PLEASE VISIT OPENINGS FOR COMPENSATION INFORMATION ON VARIOUS PRACTICE OPPORTUNITIES
- Physiatry Compensation
- Compensation Formulas
- Questions to Ask and Issues To Consider When Evaluating Compensation Plans
Physiatrist (PM&R) Compensation Overview – 2024–2025
Sources: Medscape Physician Compensation Report 2025, Doximity Physician Compensation Report 2024; Physician Side Gigs; ZipRecruiter; MedScape; Marit
Average Annual Compensation for Physiatrists
On average, physiatrists (doctors specializing in physical medicine and rehabilitation) make about $365,500 per year in clinical practice.
Physiatrist Salaries by State
Physiatrists’ pay varies a lot depending on location. In 29 states, the typical salary is above the national average. For example, Washington tops the list at about $273,000, while Florida is on the lower end at around $180,000.
State | Annual Salary |
Washington | $273,290 |
District of Columbia | $272,670 |
New York | $263,985 |
Massachusetts | $263,524 |
Alaska | $259,862 |
Vermont | $256,558 |
North Dakota | $255,310 |
Oregon | $255,118 |
Colorado | $253,726 |
Hawaii | $250,696 |
Nevada | $245,713 |
New Jersey | $244,972 |
Wisconsin | $243,552 |
Pennsylvania | $241,875 |
Delaware | $241,503 |
South Dakota | $241,295 |
Virginia | $239,226 |
California | $238,136 |
Minnesota | $236,328 |
Rhode Island | $236,303 |
New Hampshire | $234,662 |
Maryland | $234,187 |
New Mexico | $233,833 |
Illinois | $233,821 |
Maine | $233,622 |
Wyoming | $231,938 |
Nebraska | $230,063 |
Indiana | $229,608 |
Connecticut | $229,541 |
Ohio | $229,399 |
Mississippi | $228,523 |
Idaho | $227,034 |
Iowa | $226,640 |
Missouri | $226,336 |
Arizona | $224,860 |
Texas | $224,804 |
South Carolina | $223,911 |
Oklahoma | $222,796 |
Montana | $221,472 |
Utah | $219,668 |
North Carolina | $219,290 |
Tennessee | $219,004 |
Alabama | $218,707 |
Kansas | $215,199 |
Michigan | $210,312 |
Kentucky | $209,572 |
Louisiana | $206,338 |
Georgia | $203,746 |
Arkansas | $199,528 |
West Virginia | $186,803 |
Florida | $180,318 |
Salary by Employment Type
- Practice owners/partners: $482,000
• Employed/W2 physicians: $345,000
Salary by Gender
Female physiatrists reported average salaries of $329,000, while male physiatrists earned about $411,000 (25% more). Women were more likely to work in government or hospital jobs, while men often worked in private practices that tend to pay more.
Subspecialty Salaries
- Pain: $437,000
- Sports: $345,000
- Spinal cord injury: $291,500
Pain management is the highest-paying subspecialty in physical medicine and rehabilitation (PM&R), also known as physiatry. On average, these doctors make $439,000 a year. Reported salaries range from $250,000 to $736,000, with a median of $400,000.
Pediatric Rehab
We identified 10 cities where Pediatric Rehabilitation salaries exceed the national average of $105,387. Nome, AK leads, with Cupertino, CA, and Nantucket, MA close behind. Nantucket surpasses the average by 23%, and Nome by 24%.
City | Annual Salary |
Nome, AK | $130,732 |
Cupertino, CA | $130,020 |
Nantucket, MA | $129,676 |
Berkeley, CA | $129,040 |
Sitka, AK | $126,957 |
Sunnyvale, CA | $125,380 |
San Francisco, CA | $124,164 |
Santa Clara, CA | $123,770 |
Livermore, CA | $123,617 |
San Jose, CA | $123,512 |
Salary by Practice Setting
Where physiatrists work matters significantly for their pay; private practice physicians tend to earn the most, especially those who are owners or partners. Yet, it’s essential to consider the entire compensation package.
- Government hospitals (VA, city hospital, etc.): $274,000
- Academic hospitals: $296,000
- Non-academic hospitals: $434,000
- Private group practices (private equity and non-private equity backed): $454,000
Overall, we see that PM&R doctors working in government facilities averaged the lowest salaries. They made 8% less than academic hospital employees, 58% less than those at non-academic hospitals, and 66% less than those at group private practices. It’s important to note, however, that these positions often qualify for Public Student Loan Forgiveness (PSLF) or have better retirement benefits, which can be a significant benefit in the overall compensation package, which is one of the reasons we suggest considering the entire proposed compensation offer.
