Understanding Physician Salaries in PM&R: A Comprehensive Guide

Physician salary by specialty in Physical Medicine & Rehabilitation (PM&R) is more complex than a single number on a survey. Within physiatry, compensation can vary widely depending on subspecialty focus, practice setting, geographic region, and how much of your work is inpatient vs. outpatient or procedural vs. non‑procedural.

For residency applicants and early trainees, understanding these patterns is critical. The physiatry match is increasingly competitive, and your future compensation potential may influence how you rank programs, choose electives, or plan fellowship training.

This guide will walk through how PM&R fits into the broader landscape of doctor salary by specialty, then zoom in on the major “salary sub-specialties” within PM&R and the real-world levers that change your earning trajectory.

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1. Where PM&R Fits in the Physician Salary Landscape

1.1 PM&R Compared with Other Specialties

In most national compensation surveys, Physical Medicine & Rehabilitation is a mid-range specialty in terms of total physician salary—not among the highest paid specialties, but often above many cognitive, non-procedural fields.

Approximate relative ranking (order may vary slightly by survey and year):

• Highest paid specialties (often top tier)
  • Orthopedic surgery
  • Plastic surgery
  • Cardiology (especially interventional)
  • Dermatology
  • Gastroenterology
  • Radiology
  • Anesthesiology
• Upper mid-range specialties
  • Emergency medicine
  • Critical care
  • General surgery
  • Hospitalist medicine (in some markets)
• Middle tier specialties
  • Physical Medicine & Rehabilitation (PM&R)
  • Neurology
  • Rheumatology
  • Psychiatry (increasingly competitive)
  • Endocrinology (varies)
• Lower mid-range to lower tier specialties
  • Pediatrics
  • Family medicine
  • General internal medicine
  • Geriatrics

PM&R often sits near neurology and rheumatology in average compensation, but the range within PM&R itself is wide. A procedure-heavy interventional spine physiatrist in private practice can earn dramatically more than an academic general physiatrist with predominantly clinic and teaching duties.

1.2 Why Averages Don’t Tell the Whole Story

Typical surveys will quote a single number for “PM&R physician salary,” but that hides substantial variation. Differences are driven by:

• Subspecialty focus (e.g., spinal cord injury vs. pain vs. sports)
• Inpatient vs. outpatient practice
• Academic vs. private practice vs. hospital-employed
• Urban vs. rural market
• Volume of procedures
• Call responsibilities and nocturnist coverage (e.g., rehab consult service vs. no call)
• Productivity incentives (RVU-based bonuses, profit sharing, partnership track)

As a residency applicant, think of PM&R less as one career and more as a set of career archetypes with different salary bands, hours, and lifestyles.

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2. Major Practice Archetypes in PM&R and Their Compensation Patterns

Within PM&R, “specialty” is less about board certification and more about your clinical niche and practice model. Below are the most common PM&R “subspecialty-like” practice types and how they typically affect doctor salary by specialty within physiatry.

2.1 Inpatient Rehabilitation Physiatry

Typical roles:

• Medical director or staff physician at an acute inpatient rehab facility (IRF)
• Hospital-employed physiatrist managing stroke, spinal cord injury, TBI, and complex medical rehab patients
• SNF (skilled nursing facility) or LTACH (long-term acute care hospital) consult work

Compensation profile:

• Commonly base salary plus productivity (per census or RVUs)
• Additional medical director stipend if you take on leadership
• Can be among the higher-earning “classical” PM&R paths, especially with high census and efficient rounding models

Key income drivers:

• Patient census and coverage model
  Higher daily census (e.g., 18–25 patients) can significantly increase earnings, especially with census-based pay.
• Medical director roles
  Stipends can meaningfully boost income for oversight of program development, quality metrics, and staffing.
• Weekend coverage and call
  Additional pay for weekends or cross-coverage can add up quickly.
• Facility ownership or shared savings
  In some private models, Rehab physicians may receive additional compensation tied to facility productivity.

Lifestyle trade-offs:

• More predictable daytime schedule, but night/weekend call can be nontrivial, especially in smaller groups.
• High cognitive and coordination demands (multidisciplinary team, complex medical comorbidities).
• Good fit if you like longitudinal functional outcomes and leading a team (PT/OT/SLP, nursing, case management).

