Podiatry Employment/Income as a New Grad - questions answered

[IPODiatrist]

Greetings,

There seem to be a great many questions regarding income as a podiatrist for the new graduate. A buddy of mine encouraged me to break my hiatus and post my 2 cents.

I will try and answer some of these seeing as how I would also cruise through these threads trying to make myself feel better about my chosen path. This is geared towards residents and pod students.

Employment -- you will be employed after residency. Jobs are plentiful contrary to the doom and gloom.

A little bit about myself, graduate from residency in the Midwest, signed with a hospital group. Will probably pull a little over 170K plus after year 2-3 here with productivity. There is a ceiling. Trained to do everything, but I don't get ankle fxs etc certainly not pilons. Ortho eats it up. Lots of typical podiatry stuff.

My friends who graduate from residency this year:

One of them signed with Ortho group, will be pulling 150-160+ year 2. With that going to 35% pure collections as he moves along. Percentage can increase as he moves forward. No option for partnership, ever. The other podiatrist who is been in practice with his group is grossing income is ~300k. Been in practice 5 -10 yrs.

Another signed with hospital group in Cali has a similar package to mine. He is doing trauma.

Another signed with Kaiser. Graduate of kaiser program. He is doing calc fxs first week out. Similar package to mine.

Yet another 3 have signed with private practice groups. All 3 with options for partnership after 2-3 years. You must ASK for these things during negotiations. Salaries for them in the beginning is around 100k+ in the beginning.

Another out right bought a practice, with an agreement for owner to stay on for 2 years for training him to take over. Risky, but he is aggressive.

Another did indian health reservation. TONS of surgery. Some stuff that would be out of scope. Fantastic pay. Job security. Crappy location.

Another was offered a job by the hospital he trained at at a sister hospital. The pay they offered was 125K plus productivity. Again, no trauma/big bad surgical cases.

Yet another turned down an Ortho group who pay pod associates with 200K base but they don't do ANY surgery. All the pods do the conservative care -- and once patient needs surgery -- they are referred to orthopedist. You function a lot like an NP/PA. Not bad for the money if you don't like surgery. Yes, this option does actually exist.

Private practice: A lot about who you know -- how aggressive you are in making connections will determine what set up you end up in. I also know some VA grads who ended up choosing chipnclip clinics to work at after residency. The pay is similar to the horror stories everyone talks about.

If you want trauma etc (routinely), you will not find this in major cities unless you join a group in which your partners hire you to do this. Better bet is smaller practices in rural settings. You will find a ton there and in most under served areas.

Pay is usually 100k+ with a percentage. Partnerships are variable, and you have to ASK for it to be defined in the contract if you are looking for long term. A lot of my attendings were in big podiatry priv practice set ups: they are taking home ~250k+. None of them made that coming out of residency. They have all been in practice longer than 5-10yrs. Sx once a week. Infrequent call and variable call with local hospitals with residents. The more you work, the more you make. That's an honest private practice set up.

Hospital employment: Not as rare as one would have you believe, with ACOs coming into play, I think this will become more common. Downside is -- you do what they give you to do. What they give you is a lot. These jobs usually have a ceiling, but they can literally get rid of you whenever they want. It can and does happen. Pay is great starting off and tops off.

All of us are satisfied with where we ended up and what we are doing. Some of us were chasing location, others trauma, and others solo practice. I'll also add, I work in the hospital set up, and while I may make more money than a buddy who is in private practice, he is doing bigger and better surgical cases, and more of them. Lots of different set ups out there.

All of them are viable options. And all of us will be taking home 100k+ plus 1st year out, with most of taking home 150k+, all of us work M-F, some of us 2 weekends a month. All of us irregular hours - 7am- 8pm. 9am-7pm etc etc.

This is just what my experience has been post residency.

Others may be different. A lot of the doom and gloom will come from people who started looking for employment late in the game and your socially awkward classmates (we all had one or two). Some will come from legitimate people who got screwed with their first place of employment.

Hope this helps alleviate some unwarranted fears. Good luck.

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[SLCpod]

Thanks for the information. Greatly appreciated.

 

[txlioness]

Where is the best place to look for hospital vacancies? I don't always see listing for podiatrists on the hospital websites.
I have seen various vacancies on AAPPM site, PM News, JAPMA. But any advice on other places to look for positions?
I am currently a 3rd yr resident from Texas, doing my residency in New York. I would prefer to move back there but open to moving provided it's a good opportunity.

 

[skelper101]

Thank you for the information! Greatly appreciated.

 

[newfeet]

Where is the best place to look for hospital vacancies? I don't always see listing for podiatrists on the hospital websites.
I have seen various vacancies on AAPPM site, PM News, JAPMA. But any advice on other places to look for positions?
I am currently a 3rd yr resident from Texas, doing my residency in New York. I would prefer to move back there but open to moving provided it's a good opportunity.

