MSG/Hospital jobs

[Homo sapien]

Hello, everyone

I am an associate in a somewhat rural place right now. The job ain't the worst but not the greatest either (i've heard stories). It's ok and for my first job out of residency I'm fine with that. But it's not in a place I see myself staying for more than a few years (I only have my mom here and she don't like it either ) but I was wondering, how does one get these hospital/multispecialty physicians group jobs? Do you just cold call/email everyone and their dog in the region you want to go and see what clicks?

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[HardRoadPaved]

Yep cold call pretty much. Problem with the larger practices like MSG is that you need to know about how you can help them. They pretty much dont know squat about how we generate money so have a prepared speech. Pull in some of your production data.

 

[Pronation]

There‘s so many non-PP opportunities these days that I don’t think you will have any trouble.

As someone who has been out in the real world, I will say that you and your acquaintances got lucky. Without a doubt, more graduating pod residents go into PP as compared to the better options.

 

[HardRoadPaved]

more graduating pod residents go into PP as compared to the better options.

Yea, a lot of worthless great positions out there! Just cold call some offices and ask for the wife practice manager about how they plan to overwork you with BS/call/low pay/chance for partnership or meaningful equity high salary options and working in a strong medical environment treating long toenails complex medical conditions.

 

[heybrother]

My PP job is bringing in a quality control nurse to make me sign consents before injections...

 

[Homo sapien]

Yep cold call pretty much. Problem with the larger practices like MSG is that you need to know about how you can help them. They pretty much dont know squat about how we generate money so have a prepared speech. Pull in some of your production data.

I was planning to maybe do it next year. This is my first year out I'm starting. I was planning to get a whole year and change worth of production data then start hunting. I'm in the Southeast but don't really want to stay exactly where I am. I was thinking somewhere bigger such as Georgia or texas

 

[air bud]

I was planning to maybe do it next year. This is my first year out I'm starting. I was planning to get a whole year and change worth of production data then start hunting. I'm in the Southeast but don't really want to stay exactly where I am. I was thinking somewhere bigger such as Georgia or texas

Production data means nothing. As in what you did in private practice.

 

[DYK343]

There‘s so many non-PP opportunities these days that I don’t think you will have any trouble. I was able to lock in a hospital gig with perks I wont go into in a great location 1 year prior to finishing residency with other options all but telling me to come aboard. I know more prior residents who were able to this than who have gone into PP. Lots of variety in practice set ups. I prefer everything under 1 roof from my office, exam rooms, ORs, no driving etc e.g. hospitalist Podiatry and was able to find that. At 1 point in the process I was iMessaging a hospital CEO. You’d be surprised how accessible the higher ups are. On the flip side you will get plenty of thanks but no thanks. Also for me as a resident looking a year in advance I got tons of “we were looking for someone right now” so being already out will work in your favor. Best of luck

I had a few MSG/Hosp/Ortho jobs lined up before graduation.
If youre flexible on location I agree they are there.
I had a good resume and confidence which helps.

We make a LOT of money for these facilities especially if they own an OR.
With the coming years it will get more and more common to be employed in hospital and MSG setting.

 

[air bud]

Keep the following in mind during your job search and life in general:. Never underestimate how lazy people are.

Pick up the phone.

 

[Homo sapien]

Production data means nothing. As in what you did in private practice.

So, from your standpoint, what does mean something?

And also, are you suggesting we call hospitals directly (which is what I was thinking of), or try to find particular people or what?

 

[DYK343]

So, from your standpoint, what does mean something?

And also, are you suggesting we call hospitals directly (which is what I was thinking of), or try to find particular people or what?

ALmost every hospital has a physician recruiter you can contact off their website.

 

[air bud]

ALmost every hospital has a physician recruiter you can contact off their website.

Small community hospitals, I promise you you can get them on the phone directly. They don't have recruiters.

Plus recruiters are a middle man or woman. A middle person if you will. Talk to the decision maker.

 

[DYK343]

Small community hospitals, I promise you you can get them on the phone directly. They don't have recruiters.

Plus recruiters are a middle man or woman. A middle person if you will. Talk to the decision maker.

Got me some job offers

 

[dtrack22]

Recruiters are fine if they already have podiatry. They go to meetings with admin and can report that they had a podiatrist reach out, but I never felt like they had any pull when it came to creating podiatry positions at a hospital who didn’t have it and/or wasn’t looking for it.

I would go straight to COO or CEO if it’s a facility without podiatry. I found these folks surprisingly accessible and responsive.

 

[air bud]

also - my first time around looking for jobs I said "nah, a town under 10k people doesn't need a podiatrist." WRONG. If there is a hospital there call it. I have now been hired in 2 areas where the "population" was under 10k - one MSG/Hospital and one ortho.

HINT - Each state has a website that lists all the hospitals in the state.

For the record, I prefer bottles of bourbon (cask/barrel strength encouraged) instead of likes.

 

[Feli]

Good advice above...

