Choosing Between Academic Medicine and Private Practice as a DO Graduate in PM&R

As a DO graduate in Physical Medicine & Rehabilitation (PM&R), you’re entering a specialty that offers remarkable flexibility in practice settings, patient populations, and career trajectories. One of the earliest—and most impactful—decisions you’ll face after the physiatry match is whether to pursue an academic medicine career or private practice.

Both paths can be deeply fulfilling and financially viable, but they shape your day-to-day life, long‑term growth, and professional identity in very different ways. This article will walk you through the major distinctions, using the lens of a DO graduate residency background in PM&R, and help you align your first (or next) job with the kind of physiatrist you want to become.

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Understanding the Landscape: What “Academic” and “Private” Really Mean in PM&R

Before you compare, it’s critical to define the terms. In PM&R, practice settings can be more blended than in some other specialties.

What is an Academic PM&R Position?

An academic medicine career in PM&R generally means:

• Employment by a university or teaching hospital system
• A formal faculty appointment, often with a title like Assistant Professor or Clinical Instructor
• Core responsibilities in:
  • Clinical care
  • Teaching (residents, fellows, medical students, sometimes other disciplines)
  • Scholarly activity (research, quality improvement, curriculum development, publications)

You may practice in:

• Academic inpatient rehab units
• Specialty outpatient clinics (spasticity, SCI, TBI, stroke, amputee, neuromuscular, cancer rehab, sports & spine, pain)
• Affiliated VA hospitals
• Satellite clinics owned by the academic system

Key point: “Academic” often means tripartite mission (clinical + teaching + scholarship), even if the proportion of each varies widely by job and institution.

What is Private Practice in PM&R?

Private practice is a broad category that may include:

• Solo or small group practices owned by physiatrists
• Large multispecialty groups (orthopedics, neurology, pain, primary care)
• Hospital-employed non-academic roles
• Rehab hospital or SNF-based consulting models

In private practice PM&R, your primary focus is:

• Clinical care
• Practice growth and efficiency
• Business performance and revenue generation

There may be opportunities to teach or do research, but these are usually secondary and less formalized.

Hybrid and “Gray Zone” Models

Many positions don’t fit neatly into one box:

• A community PM&R group that hosts residents for rotations
• A VA job with an academic title at an affiliated university
• A hospital-employed outpatient physiatry job with optional teaching

As you evaluate offers, ask clearly:

• “Is this considered an academic faculty role?”
• “How is time divided between patient care, teaching, and research?”
• “What productivity expectations (RVUs, visits per day) do you have?”

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Training Pathway Recap: How Your DO Background Shapes Options

For DO graduates, the landscape has shifted significantly since the single accreditation system began. The osteopathic residency match now mostly runs through the NRMP, but your DO identity and training can still influence opportunities.

DO Graduate Residency and Academic Doors

As a DO physiatrist, you can absolutely build a robust academic career. Many PM&R departments value:

• Osteopathic training in holistic, functional, and musculoskeletal care
• Strong clinical reasoning and physical exam skills
• Comfort with manual techniques and procedural approaches

However, some academic centers—especially those highly research-intensive—may still subtly favor candidates with:

• Fellowship training (sports, pain, SCI, TBI, neuromuscular, cancer rehab, pediatric rehab)
• Research experience (publications, QI projects, abstracts)
• Training at a well-known academic PM&R residency

If you know you’re interested in academic physiatry early on, you can maximize your readiness by:

• Targeting residency programs with strong academic reputations
• Participating in research projects during residency
• Presenting at conferences (AAP, AAPM&R)
• Building mentorship relationships with faculty in your area of interest

DO Graduate and Private Practice Advantage

In private practice, your DO background can be particularly advantageous:

• Many patients seek out DOs for hands-on, functional, and holistic care
• Your musculoskeletal training aligns well with high-demand PM&R niches (spine, sports, pain, EMG)
• Private and community practices may place less emphasis on publications or academic pedigree and more on clinical skill, communication, and work ethic

The physiatry match often exposes you to both academic and community training sites. Pay attention during residency:

• Which settings felt energizing?
• Where did you enjoy the culture, pace, and patient mix?
• Did teaching or research feel like a natural fit?

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Day-to-Day Life: How Academic and Private PM&R Really Differ

The “feel” of your workweek is often the most important determinant of long‑term satisfaction. Below are detailed comparisons across critical dimensions.

