Here's my dilemma. I am ranked #1 in my class, I scored a 260+ on Step 1, and I honored all my 3rd year clerkships. However, I want to do sports medicine but not orthopedic surgery. I am so stressed trying to make the right decision on whether to choose FM (lack of prestige) vs. IM (safer choice with number of fellowships) vs. PM&R (not as familiar with) vs. EM (better pay but stressful work) on my way to doing PCSM (sports med). Anybody have any tips? Would love to hear from any primary care sports medicine docs who chose any of the pathways above and why the are happy/regret their decision. Thanks!....
NEED HELP - Am I crazy for choosing FM?
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Are you wanting prestige or sports medicine? What do you plan on doing with the sports medicine fellowship? I know many sports medicine docs that did the fellowship after family medicine. But if you are only worried about "prestige" maybe you should do something else because your fellow family med residents will get tired of hearing "but I'm going to do sports med, so do I have to cover, do that rotation, etc."
I enjoy MEDICINE in general, that's why I'm not doing surgery. I wont consider any rotation as a burden. But I also have worked very hard to get where I am at and don't want any regrets (esp. financially as I have two children and a wife now). I'm just curious as to which route is best to go to secure a solid income/future and be able to practice sports medicine.
pick the primary specialty you like the best. Most, but not all, sports meds doc do sports as only a small percentage of their practice. If you don't know what you like best, choose IM. Better career flexibility and more fellowship options (plenty with "prestige").
Just curious, what is your primary field? Do you practice SM? Thanks for your input
PM&R. i do "some" sports. not boarded in it. dont really feel like i need to be in my particular situation.
btw, if you truly plan on doing "mostly" sports, you should count on having to cover a buttload of games on night/weekends. i wouldnt worry about it --wife and kids usually dont take up much of your time.....
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A couple of the sports med doc here in my area I know are family med docs. They work with a private ortho group and also are the docs for the local college sport teams (I was able to rotate at the college's sport's med clinic with them). Others in the community do both sports med and primary care (they are both family med). They are with different high schools and covers their football and basketball games. I know one of them actually has a day set aside in their clinic as just sports med appointments. These 2 also do most of the sport's physicals for the area schools (and get residents to help). Find some sport med docs in your area and talk to them. That will be your best way to get a feel for what their part is and what residency they did before fellowship.
SSdoc33 - PM&R has interested me lately. I never got much exposure throughout medical school to it but it seems like a decent mix of procedures and also seems somewhat relaxed. Do you enjoy it? Also, I realize the game coverage is a part of it. I grew up with a father who was the athletic director and head football coach for a big high school so I spent my childhood going to games with him. I have a young son who I know could come to the games if he wanted. Also, I would probably cut back on the amount of coverage I do once I'm established. I'm sure fellowship requires a lot of coverage.
drcrispmd - Good advice. I do have a 4th year elective set up with a local sports med fellowship program here. I look forward to it.
My biggest concern is job security + decent income (don't care to make tons of $) + family life + enjoying what I'm doing. It's just hard when I have advisors at my school saying, "You could do plastics, derm, ortho, whatever you want. You got a golden ticket, don't waste it." But honestly I just want a good lifestyle and to enjoy what I'm doing.
drcrispmd - Good advice. I do have a 4th year elective set up with a local sports med fellowship program here. I look forward to it.
My biggest concern is job security + decent income (don't care to make tons of $) + family life + enjoying what I'm doing. It's just hard when I have advisors at my school saying, "You could do plastics, derm, ortho, whatever you want. You got a golden ticket, don't waste it." But honestly I just want a good lifestyle and to enjoy what I'm doing.
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If you are dead set on sports medicine, I would advise against IM. Sports med does quite a bit of peds.
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I'm not sports med, but I know quite a few family docs who are. The last 4 classes of fellowship from my residency program are all now working for large ortho groups doing non-operative ortho, lots of u/s guided injections. About half of them cover local football games (high school or small college) during the fall.
I think FM is a great path to sports med, especially as our ortho curriculum is likely only less comprehensive than orthopedic surgery and PMR. IM misses kids (and mostly focuses on inpatient these days), peds misses adults. EM isn't a bad choice, especially for covering side lines as you'll likely get more exposure to acute injuries - dislocations especially, compared to FM. I don't know enough about PMR training to comment much, except that I do know they get great ortho training. I don't know if they see many kids would be my only hesitation.
