2 questions

[SportsMed09]

I was wondering if people could tell me or refer me to sources for these answers


1. Where can I find out how good of a job market certain cities are? I plan on practicing in San Diego, but I don't know where to look to see how saturated it is with physiatrists or how many jobs there are/income/etc. Is there somewhere I can go to find this out for other cities too?

2. I was wondering if anyone remembers who posted in the past about their experience doing research in private practice. I tried searching but couldn't find it.

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[PMR 4 MSK]

I was wondering if people could tell me or refer me to sources for these answers


1. Where can I find out how good of a job market certain cities are? I plan on practicing in San Diego, but I don't know where to look to see how saturated it is with physiatrists or how many jobs there are/income/etc. Is there somewhere I can go to find this out for other cities too?

2. I was wondering if anyone remembers who posted in the past about their experience doing research in private practice. I tried searching but couldn't find it.

For 1 - when you get into residency, you can joint the AAP&M and you'll get a book with everyone in the academy and it is available on the AAPM&R wesite. (I think it will be or has transitioned to only online on the AAPM&R website). You might be able to look it up now http://www.aapmr.org/. There are a bunch in San Diego. Compare that to the city's population (have to look elsewhere) as well as those in surrounding towns/suburbs, and you'll get an idea of how many physiatrists/population there is.

The red journal lists many physiatry jobs, or did, I think that has transitioned to the purple journal now. Salary data is available by region, from many websites, but you'll have difficulty finding reliable data for a city, due to too few docs to make data colleciton reliable. There are numerous MD employment websites, mostly populated by head-hunter listings. Most docs here believe word-of-mouth is the best way to get your desired job. Talk to people and find out who they know and can help you when the time comes. Your attendings in residency will often have many contacts from former classmates and attendings, as well as other Academy contacts. The academy website also lists jobs for members only.

 

[Ludicolo]

For 2 - http://forums.studentdoctor.net/showthread.php?t=584323

 

[SportsMed09]

I'm a student member of the AAPM&R, and have looked at the physiatrists listed in San Diego and the surrounding areas (roughly 50). Honestly, I find it hard to believe there are only 50 or so physiatrists in the San Diego area.Then again, the membership of the AAPM&R compared to the total # of physiatrists has been listed at 85%.
I've looked at the job board as well as the classifeds in The Physiatrist, and there don't seem to be alot of jobs in that region. I guess you can tell my approach to practice at this point in my life for the future, and was also wondering if I should wait until I actually get into residency, vs. doing anything more actively to research this.

 

[Disciple]

Physiatry is relatively unknown in San Diego. Not much awareness.

You'll probably have to call yourself "Pain Management" there.


Even then, it's a tough market.


I saw a listing on the job board at the AAPMR annual meeting this past November, for a position in San Diego with a Interventional Pain Group.

It said something like "Those not willing to work extremely hard for a minimum of 2 years need not apply".


In other words, "We're looking for a new grad to abuse with narcotic refills, call and hospital consults, in beautiful San Diego. If this describes your ideal position, give us a call".

 

[SSdoc33]

Physiatry is relatively unknown in San Diego. Not much awareness.

You'll probably have to call yourself "Pain Management" there.


Even then, it's a tough market.


I saw a listing on the job board at the AAPMR annual meeting this past November, for a position in San Diego with a Interventional Pain Group.

It said something like "Those not willing to work extremely hard for a minimum of 2 years need not apply".


In other words, "We're looking for a new grad to abuse with narcotic refills, call and hospital consults, in beautiful San Diego. If this describes your ideal position, give us a call".

hey hey!!!! try not to make him (her) too jaded. let him/learn that in residency like the rest of us did

 

[drvlad2004]

I remember seeing a listing of a 2 PM&R positions in San Diego but it was back in November. One was at the VA and another was peds physiatry. I tried looking at positions in Cali. It is saturated. Most of those positions available were in the Central Valley and Sierra Nevada, where the population is much smaller. It was disappointing that I hard time finding a position in the Bay Area. Well, I will be glad to come back to NY once I am done with fellowship. I will also miss Fort Wayne at the same time.

 

[SportsMed09]

That sounds pretty depressing. I actually don't plan on going into Pain, simply because I've had plenty of experience with pain type patient while in medical school. and I don't find that to be the best fit for me. Wouldn't being a sports medicine physician in San Diego work well, especially considering that there is a sports board to take now for ACGME accreditation?

 

[Llenroc]

Is there really that much work for "sports medicine" doctors? How many real "athletes" are there in this fat sedentary country , and how often do folks get injuries that need more than Ibuprofen and less than surgery to fall within the range of non-surgical "sports medicine"?

