How do you know when associates are getting screwed

[thefootfixer]

Hi all

I’m in the process of renegotiating some terms and I’m trying to understand…as an associate, how do you know when you’re being taken advantage of?

What I’m told is, whatever salary you want, should be justified be having a production value of 3x that number (eg. 100k salary should be justified by 300k collections , 200k by 600k etc)..is this true? Some of it doesn’t make sense because my understanding is that overhead for associates is 40%…maybe 50% at the most. So if you’re truly collecting 300k, 50% overhead leaves you with a $150k salary. Is my math or understanding wrong here? With the 3x the salary equation, it seems like 100k is paid to the associate, 100k or so is overhead and 100k or so is pocketed by the owner.

I have colleagues in other fields of medicine who I’ve spoken to and none have been able to explain this logic. Could be because they’re paid via RVU etc.

Just looking for y’all thoughts on here .

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[619]

It has been discussed in several forums here on sdn how unfair the contracts that pod associates have to deal it, not seen in any other medical specialty. Most practices are offering 25-30% "bonus" after 3 times collections. And these are the generous or good offers. Some get as low as 15% after 3x. Either way, the number one rule of any negotiation is the ability to walk away.

So ask yourself; Do you have any job lined up? Do you have other options? Are you willing to walk away from the contract negotiation? If NO then any advice you get is not going to serve you any much purpose. The pod owner is going to do what he/she wants to do in terms of contract renegotiation. Every year, most practice owners in any desirable city or metro area get tons of solicitations from current PGY3 grads looking for jobs and looking to move to the area. Very hard to negotiate with an army of new graduates looking for jobs every year.

Final truth is, No one gets a fair contract as a podiatry associate. Sad but true

 

[heybrother]

Hi all

I’m in the process of renegotiating some terms and I’m trying to understand…as an associate, how do you know when you’re being taken advantage of?

What I’m told is, whatever salary you want, should be justified be having a production value of 3x that number (eg. 100k salary should be justified by 300k collections , 200k by 600k etc)..is this true? Some of it doesn’t make sense because my understanding is that overhead for associates is 40%…maybe 50% at the most. So if you’re truly collecting 300k, 50% overhead leaves you with a $150k salary. Is my math or understanding wrong here? With the 3x the salary equation, it seems like 100k is paid to the associate, 100k or so is overhead and 100k or so is pocketed by the owner.

I have colleagues in other fields of medicine who I’ve spoken to and none have been able to explain this logic. Could be because they’re paid via RVU etc.

Just looking for y’all thoughts on here .

There's a self reinforcing belief amongst the majority of owners that an associate should never keep more than 35% of their collections and probably less than that. Often the structures are even more complicated. You are being screwed, but whether you can do anything about it is another question. MDs and DOs who use % based collections often pay some variation of 40-50% depending on the health of the practice.

The painful truth is that overhead decreases as collections increase assuming expenses stay relatively fixed ie. Once the rent/office manager/lights/nurses etc are paid for. An associate who brings in $400K their first year and $600K their secondary year has likely brought in substantially more money for the owner unless their contract is tiered.

 

[Pronation]

Here’s a simple formula to understand if you’re getting screwed or not:

If you work for another podiatrist you are getting screwed.

 

[Boba Foot]

Every time I hear someone refer to collections percentage as a "bonus", I cringe. It's not even close to a bonus. It is literally a percentage of what you've billed and you've earned it. Even calling it a commission is more accurate, but that sounds super sketchy in medicine.

 

[dtrack22]

Someone go link this on the IPED Facebook group and watch all the practice owners loose their s*** over their preferred associate contract terms which have been detailed above…

 

[wakaflocka88]

Every time I hear someone refer to collections percentage as a "bonus", I cringe. It's not even close to a bonus. It is literally a percentage of what you've billed and you've earned it. Even calling it a commission is more accurate, but that sounds super sketchy in medicine.

Have you see the videos that Lowell Jr posts up. He made one on hiring associates/contract structure 😂

Anyways it’s disheartening an associate is milked for their hard work.

To the OP, I’m sure you’ve learned enough thus far. I’d say job hunt for something better or open shop across the street. You will rarely get a fair shake from a PP owner (some are the exception), despite what APMA says.

 

[Boba Foot]

Have you see the videos that Lowell Jr posts up. He made one on hiring associates/contract structure 😂

Anyways it’s disheartening an associate is milked for their hard work.

