Scrolling Through Reddit Salaries And...

[Notasmartguy:(]

How TF are people making 300-350k a year working general PM&R?

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[RangerBob]

Very doable for inpatient rehab, at least as an independent contractor. Could make even more with a director stipend.

SNF consults seems to be really lucrative, though not quite my thing.

Interventional pain can make yet even more.

$300-350k is not at all an unreasonable income for PM&R.

On the other hand, I also wouldn't use Reddit as a reliable source of information.

 

[j4pac]

$300k? I’ve seen people throwing around $500-600k+.

 

[Notasmartguy:(]

$300k? I’ve seen people throwing around $500-600k+.

Is this possible for general PM&R?

 

[Notasmartguy:(]

Very doable for inpatient rehab, at least as an independent contractor. Could make even more with a director stipend.

SNF consults seems to be really lucrative, though not quite my thing.

Interventional pain can make yet even more.

$300-350k is not at all an unreasonable income for PM&R.

On the other hand, I also wouldn't use Reddit as a reliable source of information.

how does one do snf consults after residency? do they have to go through recruiters or smth?

 

[DMBandFan86]

50% MGMA for general is like 280k (and that is several years old). So 49% make more than that. 99% is like 800k. So there you go. Sign up for AAPMR and look at the physician compensation report as well.

The more people you see, the more you make. If you work employed you will want to have a good wRVU contract that encourages being busy. If you are independent then you just want to be busy. Stay away from government and many academics.

If you do inpatient, you will have to see about 16- 20 per day or more. Bill level 2-3 for coding. Add a director stipend. And you’ll make 400+ per year after taking out collections, billing and practice costs.

 

[RangerBob]

how does one do snf consults after residency? do they have to go through recruiters or smth?

I don't do SNF consults so I'm not the best person to ask--I just know there are people doing it and they can do very well, and don't have a lot of the stresses that come with inpatient rehab (being primary attending/overnight call).

There are some posts here about how to get involved at SNFs. The main options, if I recall, are to just cold call the medical director and ask if they'd like a consult physiatrist on board. For others you can go through a recruiting agency/SNF staffing company, which tends to take a large cut of your earnings.

 

[sloh]

How TF are people making 300-350k a year working general PM&R?

Haha you can make wayyyy more than that as a 1099.

 

[sloh]

cold call the medical director and ask if they'd like a consult physiatrist on board.

This might have worked a couple years ago. Not anymore. Too competitive and even if you get an in, you will likely be replaced.

 

[PMR2008]

Very unlikely to succeed if just cold calling unless small town and you know the medical director. A few hundred Physiatrists have been able to do it independently but the competition is fierce in desirable locations.

 

[j4pac]

Very unlikely to succeed if just cold calling unless small town and you know the medical director. A few hundred Physiatrists have been able to do it independently but the competition is fierce in desirable locations.

I had quite a bit success emailing hospital recruiters in the areas I was interested (not the national recruiters). I think that I got either 3 or 4 interviews for unlisted positions that way. I would say that it’s a moderately competitive area. There’s probably not much downside aside from lost time.

 

[DrPhysiatry]

I had quite a bit success emailing hospital recruiters in the areas I was interested (not the national recruiters). I think that I got either 3 or 4 interviews for unlisted positions that way. I would say that it’s a moderately competitive area. There’s probably not much downside aside from lost time.

How do you find such recruiters?

 

[j4pac]

How do you find such recruiters?

I knew the local hospitals and group in the areas I wanted to go…and I typed “physician recruiter” along with the hospital/group name in Google.

 

[psychemdoc]

This might have worked a couple years ago. Not anymore. Too competitive and even if you get an in, you will likely be replaced.

How/why would one get replaced? If you’re a consultant and you’re booking the insurance directly then why would the SNFs care about replacing one physiatrist with another?

 

[sloh]

How/why would one get replaced? If you’re a consultant and you’re booking the insurance directly then why would the SNFs care about replacing one physiatrist with another?

Because other companies and physiatrists will make promises (and some of these can’t even be fulfilled) that they will refer patients to their SNF, have “providers” see the patients at a higher frequency, and offer other ancillary services that will reduce hospital readmissions both during the patients’ stay and post-discharge. That’s as much as I can divulge on a public forum. There’s a lot of politics in SNF work and a physiatrist’s presence in the SNF is threatened every time there is turnover in admin, DON, DOR, or change in ownership—which isn’t unusual. If a physiatrist wants to go about this alone….all I have to say is good luck. You truly don’t know what you don’t know and it will be a waste of your time. Physiatrists aren’t all in this together as a specialty singing kumbaya. It’s cut throat and competitive out there when money is on the line.

 

[RangerBob]

\

This might have worked a couple years ago. Not anymore. Too competitive and even if you get an in, you will likely be replaced.

It's how I got my current job (inpatient rehab) and how we got a colleague a job at a nearby SNF. Other than that SNF, no SNF in the area has PM&R coverage, so it wouldn't be hard at all to set up a SNF gig here.