You absolutely can get hospital/group jobs in rural areas with cold calling and trying to create a position. Like any job, it will help significantly if you are already in that state so they know you have a license, are on some of the payers, and are serious. As was mentioned, your PP productivity means little to a hospital... the RVU game is quite different, so just emphasize that you have good training and do a lot of procedures, you would generate imaging and labs, etc. If it is a rural IHS, you can skip all of that also... they are generally not too good at making money and don't need to be, they just value reasonable skill and highly value potential long term docs.

In the metros, it's usually much tougher. The vast majority of those hospital/MSG jobs are just passed around within networks of residencies/friends/etc and never advertised. A lot of the ones you do see advertised might not even be truly available (but send your CV and call the next week anyways). Sometimes they will just be posted as a formality where they have to interview 3 people, have to post it even if they know who they want all along, etc. For those ones, it never hurts to talk to HR (if hospital or large group) or manager (smaller groups). Even a lot of the VA jobs are getting fairly competitive... most used to have quite a bit of trouble getting/keeping even average DPMs due to pay, but they now get a lot of apps also since the pay got more towards average and benefits are good.

As was said, luckily, hospital/MSG jobs for pods are getting more and more common. Ortho jobs are also. It's a training thing, but it is also just a trailblazer thing where people have to keep knocking and knocking.... and future grads benefit. GL

 

[air bud]

Good advice above...

You absolutely can get hospital/group jobs in rural areas with cold calling and trying to create a position. Like any job, it will help significantly if you are already in that state so they know you have a license, are on some of the payers, and are serious. As was mentioned, your PP productivity means little to a hospital... the RVU game is quite different, so just emphasize that you have good training and do a lot of procedures, you would generate imaging and labs, etc. If it is a rural IHS, you can skip all of that also... they are generally not too good at making money and don't need to be, they just value reasonable skill and highly value potential long term docs.

In the metros, it's usually much tougher. The vast majority of those hospital/MSG jobs are just passed around within networks of residencies/friends/etc and never advertised. A lot of the ones you do see advertised might not even be truly available (but send your CV and call the next week anyways). Sometimes they will just be posted as a formality where they have to interview 3 people, have to post it even if they know who they want all along, etc. For those ones, it never hurts to talk to HR (if hospital or large group) or manager (smaller groups). Even a lot of the VA jobs are getting fairly competitive... most used to have quite a bit of trouble getting/keeping even average DPMs due to pay, but they now get a lot of apps also since the pay got more towards average and benefits are good.

As was said, luckily, hospital/MSG jobs for pods are getting more and more common. Ortho jobs are also. It's a training thing, but it is also just a trailblazer thing where people have to keep knocking and knocking.... and future grads benefit. GL

To comment on the having a state license thing....there was one job that I applied for a year or so ago that on paper sounded pretty amazing. Hundred plus applicants. 15 or so phone interviews, then 5 or 6 2nd interview with doc. I felt good, recruiter told me basically at top of list. Well stuff happened, the doc had to take a leave of absence and they needed someone ASAP. So they hired a guy who already had a state license so he could start right away (this state had a lengthy process). Also a great candidate don't get me wrong. But they cancelled the in person interviews and hired this dude.

So if easy to get state license and have interview set up with someone, having a license up and ready to go is not a bad idea to help expedite the potential process, but also helps show seriousness of intent.

 

[NobodyDPM]

also - my first time around looking for jobs I said "nah, a town under 10k people doesn't need a podiatrist." WRONG. If there is a hospital there call it. I have now been hired in 2 areas where the "population" was under 10k - one MSG/Hospital and one ortho.

HINT - Each state has a website that lists all the hospitals in the state.

For the record, I prefer bottles of bourbon (cask/barrel strength encouraged) instead of likes.

You can't just throw that out there without telling us what kind of Bourbon you prefer. Pfft...we don't want to send you crap, you know.

 

[air bud]

You can't just throw that out there without telling us what kind of Bourbon you prefer. Pfft...we don't want to send you crap, you know.

BTAC is a good start...but these days there isn't a lot of barrel strenght/cask strength junk out there. Lots of small independent places making small batch stuff that is BIB or young and not great. But if you are bottling at cask strength, probably have made some good stuff already.

Also, to copy a facebook request I have out there...want to find a bottle of ECBP c920. Will trade a Stagg Jr. batch 15 for it.

 

[NobodyDPM]

BTAC is a good start...but these days there isn't a lot of barrel strenght/cask strength junk out there. Lots of small independent places making small batch stuff that is BIB or young and not great. But if you are bottling at cask strength, probably have made some good stuff already.

Also, to copy a facebook request I have out there...want to find a bottle of ECBP c920. Will trade a Stagg Jr. batch 15 for it.

Wow, the BTAC sounds amazing. May have to seek that out. Thanks!

 

[air bud]

Wow, the BTAC sounds amazing. May have to seek that out. Thanks!

Yeah it doesn't work like that....more like if you want some of that lineup you pay 1500 bucks for a 100 dollar bottle. Or have a buddy who works at the store and can get it for you....after you pay him 500 bucks.

