How much money can you make in this specialty?

[RangerBob]

As a PM&R doctor what would my pt base consist of besides sports? Would it be mostly post surgery patients to make plans for outpatient rehab?

Likely not--the surgeon can plan the rehab (they just write the script). Most patients doing therapy don't need our director, though many would benefit.

Most common (for folks doing sports) would be general MSK/spine/pain/EMG. Which may very well be a lot of older patients who can't undergo surgery. But if you're attached to an ortho/multi-specialty clinic, you could also be treating patients conservatively in the hopes of avoiding/deferring surgery.

You could also do "general rehab" outpt, which would include stroke/SCI/amputee clinic. I'm not sure why it's called general rehab, since most outpt rehab docs do more MSK/pain. It probably dates from when inpatient rehab (which is what I do) was the predominant focus of the specialty, and clinic was often based around follow-up for the patients you discharged--many of whom can easily become lifelong patients.

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[RangerBob]

As someone in a prior life who did primary care, I wouldn’t sweat the primary care aspect of Sports Medicine. You’ll learn it. MSK is the significant majority of your job in Sports Med, it makes much more sense to be great at that, and fill in the gaps with the primary care side of the job. Either way, you’d be fine. But if your passion is MSK, PM&R residency will be much more tolerable. I also think that the neurorehab side of PM&R adds significantly to your knowledge base and approach to Sports Med. The ability to do Botox is also nice, as it is typically more lucrative than the Sports Med procedures. It also buys you a different patient population with significant MSK needs, so you don’t gave to spend as much of your time managing hypertension and diabetes.

People underestimate the power of Botox. As a potent neurotoxin, it's not allowed to become a generic formulation. (ie., it will remain expense, meaning those who use it will get paid well to use it).

OP--J4pac has a lot more experience in sports/MSK than me, so I'd give more weight to his opinion than mine. I certainly 100% agree with him your MSK/sports knowledge in of itself will be far superior if you do PM&R residency.

 

[runfastnow]

Thank you for someone who wants to spend most of their career doing private practice so you think that difference is worth giving up alot of the stuff that one could do if they did FM instead? I've always wanted to own my own business and be my own boss eventually so I think private practice is what I'm doing to do after a few years of working in a hospital or group to pay off my loans.

IMO if you want to do own an outpatient private practice from PM&R then you need to do a pain/spine fellowship. Other portions of PM&R (even sports) just do not bring in enough revenue or patient load to keep the lights on in the outpatient realm.

If the most important thing to you is being your own boss no matter what then do FM + sports so you can do some extra procedures and then hang up your shingle.

If you want to join a practice and build into being a partner (which is essentially ownership stake even if you are not primary owner) - then pursue whatever part of PM&R makes you happy. If you bring some mix of ultrasound, fluoro, and EMG to the table most orthopedic practices will gladly welcome you.

As a PM&R doctor what would my pt base consist of besides sports? Would it be mostly post surgery patients to make plans for outpatient rehab?

Outpatient MSK/sports is going to be largely weekend warriors (30-50s age range) who have rotator cuff, meniscus, hip, and spine issues who want to (or should) avoid surgery and older individuals who have osteoarthritis to manage. Based on your interests you can do EMG and/or amputee fairly easily as well.

My personal opinion is if you want to be a team doctor, FM + sports fellowship is the best route. As mentioned above, as a team doctor most of what you're doing is PCP stuff. The fellowship will teach you the MSK stuff/injections.

If you want to be a "real" sports doctor (ie,., treat just sports injuries), PM&R is no doubt the better route (unless you want to do surgery, then obviously go ortho). But it's really hard to run a true sports-only practice. Most sports docs are practicing in their original field as well, whether it's peds, FM, ortho, EM, or PM&R. So I would choose residency based on what you would want to do more if you can't do 100% sports, then get that extra sports training.

One of my residency docs had it good. PM&R + sports. She worked part-time, about 6hrs/day 3 days/week. Husband made a lot of money so she didn't have to work for money. 80-90% classic "sports" patients (18-30/young, healthy, minimal comorbidities, doing sports), with a handful of older classic MSK patients (the opposite), usually because they were friends of friends, etc. She did injections and all that jazz. But she was attached to an academic center and had a referral base that clearly took time to build up. I imagine it's what most sports docs dream of--she had everything including the therapy gym onsite. Only thing lacking was being a team doc, which many would argue is a plus considering the time drain that requires (which is often uncompensated as mentioned above)

Completely agree - if you want to be a team physician or have a shot at working with NFL/MLB/NBA/NHL team then FM or IM is the way to go with the expectation that you will be weak-ish in MSK/procedure skills compared to a competent PM&R sports physician, but can make up for that by managing HTN, DM, runny noses, etc. more comfortably for college kids/young adults. Most university athletic departments will be this type of set up.

