Why is PM&R becoming competitive?

[PMR2008]

I have my theories, but I matched in '08 so want feedback from others.

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[lejeunesage]

The first part of the answer is that everything has become more competitive.
Why? The number of med school graduate increased from about 16.5K in 2003 to 22K in 2020.
Medical school enrollments grow, but residency slots haven’t kept pace

But the number of residency slots have been frozen at a rate of increase set in 1996.

So all else equal, it's harder to match. When I was graduating from med school, all you needed to get into Psych was a pulse and a medical degree. Now it's not so easy.

Everything is harder to get into.
The ‘Yawning’ Chart Med School Students Fear

The chart above ends in 2010 but, unless I'm mistaken, Congress has still not increased residency funding.


The second factor is that younger physicians prize work-life balance much more than their predecessors did. So PM&R is attracting more interest now than it did 20 years ago. But that it something I don't have any data to back up, only anecdotes. I still think the first factor is the dominant one.

 

[DMBandFan86]

I agree, just supply and demand.

Schools increase med students on an exponential factor to make tons of money and eventually everything will be saturated.

It’s also an easier track to make money from pain management. So as PMR has grown interventional spine, more candidates seeking PMR residency to pursue that route.

 

[HemeOncHopeful19]

The first part of the answer is that everything has become more competitive.
Why? The number of med school graduate increased from about 16.5K in 2003 to 22K in 2020.
Medical school enrollments grow, but residency slots haven’t kept pace

But the number of residency slots have been frozen at a rate of increase set in 1996.

So all else equal, it's harder to match. When I was graduating from med school, all you needed to get into Psych was a pulse and a medical degree. Now it's not so easy.

View attachment 366938
Everything is harder to get into.
The ‘Yawning’ Chart Med School Students Fear

View attachment 366939
The chart above ends in 2010 but, unless I'm mistaken, Congress has still not increased residency funding.

This is a common misconception, or possibly I did not read your post correctly.

Just because Congress does not fund new spots doesn’t mean that new spots don’t open. There has definitely been an increase in residency positions since 2010 although I’m not sure how they have kept up with the massive proliferation of for-profit DO schools (nor should they).

 

[j4pac]

This is a common misconception, or possibly I did not read your post correctly.

Just because Congress does not fund new spots doesn’t mean that new spots don’t open. There has definitely been an increase in residency positions since 2010 although I’m not sure how they have kept up with the massive proliferation of for-profit DO schools (nor should they).

There has been residency expansion but I’m doubtful it is matching medical school attendance. These DOs/Caribbean schools that are opening are huge. Many of a them are bigger than established MD schools. Meanwhile, look at new PM&R residency programs. They are all typically really small.

I’m hoping to announce a new program next month assuming we get ACGME approval. It’ll be a great program, but even we are starting small (2 residents).

 

[lejeunesage]

This is a common misconception, or possibly I did not read your post correctly.

Just because Congress does not fund new spots doesn’t mean that new spots don’t open. There has definitely been an increase in residency positions since 2010 although I’m not sure how they have kept up with the massive proliferation of for-profit DO schools (nor should they).

But the number of residency slots have been frozen at a rate of increase set in 1996.

I never said we had the same number of residency spots. I even included a graph that showed an increasing number of residency positions.

Here it is again:

 

[runfastnow]

Anecdotally from the med students I've had rotate - most are either between FM/PMR or IM/PMR or unsure of specialty and have interest in better lifestyle, ultrasound, and advanced procedures while also not having interest in typical FM/IM things or surgery.

I think the word is out on PM&R and sports/spine world and the PM&R pathway is a much more enjoyable/useful way to have those skills than anesthesia/pain or FM/sports. I do wish ACGME (or whoever does these things) would allow a sports or sports/pain specialty apart from any of the core specialties. .

 

[Iamnew2]

One word: Money.
Even for inpatient and/or SNF, even without interventional pain, it's become a lucrative field. It's not fancy or glamorous but it does have a good lifestyle and you can make a substantial amount of $$.

 

[j4pac]

One word: Money.
Even for inpatient and/or SNF, even without interventional pain, it's become a lucrative field. It's not fancy or glamorous but it does have a good lifestyle and you can make a substantial amount of $$.

