Honestly it is fairly feasible to start subacute consultants right out of residency. But it depends on where you are practicing. If you are in a desirable location like NYC, Chicago, Miami, Dallas, LA etc cold calling might not work. Most well run facilities have a relationship with local or national PM&R groups( IRC, ARC, US Physiatry etc). I practice in the midwest and I am the physiatry consultant at 2 very large subacute facilities. They are practically run like inpatient units. One is actually owned by the hospital. We have specialized units, therapy 6 days a week, NP/PA on staff, very involved PCPs, large therapy gyms with equipment seen in inpatient rehab units, EMR etc. The only reason I am working at these facilities is because they are more interested in talking to larger national groups that already have a reputation. If I ran the local inpatient rehab unit I would have no trouble getting my foot in the door at these facilities since I could bring them business. I am adding a lot of value at these facilities. I just received an email from the director of one of the facility and in 6 months I was able to increase there therapy outcomes, reduce re hospitalization rates and helped them move from a 2 star to 3 star rating by addressing untreated pain.
The work is not glamorous but it is very satisfying. I have an outpatient clinic where I get to work on my msk/needle skill set.
If you are in a small town all you need to do is cold call, show up at the facility, sell yourself, hire a billing/credentialing company, purchase malpractice insurance, learn billing, maybe hire someone to do part time admin work, figure out medicare regulations, meet and educate the primary care physicians, start seeing patients and wait 3 months from the day you start to get paid.
For the past 2 1/2 years I have worked as an independent contractor for the largest group of subacute physiatrist in the US. The 'cut' is basically your overhead. The overhead covers full time admin support (answering calls, faxes, credentialing etc), all the billing, billing software on my smartphone, mentorship from one of the many physicians,education etc. Depending on your level of experience the 'cut' can vary. It is also negotiable. Somewhere between 20-35 sounds about right be it depends on if you work part time or full time. I personally don't mind the 'cut' even after 2 1/2 years since the group has been very supportive and has even hired me a PA. The percentage is negotiable every year as is the rest of the contract.
There is no strict expectation on how many patients need to be seen. 15 is probably a minimum. Most people can easily see 20+. Since you are an independent contractor you cover your own malpractice/Dental/Health/Retirement. Being part of a big group means a big discount because of group buy.
I work from 9am to 4pm 3 or 4 days a week. The other days I have clinic with can be from 9am to 7pm.
It is very hard to predict ball park figures. It will depend on how efficient you are. If you see 10 patients a day you will probably not do well. Having a PA will add additional income. You will definitely make more if you work in a small town inpatient rehab unit or do injections all day. But you will probably have to take call or have to deal with chronic pain.
PM me if you have any more questions.
