Sports medicine

[miamiheatfan]

I hope that this is an okay place to post this! I was reading up on the forums of all of the specialties and I know I haven't started medical school yet, but I was wondering why there isn't a FAQ for sports medicine. Also I was wondering if there is anyone who is going into sports medicine who can tell me more about their experience, the competitiveness of it, etc. or direct me to good links. Thank you in advance!

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[meliora27]

Most people who end up doing sports med do it by one of 2 routes:

1. Orthopedic Surgery --> Sport Med Fellowship

2. Family Medicine --> Sports Med Fellowship

Try asking in the FM or Ortho forums.

 

[miamiheatfan]

Most people who end up doing sports med do it by one of 2 routes:

1. Orthopedic Surgery --> Sport Med Fellowship

2. Family Medicine --> Sports Med Fellowship

Try asking in the FM or Ortho forums.

Thank you! Will I get in trouble for posting this question again in another/multiple forums?

 

[jdh71]

Hey @gutonc

Feel like doing some holiday cheer stuff and moving to FM??

 

[gutonc]

Moving to FM. Merry Happy.

 

[miamiheatfan]

Thank you! Wondering if anyone could offer their experiences or information?

 

[galactus]

I practice sports med, and love it. I take care of all ages, amateur/pee-wee to elite/pro. Went through family medicine. It's getting a little bit more competitive, but if you do a lot of sports med activities during your residency, then matching chances should be good. There's other sports med threads on the FM forum. You have plenty of time to think about what you want to do, but it's never too late to get an early experience. Hopefully there should be a sports medicine physician at your med school that you can ask to shadow (ortho or non-ortho), and that will at least help you in which route you want to go through.

 

[miamiheatfan]

I practice sports med, and love it. I take care of all ages, amateur/pee-wee to elite/pro. Went through family medicine. It's getting a little bit more competitive, but if you do a lot of sports med activities during your residency, then matching chances should be good. There's other sports med threads on the FM forum. You have plenty of time to think about what you want to do, but it's never too late to get an early experience. Hopefully there should be a sports medicine physician at your med school that you can ask to shadow (ortho or non-ortho), and that will at least help you in which route you want to go through.

Thank you so much! So when would be the best time to shadow during med school? Sorry if this is a bad question but does Step scores have an impact on getting sports med? Also could I PM you with future questions?

 

[SuperSoccer19]

I hope that this is an okay place to post this! I was reading up on the forums of all of the specialties and I know I haven't started medical school yet, but I was wondering why there isn't a FAQ for sports medicine. Also I was wondering if there is anyone who is going into sports medicine who can tell me more about their experience, the competitiveness of it, etc. or direct me to good links. Thank you in advance!

Another option that's not as well known is PM&R. IM and EM also sometimes go through the fellowship too.

 

[TXPMR]

This topic seems to come up quite frequently. One of these days SDN will get a sports medicine subforum.

This is a modification of what I've previously posted about the topic elsewhere:

1. Ortho: very competitive, need great scores. HAVE to like surgery. Residency is grueling but practice, depending on setting, can be very busy to cush-ish. Fast track to "head team physician" if that's your thing. Not as much training in non-operative MSK medicine compared to PM&R. Great pay all around.

2. PM&R: generally less competitive but getting a lot more competitive especially at the "top" places. Have to get over the fact that when you say you are PM&R/a physiatrist most people are like "huh"? (this can actually be a hang up for people). Otherwise have to like a lot of different areas: neuro, ortho, a little bit of medicine. If it's your thing, out all the other paths to sports med docdom PM&R is second to ortho in terms of procedures available (interventional spine, US injections, EMGs). AWESOME lifestyle. Actually great pay when you consider the hours/relative lack of stress involved.

3. FM: competitive to not competitive at all: can literally walk in to some of the lower tiered FM programs (but they may not have any sports/MSK faculty though). Great jumping off point for the medical care of the athlete since your backbone is the medical care of all ages and types. Much less neuro compared to PM&R and much less ortho compared to ortho/PM&R. But you will be THE medicine guru when it comes to athletes. Ok lifestyle depending on your practice mix. Pay is moderate.

4. IM: competitive to not competitive at all. Have a medicine backbone like FM but get MUCH less outpatient exposure these days in residency in most places. Plus as mentioned never really take care of kids which is a minus for a well rounded sports doc. Lifestyle can be what you make it. Pay can actually be pretty high if you take hospitalist type jobs on the side.

5. EM: competitive to moderately competitive...in general you have to actually be a decent candidate to match into any EM program. AWESOME at taking care of acute issues/injuries medical and MSK related, not so awesome at longitudinally taking care of patients (or at least not part of the core residency training at most places). Lifestyle and pay is what you make it depending on how many ER shifts you take on the side.

 

[miamiheatfan]

This topic seems to come up quite frequently. One of these days SDN will get a sports medicine subforum.

This is a modification of what I've previously posted about the topic elsewhere:

1. Ortho: very competitive, need great scores. HAVE to like surgery. Residency is grueling but practice, depending on setting, can be very busy to cush-ish. Fast track to "head team physician" if that's your thing. Not as much training in non-operative MSK medicine compared to PM&R. Great pay all around.