I think that’s part of it. But I think that this next generation is a little less driven by money than prior generations. Don’t get me wrong, money is always a big factor. But I think that money is a means to a lifestyle…having a secure and comfortable life, but with the ability to just ditch it for something down the road. If that’s your plan, specialties like Derm, PM&R, and ER are going to be competitive. They are shorter training programs that allow their residents to jump straight into practice and make money. I can’t even tell you the number of residents I know who could have done literally anything for fellowship but decided to go straight out into practice. Pain remains a great financial decision, but I think that word is out on general PM&R.

The idea of a doctor just leaving medicine at a young age was previously inconceivable. I think that’s changing. More are going to be giving up medicine at a young age. The reform on non-competes is coming at the right time, because while we were sheepishly grateful to be trapped into bad jobs, millennials are just not going to deal with it.

 

[DMBandFan86]

Where will we be after the baby boomers fade away? People utilize health care more than they used to, but I think there will be a decline in overall patient numbers.

I wouldn’t want PM&R to expand a ton, that in the future we become a dime-a-dozen like the orthopods. I don’t think it would fit well for a non-surgical specialty. Some growth is good, but I wouldn’t want to see an over abundance of physiatrists. I’d rather be a competitive specialty that attracts the best.

 

[j4pac]

Where will we be after the baby boomers fade away? People utilize health care more than they used to, but I think there will be a decline in overall patient numbers.

I wouldn’t want PM&R to expand a ton, that in the future we become a dime-a-dozen like the orthopods. I don’t think it would fit well for a non-surgical specialty. Some growth is good, but I wouldn’t want to see an over abundance of physiatrists. I’d rather be a competitive specialty that attracts the best.

The baby boomers probably have better family support than the future generations will have. There many be fewer old folks, but there may be a greater need for rehabilitation services. Social determinants are a pretty important, especially at the IRF/SNF level. I’d also imaging life expectancy to continue to increase.

 

[DMBandFan86]

Yeah I don’t know. You need good family support to succeed currently at IRF level. If the future is having worse family support then maybe more growth to SNF and less to IRF.

 

[j4pac]

Yeah I don’t know. You need good family support to succeed currently at IRF level. If the future is having worse family support then maybe more growth to SNF and less to IRF.

Fair point. I’m hoping that there will continue to be a push for more intervention procedures which could profit PM&R.

 

[aklohia]

The word is out PM&R is lifestyle friendly and makes solid money. This is also why psych has exploded in competitiveness. I do think that’s also why general PM&R is starting to get a bit more popular. At my program, the most recent graduating class 5 of 6 went into pain. The current 4s, 1 is doing interventional spine, 1 is doing palliative and the rest are general. My class, 1 is planning pain, 1 might do an unaccredited wound care fellowship and the rest are general. Pain is still great from a money standpoint but I can literally finish residency and go straight to inpatient or SNF work, make good money with a good lifestyle and I think that’s enough for a lot of people

 

[sloh]

Where will we be after the baby boomers fade away? People utilize health care more than they used to, but I think there will be a decline in overall patient numbers.

I wouldn’t want PM&R to expand a ton, that in the future we become a dime-a-dozen like the orthopods. I don’t think it would fit well for a non-surgical specialty. Some growth is good, but I wouldn’t want to see an over abundance of physiatrists. I’d rather be a competitive specialty that attracts the best.

Soft undersupply is the sweet spot

 

[MusicalMed]

There has been residency expansion but I’m doubtful it is matching medical school attendance. These DOs/Caribbean schools that are opening are huge. Many of a them are bigger than established MD schools. Meanwhile, look at new PM&R residency programs. They are all typically really small.

I’m hoping to announce a new program next month assuming we get ACGME approval. It’ll be a great program, but even we are starting small (2 residents).

All the best on getting a new program up and running! I know it's quite the process.

 

[drusso]

I have my theories, but I matched in '08 so want feedback from others.

This didn't help...

20 Questions: David Russo, DO, Pain Medicine and Physiatry - SDN

The Student Doctor Network provides free tools, resources, and advising services to help students become health professionals.

www.studentdoctor.net

 

[Hirro]

The second factor is that younger physicians prize work-life balance much more than their predecessors did. So PM&R is attracting more interest now than it did 20 years ago. But that it something I don't have any data to back up, only anecdotes. I still think the first factor is the dominant one.

