Llenroc

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I have 1.5 years left in my residency. I'm not looking to do a fellowship at this time. I don't plan on staying permanently in whatever job I take immediately after residency. I want to work a few different jobs I guess and see what things I really like, what locations I really like, before I get real serious about building a practice, if that makes sense.

Initially I was planning on any inpatient or outpatient job, but I'm worried that I may lose procedural skills on the inpatient side. That and lifestyle considerations have made me look at the outpatient side moreso.

One particular location that I'm interested in does not have many job listings as far as I can tell. However, I do notice that in this city there are a number of orthopedic groups with only surgeons. Do you think it might be worthwhile to contact them to see if they would want to hire a PM&R doctor to screen their referrals, do the conservative management, do the knee/shoulder injections, do the EMG's, before surgical referral? Also, by looking into this now is it too soon? Also, I will not be fellowship trained. Do the orthos have a strong preference for sports or spine fellowship trained folks?
 

PMR 4 MSK

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First, I would not tell anyone about your first paragraph.

Consider doing Locum Tenens for a while out of residency. There's usually a need for that.

You can contact the ortho groups, but most are like teenagers - they know it all, and can't be reason with. Plus you have nothing to offer them, especially not a lowly Physiatrist ;).

The smart ones have figured it out for themselves - PM&R = less time for them in the clinic, more time for surgery, in-house EMG, increased revenue from injections, new patients to clinic, etc.

Now would be an ok time to start sending out some feelers - contacting the lead physicians in groups.
 
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Llenroc

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Job market is not looking that great for musculoskeletal PM&R. Lots of inpatient "medical director" jobs are listed.



There's a number of pain medicine jobs listed, though down sharply from a few years ago. Not many listings for general outpatient PM&R.
 

RUOkie

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Job market is not looking that great for musculoskeletal PM&R. Lots of inpatient "medical director" jobs are listed.
There's a number of pain medicine jobs listed, though down sharply from a few years ago. Not many listings for general outpatient PM&R.
That is because most of those "jobs" are self made. Many of the "medical director" positions out there are smaller rehab units looking for someone to run the unit. The med director stipend helps to supplement your income.

I came to my current community 7 yrs ago as the "medical director". My office practice is primarily MSK (no fluoro) with some spasticity/prosthetics stuff too. I am no longer the med director, but still do some inpt (my office hrs are 8:30-5, 4 1/2 d/wk). Any inpt stuff is done either before or after office hrs.

Having the inpt stuff allowed me to grow my practice slowly. It was a very nice cushion.

Most orthopedists and neurosurgeons have absolutely no idea what you can do. They also don't care, unless you can improve their outcomes or their bottom line. There are also enough bad physiatrists out there, that many have never seen what you know/can do. You have to prove it to them, and that takes time.
 

axm397

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Most good jobs are filled word of mouth. With 1.5 years left, you have nothing to lose by contacting these groups and getting some feelers out. Talk to your residency faculty members and ask them about their contacts in certain locations. Look into alums from your program. If you can somehow create some degree of connection to a group, they will trust you more and you'll be screwed less. (i didn't say no screwing :laugh:)

having strong references are key if you don't have that personal "in" so make sure you don't piss anyone off in your residency and identify the few people who you can count on as good references who will go to bat for you. (and make sure they are quick responders too) polish and update your CV and write concise but memorable cover letters that highlight your strengths and unique abilities.

orthopods could care less about fellowship training. its all about what you can do for them and how you can make their life easier. do some research on the groups, find out about the patient population in the city, figure out the needs of the group. offering to "screen" patients may not be the best approach in some groups because some practices make $$ off E&Ms with the associated ancillaries and not as much from cases if done in OR at hospital. other groups may want you to "feed" the surgeon. some of your choices will depend on how badly u want that location, how much u r willing to compromise, your ethics, your need for autonomy, and your practice style.

if you are as certain as you say you are about not wanting to stay at your first job, then i would make sure your exit strategy is set and strong. look at contracts and explore issues like tail coverage (depends on market), non-compete/solicitation (depends on location), if you could owe $$$ back to group if you don't stay for a certain length of time or make a certain amount of $$$, what happens to AR when you leave, and cause vs no cause termination terms.