PM&R Practice and Compensation

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    I have growing interests in PMR but there is very little data on how physiatrists model their practices. Would any veteran physiatrists offer more details about their practice and specifically compensation? While I am verybinterested in PM&R, I *do* have the stats for other very competitive and profitable specialties, and if PMR’s compensation is lackluster, I’d rather not sacrifice the pay if it is very low. I hope not to come across avaricious/myopic, and am only asking for genuine answers.

    1. How is physiatry demand? I would be interested in locums work.

    2. Is there any possibility to do shift work/hospital work in PM&R?

    3. Is PM&R open to setting up potential ancillary revenue streams/extenders? Maybe a “med spa”?

    4. Is the practice conducive to setting up direct care or concierge medicine?

    5. Is there any opportunity for research or clinical trials in the field?

    6. How do you foresee PM&R to change in the future?

    7. Are there any opportunities to practice telemedicine?

    8. Are there any anecdotes from the upper echelons of PM&R salary? I have heard of neurologists taking home 600K-1M. Is such a range possible for a private practice physiatrist in rural medicine doing everything to maximize salary, increasing volume, and setting up ancillary services?

    9. How is the possibility for encroachment by mid level practitioners?

    Thank you for the answers
     
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    Bostonspine

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      I have growing interests in PMR but there is very little data on how physiatrists model their practices. Would any veteran physiatrists offer more details about their practice and specifically compensation? While I am verybinterested in PM&R, I *do* have the stats for other very competitive and profitable specialties, and if PMR’s compensation is lackluster, I’d rather not sacrifice the pay if it is very low. I hope not to come across avaricious/myopic, and am only asking for genuine answers.

      1. How is physiatry demand? I would be interested in locums work.

      2. Is there any possibility to do shift work/hospital work in PM&R?

      3. Is PM&R open to setting up potential ancillary revenue streams/extenders? Maybe a “med spa”?

      4. Is the practice conducive to setting up direct care or concierge medicine?

      5. Is there any opportunity for research or clinical trials in the field?

      6. How do you foresee PM&R to change in the future?

      7. Are there any opportunities to practice telemedicine?

      8. Are there any anecdotes from the upper echelons of PM&R salary? I have heard of neurologists taking home 600K-1M. Is such a range possible for a private practice physiatrist in rural medicine doing everything to maximize salary, increasing volume, and setting up ancillary services?

      9. How is the possibility for encroachment by mid level practitioners?

      Thank you for the answers

      I guess I’ll assume you well meaning and try to answer

      1. Pretty high demand but you got to build a practice... not sure about locums and would not do that for pain
      2. Shift work probably not...
      3. Sport medicine and spine practices are pretty common and lend itself to medispa(lots in NYC)
      4. Nope those are PCP models but there are cash based procedures. If you do a good job you could be the go to guy for those physicians
      5. Lots research opportunities that would be training program dependent
      6. Google PMR Bold
      7. Limit telemedicine
      8. A function of business skill and opportunities only spine surgery can make that money by just seeing patients. Also a block shop but not a good long term strategy
      9. I wouldn’t worry about mid levels just other physicians. Everybody want same compliant outpatient MSK patients do a good job and the patients will come


      Sent from my iPhone using SDN mobile
       
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      Cassowary

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        I guess I’ll assume you well meaning and try to answer

        1. Pretty high demand but you got to build a practice... not sure about locums and would not do that for pain
        2. Shift work probably not...
        3. Sport medicine and spine practices are pretty common and lend itself to medispa(lots in NYC)
        4. Nope those are PCP models but there are cash based procedures. If you do a good job you could be the go to guy for those physicians
        5. Lots research opportunities that would be training program dependent
        6. Google PMR Bold
        7. Limit telemedicine
        8. A function of business skill and opportunities only spine surgery can make that money by just seeing patients. Also a block shop but not a good long term strategy
        9. I wouldn’t worry about mid levels just other physicians. Everybody want same compliant outpatient MSK patients do a good job and the patients will come


        Sent from my iPhone using SDN mobile
        Thanks for the very comprehensive answer. I’m unfortunately torn between neurology and PM&R haha. I really would appreciate a telemedicine application.

