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PM & R -- Outpatient jobs are hard to find?

Discussion in 'PM&R' started by bigfrank, May 15, 2002.

  1. bigfrank

    bigfrank SDN Donor

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    Hello, I have heard so much B.S. about PM & R that it is making me nauseated.

    First of all, don't MOST physiatrists do inpatient rehab?

    Aren't 99.9999999999% of the Pain Fellowships through Anesthesiology?

    Aren't most "clinical" physiatrists associated with Orthopods doing their left-overs?

    I've done a comprehensive search and found VERY VERY few jobs in PM & R that are clinically-based.

    I just don't want people to get the wrong idea about PM & R and go into the field thinking they're going to make "700K/year" as it has been recently stated.

    Maybe I'm wrong and, if I am, could someone please clear up this outpatient question for me?
     
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  3. Ligament

    Ligament Interventional Pain Management
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  4. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved

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    Big Frank,

    Many physiatrists do inpatient care, but out-patient is a booming, I mean booming area for those with the right skills and qualifications. It really does sound like you have a axe to grind against rehab. Here's a sampling of job listings for physiatry on the AAPMR site. (some identifers removed to protect against spamming, etc).

    Pittsburgh, California
    Diablo Orthopaedic Specialists is an eight member Orthopaedic Surgery group with one generalist, and seven fellowship-trained surgeons in traumatology (1), total joint replacements (1), hand and upper extremities (2), sports medicine (1), and spine surgery (2). We would like to recruit a PM & R trained individual to complete our office-based practice and provide services in interventional pain management. The position offers a competitive salary, with full benefits, including partnership opportunities. Our practice is located in an upscale suburban community, 30 miles from San Francisco, servicing local hospitals and a Level One Trauma Center. Send CV ad Inquiries to: xxxx

    Los Angeles, California
    Assistant Clinical Professor, Nontenured Position-Department Of Orthopaedic Surgery - UCLA School Of Medicine. The UCLA Department of Orthopaedic Surgery is searching for a physiatrist to join the UCLA Comprehensive Spine Center. This physician will see and evaluate patients with spinal disorders and specialize in the non-operative rehabilitation of these conditions. This physician will be expected to maintain creative collaboration with departmental faculty, fellows and residents as well as participate in teaching. Appointment in this series does not confer tenure or membership in the UC Academic Senate. Qualified applicants must be able to obtain a medical license in the State of California. Send curriculum vitae to XXXXXC

    Kalispell, Montana
    BC/BE Physiatrist: Incredible opportunity for a well-trained BC/BE Physiatrist to join a very well-established group of seven orthopedists and a physiatrist covering Kalispell, Whitefish and Northwest Montana/Northern Idaho. The position is office based, focusing on the conservative management of musculoskeletal pathology, electrodiagnostics, with a special focus on spine. Spine care includes a busy clinical practice in conjunction with a fellowship-trained spine surgeon, with ample opportunity for in-office Fluoro injections. Practice in one of the last, best places in Northwest Montana, within an hour of Glacier National Park, 2 downhill ski resorts, and abundant summer river and lake water sports. Fax CV to XXXXX

    Salt Lake City, Utah

    Salt Lake Pain & Med Rehab. Established outpatient rehab clinic looking for BE/BC applicant with excellent interpersonal skills and self motivated. Interventional procedure skills, occ med experience & Spanish speaking a plus but not required. Recent grads welcome. Ability to manage acute/chronic pain, work & MVA related injuries. Come live/work in a safe/clean city within 30 mins of ski lifts. Salt Lake City offers everything from theatre to outdoors. Salary guarantee & ownership available. Fax CV to: XXXXX

    Maine
    Dynamic, growing, comprehensive rehab practice offers outstanding opportunity for a staff physiatrist. Eastern Maine Medical Center, a 400-bed tertiary hospital serving 500,000, has a 26-bed unit and 15-bed SNF. Outpatient services include TBI, SCI, musculoskeletal and spine, pain, CP/spasticity management, EMG and procedural Rx. Exceptional opportunity for flexible, patient oriented team player. Competitive compensation and benefits. Bangor rates among the top twenty places to raise a family per national poll rating schools, safety, health care, and environment. University of Maine's flagship campus is in neighboring Orono. Year-round recreation, with easy access to coast, mountains, lakes, and Acadia National Park. Not a J1 opportunity. Please fax letter of inquiry and CV to XXXXX

