Inpatient rehab / IRF salary with significant vacation time?

[megan1010]

I'm still a resident, but am thinking of primarily of general inpatient. I've talked to a few physiatrists out in private practice, but was curious about expected salary with significant vacation time? From the physiatrists I've talked to, they take 2-3 weeks off per year, which seems pretty low to me. Does anyone know the range of salary one might be able to expect for someone taking 6-8 weeks off for vacation time for the year (or even more)? While I enjoy working, I really enjoy traveling, it's a huge passion of mine and definitely want to be doing multiple trips throughout each year. I'm seeing a lot of job postings, mostly from Integrated Rehab Consultants for 350-400k for IRF jobs.

Does anyone have some experience with taking that much vacation time while doing inpatient and how much of a salary one could expect?

Thanks in advance.

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[DMBandFan86]

Are you looking for an employed position or an independent position?

Most full time employed positions will get 15-25 days per year based on your experience level. Competitive markets lean more on the lower to average end. Can always negotiate anything as long as the other party really wants you. Usually start to accrue more vacation after 2+ years. If you go rural or to a less desirable location then they are more likely to give you what you want.

If you are independent, then the facility may or may not want you to take that much vacation. Depends how good their Locums support is or if other providers are willing to cover your patients that much. It will be harder to get med director roles, but not impossible. But if you truly set up an independent practice you can take as much time off as you want as long as some is covering your patients.

Salary figures are posted all over the forum primarily based on 4 weeks vacation. So just take that and subtract out another 2 weeks or 1 months worth of collections that you won’t get. So if you think you will collect about 300k for your position, then it would be more like 275-285K instead.

But it also depends on how many patients you are seeing when you are working. If you see 16-20 IPR patients per day and then also add SNF and just work harder to see more patients then you make the same. I’ve seen people go “part time” by seeing a full 4 weeks worth of patients per month, but only working 3 weeks. Mostly outpatient though with established practices.

 

[Momentum70]

Getting 350k-400k is easy but not if taking off 2 months of the year. You may want to look into independent or partnership type situations. For instance I can technically take off 6 weeks easily a year, but I dont get any PTO, time off for me means no billing. The only limitation to my time off is if one of my partners can cover for me. One of my partners took off 3 weeks last year to go to Israel. Ill be taking off 3 weeks to go to japan. Just to give a few examples. Our IPR only cares that there are doctors to admit and fill the beds and take care of the people here, they dont really care who is doing it.

 

[RangerBob]

Getting 350k-400k is easy but not if taking off 2 months of the year. You may want to look into independent or partnership type situations. For instance I can technically take off 6 weeks easily a year, but I dont get any PTO, time off for me means no billing. The only limitation to my time off is if one of my partners can cover for me. One of my partners took off 3 weeks last year to go to Israel. Ill be taking off 3 weeks to go to japan. Just to give a few examples. Our IPR only cares that there are doctors to admit and fill the beds and take care of the people here, they dont really care who is doing it.

Same here. If I take time off, I don't get paid (independent contractor). But when my partner takes time off, I have to work double so I recoup my losses.

I take a lot more time off than he does though... I aim for at least 6 weeks or so.

OP-I don't recall seeing many employed positions that offer 6-8 weeks vacation from the start (though I think the VA did), but you could try and negotiate it in any contract. However, someone has to cover you for that time off, so typically you'll get off a similar amount of time off as the other docs.

Once again, if you're an independent contractor, you can take as much time off as you want, as long as you have coverage. I know many docs working solo on an inpatient unit can't get any time off because they have no partner to cover them and it can be difficult to find locums and sometimes the facility has no responsibility to find/pay for the locums, which would mean that responsibility falls to the individual doc. Obviously something you could address in a contract--I knew a solo doc who had off-hours hospitalists cover rehab call/weekend admits (they admitted Sunday and he did H&P Monday) and the hospital covered something like 4 weeks of locums for vacation for him.

 

[megan1010]

Are you looking for an employed position or an independent position?

Most full time employed positions will get 15-25 days per year based on your experience level. Competitive markets lean more on the lower to average end. Can always negotiate anything as long as the other party really wants you. Usually start to accrue more vacation after 2+ years. If you go rural or to a less desirable location then they are more likely to give you what you want.

