Not Interested In Fellowship

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Jun 3, 2014
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Hi everyone, I'm a PM&R resident and not interested in any fellowships, what are my job outlooks? Are Pain/Sports&Spine fellowships the only way to make a decent living? How would one get involved into subacute rehab?

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Been covered a few times before. A few anecdotes from people I know.

1 - co-resident go straight to work at a HealthSouth/Encompass rehab in Maine right out of residency. Worked like a dog. Made $500k first year out. Paid off all debt. Cut back to more normal hours making high $300k.
2 - co-resident stayed on post-residency did some grunt work inpatient/consults for a few years, decided to go into work-comp/occupational type work. Doing well - $300kish but in higher COL area.
3 - two co-residents do fellowships; within two years of practice both left their sub-specialty and started doing SNF consults 80-90% of the time with PRN coverage in their fellowship training. Don't know compensation, but doing well enough and much happier than staying in sub-specialty.

Don't need a fellowship but without one will likely need inpatient to be ~50%+ of your productivity OR do EMGs if you want to be 100% outpatient. Will be treated like a PA/NP if you want to do MSK work and not do EMG (even with US skills IMO) in an ortho group.
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There may be a better average in pay with an interventionally based fellowship, but you can do great with some directorship/outpatient/subacute mix. If you Don’t forget how to live like a resident, you’ll feel like royalty at any job post-residency. Location matters a lot. Your motivation and diversification are helpful, too.

There are several threads with expertise in sub-acute who I’ll defer to. Those opportunities came looking for me early in my career.
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You can definitely find work and make good money doing general. The stats show that you don’t really make any more doing fellowship (aside from Pain), so considering that you loss that 1-2 years of income, general is probably the smartest financial decision. But you have to be willing to be flexible…in regard to scope, patient type, and procedures. The fellowship does position you for jobs you can otherwise not get, and you can still do general with fellowship. I’m not sure that the average physician has the amount of flexibility, humility, and patience to do well in general…but for the right individual it can be a good gig. I do general at an academic center…not the easiest job to land for a generalist, but even that is possible.
Go on AAPMR job board and practice link for starters. Have a look around. You can see there are a lot of general PM&R jobs. But many will require relocation. AAPMR is better for academic jobs typically.

SNF jobs typically aren’t on there. Integrated Rehab Consultants sends me an email about twice per week to join them. There are several SNF companies. Some SNF companies will take a lot of your money up front, such as the first 10 per day will take a high %. Or you go solo (which is harder to get into a SNF, but will take some work). Some places you get benefits and others not. What you would really want is a 1099 gig. Based on what I’ve seen post training, there is a lot of turnover with some of those companies.

Encompass health physician careers is also another good place to start or reach out to a recruiter for acute IPR. There is also HCA healthcare, Kindred and others. Lots of jobs if you are willing to relocate. I’ve always been very hesitant in Kindred and they also seem to have higher physician turnover.

You can also try locums, doc cafe, comphealth, ect. Comphealth will send you job postings several times per week for the rest of your life if you give them your email. If you call them about a job they never follow through because likely the job was already filled. Some people make a great career by just being Locums. I’ve just not found a recruiting company to be helpful.

So overall, I agree with above. No you don’t have to do spine to make a lot of money. The more patients you see per year the more money you make typically (depending on your contract). With a busy pain practice it can be easier to get higher income, however with a 1099 general you can also get there, but be prepared to work for it.

As a generalist that wants to make money, I’d recommend going inpatient as a 1099 and getting to 20 patients per day, then either adding additional inpatient or SNF if you want to make more. It’s more work than I do, but that’s how you make higher income. Also adding on some admin work helps too.
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Hi everyone, I'm a PM&R resident and not interested in any fellowships, what are my job outlooks? Are Pain/Sports&Spine fellowships the only way to make a decent living? How would one get involved into subacute rehab?
Lots of options. Depends on your interest. How do you define decent? Where do you want to live? What type of lifestyle do you aspire to have?
I know docs doing all sorts of things making a decent living. For me the most important thing was location(having family around, enjoying the finer things in life), flexibility (no call, weekends, being around my kids in the golden years, being able to work my hours and be my own boss), financial freedom, and the joy of working. No job is perfect but for me SNF work with a little sports/spine/regen is the best fit. For some acute rehab is ideal. Some of my friends actually love pain and procedures. Just find out what you value and enjoy and get as much guidance you can from here and from residency alumni. No reason to talk about career choices from current co residents, attendings or future potential employers.