FM vs PM&R and the future

[Osteoimposter]

MS3 here, having some issues deciding what I should go into (decisions being made soon). I talked to a pulmonologist today who was going to "give me advice" and he basically crushed both FM and PMR with an iron fist. His quote was "throw FM out, that field is dead in 10 years". He claimed that FM will bring in 80-120K in 10-15 years which scares the crap out of me (much too low for all that training). Is the compensation for FM really gonna drop (would medicare for all crush the field)?

I need advice from more people, is FM really going down the drain? Is PMR 'safer'? I love both equally and am making decisions now based on my financial security in the future (not in medicine for the money but also not trynna get ripped off). Any advice/insight would be greatly appreciated.

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[VA Hopeful Dr]

I love when other specialties predict our downfall.

Here's what I know:

FM salaries have been increasing every year for the last 2 decades.

We have the best job market in all of medicine except maybe psych.

If we end up with socialized medicine, primary care will get even more important since it's been well proven that good primary care is very cost effective.

Patients like us more. Every FP has countless stories of their patients seeing a specialist, the specialist recommending a treatment, and the patient coming back to us and making sure we thought it was a good idea.

 

[Osteoimposter]

I love when other specialties predict our downfall.

Here's what I know:

FM salaries have been increasing every year for the last 2 decades.

We have the best job market in all of medicine except maybe psych.

If we end up with socialized medicine, primary care will get even more important since it's been well proven that good primary care is very cost effective.

Patients like us more. Every FP has countless stories of their patients seeing a specialist, the specialist recommending a treatment, and the patient coming back to us and making sure we thought it was a good idea.

Thanks for your response. I know.. FM is something that a lot of docs love to hate on for some reason. My worry with socialized medicine would be the potential for a compensation drop. Looking at countries where there's such a system, some FM docs struggle quite a bit.

What are your thoughts on PMR?

 

[VA Hopeful Dr]

Thanks for your response. I know.. FM is something that a lot of docs love to hate on for some reason. My worry with socialized medicine would be the potential for a compensation drop. Looking at countries where there's such a system, some FM docs struggle quite a bit.

What are your thoughts on PMR?

I have no knowledge of PMR.

 

[Eilat87]

MS3 here, having some issues deciding what I should go into (decisions being made soon). I talked to a pulmonologist today who was going to "give me advice" and he basically crushed both FM and PMR with an iron fist. His quote was "throw FM out, that field is dead in 10 years". He claimed that FM will bring in 80-120K in 10-15 years which scares the crap out of me (much too low for all that training). Is the compensation for FM really gonna drop (would medicare for all crush the field)?

I need advice from more people, is FM really going down the drain? Is PMR 'safer'? I love both equally and am making decisions now based on my financial security in the future (not in medicine for the money but also not trynna get ripped off). Any advice/insight would be greatly appreciated.

I'm sure both specialties will be just fine, existentially. More importantly, what kind of patient population do you want to see? What kind of pathology do you want to address? The two specialties are so different. You should really just do rotations in both and figure it out that way.

 

[deleted87716]

I have literally never referred a patient to PM&R. I guess somebody does.

 

[deleted87716]

My worry with socialized medicine would be the potential for a compensation drop. Looking at countries where there's such a system, some FM docs struggle quite a bit.

Like, where? And, compared to what?

 

[Osteoimposter]

Like, where? And, compared to what?

In pretty much every socialized system aside from Australia (where they're allowed more latitude) and Canada (hit and miss depending on the area).. they make less. On average I have found that its about 30-40% less compared to US FM docs today.

 

[sloh]

PM&R here. I practice outpatient MSK in Southern California. FM job market is much better especially if you want to do outpatient. Kaiser FM docs make around ~270k/year I believe....they have very busy schedules...but the salary is pretty high.

Within PM&R, there are much more job opportunities in SAR/SNF's. Good job flexibility, good hours, good compensation. That patient population isn't everyone's cup of tea though.

 

[Link0358]

In pretty much every socialized system aside from Australia (where they're allowed more latitude) and Canada (hit and miss depending on the area).. they make less. On average I have found that its about 30-40% less compared to US FM docs today.

In those socialist systems, every specialty makes less with the salary gap between primary care docs and specialists closer than here in the US. In some (Denmark) GPs make more than specialists.

