Income disparity between Podiatric surgeon and ortho F&A specialist?

[Jumpman26]

Hi all, let me first preface by saying i am not a pod student nor am i pre pod. I am a dental student, but a friend of mine is considering podiatry and asked that post something here. So do forgive me if i say something incorrect! My friend is really attracted to the idea of being a foot and ankle surgeon. To my understanding, you can do this by either going through pod school and then F&A residency, or med school then ortho residency then F&A fellowship. For some reason, it seems the income for the ortho F&As are higher than the pod F&As? Why is this? Arent they doing the exact same procedures?

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[PeaJay]

There are various reasons for the pay disparity. Here are the top two in my experience.

1. Ability to take general ortho call. This drives revenue and thus increases pay.

2. Ability to handle poly trauma. Have a calcaneus fracture and a mid tibia fracture? With a podiatrist you will need an orthopedist to step in to handle the tibial nailing. The FA orthopedic could just handle it all.

 

[heybrother]

The thing you have to keep in mind for all hospital employed doctors is - what is their combined economic value to the hospital. Orthopedists as a group are very valuable. They generate highly profitable services. You would not believe what a hospital can get paid for a total knee. They cover an essential need. When they add a new member they add potentially (a) expertise in something that others didn't want to do ie. knee guys probably don't want to do bunions (b) and they share their call burden. So a F&A ortho may do some of the same procedures a podiatrist does, but they will also take general call. Forget whether the individual procedures they do on call are profitable or not - the call had to be taken, the group wants it divided amongst as many members as possible, and they are going to make the hospital pay them their worth or they are going to leave. Their group bargaining power is substantial. A procedure may generate the same amoutn of RVUs but a hospital in general will pay an orthopedists more per RVU.

 

[dtrack22]

Median wRVU (ie production) is 9,800 for F&A orthos. Median wRVU for podiatrists who do foot and ankle surgery is 5,800. Increased OR utilization tends to lead to higher $/wRVU compensation so they are getting paid more for the same production in virtually every multi specialty group and hospital system that employs the two and pays based on wRVU production. But even if you multiply what podiatrists are getting paid per wRVU, by the difference in total wRVU production…that’s over $200,000 a year in additional compensation. Which makes up a huge chunk of the difference in median pay between the two.

$1000 a day for general ortho call adds up quick and basically makes up the rest.

 

[Jumpman26]

Thanks for the responses guys. What is the likely income of a pod who only practices F&A surgery then?

 

[DexterMorganSK]

Thanks for the responses guys. What is the likely income of a pod who only practices F&A surgery then?

Ask your friend to make an account and search for "DPM salaries" threads (particularly the MGMA #s); this topic has been

 

[Pronation]

Thanks for the responses guys. What is the likely income of a pod who only practices F&A surgery then?

Bout $100k, minimal to no benefits, involves taking free call, lots of driving if practice has multiple locations.

 

[air bud]

Bout $100k, minimal to no benefits, involves taking free call, lots of driving if practice has multiple locations.

Don't forget ridiculous non compete.

 

[Utvolsdpm]

Don't forget ridiculous non compete.

Haha yea the obligatory can’t work within 50 miles of any of the multiple clinic locations for 5 years

 

[Pronation]

Don't forget ridiculous non compete.

Ah yes, how could I forget this little gem. Also the $15k+ that you'll have to pay for tail coverage when you eventually free yourself of working for a podiatry practice.

 

[king22]

Don't forget ridiculous non compete.

Non-compete clauses are practically unenforceable in professional services.

 

[dtrack22]

Non-compete clauses are practically unenforceable in professional services.

This is true. The problem is usually paying for a lawyer and mediation or court costs to fight it when you’ve been paid $100k (or less…) for the past year or two.

 

[king22]

This is true. The problem is usually paying for a lawyer and mediation or court costs to fight it when you’ve been paid $100k (or less…) for the past year or two.

It will never get that far. Most lawyers refuse to take those cases. They're guaranteed losses

 

[dtrack22]

It will never get that far. Most lawyers refuse to take those cases. They're guaranteed losses

I would agree that it is unlikely to get that far in the case of a small podiatry group fighting an associate. But it most certainly can, and has in plenty of states. And the same lawyer who wrote the contract will always take that case. This isn't medical malpractice, they aren't getting a % of a settlement. They are billing hourly and don't give two ****s about wether or not they win or lose. Because even if they lose, it isn't their money that is paying the employee's legal fees, it's their client who has to pony up. The attorneys have absolutely no reason to refuse to file an injunction against the employee. Also, it costs the employer very little to have their attorney file the injunction. The financial burden is immediately shifted to the employee if there is to be a court battle and in most states and most contracts you run the risk of not only being required to pay your own legal fees but that of your employers if the non compete is found to be enforceable. Regardless of wether or not the court "narrows" the scope of the non-compete.

