physical medicine and rehabilitation

[spreesbeers]

im am considering physical medicine and rehabilitation medicine, but am discouraged that the median income is only $130,000 (obviously, this varies in location and other factors). i think this is a good field for me, but can u realistically make make money in this field? i am especially interested in doing a fellowship in sports medicine. from what ive been told, its not that hard to get a residency in physical medicine and rehabiltation. is there a bright future in physical medicine and rehabiltation?

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[electra]

please pardon my meryy display of ATTITUDE this morning, but:

1. Look in a stats text and see the definition of median, and then ask yourself if you can make a living doing PM&R.

One the planet I come from, $130,000 bones can be "lived on" quite comfortably.

 

[spreesbeers]

i agree with ur opinion that one can live more than comfortably with a $130,000 salary. but compared to the other medical specialties, this figure is towards the low end of the spectrum, comparable with pediatrics and psychiatry. with a high debt coming out medical school, your salary is an important factor to consider. since $130,000 is the median, it is possible to be making $90,000. this is a nice figure compared to other professions, but after 4 years of college, 4 years of medical school, and 4 years of residency, this figure seems discouraging.

but, like i mentioned earlier, i am interested in physical medicine and rehab. but this specialty seems like an obscure one that it is only in the up-and-coming stage. i wonder if there will be ample opportunities in this field. will there will be abundant employment opportuntites as a physiatrist? or will the job options be specific to certain parts of the country (i.e. midwest)? baically my concern with physical medicine and rehab seems to stem from the amount of uncertainty and the the "unknown factor" associated with this field.

i am interested in this field, and i feel i would be happy doind this for a living, regardless of the salary. but, what are some of the career options you can have by going into physical medicine and rehab? i have heard you can pursue a fellowship in sports medicine once completing a residency in physical medicine and rehab. how does the job market in sports medicine look right now? i welcome any comments. thanx.

 

[drusso]

Originally posted by spreesbeers:
•i agree with ur opinion that one can live more than comfortably with a $130,000 salary. but compared to the other medical specialties, this figure is towards the low end of the spectrum, comparable with pediatrics and psychiatry. with a high debt coming out medical school, your salary is an important factor to consider. since $130,000 is the median, it is possible to be making $90,000. this is a nice figure compared to other professions, but after 4 years of college, 4 years of medical school, and 4 years of residency, this figure seems discouraging.•

Those are just figures for starting salaries--the salaries climb dramatically each year out after practice and it's not uncommon for physiatrists who do a lot musculoskeletal medicine, pain management, disability evaluations, and EMG's to make upwards of $200,000. Ditto for those specializing in complex areas of inpatient rehab--trauma, spinal cord injury, and traumatic brain injury.

Keep in mind that PM&R is a lifestyle specialty along the lines of derm, ophtho, and anesthesiology. There is very little call, the malpractice insurance rates are low, and the field lends itself to a more-or-less 9-5 lifestyle. The salaries are lower compared to other lifestyle specialties initially, but rapidly catch-up.

 

[lilycat]

You might try to find a poster known as "Stinky Tofu" on this site -- he's starting his PM&R residency this summer, and I know he's participated in other PM&R related threads in this section -- it would probably be a good idea to do a search for those threads. He could be biased, since he will be doing his residency in PM&R, but I know he thought that it was very much an up-and-coming field, and that if you do a fellowship, the income can be extremely rewarding.

 

[Winged Scapula]

lilycat is right - a search for threads on PM&R would be rewarding for you. As I recall, Stinky Tofu said that with Pain management fellowships, you can make in excess of $400K. Pretty easy to live on in my book!

 

[spreesbeers]

hey stinky tofu,
ill post my questions in this thread.

i saw ur post that said that UTHSCSA has a good residency program. where is this program? thanx.

 

[Stinky T]

UTHSCSA stands for University of Texas Health Science Center of San Antonio. They are the only program that will pay for your airfare, hotel room, and treat you out to dinner the night before. This was the main reason I interviewed there since they would pay for me to get into and out of Texas -- this made travelling a bit cheaper to my other interviews. I'm glad I went to the interview and was very impressed by the program.

 

[nydude]

i am an IMG, and i want to pursue a career in physiatry. i currently attend ross university, in the caribbean. i have heard that physical medicine and rehabilitation is an IMG accessible field. how difficult would it be for an IMG to get a top 20 residency in this field? what about just a good residency? does anyone know of any quality residency programs which are IMG friendly?

i have heard that only 1% of the US grads pursue this field. accordingly, residency directors look at an applicant's whole package. To me, this suggests that mediocre USMLE scores can be overlooked if one has good clinical grades, shown interest via doing a PM&R rotation, letters of recommendation, and personal statement. is this accurate?

how important are basic science grades? my basic science cumulative gpa is only a 2.5.

what kind of USMLE scores are needed to have a chance at a top residency program in this field, on average? to get into a good program in PM&R, i am guessing that a score of 200 or higher is sufficent. what do you think? the reason i am asking is that i have heard that in dermatology, you should not bother applying if you have less than a 230 on part I. i would like to have a cutoff score in mind to apply for a residency in this PM&R.