2. PM&R: generally less competitive but getting a lot more competitive especially at the "top" places. Have to get over the fact that when you say you are PM&R/a physiatrist most people are like "huh"? (this can actually be a hang up for people). Otherwise have to like a lot of different areas: neuro, ortho, a little bit of medicine. If it's your thing, out all the other paths to sports med docdom PM&R is second to ortho in terms of procedures available (interventional spine, US injections, EMGs). AWESOME lifestyle. Actually great pay when you consider the hours/relative lack of stress involved.

3. FM: competitive to not competitive at all: can literally walk in to some of the lower tiered FM programs (but they may not have any sports/MSK faculty though). Great jumping off point for the medical care of the athlete since your backbone is the medical care of all ages and types. Much less neuro compared to PM&R and much less ortho compared to ortho/PM&R. But you will be THE medicine guru when it comes to athletes. Ok lifestyle depending on your practice mix. Pay is moderate.

4. IM: competitive to not competitive at all. Have a medicine backbone like FM but get MUCH less outpatient exposure these days in residency in most places. Plus as mentioned never really take care of kids which is a minus for a well rounded sports doc. Lifestyle can be what you make it. Pay can actually be pretty high if you take hospitalist type jobs on the side.

5. EM: competitive to moderately competitive...in general you have to actually be a decent candidate to match into any EM program. AWESOME at taking care of acute issues/injuries medical and MSK related, not so awesome at longitudinally taking care of patients (or at least not part of the core residency training at most places). Lifestyle and pay is what you make it depending on how many ER shifts you take on the side.

Thank you so much for this and the other link! I really appreciate it! So is it unlikely for me to end up doing sports medicine if I chose EM as a specialty? It seems like EM/sports isn't very common. I'm really interested in all 5 of these specialties and I love sports as well. It seems like PM&R is one of the less desired residencies as a whole, why is that exactly? I will be starting medical school in August but I'd like to narrow down my interests a bit, which honestly seem almost limitless for me.

 

[TXPMR]

Thank you so much for this and the other link! I really appreciate it! So is it unlikely for me to end up doing sports medicine if I chose EM as a specialty? It seems like EM/sports isn't very common. I'm really interested in all 5 of these specialties and I love sports as well. It seems like PM&R is one of the less desired residencies as a whole, why is that exactly? I will be starting medical school in August but I'd like to narrow down my interests a bit, which honestly seem almost limitless for me.

Not so much that PM&R is not "desired" but more so that PM&R is relatively undiscovered. There are a number of factors for this but from an academic standpoint med students get little to no PM&R experience in their curriculum and from a social/systemic standpoint one of the beauties and curses of PM&R is its diversity so much so that when people see a physiatrist they may have no idea they are seeing a physiatrist: if it's in sports clinic they think they're seeing a sports doc/orthopod, if it's spine clinic a "spine doctor", in palliative care center a cancer doctor, stroke clinic a neurologist and so on. Part of it is a branding issue with PM&R I think.

Aside from that you'll find that on the PM&R interview trail or in interviewing PM&R candidates that most of everyone has an aha Eureka "coming to PM&R" type of experience. Few people go into med school thinking they want to become a physiatrist. Most people "discover PM&R" and are like "wait, whaaa? Something like that exists?" and then decide to do PM&R. I will say that traditions are hard to break and PM&R historically has had the reputation of being a band of awkward misanthropes or ortho rejects. In my opinion it's changed a lot in the last 5 years or so but it takes a while to change perception.

As far as EM to sports, it's totally doable but just more non-traditional. There are plenty of students who go into ortho to do sports, PM&R to do sports, primary care to do sports...those traditionally are natural feeders into sports medicine. It's not so much that EM is at a disadvantage in sports medicine, more so that few people go into EM with the mindset of doing sports medicine.

 

[miamiheatfan]

Not so much that PM&R is not "desired" but more so that PM&R is relatively undiscovered. There are a number of factors for this but from an academic standpoint med students get little to no PM&R experience in their curriculum and from a social/systemic standpoint one of the beauties and curses of PM&R is its diversity so much so that when people see a physiatrist they may have no idea they are seeing a physiatrist: if it's in sports clinic they think they're seeing a sports doc/orthopod, if it's spine clinic a "spine doctor", in palliative care center a cancer doctor, stroke clinic a neurologist and so on. Part of it is a branding issue with PM&R I think.

Aside from that you'll find that on the PM&R interview trail or in interviewing PM&R candidates that most of everyone has an aha Eureka "coming to PM&R" type of experience. Few people go into med school thinking they want to become a physiatrist. Most people "discover PM&R" and are like "wait, whaaa? Something like that exists?" and then decide to do PM&R. I will say that traditions are hard to break and PM&R historically has had the reputation of being a band of awkward misanthropes or ortho rejects. In my opinion it's changed a lot in the last 5 years or so but it takes a while to change perception.

As far as EM to sports, it's totally doable but just more non-traditional. There are plenty of students who go into ortho to do sports, PM&R to do sports, primary care to do sports...those traditionally are natural feeders into sports medicine. It's not so much that EM is at a disadvantage in sports medicine, more so that few people go into EM with the mindset of doing sports medicine.

Is there a way to look into PM&R activities before 3rd year? What do you think is the most efficient way to do EM and Sports together as a physician? Thank you so much!

 

[galactus]

Is there a way to look into PM&R activities before 3rd year? What do you think is the most efficient way to do EM and Sports together as a physician? Thank you so much!

You can always try to shadow a PM&R doc during your first two years. TXPMR is right though the field is so wide that there are a lot of aspects about it that people don't realize.

