How much money can you make in this specialty?

[Proudfather94]

Hey guys I'm interested in this specialty and was wondering how much one typically makes in private practice vs inpatient.

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[Iamnew2]

Hey guys I'm interested in this specialty and was wondering how much one typically makes in private practice vs inpatient.

One million dollars! Jk. Everything depends! You can do well inpatient or you can do well outpatient. All depends on how you structure things, where you are at, how much you work etc

 

[sloh]

Yes, 1 million. Huge variance within this specialty.

 

[Iamnew2]

Yes, 1 million. Huge variance within this specialty.

 

[cluelessme7]

Very variable depending on payment structure, how much you're working, procedural volume, etc. Check out the AAPMR compensation survey for some thorough analysis. Medscape also has compensation surveys although the number of participants is quite low on those.
The AAPMR one has the most amount of data.

Compensation Survey

Medscape: Medscape: Medscape Access

300k seems to be the median overall, not stratified by focus.

 

[j4pac]

How much do you want to work?

 

[Proudfather94]

Thanks for replying guys! I think my end goal would be to try to do the pediatric specialty and eventually do outpatient work. Since I have a kid I definitely want a good lifestyle if I can help it.

 

[PMR2008]

I have seen 120k and 5 million/year. Too many variables. Average is about 350-400k. I know plenty who make more than ortho surgeons. But you need multiple income streams and business acumen. No way you make that kind of money by just seeing patients.

 

[j4pac]

Thanks for replying guys! I think my end goal would be to try to do the pediatric specialty and eventually do outpatient work. Since I have a kid I definitely want a good lifestyle if I can help it.

Peds Rehab is on the low end of PM&R compensation. But it’s a great gig. Still
a good chance to make $250+

 

[Proudfather94]

Peds Rehab is on the low end of PM&R compensation. But it’s a great gig. Still
a good chance to make $250+

Thanks I overcame a disability growing up so that's what makes me so interested in that fellowship.

 

[j4pac]

Thanks I overcame a disability growing up so that's what makes me so interested in that fellowship.

The biggest factor when looking at Peds PM&R is that it is a two year fellowship. So considering that most PM&R physicians make over $200k out of residency, you’re likely looking at at least $140k from opportunity loss. And then expect to make $20-60k per year less than your PM&R colleagues. It’s not a good deal financially, but it’s a great and incredibly rewarding job.

 

[Proudfather94]

The biggest factor when looking at Peds PM&R is that it is a two year fellowship. So considering that most PM&R physicians make over $200k out of residency, you’re likely looking at at least $140k from opportunity loss. And then expect to make $20-60k per year less than your PM&R colleagues. It’s not a good deal financially, but it’s a great and incredibly rewarding job.

Thank you so much! that's definitely something I need to think about. I'll probably wait until I'm through medical school before I decide if I want to do that fellowship. Is there anyone on here that did the peds fellowship for PM&R?

 

[Iamnew2]

I have seen 120k and 5 million/year. Too many variables. Average is about 350-400k. I know plenty who make more than ortho surgeons. But you need multiple income streams and business acumen. No way you make that kind of money by just seeing patients.

I have never seen 5 million but anything is possible. Multiple income streams and business acumen is essential I would agree. I don't think anyone makes that kind of money though just working for someone else or having a regular type of job. Anything >500k I think certainly requires more than one gig - likely multiple gigs or one gig with multiple revenue sources.

 

[Iamnew2]

Thank you so much! that's definitely something I need to think about. I'll probably wait until I'm through medical school before I decide if I want to do that fellowship. Is there anyone on here that did the peds fellowship for PM&R?

I have a few classmates taht did Peds, it's 2 years and I think all of them are doing academic gigs in big hospitals, which pretty much is where you will need to be. I think it's hard to have a stand alone practice in peds so if you are ok with always being tied down to a medical center then you are good. But it's 6 years - long road.

 

[timisdaman]

The biggest factor when looking at Peds PM&R is that it is a two year fellowship. So considering that most PM&R physicians make over $200k out of residency, you’re likely looking at at least $140k from opportunity loss. And then expect to make $20-60k per year less than your PM&R colleagues. It’s not a good deal financially, but it’s a great and incredibly rewarding job.

This guy hit the nail right on the head.

But, I suppose there is wiggle room for negotiation if you know that demand outweighs supply.

 

[lejeunesage]

Thanks for replying guys! I think my end goal would be to try to do the pediatric specialty and eventually do outpatient work. Since I have a kid I definitely want a good lifestyle if I can help it.

Looks like you want antagonistic things: You want to make money on one hand and do peds on the other.

A pediatric fellowship is a 2-year investment in which you're deferring attending income. All else equal, that means that the money you'll earn in the decade post residency graduation will be lower by $250-300K. The less money you earn, the less you can invest. The trick in becoming wealthy is to grow your investments to such an extent that eventually start generating north of $100K per year. This isn't as far fetched as it might sound at first glance. It's reasonable to expect market returns of 7-8% per annum over the course of your career. Returns have been MUCH higher lately, but it's likely an aberration.

