Unmatched Ortho MS4 - want to reapply to PMNR

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nkdoc

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Hello all, I am an MS4 at a DO school on a student visa. I applied to ortho and went unmatched. This upcoming cycle I want to apply to PMnR with a back up of FM. The chances of finding a TY or prelim position right now are slim. I have two options. Either (1) do a research year or (2) accept any open residency spot. Which one is a better plan, and how can I strengthen my application in the next few months? Step 2 is 253, I have 12 ortho pubs, 20 abstracts, and multiple leadership positions during med school.
For 1, I only found ortho research positions. Do you think I can justify that during my interviews?
For 2, does anyone have experience going into FM and then switching residency specialties?

If anyone has experience applying for a visa and securing an H1b, please let me know as well.

Thank you so so much! Appreciate any guidance.
 
nkdoc said:
Hello all, I am an MS4 at a DO school on a student visa. I applied to ortho and went unmatched. This upcoming cycle I want to apply to PMnR with a back up of FM. The chances of finding a TY or prelim position right now are slim. I have two options. Either (1) do a research year or (2) accept any open residency spot. Which one is a better plan, and how can I strengthen my application in the next few months? Step 2 is 253, I have 12 ortho pubs, 20 abstracts, and multiple leadership positions during med school.
For 1, I only found ortho research positions. Do you think I can justify that during my interviews?
For 2, does anyone have experience going into FM and then switching residency specialties?

If anyone has experience applying for a visa and securing an H1b, please let me know as well.

Thank you so so much! Appreciate any guidance.
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You will have to have a convincing story as to why PM&R - in the past PM&R was used as a gateway for ortho peeps who didn't make it into Ortho. These days PM&R has far more applicants than spots likely in correlation to sky rocketing salaries.
So I would recommend you find some reasonable PM&R rotations, research or something that says hey PM&R rocks! and I want in.
I do a lot of MSK and enjoy it and work closely with surgeons. I would imagine that with the right experiences and spin on stuff it's feasible. They are also opening a program it seems in
Sanford, FL - you might want to inquire there. It's on the forum listed above somewhere.
 
Iamnew2 said:
You will have to have a convincing story as to why PM&R - in the past PM&R was used as a gateway for ortho peeps who didn't make it into Ortho. These days PM&R has far more applicants than spots likely in correlation to sky rocketing salaries.
So I would recommend you find some reasonable PM&R rotations, research or something that says hey PM&R rocks! and I want in.
I do a lot of MSK and enjoy it and work closely with surgeons. I would imagine that with the right experiences and spin on stuff it's feasible. They are also opening a program it seems in
Sanford, FL - you might want to inquire there. It's on the forum listed above somewhere.
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What kinda salaries are you guys seeing? Considered PM&R during med school, so I'm curious, lol
 
I agree matching PM&R will be hard without some experience. Your Step 2 is great, and research always looks great, but your research clearly says "I want ortho." An application to PM&R residency without anything different is going to raise a lot of questions. As most program directors are concerned about competency and commitment, they may question your commitment to PM&R (and whether you'd stay).

So if you do a research year, make it as PM&R-relevant as possible and do a few PM&R rotations if possible. Talk with your school about what they can work out.

DO NOT go into an FM (or any other program aside from a prelim/TY) with the plan to switch residency programs. You can read way too many cases of people who change their minds and want to change residency specialties during residency, and the bottom line is most are advised to finish their current program. If you insist on leaving, you would need to tell your current program director so you have their support (you'll need a LOR from them), which means they will start looking for someone to replace you and you could end up with a scenario when you don't match into your new specialty and your program has given away your spot.

You could try to SOAP into unfilled prelim programs (IM, surgery, TY). There are typically lots of them, they just might not be that desirable.
 
I didn’t match into Pm&r and scrambled into a family medicine residency program. A few months in, I decided that the specialty wasn’t for me and wanted to reapply for pm&r.

I agree with everything stated above. It is pretty awkward asking the program director for a letter of recommendation but in my scenario, my whole application was Pm&r so they understood. I also found a spot outside of the match so I kinda knew I had a spot before I left.

Pm&r has become pretty competitive and I’m not sure how feasible it is to secure a visa spot. You could also consider other routes to end up to your career goal - for example, sports medicine via family medicine.

Feel free to DM me if you have any questions
 
You're a borderline PM&R applicant. Truthfully, you likely wouldn't match at my program. Fit is incredibly important and there are enough folks on review committees that will be scared off by you having PM&R as a second choice. We're competitive enough that we can take strong applicants with PM&R as their first choice.

