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And is the pay comparable?
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What's the difference between a PMR sports med doc and family med sports med doc?
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We have a way bigger toolbox coming from PM&R
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PM&R usually pays a bit more than FM, mostly because general PM&R pays a little more than general FM, and most sports docs practice more of their primary specialty than sports. Few sports physicians have true 100% sports practices.
Do you want to be the team doc who treats all the primary medical issues of a sports team? Then go FM sports.
Do you want to be a physician who treats just sports injuries and knows MSK anatomy far stronger/gets more interventional training? Then go PM&R sports.
I believe FM sports is less competitive than PM&R sports, but it may not be significantly so. Sports is generally competitive from an specialty.
So pursue whatever primary specialty you'd be happier in if you weren't able to get into a sports fellowship.
Do you want to be the team doc who treats all the primary medical issues of a sports team? Then go FM sports.
Do you want to be a physician who treats just sports injuries and knows MSK anatomy far stronger/gets more interventional training? Then go PM&R sports.
I believe FM sports is less competitive than PM&R sports, but it may not be significantly so. Sports is generally competitive from an specialty.
So pursue whatever primary specialty you'd be happier in if you weren't able to get into a sports fellowship.
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True story…I previously worked for a hospital group with a FP residency and SM fellowship. Guess who was teaching the SM fellows ultrasound? This guy right here…a PM&R trained non-sports medicine doctor.
Sports is great…coverage is a ton of fun. But reality is that you almost never get paid for coverage. Even professional SM docs often don’t. That is time working for free. Meanwhile, I know generalist PM&R physicians making $500k. I was making more from OMT and Botox than peripheral joint injections in my prior, non-academia life. I love Sports, but pay is NOT a selling point. Frankly, there is very little you can get paid to do as a sports physician that you can’t as a well trained PM&R generalist. Botox, EMG, ultrasound, regen…it’s not like the credentialing is that difficult. Sports fellowship is great if you have inadequate MSK training in residency (some PM&R programs and essentially all FP programs), need D-1/pro coverage, or insist on diagnostic ultrasound in high levels. Otherwise, I’d just do general for the cost.
Sports is great…coverage is a ton of fun. But reality is that you almost never get paid for coverage. Even professional SM docs often don’t. That is time working for free. Meanwhile, I know generalist PM&R physicians making $500k. I was making more from OMT and Botox than peripheral joint injections in my prior, non-academia life. I love Sports, but pay is NOT a selling point. Frankly, there is very little you can get paid to do as a sports physician that you can’t as a well trained PM&R generalist. Botox, EMG, ultrasound, regen…it’s not like the credentialing is that difficult. Sports fellowship is great if you have inadequate MSK training in residency (some PM&R programs and essentially all FP programs), need D-1/pro coverage, or insist on diagnostic ultrasound in high levels. Otherwise, I’d just do general for the cost.
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My FM and EM/sports partners have all at some point told me they wished they did PMR before sports just because of the extra tools we learn in residency. I think I had more diagnostic ultrasounds and ultrasound-guided injections under my belt leaving residency than many FM/EM have through fellowship. The understanding of the nervous system and of the MSK system you get seeing extreme pathology on inpatient actually really lends well to better understanding smaller pathology in the MSK/sports realm.
Big things I learned in fellowship that I don't think I would do right out of residency: fracture care (not many rehab programs give you much of that, and few give you any peds fracture management), reductions. Getting better at some of the acute MSK management. TENEX, I got more reps for genic/shoulder RFA and spine interventions in fellowship. Big boost in confidence with diagnostic ultrasound. Along those lines, I now also do ultrasound-guided percutaneous surgery (a1 pulley, dequervains, fasciotomy, CTR, etc). I suppose I could have picked those all up later but I think the high volume in fellowship made this more natural.
Agree that sideline coverage - EM is superior (though so rare you are really needed, I think its a waste of time for me and thankfully don't do much), team doc, FM is best. (though in my experience, most of the FM problems for college and pro athletes are STIs, URIs, Asthma, Depression/anxiety).
Big things I learned in fellowship that I don't think I would do right out of residency: fracture care (not many rehab programs give you much of that, and few give you any peds fracture management), reductions. Getting better at some of the acute MSK management. TENEX, I got more reps for genic/shoulder RFA and spine interventions in fellowship. Big boost in confidence with diagnostic ultrasound. Along those lines, I now also do ultrasound-guided percutaneous surgery (a1 pulley, dequervains, fasciotomy, CTR, etc). I suppose I could have picked those all up later but I think the high volume in fellowship made this more natural.