The sooner you get to the point where you have 1.5 mil in invested assets, the sooner you'll get to the point where your investments are returning > $100K each year and the sooner you'll get to financial independence. At that point, you can choose to cut back on work and spend more time with your family. If wealth is important to you, you're only going to want to delay earning your attending-level income if you're absolutely sure that the fellowship you're pursuing is going to be financially worth it. The only fellowships that are financially worth it are those that teach you interventional spine procedures. This isn't to say that money should be your sole consideration when choosing what you'll do. I'm only bringing this up because you started the thread by talking about money.

The second issue with pediatric fellowships is that most jobs are in academia, also known as the graveyard of financial aspirations. All else equal, academic compensation is far below what the private sector will pay. You have to decide for yourself whether prestige and academic accolades are worth more to you than building wealth. For some people, it's not even close. They don't care that much about one or the other, and the choice is easy. For other people, it's a harder choice. Only you will know which of these fits you better.

The third issue with pediatrics is that you might end up with a practice where most of your patients have Medicaid, depending on where you live. I think it's a fantastic thing that we have health insurance for children and the indigent, but the level of compensation from Medicaid is atrocious. It's better than not being paid, mind you, but it can translate into doing much more work for the same or less amount of money than if most of your patients have Medicare.

Personally, I'll say that if you care about making money, you should stay away from Peds.

How do you make money, then?

My own experience is in the inpatient rehab world. There are some people on this forum who know the SNF world like the back of their hand and can tell you all about it.

Shout-outs to https://forums.studentdoctor.net/members/sloh.196795/ and https://forums.studentdoctor.net/members/pmr2008.163536/

In inpatient rehab, you make money by:

1. Seeing more patients. I generally recommend seeing at least 15 patients per day. But if you can see 20/ day without negatively impacting the care you're giving, you'll do even better.
2. Living in a place with a favorable insurance mix.
a. More Commercial insurance generally means more money.
b. More Medicaid means less money.
c. More patients with secondary insurance means more money.
Generally speaking, the wealthier the area and the lower the poverty rate, the better you'll do.
3. Being an independent contractor. Employers will generally want to eat part of your lunch. Your best bet is to keep all your collections minus whatever you might pay to a billing company.
4. Avoiding set-ups where a company takes 30% of your collections in order to provide things you can get for yourself. I will never understand why so many people sign up to work for companies like US Physiatry. Malpractice isn't that bad for inpatient PM&R. You can get your own health insurance policy from healthcare.gov. And you can contract with a billing company to handle your collections. What else do you need from a company?
5. Climbing your way to Medical Director ASAP. With an inpatient medical directorship, you can generally expect to earn anywhere from $6 to $12K per month on top of your collections.

You put all those things together, and most medical directors have no problem landing solidly north of $400K/year.
Some people made additional money by:
1. Hiring a scribe and seeing more patients per day.
2. Hiring one or more NPs/PAs and seeing more patients or having them round on your off weekends.
3. Adding SNF rounding.
4. Adding acute care consults.
5. Adding a Botox clinic for headaches (you can see a lot more patients than you can for spasticity).
6. Doing medical-legal work, for instance Advanced Life Care Planning.

Lots of ideas. Basically, you can work hard, you can work smart, or you can work hard and smart.
Of course, you might get to $400K and decide that you're making all the money you want to make and not feel like you want to take on more work. Nothing wrong with that.
Good luck! PM me for more dets and tips.

 

[Iamnew2]

Looks like you want antagonistic things: You want to make money on one hand and do peds on the other.

A pediatric fellowship is a 2-year investment in which you're deferring attending income. All else equal, that means that the money you'll earn in the decade post residency graduation will be lower by $250-300K. The less money you earn, the less you can invest. The trick in becoming wealthy is to grow your investments to such an extent that eventually start generating north of $100K per year. This isn't as far fetched as it might sound at first glance. It's reasonable to expect market returns of 7-8% per annum over the course of your career. Returns have been MUCH higher lately, but it's likely an aberration.

The sooner you get to the point where you have 1.5 mil in invested assets, the sooner you'll get to the point where your investments are returning > $100K each year and the sooner you'll get to financial independence. At that point, you can choose to cut back on work and spend more time with your family. If wealth is important to you, you're only going to want to delay earning your attending-level income if you're absolutely sure that the fellowship you're pursuing is going to be financially worth it. The only fellowships that are financially worth it are those that teach you interventional spine procedures. This isn't to say that money should be your sole consideration when choosing what you'll do. I'm only bringing this up because you started the thread by talking about money.

The second issue with pediatric fellowships is that most jobs are in academia, also known as the graveyard of financial aspirations. All else equal, academic compensation is far below what the private sector will pay. You have to decide for yourself whether prestige and academic accolades are worth more to you than building wealth. For some people, it's not even close. They don't care that much about one or the other, and the choice is easy. For other people, it's a harder choice. Only you will know which of these fits you better.

The third issue with pediatrics is that you might end up with a practice where most of your patients have Medicaid, depending on where you live. I think it's a fantastic thing that we have health insurance for children and the indigent, but the level of compensation from Medicaid is atrocious. It's better than not being paid, mind you, but it can translate into doing much more work for the same or less amount of money than if most of your patients have Medicare.

Personally, I'll say that if you care about making money, you should stay away from Peds.

