job outlook

[burlingame.2]

I am applying to medical school and am very interested in PM&R as a medical specialty. I was wondering what the job outlook for this disipline is and what the future holds for it. I was also curious about if this was a disipline that you could move to any city and find a job or if you would have to be willing to go anywhere to find a job. Also does this discipline fall into the primary care categories that usually offer some student loan relief? Thank you for all of your responses.

Jason

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[Finally M3]

Can't comment on the future job prospects although you can find ads for practices hiring just about anywhere (ie you don't have to go to BFE if you don't want to). But PM&R isn't a primary care specialty, and thus you can't join the Public Health Core or participate in some state's tuition reimbursment program.

 

[drvlad2004]

Jason,

The job outlook is excellent in PM&R. Every PD that I have spoken to says that we have reached an opportune time in this field. There are many hospitals and rehab centers that are looking for medical directors, physiatrists w/ a fellowship in pain management, interventionalists, etc. The job market is basically resident driven. Many residents have had the choice to practice wherever they want in the US. Currently the Northeast is the biggest market but there has been much higher demand in the South and Midwest. Also, like most specialties, the average salaries tend to be higher in the South and Midwest with a lower cost of living. That is one reason why I am almost definitely moving out of NY (4 more years!) once I am done with residency. The cost of living is too high and average is not that great.

Hence, jobs prospects are very good in PM&R. It is a field that you can almost design how you want to practice, depending upon family and other personal situation. Finally, you cannot qualify for a primary care loan (or loan forgiveness) program through PM&R. PM&R is a distinct specialty. Do a rotation in PM&R and see if you like this field .

 

[drusso]

Here's a typical job advertisement that comes my way not infrequently:

CALIFORNIA (within 60 minutes to SAN FRANCISCO) -
Well-established single specialty group of Orthopaedic Surgeons seeks to
add PM&R Physician. The new Doctor can either focus on straight PM&R
with some pain or can have a Pain Fellowship and focus a high percentage
of their practice in that area. This Orthopaedic Group is in their
thirty first year of operation and has just opened a new 10,000 SF
offices with state of the art rehabilitation complex. New Doctor can
oversea the Rehab center, perform EMG's, epidurals, neuromuscular and
invasive pain management. If the new Doctor is Pain Oriented the group
can setup a procedure room where they can handle a high volume epidural
procedures working with a Spine Fellowship trained Orthopaedic Surgeon.
Located within one hour to the ocean and four hours to the mountains in
the heart of wine country. Excellent compensation is base salary with
productivity bonus.

 

[rehabmd]

I think there are good private practice jobs available but few good teaching jobs in outpatient academic rehab. I want to teach bread and butter noninvasive outpatient adult and pediatric rehab, no inpatient rehab, and I am having trouble finding such opportunities here in NYC, even though there are many hospitals and my salary expectations are very low. I am currently teaching residents at an inner city hospital but there is virtually no formal education or mentorship for me as a junior attending. The academic medcial center we are affiliated with is preoccupied with its inpatient unit and there is too much politics there, as in most large academic rehab centers. Ironically it is the internal medicine department, not the rehab dept that sends its med students and internal medicine residents on home visits to evaluate home safety, mobility and ADLs. Improving the delivery of high quality outpatient long term care is not a priority in academic rehab, although it is what many residents prefer to do after graduation, and what other specialties think we have expertise in from doing a rehab residency.

 

[drvlad2004]

Rehabmd,

How is the job outlook when it comes to private practice in NYC?

 

[rehabmd]

Depends on what you are looking for and what skills you have to offer in private practice. Since i am interested in teaching and writing, I have not looked into private practice opportunities but my colleagues and residents who have are all doing very well, especially since there are so many orthopedists and internists in NYC who offer excellent group practice opportunities. For part time work, opportunities for workers comp and no fault work doing EMGs and f/u physical exams are almost always available, as well as positions working for chiropracters, and can help you get by financially while looking for more desirable work. Manhattan is a difficult neighborhood to start practicing in bc of the high cost of rent($10,000 per month in many parts of the upper east side) but there are many reasonable opportunities in the outer boroughs Brooklyn, Bronx and Queens.