If you want be a sports doc who can offer a vast array of procedures but also be able to do the easy PCP stuff for healthy young people then do PM&R sports. A minority of athletic departments filter all athletes through non-op sports first, regardless of injury (unless obvious surgical need on sideline), and then on to surgeon if there is a surgical need. If you are not comfortable with a primary care type diagnosis then you can always send them on to another specialist - I did this a lot with diabetic athletes since I had access to great endocrinologists and it is my least favorite disease to manage.

 

[Proudfather94]

IMO if you want to do own an outpatient private practice from PM&R then you need to do a pain/spine fellowship. Other portions of PM&R (even sports) just do not bring in enough revenue or patient load to keep the lights on in the outpatient realm.

If the most important thing to you is being your own boss no matter what then do FM + sports so you can do some extra procedures and then hang up your shingle.

If you want to join a practice and build into being a partner (which is essentially ownership stake even if you are not primary owner) - then pursue whatever part of PM&R makes you happy. If you bring some mix of ultrasound, fluoro, and EMG to the table most orthopedic practices will gladly welcome you.

Outpatient MSK/sports is going to be largely weekend warriors (30-50s age range) who have rotator cuff, meniscus, hip, and spine issues who want to (or should) avoid surgery and older individuals who have osteoarthritis to manage. Based on your interests you can do EMG and/or amputee fairly easily as well.


Completely agree - if you want to be a team physician or have a shot at working with NFL/MLB/NBA/NHL team then FM or IM is the way to go with the expectation that you will be weak-ish in MSK/procedure skills compared to a competent PM&R sports physician, but can make up for that by managing HTN, DM, runny noses, etc. more comfortably for college kids/young adults. Most university athletic departments will be this type of set up.

If you want be a sports doc who can offer a vast array of procedures but also be able to do the easy PCP stuff for healthy young people then do PM&R sports. A minority of athletic departments filter all athletes through non-op sports first, regardless of injury (unless obvious surgical need on sideline), and then on to surgeon if there is a surgical need. If you are not comfortable with a primary care type diagnosis then you can always send them on to another specialist - I did this a lot with diabetic athletes since I had access to great endocrinologists and it is my least favorite disease to manage.

Thanks the pain fellowship looks interesting I'll have to look into that a little more. I'm guessing that mixed with PM&R would be best at managing people's pain while they do rehab so that they can have a better outcome from it.

 

[Iamnew2]

As a PM&R doctor what would my pt base consist of besides sports? Would it be mostly post surgery patients to make plans for outpatient rehab?

As a PM&R based doctor you probably would have to work with/for an Ortho group. Not much planning involved in sending a referral for outpatinet rehab for post op patients so not really.

 

[Proudfather94]

As a PM&R based doctor you probably would have to work with/for an Ortho group. Not much planning involved in sending a referral for outpatinet rehab for post op patients so not really.

Oh I see. I think I'm starting to get the idea that FM with a sports fellowship may be what's more in line with what I want to do.

 

[j4pac]

Oh I see. I think I'm starting to get the idea that FM with a sports fellowship may be what's more in line with what I want to do.

Something to at least consider…you aren’t guaranteed fellowship. It’s good to make it a goal, but I’d consider doing a residency that you’d enjoy without fellowship. In my particular situation, I felt capable of doing everything I wanted to do in Sports Med without fellowship, and really likely neurorehab, so I did general PM&R. It is just about impossible to do heavy MSK while doing FP without a Sports fellowship. FP is a great specialty in its own ways, but you just need to know what you want to get out of it. Just a consideration.

 

[Proudfather94]

Something to at least consider…you aren’t guaranteed fellowship. It’s good to make it a goal, but I’d consider doing a residency that you’d enjoy without fellowship. In my particular situation, I felt capable of doing everything I wanted to do in Sports Med without fellowship, and really likely neurorehab, so I did general PM&R. It is just about impossible to do heavy MSK while doing FP without a Sports fellowship. FP is a great specialty in its own ways, but you just need to know what you want to get out of it. Just a consideration.

Thanks honestly I keep changing what I want to do at this point and think I need to just wait until my rotations to decide lol. I always try to plan my life as far out as I can so I can have goals to work towards but I don't think I'm going to be able to do that with what specialty I want to do until I get experience with them.

