Examples of life in practice in PMR

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PorcupineDoc

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Hello, I'm a MS3 and i've been looking into PMR for over a year. Have a lot going for me in that regard and recently did my first elective rotation in PMR.

The doctor I was with is kind of slowing down so we really just did EMGs 4 days a week plus some new patient visits. I also got to see a couple baclofen pump refills and botox injections plus a little small part of inpatient rehab. So i'm just curious what a day in PMR is filled with if you aren't doing any EMGs and such.

So with this thread I'm just asking for good and varying examples of what your day practicing PMR in clinic or inpatient is like. I feel like my rotation didn't give me the overall "fall in love with the specialty" feeling I was hoping for and I think it might be because the scope I saw was so limited.

I'm sure this post is redundant and gets asked a lot, but I'd really appreciate some help.

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I do sports/spine (mostly spine at this point). My weekly breakdown:
M/W/Th: 0800 start | 20-25 patients per day random mix of new/est patients, EMGs, US procedures, PRP.
Tu: 0800 start | 10-15 patients in AM with 5-6 fluoro procedures or 1-2 MILD procedures in PM.
F: 0745 AM start | 15-20 fluoro procedures (ESI, MBB, RF, SIJ, etc.)

Goal to have around 90-100 patient encounters per week, 20 fluoro procedures, 5 EMGs, 15 US procedures. Finished most days anywhere between 1400 to 1600.

When I was university team doc I had the above schedule + training room from 1600-1800 3 days per week along with covering games for football, soccer, basketball, and various meetings. Still do some high school football but that is only a handful of Friday nights.
 
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I do sports/spine (mostly spine at this point). My weekly breakdown:
M/W/Th: 0800 start | 20-25 patients per day random mix of new/est patients, EMGs, US procedures, PRP.
Tu: 0800 start | 10-15 patients in AM with 5-6 fluoro procedures or 1-2 MILD procedures in PM.
F: 0745 AM start | 15-20 fluoro procedures (ESI, MBB, RF, SIJ, etc.)

Goal to have around 90-100 patient encounters per week, 20 fluoro procedures, 5 EMGs, 15 US procedures. Finished most days anywhere between 1400 to 1600.

When I was university team doc I had the above schedule + training room from 1600-1800 3 days per week along with covering games for football, soccer, basketball, and various meetings. Still do some high school football but that is only a handful of Friday nights.
Thank you I appreciate it. Exactly what I was looking for. Your practice sounds pretty great and interesting. Seems like you get to use your full skill set everyday
 
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I mostly do inpatient. You can make your own hours if you really wanted.

Days can be a little variable, but mostly the same sort of stuff as below:

See any new patients, place admission orders and write notes.
See follow up patients usually 4-5 times per week (could go down to 3 days per week if you really wanted), write notes, orders, etc
Weekly team conferences, some family conferences, and call family members as needed
Frequently discuss care with hospitalist, therapists, social work, etc.
Rarely on phone with insurance companies for peer-to-peers
A few calls in the evening, but overall rare. No one wakes me up at night. Weekend call for admissions.

Some days I can work a 7-5 schedule, other days I can work about 1-2 hours. Just depends on the census and if I really need to see anyone or not.
 
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It’s a cool gig largely because of its diversity. I had 6 co-residents, and we all have vastly different practices.

I work in academics doing general PM&R. I do lots of Spine Center, outpatient MSK, outpatient Neuro rehab, Botox, ultrasound, dry needling, OMT, inpatient consults. I will make 70th percentile of regional compensation at 6 years post-residency training. Damn good for academics.

Of my co-residents, we all had pretty different scopes of practice. One did general at an academic institution and she does inpatient. One did general in a non-academic hospital group and she does SNF work. Another did non-academic Sports Med. Another in non-academic Pain. Another did academic SCI. Another did academic Amputee. There are lots of different opportunities based on one’s interests.
 
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Probably be more of informative if you guys specify your income as well

I changed practices within the last year. I likely won’t meet my productivity quota my first year since I’m basically starting again from scratch. If I inherited patients or had an established referral network it would be easier. Or if I was a procedure-machine. I have a guarantee of around 280k + benefits if that helps. I plan to exceed my production quota next year, but is a work in progress.

Id like to either just do sole IPR or get a NP to help cover inpatient and do some clinics/SNF work or even add on some admin work / admin-education work. Someone was asking me to do a PASC clinic even. So I don’t know, haven’t figured it all out yet. But, I like this field because there is so much variability and choice about what I can do. And easy to switch to something else if I get bored.