If you are independent, then the facility may or may not want you to take that much vacation. Depends how good their Locums support is or if other providers are willing to cover your patients that much. It will be harder to get med director roles, but not impossible. But if you truly set up an independent practice you can take as much time off as you want as long as some is covering your patients.

Salary figures are posted all over the forum primarily based on 4 weeks vacation. So just take that and subtract out another 2 weeks or 1 months worth of collections that you won’t get. So if you think you will collect about 300k for your position, then it would be more like 275-285K instead.

But it also depends on how many patients you are seeing when you are working. If you see 16-20 IPR patients per day and then also add SNF and just work harder to see more patients then you make the same. I’ve seen people go “part time” by seeing a full 4 weeks worth of patients per month, but only working 3 weeks. Mostly outpatient though with established practices.

I think I'd prefer an independent position. And thanks, that's helpful information. To me, I'm fairly flexible with location; I'm more interested in overall pay and flexibility to travel since that's really important to me.

Getting 350k-400k is easy but not if taking off 2 months of the year. You may want to look into independent or partnership type situations. For instance I can technically take off 6 weeks easily a year, but I dont get any PTO, time off for me means no billing. The only limitation to my time off is if one of my partners can cover for me. One of my partners took off 3 weeks last year to go to Israel. Ill be taking off 3 weeks to go to japan. Just to give a few examples. Our IPR only cares that there are doctors to admit and fill the beds and take care of the people here, they dont really care who is doing it.

So for 350-400k, is 4 weeks vacation typically the norm? I did figure that having someone available to cover for me would be the limiting factor.

Same here. If I take time off, I don't get paid (independent contractor). But when my partner takes time off, I have to work double so I recoup my losses.

I take a lot more time off than he does though... I aim for at least 6 weeks or so.

OP-I don't recall seeing many employed positions that offer 6-8 weeks vacation from the start (though I think the VA did), but you could try and negotiate it in any contract. However, someone has to cover you for that time off, so typically you'll get off a similar amount of time off as the other docs.

Once again, if you're an independent contractor, you can take as much time off as you want, as long as you have coverage. I know many docs working solo on an inpatient unit can't get any time off because they have no partner to cover them and it can be difficult to find locums and sometimes the facility has no responsibility to find/pay for the locums, which would mean that responsibility falls to the individual doc. Obviously something you could address in a contract--I knew a solo doc who had off-hours hospitalists cover rehab call/weekend admits (they admitted Sunday and he did H&P Monday) and the hospital covered something like 4 weeks of locums for vacation for him.

6 weeks is pretty decent. I think I'd prefer the independent route. I want to be able to take a couple weeks off at a time and take around 2-3 trips per year. Being in residency, while 1 week of vacation feels so good when traveling somewhere, it often feels restrictive and short. I have a fear of becoming someone who talks about travel in their future and getting caught up in a "rat race" sort of lifestyle to only lose sight of the big picture. I feel I see this far too often, especially in academics. So many of our staff don't take much vacation time and if they do, they don't go anywhere. Maybe it's due to lifestyle creep though, I don't know. I don't spend a ton day-to-day, so a lot of my spend goes towards travel.

 

[lejeunesage]

Basically sounds like what I do.
I tend to take 1-2 weeks off every 3 months. In a typical year, I take 7 weeks off.

If you're looking for inpatient, your best bet is to be an independent contractor and have a medical directorship. Unless you're willing to move to the boonies, you're not likely to get that straight out of training. But you might find an associate directorship or program directorship that will pay you a smaller stipend on top of your collections.

Medical directorship stipends vary. Employed positions pay you a nominal stipend like $30-40K/year.
Independent directorships with the big companies might pay you anywhere from $80-150K/year.
That's where you want to land. Get 1-2 years of experience somewhere, then take a directorship wherever one opens up.

The other way to increase your revenue is to see more patients per day.
Most IPR docs see 12-15 pts/day.
As you increase your efficiency, you can move to 18, then 20-25 pts/day if you get a scribe (pays for itself multiple times over).
The more you generate when you're working, the less you time you need to spend working.
If your IPR facility won't let you see that many patients (too small or too many docs per patient) you can start rounding at SNFs to supplement your income.