 

[Captain_Falcon]

I am the same way in wanting everything planned out long term, I hate uncertainty

 

[drg123]

Thanks honestly I keep changing what I want to do at this point and think I need to just wait until my rotations to decide lol. I always try to plan my life as far out as I can so I can have goals to work towards but I don't think I'm going to be able to do that with what specialty I want to do until I get experience with them.

Plans change often in life. It's good to have a general target in mind, but the path will often be very different than the one you think it will be. Have a goal but be flexible.

Yes, you should get exposure to FM and PM&R. You need to figure out which of those fields you'd be happy practicing even if Sports Med didn't work out. Do you like the bread and butter of FM or PM&R? And when you do find yourself having some preferences, try to introspect why.

 

[Proudfather94]

Could I get more information about what PM&R docs do that's part of an ortho group? Are you as respected as the ortho surgeons or are you treated as being lower on the totem pole? I've seen that working in a group is usually the better option so that one can get a full pt load easier and have more negotiation power with insurance companies.

 

[cowboydoc]

Could I get more information about what PM&R docs do that's part of an ortho group? Are you as respected as the ortho surgeons or are you treated as being lower on the totem pole? I've seen that working in a group is usually the better option so that one can get a full pt load easier and have more negotiation power with insurance companies.

The average ortho doesn’t respect anyone. The orthos I was previously associated with blew up their group, but I still share a building with many of them. They treat me far better than their partners. Most of them have no respect for their partners.

Early on, they fought anything that could encroach on their practice (PRP). Now many of them send family members to me regularly.

It’s easier to be a needle jockey in an ortho group. It’s easier to be busy. It’s also easy to get dumped on (crps) if you don’t pay attention.

The important thing is equitable treatment. Forget respect, don’t get dragged into a situation where they expect you to pay the same overhead, though our practice can be exponentially leaner.

 

[Proudfather94]

The average ortho doesn’t respect anyone. The orthos I was previously associated with blew up their group, but I still share a building with many of them. They treat me far better than their partners. Most of them have no respect for their partners.

Early on, they fought anything that could encroach on their practice (PRP). Now many of them send family members to me regularly.

It’s easier to be a needle jockey in an ortho group. It’s easier to be busy. It’s also easy to get dumped on (crps) if you don’t pay attention.

The important thing is equitable treatment. Forget respect, don’t get dragged into a situation where they expect you to pay the same overhead, though our practice can be exponentially leaner.

So if you want to work for a ortho group make vet them and make sure they're tolerable first. What's wrong with crps? Is it too time intensive to treat the pt and your volume goes down? How should one handle overhead in this type of situation? I percentage of the fixed costs like lights and support staff and then your portion of the overhead from your overhead in the practice?

 

[cowboydoc]

So if you want to work for a ortho group make vet them and make sure they're tolerable first. What's wrong with crps? Is it too time intensive to treat the pt and your volume goes down? How should one handle overhead in this type of situation? I percentage of the fixed costs like lights and support staff and then your portion of the overhead from your overhead in the practice?

Working with an ortho group can be fine, but often we are a commodity, replaceable and not treated equitably. Ortho overhead is usually higher than ours, but it’s easy for the group to f give everyone the same overhead, making it hard for a non-surgeon to “compete” for a reasonable piece of the pie.

CRPS is a time suck and often thankless. It was just the first idea that came to mind, the more common would be chronic opioid management.

You shouldn’t be expected to cover OR staff, PA, equipment, etc. that you don’t use. Is partnership track an option?

 

[nvrsumr]

If you’re lucky they will let you round on their post op patients over the weekend as you can bill for a rehab consult while they are in global period and sleeping off their $250 bottle of wine hangover

 

[Proudfather94]

Working with an ortho group can be fine, but often we are a commodity, replaceable and not treated equitably. Ortho overhead is usually higher than ours, but it’s easy for the group to f give everyone the same overhead, making it hard for a non-surgeon to “compete” for a reasonable piece of the pie.

CRPS is a time suck and often thankless. It was just the first idea that came to mind, the more common would be chronic opioid management.

You shouldn’t be expected to cover OR staff, PA, equipment, etc. that you don’t use. Is partnership track an option?

Sounds like many of them have an ego issue. What would be a better outpatient option a rehab center?

 

[Iamnew2]

Sounds like many of them have an ego issue. What would be a better outpatient option a rehab center?

Rehab centers don't typically offer outpatient options. They should- but typically don't.

 

[Proudfather94]

Rehab centers don't typically offer outpatient options. They should- but typically don't.

Oh that's disappointing. If I eventually wanted to have my own clinic and primarily diagnose and treat msk injuries with athletes and body builders would PM&R be a good fit?