Our region is desperate for physicians in every specialty. We could all in theory be replaced, but that's simply not going to happen since the physicians have the upper hand (particularly since we're independent contractors and can easily move elsewhere on short notice).

I can see if you're in a crowded market it might be difficult. But despite being in a desireable place to live, that's not the case where we are.

 

[sloh]

\

It's how I got my current job (inpatient rehab) and how we got a colleague a job at a nearby SNF. Other than that SNF, no SNF in the area has PM&R coverage, so it wouldn't be hard at all to set up a SNF gig here.

Our region is desperate for physicians in every specialty. We could all in theory be replaced, but that's simply not going to happen since the physicians have the upper hand (particularly since we're independent contractors and can easily move elsewhere on short notice).

I can see if you're in a crowded market it might be difficult. But despite being in a desireable place to live, that's not the case where we are.

Yes agreed location dependent but the secret on SNF work is out and becoming more saturated/competitive. Even tele could encroach on where you are

 

[RangerBob]

Yes agreed location dependent but the secret on SNF work is out and becoming more saturated/competitive. Even tele could encroach on where you are

Perhaps. But tele work is pretty frowned upon everywhere unless it's giving you access to a specialist who you otherwise wouldn't have access to. The tele-neurology consults done at one of our local hospitals are inferior to the in-person neurology consults done at our own and the other local hospitals. As of right now those are the only inpatient or SNF tele services provided anywhere.

Very few inpatient wants to be seen by a tele doc. Our local SNF physiatrist is beloved by patients because they actually get to a see a real doctor face to face more than once a month.

 

[Notasmartguy:(]

Because other companies and physiatrists will make promises (and some of these can’t even be fulfilled) that they will refer patients to their SNF, have “providers” see the patients at a higher frequency, and offer other ancillary services that will reduce hospital readmissions both during the patients’ stay and post-discharge. That’s as much as I can divulge on a public forum. There’s a lot of politics in SNF work and a physiatrist’s presence in the SNF is threatened every time there is turnover in admin, DON, DOR, or change in ownership—which isn’t unusual. If a physiatrist wants to go about this alone….all I have to say is good luck. You truly don’t know what you don’t know and it will be a waste of your time. Physiatrists aren’t all in this together as a specialty singing kumbaya. It’s cut throat and competitive out there when money is on the line.

so how do you get into it then? go through a staffing comapny/recruiter? there are so many out there lol

 

[Iamnew2]

\

It's how I got my current job (inpatient rehab) and how we got a colleague a job at a nearby SNF. Other than that SNF, no SNF in the area has PM&R coverage, so it wouldn't be hard at all to set up a SNF gig here.

Our region is desperate for physicians in every specialty. We could all in theory be replaced, but that's simply not going to happen since the physicians have the upper hand (particularly since we're independent contractors and can easily move elsewhere on short notice).

I can see if you're in a crowded market it might be difficult. But despite being in a desireable place to live, that's not the case where we are.

Agreed. In some of the areas I'm at and have worked at, there are quite a few SNF that have no PM&R coverage and it would be I think very easy to set up shop. I personally don't have any more bandwith to do it, but don't think I'd have that much trouble in some areas.
More competitive areas - I agree it would be challenging.

 

[psychemdoc]

\

It's how I got my current job (inpatient rehab) and how we got a colleague a job at a nearby SNF. Other than that SNF, no SNF in the area has PM&R coverage, so it wouldn't be hard at all to set up a SNF gig here.

Our region is desperate for physicians in every specialty. We could all in theory be replaced, but that's simply not going to happen since the physicians have the upper hand (particularly since we're independent contractors and can easily move elsewhere on short notice).

I can see if you're in a crowded market it might be difficult. But despite being in a desireable place to live, that's not the case where we are.

What region is “desirable” but has a shortage of every specialty? Maybe it’s not actually a desirable region? It must have a reason that it’s not actually as desirable as you think. I’m trying to think of high amenity geographies with high shortages and I can’t think of any aside from some with high crime rates.

 

[redfish1891]

I'm in the middle of trying to start SNF work at the moment. I am working with a company and it has been challenging getting a foot in the door. There is no physiatrist SNF presence in the area but everyone we talk to "has to talk to their boss". Its' a highly corporate structure and everyone has to buy in from the director of nursing, admin, to the regional director, sometimes up to the C suite. I am in a rural area and thought "hey, they will be thrilled to have me" but it hasn't been that easy. I'm thankful to not be trying to navigate this by myself.

 

[sloh]

What region is “desirable” but has a shortage of every specialty? Maybe it’s not actually a desirable region? It must have a reason that it’s not actually as desirable as you think. I’m trying to think of high amenity geographies with high shortages and I can’t think of any aside from some with high crime rates.

Curious what this “desirable” place is as well

 

[j4pac]

Curious what this “desirable” place is as well

I’d argue that there is Chicago, LA, and NY…and everywhere else. Those three locations you can expect to make nickels on the dollar because people are willing to work for free to live there. So you aren’t competing for a reasonable salary in those places…they are already saturated with people happily making poor wages (COL adjusted). But I think that there are opportunities in most other large markets.