To the OP, I’m sure you’ve learned enough thus far. I’d say job hunt for something better or open shop across the street. You will rarely get a fair shake from a PP owner (some are the exception), despite what APMA says.

No idea who this Lowell Jr fellow is.

I had a guy in Houston give me an offer last year though for a straight 30% with no base "because it's the only thing that's fair for both the owner and the associate". He was told to offer that to associates by Hal Ornstein, whom he "learned to open a practice from". So apparently this jabroni thinks that him making ~20% off my work while I make 30% is fair to both of us, while not even nutting up to guarantee a base. Oh, and he also said if I wanted, he knows a guy that can put me in touch with nursing homes to round on during the weekend to help make some extra while I build up a patient base. That was a big HELL NO.

 

[wakaflocka88]

No idea who this Lowell Jr fellow is.

I had a guy in Houston give me an offer last year though for a straight 30% with no base "because it's the only thing that's fair for both the owner and the associate". He was told to offer that to associates by Hal Ornstein, whom he "learned to open a practice from". So apparently this jabroni thinks that him making ~20% off my work while I make 30% is fair to both of us, while not even nutting up to guarantee a base. Oh, and he also said if I wanted, he knows a guy that can put me in touch with nursing homes to round on during the weekend to help make some extra while I build up a patient base. That was a big HELL NO.

Lowell Weil Jr.

 

[air bud]

Someone go link this on the IPED Facebook group and watch all the practice owners loose their s*** over their preferred associate contract terms which have been detailed above…

First thing I thought of when the discussion veered towards self-reinforcing belief amongst current practice owners.

 

[CutsWithFury]

Have you see the videos that Lowell Jr posts up. He made one on hiring associates/contract structure

Anyways it’s disheartening an associate is milked for their hard work.

To the OP, I’m sure you’ve learned enough thus far. I’d say job hunt for something better or open shop across the street. You will rarely get a fair shake from a PP owner (some are the exception), despite what APMA says.

Post the link

 

[deleted1138023]

Lowell Weil Jr.

how much is that practice paying associates? don't they have a million offices

 

[wakaflocka88]

Post the link

It’s a 4 part series. Enjoy.

 

[wakaflocka88]

how much is that practice paying associates? don't they have a million offices

No clue. But I assume their fellowship spends 1 year teaching the intricacy of the Weil osteotomy until they’ve mastered it.

 

[CutsWithFury]

It’s a 4 part series. Enjoy.

This is awful

 

[dtrack22]

This is awful

Every podiatry resident should be forced to watch all 4 videos. Everyone claiming that the information provided here about the average podiatry employment experience is anything less than honest and true, should be forced to watch those videos.

Let’s ignore the fact that his entire argument for hiring associates is to 1) allow you to take more vacations, which he mentions multiple times in every video and 2) to increase revenue for “your” practice.

I want everyone to do one thing. Watch the videos. Then watch them again, and replace the word “associate” with the word “Partner.” Now ask yourself some questions. Why does he never say the word “partner” in any of the videos? Does a partner offer the same “benefits” to your practice (more vacation, call coverage, shared responsibilities in patient care, more revenue, more services offered, expanded locations, etc.)? Doesn’t the word “partner” fit just as well as “associate” in most instances? So why choose one over the other? What is the biggest difference between the two?

It’s clear that associates are nothing more than permanent labor who allow you to take vacations and make more money. More akin to MAs than colleagues or partners.

But hey, he validated what people have been saying here for years. The “market will bear” compensation for an associate somewhere between 25-35% of collections. To those naysayers who came and went (boy their shelf life was short), I told you so. And Lowell Weil Jr confirmed it.

 

[wakaflocka88]

Every podiatry resident should be forced to watch all 4 videos. Everyone claiming that the information provided here about the average podiatry employment experience is anything less than honest and true, should be forced to watch those videos.

Let’s ignore the fact that his entire argument for hiring associates is to 1) allow you to take more vacations, which he mentions multiple times in every video and 2) to increase revenue for “your” practice.

I want everyone to do one thing. Watch the videos. Then watch them again, and replace the word “associate” with the word “Partner.” Now ask yourself some questions. Why does he never say the word “partner” in any of the videos? Does a partner offer the same “benefits” to your practice (more vacation, call coverage, shared responsibilities in patient care, more revenue, more services offered, expanded locations, etc.)? Doesn’t the word “partner” fit just as well as “associate” in most instances? So why choose one over the other? What is the biggest difference between the two?