One guy I talked to said professional sports teams prefer to go to the orthopedic surgeon for perceived superiority. Family Medicine Sports Medicine doctors tend to do mostly Family Medicine.

 

[axm397]

most major cities are saturated for many of the specialties including places like LA, San Diego, San Fran, Chicago, NYC, etc. etc.

if u are brave and have business skills - can open your own practice. There's definitely a lot more hustling out in the "real world" than I would have imagined in med school.

your best bet is to shadow physiatrists in the san diego area - look for docs who are doing what you would want to do, keep in touch with them. a friend of mine did that in denver - rotated with a group as a student, then got a job with them after residency.

Many groups in high demand locations will fill before they even need to place ads, etc. it's all word of mouth for the more desirable areas - and it's also your own marketing - one guy i know approached an ortho group and told them what he could bring to them - told them he would take a low base the first year to lower the risk for the group in exchange for equal partnership (if successful within a certain timeframe) and fair expense sharing arrangement. He's doing very well in a very desirable so cal location. oh and he is doing research also - getting industry funding to do some interesting spine research

 

[Disciple]

That sounds pretty depressing. I actually don't plan on going into Pain, simply because I've had plenty of experience with pain type patient while in medical school. and I don't find that to be the best fit for me. Wouldn't being a sports medicine physician in San Diego work well, especially considering that there is a sports board to take now for ACGME accreditation?

Desireable areas generally have an abundance of Sports Orthopods, who have been in the area for a long-time, with impressive credentials. Generally speaking, most of highschools and community college teams will be spoken for.

There are usually enough Orthos that they have to divide up the Sports Med volume amongst themselves.

That leaves little for Physiatrists, unless you work for them.

If you do that, take your chances with potential partnership.

You'll have to produce revenue on par with theirs (Lots of epidurals, EMGs and newpts that are referred specifically to you, not their hand-me-downs).

Starting out on your own in these locations is tough.

You may not eat for a while unless you're moonlighting in an inpt rehab unit.

 

[Finally M3]

San Diego is very saturated. I think most of the desirable locations in California are saturated for EVERYTHING, let alone PM&R.

 

[drusso]

Agree with everything above. It's too bad that more attention is not given to marketing and "hustling" in our training.

 

[RUOkie]

Agree with everything above. It's too bad that more attention is not given to marketing and "hustling" in our training.

Back when we could moonlight, there was. That is where the 90hr work week went wrong. No one in any specialty learns to hustle anymore. In rural/semirural areas, you can't practice without it. We can't find doctors to come to this kind of area (it is not glorious like San Diego!) because once new grads find out how hard they have to work, they say no way.

Remember, that when you first get out of training you will be working very long hours. If you go to a lower cost of living area while you are learning your trade, you can pay off your loans and start banking money sooner. Then you can vacation/retire wherever you want. Or, you can get a job somewhere, learn to be a good doc, and become more marketable. Then, when a job comes up in your dream location (or when you are comfortable hanging a shingle), you will be more likely to get it.

 

[Ludicolo]

Back when we could moonlight, there was. That is where the 90hr work week went wrong. No one in any specialty learns to hustle anymore.

100% agree. This cuts across all specialties, not just PM&R. And in all self-flagellating honesty, academic physicians in general are probably not the best qualified to be providing private practice job search advice. Some of us try our best to keep a pulse on things, but most are unfortunately quite out of touch.

 

[SportsMed09]

Does anyone know any sports/msk physiatrists in San Diego, Miami, LA, Austin, or even Seattle who'd be willing to talk to me? I know that goes beyond my original question, but they are all cities that I am interested in practicing in with my fiance's career in mind as well.

 

[Finally M3]

Does anyone know any sports/msk physiatrists in San Diego, Miami, LA, Austin, or even Seattle who'd be willing to talk to me? I know that goes beyond my original question, but they are all cities that I am interested in practicing in with my fiance's career in mind as well.

PM Axm

BTW all those cities on your list will have similar problems with oversaturation like San Diego

 

[SportsMed09]

I figured as much, but it seems like the best way to find a good job in a saturated city is to network. Isn't that why they have the job fair at the Annual Assembly?

Another question I had related to everyone mentioning hustling. I'm assuming this is the general idea of marketing/networking/getting your name out there? If so, any good stories to share?

 

[RUOkie]

I figured as much, but it seems like the best way to find a good job in a saturated city is to network. Isn't that why they have the job fair at the Annual Assembly?