US medical school eductaion is far superior to that of any Caribbean school. but due to the low volume of PM&R applicants relative to other specialties, i was curious to know if all apllicants are viewed equally and on an individual basis, regardless if they are a U.S. grad or an IMG?

i would like anyone who has knowledge of the application process in PM&R to shed some light to the questions i have posed. thank your for your time and assistance.

 

[Stinky T]

There weren't any IMGs at the higher ranked programs that I interviewed at. Even with 1% of US Medical students applying, that would mean roughly about 150-200 students (I'm going by your numbers, I have no idea what the actual numbers are). On average there are maybe 5-10 seats at each program in PM&R. Thus, the top programs and CA programs are usually filled by AMGs. I would advise you to try to go to the websites of the schools and look at the current residents. I think UTHSCSA is a good program and there were a few FMGs there. If you want to get into a good program as an IMG, you probably want to do a little better than just passing. Personally, I would've gone into another field rather than go to a crappy program.

Your GPA is rather low, I would recommend doing a sub-i at the program you are interested in and try to do well on the USMLE. Good luck.

 

[nydude]

Originally posted by Stinky Tofu:
•Personally, I would've gone into another field rather than go to a crappy program.
•

stinkytofu, what programs do you consider "crappy"? what do you think would classify a program as "crappy"?

as an IMG, i will not have a chance at the top programs in PM&R. with my low basic science gpa, i will probably end up in a mediocre/low level residency.

why would you have gone to another field than go into a so-called crappy PM&R program? obviously, i will decide to specialize in the field that will ultimately make me happy, even if i am in a so-called "crappy residency", but i would like to hear your thoughts on the subject. thank you.

 

[nydude]

stinkytofu, here's some follow-up questions.

can one still be successful coming out of a "crappy" PM&R residency?

will going to a "crappy residency" affect one's starting salary on the job market?

will going to such a residency hurt one's ability to go for a fellowship once residency training is finished?

 

[nydude]

can someone please answer my last 2 posts? please see above. much thanks.

 

[Stinky T]

I think the answers are intuitive. Things will be more difficult, but not impossible. Connections also play a role and try to go to a residency with some elective time. This way you can do some electives there before you apply for fellowship.

 

[oceana]

Spreesbeers,

Seems like your very interested in the PM&R field. Just wanted to inform you on a good information source. You can get more information on PM&R from the American Academy of Physical Medicine & Rehabilitation at http://www.aapmr.org/
They can also send you a free med student packet within a week, that has everything you need to know on PM&R from residency match info, what a typical day is like as a resident, trends in the specialty etc. I really recommend it if your interested in the field.

To request a medical student packet, provide your name and mailing address to Dawn Levreau at [email protected] or (312) 464-9700.?

 

[soggybottomboys]

Is anyone here familiar with industrial medicine?

 

[melialva]

Ok, I am physical med. and rehab specialist and also did a fellowship in SCI.
I've interviewed in a lot of places so maybe my input might help.
Usually in very desirable cities (NYC, Chicago, around Florida) the pay will be lower because most people want to go there, thus...more marked saturation with rehab docs. In Fl I was offered 140,000 plus 35% of what I made over my overhead expenses ( I did not have a fellowship back then). In Tucson, AZ I was offered 220,000 w/o fellowship. In Cleveland, OH I was offered 250,000 on one position and another offered me 170,000. In Alabama I was offered 240,000. In Hazard, KY I was offered 200,000

Thus the deeper in the sticks you are, the higher the compensation because they tend to have more trouble recruiting staff. Plus academic positions pay way less.

 

[RUOkie]

you just bumped a 12 year old thread for that?

 

[Jitter Bug]

Ahhh! Old thread.

I was so damned confused.

 

[riverdude]

Ok, I am physical med. and rehab specialist and also did a fellowship in SCI.
I've interviewed in a lot of places so maybe my input might help.
Usually in very desirable cities (NYC, Chicago, around Florida) the pay will be lower because most people want to go there, thus...more marked saturation with rehab docs. In Fl I was offered 140,000 plus 35% of what I made over my overhead expenses ( I did not have a fellowship back then). In Tucson, AZ I was offered 220,000 w/o fellowship. In Cleveland, OH I was offered 250,000 on one position and another offered me 170,000. In Alabama I was offered 240,000. In Hazard, KY I was offered 200,000

Thus the deeper in the sticks you are, the higher the compensation because they tend to have more trouble recruiting staff. Plus academic positions pay way less.