2.2 Outpatient Musculoskeletal and General Physiatry

Typical roles:

• Multi-disciplinary rehab clinic
• Hospital-based musculoskeletal clinic
• Integrated spine and pain service with non-interventional focus

Compensation profile:

• Usually moderate within PM&R—often similar or slightly lower than inpatient-focused roles if primarily non-procedural
• Mix of salary, productivity bonus (RVUs), and sometimes group-level profit-sharing in private practice

Key income drivers:

• Clinic volume (new vs. follow-up visits)
• Mix of patients (MSK, chronic pain, sports injuries, general rehab follow-up)
• Limited vs. broad scope of procedures
  Physiatrists who integrate injections, ultrasound-guided interventions, and EMG/NCS often see higher compensation than those with a purely consultative practice.

Lifestyle trade-offs:

• Typically regular office hours, limited call (often phone-call only).
• Highly flexible—good for physicians prioritizing work–life balance or part-time options.
• Income can be modest if practice is largely consultative and low-volume.

2.3 Interventional Spine & Pain Physiatry

Typical roles:

• Pain clinic with fluoroscopy suite and/or procedure room
• Spine and interventional pain center (often multi-specialty: PM&R, anesthesiology, neurosurgery, orthopedics)
• Hospital- or ASC-based (ambulatory surgery center) procedures

Compensation profile:

• Often at the upper end of PM&R earnings; in some markets comparable to middle-tier surgical subspecialties
• Driven by high-RVU, high-reimbursement procedures
• Compensation structures vary widely:
  • Employed with base + RVU incentives
  • Private practice with partnership track and profit sharing
  • ASC ownership or co-management agreements

Key income drivers:

• Procedure mix and volume
  Epidural steroid injections, facet blocks, medial branch blocks, radiofrequency ablation, spinal cord stimulator trials, etc.
• Payer mix
  Commercial insurance vs. Medicare/Medicaid vs. workers’ compensation significantly affects reimbursement.
• ASC or facility ownership
  Professional fees + facility fees can substantially elevate overall income.
• Referral base and marketing
  Strong relationships with primary care, surgeons, and chiropractors matter.

Lifestyle trade-offs:

• Higher compensation often comes with:
  • Higher throughput expectations
  • Potential evening/weekend responsibilities for urgent consults or on-call coverage
  • Business and regulatory complexity (prior authorizations, compliance, opioid stewardship)
• Physical demands of procedural work and risk profile (e.g., fluoroscopy exposure).

For residents, this is the PM&R niche most often associated with a trajectory toward the highest paid specialties within the broader pain/spine world, though the training pipeline can be competitive.

2.4 EMG, Neuromuscular, and Electrodiagnostic Physiatry

Typical roles:

• Hospital-based or private EMG lab
• Neuromuscular clinic (often shared with neurology)
• Outpatient practice with significant EMG/nerve conduction volume

Compensation profile:

• Often in the upper-middle range for PM&R when EMG volume is robust
• Revenue derived from high-complexity diagnostic studies and associated consult visits

Key income drivers:

• Number of EMG/NCS studies per week
• Practice efficiency (optimized scheduling, technologist support)
• Referral sources (orthopedics, neurology, rheumatology, primary care)
• Payer mix and local reimbursement rates

Lifestyle trade-offs:

• Predictable daytime hours, generally minimal call.
• Technically demanding work that rewards attention to detail and pattern recognition.
• Repetitive hand/arm use can be physically taxing over a long career; ergonomics matter.

2.5 Pediatric Rehabilitation, SCI, TBI, and Other Highly Specialized Tracks

Typical roles:

• Pediatric rehab in children’s hospitals or developmental centers
• Dedicated spinal cord injury (SCI) or traumatic brain injury (TBI) units
• Academic medical center subspecialty services

Compensation profile:

• Frequently lower than procedural and general inpatient roles, especially in predominantly academic or pediatric settings
• Compensation often tied to university or children’s hospital scales

Key income drivers:

• Academic rank and promotion
• Supplemental clinical duties (additional clinics, consult services)
• Grants, program development stipends, and leadership roles (e.g., division chief, program director)

Lifestyle trade-offs:

• Strong alignment with mission-driven work and complex patient populations.
• Heavy emphasis on multidisciplinary care, research, and teaching.
• Usually stable hours, though inpatient coverage and call can vary.

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3. Factors That Influence PM&R Compensation Across All “Subspecialties”

Whether you aim for inpatient rehab, outpatient MSK, or interventional spine, many of the same variables shape your long-term doctor salary by specialty within PM&R.