Agree that sideline coverage - EM is superior (though so rare you are really needed, I think its a waste of time for me and thankfully don't do much), team doc, FM is best. (though in my experience, most of the FM problems for college and pro athletes are STIs, URIs, Asthma, Depression/anxiety).
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I agree with the acute injury management part. That is actually the reason I wanted to do a sports medicine fellowship (not because of diagnostic or interventional ultrasound, or to learn how to manage chronic musculoskeletal conditions) That is not something most PM&R residents are exposed to.
The first four high school football games I covered there were ACL tears. Over the next several weeks I also had to manage a shoulder dislocation, an ankle fracture dislocation, a finger fracture dislocation, and a both bone fracture on the sideline.
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If you really want sports, my opinion is to seek out orthopedic surgery. You’ll make the most money and be able to manage everything. Of course that route is not always easy or desirable.
Sports and spine is probably the second best financially since you’ll be trained to do spine procedures. There are quite a bit of sports and spine trained docs that gave up on sports and just stick to the spine procedures.
If you want to do MSK care and not hyper focused on sports then PMR may be a good option. You shouldn’t really need a fellowship, unless you want to super-focus on athletics.
If you want to do some primary general medicine then go FM/IM with sports fellowship. A lot of the FM still do primary care as well. IM training provides a great background to fall back on, but little for MSK. (IE can moonlight as a hospitalist)
Depending on your market, you could end up mostly seeing geriatric joints and kids with growing pains. Then doing high school sports coverage for free. Financially you’ll never really make up the money lost from the fellowship.
Sports and spine is probably the second best financially since you’ll be trained to do spine procedures. There are quite a bit of sports and spine trained docs that gave up on sports and just stick to the spine procedures.
If you want to do MSK care and not hyper focused on sports then PMR may be a good option. You shouldn’t really need a fellowship, unless you want to super-focus on athletics.
If you want to do some primary general medicine then go FM/IM with sports fellowship. A lot of the FM still do primary care as well. IM training provides a great background to fall back on, but little for MSK. (IE can moonlight as a hospitalist)
Depending on your market, you could end up mostly seeing geriatric joints and kids with growing pains. Then doing high school sports coverage for free. Financially you’ll never really make up the money lost from the fellowship.
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Frankenstein collage of my post to similar questions:
I am PM&R + ACGME PM&R sports fellowship trained. My fellowship was probably 70/30 sports/spine. Toyed with the idea of ortho in med school but I HATE the OR.
Started life as a D1 P5 team doc and was heavy sports vs spine - probably 80/20. I may have been better served if I had done FM/IM as most of my management was asthma, ADHD, runny noses, and GI bugs. Certainly easy enough to do but not what I was necessarily interested in doing all the time.
I no longer do the D1 thing and now that ratio has flipped to probably 85/15 spine/sports doing ESIs, RFs, MILD, PNS, fluoro and USG peripheral joints, EMGs, and some rare Botox + mobility/wheelchair management.
As an FM/IM graduate - if you go to an average (or better) FM residency and have interest in MSK (and put in the effort) your MSK physical exam skills and understanding of some more deep MSK/sports stuff will be mediocre but fine for 90% of things that roll into the office. But you will also lack the knowledge of working within an athletic department as a team physician - i.e. interacting with ATCs, coaches, administrators, agents, diva athletes more worried about going pro/next contract, etc.. A good sports fellowship that gives you exposure to ortho surgeons, PCSM FM, and PM&R trained physicians will make you much better at all of those things and give you more time to improve US skills.
You will likely fall back on some percentage of 'typical FM/IM' stuff which is less lucrative than your fall back PM&R stuff (i.e. EMGs, Botox, maybe some easy spine procedures).
If you enjoy PM&R stuff (MSK, EMG, function, etc.) and want a more procedure based practice then I'd do an ACGME PM&R sports fellowship (with NASS fellowship back up) and ensure you get spine training (fellowships will be up front about their spine training). If you do ESIs and RFs you will have plenty of business and can punt the "crazy pain patient" for SCS/DRG to your pain colleagues and they can deal with the complications and make the extra $50k per year for the SCS/DRG/pain pump headaches.
I am PM&R + ACGME PM&R sports fellowship trained. My fellowship was probably 70/30 sports/spine. Toyed with the idea of ortho in med school but I HATE the OR.
Started life as a D1 P5 team doc and was heavy sports vs spine - probably 80/20. I may have been better served if I had done FM/IM as most of my management was asthma, ADHD, runny noses, and GI bugs. Certainly easy enough to do but not what I was necessarily interested in doing all the time.