How do you make money, then?

My own experience is in the inpatient rehab world. There are some people on this forum who know the SNF world like the back of their hand and can tell you all about it.

Shout-outs to https://forums.studentdoctor.net/members/sloh.196795/ and https://forums.studentdoctor.net/members/pmr2008.163536/

In inpatient rehab, you make money by:

1. Seeing more patients. I generally recommend seeing at least 15 patients per day. But if you can see 20/ day without negatively impacting the care you're giving, you'll do even better.
2. Living in a place with a favorable insurance mix.
a. More Commercial insurance generally means more money.
b. More Medicaid means less money.
c. More patients with secondary insurance means more money.
Generally speaking, the wealthier the area and the lower the poverty rate, the better you'll do.
3. Being an independent contractor. Employers will generally want to eat part of your lunch. Your best bet is to keep all your collections minus whatever you might pay to a billing company.
4. Avoiding set-ups where a company takes 30% of your collections in order to provide things you can get for yourself. I will never understand why so many people sign up to work for companies like US Physiatry. Malpractice isn't that bad for inpatient PM&R. You can get your own health insurance policy from healthcare.gov. And you can contract with a billing company to handle your collections. What else do you need from a company?
5. Climbing your way to Medical Director ASAP. With an inpatient medical directorship, you can generally expect to earn anywhere from $9 to $12K per month on top of your collections.

You put all those things together, and most medical directors have no problem landing solidly north of $400K/year.
Some people made additional money by:
1. Hiring a scribe and seeing more patients per day.
2. Hiring one or more NPs/PAs and seeing more patients or having them round on your off weekends.
3. Adding SNF rounding.
4. Adding acute care consults.
5. Adding a Botox clinic for headaches (you can see a lot more patients than you can for spasticity).
6. Doing medical-legal work, for instance Advanced Life Care Planning.

Lots of ideas. Basically, you can work hard, you can work smart, or you can work hard and smart.
Of course, you might get to $400K and decide that you're making all the money you want to make and not feel like you want to take on more work. Nothing wrong with that.
Good luck! PM me for more dets and tips.

I think you did an excellent job by covering all the plusses and minusses of the different portions of rehab.

I will agree that Peds rehab is not only a big investment (6 years!) but also financially not for the faint of heart. However for the few brave who do go into Peds rehab they do seem to have a high level of satisfaction. I know one of my classmates who did Peds rehab went specifically into rehab because she wanted to only see kids - and I think there is great satisfaction for many of these docs which is important. I would say that Peds probably has a greater level of satisfaction than adult rehab and prob less paperwork. I do think the Medicaid component in Pediatric peds is problematic - and tends to grossly underpaid salaries. I agree with you that it's important to have healthcare for kids who cannot otherwise access medical care but it's definitely not something everyone can do.

Being tied to a medical center that's academic in nature for the rest of your career is also challenging. For me I have found that freedom to move around is important. But some people find a job they love and stay there forever. Different likes and dislikes for different people.

It really is all a matter of personal choice and contentment, but it's important to decide what's important. If doing Peds makes you happy and you can live well and are happy with a lower salary I say do it. If financial aspects are more important Peds is the wrong way to go.

Good luck OP!

 

[Proudfather94]

Looks like you want antagonistic things: You want to make money on one hand and do peds on the other.

A pediatric fellowship is a 2-year investment in which you're deferring attending income. All else equal, that means that the money you'll earn in the decade post residency graduation will be lower by $250-300K. The less money you earn, the less you can invest. The trick in becoming wealthy is to grow your investments to such an extent that eventually start generating north of $100K per year. This isn't as far fetched as it might sound at first glance. It's reasonable to expect market returns of 7-8% per annum over the course of your career. Returns have been MUCH higher lately, but it's likely an aberration.

The sooner you get to the point where you have 1.5 mil in invested assets, the sooner you'll get to the point where your investments are returning > $100K each year and the sooner you'll get to financial independence. At that point, you can choose to cut back on work and spend more time with your family. If wealth is important to you, you're only going to want to delay earning your attending-level income if you're absolutely sure that the fellowship you're pursuing is going to be financially worth it. The only fellowships that are financially worth it are those that teach you interventional spine procedures. This isn't to say that money should be your sole consideration when choosing what you'll do. I'm only bringing this up because you started the thread by talking about money.

The second issue with pediatric fellowships is that most jobs are in academia, also known as the graveyard of financial aspirations. All else equal, academic compensation is far below what the private sector will pay. You have to decide for yourself whether prestige and academic accolades are worth more to you than building wealth. For some people, it's not even close. They don't care that much about one or the other, and the choice is easy. For other people, it's a harder choice. Only you will know which of these fits you better.

The third issue with pediatrics is that you might end up with a practice where most of your patients have Medicaid, depending on where you live. I think it's a fantastic thing that we have health insurance for children and the indigent, but the level of compensation from Medicaid is atrocious. It's better than not being paid, mind you, but it can translate into doing much more work for the same or less amount of money than if most of your patients have Medicare.

Personally, I'll say that if you care about making money, you should stay away from Peds.

How do you make money, then?

My own experience is in the inpatient rehab world. There are some people on this forum who know the SNF world like the back of their hand and can tell you all about it.