        Do you have any stories of colleagues making over $600K?
         
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        Cassowary

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          if you are in it for the money, you are in the wrong field (and definitely wrong specialty)

          that being said, if you put in the work, you can make that much.

          this is a useless comment, has been bruited repeatedly since I have been in high school, and seeks to terminate any discussion on the extremely valid and important topic of physician compensation.

          I hope you soon learn to stop discouraging discussion over salary.
           
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          PMR2008

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            1. High demand. I don’t see an issue getting a job in the future. Off course it is very competitive in highly desirable areas of the country just like any specialty.

            2. Plenty of locum opportunities but we are not like hospitalist or ER docs so shift work is unlikely

            3. I know many PM&R docs with med spas and ancillary revenue sources. I own a few businesses including medical offices I rent out and a gym. Planning on opening a home health agency soon. I have friends who run therapy companies are hospice directors, subacute/SNF directors, own drug labs, DME etc.

            4. Direct care or concierge is unlikely in PM&R or Neurology. Unless you got some training in functional medicine and cosmetic care.

            5. Lots of opportunity.

            6. Bright future. We are cost savers.

            7. I looked into telemedicine. I don’t see a lot of value in it for us. Exam is limited and the tech is not there yet. Not worth the time and hassle.

            8. I know docs making 750k+ and some making 1M+. But this is not just from seeing patients. You have to own a practice, have multiple income streams and be very business savvy. Some docs who make that much are doing it the wrong way (block shops, cash pay pain clinics) before they get in trouble. If you owned a practice with 2-3 docs/midl evels, had your own therapy, DME, office building, drug testing and did a decent number of procedures you can easily make 1M+.

            9. A little concerned about mid levels since we are not a surgical specialty.
             
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            Piebaldi

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              1. High demand. I don’t see an issue getting a job in the future. Off course it is very competitive in highly desirable areas of the country just like any specialty.

              2. Plenty of locum opportunities but we are not like hospitalist or ER docs so shift work is unlikely

              3. I know many PM&R docs with med spas and ancillary revenue sources. I own a few businesses including medical offices I rent out and a gym. Planning on opening a home health agency soon. I have friends who run therapy companies are hospice directors, subacute/SNF directors, own drug labs, DME etc.

              4. Direct care or concierge is unlikely in PM&R or Neurology. Unless you got some training in functional medicine and cosmetic care.

              5. Lots of opportunity.

              6. Bright future. We are cost savers.

              7. I looked into telemedicine. I don’t see a lot of value in it for us. Exam is limited and the tech is not there yet. Not worth the time and hassle.

              8. I know docs making 750k+ and some making 1M+. But this is not just from seeing patients. You have to own a practice, have multiple income streams and be very business savvy. Some docs who make that much are doing it the wrong way (block shops, cash pay pain clinics) before they get in trouble. If you owned a practice with 2-3 docs/midl evels, had your own therapy, DME, office building, drug testing and did a decent number of procedures you can easily make 1M+.

              9. A little concerned about mid levels since we are not a surgical specialty.


              I am thinking of possible buying therapy practices. It seems thought that not all make good $$. What are your thoughts on that? I have thought about buying a home health care since about 90% of our SNF patients go home with home health, but the social worker at one of our sites was mentioning how given the big hospital chains have their home health cares. What are your thoughts on that? I think both me and you are in the same area of the country. So curious what your thoughts are.

              I am thinking into branching out into some regenerative stuff too. That seems like an untapped market here in Chicagoland.
               

              Piebaldi

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                I have growing interests in PMR but there is very little data on how physiatrists model their practices. Would any veteran physiatrists offer more details about their practice and specifically compensation? While I am verybinterested in PM&R, I *do* have the stats for other very competitive and profitable specialties, and if PMR’s compensation is lackluster, I’d rather not sacrifice the pay if it is very low. I hope not to come across avaricious/myopic, and am only asking for genuine answers.