 

[NobodyDPM]

Yeah it doesn't work like that....more like if you want some of that lineup you pay 1500 bucks for a 100 dollar bottle. Or have a buddy who works at the store and can get it for you....after you pay him 500 bucks.

YOLO, brother. If it's a passion, make it happen!

 

[Feli]

To comment on the having a state license thing....

Yeah, it's pretty important. It is consistently amazing to me how many places prefer or won't even consider a candidate who doesn't have that state's license yet. That is semi-understandable in NC and a few other states where the license is harder to get or only offered once or twice per year, but in most places, it's not a huge deal and shouldn't rule out otherwise strong candidates (if it were my hire decision). In reality, though, somebody with a GA license or whatever will almost always be much more desired in interviews for a Savannah, GA hospital job than a similar/better trained candidate who only has FL or PA license at the app/interview time (even though they could easily get GA fairly soon). It is just a really easy way to prove to the interviewer that you're serious and ready to roll. I guess they like to weed out most of the out-of-state people (esp residents) who are just fishing around and applying to dozens and dozens of jobs. I dunno.

In most states, they can start you in the office as soon as you get a license (usually about 2-4 months after you apply) and then just hold your billing and wait on hospital/OR stuff until you're on payers and hospitals (another ~3mo after that license, but variable by area/facilities). I think a lot of places who are hiring just have fairly unrealistic timeline from hire to start date to collecting for a DPM's services (or MD, DMD, etc). Some rule out residents, even ones who have that state license already or in process, who are 6+ months from graduation when they probably shouldn't for the same reason of "couldn't start until next summer." In reality, getting onto the payers would take almost that long regardless. Still, they are the ones driving the interviews/hire, so it's their rules. They prefer state license and definitely prefer already on the state/area payers. I always suggest DPMs (esp ones with sizable CME/boards/license allowance) collect state licenses and don't let them expire unless they are costly or they're almost certain they'll never return to that locality. If you just have one state, you are somewhat limited to that one or VA/IHS stuff... and that's never ideal, no matter how secure/great your job seems at the time.

 

[NobodyDPM]

Yeah, it's pretty important. It is consistently amazing to me how many places prefer or won't even consider a candidate who doesn't have that state's license yet. That is semi-understandable in NC and a few other states where the license is harder to get or only offered once or twice per year, but in most places, it's not a huge deal and shouldn't rule out otherwise strong candidates (if it were my hire decision). In reality, though, somebody with a GA license or whatever will almost always be much more desired in interviews for a Savannah, GA hospital job than a similar/better trained candidate who only has FL or PA license at the app/interview time (even though they could easily get GA fairly soon). It is just a really easy way to prove to the interviewer that you're serious and ready to roll. I guess they like to weed out most of the out-of-state people (esp residents) who are just fishing around and applying to dozens and dozens of jobs. I dunno.

In most states, they can start you in the office as soon as you get a license (usually about 2-4 months after you apply) and then just hold your billing and wait on hospital/OR stuff until you're on payers and hospitals (another ~3mo after that license, but variable by area/facilities). I think a lot of places who are hiring just have fairly unrealistic timeline from hire to start date to collecting for a DPM's services (or MD, DMD, etc). Some rule out residents, even ones who have that state license already or in process, who are 6+ months from graduation when they probably shouldn't for the same reason of "couldn't start until next summer." In reality, getting onto the payers would take almost that long regardless. Still, they are the ones driving the interviews/hire, so it's their rules. They prefer state license and definitely prefer already on the state/area payers. I always suggest DPMs (esp ones with sizable CME/boards/license allowance) collect state licenses and don't let them expire unless they are costly or they're almost certain they'll never return to that locality. If you just have one state, you are limited to that or VA/IHS stuff... and that's never ideal, no matter how secure/great your job seems at the time.

The only issue with this, is that if you are presently employed, and your employer gets a request for any information from another state for licensure purposes, the employer can get miffed and start questioning your employment with them. In "At Will Employment" states, that could become a serious problem for the employee. Sometimes, it is walking on egg shells in this type of situation, but ultimately, do what's best for YOU.

 

[Scrantonicity]

The only issue with this, is that if you are presently employed, and your employer gets a request for any information from another state for licensure purposes, the employer can get miffed and start questioning your employment with them. In "At Will Employment" states, that could become a serious problem for the employee. Sometimes, it is walking on egg shells in this type of situation, but ultimately, do what's best for YOU.

Instead of miffed, I would think the current employer would be worried/scared. Maybe worried enough to improve the way they're treating you so you'll consider staying!

 

[Pronation]

Instead of miffed, I would think the current employer would be worried/scared. Maybe worried enough to improve the way they're treating you so you'll consider staying!

I'm sure they'll take your feelings into strong consideration as they sift through the other 200 applications for your position.

 

[CutsWithFury]

I'm sure they'll take your feelings into strong consideration as they sift through the other 200 applications for your position.