    Baltimore, Maryland
    Join several other Physiatrists in an office based Physiatry Group private practice opportunity in suburban Baltimore Maryland. Practice currently involves electrodiagnostics, acupuncture, musculoskeletal medicine, acute and chronic pain management & rehabilitation. We are primarily an outpatient practice and there is ample opportunity for development interventional procedures and/or an inpatient practice and for an interested individual. The salary is competitive with an excellent benefits package. For more information regarding this position please send a CV by e-mail xxxxx

    Hagerstown, Maryland
    Extremely busy, established four-physician Orthopedic practice with physical therapy, MRI, XR, and dexa scanner seeking a BE/BC Physiatrist. Located in scenic Hagerstown, Maryland our main office is an easy 70-mile commute to Washington, DC and Baltimore, Maryland. We are located in a Medical Mall and service the tri-state area of Maryland, Pennsylvania and West Virginia. Competitive salary, excellent benefits, pension and 401K. Fax your CV or call XXXX

    Western Massachusetts
    Baystate Health System -Baystate Medical Education & Research Foundation -Western Campus of Tufts University School of Medicine -Inpatient Medical Director Physiatry Position- Seeking a candidate with excellent training & recent experience with inpatient rehabilitation. Individual will have solid clinical skills in SCI/TBI, be solution oriented, and enjoy team development & medical management. The medical director will be a vital member of a team establishing a new inpatient rehabilitation unit. This position is a mix of administrative & clinical duties and represents collaborative program development with the Spaulding Institute. This position is with BMERF, our full time employed, multi-specialty physician practice. BMERF is a large group of collegial academically oriented physicians. Baystate Health System is one of New England?s largest integrated multi-institutional health care systems and offers a coordinated continuum of hospital, physician services and home health care services. Baystate Medical Center has over 600 beds and is the regional referral and tertiary care center for Western New England. Springfield is located in the beautiful Connecticut River valley at the foothills of the Berkshires with convenient access to coastal New England, Vermont and metropolitan Boston and New York. The area also supports a rich network of academic institutions including the Univ. of Mass. at Amherst, Smith, Hampshire and Mt Holyoke Colleges. Interested applicants should contact: xxxxx

    Northeastern Pennsylvania
    Northeastern Rehabilitation Associates, P.C. has an immediate opening for a BC/BE interventional physiatrist in our Scranton office. This position includes working in a new local state of the art surgery center. You will receive patient referrals from a number of specialties including orthopedics and occupational medicine. This is an exciting opportunity for the right individual to join a well-established physiatry and pain management practice. We offer a competitive salary and benefit package. Please send or fax your CV in confidence to:xxxxx

    Chicago Suburbs
    Outstanding opportunity for a Medical Director, one full-time Physiatrist and one part-time Physiatrist at a 32-bed rehabilitation center affiliated with a 400-bed tertiary care hospital just 25 minutes from downtown Chicago. This is one of the largest, most comprehensive rehabilitation facilities in the southern metropolitan area. Requirements for the Director position include board certification with a minimum of two years experience as a collaborative team player providing rehabilitation services in an inpatient program. Applicants should contact XXXX

    Outstanding Private Practice opportunity. Join our thriving regional center of excellence in pain management, spinal diagnostics and musculoskeletal health. We have two rapidly expanding satellite clinics with a good blend of outpatient and inpatient consultation services. Our state of the art facility-which features onsite fluoroscopy suite, CT, MRI and electrodiagnostics-is under the direction of XXXX. Candidates Board Certified or Board Eligible in Physiatry can look forward to an area with a booming economy, a great place to raise a family, and excellent educational systems. Please send CV to: XXXX

    Mt. Vernon, WA
    THE PRACTICE: Skagit Island Orthopedic Surgeons is a 5-man private practice, seeking a BC/BE Physiatrist experienced in the areas of inpatient, geriatrics and outpatient musculoskeletal rehabilitation. Two offices, two hospitals in Mt. Vernon and Anacortes, Washington; in the process of building a new clinic, surgery center and physical therapy to be completed in 2003. Practice covers entire spectrum of Ortho, except oncology, replants and complex peds. S.I.O.S. is a Division of Proliance Surgeons, Inc. P.S., (formerly Orthopedic Consultants of WA) a single corporate group combining 11 of the best private Orthopedic practices (70+ Ortho docs) and 11 General Surgeon practices (35+ General docs). Each practice is autonomous, with business functions, group purchasing, human resources and marketing/contract negotiations managed by the Proliance Central Business Office in Seattle.

