A practicing physiatrist recently asked me about the best resources for interventional physiatry compensation information. Here’s what I told him:
The best resource is the Medical Group Management Association’s compensation survey. The 2023 MGMA Compensation & Production Report (which is compiled based on 2022 data) estimates that the average PM&R salary is around $325,429. https://physiciansthrive.com/physician-compensation/physiatrist-palary-your-guide-to-compensation-in-physicial-medicine-and-rehabilitation.You might be able to call them and get a spine figure from them. Otherwise, the survey can be purchased although it’s expensive. (If you’re with an academic program, this survey should be in their library.)
MedScape does physician compensation surveys which as a doctor you can get on the web.
A Google search showed:
Pain Medicine: Pain medicine physicians actually get paid quite well (for those looking to boost their PM&R salary), with the national average reported by com being $376,218
As of Oct 27, 2023, the average annual pay for an Interventional Spine Physiatrist in the United States is $142,182 a year.
Salary: Interventional Spine Physiatrist (Nov, 2023) US. Please note that this figure goes to show that not all surveys are accurate!
The estimated total pay for a Spine Physiatrist Physician is $243,726 per year in the United States area, with an average salary of $223,802 per year. These numbers represent the median, which is the midpoint of the ranges from our proprietary Total Pay Estimate model and based on salaries collected from our users. The estimated additional pay is $19,924 per year. Additional pay could include cash bonus, commission, tips, and profit sharing. The “Most Likely Range” represents values that exist within the 25th and 75th percentile of all pay data available for this role. https://www.glassdoor.com/Salaries/spine-physiatrist-physician-salary-SRCH_KO0,27.htm
With RVU-based compensation and bonus, either the practice or the employee may be shortchanged, as follows:
Practice has many low-reimbursing payors – Practice is short-changed
In practices with many self-pay (often becomes no-pay) or Medicaid patients (with its lower reimbursement), the practice may be shortchanged by tying compensation and bonuses to RVUs. Although the employed physician meets his RVU work requirement, the lower reimbursement will result in lower practice income which may be insufficient to cover the physician’s compensation and bonus.
Practice has many traditional reimbursing payors – Physician-employee is short-changed
In practices with a payor mix of traditional carriers (Medicare, BCBS), the employee may be shortchanged. Presuming the same level of RVUs are achieved (as in the above example), the practice’s higher income may far exceed the physician’s compensation and bonus
Opinion
I prefer physician-employee compensation and bonuses which are based on income generated by the employee, and not based on RVUs.
RVUs is a nebulous, difficult to understand term, but dollars and cents is a universally-understood language.
The more or less income the practice earns based on the employee’s services, the more or less compensation and bonus the employee gets.
Stated plainly: Pay me based on what income I generate, not the number of hours (which will increase RVU’s) I work.
This article Was contributed by Bruno Stillo, Physiatry Billing Specialists. 800-835-4482, [email protected]
Recently a physical medicine and rehabilitation physician asked me the average compensation for an Executive Medical Director job. The vast majority of the physical medicine and rehabilitation positions we represent are clinical, not executive. According to salary.com, the average Executive Medical Director salary is $359,636 as of December 27, 2022, and the salary range typically falls between $295,670 and $446,617.
One of the many current clinical Medical Director positions available now through Farr Healthcare, Inc. is in the Houston area. This rehab hospital has great clinical outcomes and an outstanding reputation in the market. For more information about this physical medicine and rehabilitation practice opportunity and many more may be found at www.farrhealthcare.com.
Physiatry jobs, they come in many shapes and sizes but one factor, cost of living, can make all the difference in the world. I’ll never forget a physiatrist with an opening in Las Vegas, NV. He told me that because of the lower cost of living in NV, that a doctor moving from CA to NV could buy a new car every year!
Unlike other professions, physiatrists often receive greater financial income in pm&r jobs in less metropolitan areas. The basis for this is the law of supply and demand; more physiatrists want a practice opportunity in a metropolitan area so the physiatry supply is greater in metro areas. The financial remuneration maybe be lower in metro areas yet physiatrists are willing to take these positions.