Shout-outs to https://forums.studentdoctor.net/members/sloh.196795/ and https://forums.studentdoctor.net/members/pmr2008.163536/

In inpatient rehab, you make money by:

1. Seeing more patients. I generally recommend seeing at least 15 patients per day. But if you can see 20/ day without negatively impacting the care you're giving, you'll do even better.
2. Living in a place with a favorable insurance mix.
a. More Commercial insurance generally means more money.
b. More Medicaid means less money.
c. More patients with secondary insurance means more money.
Generally speaking, the wealthier the area and the lower the poverty rate, the better you'll do.
3. Being an independent contractor. Employers will generally want to eat part of your lunch. Your best bet is to keep all your collections minus whatever you might pay to a billing company.
4. Avoiding set-ups where a company takes 30% of your collections in order to provide things you can get for yourself. I will never understand why so many people sign up to work for companies like US Physiatry. Malpractice isn't that bad for inpatient PM&R. You can get your own health insurance policy from healthcare.gov. And you can contract with a billing company to handle your collections. What else do you need from a company?
5. Climbing your way to Medical Director ASAP. With an inpatient medical directorship, you can generally expect to earn anywhere from $9 to $12K per month on top of your collections.

You put all those things together, and most medical directors have no problem landing solidly north of $400K/year.
Some people made additional money by:
1. Hiring a scribe and seeing more patients per day.
2. Hiring one or more NPs/PAs and seeing more patients or having them round on your off weekends.
3. Adding SNF rounding.
4. Adding acute care consults.
5. Adding a Botox clinic for headaches (you can see a lot more patients than you can for spasticity).
6. Doing medical-legal work, for instance Advanced Life Care Planning.

Lots of ideas. Basically, you can work hard, you can work smart, or you can work hard and smart.
Of course, you might get to $400K and decide that you're making all the money you want to make and not feel like you want to take on more work. Nothing wrong with that.
Good luck! PM me for more dets and tips.

Thank you I'm going to PM you

 

[Proudfather94]

I think you did an excellent job by covering all the plusses and minusses of the different portions of rehab.

I will agree that Peds rehab is not only a big investment (6 years!) but also financially not for the faint of heart. However for the few brave who do go into Peds rehab they do seem to have a high level of satisfaction. I know one of my classmates who did Peds rehab went specifically into rehab because she wanted to only see kids - and I think there is great satisfaction for many of these docs which is important. I would say that Peds probably has a greater level of satisfaction than adult rehab and prob less paperwork. I do think the Medicaid component in Pediatric peds is problematic - and tends to grossly underpaid salaries. I agree with you that it's important to have healthcare for kids who cannot otherwise access medical care but it's definitely not something everyone can do.

Being tied to a medical center that's academic in nature for the rest of your career is also challenging. For me I have found that freedom to move around is important. But some people find a job they love and stay there forever. Different likes and dislikes for different people.

It really is all a matter of personal choice and contentment, but it's important to decide what's important. If doing Peds makes you happy and you can live well and are happy with a lower salary I say do it. If financial aspects are more important Peds is the wrong way to go.

Good luck OP!

One thing I need to consider is I'll be in my mid 30s by the time I'm out of medical school, do my intern year, and 3 years of PM&R residency which means that I'll be working less years overall than someone who started medical school at the age of 24. I think income potential will need to be important at that point.

 

[j4pac]

One thing I need to consider is I'll be in my mid 30s by the time I'm out of medical school, do my intern year, and 3 years of PM&R residency which means that I'll be working less years overall than someone who started medical school at the age of 24. I think income potential will need to be important at that point.

I’d highly recommend doing something that you are passionate about. Life’s too short, and this job is too hard. You don’t find find PM&R physicians on the street corner asking for change. You’ll be fine regardless. Just make good financial decisions in the context of your preferred specialty.

What you don’t want to happen is to go in the wrong field, and hate it…or burn out. That is means to financial disaster.

 

[Proudfather94]

I’d highly recommend doing something that you are passionate about. Life’s too short, and this job is too hard. You don’t find find PM&R physicians on the street corner asking for change. You’ll be fine regardless. Just make good financial decisions in the context of your preferred specialty.

What you don’t want to happen is to go in the wrong field, and hate it…or burn out. That is means to financial disaster.

What do you think about the sports medicine fellowship? It would be cool having alot of patients that have sports injuries. The fellowship is only one year as well it looks like. I feel like if you build up enough of a reputation that people would pay alot of money to see you especially if their sports career depends on their recovery.

 

[j4pac]

What do you think about the sports medicine fellowship? It would be cool having alot of patients that have sports injuries. The fellowship is only one year as well it looks like. I feel like if you build up enough of a reputation that people would pay alot of money to see you especially if their sports career depends on their recovery.

You can make money in sports. Regen gives you that option. The money is definitely not the biggest reason to do sports. The biggest reasons are buying a motivated patient population and the ability to cover high level athletics. A suppose the injections/procedures can also be fun to a degree.

You can make money doing anything in PM&R. I’d really just focus on what interests you about the specialty. I did general and have no regrets. Know your options, know yourself, and find something you’re passionate about.