It might seem like a crazy bump, but I was reading this thread while trying to convert how the situation applies to now - and you totally helped out. So I'm actually quite grateful you pulled this out of the last decade!

I might PM you to pick your braid a bit more about PM&R if you don't mind!

 

[KGflyboy]

How much more marketable will a fellowship make you? Will you see an increase in pay, or will the pre-fellowship offers you posted be similar to post-fellowship pay?

 

[Louisville04]

How much more marketable will a fellowship make you? Will you see an increase in pay, or will the pre-fellowship offers you posted be similar to post-fellowship pay?

You will definitely be more marketable if you have procedure skills (mainly interventional pain). Depending on your residency, you may or you may not need a pain fellowship (preferably ACGME accredited).

 

[imagoodmanyea]

In general, yes. I think most PM&R fellowships will make you marketable. It seems that TBI, SCI, peds fellowships will make you more attractive to large inpatient rehabilitation hospitals or academic centers.

I am current pain fellow applying for jobs, and the interventional training does make you a more attractive applicant for outpatient practices. If you are limited to large metropolitan areas, salary and job opportunities will be very limited despite having a fellowship. I am looking around major cities such as Chicago and DC, and my offers have been ranging around 150k to 250k base salary. You may be offered a percentage of collections and potential for partnership, which may increase your salary in the long-run. The other fellows in my program have received offers for 300k to 350k to work in more undesirable locations.

I do not think there is a straight-foward answer to whether fellowship will increase your income potential. There are general PM&R docs who are self-employed, probably making more than fellowship trained PM&R. Pain procedures pay well for now, but reimbursement for most PM&R procedures is on the decline. My rationale to choose fellowship was to expand my skill set to be more marketable. I have heard of attendings transitioning from MSK/pain practice back to general PM&R. It is difficult to do the converse (general PM&R for a few years to MSK/pain) since MSK/pain fellowships are very competitive.

 

[PMR2008]

I am looking around major cities such as Chicago and DC, and my offers have been ranging around 150k to 250k base salary. You may be offered a percentage of collections and potential for partnership, which may increase your salary in the long-run. The other fellows in my program have received offers for 300k to 350k to work in more undesirable locations.

Agree with the above. Having interviewed for almost 6 months around the Chicago and Dallas area the numbers mentioned above are very accurate. I was honestly shocked to hear the 150K base salary number but I soon realized that most of my fellow colleagues were getting similar offers in other large cities. A lot of it has to do with the recent and upcoming cuts in reimbursement, uncertainty in the health care environment and economy in general. There are still plenty of jobs out there in small town USA where you can make 300+ starting with potential to make a lot more in the long run. It is easier to find jobs that require seeing chronic pain patients 3-4 days a week even in big cities. Hospitals love hiring new grads to help out the PCPs. The senior pain guys will love you since you can see all the opioid patients while they do all the stims etc. I for one am not willing go that route specially after sacrificing a year after residency for a fellowship. In big cities are options can be very limited. True private practice sports/spine positions with a good base salary, partnership potential, good work environment are pretty much non existent. Most orthopedic practices already have a pain/spine PM&R doc on board and are not looking to hire until things settle down. But don't get me wrong. These practices will not interview you if you don't have a fellowship. So to get into the door you will still need a fellowship.

I do not think there is a straight-foward answer to whether fellowship will increase your income potential. There are general PM&R docs who are self-employed, probably making more than fellowship trained PM&R. Pain procedures pay well for now, but reimbursement for most PM&R procedures is on the decline. My rationale to choose fellowship was to expand my skill set to be more marketable. I have heard of attendings transitioning from MSK/pain practice back to general PM&R. It is difficult to do the converse (general PM&R for a few years to MSK/pain) since MSK/pain fellowships are very competitive.

Again I think you hit the nail on the head. I know plenty of docs doing general PM&R and SNFs who are doing very well and the procedural reimbursement cuts will not affect them. But than again you have to love what you do and have reasonable expectations on what your take home income will be. I think the key for fellows coming out of fellowship now and in the near future will be to diversify. PM&R attendings who were doing 5 days a week of EMGs are currently scrambling after the 50% cut recently announced. The same will happen when CMS announces that since the utilization of epidurals has gone up now that even CRNAs can perform them they will cut the reimbursement by 30-40%. Sooner rather than later ultrasound reimbursement will get cut as well. Basically it is only a matter of time that all procedures will be paid half of what they were paid 4-5 years ago. With the cost of living and over head going up most practices will consolidate and be bought by hospitals. This happened to Cardiology groups 2-3 years ago and is now happening to Orthopedic groups in my area. I personally think at this time it is possible to do both general PM&R and MSK/Spine concurrently. You do not necessarily need to do inpatient rehab and take call. There is a huge need for PM&R docs in subacute facilities and it is a very easy way to supplement your income in an ethical and rewarding way.