I enjoyed seeing everyone at the 2023 AAPMR physiatry meeting in New Orleans. We attended the Job Fair and the Exhibit Hall. Each year, Farr Healthcare provides a thank you $500 cash gift to one lucky doctor who who visited our booths. This year’s recipient was Esther Jung, M.D. Congratulations to Dr. Jung!
A practicing physiatrist recently asked me about the best resources for interventional physiatry compensation information. Here’s what I told him:
The field of physiatry, also known as physical medicine and rehabilitation, has been experiencing several notable trends in PM&R job hiring and physiatry job opportunities. Hiring trends can change rapidly depending on regional and local needs. Rapid change in the healthcare system also creates demand for different subspecialties in different regions.
Growing Demand: There has been an increasing demand for physiatrists due to various factors. Other factors include aging physiatrists and many physiatrists who accelerated their retirement because of Covid and the increasing electronic billing requirements, an aging population, higher rates of chronic conditions, and a growing emphasis on non-surgical treatments for musculoskeletal and neurological conditions. Physiatrist demand is projected to grow 7% from 2018 to 2028. https://www.zippia.com/physiatrist-jobs/trends/
Less Supply: As many senior PM&R residents choose to do interventional fellowships, it leaves a large gap in the supply of inpatient physiatrists. I’d guesstimate that 2/3 of the physiatry seniors do an interventional fellowship. Without an increase in physiatry residency positions, the current national shortfall of physiatrists is projected to persist. Although a projected increase in physiatrists’ use of advanced practice providers may help preserve access to comprehensive physiatry care, it is not expected to eliminate the shortfall. https://pubmed.ncbi.nlm.nih.gov/33278133/
As a result of COVID-19, in 2021, 72% of physicians in general reported a reduction in income, 43% had to work with reduced staff, and 8% closed their practices.
By 2022, hiring trends had increased and long-term health challenges and the aging population drove rehiring and increased income. 15% of physicians experienced a reduction in income, down from 72% in 2021. 8% of physicians have had to work with reduced staff. 8% of physicians have had to close their practice largely a result of retirement.
Physicians report heavier workloads along with the following impacts: burnout-68%, feelings of anger and/or anxiety-53%, withdrawing from family and friends-35%, and sought medical attention for a mental health issue-17%.
The biggest factors causing physician shortages are: an aging population as the number of people 65 and older is expected to grow by 42% between now and 2034, and retirements as more than two out of five current physicians will be over age 65 between now and 2034.
Burnout, stress, and COVID-19 effects are also expected to have an impact on physician shortages.
Regional and geographic impacts are expected to continue in areas with more aging adults particularly in the Midwest and the South.
Physician demographics in general, and probably reflective of physiatry, are that the Eastern region and most large metro areas throughout the nation have the greatest number of trained physicians. Midwestern and Southern states, along with rural areas, are confronting large aging populations and have a greater shortage of trained practitioners.
Hiring trend surveys show that areas with a shortage of physicians continue to offer higher salaries and larger bonuses to attract qualified candidates.
Shifts in care models are also affecting recruitment and hiring, including an increase in academic medical center recruitment and a move toward convenient care and telemedicine.
Here’s how recruitment trends for physicians in general have changed, based on employment setting, over the past year: Hospital recruitment: 34% in 2022 (up from 33% in 2021), medical group recruitment: 18% in 2022 (down from 29% in 2021), academic medical center recruitment: 34% in 2022 (up from 20% in 2021), physician recruitment for solo, partnership, & concierge practices: 1% in 2022 (down from 3% in 2021).
https://physiciansthrive.com/wp-content/uploads/2023/05/Compensation-Report-2023.pdf (This reference also was used for some of the summary below.)
Diverse Employment Settings: Physiatrists have opportunities in more and more settings, including hospitals, rehabilitation centers, private practice, subacute centers, skilled nursing facilities, academic institutions, and interdisciplinary clinics. Some of these services such as subacute have consolidated among a few provider organizations and are now more organized than in years past. In turn, they are proactively filling the need for these services and therefore looking for more physiatrists. These diverse options allow for different work environments and patient populations.