I no longer do the D1 thing and now that ratio has flipped to probably 85/15 spine/sports doing ESIs, RFs, MILD, PNS, fluoro and USG peripheral joints, EMGs, and some rare Botox + mobility/wheelchair management.
As an FM/IM graduate - if you go to an average (or better) FM residency and have interest in MSK (and put in the effort) your MSK physical exam skills and understanding of some more deep MSK/sports stuff will be mediocre but fine for 90% of things that roll into the office. But you will also lack the knowledge of working within an athletic department as a team physician - i.e. interacting with ATCs, coaches, administrators, agents, diva athletes more worried about going pro/next contract, etc.. A good sports fellowship that gives you exposure to ortho surgeons, PCSM FM, and PM&R trained physicians will make you much better at all of those things and give you more time to improve US skills.
You will likely fall back on some percentage of 'typical FM/IM' stuff which is less lucrative than your fall back PM&R stuff (i.e. EMGs, Botox, maybe some easy spine procedures).
If you enjoy PM&R stuff (MSK, EMG, function, etc.) and want a more procedure based practice then I'd do an ACGME PM&R sports fellowship (with NASS fellowship back up) and ensure you get spine training (fellowships will be up front about their spine training). If you do ESIs and RFs you will have plenty of business and can punt the "crazy pain patient" for SCS/DRG to your pain colleagues and they can deal with the complications and make the extra $50k per year for the SCS/DRG/pain pump headaches.
Not sure this is accurate. Would need a little more details to generalize this. Is he sports/spine, pure sports, looking for college or pro coverage? All of these factor into marketability. All things being equal, physiatrists are going to have more "MSK" type positions available to them and will make more due to doing procedures. One area where PM&R is at a disadvantage is if a group is specifically looking for someone to do sports medicine AND primary care.
There is a lot of overlap in the treatment of MSK conditions. In general, physiatrists just out of training are likely to be more advanced than primary care docs due to extensive MSK training in residency. But over time primary care sports docs' MSK skills do equal out with the exception of the spine. Physiatrists are usually superior in managing spine conditions in general and spine conditions in athlete. Sports physiatrists can carve out a nice niche in the spinal care of athletes, especially if they do interventions. Primary care sports docs are superior in the primary care management of athletes.
At the highest level of sports coverage, physiatrists in general are at a disadvantage. This is due to many teams and organizations having an orthopaedic surgeon to cover orthopaedic injuries and then someone to care primarily for medical needs of the athletes (ie primary care sports). Of course, there is not always a 100% clear separation of roles as orthopaedic surgeons often have to address medical issues and primary care docs have to address orthopaedic issues. That being said, there are some physiatrists who are team docs in the top leagues in the US. I would say though, that this set up/bias is most prevalent at the major professional level and major D1 level. Beyond that (smaller D1 schools, Olympic sports, combat sports, etc) there is not as much of a bias. There are several physiatrists that are team doctors in high level athletics (for example, the chief medical officer for the USOPC is a physiatrist).
Academically there is near 100% overlap in leadership capabilities. Both can be active faculty in sports fellowship programs. There are PM&R trained docs who are PDs of primary care sports programs. I'm not aware of any primary care docs that are PDs of PM&R based programs though.
Pay wise, physiatrists is general will make more. But this is primarily due to physiatrists being more procedure heavy than primary care sports docs. One thing trainees fail to realize this is that in general, institutions, groups, insurances don't pay physicians different rates for doing the same thing. That is, you just don't show up and say "I'm a physiatrist, pay me more." In general, you are paid for what you do. A primary care doc sports specialist and a sports physiatrist with the same exact patient mix will get paid the same because they would bill the same CPT codes. There may be some subtilities in base pay and incentive/bonus plan with some groups, but in the end it mostly evens out. Ceiling wise, physiatrists have very high pay ceilings because of the ability to bill for higher value CPT codes than primary care sports docs, but this would likely entail having to be very heavily procedure based while leaving less room for true sports medicine care.
At the highest level of sports coverage, physiatrists in general are at a disadvantage. This is due to many teams and organizations having an orthopaedic surgeon to cover orthopaedic injuries and then someone to care primarily for medical needs of the athletes (ie primary care sports). Of course, there is not always a 100% clear separation of roles as orthopaedic surgeons often have to address medical issues and primary care docs have to address orthopaedic issues. That being said, there are some physiatrists who are team docs in the top leagues in the US. I would say though, that this set up/bias is most prevalent at the major professional level and major D1 level. Beyond that (smaller D1 schools, Olympic sports, combat sports, etc) there is not as much of a bias. There are several physiatrists that are team doctors in high level athletics (for example, the chief medical officer for the USOPC is a physiatrist).