But the good news for you is that there are a number of PM&R residency programs sprouting up like dandelions all over the country. HCA has a clear business model to recruit residents into their new rehabilitation hospitals to get cheap labor and increase the likelihood of retention in otherwise difficult to fill spots. True story, about 7-8 years ago I was being recruited to a department to be the 2nd PM&R attending. I learned that it would be q2 call and that was enough for me to say "peace-out". Well, that same department within three years had an ACGME residency program. Since then I have been sent two HCA recruitment letters to become Program Director at their sites. I looked on the intraweb to learn that both rehab hospitals had been built within the past few years, and neither had more than 3 PM&R physicians on staff.

It is clear that HCA rehab hospitals are opening hospitals with the plan to have PM&R residents from the jump. The business model is quite ingenious actually. They know that PM&R has too many applicants for the number of spots so that are guaranteed that they match on a yearly basis. So there should be slots opening (including slots for PGY-2 and PGY-3, because they don't have any interest in developing PM&R residents, they are looking for workers. So the opportunities may be there for you, but of course you'll have to balance that with the likelihood that you'll get a decent education. The standards set by the ACGME are not particularly high.
 
Can be $400k+
 
Iamnew2 said:
400-600k is not hard to do
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There’s a reason why Pain has been less competitive in recent years. It becomes harder to justify the year of lost income when general PM&R and general anesthesiology are doing so well. The ones pursuing Pain now are doing it for better reasons (they’re passionate about caring for that population or the desire to gain that skillset).
 
I don't know of anyone making that much salaried with just PM&R, inpatient or general outpatient. I do know people who bonus into that territory though. But they are seeing a lot of patients and/or doing a lot of basic injections and EMGs, at least the outpatient side. The outpatient folks I know aren't taking call or working weekends. Different story for inpatient. if your inpatient and getting a med director stipend then I could see making that.
 
j4pac said:
There’s a reason why Pain has been less competitive in recent years. It becomes harder to justify the year of lost income when general PM&R and general anesthesiology are doing so well. The ones pursuing Pain now are doing it for better reasons (they’re passionate about caring for that population or the desire to gain that skillset).
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Anesthesiology makes about 500k base starting, W2. They really have no incentive to do pain anymore. Is that what PMR starts at now?
 
Prehealth1011 said:
Anesthesiology makes about 500k base starting, W2. They really have no incentive to do pain anymore. Is that what PMR starts at now?
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Definitely not. Unless it's PM&R with pain in particular areas. But most pain physicians aren't salaried at that much either regardless of base specialty.
 
Remember that’s it’s important to be patient with a response from the SNF doctors this time of the year. They’re all getting back from their month long SNF conference in The Maldives. @PMR2008
 
Dansk2011 said:
I don't know of anyone making that much salaried with just PM&R, inpatient or general outpatient. I do know people who bonus into that territory though. But they are seeing a lot of patients and/or doing a lot of basic injections and EMGs, at least the outpatient side. The outpatient folks I know aren't taking call or working weekends. Different story for inpatient. if your inpatient and getting a med director stipend then I could see making that.
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Inpatient medical director here! Very much possible with bonus. Only a few weekends a year due to a healthy size group, most days home by 4pm or earlier, etc. Very nice gig.
 
Dansk2011 said:
I don't know of anyone making that much salaried with just PM&R, inpatient or general outpatient. I do know people who bonus into that territory though. But they are seeing a lot of patients and/or doing a lot of basic injections and EMGs, at least the outpatient side. The outpatient folks I know aren't taking call or working weekends. Different story for inpatient. if your inpatient and getting a med director stipend then I could see making that.
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Very possible with inpatient only job and leading a pretty good lifestyle. Im in a group on call once a week and one weekend every 4-5 weeks. Weekends can round on just the unstable to see more if needed. Typically go in around 8-8:30 and out by 4-5. On average one day a week im there later than 5 but that is balanced out with an early day. Just depends on if big admit day/team conference etc. If you balance out your discharges it makes this much better. I switched from all outpatient to all inpatient for lifestyle. I can easily leave unit for a couple hours and come back later to get things done, or adjust my rounding times. This way I can see my kids activities and school events. I had a partner that liked to come in at 6:30 am each morning so was always out by 3. That's just way to early for me to get up.
 
Momentum70 said:
Very possible with inpatient only job and leading a pretty good lifestyle. Im in a group on call once a week and one weekend every 4-5 weeks. Weekends can round on just the unstable to see more if needed. Typically go in around 8-8:30 and out by 4-5. On average one day a week im there later than 5 but that is balanced out with an early day. Just depends on if big admit day/team conference etc. If you balance out your discharges it makes this much better. I switched from all outpatient to all inpatient for lifestyle. I can easily leave unit for a couple hours and come back later to get things done, or adjust my rounding times. This way I can see my kids activities and school events. I had a partner that liked to come in at 6:30 am each morning so was always out by 3. That's just way to early for me to get up.
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Are you W2?
 