100%

Hospital employed podiatrists are grossly underpaid for what they bring to the hospital. Especially if the podiatrist is comfortable doing toes to TARs as well as diabetic limb salvage, wounds and charcot. It ends up being SIGNIFICANT volume.

I generate 850-1000 RVUs a month. I see 30-40 patients in a full day of clinic. Most days I am half clinic where I see 20-25 patients in a half day then off to the OR for several cases. I also handle all the inpatient garbage. I have no help. No PAs or APRNs.

I get paid very well compared to my private practice podiatry colleagues. But for the amount of work I do compared to the orthopedists and some generals surgeons I am working way harder for my money. I see more patients than they do and I do all the paperwork/orders/ etc. I have no residents.

I could complain and make a huge deal about it but then I remember there are like 300-400 DPM applications for every hospital podiatry position that's promoted online. It is a joke. I once talked to a recruiter who labeled podiatry as "pretty desperate" when it comes to hospital or orthopedic groups hiring for a podiatrist.

These hospitals know they can find another podiatrist in a heartbeat.

 

[heybrother]

Beyonce has a song about replacing podiatrists.

 

[deleted1097413]

Beyonce has a song about replacing podiatrists.

to the left to the left

 

[NobodyDPM]

I'm sure they'll take your feelings into strong consideration as they sift through the other 200 applications for your position.

Yes and no. I find the younger generation is growing wise to the schtick. There are enough people out there who have been burned by some of the practices/groups in every city area that the word is getting out about who is "trustworthy" (if that is even possible) and who isn't.

Funny enough, I know of quite a few "boomer" groups, who thought they'd sucker some poor kid into spending a fortune to buy their practice, only to realize that these "poor kids" are much more business savvy than they realized. And now some are in their mid-70s, still having to work, because they thought some idiot would be their leprechaun with the gold pot at the end of the rainbow.

 

[Scrantonicity]

I'm sure they'll take your feelings into strong consideration as they sift through the other 200 applications for your position.

Guess I should have qualified my statement with "if you're in a rural location" with zero applications for your position. Ever.

 

[Feli]

Instead of miffed, I would think the current employer would be worried/scared. Maybe worried enough to improve the way they're treating you so you'll consider staying!

It all depends. It's a risk you take.
It helps to have an abundance mentality... not a scarcity mentality. That goes for many things.
The abundance mentality only is logical if you have good training, good networking, area-independent, etc.

Still, I don't think they'd think much of me getting a license. Plenty of docs get or maintain out-of-state licenses. You can easily brush it off.

...I know of quite a few "boomer" groups, who thought they'd sucker some poor kid into spending a fortune to buy their practice, only to realize that these "poor kids" are much more business savvy than they realized. And now some are in their mid-70s, still having to work, because they thought some idiot would be their leprechaun with the gold pot at the end of the rainbow.

It all depends. Those successful DPM practices do have value if they can reliably transfer the goodwill of area PCPs, urgent care, etc to the buyer and get the buyer onto all payers. The problem is owners almost invariably want waaay too much, esp when younger docs have loans already stretching credit. Or, if they want a reasonable amount, they want to pay the buyer in peanuts for years... so that kills the deal also.

Still, the private practice options are all pretty rough for young docs:
-associate (fair to poor depending on the group)
-associate to owner (fair to good... IFFFF the seller is reliable and will transfer the goodwill)
-associate to partner (can be probably decent if that's what you want, but "partner" just = higher paid associate in most I've ever seen)
-loan to become owner (depends on price, interest rate, etc... was a lot more feasible pre-2007 when interest was low, loans easier, and tuition more affordable)
-startup (low cost but veeeeery painful to be incredibly slow for years, trouble getting cases for boards/etc... nearly impossible in saturated HCOL areas with high rent/labor cost)

 

[NobodyDPM]

It all depends. Those successful DPM practices do have value if they can reliably transfer the goodwill of area PCPs, urgent care, etc to the buyer and get the buyer onto all payers. The problem is owners almost invariably want waaay too much, esp when younger docs have loans already stretching credit. Or, if they want a reasonable amount, they want to pay the buyer in peanuts for years... so that kills the deal also.

Bolded mine.

Actually they don't. This BS about "Sweat Equity" is a myth. There is no way a seller can guarantee any of that. If you still buy into that, you will get killed on a deal. "Goodwill of area PCPs, urgent care, etc..."? Sorry, but that can't be measured and certainly no one can put a cash value on that. Don't be suckered into buying "patients" or "patient charts" either. Patients aren't something you can put a dollar value on because there is no way to tell if they will stay. If anything, the stats say that you are virtually guaranteed a 25% attrition rate. And that's best case scenario. There are ways to mitigate this, but it's more of a hope than the reality.

The ONLY thing measurable about a business sale is its assets. And it's liabilities.

You can't guarantee the potential liability, either. Example: you buy a practice from someone and the office is on a lease, and is in the middle of it. Unless it's actually in the sale contract that the landlord won't up the rent once a new company takes over, which yours would be, if you are outright buying the practice, the landlord will increase your rent. And why would any landlord guarantee such a thing? Especially in states where rent is locked in, the only way they can increase it is if a new leasee comes in.