 

[RangerBob]

For those asking I’m in Coastal CA. I want to stay somewhat anonymous here, so I’ll just say it’s not SF and not LA. There’s a lot more to CA than just those two metros.

Lots of retirees relocate here. College town. Great food and great weather, with more small town vibes. After growing up in SF Bay Area and living in the Midwest for 8 years, I’d say our region has more “Midwestern” vibes than “SF/ LA” vibes. Maybe a 10 minute drive to the beach, even less for great hiking trails. Issue is it costs $1 million to buy the avg home and unlike LA where the cost is similar (and even more in SF), we don’t have tons of jobs for non healthcare spouses. So spouses often either need to be in healthcare, work remotely, or not be working to make a move here work.

Also, most docs are cheap so the COL keeps many away. We have same issue with RNs, therapists, and lots of others.

We’re similar to Hawaii (outside Honolulu). Great people, great weather and vibes, but still ridiculously expensive. But family is worth it.

 

[sloh]

For those asking I’m in Coastal CA. I want to stay somewhat anonymous here, so I’ll just say it’s not SF and not LA. There’s a lot more to CA than just those two metros.

Lots of retirees relocate here. College town. Great food and great weather, with more small town vibes. After growing up in SF Bay Area and living in the Midwest for 8 years, I’d say our region has more “Midwestern” vibes than “SF/ LA” vibes. Maybe a 10 minute drive to the beach, even less for great hiking trails. Issue is it costs $1 million to buy the avg home and unlike LA where the cost is similar (and even more in SF), we don’t have tons of jobs for non healthcare spouses. So spouses often either need to be in healthcare, work remotely, or not be working to make a move here work.

Also, most docs are cheap so the COL keeps many away. We have same issue with RNs, therapists, and lots of others.

We’re similar to Hawaii (outside Honolulu). Great people, great weather and vibes, but still ridiculously expensive. But family is worth it.

Thanks! I appreciate the answer. Was genuinely curious and it’s good for all of us to know about the job market/opportunities depending on location

I will say I do know physiatrists who have tried breaking into the SNF market in central Cali which is considered way more “rural” and they faced a lot of difficulties

 

[sloh]

I’d argue that there is Chicago, LA, and NY…and everywhere else. Those three locations you can expect to make nickels on the dollar because people are willing to work for free to live there. So you aren’t competing for a reasonable salary in those places…they are already saturated with people happily making poor wages (COL adjusted). But I think that there are opportunities in most other large markets.

I don’t disagree

 

[RangerBob]

Thanks! I appreciate the answer. Was genuinely curious and it’s good for all of us to know about the job market/opportunities depending on location

I will say I do know physiatrists who have tried breaking into the SNF market in central Cali which is considered way more “rural” and they faced a lot of difficulties

Central CA usually refers to Fresno/Bakersfield/Sacramento—none of which are nice places due to the heat and pollution (it’s a big valley, so there’s nowhere for smog and AG dust to go).

We are more rural than them however. We’re just a unique spot.

I can’t say it is easy to get into all SNFs here as I didn’t personally try. But it was easy to get our colleague set up with a hospital-associated SNF and then he got himself into another.

Medical care here is subpar generally compared to everywhere I have lived before, including some old rust-belt towns. So perhaps that is why the SNFs made it quite painless for him to come on board. Or maybe it was just luck.

What we really need here are PCPs. I have so many patients who are admitted to my unit and they don’t have a PCP. Mine just left and it took a few months to get an appointment with a new one.

 

[Iamnew2]

I'm in the middle of trying to start SNF work at the moment. I am working with a company and it has been challenging getting a foot in the door. There is no physiatrist SNF presence in the area but everyone we talk to "has to talk to their boss". Its' a highly corporate structure and everyone has to buy in from the director of nursing, admin, to the regional director, sometimes up to the C suite. I am in a rural area and thought "hey, they will be thrilled to have me" but it hasn't been that easy. I'm thankful to not be trying to navigate this by myself.

I’d argue that there is Chicago, LA, and NY…and everywhere else. Those three locations you can expect to make nickels on the dollar because people are willing to work for free to live there. So you aren’t competing for a reasonable salary in those places…they are already saturated with people happily making poor wages (COL adjusted). But I think that there are opportunities in most other large markets.

Yes and no. In Chicago I’d agree that wages tend to be lower bc lots of people want to be here. But with enough negotiation typically you can do fine. I make a good chunk of change given the above and work for a pretty prominent institution. Yes I had to negotiate my salary and I was offered a wage that I felt was low but they were amenable to increasing to what I felt was reasonable.
Not all areas of Chicago are saturated either. In the burbs you can find options

 

[j4pac]

Yes and no. In Chicago I’d agree that wages tend to be lower bc lots of people want to be here. But with enough negotiation typically you can do fine. I make a good chunk of change given the above and work for a pretty prominent institution. Yes I had to negotiate my salary and I was offered a wage that I felt was low but they were amenable to increasing to what I felt was reasonable.
Not all areas of Chicago are saturated either. In the burbs you can find options

Agreed about the suburbs of Chicagoland. I have a friend that received a decent contract as an independent contractor…but it’s still not close to some of the silly contracts being offered outside of the big cities.

