Rise in PM&R grads

[klumpke]

Just came across this graph and wondering what everyone’s thoughts are about how it relates to the future of the field? Does this mean we run the risk of oversaturating like EM/Rad Onc or is this a good thing as we are such a small field?

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[RangerBob]

They could at least get the acronym right... We're not Physical Medicine Rehabilitation. The ampersand is what makes our specialty name (sort of) cool. The French may leave it out, but when you have a French accent you can do these sorts of things and people love it all the more.

Personally, I'm not sure we'll get over-saturated anytime soon. As you point out, we're a small field. On the inpatient side, we still don't have enough physiatrists. Lots of units don't have a permanent rehab doctor, and many don't have a rehab physician at all and are using IM or other specialties. So there's still plenty of room for more on the inpatient side.

Outpatient MSK has always been underutilized. Part of that is we're not well understood, so we don't get the referrals we need--and our small numbers further compound that by making us less common and less likely for providers to know they can refer to us. So I think as ortho groups and neurosurgery groups (and PCPs in general) better understand what we do, we'll get more outpt referrals. Plus, with the way things are going we'll see more PA/NPs, which means more referrals for back pain that will probably cure itself. But at least those patients will love us!

There have never been enough peds PM&R or "general outpt PM&R" (stroke/SCI/amputee care).

I'm not so sure there's much more room for interventional/pain on the other hand.

Just my two cents. I am in SF or LA though. Maybe the big cities are a bit different?

 

[DMBandFan86]

Great find! yeah I think they are somewhat over expanding and they have also allowed some odd residency programs in my opinion. More supply means potentially less pay esp in bigger cities. To be honest I am surprised that family medicine isn’t higher than us.

Ortho on the other hand can be really saturated so they haven’t expanded as fast, which makes sense.

It doesn’t really matter though, once the baby boomers pass the whole health system is going to be over expanded. Then we will have to duke it out. But currently EDs and hospitals are at capacity.

I’d say about half of residents want to do sports or pain. There is definitely a need for brain injury and inpatient PM&R. But I agree interventional pain may be getting to the saturation point. There is also some demand for diagnostic ultrasound, but takes a special person to do it. Outpatient PM&R can be competitive in bigger cities or impossible to find. Doesn’t mean there isn’t room, but may have to market or do private.

 

[sloh]

I practice in LA. It’s pretty saturated here. We don’t need more residencies. It’s a distribution problem.

 

[zenmedic]

How's the job market for SAR and SNF? When I asked on my sub-I none of the residents seemed to have a good pulse on it or any exposure for that matter.

 

[sloh]

How's the job market for SAR and SNF? When I asked on my sub-I none of the residents seemed to have a good pulse on it or any exposure for that matter.

Depends on location. Becoming more saturated as well.

 

[RangerBob]

Depends on location. Becoming more saturated as well.

Really? I though no one wants to do SNF work. We have literally only one physiatrist working at only 1 of about 10 or 13 SNFs in the area. And we didn’t have them up until a month ago.

 

[drg123]

Really? I though no one wants to do SNF work. We have literally only one physiatrist working at only 1 of about 10 or 13 SNFs in the area. And we didn’t have them up until a month ago.

Amongst my residency cohort, SNF work is frequently discussed and seen as attractive option for some. But in terms of our residency education, there is zero exposure. All the talk and info is driven by the residents taking initiative. Same goes for those actually doing SNF work after residency. Requires significant amount of self-starting, which is not for everyone.

 

[PMR2008]

I have hundreds of PMs regarding PM&R SNF work that I have answered in my mailbox and I have talked to many on the phone over the years. Maybe a decade ago no one wanted this work but now atleast one resident per year per program is skipping academic jobs/fellowship and doing this. It is unfortunate that exposure during residency is limited (GME rules).

 

[PMR2008]

Really? I though no one wants to do SNF work. We have literally only one physiatrist working at only 1 of about 10 or 13 SNFs in the area. And we didn’t have them up until a month ago.

Depends on geography. Try that in any of the larger metro cities. Cities are saturated but finding work is not impossible.

 

[PMR2008]

How's the job market for SAR and SNF? When I asked on my sub-I none of the residents seemed to have a good pulse on it or any exposure for that matter.

