Thanks for the advice.
I was actually thinking of choosing either psych or pm&r. There are a couple things that are making it difficult to come to a final decision. I prefer MSK pathology and procedures more than Psychiatry. I prefer actually helping people in a way in which the benefits of the treatment is very tangible to the patient.
Also, I'm not sure if it's going to get difficult to open a solo private practice in psych in the near future. If that happens then the major benefit of psych gets thrown out of the window. Do you think this might happen in the near future?
I'm prepared to go through with the startup costs because this is what I want. I already bought a couple of books to get an idea at first..but I'm just wondering, is it much more difficult to survive in solo/private practice in pm&r? Is it possible to make >200k in private practice? or is it really difficult with the current economic climate and the nature of the specialty?
I would actually argue psych patients who are helped by their psychiatrist will feel their physician more tangibly helped them than most doctors out there. While PM&R patients are among the most grateful out there, a psych patient who is actually helped/feels helped may be even more grateful.
I don't see why it'd be difficult to open a solo practice (unless you're in a saturated area like Manhattan). I could probably open up a "psych" practice, cash pay (insurance won't reimburse me without psych residency), since demand where I live is so high and supply is so low.
I think starting a solo practice in MSK would be difficult if you are going to need any imaging. But if the most you do are peripheral injections, then that's quite doable--I have a collegue who started her own general PM&R practice. She does EMG and peripheral injections, botox, etc. Keep in mind we're in a low supply area. I could easilly go out there and start my own consult service, or an MSK clinic--we have that high a supply of patients and low supply of physicians in general.
If you start a practice in the right area, and work hard/are good at what you do, it'd be hard to make less than $200k. The first year or two could be rough, but unless you're taking an absurd amount of time off or just can't fill your clinic, $200k is not much in private practice. If you own your practice, that might be a half-time salary. There's a big difference in income when comparing employed physicians vs those who own their practice. Hopefully some private MSK physiatrists can chip in about what a reasonable salary is.
Of course, you have no safety net if you own your practice. While you can, and often, earn more than employed physicians, if you're not good at what you do/can't manage your business (a whole new set of skills that need to be learned), or can't get enough referrals (people skills are important here), then you could end up making less.