 

[Iamnew2]

Agreed about the suburbs of Chicagoland. I have a friend that received a decent contract as an independent contractor…but it’s still not close to some of the silly contracts being offered outside of the big cities.

That I would agree with - I made shy of 7 figures when I worked about 2.5 hours away from Chicago -I doubt I’d find that deal again even in the burbs. But quality of life also matters particularly if you have a spouse and stuff

 

[DrPhysiatry]

I'm in the middle of trying to start SNF work at the moment. I am working with a company and it has been challenging getting a foot in the door. There is no physiatrist SNF presence in the area but everyone we talk to "has to talk to their boss". Its' a highly corporate structure and everyone has to buy in from the director of nursing, admin, to the regional director, sometimes up to the C suite. I am in a rural area and thought "hey, they will be thrilled to have me" but it hasn't been that easy. I'm thankful to not be trying to navigate this by myself.

What company are you using? What are some ways of overcoming these difficulties? I was thinking of SNF work once I graduate.

 

[psychemdoc]

That I would agree with - I made shy of 7 figures when I worked about 2.5 hours away from Chicago -I doubt I’d find that deal again even in the burbs. But quality of life also matters particularly if you have a spouse and stuff

Shy of 7 figures? Man, find a LCOL and low tax state and do that for a few years to start your career is a great way to pay off the debt and catch up on your earning years.

Mind if I ask what kind of work was this exactly and how many hours were you working?

 

[Momentum70]

How TF are people making 300-350k a year working general PM&R?

I made much more than that but just quit that job, I had average daily census 25 and if you include averaging 2-3 admits and discharges a day my daily billing average was 2 F3, 20 F2, 3 F1, 2-3 A3 and 2-3 D2. Generates a lot of RVU. On top of that I would sometimes do consults over in acute care. Good thing about that is I write my consult like an H&P so if I end up admitting them my note is pretty much done.

Downside to that is you dont see your family often and after they wanted to increase my load even more I quit.

 

[PMR2008]

Location, job you love or money. Pick 2. Location and money is subjective. 300k goes a long way in many parts of the county. Most docs still want to live in areas where they can enjoy their money and send kids to good schools which tends to be around the top 25 big cities.
Also it is obvious but has to be said. After a certain amount, making more money usually has a diminishing rate of return.

 

[lejeunesage]

In my best 2 years, I made north of $450K from a combination of collections from billings and medical director stipend.
This figure does not account for a number of things you have to spend money on as an independent contractor:
1. Malpractice. Depending on your number of years out of training. This might be anywhere from $1-10K, assuming you've never been sued.
2. Billing. Most of us contract with a billing company that takes a 5-10% cut out from our collections. If you're collecting, say, $350K one year, you might pay $17-35K to a billing company.
3. Health + Dental Insurance. If you're single and young-ish, you might be in the $500-700 range per month. That annualizes to about $7.2K/year
4. Disability insurance. This is important if you're not yet at the point where you can self-insure. It might easily run you another $300-400/month.
5. There is also the fact that no one will be for your CME. And every time you take time off, you stop generating money. Overall, this depresses your incentive for vacation and/or conferences.
6. No one but you will fund your retirement account. There is no match.

When you put together all the benefits of employment, depending on how fare into your career you are, employment benefits can easily reach $50K/year. So, you need to factor that in when you compare self-employment income to employment income.

Still, you can make pretty good money as an independent contractor.

Now, as to your question about how to work in SNF, in practice, most people work for a company that's already done the legwork: Medrina and US Physiatry are two prominent ones. These companies are good at marketing themselves and/or you to prospective SNFs. And they can find your work wherever you want to live. Want to move to Fort Collins, CO in a couple of months? They've got you covered. Want to ditch your current hospital and find SNFs wherever you already live? They've also got you covered. In exchange, though, they take a pretty steep fee: 30% of your collections. That's a lot of money to leave on the table. That's the difference between seeing 30 patients a day or 21 patients a day for the same amount of money. If you're the kind of person who can easily do 40+ visits in a day, you'll do really well. If you're not at the upper end of the speed spectrum, you'll either have super long days or have to do with a lot less money than you could make doing inpatient rehab. So far, every time I've considered it, I've decided that permanently parting from 30% of my collections was more than I was willing to pay as the price of admission. I might be willing to pay a one-time finder's fee but not 30% month after month, year after year.

Other people have mentioned cold-calling places. It's not as easy as you might think. I've contacted over 20 facilities in the past 2 years and I've only gotten a positive response once. As Dr. McCoy might have once said, I'm a doctor, not a marketing specialist.



There's a reason the people who specialize is marketing are able to get market shares. They get paid for a reason. Still, you have to ask yourself whether you're willing to pay their price.