One specialty that was not mentioned as a route to sports medicine is pediatrics. There's a decent amount of pedi/SM guys out there, and actually the majority of them I know also see adults.

EM/SM does exist. I know a few of them. The ones I know mix it in between doing EM shifts and having their own clinic for SM. It's a little unconventional as SM is more of a clinic based situation but it can be done.

Bottom line is we all take the same board exam, so for the students who want go to into sports medicine I always give this advice: what aspect of SM do you like? Game coverage? Continuity? Full PCP for the athlete? Youth/adolescent? Procedures? Wilderness med? Sports medicine is a wide field and all of us form all specialties are trained to do all, but sometimes having a background in your primary residency will help during fellowship training. What's great about a multidisciplinary subspecialty is that you can learn from each field to complement your skills.

 

[miamiheatfan]

All of this is really good information! Thank you all so much for answering my questions!

 

[UTsksk]

This may be a silly question, but I was wondering what is more the norm with sports medicine. Have a Family/Sports clinic where you see sports as well as everything else, or do you just focus on sports and see just that type of patient population? One of the sports docs at my school said it was doable to be involved in both FM and SM, but he's never done it.

 

[septoplasty]

This may be a silly question, but I was wondering what is more the norm with sports medicine. Have a Family/Sports clinic where you see sports as well as everything else, or do you just focus on sports and see just that type of patient population? One of the sports docs at my school said it was doable to be involved in both FM and SM, but he's never done it.

I've actually seen both models.

Although more predominant is sports only, since this is kinda "what you wanna do". i.e. not have to deal w/ other primary care stuff.

People generally do a mix until they can narrow their patient population. Keeping the clinic door open may mean you have to do some primary care stuff initially, but up to you if you can find a well settled practice to join.

Speaking of... who else is applying this year?

 

[thethom]

I have been in sports medicine practice for 2 years now. My residency was in family medicine. I see patients M-F with a half day on wednesdays, approx 25-30 patients daily. I practice some general primary care (trying to grow this) but 90% of my practice is general office orthopedics heavy on procedures, fracture reductions, dislocations, joint injections, viscosupplementation, acute and chronic msk pain, skin/bursa injections and drainage, and I for the most part only prescribe narcotics for acute pain. I do see a number of athletes as well, I treat them for common ailments, injuries, keep them up to date on their preventive measures, and even help them boost their performance (Always NCAA and WADA appropriate of course). Every day is different and exciting, my patient population is well insured and very driven to get better. I am in a multispecialty outpatient MedCenter with all the ancillaries and imaging in-house. I do take call, but there are 4 of us so we each share telephone call for a week each month. We have call-a-nurse so most calls are triaged before they even get to us. Its sunday today, the last day of my week on call and I haven't gotten a single call yet (knock on wood). We have an attached extended hours Urgent Care center that helps feed my schedule and I see patients there as consults frequently. I am not required to per my contract but I do give my cell number to the urgent care docs if they have any questions about injuries/msk illnesses seen over the weekends or after hours and I have no problem driving 15 mins from my house to the MedCenter to help out (happens maybe once or twice a month). I get 4 weeks paid vacation a year and 4 weeks paid CME time off, not including holidays. The money is great, base salary was recently increased from my starting salary of $175,000 and is now $200,000 and my productivity bonus is paid out twice a year, last one was $50,000 (ie $100,000 a year), there is also a non-productivity bonus of $10,000 for good behavior, meeting certain meaningful use measures, patient satisfaction, etc, so income before taxes is about $310,000. Malpractice, disability, medical, dental, vision for my wife and myself is included. The health system also matches 50% of what I place into my retirement account (up to 8% total) .

I love my job, and will probably never move to another practice. Definately consider primary care sports medicine (beats taking trauma call as Ortho/Sports Med ;-) ) I'm happy to answer any questions.

 

[Firelambo]

Thanks for the awesome reply. Do you think that you would have trouble recertifying for family medicine boards 10,20 yrs down the road if most of your practice (let's say 90% is msk?)How competitive would you say getting sports medicine fellowship is as a family medicine resident coming from a low tiered Fm program? In your opinion Is it risky going into Fm attempting to get into a sports med fellowship vs PM&R (guaranteed msk training)? Any insight would be greatly appreciated. Thanks

 

[miamiheatfan]

Yeah I want to know the answer to that question above me as well. Also I would like someone to elaborate more about PM&R as a whole. I feel like this specialty should be more competitive, why isn’t it? Also how is the job market for PM&R, can I find a job easily almost anywhere? Also the fellowships that allow for the greatest growth in all areas of a career. @TXPMR @SuperSoccer19

@thethom I will PM you if that is okay!

 

[septoplasty]

Thanks for the awesome reply. Do you think that you would have trouble recertifying for family medicine boards 10,20 yrs down the road if most of your practice (let's say 90% is msk?)How competitive would you say getting sports medicine fellowship is as a family medicine resident coming from a low tiered Fm program? In your opinion Is it risky going into Fm attempting to get into a sports med fellowship vs PM&R (guaranteed msk training)? Any insight would be greatly appreciated. Thanks

Competitiveness is based on your qualifications, interest levels, research, etc. I've seen people from "low" tiered programs get matched into good places aswell. Sure it maybe hard, but then again, the "big names" aren't the best for PCSM training anyways

Yeah I want to know the answer to that question above me as well. Also I would like someone to elaborate more about PM&R as a whole. I feel like this specialty should be more competitive, why isn’t it? Also how is the job market for PM&R, can I find a job easily almost anywhere? Also the fellowships that allow for the greatest growth in all areas of a career. @TXPMR @SuperSoccer19

So initially I was under the impression that PM&R are better trained at MSK, there maybe variation in this but our university has a PM&R program and the residents aren't a whole lot better at it either. This was coming from a PGY-3 too. PM&R isn't necessarily focused on just msk, they do alot of other stuff TBI, Neuro, SC Injury, etc. whicih you may not necessaril deal with.