Clinical Focus and Case Mix

Academic PM&R:

• Tends to see:
  • More complex and rare pathologies (SCI, TBI, complex stroke, neuromuscular disease, transplant rehab, cancer rehab)
  • Patients referred for subspecialty expertise or second opinions
  • Multidisciplinary care with therapists, psychologists, orthotists, and social workers
• Inpatient roles might emphasize:
  • Acute inpatient rehab units with medically complex patients
  • Close collaboration with neurology, neurosurgery, orthopedics, internal medicine
• Outpatient roles might include:
  • Subspecialty clinics: spasticity, baclofen pumps, EMG, sports, MSK, pain, amputee, pediatric rehab

Private Practice PM&R:

• Often more:
  • Musculoskeletal and spine focused in outpatient settings
  • EMG and electrodiagnostic heavy in some groups
  • Pain management, including procedures (injections, fluoroscopic or ultrasound-guided interventions)
• In hospital or post-acute roles:
  • Strong emphasis on functional gains and throughput in rehab hospitals or SNFs
  • Productivity often tied directly to your compensation

Consider your preferences:

• Do you enjoy rare, complex, multi-system cases and extended interdisciplinary rounds? That leans academic.
• Do you like procedures, MSK, and building a long-term outpatient practice? That leans private practice.

Teaching and Mentorship Responsibilities

Academic PM&R:

• Teaching is built into the job:
  • Supervising residents and medical students in clinic, inpatient, and consult services
  • Leading didactic lectures, workshops, boards review sessions
  • Providing feedback and evaluations
• You’re also more likely to:
  • Mentor residents on research, QI, and career planning
  • Sit on curriculum committees or program evaluation committees

Private Practice PM&R:

• Teaching is usually:
  • Optional and less formal (e.g., hosting rotating residents, giving occasional talks)
  • Sometimes compensated with modest stipends or reduced clinical quotas, but often not
• Mentorship may be:
  • Focused on junior partners or new associates
  • Centered on clinical and business skills rather than research

If working with learners energizes you and you enjoy explaining complex ideas, academic settings provide structured and consistent teaching opportunities.

Research and Scholarly Activity

Academic PM&R:

• Expectations vary greatly:
  • At heavily research-oriented departments, you may need grant funding, publications, and national presentations to be promoted.
  • At more clinically focused academic centers, “scholarship” may include:
    • Case reports
    • QI projects
    • Educational curricula
    • Book chapters or review articles
• You may get protected time (e.g., 10–40%) for research, especially if you have funding or a defined role.

Private Practice PM&R:

• Research is typically:
  • Minimal or absent, unless you personally seek it out
  • Focused on industry-sponsored trials or practice-based QI projects
• Your primary scholarly outlets may be:
  • Clinical talks at community hospitals
  • Occasional conference presentations
  • Contributions to guideline committees if you stay heavily involved in national societies

If publishing and academic promotion matter to you, or you imagine directing a rehab program or research lab, academic medicine is usually the clearer route.

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Compensation, Lifestyle, and Stability: The Trade-Offs That Matter

Compensation and Earning Trajectory

Private Practice:

• Typically offers higher earning potential, especially in:
  • Procedure-heavy spine and pain practices
  • High-volume EMG clinics
  • Ownership or partnership tracks
• You may see:
  • Productivity-based compensation (RVUs, collections)
  • Opportunities for ancillary income (ASC ownership, imaging, PT, real estate)
• Income can be more variable, depending on:
  • Payer mix
  • Referral patterns
  • Local competition
  • Your own risk tolerance and business acumen

Academic PM&R:

• Base salary is often lower than private practice, particularly early on.
• Compensation is more predictable, with:
  • Stable salary + modest productivity incentives
  • Occasional bonuses for leadership roles or extra call
• Benefits may be stronger:
  • Robust retirement contributions
  • Tuition benefits (for you or family)
  • Comprehensive health and disability insurance
• Long-term, you can boost income via:
  • Leadership roles (program director, department chair, medical director)
  • Additional clinics or moonlighting
  • Consulting or speaking engagements

When comparing offers, look at total compensation and benefits over 3–5 years, not just the starting salary.