                1. How is physiatry demand? I would be interested in locums work.

                2. Is there any possibility to do shift work/hospital work in PM&R?

                3. Is PM&R open to setting up potential ancillary revenue streams/extenders? Maybe a “med spa”?

                4. Is the practice conducive to setting up direct care or concierge medicine?

                5. Is there any opportunity for research or clinical trials in the field?

                6. How do you foresee PM&R to change in the future?

                7. Are there any opportunities to practice telemedicine?

                8. Are there any anecdotes from the upper echelons of PM&R salary? I have heard of neurologists taking home 600K-1M. Is such a range possible for a private practice physiatrist in rural medicine doing everything to maximize salary, increasing volume, and setting up ancillary services?

                9. How is the possibility for encroachment by mid level practitioners?

                Thank you for the answers


                My suggestion to you: you scoffed at someone on here telling you that you should do what you want and enjoy and not worry about the money. As a med student be open to learning and hearing things from other people. It's valuable.

                I agree. This is coming from someone who switched from a competitive, high paying specialty like Radiology to PM&R. I got into a pretty cush program in a nice state with good track record of getting people into nice competitive fellowships. I will be honest and say that I mostly went into Rads bc of the $$ making opportunity. I found out I HATED Rads. I switched into PM&R, people told me I was crazy to do so. I think it's one of the best professional choices I have made. I am in a very saturated area of the country and while my job is not idea, it is rather cush, I work cush hours, have low stress and going into a Pain Fellowship where my salary can grow even more.

                I am also going to branch out into other options - probably regen med, cosmetic stuff, possibly therapy stuff, etc.

                Trust me - as a med student you are probably poor and money seems amazing. Now you hit attendinghood, regardless of what you make, if you hate the specialty you will be miserable and likely bad at it. When I was in Rads residency i would count the hours until the end of my day. I was like - I don't think I can do this for the next 30 years of my life.

                Money will come. But make sure you like or at least can tolerate what you do. Otherwise misery and lawsuits will follow.
                 
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                PMR2008

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                  I am thinking of possible buying therapy practices. It seems thought that not all make good $$. What are your thoughts on that? I have thought about buying a home health care since about 90% of our SNF patients go home with home health, but the social worker at one of our sites was mentioning how given the big hospital chains have their home health cares. What are your thoughts on that? I think both me and you are in the same area of the country. So curious what your thoughts are.

                  I am thinking into branching out into some regenerative stuff too. That seems like an untapped market here in Chicagoland.

                  Therapy is not very lucrative unless you can feed them patients or have lots of referral sources. In a big city like Chicago it can be very tough. Home health is also competitive. Hospitals have home health but they are pretty horrible at it. Also in Illinois you are not allowed to start a home health since the stopped allowing new companies. Your only options are to purchase one. That can cost a decent amount of money. Usually 500k+. There is plenty of room to setup a regen practice in Chicago.
                   
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                  Piebaldi

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                    Therapy is not very lucrative unless you can feed them patients or have lots of referral sources. In a big city like Chicago it can be very tough. Home health is also competitive. Hospitals have home health but they are pretty horrible at it. Also in Illinois you are not allowed to start a home health since the stopped allowing new companies. Your only options are to purchase one. That can cost a decent amount of money. Usually 500k+. There is plenty of room to setup a regen practice in Chicago.

                    You know I have looked at a number of therapy practices across the country and I have noticed that they don't make a ton of money. I wonder why that is? I was not aware that in IL you cannot start a new home health. I have noticed quite a few for sale though. Many are not that $$ - number of them that I have seen are 100k or less, but I am not sure how much they make. A lot of the elderly patients seem to not have much income, so mostly medicare.

                    But yeah I am heavily thinking of cosmetics and regen med. Not that widespread it seems in Chi town from what I have seen thus far.
                     
                    Thanks for the very comprehensive answer. I’m unfortunately torn between neurology and PM&R haha. I really would appreciate a telemedicine application.

                    Do you have any stories of colleagues making over $600K?

                    There are many, many people out there making well over $600k in PMR. It is a very flexible field and you have the freedom to be entrepreneurial.

                    Forget neurology. It’s a miserable field. PMR residency then a pain/spine fellowship is the best gig in medicine IMO. Regenerative medicine is growing like crazy.
                     