Basically, there are a lot of ways to generate money. The bottom line is:
1. Directorship stipends are very generous.
2. More patients = more money.
3. Don't forget to write your note well enough so that you're adequately capturing the medical complexity of what you're doing. I never bill a 99231. At this point, about 25% of my notes are 99233. For some people, that ratio is more. This is easier to justify if you do your own medical management. If you're consulting IM for everything, it'll be hard to justify.

The other way to make money while taking a lot of time of is locum tenens.
You might have to shop around until you find an agency to your liking.
There are companies out there whose rates are insultingly low.

PM for details.

 

[DMBandFan86]

I would say most academics get around 20 days off per year for vacation. They may not use all their vacation because it roles over or they get paid out at the end of the year for unused vacation days. Academics usually gets a negative wrap on here, but it isn’t all negative. You may also get 10+ days off for CME in addition. They also get sick days for which you don’t get as an independent or apart of some groups. Everything has their ups and downs.

If you do independent, you will likely want to work as much as possible the first year to build an established practice and to help offset the initial delays in collections which can be long for some patients.

Another thing to note, people on here always throw out 350-450K plus salary for independents. Then we compare that with employed roles which are likely around or under 290K +/- production. But we really should do a 1:1 comparison and take practice costs out of the 350-450K.

On another note, there maybe other reasons why you don’t see enough physicians traveling. Doctors are notorious for coming out of training and buying expensive houses and cars. Maybe a lot of the travel money you would use is tied up in housing or something else. Or they enjoy traveling at home. If you have school aged kids the costs of plane travel gets much more expensive and you are limited to travel when school is out (which is always crowded times) and kids sports never ends. I’d love to travel to Cancun in December, but alas the kids. So if you want to travel a lot I’d recommend a modest lifestyle and avoid taking on tons of more debt.

My last thought is have you considered interventional spine? Those guys make 500K+ and can take lots of vacation and you don’t really need coverage. If lifestyle is big on your list, you might just want to consider. As inpatient docs we tend to work weekends and holidays.

 

[megan1010]

I would say most academics get around 20 days off per year for vacation. They may not use all their vacation because it roles over or they get paid out at the end of the year for unused vacation days. Academics usually gets a negative wrap on here, but it isn’t all negative. You may also get 10+ days off for CME in addition. They also get sick days for which you don’t get as an independent or apart of some groups. Everything has their ups and downs.

If you do independent, you will likely want to work as much as possible the first year to build an established practice and to help offset the initial delays in collections which can be long for some patients.

Another thing to note, people on here always throw out 350-450K plus salary for independents. Then we compare that with employed roles which are likely around or under 290K +/- production. But we really should do a 1:1 comparison and take practice costs out of the 350-450K.

On another note, there maybe other reasons why you don’t see enough physicians traveling. Doctors are notorious for coming out of training and buying expensive houses and cars. Maybe a lot of the travel money you would use is tied up in housing or something else. Or they enjoy traveling at home. If you have school aged kids the costs of plane travel gets much more expensive and you are limited to travel when school is out (which is always crowded times) and kids sports never ends. I’d love to travel to Cancun in December, but alas the kids. So if you want to travel a lot I’d recommend a modest lifestyle and avoid taking on tons of more debt.

My last thought is have you considered interventional spine? Those guys make 500K+ and can take lots of vacation and you don’t really need coverage. If lifestyle is big on your list, you might just want to consider. As inpatient docs we tend to work weekends and holidays.

I don't dislike academics. I actually really like the teaching aspect of it. I do wonder how much I might miss having a resident/teaching. But I feel the pay is pretty low overall and most positions require you don't other things on top of inpatient like outpatient clinics, EMG, etc to hit RVUs for bonuses. The only other thing outpatient I like is spasticity management. I would like to try working as an independent contractor for awhile and if after 5-10 years I didn't like it or missed academics, I could always go back.

And with overhead costs, I think you'd still come out ahead as a 1099 than a W2 likely. That was my impression at least, but I'm still learning a lot about different career paths, payment models, etc.