Just chiming in from the medical student side of things. N=~6 for the class of 2022, 2023, and 2024 who want PM&R. Most of us were beyond grateful to learn about a non-surgical (read: lifestyle but even more-so culture) specialty with a mix of MSK, neurology, continuity of care, procedural opportunity. For me at least, I also wanted to be able to feel like I made a difference for my patients. Finding that sweet spot of each was a dream come true. Why that matters for the topic at hand, I think PM&R gaining more notoriety was a large part of what attracted us to it whereas if we had gone to medical school circa 2010, we may not have heard of the specialty altogether. I certainly didn't until halfway into M1 year.

For context, there was no interest group or PM&R faculty at our school when we were M1 students. Now as an M4, we have both.

 

[j4pac]

Just chiming in from the medical student side of things. N=~6 for the class of 2022, 2023, and 2024 who want PM&R. Most of us were beyond grateful to learn about a non-surgical (read: lifestyle but even more-so culture) specialty with a mix of MSK, neurology, continuity of care, procedural opportunity. For me at least, I also wanted to be able to feel like I made a difference for my patients. Finding that sweet spot of each was a dream come true. Why that matters for the topic at hand, I think PM&R gaining more notoriety was a large part of what attracted us to it whereas if we had gone to medical school circa 2010, we may not have heard of the specialty altogether. I certainly didn't until halfway into M1 year.

For context, there was no interest group or PM&R faculty at our school when we were M1 students. Now as an M4, we have both.

Lol interesting observations. First, choosing personality over lifestyle is very true for most of us. I think most of us can’t truly appreciate what the heck lifestyle even means. I came from a family of blue collared military men. The idea of a residents salary seemed pretty damn appealing when saw my parents grinding while working 70 hour work weeks making a fraction of a physicians salary. You want me to grind? Sure, I can do that. That’s what I thought people do for a living. I honestly couldn’t even wrap my mind around the concept of “lifestyle”. But when I was going through med school I could much more easily relate to “fit”. I didn’t feel comfortable in the surgery setting, and for the life of me, I couldn’t relate to my attending that were surgeons (great people, but I couldn’t envision myself being them).

Regarding interest groups, I can’t help to laugh because it’s very true. I remember when I use to advise med students to start a PM&R interest group to show interest in the specialty. Well…good luck finding a Med school without a PM&R interest group. Awareness if the specialty has really exploded over the past five years, and as a result so has the competition for spots. With elimination of Step 1 scoring, applicants have to be even more creative in finding ways to look different that the rest of the herd.

 

[Iamnew2]

Lol interesting observations. First, choosing personality over lifestyle is very true for most of us. I think most of us can’t truly appreciate what the heck lifestyle even means. I came from a family of blue collared military men. The idea of a residents salary seemed pretty damn appealing when saw my parents grinding while working 70 hour work weeks making a fraction of a physicians salary. You want me to grind? Sure, I can do that. That’s what I thought people do for a living. I honestly couldn’t even wrap my mind around the concept of “lifestyle”. But when I was going through med school I could much more easily relate to “fit”. I didn’t feel comfortable in the surgery setting, and for the life of me, I couldn’t relate to my attending that were surgeons (great people, but I couldn’t envision myself being them).

Regarding interest groups, I can’t help to laugh because it’s very true. I remember when I use to advise med students to start a PM&R interest group to show interest in the specialty. Well…good luck finding a Med school without a PM&R interest group. Awareness if the specialty has really exploded over the past five years, and as a result so has the competition for spots. With elimination of Step 1 scoring, applicants have to be even more creative in finding ways to look different that the rest of the herd.

Can I piggy back on this thread and ask what most of you bill your team conference notes as? Level 2 or 3?

 

[DMBandFan86]

Prob should make a different tread,

Team conference is not separately billable. You can add time to your days note. 39-49 minutes level 2 or 50-64 min level 3. Or prolonged service if above.

I bill most of mine on level of service already at level 2, so team conference is a complete waste of time. In total, I spend <2 hours per week on team conference. At most someone gets 10 minutes for team, but most are a few minutes. The new 50 min requirement per encounter is hard now because I don’t work 16 hours in a day. Maybe I fit in a couple level 3’s, but I would definitely be lying if I coded everyone level 3 on conference days.

 

[PainDoc2025]

According to NRMP data for the 2022-2023 cycle, there were a total of 531 PM&R spots (PGY1 + PGY2) of which 529 were filled before the SOAP (99.6%). And per ERAS data from this cycle, there were a total of 1,092 students applying for 531 spots (48.6%)

Yep, getting quite competitive indeed.