 

[Osteoimposter]

In those socialist systems, every specialty makes less with the salary gap between primary care docs and specialists closer than here in the US. In some (Denmark) GPs make more than specialists.

I agree with you. But in that scenario id rather be the guy that gets shafted but still makes 200+ (PMR salaries in socialized systems) than the guy that gets shafted and makes 150. But your point is totally correct.

 

[deleted87716]

I'd suggest making decisions based on what is, rather than what might (or might not) be.

 

[Link0358]

I understand where you are coming from. I am an MS4 going into family and had the same considerations you are having.

No one knows what is going to happen in the future. I ended up deciding by picturing what kind of practice I would want in the future and chose the specialty which best matched up with it. My dream is a 1/2 primary care and 1/2 sports medicine clinic, so I went with FM.

The pulmonologist has no idea what he is talking about. With how broad and in demand FM is, it is one of the most secure fields in medicine. If medicare for all does happen (which is not likely in the next 10 years), it will only increase the demand for good primary care doctors.

 

[VA Hopeful Dr]

I have literally never referred a patient to PM&R. I guess somebody does.

Around here, anyone that goes to short term rehab after a hospital stay is under the care of PM&R. Most of the ortho groups have 1-2 as well for non-operative stuff.

 

[bronx43]

Not sure what the value of PM&R is other than inpatient rehab. They're not really needed in outpatient MSK to be honest...

If you're worried about Medicare For All, the question isn't "what specialty should I go into," but "should I have gone into or stay in medicine in the first place?"

 

[Osteoimposter]

Not sure what the value of PM&R is other than inpatient rehab. They're not really needed in outpatient MSK to be honest...

If you're worried about Medicare For All, the question isn't "what specialty should I go into," but "should I have gone into or stay in medicine in the first place?"

It is possible to be passionate about helping people in medicine while also caring how much money I will make. They are not mutually exclusive. But I understand your point. Having the same thoughts about PMR.

 

[bronx43]

It is possible to be passionate about helping people in medicine while also caring how much money I will make. They are not mutually exclusive. But I understand your point. Having the same thoughts about PMR.

Huh? what I meant is that M4A hurts ALL specialties so there’s no point in choosing between specialty A,B, or C.

Instead one should think, when M4A comes, do I even want to be a doctor?

 

[Osteoimposter]

Huh? what I meant is that M4A hurts ALL specialties so there’s no point in choosing between specialty A,B, or C.

Instead one should think, when M4A comes, do I even want to be a doctor?

Ohhhh I see. Yeah that's probably a choice a lot of people will have to make. Good point.

 

[Sardonix]

MS3 here, having some issues deciding what I should go into (decisions being made soon). I talked to a pulmonologist today who was going to "give me advice" and he basically crushed both FM and PMR with an iron fist. His quote was "throw FM out, that field is dead in 10 years". He claimed that FM will bring in 80-120K in 10-15 years which scares the crap out of me (much too low for all that training). Is the compensation for FM really gonna drop (would medicare for all crush the field)?

I need advice from more people, is FM really going down the drain? Is PMR 'safer'? I love both equally and am making decisions now based on my financial security in the future (not in medicine for the money but also not trynna get ripped off). Any advice/insight would be greatly appreciated.

It is ALWAYS some specialist that tells me "Oh man, don't do FM. It's gonna be dead because of [decreased pay/midlevel takeover/socialized med/meteor crashing to the earth]. I just smile and nod then also note any time they complain about referrals/difficulty getting PCP appts for their patients in the future.

 

[Splenda88]

If you want flexibility in term of geographic locations and 250-300k/year, FM is the way to go...

 

[deleted941485]

It is ALWAYS some specialist that tells me "Oh man, don't do FM. It's gonna be dead because of [decreased pay/midlevel takeover/socialized med/meteor crashing to the earth]. I just smile and nod then also note any time they complain about referrals/difficulty getting PCP appts for their patients in the future.

Even if you don’t believe that, reported burnout seems pretty high.

 

[VA Hopeful Dr]

Even if you don’t believe that, reported burnout seems pretty high.

Meh, the difference in burnout rates between specialties is pretty small. The vast majority are somewhere between 35-45%. In this specific case, pulm is 41%, FM is 46% based on the Medscape survey. I'm not sure that reaches any kind of statistical significance.

