How do you feel about the recent expansion in PM&R?

[dangEras]

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Over the past five years, the following started residency programs:
UCF, UF, Tower Health, Honor Health, Sunrise Health, UNM, U nebraska, Casa Colina, Geisinger, Memorial Hollywood, Mary Free Bed, Burke, Cleveland Clinic, Penn State, and Vanderbilt.

In the five year range prior to that:
UT Austin

Five year range prior to that:
Beaumont Taylor, UMiami

Five year range prior to that:
USF

The field went from opening 1-2 residencies every five years to opening 15. Is this new fad going to squeeze the job market? Drive downward salary pressure?

 

[Eilat87]

Over the past five years, the following started residency programs:
UCF, UF, Tower Health, Honor Health, Sunrise Health, UNM, U nebraska, Casa Colina, Geisinger, Memorial Hollywood, Mary Free Bed, Burke, Cleveland Clinic, Penn State, and Vanderbilt.

In the five year range prior to that:
UT Austin

Five year range prior to that:
Beaumont Taylor, UMiami

Five year range prior to that:
USF

The field went from opening 1-2 residencies every five years to opening 15. Is this new fad going to squeeze the job market? Drive downward salary pressure?

Sounds good to me. We are a pretty small field yknow..

 

[lobelsteve]

What is PM&R?

 

[Eurycea]

I imagine that the demand for PM&R is going to go up with an aging population and increased pressure for cost-effective care. Might be enough to account for the increase in residency graduates?

 

[Eilat87]

The average person in the general public doesn't even know who we are or what we do or that we even exist.. Recent expansion is not on the top of the list of things I worry about.

 

[dangEras]

The average person in the general public doesn't even know who we are or what we do or that we even exist.. Recent expansion is not on the top of the list of things I worry about.

The average person also has no clue about rad onc and a 30% expansion nuked their job market.

As it stands, the job market was already extremely tight for all of the pgy3s and 4s in my program.

 

[PainRehabMD]

Yes, it will likely affect the job market based on supply and demand.

 

[runfastnow]

It all depends on what you want to do and the value you add to a practice/health system (unless you are bold enough to go solo).

Inpatient jobs will always exist (i.e. Encompass, etc.) and in my opinion likely continue to grow at rate that can handle an influx of the extra graduates interested in that portion of PM&R.

However, if you want a cushy outpatient job just writing PT and NSAIDs for various MSK complaints (this is a bit of a straw man argument, but not far off base); those days are over. This role is being taken over more and more by ortho/neurosurgery PAs/NPs whether you like it or not as they are cheaper (50-60+% cheaper than us) and generally work within a surgical team for cheap/quick surgical access if necessary.

If you want to be 100% outpatient you will need to bring at least one (if not two or three) procedural skills that are within our scope such as EMG, US injection/diagnostic, fluoro, Botox, and P&O to compete for good jobs.

As long as there is a hint of fee-for-service in the medical marketplace the salaries will be there if you are willing to work and be productive. If/when we move to a universal Medicare/VA type system ... who knows.

 

[Piebaldi]

It all depends on what you want to do and the value you add to a practice/health system (unless you are bold enough to go solo).

Inpatient jobs will always exist (i.e. Encompass, etc.) and in my opinion likely continue to grow at rate that can handle an influx of the extra graduates interested in that portion of PM&R.

However, if you want a cushy outpatient job just writing PT and NSAIDs for various MSK complaints (this is a bit of a straw man argument, but not far off base); those days are over. This role is being taken over more and more by ortho/neurosurgery PAs/NPs whether you like it or not as they are cheaper (50-60+% cheaper than us) and generally work within a surgical team for cheap/quick surgical access if necessary.

If you want to be 100% outpatient you will need to bring at least one (if not two or three) procedural skills that are within our scope such as EMG, US injection/diagnostic, fluoro, Botox, and P&O to compete for good jobs.

As long as there is a hint of fee-for-service in the medical marketplace the salaries will be there if you are willing to work and be productive. If/when we move to a universal Medicare/VA type system ... who knows.

I would agree. In tight markets, the outpatient MSK type jobs are hard to come by. It is importnat to have procedural skills. I think most PM&R programs should have some sort of automatic "pain" type certification.

 

[PMR2008]

There are plenty of jobs. 273+ listed on Indeed, many more on doximity and tons are word of mouth anyway. Unfortunately right now is a horrible time to graduating or looking for a job. Tremendous amount of uncertainty in the market. I personally know 4 outpatient PM&R docs who were furloughed. Things will improve in the next few months. Obviously if you want the cush outpatient job in a metro and make 300+ those days are gone. People have been talking about doom and gloom in PM&R since I heard about the specialty in 2004. All residents need to do is gain as many skills as you can while training, be flexible about job location and be personable.

 

[dangEras]

There are plenty of jobs. 273+ listed on Indeed, many more on doximity and tons are word of mouth anyway. Unfortunately right now is a horrible time to graduating or looking for a job. Tremendous amount of uncertainty in the market. I personally know 4 outpatient PM&R docs who were furloughed. Things will improve in the next few months. Obviously if you want the cush outpatient job in a metro and make 300+ those days are gone. People have been talking about doom and gloom in PM&R since I heard about the specialty in 2004. All residents need to do is gain as many skills as you can while training, be flexible about job location and be personable.