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                    Ogliodendrocyte

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                      There are many, many people out there making well over $600k in PMR. It is a very flexible field and you have the freedom to be entrepreneurial.

                      Forget neurology. It’s a miserable field. PMR residency then a pain/spine fellowship is the best gig in medicine IMO. Regenerative medicine is growing like crazy.

                      What does regenerative medicine look like?
                       
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                      Cassowary

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                        There are many, many people out there making well over $600k in PMR. It is a very flexible field and you have the freedom to be entrepreneurial.

                        Forget neurology. It’s a miserable field. PMR residency then a pain/spine fellowship is the best gig in medicine IMO. Regenerative medicine is growing like crazy.

                        You're convincing me. Pain, spine, and MSK have been the fellowships I've been considering. The things I appreciated about neurology were: teleneuro (and potential entrepreneurial pursuits that it can offer), Neuro-IR, and a high demand for locums which can pay a 7 figure salary ($550/hr) according to a user on this website. Also, I spoke to a neurologist with his own practice in the midwest who claims a salary of $700k. Neurology seems more tried and true with much more success stories.

                        I hope to be able to work in South Florida, or at least reside there for most of my time.
                         
                        You're convincing me. Pain, spine, and MSK have been the fellowships I've been considering. The things I appreciated about neurology were: teleneuro (and potential entrepreneurial pursuits that it can offer), Neuro-IR, and a high demand for locums which can pay a 7 figure salary ($550/hr) according to a user on this website. Also, I spoke to a neurologist with his own practice in the midwest who claims a salary of $700k. Neurology seems more tried and true with much more success stories.

                        I hope to be able to work in South Florida, or at least reside there for most of my time.
                        Neurology is definitely NOT a more tried and true way with a lot of success stories. Procedures like coiling and other neurovascular things are done by neurosurgeons and radiologists.
                        Neurology is not a good choice if you want a good lifestyle, entrepreneurship, and to live in a competitive place like south florida. Do PMR with a fellowship. I don't think it can be beat.

                        PM me if you want to chat more.
                         
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                        PMR2008

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                          Neurology used to be decently lucrative when EMGs and sleep studies paid a lot. Procedures make money. Seeing patients all day will burn you out.
                          I don't know any neurologists in the Chicagoland area making a lot of money. Independent and pain physiatrist on the other than do well and have a good lifestyle. Most importantly they are not dependent on the hospital. A lot of neuro is incorporated into PM&R. But eventually you need to decide if you prefer MSK with a little neuro or brain/nerves/dementia/psych.
                           

                          Piebaldi

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                            You're convincing me. Pain, spine, and MSK have been the fellowships I've been considering. The things I appreciated about neurology were: teleneuro (and potential entrepreneurial pursuits that it can offer), Neuro-IR, and a high demand for locums which can pay a 7 figure salary ($550/hr) according to a user on this website. Also, I spoke to a neurologist with his own practice in the midwest who claims a salary of $700k. Neurology seems more tried and true with much more success stories.

                            I hope to be able to work in South Florida, or at least reside there for most of my time.

                            This is ridiculous i'm sorry. 550/hr is certainly not going to be in a great city - it's going to be in the middle of nowhere. I'm sure all types of physicians make 700k + . I doubt many of those are on *salary* per se. Many physicians with time develop entreprenurial elements that can generate good money. Again dont go into a specialty just bc of money.
                            You can also open a headache clinic and do botox daily and make a ton of money. Or do PRP all day and make money. Or do colonoscopies daily and make a lot of money.
                            Do what you like. Goodness.
                             
                            This is ridiculous i'm sorry. 550/hr is certainly not going to be in a great city - it's going to be in the middle of nowhere. I'm sure all types of physicians make 700k + . I doubt many of those are on *salary* per se. Many physicians with time develop entreprenurial elements that can generate good money. Again dont go into a specialty just bc of money.
                            You can also open a headache clinic and do botox daily and make a ton of money. Or do PRP all day and make money. Or do colonoscopies daily and make a lot of money.
                            Do what you like. Goodness.
                            $550/hour can be anywhere. Doesn’t have to be in the middle of nowhere.
                            And money is as good a reason to pick a specialty as anything else.
                             
