Truth in Salary (Part I)

[davidgreen]

OK, this is kind of a long message, so I'll send it in installments.

================

There's so much contradictory information out there about who makes how much, etc., that it's impossible to separate the BS (bowel sounds) from the truth.

Case in point: PM&R. This has got to be the ultimate example of word-of-mouth hype spinning out of control. Everyone keeps talking about PM&R docs STARTING at $185,000 and easily making a quarter-mill within a few years. "Omigod, and they have such a cush lifestyle, too!" goes the frequent yelp before certain orgasm is attained.

The average PM&R doc pulls in about 140 Gs a year, according to at least 3 salary surveys I've seen on various physician career websites. So, for four lousy years of residency, your average rehab doc emerges making about the same money as a 3-yr trained family med doc. "Ooooh, but the lifestyle!"

But there are other fields that also have conflicting reports about salary. One of them is often called the best-kept secret* in medicine: Occupational Med. No one's heard of it, those who have heard of it don't know what it is. Even Occ Med docs aren't sure what it is they're doing. I keep hearing, though, from those who are supposedly in the know, that demand for Occ Med docs has grown so high that companies/groups/gov't agencies/etc are paying $250k/yr.

Consulting the Occ Med society website, we find that the average salary, according to biannual surveys, is about $157k. Still not bad. (Better than PM&R, anyway.) However, keep in mind that most Occ Med docs are famiy med or internists who did short OM certification courses so they could earn the (somewhat) big bucks. People who have a full 2-yr residency/fellowship training in OM probably do signficantly better - maybe that's where these $250k/yr stories come from.

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[davidgreen]

Here's Part II:

However, I can't find any loophole to explain the lousy pay discrepancy between fact and anecdote for PM&R guys. There are no non-residency trained rehab docs (unlike EM, where you find that a substantial portion of EM docs are internists or family med guys who just work full-time in the EM; yes, the trend is toward EM-trained docs, but good numbers of nonacademic setting EM guys are actually internists looking for a little adventure.)

If anyone has any real data or insight on this (PM&R pay reality and/or Occ Med as an easy-to-come-by and lucrative career), please contribute. I'm confused as all heck.

Even at my own medical school, there are two sets of rumors regarding the head of our PM&R dept. One rumor says that Dr. Headofdept makes $145k, the other says $250k. The two figures are nowhere near each other.

 

[davidgreen]

Part III: (a footnote)

*There are few secrets in medical specialties (not "specialIties" - sorry, but that's annoying). Every few years another specialty is exposed after years of toiling in obscurity as an amazingly well-paying but noncompetitive field. Many of these secrets were exposed at about the same time. A brief history:

1997: Rad onc (avg salary: $296k) and radiology ($276k) are a joke to get into. Radioholiday fills <60% of its spots, and if you were one of the few even to have heard of rad onc, you got in. A friend of mine matched in rad onc at Wake Forest in '97, and she was one of only 4 who interviewed for that job.

 

[davidgreen]

Part IV: (footnote cont'd, I think)

Time out: Come on, who here has heard of rad onc, knows what it is? I'm not insulting anyone here, but even at my med school (a top quartile school located on the West Coast), most people have no idea what it is. One of the top students in my class (254 on Step I, 4.0 GPA so far) recently remarked that rad onc is a fellowship one completes after radiology residency!

I've heard exactly one other student ever mention rad onc during my three years of med school. One reason for this is that the few who do know about it will NEVER discuss it publicly, b/c it's so highly sought after by the few in the know that they want to keep it as much on the down low as possible.

But it doesn't matter that no one's heard of rad onc. It's still impossible to get. If only two people per med school apply for it, it's game over in terms of match rate. 250 applicants for ~85 spots = deadly odds. Hence the overwhelming silence.

 

[davidgreen]

Part V:

Back to the history lesson:

2000: Suddenly, everyone and his mother has heard about radiology. Suddenly, everyone and his mother cares about lifestyle. For DECADES before this, no one gave two hoots about working good hours, but suddenly, the word is out: LIFE is GOOD, LIFE is meant to be LIVED, and applications for rads and rad onc SKYROCKET. Suddenly, it's impossible to get a spot in either field.

Similar history for anesthesiology, although we haven't quite yet seen the preposterous levels of competition that rads and rad onc have. In '97, anesthesia fills LESS THAN HALF of available spots, and most of those were FMGs and other groups who are unjustly discriminated against. By 2000, by which time rads and rad onc have gone apesh*t, anesthesia fills ~80%. By 2002, we're up to more than 90% (this is an estimate; some obsessive freak like big frank can do the actual math) of anesth spots are taken. Within 2-3 yrs, anesthesia might be as competitive as rads.

As the head of rads at my med school has said many a time, "If radiology were anywhere near as competitive in my day as it is today, I would NEVER have matched into it." In his day, you needed ~215 and so-so grades to get in. He had numbers like that, and now he's head of the friggin' department.