Physiatrists who are willing to consider physiatry jobs in less metropolitan areas are often rewarded financially. It’s helpful to know that you can earn 15% to 20% more by living in middle America according to “Where Doctors Can Find a Higher Pay & Lower Cost of Living” https://www.hcplive.com/view/often-overlooked-way-fund-your-roth-ira-has-many-advantages,
When you’re considering physical medicine and rehabilitation jobs, the website Doximetry has a salary map which shows nationwide salaries on a county-by-county basis. According to Doximetry’s 2020 Physician Compensation Report – Physiatry is one of the top ten specialties with the largest increase in average annual compensation with $338,554 as the average compensation in 2019 versus $354,457 in 2020.
Some cost-of-living comparisons are as follows:
Moving from Los Angeles- to Phoenix, AZ with a salary in CA of $300,000. You’ll only need $201,486 for the same standard of living in Phoenix- a savings of $98,514!
Moving from Chicago, IL to Rockford, IL with a salary in Chicago of $300,000. You’ll only need $220,509 for the same standard of living in Rockford- a savings of $79,491!
Moving from Atlanta, GA to Florence, AL with a salary in Atlanta of $300,000. You’ll only need $247,110 for the same standard of living in Florence-a savings of $52,890
Moving from NY, NY to Allentown, PA with a salary in NYC of $300,000. You’ll only need $123,793 for the same standard of living in Allentown-a savings of $176,207!
These savings can provide monies to use as you wish such as travelling to the bigger cities in your spare time. So there’s a lot to consider when taking a new physiatry job, least or most of which may be the cost of living. To find great practice opportunities, click here.
PLEASE VISIT THE OPENINGS PAGE AS MORE INFORMATION IS AVAILABLE THERE ABOUT COMPENSATION FOR VARIOUS PRACTICE OPPORTUNITIES
Whether you’re looking into physiatry as a career or you are an established practitioner interested in a new position, compensation is a significant consideration that will guide your decision. This is our guide to everything you need to know about physiatry compensation. Farr Healthcare prides itself on relaying accurate and updated information regarding physiatry trends. Information ranges from compensation considerations, contribution articles from fellow physiatrists and others who work in the medical field and the recent physiatry trends and benefits for the year. With an accurate picture of the physiatrist salary landscape, you can confidently approach negotiations and ensure you will receive a physical medicine and rehabilitation salary on par with your skills and experience.
The adjusted physiatrist average salary for out-patient and in-patient are $247,627.12 and $208,404.76 respectively (p-value 1.66508E-16). The mean out-patient and in-patient salaries were compared within regions of the US as the following:
New England: out-patient $262,412, in-patient $208,840 (p-value 0.01411).
Conclusions: The regions with the highest and lowest mean out-patient salaries are the Mid-Atlantic (NJ, NY, PA) ($293,054) and the West South Central region (AR, LA, OK, TX) ($216,498). The regions with the highest and lowest mean in-patient salaries are the West North Central (IA, KS, MN, MO, ND, NE, SD) ($228,420) and the Mid-Atlantic region ($194,805). The Mid-Atlantic region has the greatest discrepancy with highest mean out-patient salary and the lowest mean in-patient salary. There’s a statistically significant difference in physiatrist salary in in-patient vs. out-patient practices.
Per salary.com – The average Physician – Physiatry salary in the United States is $251,769 as of January 26, 2023, but the range typically falls between $227,810 and $280,825.
Per https://www.zippia.com/physiatrist-jobs/salary/:
Physiatrists make $305,616 per year on average, or $146.93 per hour, in the United States. Physiatrists on the lower end of that spectrum, the bottom 10% to be exact, make roughly $147,000 a year, while the top 10% makes $635,000.
Location impacts how much a physiatrist can expect to make. Physiatrists make the most in Alaska, Illinois, North Dakota, Minnesota, and Missouri.
Per https://www.comparably.com/salaries/salaries-for-physician-physiatry is:
$244,218
Base Salary
$230,356
Bonus
$13,862
Get Bonus
100%
1. 24% more in Seattle
2. 17% more in Dallas
3. 15% more in Portland
4. 11% more in New York
5. 8% less in Boston
6. 8% less in Los Angeles
Per ZipRecruiter.com as of 2/26/23:Top Highest Paying States for Physiatrist Jobs in the U.S.