 

[drusso]

I think there are good private practice jobs available but few good teaching jobs in outpatient academic rehab. I want to teach bread and butter noninvasive outpatient adult and pediatric rehab, no inpatient rehab, and I am having trouble finding such opportunities here in NYC, even though there are many hospitals and my salary expectations are very low. I am currently teaching residents at an inner city hospital but there is virtually no formal education or mentorship for me as a junior attending. The academic medcial center we are affiliated with is preoccupied with its inpatient unit and there is too much politics there, as in most large academic rehab centers. Ironically it is the internal medicine department, not the rehab dept that sends its med students and internal medicine residents on home visits to evaluate home safety, mobility and ADLs. Improving the delivery of high quality outpatient long term care is not a priority in academic rehab, although it is what many residents prefer to do after graduation, and what other specialties think we have expertise in from doing a rehab residency.

I think that you identified some key issues. Have you considered a faculty position at an osteopathic school? You could be involved in the musculoskeletal components of their curricula which is usually more developed than most allopathic medical schools.

 

[rehabmd]

That's a great idea! I love the idea of teaching medical students who are interested in doing a rehab residency. I currently teach physical diagnosis at an allopathic NYC medical school (my alma mater) where all the med students are really interested in learning about musculoskeletal care but not one of this year's med students applied for rehab residency. To be perfectly honest, I dont feel right encouraging my med students to do a rehab elective in the program I work for bc of the the low morale in the rehab dept and the lack of supportive leadership. The way the rehab residents are treated by the leadership in their own dept is so poor compared to how well the med students are treated by other depts in the hospital. Having trained and worked in all three large NYC programs, I do not feel right recommending any medical students to do rehab electives in the NYC area bc I feel it turns them off rehab when they see how unhappy residents are and it perpetuates negative stereotypes about our specialty. But I know our specialty has no future if we do not invest in the education of med students and residents. Are there any rehab programs on the East Coast that are medical student friendly that will meet high educational and professional standards and not turn med students away from rehab?

 

[BrooklynDO]

That's a great idea! I love the idea of teaching medical students who are interested in doing a rehab residency. I currently teach physical diagnosis at an allopathic NYC medical school (my alma mater) where all the med students are really interested in learning about musculoskeletal care but not one of this year's med students applied for rehab residency. To be perfectly honest, I dont feel right encouraging my med students to do a rehab elective in the program I work for bc of the the low morale in the rehab dept and the lack of supportive leadership. The way the rehab residents are treated by the leadership in their own dept is so poor compared to how well the med students are treated by other depts in the hospital. Having trained and worked in all three large NYC programs, I do not feel right recommending any medical students to do rehab electives in the NYC area bc I feel it turns them off rehab when they see how unhappy residents are and it perpetuates negative stereotypes about our specialty. But I know our specialty has no future if we do not invest in the education of med students and residents. Are there any rehab programs on the East Coast that are medical student friendly that will meet high educational and professional standards and not turn med students away from rehab?

So where would you recommend a student do his rotations, who is very interested in primarily a msk centered outpatient practice eventually... I know im kind of jumping a level... but so far from what I am hearing, none of the NY programs seem to be all that great for students.... And, what are the good msk programs anyway? thanks a bunch...
~Brooklyn,

 

[drvlad2004]

That's a great idea! I love the idea of teaching medical students who are interested in doing a rehab residency. I currently teach physical diagnosis at an allopathic NYC medical school (my alma mater) where all the med students are really interested in learning about musculoskeletal care but not one of this year's med students applied for rehab residency. To be perfectly honest, I dont feel right encouraging my med students to do a rehab elective in the program I work for bc of the the low morale in the rehab dept and the lack of supportive leadership. The way the rehab residents are treated by the leadership in their own dept is so poor compared to how well the med students are treated by other depts in the hospital. Having trained and worked in all three large NYC programs, I do not feel right recommending any medical students to do rehab electives in the NYC area bc I feel it turns them off rehab when they see how unhappy residents are and it perpetuates negative stereotypes about our specialty. But I know our specialty has no future if we do not invest in the education of med students and residents. Are there any rehab programs on the East Coast that are medical student friendly that will meet high educational and professional standards and not turn med students away from rehab?