Physiatrists at non-academic hospitals averaged 47% more than colleagues working for academic hospitals, but these positions often qualify for Public Student Loan Forgiveness (PSLF).
PM&R physicians working in group private practices averaged the highest salaries. Many of these reported being an owner or partner in their practice, which can influence potential earnings. We don’t currently have enough data to assess an average for physiatrists running a solo private practice, but generally, they make more than the average across all PM&R doctors.
Salary Growth Over Time
Physiatrist pay has increased steadily over the last 7 years.
- 2018–2020: $283,000
- 2021–2023: $318,000 (+12%)
- 2024: $364,000 (+14%)
Bonuses
- Sign-on bonus: 37% receive one, averaging $29,000 (range $5k–$100k)
• Relocation bonus: 30% receive one, averaging $13,000 (range $5k–$60k)
Vacation
Most physiatrists receive between 21 and 23 vacation days per year. Some report ‘unlimited’ time off, but usually only get paid for days worked.
CME Stipends
About 71% of physiatrists receive funding for continuing medical education (CME). The average stipend is $3,300 per year. (range $1k-$7.5k)
Student Loan Debt
The average student loan debt for physiatrists at graduation is $228,000. Government and academic hospital jobs may qualify for Public Service Loan Forgiveness (PSLF), which can help offset lower salaries. The higher your federal loan debt burden, the more beneficial repayment programs and loan forgiveness programs can be.
How to Increase Income
There are a few different ways to increase your income in PM&R. However, remember to look at the overall picture. Salary is a key component of physician compensation, but it isn’t the only part of a well-negotiated physician employment contract.
Ways to boost earnings include:
- Discuss your salary with your manager
- If you like where you work but don’t love the pay, consider setting aside a time to talk with management. If you are a valued part of their team, they may be willing to work with you to renegotiate your contract, rather than risk your leaving. Their answer may be no, but it doesn’t hurt to ask.
- Negotiating contracts
- Hire a local contract review attorney for physicians to review your contract. They will have invaluable experience when it comes to negotiating physician contracts, including understanding what red flags to watch out for.
- Changing practice setting
- Interviewing for a few other positions can give you a feel of what the market looks like from the employer’s perspective, and what employers are willing to offer.
- Taking on side work: 37% of physiatrists said they supplement their income with extra work
- Consulting, including consulting for pharmaceutical companies, and being a startup advisor
- Medical surveys
- Ambulatory surgery center owner
- Expert witness
- Running a pain clinic
- Offering concierge services
- Providing outpatient physician therapy/rehab services
Compensation Considerations From Kathy Jefferies
These are insights of our owner, Kathy Jefferies, whose expertise comes from years of working at a hospital in physician relations.
“One physiatrist expressed an interest in building a part-time practice performing only electromyography (EMG). That physician was obviously well informed about medical billing, and he desired to build a practice with only high-level billable codes. If you entered into practice with this physiatrist on a production-based compensation, what type of practice could you expect to build and how much money might you earn monthly? First, you need to determine the primary needs of the patient population in the practice area.
“As an employee, you will receive financial compensation based on a salary guarantee, production or a combination of both. A salary guarantee is an amount you can bank on, literally, and it may be a great way to start up your practice. However, no group will want to continue to pay you more than you earn. It just isn’t good business. That means it is expected that your gross charges will increase as you build your practice. Your earning potential will typically be production-based, or tied to the revenue you generate for your group. This is an important point to consider as you begin your contract negotiations.
“Production is typically not the best option for a start-up practice for several reasons. It takes an investment of time and money to build a practice, and this may be one of the most underestimated aspects of medical practice start-up. Retirement benefits within a group practice may exceed those available in hospital-owned practices — a notable advantage. Group practices tend to invest the maximum allowable amount — $30,000 annually — into each retirement plan for each physician in the group. In some groups, that money is self-directed, so each physician can elect their own investment options independently of the group. Hospitals, however, have a different set of governmental guidelines as not-for-profit or for-profit entities and are thereby limited in the amount that they can invest in the retirement plan for their employed physicians.
“In addition, there may be limited investment options for physicians in those plans. This is an important point to include in physician compensation when comparing practice opportunities and negotiating salary compensation. I have worked with many physicians who have built medical practices through trial and error. If some of these shared experiences help to shorten that course for you, I have met my goal.”