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Assuming you're not trolling here...
That's great that you're highly ranked and have good scores. Definitely do what you truly like and not what "you could do because you're so competitive" as some have advised you. The sooner you get over that in your career/life, the better, and it sounds like you've got that covered. You will be happier being yourself.
I know some awesome FM and PM&R sports med docs. I think one of these would be a good route. With FM, you get more of the peds component and all the primary care stuff. With PM&R, you get the (neuro)-MSK component and should get pretty good procedural skills including US- and fluoro-guided procedures. There is a little bit of peds in PM&R residency too. In PM&R-based sports med fellowships you can further your interventional spine skills should you choose. MSK US can be learned by anyone, including FM, but it is making waves in PM&R and getting incorporated into many residency programs. Mayo is probably the best in this regard.
Another thing to consider is duration of training. FM is 3 years vs PM&R is 4. Either way you will go through a lot of stuff that is not sports med, but is all part of your training to make you a good, well-rounded physician. And while PM&R may come out with better MSK skills, it's an extra year and as an FM you could do a lot of extra CME in a year to pick up whatever skills you want. Or even do a second fellowship.
So I think they are both good choices and I agree with doing the one you like more as a base specialty.
That's great that you're highly ranked and have good scores. Definitely do what you truly like and not what "you could do because you're so competitive" as some have advised you. The sooner you get over that in your career/life, the better, and it sounds like you've got that covered. You will be happier being yourself.
I know some awesome FM and PM&R sports med docs. I think one of these would be a good route. With FM, you get more of the peds component and all the primary care stuff. With PM&R, you get the (neuro)-MSK component and should get pretty good procedural skills including US- and fluoro-guided procedures. There is a little bit of peds in PM&R residency too. In PM&R-based sports med fellowships you can further your interventional spine skills should you choose. MSK US can be learned by anyone, including FM, but it is making waves in PM&R and getting incorporated into many residency programs. Mayo is probably the best in this regard.
Another thing to consider is duration of training. FM is 3 years vs PM&R is 4. Either way you will go through a lot of stuff that is not sports med, but is all part of your training to make you a good, well-rounded physician. And while PM&R may come out with better MSK skills, it's an extra year and as an FM you could do a lot of extra CME in a year to pick up whatever skills you want. Or even do a second fellowship.
So I think they are both good choices and I agree with doing the one you like more as a base specialty.
PM&R has pediatric rehab as part of its core curriculum in residency training.
Otherwise I agree with others as it regards to ANY primary specialty and its associated fellowships. Choose the primary specialty FIRST then the fellowship as you will A. have to endure the primary specialty residency first and B. when done likely still have a significant component of your practice be your primary specialty.
I usually advise people the following for sports:
1. Ortho: very competitive, need great scores. HAVE to like surgery. Residency is grueling but practice, depending on setting, can be very busy to cush-ish. Fast track to "head team physician" if that's your thing. Not much training in non-operative MSK medicine compared to PM&R. Great pay all around
2. PM&R: generally less competitive but getting more competitive especially at the "top" places. Have to get over the fact that when you say you are PM&R/a physiatrist most people are like "huh"? (this can actually be a hang up for people). Otherwise have to like a lot of different areas: neuro, ortho, a little bit of medicine. If it's your thing, out all the other paths to sports med docdom PM&R is second to ortho in terms of procedures available (interventional spine, US injections, EMGs). AWESOME lifestyle. Actually great pay when you consider the hours/stress involved.
3. FM: competitive to not competitive at all: can literally walk in to some of the lower tiered FM programs (but they may not have any sports/MSK faculty though). Great jumping off point for MSK medicine since your backbone is the medical care of all ages and types. Much less neuro compared to PM&R and much less ortho compared to ortho/PM&R. But you will be THE medical guru when it comes to athletes. Ok lifestyle depending on your practice mix. Pay is moderate.
4. IM: competitive to not competitive at all. Have a medical backbone like FM but get MUCH less outpatient exposure these days in residency in most places. Plus as mentioned never really take care of kids which is a minus for a well rounded sports doc. Lifestyle can be what you make it. Pay can actually be pretty high if you take hospitalist type jobs on the side.
