Essential Job Search Timing Guide for MD Graduates in PM&R Residency

Understanding the Job Search Timing Landscape in PM&R

For an MD graduate in Physical Medicine & Rehabilitation (PM&R), the question is not if you will find a job—it’s when and how strategically you should start looking. The physician job market for physiatrists is generally strong and growing, but timing your search well can mean the difference between:

• Taking the first job that says yes, and
• Choosing between several well‑negotiated offers aligned with your interests and lifestyle.

As you transition from allopathic medical school match and residency into the next phase of your career, it helps to think of your job search as a staged process that begins 18–24 months before graduation and continues through your first contract signing.

In this article, we’ll walk through:

• When to start your job search as a PM&R resident
• How the timeline differs by setting (academic vs private vs hospital-employed)
• Key milestones from PGY-2 through graduation
• How to align fellowships with your job planning
• Practical steps, examples, and a FAQ section tailored to the physiatry match graduate entering the workforce

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The Big Picture: When Should a PM&R Resident Start Their Job Search?

The most important timing question you’ll ask is: When to start job search efforts during residency?

For a typical MD graduate in PM&R residency (categorical or advanced), a strong working timeline looks like this:

• PGY-2 (or first year in PM&R if doing prelim)

  • Self-assessment and career exploration
  • Early networking and shadowing subspecialty mentors

• PGY-3

  • Decision on fellowship vs direct-to-practice
  • Focused skills/experiences to match your target job types
  • Begin casual/early conversations with potential employers

• Early PGY-4 (about 18–24 months before graduation)

  • Start formal attending job search for non-fellowship paths
  • Update CV, clarify geographic preferences, contact recruiters

• Mid–Late PGY-4 (12–15 months before graduation)

  • Site visits, formal interviews, narrowing options
  • Start contract negotiations

• 6–9 months before graduation

  • Sign final contract (common window)
  • Initiate credentialing, licensing, and relocation planning

If you’re planning a fellowship, you’ll shift the attending job search approximately one year later, but the conceptual timeline is similar relative to your fellowship graduation date.

The bottom line: For most PM&R residents not pursuing fellowship, you should think of your attending job search as beginning in early PGY-4—not a month before graduation.

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Year-by-Year Strategy: From Residency to First Job

PGY-2: Laying the Foundation (Exploration and Positioning)

Even though you are still working through core rotations, this is where intelligent timing really starts.

Primary goals:

1. Clarify interests within PM&R

   • Inpatient rehab (stroke, TBI, SCI)
   • Outpatient MSK, spine, sports
   • Pain, EMG/neuromuscular, cancer rehab, pedi rehab, etc.
   • Academic vs community vs private group

2. Build relationships and a reputation

   • Identify 2–3 faculty who may later serve as references
   • Ask about their career paths and what they would change about their job search timing
   • Attend departmental or local PM&R society meetings

3. Optimize your training experience

   • Seek rotations that align with high-demand job areas (e.g., spine/MSK, EMG, inpatient neurorehab)
   • Participate in QI projects or teaching that highlight your future career interests

Why this matters for timing:
Understanding early which job types you might want lets you intentionally shape your CV and clinical skills, so that when the attending job search truly starts, your profile fits the roles you want—rather than scrambling to fit the jobs that happen to be open.

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PGY-3: Decide Your Path and Prepare for the Market

PGY-3 is often the pivotal year for MD graduate residency decision-making: fellowship vs straight to practice, and what kind of practice.

1. Fellowship vs Direct to Practice

If considering fellowship (e.g., pain, sports, SCI, pedi rehab, brain injury, neuromuscular):

• Application cycles may start 12–18 months before fellowship start, meaning you’ll decide halfway through PGY-3.
• Your attending job search timing will then be structured around your fellowship completion, not residency completion.
• The same principles apply, just shifted one year later.

If not doing fellowship:

• Begin thinking of your attending job search as starting about 12–18 months before residency end—which falls in late PGY-3 / early PGY-4.
• PGY-3 is the time to clarify:
  • Preferred geography (coasts vs Midwest vs South, urban vs suburban vs rural)
  • Setting (academic center, hospital-employed, multispecialty group, independent PM&R group, VA, rehab hospital)
  • Major clinical focus (inpatient vs outpatient vs mixed)

2. Start Light, Strategic Networking

This is a good time to begin “soft” job search activities without fully entering the market:

• Conferences (AAPM&R, AAP, subspecialty meetings)
  • Attend networking events for residents
  • Introduce yourself to program alumni and ask about their job search timing and experience
• Local/regional PM&R societies
  • Present a poster or case; connect with community physiatrists
• Mentor conversations focused on careers
  • Ask: “If I want to be in [X setting] and [Y location], when should I realistically start my job search?”

You’re not formally applying yet, but you’re gathering market intelligence: where jobs are, what skills are valued, and how early others in that environment typically sign.

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PGY-4: Active Job Search and Contracting

For MD graduates in PM&R who are not doing fellowship, PGY-4 is your main attending job search year.

1. 18–24 Months Before Graduation: Get Organized

This may sound early, but large systems and academic centers often plan positions well in advance.