Btw, this also applies to buying into a practice as a partner, as well. What the company brings in Gross is irrelevant. Sorry, but that's not what a business is worth. Unless it's traded publicly. Or you have a firm buy out agreement. Good luck with that.

And you know what the assets are in a podiatry practice? All the hardware. Instruments, chairs, computers, etc. Which are worth virtually zero. If the practice you are buying has digital x-rays and ultrasound machines, and they are new, they may be worth something, but only if they are paid off outright. If they are still on lease, that's part of the company liability to look at.

The only situation this can differ in is if the seller owns the building and the land which the practice is on, and you are buying that as well. That's a whole different ballgame as you have to then start two companies. One for the practice, and another for managing the property. If the seller wants to hold onto the property and building, you will have to negotiate the lease with the seller. Which can get ugly, too.

 

[HardRoadPaved]

It all depends. It's a risk you take.

-startup (low cost but veeeeery painful to be incredibly slow for years, trouble getting cases for boards/etc... nearly impossible in saturated HCOL areas with high rent/labor cost)

I took the plunge and it was the best decision in life I ever made. With the right marketing strategy it may not take "years" to build. Do you need to hustle and market and be a good salesman about yourself? hell yea.

 

[Feli]

I took the plunge and it was the best decision in life I ever made. With the right marketing strategy it may not take "years" to build. Do you need to hustle and market and be a good salesman about yourself? hell yea.

Oh for sure. It can be done. I think it's a great decision also. It can even be done fairly quickly in areas where there is no podiatrist within 5-10+ miles and still enough of a population to support one (maybe a place that lost a busy DPM or F&A ortho recently). Those places are definitely few and far between, though. Growing cities are a good target, but established groups will generally grow and add new offices along with the new/booming suburbs of a growing metro. It can still be fine to start up in a west or midwest or any place that is under the radar... and it can be lucrative with little or no competition around.

...I was talking more in metro and suburbs areas (where most people prefer to practice and live). Those areas can be very difficult and expensive to break into, esp if they have good insurance payers and have already attracted strong established podiatrists/groups. It won't work well to just hang a shingle, make a basic website, pay $10k-20+k triple net office rent, and start from nothing in Scottdale, AZ or Malibu, CA or Grosse Pointe, MI or Palm Beach, FL or Strathmere, NJ or those sorts of place.

If every PCP in the area already refers to Dr. X or Dr. Y, then Dr. Z has a heck of a time getting going unless they want to take the worst payers and/or spend a whole lot of time/money on marketing to attract patients. Even if they're charismatic, aggressive, and persistent with PCPs... the referral patterns are pretty ingrained and have been for many years. A young doc with dynamite training and a megawatt smile still usually can't budge an established group/doc who has been working with that PCP, seeing him in the hospital, and sending him xmas gifts for many years. That is the same reason rep/industry companies usually buy-out or cooperate with one another instead of making a new product and competing against entrenched similar reps/product in areas. I think, in those situations, it is usually also best to buy out a retiring DPM or do a <5yr transition buyout (or you can work for another doc/group for a few years and then break off as their competition... if non-competes aren't enforced... but you sure won't be loved for that). Other docs can work for an ortho or MSG or hospital for awhile and then start their own PP nearby years later, but non-compete makes that hard in some areas.

Starting from nothing solo PP is tough in the majority of big cities and other most popular areas, though. I think that is why the hospital/MSG group jobs remain so popular among DPMs and MDs alike: good location with city entertainment/dining/schools/etc, decent pay, volume for boards/competence, good benefits... can always start solo later. People generally like the freedom of PP, but since the pay is low or dicey, the MSG job safety net is usually more attractive, at least early on. I think it's unreal how popular VA/IHS jobs have gotten in podiatry for the same security blanket and benefits reasoning (well, except IHS doesn't have good locations, haha). Still, jobs that used to go basically unfilled for years back when I was in pod school now get hundreds of apps just due to a moderate pay bump.

...This BS about "Sweat Equity" is a myth. There is no way a seller can guarantee any of that. If you still buy into that, you will get killed on a deal. "Goodwill of area PCPs, urgent care, etc..."? Sorry, but that can't be measured and certainly no one can put a cash value on that. Don't be suckered into buying "patients" or "patient charts" either. Patients aren't something you can put a dollar value on because there is no way to tell if they will stay. If anything, the stats say that you are virtually guaranteed a 25% attrition rate. And that's best case scenario. There are ways to mitigate this, but it's more of a hope than the reality...

Haha... we'll see.

 

[msuDPM]

Oh for sure. It can be done. I think it's a great decision also. It can even be done fairly quickly in areas where there is no podiatrist within 5-10+ miles and still enough of a population to support one (maybe a place that lost a busy DPM or F&A ortho recently). Those places are definitely few and far between, though. Growing cities are a good target, but established groups will generally grow and add new offices along with the new/booming suburbs of a growing metro. It can still be fine to start up in a west or midwest or any place that is under the radar... and it can be lucrative with little or no competition around.

