Outside perspective - job market

[eyeeye_captain]

Hi all, random ophthalmologist here. As promised in the job postings thread, here are the differences in our markets which I find interesting. Absolutely nothing posted here is to brag on me or demean you, or vice versa. I post this, again, as an outside perspective because I think these are reasonable guidelines for initial contracts.

For reference, I'm a private practice partner in a subspecialty practice. I think our market environment/psychology is more conducive to happy employment, so here is what we have. Granted, we are also far from perfect.

As a sidebar, we froze residency positions in ~1997 when we were getting saturated, and go figure, we have a significant surplus of jobs 25 years later. *cough cough* Now pretty much everybody has a reasonable offer when they graduate, if not significantly sooner than that.

Our markets seem similar in terms of percentages in private practice or hospital/academic employed, though my suspicion is there are more solo practitioners in podiatry. Given what I have seen here, the majority of private practice entry level contracts are suboptimal. Granted, we're worse than we used to be, moving from about 50% retention to partnership previously to 30-40% at a first job, which still sounds significantly higher than podiatry's retention rate. Some of our lack of retention is from better opportunities, personality conflicts, moving closer to family, etc., but it seems like we have way fewer associate mills.

It seems that hospital, multi-specialty, and VA jobs are the creme-de-la-creme in podiatry. I won't speak to these jobs too much given that it's a minority of both fields' employment, and they are actually the opposite for us. For us, the VA is where you go to either retire or teach and is sort of a dead end. Hospital employment is fine, but with a capped reimbursement and having to deal with admin. I get a crazy number of emails from recruiters for hospitals in places with >100k population with 50th percentile MGMA, plus the benefits below, that will never fill. We also have jobs in every saturated market you can name.

So for a field that is 1 year longer in residency than you have, here's a basic private practice contract:

10-25th percentile MGMA base salary, depending on region, can be higher
Bonus on collections 2.5-3x your base, percentage will vary
Malpractice, CME, PTO, health, dental, relocation etc. (the works)
Partnership in 2-3 years on a transparent track (I've heard as long as 7 though)
Many practices put you on the board of directors as an associate as well for practice decisions
Equal, shared call

As opposed to:
What sounds like generally 2/3 of the 10% percentile of MGMA (~$100k)
Questionable bonus structure
Questionable benefits
Questionable track to partnership

I think the difference is pretty stark for similar amounts of time in training and student loan debt burden.

We worry about a practice being sold out from under us for private equity money, while you worry about an owner cutting your knees out from under you at any time for pretty much anything.

Bottom line, I feel for you guys. Hardworking, well-trained individuals who are getting crappier starting positions financially than an NP or PA. I think graduates should have contracts more along the lines of what we start with. I think you should have more opportunities, even if they're not in exciting spots. If you're trending toward saturation, don't be the next set of pharmacists. Based on what I've read, better standardized training could also help create value to incentivize more hospitals to throw you the $$$.

Sorry for the word dump, and thanks for letting me be part of your community.

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[Feli]

....As a sidebar, we froze residency positions in ~1997 when we were getting saturated, and go figure, we have a significant surplus of jobs 25 years later. *cough cough* Now pretty much everybody has a reasonable offer when they graduate, if not significantly sooner than that...

Yes... 100%
This is the start and the end of it.

Podiatry has been suffering from saturation awhile. We lack the hospital jobs, and private practice, solo or employee, is limited due to supply/demand. It forces unfortunate deals, cutthroat tactics, banks reluctant to lend, highly variable results.

It is good to see a fresh perspective

 

[icebreaker32]

You are a quick study and have summarized our market well. Are you sure your brother or sister is not a podiatrist?

Our training does deserve more than what most start out and what too many end up at.

It causes cutthroat competition, low paying bases for associate jobs and an elitist subset of our profession that hates the word podiatry and considered themselves foot and ankle surgeons and all the others podiatrists.

There is some comradery which is more common when podiatrists have a mutual financial investment including but not limited to surgery centers, but also exists to some extent on the internet. Much of the internet cronyism involves exploiting whatever new CPT or DME pays well....which never lasts forever and often eventually leads to audits and paybacks. Certainly other specialties are not immune to this behavior, but it is more common in podiatry.

Almost all our problems could be solved by less saturation, but since this will never happen voluntarily in our profession, we argue about other issues which have much less meaningful impact.

 

[Pronation]

Bonus on collections 2.5-3x your base, percentage will vary

Let’s go ahead and rub it into the pod associates’ faces - would you mind sharing what the average percentage of collections for bonus is?

 

[AttackNME]

As a sidebar, we froze residency positions in ~1997 when we were getting saturated

Thanks for giving your perspective on this. I was wondering if you could elaborate on this statement. Who and how was it determined that your market was saturated, and how did they freeze residency positions?

 

[eyeeye_captain]

Let’s go ahead and rub it into the pod associates’ faces - would you mind sharing what the average percentage of collections for bonus is?

