Hi all,
I've gotten a couple pm's from people asking some updated PCSM questions.
Background:
For those that are interested in PCSM, it's a very dynamic fast paced field, with GREAT patients (motivated to get better, athletic, youngish, and tend to be well insured. The hours are phenomenal. The pay is very variable depending on a few factors as outlined below.
Fellowship is very competitive (I interviewed over a hundred applicants for 2 fellowship positions when I was a fellow) but there are more and more fellowships opening up around the country.
It's a relatively new field (30 years), so it flies under the radar even though it's a sweet field.
Training:
You can practice FM, IM, Peds, PMNR and do PCSM as part of your practice (referrals mostly for PCSM) or you can do what I did and joined an Ortho group.
Residency at O'Connor Hospital/Stanford University, fellowship at University of Utah.
I am a PCSM attending in a 12 person Ortho group in California. It's a hybrid private/academic program affiliated with a major private hospital system in SF. We see UCSF, CPMC, residents as well as Dartmouth med students.
My scope of practice:
I actually have a pretty sweet niche in the group. I see all comers, decide if they are surgical or non surgical (by far most are non), and send the cases to the surgeons. They also send me non op patients.
It took a year for them to figure out what I'm good at and it took me a year to figure out what I could do better than the orthopods.
These include non operative treatment of tendonopathy, cartilage problems, root cause issues of musculoskeletal problems, medical causes for msk issues,nutritional assessment, and treating hypermobility patients.
However my biggest value to the group and niche is with minimally invasive ultrasound guided procedures; Ex tendon debridements, needle tenotomy, cheilectomy, intra-articular hip, facet, SI joint injections, as well as regenerative injections of platelet rich plasma. I am just starting to get into mesenchymal stem cells as well.
I got trained in fluoroscopy and ultrasound in fellowship and in my first year in practice did a lot of epidurals, selective nerve root blocks, fluro guided joint injections etc but my practice started to become more back /spine heavy so I stopped fluoro and started exclusively doing MSK U/S which is the best decision I've ever made.
I am also one of the team doc's for the SF Ballet as part of my gig, which is SO rewarding, again fast paced, and surprisingly not as much of a time commitment if you have help. (I do).
So my practice is full of exactly what I want to see. I feed them, they feed me. Very synergistic. Remember, the surgeons' focus is surgery/non-surgery. Mine is figuring out the root problems, and preventing surgery if possible and keeping people active and doing the things they love. My patients and I have a great relationship.
Lifestyle vs Pay:
I work 4 days a week, no call no weekends and 2 years in, I'm above the 95th percentile for FM trained docs. Pay is about 10-20k more if you have an FP practice and also see sports patients. Ortho jobs pay better but then again the model is different. You tend to see more patients (20-30 per day) and the problems are very focused which I like vs in a primary care setting, people typically have 2-4 problems which you are obligated to at least partially address. if you do procedures (fluoro, ultrasound guided, surgically assist), you'll make more money. Lastly, if you work for Kaiser, you can add on at least 75K-100/yr more but you work a bit harder, with a bit less vacation, but have phenomenal benefits and a 9-5 job, but are more of a worker bee than rather than a captain.
My advice. If you interested, go to the national AMSSM conference, and secondly the ACSM one. You'll meet all the fellowship directors, fellows, and walk away so inspired, and excited to do PCSM.
pm me if you have any questions.
cheers.