Workload, Autonomy, and Scheduling

Academic PM&R:

• Schedule may be more:
  • Structured (e.g., fixed clinics and inpatient blocks)
  • Tied to service needs (call, coverage for teaching services)
  • Subject to institutional rules for holiday coverage and clinics
• Autonomy can be:
  • Limited regarding clinic templates, support staff, and EMR
  • Balanced by strong resources (therapies, subspecialists, case managers)
• Workload includes:
  • Clinical volume
  • Teaching and mentorship
  • Committees and administrative tasks
  • Scholarly output to maintain promotion trajectory

Private Practice:

• Autonomy is often higher in:
  • Choosing clinic hours, templates, and procedural focus
  • Deciding how quickly to grow your panel
• But:
  • Pressure to be productive can be intense
  • Time for documentation and admin tasks may extend beyond clinic hours
• Business considerations:
  • Marketing yourself to referral sources
  • Managing staff, overhead, and compliance (if you’re an owner or partner)

Ask specific questions during interviews:

• “What is the expected number of patients per day?”
• “How is documentation time built into the schedule?”
• “How often are clinics double-booked?”
• “Who controls scheduling templates and support staffing?”

Job Stability and Institutional vs Market Risk

Academic PM&R:

• Institutions are often:
  • Financially diversified (clinical revenue, research grants, philanthropy)
  • More stable through market fluctuations
• But:
  • Budgets can tighten
  • Faculty lines may be frozen
  • Promotions and raises can be slow and bureaucratic

Private Practice PM&R:

• The practice’s success is tied to:
  • Local market dynamics
  • Referral relationships
  • Regulatory and reimbursement changes
• Joining an established, well-run group can feel very stable.
• Starting or joining a younger or high-growth group can be lucrative but carries more risk.

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Career Growth, Identity, and Long-Term Flexibility

The decision between academic and private practice is not necessarily permanent. Physiatrists often move between settings over their career. Still, each path tends to shape your professional identity and options.

Academic Medicine Career Trajectory in PM&R

Common long-term roles:

• Program Director or Associate PD
• Division Chief (e.g., inpatient rehab, sports & spine, SCI, TBI)
• Department Chair or Vice Chair
• Research Director or Center Director (e.g., SCI model system)
• Medical Director of rehab units or specialty clinics

Academic careers reward:

• Scholarly productivity and national presence
• Contributions to education and mentorship
• Committee and leadership service at institutional and national levels

Promotion milestones (Instructor → Assistant Professor → Associate Professor → Professor) vary by institution, but often rely on:

• Peer-reviewed publications
• Invited talks
• Teaching evaluations
• Leadership roles
• Letters from external academic leaders

For a DO graduate, building a strong national profile in PM&R societies (AAPM&R, AAP, subspecialty societies) is particularly valuable for promotion and recognition.

Private Practice Career Path in PM&R

Long-term options may include:

• Partner or shareholder in a group practice
• Medical Director of a rehab hospital or SNF network
• Leadership in multispecialty or orthopedic groups
• Development of specialty service lines (interventional spine, EMG, amputee clinic)
• Ownership of or investment in:
  • Ambulatory surgery centers
  • Imaging centers
  • Physical therapy services

Private practice careers reward:

• Clinical reputation and referral relationships
• Efficiency, patient satisfaction, and outcomes
• Skillful business management and adaptability

You can still engage nationally through:

• Society leadership
• Guideline committees
• Course faculty roles at conferences

Switching Between Academic and Private Settings

It’s not uncommon to:

• Start in academic PM&R, then transition to private practice for:
  • Higher income
  • Geographic preferences
  • Lifestyle flexibility
• Start in private practice, then move into academics when:
  • You miss teaching
  • You want to reduce business responsibilities
  • You aim for leadership or subspecialty roles

To preserve flexibility:

• Maintain board certification and consider subspecialty certification (sports, pain, SCI, brain injury, pediatric rehab).
• Stay active in national societies.
• Keep some level of ongoing scholarly or educational engagement, even if minimal.

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How to Choose: A Stepwise Framework for DO Physiatrists

With so many variables, how do you actually decide? Use this structured approach.

Step 1: Clarify Your Personal Priorities

Rank the following (high/medium/low importance):

• Teaching and mentorship
• Research and scholarship
• Income potential
• Schedule predictability
• Geographic preference
• Procedural focus (e.g., injections, EMG, interventional spine)
• Complex inpatient vs outpatient focus
• Desire for leadership roles
• Comfort with business and financial risk
• Interest in a long-term academic vs entrepreneurial identity

Be honest about what matters both now (early career) and in 10 years.

Step 2: Map Priorities to Practice Type

In general:

• If teaching, scholarship, complex pathology, and institutional leadership are high-priority → Academic PM&R fits well.
• If higher income, procedural focus, autonomy, and entrepreneurial opportunities matter most → Private practice is likely better.