Physiatry Supervision Compensation
According to the American College of Physicians (ACP) Online, in practices that use nurse practitioners (NPs), physician assistants (PAs), or other non-physician providers, there may be some time spent doing oversight. In practices that use production-based compensation, such as Work Relative Value Units (wRVUs), this can be an issue because the time spent supervising is non-productive time despite being necessary for the proper operation of the practice. It is possible to structure compensation to include a production credit or a supervisory stipend. The important thing to keep in mind is that, in the end, in any compensation formula, the total compensation should be fair and end up in the fair market value range.
Compensation With an Independent Contractor Affiliation
Some practice opportunities don’t offer a salary because the affiliation is as an independent contractor. Companies such as Encompass and Kindred typically affiliate with a physiatrist as an independent contractor. They offer a stipend if it’s a Medical Director position. The stipend varies based on the bed size, the reasonable and fair compensation for physiatry in the area and more. Medical Director stipends can range from $60,000 – $120,000.
An income guarantee may also be offered when it’s an independent contractor affiliation. The guarantee amount is similar to the amount a salary would be for the same position. The guarantee is usually a loan with payback. In these arrangements, failing to meet your guarantee amount results in having to pay back the difference, which is a significant drawback when it happens. However, most of these cases are large rehab institutions with a good census, so there’s usually no worry that you wouldn’t make your guarantee amount and would have to reimburse them.
Physiatry Compensation Negotiation
Negotiating your physiatry compensation should start with a plan. First, outline your qualifications, skills and accomplishments so you can approach your employer with that information. This information will help you to sell yourself and get your desired compensation.
Second, find out what the pay is for someone with your experience. A new residency graduate may command anywhere from $175,000 – $300,000 depending on where it is in the U.S. Once you’re onsite, take advantage of any opportunity to ask doctors with similar experience to your experience what compensation amount you might expect.
Third, practice what you’re going to say and how to respond to questions. Don’t have reservations about asking for more money. It is an expected part of the negotiation process, and won’t be seen as abnormal as long as you make your case politely. Only your employer, not you, know how much they will pay you. Here are a few more tips to keep in mind as you proceed through the outlined three steps:
- Consider the employer’s perspective and think about what you can do to make yourself more appealing for each specific position.
- Check offers against the AAPM&R to make sure they are competitive but don’t fixate on the base salary without taking incentives into account.
- Become familiar with the metrics and activities — like productivity, cost and quality — that will affect your compensation.
- Operate under the assumption that you won’t obtain any productivity bonuses and negotiate for a base physiatrist salary that is adequate on its own.
Also, ensure the contract specifies the following:
- Hospital rounds
- Appointment hours
- Office duties
- The number of patients you have to see
- The number of hours you have to work
- Policies on weekend or holiday work
Medical Director Compensation
The average Medical Director Stipend for a 15-bed rehab unit varies from facility to facility. It depends on the individual facility and what their needs and expectations are. The exact amount the Director receives is based on an hourly pre-determined fee for administrative costs only. The contract usually stipulates a mandatory 20 hours per week of administrative time. The facility typically generates a form for the Medical Director to use to document their time. The average hourly rate is from $100 to $150 per hour.
When negotiating the contract for the per hour rate, the physician must be aware of what encompasses the administrative time. The easiest way to determine this is to ask to see their reporting form. This should list each of the categories that you would spend administrative time on.
(Contributed by Elizabeth Lee, PRS, Former President)
Questions to Ask & Issues to Consider When Evaluating Compensation Plans
Determine how the compensation plan works, initially and at different points in time. It is perfectly reasonable for a physician to ask how much he or she will be paid in the first year and in subsequent years. For example, if the first one or two years’ salaries are fixed, and compensation then moves to a productivity basis, ask for details on how the transition is handled and how other physicians have fared in year two or three. The bottom line, Merritt Hawkins EVP Mark Smith says, is that “if physicians can’t determine how much they will earn while they’re brushing their teeth, the (plan) is too complex.”
Inquire about how overhead expenses are allocated. In most cases, newly hired physicians will receive a “grace period” in the first year from financial responsibility for overhead. But those expenses, which could equal up to half of a group’s revenues, may be a significant consideration when the physician becomes a partner or shareholder. “Physicians should ask whether there are any limitations based on overhead,” Smith advises. “For example, if there’s a net income guarantee of $175,000 and only$5,000 monthly is allowed for overhead, that won’t work well.”
What is the income distribution methodology for partners or stockholders? Even if the position will be straight salary initially, physicians should inquire about how income is distributed among the group’s partners, and which factors, if any, affect the proportional distribution among individual physicians.