 

[Iamnew2]

Oh that's disappointing. If I eventually wanted to have my own clinic and primarily diagnose and treat msk injuries with athletes and body builders would PM&R be a good fit?

Going into private practice as a PM&R physician is likely a challenging task. Can you do it? I'm sure it's possible. Are you a med student?

 

[sloh]

Oh that's disappointing. If I eventually wanted to have my own clinic and primarily diagnose and treat msk injuries with athletes and body builders would PM&R be a good fit?

You won’t be able to keep the practice afloat limiting yourself to only that patient population. Many want to do this. Almost none end up largely with this patient population. Outpatient PM&R is kind of like chronic pain lite.

 

[Proudfather94]

Going into private practice as a PM&R physician is likely a challenging task. Can you do it? I'm sure it's possible. Are you a med student?

I've been accepted but haven't started yet .

 

[Iamnew2]

I've been accepted but haven't started yet .

Way too early for you to be asking this stuff. Get through med school first, then go through your rotations. Then come back and ask

 

[cowboydoc]

I've been accepted but haven't started yet .

I apologize for my tone and candor. I wrongly assumed I was offering advice to someone ready to interview with a group and needed some frank advice. You’re far too early on the path to be jaded, but are far ahead of the game with your questions and job plans.

It’s good to begin with the end in mind, but don’t paint yourself into a corner. Things change, keep an open mind. Good luck!

 

[Proudfather94]

I apologize for my tone and candor. I wrongly assumed I was offering advice to someone ready to interview with a group and needed some frank advice. You’re far too early on the path to be jaded, but are far ahead of the game with your questions and job plans.

It’s good to begin with the end in mind, but don’t paint yourself into a corner. Things change, keep an open mind. Good luck!

Thanks I never took offense to anything you posted. I'm just looking at options to choose from. I know from my experience working in a hospital that I hate admins and the hospital environment and want to pick a specialty where I can avoid staying there after medical school.

 

[cowboydoc]

Thanks I never took offense to anything you posted. I'm just looking at options to choose from. I know from my experience working in a hospital that I hate admins and the hospital environment and want to pick a specialty where I can avoid staying there after medical school.

There are ever decreasing options to avoid hospital admin. PM&R, Pain are viable options for an independent outpatient set up with a decent income. Unless something changes at the federal level, the deck is heavily stacked in the hospital’s favor to employ physicians vs. them maintaining independent practices.

 

[Proudfather94]

There are ever decreasing options to avoid hospital admin. PM&R, Pain are viable options for an independent outpatient set up with a decent income. Unless something changes at the federal level, the deck is heavily stacked in the hospital’s favor to employ physicians vs. them maintaining independent practices.

I hope that changes for the sake of doctors and patients. If there's no competition there is no one to give financial or ethical competition and hospitals charge whatever they want and cut as many corners as they want.

 

[RangerBob]

There are ever decreasing options to avoid hospital admin. PM&R, Pain are viable options for an independent outpatient set up with a decent income. Unless something changes at the federal level, the deck is heavily stacked in the hospital’s favor to employ physicians vs. them maintaining independent practices.

Come practice in CA—it’s illegal for hospitals to directly employ docs here. There are a few ways to get around it, but it really only applies to docs with clinics (ortho/nsurg) or those working for Kaiser. County hospitals/VA’s are all exempt.

Admin minimally affects what I do on a regular basis on my rehab unit. There’s some politics, but not much, and I suspect most clinics have more politics, particularly in multi-specialty groups. That said, I work with great admins here and have a great PM&R partner, so I could be an oddball.

 

[cowboydoc]

Come practice in CA—it’s illegal for hospitals to directly employ docs here. There are a few ways to get around it, but it really only applies to docs with clinics (ortho/nsurg) or those working for Kaiser. County hospitals/VA’s are all exempt.

Admin minimally affects what I do on a regular basis on my rehab unit. There’s some politics, but not much, and I suspect most clinics have more politics, particularly in multi-specialty groups. That said, I work with great admins here and have a great PM&R partner, so I could be an oddball.

Ha! I couldn’t live in CA.

-I’d take a 30-40% pay cut.
-the cost of living is much more.
-I’m fairly sure my boots are illegal in CA.

I work for a multispecialty physicians group associated with a hospital. I thought it was a leaner, more nimble, more physician-centered organization. To be real, the org is a red-headed stepchild shell corporation of the “not fit profit” hospital.

There is substantial autonomy to practice as I please in clinic and minimal admin burden in clinic. For bigger decisions and issues, the hospital bureaucracy may get involved.

