Confused by PM&R fellowships... been reading threads all day, but I have questions

[Thumpar]

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I'm a 2nd year DO student looking into PM&R and I really like what I'm reading. Sounds like a very diverse field that can be practiced very differently depending on what you want to do. I apologize for my ignorance in advance.

Fellowships are confusing the hell out of me. I get the concept in a nutshell: spend a year learning certain procedures that help you specialize in an area of interest, i.e. spine, pain, sports. Am I right in saying that only pain fellowships actually lead to higher salaries? Sport Medicine looks like you might actually get paid less (but hey, if you want to do sports medicine more than anything it's worth it, right?)

It also looks like there is a lot of overlap between spine fellowships and pain fellowships. Can someone with a spine fellowship practice pain medicine? I'm also getting the impression that if you become competent with these skills during your residency, you may not even need a fellowship at all to do them in your practice.

And if a fellowship is not ACGME accredited, then what is the point? You learn how to do new procedures, but are you "allowed" to do them in practice? Or some groups will let you and some won't?

Random salary question: PM&R seems like such a diverse field, so these mean salaries I look up feel a bit misleading. I know that this isn't a specialty to make big bucks, but I still want to know what is attainable as a physiatrist. I've read that many docs have a base pay plus "eat what you kill." If you're very busy and doing a lot of procedures what is possible to earn in a year? Looks like Pain fellowship can get up to 400-600k, but what about the other fellowships, or no fellowship at all?

Thanks!

 

[RangerBob]

I'm a 2nd year DO student looking into PM&R and I really like what I'm reading. Sounds like a very diverse field that can be practiced very differently depending on what you want to do. I apologize for my ignorance in advance.

Fellowships are confusing the hell out of me. I get the concept in a nutshell: spend a year learning certain procedures that help you specialize in an area of interest, i.e. spine, pain, sports. Am I right in saying that only pain fellowships actually lead to higher salaries? Sport Medicine looks like you might actually get paid less (but hey, if you want to do sports medicine more than anything it's worth it, right?)

It also looks like there is a lot of overlap between spine fellowships and pain fellowships. Can someone with a spine fellowship practice pain medicine? I'm also getting the impression that if you become competent with these skills during your residency, you may not even need a fellowship at all to do them in your practice.

And if a fellowship is not ACGME accredited, then what is the point? You learn how to do new procedures, but are you "allowed" to do them in practice? Or some groups will let you and some won't?

Random salary question: PM&R seems like such a diverse field, so these mean salaries I look up feel a bit misleading. I know that this isn't a specialty to make big bucks, but I still want to know what is attainable as a physiatrist. I've read that many docs have a base pay plus "eat what you kill." If you're very busy and doing a lot of procedures what is possible to earn in a year? Looks like Pain fellowship can get up to 400-600k, but what about the other fellowships, or no fellowship at all?

Thanks!

I don't know anyone making $400-600k. I know an inpatient physiatrist in the 300's, and a few pain physicians. I'm sure it's possible to get to $400k doing a lot of procedures/lot of hours, but $600k is definitely an extreme outlier for PM&R. I think to get that kind of salary you have to own your own practice and maybe still be doing some shady business and/or medicine, or just blatant fraud. More experienced physiatrists can chip in on that. I think the latest data AAPM&R put out showed the average to be around the upper $200's, which seems high to me (I hear most PGY4s getting offers around $180-$240k), but it included pain.

Regarding ACGME vs non-ACGME--some practices specifically want someone who did an ACGME fellowship. They may not hire you without the fellowship. You can't become board certified in a sub-specialty unless it's ACGME-accredited. Some residents opt for non-ACGME sports & spine fellowships because they do some wacky procedures and they typically get paid a lot more (you're often billing under your own name). Non-ACGME spine fellowships are also often very procedural focused, whereas pain medicine fellowships are going to be much more comprehensive (ie., clinic too).

I am not sure if any hospitals/ambulatory surgery centers out there will credential a newly-trained physiatrist who did not do a fellowship in interventional spine procedures. That just sounds inviting for a lawsuit when things go wrong. Many programs do a lot of interventional procedures, but I don't know how how confident/competent those residents really turn out with things other than MBB/RFAs, FJI's, lumbar epidurals, etc. And I don't know if you can get credentialed in those without advanced training.

I'm not so sure if sports pays less. If you do ultrasound guided injections you can make quite a bit. We had a part-time sports attending and she seemed to be doing quite well with the US procedures, Tenex, and normal clinic.

 

[RangerBob]

This is what I struggle with. It's so tempting to just pick anesthesia and start making 350k in a mommy track job that's 8am-4pm four days a week straight out of residency.

It would be great to make that kind of money, but $200k still isn't too shabby. But if you would be happy in anesthesia, $350k and a 4-day workweek sounds great!

 

[j4pac]

Problem is I like pm&r's subject matter more. PM&R's leadership dropped the ball in proving the field's worth. Specialists trained for 4 years shouldn't be getting paid so low. Do you see the field rising in compensation in the future?

I love the field, but the income is something that really hard to get past.

PM&R physicians aren’t on the street corner begging for change. Considering the hours...they are fairly compensated. You won’t live in a mansion and drive a Ferrari. You have to figure out what’s important to you. If you want to make money...there is nothing wrong with that...there are professions that make more than PM&R.

 

[RangerBob]

Problem is I like pm&r's subject matter more. PM&R's leadership dropped the ball in proving the field's worth. Specialists trained for 4 years shouldn't be getting paid so low. Do you see the field rising in compensation in the future?