Academically there is near 100% overlap in leadership capabilities. Both can be active faculty in sports fellowship programs. There are PM&R trained docs who are PDs of primary care sports programs. I'm not aware of any primary care docs that are PDs of PM&R based programs though.
Pay wise, physiatrists is general will make more. But this is primarily due to physiatrists being more procedure heavy than primary care sports docs. One thing trainees fail to realize this is that in general, institutions, groups, insurances don't pay physicians different rates for doing the same thing. That is, you just don't show up and say "I'm a physiatrist, pay me more." In general, you are paid for what you do. A primary care doc sports specialist and a sports physiatrist with the same exact patient mix will get paid the same because they would bill the same CPT codes. There may be some subtilities in base pay and incentive/bonus plan with some groups, but in the end it mostly evens out. Ceiling wise, physiatrists have very high pay ceilings because of the ability to bill for higher value CPT codes than primary care sports docs, but this would likely entail having to be very heavily procedure based while leaving less room for true sports medicine care.
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How much more does one really make if they do SCS? I am also interventional PMR in an ortho group but find SCS is a relatively rare procedure and so the 3-4 I may do in a year doesn't even really bring in that much more $. Particularly because they take at least an hour and in that same time I could have done four epidurals.
I guess if one is really high volume with SCS trials and can knock them out in 30 minutes then you could potentially bring in an extra 50k. But I am relatively conservative so also don't understand how someone can be that high volume in the first place.
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Yeah - a lot of folks high volume/aggressive around me or have shares in ASC which all change incentives.
I'm with you - see maybe 5-6 per year that would be good candidates. Send them to a trusted anesthesia pain doc. She's appreciative of the SCS all ready to go.
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Better to post this in the pain forum. Lots of different answers there, but more often used modality by us.
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Depends on how many spine surgeons you have in the area and how conservative(refer if they think they are a bad revision or fusion candidate) or aggressive (refer after said poor fusion revision case fails) they are
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This is an age-old debate, but I think it's helpful to remind those newer to the conversation.
Depending on where you work, certain places will require certain criterion to practice in certain ways. From PM&R, for example, some academic institutions will not allow you to perform any spinal procedure unless you were trained in an ACGME Pain Medicine fellowship and hold a ABPMR Pain Medicine board certification. Some academic institutions will say you need formal fellowship training in spinal procedures (ACGME Pain Medicine fellowship, NASS ISMM fellowship, ACGME Sports Medicine fellowship with spine training, or unaccredited pain/sports&spine fellowship). Some institutions only take ABPMR board while others may be amenable to the ABIPP or ABPM boards. On the other hand, there are some places that only allow you to be in the sports "department" or "division" if you completed an ACGME Sports Medicine fellowship and will not count a sports/spine fellowship. Some places won't let you perform EMG without a Neuromuscular Medicine fellowship and board, or at least the EMG board through AANEM. In all of these cases there are exceptions, but something to realize and pay attention to. Many private practices will not care as long as you are safe, proficient, and efficient.
What pathway you choose to go down should focus some on what you want to do at the end. If there is a certain area of the country you are interested in, wouldn't be bad to look ahead and see what's in store in that area. Certain institutions, same thing.
Depending on where you work, certain places will require certain criterion to practice in certain ways. From PM&R, for example, some academic institutions will not allow you to perform any spinal procedure unless you were trained in an ACGME Pain Medicine fellowship and hold a ABPMR Pain Medicine board certification. Some academic institutions will say you need formal fellowship training in spinal procedures (ACGME Pain Medicine fellowship, NASS ISMM fellowship, ACGME Sports Medicine fellowship with spine training, or unaccredited pain/sports&spine fellowship). Some institutions only take ABPMR board while others may be amenable to the ABIPP or ABPM boards. On the other hand, there are some places that only allow you to be in the sports "department" or "division" if you completed an ACGME Sports Medicine fellowship and will not count a sports/spine fellowship. Some places won't let you perform EMG without a Neuromuscular Medicine fellowship and board, or at least the EMG board through AANEM. In all of these cases there are exceptions, but something to realize and pay attention to. Many private practices will not care as long as you are safe, proficient, and efficient.
What pathway you choose to go down should focus some on what you want to do at the end. If there is a certain area of the country you are interested in, wouldn't be bad to look ahead and see what's in store in that area. Certain institutions, same thing.
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