It’s clear that associates are nothing more than permanent labor who allow you to take vacations and make more money. More akin to MAs than colleagues or partners.

But hey, he validated what people have been saying here for years. The “market will bear” compensation for an associate somewhere between 25-35% of collections. To those naysayers who came and went (boy their shelf life was short), I told you so. And Lowell Weil Jr confirmed it.

It’s sad TFPs listen to his garbage and then implement. You’re right - the naysayers have been pretty quiet. Maybe they’re busy chatting it up with Jr on another 4 part series, maybe incorporate some of your ideas too.

 

[Pronation]

Where’s that one guy who designed a super cool brace marketed towards TFPs who’s flabbergasted about why pod school admissions are down?

 

[shadesofgrey]

Every podiatry resident should be forced to watch all 4 videos. Everyone claiming that the information provided here about the average podiatry employment experience is anything less than honest and true, should be forced to watch those videos.

Let’s ignore the fact that his entire argument for hiring associates is to 1) allow you to take more vacations, which he mentions multiple times in every video and 2) to increase revenue for “your” practice.

I want everyone to do one thing. Watch the videos. Then watch them again, and replace the word “associate” with the word “Partner.” Now ask yourself some questions. Why does he never say the word “partner” in any of the videos? Does a partner offer the same “benefits” to your practice (more vacation, call coverage, shared responsibilities in patient care, more revenue, more services offered, expanded locations, etc.)? Doesn’t the word “partner” fit just as well as “associate” in most instances? So why choose one over the other? What is the biggest difference between the two?

It’s clear that associates are nothing more than permanent labor who allow you to take vacations and make more money. More akin to MAs than colleagues or partners.

But hey, he validated what people have been saying here for years. The “market will bear” compensation for an associate somewhere between 25-35% of collections. To those naysayers who came and went (boy their shelf life was short), I told you so. And Lowell Weil Jr confirmed it.

I did not watch the videos, always came off sounding to much like a televangelist for me.

However, his supergroup tried to buy our practice a few years ago. If I recall, a buy in for associates to partnership was considered after 3+ years of 800k in collections per year. They also ensured us that one of the benefits of the centralized scheduler was to ensure that Medicaid patients went to the associate first.

 

[icebreaker32]

Words matter, but I am less upset at what this profession says then what it does. Nothing wrong with an owner wanting to take a vacation or make some profit.

Here are are a few major issues I have.

1. Being honest about the job and potential for partnership.

2. If the practice is very successful and the owner is very well off, they should pay at least 150K and good benefits and take a risk on the front side and not just offer 30%.

3. It is just wrong to create clinics in poor areas that do not receive federal funding and staff them with podiatrists as they will never be able to earn a livable salary, especially with the owner skimming money off the top.

4. If you are into shady ways of making money, do not teach this to others. Pushing the limits of what is allowed is different and that is not what I am talking about.

5. Don’t hire an associate, because you think you might be busy enough for one. Either you will subsidize them for a couple years if necessary or wait a bit longer.

If you are straight forward and offering anything above 120K, even with few benefits it is sadly a good first job in this profession.

As for about every other issue in this profession the fix……..cut the number of graduating podiatrists in half. Might happen on its own, but it is unrealistic to think the schools can do it. The profession could do something not only to cap enrollment to residencies, but be aggressive about shutting down more when not filled and be very, very selective on allowing new ones to open. More residencies could voluntarily drop a position etc. They could stop new schools from opening unless they close existing schools or reduce seats at other schools.

70 years ago a new MD would reply to an add, and be hired as an associate and would only be busy enough to see 5 patients a day, while the owner was busy Then the associate doctor would move a year or two later, open their own practice and be busy. Then what happened…..the explosion of medicine as big business with health insurance and this disappeared.

Podiatry might get there in another 70 years.

 

[HaimFeldman]

If you're browsing PMnews for new job listings, and something like this one pops up, run far far away:

 

[CutsWithFury]

If you're browsing PMnews for new job listings, and something like this one pops up, run far far away:

View attachment 360799

This guy goes through associates every couple of years. There’s a group in Delaware that changes associates almost on a yearly basis.