 

[RangerBob]

Ha! I couldn’t live in CA.

-I’d take a 30-40% pay cut.
-the cost of living is much more.
-I’m fairly sure my boots are illegal in CA.

I work for a multispecialty physicians group associated with a hospital. I thought it was a leaner, more nimble, more physician-centered organization. To be real, the org is a red-headed stepchild shell corporation of the “not fit profit” hospital.

There is substantial autonomy to practice as I please in clinic and minimal admin burden in clinic. For bigger decisions and issues, the hospital bureaucracy may get involved.

I think all boots may be illegal here… Unless they’re made from CBD oil.

It’s certainly not cheap. My house is quite unimpressive compared to my classmates/co-residents who remained in the Midwest. But, my family is here, which is why we took the job here. We do live in what I consider one of the nicest parts of the state—by the coast, not LA/SF, rural-ish with more small town values but still some bigger city diversity/food due to a nearby college.

Unfortunately I’m not a foodie, so what it means is much of the food looks/sounds uninteresting or costs too much! Thankfully the Thai, Mexican, BBQ, and pizza places aren’t into the foodie vibe. But ice cream! There’s goat ice cream and another place doing liquid nitrogen ice cream. Can’t a man just have some plain ice cream???

 

[Proudfather94]

Hey guys I've done some self reflecting and honestly the money isn't that important to me. I'm going to be making way more than enough no matter what kind of doctor I am. I'm interested in the peds PM&R fellowship. Would it be a good idea to cold email some local peds PM&R docs as well as some adult ones to see if I can have a meeting with them to see what their days consist of?

 

[cowboydoc]

Hey guys I've done some self reflecting and honestly the money isn't that important to me. I'm going to be making way more than enough no matter what kind of doctor I am. I'm interested in the peds PM&R fellowship. Would it be a good idea to cold email some local peds PM&R docs as well as some adult ones to see if I can have a meeting with them to see what their days consist of?

Absolutely. Nearly every Peds PM&R doc I know would be more than happy to have you shadow if you are actually interested in peds rehab.

 

[Ligament]

You can make money in sports. Regen gives you that option. The money is definitely not the biggest reason to do sports. The biggest reasons are buying a motivated patient population and the ability to cover high level athletics. A suppose the injections/procedures can also be fun to a degree.

You can make money doing anything in PM&R. I’d really just focus on what interests you about the specialty. I did general and have no regrets. Know your options, know yourself, and find something you’re passionate about.

How does covering high level athletics make you money?

 

[Ligament]

Sports medicine can be A LOT of fun, but go into it with your eyes open.

I am private practice and was head team physician for large university and it consumed my life - i.e. 100 hrs/per week.
50 hrs/week practice with patient visits and procedures (50/50 mix of sports/spine) and 50 hrs/wk game coverage, training room, meetings that was essentially uncompensated.

We no longer are team physicians and I have a life again. It was bittersweet to stop because there are a lot of cool perks - personal relationships with power players in the state/community and future pro athletes, reputation for being the team doc for organization people care about in the community, private jets, nice ego petting, etc. BUT it is also incredible amounts of time away from family, nights and weekends consumed with coverage, seeing things that are primary care but non-PM&R related (ADHD, diabetes, etc.) that are uninteresting to me, and high level college athletes and trainers can be extremely demanding (i.e. every runny nose needs to be treated immediately and with a $1,000,000 work up).

If you can work your way into an academic job that is head of sports medicine at a large university it can be an easy gig if your production requirements go away and you can just focus on seeing athletes and some VIPs - but know that a lot of it is going to be pure primary care (i.e. runny noses, ADHD, asthma, diabetes management) and not doing ultrasound and everything in the PM&R realm.

In my experience PM&R sports in private practice ends up being a pseudo-pain management in the real world. A lot of arthritis, back/neck pain, and some torn meniscus/rotator cuff stuff. If you can get in with some high schools and see their athletes that can be more "real" sports medicine, but what are you going to be providing that the PCP cannot? You aren't going to be injecting and doing a lot of procedures on 14-18 year olds - although you will be much more competent in return to play decisions which PCPs are typically TERRIBLE at.

To your original question - in PM&R sports you can make $400k+ if you are busy (90-100+ patient encounters per week) and do some spine injections (12-15 per week) or are able to build a healthy PRP/regen medicine following (this requires an affluent patient base).

Why would you spend 50 hours per week in uncompensated clinical work and not get any pay from it? Why waste that much time for nothing in return?

 

[RangerBob]

Why would you spend 50 hours per week in uncompensated clinical work and not get any pay from it? Why waste that much time for nothing in return?