Another question I had related to everyone mentioning hustling. I'm assuming this is the general idea of marketing/networking/getting your name out there? If so, any good stories to share?

http://forums.studentdoctor.net/showthread.php?t=607210

This thread has some stories. The key to building a practice is to let everyone know you are HUNGRY!. Work hard, get to know the primary docs, ortho, neuro, and neurosurg. Ask questions, if you see something weird, call them! Fax handwritten notes to referral sources on the day you see the patients. Get good quality transcription and send every note to the referral source. Do real good EMG's. Never schedule an EMG for later than 2 weeks, you will lose it (ie, if you are booked out for 2 weeks, work later or on Saturday!) If you are in a city with a lot of competition, schedule office hours late (till 7-8pm) and on Saturday a few times a month (you will get working people!). Make sure that your front desk is friendly to the other offices, and acts like he/she likes the job or is personally invested (I'm lucky, my wife runs my office so she is really invested) In other words work hard, and let the other docs know you are willing to work hard. Be creative.

 

[RUOkie]

double post

 

[RUOkie]

triple post

 

[goodandplenty]

I'm just a medstudent and may not know much. As a medstudent from CA and in a CA medschool from what I here from my PM&R attendings, they say that you would have to either do residency of fellowship in CA to get a decent job in CA. The ones posted are usually not desired by the local PM&R docs.

 

[RUOkie]

I'm just a medstudent and may not know much. As a medstudent from CA and in a CA medschool from what I here from my PM&R attendings, they say that you would have to either do residency of fellowship in CA to get a decent job in CA. The ones posted are usually not desired by the local PM&R docs.

Not true at all.

I did my training in Houston. In the year before me 2 out of 12 residents got jobs in CA. In my year, 2/14 ended up in CA. and the year after me, 3/14. Granted, BCM has contacts everywhere. It is always easier to get a job in a location where you did your training, but some places want new blood, or top programs (RIC/Washington/Kessler/BCM)

 

[goodandplenty]

Not true at all.

I did my training in Houston. In the year before me 2 out of 12 residents got jobs in CA. In my year, 2/14 ended up in CA. and the year after me, 3/14. Granted, BCM has contacts everywhere. It is always easier to get a job in a location where you did your training, but some places want new blood, or top programs (RIC/Washington/Kessler/BCM)

I agree, I think coming from any big name program with good connections will get you a job any where and that would probably be true for any specialty. Otherwise, I think things would be harder as the point I think my attendings were trying to make. (though, one of the attendings who told me about the CA job outlook trained at RIC)

 

[axm397]

in the highly saturated areas you probably have to know someone to get a job there. Alums are a good way, networking is also good. Recruiters usually don't work well and neither do answering ads.

It's tough to get into a saturated area - I know at UCLA every year most of the residents want to stay in the LA area - yet they find it difficult to do so. The ones who have succeeded were in the right place at the right time or knew the right people.

I think a lot of residents have been practicing delayed gratification for so long, that they have the illusion that when they get out of residency, they are finally going to only have to answer to themselves, make a lot of money, and land a dream job in the dream location. When reality hits, many get bitter, others give up, and some keep trying.

It really depends on how committed you are to going to an area - are you willing to be unemployed for months? are you willing to get paid very little? are you willing to work for people you don't like? are you going to cross some ethical boundaries? are you going to work weekends, early mornings, and late nights? are you willing to travel? Hence the hustling - need to work harder than during residency - especially during the first years.

It's rare to be able to get the dream job doing what you want, getting paid what you want, and in a location where you want. (trifecta) you usually have to compromise on one or two of those factors.

 

[MSKalltheway]

One guy I talked to said professional sports teams prefer to go to the orthopedic surgeon for perceived superiority.

That may be true, but I've had the head of the orthopaedic sports fellowship here tell me that he would love to have a Sports Med Physiatrist on his staff. He explicitly stated that it would allow him to be in the OR more and he wouldnt have to worry about another orthopod he hired to take his caseload from him.

Though, I dunno how much "clean up" work that would involve.

 

[ampaphb]

That may be true, but I've had the head of the orthopaedic sports fellowship here tell me that he would love to have a Sports Med Physiatrist on his staff. He explicitly stated that it would allow him to be in the OR more and he wouldnt have to worry about another orthopod he hired to take his caseload from him.

Though, I dunno how much "clean up" work that would involve.

Ask him how much he (or the Department/Institution) is willing to pay for some to fill that position before you get too terribly excited.

 

[MSKalltheway]

Ask him how much he (or the Department/Institution) is willing to pay for some to fill that position before you get too terribly excited.

Oh, trust me, that's the first thing I was thinking. Just one of those things a student is afraid to say aloud...