 

[Iamnew2]

According to NRMP data for the 2022-2023 cycle, there were a total of 531 PM&R spots (PGY1 + PGY2) of which 529 were filled before the SOAP (99.6%). And per ERAS data from this cycle, there were a total of 1,092 students applying for 531 spots (48.6%)

Yep, getting quite competitive indeed.

That’s pretty bad

 

[PMR2008]

Why well-qualified medical school graduates can’t get jobs — despite doctor shortages

The US is fighting a modern pandemic with a 1990s-sized workforce.

www.vox.com

 

[Butterfly23]

According to NRMP data for the 2022-2023 cycle, there were a total of 531 PM&R spots (PGY1 + PGY2) of which 529 were filled before the SOAP (99.6%). And per ERAS data from this cycle, there were a total of 1,092 students applying for 531 spots (48.6%)

Yep, getting quite competitive indeed.

Where did u get 1092 applicant # come from?
According to advanced table from NRMP 745 for pgy1 position and 788 for pgy2 positions . Approximately 788 applicants for 531 spots(68 percent) Trust me! I want to be wrong with glory. Tbh, we are no where near competitive field. Also family med 6927 applicants for 5088 spots(73 percent). 68 percent vs 73 percent hmmm
Everything is competitive like our medical education is undergoing similar to silicon valley is going through.(where many fake software engineers who took coding class to be “software engineer” getting fired).
Too many med schools and not enough funding to create residencies! Once again i want to be wrong

 

[Dantes]

Where did u get 1092 applicant # come from?
According to advanced table from NRMP 745 for pgy1 position and 788 for pgy2 positions . Approximately 788 applicants for 531 spots(68 percent) Trust me! I want to be wrong with glory. Tbh, we are no where near competitive field. Also family med 6927 applicants for 5088 spots(73 percent). 68 percent vs 73 percent hmmm
Everything is competitive like our medical education is undergoing similar to silicon valley is going through.(where many fake software engineers who took coding class to be “software engineer” getting fired).
Too many med schools and not enough funding to create residencies! Once again i want to be wrong

We also won't have data on dual applicants, or at least who matched into their first choice specialty until later in the cycle. And yes, unfortunately med school spots are outpacing residency seat expansion. Even specialties like neuro basically completely filled with only a couple spots in SOAP this year.

 

[BSM_OTO]

Where did u get 1092 applicant # come from?
According to advanced table from NRMP 745 for pgy1 position and 788 for pgy2 positions . Approximately 788 applicants for 531 spots(68 percent) Trust me! I want to be wrong with glory. Tbh, we are no where near competitive field. Also family med 6927 applicants for 5088 spots(73 percent). 68 percent vs 73 percent hmmm
Everything is competitive like our medical education is undergoing similar to silicon valley is going through.(where many fake software engineers who took coding class to be “software engineer” getting fired).
Too many med schools and not enough funding to create residencies! Once again i want to be wrong

"nowhere near a competitive field" is just wrong.

I know plenty of medical students from US MD and US DO schools that went unmatched with 240+ board scores and PM&R program director letter of recommendations.

I know a DO school that usually has a ton of PM&R matches that had 8 students not get PM&R in the 2023 match, most of which had above average board scores and great apps.

That 1000+ applicants figure is off the NMRP website.

 

[voxveritatisetlucis]

Everything besides primary care is becoming competitive due to rapid school expansion

 

[Butterfly23]

"nowhere near a competitive field" is just wrong.

I know plenty of medical students from US MD and US DO schools that went unmatched with 240+ board scores and PM&R program director letter of recommendations.

I know a DO school that usually has a ton of PM&R matches that had 8 students not get PM&R in the 2023 match, most of which had above average board scores and great apps.

That 1000+ applicants figure is off the NMRP website.

Once again i want to be wrong
But a lot of your claims are just anecdotes “he says she says” I hope that applicant numbers more than 1000 came from reliable sources. I will trust that number when all pmr residency coordinators in the country gathered together and analyzed the number together . What are the chances that you will get that peculiar reaction “oh WOW you matched into pmr!!!! From medical students and deans and attendings and preceptors etc
This should be on different thread. The publics do not know what we do. Until we get public recognition, no matter how competitive we are becoming, our daily lives of having to explain/justify our existence will go on many years. I remember my residency days when i got denied from housing office after i applied for housing near the hospital to save money and housing officer laughed at me saying what is physical medicine and rehab!!!