5. EM: competitive to moderately competitive...in general, you have to actually be a decent candidate to match into any EM program. AWESOME at taking care of acute issues/injuries medical and MSK related, not so awesome at longitudinally taking care of patients (or at least not part of the core residency training at most places). Lifestyle and pay is what you make it depending on how many ER shifts you take on the side.
I for the most part ruled out IM essentially for that reason...no peds. I actually like kids, so I want kids in my practice and training. I'm torn between FM/EM/PMR. I have a few early EM rotations to help rule in/out EM, I have already done 2 months of family and it was OK, I have zero PM&R experience so that is what I feel like I need to do. Just sucks when you have hardly any time to see all the fields in medicine before making a commitment.
I'm def not trolling. I'm serious about everything I've written. I am really curious about PM&R. I guess my biggest drawback to PM&R is that from what I can tell it is a lot of rehab and not so much diagnosis or general medicine, if you will. Not sure though...?
Man thanks for that outline. That provides a nice overview. I do not like surgery, never have. That's why I can't do ortho. I like being with patients more and I don't have a surgeons attitude. EM was my goal all through med school but the shifts and crackheads are holding me back. FM seems like the best fit for me but I guess I'm just hesitant. PM&R interests me a lot but I have no experience in it and I'm afraid it will be hard to get much before it's too late.
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FM to SM here. Just got out of fellowship but I'll be doing both. Joined a FM practice. Pay is great. I'll have a better feel probably in a few months to see how my model of practice turns out..
Anyway I've come across med students such as yourself during my residency and fellowship. Love sports but do not want to do ortho. The advice I give them is to take sports medicine out of the equation. Would you be happy doing your primary specialty?
TXPMR pointed out great differences between the primary specialties going into sports med. Mind you the sports medicine board (which I took last week!) is the same board exam across ALL the specialties. In general IM does not do a lot of exposure to MSK stuff during residency, so FM or peds maybe the better option. That being said I know a SM doc who is Med/Peds trained lol.
Another thought that you should come across is what kind of sports medicine physician do YOU want to be? If you want to do pure clinic and do procedures, then PM&R is your answer.
Wanna handle the entire athlete besides MSK stuff? What about ADHD management of the collegiate athlete? The asthmatic track star? Or how to teach a HS basketballer how to manage their insulin pump during games? Do FM/IM/Peds. I've seen models of practice where the team physician is also the team PCP as well as backup ortho with the team orthopedist.
We all cover games as part of the fellowship, however being EM trained may get you the leg up in terms of emergency management on the sidelines, however by the end of the fellowship everyone's pretty much on par.
Now since you posted this in an FM forum, there are very competitive FM residencies out there that have awesome SM fellowships. If you decide the FM route, look for ones that have an SM fellowship as well, as this will get you the best exposure to sports medicine during your residency and will beef up your CV when it's time to apply.
Good luck in choosing a specialty!
Anyway I've come across med students such as yourself during my residency and fellowship. Love sports but do not want to do ortho. The advice I give them is to take sports medicine out of the equation. Would you be happy doing your primary specialty?
TXPMR pointed out great differences between the primary specialties going into sports med. Mind you the sports medicine board (which I took last week!) is the same board exam across ALL the specialties. In general IM does not do a lot of exposure to MSK stuff during residency, so FM or peds maybe the better option. That being said I know a SM doc who is Med/Peds trained lol.
Another thought that you should come across is what kind of sports medicine physician do YOU want to be? If you want to do pure clinic and do procedures, then PM&R is your answer.
Wanna handle the entire athlete besides MSK stuff? What about ADHD management of the collegiate athlete? The asthmatic track star? Or how to teach a HS basketballer how to manage their insulin pump during games? Do FM/IM/Peds. I've seen models of practice where the team physician is also the team PCP as well as backup ortho with the team orthopedist.
We all cover games as part of the fellowship, however being EM trained may get you the leg up in terms of emergency management on the sidelines, however by the end of the fellowship everyone's pretty much on par.
Now since you posted this in an FM forum, there are very competitive FM residencies out there that have awesome SM fellowships. If you decide the FM route, look for ones that have an SM fellowship as well, as this will get you the best exposure to sports medicine during your residency and will beef up your CV when it's time to apply.
