For those with knowledge of the current landscape

[lejeunesage]

What does the actual job market landscape look like for newly minted physiatrist? How do the following domains compare in terms of demand, work-life balance, and expected compensation for an average physiatrist working an average number of hours?

- Spinal Cord Injury

- General Inpatient Rehab

- Interventional Pain

- Sports

- Peds

- Outpatient/MSK: talking to my peers and on the interview trail, this seemed to be by far the most popular area of interest. Has this led to depressed compensation?

- Occ Med jobs/Worker's comp/Med-legal

- SNF

Thinking purely in terms of an investment as opposed to love of a specific area, is there any advantage in doing a fellowship? I know the compensation for interventional pain is (for now at least) much higher than for non interventional PM&R, but does doing other fellowships result in higher compensation as well? Or in more time off?

Thank you all.

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[Xardas]

I'll comment on some of this.

SCI - if you want to do purely SCI you are looking at probably big city only and most likely academics. There are some non-academic jobs out there but the vast majority of SCI is done at very large rehab facilities with close connections to level 1 trauma. This usually means academic institutions. In which case the job market will be unique to that city/institution.

Work-life balance is probably good if you are in academics but the patient care can be demanding; quads have a lot of medical and social issues. If you are academic then your pay is probably 140-170 starting off as instructor or assistant professor.

Inpatient - reasonably good market. Depends where you want to go. A lot of people in recent years have shied away from inpt in favor of outpt. In a large saturated city getting inpatient work can be hard though. There will be lots of competition. And it can be cut throat, very very cut throat.

Work-life depends on your call schedule/weekends. THe more you work the better you get paid. With a decent census of 15+ you should expect easily 200K or more again depends how much weekend rounding you do.
** do not do inpatient rehab if you are not interested let alone passionate about it. There is onerous documentation and while you can always say you have an IM consultant at the end of the day you ARE the primary MD, you better know what is going on medically and you need to be able to understand what is going on medically to look the patient in the eye and say what is going on. Nothing breaks a patient's confidence in an MD faster than a bad inpt rehab doc saying, "i don't know the internist handles everything." You may not be handling the medical nitty gritty but again you have to understand how the medical issues affect functional status, and coordinate that between rehab and the medical.

I do inpt and have been for years. It is second nature for me. It is NOT for everyone though. If you do not like it you will burn out fast... very fast.

SNF - I think this is a growth area because there is so much SNF around the country. I'm not convinced you have to sign on with these companies to get access to a SNF locally to work, but in big cities it may be advantageous as there is more competition.

Thing you got to be careful about in SNF is even if you are the 'rehab consultant' if there is a bad outcome your name is still in teh chart.. expect a friendly call from a plaintiff's lawyer if things really went bad. In other words, yes there is a lot of SNF, but you should sign on to a good SNF.

Med-Legal - is NOT an option for newly minted grads. You have zero credibility, zero connections, and zero experience. Nobody will be asking you to be an expert witness straight out of residency. You will get a new one torn into you if you end up on a witness stand unless you are a natural and can charm your way through (doubtful. Attorneys are better).

Work -comp - Usually is viewed as an adjunct to a practice. I like doing a little on the side. A lot of this depends on developing relationships with Case managers etc. Takes years to build relationships and connections. Nobody trusts the new guy.

Occ Med. I think RUOkie an attending here does a lot of occ med though he'd be good to ask about this.


Other issues. Fellowships help if you use it. If you don't use it its a waste. That was opportunity cost loss of > $100k for that year. And much much more if you factor in the amt you could have saved investing in an index fund or paying off loans.

All things have supply and demand. As things get saturated competition picks up and your ability to make more decreases. PM&R by and large is a very local market driven field. Things are not the same city to city and region to region.

 

[Xardas]

Oh and one more thing outpt by and large has one massive advantage over inpt (in all fields).. much improved quality of life. Inpatient tends to be emotionally draining. Hospital pts have lots of social issues, family issues etc.

Its much easier to walk home from an outpt job and not worry about anything till the next day.

