There are many physiatry jobs available in many different physical medicine and rehabilitation subspecialties. The demand for physical medicine and rehabilitation is greater than the supply. Although Farr Healthcare only recruits for physiatry, my understanding is that it is a specialty that is more in demand than many other specialties and has exceptional job prospects. Please visit www.farrhealthcare.com for a list of physical medicine and rehabilitation practice opportunities.
There is a need for inpatient, general outpatient and interventional physiatrists. The need is greatest for inpatient physiatrists, followed by general outpatient physiatrists and then interventional physiatrists. The need is greatest for inpatient rehab because many middle age and younger physiatrists have chosen to pursue outpatient work.
Farr Healthcare doesn’t usually have many general outpatient physical medicine practice opportunities. This may be due to there being less a demand for them and that there is a fairly large pool of outpatient physiatrists available. It is usually in more rural locations that Farr Healthcare is asked to recruit general outpatient physiatrists.
The general outpatient sector can be broken down from the standpoint that some physiatry practices treat mostly acute cases while other physiatry practices treat mostly chronic cases. The latter physical medicine and rehabilitation practices have experienced censure from the federal government for the use of opiates and some physical medicine specialists have even lost their licenses as a result. As a result, many physiatrists shy away from treating chronic pain patients.
Outpatient physiatry work can also involve to a greater or lesser extent the care of personal injury and worker’s compensation cases. As in all of the various areas of care physical medicine and rehabilitation doctors can pursue, the choice of this type of work is one of personal preference with some attention to economics.
Interventional physiatry practice opportunities are greater from the standpoint that there are so many different specialties seeking out their services, e.g., physiatrists, neurosurgeons, orthopods, anesthesiologists. The compensation and partnership opportunities can vary significantly among these specialties. One shouldn’t presume that because it is a physical medicine group that the compensation and partnership opportunities are greater. They are different and unique on a case-by-case basis, and not necessarily particular to the specialty.
A guesstimate is that two-thirds of graduating physiatry residents however go onto spine fellowships thereby reducing the number of physiatrists available for general work. Some employers require an ACGME-accredited fellowship.
It may be advisable to pursue a spine fellowship to increase your skill set but it may box you in later when you want to pursue other physiatry work such as inpatient. Inpatient employers want physical medicine and rehabilitation doctors who have done inpatient work within at least the past year. This interest in due to the many and changing Medicare regulations that inpatient rehab physicians must know.
Another field is regenerative medicine which has a much smaller supply of physiatrists due to its relatively new beginnings and the small number of physical medicine doctors qualified to provide these services. The opportunities to learn these services are fairly small. The reimbursement for services by insurance providers may not be recognized and private pay patients may be less able to partake of these services in difficult economic times.
Some physiatrists go into traumatic brain injury, spinal cord injury and pediatric fellowships. The number of physical medicine and rehabilitation residents going into these specialties seems to be rising in the last 5+ years but not to the extent that it was 20 years ago. There is a huge demand for these subspecialties. Starting compensation for these subspecialties is usually higher although not relatively significant.
Other subspecialties are rising such as neuromuscular, palliative, research, etc. but the number of physiatrists in these remain few in number. It is probable that these fellowships will grow in the number and in the number of graduates. Again, as in the case of these and other subspecialties, one of many determining factors will be the ability and level for reimbursement of these subspecialties.
Service settings which have grown in the number of physiatrists in the last 15 or so years and continue to grow are subacute, long term acute care and skilled nursing facilities. There are many large national and regional companies that own these facilities. There are also many national and regional companies that contract with the facilities and then in turn contract with physical medicine and rehabilitation doctors to provide these services. Some companies compensate based on a set salary while others are on a pure production basis.
As a result of the demand for physiatry, the compensation is often open to much negotiation. Most hiring entities set a salary base with an incentive component. Negotiation would usually focus on the base salary.
The other day a physiatrist commented to us about the future of inpatient rehab. In his area, he was one of the few doctors of physical medicine and rehabilitation doing inpatient work. He felt that inpatient rehab jobs in general were diminishing.
The reality is that there are many inpatient physiatry practice opportunities and that companies continue to grow and build more inpatient programs and facilities. The supply of inpatient rehab doctors is much less than the demand as many physical medicine and rehabilitation residents go onto interventional fellowships.
Occasionally, we’ll hear from an interventional physical medicine doctor who wants to return to an inpatient job which has less overhead, less competition and less decreased reimbursements.
Some physiatry residencies have affiliations with for-profit hospitals, subacute facilities, etc. This is a great opportunity for the physical medicine and rehabilitation residents to experience life as it will be once they graduate and help direct them in their career choice. Physiatry residents graduating from such programs are also more desirable to these settings as they have the experience working in such settings and therefore are more inclined to have a longer retention in their positions.
Future prospects for physiatry practice opportunities should continue due to the aging population, the ability of physical medicine and rehabilitation doctors to treat pain and the complications resulting from Covid. According to the 2020 Association of American Medical Colleges Physician Shortage Report “population growth and aging — continue to be the primary driver of increasing demand from 2018 to 2033. During this period, the U.S. population is projected to grow by 10.4% from about 327 million to 361 million. The U.S. population under age 18 is projected to grow by 3.9%, while the population aged 65 and over is projected to grow by 45.1% by 2033. Therefore, demand for physician specialties that predominantly care for older Americans will continue to increase.”
Addressing the demand in physiatry services is the increase in graduating residents. There has been a twofold increase in physiatry resident graduates in the last ten years. Although this might seem to address the demand, it seems physiatry continues to be one of the few specialties seeing a shortage of physicians. According to an article titled Physiatry rising: on engaging the next generation of physiatrists by Charles Odonkor, MD in 2016 “For every 5 people in the US, 1 has a disability and in order to be able to serve and meet this population’s medical needs, more physiatrists are needed. With aging of the population, the rise in chronic disease, chronic pain, neuromuscular and musculoskeletal conditions, post-war traumatic and dysvascular populations, demand for physiatry will continue to increase. ”