The Guide to Physiatry Compensation – All You Need to Know

Physiatry Compensation

New Trends in Physiatry Compensation

Physiatry Compensation By State

Sports Medicine Compensation

Average Physiatry Compensation in the U.S. – 2023

Per: https://www.eventscribe.net/2023/Physiatry23/fsPopup.asp?Mode=posterinfo&PosterID=551823

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).

Mid-Atlantic: out-patient $293,054, in-patient $194,805 (p-value 0.18771).

East North Central: out-patient $249,573, in-patient $211,892 (p-value 0.02960).

West North Central: out-patient $241,238, in-patient $228,420 (p-value 0.14550).

South Atlantic: outpatient $236,363, in-patient $196,930 (p-value 0.00250).

East South Central: out-patient $235,221, in-patient $205,356 (p-value 0.20486).

West South Central: out-patient $216,498, in-patient $198,984 (p-value 0.05390).

Mountain: out-patient $255,702, in-patient $219,952 (p-value 0.00256).

Pacific: out-patient $259,420, in-patient $199,937 (p-value 0.03152).

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:

$244,200 – https://www.salary.com/research/salary/alternate/physiatrist-salary/pa

$263,123 – https://www.ziprecruiter.com/Salaries/Physiatry-Salary–in-Pennsylvania

$286,960 – https://www.salaryexpert.com/salary/job/physician-physiatry/united-states/pennsylvania

$94,719 -Philadelphia – https://www.comparably.com/salaries/salaries-for-physiatrist-in-philadelphia-pa

$232,000 – https://www.zippia.com/physiatrist-jobs/salary/

$200,000 – https://www.talent.com/salary?job=physiatrist

$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.”

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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.

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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.

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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

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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)

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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,”

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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.

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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.

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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])

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Find the Position You Deserve With Farr Healthcare

Farr Healthcare is the leading partner for physiatrists looking to begin their careers or find a new job. We have more than 30 years of experience recruiting physicians, and we make the process as simple as possible so you can find the right position based on your skills and experience. To get started, view our listed openings or fill out our physician application.