On the contrary, i heard some physiatrists making great strides of climbing the ladder and advocating our fields for example UPMC higher up is pmr guy. That is good for us!!!

In east asian country, pmr is considered as valedictorian specialty

However, our daily lives of dealing with lack of recognition will continue

Therefore we are not competitive field

 

[sloh]

Until we get public recognition, no matter how competitive we are becoming, our daily lives of having to explain/justify our existence will go on many years.

This is so true. And it has consequences where it matters most—job market and security.

 

[lobelsteve]

This is so true. And it has consequences where it matters most—job market and security.

Since 2000 : Aapmr. What’s a physiatrist?

 

[wendalltwolf]

Since 2000 : Aapmr. What’s a physiatrist?

And still no consensus on its pronunciation…

 

[j4pac]

Since 2000 : Aapmr. What’s a physiatrist?

At the AAP PD meeting this year there was a lecture on defining a “PM&R doctor of the future”. They plan on getting it done within the year

 

[Iamnew2]

Since 2000 : Aapmr. What’s a physiatrist?

The specialty title though "Physical Medicine & Rehabilitation" I have always thought is somewhat ridiculous - Saying Physiatrist or Rehab Medicine would make much more sense. The whole "Physical Medicine" portion doesn't really make much sense to me or I think to the average patient and probably many physicians.
But then again there are other specialties that suffer from similar issues - people frequently confused Neurosurgeons with Neurologists. When I was in Radiology residency, I remember that patients would frequently confused Radiologists with techs who took the images - in part because they never saw the Radiologists.

 

[lobelsteve]

The specialty title though "Physical Medicine & Rehabilitation" I have always thought is somewhat ridiculous - Saying Physiatrist or Rehab Medicine would make much more sense. The whole "Physical Medicine" portion doesn't really make much sense to me or I think to the average patient and probably many physicians.
But then again there are other specialties that suffer from similar issues - people frequently confused Neurosurgeons with Neurologists. When I was in Radiology residency, I remember that patients would frequently confused Radiologists with techs who took the images - in part because they never saw the Radiologists.

What does a Radiologist do?
What does a Neurologist do?
What does a Neurosurgeon do?

No confusion on specialties for the public with nuance of surgical vs nonsurgical care for N/NS.

What's a physiatrist?
What's a physiatrist do?

No name recognition.
No easy explanation of what we do either.

 

[DMBandFan86]

Why would you not want it to be a competitive specialty?

What’s the solution? Increase residency training spots is typically what I hear. which would need to double to satisfy those numbers. Then med schools can just keep increasing enrollment and have residency spots increase as well. $$ Which, of course, would eventually mean increased job competition and decreased salaries. Resident trained docs not getting jobs. Especially after the baby boomers pass.

Resident graduates want to mostly live in the popular areas as well. Where I trained, there were no mainstream PMR jobs (saturated) and people were ending up going into SNF contracts just to stay in the location or to stay in a larger city. Nothing against SNF work, but was the only jobs open for popular locations, and most ended up not liking it. I went and worked in an underserved, undesirable place for years out of residency. Base salary was okay, but the show rate for clinics was less than 50%, and medical complexity that big cities get was lacking. Which is a problem with low population areas for PMR and I had to take over terribly managed opiate care just to get referrals.

My point is, I just don’t know why we would need so many physiatrists to meet demand. I selfishly like having a job market that has possibilities to switch locations fairly well with reasonable pay. Obviously that would close if we substantially increased training slots. Or Potentially getting stuck in a job with shrinking salary and no where better to go. Pain and sports are already fairly saturated as it is. Sure we could use more fellowship brain injury specialists and pediatric care. But people don’t want to do it. Do we really need cancer trained fellowships, I mean I do the same thing without the fellowship. But it’s hard to expect PMR to grow so much more when we don’t really have consensus of what we really do.

and that’s my rant

 

[Butterfly23]

Why would you not want it to be a competitive specialty?

What’s the solution? Increase residency training spots is typically what I hear. which would need to double to satisfy those numbers. Then med schools can just keep increasing enrollment and have residency spots increase as well. $$ Which, of course, would eventually mean increased job competition and decreased salaries. Resident trained docs not getting jobs. Especially after the baby boomers pass.