The good news is that there are lots of ways to make good money. SNF isn't the only game in town.
1. Stay out of academia.
2. You need volume. Whatever you do, you'll make more money if you see more patients. If you're only seeing 5-7 inpatients in the morning and a similar volume in outpatient, you won't get rich any time soon. The difference between 12 patients per day and 18 patients per day is 50% more collections. You also make more money the more days your work. In practice, it's not hard to see about 80 visits per week. But you'll make more if you can increase that to 100+ visits per week.
3. Stay out of academia.
4. You can leverage yourself by hiring people and making a cut off what they make. At one end of the spectrum it's hiring a PA/NP and seeing 30 patients per day rather than 15. At the other end it's having what's essentially a staffing company. A locum company charges $3K/day and pays the physician about half that. Companies in the SNF world have many physicians around the country and take 30% off their collections. Different versions of the same idea, whether you're dealing with physicians or mid-levels.
5. Stay out of academia.
6. Medical-legal, consulting, etc. You can work with lawyers and get $500+/hr as a Certified Life Care Planner. You can do IMEs. You can give expert testimony etc. The problem is that you'll more than likely have to keep a day job. Few people can make more than $100K/year in extra money doing that stuff. And it's pretty time-consuming.
7. Stay the hell away from academia, in case I haven't already mentioned that.

 

[wendalltwolf]

7. Stay the hell away from academia, in case I haven't already mentioned that.

Excellent write-up. To expand on Academics, you’ll most likely be held to AAMC data for compensation and told MGMA (which is usually much higher) just doesn’t apply to you as an academician.

Also there’s tons of unpaid work with lectures, committees, etc. Not to mention Academia-level politics where even chairs can act like children. There’s also pressure to serve the community (likely Medicaid populations paying pennies on the dollar) rather than asking about your real worth. Another issue was not being able to weed out support staff who might be slowing you down in clinic.

Still, I truly miss the teaching…

 

[DMBandFan86]

I’ve seen people in academics make great money. Plus factor in a full pension, insurance, days off, holidays and paid conference days off. I remember where I trained there was an interventionist making >800k per year. Most attendings could have seen double or triple the amounts of patients since they didn’t write any notes, didn’t place any orders, and didn’t really talk to the patients. But they liked only working a few hours per day. Plus getting paid practically your full salary every month after retirement is a pretty good thing.

Again making money comes down to how many people you see. Your wRVU rate will be lower in academics but doesn’t mean you can’t produce and make decent money. The problem is most academics think 6-8 patients per day is a full load and they are wiped from it.

Now some places are the opposite, but doesn’t mean all bad.

 

[j4pac]

I’ve seen people in academics make great money. Plus factor in a full pension, insurance, days off, holidays and paid conference days off. I remember where I trained there was an interventionist making >800k per year. Most attendings could have seen double or triple the amounts of patients since they didn’t write any notes, didn’t place any orders, and didn’t really talk to the patients. But they liked only working a few hours per day. Plus getting paid practically your full salary every month after retirement is a pretty good thing.

Again making money comes down to how many people you see. Your wRVU rate will be lower in academics but doesn’t mean you can’t produce and make decent money. The problem is most academics think 6-8 patients per day is a full load and they are wiped from it.

Now some places are the opposite, but doesn’t mean all bad.

70th percentile when we hit year 6. I’m not rolling up in a Ferrari like you ballers, but the compensation is fair for the work. We also get a pension…which is honestly better than military retirement.

 

[PMR2008]

Go to the pain board for Physiatist who drive Ferraris lol. We are all probably BMW/Mercedes or Tesla at best lol

 

[Iamnew2]

In my best 2 years, I made north of $450K from a combination of collections from billings and medical director stipend.
This figure does not account for a number of things you have to spend money on as an independent contractor:
1. Malpractice. Depending on your number of years out of training. This might be anywhere from $1-10K, assuming you've never been sued.
2. Billing. Most of us contract with a billing company that takes a 5-10% cut out from our collections. If you're collecting, say, $350K one year, you might pay $17-35K to a billing company.
3. Health + Dental Insurance. If you're single and young-ish, you might be in the $500-700 range per month. That annualizes to about $7.2K/year
4. Disability insurance. This is important if you're not yet at the point where you can self-insure. It might easily run you another $300-400/month.
5. There is also the fact that no one will be for your CME. And every time you take time off, you stop generating money. Overall, this depresses your incentive for vacation and/or conferences.
6. No one but you will fund your retirement account. There is no match.

When you put together all the benefits of employment, depending on how fare into your career you are, employment benefits can easily reach $50K/year. So, you need to factor that in when you compare self-employment income to employment income.

Still, you can make pretty good money as an independent contractor.

