Cross posted in the PM&R thread:
There is a lot of overlap in the treatment of MSK conditions. In general, physiatrists just out of training are likely to be more advanced than primary care docs due to extensive MSK training in residency. But over time primary care sports docs' MSK skills do equal out with the exception of the spine. Physiatrists are usually superior in managing spine conditions in general and spine conditions in athlete. Sports physiatrists can carve out a nice niche in the spinal care of athletes, especially if they do interventions. Primary care sports docs are superior in the primary care management of athletes.
At the highest level of sports coverage, physiatrists in general are at a disadvantage. This is due to many teams and organizations having an orthopaedic surgeon to cover orthopaedic injuries and then someone to care primarily for medical needs of the athletes (ie primary care sports). Of course, there is not always a 100% clear separation of roles as orthopaedic surgeons often have to address medical issues and primary care docs have to address orthopaedic issues. That being said, there are some physiatrists who are team docs in the top leagues in the US. I would say though, that this set up/bias is most prevalent at the major professional level and major D1 level. Beyond that (smaller D1 schools, Olympic sports, combat sports, etc) there is not as much of a bias. There are several physiatrists that are team doctors in high level athletics (for example, the chief medical officer for the USOPC is a physiatrist).
Academically there is near 100% overlap in leadership capabilities. Both can be active faculty in sports fellowship programs. There are PM&R trained docs who are PDs of primary care sports programs. I'm not aware of any primary care docs that are PDs of PM&R based programs though.
Pay wise, physiatrists is general will make more. But this is primarily due to physiatrists being more procedure heavy than primary care sports docs. One thing trainees fail to realize this is that in general, institutions, groups, insurances don't pay physicians different rates for doing the same thing. That is, you just don't show up and say "I'm a physiatrist, pay me more." In general, you are paid for what you do. A primary care doc sports specialist and a sports physiatrist with the same exact patient mix will get paid the same because they would bill the same CPT codes. There may be some subtilities in base pay and incentive/bonus plan with some groups, but in the end it mostly evens out. Ceiling wise, physiatrists have very high pay ceilings because of the ability to bill for higher value CPT codes than primary care sports docs, but this would likely entail having to be very heavily procedure based while leaving less room for true sports medicine care.
care.