Can't answer your other questions, the PM&R subforum may be better.

 

[galactus]

This may be a silly question, but I was wondering what is more the norm with sports medicine. Have a Family/Sports clinic where you see sports as well as everything else, or do you just focus on sports and see just that type of patient population? One of the sports docs at my school said it was doable to be involved in both FM and SM, but he's never done it.

I practice both FM and SM. 50/50 split. I do work at an academic institution so I still do primary care half days, mentor med students, but the other half the time I'm doing sports medicine, non-op ortho, game coverage, concussion management, etc. I take any resident/med student interested along with me when I am covering events (mostly for HS football. College football is fellow/attending only)
At our institution, we have a sports medicine/PM&R person as well, and we stay in constant contact (along with ortho dept) for a comprehensive care of the athletes and weekend warriors we see. We have a comprehensive sports medicine team, but we are all based (at least salary wise) at our respective specialty department (ortho, PMR, peds, FM).

I like my practice model, but to each their own. I know my PM&R colleague does general PM&R as well, but my pedi colleague does 100% pedi sports med. The fellow a year above me was pedi trained and he does outpatient general peds, sports med, AND inpatient (academic institution).

I think what's great about the sub-specialty is that you can tailor how much of sports medicine you want into your own practice. For me I enjoy doing primary care, but since I do both I have noticed that my patient population on the primary care end is now a little more healthier and active than the patient population I had in residency.

 

[Chicago2012]

I practice both FM and SM. 50/50 split. I do work at an academic institution so I still do primary care half days, mentor med students, but the other half the time I'm doing sports medicine, non-op ortho, game coverage, concussion management, etc. I take any resident/med student interested along with me when I am covering events (mostly for HS football. College football is fellow/attending only)
At our institution, we have a sports medicine/PM&R person as well, and we stay in constant contact (along with ortho dept) for a comprehensive care of the athletes and weekend warriors we see. We have a comprehensive sports medicine team, but we are all based (at least salary wise) at our respective specialty department (ortho, PMR, peds, FM).

I like my practice model, but to each their own. I know my PM&R colleague does general PM&R as well, but my pedi colleague does 100% pedi sports med. The fellow a year above me was pedi trained and he does outpatient general peds, sports med, AND inpatient (academic institution).

I think what's great about the sub-specialty is that you can tailor how much of sports medicine you want into your own practice. For me I enjoy doing primary care, but since I do both I have noticed that my patient population on the primary care end is now a little more healthier and active than the patient population I had in residency.

I hope you call the residents your Heralds. Please please please

 

[TXPMR]

Yeah I want to know the answer to that question above me as well. Also I would like someone to elaborate more about PM&R as a whole. I feel like this specialty should be more competitive, why isn’t it? Also how is the job market for PM&R, can I find a job easily almost anywhere? Also the fellowships that allow for the greatest growth in all areas of a career. @TXPMR @SuperSoccer19

@thethom I will PM you if that is okay!

In all honesty, that's like the broadest of broad set of questions in terms of "elaborating." Could you be more specific in terms of what questions you have about PM&R. I could write a several page essay on PM&R because there is a lot to cover in the field as with all other fields. Job market for PM&R is generally very good. You won't have trouble finding a job in pretty much any market if you aim to be a general physiatrist. If you are more subspecialized and want to be exclusively that (e.g. peds PM&R) then you options may be more limited due primarily to the supply of jobs. As with any other specialty you get paid more in private practice away from big cities and less for academic medicine in big cities. There are advantages and disadvantages to both.

In terms of fellowship, the traditional PM&R fellowships are spinal cord medicine, traumatic brain injury, sports medicine (PM&R or primary care based), spine and sports medicine, interventional pain (PM&R or anesthesia based), neuromuscular rehab, electrodiagnostic medicine, pediatric rehab. Other fellowships I've seen people do palliative care, cancer rehab, and occupational medicine. Out of those SCI and TBI probably limit you the most because of the general need to be connected to large academic institutions. The others you pretty much have great flexibility in jobs...and things end up being what you make of it. As with any subspecialty the more you are willing to also spend time practicing in your base specialty (e.g. PM&R sports med doc doing general rehab, anesthesia pain doc doing anesthesia in the OR) the more flexibility you'll have in your job prospects.

 

[TXPMR]

Is there a way to look into PM&R activities before 3rd year? What do you think is the most efficient way to do EM and Sports together as a physician? Thank you so much!

If your institution has a PM&R department, send an e-mail to the program coordinator (NOT director...you are more likely to get a prompt response from the coordinator) and find out how you can get involved in the department via shadowing, rotations/sub-Is, research, or all three. They may likely then refer you to one of the chief residents or program director. If your institution does not have a PM&R department and you are in/close to a city with other academic institutions, see if one of those has a PM&R department and repeat the steps above. If you find yourself in an institution without a PM&R department and without an academic PM&R department close by then you'll need to reach out to a local physiatrist for shadowing opportunities. The best place to start is the APM&R physiatrist locator tool: https://www.aapmr.org/patients/findphysician/Pages/default.aspx. Since it searches only for AAPM&R members the physiatrists you find there are most likely at least mildly academically including and can help steer you academically in terms of thinking about and applying to PM&R.