Subspecialty Growth: Subspecialties within physical medicine and rehabilitation, such as sports medicine, spinal cord injury, pain medicine, and pediatric rehabilitation, are expanding. This growth has led to more specialized job openings for physiatrists with expertise in these areas.
Telemedicine Opportunities: The COVID-19 pandemic accelerated the adoption of telemedicine in healthcare. Physiatrists have increasingly utilized telemedicine for consultations, follow-ups, and remote patient care, which has opened up new job opportunities in virtual healthcare settings.
Employment in Alternative Settings: Some PM&R physicians are exploring opportunities in non-traditional settings such as corporate health, insurance companies, and government agencies, leveraging their expertise in functional restoration and disability management.
Focus on Outpatient Services: Outpatient rehabilitation services are in demand, especially with a growing emphasis on early intervention and preventive care. Job opportunities in outpatient clinics and community health settings are expanding.
HIRING TRENDS SUMMARY:
The job market for physiatrists appears to be robust and diverse, offering a wide range of opportunities in various healthcare settings
Specific hiring trends vary based on geographic locations, healthcare policies, etc.
There is a shortage for physicians in general, particularly in the Midwest and Southern regions.
The demand for physical medicine and rehabilitation physicians is expected to increase
Rural and underserved areas pay the highest salaries and the biggest bonuses.
Please feel free to consult with Farr Healthcare, Inc. for the most recent updates on hiring trends in physiatry. www.farrhealthcare.com, 888-362-7200, farrhealth@comcast.net
I recently spoke with a fellow recently who asked me whether a cover letter should be used when approaching an employer for the first time using email. I used to say that a cover letter isn’t necessary but as it’s your initial contact with the pm&r employer, I think it’s a good idea. It should include concise information about how your skills relate to the needs of the employer. Sometimes the needs of the employer aren’t clear in an advertisement so research on the employer may be helpful. Regardless, you should always research the employer before any contacts with them.
The main consideration when applying for a physical medicine and rehabilitation job is to be concise in your communications. This rationale is because the employer is busy with their daily activities and recruitment for them is added work on top of their daily work. So, for example, you might want to use bullet points in your cover letter as you list your skills and their needs.
You might also want to include the cover letter as an attachment along with your attached cv. I say this because if you include your cover letter only in the body of the email, it may not get passed along to the other members of the employer group. The HR manager may only print out your cv and pass it along. If your cv and your cover letter are attached, hopefully both will be passed onto the decision makers in the company/practice.
I’ve been seeing some curricula vitae (cv) with two columns, boxed sections, etc. and I suggest a basic curriculum vitae instead. It’s much easier to read by the employer. I understand that two columns may allow you to shorten your curriculum vitae to a page but if the reader has to skip around on the cv not knowing where everything is listed as it’s in different format for each candidate, it’s more difficult and time-consuming for them. Your contact information of your email address and phone number should be on the top of your cv. A sample cv can be found on my website.
Best wishes on your practice search!
Farr Healthcare, Inc. had the good fortune to speak recently during a Zoom AAPMR presentation about the questions you should ask during a job interview. Usually, presentations speak about the questions you will be asked during a job interview. It’s less frequent to learn about the questions you should ask. Some of the questions are specific to the PM&R audience. For more information, visit 5 Questions You Need to be Asking: Tips for Interviewing to Find Your Best Fit – Zoom
For more Physical Medicine and Rehabilitation Jobs, don’t forget to visit https://farrhealthcare.com/openings/physical-medicine-and-rehabilitation-jobs/
WalletHub’s 2023 ranking is based on comparisons across two key dimensions: opportunity and competition, and medical environment. Within those dimensions, 19 metrics are considered, including average annual wage, hospitals per capita and quality of the public health system. WalletHub calculated each state’s overall score using the weighted average across all metrics.
