Know your number before you call back.

What's Inside

A complete assignment toolkit:

1. Rate Benchmark Database

   Physical medicine and rehabilitation rates by state and setting — urban IRF and rural inpatient rehab — at the 25th, 50th, 75th, and 90th percentile. Fifty states. Includes the rural premium data: rural PM&R median exceeds urban in this specialty. The number you need before you call the recruiter back.

2. Recruiter Call Scripts

   Word-for-word. The exact sentences:

   • The opening anchor when you've received a below-market offer
   • The counter when they say "this is our standard rate"
   • The census cap script — define the daily patient ceiling before finalizing the rate
   • The documentation expectation script — IRF-PAI and Section GG work must be factored into the schedule, not added to patient contact hours
   • The swing bed medical director add-on script — negotiate the separate daily rate at rural sites
3. PM&R Leverage Points

   The specific capabilities and contract terms that determine your real compensation:

   • Daily patient census is the most important variable in a PM&R locum contract — at 40 IRF patients with 2 hours of IRF-PAI documentation on a 10-hour day, your stated rate and your effective rate are not the same number. The census cap protects both
   • IRF coverage requires documented rehabilitation-physician involvement, including required face-to-face visits. Rural facilities with limited backup have fewer ways to absorb a vacancy, making the census, schedule, and coverage plan meaningful negotiating points
   • Spinal cord injury and traumatic brain injury experience opens CARF-accredited SCI and TBI rehab center assignments nationally — the highest-acuity and highest-rate tier of inpatient rehab locum work
   • Swing bed and skilled nursing facility medical director roles are available at most rural locum sites, are commonly missed, and add $200–400/day in separately negotiated supplemental income
4. Contract Red Flag Checklist

   Patient census not defined, documentation requirements not disclosed, on-call expectations unspecified, non-physician supervision scope not defined, and swing bed/SNF role not separately priced. One page, annotated. Open it while reviewing any contract.

5. Agency Markup Framework

   The math behind what the IRF actually pays for your coverage. IRF Medicare margins run approximately 14% above costs — meaning IRF reimbursement structurally exceeds what the facility spends. The physician overhead cost is a fraction of the IRF-differentiated revenue your presence enables. When you know the approximate bill rate, "that's our maximum" means something different.

6. Locum Tax Framework

   The 1099 math most physiatrists undercount: the S-corp threshold, the Solo 401(k) gap, and the minimum premium required to break even against a W-2 employed IRF rate.

7. Licensing & Credentialing Roadmap

   The licenses, registrations, facility privileges, documents, start gates, and timelines required for the assignment.

8. From Signed Contract to Final Shift

   A specialty-specific first-shift gate, assignment escalation scripts, a stay/pause/leave framework, and a final-shift checklist.

What It Looks Like on the Call

When a recruiter quotes $180/hr for a rural IRF assignment without disclosing the daily census or documentation requirements, this is the sentence from Section 2:

"The national median for rural IRF coverage is $194/hr. Before we discuss rate, I need to confirm the expected daily patient census and how IRF-PAI documentation time is factored into the schedule — documentation obligations affect my effective rate, and I need those defined before we finalize a number. I'd expect to be at $195–205/hr with a census ceiling at 25 patients. If this assignment includes swing bed or SNF medical director coverage, I'd want that priced separately. Can we structure it that way?"

You change the numbers to match your state. You say it. That is the product.

Who Built This

For years I took every rate I was offered without pushing back. Not because I was naive. I did not have the data to know whether I should. Neither did anyone I trained with.

I built the same rate model and negotiation framework across 22 physician specialties, then added the contract, credentialing, first-shift, and assignment protections I would want before accepting the work myself.

The agency has this organized. Now you do too.

— General Surgery MD

Built on Evidence, Written for the Call

The toolkit combines 50-state benchmark data, specialty-specific assignment research, current licensing and tax guidance, and 17 peer-reviewed negotiation sources. The research establishes the framework; the product gives you the number, language, and checklists to act on it.

What $99 Has to Do

One $10/hr improvement on one 10-hour shift covers the full price. One avoided unpaid hour can do the same. Every protected shift, corrected contract term, or future renewal comes after that.

One Honest Limitation

This will not help you if you are already negotiating above the 75th percentile for your specialty and state. If you don't know what percentile your current rate is, that is the problem this solves.

About the Data

Based on BLS OEWS public data and CMS geographic adjustment factors, processed through a locum-adjusted model, calibrated and validated against publicly posted rates and observations.