At the end of the day do what you like. Chasing the dollar is not a good way to approach your career. Your ability to accumulate wealth is more a function of how you save and invest not how much you earn.

 

[RUOkie]

My practice is mostly EMG/MSK/Occ med. I will comment on the practical side of the occupational med part. There is demand nationwide for PM&R to take on that role. But it is a very "interesting" way to practice. You basically have two clients (the patient and the employer). If you only address one side of the equation, you will not be successful. There is a LOT of symptom magnification and you need to be able to spot it. One of my early employers put it this way. "your best skill needs to be to be able to tell people what they don't want to hear, and leave the office with a smile on their face".

To do this stuff you need to be able to do basic suturing and basic eye care as well. I don't remove foreign bodies from eyes, but have an optho who will see people same day if needed. There is also administrative stuff involved there as well. If you do real occ med, you also need to be able to understand audiology and PFTs (part of fitness for duty), and likely take a course to be an MRO (medical review officer for workplace drug testing)

That also brings in the IME/legal aspect of the job. This is VERY lucrative, but a royal pain in the ass. Attorneys are difficult to deal with and often don't pay their bills. You need a thick skin and to NEVER bull****. When I deal with lawyers it is always $$ up front. They pay for my time just like they charge their clients for theirs. I don't do med mal cases except in very rare circumstance so I can't really speak to that aspect.

I used to do inpatient, and now do little to none (except for the rare inpatient spine consult). I love my job now and it is much lower stress. My hours are much more predictable.

 

[outdoorfanatic]

Really glad this question was asked, and very grateful for any responses that have/will be given. I remember a thread in which bedrock shared some sage wisdom about the outpatient job market, would love to hear more things like that about the current climate.

 

[lejeunesage]

Thank you for the great answers. I think this will be a very helpful thread. These are the types of questions that every potential applicant thinks about but are too shy/afraid to be perceived as shallow to ask.

 

[sloh]

nice thread, can someone also comment on Spine and Interventional Pain?

 

[Xardas]

For spine/pain you may get a better response if you just post in the Pain forums, asking about the prospects for PM&R pain specialists. Keep in mind its populated by the anesthesia folks here so the community, though friendly, is different than here. However its also very important to here what the anesthesia folks have to say as well.

I'm glad you guys are asking this question. In the academic world you often get a very narrow biased answer as your attendings are your only source of info. However many of these same attendings have never ever left the academic world as they have been in it essentially since residency. So you are absolutely correct in saying that its difficult to ask these questions to your attendings.

I will say this about PM&R before others post. It is a very different world when I applied. It sounds way more competitive and people come in knowing what they want to do and are very driven. Do well on ALL rotations to give yourself the most flexibility. You also never ever know what you may end up liking or not. I've seen guys flip into totally different pathways because they discovered they really liked something. Your attendings talk amongst each other- you may do great in say EMG or pain, but if you act like you are totally uninterested in say SCI and loaf off or worse give attitude, that will affect you in your residency. You can't just expect to graduate and get a good job. You gotta work for it.

 

[RUOkie]

I will say this about PM&R before others post. It is a very different world when I applied. It sounds way more competitive and people come in knowing what they want to do and are very driven. Do well on ALL rotations to give yourself the most flexibility. You also never ever know what you may end up liking or not. I've seen guys flip into totally different pathways because they discovered they really liked something. Your attendings talk amongst each other- you may do great in say EMG or pain, but if you act like you are totally uninterested in say SCI and loaf off or worse give attitude, that will affect you in your residency. You can't just expect to graduate and get a good job. You gotta work for it.

IMO this is the most important advise anyone can give a resident. When I entered residency 22yrs ago, I expected to do traditional rehab medicine. Amputee, stroke, brain injury etc. I thought that you had to be crazy to want to take care of spine patients and workers compensation. I didn't want to take care of fakers after all.

