Question about MSK/Spine practice

[ErrantWhatever]

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Hey PM&R Gang,

M3 here who's very seriously considering PM&R as a future career. I've done a fair amount of shadowing and already have an interest in MSK/Spine issues. I recently did a short TBI inpatient rotation that was interesting for other reasons. It honestly really was not my thing, but several of my residents admitted this was not their cup of tea either. It was good to experience the breadth of the training and see what I might be doing during residency, but lately I have been wondering: is a strictly MSK/Spine practice an achievable goal in PM&R? A lot of residents and attendings I've spoken with have implied that either A) a diverse practice with some inpatient coverage is necessary to pay the bills, or B) you can't plan on any practice style at this point (implying the market really isn't in our favor).

I'm especially interested in this topic this week, as we have had several back pain pts in my fam med clinic who have either been referred to ortho or pain management (and I realize the latter may be PM&R-trained). When I've brought up a PM&R option, most of the residents/attendings acknowledge such a thing exists in theory but had no one in mind. Perhaps just a marketing/networking issue in my area?

Any thoughts would be greatly appreciated. Cheers.

 

[314117]

I am 6 years out of residency, and the job you describe as "strictly MSK/Spine" is everywhere. I'd argue that it's the most common PM&R role today. This is what outpatient PM&R is. I think that the majority of PM&R residents out there plan to do some kind of outpatient spine/MSK/pain job. I suppose that there are some individuals who want to do TBI/SCI/peds/inpatient etc, but it's surely the minority.

I haven't done a single day of inpatient or seen typical rehab patients at all in my career so far, and if I have my way, I never will. There are tons of jobs that are Monday-Friday outpatient in spine care. Spine is a massive industry, and if you look on recruiting sites, Indeed.com, etc you will find many, many job listings for spine/pain management physiatry.

If you do a PM&R residency, you'll have to suffer through TBI/SCI/inpatient/peds etc during residency, but at this time, you can rest assured that you won't ever have to deal with that again if you don't want to. You'll just have to re-learn all the useless crap for re-certification, although hopefully that will go away.

You would be smart to do an ACGME pain fellowship after residency. And if you do an ACGME pain fellowship, you can certainly tailor your career to minimize the actual "pain management" patients that you will meet in fellowship. But the exposure and procedures that you get in an ACGME pain fellowship, as well as the ability to become board-certified in pain medicine (not the fake ABPM test) is invaluable.

 

[DubVille]

Hey PM&R Gang,

M3 here who's very seriously considering PM&R as a future career. I've done a fair amount of shadowing and already have an interest in MSK/Spine issues. I recently did a short TBI inpatient rotation that was interesting for other reasons. It honestly really was not my thing, but several of my residents admitted this was not their cup of tea either. It was good to experience the breadth of the training and see what I might be doing during residency, but lately I have been wondering: is a strictly MSK/Spine practice an achievable goal in PM&R? A lot of residents and attendings I've spoken with have implied that either A) a diverse practice with some inpatient coverage is necessary to pay the bills, or B) you can't plan on any practice style at this point (implying the market really isn't in our favor).

I'm especially interested in this topic this week, as we have had several back pain pts in my fam med clinic who have either been referred to ortho or pain management (and I realize the latter may be PM&R-trained). When I've brought up a PM&R option, most of the residents/attendings acknowledge such a thing exists in theory but had no one in mind. Perhaps just a marketing/networking issue in my area.
Any thoughts would be greatly appreciated. Cheers.

There is absolutely a market for outpatient spine. You will almost certainly have to do a fellowship for the interventional spine stuff. For General msk practice may be a bit harder to market and get referrals unless you join a big practice with a good base or do a sports med fellowship. There are certainly outpatient jobs that will get you a mixture of some msk, spine, emg/ncs but they will likely want you to do pain medicine management as well.

I'm starting to look at jobs and applying for a fellowship. The job boards are filled with 3 types: interventional pain +/- medical management, inpatient stuff, and pain medical management only (probably pill mills). There are a smattering of others jobs but this is far and away what I'm seeing the most of.

 

[RUOkie]

A majority of the "non-interventional" spine/MSK practices are ones that grew organically. You start out taking all comers (like non-interventional pain) and then slowly but surely weed out the things you don't want to see. I (after 20 yrs) have that kind of practice. MSK medicine,diagnostic U/S and U/S guided injections, EMG, and then some general PM&R (balance issues, some BoTox, and outpatient f/u of myelopathy, amputees and CVA) purely because nobody else is. I almost never prescribe opiates, but do manage nerve pain issues (education, neuroleptics etc.)

But people don't advertise for these kinds of jobs, because they are not the standard. Ortho practices usually want someone to do interventions and manage their chronic pain pts (who are usually already on opiates), and academic practices can't imagine this type of practice because it doesn't fit snugly in their "box". But with time and patience (and the willingness to work in an underserved area), you can make it work. I have.

 

[ErrantWhatever]

I really appreciate the responses--feeling relieved about this path. Thanks!

 

[sdnuser001]

Hey guys I'm actually also a MS4 highly leaning towards PM&R, but if one is interested in an outpatient interventional spine + msk practice, is an ACGME pain fellowship an absolute must? I understand you need an extra year of fellowship to learn the procedures, but ACGME accredited pain fellowships are super competitive according to the NRMP data. How much are you at a disadvantage if you do a spine or non-accredited fellowship? Are you basically limited to the Midwest or something?