 

[Drrrrrr. Celty]

Meh, the difference in burnout rates between specialties is pretty small. The vast majority are somewhere between 35-45%. In this specific case, pulm is 41%, FM is 46% based on the Medscape survey. I'm not sure that reaches any kind of statistical significance.

I don't think physicians are generally happy as a baseline. I've seen physicians in 'lifestyle' specialties and or subspecialties who still managed to somehow be miserable.

Similarly my FM preceptor during 3rd year was the most miserable human being I ever met in my life despite 95% of her work and caseload of pts being extremely pleasant, the pathology being entirely manageable chronic diseases ( worst a1c I saw was 9), and anything that was more complicated being managed by a subspecialist.

Looking back if I could run a practice like her I'd probably jump into it without a second thought and have done FM. 3 years of residency, good ability to have solid patient interactions, and she easily had every opportunity to have a life. And ****, I'd be really happy with it.

 

[Sardonix]

Even if you don’t believe that, reported burnout seems pretty high.

I don't see your point. I'm going into FM because I want to. Aside from the fact that I enjoy FM, the nation is specialist heavy enough as is--there's need for more primary care and I'm happy to help with that. Meanwhile, going into a specialty based on a random attending's opinion seems like a fantastic way to be burnt out. While I know they mean well, it's kind of offensive that they believe their opinion and experience is far superior to whatever reasoning I have to go into my chosen specialty.

 

[bronx43]

I don't see your point. I'm going into FM because I want to. Aside from the fact that I enjoy FM, the nation is specialist heavy enough as is--there's need for more primary care and I'm happy to help with that. Meanwhile, going into a specialty based on a random attending's opinion seems like a fantastic way to be burnt out. While I know they mean well, it's kind of offensive that they believe their opinion and experience is far superior to whatever reasoning I have to go into my chosen specialty.

Agreed. If you take away midlevels (who refer out more) and patient satisfaction (pts who demand to be referred to a specialist), there is an oversupply of most specialists.

 

[Splenda88]

I don't think physicians are generally happy as a baseline. I've seen physicians in 'lifestyle' specialties and or subspecialties who still managed to somehow be miserable.

Similarly my FM preceptor during 3rd year was the most miserable human being I ever met in my life despite 95% of her work and caseload of pts being extremely pleasant, the pathology being entirely manageable chronic diseases ( worst a1c I saw was 9), and anything that was more complicated being managed by a subspecialist.

Looking back if I could run a practice like her I'd probably jump into it without a second thought and have done FM. 3 years of residency, good ability to have solid patient interactions, and she easily had every opportunity to have a life. And ****, I'd be really happy with it.

Why is that? Is it because many (or most) docs come from upper middle class families and never had a 'meaningful' job before becoming attending?

From my experience, most jobs have their own BS that one has to deal with.

 

[Drrrrrr. Celty]

Why is that? Is it because many (or most) docs come from upper middle class families and never had a 'meaningful' job before becoming attending?

From my experience, most jobs have their own BS that one has to deal with.

I'm sure it's more complicated than that. And I think very little of it has to do with specialty for most non-proceduralists. For proceduralist I think just the time, hours, malpractice, etc makes for hell on earth.

 

[Drrrrrr. Celty]

Agreed. If you take away midlevels (who refer out more) and patient satisfaction (pts who demand to be referred to a specialist), there is an oversupply of most specialists.

I have mixed feelings about this statement mostly because it doesn't specify how complicated your census of pts are. Like I said earlier, some PCPs like my fm preceptor never saw really complicated patients. Alternatively in my resident clinic there are pts who would probably die if they did not have 3 subspecialtists on board.

 

[bronx43]

I have mixed feelings about this statement mostly because it doesn't specify how complicated your census of pts are. Like I said earlier, some PCPs like my fm preceptor never saw really complicated patients. Alternatively in my resident clinic there are pts who would probably die if they did not have 3 subspecialtists on board.

It doesn't matter what level of complexity your particular census holds. I'm talking from a macro standpoint. Yes, all those complicated patients in resident clinic need specialists.
However, specialists' clinics are not completely filled with that level of complexity. Most specialists in private practice are kept afloat by the "worried well" - the soccer mom who has +ANA and fatigue, the young engineer with palpitations and a coffee addiction, the otherwise healthy grandmother with mildly high TSH, etc.
These are the people that keep the lights on for most specialists, and it is this referral base that would decrease significantly without the external forces I mentioned. Without them, you would need a lot FEWER specialists.