 

[PMG03470]

If you're browsing PMnews for new job listings, and something like this one pops up, run far far away:

View attachment 360799

I almost posted this here myself… what the absolute F***

He is asking for bottom of the barrel residency graduate that really should have never been admitted to Pod school in the first place

 

[CutsWithFury]

I almost posted this here myself… what the absolute F***

He is asking for bottom of the barrel residency graduate that really should have never been admitted to Pod school in the first place

Easier to manipulate and take advantage of for a year until they finally figure it out

 

[thefootfixer]

So it seems like the general consensus here is to expect to get screwed as an associate…especially in the first couple years and work/focus on getting your own practice up and going . I’ll probably have to weigh out the pros and cons of this but I think I’d be ok taking less money and being owner at some point than taking a slightly higher pay and be a workhorse disposable pawn of an associate 🤨

 

[CutsWithFury]

So it seems like the general consensus here is to expect to get screwed as an associate…especially in the first couple years and work/focus on getting your own practice up and going . I’ll probably have to weigh out the pros and cons of this but I think I’d be ok taking less money and being owner at some point than taking a slightly higher pay and be a workhorse disposable pawn of an associate 🤨

If you have already figured it out you are ahead of the game.

 

[bloxxeeey]

If you have already figured it out you are ahead of the game.

Realistically would I make more seeing 15-20 patients a day in my own practice than a typically associate?

 

[thefootfixer]

Realistically would I make more seeing 15-20 patients a day in my own practice than a typically associate?

Well with a new practice it’s probably more like 5-6 patients a day

 

[Pronation]

Realistically would I make more seeing 15-20 patients a day in my own practice than a typically associate?

If you run your practice horribly with >60% overhead then you will bring home about $200k at 15-20 patients per day. If you can run your practice efficiently then you can bring home somewhere in the mid to upper 200s with that patient load. As an associate, some slimy older pod is going to skim off about $100k per year of your profits.

 

[619]

Realistically would I make more seeing 15-20 patients a day in my own practice than a typically associate?

You will make more seeing 10 patients a day working in your own practice than seeing 30 patients a day working for someone else.

 

[thefootfixer]

You will make more seeing 10 patients a day working in your own practice than seeing 30 patients a day working for someone else.

In that retrospect is quality preferred over quantity ?

 

[Pronation]

In that retrospect is quality preferred over quantity ?

No no, definitely you want to prioritize profits over patient care. What do you think this is, Canada or something?

 

[619]

In that retrospect is quality preferred over quantity ?

Yes yes. Most folks in PP seeing 30 patients or more are getting their schedules filled with routine nail care or medicaid and state insurances that pays crap. There is no reason to be seeing 30 patients a day as a specialists. 18-20 is my sweet spot. 24 is getting too much except if it is a holiday week.

 

[hockeyfan5110786]

If you run your practice horribly with >60% overhead then you will bring home about $200k at 15-20 patients per day. If you can run your practice efficiently then you can bring home somewhere in the mid to upper 200s with that patient load. As an associate, some slimy older pod is going to skim off about $100k per year of your profits.

that seems high, 200k with seeing 20 patients day? Is that 100$ per patient and no days off?

 

[619]

that seems high, 200k with seeing 20 patients day? Is that 100$ per patient and no days off?

Too many variables to get any accurate answer. Insurance mix and reimbursement plays the biggest role. The whole system is a mess

 

[Pronation]

that seems high, 200k with seeing 20 patients day? Is that 100$ per patient and no days off?

Average revenue per visit should be between $180-250, depending on how well you bill, dispense DME, and optionally peddle custom orthotic. Even if you are terrible at billing and just do straight office visits with just CPT codes for matrixectomies and joint injections, then you should still be cruising at minimum average $140 RPV. 20 patients per day making $200k is a 4 day work week, with a few weeks of vacation too...

 

[dtrack22]

that seems high, 200k with seeing 20 patients day? Is that 100$ per patient and no days off?

20 patients per day, 4 days per week, 48 weeks out of the year, $130 PPV…$499k in collections. If overhead is 40% you’re grossing $300k. If overhead is 50%, $250k.

$100 per patient (or encounter, really) is low.

 

[hockeyfan5110786]

Average revenue per visit should be between $180-250, depending on how well you bill, dispense DME, and optionally peddle custom orthotic. Even if you are terrible at billing and just do straight office visits with just CPT codes for matrixectomies and joint injections, then you should still be cruising at minimum average $140 RPV. 20 patients per day making $200k is a 4 day work week, with a few weeks of vacation too...

if you are following up on a plantar fasciitis patient, can you still bill for the 99213 code and a procedure code? Is there a rule saying you cant bill for procedure code and patient visit code?