Resident graduates want to mostly live in the popular areas as well. Where I trained, there were no mainstream PMR jobs (saturated) and people were ending up going into SNF contracts just to stay in the location or to stay in a larger city. Nothing against SNF work, but was the only jobs open for popular locations, and most ended up not liking it. I went and worked in an underserved, undesirable place for years out of residency. Base salary was okay, but the show rate for clinics was less than 50%, and medical complexity that big cities get was lacking. Which is a

 

[sloh]

Why would you not want it to be a competitive specialty?

What’s the solution? Increase residency training spots is typically what I hear. which would need to double to satisfy those numbers. Then med schools can just keep increasing enrollment and have residency spots increase as well. $$ Which, of course, would eventually mean increased job competition and decreased salaries. Resident trained docs not getting jobs. Especially after the baby boomers pass.

Resident graduates want to mostly live in the popular areas as well. Where I trained, there were no mainstream PMR jobs (saturated) and people were ending up going into SNF contracts just to stay in the location or to stay in a larger city. Nothing against SNF work, but was the only jobs open for popular locations, and most ended up not liking it. I went and worked in an underserved, undesirable place for years out of residency. Base salary was okay, but the show rate for clinics was less than 50%, and medical complexity that big cities get was lacking. Which is a problem with low population areas for PMR and I had to take over terribly managed opiate care just to get referrals.

My point is, I just don’t know why we would need so many physiatrists to meet demand. I selfishly like having a job market that has possibilities to switch locations fairly well with reasonable pay. Obviously that would close if we substantially increased training slots. Or Potentially getting stuck in a job with shrinking salary and no where better to go. Pain and sports are already fairly saturated as it is. Sure we could use more fellowship brain injury specialists and pediatric care. But people don’t want to do it. Do we really need cancer trained fellowships, I mean I do the same thing without the fellowship. But it’s hard to expect PMR to grow so much more when we don’t really have consensus of what we really do.

and that’s my rant

Yes. No more residency spots please. The last thing we need is to follow in the footsteps of EM and RadOnc—decimated job market

 

[Iamnew2]

Why would you not want it to be a competitive specialty?

What’s the solution? Increase residency training spots is typically what I hear. which would need to double to satisfy those numbers. Then med schools can just keep increasing enrollment and have residency spots increase as well. $$ Which, of course, would eventually mean increased job competition and decreased salaries. Resident trained docs not getting jobs. Especially after the baby boomers pass.

Resident graduates want to mostly live in the popular areas as well. Where I trained, there were no mainstream PMR jobs (saturated) and people were ending up going into SNF contracts just to stay in the location or to stay in a larger city. Nothing against SNF work, but was the only jobs open for popular locations, and most ended up not liking it. I went and worked in an underserved, undesirable place for years out of residency. Base salary was okay, but the show rate for clinics was less than 50%, and medical complexity that big cities get was lacking. Which is a problem with low population areas for PMR and I had to take over terribly managed opiate care just to get referrals.

My point is, I just don’t know why we would need so many physiatrists to meet demand. I selfishly like having a job market that has possibilities to switch locations fairly well with reasonable pay. Obviously that would close if we substantially increased training slots. Or Potentially getting stuck in a job with shrinking salary and no where better to go. Pain and sports are already fairly saturated as it is. Sure we could use more fellowship brain injury specialists and pediatric care. But people don’t want to do it. Do we really need cancer trained fellowships, I mean I do the same thing without the fellowship. But it’s hard to expect PMR to grow so much more when we don’t really have consensus of what we really do.

and that’s my rant

I don't think that there is much of a need for brain injury trained doctors. Jobs are limited and you can do the job without a fellowship. Peds - outside of academic areas, there really just isn't a need for pediatric PM&R doctors.

 

[j4pac]

I don't think that there is much of a need for brain injury trained doctors. Jobs are limited and you can do the job without a fellowship. Peds - outside of academic areas, there really just isn't a need for pediatric PM&R doctors.

Those fellowships give you a nice advantage at an academic institution. But the majority of fellowships are unnecessary in non-academic environments.

 

[lejeunesage]

Why would you not want it to be a competitive specialty?

What’s the solution? Increase residency training spots is typically what I hear. which would need to double to satisfy those numbers. Then med schools can just keep increasing enrollment and have residency spots increase as well. $$ Which, of course, would eventually mean increased job competition and decreased salaries. Resident trained docs not getting jobs. Especially after the baby boomers pass.

