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!