I love the field, but the income is something that really hard to get past.

I agree with J4Pac--we get paid quite well for our hours. I like what I do, and would take PM&R over a job I didn't like that paid double. If all things are equal, go for the higher paying job, but otherwise I think it's best to spend your life doing something you enjoy.

I have no idea if income will drop or go up. We could say the same thing about every field. Unfortunately there is no certainty in income in any field. One could argue PM&R salaries will go up (both for MSK/pain providers and inpatient/traditional outpatient rehab providers) with the aging baby boomers. But almost every field can make that argument. And with an aging population comes higher healthcare costs--> more incentive for the gov't to figure out a way to bring down costs, which may mean cuts to physician salaries.

I thought a lot about all that as well as how I was going to pay off my loans (undergrad + full COA from a private med school), and I still chose PM&R. If you've never had a job you hated, you don't know how much that saps the energy out of your life. That kind of dissatisfaction also has a tendency to follow you home and affect your relationships with those you love.

 

[Doctor Christmas]

This is what I struggle with. It's so tempting to just pick anesthesia and start making 350k in a mommy track job that's 8am-4pm four days a week straight out of residency.

I don't think you'll be making 350k 8-4 straight out of residency in the mommy track. A starting salary of 300-350k is roughly what an anesthesiologist taking call is making. Thinking you'll make the same will make you very disappointed. Think about 200's and I think you'll be more in the range of mommy track salaries. Why do you think they call it that?

 

[j4pac]

To my knowledge...Derm is the only profession that pays generously with easy work hours. Otherwise, you get paid by working your butt off. There are some that pay more than others...but I’d imagine that the easy money concept is a delusion more often than not.

 

[Thumpar]

Random question, since I'm making too many threads. If you do a residency that offers a fellowship you are interested in, do you have an edge when applying to it?

 

[j4pac]

Random question, since I'm making too many threads. If you do a residency that offers a fellowship you are interested in, do you have an edge when applying to it?

If you’re not a crap resident...absolutely

 

[Thumpar]

Thanks everyone for your thoughts, I appreciate all the information.

If I can keep badgering you all:

Categorical vs Advanced programs. Is there an advantage to one over the other? I see there are a lot fewer categorical spots, is that because it's less desirable? I would think it would be nice not to uproot my family somewhere for a year of intern year and then move them again for an advanced residency. I'd rather stay put if I could help it, unless it's disadvantageous to my future.

I've read elsewhere that preliminary surgery might be beneficial if I wanted to do a fellowship in spine or pain, since you spend more time doing procedures (depending on the program). That kind of makes sense to me. I'm also interested in surgery, and maybe after a year of preliminary surgery I'll decide I can't imagine doing anything else and so that door will still be open. (currently heavily leaning towards the lifestyle balance of PM&R though). Can anyone draw some new blood on that idea?

 

[Mr Kenobi]

Thanks everyone for your thoughts, I appreciate all the information.

If I can keep badgering you all:

Categorical vs Advanced programs. Is there an advantage to one over the other? I see there are a lot fewer categorical spots, is that because it's less desirable? I would think it would be nice not to uproot my family somewhere for a year of intern year and then move them again for an advanced residency. I'd rather stay put if I could help it, unless it's disadvantageous to my future.

It is my understanding that categorical programs generally are more desirable and are notoriously more competitive for exactly the reasons you say you'd be interested in them. There are less categorical spots largely due to cost to the programs.

 

[lobelsteve]

Hi.

 

[Thumpar]

Hi.

I've been going DEEP down a PM&R/Pain rabbit hole this whole week. I've read hundreds of your comments.

This is like meeting a celebrity.

 

[lobelsteve]

600 is doable. Acgme pain fellowship. Do the work, study hard, be nice.

 

[Thumpar]

600 is doable. Acgme pain fellowship. Do the work, study hard, be nice.

Dr. Lobel, can you tell me your opinion on the future of "regenerative medicine" or so-called interventional orthopedics? I get the impression that right now it's maybe promising, but very unrefined. It sounds like it's being very heavily marketed and there are a lot of dubious people trying to make a quick buck with questionable methods. It also sounds like there are people offering more legitimate treatments that are very promising.

Maybe it's the wild west of regenerative medicine right now, but by the time I get out of residency/fellowship (7 years from now) I'm thinking it could be a much more established field. Is it a good idea to gravitate towards this stuff, or am I just getting suckered from all the marketing like everyone else?

 

[lobelsteve]

Currently it is at proof of concept. Offering the procedure for cash is a money grab, preying on false hope. Nothing more than a study with n=1 for each patient.

Better study designs and standardization of protocols to allow multicenter RCT under an IRB would be a big step. But the folks out there now are happier to take 4 to 8 grand per sucker, err, patient. For now.

 

[Bostonspine]

Fellowship credentials are most important if you are solo... I am so Spine, have friends who are sports and pain acgme if you work in group practice you’ll get privileged. The solo guy completing with the anesthesia/pain group will have a hard time but the fellowship makes it easier. At the end of the day the suits care about malpractice coverage and facility fee. In my hospital neuro-radiology, PMR Spine, PMR Pain, Anesthetia with and without fellowship do Spine procedures. In the community Ortho Spine and Neurosurgery do injects after weekend course. The codes bill the same for all specialties

 

[Bostonspine]

In real life after residency you get payed for what you do in relation to payer mix. If you do procedures they pay more than office visit.doesn’t matter if it’s RVu or collects if you work hard and have a good payer mix. Spine/pain procedure pay more than Sport procedures which is more than General PMR.