What is the buy-in and how does it work? Since many practice positions involve either net income guarantees or salaries in the early years, entrepreneurial physicians who desire an ownership position should request the details if they’re considering more than one position. A five-year partnership track may be far less appealing than a two-year track, for example, and the longer route to partnership may mean less long-term earning potential.
For the complete article, “Physician Compensation Models: The Basics, the Pros, and the Cons,”
Compensation Formulas
Practices, hospitals and other entities compensate physicians in many ways. Multiple variations of these formulas are possible, so your task is to identify the combination that works best for you. As the physician looking at the compensation formula that involves collections or office expenses, you need to get a handle on what these items realistically might total.
Partnership Potential
Partnership is one of the important things for physiatrists to consider, as it has a significant impact on PM&R compensation. Here are six formulas you might encounter for determining compensation along partnership tracks.
For these calculations, expenses typically include professional physician expenses and administrative expenses for the entire group. Professional physician expenses include the base salary, the cost of health and malpractice insurances and the cost of professional society dues, journal subscriptions and other professional fees. Administrative expenses of the practice include all items not included in professional physician expenses, such as rent, utilities, employees’ salaries and benefits, marketing and advertising, legal and accounting expenses and equipment purchase or lease payments.
1. Salary Plus Incentive
Compensation with this type of plan is typically a $175,000 – $185,000 salary plus an incentive. Incentive plans are often 20% of collections on physician-provided services after three times the salary. For example, a salary of $180,000 with collections of $600,000 would result in a $12,000 incentive bonus:
- $180,000 x 3 = $540,000
- $600,000 – $540,000 x 20% = $12,000
2. Salary Then Production
Another option is straight salary without incentives for the first two years, then a transition to compensation based 100% on your production.
3. Salary to Partnership
This track typically starts with a base salary of $250,000 with 10% share after expenses for the first year. The second year, the salary increases by $20,000 with a 15% share of expenses, and the third year is a partnership.
4. Salary Plus Incentive to Partnership
A formula like this is a little more complicated. The salary is usually between $160,000 and $175,000 plus an incentive, which changes each year. The first-year incentive formula is 20% of the difference between the net income minus expenses. The second year, the incentive is 30% of that difference, and the third-year incentive is 40%. The fourth year transitions to a partnership.
5. Salary Plus Bonus
This is similar to the incentive model, but the bonus is calculated differently. Since there is potential for a higher bonus, the base salary is a little lower, typically around $150,000. The bonus has no limit and is based on productivity and length of service. The bonus is calculated as a percentage of “net” revenue, once general practice overhead and physician expenses — including base salary — are deducted. The percentage is 40, 45 and 50% in the first, second and third years, respectively. Net earnings are defined as gross earnings minus professional physician expenses and 50% of the practice administrative expenses.
Partnership will be considered after two or three years in practice.
An example sometimes helps. This is all very hypothetical, and numbers are only used that make for easy calculations:
- Gross collections for the quarter: $150,000
- Overhead expenses: $60,000
- Physician expenses: $60,000
- Net: $30,000
- Bonus at 40%: $12,000 for the quarter
6. Draw Plus Stipend Plus Productivity Bonus
You can set the draw up to $250,000. The physician plan allocates overhead in two ways. Part of the overhead — usually 20% — is distributed equally, and the rest is allocated based on receipts. Thus all physician partners have a basic share of the overhead, and those who produce more revenue and consume more resources are allocated a greater share for the rest of the overhead.
New physicians are paid the draw until their practice grows to the point that receipts cover the incremental costs incurred by adding the new doctor.
Employee Affiliation
There are three main types of compensation possible for employee affiliation.
1. Income Guarantee Plus Incentive
This is typically an income guarantee of $200,000 and incentive of 33% of production after overhead is covered.
2.Income Guarantee With Possible Incentive
Because the potential incentive is higher with this method, the income guarantee is lower, usually between $160,000 and $180,000. If a straight percentage method pays more than the salary, then the candidate can switch over to it before the first year.
The incentive will be available if the candidate makes two times their income guarantee. The incentive formula is net income minus two times the salary. The doctor gets 50%, and the other 50% goes to cover overhead.
For example, if the net income is $400,000 and the income guarantee is $150,000, then the incentive payment is $50,000:
- $150,000 x 2 = $300,000
- $400,000 – $300,000 = $100,000
- $100,000 x 50% = $ 50,000
A similar method is with a guaranteed salary of $120,000 to $135,000 plus an incentive which is 30% of triple the salary.