    THE LOCATION: Anacortes and Mt. Vernon, halfway between Seattle and Vancouver, B.C. are growing communities in the beautiful Skagit Valley area of NW Washington. Practice serves approximately 100,000 from west slope of North Cascade Mountains through San Juan Islands. Lifestyle, Education, Recreation are exceptional.

    The Candidate must be a BC/BE Physiatrist and be competent in geriatrics, outpatient musculoskeletal rehabilitation, injections for spasticity, and pain management.
     
  5. bigfrank

    bigfrank SDN Donor

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    Please know, I have NO axe to grind against Physiatry. In fact, I am actually considering the field. I do NOT want to do INpatient rehab, however.

    I DO want to know exactly what I'm getting into, though.

    Isn't outpatient Physiatry the same as Neurology, for the most part? In terms of procedures, salary, etc.?
     
  6. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved

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    Neurologists are focusing increasingly on the CNS only and lack musculoskeletal training. Physiatrists focus more on the PNS and of course do get a bunch of training in musculoskeletal medicine. I was very interested in neurology, but chose physiatry instead. I just clicked better with the physiatrists instead of the neuro guys.
     
  7. drusso

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  8. Jazz Gal

    Jazz Gal Junior Member

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    I'm new to this board, so excuse my ignorance:

    What does "bump" mean?
     
  9. bigfrank

    bigfrank SDN Donor

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    bump means that someone with an interest in the topic hits reply to move it more towards the top of the page, where it will naturally receive more reviews.
     
  10. docronmd1

    docronmd1 Junior Member

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    BigFrank,

    Your frustration with not finding consistent information about physiatrists' work issues and salary is understandable and expected. Physiatrists' are few in no. compared to other specialties (and this infact maintains the demand for their services). They also take on very different and varied career paths.

    I too considered neurology very seriously before deciding on pursuing PM&R. Believe me, i gave it a LOT of thought. I made my decision based on several reasons which i will outline for u.

    There is a very broad choice from which to shape your career and practice into what you enjoy doing after a PM&R residency....if u would like to only see out-pts, u could do that in the form of musculoskeletal medicine....this is essentially non-surgical orthopedics. A majority of patients prefer to try non-surgical methods of treatment before undergoing surgery for musculoskeletal problems. Physiatrists do not lack patients seeking their services for out-pt rehab. While MANY physiatrists do OUT-patient rehab, most are ALSO involved in IN-patient rehab of some kind, simply becoz many physiatrists maintain an association with rehab hosps and facilities that care for in-patients. So it is not surprising that 99.99% physiatrists do in-patient rehab.

    Pain management is an accredited fellowship for PM&R residents. Several PM&R programs offer the fellowship, but there are a larger no. of anesthesia programs that offer it, simply becoz on a whole, there ARE more anesthesia residency programs! Some physiatrists do their PM fellowship at an anesthesia program, and then combine their PM&R training in physical modalities, with the "interventional" PM techniques they learn at the anes programs. It is my personal belief that physiatrist make better pain management specialists becoz they have training in rehab and physical modalities of treatment in addition to "interventional" PM, and patients appreciate being offered more modalities of treatment. The anesthesiologist's training revolves around interventional methods only.

    In addition to Pain Man, 2 other accredited fellowships are open to PM&R residents....spinal cord injury and Pediatric Rehab. I know that u aren't interested in in-pt rehab at this time, but u might consider it later, if u realize that it is infact professionally satisfying for u. There has recently been tremendous advancement in spinal surgery, with an increasing demand for physiatrists trained in SCI. Just check out the job openings listed in any of the PM&R journals.

    Pediatric rehab was recently added to the list of accepted fellowships for pm&r residents. There isn't any accredited fellowship for Peds rehab yet, but likely in the next 5 yrs when we're ready to enter fellowship training.

    In addition, many physiatrists pursue further training in Sports Medicine and Industrial Medicine.

    I also know physiatrists who specialize in assessing work-place injuries and appear in court as expert witnesses for work-related injury compensation cases.

    Some physiatrist prefer to work in the academic setting or in research. For e.g., Physiatrists have been using and experimenting with Botox for years. Also, neural remapping, robotic prosthesis, fertility in pts with spinal cord injury, etc.

    Physiatrists also serve in administrative roles and as rehab directors.