3.1 Practice Setting

Academic Medical Centers

• Typically lower base salary compared to private practice or hospital-employed community positions.
• May offer:
  • Protected research or teaching time
  • Enhanced job stability and institutional benefits
  • Career advancement pathways (promotion, leadership roles)
• Good fit if your priorities include academics, reputation, mentorship, and complex case mix over maximum income.

Hospital-Employed Community Positions

• Increasingly common model for PM&R.
• Often offer:
  • Competitive base salary + RVU bonus
  • Robust benefits (retirement match, health insurance, CME funds)
  • Less business overhead than private practice
• Compensation can be relatively strong, especially for inpatient rehab or high-need markets.

Private Practice (Solo or Group)

• Income can be higher, especially for:
  • Interventional spine and pain
  • EMG-focused practices
  • High-volume outpatient MSK rehabilitation
• Requires engagement with:
  • Billing, collections, and payer negotiations
  • Practice management and staffing
  • Potential partnership buy-in and profit sharing

Large Multi-Specialty Groups and Health Systems

• Hybrid of hospital-employed and private practice features.
• Standardized compensation models:
  • Base salary, RVU targets, and group-level incentives
• Often provide integrated referral networks and infrastructure but may limit autonomy.

3.2 Geography and Market Forces

Location plays a major role in PM&R residency decisions and salary potential.

High-cost coastal metros:

• Higher nominal salaries but even higher cost of living.
• Extremely competitive markets with many specialists.
• Narrower margins for private practices; employed models more common.

Mid-sized cities and suburban markets:

• Often an attractive balance of:
  • Strong compensation
  • Manageable housing costs
  • Reasonable competition

Rural and underserved areas:

• Frequently offer:
  • Premium salaries, signing bonuses, and loan repayment
  • Immediate leadership opportunities (medical director roles, program building)
• Trade-offs:
  • Professional isolation
  • Limited cultural/educational options
  • Narrower clinical subspecialty options

3.3 Compensation Models and RVUs

Understanding how you get paid is as important as the raw number.

Common PM&R pay structures:

1. Straight salary

   • Common early on (e.g., first 1–2 years out of training)
   • Predictable, but less upside for high productivity.

2. Salary + RVU/bonus

   • Standard for many hospital-employed and large group positions.
   • Base salary guaranteed; above-threshold RVUs lead to bonuses.
   • PM&R-specific nuance: wide differences in RVU generation between inpatient rounding, outpatient clinic, and procedures.

3. Pure productivity / collections-based

   • More common in private practice and interventional pain.
   • Higher risk–higher reward; income closely tied to volume and payer mix.
   • Requires business acumen and comfort with variability.

4. Partnership and ownership models

   • Partnership tracks for:
     • Group practice profits
     • Real estate
     • Imaging centers or ASCs
   • Can significantly elevate long-term earnings but often require multi-year buy-in, good fit, and patience.

3.4 Experience and Career Stage

• Early career (0–3 years)

  • Lower base salaries with:
    • Loan repayment stipends
    • Signing bonuses
    • Relocation support
  • Often less procedural volume initially, especially in spine/pain.

• Mid-career (5–10+ years)

  • Peak earning years for many physiatrists as:
    • Referral base matures
    • Procedure skills and volume grow
    • Leadership or director roles accumulate

• Late career

  • Earnings may stabilize or decline slightly if:
    • Physicians cut back clinical hours
    • Call coverage is reduced
    • Emphasis shifts to administration, teaching, or part-time work

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4. Using Salary Information to Guide Your PM&R Career Decisions

As a residency applicant or early trainee, you cannot fully control your eventual doctor salary by specialty, but you can make strategic choices that nudge you toward certain compensation bands.

4.1 During the Physiatry Match and Residency

When evaluating PM&R residency programs:

• Look at clinical exposure to different niches:
  • Interventional pain / spine
  • Inpatient rehab (stroke, SCI, TBI, transplant, oncology)
  • EMG labs and neuromuscular disease
  • Pediatric rehab
• Ask graduates:
  • What percentage go into inpatient vs. outpatient vs. interventional?
  • How many pursued fellowships, and in what fields?
  • Are graduates able to join competitive practices or academic posts?

Key questions for residents with an eye on future salary:

• Do you get hands-on procedural experience (ultrasound, injections, fluoroscopy) during residency?
• Are there mentors in the practice types that interest you (pain, MSK, SCI, pediatrics)?
• Does the program support research and elective time that can lead to fellowship opportunities?

4.2 Fellowship Choices and Long-Term Earning Potential

Not all high-paying PM&R pathways require fellowship, but targeted training often enhances your trajectory.