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                            cluelessme7

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                              If you are expecting to make $550/hour as a junior attending in a non-surgical field, or even a surgical field, for that matter, you may be severely disappointed. Maybe if you were doing derm in a remote unsaturated town. It’s unrealistic to expect that out of neurology, or even PM&R. Starting a lucrative practice takes a lot of time and investment. There’s a reason why Derm, Ophthalmology, IR, etc are as competitive as they are. If you are looking for lifestyle and boatloads of money (500-600k and above range), transition into hedge funds or venture cap.
                               

                              Piebaldi

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                                If you are expecting to make $550/hour as a junior attending in a non-surgical field, or even a surgical field, for that matter, you may be severely disappointed. Maybe if you were doing derm in a remote unsaturated town. It’s unrealistic to expect that out of neurology, or even PM&R. Starting a lucrative practice takes a lot of time and investment. There’s a reason why Derm, Ophthalmology, IR, etc are as competitive as they are. If you are looking for lifestyle and boatloads of money (500-600k and above range), transition into hedge funds or venture cap.

                                And even then - thinking that going into hedge funds or venture capitalism is that simple is also erroneous.
                                 
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                                cluelessme7

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                                  ^ Exactly. I never understood why people used to say don't go into medicine for money, just seemed like an unnecessarily "taboo" topic. The real reason is that there's far better ways to make money with much less of a time investment. When you're on hour 30 of a call shift doing something you don't truly enjoy, being paid $15 an hour (resident) after earning a Doctorate degree, the money you may earn in the future becomes moot.
                                   
                                  If you think that, good luck. You are naive and clueless. No, 550/hr can't be ANYWHERE. It will be in podunk USA. Not in desirable cities. Do you have any clue about supply and demand? Clearly not. There are more physicians in large cities - ie-Chicago, NY, throughout Cali, FL, etc than in say Kansas, North Dakota, etc. So there is no need to pay that because there is ample supply in large nice cities vs other places.
                                  Dude you are the one who is clueless. You have checked with every single doctor in a desireable city and there isn't a single one making big money?!?! You think because you don’t know any of these doctors they don’t exist?!?
                                  It has nothing to do with "no need to pay that because there is ample supply in large nice cities vs other places." It has to do with what services you can offer that you can get paid X amount for.
                                  Why am I even explaining this to you?
                                  You have no idea what you’re talking about. Seriously. Best not to talk about something you don’t know anything about. You sound foolish.
                                   
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                                  If you are expecting to make $550/hour as a junior attending in a non-surgical field, or even a surgical field, for that matter, you may be severely disappointed. Maybe if you were doing derm in a remote unsaturated town. It’s unrealistic to expect that out of neurology, or even PM&R. Starting a lucrative practice takes a lot of time and investment. There’s a reason why Derm, Ophthalmology, IR, etc are as competitive as they are. If you are looking for lifestyle and boatloads of money (500-600k and above range), transition into hedge funds or venture cap.
                                  Who would ever expect to make any money as a "junior attending"?!? That implies some kind of academic BS - of course you wont' make any money doing that.
                                  Who says you have to start a practice?
                                  No one can "expect" that kind of money - but to think that it isn't possible to make that kind of money, or more, in a big city or the middle of nowhere, is completely wrong.
                                   
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                                  Lol ok little med student. Good luck. So foolish it's painful. Lol. Too funny.
                                  Listen idiot. I have been practicing for 7 years. I am speaking out of my own experience and many people I know personally and professionally. I know what I am talking about. So just stop talking.
                                   
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                                  Lol ok little med student. Good luck. So foolish it's painful. Lol. Too funny.
                                  Are you a resident???!? And you think you know what you are talking about?? Now I understand why you’re so clueless.
                                  You’re a resident dude. You know nothing about practicing in the real world. The fact that you would even dispute me is laughable. You should be embarrassed.
                                   