Well what do I do now? And I like it, and I'm good at it. I was not a particularly good inpatient rehabilitation medical director. My tolerance for administrative BS is very low, and I fought constantly with our admissions coordinators, PPS coordinators and hospital administrators. That made me bad at my job. Luckily I kept an open mind during my training and learned to like MSK medicine. And I was well trained so that when I changed course in my career, it was not difficult.

 

[lejeunesage]

I couldn't agree more. Sometimes you're surprised but what you like. I had done an outpatient rotation and didn't really want anything to do with inpatient, but much to my surprise, when I finally did do inpatient, I found that I rather liked it!

Now, I've never had to deal with the administrative BS, so my opinion of inpatient may yet change, but it's surprising how much what you end up liking on an emotional, day-to-day level can differ from what you believe will be most interesting on an analytical level.

While we're on the subject of practical questions, what is the best way for a new grad to look for a job?

- Word of mouth from attendings? How connected is the average attending to the private practice job market?

- Agencies/recruiters? How much of your potential bonus do they eat?

- Online search?

- Cold calling of hospital?

And at what point should a soon to be graduate start sending out applications?

Thanks again for anyone who can give some input.

 

[RangerBob]

I can't answer most of your question because I'm still a PGY-2, but from what I gather (from the few senior residents I know/have known), most seem to search for jobs on their own (no agents). I think cold-calling a hospital is a good idea if you really want to go somewhere--the job may just not be listed, or may not be listed yet. If there's no job available you can always ask if you can send your resume for them to have on file, since they may have an opening by the time you sign a contract with someone else (not likely, but it's always possible). I think the Academy's web site lists jobs as well, doesn't it? Word of mouth has always one of the best ways to land a gig--knowing about an opening before anyone else does can lead to you getting the job before the job is ever posted (assuming the hospital/practice really likes you and doesn't see the need to interview anyone else).

Most of the residents that really wanted to go somewhere specific started looking/getting their name out as early as Christmas of PGY3, with most having started the search around the start of PGY4. The Academy meeting during PGY4 (or any year) is also a really great way to network, and they have a job fair.

 

[TXPMR]

What does the actual job market landscape look like for newly minted physiatrist? How do the following domains compare in terms of demand, work-life balance, and expected compensation for an average physiatrist working an average number of hours?

- Sports

I'm interested in seeing what the job outlook looks like for sports physiatrists since the grandfathering in non ACGME accredited fellows to the sports boards has stopped.

 

[AndyDufrane]

I couldn't agree more. Sometimes you're surprised but what you like. I had done an outpatient rotation and didn't really want anything to do with inpatient, but much to my surprise, when I finally did do inpatient, I found that I rather liked it!

Now, I've never had to deal with the administrative BS, so my opinion of inpatient may yet change, but it's surprising how much what you end up liking on an emotional, day-to-day level can differ from what you believe will be most interesting on an analytical level.

While we're on the subject of practical questions, what is the best way for a new grad to look for a job?

- Word of mouth from attendings? How connected is the average attending to the private practice job market?

- Agencies/recruiters? How much of your potential bonus do they eat?

- Online search?

- Cold calling of hospital?

And at what point should a soon to be graduate start sending out applications?

Thanks again for anyone who can give some input.

i think cold calling the rehab program director, or medical staff office and speaking to someone like physician relations liaison person, or CMO if you can get access, is a good way, try to emphasize what you as a physiatrist can do to help the hospital, whether its doing inpatient c/s to shorten length of stays or be sa referral source for their outpatient therapies …. I would be very wary of recruiters, they end up just trying to sell you and the employer on each other, I generally think they are shady to deal with

 

[lejeunesage]

I've also just thought of a couple other practical questions.

1. When looking for a job, what is the best type of compensation structure:
a. For new grads
b. after 2 or more years of experience.

- guaranteed base?
- All productivity?
- Guaranteed base + productivity bonus after a certain amount?

And how much latitude do you have in negotiating your pay structure?

2. What is the best type of job structure to insure a good referral base?
- All PM&R group
- Ortho group
- Multi-specialty
- Hospital employed
- Solo practice
- Anything else I'm forgetting?

Thanks!