Fifteen best states for physicians:
1. Montana
2. South Dakota
3. Idaho
4. Wisconsin
5. Minnesota
6. Louisiana
7. Utah
8. Nebraska
9. Iowa
10. Indiana
11. Colorado
12. Alabama
13. Tennessee
14. Georgia
15. North Dakota
& the worst:
35. Arkansas
36. California
37. Florida
38. Vermont
39. Wyoming
40. Delaware
41. Maryland
42. Oregon
43. Pennsylvania
44. New York
45. Massachusetts
46. New Mexico
47. District of Columbia
48. New Jersey
49. Alaska
50. Rhode Island
51. Hawaii
Four other insights from the ranking:
Taken from: https://www.beckershospitalreview.com/rankings-and-ratings/15-best-worst-states-for-physicians-in-2023.html?origin=BHRSUN&utm_source=BHRSUN&utm_medium=email&utm_content=newsletter&oly_enc_id=1259D3898012A8Vhttps://www.beckershospitalreview.com/rankings-and-ratings/15-best-worst-states-for-physicians-in-2023.html?origin=BHRSUN&utm_source=BHRSUN&utm_medium=email&utm_content=newsletter&oly_enc_id=1259D3898012A8V
The demand for physiatrists is now more than ever. There are several signs of this increased demand. Employers used to wait until after the AAPMR meeting to ask me to help with recruitment but now they tell me a year+ ahead to recruit.
There has been a change in the type of PM&R jobs over the years. All I represented 20 years ago was inpatient practice opportunities. For the last 10 years, I have a sampling of all subspecialty practice opportunities to include interventional, subacute and general outpatient. Subacute has seen the greatest increase over the last 10 years.
The demand for TBI, SCI, pediatric rehab, and telemedicine continues on an upward curve. TBI and SCI positions are hard to fill as very few physiatrists pursue these fellowships. However, there seems to be an increased interest from residents in pursuing these fellowships.
A note to physiatrists pursuing interventional fellowships is that more and more employers require an ACGME-accredited fellowship.
It’s harder to find candidates as everyone is looking for physiatrists. Hence, there’s a lesser number of candidates for any one practice opportunity. That makes it more important to look for candidates as early as possible.
The type of position has also changed recently. Now there are many more Medical Director, Rehab positions. There are several reasons for this prevalence. One is that in states like FL, the certificate of need requirement has ceased so many companies are now freely able to build a rehab hospital. For example, there will be 450 new rehab beds in the Jacksonville, FL area within a year’s time. Another reason for the increase in Medical Director, Rehab positions is that less and less physiatrists have an interest in inpatient rehab.
The financial impact of this physiatry shortage is that there are more sign-on bonuses than in the past. These bonuses typically range from $20,000 on up.
More practices are using NP’s and PA’s as they can’t find physiatrists. Rehab hospital are employing internists because they can’t find physiatrists and also because more and more physiatrists do not have an interest in acting as the primary doctor for patients.
As a result of this shortage, it is more than ever imperative to use a physician recruiter. This is not a marketing pitch! Some of the studies are as follows:
First bullet https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-6
Second bullet https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage
Third bullet https://www.zippia.com/physiatrist-jobs/trends/
Fourth bullet https://www.recruiter.com/careers/physical-medicine-and-rehabilitation-physicians/outlook/
Physiatry jobs were on a slow upward curve from 2012 until 2018 and then Covid hit and there was almost no demand. Since 2019 the growth has resumed. From: https://www.zippia.com/physiatrist-jobs/trends/
In recent years, physical medicine and rehabilitation physicians have the highest job vacancies and job growth rate in the following states: ND, HI, NH, NM, AZ, VT and IL. The following states have had the lowest job openings and growth rates: NY, DE, CT, RI, MO, IN, and WV. From https://www.recruiter.com/careers/physical-medicine-and-rehabilitation-physicians/outlook/
Physical medicine and rehabilitation (PM&R), also known as physiatry, is a medical specialty that focuses on the prevention, diagnosis, treatment, and rehabilitation of conditions that affect the musculoskeletal, neurological, and other bodily systems. PM&R physicians, called physiatrists, aim to enhance and restore functional abilities, improve quality of life, and optimize overall well-being for patients with disabilities, injuries, or chronic medical conditions.
