As a person currently going through the job hunt season, I think have some experiences on how the job outlook is.
Overall, lets just say you have to be very flexible in where you want to practice. Popular MAJOR metropolitan cities(such as Boston, New York, Chicago, Seattle, and all of COASTAL CALIFORNIA) tend to be much more competitive in gaining a job. And because of the supply/demand philosophy, many don't pay well in relation to the cost of living. You will likely make a decent salary, but owning a nice house will be difficult. Think Condo living. Even then, it wont be water(or even near water). Having two incomes would definitely help in getting a house.
There is a rather well known HMO in California that hires PM&R every year. The job benefits are good, and the pay isn't too bad(when you count the benefits). The competition is fierce though. You are applying against many of the residents that did their residency in the California area, as well as all the newly graduating residents that want to a)come back home b)want to try out living in California.
Because our field overall is relatively new, many of our predecessors are not quite at that ready age for retirement. And because PM&R is not a stressful job environment, there is a low attrition rate. That makes for even greater competition in the work force. And it's definitely true that which city you do your residency, you will have a tendency to practice there. A quick look at area hospitals and physician web pages and you will see that many of them did their residencies in that area. This has been especially true in the NYC/NJ/PHILLY/SEATTLE areas. And this may largely be a consequence of programs in those cities historically having very large residency classes(6-12/yr).
The South and Midwest continue to be untapped resources for jobs. Many job recruiters will inundate you with job opportunities in these areas daily. Some in major cities, most in midsize cities. If this is your destination, you'll have no problems.
Pain has become a lucrative addition to many practices. Ortho/Neurosurg practices and hospital groups, are now starting to add up the numbers and realize how much money they lose on referring out for epidurals, and other interventional procedures. So, being a MSK/Pain physiatrist is becoming increasingly popular in these groups. One thing that allows people to stand out against many applicants(regardless of how much "experience" they received in residency) is fellowship training. One that is trying to recruit me stated that he received many responses to his job posting, but many did not complete a fellowship. It does make a difference. Another specifically asked me if I would be getting Board Certified in Pain Medicine. For many(including academic positions) it matters, for some...not so much.