...I was talking more in metro and suburbs areas (where most people prefer to practice and live). Those areas can be very difficult and expensive to break into, esp if they have good insurance payers and have already attracted strong established podiatrists/groups. It won't work well to just hang a shingle, make a basic website, pay $10k-20+k triple net office rent, and start from nothing in Scottdale, AZ or Malibu, CA or Grosse Pointe, MI or Palm Beach, FL or Strathmere, NJ or those sorts of place.

If every PCP in the area already refers to Dr. X or Dr. Y, then Dr. Z has a heck of a time getting going unless they want to take the worst payers and/or spend a whole lot of time/money on marketing to attract patients. Even if they're charismatic, aggressive, and persistent with PCPs... the referral patterns are pretty ingrained and have been for many years. A young doc with dynamite training and a megawatt smile still usually can't budge an established group/doc who has been working with that PCP, seeing him in the hospital, and sending him xmas gifts for many years. That is the same reason rep/industry companies usually buy-out or cooperate with one another instead of making a new product and competing against entrenched similar reps/product in areas. I think, in those situations, it is usually also best to buy out a retiring DPM or do a <5yr transition buyout (or you can work for another doc/group for a few years and then break off as their competition... if non-competes aren't enforced... but you sure won't be loved for that). Other docs can work for an ortho or MSG or hospital for awhile and then start their own PP nearby years later, but non-compete makes that hard in some areas.

Starting from nothing solo PP is tough in the majority of big cities and other most popular areas, though. I think that is why the hospital/MSG group jobs remain so popular among DPMs and MDs alike: good location with city entertainment/dining/schools/etc, decent pay, volume for boards/competence, good benefits... can always start solo later. People generally like the freedom of PP, but since the pay is low or dicey, the MSG job safety net is usually more attractive, at least early on. I think it's unreal how popular VA/IHS jobs have gotten in podiatry for the same security blanket and benefits reasoning (well, except IHS doesn't have good locations, haha). Still, jobs that used to go basically unfilled for years back when I was in pod school now get hundreds of apps just due to a moderate pay bump.


Haha... we'll see.

Not to chide what you're saying at all here, and I have no idea of the location, but I believe Hardroadpaved has previously said he opened up shop in a location with many pods and possibly even right down the road from an established group?

An exception to every rule...

 

[PTPuser]

Is it tough to open your own shop and get a SBL even though you have crazy amount of debt from schooling and after residency?

 

[Pronation]

Yes and no. I find the younger generation is growing wise to the schtick. There are enough people out there who have been burned by some of the practices/groups in every city area that the word is getting out about who is "trustworthy" (if that is even possible) and who isn't.

Funny enough, I know of quite a few "boomer" groups, who thought they'd sucker some poor kid into spending a fortune to buy their practice, only to realize that these "poor kids" are much more business savvy than they realized. And now some are in their mid-70s, still having to work, because they thought some idiot would be their leprechaun with the gold pot at the end of the rainbow.

There's a sucker born every minute - P. T. Barnum, DPM

 

[NobodyDPM]

Haha... we'll see.

As @Pronation quoted, there's a sucker born every minute. That being said, if you are the kind to prey on suckers, it will come back to you. I've seen it time and time again.

 

[HardRoadPaved]

Not to chide what you're saying at all here, and I have no idea of the location, but I believe Hardroadpaved has previously said he opened up shop in a location with many pods and possibly even right down the road from an established group?

An exception to every rule...

I am an east coaster in all the places you would think not to open. Instead of making MD/DO friends, I spent a ton of time finding the NP/PA no one cared about in urgent care centers and private groups. They were welcoming and now are a major referral source.

 

[Spotinho]

As was said, luckily, hospital/MSG jobs for pods are getting more and more common. Ortho jobs are also. It's a training thing, but it is also just a trailblazer thing where people have to keep knocking and knocking.... and future grads benefit. GL

Thank you everyone who has contributed to this conversation. I'm currently a 4th year student in externships/clerkships and approaching the match. And hence I've noticed very, almost opposites spectrums in training for residents. Out respect for myself and responsible financing it is hospital/msg/ortho or bust for me.... or start my own.

I believe I'm competitive for whichever residency program I've rotated through. So from yours' and colleagues' experiences what type of training would you advice makes one more competitive/sought after when advertising or creating a position for yourself with the goal of landing one of those jobs after residency?

1. Heavy clinic and normal surgery volume (less rearfoot & trauma)

2. More surgical volume (forefoot and rearfoot even) and normal clinic

3. Heavy surgical (not necessarily heavy trauma) and less clinic

4. Describe ideal and/or things to consider in training to help land these positions (research, fellowship, knowledge of billing, etc.?)

Does the ideal training to be able to sell yourself change between hospital vs. msg vs. ortho?

Thank you in advance for any feedback.