I know, not as glamorous as some people who make a lot more. I turned down some higher productivity jobs to be where I am now. I am happy with my salary and lifestyle right now with young kids. But I would like to make an additional 50-100 K per year in the future.
 
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Mostly Sports (MSK) Practice, some EMG, Interventional Spine, 4 days a week. Plenty of in-office procedures, not too many fluoro-guided injections currently. 3.5 days of clinic, 0.5 days of procedures (TENEX, TFESI, MBB/RFA mostly). 20 minute time slots, so usually 3 patients per hour unless I mark off more time as needed. Not doing all that much traditional rehab care, occasional amputee finds the way to me, but our advertising doesn't bring in stroke or TBI, SCI.

Pay is % collections, still haven't reached an equilibrium to know for sure, but around 400k/yr, with potential for more if I wanted more clinic time. I actually will probably cut a half clinic day because I like life a lot, and am OK with some pay decrease.

I share coverage for a high school with partners, cover a dozen or so HS games a year, otherwise no call.
 
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Mostly Sports (MSK) Practice, some EMG, Interventional Spine, 4 days a week. Plenty of in-office procedures, not too many fluoro-guided injections currently. 3.5 days of clinic, 0.5 days of procedures (TENEX, TFESI, MBB/RFA mostly). 20 minute time slots, so usually 3 patients per hour unless I mark off more time as needed. Not doing all that much traditional rehab care, occasional amputee finds the way to me, but our advertising doesn't bring in stroke or TBI, SCI.

Pay is % collections, still haven't reached an equilibrium to know for sure, but around 400k/yr, with potential for more if I wanted more clinic time. I actually will probably cut a half clinic day because I like life a lot, and am OK with some pay decrease.

I share coverage for a high school with partners, cover a dozen or so HS games a year, otherwise no call.
This sounds a lot like what I want my practice to look like in the future! Exciting to see it in action!
 
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Mostly Sports (MSK) Practice, some EMG, Interventional Spine, 4 days a week. Plenty of in-office procedures, not too many fluoro-guided injections currently. 3.5 days of clinic, 0.5 days of procedures (TENEX, TFESI, MBB/RFA mostly). 20 minute time slots, so usually 3 patients per hour unless I mark off more time as needed. Not doing all that much traditional rehab care, occasional amputee finds the way to me, but our advertising doesn't bring in stroke or TBI, SCI.

Pay is % collections, still haven't reached an equilibrium to know for sure, but around 400k/yr, with potential for more if I wanted more clinic time. I actually will probably cut a half clinic day because I like life a lot, and am OK with some pay decrease.

I share coverage for a high school with partners, cover a dozen or so HS games a year, otherwise no call.
Is this from a sports/spine fellowship? What part of the country?
 
Mostly Sports (MSK) Practice, some EMG, Interventional Spine, 4 days a week. Plenty of in-office procedures, not too many fluoro-guided injections currently. 3.5 days of clinic, 0.5 days of procedures (TENEX, TFESI, MBB/RFA mostly). 20 minute time slots, so usually 3 patients per hour unless I mark off more time as needed. Not doing all that much traditional rehab care, occasional amputee finds the way to me, but our advertising doesn't bring in stroke or TBI, SCI.

Pay is % collections, still haven't reached an equilibrium to know for sure, but around 400k/yr, with potential for more if I wanted more clinic time. I actually will probably cut a half clinic day because I like life a lot, and am OK with some pay decrease.

I share coverage for a high school with partners, cover a dozen or so HS games a year, otherwise no call.
FYI…anyone coming out of training should push incredibly hard to work 4 days per week. It’s much easier to add a day than subtract it down the road…and having a weekday off is incredible for wellness
 
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Is this from a sports/spine fellowship? What part of the country?
Sports fellowship PM&R based so got me more reps with spine/RFA. I agree with j4pac, its amazing how quickly the excitement and want/need for money dulls and the thought of an extra day for wellness/family/exercise/life has infinite worth.
 
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FYI…anyone coming out of training should push incredibly hard to work 4 days per week. It’s much easier to add a day than subtract it down the road…and having a weekday off is incredible for wellness
Whenever one is negotiating for 4 days a week, how does one navigate that when up against so many others that will work for 5 days a week (or more)? I love what I do but also want to make sure I am healthy for the long run, both at work and outside of work.
 
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Whenever one is negotiating for 4 days a week, how does one navigate that when up against so many others that will work for 5 days a week (or more)? I love what I do but also want to make sure I am healthy for the long run, both at work and outside of work.
Tell them you will work for 80% of what they would pay the other guy.
And make sure you file your TPS reports on time.
 