Most sports docs do sports coverage to get referrals, and because they enjoy it.

 

[runfastnow]

Why would you spend 50 hours per week in uncompensated clinical work and not get any pay from it? Why waste that much time for nothing in return?

Because at one time in my life I enjoyed it and enjoyed being a part of a multi-million (billion?) dollar athletic department and while it was a lot of work you get to form some awesome relationships with awesome people and have awesome experiences. And it in the part of the country I am in if you are associated in any way with this athletic department people beat down the door to see you.

But yes - it is illogical if that type of team physician role is not your idea of a good time. Now that I have children and increasing outside interests it is not for me with the time that was required.

 

[Ligament]

Because at one time in my life I enjoyed it and enjoyed being a part of a multi-million (billion?) dollar athletic department and while it was a lot of work you get to form some awesome relationships with awesome people and have awesome experiences. And it in the part of the country I am in if you are associated in any way with this athletic department people beat down the door to see you.

But yes - it is illogical if that type of team physician role is not your idea of a good time. Now that I have children and increasing outside interests it is not for me with the time that was required.

Getting referrals from it makes some sense, escpecially if people are beating down the door to see you. However, if you are spending 50 hrs/week doing team work for free, how do you have time to reap the benefits of the patients who want to see you?

It is very discouraging that the only people on that field or court that bring any value to society or deserve any significant money is the medical team (you), yet you get paid ZERO while the atheletes and coaches get paid 6-8 figures and the royal treatment. That they've conditioned physicians to work for FREE in such a wealthy environment is very, very sad.

 

[runfastnow]

A lot of time with team physician stuff is after clinic hours - 8:00-4:00 seeing patients, 4:00-7:00 seeing athletes vs going to games on weekends. So plenty of time to see the patient load, but you lose a lot of nights and weekends.

No one is forcing anyone to do sports medicine or to be that level team physician. 95+% of people do it because they really love sports and would be attending sporting events in their free time anyway, enjoy treating high level athletes, enjoy helping these people achieve accomplishments that only 0.000001% of the population could do, and enjoy the perks of the job that are not in cash compensation - i.e. relationships with politicians, business leaders, athletic directors, famous coaches/athletes, etc. which in and of themselves are worth something.

We billed for what we did (99212/3/4 training room visits and office visits, injections/procedures, PRP, surgery, etc.), but no, we don't bill per hour like a lawyer would so overall your time is largely uncompensated compared to clinic time. In certain academic settings your "admin time" or "education time" is utilized for this game/team coverage so that you don't have to worry as much about production, but my set up was private practice so we don't have a health system/government slush fund to keep us afloat.

Sports are entertainment, but can bring great joy to cities, communities, and all the behind the scenes employees at these organizations. I feel that communal benefit is worth some amount of economic benefit to those producing the product. If you don't think high level or professional sports are worth the cost then you do not have to consume the product and that is perfectly fine. More importantly direct your angst at the media companies that have turned sports into the monster it is today. The coaches and players are trying to get their small slice of the pie while their knees and shoulders still work or until they have a losing season. I don't blame them for utilizing their skills while they are in demand. I'd do the same thing if my mind/hands only let me be a physician for 5-10 years.

I'm now doing 30% sports/70% spine private practice, help with some local high schools for fun, and have a lot more free time to enjoy with my family. I enjoyed what I did, personally know a lot of power players in D1/pro athletics (which has perks for tickets, they are generally cool people, etc.), have some great memories/experiences from it, and now have a loyal patient base that I otherwise would have taken 3-4x as long to build.

I'm satisfied with the above ... but some may not or think I'm a fool. That's fine. I've played my career game successfully and have been fulfilled so far.

 

[Ligament]

A lot of time with team physician stuff is after clinic hours - 8:00-4:00 seeing patients, 4:00-7:00 seeing athletes vs going to games on weekends. So plenty of time to see the patient load, but you lose a lot of nights and weekends.

No one is forcing anyone to do sports medicine or to be that level team physician. 95+% of people do it because they really love sports and would be attending sporting events in their free time anyway, enjoy treating high level athletes, enjoy helping these people achieve accomplishments that only 0.000001% of the population could do, and enjoy the perks of the job that are not in cash compensation - i.e. relationships with politicians, business leaders, athletic directors, famous coaches/athletes, etc. which in and of themselves are worth something.

We billed for what we did (99212/3/4 training room visits and office visits, injections/procedures, PRP, surgery, etc.), but no, we don't bill per hour like a lawyer would so overall your time is largely uncompensated compared to clinic time. In certain academic settings your "admin time" or "education time" is utilized for this game/team coverage so that you don't have to worry as much about production, but my set up was private practice so we don't have a health system/government slush fund to keep us afloat.