Common PM&R-related fellowships that affect compensation:

• Interventional pain management (often via ACGME pain or non-ACGME spine/pain)
• Sports medicine
• Spinal cord injury (SCI)
• Traumatic brain injury (TBI)
• Pediatric rehabilitation
• Neuromuscular and EMG

Financial considerations:

• Interventional pain and sports medicine fellowships often correlate with higher long-term income due to procedure-based practice.
• SCI, TBI, and pediatric rehab fellowships are more likely to be mission-driven with modest salary impact compared to pain/sports but high professional fulfillment.

4.3 Negotiating Your First Job Offer

When the time comes to sign your first attending contract:

1. Know the local market.

   • Use multiple data sources (MGMA, specialty societies, mentors).
   • Compare offers across practice settings.

2. Clarify the compensation formula.

   • Base salary, RVU targets, and bonus percentage.
   • Expectations for call, weekend coverage, and administrative duties.

3. Look beyond the headline physician salary.

   • Loan repayment, sign-on bonus, and relocation assistance.
   • CME funds and paid time off.
   • Retirement match and health insurance.
   • Partnership track or leadership opportunities.

4. Get help.

   • Talk with senior physiatrists who have negotiated contracts.
   • Consider legal review for complex or long-term agreements.

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5. Balancing Money, Mission, and Lifestyle in PM&R

PM&R is uniquely situated at the intersection of function, quality of life, and interdisciplinary care. Compensation matters, but it’s not the sole determinant of career satisfaction.

5.1 Aligning Your Clinical Interests with Realistic Earnings

Ask yourself:

• Do you thrive on procedures and technical skills, or do you prefer complex diagnostic puzzles and team leadership?
• Is long-term patient relationship and functional progress more important than maximizing income?
• How much are you willing to trade higher salary for lifestyle (predictable hours, flexible schedule, fewer weekends)?

For example:

• If you want top-tier compensation within physiatry and are comfortable with a fast-paced, procedural environment, consider interventional spine or pain with a strong business model.
• If you prioritize daytime hours and minimal call, EMG-focused or outpatient MSK roles may be ideal even if they sit in the mid-range for PM&R physician salary.
• If your passion is pediatric rehab or SCI, you might anticipate a more modest income but very high professional meaning.

5.2 Reassessing Over Time

Your values and priorities will change:

• Early career: Loan repayment, rapid income growth, and building skills.
• Mid-career: Balancing family, leadership roles, and clinical load.
• Late career: Flexibility, teaching, and reduced call.

PM&R is flexible enough to accommodate these shifts. Many physiatrists pivot over time—from inpatient to outpatient, from full clinical to more administrative, or from academic to community practice.

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FAQs: Physician Salary by Specialty in PM&R

1. Is PM&R considered one of the highest paid specialties?
No. PM&R as a whole is usually middle of the pack in national salary surveys—higher than some primary care fields but well below top earners like orthopedic surgery, dermatology, or interventional cardiology. However, certain PM&R niches (especially interventional spine and pain, with ASC involvement or partnership) can approach or overlap with higher-earning specialties.

2. Do I need a fellowship to maximize my PM&R salary?
Not always, but it often helps. Inpatient rehab and some EMG-focused roles can be well-compensated without fellowship. However, fellowships in interventional pain, sports, or other procedure-heavy areas can expand your scope and make you more competitive for high-paying positions. Fellowships in pediatric rehab, SCI, or TBI tend to be more about clinical depth and academic opportunity than salary maximization.

3. How much does location really affect PM&R compensation?
Location is one of the biggest variables. Two physiatrists with similar training can see large salary differences between a saturated coastal city and a midwestern or southern community with high demand. Rural and underserved regions often offer premium compensation, signing bonuses, and loan repayment, although they may have fewer subspecialty options and lifestyle amenities.

4. What should I focus on during residency if I care about future income?
During residency, you can’t control everything, but you can:

• Seek strong exposure to procedures (injections, ultrasound, fluoroscopy) and EMG.
• Work closely with mentors in your areas of interest (pain, sports, inpatient, EMG, pediatrics).
• Develop efficiency, communication, and team leadership skills that translate into productivity and leadership roles.
• Learn the basics of RVUs, billing, and practice management, so you can better evaluate and negotiate future offers.

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Understanding physician salary by specialty in PM&R is less about chasing a single number and more about aligning your interests, skills, and life priorities with the right practice archetype. Use your time in the physiatry match and residency to explore, ask targeted questions, and build the foundation for a career that balances purpose, lifestyle, and financial stability.