3. Salary Plus Bonus
This method offers a higher salary of $195,000 to $205,000 along with the potential to earn two separate bonuses. One is up to 10% of their salary, and the other bonus is 35% of their gross billings above their business plan.
Beyond Compensation
PM&R compensation is always an important feature of a practice opportunity. Doctors always ask about the compensation of a practice opportunity. However, doctors don’t often ask about the benefits of the position. Benefits are expensive and can contribute greatly to the total compensation of a practice opportunity. Health insurance is usually provided as a benefit. Another pricey benefit which is sometimes provided is an employer match to a retirement plan.
Benefits, such as a sign-on bonus, are also a great negotiation item. The incentive arrangement may also be negotiated. Student loan repayment is a possible benefit, although it’s rarer. When a sign-on bonus, loan repayment or moving expense coverage are on the table, find out if you have to repay it if you leave early. For physiatrists who want to keep their options relatively open, these types of incentives may not be ideal.
You may want to create a spreadsheet to compare different practice opportunities and their compensation plans by tallying the income provided through salary plus the various benefits. The employer will often be glad to share the costs of the various benefits. A position with a lower salary but good benefits may outpace a practice opportunity with a higher salary.
Another consideration is the expenses associated with living in the cities and states where you have practice opportunities of interest. Compensation in big cities tends to be less, but the cost of living is greater. Best Places’ Cost of Living Calculator can tell you how much you’d have to make in a new city compared to what you’re making now. A shorter commute will reduce expenses. The cost of housing, meals, entertainment will vary greatly from place to place.
There are so many different factors to consider beyond the base salary. Some states have a state income tax, and others do not. States without a state income tax are:
- Alaska
- Florida
- New Hampshire
- Nevada
- South Dakota
- Tennessee
- Texas
- Washington
- Wyoming
Your physiatry job selection is based on a multitude of factors. One factor worth considering is state income tax. States like California and Oregon take 9% or more in state income taxes, so it can cost you into the millions over a career. Seven states currently have no income tax: Alaska, Florida, South Dakota, Texas, Washington and Wyoming.
For example, all things being equal, if you were to take the $17,227 tax burden in CA and not have to pay it while living in Nevada and invested that amount yearly at a 5% annual gain, here are the results: In 10 years that would amount to $255,574.29, in 20 years to $643,816.91, 30 years to $1,276,223.23.
Coincidentally, I’m representing a mostly inpatient practice opportunity in Las Vegas, NV which is also available on a locum tenens basis. Information about it may be found at https://farrhealthcare.com/inpatient-outpatient-physiatry-practice-opportunity-las-vegas-2/ It’s listed as a Medical Director practice opportunity but it is also available as a staff position. It can be an employee or an independent contractor affiliation. I hope to hear from you!
A good article about state taxes is “If Doctors Chose Their Job Locations Based on State Income Taxes” which can be found at https://www.whitecoatinvestor.com/if-doctors-chose-job-based-state-income-taxes/ It includes a chart of taxes by state.
Physiatry Reimbursement Rates Across Geographic Areas
Physiatrists often ask,” In which city or state would I earn the highest income?”
Medicare and other insurance carriers have different reimbursement rates depending on geographic locality, which in turn is based on factors such as practice costs like overhead and malpractice insurance. The most highly reimbursed areas are in the big cities and nearby suburbs. New York City reimburses more than Los Angeles, which in turn reimburses more than Houston.
Is the variation among localities significant?
Not as much as you may think. An analysis of I/P admission code 99223 shows that the National Average Medicare Allowed amount is $195. However, of the 90 localities in the country, 72 are within 6% of the national average! Only one locality is more than 6% below the national average — Puerto Rico. And only eight localities are more than 10% above the national average, including those you would expect:
- San Francisco, Anaheim and the surrounding areas
- Manhattan, Queens, Long Island and other New York cities
- Miami
If you want to locate your practice in a highly-reimbursed location, bear in mind that there is a tradeoff. Although you will be reimbursed more, the cost of running your practice will be higher, and in all probability, your personal living expenses will also be higher.
Here is a recommendation: start with an area you could see yourself enjoying, and then look at the numbers because by far, the most important determinant of practice income is the quantity of procedures performed – not the reimbursement.
But if you are looking at numbers only, the most highly-reimbursed area of the country for an I/P admission is Alaska – a full 33% higher than the national average. So, by the numbers, Alaska is the place to be — just remember to pack your thermal underwear and sled dogs.
(Contributed by Bruno Stillo, Physiatry Billing Specialists, (800)835-4482, physiatrybillman@aol.com)
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