Key tasks:

• Update your CV

  • Make it clean, 1–2 pages, emphasizing:
    • PM&R residency training details
    • Procedures (injections, EMG, ultrasound, spasticity management, etc.)
    • Leadership, QI, teaching, research

• Draft a basic cover letter template

  • Customizable to different jobs, highlighting:
    • Clinical interests (e.g., inpatient neurorehab + EMG)
    • Geographic ties or reasons for location interest
    • Interest in teaching or program-building

• Clarify “non-negotiables” vs “nice-to-haves”

  • Non-negotiables: region, call expectations, inpatient vs outpatient balance, minimum compensation level
  • Nice-to-haves: academic title, specific niche clinic, schedule flexibility

• Set up job alerts

  • National PM&R job boards (AAPM&R, AANEM, academy websites)
  • Large health system and rehab hospital websites
  • Recruiter databases (be selective; protect your contact info)

At this stage, you’re positioning yourself so that when you see attractive postings, you can respond quickly and professionally.

2. 12–18 Months Before Graduation: Enter the Market Intentionally

This is when your attending job search becomes active.

Typical activities:

• Reach out to recruiters and employers directly
  • Send concise intro emails with your CV and expected graduation date
  • Express interest in specific regions or types of practice
• Respond to job postings selectively
  • Focus on roles that reasonably match your skillset and preferences
• Leverage your network
  • Tell mentors and recent graduates, “I’m starting my job search for positions beginning [month/year]. I’m especially interested in [X] in [Y region].”
  • Ask if they know of upcoming openings not yet posted

Why this timing works:

• Academic centers and VA systems often move more slowly; starting 12–18 months out allows:

  • Departmental budgeting/approval
  • Faculty interviews
  • Institutional HR processes

• Private and hospital-employed positions may be filled 6–12 months before start date, but early outreach lets you:

  • Be on their radar before they formally post
  • Shape a role around your skillset in some cases

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6–12 Months Before Graduation: Interviews and Negotiation

By this stage, you should be engaging in interviews and beginning to see the shape of the job offers you might receive.

Typical sequence:

1. Initial screening (phone/virtual)

   • 20–60 minutes with recruiter, medical director, or department chair
   • Clarify:
     • Practice structure
     • Patient volume/acuity
     • Call responsibilities
     • Salary range and bonus structure

2. On-site interviews and visits

   • Meet partners/colleagues, tour facilities
   • Explore the city/area, assess lifestyle and family considerations
   • Ask detailed questions about:
     • Support staff (PT/OT/SLP, case management, NPs/PAs)
     • EMR, documentation expectations
     • Procedural volume and mentoring for early attendings

3. Offer and contract negotiations

   • PM&R compensation often includes:
     • Base salary + wRVU or collections bonus
     • Signing bonus, relocation assistance, loan repayment in some markets
   • Typical job acceptance window: roughly 6–9 months before your start date
     • Some academic jobs may be signed earlier
     • Some smaller private practices may sign closer to graduation

Remember that credentialing and licensing can take months; employers usually prefer to have you fully signed at least 6 months before your start date.

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How Timing Varies by Job Type in PM&R

Different practice settings in the physician job market have distinct rhythms. Understanding this helps you answer when to start job search efforts for the type of role you want.

1. Academic PM&R Positions

Timing tendencies:

• Often start recruitment 12–24 months before the desired start date
• Longer institutional processes (approval, committees, HR posting, visa issues if relevant)

Implication for you:

• If you want a faculty position, especially in a large academic center:
  • Start actively exploring 18–24 months before your intended start date
  • Attend specialty meetings and introduce yourself to divisional chiefs or program directors
  • Send formal interest emails early, even if there’s no active posting yet

Example:
You are a PGY-3 in October, graduating June two years later, and you’re interested in stroke rehab and resident education at a university program. You might:

• Introduce yourself to the stroke rehab division head at AAPM&R that fall
• Send your CV and a short letter of interest 18 months before graduation
• Interview and finalize a contract 9–12 months before your start date

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2. Hospital-Employed and Rehab Hospital Jobs

These include:

• Positions in inpatient rehab units attached to acute care hospitals
• Jobs with large national rehab hospital chains
• System-employed outpatient PM&R roles

Timing tendencies:

• Many are filled 6–12 months before the start date, though planning can start earlier
• Some systems recruit continuously due to ongoing need

Recommended timing:

• Begin reaching out and responding to postings 12–18 months before graduation, especially if:

  • You have a strong geographic preference
  • You want a very specific inpatient vs outpatient mix

• Expect to:

  • Interview and visit sites 9–12 months before graduation
  • Sign a contract about 6–9 months before your start date

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3. Private Practice and Group PM&R Roles

These can range from:

• Specialty spine or pain groups
• Multispecialty groups employing physiatrists
• Independent PM&R practices handling consults, EMG, or inpatient coverage

Timing tendencies:

• Often more variable and opportunistic
• Some groups recruit 9–12 months out, others 3–6 months before they need someone

Recommended approach:

• Start expressing interest 9–12 months before graduation to groups in your target region
• Cold or warm outreach can be effective:
  • “I’ll be graduating from a PM&R residency in [month/year], and I’m interested in [clinic type] in [city/region]. Are you anticipating any openings or expansion?”
• Be prepared for:
  • Some leads to move very fast
  • Others to stay exploratory until a partner retires or volume increases

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4. VA and Government Positions

The VA healthcare system can be an excellent employer for physiatrists.