We’ve identified seven states where the typical salary for a Physiatrist job is above the national average. Topping the list is New York, with New Hampshire and Wyoming close behind in second and third. Wyoming beats the national average by 3.6%, and New York furthers that trend with another $49,897 (18.8%) above the $265,550.
Per the Economic Research Institute, on their website on 1/16/22: Projected estimated salary in 2027:
$332,072
Per ZipRecruiter.com as of 2/26/23: What Is the Average Physiatrist Salary by State
State Annual Salary
New York $315,447
New Hampshire $292,434
Wyoming $275,110
Arizona $273,946
Tennessee $271,363
Hawaii $269,824
Massachusetts $268,218
Indiana $265,482
Montana $264,919
Nevada $264,548
West Virginia $263,819
New Jersey $263,271
Washington $260,524
Connecticut $259,601
Pennsylvania $258,479
Minnesota $258,306
Rhode Island $255,746
Alaska $254,949
Oregon $254,319
North Dakota $248,900
Wisconsin $247,033
Maryland $246,603
Ohio $244,465
Alabama $239,741
Virginia $239,322
Iowa $239,270
Idaho $238,481
South Dakota $237,330
Vermont $236,640
California $235,685
Utah $235,070
New Mexico $234,777
Colorado $232,494
Florida $232,112
Kentucky $232,039
Nebraska $231,997
Delaware $229,728
South Carolina $228,341
Kansas $225,003
Georgia $224,775
Maine $224,676
Mississippi $221,988
Oklahoma $220,464
Arkansas $220,421
Michigan $217,481
Illinois $217,004
Missouri $213,215
Texas $212,736
Louisiana $206,467
North Carolina $189,744
Sports Medicine Compensation
The average Physician – Sports Medicine salary in the United States is $242,409 as of December 27, 2021, but the range typically falls between $206,910 and $308,330.
https://www.salary.com
• Salary Range
Physician – Sports Medicine salaries in United States range from $127,000 per year (minimum salary) to $416,000 per year (maximum salary).
• Median Salary
The median salary is 276,000 USD per year, which means that half (50%) of people working as Physician – Sports Medicine(s) are earning less than 276,000 USD while the other half are earning more than 276,000 USD. The median represents the middle salary value. Generally speaking, you would want to be on the right side of the graph with the group earning more than the median salary.
• Percentiles
Closely related to the median are two values: the 25th and the 75th percentiles. Reading from the salary distribution diagram, 25% of Physician – Sports Medicine(s) are earning less than 181,000 USD while 75% of them are earning more than 181,000 USD. Also from the diagram, 75% of Physician – Sports Medicine(s) are earning less than 360,000 USD while 25% are earning more than 360,000 USD.
What is the difference between the median and the average salary?
Both are indicators. If your salary is higher than both of the average and the median then you are doing very well. If your salary is lower than both, then many people are earning more than you and there is plenty of room for improvement. If your wage is between the average and the median, then things can be a bit complicated. We wrote a guide to explain all about the different scenarios. How to compare your salary
A Physician – Sports Medicine is considered to be a high bonus-based job due to the generally limited involvement in direct revenue generation, with exceptions of course. The people who get the highest bonuses are usually somehow involved in the revenue generation cycle.
13% of surveyed staff reported that they haven’t received any bonuses or incentives in the previous year while 87% said that they received at least one form of monetary bonus.
Those who got bonuses reported rates ranging from 5% to 9% of their annual salary.
Received Bonus 87%
No Bonus 13%
Types of Bonuses Considered
Individual Performance-Based Bonuses
The most standard form of bonus where the employee is awarded based on their exceptional performance.
Company Performance Bonuses
Occasionally, some companies like to celebrate excess earnings and profits with their staff collectively in the form of bonuses that are granted to everyone. The amount of the bonus will probably be different from person to person depending on their role within the organization.
Goal-Based Bonuses
Granted upon achieving an important goal or milestone.