 

[hockeyfan5110786]

20 patients per day, 4 days per week, 48 weeks out of the year, $130 PPV…$499k in collections. If overhead is 40% you’re grossing $300k. If overhead is 50%, $250k.

$100 per patient (or encounter, really) is low

what if most of my patients will be HMO?

 

[Pronation]

if you are following up on a plantar fasciitis patient, can you still bill for the 99213 code and a procedure code? Is there a rule saying you cant bill for procedure code and patient visit code?

They almost always have something else going on beyond PF. Planus, cavus, gastroc equinus, "oh doc what about my thick toenails?" something. If you just bill another PF code with another injection then yes, your established office visit code will probably get thrown out. There's the difference between a pod cruising at $140 RPV vs $200RPV.

 

[Pronation]

what if most of my patients will be HMO?

This one is a no-brainer. Get the practice rolling and after 1 year hire an associate for $80k to see patients with garbage insurance.

 

[hockeyfan5110786]

They almost always have something else going on beyond PF. Planus, cavus, gastroc equinus, "oh doc what about my thick toenails?" something. If you just bill another PF code with another injection then yes, your established office visit code will probably get thrown out. There's the difference between a pod cruising at $140 RPV vs $200RPV.

what if you documented plantar fasciitis, pes planus, equinus all in the first visit, gave injection, DME, xray.
so if they come back and need another injection, then still cant do patient encounter and procedure code?

 

[Pronation]

what if you documented plantar fasciitis, pes planus, equinus all in the first visit, gave injection, DME, xray.
so if they come back and need another injection, then still cant do patient encounter and procedure code?

what if you put some on sensual music and then massaged lotion on their feet and legs? can you ask them to pay money for that?

 

[HardRoadPaved]

what if you put some on sensual music and then massaged lotion on their feet and legs? can you ask them to pay money for that?

you need an ABN for that too

and dont even think about whirlpool...

"Limitations- Whirlpool treatment prior to the debridement of mycotic nails to soften the nails or the skin is not eligible for separate reimbursement."

 

[wakaflocka88]

you need an ABN for that too

and dont even think about whirlpool...

"Limitations- Whirlpool treatment prior to the debridement of mycotic nails to soften the nails or the skin is not eligible for separate reimbursement."

But why do TFPs still do it. They even advertise it on social media.

 

[icebreaker32]

But why do TFPs still do it. They even advertise it on social media.

Most have not billed for it in years. They do it because it brings in patients. Many will be happy to come in every 61 days for their medical spa pedicure.

Just how much money you can make on those patients is up for debate.

Will you be booked full with this and no space for other patients?

Will your nurse. or underpaid associate see the patients or will you?

If you see them, will you find enough other legitimate pathology, sell surgery, bill very creatively or sell non insurance covered supplies and services to up your profit?

Many older podiatrists believed if you take care of grandma you will get the whole family as patients. Is this true or are you just getting grandma's bunco friends ?

 

[GreenHousePub]

They almost always have something else going on beyond PF. Planus, cavus, gastroc equinus, "oh doc what about my thick toenails?" something. If you just bill another PF code with another injection then yes, your established office visit code will probably get thrown out. There's the difference between a pod cruising at $140 RPV vs $200RPV.

You are guaranteed to be audited frequently using this method.

Also your patients who pay deductibles based on how much you bill are going to absolutely hate you.

 

[Pronation]

You are guaranteed to be audited frequently using this method.

Also your patients who pay deductibles based on how much you bill are going to absolutely hate you.

I figured it was gonna be all the level 4 visits that I’m pumping out that would’ve gotten me audited.

 

[Utvolsdpm]

I figured it was gonna be all the level 4 visits that I’m pumping out that would’ve gotten me audited.

That should be one of those podiatry memes -
Multiple complaints addressed? - audit
In office procedure? - audit
Everything by the book? - believe it or not, also audit

Someone else can probably make it better but you get the idea

 

[air bud]

That should be one of those podiatry memes -
Multiple complaints addressed? - audit
In office procedure? - audit
Everything by the book? - believe it or not, also audit

Someone else can probably make it better but you get the idea

Podiatry Patrol is on the case!