There are 15k SNFs/SARs in the US. about 5k are in rural. So that leave 10k. Of those half are low volume of rehab patients per facility. That leaves 5k that are in metro cities or the surrounding burbs and they cluster around hospital. Atleast 3k of those already have a physiatrist. So probably 2k are either not interested or have not been entertained by Physiatrist. In a nutshell we are at the early stages of Physiatry involvement in SAR. With telemed there is significant room for expansion but can be challenging with the patient population.

 

[PMR2008]

View attachment 359942
Just came across this graph and wondering what everyone’s thoughts are about how it relates to the future of the field? Does this mean we run the risk of oversaturating like EM/Rad Onc or is this a good thing as we are such a small field?

Only the large 30 metro areas are getting close to being saturated with New York, LA, Chicago, Dallas and Houston probably the closest. Insane amount of growth left in Physiatry. Interventional pain might be close to saturation since you are also competing with Anesthesia but still lot of growth left as some docs retire or leave pain and transition to SAR/Acute. We need more Physiatrist but need better distribution.

 

[Slowpoke]

This isn't good forecasting for the future graduates of our specialty if we take the current state of RadOnc and EM job markets into account (abysmal). Some argue it is cyclical, but there is nothing cyclical about increasing supply (rapid expansion of residency spots). I'd also be interested in getting a sense of the absolute # of spots, not just %.

 

[runfastnow]

Echo with above and trying to not be "old man yelling at cloud" but there seems to be a TON of current PM&R trainees that want to move to the coastal big cities + Cali with seemingly no thought to how hard they are making their life/career. Those places are saturated and adding more residencies in those places is a waste of resources IMO and disservice to those who live in southern and middle America. I trained in Philly and even though I love the city would not practice within 100 miles of there due to the amount of PM&R around (all sub-specialties).

I now live in mid-South region in a metro of 500k, cost of living is way lower, pay is higher, and flexibility is higher. We are moving towards saturation with pain/non-op spine where I am but still low in non-op sports, EMG, CVA/SCI/TBI/"real" PM&R stuff, and inpatient.

 

[j4pac]

Only the large 30 metro areas are getting close to being saturated with New York, LA, Chicago, Dallas and Houston probably the closest. Insane amount of growth left in Physiatry. Interventional pain might be close to saturation since you are also competing with Anesthesia but still lot of growth left as some docs retire or leave pain and transition to SAR/Acute. We need more Physiatrist but need better distribution.

There are parts of the country that have needs. PM&R is still a lifestyle specialty with millennials entering the workforce. This idea that people will just magically fill all of these potential positions is just silly. Much more likely that this will result in over saturation.

 

[Momentum70]

They could at least get the acronym right... We're not Physical Medicine Rehabilitation. The ampersand is what makes our specialty name (sort of) cool. The French may leave it out, but when you have a French accent you can do these sorts of things and people love it all the more.

Personally, I'm not sure we'll get over-saturated anytime soon. As you point out, we're a small field. On the inpatient side, we still don't have enough physiatrists. Lots of units don't have a permanent rehab doctor, and many don't have a rehab physician at all and are using IM or other specialties. So there's still plenty of room for more on the inpatient side.

Outpatient MSK has always been underutilized. Part of that is we're not well understood, so we don't get the referrals we need--and our small numbers further compound that by making us less common and less likely for providers to know they can refer to us. So I think as ortho groups and neurosurgery groups (and PCPs in general) better understand what we do, we'll get more outpt referrals. Plus, with the way things are going we'll see more PA/NPs, which means more referrals for back pain that will probably cure itself. But at least those patients will love us!

There have never been enough peds PM&R or "general outpt PM&R" (stroke/SCI/amputee care).

I'm not so sure there's much more room for interventional/pain on the other hand.

Just my two cents. I am in SF or LA though. Maybe the big cities are a bit different?

Im in small/medium city and we have shortage also, we are using an FP with our group and still short one position at our inpatient unit. We have not been fully staffed since I started here 3 years ago with the exception of a 1 month overlap of an incoming and outgoing physician. I originally was going to do a mix on inpt/outpt pmr but have such a full census I have no time and no need for the income.