Sports are entertainment, but can bring great joy to cities, communities, and all the behind the scenes employees at these organizations. I feel that communal benefit is worth some amount of economic benefit to those producing the product. If you don't think high level or professional sports are worth the cost then you do not have to consume the product and that is perfectly fine. More importantly direct your angst at the media companies that have turned sports into the monster it is today. The coaches and players are trying to get their small slice of the pie while their knees and shoulders still work or until they have a losing season. I don't blame them for utilizing their skills while they are in demand. I'd do the same thing if my mind/hands only let me be a physician for 5-10 years.

I'm now doing 30% sports/70% spine private practice, help with some local high schools for fun, and have a lot more free time to enjoy with my family. I enjoyed what I did, personally know a lot of power players in D1/pro athletics (which has perks for tickets, they are generally cool people, etc.), have some great memories/experiences from it, and now have a loyal patient base that I otherwise would have taken 3-4x as long to build.

I'm satisfied with the above ... but some may not or think I'm a fool. That's fine. I've played my career game successfully and have been fulfilled so far.

As long as you are happy with what you got out of it, that is all that matters

 

[Ligament]

A lot of time with team physician stuff is after clinic hours - 8:00-4:00 seeing patients, 4:00-7:00 seeing athletes vs going to games on weekends. So plenty of time to see the patient load, but you lose a lot of nights and weekends.

No one is forcing anyone to do sports medicine or to be that level team physician. 95+% of people do it because they really love sports and would be attending sporting events in their free time anyway, enjoy treating high level athletes, enjoy helping these people achieve accomplishments that only 0.000001% of the population could do, and enjoy the perks of the job that are not in cash compensation - i.e. relationships with politicians, business leaders, athletic directors, famous coaches/athletes, etc. which in and of themselves are worth something.

We billed for what we did (99212/3/4 training room visits and office visits, injections/procedures, PRP, surgery, etc.), but no, we don't bill per hour like a lawyer would so overall your time is largely uncompensated compared to clinic time. In certain academic settings your "admin time" or "education time" is utilized for this game/team coverage so that you don't have to worry as much about production, but my set up was private practice so we don't have a health system/government slush fund to keep us afloat.

Sports are entertainment, but can bring great joy to cities, communities, and all the behind the scenes employees at these organizations. I feel that communal benefit is worth some amount of economic benefit to those producing the product. If you don't think high level or professional sports are worth the cost then you do not have to consume the product and that is perfectly fine. More importantly direct your angst at the media companies that have turned sports into the monster it is today. The coaches and players are trying to get their small slice of the pie while their knees and shoulders still work or until they have a losing season. I don't blame them for utilizing their skills while they are in demand. I'd do the same thing if my mind/hands only let me be a physician for 5-10 years.

I'm now doing 30% sports/70% spine private practice, help with some local high schools for fun, and have a lot more free time to enjoy with my family. I enjoyed what I did, personally know a lot of power players in D1/pro athletics (which has perks for tickets, they are generally cool people, etc.), have some great memories/experiences from it, and now have a loyal patient base that I otherwise would have taken 3-4x as long to build.

I'm satisfied with the above ... but some may not or think I'm a fool. That's fine. I've played my career game successfully and have been fulfilled so far.

Who covered your malpractice for the team coverage? DId your standard malpractic policy cover you, or did you need to purchase an additional malpractice policy for team sports coverage? Any idea how much extra that cost, if anything?

 

[runfastnow]

Who covered your malpractice for the team coverage? DId your standard malpractic policy cover you, or did you need to purchase an additional malpractice policy for team sports coverage? Any idea how much extra that cost, if anything?

All was covered with contract with athletic department. No cost to me/practice beyond typical malpractice. Similar to VA service connection treatment - anything that happened to athlete/coach while under athletics umbrella was covered forever for athlete and malpractice in our end.

Similar deal with high schools. Run malpractice costs through hospital system that organizes our school coverage and manages ATCs for school systems.

 

[j4pac]

How does covering high level athletics make you money?

Lots of high level Sports physicians make very little with coverage. But it improves your patient base, provides advertisement for your practice…and it’s rewarding. You usually make money by seeing high volumes of patients, doing procedures, and hopefully doing some out of pocket regen stuff. If you look at pay between PM&R and SM…you’ll see very little difference. And if there is a difference it’s probably in spite of high level athletics coverage. It’s because of regen…and often more straight forward complaints that allow higher patient volumes and opportunity for procedures.