Now, as to your question about how to work in SNF, in practice, most people work for a company that's already done the legwork: Medrina and US Physiatry are two prominent ones. These companies are good at marketing themselves and/or you to prospective SNFs. And they can find your work wherever you want to live. Want to move to Fort Collins, CO in a couple of months? They've got you covered. Want to ditch your current hospital and find SNFs wherever you already live? They've also got you covered. In exchange, though, they take a pretty steep fee: 30% of your collections. That's a lot of money to leave on the table. That's the difference between seeing 30 patients a day or 21 patients a day for the same amount of money. If you're the kind of person who can easily do 40+ visits in a day, you'll do really well. If you're not at the upper end of the speed spectrum, you'll either have super long days or have to do with a lot less money than you could make doing inpatient rehab. So far, every time I've considered it, I've decided that permanently parting from 30% of my collections was more than I was willing to pay as the price of admission. I might be willing to pay a one-time finder's fee but not 30% month after month, year after year.

Other people have mentioned cold-calling places. It's not as easy as you might think. I've contacted over 20 facilities in the past 2 years and I've only gotten a positive response once. As Dr. McCoy might have once said, I'm a doctor, not a marketing specialist.



There's a reason the people who specialize is marketing are able to get market shares. They get paid for a reason. Still, you have to ask yourself whether you're willing to pay their price.

The good news is that there are lots of ways to make good money. SNF isn't the only game in town.
1. Stay out of academia.
2. You need volume. Whatever you do, you'll make more money if you see more patients. If you're only seeing 5-7 inpatients in the morning and a similar volume in outpatient, you won't get rich any time soon. The difference between 12 patients per day and 18 patients per day is 50% more collections. You also make more money the more days your work. In practice, it's not hard to see about 80 visits per week. But you'll make more if you can increase that to 100+ visits per week.
3. Stay out of academia.
4. You can leverage yourself by hiring people and making a cut off what they make. At one end of the spectrum it's hiring a PA/NP and seeing 30 patients per day rather than 15. At the other end it's having what's essentially a staffing company. A locum company charges $3K/day and pays the physician about half that. Companies in the SNF world have many physicians around the country and take 30% off their collections. Different versions of the same idea, whether you're dealing with physicians or mid-levels.
5. Stay out of academia.
6. Medical-legal, consulting, etc. You can work with lawyers and get $500+/hr as a Certified Life Care Planner. You can do IMEs. You can give expert testimony etc. The problem is that you'll more than likely have to keep a day job. Few people can make more than $100K/year in extra money doing that stuff. And it's pretty time-consuming.
7. Stay the hell away from academia, in case I haven't already mentioned that.

Wait I have a question.
What are your thoughts about going into academia? lol jk sorry I couldn’t help myself!
I will mention sometimes at some places where you are med director even if independent contractor the hospital may cover your malpractice - that was the case for me at all places I was an independent contractor.
The solo 401k that one can set up as an IC can be profitable though

 

[j4pac]

@PMR2008 arriving to his yearly SNF convention in Aspen

 

[j4pac]

@j4pac on the way to AAPMR in Baltimore

 

[lejeunesage]

Wait I have a question.
What are your thoughts about going into academia? lol jk sorry I couldn’t help myself!
I will mention sometimes at some places where you are med director even if independent contractor the hospital may cover your malpractice - that was the case for me at all places I was an independent contractor.
The solo 401k that one can set up as an IC can be profitable though

You know, I'm kind of undecided on academia. I'm slightly leaning towards staying the hell away, though!
Honestly, I'd consider a community hospital with a teaching program. That might actually be the best of both worlds.

 

[PMR2008]

So many good points there
I agree about malpractice rates but can be higher based on state. Billing 4-10% is about right. But can be add on fees like credentialing, audits, training, software etc. I have health, disability and life insurance independently and those numbers are about the same. About $1400/month for all and the best plans.
Adding vacation + CME is the way to go Travel Medical Seminars CME Credits while you travel - Travel Medical Seminars with write offs. Or online.
The main issue with being employed is the flexibility. We have employees. Trust me they don't have a lot of say in where they practice and how much.
Contract companies definitely take a cut, they are a business after all but it is what you get in return. You can have a big piece of small pie or a small piece of a big pie. But for docs who are super efficient, can market themself, have hospital relations and work in an area that is not super saturated SNF can be done independently. These companies also help with MIPS so you don't get a 9% reduction in payment.

Example - you see 25 patients =25 x ($85 x 0.90) = $1912. 5 days a week and 49 weeks/year = $468,440. Now if you don't do MIPS remove 9% from that. $426,280.4. Does not include any staff you might need to hire to keep things organized.

With contract company you see 35/day because you have more volume available and safety (EMR, MIPS training, back off support, better negotiated insurance rates, ideas to improve efficiency) = 35 x ($90 x 0.70) = $2,205/day. 5 days a week and 49 weeks/year = $540,225. Plus add in 3% for MIPS bonus $556,431. Most of us see 35 patients in 4-6 hrs. Add in a APP and that is an extra 50-75k. and you are making money even when on vacation.

If you did 25/day with a contract company your total take home would be $397,451 including MIPS bonus. So IMO for $25k you get a lot for having all the resources, business development, compliance etc. but YMMV.

