Jobs After PM&R Residency

[phoenix0610]

Hello,

I'm a medical student extremely interested in PM&R. I've done my homework, so I feel I don't have many misconceptions about the field. I like what physiatrists do, and think I would be very happy doing it, but I'm apprehensive about opportunities after residency. Is the market open, and competitive? Where do most people work--inpatient/outpatient, sports, spine, TBI/SCI pain?? I think I would like to work as part of a group, but would it be very difficult if I decided to start my own practice? Also I would like to stay in the South, mainly Texas--is that worse off than being on one of the coasts? That was a lot of questions I know, so answers to one or two would be much appreciated--thanks!

---

Members don't see this ad.

 

[axm397]

market is open in certain areas, saturated in others. Most major cities are saturated - most desirable locations are saturated (south CA, etc.)

Texas has opportunities. I know two of my friends just took pain jobs in the Dallas area. One friend is interviewing for an inpatient academic TBI job in the Dallas area. Another friend just interviewed for an outpatient MSK private practice job in the Dallas area.

I get job info from all over the country via recruiters, direct mail, emails through my program director, emails through my fellowship director, AAPM&R job site, journal job ads, and word-of-mouth in all areas of the country.

It doesn't matter what you decide to specialize in - I would not make career choice decisions based on marketability. Plus - you can't predict market factors and just plain luck. It's hard to plan for a theoretical market in 4-5 years.

solo vs multi specialty vs single specialty practice is a decision you will have to make depending on your business experience and risk tolerance. I have friends who started solo practices in PM&R - the first few years are definitely difficult - but it's difficult for any solo doc in any specialty.

Without knowing your personality, accomplishments, skills and defiicits, it's hard to predict how well you will do. probably the best thing to do would be the shadow and network with docs doing what you want to do - and pick their brains about how they got to where they are.

 

[phoenix0610]

Thanks for those comments--they help a lot. I guess my biggest thing right now is when I talk to the docs and residents at my school they always give me the standard "it depends on what you wanna do" response--which, don't get me wrong, I completely understand because the field is so diverse, but it doesn't help much...the only attending (SCI) I've been able to talk to at length about the subject had a somewhat negative outlook --just trying to get some balance.

 

[PMR 4 MSK]

PM&R is very wide open for opportunities - you can go most anywhere and do whatever you like. THere are groups and hospitals all over the country actively recruiting PM&R. Get a copy of "The Physiatrist" and you'll see many listings. The PM&R job board also lists many, but it is open only to members. A quick look at it showed me about 60 - 70 opportunities open right now, in everything - academics, groups, hospitals, in- and out-patient.

Work hard in residency, study hard and you'll do just fine. You probably won't get your dream job right out of residency, but you have to cut your teeth somewhere and build enough experience to land that dream job.

But it is true, it depends on what you want to do and where you want to do it. You may change your mind a few times during residency.

 

[Finally M3]

Check practicelink.net too if you want to see some jobs. Some are cross-listed from the AAPMR website, others are new.

 

[phoenix0610]

thanks for all the replies-- I really appreciate it...I just recently became a student member of AAPM&R, so I read the last issue of the Physiatrist, which sort of prompted my post...I saw all of the classifieds yes, but I also saw the results of the poll they had with PCPs about physiatrists...if there are still those attitudes in places like NYC and Chicago...I'm so excited about this field, and its not so much of me deciding whether or not I want to do it, but me just wanting to know what I'm getting myself into (I do love a good challenge, but still...😀)

 

[MSKalltheway]

but I also saw the results of the poll they had with PCPs about physiatrists...if there are still those attitudes in places like NYC and Chicago...

What were those attitudes exactly?

 

[axm397]

the Academy got some funding to do some market research and they hired an outside firm to hold focus groups in NY and Chicago with PCPs to see how aware they were of our specialty and what their perceptions were.

i actually saw some of the original video - and it was quite amusing. most family docs were aware of inpatient rehab services - mostly for stroke or spinal cords - because they took care of these patients pre and post-injury/disease. they had very little awareness of the outpatient side of PM&R - the MSK and neuromuscular stuff. Some PCPs thought physiatrists could be competition for them - especially when it came to more primary care related issues - i.e. medical management of post-stroke patients etc.