I would look at practicelink, podiatrycareers, doccafe or similar websites. I would contact the hospitals even if they dont have anything listed.

 

[rushrhees]

Thank you sir/madam for the information. I have been wanting to get info like this for months, just what exactly ppl are getting out of residency

 

[Evopod]

I would approach this with a trust but verify approach. The employment picture painted here is 6x better than I faced 15 years ago. Things have in fact gotten more challenging over the 15 years. If 250k jobs are readily available, I can't see how they could be sustained while fulfilling meaningful use, HIPAA and an ethical practice. That said, it is possible, but more the exception than the rule.

 

[deleted690619]

I would approach this with a trust but verify approach. The employment picture painted here is 6x better than I faced 15 years ago. Things have in fact gotten more challenging over the 15 years. If 250k jobs are readily available, I can't see how they could be sustained while fulfilling meaningful use, HIPAA and an ethical practice. That said, it is possible, but more the exception than the rule.

The salaries mentioned by the OP are actually completely within range of BLS and MGMA reported salaries. I don't understand all the skepticism from salaries reported by today's graduates. Are folks really taking out 200K and studying for 7 years post grad to be making 70 grand a year. I think not.

 

[torontopharm]

I would approach this with a trust but verify approach. The employment picture painted here is 6x better than I faced 15 years ago. Things have in fact gotten more challenging over the 15 years. If 250k jobs are readily available, I can't see how they could be sustained while fulfilling meaningful use, HIPAA and an ethical practice. That said, it is possible, but more the exception than the rule.

I highly doubt majority of the Pod applicants are chasing 250k starting out.
The expectation rather is to make in the neighborhood of 100-120k and build from there...numbers that are in line with BLS reported data.

 

[wakaflocka88]

I highly doubt majority of the Pod applicants are chasing 250k starting out.
The expectation rather is to make in the neighborhood of 100-120k and build from there...numbers that are in line with BLS reported data.

I beg to differ torontopharm, but there is a reason why I'm putting in the honest hardwork so by the time I do job hunt, I have more leverage on my side.

 

[Evopod]

The salaries mentioned by the OP are actually completely within range of BLS and MGMA reported salaries. I don't understand all the skepticism from salaries reported by today's graduates. Are folks really taking out 200K and studying for 7 years post grad to be making 70 grand a year. I think not.

Unfortunately I think so. The cost of your education is not a consideration as to what the three consolidarity health insurance providers and Medicare are willing to pay. By many surveys and my own observations, increasing numbers of health care consumers live with elective surgical problems to avoid deductibles.
When I graduated in the 90s. Many rras were taking positions for 30k and told to get out into the community and build your practice to earn 30%over 200 receivebles. Most of those pods eventuallymade some money
But less this year than 3 years ago.
After a decade and a half, I left private practice after a revenue drop of 40% over 3 years. I was still fairly busy when I left. Some of the local corporate plans switched to aca plans and I saw 28285 paying under $100.00. My E&M codes paid less than co-pays so end of the month meant subtracting large sums of patient refunds from monthly revenue totals. This might have happened once a year 5 years ago.
Larger institutions seem to be better situated to deal with this.
So my 2 cents is to try and stick with hospital, ortho, multispecialty or gov work even if it not your first choice. Podiatry will not die. But private practice will be relegated to non covered services in a country that requires every citizen to have coverage.

 

[Evopod]

To put it another way. I used to gross about A $1000 per avarage patient per day. If I averaged 30/day I would see about $350k/yr gross. It is now more like $700 papd. Your salary is generally 30-40%of gross revenue. Can you really see 50-60 a day and do a good job.?
A rear foot fusion with TAL pays about $800 from many plans. The next 90+ days you will not add any revenue
Actually many plans will pay more for 2-3 post OP cast changes than the triple. So learn what pays and what does not and quit worrying about what your patient needs or that they have a $70 copay every time you change that cast.

 

[Pronation]

After a decade and a half, I left private practice after a revenue drop of 40% over 3 years.

Evopod, did this event happen to coincide with any sort of psychiatric diagnosis during that timeframe?

 

[Evopod]

No, wrong troll. Enjoy your naivete. If your lucky it will last forever. These aren't the droids your looking for. Private practice is just fine. Make a retiring DPM's day and buy a practice or two. Is this site run by Medical Mavin? Or does someone else have a snow job agenda?

 

[NatCh]

I used to gross about A $1000 per avarage patient per day. If I averaged 30/day I would see about $350k/yr gross. It is now more like $700 papd.

Am I understanding this right?

$1000 x 30 = $30,000 per day.

$30,000 x 5 days = $150,000 per week

$150,000 x 48 weeks = $7,200,000 gross per year

Now you're only grossing 70% of that, which is $5,040,000 gross.