Holiday / End of Year Bonuses
These types of bonuses are given without a reason and usually resemble an appreciation token.
Salary Comparison By City
City Average Salary
Atlanta 250,000 USD
Austin 272,000 USD
Baltimore 256,000 USD
Boston 261,000 USD
Bristol 211,000 USD
Chicago 298,000 USD
Cincinnati 213,000 USD
Cleveland 241,000 USD
Dallas 302,000 USD
Denver 268,000 USD
Detroit 266,000 USD
Honolulu 213,000 USD
Houston 308,000 USD
Indianapolis 279,000 USD
Iowa City 215,000 USD
Jacksonville 278,000 USD
Kansas City 253,000 USD
Kent 215,000 USD
Las Vegas 256,000 USD
Long Beach 249,000 USD
Los Angeles 322,000 USD
Memphis 261,000 USD
Miami 241,000 USD
Minneapolis 244,000 USD
New Orleans 222,000 USD
New York 305,000 USD
Oakland 247,000 USD
Oklahoma City 249,000 USD
Orlando 229,000 USD
Philadelphia 304,000 USD
Phoenix 303,000 USD
Sacramento 254,000 USD
San Antonio 304,000 USD
San Diego 280,000 USD
San Francisco 275,000 USD
San Jose 279,000 USD
Seattle 270,000 USD
Tampa 231,000 USD
Vancouver 223,000 USD
Washington D.C. 262,000 USD
All of the above from http://www.salaryexplorer.com/salary-survey.php?loc=229&loctype=1&job=913&jobtype=3
Compensation in PA
Here are some average compensation numbers for physiatrists in PA from an online search in early 2022:
$338,554 in 2019 and $354,457 in 2020 – https://www.doximity.com/2020_compensation_report
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.”
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.
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:
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.
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.
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!
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, [email protected])
Find the Position You Deserve With Farr Healthcare
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The number of physiatry practice opportunities is less this year because of COVID. There are sports medicine fellows who are open to general rehab positions and residents who want to do inpatient who are open to outpatient work. This applies to the urban areas and less so for more suburban or rural areas.
There are more and more subacute and skilled nursing facility physiatry practice opportunities. Some of them are with private practices and some are with large national or regional companies. These companies often have an income guarantee and then take approximately 30% of the billings.
Part-time physiatry practice opportunities are not unusual in large metropolitan areas like New York City. Physiatrists there may not be able to find a full-time position. Sometimes it’s wise to have two part-time physiatry practice opportunities so that if one physiatry practice opportunity folds then the physiatrist has the security of the other job.
Licensure is an aspect of the practice search that is often overlooked. Most physiatrists prefer to hold off on licensure because of its cost. However, licensure puts you at an advantage over a physiatrist who is not licensed in that state. Therefore, it’s worthwhile to pursue a license particularly in states that are in high demand such as NY, FL, and CA. It’s also important to pursue a license early on if you’re interested in a state which licensure process is lengthy such as TX, CA and NJ. Sometimes, practices/hospitals will pay for a license if you take their practice opportunity. Without a license, you put yourself in possible financial disadvantage because credentialling with insurers can’t be started until you have a license number.
When considering physiatry practice opportunities, be wary of practices/hospitals with a revolving door of doctors. You may hear about this situation at a hospital/practice from doctors in the area or through research. It happens more often in metropolitan locations where there is a high demand for physiatry practice opportunities. In these locations, a hospital/practice can easily replace one doctor for another doctor.
When considering physiatry practice opportunities, you may want to consider the cost of living of various areas across the country. For example, a practice in Las Vegas with a physiatry practice opportunity makes a point that for what you’re saving by not living in Los Angeles, CA, you could buy a new car very year! If you make $212,000 in Los Angeles, it’s equivalent to making $300,000 in Las Vegas.
Another consideration when thinking about is state income tax. I know one NYC physiatrist whose main consideration with physiatry practice opportunities was states with no state income tax. States without a state income tax are AK, FL, NV, NH SD, TN, TX, WA and WY. As one physiatrist in NV told me who is hiring a physiatrist, a doctor moving here from a state with income tax would be able to buy a new car each year. For example, for every $100,000 you earn, you would save $10,000 by not having to pay state income tax. Hence, the savings amounts to a new car each year!