But FYI…you can definitely make more money doing higher volume Botox. Heck I know some DOs doing higher volume OMT clinics that make $500k+.

 

[Ligament]

All was covered with contract with athletic department. No cost to me/practice beyond typical malpractice. Similar to VA service connection treatment - anything that happened to athlete/coach while under athletics umbrella was covered forever for athlete and malpractice in our end.

Similar deal with high schools. Run malpractice costs through hospital system that organizes our school coverage and manages ATCs for school systems.

THank you!

 

[Iamnew2]

Lots of high level Sports physicians make very little with coverage. But it improves your patient base, provides advertisement for your practice…and it’s rewarding. You usually make money by seeing high volumes of patients, doing procedures, and hopefully doing some out of pocket regen stuff. If you look at pay between PM&R and SM…you’ll see very little difference. And if there is a difference it’s probably in spite of high level athletics coverage. It’s because of regen…and often more straight forward complaints that allow higher patient volumes and opportunity for procedures.

But FYI…you can definitely make more money doing higher volume Botox. Heck I know some DOs doing higher volume OMT clinics that make $500k+.

you mean spasticity botox or cosmetic botox?

 

[j4pac]

you mean spasticity botox or cosmetic botox?

Well…if you can do cosmetics that’s fantastic. But therapeutic Botox can definitely pay (besides Chronic migraine unless you’re pumping out dozens of chronic migraine Botox patients per day…which is still very possible).

 

[Iamnew2]

Well…if you can do cosmetics that’s fantastic. But therapeutic Botox can definitely pay (besides Chronic migraine unless you’re pumping out dozens of chronic migraine Botox patients per day…which is still very possible).

Iwas just curious that's all. I have wanted To do an outpatient clinic but my hospital doesn't have one and I'd have to get buy in from the hospital administration. But it's an interesting thought for sure

 

[j4pac]

Iwas just curious that's all. I have wanted To do an outpatient clinic but my hospital doesn't have one and I'd have to get buy in from the hospital administration. But it's an interesting thought for sure

In a 30 minute time slot you can typically knock out a 3-4 limb procedure with EMG guidance. The portable EMG unit is relatively cheap and gets paid off quickly. I was getting 2-3x on reimbursement compared to ultrasound guided injections for the same time.

 

[RangerBob]

Yeah, Botox is like printing money. The biggest hurdle is buying the Botox (it's expensive!) and storing it/using it before it expires.

I think any hospital/clinic would love to have a botox clinic as long as there is a large enough patient population to fill the clinic, once they find out how well it reimburses. Where I'm located, almost no one does Botox, so in theory if I wanted to be really entrepreneurial I could both serve a need in the community and make a lot if I started up a spasticity clinic. But inpatient keeps me plenty busy so I have little interest in outpatient.

Cosmetic botox is almost literally printing money, as it's cash pay. I would imagine it's not as fulfilling to do, and that the patient population is more difficult, but I think that all depends on what you enjoy/who you enjoy working with. A really savy/entrepreneurial type would probably love the business side that comes with a cosmetic practice.

 

[sloh]

If you can attract a high volume of Botox patients for migraine, you will be rolling in dough baby. Patients not as demanding as cosmetic Botox and doesn’t take nearly as long as Botox for spasticity.

 

[Iamnew2]

Yeah, Botox is like printing money. The biggest hurdle is buying the Botox (it's expensive!) and storing it/using it before it expires.

I think any hospital/clinic would love to have a botox clinic as long as there is a large enough patient population to fill the clinic, once they find out how well it reimburses. Where I'm located, almost no one does Botox, so in theory if I wanted to be really entrepreneurial I could both serve a need in the community and make a lot if I started up a spasticity clinic. But inpatient keeps me plenty busy so I have little interest in outpatient.

Cosmetic botox is almost literally printing money, as it's cash pay. I would imagine it's not as fulfilling to do, and that the patient population is more difficult, but I think that all depends on what you enjoy/who you enjoy working with. A really savy/entrepreneurial type would probably love the business side that comes with a cosmetic practice.

The inpt keeps me very busy at this time as well but given that I’m only one of two PM&R people locally it might make sense. Something worth looking into.

 

[Iamnew2]

If you can attract a high volume of Botox patients for migraine, you will be rolling in dough baby. Patients not as demanding as cosmetic Botox and doesn’t take nearly as long as Botox for spasticity.

True although Botox patients for cosmetic are demanding and th e profit is not great as the actual Botox is pricey - if you charge say $11-13 bucks a unit and it costs $6 from allergan you are not making no that much.