Wamuu said:
Are we speaking from experience here? Unless you somehow casually stroll into a medical director or chair position, this is not as easy as you say it is.
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yes from experience and medical directorships are frequently available
 
RangerBob said:
Agree, but ironically we all seem to pronounce it that way...
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Ha, touche. I guess a quirk of the English language. At the same time, people don't write Texas ANM or North Carolina ANT even though the "and" in those names sounds like "n."

Just a pet peeve of mine when I see PMNR written in notes in charts, etc. I don't really get it, either write PM&R which is an accurate abbreviation or write PMR which is an ok short hand for PM&R. PMNR and PMnR make no sense...like what does the N stand for? People are writing an unnecessary letter in an abbreviation. Again, this is just me...just a pet peeve of mine...but at the same time if I ever see that on an candidate's application that's an immediate no for interview or ranking for me.
 
TXPMR said:
Ha, touche. I guess a quirk of the English language. At the same time, people don't write Texas ANM or North Carolina ANT even though the "and" in those names sounds like "n."

Just a pet peeve of mine when I see PMNR written in notes in charts, etc. I don't really get it, either write PM&R which is an accurate abbreviation or write PMR which is an ok short hand for PM&R. PMNR and PMnR make no sense...like what does the N stand for? People are writing an unnecessary letter in an abbreviation. Again, this is just me...just a pet peeve of mine...but at the same time if I ever see that on an candidate's application that's an immediate no for interview or ranking for me.
Click to expand...
It's a pet peeve of mine as well, so I totally get it. PMNR written out is like nails on a chalkboard to my eyes.

I also think ampersands look really cool.
 
Wamuu said:
Are we speaking from experience here? Unless you somehow casually stroll into a medical director or chair position, this is not as easy as you say it is.
Click to expand...
Everyone in my small group is in this range. All inpatient. Not counting the med director into this. Carry average census 18-20 and should not make under $400k unless billing very poorly.
 
Wamuu said:
Which state?
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I think their stats are perhaps a bit high for the average PM&R job out there.

Before the recent CPT code changes, which make billing a level 3 a lot harder for PM&R, 19 patients/day, 5d/week, 52 weeks/yr would've gotten me almost $450k in patient collections, here in CA. Which is at the lower end of the range given above. But my director stipend took it quite a bit higher. Were I in SF or LA it might be almost $600k in patient collections based on what others there have told me they're collecting from insurance (our rates are lower here obviously).

If I were to see 19 patients/day now, I'd probably be in the high $300's. But I probably average closer to 14 patients/day or so, which I find a far more comfortable/sustainable number. 18+ patients/day is a busy day. And I don't want to be that busy everyday. But if you're young/single and want to work/make money, I know folks seeing well over 20 patients/day and are bringing in over $500k in patient billings alone.

So with any stipends taken into account, $400k should be very attainable with a solid work-life balance. $500k or more if you want to work a bit more.
 
RangerBob said:
I think their stats are perhaps a bit high for the average PM&R job out there.

Before the recent CPT code changes, which make billing a level 3 a lot harder for PM&R, 19 patients/day, 5d/week, 52 weeks/yr would've gotten me almost $450k in patient collections, here in CA. Which is at the lower end of the range given above. But my director stipend took it quite a bit higher. Were I in SF or LA it might be almost $600k in patient collections based on what others there have told me they're collecting from insurance (our rates are lower here obviously).

If I were to see 19 patients/day now, I'd probably be in the high $300's. But I probably average closer to 14 patients/day or so, which I find a far more comfortable/sustainable number. 18+ patients/day is a busy day. And I don't want to be that busy everyday. But if you're young/single and want to work/make money, I know folks seeing well over 20 patients/day and are bringing in over $500k in patient billings alone.

So with any stipends taken into account, $400k should be very attainable with a solid work-life balance. $500k or more if you want to work a bit more.
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California. Now the whole 400-600 range makes sense. Everywhere else east of that state doesn't share in the same salary range unless you are somebody worth paying that much or find yourself in a chair position. Or both.
 
Wamuu said:
California. Now the whole 400-600 range makes sense. Everywhere else east of that state doesn't share in the same salary range unless you are somebody worth paying that much or find yourself in a chair position. Or both.
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Hmm. CA docs actually average or below average compared to the rest of the country. Our housing is certainly my higher. Hence part of why WhiteCoatInvestor doesn’t recommend docs practice here. We make less but yet it also costs more.

I only spoke for myself. I don’t know where the poster who mentioned $400-600k lives.

$400-$600k is doable anywhere in the country if you’re getting a director stipend. I think it’s pushing if you’re not.