 

[davidgreen]

Part VI:

And so we come to PM&R, which started this (long) message. It was a total joke to match into last year, in that long ago time of 2001. But now, in 2002, people have started to take notice, and word-of-mouth got round, as began to happen with rad onc in the yesteryear of 1997. Next year, PM&R will grow more, and by 2007, let's say, it'll be today's rads/rad onc/almost anesth.

Are there any secrets left, gentlemen? Have I exposed the last one in Occ Med?

Who has any real information - or is it all just pointless speculation and sophomoric rumor-milling?

 

[davidgreen]

Part VII: afterword

For those of you offended by such frank discussion of salaries - "Can he really say that on television!" - I advise you to turn away from this message and look instead to softer, more cuddly posts about saving the world.

Caring for one's patients is of paramount importance, and enjoyment of one's work is not far from that, but salary, undeniably, is also an important - sometimes pivotal - factor in most people's decision about which specialty to enter. You don't need Dr. Successful from 3/2000 to tell you that.

we out

 

[Sanman]

Now I'm no expert, but always up for a good conversation. First, PM&R...from what I understand inpatient rehab pays around $130,000, but physical medicine pays more and w/ a pain management fellowship it can reach very high. As far as radiology, the reason it was "discovered" recently, was because there wasn't enough of a supply, so there was high demand. In several years, when the need is met, salaries will go down or hours will go up. In this way there will always be fields being "discovered" if there is a need. As far as the "lifestyle" thing, I think thats a generational difference. My friends and I would easily give up some money for better hours and personnal lives. Our parents, however would rather work and make more money.

 

[bigfrank]

I don't think that Anesthesiology will ever be as competitive as radiology, especially if the pain mgmt fellowship goes to 2 years (from 1). Anesthesiology is a field that is detestable to many (surgeons, OR, stress, cRNAs, etc.).

Rads, on the other hand, affords a better all-around lifestyle.

Yes, anesthesiology will become more competitive, but with ~1200 spots or so, a good US-MD with a *genuine* interest in the field can match somewhere.

 

[bigfrank]

Actually, most salary surveys place PM & R nearly identical to Neurology at approximately $180-$200K/ year.

 

[rad]

Actually radiology was one of the most competitive specialties around before 1995. When the HMO and primary care movement began in the mid 90s many groups were not hiring new associates. As the word got out that there were few good jobs american grads shunned the field. Now there are about 2000 unfilled positions in the private sector and about 600 unfilled academic spots including about 30 chairmanships. Remember that we produce about 900 radiologists a year. The high retirement rate as well as the increased volume of studies has created the best professional market in memory. Some fields like peds. radiology are at crisis level. Buffalo's peds hospital has lost something like 6 peds. rads. and they have been unable to recruit any for some time. The shortage is expected to last for at least 5-10 years according to "experts".

 

[davidgreen]

Bigfrank, which salary surveys are you referring to that have the avg PM&R salary ~$180-200k? I'll try to find online the ones I saw that gave an estimate of ~$140k so we can compare notes.

Once again we see the wild disparity between salary estimates for PM&R docs.

<img border="0" alt="[Pity]" title="" src="graemlins/pity.gif" />

P.S. Why is EM so damn competitive if it only pays as much as PM&R (according to Bigfrank's sources) and has a lifestyle not significantly better than a Rehab doc's?

EM salary acc to AMA survey: $197k

 

[davidgreen]

Bigfrank is right. And he's wrong. According to one website I looked at (see link below), average PM&R and Neuro salaries are mirror images: $164k for PM&R and $166k for Neuro.

Heme-Onc is shockingly high at $255k - is this a misprint or a well-guarded secret? - while Ortho barely squeaks by most IM subspecialties at a paltry (by mythical Ortho standards) $289k. That is a**. That's diddly.

There are tons more surprises - for me, anyway. Check out the website and share your dismay/shock/anger/exultancy. <img border="0" alt="[Wowie]" title="" src="graemlins/wowie.gif" />

<a href="http://www.allied-physicians.com/salary_surveys/physician-salaries.htm" target="_blank">http://www.allied-physicians.com/salary_surveys/physician-salaries.htm</a>

 

[Jim Picotte]

Pretty good essay actually. I'll be the first to admit that salary was a moderate factor in my residency choice. I have my financial aid exit interview tomorrow and according to my records, I'll be around $160,000 in debt (undergrad and med school). I think it's around 3000 a month if I pay it back over 10 years. By the time I'm done with residency, I'd also like to finally buy a decent house and will probably have a child by then. I do love radiology and I'm very glad I'll be able to practice that specialty, but I could have easily been very happy in other fields as well. Well, I guess my point to all this is that salary is indeed very important and I agree with davidgreen that it was a major influence on my specialty choice.

 

[Acinetobacter]

After perusing the above survey, I found this to be most interesting:

FP (w OB) $122,000 $144,000 $190,000
FP (w/o OB) $132,000 $151,000 $225,000

I would have guessed the opposite.

I was also surprised at how little the critical care docs made.