Timing tendencies:

• Can have lengthy hiring and credentialing processes
• Positions may open suddenly with retiring staff or funding changes

Timing recommendations:

• Begin exploring and applying 12–18 months before your planned start date
• Expect the timeline from application to final clearance to be slower than private employers

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Balancing Fellowship Planning with Job Search Timing

For many trainees, the path from allopathic medical school match to attending in PM&R includes a fellowship. This has clear implications for job search timing.

If You Are Doing a Fellowship

You generally do not need to sign an attending contract during residency, unless:

• A home institution or employer offers a combined fellowship + attending track
• You are absolutely certain of staying in one location and the offer is particularly strong

More typically:

• Residency: Focus on fellowship applications during PGY-3
• Fellowship year:
  • Begin attending job search early in fellowship, about 12–18 months before you finish fellowship
  • For one-year fellowships, that means you may be starting the attending job search only a few months into your fellowship

Practical example:
You match into a 1-year Sports & Spine fellowship starting July 2027.

• July–September 2027: Get oriented in fellowship
• October–December 2027: Begin attending job search for positions starting August–September 2028
• Early 2028: Interviews and contract negotiations
• Mid–late 2028: Transition to attending role after fellowship

This compressed timeline is important; you cannot afford to delay your attending job search until late in your fellowship.

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Practical Tips to Optimize Your PM&R Job Search

1. Know Your Market Strengths as a Physiatrist

The physician job market for PM&R is relatively favorable due to:

• Aging population and increased demand for rehab and MSK care
• Chronic pain, spine, and sports medicine needs
• Post-acute care expansion, especially following strokes and complex surgeries

Leverage that by highlighting:

• Breadth: inpatient + outpatient competencies
• Depth: specific procedural skills (ultrasound-guided injections, EMG, spasticity management)
• Teamwork: comfort leading interdisciplinary rehab teams

2. Don’t Wait for “The Perfect Posting”

Many of the best PM&R positions, especially in desirable cities, never hit public job boards. Instead:

• Contact groups and departments directly with a short, professional inquiry
• Ask your program’s alumni where they work and whether their groups are expanding
• Use conferences to signal your upcoming availability

3. Use Timing as a Negotiation Tool

If you start your attending job search early enough, you gain:

• Choice: ability to say “no” to poorly structured or under-compensated roles
• Time: space to compare multiple offers
• Leverage: signals that you’re organized and in demand

If you wait too long, you may feel pressured to accept the first decent offer purely due to the calendar.

4. Keep an Organized Timeline

Maintain a simple spreadsheet with:

• Positions you’ve contacted
• Dates of first contact, interviews, and follow-ups
• Salary and benefits details for each opportunity
• Your subjective impressions and deal-breakers

Review this with a trusted mentor who has navigated the physiatry match and early-career transitions.

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FAQs: Job Search Timing for PM&R MD Graduates

1. When should I start my attending job search as a PM&R resident?

For most MD graduates in PM&R not doing fellowship, begin active job search efforts 12–18 months before graduation, which is often early in PGY-4. Academic and VA positions may warrant even earlier outreach, around 18–24 months before your desired start date.

If you are doing a one-year fellowship, start your attending job search 3–6 months into your fellowship, targeting jobs that begin right after you finish.

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2. Is it a problem if I haven’t started looking 12 months before graduation?

Not necessarily, but your options may narrow:

• You’ll be relying more on positions that still happen to be open closer to your graduation date.
• Academic or VA jobs that needed long lead time may no longer be available.

If you’re 9–12 months from graduation and haven’t started, begin immediately:

• Update your CV
• Contact recruiters and employers
• Lean heavily on alumni and faculty connections for leads

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3. How does job search timing differ for academic vs private PM&R positions?

Academic PM&R roles often require more lead time due to institutional processes, so you should:

• Begin outreach 18–24 months before your planned start date
• Be prepared for multiple interviews and committee approvals

Private practice and many hospital-employed roles can have shorter cycles:

• They may hire 6–12 months before the start date or even faster
• Direct outreach and networking can uncover opportunities before they are publicly posted

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4. Should I sign a job contract before I decide about fellowship?

Usually, you should decide about fellowship first, then commit to an attending job. Signing an attending contract and later backing out for fellowship can damage your reputation. If you are seriously considering fellowship:

• Focus on fellowship applications during PGY-3
• Only sign an attending job contract if you are certain you will not pursue additional training or if the employer is clearly aware and supportive of your fellowship plan.

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Timing your job search well as a PM&R MD graduate residency trainee is less about rushing and more about starting early enough to have real choices. By thinking strategically from PGY-2 onward, you can align the physiatry match, residency training, possible fellowship, and your attending job search into a coherent, intentional career path.