 

[air bud]

Thank you everyone who has contributed to this conversation. I'm currently a 4th year student in externships/clerkships and approaching the match. And hence I've noticed very, almost opposites spectrums in training for residents. Out respect for myself and responsible financing it is hospital/msg/ortho or bust for me.... or start my own.

I believe I'm competitive for whichever residency program I've rotated through. So from yours' and colleagues' experiences what type of training would you advice makes one more competitive/sought after when advertising or creating a position for yourself with the goal of landing one of those jobs after residency?

1. Heavy clinic and normal surgery volume (less rearfoot & trauma)

2. More surgical volume (forefoot and rearfoot even) and normal clinic

3. Heavy surgical (not necessarily heavy trauma) and less clinic

4. Describe ideal and/or things to consider in training to help land these positions (research, fellowship, knowledge of billing, etc.?)

Does the ideal training to be able to sell yourself change between hospital vs. msg vs. ortho?

Thank you in advance for any feedback.

Many recent threads have talked about this with some great replies

 

[Weirdy]

Thank you everyone who has contributed to this conversation. I'm currently a 4th year student in externships/clerkships and approaching the match. And hence I've noticed very, almost opposites spectrums in training for residents. Out respect for myself and responsible financing it is hospital/msg/ortho or bust for me.... or start my own.

I believe I'm competitive for whichever residency program I've rotated through. So from yours' and colleagues' experiences what type of training would you advice makes one more competitive/sought after when advertising or creating a position for yourself with the goal of landing one of those jobs after residency?

1. Heavy clinic and normal surgery volume (less rearfoot & trauma)

2. More surgical volume (forefoot and rearfoot even) and normal clinic

3. Heavy surgical (not necessarily heavy trauma) and less clinic

4. Describe ideal and/or things to consider in training to help land these positions (research, fellowship, knowledge of billing, etc.?)

Does the ideal training to be able to sell yourself change between hospital vs. msg vs. ortho?

Thank you in advance for any feedback.

use search function.

See this thread. Surgery vs clinic heavy residency programs

 

[wakaflocka88]

Thank you everyone who has contributed to this conversation. I'm currently a 4th year student in externships/clerkships and approaching the match. And hence I've noticed very, almost opposites spectrums in training for residents. Out respect for myself and responsible financing it is hospital/msg/ortho or bust for me.... or start my own.

I believe I'm competitive for whichever residency program I've rotated through. So from yours' and colleagues' experiences what type of training would you advice makes one more competitive/sought after when advertising or creating a position for yourself with the goal of landing one of those jobs after residency?

1. Heavy clinic and normal surgery volume (less rearfoot & trauma)

2. More surgical volume (forefoot and rearfoot even) and normal clinic

3. Heavy surgical (not necessarily heavy trauma) and less clinic

4. Describe ideal and/or things to consider in training to help land these positions (research, fellowship, knowledge of billing, etc.?)

Does the ideal training to be able to sell yourself change between hospital vs. msg vs. ortho?

Thank you in advance for any feedback.

There is no one magical program or training that will guarantee your dream scenario above, period. It's good to be confident in yourself, but wishful optimism is another thing at your current stage.

With that said, not all podiatry PP are doom and gloom - I interviewed and networked with a few local medium sized pod PP groups during my PGY-3 and they are solid, ethical groups with a good referral base and reputation in the community.

I started out of residency in an ortho group and as many posters have said over and over again - they want to know how you can produce and help the group grow. Sure, your training matters, but good training will help lend to better confidence minus the ego when it comes to that stage of discussions. I have done almost every forefoot/midfoot/rearfoot procedure I was trained to do in the 1.5 years I've been out.

My advice is to focus on being the best version of yourself no matter where you end up. A strong program will NOT guarantee you to be a strong podiatrist. What you are willing to put in is what you will get out of your 3 years. I did not pursue a fellowship.

The jobs above are far and few, and as AirBud said many times, you need to put in the work to create a position/network/find it because most of the times they are not posted publicly. In my graduating pod school class, besides myself, I can only think of 2-3 other classmates that are also in ortho/MSG/hospital based practice. My co-residents, whom we all graduated at the height of COVID, are absolutely crushing it.

Edit - just also want to add this: majority of ortho has no clue what podiatry programs and residency consists of. Zero, nothing. You can go to the best program that is well known within our profession but the outside world has no idea what that means or entails. Like I said above, good training lends to confidence which in turn shows in how you carry yourself, your knowledge and how you perform. You can go to JPS UPMC Kaiser Yale Harvard etc etc but the name will not get you an offer in hand

 

[Shiyuan]

Also keep the VA in mind (if you don’t mind that atmosphere)... decent pay and benefits. Of course the big issue is “getting in”.