Physical medicine and rehabilitation physicians employ a multidisciplinary approach to patient care, collaborating with other healthcare professionals such as physical therapists, occupational therapists, speech-language pathologists, psychologists, and social workers. They assess patients’ functional impairments and develop individualized treatment plans that may include medication management, therapeutic exercises, assistive devices, adaptive technologies, and interventional procedures.
PM&R covers a wide range of conditions, including:
References:
A physiatrist asked me recently about the supervision of ancillary staff. He was asked to start supervising ancillary staff as part of his job. He asked me how much he should be paid additionally to do this. He had a concern about the litiguous position it might put him. I’m not familiar with this subject so I asked a Bruno Stillo, a colleague and owner of Physiatry Billing Specialists, and he also was not familiar with this circumstance. A reference on this subject was found on the web, https://www.michaeljohnsonlegal.com/physician-compensation-supervision-npp/ It says that physician supervision is VERY profitable to employers and that as a physician you should not provide this supervision without a fair compensation. You should have the foresight include language when you’re negotiating a contract to exclude this supervision.
Employers may offer to allow you to record your time spent supervising and pay you on an hourly basis. However, if you look closely, the hourly rate they are willing to pay is often lower than what you make per hour already, such that adding more time to your day would result in a diminished marginal rate of compensation. Said another way, if your first 40 hours (likely more) of work in a week pays you $175/hour, and the hourly rate for supervision your employer offers to pay is $150/hour, then it is not in your best financial interests to do agree to do more work.
The article goes on to discuss other compensation methods. Their bottom line is to be careful and to not be taken advantage of.
It seems everyone wants to add a physiatrist to their practice, hospital, etc. There are so many physical medicine and rehabilitation jobs on ourwebsite. Interventional physiatry jobs are also plentiful. Who’s going to fill all these openings? What’s the supply of physiatrists in the US?
The number of medical school applicants from 2018 to 2019 increased by 1.1%. This very small increase doesn’t bode well for physician supply in general. Many more physicians, to include physiatrists, are needed to fill all the physical medicine and rehabilitation jobs. Medical school enrollment from 2002 to present is 52% higher. This seems to be a good trend but one that really needs to escalate at a faster pace. My understanding is that all but one PM&R residency spot was filled this year. The competition for physiatry residencies is ever increasing although it isn’t high relative to other specialties.
An NIH study titled Physiatry Workforce in 2019 And Beyond said that 37% of the 8,853 physiatrists surveyed indicated that their physical medicine and rehabilitation job workload exceeded capacity (maybe burnout), 59% are working at capacity and 4% under capacity. There was a national shortfall of 940 physiatrists in 2017. From 2017 to 2030, the projected growth in physiatrist supply will approximately equal the demand. However in 2030, there will be a shortfall of 1,080 physiatrists unless there’s a change in delivery.
What does the supply of physical medicine and rehabilitation physiatrists look like? The average age of a physiatrist is 40 years old. The largest percentage, approximately 35%, of PM&R doctors stay in their job 1 – 2 years with 18% of physiatrists staying in their job 5 – 7 years. The states with the most physical medicine and rehabilitation doctors in the U.S. are NY, FL, TX and CA and SD, WY, AK, VT have the least number of physiatrists.
It’s much more difficult to find candidates for physical medicine and rehabilitation jobs to include interventional physiatry jobs than it was years ago. Now even highly desirable areas like NYC and San Diego request outside recruitment help. Twenty years ago, Farr Healthcare, Inc. was recruiting inpatient and TBI/SCI/general outpatient physiatrists; 15 years ago interventional positions were added; 5 years ago to now subacute, pelvic rehab and telemedicine have been added to the mix.
Most residents go into interventional physiatry jobs for many reasons to include their interest in the field, their student loans and to expand their service capability. Covid caused many physiatrists to retire. Some rehab hospitals are using internists because of the lack of supply in physiatrists. There is less interest among physiatrists for inpatient work because of the paperwork, dealing with insurances, call, etc. The younger physiatrists are looking for a work/life balance and for that reason some of them are going into outpatient, subacute, and skilled nursing facility work.
Please check out physical medicine and rehabilitation practice opportunities here.