30% to 40% of $5,040,000 = $1,512,000 to $2,016,000 net.

If that's what you're making, I'm impressed! I don't make anywhere near that much.

 

[ldsrmdude]

Am I understanding this right?

$1000 x 30 = $30,000 per day.

$30,000 x 5 days = $150,000 per week

$150,000 x 48 weeks = $7,200,000 gross per year

Now you're only grossing 70% of that, which is $5,040,000 gross.

30% to 40% of $5,040,000 = $1,512,000 to $2,016,000 net.

If that's what you're making, I'm impressed! I don't make anywhere near that much.

Yeah, I tried to figure that math out earlier. I think he means that he grossed $1000 a day averaged over the year which would equal about 350K. That would be like 105-140k a year net. I'm assuming if he was making 1.5 Million a year, he wouldn't have gotten out of private practice

 

[NatCh]

Yeah, I tried to figure that math out earlier. I think he means that he grossed $1000 a day averaged over the year which would equal about 350K. That would be like 105-140k a year net. I'm assuming if he was making 1.5 Million a year, he wouldn't have gotten out of private practice

Perhaps that's what he meant. Your numbers would be more consistent with our average. If you could keep your overhead expenses to 55% you'd be looking at $157,500 net, or $175,000 at 50%. Would you guys consider that a bad income?

 

[ldsrmdude]

Perhaps that's what he meant. Your numbers would be more consistent with our average. If you could keep your overhead expenses to 55% you'd be looking at $157,500 net, or $175,000 at 50%. Would you guys consider that a bad income?

I could probably live on 175k a year. That would be just less than 4x my salary as a resident last year.

 

[Evopod]

Sorry, the point was 30 patients per day used to pay 350k/year and overhead was generally 50-60%. When I left 30 patients per day might generate 280 and overhead would remain 175-210.
Lower reimbursements is only part of the problem. I wrote off 1-3 bankruptcies a month, 5-6 clawbacks, the end of dm shoes, but the biggest cause of lower revenue occurred with high deductibles switching balances from insurance to patient responsibility.
Clawbacks is when patients don't pay for there insurance and they take back everything they paid you and flip the balance to patient's responsibility.
The numbers above are rough estimates.
A conference I just attended reports 95% revocation of payments on DM Shoes per the state association. In addition, RAC audits and five other acronyms I was not aware of are now reviewing our claims to take back money. None of this existed 5 years ago. In less than three years 50%of your payments will not be fee for service, they will be value based payments, for the explicit purpose of saving money for Medicare and third party payers.
The increases in audits were noted in some cases to demand hundreds of charts be turned over to auditors requiring huge staff investments to copy files. Lastly, According to APMA's Harry Goldsmith. Icd 10 will probably require a staff member to finalize proper coding specificity as opposed to a one page superbill check list, under icd9.
Private practice does indeed face new challenges.

 

[karntrev]

It's all about how hard you work at finding a job. I decided early on that I would not be happy with $100K coming out of residency. I spent a lot of my free time (which was not much) searching the internet for hospitals by simply doing a google search of hospitals in a certain state. I would then either call or email the hospital administration to see if they were interested in hiring a podiatrist. I got a lot of "no thanks", and even more that didn't even reply. But after months of working I landed a multi-specialty group/hospital job with a base salary of $200K. I got a large sign on bonus, relocation, CME allowance, I also get semiannual bonuses which are not production based but rather more like profit sharing. I am the only podiatrist in a town of 30,000 and I am booked every day. I kind of got lucky, I decide my schedule, I work 4.5days/week. I have full scope and I take call at the hospital. This is exactly the job I was looking for. So if you want more than what you are seeing out there, then you have to be willing to go look for it.

 

[NatCh]

I also get semiannual bonuses which are not production based but rather more like profit sharing.

You get profit-sharing bonuses as an employee (versus as a shareholder)? That's really rather incredible.

 

[PatchAdamsFan]

Many hospital systems cannot legally hire physicians as employees (CA comes to mind, for now), and as such rely on contracts through various for-profit physician groups. There's your profit sharing as 'employees' of the hospital. It's a pretty lucrative gig for doctors, including pods of course, and certainly helps the push towards larger groups.

