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do sport medicine/FM get paid more than FM?

Discussion in 'Family Medicine' started by december07, 07.26.09.

  1. december07

    december07

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    Hi,
    Do FM with sport medicine fellowship get higher salary than FM alone? or the paid is the same, it's just a matter of what you wanna do?

    I know... there are many factors involve such as the # of hours you work, the # of procedure that you do and how busy you are...blah blah blah...

    Let's assume that all being equal, same hours, same # of pts etc... do a sport medicine doc bring in more money? high reimbursement? Per my research, it looks like it's the same. So, i wanna hear from some of you out there that may have more experience on this topic than I do.

    Thank you.
  2. lowbudget

    lowbudget Senior Member

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    The answer is yes but not because all things are equal. All things are not equal when you're talking about variations in pay.

    If a cardiothoracic surgeon worked the same hours, saw the same # of patients, did the same procedures with the same types of pts as an FP, they would be paid the same as an FP.
  3. Blue Dog

    Blue Dog Avec caféine. Gold Donor SDN Advisor

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    There is nothing magical about any of the FM fellowships that guarantee higher income. It is indeed possible for those in sports medicine to earn higher-than-average incomes if they position themselves appropriately and do the work. The major things potentially driving income in the typical sports medicine practice aside from office visits are consults, procedures, contracts with sports teams, and ancillary income from imaging and physical therapy.
  4. thethom

    thethom

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    The answer is yes, and as Blue said, the keys here are consults and procedures. You still can serve in the primary care role, but now you have added opportunities to serve as consultant. Check this out:

    http://www.cms.hhs.gov/AcuteInpatientPPS/06_dgme.asp#TopOfPage

    go to the bottom of the page to find the 2008 compensation PDF.

    That being said, don't do it because of the money, do it only if you are truly interested in musculoskeletal and sports medicine.
  5. december07

    december07

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    Thanks, that was helpful.
  6. tkirkwood

    tkirkwood

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    It was interesting to see what every one has said. However, I think you have to look at all aspects.
    As a fellow, depending on the location, you can expect to be paid a little more than what you mad as a resident. But, that year you could have made a base salary of 160k to 200+k. On average a FP sports med doc would earn onlyslightly more than the average FP(maybe 10k).
    I am an ex athletic trainer who is doing a FP residency. After looking at what I could make in the first year and compared it to the 1 year of fellowship and the minimal increase in pay, it would take me 10 years to make up for the money lost in that 1st year out.
    Besides, I am not real sure what a fellowship could offer that a bunch of electives in sports couldn't do for you, other than a certification that you may not need. Unless you are hoping to get in with aa pro team or large college in which case good luck. You have a better chance of being a starting pitcher in the bigs.
  7. thethom

    thethom

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    What kirkwood says regarding losing out on that first year salary as FM is true, so if you do sports med it should be because you really enjoy being a musculoskeletal specialist; you can do some SM electives and learn a lotta sports med. That being said, Those that finish the fellowship will undoubtedly be better at it, and many of the large referral based ortho/sports med practices will require their PCSM employees to have the CAQ. Now I'm sure someone will say "why would an ortho practice hire a PCSM when they can hire an orthopod?" Well trust me, PCSM is a hot commodity around here, and the major ortho groups are all hiring PCSM out of fellowship to work alongside the orthopods. (Keep in mind ~90% of musculoskeletal injuries do not require operative intervention, and many of the currently operated on problems may be shown to have better outcomes if managed non-operatively. Look at some of the previously bread and butter ortho procedures: knee arthroscopies with debridement and vertebroplasties/kyphoplasties, both had been shown to have better/similar results when managed non-operatively)

    As for hooking up with a college or pro team, all our sports med faculty either have/had positions as team physician for a college/pro team...I am covering soccer for one of the local Universities as an intern (athletics is big in NC)...just an FYI...
  8. bravotwozero

    bravotwozero Chronically ambitious

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    Is it feasible to moonlight while doing a sports med fellowship? Since you would be an attending at that point, no?

    And even if you end up working as a sports med consultant with an orthopod, doing joint injections, etc., your net income would still only be 10k more than the average fm doc?
  9. bedrock

    bedrock Member

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    You can quite a bit more a year if you do your joint and/or tendon injections with ultrasound guidance. Multiple studies have shown it to be more accurate than blind injections, and the guidance code still reimburses quite well.

    Not all sport med fellowships offer decent MSK ultrasound exposure, so that's an opportunity cost to consider. If you can get a sports fellowship spot that provides their fellows with reasonable MSK ultrasound experience, you can make up that lost year of income in much less time.
    Last edited: 04.06.11
  10. TPBC

    TPBC Member

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    How does a doc get ancillary income from imaging and physical therapy?
    Thanks.