Interviewing is a major component of the practice search process when considering physiatry practice opportunities. Be prepared to answer the standard questions such as “What do you have to bring to the table?” “What are your practice interests?” and “Tell me about yourself.” You can find countless tips online describing how to respond to the typical interview questions and to show that you’re an excellent candidate for the job to include on our website.
Another type of interview question are personality/psychological questions. Examples of these type of questions are “Describe your approach to patients.” “Tell me about a patient who came to you unhappy with the care they received elsewhere, and how you handles it.” “What makes you uncomfortable?” “When are you the happiest?” Tell me about one of your professional relationships.” “Tell me about your best supervisor.”
These questions are to see how you work under pressure. They want to know how you react to surprises, and if you can handle unusual situations quickly, creatively and effectively. The interviewer will likely ask questions about you and your work style to determine how to handle stress and challenging situations. There are no right or wrong answers to these questions, but you’ll still want to prepare as much as possible. You’ll want to answer honestly while at the same time trying to match your replies to the practice’s needs.
You can still practice how to handle these questions. First, you can practice answering strange questions with a friend or family member. This will help you practice staying calm and confident, even when you feel stumped. Show empathy and compassion in your responses. Try to demonstrate your listening skills, interest in patient education and ability to engage patients in their healthcare. If you are stumped by a question and need a little more time to respond, ask the employer to ask the question again and/or repeat the question that’s been asked.
Also, be prepared to ask questions during an interview. It shows that you have an interest in the physiatry practice opportunity. Asking good questions won’t guarantee you the job but they will certainly help make a good impression. Sample questions to ask include “How much time is allotted for appointments with new and follow-up patients?”, “How much time is allotted for appointments with new and follow-up patients?”, “How many patients a day will I be expected to see?”, “What constitutes a full-load in your practice?” and “Is this a new or replacement position?”
Having said all of these objective items to do during your physiatry practice search, it remains to be said that using your intuition/gut to decide if it’s a good physiatry practice opportunity is very worthwhile. All the questions and answers during an interview still aren’t enough to decide on a physiatry practice opportunity. Beyond what objective information you can secure, use subjective information to decide on a job. Read between the lines of what was said and not said by the employer.
In regards to compensation, according to MedScape’s 2019 physiatry survey from data collected between October, 2018 and February, 2019, the average compensation for a physiatrist is $306,000. This is up from $269,000 in 2018.
Compensation varies by area. For example, Atlanta on average pays 29% more than the national average, Miami 5% more, Tampa 1% more, Cleveland 3% less, NYC 5% less, Chicago 8% less and Philadelphia 23% less. This is information according to payscale.com.
Also, according to payscale.com, the average physiatrist salary is $208,543 with an average bonus of $72,000, and an average profit-sharing percentage of 10%. The low compensation for a physiatrist is $147,000, $290,000 as a median and $286,000 as the 90th percentile.
When considering physiatry practice opportunities, there are 3 basic compensation models: straight salary with incentive, equal shares and production-based. A straight salary is most often seen in HMO’s and academic settings. Obviously, a straight salary is the easiest to determine its value. They are guaranteed regardless of your productivity. On the other hand, if you are a hard worker and productive, then a straight salary is not your best friend. They also don’t offer an ownership track.
Regarding an incentive, you need to find out how it is derived and if it’s achievable. According to a physiatrist, it’s much more important to know an incentive’s derivation than simply that one exists. She was offered an incentive to earn an additional $50,000 a year provided her billings exceeded a certain amount. The problem was that the higher earnings were unrealistic. Looking back, she realized that she should have asked for the performance financials for other physiatrists in the practice, the payor mix, the productivity of the other physiatrists, etc. Find out how the incentive works in practice, not just in theory.
The incentive may be modest the first and second years of practice as it takes that long for the practice to break even with a new doctor. If you’re in a private practice, the incentive formula will probably start at 25% the first year, 35% the second year and 50% the third year. It’s usually by the third year that you become a partner.