Good luck in choosing a specialty!
Awesome man. Thanks for the post. I have my ER rotation in 2 weeks so I can rule it in/out soon. I'm leaning FM obviously since that's the thread I posted in but I'm also curious about PM&R. Again, just no real exposure to see if I like it or not. From the looks of it the PM&R residency is a lot of inpatient rehab, meetings with other therapist, etc. I don't know if that's what I want to do on my way to sports med. The most interesting thing to me about PM&R is the neuro/MSK knowledge and the procedures. Any PM&R sports guys out there care to shed some light?
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So --- just my $0.02 ---
During my FM residency, had an opportunity to rotate in an SM clinic during my ortho rotation -- this one had a "name" FM doc that had about 90% (if not 100%) of his practice as SM -- was the team doc to a pro sports team prior to taking a faculty position. In my experience, he did a lot of MSK exams, injections, and would order PT but that was the extent of it --- however, in the clinic there was an orthopod who also did SM and did everything the FM doc did but could also do surgical repairs when indicated...and was also doing some interesting concussion research ---
So this depends on what you want to do --- if you like being able to see patients, diagnose, inject joints, order PT and then if they need it, off to ortho -- go FM/SM
If you want to be able to do what FM does but also be able to get in and surgically repair when indicated, go Ortho
Since you mentioned "prestige" as an important factor to you --- I would lean towards ortho --- FM is not known for it's "prestige" -- about 75% of the other residents I ran into from other specialties considered us dolts and about 25% admitted that they couldn't handle having to know everything we knew to the level we knew it.....
But, a word of advice, --- in the end, prestige doesn't matter, neither does $$$ --- I know of more than one surgeon who has mucho dinero yet doesn't know their own kiddos and the wife is more of a trophy --- in the end, my choice of FM was not about prestige or $$$, it was about how my time was spent --- most, if not all, of the people I love and care about work or are in school from 8-5 M-F, so for me, that meant not having to move them for residency (I suffered in a real hellhole of a program) and being able to enjoy the weekends/holidays/evenings with them -- my family will be here long after I've hung up the stethoscope and with good financial management, we live comfortably ---
Yeah, you've worked your butt off to get where you are --- but ask yourself why? If it's only for you, ok; if it's to provide better for your family, find out what they'd be happy with? You kids will likely want time with you as will your wife -- and if they love you, does it really matter what other people think? i.e. "prestige"......
These are questions only you can answer ----
During my FM residency, had an opportunity to rotate in an SM clinic during my ortho rotation -- this one had a "name" FM doc that had about 90% (if not 100%) of his practice as SM -- was the team doc to a pro sports team prior to taking a faculty position. In my experience, he did a lot of MSK exams, injections, and would order PT but that was the extent of it --- however, in the clinic there was an orthopod who also did SM and did everything the FM doc did but could also do surgical repairs when indicated...and was also doing some interesting concussion research ---
So this depends on what you want to do --- if you like being able to see patients, diagnose, inject joints, order PT and then if they need it, off to ortho -- go FM/SM
If you want to be able to do what FM does but also be able to get in and surgically repair when indicated, go Ortho
Since you mentioned "prestige" as an important factor to you --- I would lean towards ortho --- FM is not known for it's "prestige" -- about 75% of the other residents I ran into from other specialties considered us dolts and about 25% admitted that they couldn't handle having to know everything we knew to the level we knew it.....
But, a word of advice, --- in the end, prestige doesn't matter, neither does $$$ --- I know of more than one surgeon who has mucho dinero yet doesn't know their own kiddos and the wife is more of a trophy --- in the end, my choice of FM was not about prestige or $$$, it was about how my time was spent --- most, if not all, of the people I love and care about work or are in school from 8-5 M-F, so for me, that meant not having to move them for residency (I suffered in a real hellhole of a program) and being able to enjoy the weekends/holidays/evenings with them -- my family will be here long after I've hung up the stethoscope and with good financial management, we live comfortably ---
Yeah, you've worked your butt off to get where you are --- but ask yourself why? If it's only for you, ok; if it's to provide better for your family, find out what they'd be happy with? You kids will likely want time with you as will your wife -- and if they love you, does it really matter what other people think? i.e. "prestige"......