  11. Blue Dog

    Blue Dog Avec caféine. Gold Donor SDN Advisor

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    You have your own imaging center (typ. x-ray and MRI) and in-house PT and operate them for a profit.
  12. thethom

    thethom

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    Some of our fellows do that. More in the spring as fall football season is a lot busier.

    Sure its only 10-15k more but if its what you love then that 10-15k is worth billions...in smiles.

    Personally I love family medicine, and I couldn't do 100% SM and forget everything I'm learning in residency, but SM patients are sooo pleasant (usually) and compliant. So a 50/50 practice would be ideal. Make it what you want, we have fellowship grads in all settings from primary care offices to full time urgent care to ortho offices doing 100% MSK medicine.
  13. bravotwozero

    bravotwozero Chronically ambitious

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    No disagreements there. That's what's making me seriously consider sports med.
  14. skiz knot

    skiz knot Legendary Dr. X

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    Contracts with sports teams almost always do not directly bring money into a practice. Often time services to the teams are provided Gratis, and for most pro teams, big money is spent by a practice to the team for the right to say they are the team physician of the "insert team here."
  15. Blue Dog

    Blue Dog Avec caféine. Gold Donor SDN Advisor

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    I was thinking more of local high schools and colleges. Our sports med folks do receive a stipend from the colleges for which they serve as team physicians. AKAIK, their high school work is gratis aside from what they make doing sports physicals. However, this sort of thing is variable.
  16. atstudent

    atstudent Certified Athletic Traine

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    We just did sports physicals at our PT clinic the other day. We work with the docs in our same building to get these done. The kids pay $25 to the school and then the school pays the doctors for this. I believe the school pays enough to pay for the supplies (gloves, etc) and that's it. Otherwise that money stays with the school as a fundraiser for the athletic department.
  17. Blue Dog

    Blue Dog Avec caféine. Gold Donor SDN Advisor

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    When I was a resident, one of our easier moonlighting opportunities was doing sports physicals. Usually, two of us at a time would go to the school and do 40-50 of them at a time for something like $20-25 apiece. We got to keep all of it. Unfortunately, lots of people wanted to do it and there weren't very many opportunities during the year.

    As I said, highly variable.
  18. lowbudget

    lowbudget Senior Member

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    Contracts depend on what you can negotiate. It can range from marketing/advertising rights, to preferred provider, to fee for service/time (i.e. training room), to full on retainer/employee.

    Vast majority of arrangements are marketing/advertising and preferred provider. Depends on where you practice, of course; but the way it looks is doctors/hospitals buy advertising from the team, the team fills doctors waiting room with patients/procedures, the doctors use the hospital for testing/procedures/therapy. So yes and no, in a sense the services you provide to the team may be considered gratis, but some times not really. It all depends on what you negotiate and what the market is like in the area you practice.

    That model works best for doctors who are either employed by a hospital system, who are in a partnership where you have a share in surgical, PT, and imaging profits, or if you can bill for and capture high dollar procedures on the back end (i.e. if you are a surgeon).

    The financial model for PCSM will continue to evolve to meet the needs of the docs who don't fall in the above categories AND for the teams who can't find docs who fit in the above categories.

    I'll tell you this: In my market, the doctors who are providing gratis services at the team level are orthopedic surgeons or PCSM doctors who work in an orthopedic practice. That's because they can capture revenues on the back end. Increasingly, teams are starting to understand that maybe orthopedic surgeons shouldn't be their primary team physician. Increasingly, teams want a PCSM doctor to be the first to see an athlete for all of their complaints; especially when for a non-orthopedic issue where an orthopod functioning as a PCP would make inappropriate referrals to medical subspecialists.

    Unfortunately, teams are just like everyone else... You can't find a FM doc willing to work for pay (!) much less show up to the training room to work for free(!). So, right now, the demand/opportunity is with established orthopedic practices to hire and subsidize a PCSM doctor to come in and fill that role. Unfortunately, for most PCSM doctors who work in orthopedic practices, their medical skills atrophy if they only see MSK cases. And orthopedic practices have a problem if their PCSM doctor is doing primary care out of the orthopedic office.

    You don't see this on the professional side, since they have so much money to spend that they have no problem accessing the health care system. You will see this increasingly so with collegiate teams who are not affiliated with a medical school and you will see this increasingly to be the case with high schools. It's already seen on the semi-pro/amateur side where there is high demand for PCSM services but no money.

    There is a lot of uncertainty for traditional orthopedic-sports med model because the revenue on the back end is under pressure to get cut (outpatient surgery center, imaging, therapy). It's not going to crash or disappear but there will be some downward pressure, so groups and teams on the margin will have to evolve and adapt. Doing a physical here and there for some peanuts is hardly a money maker for a PCSM who is not cross-subsidized by an ortho group.

    What you see today isn't what will be around in the future.
    Last edited: 05.07.11

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