I have thought about interventional spine! While the money is appealing, I don't really love interventional spine. I just don't think I'd enjoy it in the long run.

I definitely plan to live modestly. I don't really have an interest in a huge house or fancy car. Mostly food and travel and some hobbies lol.

 

[PurpleSmiley]

I'm an employed physician at a large academic hospital with my inpatient rehabilitation unit located in the suburbs of a large city (so more community hospital type but with the support of the large academic group). I'm also a recent graduate (last few years), and I personally wanted an employed position because of the support I knew I would get, retirement benefits, and didn't want to have to manage or find a billing/coding company, etc. I get 4 weeks PTO for vacation, and 2 weeks for CME. My schedule works out so I work 10-11 days every 2 weeks (so always get 2-3 days off that's not PTO), it's not a typical Monday-Friday as includes weekend coverage.

I am relatively more busy but I like the work of acute inpatient rehab - I see on average 18+ patients at my unit (mostly neuro rehab, ortho, debility) 2-3 days per week, plus do consults on the other 2-3 days of the week. All patients are seen by a hospitalist so I can focus mostly on the rehab side. I have a base salary + RVU bonus structure, and make well over $300k+. This is not including the additional benefits of 100% of 6% salary 401K match (around $20k extra), and $ for the intermittent residents that rotate.

Now in 2023 with the updates to E&M coding, with RVUs we can include time spent reviewing notes, documenting, reviewing images/labs and not just the time of face to face. So this would allow people with RVU bonuses or payment to actually bill for all the time that is spent seeing a patient that day (vs MDM whichever is higher), so I will be billing consults at 99254/99255, and like a previous poster said, most of my follow-up visits are 99232/99233, and admissions are always 99223.

 

[Iamnew2]

I'm an employed physician at a large academic hospital with my inpatient rehabilitation unit located in the suburbs of a large city (so more community hospital type but with the support of the large academic group). I'm also a recent graduate (last few years), and I personally wanted an employed position because of the support I knew I would get, retirement benefits, and didn't want to have to manage or find a billing/coding company, etc. I get 4 weeks PTO for vacation, and 2 weeks for CME. My schedule works out so I work 10-11 days every 2 weeks (so always get 2-3 days off that's not PTO), it's not a typical Monday-Friday as includes weekend coverage.

I am relatively more busy but I like the work of acute inpatient rehab - I see on average 18+ patients at my unit (mostly neuro rehab, ortho, debility) 2-3 days per week, plus do consults on the other 2-3 days of the week. All patients are seen by a hospitalist so I can focus mostly on the rehab side. I have a base salary + RVU bonus structure, and make well over $300k+. This is not including the additional benefits of 100% of 6% salary 401K match (around $20k extra), and $ for the intermittent residents that rotate.

Now in 2023 with the updates to E&M coding, with RVUs we can include time spent reviewing notes, documenting, reviewing images/labs and not just the time of face to face. So this would allow people with RVU bonuses or payment to actually bill for all the time that is spent seeing a patient that day (vs MDM whichever is higher), so I will be billing consults at 99254/99255, and like a previous poster said, most of my follow-up visits are 99232/99233, and admissions are always 99223.

I'm glad they are changing the E&M codes to include all the reviewing of notes, imaging, etc! Lawyers charge for all this stuff but we never could, which I always thought was kind of shady as it takes up a ton of time! What part of the country are you in? It's interesting that they give you $$ for rotating residents. My next job coming up I'll be working with residents for part of the role for I don't think I get extra $$ for that. I like you have 4 weeks + 2for CME, which is nice, my first job out of residency gave me 3! and one for CMEwhich I thought was kinda low. Do you do the 10 days on, 4 days off type schedule? I have seen that model in some practices, but seems unusual - at least to me.

