhead burden cost as bonus is not achieved until 3x base salary is met after expenses. This will also not be told upfront and that’s why they love new grads. Historically they also screwed docs who were capable of doing more advanced procedures by forcing them into facilities they owned without offering a piece of it. The real winners in that group are the docs that work in a few offices where they are all in office based procedurally. Those docs are rewarded for having sub par skill sets and favorable contractural payors for bread and butter interventions. I know for a fact one of my friends who works there who can basically only do lumbar injections (no rfa, no cervical procedures) was making 500k a few years ago. They also only see like 25 patients in an entire day because the contracts are that good. The trade off is..little to no growth (again based on culture of your microcosm within the practice), poor base salary, surgical dumping ground, you are letter boxed into spine solely, won’t get referrals for regen (if you have interest).

It just wasn’t for me..they screwed me royally but looking back, I have grown myself as a physical enormously over the last 8 years since I left that place. I can’t be told what to do, def not by a chief that has 1/4 my skill set (which it was at the time I was there). Now I am way more comfortable doing so much more and know that I can go anywhere and work because I had to survive in a real private practice environment.

 

[Forwho]

They will exploit their favorable geographic area, their name and their contracts which are not talked about with new employees. They also love new grads who are wet behind the ears. They have good contracts of course and the salary is based on hidden overhead burden cost as bonus is not achieved until 3x base salary is met after expenses. This will also not be told upfront and that’s why they love new grads. Historically they also screwed docs who were capable of doing more advanced procedures by forcing them into facilities they owned without offering a piece of it. The real winners in that group are the docs that work in a few offices where they are all in office based procedurally. Those docs are rewarded for having sub par skill sets and favorable contractural payors for bread and butter interventions. I know for a fact one of my friends who works there who can basically only do lumbar injections (no rfa, no cervical procedures) was making 500k a few years ago. They also only see like 25 patients in an entire day because the contracts are that good. The trade off is..little to no growth (again based on culture of your microcosm within the practice), poor base salary, surgical dumping ground, you are letter boxed into spine solely, won’t get referrals for regen (if you have interest).

It just wasn’t for me..they screwed me royally but looking back, I have grown myself as a physical enormously over the last 8 years since I left that place. I can’t be told what to do, def not by a chief that has 1/4 my skill set (which it was at the time I was there). Now I am way more comfortable doing so much more and know that I can go anywhere and work because I had to survive in a real private practice environment.

I've noticed this as well. Seems like they hire a few all star docs who they give a massive amount of control to, and the remaining 90% docs are new grads who are thirsty for any six figure salary.

agree on the spine only part as well. was also told that it's frowned upon to venture out and do any peripheral joint injections as to not step on anyone's toes. would be an ideal position for someone with extremely limited skill, as you said, but if you're skillset is even in the slightest bit diverse then it's gotta be bottom tier compensation wise. i figure it would be the same for many ortho groups

 

[GoBeers]

Hmm... interesting experiences and points of view. I'm coming from a single specialty practice but have an opportunity to talk to a premier multispecialty group. I have no idea what to expect.

To be honest, I wouldnt mind just spine patients if the alternative is dealing with abdominopelvic consults but I get what the concern is in regards to limited scope of practice

 

[drusso]

They will exploit their favorable geographic area, their name and their contracts which are not talked about with new employees. They also love new grads who are wet behind the ears. They have good contracts of course and the salary is based on hidden overhead burden cost as bonus is not achieved until 3x base salary is met after expenses. This will also not be told upfront and that’s why they love new grads. Historically they also screwed docs who were capable of doing more advanced procedures by forcing them into facilities they owned without offering a piece of it. The real winners in that group are the docs that work in a few offices where they are all in office based procedurally. Those docs are rewarded for having sub par skill sets and favorable contractural payors for bread and butter interventions. I know for a fact one of my friends who works there who can basically only do lumbar injections (no rfa, no cervical procedures) was making 500k a few years ago. They also only see like 25 patients in an entire day because the contracts are that good. The trade off is..little to no growth (again based on culture of your microcosm within the practice), poor base salary, surgical dumping ground, you are letter boxed into spine solely, won’t get referrals for regen (if you have interest).