These are questions only you can answer ----
Dang good post right there. I do not enjoy surgery like I thought I was going to upon entering school so ORTHO is out. I'm definitely a family-oriented guy. I would rather make way less money and be with my wife/kids than to be over-worked and make a lot of money. Most of my friends in school don't understand this but I enjoy spending time with my wife/kids more than going to the bar with my med school buddies or being in the OR for 12 hours a day. I too chose a nearby program for med school close to home because my wife's entire family is here and they are super close. I got offers elsewhere at better programs but turned them down. I want my wife to be happy and she has told me that she would rather me make 150K and be able to coach ours sons little league team and go to church with the fam on Sundays than to make a half a mil and go through a terrible residency and work all the dang time. Again it's just the voice in my head saying, "but you worked so hard to get to the top, do something big". I know that sounds stupid but honestly put yourself in my shoes back when you were in med school (#1 and Step >260). Would your mind have been a little mixed up with options? Please don't take me as arrogant. I think a total of 5 people know that I am #1 and scored well on Step 1. I hate praise or compliments. I guess in my case it is a blessing and a curse.
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It's hard to realize this as a young man (medicine is a 2nd career for me) but "doing something big" is the natural bent of all men -- you mentioned church so I hope this won't be too off tangent -- we were designed by God to "have dominion" and "subdue the earth" --- which is where you get your drive to "do something big" --- now, that can take many forms --- but in my opinion your first "do something big" is in setting the example for your kids by loving their Mom, being there for them to train them in the way they should go (not in the way they should not -- show them what to do and they'll be less likely to do the things they should not) -- and by setting the example of hardwork and provision for the family --- you can "do something big" in FM by being an excellent FM doc and making a positive impact on the community -- believe me, a good FM doc who sets up shop for more than 3 years and goes to the high school games, volunteers at local shelters with free physicals, works to get low cost meds to their indigent/poor populations, eats the cost of school vaccines, etc. will be "doing something big"....
I think the most rewarding thing that's happened to me professionally is when more than one of my patients has told a specialist to their face that they wanted "their doctor's" opinion on the proposed treatment plan -- and then came to me to discuss the ins/outs of that treatment plan -- I was honored with their trust ----
Remember, you only get one shot at this thing called life -- spend it wisely and make it what YOU want -- I chose my path early on --- holding my son and later my daughter within seconds of them taking their first breath was a blessing I can't describe -- being married to my wife for 26 years with all the good times and bad times together -- wouldn't trade it for anything ---
As the Knight Templar said to Indiana Jones --- "Choose wisely" ----
PM me if you want to chat some more --
Forgot to say -- EM is also a fun field -- Upside -- no patient continuity visits i.e. you don't have to titrate insulin, listen to complaints about toejam, etc. Downside -- to me - shiftwork -- I hate working nights/weekends for reasons mentioned in a prior post -- but I've got several good friends (in fact, one was #1 in their class, going FM and switched at the last minute to EM and is loving it) that are family oriented people that manage the shift work quite well -- they have strong spouses and make it work.....give it a close look -- but you won't get SM that I know of.....
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My program had a sports medicine residency, 2 fellows a year. They worked closely with the Orthopedics department and with Sports medicine FM attendings. The sports medicineFM doctors work solely in ortho and do not see FM patients - they are under the "ortho/sports medicine" dept, and are at those clinics as opposed to family medicine clinics. One of them is a concussion expert - sees NFL/etc players, and is active in extensive concussion research.
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Your situation is similar to mine except in one very important way: I have had the opportunity to get a lot of PM&R exposure in med school. I've been planning on doing PM&R since I started med school and have had the privilege to do elective rotations and go to some national conferences. I just got my scores, and got a much better score than I ever dreamed possible for me (still not quite a 260 though haha). Since hearing, I have definitely thought "geez, I could do anything now, am I ok with turning down options that others only dream of?" The answer has come again and again in the form of memories of my brushes with PM&R. I love the vibe I felt at the conferences. So many easygoing and fun people, in a noncompetitive & relaxed atmosphere. My shadowing experiences have surpassed anything I have seen in other specialties in terms of variety of cool procedures. The PM&R sports clinic I visited was way more in line with what I imagine myself wanting to do someday. And almost every day I shadowed Pm&r docs I was home to my wife by early afternoon. I didn't mind the inpatient side of it either. Most of the patients were spinal cord injury or brain injury patients, and any good sports doc would benefit greatly by knowing more about such issues. Someone recently said the average score to get into Mayo Pm&R was 240... the secret is getting out.