Dr. Lanoff, the head of the PPA committee - and others on the AAPM&R BOG shared their local marketing strategies - doing lunches at PCP offices, talking to nurses and administrative staff at PCP practices in the area, giving grand rounds at hospitals, etc. there were also representatives sent to the annual AAFP meeting and Dr. Lanoff even did a satellite CME course on our role in nonsurgical interventions for pain and disability.

The focus group results aside - many of the successful outpatient physiatrists I know (not to mention the inpatient ones) have very good relationships with PCPs in their area and have effective marketing strategies. Dr. Press actually gives RIC residents a talk every year about marketing, starting up your practice, how to generate more referrals, how to keep your referring docs happy, etc. A lot of common sense stuff - but also pretty powerful considering how successful his practice has become.

if you have good interpersonal skills and you are good at telling others about what you do and promoting the field, you don't need to worry about referrals. I think you do have to make a choice to go into PM&R and realize that more often than not, you will end up having to explain what you do and who you are to patients, family and friends, and other physicians. You probably will pick up more people at the bars by saying you are a surgeon than by saying you are a physiatrist - but if impressing others is your sole reason for choosing a field, then PM&R is not for you anyways. 😉

 

[phoenix0610]

oh trust me I know PM&R is not the "sexiest" of specialties--I'm constantly trying to explain to other people what it is I want to do and they are constantly asking me why...no matter though...I feel more at ease about things---working hard and being on top of your game is how to succeed in life in general, so this should be no different😀

 

[PMR 4 MSK]

I'm constantly trying to explain to other people what it is I want to do and they are constantly asking me why

Tell them, because you want to work 1/2 as much as an FP for 2x the money... 😀

 

[phoenix0610]

Tell them, because you want to work 1/2 as much as an FP for 2x the money... 😀

hahaha--good one, think I'll add that to my repetoire...

 

[WaterAvatar]

PMR is practiced like "Clinical Orthopedics" in London. Much like there is Neurosurgery and Neurology, PMR I feel is the non-surgical version of Orthopedic Surgery + the Rehab component....

anybody like that name?? "clinical orthopedics"... People will sort of have an idea then, however it mostly describes the MSK part of PMR.

 

[phoenix0610]

PMR is practiced like "Clinical Orthopedics" in London. Much like there is Neurosurgery and Neurology, PMR I feel is the non-surgical version of Orthopedic Surgery + the Rehab component....

anybody like that name?? "clinical orthopedics"... People will sort of have an idea then, however it mostly describes the MSK part of PMR.

Yeah, I see what you're going for, but it does leave out the other half...one resident described it to me, and I use this to describe it to others--it's a function oriented neurologist and a non-surgical orthopedist rolled into one.

 

[WaterAvatar]

A Functional Neuro-Orthopedist

 

[Llenroc]

PMR is practiced like "Clinical Orthopedics" in London. Much like there is Neurosurgery and Neurology, PMR I feel is the non-surgical version of Orthopedic Surgery + the Rehab component....

anybody like that name?? "clinical orthopedics"... People will sort of have an idea then, however it mostly describes the MSK part of PMR.

PM&R has this reputation of being Orthopedics Jr., which a surprising number of people in the field buy into. Many people in the field will say stuff like "I really liked Orthopedics but couldn't do it because of my board scores/desire to have a life/nasty people so I did PM&R instead". 😴

Having done multiple rotations in different PM&R settings, I honestly can't see much overlap - if any - between the two branches when it comes to the day to day work. I was on a General Rehab./Ortho service one time, and during the month there were 3 actual ortho patients. They had me (and the other resident) follow the Stroke patients as well because the service was so slow. At a major trauma hospital, the vast majority of consults were for head injuries, strokes, and EMG's. Orthopedic problems tended to be incidental or patients with multiple limb injuries. There's a lot more Neurologic issues in PM&R than there are Orthopedic issues. Outpatient practice is often primarily back pain and carpal tunnel syndrome, which can be seen as orthopedic issues, but from the Physiatrists point of view require an understanding of the peripheral nervous system more than anything else (i.e. EMG's).

That and Orthopedic surgery is all about the operating room, of which in PM&R there is none. IMO, PM&R is more like Neurology than anything else.