Also, if your school doesn't have a PM&R interest group, start one.

 

[TXPMR]

Yeah I want to know the answer to that question above me as well. Also I would like someone to elaborate more about PM&R as a whole. I feel like this specialty should be more competitive, why isn’t it?

Realized I never addressed the competitive question. As I said earlier in the thread:

Not so much that PM&R is not "desired" but more so that PM&R is relatively undiscovered. There are a number of factors for this but from an academic standpoint med students get little to no PM&R experience in their curriculum and from a social/systemic standpoint one of the beauties and curses of PM&R is its diversity so much so that when people see a physiatrist they may have no idea they are seeing a physiatrist: if it's in sports clinic they think they're seeing a sports doc/orthopod, if it's spine clinic a "spine doctor", in palliative care center a cancer doctor, stroke clinic a neurologist and so on. Part of it is a branding issue with PM&R I think.

Further, I think there are a couple things at play in terms of competitiveness. One, as I said, it's hard for a specialty to be competitive if students don't even know it exists. To be competitive you need applicants...which historically (up until very recently) PM&R hasn't had. Also, medical school curricula are political behemoths and it's difficulty for the even the powerhouse subspecialties to get a modicum of time in the curricula let alone lesser known fields like PM&R. And to boot, many schools don't even have PM&R department, so in those cases it's virtually impossible for students to be exposed to PM&R without intentionally going out and getting exposure.

Another factor, which I think is a reflection of med students' station in life if nothing else, is salary. With the exception of those physiatrists who are interventionalists, PM&R salaries tend to be in the lower end of the medical specialty spectrum...not the lowest but lower. If you're looking at a list of highest paid docs PM&R doesn't really jump out at you. So for med students who are applying to specialties based on salary (most likely most of them), they may overlook PM&R in terms of gross pay. What these students miss however is the attached lifestyle to a particular salary. For example, a primary care doc making $200k a year and a physiatrist making $200k a year is vastly different. I'd argue that the lifestyle of the physiatrist would likely be better in that scenario...i.e. getting a better deal than the PCP. The physiatrist will likely be working less hours and dealing with less acute patients for that $200k. For that matter, you have to consider if making $300k as a general surgeon (with its long hours and patient acuity and complications) is worth more than $200k as a physiatrist...this all assumes that you're making specialty choices solely on money/opportunity cost which I'd advise for you to NOT do, lest you risk not liking what you do. I usually advise setting your life priorities first: family vs. job then considering what you like to do most in medicine, then considering pay. In sum, in terms of lifestyle, PM&R is a great field if you want to make a decent living in a relatively low stress environment and have ample time for family life/interests outside of direct medical care itself. But because the salary is on the lower end people make consider the $$$ first and not consider the favorable opportunity lifestyle cost of PM&R.

 

[miamiheatfan]

In all honesty, that's like the broadest of broad set of questions in terms of "elaborating." Could you be more specific in terms of what questions you have about PM&R. I could write a several page essay on PM&R because there is a lot to cover in the field as with all other fields. Job market for PM&R is generally very good. You won't have trouble finding a job in pretty much any market if you aim to be a general physiatrist. If you are more subspecialized and want to be exclusively that (e.g. peds PM&R) then you options may be more limited due primarily to the supply of jobs. As with any other specialty you get paid more in private practice away from big cities and less for academic medicine in big cities. There are advantages and disadvantages to both.

In terms of fellowship, the traditional PM&R fellowships are spinal cord medicine, traumatic brain injury, sports medicine (PM&R or primary care based), spine and sports medicine, interventional pain (PM&R or anesthesia based), neuromuscular rehab, electrodiagnostic medicine, pediatric rehab. Other fellowships I've seen people do palliative care, cancer rehab, and occupational medicine. Out of those SCI and TBI probably limit you the most because of the general need to be connected to large academic institutions. The others you pretty much have great flexibility in jobs...and things end up being what you make of it. As with any subspecialty the more you are willing to also spend time practicing in your base specialty (e.g. PM&R sports med doc doing general rehab, anesthesia pain doc doing anesthesia in the OR) the more flexibility you'll have in your job prospects.

What is the best way to get involved in private practice so that patients know to come to you and you can make a decent living? Also is it possible to do a sports and spine combined fellowship? What do you think will be a competitive application 3-4 years from now for a top-10 PM&R residency, in terms of Step 1, publications, rotations, etc.? Luckily my school does have PM&R so I will definitely get on top of that! Other than that you've answered everything really well! If I do have further questions I can ask on this thread if that's ok!

Thank you so much for taking so much time to help me out and answer questions, I appreciate it very much!!!