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Tell them you will work for 80% of what they would pay the other guy.
And make sure you file your TPS reports on time.
Or if it absolutely comes down to it…increase hours/day. But obviously not as ideal
 
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Whenever one is negotiating for 4 days a week, how does one navigate that when up against so many others that will work for 5 days a week (or more)? I love what I do but also want to make sure I am healthy for the long run, both at work and outside of work.
When I started I did clinic 5 days a week with Friday AM fluoro at ASC was there until 5:00ish on Fridays + still had sports coverage or sports travel. Was not a fan of that set up but you have to put in your dues when you start anywhere.

As I got busier and we dropped our university sports coverage I changed Friday to all day procedures (and got the practice to add in office fluoro suite) and a half day Tuesday PM of fluoro. Now my Tuesdays and Fridays finish anywhere between 1300 to 1500 based on case load. It's not a "day off" but a few easy half days and typically starting the weekend early significantly increase QOL and are easier to negotiate than "work 4 days per week" which GenX/Boomer generation who probably run your practice will typically not have patience for from a new hire.
 
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Easiest way is to start your own practice and shake that money tree. After that hire a few docs who work 3 days a week and everyone makes tiktoks on their days off as influencer sidegig while eating avocado toast.

Your mental health will be amazing and everyone so happy for u
 
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Easiest way is to start your own practice and shake that money tree. After that hire a few docs who work 3 days a week and everyone makes tiktoks on their days off as influencer sidegig while eating avocado toast.

Your mental health will be amazing and everyone so happy for u
Lol. Avocado toast. Most pretentious meal ever. Make sure it’s with a side of celery green drink
 
Ya know - I do aspire to work as much as my 50+ year old partners who worked so many hours they have broken marriages/divorces and poor relationships with their children. Seems worth it.

I think 4.5 efficient FTE instead of 6.0 inefficient FTE won't destroy the practice.
 
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I agree with others it's best to set your ideal work hours from the start if possible. Once you start making money it's very hard to step back. One of my neighbors is a dentist who happened to be one of the few ones who started his practice working 5 days per week, and now if he takes a day off all he can think about is how much money he misses out on making + how much he's spending (since most of his office staff still work that day), so he still works 5 days/week.

I don't mind working 5 days a week--I prefer myself to have a few light days rather than cut down to 4. That way I have more useful time during the week to do errands or spend time with my family on a regular basis.

However, do expect that many older docs/admins will complain about your work ethic. I don't know why wanting a work-life balance is something to be made fun of, but it seems to be a lightning rod.
 
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Lol. Avocado toast. Most pretentious meal ever. Make sure it’s with a side of celery green drink
Hey now! I LOVE avocado toast. What's with the hating on avos?
 
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FYI…anyone coming out of training should push incredibly hard to work 4 days per week. It’s much easier to add a day than subtract it down the road…and having a weekday off is incredible for wellness
Amen to this. I pared back from 5 days a week to 4 days a week. I'm much happier now but it wasn't an easy decision to make.
 
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I do sports/spine (mostly spine at this point). My weekly breakdown:
M/W/Th: 0800 start | 20-25 patients per day random mix of new/est patients, EMGs, US procedures, PRP.
Tu: 0800 start | 10-15 patients in AM with 5-6 fluoro procedures or 1-2 MILD procedures in PM.
F: 0745 AM start | 15-20 fluoro procedures (ESI, MBB, RF, SIJ, etc.)

Goal to have around 90-100 patient encounters per week, 20 fluoro procedures, 5 EMGs, 15 US procedures. Finished most days anywhere between 1400 to 1600.

When I was university team doc I had the above schedule + training room from 1600-1800 3 days per week along with covering games for football, soccer, basketball, and various meetings. Still do some high school football but that is only a handful of Friday nights.
This seems fantastic. Maybe you could DM me as I am interested in a gig like this. Currently PGY-2 and having to start making decisions on electives and aways and what fellowship to pursue which is stressing me out significant
Sports fellowship PM&R based so got me more reps with spine/RFA. I agree with j4pac, it’s amazing how quickly the excitement and want/need for money dulls and the thought of an extra day for wellness/family/exercise/life has infinite worth.
Would love to chat more about some of the job outlook and prospects if you’re willing. PGY2 trying to settle on a fellowship and every day I waiver back and forth.
 
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Easiest way is to start your own practice and shake that money tree. After that hire a few docs who work 3 days a week and everyone makes tiktoks on their days off as influencer sidegig while eating avocado toast.

Your mental health will be amazing and everyone so happy for u
You following me on IG?
 
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