Critical Care $109,000 $124,000 $160,000

 

[Stinky T]

Here's another site for salaries:

<a href="http://www.cejka.com/content.asp?intPageID=264&intBrowserRes=1024" target="_blank">http://www.cejka.com/content.asp?intPageID=264&intBrowserRes=1024</a>

Physical Medicine & Rehabilitation is a very broad field. Those who focus on outpatient physical medicine will have a higher salary than those who do inpatient rehabilitation. People who do outpatient physical medicine are practicing combinations of medical orthopedics (notice there are two different salaries listed under Ortho -- one for medical and one for surgical), sports medicine, interventional pain management, EMGs, etc. The Physiatrists in academic institutions primarily do inpatient rehab. One of the main benefits of PM&R is also the lifestyle during and after residency. You should also consider how many hours a physician in a given specialty works for that annual salary. How much is he/she making per hour of work/being on call? Malpractice insurance is also another consideration. Malpractice for PM&R is amongst the lowest of all the medical specialties.

 

[Stinky T]

•••quote:•••Originally posted by Acinetobacter:
•After perusing the above survey, I found this to be most interesting:

FP (w OB) $122,000 $144,000 $190,000
FP (w/o OB) $132,000 $151,000 $225,000

•••••Perhaps that survey took into consideration the cost of malpractice insurance.

 

[ckent]

This is an interesting discussion on how salary drives med students decisions about residency (even though they are often "ashamed" to admit it). Studies have shown that students who graduate with more debt do tend to pick higher paying specialties then their counterparts who have less debt, but when you ask many of the individual students about their decision making, they will often minimize the importance that salary played in their decision and attribute their decision to just wanting to work in that specialty. I do have some points to add on occupational medicine though, my dad does some occupational medicine work, probably like 4 days per week. He has a really easy job because he works for the government, and he "oversees" many different clinics that PAs and NPs run so he often has a lot of free time on his hands (he works much less then 40 hrs per week, takes off afternoons quite often, but gets paid a regular physician's salary). It's only low stress because he works for the federal government though, and the federal government doesn't care about wasting money on it's employees or wasting money in general. If you work for a a private company or some of the local governments, it's a completely different story. Occupational medicine docs are often hated by employee and management alike. If you do too much and send home all the patients who have "back pain" or who say that they can't work that day, management will fire you. If you try to save management money by screwing over the employees, the employees (your patients) will hate you even though they still have to go see you. Actually, the occupational medicine doc who works for our city government actually has to have security guards posted outside of her office at all times because of the number of threats she has received. Occupational medicine might have some financial rewards and have lenient work hours, but I can assure you that if you want to go out into private practice or work for a company, the lifestyle is not "easy" (unless you don't mind working in that type of environment). Working for the federal government, my dad doesn't encounter this very much because he can often just accomodate whatever the employees and just acts as a middle man for their disputes, but if you have a real responsibity to save your employers money, the work seems like it can be a real headache to me.

P.S. Even with malpractice, I think that the FP w/ OB is actually higher then the FP w/o OB. FPs would not want to wake up at 3 in the morning every other week to deliver a baby if they were not getting a little extra for it. :wink:

 

[marathon chick]

The PM&R chair at my medical school states the average is aprox. 185,000 in the mid-west region. However, in the west coast and east coast you get much less. So , It's location, location, location!!

 

[bigfrank]

"davidgreen":

<a href="http://www.shrmedquest.com/tablets/ptablet4.htm" target="_blank">http://www.shrmedquest.com/tablets/ptablet4.htm</a>

is a definitive salary website. Very large "n"

See, PM & R really isn't as bleak as you're painting. And as far as its relative competiveness with Emergency Medicine, which as you can see from the salary quote is quite comparable, many people just LIKE ER more and it has nothing to do with money.

 

[Acinetobacter]

More salary surveys for those interested.

<a href="http://www.physicianssearch.com/physician/salary2.html" target="_blank">Physician Salaries - In practice 3 years +</a>

<a href="http://www.physicianssearch.com/physician/salary1.html" target="_blank">Physician Salaries - First year out</a>

<a href="http://www.salary.com" target="_blank">Salary.com</a>

 

[Mutterkuchen]

It is important to consider the sources of these salary reports listed and other that are not listed. There is only so much useful information that can be obtained from them, such as your approximate value and value relative to other specialties.

As a former recruiter (IT professionals not doctors), I know that these salary surveys are frequently inflated. Why? Because recruiters get a percentage of the starting salary as commission. Higher starting salary=higher commission. If you know what your (nonmedical) friends make, compare their salary to salary surveys out there. <a href="http://jobstar.org/tools/salary/index.cfm" target="_blank">http://jobstar.org/tools/salary/index.cfm</a>

My guess is that they are earning less than what the salary surveys say they should be earning. The salary surveys are like the blue book value of cars. They give you one value for the recruits and another value for the recruiting company. Then there is a recruiter who is taking a cut.

The value for the recruits is public information. The salary value for the company is not public. They pay more neutral sources for this information, but most job seekers do not have access to it. Most recruiting firms are biased information sources.

Don't forget the bias.