 

[Proudfather94]

You can make money in sports. Regen gives you that option. The money is definitely not the biggest reason to do sports. The biggest reasons are buying a motivated patient population and the ability to cover high level athletics. A suppose the injections/procedures can also be fun to a degree.

You can make money doing anything in PM&R. I’d really just focus on what interests you about the specialty. I did general and have no regrets. Know your options, know yourself, and find something you’re passionate about.

Thank you I'll keep an open mind about it I definitely have a long time to decide since I'm waiting until August to start. Are any of these fellowships closed off to DOs?

 

[cowboydoc]

What do you think about the sports medicine fellowship? It would be cool having alot of patients that have sports injuries. The fellowship is only one year as well it looks like. I feel like if you build up enough of a reputation that people would pay alot of money to see you especially if their sports career depends on their recovery.

Or…you could be a “sports” guy and be expected to cover lots of nights and weekends at events, typically with poor or no compensation. This is akin to the “prestige” in academics discussed above.

That reputation gets you high maintenance, or worse, famous patients. You make the same amount per visit/procedure, but when things don’t work out with their career, the suit against you is a lot juicier.

Hard pass.

 

[Iamnew2]

Or…you could be a “sports” guy and be expected to cover lots of nights and weekends at events, typically with poor or no compensation. This is akin to the “prestige” in academics discussed above.

That reputation gets you high maintenance, or worse, famous patients. You make the same amount per visit/procedure, but when things don’t work out with their career, the suit against you is a lot juicier.

Hard pass.

Agreed. We rotated with a *sports guy* while in residency who was the PM&R guy in the Ortho group essentially, and he covered almost every weekend a bunch of games - don't think he was compensated. The guy saw like 30-40 patients a day a nightmare. No thanks.

 

[Proudfather94]

Or…you could be a “sports” guy and be expected to cover lots of nights and weekends at events, typically with poor or no compensation. This is akin to the “prestige” in academics discussed above.

That reputation gets you high maintenance, or worse, famous patients. You make the same amount per visit/procedure, but when things don’t work out with their career, the suit against you is a lot juicier.

Hard pass.

So be careful if I join a group. Would I be able to do private practice? I could diagnose injuries and refer them to a physical therapist or rehab center right? I could do procedures like injections or ultrasound their joints?

 

[Iamnew2]

So be careful if I join a group. Would I be able to do private practice? I could diagnose injuries and refer them to a physical therapist or rehab center right? I could do procedures like injections or ultrasound their joints?

*rehab centers* are typically inpatient. Yes you can refer them to a therapist, but you don't need to do sports for that. You can do US injections, which pay next to nothing, and injections yes but it's far more profitable overall to do spine/pain for that. Knee/shoulder/joint injections - you don't need a sports fellowship for that.

 

[Proudfather94]

*rehab centers* are typically inpatient. Yes you can refer them to a therapist, but you don't need to do sports for that. You can do US injections, which pay next to nothing, and injections yes but it's far more profitable overall to do spine/pain for that. Knee/shoulder/joint injections - you don't need a sports fellowship for that.

Oh I see would sports medicine be more like if I wanted to work for a sports team or something like that? Ultimately I want to do something like private practice. I've worked in the hospital for 3 years before I got accepted into medical school and I know I don't want to spend my career in one and I'd like to be my own boss or at least eventually have an equal say in a physician group.

 

[Iamnew2]

Oh I see would sports medicine be more like if I wanted to work for a sports team or something like that? Ultimately I want to do something like private practice. I've worked in the hospital for 3 years before I got accepted into medical school and I know I don't want to spend my career in one and I'd like to be my own boss or at least eventually have an equal say in a physician group.

You can do private practice in sports, generally speaking you'd be joining an Ortho group. Ortho groups notoriously dont give PM&R doctors equal share and frequently dont make them partners. So you may never get an equal say. Can you open your own practice? Certainly. that comes with plusses and minuses.

 

[Proudfather94]

You can do private practice in sports, generally speaking you'd be joining an Ortho group. Ortho groups notoriously dont give PM&R doctors equal share and frequently dont make them partners. So you may never get an equal say. Can you open your own practice? Certainly. that comes with plusses and minuses.

So basically don't trust ortho groups

 

[j4pac]

So basically don't trust ortho groups

Trust but verify. I think that applies to any employer. I’ve seen single specialty physicians that own their own practice screw over their comrades.

 

[Proudfather94]

Trust but verify. I think that applies to any employer. I’ve seen single specialty physicians that own their own practice screw over their comrades.

Thanks I'll keep that in mind. Do you guys know if it's hard to get good residencies in this specialty as a DO?

 

[j4pac]

Thanks I'll keep that in mind. Do you guys know if it's hard to get good residencies in this specialty as a DO?

It’s by far the most DO friendly. Tons of big names, including in academics. There are only a few relatively DO unfriendly programs. It’s honestly debatable if you even need a USMLE (though I’d still probably recommend it).

 

[Proudfather94]

It’s by far the most DO friendly. Tons of big names, including in academics. There are only a few relatively DO unfriendly programs. It’s honestly debatable if you even need a USMLE (though I’d still probably recommend it).