Even though you probably won’t be able to negotiate the compensation model, it’s important to understand it to realize what annual income you might anticipate. Determine how the compensation model works initially and at different points in time. For example, if the first one or two yea’s salaries are fixed and then 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 and three. As Merritt Hawkins Executive Vice President Mark Smith says, “if physician can’t determine how much they will earn while brushing their teeth, the plan is too complex.”
One type of incentive formula is based on getting a percentage after x times the salary or receipts. For example, you might get 20% of collections after three times your salary. For example, a salary of $180,000 with collections of $600,000 would result ($180,000 x 3 =$540,000, $600,000 – $540,000 x 20%) in a $12,000 incentive bonus. This is an example of what I spoke to earlier that you should make sure the collection incentive is attainable. Also, I was just talking with a physiatrist yesterday who told me there were different collection thresholds with different associated percentages. The percentages should be the same.
Another type of incentive formula is a percentage of the difference between the net income and expenses. For example, if your gross collections for a quarter are $150,000 and there are $60,000 in overhead expenses and $60,000 in physician expenses like malpractice, benefits, etc., the net is $30,000 and at a bonus of 20% you would receive $6,000 for the quarter. Years ago, a physiatrist I recruited warned me of the physiatry owner who had a very large rental expense which a portion was to him and greatly reduced his income. You may also receive a share of the ancillaries like PT and lab.
A third compensation formula is purely production-based. There are a myriad of variations with these formulas just as is the case with the incentive formulas. You might be paid a percentage of billings OR collections OR RVS units of service. One physiatrist told me how his compensation formula was different than his older associates. The overhead should be shared unless perhaps in situations of multispecialty groups. The positive of a production-based compensation formula is that you are rewarded for the work you do. A negative is that it might cause friction among the physicians as some physiatrists will be paid more than other physiatrists.
Other compensation considerations are to find out the percent of billings that the physician group/hospital typically collects and how quickly it collects it. The time value of money comes into play. It’s far better to step away from a practice opportunity before digging yourself in a hole.
Find out the patient mix. Private pay pays the best but you have to be in a demographic that will support it. The order of payment thereafter is commercial insurance, Medicare and Medicaid. Personal injury payments usually are much longer to receive. Also find out if you’ll be seeing the same share of these patients as the other doctors.
Don’t count on the incentive even if it looks likely. This past year was a perfect example with the impact of Covid. I talked with a doctor who told me she hasn’t earned the incentive in the 30 years with the hospital!
Partnership terms usually aren’t discussed upfront. Until the doctor group works for you and feels comfortable with you, partnership won’t be discussed. However, you could probably find out what the terms are for the existing physicians. A five-year partnership track may be far less appealing than a two-year track and the longer route to partnership may mean less long-term earning potential.
Finally, the last aspect of considering a physiatry practice opportunity is the contract. Large corporations and health systems have boilerplate contracts and won’t negotiate them so a legal review is not as valuable as it might be. However, I recently had a group which told me to tell the physician to whom they offered a contract that it is a boilerplate that he couldn’t negotiate. However, he did ask for a sign-on bonus and received a sizeable figure.
If you decide to work as an independent contractor and are responsible for your own billings, you might want to refer to my website to the Resources tab which includes for one, Physiatry Billing Specialists. Other resources are included on this tab to include lawyers, billings, and practice management.
So here’s best wishes to you in your consideration of physiatry practice opportunities!
AUTOMATIC MIPS Exception for Performance Year 2020
CMS issued a new directive on 2-25-21 – CMS will apply an AUTOMATIC extreme and uncontrollable circumstances exception (EUC) to the following clinicians for the MIPS 2020 performance year:
Individual clinicians that haven’t submitted data. If you haven’t submitted data for 2020, then you don’t need to, if you want to avoid a penalty in 2022.
Individual MIPS eligible clinicians that have submitted data for a single performance category (such as Medicare Part B Claims measures submitted throughout the 2020 performance period).