Man that's awesome. Congrats on the good score! I am jealous of your early exposure, it never really popped up until 3rd year for me and that exposure was limited. Are you interested in sports medicine after doing PM&R? I'm about to start 4th year and I have one open elective slot for October that I am going to try and set up with PM&R. Thanks for the post.
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Yes, sports med is the direction I see myself headed for sure. I don't have a strong interest in team sports, more along the lines of snow sports and getting weekend warriors back outdoors.
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look at the SM jobs that are out there and you will find most are through FM. It is very hard to find a pure SM job in PM&R and most involve seeing some amount of chronic spine pain and/or workcomp. It is really not possible to set up your own practice anymore so you will be tied to some institution and at their mercy for jobs. Back in the day when I chose PM&R I thought I would be in a small private group and be able to create my own practice and be my own boss. HA! If I could do it over I would've gone into ortho
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Gauss, you hit the nail on the head with my one outstanding major concern. Job availability. It sounds a bit bleak for someone who wants a job doing non operative sports med. I really don't like the surgery atmosphere at all, but if it means actually getting a job in the end... glad I still have a year to decide.
There are definitely jobs out there in non-op sports med. Whether its with ortho groups, sports groups, schools, multispecialty groups, etc. I think Gauss was just saying for PM&R there is not a ton of dream sports med only jobs where you are your own boss, team doc maybe, etc.
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I hope so. It would take a mighty bleak picture for me to forget all of the good experiences I have had and choose ortho over PM&R . Still, I definitely pause to listen when words of caution are uttered from those who have gone before. I know my first real job is still 7+ years away, who knows how things will change in that time.
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The SM job market is heavily FM, not PM&R, is what I'm saying. The landscape is constantly changing in ways you may not understand because med school is not reality. It used to be top heavy, patients start at ortho and then may trickle down. Now, it is way cheaper for non-ortho to take care of MSK. FM can win that pathway over PM&R, ED, and maybe even peds. Insurances, ACO's are pushing that direction.
Understandable, makes sense.
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One question I have about people's posts in this thread is the availability of free time as a FP. I too am considering FP strongly and have good scores, and like many here value my free time and family time above money or prestige. The one concern I have is that in my experience, from what I have seen, many FPs have no more free time than any of the specialists. They are increasingly burdened with bureaucratic bull$&**, paperwork, EMR training, etc. and are acting more and more like task managers. For those of you who went FP or those with extensive experience with the FP lifestyle, do you find that FPs do in fact have more free time? This is one area of debate for me as I begin my 4th year.
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At my first job out of residency, the office was open from 8:30 to 5, M-F. I never left later than 5:30. I took Wed. afternoon off, my partner took Friday, so we worked essentially 35 hour weeks. Realistically this was closer to 37, but that's still not bad. Our nurses did all the forms/paperwork/whatever and we just signed them. At my current urgent care gig, I work 12 hour days but only 12 of them per month. That means I get 18 days of not working.
By contrast, my wife is a hospitalist who averages out to 40 hours/week (12 hour days, 7on 7off). My father in law is an OB/GYN, and when he's not on call his days are the same length as mine were, 8-5ish. When he's on call though, he might get absolutely no sleep for as much as 2 straight nights (if weekend call).
The only "lifestyle" part that family medicine is missing is the money. Our schedules tend to be predictable (unlike ED), no inhouse call (unlike anything surgery), no nights (unlike hospitalists), no weekends. In exchange for that, a short residency, and not competitive residencies, we do make less than most. But, I know of very few family docs not breaking 200k within 5 years out and that's not bad money. Plus, we have the most job openings of anyone, possibly everyone. When I was thinking about leaving my current job, I found another one that could have me starting 7 days from the first phone call, and there were 2 more after that.