This was highlighted in WA recently when restrictive covenant laws were changed. Now, they were changed for the better as they would not only make most podiatry associate non-competes unenforceable (due to the new wage caps), but even in instances where they are valid, any court ordered changes to a non-compete would punish the employer and force them to cover all legal fees. The latter is a reversal from previous laws where the employer was still considered the prevailing party so long as the non-compete wasn't completely tossed out. This new law highlighted a previous case where a physician fought his medical group's non compete, got it narrowed, but still had to pay his employer's legal fees. It was something like 8 years and covered an entire county. The judge ruled that the non-compete was overly broad, modified it to 2 miles and 4 years, but since it was not thrown out entirely the medical group was considered the prevailing party. Meaning the physician had to pay his previous employer's $200,000 in legal fees.

I've seen a few unreasonable non-competes in podiatry associate contracts. Hell, I had one at one point. They would likely be narrowed by a court. But in the states I practiced they could still be enforced. 10 miles would likely just get shrunk to 2 or 5. 4-5 years might get lessened to 1 or 2. The Indiana supreme court ruled on a case where a podiatrist had a non compete that covered 43 counties...I don't know my Indiana geography but that has to be damn near the whole state. But the court didn't throw out the non compete, they simply narrowed it to the counties in which the podiatrist had actually worked, which was still 3 counties. Not 3 miles. Three entire counties. Luckily he went to work in a neighboring county outside of the ones that remained in his non compete. I was actually offered a job that had a non compete like that, where you would be barred from practicing 5 miles form any of the offices owned by the practice even though you would only ever regularly work at 1-2 of the 6. That was in a state where had I taken the job, left and fought the non compete, had it narrowed to only the offices I worked at (like the Indiana podiatrist), I still would have been on the hook for the podiatry group's legal fees just like the physician in WA noted above.

The best advice is to negotiate down any non compete in states where they are enforceable before signing a contract. If/when that doesn't work, then just assume that there is some time frame and mileage that has been already considered "reasonable" by the courts in that state and make sure said distance isn't likely to affect long term job prospects. Because 1-2 years and 2 miles, for example, could easily be upheld (and has been numerous times) by the courts. Or just get a job in CA, OK, ND, or RI and you really won't have to worry about non competes.

 

[Pronation]

Some of these non compete contracts mentioned above are outrageous. I wonder if any other professions try to pull this crap. In a majority of states, the maximum enforceable restrictive covenant is usually 10-15 miles from the primary working location or within the same county, whichever is greater. Regardless, I would never sign a contract with some absurd non compete as mentioned above. Also I disagree with a lawyer not taking the case; I would not mess around with violating a non compete and then seeing what happens after a painful legal battle.

 

[HardRoadPaved]

I am on the bandwagon against challenging someone's non-compete. Always speak to an attorney before pulling that stuff or else an injunction could really kill you trying to start elsewhere. A vindictive DPM will out of pride sometimes go after you if they felt like they groomed you and you made them feel bad by leaving.

 

[GreenHousePub]

I am on the bandwagon against challenging someone's non-compete.

Nice try, practice owner

 

[Feli]

Non-compete clauses are practically unenforceable in professional services.

This is completely regional... mainly state driven. ^^

Some places, they are highly enforced. Other places, they have no teeth all (CA, etc as mentioned).

In some areas, they can try to basically block you from certain hospitals... most, it's only same/similar practice in X mile radius.

Some places, they don't work vs associates (but will hold up vs group partners who leave).

You can ask around in an area, but in some places, they are quite enforced. I received many calls in Michigan asking me about office locations (for non-compete litigation and new job or office start-up purposes). Those enforced/protected areas tend to be the saturated places and large metros. In other spots, you might get out of it or get it reduced with some litigation, but the business typically has deeper pockets than you and will try to hurt you in that way or delay you until most patients that might leave them for your new office/startup have decided to stay. They can make it painful if they want to spend attorney hours... and even if it is ok'd for you to practice in the radius, they can later go after you for solicitation of patients. The best thing to do is to know your area well going in and not scramble after the firing/quit date.

And yes, as was said, the attorney who wrote up the non-compete for the group's contracts will ALWAYS take the case if that group pays them.