 

[Disciple]

I think a lot of residents have been practicing delayed gratification for so long, that they have the illusion that when they get out of residency, they are finally going to only have to answer to themselves, make a lot of money, and land a dream job in the dream location. When reality hits, many get bitter, others give up, and some keep trying.

 

[Disciple]

That may be true, but I've had the head of the orthopaedic sports fellowship here tell me that he would love to have a Sports Med Physiatrist on his staff. He explicitly stated that it would allow him to be in the OR more and he wouldnt have to worry about another orthopod he hired to take his caseload from him.

Though, I dunno how much "clean up" work that would involve.

Again, that goes back to you having to work for the surgeons.

I attended a Sports Med football conference this past week, with most of the lectures given by team docs (mostly Orthopods) for various NFL teams.

Being a team physician at that level requires alot of in-depth/detailed discussion and prognostication about various injuries and the decision whether or not to operate and what surgical approach should be used, taking into consideration the team's immediate situation, the players career, the player's age, etc. These discussions are often going to include the player's agent, the General Manager and the player's family.

Team physicians are asked to attend pre-draft workouts (e.g. NFL Combine) and estimate the risk a team will be taking by drafting particular players with previous injuries.

Save for a few Physiatrists in the entire country, we are not really qualified to do this.

As has been said a million times before, If we really want establish ourselves as the non-operative musculoskeletal experts, we need more uniform MSK training, more in-depth knowledge of Orthopedics, better procedural skills, etc.

 

[Disciple]

I'm just a medstudent and may not know much. As a medstudent from CA and in a CA medschool from what I here from my PM&R attendings, they say that you would have to either do residency of fellowship in CA to get a decent job in CA. The ones posted are usually not desired by the local PM&R docs.

What do you mean by a "decent" job?

High starting salary? Short Partnership tract?

Connections and training in a competitive geographic region might give you a few more leads and ultimately that first job, but this does not necessarily correlate with a higher income.

You can't change the medical economics of competitive areas.

These locales will have alot of specialists (some within your specialty), well trained, with alot of experience, who will likely duplicate alot of the services you have to offer.

Physicians in these areas have to work that much harder to maintain a volume comparable to other areas.

Saturated geographic locations typically have high HMO penetration, futher decreasing average income.

All these factors have an impact on how much a group is able to offer a new graduate, and the potential for partnership.


There are sacrifices to be made if you want to live where alot of people want to live.

 

[goodandplenty]

What do you mean by a "decent" job?

High starting salary? Short Partnership tract?

Not clear to what they ment by "decent". Just what I've heard. It was the impression I consistently got after asking my attendings about the CA job market. I didn't even know what to ask about what made a job "decent" at the time I was asking around.

 

[ampaphb]

High salary does not necessarily equate to a decent job. You need to be VERY careful that high salary does not not equate to a mill. Another of my favorite Aprill aphorisms is "You can either eat well OR sleep well". Personally, I would chose the former.

 

[drvlad2004]

Not clear to what they ment by "decent". Just what I've heard. It was the impression I consistently got after asking my attendings about the CA job market. I didn't even know what to ask about what made a job "decent" at the time I was asking around.

Yes "decent" is a vague term. Salary isn't the true deal breaker. Reading through a contract CAREFULLY and thoroughly and having others read it, especially a lawyer, helps give you a better sense if this job may be right for you. When looking and interviewing for positions, it felt like an intimidating experience, especially for me looking to come back to the saturated NY tri-state area. As an interventionalist, I got concerned about how working with another practice outside of fellowship may alter the things that I am learning and doing now during fellowship. Having the flexibility and independence of creating my practice soon after fellowship was a major factor when applying for certain jobs. I guess it comes down to if this job is the right fit for you and your goals.

As ampaphb said, be careful with mills. We all need to achieve profit to make a living in the field but having a reputation of running a mill is not a good look early in any anyone's career.

 

[Llenroc]

I'll take any job for $150,000.

 

[Ludicolo]

It's rare to be able to get the dream job doing what you want, getting paid what you want, and in a location where you want. (trifecta) you usually have to compromise on one or two of those factors.

I would add a 4th factor to consider: Whom you work with. Not meshing with your co-workers from a personality standpoint can seriously affect your work QOL.

 

[axm397]

I would add a 4th factor to consider: Whom you work with. Not meshing with your co-workers from a personality standpoint can seriously affect your work QOL.

Agree - that's the main reason why I chose my job. I really liked the people in the group - even the surgeons!

 

[AviatorDoc]

I went to college in San Diego. My wife is from there, and I'd absolutely love to go back, but it's just not realistic.