 

[PurpleSmiley]

I'm glad they are changing the E&M codes to include all the reviewing of notes, imaging, etc! Lawyers charge for all this stuff but we never could, which I always thought was kind of shady as it takes up a ton of time! What part of the country are you in? It's interesting that they give you $$ for rotating residents. My next job coming up I'll be working with residents for part of the role for I don't think I get extra $$ for that. I like you have 4 weeks + 2for CME, which is nice, my first job out of residency gave me 3! and one for CMEwhich I thought was kinda low. Do you do the 10 days on, 4 days off type schedule? I have seen that model in some practices, but seems unusual - at least to me.

I think the $ for residents was decided by the residency program to incentivize providers to have residents and to somewhat make up for lost productivity spent teaching. It’s not much $, but it is a nice extra.

My schedule is basically I get most Fridays off the weekend before I’m working (depends sometimes on consult census), and the Wednesdays after the weekend I work. And I work Monday-Friday the other weeks. There’s another part time PM&R who covers the rehab unit when I’m not there and doing consults.

Yes I felt pretty lucky with this job, good benefits and PTO time and a great salary (in my opinion). Also having a good team and good communication make the job much more enjoyable - so don’t just look at the $! And I’m in the Midwest so cost of living is pretty affordable! Especially compared to the East coast where I grew up.

 

[Iamnew2]

I think the $ for residents was decided by the residency program to incentivize providers to have residents and to somewhat make up for lost productivity spent teaching. It’s not much $, but it is a nice extra.

My schedule is basically I get most Fridays off the weekend before I’m working (depends sometimes on consult census), and the Wednesdays after the weekend I work. And I work Monday-Friday the other weeks. There’s another part time PM&R who covers the rehab unit when I’m not there and doing consults.

Yes I felt pretty lucky with this job, good benefits and PTO time and a great salary (in my opinion). Also having a good team and good communication make the job much more enjoyable - so don’t just look at the $! And I’m in the Midwest so cost of living is pretty affordable! Especially compared to the East coast where I grew up.

I'm in the Midwest as well, I haven't worked in the East coast myself but it seems that salaries in the East coast as pretty bad.

 

[sloh]

I'm an employed physician at a large academic hospital with my inpatient rehabilitation unit located in the suburbs of a large city (so more community hospital type but with the support of the large academic group). I'm also a recent graduate (last few years), and I personally wanted an employed position because of the support I knew I would get, retirement benefits, and didn't want to have to manage or find a billing/coding company, etc. I get 4 weeks PTO for vacation, and 2 weeks for CME. My schedule works out so I work 10-11 days every 2 weeks (so always get 2-3 days off that's not PTO), it's not a typical Monday-Friday as includes weekend coverage.

I am relatively more busy but I like the work of acute inpatient rehab - I see on average 18+ patients at my unit (mostly neuro rehab, ortho, debility) 2-3 days per week, plus do consults on the other 2-3 days of the week. All patients are seen by a hospitalist so I can focus mostly on the rehab side. I have a base salary + RVU bonus structure, and make well over $300k+. This is not including the additional benefits of 100% of 6% salary 401K match (around $20k extra), and $ for the intermittent residents that rotate.

Now in 2023 with the updates to E&M coding, with RVUs we can include time spent reviewing notes, documenting, reviewing images/labs and not just the time of face to face. So this would allow people with RVU bonuses or payment to actually bill for all the time that is spent seeing a patient that day (vs MDM whichever is higher), so I will be billing consults at 99254/99255, and like a previous poster said, most of my follow-up visits are 99232/99233, and admissions are always 99223.

Seems like a really sweet gig. Thanks for sharing. I live in LA and these types of gigs are non-existent

 

[TIVAndy]

asking around for a friend considering inpatient rehab position
what would be a reasonable percentage paid to the private group when joining as an independent contractor?
some want to take 20% of billing, some want 30% for few years then 10% etc. not sure what the general consensus is and a fair way to shake hands as an independent contractor.

 

[Dansk2011]

If you're an independent contractor you shouldn't have to join a group. I guess you technically wouldn't be independent then. Collections should be around 6-7%. If they are telling you 20-30% I'd be very weary. What is it you are getting for that money they are taking?