Incredibly nuanced question there. You have to factor in overhead, which varies widely, but runs generally between 50-70% for most practices. I would say most practices (thought I can't speak definitively speak to others) have your base at ~45% to collections prior to covering your salary as an associate. Thereafter, it's a roll of the dice. Most put it at a lower percentage, maybe closer to 25%. This is with the assumption that you're making the business some money, but it's only for a short period to be a partner and rake in some $$$. It's a give and take, the partners float you for a while and then you float them back.

 

[eyeeye_captain]

Thanks for giving your perspective on this. I was wondering if you could elaborate on this statement. Who and how was it determined that your market was saturated, and how did they freeze residency positions?

Frankly, this was before my time. Medicare/the government/ACGME said we don't need more ophthalmologists and other specialties, so residencies got leveled and/or cut in favor of primary care positions. There have been new spots approved in the last few years where appropriate.

 

[wakaflocka88]

Frankly, this was before my time. Medicare/the government/ACGME said we don't need more ophthalmologists and other specialties, so residencies got leveled and/or cut in favor of primary care positions. There have been new spots approved in the last few years where appropriate.

Thanks for the info. This is very eye-opening (haha) but unfortunately our profession refuses to acknowledge that we need to follow your model as well. The greed is too deep to stop

 

[AttackNME]

Thanks for the info. This is very eye-opening (haha) but unfortunately our profession refuses to acknowledge that we need to follow your model as well. The greed is too deep to stop

We need SDNers to join CPME and rewrite the bylaws to set limits to new program based on data. Boring but important work. Primary goal is to improve quality of residency training and thus patient care. Any suggestion of poor job market due to oversaturation will be viewed as anticompetitive and our efforts will be shut down

 

[LossToFollowUp]

So for a field that is 1 year longer in residency than you have, here's a basic private practice contract:

10-25th percentile MGMA base salary, depending on region, can be higher
Bonus on collections 2.5-3x your base, percentage will vary
Malpractice, CME, PTO, health, dental, relocation etc. (the works)
Partnership in 2-3 years on a transparent track (I've heard as long as 7 though)
Many practices put you on the board of directors as an associate as well for practice decisions
Equal, shared call

Can you share what the average/expected starting salary is after your residency? I think there will be spins on your above quoted statement and prospective DPM students deserve to know what the real discrepancies are.

 

[eyeeye_captain]

Can you share what the average/expected starting salary is after your residency? I think there will be spins on your above quoted statement and prospective DPM students deserve to know what the real discrepancies are.

Massive variations depending on academics, VA, private practice, subspecialty, region, and if a practice was bought by private equity. Probably no less than $200k with full benefits if you look across the board, but academics may run lower, don’t know personally

 

[LossToFollowUp]

That's a solid double from what I was offered coming out, even with full benefits. Tragic...

 

[PatchAdamsFan]

That's a solid double from what I was offered coming out, even with full benefits. Tragic...

Well yes they're specialists like us, but their mean RVUs are almost double ours. 200k offers for them are like our 100k's, very low ball.

 

[eyeeye_captain]

There are $400k+ offers out there. Those “low ball” offers are usually academia/VA. If that’s in PP, it’s in a saturated/desirable market with a pretty easy track to a bonus. I think our markets are also a little different in where people are willing to work geographically.

 

[LossToFollowUp]

Well yes they're specialists like us, but their mean RVUs are almost double ours. 200k offers for them are like our 100k's, very low ball.

I'm not focusing on RVUs just salary. 200k, low ball or not, is a sizeable difference from 100k. At least starting at 200k would change approaches and attitudes within our profession

 

[JewOnThis]

Well yes they're specialists like us, but their mean RVUs are almost double ours. 200k offers for them are like our 100k's, very low ball.

You think 100k is low balling? You haven’t seen those 70k base salary offers from private practices with impossible to reach bonuses.

Hell, if I was fresh out of residency, I wouldn’t mind working for 100k base. That is considered average in private practice.

 

[PatchAdamsFan]

I think my point was missed. You cannot compare ophthalmology salary/collections to ours, or really any surgical subspecialist to ours. To my fellow Jew, I am well aware, I was on 80k base my first year out. As noted above - tragic.

 

[eyeeye_captain]

John Pinto's Ophthalmology Business Management Series

As a side note, for any residents/younger docs in the job market, this is a really good series of lectures. Slightly ophtho specific as the guy is an ophtho consultant, but great general points overall.

Edit: We don’t make the dough quoted in the contract negotiation video if he’s calling that the middle third.

 

[Bored Snorlax]

Hi all, random ophthalmologist here. As promised in the job postings thread, here are the differences in our markets which I find interesting. Absolutely nothing posted here is to brag on me or demean you, or vice versa. I post this, again, as an outside perspective because I think these are reasonable guidelines for initial contracts.

For reference, I'm a private practice partner in a subspecialty practice. I think our market environment/psychology is more conducive to happy employment, so here is what we have. Granted, we are also far from perfect.