                                  You are clueless. How you would think I'm a resident is beyond me. I am an actual attending. Don't respond to me again. I have already sent your abusive post to admin. Goodbye.
                                  I find it hard to believe that you are actually practicing medicine given how little you know about the world. You are wrong, but you think you're right, and have your mind made up about it.
                                  It's impossible to have an intelligent discussion with someone like that.
                                   

                                  j4pac

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                                    I find it hard to believe that you are actually practicing medicine given how little you know about the world. You are wrong, but you think you're right, and have your mind made up about it.
                                    It's impossible to have an intelligent discussion with someone like that.

                                    Maybe my last post wasn’t as tactful as it should have been. :)

                                    Money is important, and so is lifestyle. But reimbursements change, and lifestyle is very relative. Both shouldn’t be ignored, but I think that the most sustainable career approach is to have skills that provide flexibility and work at what you’re passionate about. Because you’d hate to be living like a fat cat like many PM&R docs were a few decades ago with EMG and trigger point injections, only to see reimbursements change. There are many pain physicians nervous about the future of pain, a quick trip to the pain forum could show that. I could invision a scenario where many of the bread and butter, lucrative pain procedures, either stop paying because of questionable efficacy or something new comes about. There is absolutely NOTHING wrong with jumping on the pain train...I know many who do it and love it...but I’d be careful advising people toward pain for financial reasons.
                                     
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                                    Admiralk83

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                                      I have been in private practice for 6 years.

                                      To think you are going to make anything close to $500 an hour in a desirable location right out of training is foolish and just a setup for disappointment.

                                      There are 4 options

                                      1. Academics: Forget making anything close to that amount of money

                                      2. Locums: Honestly, I don't know much about this as I have never tried it, but do you plan on getting a license in a bunch of states to be able to practice in the most lucrative open positions? Licenses are expensive. Are you ok moving around every few weeks or months? It doesn't seem like a great lifestyle to me.

                                      4. Join a well established group: Yes, this will get you "busy" right off the bat, but do you think your senior partners who have invested time and their own money into the practice are just going to give you 100% of the fruits of your labor right up front? Please.

                                      4. Start your own practice: This is probably the most lucrative of the 3 if it is done right, but remember, you are the one paying for all of your staff, equipment, etc. Also, there are no pre-set referral patterns. YOU have to be the one to bust your butt generating business. It won't be the lifestyle you envision.

                                      In summary, YES you probably can make that kind of money in our field, but it will take A LOT of work on your part networking, seeing many many patients and being the administrator of your own practice. It also will not happen the first year out of fellowship. That is a pipe-dream.
                                       
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                                      PMR2008

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                                        Just like admiralk83 I have been in private practice for 6 going on 7 years.
                                        You can make $500/hour in a big city but you have to be creative and have entrepreneur bug.
                                        1) I don't think most docs go to academic to make money. They have the passion to teach and are comfortable in the hospital/academic environment. Some of them like the prestige that comes with it and have goals to be the Chairman. I know PM&R department chairman that make 650k+. Some charge $1k-2k an hour for depositions. But this can take years/decades to achieve.
                                        2) Locum is not my cup of tea. You can make decent money. If you are single and willing to move around it can be lucrative. I have a few colleagues who did this for a few years until they found a locum position they liked.
                                        3) Established practice - Agree with Admiral. After a few years you can possibly make partner, get a piece of the ancillary and establish connections in the industry.
                                        4) Start your own - definitely the highest upside and the most difficult to do.

                                        I know a couple of docs doing very well but as I mentioned earlier they have their own practice, have ancillary, labs, do a ton of injections and have other business interests.
                                         

                                        Cassowary

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                                          Please don't take what I said out of context. The $550 an hour was in reference to SHIFT WORK that a stroke neurologist claimed to make working in rural areas.

                                          I would hope PMR isn't being paid hourly.
                                           

                                          Admiralk83

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                                          2
                                          1. Attending Physician
                                            550 per hour is 1+mil per year working a full time job. No, most pm&r do not work at an hourly rate, including myself. You will not make that much unless you are and the extreme end of how many patients a person can see (40+ per day) and/or have significant ancillary streams of revenue.
                                             
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