Thanks do you guys think I should email some PM&R docs at the local university's to see if they will have research available for the summer between m1 and m2?

 

[sloh]

You can do private practice in sports, generally speaking you'd be joining an Ortho group. Ortho groups notoriously dont give PM&R doctors equal share and frequently dont make them partners. So you may never get an equal say. Can you open your own practice? Certainly. that comes with plusses and minuses.

Not unusual it’s many more minuses than pluses today.

 

[sloh]

What do you think about the sports medicine fellowship? It would be cool having alot of patients that have sports injuries. The fellowship is only one year as well it looks like. I feel like if you build up enough of a reputation that people would pay alot of money to see you especially if their sports career depends on their recovery.

Unlikely you’re going to be able to financially keep a clinic afloat with lots of patients with sports injuries. A lot of PM&R clinics are chronic pain-lite. Even “sports med.”

 

[j4pac]

Thanks do you guys think I should email some PM&R docs at the local university's to see if they will have research available for the summer between m1 and m2?

PM&R research is nice, but unnecessary. I’d just demonstrate that you are willing and capable to do research of any kind. PM&R PDs know how difficult it is to get access to PM&R research. But it certainly doesn’t hurt to try because I suppose it could help separate you from the pack.

 

[runfastnow]

What do you think about the sports medicine fellowship? It would be cool having alot of patients that have sports injuries. The fellowship is only one year as well it looks like. I feel like if you build up enough of a reputation that people would pay alot of money to see you especially if their sports career depends on their recovery.

Sports medicine can be A LOT of fun, but go into it with your eyes open.

I am private practice and was head team physician for large university and it consumed my life - i.e. 100 hrs/per week.
50 hrs/week practice with patient visits and procedures (50/50 mix of sports/spine) and 50 hrs/wk game coverage, training room, meetings that was essentially uncompensated.

We no longer are team physicians and I have a life again. It was bittersweet to stop because there are a lot of cool perks - personal relationships with power players in the state/community and future pro athletes, reputation for being the team doc for organization people care about in the community, private jets, nice ego petting, etc. BUT it is also incredible amounts of time away from family, nights and weekends consumed with coverage, seeing things that are primary care but non-PM&R related (ADHD, diabetes, etc.) that are uninteresting to me, and high level college athletes and trainers can be extremely demanding (i.e. every runny nose needs to be treated immediately and with a $1,000,000 work up).

If you can work your way into an academic job that is head of sports medicine at a large university it can be an easy gig if your production requirements go away and you can just focus on seeing athletes and some VIPs - but know that a lot of it is going to be pure primary care (i.e. runny noses, ADHD, asthma, diabetes management) and not doing ultrasound and everything in the PM&R realm.

In my experience PM&R sports in private practice ends up being a pseudo-pain management in the real world. A lot of arthritis, back/neck pain, and some torn meniscus/rotator cuff stuff. If you can get in with some high schools and see their athletes that can be more "real" sports medicine, but what are you going to be providing that the PCP cannot? You aren't going to be injecting and doing a lot of procedures on 14-18 year olds - although you will be much more competent in return to play decisions which PCPs are typically TERRIBLE at.

To your original question - in PM&R sports you can make $400k+ if you are busy (90-100+ patient encounters per week) and do some spine injections (12-15 per week) or are able to build a healthy PRP/regen medicine following (this requires an affluent patient base).

 

[Iamnew2]

Sports medicine can be A LOT of fun, but go into it with your eyes open.

I am private practice and was head team physician for large university and it consumed my life - i.e. 100 hrs/per week.
50 hrs/week practice with patient visits and procedures (50/50 mix of sports/spine) and 50 hrs/wk game coverage, training room, meetings that was essentially uncompensated.

We no longer are team physicians and I have a life again. It was bittersweet to stop because there are a lot of cool perks - personal relationships with power players in the state/community and future pro athletes, reputation for being the team doc for organization people care about in the community, private jets, nice ego petting, etc. BUT it is also incredible amounts of time away from family, nights and weekends consumed with coverage, seeing things that are primary care but non-PM&R related (ADHD, diabetes, etc.) that are uninteresting to me, and high level college athletes and trainers can be extremely demanding (i.e. every runny nose needs to be treated immediately and with a $1,000,000 work up).

If you can work your way into an academic job that is head of sports medicine at a large university it can be an easy gig if your production requirements go away and you can just focus on seeing athletes and some VIPs - but know that a lot of it is going to be pure primary care (i.e. runny noses, ADHD, asthma, diabetes management) and not doing ultrasound and everything in the PM&R realm.

In my experience PM&R sports in private practice ends up being a pseudo-pain management in the real world. A lot of arthritis, back/neck pain, and some torn meniscus/rotator cuff stuff. If you can get in with some high schools and see their athletes that can be more "real" sports medicine, but what are going to be providing that the PCP cannot? You aren't going to be injecting and doing a lot of procedures on 14-18 year olds.

To your original question - in PM&R sports you can make $400k+ if you are busy (90-100+ patient encounters per week) and do some spine injections (12-15 per week) or are able to build a healthy PRP/regen medicine following (this requires an affluent patient base).

