Interesting career options

[NolanPM&R]

Hey everyone,

My name is Nolan Fisher. I'm currently a PGY-3 at the Cleveland Clinic PM&R Residency. As I approach the end of residency I'm starting to think more about what my practice will look like. Through residency we all get familiar with traditional inpatient rehab jobs in academia, inpatient consult services, and the traditional PM&R outpatient clinics. What I am looking for are the options that residents may not be as familiar with. I'd enjoy hearing from some of you about your jobs that offer autonomy, work-life balance, and are great options for residents to consider. Feel free to share details about how you ended up in your job and how a graduating resident would pursue work that is similar to yours.

Looking forward to hearing what you have to say!

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[DOctorJay]

Look at the posts from @PMR2008

 

[lejeunesage]

Personally, what my residency program didn't expose me to very much was:
- SNF practice. This can be very lucrative for people who are able to see large numbers of patients per day.
- Medical-legal work: Independent Medical Examinations, Depositions, Advanced Life Care Planning

I've never done SNF. Well, I did a grand total of 1 consult at a facility that clearly didn't know how to use my services. I could have stayed and tried to refine things but I hated the EMR, hated the lack of a dedicated dictation/charting room, and I was making enough bank from my primary job that I didn't care to continue. But I know some people who make 2-3 times what I make doing SNF work.

I'm just dipping my toes in Medical-legal work right now. You can make serious bank/unit of time doing this. Only downside is that it's a lot of paperwork and it's hard to have enough referrals to make a full time practice out of it.

Other things to consider:

- Botox injections for headaches. Very quick way to make a ton of money. Patients keep coming back every 3 months over time, that adds to a lot of patients. Much faster than injections for spasticity as well. Downsides: You might want to have a cash practice because insurers are great at finding ways to deny payment.

- Inpatient rehab medical director with one of the big rehab companies (Encompass vs Kindred vs Vibra). Income stream from collections and directorship stipend. That's my primary gig and it keeps me well fed. Downsides: with corporate medicine, there are a lot of pressures to take inappropriate patients: the bigger your unit is, the more you'll have to deal with administrators who look at beds and see $$$, irrespective of what the patients are able/willing to do. My advice? Get one of these gigs with a unit that has only so many beds: 14-22. Make sure your hospital gives you coverage for weekends/vacations. Then add a second stream from either acute care consults/SNF consults or Med-legal.

- Locum: no home base. Travel to new gigs as frequently as you want. Take a vacation whenever you want. It's fine but you won't really get rich doing it. Most places are paying something like $150/hr. That sounds impressive when you're a new graduate but at this point, if someone won't pay me $1600+ per day, I'm not interested.

- If you're an entrepreneur, you can see if the SBA will loan you money to start a health clinic/health spa: Find a big space. Hire a dietitian, some massage therapists, some fitness coaches. Offer cooking classes, yoga, massage, etc. You as the doc focus on doing steroid injections, cosmetic Botox, preventive health counseling, etc. Downside: unless you have a good business background you'll have no idea how workable the business plan is. It will also be hard to find a loan. EIDL funds are exhausted, alas.