 

[remzremz]

I have been in sports medicine practice for 2 years now. My residency was in family medicine. I see patients M-F with a half day on wednesdays, approx 25-30 patients daily. I practice some general primary care (trying to grow this) but 90% of my practice is general office orthopedics heavy on procedures, fracture reductions, dislocations, joint injections, viscosupplementation, acute and chronic msk pain, skin/bursa injections and drainage, and I for the most part only prescribe narcotics for acute pain. I do see a number of athletes as well, I treat them for common ailments, injuries, keep them up to date on their preventive measures, and even help them boost their performance (Always NCAA and WADA appropriate of course). Every day is different and exciting, my patient population is well insured and very driven to get better. I am in a multispecialty outpatient MedCenter with all the ancillaries and imaging in-house. I do take call, but there are 4 of us so we each share telephone call for a week each month. We have call-a-nurse so most calls are triaged before they even get to us. Its sunday today, the last day of my week on call and I haven't gotten a single call yet (knock on wood). We have an attached extended hours Urgent Care center that helps feed my schedule and I see patients there as consults frequently. I am not required to per my contract but I do give my cell number to the urgent care docs if they have any questions about injuries/msk illnesses seen over the weekends or after hours and I have no problem driving 15 mins from my house to the MedCenter to help out (happens maybe once or twice a month). I get 4 weeks paid vacation a year and 4 weeks paid CME time off, not including holidays. The money is great, base salary was recently increased from my starting salary of $175,000 and is now $200,000 and my productivity bonus is paid out twice a year, last one was $50,000 (ie $100,000 a year), there is also a non-productivity bonus of $10,000 for good behavior, meeting certain meaningful use measures, patient satisfaction, etc, so income before taxes is about $310,000. Malpractice, disability, medical, dental, vision for my wife and myself is included. The health system also matches 50% of what I place into my retirement account (up to 8% total) .

I love my job, and will probably never move to another practice. Definitely consider primary care sports medicine (beats taking trauma call as Ortho/Sports Med ;-) ) I'm happy to answer any questions.

Very informative write-up! Much appreciated! Do you know any colleagues that have gone into Sports Medicine (fellowship) coming from an Internal Medicine residency? I know the usual route is Family Medicine but I was wondering about people who do Sports Medicine with an Internal Medicine background.

 

[TXPMR]

What is the best way to get involved in private practice so that patients know to come to you and you can make a decent living? Also is it possible to do a sports and spine combined fellowship? What do you think will be a competitive application 3-4 years from now for a top-10 PM&R residency, in terms of Step 1, publications, rotations, etc.? Luckily my school does have PM&R so I will definitely get on top of that! Other than that you've answered everything really well! If I do have further questions I can ask on this thread if that's ok!

Thank you so much for taking so much time to help me out and answer questions, I appreciate it very much!!!

Not a problem...just passing it forward.

I'm assuming you're in med school...so by the time you're ready to be out in practice pretty much everyone in outpatient PM&R is going to be in A. a large university based practice B. a large private PM&R based practice C. a large private orthopaedic surgery based practice or D. a large private neurosurgery based practice...that's where it looks like things are headed right now. That being said if you are part of a large practice you will initially have patients funneled to you. They may not be the most desirable patients, but you schedule will be full and you'll be paying your mortgage and putting food on the table.

In an outpatient based private practice. if you are in a smaller group (or in a large group and want to recruit more desirable patients) you'll need to hit up your local PCP's office to advertise your skill set.

Spine and sports is a fellowship option out of PM&R residency. These used to be much more desirable for those wanting to truly do spine and sports until a couple of years or so ago as sports and spine fellowships are non-ACGME accredited. Used to be you could do one of these fellowships and sit for the sports medicine boards, pass, and be board certified in sports medicine. This changed a couple of years ago such that now the only way to become board certified in sports medicine as a physiatrist is to do accredited PM&R based or primary care based sports medicine fellowships. That being said, there are plenty of fabulous non-accredited sports and spine fellowships at very reputable institutions (such fellowships at places like HSS, Penn, and Columbia) come to mind. You'll tend to do at least 50% clinical/interventional spine care and the rest MSK and sports. However, nowadays fellows in these programs seem to be more interested in spine than true sports medicine. And for good reason...those interventional spine jobs pay well and offer potentially a great lifestyle. Graduates from these programs tend to end up doing a lot of spine and then some general MSK medicine. Seems to be nowadays that the true sports medicine physiatrists who are team docs for college and pro teams are coming from accredited programs (for board certification purposes). Also, there are some PM&R based accredited sports medicine fellowships where you can get some training in interventional spine care.

The most important thing you can do right now to make yourself competitive is show a genuine interest in PM&R and develop meaningful mentorship relationships with attending physiatrists...the more well known the better. Academic PM&R is still a relatively small community and great recommendation letters from big names carry weight. Obviously, you shouldn't bomb the Steps...but you don't need 240+ to match anywhere. I'm just throwing numbers out there but I think if you are above a 220-225 you won't be hindered by your board scores pretty much anywhere. Below that won't kill you but it may hurt. It still stands that if you merely pass all your boards, show a genuine interest in PM&R, and aren't a complete dud of a personality, you'll match somewhere in PM&R.

 

[miamiheatfan]

Not a problem...just passing it forward.

I'm assuming you're in med school...so by the time you're ready to be out in practice pretty much everyone in outpatient PM&R is going to be in A. a large university based practice B. a large private PM&R based practice C. a large private orthopaedic surgery based practice or D. a large private neurosurgery based practice...that's where it looks like things are headed right now. That being said if you are part of a large practice you will initially have patients funneled to you. They may not be the most desirable patients, but you schedule will be full and you'll be paying your mortgage and putting food on the table.