 

[podiatrist12]

No one knows who will and who will not be employed after residency. Has any publication published how many podiatrists in the graduating class of 2015 actually got jobs with salaries of greater than $50,000 per year?
What about greater than $75,000 per year? What about greater than $100,000 per year.
Please understand that my personal opinion is that dermoscopy and skin biopsies are so important why not do them? Also regarding orthotics why not explain to patients about the possibility they may not help and that monies could be spent without a patient being happy? Why not try shoe modifications, felt, etc.... I do not like joint implant surgery and only did one case at the first MTPJ on someone that needed it. It does not matter how many good patient reviews about you are present expenses are so high it is hard to earn a living in certain states as a self employed podiatrist. As far as 10 years ago, earning a living was so much easier. Now please understand that there are so many self employed podiatrists out there that the US dept of labor just might not calculate their net pay of self employed podiatrists in to their calculations. If someone does get a salary job this might be a good thing if the employee is happy with the salary. But until there is some publication about the results of how many podiatry residents graduated in 2015 actually got jobs of more than $50,000 and more than $75,000 per year how can anyone conclude that anyone will or will not be employed by someone else after residency? Perhaps a conclusion might be made that someone will be self employed after residency but if self employed there are advantages and disadvantages. Perhaps one disadvantage is a lack of a positive cash flow to begin with. Now if a spouse or relative could financially support the start up fees there is a possibility that a starting negative cash flow could become a positive cash flow. There was a book I bought called 31 and one half essentials for running your medical practice. Also when one graduates there is the APMA that they can join and I am guessing state societies have discounted rates. Problem is after a number of years if the dues become too expensive to afford then it is possible people will not be able to afford to pay them. Even if one has a problem earning a living even if they become board certified in podiatric medicine or another podiatry board just think of all the people a podiatrist can help regarding attempting to prevent foot pain. My personal opinion is being a podiatrist is wonderful in that one is able to attempt to help others, use felt pads in shoes, use biomechanics. By the way, a lot of the biomechanical principles I learned are different in some of the orthopedic literature. Please look up the lamina pedis concept and the calcaneal position.
One last comment, in podiatric residency how many times was dermoscopy used and images from a dermatoscope charted regarding skin biopsies on the foot. Above all please cherish and enjoy the ability to help others.

The above are my personal opinions.

 

[jellybean2020]

Uhhhh....what? How is it even remotely possible to NOT make >$50k salary? Unless you're in the military or working like 2 days a week?

 

[podiatrist12]

There are some podiatrists that have gotten high salaries after graduating podiatric residency programs but how many have in 2015 as per my questions in my previous post.
I believe the range of BLS Bureau of labor statistics do not include the net salaries of self employed podiatrists. Call the Bureau and ask them to confirm this for yourself. Now check to see how many podiatrists out there are self employed. With all the cases in the healthcare environment meaningful use, EHR, malpractice, rent, expenses are going higher and some physicians are selling their practices to hospitals to keep up. Yet how many podiatrists throughout 2015 sold their practices to hospitals. Was there ever a survey sent out regarding my questions in my previous comment. Bottom line is there are other ways to earn a living or have a spouse or relative financially support a private practice that is no longer as financially successful. Please understand that being board certified in podiatric medicine or another board is very helpful. Yet some insurance panels are closed. Yet being a podiatrist is wonderful. Think of the payback in terms of being happy knowing that podiatrists help others alleviate foot pain and suffering. Also think of all the friendships formed with other podiatrists and all the wonderful podiatric seminars out there to learn. Also when one is an attending on staff at a hospital there is the opportunity to teach podiatric residents. Think of all the enjoyment teaching others and patients and helping foot pain. What about saving lives by telling patients about the need to biopsy suspicious skin lesions, etc... There is so much positive enjoyment in being a podiatrist to look forward to regarding helping others.

The above are my personal opinions.

 

[dyk343]

Read about 3 sentences of the first rant. Wow...

The residents coming out of my program are starting in the $200k range.

 

[podiatrist12]

Read about 3 sentences of the first rant. Wow...

The residents coming out of my program are starting in the $200k range.

How many residents in 2015 got jobs for salaries of more than $200,000 and from which program and which groups hired them. Can such answers be forwarded to Barry Block at PM news.
PM news if you review it they post articles on people getting jobs. Now if podiatrists that are board certified, with hospital privileges are making less than $75,000 per year then perhaps it is news that
a resident who is possibly not board certified is starting in the $200K range if this is occurring in 2015. Please understand that money is not everything and one has to enjoy what they are
doing. Podiatry is such a wonderful field to help others, make friends and prevent foot suffering. It is also wonderful being an attending and having an opportunity to have residents learn from you.

 

[yayayaok]

Am I understanding this right?

$1000 x 30 = $30,000 per day.

$30,000 x 5 days = $150,000 per week

$150,000 x 48 weeks = $7,200,000 gross per year

Now you're only grossing 70% of that, which is $5,040,000 gross.

30% to 40% of $5,040,000 = $1,512,000 to $2,016,000 net.

If that's what you're making, I'm impressed! I don't make anywhere near that much.

NET is the amount you take after ALL expenses and deductions.

So we have 300k for employee salaries & benefits

Practice Insurance + Rent ~ 60k

Income tax + Tax on the practice ~ do the math.

Grow up