Resident graduates want to mostly live in the popular areas as well. Where I trained, there were no mainstream PMR jobs (saturated) and people were ending up going into SNF contracts just to stay in the location or to stay in a larger city. Nothing against SNF work, but was the only jobs open for popular locations, and most ended up not liking it. I went and worked in an underserved, undesirable place for years out of residency. Base salary was okay, but the show rate for clinics was less than 50%, and medical complexity that big cities get was lacking. Which is a problem with low population areas for PMR and I had to take over terribly managed opiate care just to get referrals.

My point is, I just don’t know why we would need so many physiatrists to meet demand. I selfishly like having a job market that has possibilities to switch locations fairly well with reasonable pay. Obviously that would close if we substantially increased training slots. Or Potentially getting stuck in a job with shrinking salary and no where better to go. Pain and sports are already fairly saturated as it is. Sure we could use more fellowship brain injury specialists and pediatric care. But people don’t want to do it. Do we really need cancer trained fellowships, I mean I do the same thing without the fellowship. But it’s hard to expect PMR to grow so much more when we don’t really have consensus of what we really do.

and that’s my rant

Something else to think about here is that eventually, if there are too residency few spots/new physiatrists minted, hospital systems start hiring IM and/or NPs. So you don't want the market to be too undersaturated. There are a lot of inpatient PM&R docs who attend meetings, adjust bowel/bladder meds, and let IM do pretty much everything else. It would not take much for hospitals to decide that we are redundant.

 

[Iamnew2]

Something else to think about here is that eventually, if there are too residency few spots/new physiatrists minted, hospital systems start hiring IM and/or NPs. So you don't want the market to be too undersaturated. There are a lot of inpatient PM&R docs who attend meetings, adjust bowel/bladder meds, and let IM do pretty much everything else. It would not take much for hospitals to decide that we are redundant.

Rehab hospitals still need rehab doctor not just IM don’t think you can have just IM

 

[DMBandFan86]

Yes there is a loose description that defines a rehab doctor. Some positions currently are looking for neurologists or internists with enough rehab exposure.

However, I think it’s a very small number of hospitalists that would want to add on all the admin work we do. Especially given the other opportunities they have. And most end up specializing or doing primary care.

The larger threat is the NPs. I agree. I think eventually Medicare will change the rules to allow NPs to take over. And we are setting them up in droves with all the training and experience they need. But I don’t think having more residents has any effect on it.

 

[lejeunesage]

Rehab hospitals still need rehab doctor not just IM don’t think you can have just IM

For now!!!

 

[PMR2008]

Rehab hospitals still need rehab doctor not just IM don’t think you can have just IM

You can just have IM.

 

[PMR2008]

For now!!!

Not true.

 

[sloh]

Not true.

From your vantage point, do you think IM supplanting PM&R is a viable threat?

 

[PMR2008]

Yes. But some groups like encompass/PAM etc would prefer to use Physiatrist so they don't rock the boat with current Physiatrist. Regional or small free standing hospitals could care less. Show me the data that a Physiatrist medical director has better outcomes versus a IM? there is none and if there is the hospitals might not care. As long as insurance pays they need a good team leader regardless of specialty. NPs will likely never take over as Medical director but I can see them keep trying.

 

[lejeunesage]

Yes. But some groups like encompass/PAM etc would prefer to use Physiatrist so they don't rock the boat with current Physiatrist. Regional or small free standing hospitals could care less. Show me the data that a Physiatrist medical director has better outcomes versus a IM? there is none and if there is the hospitals might not care. As long as insurance pays they need a good team leader regardless of specialty. NPs will likely never take over as Medical director but I can see them keep trying.

I know for a fact that HCA has had some non-physiatrist medical directors.

 

[Taus]

What does a Radiologist do?
What does a Neurologist do?
What does a Neurosurgeon do?

No confusion on specialties for the public with nuance of surgical vs nonsurgical care for N/NS.

What's a physiatrist?
What's a physiatrist do?

No name recognition.
No easy explanation of what we do either.

This is correct. I have been a physiatrist for about a decade. No one, most physicians and other healthcare workers included, truly know what we do without a detailed explanation, unless you present yourself by your subspecialty. If this seriously bothers you, I would suggest choosing another field.