If you're dead set on sports, then FM would be the shortest and the easiest track to get there. The majority of sports fellowships are FM based fellowships, and with your score, you should get into a top FM residency, which will help you get into sports fellowship.
I don't think you should choose IM unless you're actually interested in IM and its fellowship options.
PM&R is 4 years vs 3 years in other specialties and you'll basically be spending 2-2.5 out of those 4 years working as an internist.
I've heard that quite a few EM docs work in the ER when they're young and do sports as they get older, but I don't know much about it myself.
Whether or not you'll make a good sports doc will depend on you rather than which specialty you choose. All of the above specialties provide good training for sports combined with the actual fellowship.
I don't think you should choose IM unless you're actually interested in IM and its fellowship options.
PM&R is 4 years vs 3 years in other specialties and you'll basically be spending 2-2.5 out of those 4 years working as an internist.
I've heard that quite a few EM docs work in the ER when they're young and do sports as they get older, but I don't know much about it myself.
Whether or not you'll make a good sports doc will depend on you rather than which specialty you choose. All of the above specialties provide good training for sports combined with the actual fellowship.
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Agreed --- While I've only been out of residency about 8 months, my first position had a required 1 weekend in 5 hospital call (admissions, etc.) but other than that was 8-5; I'm moonlighting urgent care and love it -- shifts are 6,9,12 hours depending on how you schedule them, 2 weekend days per month required to keep the position; otherwise, schedule what you want...if you want full time, you can do that also when the positions become available.
As far as openings --- I'm currently being recruited by 3 major hospital systems, locums recruiters, etc......Depending on the setup, if you want, you can be all in and follow patients into the hospital/ICU, etc....or you can be outpatient only and let the hospitalists/intensivists deal with it......
As far as pay? I'm making about 2.5 times as much as I made as an engineer with 17 years experience and I'm just starting out -- we had a comfortable lifestyle then and are doing just fine right now --- we have family time, can do spontaneous weekends away plus planned vacations, the job requires intelligent thought and I get my adrenaline rush fixation by doing extreme sports -- it's all good......
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I work 8-4:30 M-F as an outpt Family medicine in addition to urgent care work for a 2nd company. For my clinic I never have to go in afterhours or weekends. When I am "on call" it is just phone triage. For ER you will most likely be working "swing shift" unless you have "nocturnalist" who only do nights. A hospitalist wouldn't really go in to SM - but they often work a certain amount of days on then off (Example: 4 on, 4off or 7 on, 7 off) you may also work swing shift or 24hr shifts as a hospitalist unless there is a "nocturnalist".
Thanks for the great posts. Good information and insight from you all. I welcome more.
Seems like urgent care is a decent gig if you want to bring in the extra $. I honestly do feel FM --> SM is probably my best bet. Seems as though they make the best non-op SM docs and also have options to work as inpt/outpt, UC, academics, rural ED, etc.
Seems like urgent care is a decent gig if you want to bring in the extra $. I honestly do feel FM --> SM is probably my best bet. Seems as though they make the best non-op SM docs and also have options to work as inpt/outpt, UC, academics, rural ED, etc.
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You gotta get some PM&R exposure before you make this critical decision. I did 3 months of FM and it never really clicked for me. I got 2 weeks into a PM&R rotation and I knew what I wanted to do. FM is still a great background, and definitely the right choice for some. If it clicks for you, great. But if you're not sure, do yourself a favor and look into PM&R at least a little bit.
I do enjoy FM in the right setting. I like the FM docs who do some derm procedures and other minor office procedures to keep the variety. With that said, I am still trying to set up a PM&R rotation for this fall so I can get some exposure before deciding. Thanks for the post.
Oh and the poll has def narrowed it down to FM vs. PM&R but come on, look at the deadlock haha.
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i am a pre-med student also interested in sports medicine. i found this thread to be very informative. the sports medicine threads are dispersed all over the place on this website......wish more people would respond. i enjoy reading people's 2 cents and experiences in the field
Same.
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This is a great thread. I'm about to start M1. I like the idea of ortho and I think I'm interested in sports medicine (Yes, I've done a bit of shadowing to know I at least have an interest). But I have no idea if I'll be competitive or if I'll love the OR, and I do have a young daughter that I'd kind of like to actually see grow up...so its fantastic to see that there are so many paths to sports medicine. You guys rock. Is it safe to say that if you love everything about ortho, but prefer a bit more medicine, PM&R is a legit path to consider?