But remember the nuance:

• Academic departments can vary from research-heavy to near-community-style practices.
• Private groups can vary from high-volume, high-pressure to moderate-paced, lifestyle-focused.

Step 3: Use Residency and Fellowship to Test-Drive Settings

During residency or fellowship:

• Seek electives in:
  • Academic subspecialty services
  • Private outpatient spine/pain groups
  • VA and rehab hospitals
• Ask attendings candid questions:
  • “What do you like most/least about your job?”
  • “If you could redo your early career, what would you change?”
  • “How has your compensation and workload evolved?”

Keep a simple journal of:

• Work environments where you felt most engaged
• Tasks that drained you vs energized you
• How you responded to different expectations (RVU targets vs academic metrics)

Step 4: Analyze Specific Job Offers in Detail

When comparing offers:

1. Clinical Workload

   • Patient volume
   • Inpatient vs outpatient mix
   • Procedures available and supported

2. Academic Expectations (if applicable)

   • Required teaching, committees, research
   • Promotion criteria and timeline
   • Protected time and mentorship

3. Compensation Model

   • Base salary
   • RVU or collection-based incentives
   • Benefits (retirement, insurance, CME, loan repayment)

4. Culture and Support

   • Collegiality and turnover
   • Support staff quality
   • EMR and process efficiency
   • Leadership transparency and responsiveness

5. Growth and Exit Options

   • Partnership path in private practice
   • Leadership opportunities in academics
   • Flexibility to modify your role over time

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FAQs: Academic vs Private Practice for DO PM&R Graduates

1. As a DO, am I at a disadvantage for an academic PM&R career compared to MDs?

No, many DO physiatrists have successful academic careers, including leadership roles. What matters most is your training quality, scholarly output, teaching skills, and national involvement. To strengthen your academic profile:

• Seek research and QI projects in residency
• Present at national PM&R meetings
• Pursue fellowship if you want a subspecialty academic niche
• Build mentoring relationships with academic faculty who can advocate for you

Your DO degree does not inherently limit academic opportunities, especially in a specialty like PM&R that values holistic, functional care.

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2. Is it easier to move from academics to private practice, or from private practice to academics in PM&R?

It is typically easier to move from academics to private practice than the other way around. Academic roles help you build:

• A record of teaching and scholarship
• Connections with national leaders
• Exposure to complex cases

Transitioning into private practice mostly requires strong clinical skills, work ethic, and adaptability to a productivity-based environment.

Moving from private practice into academia later is possible, but more challenging if you:

• Lack recent publications or scholarly work
• Have minimal teaching experience
• Are not active in national societies

If you might want academia later, keep a small thread of academic or society involvement even while in private practice.

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3. Does academic PM&R always pay significantly less than private practice?

Not always, but on average, private practice opportunities—especially in procedure-heavy areas like spine and pain—tend to offer higher compensation, particularly at peak career.

However:

• Some academic systems offer competitive salaries, especially in high cost-of-living regions or for in-demand subspecialties.
• Total value includes benefits, loan repayment, retirement contributions, and job security.
• An academic role with additional medical directorships, leadership stipends, or moonlighting may significantly narrow the income gap.

Evaluate each offer individually and consider your desired lifestyle, risk tolerance, and non-monetary priorities.

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4. If I’m undecided, what’s a good first job choice after PM&R residency?

If you’re truly unsure between academic vs private practice:

• Consider a clinically focused academic job or a large hospital-employed position that:
  • Offers exposure to residents or students
  • Has some opportunity for minor scholarly work or QI
  • Still maintains strong outpatient or procedural components
• Alternatively, a reputable, well-structured private group with:
  • Mentorship from senior physiatrists
  • Reasonable RVU targets
  • Balanced lifestyle expectations

Focus on a first job that provides:

• A supportive environment
• Strong clinical growth
• Flexibility to adjust your focus (more teaching, more procedures, etc.) as you learn more about what you value.

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Choosing between an academic medicine career and private practice as a DO graduate in Physical Medicine & Rehabilitation isn’t about finding the “better” path—it’s about matching your personality, values, and long-term goals with the right environment.

Use your residency years, mentors, and concrete job offers as data points. Revisit your priorities periodically. And remember: your PM&R career can evolve across settings over decades. The most important thing is to start in a role that supports your growth, protects your well-being, and keeps the door open to the kind of physiatrist you ultimately want to become.