    I checked salary.com to make sure i got this right...."A typical physiatrist working in the United States earns a median base salary of $134,875". Obviously, this varies widely, and like the previous posting rightly said, becoz the no. of practicing physiatrists is relatively small compared to other specialties, accurate salary info is difficult to come by and varies a lot. Rehab Directors make much more. So do physiatrist that do more of interventional procedures.

    If you like neurology, the non-surgical aspects of orthopedics (musculoskeletal medicine), Rehab, like working as part of a team (with PTs, OTs, speech therapists, prosthetists, etc)and life-style issues are important to you, then look carefully into PM&R as a specialty.
    Thats my sales pitch for you <img border="0" title="" alt="[Wink]" src="wink.gif" />

    Just remember that your residency training WILL involve a lot of IN-patient rehab, even if thats not what u want to do later. I would suggest doing an elective, spending some time at a physiatrist's office or shadowing a physiatrist at a rehab facility. Thats important so that u don't get disillusioned later.
     
  11. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved

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    I recently came across this post on a physiatry newsgroup. It reminded me of the discussions here. I thought some people might find this helpful.

    "Poll: How much PM&R income did you declare to Uncle Sam this year?"

    350k last year was my net income. Overheard is 36%. I have a lean mean machine with one office manager, one nurse, and use speech recognition dictation system, and outsource my billing. I own all my own equipment including EMG and fluoro. I have the trust of the medical community so I can direct care the way I see fit.

    I started spinal injection techniques just this year (actually late last year but really up and running this year)out of necessity (two pain anaesthesiologists both left town and remaining guys too busy in the OR and have no interest). I couldnt get people to drive to the next nearest who is 25 miles away. Never really had an incliniation to learn (I always thought it would be a pain in the ass), but now that I am doing it I enjoy taking care of this aspect of my patients care (and find that I can combine other interventions with the spinal injections to get more out of both, for instance, SI joint injections with osteopathic manipulation). So...this year, if I extrapolate from the first two months, should net min of 425k working 4 days per week, 8-6. New spine surgeon coming to town beginning this spring wants me to do all his injections and EMGs. I may be retiring soon at this rate, and so glad I picked PM&R, where I can make a damn good income, have a 3 day weekend every week, take care of my patients the way I want to, and generally enjoy life.

    "It would be interesting to note what the payor mix is as well (%medicare, HMO, etc.)?"

    Sorry it took so long to reply. I have to be really bored to get on this site or get on any site for that matter, and I am tonight.

    Here's my breakdown from 2000:

    HMO 49%
    Indemnity 7.5
    Workers comp 13
    Self Pay 2.5
    Personal Inj. 10
    Medicare 1
    Medicaid 12
    Free care 6

    Thats a rough listing, I think that adds up to about 100%. Alot of my free care doesnt start out that way, but then I end up giving some folks a break if they are on hard times. That percentage might be a little higher, not sure, would have to look at last years numbers a little closer. year.

    I was just talking to my office manager last week about my worker's comp patients. Here's an interesting little tidbit, she estimates that she spends approximately 55% of her time dealing with all the b.s. surrounding worker's comp insurance which comprises 13% of my practice. Since I have a 4 month waiting list as it is, why, I ask myself, am I putting up with this. It is probably the most frustrating part of my practice because so many (not all but many) of these patients have an incentive not to get better. Often a nurse manager joins them and this can be intrusive and has many times tended to alter the treatment. Then you get faxed by the nurse manager asking for information you already have in your note(and that you've given to her). Not long after this, the lawyer letters start. You work your ass off trying to get this individual better (having given them the benefit of the doubt) and you see them in the community doing things that they represent to you would be too painful to do. Well, I have decided to drop worker's comp starting in July and uncomplicate my life.

    Are others having a similar experience?
     
  12. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved

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  13. Vash311

    Vash311 Senior Member

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    As a DO would I have an advantage in this field? Thanks.
     
  14. Ligament

    Ligament Interventional Pain Management
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    Very much so.
     
  15. docronmd1

    docronmd1 Junior Member

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    I don't know if you would have any definite 'advantage' just by virtue of the fact that you are a DO. But on the other hand, the Michigan State Univ PM&R program, which tradiionally accepted DOs and MDs into the residency program, this year filled only with DOs. I happen to still have the e-mail i received from the PD: "Up until recently, we were intending to participate in the AAMC match as we have done previously. However, we have had the opportunity to pursue osteopathic residents outside the match. We believe this will be best for our program in both the short and long runs."

    I guess the reason for this decision is probably becoz it is affiliated to the Osteopathic School of Medicine.
     

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