Yeah, that rate has been 180-220k in my city for the past year.

Seems to me that the doom and gloom was correct when pm&r was expanding by 0.3 program/yr.

 

[RangerBob]

Yeah, that rate has been 180-220k in my city for the past year.

Seems to me that the doom and gloom was correct when pm&r was expanding by 0.3 program/yr.

That seems oddly low. That’s the salary you can often expect from academic/VA positions. A county hospital offered me well over that. Average PM&R compensation, from the AAPM&R’s survey, is upper 200’s.

I don’t follow outpatient jobs, but there are plenty enough inpatient PM&R gigs to accommodate even more grads. A good proportion of rehab facilities don’t have a PM&R trained physician/medical director.

 

[PMR2008]

Inpatient has plenty of jobs. Specially right now. But no way am I going back to taking call. 200-250k is about average for outpatient PM&R jobs in big cities.

 

[RangerBob]

Inpatient has plenty of jobs. Specially right now. But no way am I going back to taking call. 200-250k is about average for outpatient PM&R jobs in big cities.

Call is the main downside of inpatient, though it’s mitigated by hospitalists covering most of the “medical” calls. Still, it means rounding on weekends at times.

Personally I find inpatient much more relaxed. Clinic always stressed me out. But, I was one of the only residents who felt that way-most can’t stand inpatient and want to do outpatient, which unfortunately worsens the shortage for inpatient rehab physicians.

 

[Piebaldi]

Call is the main downside of inpatient, though it’s mitigated by hospitalists covering most of the “medical” calls. Still, it means rounding on weekends at times.

Personally I find inpatient much more relaxed. Clinic always stressed me out. But, I was one of the only residents who felt that way-most can’t stand inpatient and want to do outpatient, which unfortunately worsens the shortage for inpatient rehab physicians.

But inpatient is pricey and insurance doens't want to cover it. not to mention with the new nonsensical requirements by CMS, they are saying that physicians essentially can be replaced by nurses.
So why are we needing to be BC and go through all this when nurses can supposedly do the same?

 

[RangerBob]

But inpatient is pricey and insurance doens't want to cover it. not to mention with the new nonsensical requirements by CMS, they are saying that physicians essentially can be replaced by nurses.
So why are we needing to be BC and go through all this when nurses can supposedly do the same?

Are you talking about insurance covering the unit or the physician? My malpractice insurance isn't pricey at all. I pay less than $4,000 per year, and that's for an occurrence based policy. A claims-made policy would be cheaper.

Maybe CMS is saying that physicians can replaced by nurses, but I think that argument is overblown. Most patients I encounter (in a more rural area) actually do know the difference and prefer physicians by and large to midlevels. Physicians are finding work just fine. Still, it's probably a debate for a different thread.

 

[PMR2008]

You are either in a tort reform or low density state. $4000 is very low. I pay about the same.

 

[Piebaldi]

Are you talking about insurance covering the unit or the physician? My malpractice insurance isn't pricey at all. I pay less than $4,000 per year, and that's for an occurrence based policy. A claims-made policy would be cheaper.

Maybe CMS is saying that physicians can replaced by nurses, but I think that argument is overblown. Most patients I encounter (in a more rural area) actually do know the difference and prefer physicians by and large to midlevels. Physicians are finding work just fine. Still, it's probably a debate for a different thread.

No, I mean medical insurance, not malpractice insurance. I mean rehab costs per patient are $$ for insurances. So there is a downward pressure to keep patients out of rehab and send them to SNFs which is cheaper.

I don't think it's a good idea to expand residencies to this extent. The market does not need this many PM&R docs. Expansion was bad for path, rads, gas, rad onc as well

 

[RangerBob]

No, I mean medical insurance, not malpractice insurance. I mean rehab costs per patient are $$ for insurances. So there is a downward pressure to keep patients out of rehab and send them to SNFs which is cheaper.

I don't think it's a good idea to expand residencies to this extent. The market does not need this many PM&R docs. Expansion was bad for path, rads, gas, rad onc as well

I understand.

I disagree on what the market needs though-maybe (maybe-I don’t follow outpatient prospects) there’s not much demand for outpatient, but we could use a lot more inpatient docs-especially now that fewer and fewer outpatient docs want to help cover the inpatient units.

Unfortunately, the increasing interest in PM&R is really more outpatient focused. Still, I think there’s plenty of work for MSK docs once other providers better understand what we do. We’ve only been working on that a few decades...

 

[RangerBob]

You are either in a tort reform or low density state. $4000 is very low. I pay about the same.

CA. One of the few upsides to being a physician in this state.

 

[Piebaldi]

CA. One of the few upsides to being a physician in this state.

Ya, medmalpractice for general PM&R is dirt cheap.
Does CA have tort reform?

 

[RangerBob]

Ya, medmalpractice for general PM&R is dirt cheap.
Does CA have tort reform?

Non-economic damages are capped at $250,000.

I’m not going to get into the argument over whether that’s fair/just, but it’s one of the few areas where CA is friendlier to physicians than most other states.

 

[drusso]

PM&R was the dream of the 1990s...