 

[Drrrrrr. Celty]

It doesn't matter what level of complexity your particular census holds. I'm talking from a macro standpoint. Yes, all those complicated patients in resident clinic need specialists.
However, specialists' clinics are not completely filled with that level of complexity. Most specialists in private practice are kept afloat by the "worried well" - the soccer mom who has +ANA and fatigue, the young engineer with palpitations and a coffee addiction, the otherwise healthy grandmother with mildly high TSH, etc.
These are the people that keep the lights on for most specialists, and it is this referral base that would decrease significantly without the external forces I mentioned. Without them, you would need a lot FEWER specialists.

I think a lot of these patients are more common in primary care practices than they are in pp or academic subspecialties.

I dont want to be dismissive, but it's really not been what I've seen. But I also again do alot of my practice with the poor and indigent.

You're working with likely a very well off census. And that's an unfortunate consequence because they have the money to invent their own diseases. The poor and already sick dont.

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[bronx43]

I think a lot of these patients are more common in primary care practices than they are in pp or academic subspecialties.

I dont want to be dismissive, but it's really not been what I've seen. But I also again do alot of my practice with the poor and indigent.

You're working with likely a very well off census. And that's an unfortunate consequence because they have the money to invent their own diseases. The poor and already sick dont.

Sent from my SM-G950U using SDN mobile

Well, I am a medicine subspecialist. I have practiced in both the private and the academic setting where our patient population was the urban underserved. There certainly is a lot of complex disease there, but there's only so much of that to go around. In PP, it's A LOT of non-sense referrals day in and day out which keeps the lights on.

 

[sloh]

It doesn't matter what level of complexity your particular census holds. I'm talking from a macro standpoint. Yes, all those complicated patients in resident clinic need specialists.
However, specialists' clinics are not completely filled with that level of complexity. Most specialists in private practice are kept afloat by the "worried well" - the soccer mom who has +ANA and fatigue, the young engineer with palpitations and a coffee addiction, the otherwise healthy grandmother with mildly high TSH, etc.
These are the people that keep the lights on for most specialists, and it is this referral base that would decrease significantly without the external forces I mentioned. Without them, you would need a lot FEWER specialists.

All I have to say as a PM&R attending is....you are absolutely correct. And I have no shame in admitting this. Many of the injections/procedures PM&R and Pain Specialists deploy are nothing more than placebo and/or amusing the patient while nature cures the disease.

 

[VA Hopeful Dr]

All I have to say as a PM&R attending is....you are absolutely correct. And I have no shame in admitting this. Many of the injections/procedures PM&R and Pain Specialists deploy are nothing more than placebo and/or amusing the patient while nature cures the disease.

One of my favorite attendings in residency had a saying for times like that, "Don't just do something, stand there"

 

[camng11]

Im entering fm residency this year, had the same thoughts as you during 3rd year. I ultimately chose fm because of its flexibility, shorter year of training, and job opportunities. I am planning on living in a major city and pm&r jobs will not be as abundant compared to fm jobs. FM jobs in california is mostly 250k+ minimum from almost all docs I've talked to and worked with. Both fields are very broad. It also depends on your interests. FM has the sports medicine route which total would be 4 yrs. Dont listen to that pulm doc, he doesnt know anything if he says fm is a dying field lol.

 

[TableMD]

I did sports med after FM residency and I likewise struggled with this. I think that PM&R is a very rewarding specialty and almost chose it (vs Peds vs FM vs PMR - Peds..lol) and I totally get OPs thoughts on this matter. For me the decision was made by looking at the day to day routine of the PCSM docs I worked with in med school and realized that is what I want to do, and so residency and fellowship reflected that.

I wouldn't pass up PM&R for FM because of job opportunities, as Im sure a good physiatrist can find a fairly large population of otherwise less than ideally served patients. My practice is almost entirely peripheral MSK and I went from being a new attending 1 1/2 years ago to now being booked 4 - 5 weeks out. If you bring good clinical skills and novel approaches to patient eval & care, the local physicians will want to work with you.