If you meet either of the above criteria, you will be automatically identified and will receive a neutral payment adjustment(i.e. – no penalty) for the 2022 MIPS payment year. You don’t need to take any additional action!
The automatic exception is welcome news for individual clinicians who are having trouble meeting the requirements of the 2020 MIPS program.
1. Physician work RVU = the level of time, skill, training and intensity to provide a given service.
2. Practice Expense RVU = Addresses the cost of maintaining a practice including rent, equipment, supplies and non-physician staff costs.
3. Malpractice RVU = Represent payment for the professional liability expenses. These are supposed to be reviewed on a bi-annual basis, but in practice this has not frequently occurred. This is the smallest component of the RVU.
Each CPT code is targeted for review at least every 5 years. Historically, a group of codes appear to be targeted each year by Medicare in order to reduce the amount reimbursed. Rarely do we see increases. This is for Medicare, Medicaid and Medicare Replacements. In the case of EMG’s a few years ago, the actual CPT codes were changed by the AMA as well as the definitions, allowing Medicare to assign completely new RVU’s rather than adjusting them, resulting in a whopping 50% decrease.
Another factor that is applied is the GPCI (Geographic Practice Cost Indices). This takes into consideration the cost of living differences across the country. CMS calculates an individual GPCI for each of the RVU components, i.e., physician work, practice expense and malpractice. The GPCI’s are reviewed every 3 years.
The Conversion Factor converts the RVU into actual dollar amounts. This is updated every year. This is what controls budget neutrality. There is a certain Budget amount allocated for reimbursement of Federal Funds every year (when there is a budget). If the expenses exceed the Budget, then the conversion factor is adjusted to achieve Budget neutrality.
When looking at practice RVUs it can become very complicated, especially for non-Medicare RVUs where the conversion factors are different from Medicare. Each practice can literally come up with their own RVUs, but you also have to know what the conversion factor is to turn the RVUs into a dollar amount. The safest way to proceed in that direction is to ask what their Formula is for calculating the actual dollar amount for each procedure. Then compare with each practice you is looking at.
Contributed by Elizabeth Lee, President
Physiatry Reimbursement Specialists, Inc.
A National Company serving Physiatrists all over the U.S. for 25+ years
Fort Worth, TX
1-800-324-4777
www.Prsinc.com
Many physiatrists are unaware of their ability to bill for Certifications of Home Health Service, and have lost many thousands of dollars over the past ten years.
Background
Physicians have always been able to bill for Care Plan Oversight services. However,the physician must meet and document that he/she has spent 30 minutes within the month providing these services. Most physicians do not meet the 30-minute time requirement – and many feel that the effort to document the 30 minutes is just too difficult, and therefore do not bill. However, since October 1, 2000, physicians have been able to bill for Home Health Certifications, defined as “Physician certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient’s needs, per certification period (60 days).”
How it works
Physiatrists often receive Medicare Form CMS-485 which is entitled “Home Health Certificationa nd Plna of Care” for patients discharged from their inpatient service. Physiatrists review these plans of care, sign them, and return them to their Home Health Agency. Believe it or not, many physiatrists are not aware that they can bill for these services. But wait, there’s more! After 60 days, the patients may be Re-certified for another 60 days of home health services, and another Certification form will be signed by the physician. This second 60-day Certification is ALSO billable, although with a different CPT code.
Reimbursement
Medicare reimbursement is over $50 for the initial Home Health Certification, and over $40 for each Re-certification. If you have not been billing for these services for the past ten years, and if you have had an average of two Certifications per month, you have lost income of well over $10,000. If so, don’t look back, but bill going forward.
Bruno Stillo, CPA is the owner of Physiatry Billing Specialists, 800-835-4482, [email protected]
I was recently asked by a practice who is looking for a doctor if it is common for the practice to have a financial penalty should the doctor leave before the end of the contract term. This is the case usually when the new doctor was paid an income guarantee, an advance, a relocation allowance, etc. If not, then a financial penalty is not usually the case. I obtained this information from Physiatry Reimbursement Specialists, Inc., a national billing and practice management company serving Physiatrists all over the U.S. for 20 years, 1-800-324-4777, www.Prsinc.com