It just wasn’t for me..they screwed me royally but looking back, I have grown myself as a physical enormously over the last 8 years since I left that place. I can’t be told what to do, def not by a chief that has 1/4 my skill set (which it was at the time I was there). Now I am way more comfortable doing so much more and know that I can go anywhere and work because I had to survive in a real private practice environment.

"They will never love you back."

 

[MitchLevi]

Not at all similar to my practice. We're an ortho group with 20+ surgeons and 2 pain doctors. Bunch of midlevels.

I do spine and joints. Not once have I been told what I can or can't see. Not once have I denied any procedure I want to bring to the practice.

I choose to Rx opiates to a select number of pts.

Surgeons refer out to med management clinics instead of sending me those.

Zero postop opiates.

Occasional painful post TKA dump, but truthfully it isn't very frequent. I'm prob about to email everyone and say no more painful TKA bc Gen RFA pays zero.

 

[SC Tian]

Not at all similar to my practice. We're an ortho group with 20+ surgeons and 2 pain doctors. Bunch of midlevels.

I do spine and joints. Not once have I been told what I can or can't see. Not once have I denied any procedure I want to bring to the practice.

I choose to Rx opiates to a select number of pts.

Surgeons refer out to med management clinics instead of sending me those.

Zero postop opiates.

Occasional painful post TKA dump, but truthfully it isn't very frequent. I'm prob about to email everyone and say no more painful TKA bc Gen RFA pays zero.

Almost identical here, imo The pain practice in ortho is not terrible and greedy, some still do EMG/NCS as well.

 

[Taus]

it really is doctor-dependent. i know some scrubs who work there

I always suspected that I was a scrub with a limited skillset…

 

[SSdoc33]

I always suspected that I was a scrub with a limited skillset…

i think you would probably agree that not everyone is up to your standards, taus

 

[Dr. Ice]

I always suspected that I was a scrub with a limited skillset…

I said the real winners are..can’t discount your cohorts raking it in with minimal skill sets all in office, good contracts. I’m talking specifically about your marlton office. What a sweet sweet gig that is…no wonder JS left for that geography and with hospital umbrella. Even though his commute must be insane…

 

[Dr. Ice]

i think rothman is actually pretty good for ortho.

problem is, we are not orthopedic surgeons. cant claim credit for another specialty's prowess...

Is that why they had to pay the eagles back 14 million for either mis diagnosis or improper treatment. Yeah right, the official “providers” of an nfl team…cool story bros. You know what they say about hubris…

Don’t even get me started on sexual scandals and lawsuits..

It’s more like a reality tv show than “world class docs”

Man I can keep going…guess I’ll stop now

 

[Dr. Ice]

Almost identical here, imo The pain practice in ortho is not terrible and greedy, some still do EMG/NCS as well.

Just because the “model” was delivered to you, doesn’t mean your set up is what is experienced by their own docs. The model can also break down…

I’m not sure what kind of charlatan new money venture they are trying to carry out now by delivering their “model” to other ortho groups. I’m sure it’s quite lucrative for kool aid drinkers. Here’s what I’ve learned. Anyone can adapt a model system. The word model implies something idealic. Much of successful group practice largely depends on the culture. A good model works with a good culture within the practice. A good model doesn’t work for a crappy practice culture. That’s it. If you are implanting scs in asc and getting a piece of it, your version of the rothman model is very different from what the actual practice is like.

That’s all I’m saying

 

[nynydoc]

I interviewed with Rothmans, and other orthopedic groups, and was offered less than average. They tend to want PMR/Pain or sports/spine as they usually take the lower paying contracts upfront; they don’t care too much about the ACGME board certification. The thing that is great though, is that you’re always fed and kept busy. The busier you are, the more they make in their fluoro “investment”. Whether that percentage fairly comes to the PMR doc depends on that particular group and how fair they are in sharing revenue. If you have that golden group, this can be a very cush setup because the volume will always be there. My experience, in a saturated market, is that it’s tough to come by especially as the groups are also being bought by bigger hospitals.

 

[Dr. Ice]

Their marlton nj is that golden goose egg. Always cranking, all in office procedure suite. Good horizon nj contracts for in network. The docs that work there do the same 3 procedures on everyone, punt more complex stuff to other docs within the group and still have massive collections for doing basically nothing. I can’t comment on how mainline PA is. But I know Bensalem and newtown pa and center city Philly is a really crap deal for those guys.