 

[TIVAndy]

If you're an independent contractor you shouldn't have to join a group. I guess you technically wouldn't be independent then. Collections should be around 6-7%. If they are telling you 20-30% I'd be very weary. What is it you are getting for that money they are taking?

i am not sure of the details but seeing around 15-20 pts. take home billing collections minus the cut they are claiming. i guess they have a established patient base/contract with the hospital and my friend will be joining to help out with call pool and workload

 

[DMBandFan86]

I would see what benefits the group is offering for the fee. Some give insurance or retirement matching while others do not.

If it’s just paying 20-30% to be apart of a group then that could be high. Depends on how much you value the group and if being apart of the group helps you be successful and make money.

If you truly want to be independent then start your own business, if you pay for collecting then it can be 6-10% + insurance and other costs.

With the lack of specifics it is hard to say.

 

[Iamnew2]

i am not sure of the details but seeing around 15-20 pts. take home billing collections minus the cut they are claiming. i guess they have a established patient base/contract with the hospital and my friend will be joining to help out with call pool and workload

Is this a hospital system or snf type of set up? Snf is a little harder because depending on the area some places are saturated. If it’s a hospiral you frequently can directly make an agreement w the hospital and be an independent contractor. That means having a billing company and making money based on your collections so likely far more lucrative than having a place take a big chunk of your income.

 

[RangerBob]

This sounds odd. I wouldn't charge a percentage of collections of anyone wanting to help us out with weekend rounding. Unless I actually billed for them (in which case I'd pay them a set fee).

I'd expect any weekend covering doc here to pay their own malpractice, licensing fees/etc, biller fees. Basically they'd cover (and keep) everything.

Usually it's hard to get docs to agree to help with coverage for collections alone. Often the hospital/group needs to provide an additional stipend. So it's odd that the group is actually trying to charge your friend. Even if they're doing the billing for your friend, that's usually only 6-10%, so I'm not sure what the rest of the cut would be for.

Wouldn't be worth it without some benefits/salary guarantee, etc.

 

[Iamnew2]

This sounds odd. I wouldn't charge a percentage of collections of anyone wanting to help us out with weekend rounding. Unless I actually billed for them (in which case I'd pay them a set fee).

I'd expect any weekend covering doc here to pay their own malpractice, licensing fees/etc, biller fees. Basically they'd cover (and keep) everything.

Usually it's hard to get docs to agree to help with coverage for collections alone. Often the hospital/group needs to provide an additional stipend. So it's odd that the group is actually trying to charge your friend. Even if they're doing the billing for your friend, that's usually only 6-10%, so I'm not sure what the rest of the cut would be for.

Wouldn't be worth it without some benefits/salary guarantee, etc.

A lot of the SNF companies work this way - they charge 25-30% of what is collected. They do the billing, sometimes they provide some benefits but frequently not as you are still considered an independent contractor. Essentially they find the sites to work at which otherwise an individual physician might not be able to do.

 

[TIVAndy]

thanks for everyone's input. it is a hospital plus minus SNF. it will be independent contractor so no benefit. i think these groups hold agreement/contracts for coverage with the hospital so they are giving the "work" otherwise not available to others in a saturated city.

 

[RangerBob]

A lot of the SNF companies work this way - they charge 25-30% of what is collected. They do the billing, sometimes they provide some benefits but frequently not as you are still considered an independent contractor. Essentially they find the sites to work at which otherwise an individual physician might not be able to do.

I've heard of SNFs working that way, but not inpatient rehab.

It still sounds like a hustle to me. It's not that hard to talk to the medical directors of SNFs to start coverage at them.

 

[Iamnew2]

I've heard of SNFs working that way, but not inpatient rehab.

It still sounds like a hustle to me. It's not that hard to talk to the medical directors of SNFs to start coverage at them.

I don’t disagree.

 

[Dansk2011]

The justification on their part for 20-30% is for billing, malpractice, and then "compliance". Seems like a lot of lost revenue for things you could essentially do on your own. Not sure exactly what the "compliance" aspect entails...maybe someone else can explain or justify that portion of the take.

 

[Iamnew2]

The justification on their part for 20-30% is for billing, malpractice, and then "compliance". Seems like a lot of lost revenue for things you could essentially do on your own. Not sure exactly what the "compliance" aspect entails...maybe someone else can explain or justify that portion of the take.