As a sidebar, we froze residency positions in ~1997 when we were getting saturated, and go figure, we have a significant surplus of jobs 25 years later. *cough cough* Now pretty much everybody has a reasonable offer when they graduate, if not significantly sooner than that.

Our markets seem similar in terms of percentages in private practice or hospital/academic employed, though my suspicion is there are more solo practitioners in podiatry. Given what I have seen here, the majority of private practice entry level contracts are suboptimal. Granted, we're worse than we used to be, moving from about 50% retention to partnership previously to 30-40% at a first job, which still sounds significantly higher than podiatry's retention rate. Some of our lack of retention is from better opportunities, personality conflicts, moving closer to family, etc., but it seems like we have way fewer associate mills.

It seems that hospital, multi-specialty, and VA jobs are the creme-de-la-creme in podiatry. I won't speak to these jobs too much given that it's a minority of both fields' employment, and they are actually the opposite for us. For us, the VA is where you go to either retire or teach and is sort of a dead end. Hospital employment is fine, but with a capped reimbursement and having to deal with admin. I get a crazy number of emails from recruiters for hospitals in places with >100k population with 50th percentile MGMA, plus the benefits below, that will never fill. We also have jobs in every saturated market you can name.

So for a field that is 1 year longer in residency than you have, here's a basic private practice contract:

10-25th percentile MGMA base salary, depending on region, can be higher
Bonus on collections 2.5-3x your base, percentage will vary
Malpractice, CME, PTO, health, dental, relocation etc. (the works)
Partnership in 2-3 years on a transparent track (I've heard as long as 7 though)
Many practices put you on the board of directors as an associate as well for practice decisions
Equal, shared call

As opposed to:
What sounds like generally 2/3 of the 10% percentile of MGMA (~$100k)
Questionable bonus structure
Questionable benefits
Questionable track to partnership

I think the difference is pretty stark for similar amounts of time in training and student loan debt burden.

We worry about a practice being sold out from under us for private equity money, while you worry about an owner cutting your knees out from under you at any time for pretty much anything.

Bottom line, I feel for you guys. Hardworking, well-trained individuals who are getting crappier starting positions financially than an NP or PA. I think graduates should have contracts more along the lines of what we start with. I think you should have more opportunities, even if they're not in exciting spots. If you're trending toward saturation, don't be the next set of pharmacists. Based on what I've read, better standardized training could also help create value to incentivize more hospitals to throw you the $$$.

Sorry for the word dump, and thanks for letting me be part of your community.

Thank you, Dr., for sharing your perspective and insight.

I have a few questions if you don't mind entertaining them:

1. From my understanding ophthalmology is a highly competitive specialty in medicine- how is the market in ophthalmology compared to other slightly less competitive but equally important medical specialties e.g., internal medicine, family medicine, pediatrics, etc.?

2. In addition, are those medical specialties closer to ophthalmology or podiatry in terms of markets as you eloquently portrayed above?

I agree we definitely need better standardized residency training @CPME @ABFAS @ABPM, and I am optimistic as we continue to increase our standards and patient satisfaction podiatry will continue to be a major asset to health care. For example, my mother was saved from a foot amputation several years ago and that inspired me to pursue podiatric medicine.

It is a pleasure to have you as part of our community and hope to learn more from someone as experienced as you!

 

[eyeeye_captain]

Thank you, Dr., for sharing your perspective and insight.

I have a few questions if you don't mind entertaining them:

1. From my understanding ophthalmology is a highly competitive specialty in medicine- how is the market in ophthalmology compared to other slightly less competitive but equally important medical specialties e.g., internal medicine, family medicine, pediatrics, etc.?

2. In addition, are those medical specialties closer to ophthalmology or podiatry in terms of markets as you eloquently portrayed above?

I agree we definitely need better standardized residency training @CPME @ABFAS @ABPM, and I am optimistic as we continue to increase our standards and patient satisfaction podiatry will continue to be a major asset to health care. For example, my mother was saved from a foot amputation several years ago and that inspired me to pursue podiatric medicine.

It is a pleasure to have you as part of our community and hope to learn more from someone as experienced as you!

1. Ophtho is a very different market from the fields you quoted (IM without fellowship, FM, Peds). There will always be more jobs for them wherever you want to go than we have, as we're a small field. IM can do hospitalist jobs for $300+k working 1 week on, 1 week off. FM folks can work 40 weeks a year 9-5. Peds I honestly don't know, zero interest, but I'd say around FM (both $200k+). None of them struggle to find a place in saturated areas, whereas we can at times, partly because the majority of ophthalmologists, especially sub-specialists, want to be in/near a metro. More reasonable jobs is cool, which I think is the goal for podiatry.

2. I think the specialties you mentioned have way better markets than both fields in terms of reasonable jobs, not counting if Internal Medicine includes fellowship trained folks (cardiology, GI, etc.), who do very well financially and have everyone asking for them. This is due to substantial demand. Some of this is need, some of this is retiring doctors in the COVID age. Nobody has too much trouble finding a decent job, whether hospital employed or a decent private practice.