In an outpatient based private practice. if you are in a smaller group (or in a large group and want to recruit more desirable patients) you'll need to hit up your local PCP's office to advertise your skill set.

Spine and sports is a fellowship option out of PM&R residency. These used to be much more desirable for those wanting to truly do spine and sports until a couple of years or so ago as sports and spine fellowships are non-ACGME accredited. Used to be you could do one of these fellowships and sit for the sports medicine boards, pass, and be board certified in sports medicine. This changed a couple of years ago such that now the only way to become board certified in sports medicine as a physiatrist is to do accredited PM&R based or primary care based sports medicine fellowships. That being said, there are plenty of fabulous non-accredited sports and spine fellowships at very reputable institutions (such fellowships at places like HSS, Penn, and Columbia) come to mind. You'll tend to do at least 50% clinical/interventional spine care and the rest MSK and sports. However, nowadays fellows in these programs seem to be more interested in spine than true sports medicine. And for good reason...those interventional spine jobs pay well and offer potentially a great lifestyle. Graduates from these programs tend to end up doing a lot of spine and then some general MSK medicine. Seems to be nowadays that the true sports medicine physiatrists who are team docs for college and pro teams are coming from accredited programs (for board certification purposes). Also, there are some PM&R based accredited sports medicine fellowships where you can get some training in interventional spine care.

The most important thing you can do right now to make yourself competitive is show a genuine interest in PM&R and develop meaningful mentorship relationships with attending physiatrists...the more well known the better. Academic PM&R is still a relatively small community and great recommendation letters from big names carry weight. Obviously, you shouldn't bomb the Steps...but you don't need 240+ to match anywhere. I'm just throwing numbers out there but I think if you are above a 220-225 you won't be hindered by your board scores pretty much anywhere. Below that won't kill you but it may hurt. It still stands that if you merely pass all your boards, show a genuine interest in PM&R, and aren't a complete dud of a personality, you'll match somewhere in PM&R.

Wow this is awesome information! So if I want an opportunity to work on a college/pro sports team I definitely want an accredited fellowship and of course connections and luck? Can I avoid research and still have a good chance at matching in one of the better residencies? Yes I'm starting med school in August!

 

[galactus]

Very informative write-up! Much appreciated! Do you know any colleagues that have gone into Sports Medicine (fellowship) coming from an Internal Medicine residency? I know the usual route is Family Medicine but I was wondering about people who do Sports Medicine with an Internal Medicine background.

I know of a few sports med docs that came out of IM, but not many. My mentor did med-peds prior to a sports medicine fellowship.
There are 5 specialties that can go into a primary care sports medicine fellowship:
Emergency Medicine
Family Medicine
Internal Medicine
Pediatrics
PM&R

 

[TXPMR]

Wow this is awesome information! So if I want an opportunity to work on a college/pro sports team I definitely want an accredited fellowship and of course connections and luck? Can I avoid research and still have a good chance at matching in one of the better residencies? Yes I'm starting med school in August!

Historically most of the D1 academic sports jobs and pro positions are going to sports boarded/eligible physiatrists. Used to be you didn't need to train in an ACGME accredited fellowship to sit for the sports boards. However, now you must train in an ACGME accredited program (PM&R based or primary care based) to sit for the sports boards. So, if you are truly interested in covering high level teams/sports accredited fellowship programs are what you want. Can you do D1/pro sports without board certification? Certainly. As far as I know, there's no hard and fast rule that you have to be board certified in sports medicine to do sports coverage. But you'll probably have more of an uphill battle relative to your board certified colleagues in the sports medicine world. As it stands, the only thing a sports boarded physiatrist can do that a non-sports boarded physiatrist can't is be fellowship director of an ACGME accredited sports medicine fellowship program. The ACGME accredited fellowships are VERY competitive (especially the PM&R based ones) so I'd advise that you decide if you truly want to do SPORTS medicine which is somewhat different than MSK medicine. If you have more of an interest in MSK than sports I'd advise not to kill yourself going through the sports match when you can find phenomenal non-accredited MSK/Sports/Spine non-accredited programs.

As it stands you don't need research per se to have a chance to match at the "better" residencies, but it's definitely helpful. You don't need 10+ peer reviewed publications to match, but a paper, poster presentation, or case report or two certainly helps. Research in PM&R is preferable, but any research is good. It definitely varies program to program, but it's likely further down the totem pole at most places in terms of applicant competitiveness.

 

[miamiheatfan]

Historically most of the D1 academic sports jobs and pro positions are going to sports boarded/eligible physiatrists. Used to be you didn't need to train in an ACGME accredited fellowship to sit for the sports boards. However, now you must train in an ACGME accredited program (PM&R based or primary care based) to sit for the sports boards. So, if you are truly interested in covering high level teams/sports accredited fellowship programs are what you want. Can you do D1/pro sports without board certification? Certainly. As far as I know, there's no hard and fast rule that you have to be board certified in sports medicine to do sports coverage. But you'll probably have more of an uphill battle relative to your board certified colleagues in the sports medicine world. As it stands, the only thing a sports boarded physiatrist can do that a non-sports boarded physiatrist can't is be fellowship director of an ACGME accredited sports medicine fellowship program. The ACGME accredited fellowships are VERY competitive (especially the PM&R based ones) so I'd advise that you decide if you truly want to do SPORTS medicine which is somewhat different than MSK medicine. If you have more of an interest in MSK than sports I'd advise not to kill yourself going through the sports match when you can find phenomenal non-accredited MSK/Sports/Spine non-accredited programs.