$600 is pushing it perhaps unless you’re working hard and have a stipend. But $400 is certainly very doable unless all you serve is MediCaid. I’m probably 20% MediCal (pays less than most state Medicaid) and I probably average $80/patient/day now. It used to be closer to $95/patient/day before recent CPT changes. The folks I knew practicing in SF were making closer to $120/patient/day. I think they were a bit more aggressive in their coding and likely had a better payor mix.

Again, that’s just insurance/patient payments. Add on a six figure director stipend and $400k+ is quite attainable without killing yourself.
 
Wamuu said:
California. Now the whole 400-600 range makes sense. Everywhere else east of that state doesn't share in the same salary range unless you are somebody worth paying that much or find yourself in a chair position. Or both.
Click to expand...
Umm no the 400-600k is very doable just about everywhere. I'm in the midwest.
Yes directorship as Rangerbob mentioned is very helpful.
 
Momentum70 said:
Everyone in my small group is in this range. All inpatient. Not counting the med director into this. Carry average census 18-20 and should not make under $400k unless billing very poorly.
Click to expand...
Im in midwest now and friends in Texas making a little less but still hitting above $400k. When i was looking for jobs a couple years ago I found midwest seemed to pay better than a lot of areas. It really surprised me that california which has a much higher cost of living did not compensate in pay category. This could be different with others but my last job and current are wRVU models. The change in making level 3 harder to get was more than balanced out by increase in rvu value for prog and dc notes.
 
Momentum70 said:
Im in midwest now and friends in Texas making a little less but still hitting above $400k. When i was looking for jobs a couple years ago I found midwest seemed to pay better than a lot of areas. It really surprised me that california which has a much higher cost of living did not compensate in pay category. This could be different with others but my last job and current are wRVU models. The change in making level 3 harder to get was more than balanced out by increase in rvu value for prog and dc notes.
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The east coast also pays poorly for some reason.
But the base salaries are not all the story - WRVU and bonuses can add up over time.
 
Iamnew2 said:
The east coast also pays poorly for some reason.
But the base salaries are not all the story - WRVU and bonuses can add up over time.
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I did 1099 for less than a year in between my former and current job which were both wRVU based w2 positions. Now each unit is different as far as complexity but for a W2 RVU based physician on inpatient I jotted down some napkin math.

When carrying an average census of 18 can probably expect to see about 20 patients a day when you factor in 2 admits/discharges a day. Most patients for me are level 2 with a few 1s and 3s. Lets say your average breakdown is as follows.
2 99223
2 99239
2 99231
12 99232
2 99233

That will give you an average daily 37.18 wRVU

If you take off 4 weeks a year then that means working 240 days. If you are doing inpatient then probably covering some weekends so add in another 24 days for 1 weekend a month coverage to get a total of 264 work days in a year.

Yearly total RVU 9815

When I was job searching about 3 years ago I was getting offers in the range of $48-62 per RVU. That gives a salary range of $471k-$608k

That does not include a lot of misc RVU that can be generated. For example smoking cessation talk, advanced directive/ACP planning discussions, injections, EKG interpretations, etc.

Now this may be considered a lot of work by some and not as much for others but I feel I have a pretty good life balance but even doing a little less will still hit the $400k mark that I posted early was very achievable.
 
Inpatient medical director here too working as 1099. I'm in the 400k-600k range, but at the upper end. I'm also on the East Coast in a desirable area. Definitely busy, like 8-9 hour days and call once a month, but doable with a family. I've also had medical directorships offered to me, which is not hard to get if you're in a nonsaturated area.

400k-600k is doable in most places whether it be acute inpatient/SNF/pain with a decent lifestyle. However I do personally know multiple PM&Rs making much more than that, but they tend to be workaholics, sloppy, or business savvy.
 
piviti said:
Inpatient medical director here too working as 1099. I'm in the 400k-600k range, but at the upper end. I'm also on the East Coast in a desirable area. Definitely busy, like 8-9 hour days and call once a month, but doable with a family. I've also had medical directorships offered to me, which is not hard to get if you're in a nonsaturated area.

400k-600k is doable in most places whether it be acute inpatient/SNF/pain with a decent lifestyle. However I do personally know multiple PM&Rs making much more than that, but they tend to be workaholics, sloppy, or business savvy.
Click to expand...

How many patients do you see per day on average?
 
piviti said:
Census is 23 currently but might cut back a bit.
Click to expand...

I consider that a pretty busy day if it's everyday. But I agree it can certainly be done in 8-9hrs and you would make great income. I'm not quite efficient enough to see 23 patients/day and regularly get home in 8-9hrs.

Personally I like 14/day. Busy enough you don't feel like you're not doing anything, but light enough to be able to take your time with patients, chat with staff, get home early (often very early if you aren't admitting) to see the family, and still make quite good money, especially if you have some kind of director/associate director stipend.
 
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