*$85 average between follow up and new for non negotiated rates
*$90 average between follow up and new for negotiated rates

Agree with your points
1) Volume and efficiency is the name of the game. Knowing your hourly value and out sourcing the rest.
2) Medlegal is very very lucrative but most don't know how to start and maintain. 100k/year is easy. That's about 2-4hrs per week. But you need a steady stream of cases, IME, life care plans, personal injury cases etc. Most cases lead to depos. Very few end up going to trials and that is where the real money is at.
3) More power to those who do academia. It is obviously much needed.
But please do not get career advice from someone who is in academia.

In my best 2 years, I made north of $450K from a combination of collections from billings and medical director stipend.
This figure does not account for a number of things you have to spend money on as an independent contractor:
1. Malpractice. Depending on your number of years out of training. This might be anywhere from $1-10K, assuming you've never been sued.
2. Billing. Most of us contract with a billing company that takes a 5-10% cut out from our collections. If you're collecting, say, $350K one year, you might pay $17-35K to a billing company.
3. Health + Dental Insurance. If you're single and young-ish, you might be in the $500-700 range per month. That annualizes to about $7.2K/year
4. Disability insurance. This is important if you're not yet at the point where you can self-insure. It might easily run you another $300-400/month.
5. There is also the fact that no one will be for your CME. And every time you take time off, you stop generating money. Overall, this depresses your incentive for vacation and/or conferences.
6. No one but you will fund your retirement account. There is no match.

When you put together all the benefits of employment, depending on how fare into your career you are, employment benefits can easily reach $50K/year. So, you need to factor that in when you compare self-employment income to employment income.

Still, you can make pretty good money as an independent contractor.

Now, as to your question about how to work in SNF, in practice, most people work for a company that's already done the legwork: Medrina and US Physiatry are two prominent ones. These companies are good at marketing themselves and/or you to prospective SNFs. And they can find your work wherever you want to live. Want to move to Fort Collins, CO in a couple of months? They've got you covered. Want to ditch your current hospital and find SNFs wherever you already live? They've also got you covered. In exchange, though, they take a pretty steep fee: 30% of your collections. That's a lot of money to leave on the table. That's the difference between seeing 30 patients a day or 21 patients a day for the same amount of money. If you're the kind of person who can easily do 40+ visits in a day, you'll do really well. If you're not at the upper end of the speed spectrum, you'll either have super long days or have to do with a lot less money than you could make doing inpatient rehab. So far, every time I've considered it, I've decided that permanently parting from 30% of my collections was more than I was willing to pay as the price of admission. I might be willing to pay a one-time finder's fee but not 30% month after month, year after year.

Other people have mentioned cold-calling places. It's not as easy as you might think. I've contacted over 20 facilities in the past 2 years and I've only gotten a positive response once. As Dr. McCoy might have once said, I'm a doctor, not a marketing specialist.



There's a reason the people who specialize is marketing are able to get market shares. They get paid for a reason. Still, you have to ask yourself whether you're willing to pay their price.

The good news is that there are lots of ways to make good money. SNF isn't the only game in town.
1. Stay out of academia.
2. You need volume. Whatever you do, you'll make more money if you see more patients. If you're only seeing 5-7 inpatients in the morning and a similar volume in outpatient, you won't get rich any time soon. The difference between 12 patients per day and 18 patients per day is 50% more collections. You also make more money the more days your work. In practice, it's not hard to see about 80 visits per week. But you'll make more if you can increase that to 100+ visits per week.
3. Stay out of academia.
4. You can leverage yourself by hiring people and making a cut off what they make. At one end of the spectrum it's hiring a PA/NP and seeing 30 patients per day rather than 15. At the other end it's having what's essentially a staffing company. A locum company charges $3K/day and pays the physician about half that. Companies in the SNF world have many physicians around the country and take 30% off their collections. Different versions of the same idea, whether you're dealing with physicians or mid-levels.
5. Stay out of academia.
6. Medical-legal, consulting, etc. You can work with lawyers and get $500+/hr as a Certified Life Care Planner. You can do IMEs. You can give expert testimony etc. The problem is that you'll more than likely have to keep a day job. Few people can make more than $100K/year in extra money doing that stuff. And it's pretty time-consuming.
7. Stay the hell away from academia, in case I haven't already mentioned that.

 

[Iamnew2]

So many good points there
I agree about malpractice rates but can be higher based on state. Billing 4-10% is about right. But can be add on fees like credentialing, audits, training, software etc. I have health, disability and life insurance independently and those numbers are about the same. About $1400/month for all and the best plans.
Adding vacation + CME is the way to go Travel Medical Seminars CME Credits while you travel - Travel Medical Seminars with write offs. Or online.
The main issue with being employed is the flexibility. We have employees. Trust me they don't have a lot of say in where they practice and how much.
Contract companies definitely take a cut, they are a business after all but it is what you get in return. You can have a big piece of small pie or a small piece of a big pie. But for docs who are super efficient, can market themself, have hospital relations and work in an area that is not super saturated SNF can be done independently. These companies also help with MIPS so you don't get a 9% reduction in payment.

Example - you see 25 patients =25 x ($85 x 0.90) = $1912. 5 days a week and 49 weeks/year = $468,440. Now if you don't do MIPS remove 9% from that. $426,280.4. Does not include any staff you might need to hire to keep things organized.