Bump. Need some PM&R people to comment on this.
There has been a small push for a sports medicine specific forum but unfortunately a bigger push back against this idea. I think it would be a great arena for those in different discipline to discuss sports med issues and for high school/college/med students to come learn more about the diverse field.
Part of the blessing and curse of PM&R is that we do a lot of different things in lot of different settings. The inpatient internist and PT/OTs may think physiatrists are all dispo king/queens because the main interaction they have with PM&R is inpatient consults and deciding dispos. The pain med anesthesiologist may think physiatrists are all needle jockeys like them. The pediatrician may think that physiatrists are all Botox needle jockeys and only see CP patients. The spine surgeon may think physiatrists are all non-op spine guys. The inpatient PT/OTs may think of physiatrists are all internists-light. The neurologist may think physiatrists are all electromyographers. Germane to this thread, the sports med orthopod may think physiatrists are all non-op sports med guys.
So, as a result the physiatrist can find him or herself in a wide variety of settings interacting with a wide variety of specialties. Some people love this and some people can't stand this.
As it regards to PM&R being ortho without the OR when it comes to sports medicine I'd say that's a fair comparison. MSK medicine training at PM&R and ortho programs is probably on par. The difference comes in what fills up the rest of the training time. For orthopods they need to learn how to operate (takes a lot of time). And for physiatrists we have to learn neurology, EMGs, SCI, TBI, amputee, interventional spine/pain with a greater emphasis on kinesiology and overall function of the patient.
This is opposed to FM/IM where MSK is not part of the core training at most places I've heard of. By core I mean emphasized in every single rotation and not just a stand alone rotation "sports medicine." Whether ortho guys are rotating on sports, shoulder, joints, trauma MSK medicine is emphasized. Much in the same way with PM&R residents rotating on spine, stroke, sports, or amputee...MSK is a core part of those rotations.
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I've always wondered why there isn't a specific forum for just sports med. It's multi-specialty, and it would be a great forum to exchange ideas off from other people/other specialties and med students/residents asking specific questions about SM. I know the AMSSM already has a listserv, which is very lively and educational I might add, but I think a SM specific forum would be beneficial as well.
I agree with a lot of what TXPMR stated above. It's good to have different viewpoints on how sports medicine maybe different coming in from other specialties. I do want to say though is that once you're in fellowship everyone learns the same thing! This is why it's multi-specialty. Everyone learns from each other's primary background. Of course this is excluding specialty specific fellowships (like Pedi only SM, etc), however the end game is that everyone takes the same board exam.
I also agree that in FM residencies MSK is not emphasized as much as other specialties such as Ortho and PM&R, however I would like to add that for the FM boards, musculoskeletal is almost equal weight in percentage with cardio and respiratory (9% Cardio, 10% Resp, 9% MSK). For the IM boards they combine Rheumatology and Orthopedics together into one category, with it being 8% of their exam, however looking at the ABIM breakdown only 1-2 questions pertain to actualy SM/ortho, and the rest are all rheum.
Now then again how well your MSK training is really dependent on the residency, so when anyone considers the FM --> SM route I usually recommend finding a residency with a SM fellowship attached to get a decent exposure to the field. If someone ends up at a residency with no SM fellowship, one has to be proactive is seeing as much sports medicine as possible. Remember SM and Ortho are required rotations in FM, so try to get as much as you can during the rotations, and opt to do more or even do an away rotation.
Wanting to do sports medicine is great (for once it's nice to treat healthy people, or people who are motivated enough want get healthier), but I can see why trying to choose which specialty to go to first is difficult. I've advised med students before who have had this predicament; one ended up deciding on PM&R, another decided to do FM. Also you may even change your mind in residency and decide to emphasize on something completely different! Life's crazy like that, but whoever reads this good luck in deciding what to do!
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I would agree with the above and add - residency is what you make of it, especially family medicine.
For example: I like doing procedures - and did them in my two sports medicine rotations, plus my own continuity clinic. In residency I ended up with +30 joint injections and +30 trigger point injections - yet other residents only had 1-2 injections in the 3 years.