 

[hotpoddy]

What about this buyout scenario with a MSG.
Last year's gross pay for a retiring doctor is 600K. He wants 350-400K over 3-4 years as his buyout.
The MSG buyout usually consists of hiring another doctor and paying the retiring doctor for 2 years. Basically the difference between the cost of hiring another doc and the amount that doctor is making.
So if it takes 200k to hire another doc, but they gross 500, the retiring doctor would have gotten 300k x 2 = 600K.
The crust however doesn't want any contingency plans, just a straight buyout.
The payout would come out of the overhead from the practice.
I think the practice has even higher potential when the crust moves on, plus the possibility of owning a building/ASC

 

[hotpoddy]

To clarify, 200k would be the salary of the incoming physician, obviously there would be some type of bonus structure but using this for easy math.

 

[Feli]

What about this buyout scenario with a MSG.
Last year's gross pay for a retiring doctor is 600K. He wants 350-400K over 3-4 years as his buyout.
The MSG buyout usually consists of hiring another doctor and paying the retiring doctor for 2 years. Basically the difference between the cost of hiring another doc and the amount that doctor is making.
So if it takes 200k to hire another doc, but they gross 500, the retiring doctor would have gotten 300k x 2 = 600K.
The crust however doesn't want any contingency plans, just a straight buyout.
The payout would come out of the overhead from the practice.
I think the practice has even higher potential when the crust moves on, plus the possibility of owning a building/ASC

This wouldn't make any sense for me unless I'm misunderstanding it.

You aren't 'buying' anything besides a DPM retiring (which he will anyways) and buying a MSG job (which is not hard to get) and "possibility of X" (which is worth next to nothing). So you aren't getting anything of value.

Where are you coming up with bolded part? The DPM retiring told you that? He is trying to sell something he doesn't own. It would be like me trying to sell you my job when I'm leaving hospital employ... makes no sense.

Fill me in if I'm missing something , but I don't understand what you'd be buying. You don't own anything. You don't control anything. So, where is your 400k going? Hmmm.

Who are you talking to about this? The DPM? The MSG owners? Their HR people? I would bet dollars to doughnuts the retiring DPM is the one coming up with this "deal" to "help you." It is a great deal... for him.

If anything, just talk to the MSG and have them hire you. You are probably talking to the DPM who is blowing smoke and trying to get a finder's fee just for transitioning you into his job. He is trying to sell you a job he doesn't own. That finder fee, if you even want to do it at all, is worth a tiny percent of your salary the first year or two... max. It is worth nothing if you want to just step on him and take it, but you could offer 3% or something to be gracious if it would be hard to get the job otherwise and you like the job or he may be your co-worker for awhile. That would only be about $5-20k to join the MSG... not 400k. You could sidestep him entirely and just communicate directly and work for the MSG directly, so that would probably be the play (assuming you have the state license, hospitals, etc they need or could easily get them). Paying $400k for nothing is not the best option, lol.

 

[Feli]

...not all podiatry PP are doom and gloom - I interviewed and networked with a few local medium sized pod PP groups during my PGY-3 and they are solid, ethical groups with a good referral base and reputation in the community...

Yes, exactly.

A well run group is a well run group (or facility). A poor one is a poor one. MSG/ortho/hosp doesn't automatically mean good, and PP doesn't automatically mean bad. There are a lot of exceptions. The only safety net is that most MSG/ortho/hosp generally have higher salary (which lets you work things out in a semi-comfortable situation), so that can be a reasonable tiebreak for most young DPMs if they can get hired at either. PP can absolutely have higher upside if it is well-run, but it can also be a headache with very low income in other situations (namely that the young associate signs some 75k-100k base with 25% bonus crap deal in a HCOL area... so even if the owner pays exactly as contracted, they have set themselves up for failure).

Personally, I was in a pretty good MSG that turned south based on new management making changes (skeleton staffing + overbooking, etc) that even led to the MD founder leaving right before me. Now, I am happy to get back to (large) PP after the disaster that IHS admin and efficiency was. There are plenty of people who probably feel the opposite (would do anything for VA/IHS to get themselves out of PP).

We should make a "what kind of job should I do" decision tree algorithm for DPM jobs sometime

 

[hotpoddy]

This is how the MSG operates when a physician retires and they hire a replacement.
Another scenarios is, they hire a new grad for 500k, the retiring doc was making (producing) 500K, it's a wash and they don't get anything except for whatever equity they have in their own building or whatever real estate purchased through the MSG. (get AR obviously)

So he could get 500K through two years by hiring me within a few months, and then me and the other partner find a 3rd (base of 200-250k).

I could also wait him out for a few years, but this is coming directly from the MSG. They are trying to stay out of it and let the two man practice decide who to hire. This is a way to protect the older doctors in the group, including non podiatry.
.
However, what this retiring doctor doesn't want to do is have a contingency (they hire me, he retires and then we hire a 3rd to basically pay for his "retirement"), he just wants a negotiated payout without the third. We could always pay him 400, and then hire another guy at 200 base with some bonus type potential, to pay the guy off over 3 years which is exactly what we would do.
You are basically paying to be a part of the MSG, with access to buying a building, profit sharing, etc.
I do think the potential is HUGE. So if the other partner split it with me it would come out as overhead from the practice and maybe 50-75k per year of lost wages. even less if we hired a third.