As for the safety of FM, when I opened up a small primary care panel (to keep that side of my brain on point), I effortlessly filled it in a few weeks, with the common reason for wanting to establish care being (I dont want to have an NP/PA as a primary doc). As an experiment, think of whatever town/city is the dream to live in, and see what the job posting situation, I dont think you'll have a hard time figuring out which specialties are in demand. Has a family doc ever told you it's a dying field?

 

[Captain_Falcon]

@Osteoimposter what did you decide on applying to?

 

[MedLife20]

I love when other specialties predict our downfall.

Here's what I know:

FM salaries have been increasing every year for the last 2 decades.

We have the best job market in all of medicine except maybe psych.

If we end up with socialized medicine, primary care will get even more important since it's been well proven that good primary care is very cost effective.

Patients like us more. Every FP has countless stories of their patients seeing a specialist, the specialist recommending a treatment, and the patient coming back to us and making sure we thought it was a good idea.

Lol so true. Got a cousin who is a surgeon and says don’t go into primary care because you will barely break $100k and you would be better off going to PA school or nurse practitioner because of the loans. The ignorance is astounding.

 

[Bostonspine]

I think if you vein residency as an opportunity to develop skill then you’d succeed no matter what you do. Think outside the box. With Family demand is up you can build a business and serve a. Community. With PMR it’s niche but that makes you versatile where I practice Neurology has become so inpatient tilted that you may wait 6 weeks or more for an EMG eval, ortho you may only see a PA til the pre-op, rheum forget about 2 month and a 60min drive so I’ll never be out of business. Be great, build a reputation and brand and you’ll never be out of a job

 

[kratos99]

I moved up to Canada over a decade ago.
I have some colleagues who routinely bill 500-800K a year, out of which they pay overhead. (About 20%... when you also include the fact that our taxes pay for our health care as well, we actually come out ahead than if I were to have stayed in the US).
Every year the government gives us more incentives and money as we save the system money by preventing illness and preventing emerg visits, specialist visits, etc.
I bill 250K a year, doing two days a week in clinic.
I became financially independent at age 35, and only work because I'm bored (I'm 41 now). A socialist system is what you SHOULD be aiming for. Stop listening to Fox News.

 

[deleted1025203]

I love when other specialties predict our downfall.

Here's what I know:

FM salaries have been increasing every year for the last 2 decades.

We have the best job market in all of medicine except maybe psych.

If we end up with socialized medicine, primary care will get even more important since it's been well proven that good primary care is very cost effective.

Patients like us more. Every FP has countless stories of their patients seeing a specialist, the specialist recommending a treatment, and the patient coming back to us and making sure we thought it was a good idea.

Lmao did anyone mention Canada to this guy. FM is having a ****ing good time up there.

 

[bltzybltz]

I moved up to Canada over a decade ago.
I have some colleagues who routinely bill 500-800K a year, out of which they pay overhead. (About 20%... when you also include the fact that our taxes pay for our health care as well, we actually come out ahead than if I were to have stayed in the US).
Every year the government gives us more incentives and money as we save the system money by preventing illness and preventing emerg visits, specialist visits, etc.
I bill 250K a year, doing two days a week in clinic.
I became financially independent at age 35, and only work because I'm bored (I'm 41 now). A socialist system is what you SHOULD be aiming for. Stop listening to Fox News.

Do you have any advice for moving to Canada as FM?

 

[EMTAB]

I moved up to Canada over a decade ago.
I have some colleagues who routinely bill 500-800K a year, out of which they pay overhead. (About 20%... when you also include the fact that our taxes pay for our health care as well, we actually come out ahead than if I were to have stayed in the US).
Every year the government gives us more incentives and money as we save the system money by preventing illness and preventing emerg visits, specialist visits, etc.
I bill 250K a year, doing two days a week in clinic.
I became financially independent at age 35, and only work because I'm bored (I'm 41 now). A socialist system is what you SHOULD be aiming for. Stop listening to Fox News.

I'm Canadian and thinking about this too, how difficult was it getting licensed in Canada?

 

[I_Cant_tell_you]

I've actually never heard of any specialist or surgeon ever say anything bad about a family medicine doctor. It's only medical students talking ****.

 

[VA Hopeful Dr]

I've actually never heard of any specialist or surgeon ever say anything bad about a family medicine doctor. It's only medical students talking ****.

Really? It's pretty common in big academic centers in my experience.