From personal experience, I also find that NYC rehab programs are harsher environments to deal with. The big 3 NYC programs are strongly inpatient oriented but way too heavy on IM at the same time. IMHO, I think the very fast pace of NYC somewhat contradicts the slower, more easy going manner of PM&R. The call schedule that I see at NYC programs are definitely longer than most. However, it seems that residents are still well-trained due to a greater need of self-motivation. The city can sometimes feel like just a work factory due to the high volume of patients at the every single hospital. Most students and residents want to be in NYC mostly b/c of location. Manhattan's cost of living was too much for me.

I rotated at JFK and totally loved it. Everybody (including ST, OT, psych and PT) was so committed to teaching. Even though it is a very competitive program that tend to prefer their own state residents (namely RWJ students), the rehab faculty provided a warm environment to fully appreciate rehab. The place isn't as highly touted as Kessler but I didn't see too many other programs that were as happy like JFK.

This a shameless plug but the program that I will be entering, Nassau University Medical Center, seems very medical student and resident friendly. One classmate who decided to do FP commented on how she loved it over there when she did a PM&R rotation at NUMC. Thanks to an amazing program director and solid faculty members (who trained all over the NYC area), the program is very structured unlike the rest of the hospital (financial difficulties largely due to county's budget deficit). The faculty really stay on top of their residents to make sure that they're learning. The program's weakness seems to be SCI and TBI. Their greatest strength is anything related to musculoskeletal. However, the chief resident ended up getting accepted into Mt. Sinai's SCI fellowship.

The East Coast still has plenty of solid programs that strive to meet high educational standards. I also found that programs that may have been historically weak are quickly improving on their weakness, especially msk rehab (e.g. U of Pitt).

Teaching at a DO school may not be a bad idea. Your knowledge of msk can be beneficial for students learning OMM and msk medicine. Musculoskeletal medicine is highly emphasized in the curriculum and many more students are interested in it.

 

[rehabdoc]

Well, I am sorry that my friends RehabMD experience in NY is not as he desires.
I was in the market last year for interventional jobs out in NY and found them about 5-10 year behind other east coast rehab departments. They think very limited, very conservative and basically too pleased of themselves and ways things are done there. I was offered many posts in NYC but they either didn't pay what they should or got scared with plans I had for the interventional program.

If research is what you want and NY is not the most important place, try Boston or Seattle. You are certainly more appreciated in the two cities if you are a researcher, and if you have desire to teach.

I agree with commend about Nassau county program. Dr. Wiese (? spelling) is really nice and well connected in the academy. They do plenty of research and is student friendly.

if I could be of more help please PM me and will guide to right place in Boston.

rehabdoc

 

[drvlad2004]

Rehabdoc,

In terms of interventional spine programs in NYC, is the Hospital of Special Surgery (NY Presbyterian) the only one in the area. Throughout my interviews, none of NYC programs seemed to be big on interventional since most of them have around been much longer but remain old-fashion compared to most younger programs. There does not seem to be much PM&R-related fellowships in NY, especially when it comes to interventional physiatry and sports.

 

[tempperson]

Has anyone heard about pain in california?

I was talking to an anesthesiologist at baylor who knew of some guys doing pain medicine. He said that in general, the reimbursements in cali are not very good relative to that of the south, and that the market getting saturated with pain specialists in major cities there. anyone know anything about this?