As it stands you don't need research per se to have a chance to match at the "better" residencies, but it's definitely helpful. You don't need 10+ peer reviewed publications to match, but a paper, poster presentation, or case report or two certainly helps. Research in PM&R is preferable, but any research is good. It definitely varies program to program, but it's likely further down the totem pole at most places in terms of applicant competitiveness.

Thank you so much for helping me!

 

[DoctorDontStop]

This has been an amazing thread to read through. Thank you all for your contributions. I am interested in Sports Medicine, but also Hospital medicine via the family medicine route. Is it possible for me to do both? Ideally I would like to have a heavy focus on Hospital medicine or 50/50 until I burn out and then switch over to 100% Sports medicine as I age. Does this sound possible to those of you familiar with FM?

 

[galactus]

This has been an amazing thread to read through. Thank you all for your contributions. I am interested in Sports Medicine, but also Hospital medicine via the family medicine route. Is it possible for me to do both? Ideally I would like to have a heavy focus on Hospital medicine or 50/50 until I burn out and then switch over to 100% Sports medicine as I age. Does this sound possible to those of you familiar with FM?

Yes..it's easier if you go the academic route to do it.

I moonlit as a nocturnist during sports medicine fellowship and my co-fellow did ER shifts. My SM attendings also did inpatient for the FM residency. Basically they did inpatient when there were no collegiate sports going on (summer/winter). Shoot when an athlete from a college we covered had to be admitted (which was very rare), the fellow did the admission and we rounded on them

I just got my privileges at the hospital I'm affiliated at, and will be in the faculty rotation for inpatient medicine for the residency.

Long story short: You can do both.

 

[anatomsnuffbox]

You can't do AOA FM program and then match ACGME sports med?

 

[DancingDoggie]

del.

 

[Doctor4Life1769]

No, thank you. No fellowship for me.

 

[Tri2Fly]

Anyone hear anything from any of the places they applied? Just wondering if interviews have started to come in for anyone else as it has been radio silence on my end, and with applications submitted over a month ago I'm starting to worry slightly.

 

[galactus]

Still too early in the game bro! Prior to SM fellowship going on ERAS, the deadlines for most programs were like Sept 1. Programs weren't even accepting applications in July (until they all joined ERAS). The match is still first wednesday of January. You'll likely hear back from programs around september, interview during late Sept - early dec.

 

[septoplasty]

Yeah, i've got nothing........

 

[Tri2Fly]

Thank you for the responses. Seeing all the interviews flying around for the medicine specialties made me nervous.

 

[septoplasty]

Thank you for the responses. Seeing all the interviews flying around for the medicine specialties made me nervous.

Yea, my memory of how it worked for residency got me thinking I should have a couple by now.. but nothing. Only a few saying that we've got your apps, will review in sept for interviews in oct-november..

I doubt programs interview more than 5-10 candidates for each spot, with average of 2 fellows a year/program, so the process is a lot smaller.

 

[galactus]

you're exactly right. the process is way smaller with 1-2 spots usually for fellowship. also keep in mind that interviews happen during the busiest time of the year (football season), so some programs either interview one candidate a week, or even clump them together during a few interview dates.

 

[15MD]

Any updates?

 

[DoctorDontStop]

How lucrative/worth while is doing game coverage at the community, university and professional level? I know we all love sports medicine and don't want to do it for the money, but I don't think the extra pay is worth the lost sleep after being in the clinic all day. Or is game coverage pay included in your salary normally?

 

[Tri2Fly]

Any updates?

I've received almost a handful of invites at this point, but not enough to make me feel comfortable. Hopefully things pick up in the next few weeks.

 

[galactus]

For me game coverage is not included in salary. I don't know of anyone who gets paid to cover games. It's about a healthcare system "sponsoring" a team with athletic trainers and physicians, and in return you get patients in clinic. I even get new patients in clinic (in both my FM and SM practice) after people heard that I am a team physician.
Money is generated from seeing the athletes in clinic. Since I'm FM/SM, I am the PCP for some of the coaches, and athletic director staff. I am also a PCP for local athletic directors of soccer leagues, college conference refs, HS athletic directors, so my ears are generally open to upcoming sporting events in the city I practice in. Also, it's good marketing, especially if you are employed by a giant med school/healthcare system.

Getting involved at the community/college/pro level to provide care gets your foot in the door for networking opportunities. First year out of fellowship I was covering high schools, and now I do college coverage. Knowing the trainers around your area, orthopedists, and athletic directors of high school and colleges is a great networking tool for your practice. If you provide good care patients will come to you. Sometimes you may get invited to all the sports charity events or award ceremonies which is pretty cool, as well as an excellent business opportunity for people to know your name and brand.

 

[DoctorDontStop]

Thank you so much for all your info, I'm not sure why its so hard to find this info online. How easy is it to start getting sports medicine exposure during residency? Can I just go to clinics and athletic events and say "Hey I'm Joe Blow PGY-1, mind if I hang around and help out?" Or should I check with the program director for instruction?

 

[septoplasty]

I've received almost a handful of invites at this point, but not enough to make me feel comfortable. Hopefully things pick up in the next few weeks.

Handful huh?

Making me nervous lol.

I've gotten about 4... 2 of which are places that I don't wanna go *fingers crossed* lol.

(if anyone was wanting deets on numbers).