PRP/regen is challenging. Very limited number of patients willing to pay out of pocket for uncertain benefit. Kind of the same issue with plastic surgeons - everyone is competing for the same base of patients. practice costs can also be high. I have a small cosmetic business in an affluent area and man it's tough work. People are unrealistic, even people with $ are unrealistic (newsflash! I can't make people look like they are 25 again!), demanding, needy, etc. The sports coverage sounds dredful. I covered essentially one game during my sports rotation and despised it. Would never do that - particularly because it's uncompensated - but the main partners make a good chunk of change for the coverage.

 

[PMR2008]

What is the best one can do per hour, and what setting would this be in? Thanks!

Procedures or medlegal.

 

[runfastnow]

What is the best one can do per hour, and what setting would this be in? Thanks!

Per Hour = Yearly Comp / 2000 hrs -> formula I've seen most often.

To answer your question - depends on how cowboy/girl you want to get in the outpatient world.

If you are ok doing epidurals, MBBs/RFs, SI joints, etc. without seeing these patients in clinic and can get direct to injection referral flow to support this for 3+ days (~50+ injections) per week then probably $300/hr - more if you do MILD and/or SCS efficiently. This can open you up to some moderate/major risk and doing inappropriate procedures if you don't carefully review notes, images, etc. though. I would advise against this unless you have ethical/good direct referral sources in house/health system.

In a more typical setting:
Spine/pain world then you probably average out to $200-250/hr based on how many procedures you do per week.
Sports/outpatient (with no spine) world somewhere between $150-180/hr based on how fast you are with patients and how much ultrasound and/or EMG you do.
Inpatient - no clue. Depends on patient load and how much you are willing to work; n=1 but friend from residency made $500k first year at Encompass working essentially all holidays an 20+ weekends his first year out of training which equals about $250/hr

 

[PMR2008]

Medlegal is easily $500/hr up to $1500/hr for PM&R. I have seen much lower and a little higher. But it is nearly impossible to do 40 hours a week of medlegal. Needle jockeys or those doing a lot of STIMS/RFAS can easily make $1000+/hr. Obviously if you average out to patient visits/admin it is usually $250-300/hr.
Best IMO is to value your time at $250/hr and find a balance between your interest, stress and financial goals.

 

[Proudfather94]

Hey guys I have another big question. What can a PM&R doctor do that a FM doctor can't in an outpatient clinic setting? I'm looking and it seems like they can do alot of the joint injections and things like that.

 

[runfastnow]

In the MSK/sports world - ideally you would have a much better understanding of rehabilitation course, treatment options beyond steroid injections, appropriate times to refer to ortho (i.e. mensicus root tears, etc.) instead of blindly PT/inject/NSAID and be able to pass along this information to your patients. Plus depending on training program some amount of ultrasound skill directly out of residency and fluoroscopy skill based on fellowship if you pursue that.

Outside of MSK you would have a much different skill set - EMG, spasticity management, good amputee care (again - beyond just writing "Rx for BKA prosthetic"), chronic stroke/SCI/brain injury management.

 

[Proudfather94]

In the MSK/sports world - ideally you would have a much better understanding of rehabilitation course, treatment options beyond steroid injections, appropriate times to refer to ortho (i.e. mensicus root tears, etc.) instead of blindly PT/inject/NSAID and be able to pass along this information to your patients. Plus depending on training program some amount of ultrasound skill directly out of residency and fluoroscopy skill based on fellowship if you pursue that.

Outside of MSK you would have a much different skill set - EMG, spasticity management, good amputee care (again - beyond just writing "Rx for BKA prosthetic"), chronic stroke/SCI/brain injury management.

Thank you for someone who wants to spend most of their career doing private practice so you think that difference is worth giving up alot of the stuff that one could do if they did FM instead? I've always wanted to own my own business and be my own boss eventually so I think private practice is what I'm doing to do after a few years of working in a hospital or group to pay off my loans.

 

[drg123]

In the MSK/sports world - ideally you would have a much better understanding of rehabilitation course, treatment options beyond steroid injections, appropriate times to refer to ortho (i.e. mensicus root tears, etc.) instead of blindly PT/inject/NSAID and be able to pass along this information to your patients. Plus depending on training program some amount of ultrasound skill directly out of residency and fluoroscopy skill based on fellowship if you pursue that.

Outside of MSK you would have a much different skill set - EMG, spasticity management, good amputee care (again - beyond just writing "Rx for BKA prosthetic"), chronic stroke/SCI/brain injury management.

Agree with this. No residency is perfectly aligned with one's end goals, but there are definitely degrees of overlap. I think PM&R is maximally aligned with a future career in OP MSK medicine compared to FM. In FM, you will spend a great deal of time managing chronic, non-MSK disease (DM, HTN, HLD, etc.) with a small portion managing MSK disease. In PM&R, MSK medicine makes up a very large fraction of the training, and from good programs, you should have ample experience with US and fluoro-guided injections. From my program, an assertive resident can graduate with at least 200 (and often more) MSK injections under US guidance. And as @runfastnow, you're not just an injection machine. You understand the why and how of the pathology and management. I don't think there is any residency better aligned with the end goal of MSK/Sports.