With contract company you see 35/day because you have more volume available and safety (EMR, MIPS training, back off support, better negotiated insurance rates, ideas to improve efficiency) = 35 x ($90 x 0.70) = $2,205/day. 5 days a week and 49 weeks/year = $540,225. Plus add in 3% for MIPS bonus $556,431. Most of us see 35 patients in 4-6 hrs. Add in a APP and that is an extra 50-75k. and you are making money even when on vacation.

If you did 25/day with a contract company your total take home would be $397,451 including MIPS bonus. So IMO for $25k you get a lot for having all the resources, business development, compliance etc. but YMMV.

*$85 average between follow up and new for non negotiated rates
*$90 average between follow up and new for negotiated rates

Agree with your points
1) Volume and efficiency is the name of the game. Knowing your hourly value and out sourcing the rest.
2) Medlegal is very very lucrative but most don't know how to start and maintain. 100k/year is easy. That's about 2-4hrs per week. But you need a steady stream of cases, IME, life care plans, personal injury cases etc. Most cases lead to depos. Very few end up going to trials and that is where the real money is at.
3) More power to those who do academia. It is obviously much needed.
But please do not get career advice from someone who is in academia.

I started doing life care planning recently, definitely different than clinical work, and it's a little weird working with lawyers.

So many good points there
I agree about malpractice rates but can be higher based on state. Billing 4-10% is about right. But can be add on fees like credentialing, audits, training, software etc. I have health, disability and life insurance independently and those numbers are about the same. About $1400/month for all and the best plans.
Adding vacation + CME is the way to go Travel Medical Seminars CME Credits while you travel - Travel Medical Seminars with write offs. Or online.
The main issue with being employed is the flexibility. We have employees. Trust me they don't have a lot of say in where they practice and how much.
Contract companies definitely take a cut, they are a business after all but it is what you get in return. You can have a big piece of small pie or a small piece of a big pie. But for docs who are super efficient, can market themself, have hospital relations and work in an area that is not super saturated SNF can be done independently. These companies also help with MIPS so you don't get a 9% reduction in payment.

Example - you see 25 patients =25 x ($85 x 0.90) = $1912. 5 days a week and 49 weeks/year = $468,440. Now if you don't do MIPS remove 9% from that. $426,280.4. Does not include any staff you might need to hire to keep things organized.

With contract company you see 35/day because you have more volume available and safety (EMR, MIPS training, back off support, better negotiated insurance rates, ideas to improve efficiency) = 35 x ($90 x 0.70) = $2,205/day. 5 days a week and 49 weeks/year = $540,225. Plus add in 3% for MIPS bonus $556,431. Most of us see 35 patients in 4-6 hrs. Add in a APP and that is an extra 50-75k. and you are making money even when on vacation.

If you did 25/day with a contract company your total take home would be $397,451 including MIPS bonus. So IMO for $25k you get a lot for having all the resources, business development, compliance etc. but YMMV.

*$85 average between follow up and new for non negotiated rates
*$90 average between follow up and new for negotiated rates

Agree with your points
1) Volume and efficiency is the name of the game. Knowing your hourly value and out sourcing the rest.
2) Medlegal is very very lucrative but most don't know how to start and maintain. 100k/year is easy. That's about 2-4hrs per week. But you need a steady stream of cases, IME, life care plans, personal injury cases etc. Most cases lead to depos. Very few end up going to trials and that is where the real money is at.
3) More power to those who do academia. It is obviously much needed.
But please do not get career advice from someone who is in academia

 

[lejeunesage]

"But please do not get career advice from someone who is in academia."

You can say that again.
Also, in case I forgot to mention it, if making money is a priority, you might want to think about considering staying away from academia.

 

[DMBandFan86]

Y’all had some bad mentors or are a bit salty. I think the best advice would be to find a good mentor wherever they work to get good career advice. If it’s just “do what I do” then that’s not good advice.

As 2 of us have pointed out you can make good money in academics. Just like in employment, it helps if you work for a good institution. But no one is making 99%. You also can work up the ladder for admin work that pays very well. But again the majority of academics like their lifestyle and don’t want to make more money.

 

[DMBandFan86]

As another perspective, Since I’ve been out of residency I’ve seen more people fail at SNF or get out for other reasons than anything else. Most of them just disliked it or didn’t like the overhead costs. Others were not as busy as promised or didn’t like the mostly lower quality of care they had to deal with at random SNFs. There is also the skills atrophy and I think some didn’t want to loose their procedure skills. There is a lack of true job security as well. I remember the private practice academic doc who told residents it was stupid to join a company that took such high collections off the top. Then some fairly quickly got out of it.

I know there are some very successful SNF people on here, but especially out of residency it’s not a guaranteed easy start or success. And you may not like it. I tried setting up some SNF consults a few years ago and it just didn’t work out. Doesn’t mean I won’t try again in the future, but definitely not as easy as just cold calling unless you get lucky.

 

[PMR2008]

Good to hear your prospective but I disagree with most point. Are you in academia?