 

[SC Tian]

thanks, The model I am trying to point out is academic practice became private, While able to maintain the quality of care, there are differences of profits sharing in each group, the practice draws attention due to the name of the university program, just my two cents.

 

[MitchLevi]

Many physicians think bc they participate in the clinic flow of any random practice they're entitled to owning a piece of that practice.

I don't think that.

 

[Dr. Ice]

Many physicians think bc they participate in the clinic flow of any random practice they're entitled to owning a piece of that practice.

I don't think that.

That might be true, but when 90% of what we do can be done in an office, why would I want to do anything in any type of facility unless I’m either getting a piece of the whole pie (hospital) or at least get a piece of a smaller pie (asc). I’ll never put myself in that position again where those in power can pat me on the head and say good job sparkey

 

[Dr. Ice]

thanks, The model I am trying to point out is academic practice became private, While able to maintain the quality of care, there are differences of profits sharing in each group, the practice draws attention due to the name of the university program, just my two cents.

Yes take away Jefferson backing and see what happens. Jefferson bailed out their physician owned hospital in Bensalem. Ultimately you gotta pay the piper

 

[SC Tian]

Yes take away Jefferson backing and see what happens. Jefferson bailed out their physician owned hospital in Bensalem. Ultimately you gotta pay the piper

it is a dynamically changing practice environment, Pain doc cannot just jump in practice because it is physician-owned, or because it is a busy orthopedic practice, The detailed structure and profit-sharing plan need very serious evaluation when I joined this practice, I asked the CEO to bring up one-year production of the peer, compare the profits side by side. One just lost one anesthesia pain, sports medicine, and interventional spine provider due to a lack of insight into the practice. hoping this helps PMR physicians to understand the practice and make reasonable decisions.

 

[Dr. Ice]

it is a dynamically changing practice environment, Pain doc cannot just jump in practice because it is physician-owned, or because it is a busy orthopedic practice, The detailed structure and profit-sharing plan need very serious evaluation when I joined this practice, I asked the CEO to bring up one-year production of the peer, compare the profits side by side. One just lost one anesthesia pain, sports medicine, and interventional spine provider due to a lack of insight into the practice. hoping this helps PMR physicians to understand the practice and make reasonable decisions.

Your CEO shared the books with you? Where do you practice? Happy land?! I wonder if I ever asked the then roth ceo to share anything with me at the time of employment. I’m pretty sure he would have spit in my face. I fondly remember my interview there at 30 years old. I drove to Philly in my nice suit and waited for 3 hours in the patient waiting room until the now president could grace me with his presence. I was asked “can you do all the blocks?” And I said yes. That was it.

I was allured by the name, nice city and the fact that my friends worked there..like any idiot 30 year old would do, I signed a contract even though my gut told me to run far away.

I had no insight at 30. Perhaps you are a seasoned doc with a lot of insight into contracts and practice culture. 14 years later…ain’t nobody’s fool

 

[Taus]

Your CEO shared the books with you? Where do you practice? Happy land?! I wonder if I ever asked the then roth ceo to share anything with me at the time of employment. I’m pretty sure he would have spit in my face. I fondly remember my interview there at 30 years old. I drove to Philly in my nice suit and waited for 3 hours in the patient waiting room until the now president could grace me with his presence. I was asked “can you do all the blocks?” And I said yes. That was it.

I was allured by the name, nice city and the fact that my friends worked there..like any idiot 30 year old would do, I signed a contract even though my gut told me to run far away.

I had no insight at 30. Perhaps you are a seasoned doc with a lot of insight into contracts and practice culture. 14 years later…ain’t nobody’s fool

Things have changed in certain respects since you have been there. Some for the better. Some not. You know we have largely had very different experiences from our prior conversations.

Like anything else, there are pros and cons, benefits, and trade offs.
It is not all good. It is not all bad. Pros have outweighed cons, hence Im still there after a decade.
I’m not going to go point by point and comment on everything you have said in this thread, some are true, some are not.

I think, however, you have crossed the line with putting the level of specific detail in a public forum. True or not, I don’t think you would take kindly to someone airing your dirty laundry.