However, PM&R is 4 years while FM is 3, and if you want to do sports fellowship, now you're at 5 years for PMR + Sports, or 4 FM + Sports. One could argue that the 1 year of sports fellowship is adequate for someone trained in FM to get the requisite knowledge/skills. So there is that. I don't doubt that a motivated person could quickly catch up. But if you want to spend residency also doing the things you hope to do after training, PM&R is tops, in my opinion.

 

[Proudfather94]

Agree with this. No residency is perfectly aligned with one's end goals, but there are definitely degrees of overlap. I think PM&R is maximally aligned with a future career in OP MSK medicine compared to FM. In FM, you will spend a great deal of time managing chronic, non-MSK disease (DM, HTN, HLD, etc.) with a small portion managing MSK disease. In PM&R, MSK medicine makes up a very large fraction of the training, and from good programs, you should have ample experience with US and fluoro-guided injections. From my program, an assertive resident can graduate with at least 200 (and often more) MSK injections under US guidance. And as @runfastnow, you're not just an injection machine. You understand the why and how of the pathology and management. I don't think there is any residency better aligned with the end goal of MSK/Sports.

However, PM&R is 4 years while FM is 3, and if you want to do sports fellowship, now you're at 5 years for PMR + Sports, or 4 FM + Sports. One could argue that the 1 year of sports fellowship is adequate for someone trained in FM to get the requisite knowledge/skills. So there is that. I don't doubt that a motivated person could quickly catch up. But if you want to spend residency also doing the things you hope to do after training, PM&R is tops, in my opinion.

Thank you that is a great point. I feel like I would enjoy the PM&R residency more. I think seeing patients come in with pain and treating them to see them have better lives would be very fulfilling to me. I think working in a rehab center for a few years and seeing my patients improve would also be great but I know that I wouldn't want to do that for my entire career.

 

[RangerBob]

Hey guys I have another big question. What can a PM&R doctor do that a FM doctor can't in an outpatient clinic setting? I'm looking and it seems like they can do alot of the joint injections and things like that.

My personal opinion is if you want to be a team doctor, FM + sports fellowship is the best route. As mentioned above, as a team doctor most of what you're doing is PCP stuff. The fellowship will teach you the MSK stuff/injections.

If you want to be a "real" sports doctor (ie,., treat just sports injuries), PM&R is no doubt the better route (unless you want to do surgery, then obviously go ortho). But it's really hard to run a true sports-only practice. Most sports docs are practicing in their original field as well, whether it's peds, FM, ortho, EM, or PM&R. So I would choose residency based on what you would want to do more if you can't do 100% sports, then get that extra sports training.

One of my residency docs had it good. PM&R + sports. She worked part-time, about 6hrs/day 3 days/week. Husband made a lot of money so she didn't have to work for money. 80-90% classic "sports" patients (18-30/young, healthy, minimal comorbidities, doing sports), with a handful of older classic MSK patients (the opposite), usually because they were friends of friends, etc. She did injections and all that jazz. But she was attached to an academic center and had a referral base that clearly took time to build up. I imagine it's what most sports docs dream of--she had everything including the therapy gym onsite. Only thing lacking was being a team doc, which many would argue is a plus considering the time drain that requires (which is often uncompensated as mentioned above)

 

[Proudfather94]

My personal opinion is if you want to be a team doctor, FM + sports fellowship is the best route. As mentioned above, as a team doctor most of what you're doing is PCP stuff. The fellowship will teach you the MSK stuff/injections.

If you want to be a "real" sports doctor (ie,., treat just sports injuries), PM&R is no doubt the better route (unless you want to do surgery, then obviously go ortho). But it's really hard to run a true sports-only practice. Most sports docs are practicing in their original field as well, whether it's peds, FM, ortho, EM, or PM&R. So I would choose residency based on what you would want to do more if you can't do 100% sports, then get that extra sports training.

One of my residency docs had it good. PM&R + sports. She worked part-time, about 6hrs/day 3 days/week. Husband made a lot of money so she didn't have to work for money. 80-90% classic "sports" patients (18-30/young, healthy, minimal comorbidities, doing sports), with a handful of older classic MSK patients (the opposite), usually because they were friends of friends, etc. She did injections and all that jazz. But she was attached to an academic center and had a referral base that clearly took time to build up. I imagine it's what most sports docs dream of--she had everything including the therapy gym onsite. Only thing lacking was being a team doc, which many would argue is a plus considering the time drain that requires (which is often uncompensated as mentioned above)

As a PM&R doctor what would my pt base consist of besides sports? Would it be mostly post surgery patients to make plans for outpatient rehab?

 

[j4pac]

As someone in a prior life who did primary care, I wouldn’t sweat the primary care aspect of Sports Medicine. You’ll learn it. MSK is the significant majority of your job in Sports Med, it makes much more sense to be great at that, and fill in the gaps with the primary care side of the job. Either way, you’d be fine. But if your passion is MSK, PM&R residency will be much more tolerable. I also think that the neurorehab side of PM&R adds significantly to your knowledge base and approach to Sports Med. The ability to do Botox is also nice, as it is typically more lucrative than the Sports Med procedures. It also buys you a different patient population with significant MSK needs, so you don’t gave to spend as much of your time managing hypertension and diabetes.