 

[ampaphb]

PM&R has this reputation of being Orthopedics Jr., which a surprising number of people in the field buy into. Many people in the field will say stuff like "I really liked Orthopedics but couldn't do it because of my board scores/desire to have a life/nasty people so I did PM&R instead". 😴

Having done multiple rotations in different PM&R settings, I honestly can't see much overlap - if any - between the two branches when it comes to the day to day work. I was on a General Rehab./Ortho service one time, and during the month there were 3 actual ortho patients. They had me (and the other resident) follow the Stroke patients as well because the service was so slow. At a major trauma hospital, the vast majority of consults were for head injuries, strokes, and EMG's. Orthopedic problems tended to be incidental or patients with multiple limb injuries. There's a lot more Neurologic issues in PM&R than there are Orthopedic issues. Outpatient practice is often primarily back pain and carpal tunnel syndrome, which can be seen as orthopedic issues, but from the Physiatrists point of view require an understanding of the peripheral nervous system more than anything else (i.e. EMG's).

That and Orthopedic surgery is all about the operating room, of which in PM&R there is none. IMO, PM&R is more like Neurology than anything else.

The floor at any rehab hospital was full of Ortho patients until the advent of the 75% rule, which typiclly med students, and to some extent residents, have no clue about. Basically what it did was say there are these 13 diagnoses we feel are appropriate for inpatient rehab. Sure, you can have debility patients, and anything else you feel appropriate, but unless 75% of your patients fit into one of our 13 categories, we are taking away your CARF (which is basically Medicare) accreditation. Oh yes, by the way, s/p THA and TKA are NOT amongst those 13 categories, UNLESS your patents are are over 85, had bilateral procedures done, or have a BMI over 50.

Now mind you, the 75% Rule was a good idea, 'cause a lot of free standing rehab hospitals were incredibly abusive before it's implementation, but excluding single joint arthroplasties seemed excessive. Yes, I know there are no studies that show inpatient rehab was particularly useful, and there have been arguments made that SNFs are just as good, but you and I both know that the average SNF is rediculously understaffed, and unable to provide adequate services.

In CMS's defense, IRFs experienced rapid growth from 2000 to 2004, with utilization up 24 percent, according to CMS. When the agency reinstated its enforcement of the 75 percent rule, IRF utilization fell back to 2000 levels.

In short, why is the population of inpatient rehab facilities less ortho than in the past? 'Cause your attendings were too greedy, and CMS noticed, but then over-reacted

 

[PMR 4 MSK]

PM&R has this reputation of being Orthopedics Jr., which a surprising number of people in the field buy into. Many people in the field will say stuff like "I really liked Orthopedics but couldn't do it because of my board scores/desire to have a life/nasty people so I did PM&R instead". 😴

Having done multiple rotations in different PM&R settings, I honestly can't see much overlap - if any - between the two branches when it comes to the day to day work. I was on a General Rehab./Ortho service one time, and during the month there were 3 actual ortho patients. They had me (and the other resident) follow the Stroke patients as well because the service was so slow. At a major trauma hospital, the vast majority of consults were for head injuries, strokes, and EMG's. Orthopedic problems tended to be incidental or patients with multiple limb injuries. There's a lot more Neurologic issues in PM&R than there are Orthopedic issues. Outpatient practice is often primarily back pain and carpal tunnel syndrome, which can be seen as orthopedic issues, but from the Physiatrists point of view require an understanding of the peripheral nervous system more than anything else (i.e. EMG's).

That and Orthopedic surgery is all about the operating room, of which in PM&R there is none. IMO, PM&R is more like Neurology than anything else.

My outpatient PM&R practice is mostly ortho - granted, much is spine, but I also do a lot of muscle, tendon, ligament and joint work. Of course, I work with a bunch of ortho's so my practice is biased, but I like the ortho aspects of PM&R more the neuro, except for EMGs.

 

[drusso]

In CMS's defense, IRFs experienced rapid growth from 2000 to 2004, with utilization up 24 percent, according to CMS. When the agency reinstated its enforcement of the 75 percent rule, IRF utilization fell back to 2000 levels.

In short, why is the population of inpatient rehab facilities less ortho than in the past? 'Cause your attendings were too greedy, and CMS noticed, but then over-reacted

The party was already long over by the time most people who post on SDN got into the field, but get physiatrists who trained and entered practice in the mid-80's to start talking...wow...before Schrushy and the HealthSouth Fraud debacle, the PM&R really did mean "Plenty of Money and Relaxation."