Malpractice is not always included although sometimes it is. The compliance essentially is ensuring that you are coding appropriately, billing appropriately, etc. it’s something that most doctors should know how to do. The biggest issue is finding facilities.

 

[RangerBob]

Malpractice is not always included although sometimes it is. The compliance essentially is ensuring that you are coding appropriately, billing appropriately, etc. it’s something that most doctors should know how to do. The biggest issue is finding facilities.

I agree about the compliance stuff—we should know how to do that.

My (acute) rehab unit doesn’t take a cut for compliance for me. I’m fact they pay me a director stipend plus they hire their own compliance department to make sure we’ll pass an audit (more for the admission/rehab unit billing than for individual physician billing—but it’s rare for Medicare/OIG to go after individual docs unless something is really amiss)

In saturated areas maybe that 20-30% fee is just the price you pay for access. But where I live we have literally one SNF that has PM&R coverage.

Does Encompass (or other large SNF groups) refuse to work with individual physicians, and only contract with groups (the ones that then charge 20-30% overhead)?

 

[Iamnew2]

I agree about the compliance stuff—we should know how to do that.

My (acute) rehab unit doesn’t take a cut for compliance for me. I’m fact they pay me a director stipend plus they hire their own compliance department to make sure we’ll pass an audit (more for the admission/rehab unit billing than for individual physician billing—but it’s rare for Medicare/OIG to go after individual docs unless something is really amiss)

In saturated areas maybe that 20-30% fee is just the price you pay for access. But where I live we have literally one SNF that has PM&R coverage.

Does Encompass (or other large SNF groups) refuse to work with individual physicians, and only contract with groups (the ones that then charge 20-30% overhead)?

No the big rehab companies - encompass, kindred, etc work individually with doctors, it's not typical for them to hire doctors through third party places. I think some of the smaller rehab hospitals sometimes have a hard time hiring on their own and they hire one of these groups to hire a doctor and then what we talked about happens. for example in a former group I got hired through a company and I worked a hospital through them - they took like 35% (I didn't know any better then) and then I found out the hospital would hire directly as well. I only worked there for less than 2 mo or so since it's not something that worked well for me given how much they took and how little control I had, but I learned what works and what doesn't work for me. they also didn't do anything for me - no white coat, no id, no office space, no lap top, nothing. mostly the above set up is for snf or other hospitals that have a hard time hiring.

 

[DocUpNorth]

Getting 350k-400k is easy but not if taking off 2 months of the year. You may want to look into independent or partnership type situations. For instance I can technically take off 6 weeks easily a year, but I dont get any PTO, time off for me means no billing. The only limitation to my time off is if one of my partners can cover for me. One of my partners took off 3 weeks last year to go to Israel. Ill be taking off 3 weeks to go to japan. Just to give a few examples. Our IPR only cares that there are doctors to admit and fill the beds and take care of the people here, they dont really care who is doing it.

For those in IPR getting extended periods of time off, how are they interpreting the 20 hours per week covered by the medical director? Are they averaging it? Are there compliance companies that anyone would recommend? I am looking at a place that has not been able to fill a position in years but also they’re really not allowing docs to take that kind of time off which is why they can’t fill it.

 

[Iamnew2]

For those in IPR getting extended periods of time off, how are they interpreting the 20 hours per week covered by the medical director? Are they averaging it? Are there compliance companies that anyone would recommend? I am looking at a place that has not been able to fill a position in years but also they’re really not allowing docs to take that kind of time off which is why they can’t fill it.

Every place will give you some sort of time off - it is expected that if you are the med director you still need time off.
generally a replacement type person would help or if you have a colleague who can help cover you would be ideal.
if a place doesn't allow time off they won't be able to fill positions period.
we all need time off

 

[RangerBob]

Every place will give you some sort of time off - it is expected that if you are the med director you still need time off.
generally a replacement type person would help or if you have a colleague who can help cover you would be ideal.
if a place doesn't allow time off they won't be able to fill positions period.
we all need time off

I've heard of some programs out there with one sole physiatrist manning the unit with minimal/no time off since the hospital can't find anyone

I certainly wouldn't want that job... But apparently they're out there