=)
I suppose "super high volumes" is relative.
In IPR, you make north of 300K seeing only 15 patients a day. And that's without a directorship stipend. If you're looking to have IM do the admissions and PM&R as consultant, there are plenty of Encompass facilities where that's the set up. It might be more time-intensive because you have to do team conferences but that's a trade-off many people would be comfortable with.
Personally, if I were seeing 22-25 patients a day, I'd hire my own scribe and still expect to earn north of $500K. But, then again, IPR is what I grew up with, so to speak.
Assuming 22-25 patients a day with an average of 3 discharges and 3 admissions a day (fairly conservative), I'd expect to bill:
Admissions: 99223 ($200) X 3 = $600
Discharges: 99239 ($100) X 3 = $300
Progress notes: 99232 ($70) X 19) = $1330
[YMMV. I'm using Medicare rates for the above calculations. If you live in an area with generous commercial insurance plans, you'd make more. If you live somewhere with a ton of Medicaid, you might make a lot less.]
That comes to $2230/day and $11,150/week in billings, and that's if you never bill a level 3 progress note.
Assuming a 15% loss to unpaid bills and billing company cut, you still get something like $9477.5/week.
You can take 6 weeks off and still expect to take home $435,965 before any directorship stipend.
Depending on whether you work for Encompass, HCA, Vibra, or Lifepoint, you can expect to add another $80-150K/year to that as medical director.
On the other hand, if you take a good employment contract with a hospital medical group and you see that kind of volume, your directorship stipend will be much lower ($30-60K) but you'd essentially get a 100% collections rate (in the scenario above, you'd take home $512,900 before any stipends) + benefits + [sometimes] call pay.
I still think there are some advantages to SNF and many people would thrive a lot more with SNF work. The highest grossing SNF physiatrist I know makes way way WAY more than the highest grossing IPR doc I know. But your average physiatrist seeing an average number of patients is likely to do a lot better financially in IPR. Personally, like I said, I know my limits. 25-30 patients is the absolute maximum I could every see myself seeing in any setting. And at that level, I'm sweating, even with a scribe. And I feel like my chances of making a bad mistake increase exponentially.
I'm not the slowest doc I know but I was never anywhere near some of the speed demons I've encountered in my years of training. There was a guy in 3rd year of Med school who was already faster, more organized, and efficient than most attendings I knew in residency. My guess is that today, his billings are somewhere in the stratosphere, wherever he works.