Podiatry in rural areas?

[TimmyTurner]

A good friend from high school is graduating from PA school this spring. He has a couple of job offers already, but the best one by far is a small hospital on the Washington/Idaho border. It is in the epicenter of nowhere.

The offer: 105k base, 5k relocation expenses, 20k in loan repayment, on call pager, if called $105/hour, and here is the best part- housing stipend.

Pretty insane imo. This is not part of any subsidized government program, this is the hospital paying all these fees. He told me that they offer similar packages for Physicians, including Pods. I have heard that some of the best Pod jobs (in terms of compensation) out of residency are in these rural areas.

I don't question the validity of this based on his account and similar accounts I have heard- the questions I have are
1) How do these hospitals, that don't have huge volume, pay their providers these sums?
2) Are there consequences of practicing in these regions? ie, you may make a sizeable living, but may not be a desirable candidate in subsequent job apps due to low volume of these rural positions. He said that the staff Pod sees about 8 patients a day.

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[Weirdy]

Is #1 simply based off market demand?

Can't get anyone to move out there even with low volume patients- have to increase pay to make it pretty?

 

[TimmyTurner]

Is #1 simply based off market demand?

Can't get anyone to move out there even with low volume patients- have to increase pay to make it pretty?

The assumption is that the reason for the high pay scale is based off of lack of interest in these areas... But the question is HOW do they pay MORE than urban areas while taking in LESS revenue because of their significantly lower volume. I suppose it could be that the patient to provider ratio is equivalent to that in urban areas? But I never get the sense that the rural providers are overworked the way urban providers are, so that isn't true. Based on what they pay providers and the volume they take in... How do the hospitals make ends meet, let alone operate at a profit?

*edit*- basically, I feel like I am missing something here. They pay more but have less volume/procedures --> less revenue. So how are they able to pay what they do?

 

[ldsrmdude]

A good friend from high school is graduating from PA school this spring. He has a couple of job offers already, but the best one by far is a small hospital on the Washington/Idaho border. It is in the epicenter of nowhere.

The offer: 105k base, 5k relocation expenses, 20k in loan repayment, on call pager, if called $105/hour, and here is the best part- housing stipend.

Pretty insane imo. This is not part of any subsidized government program, this is the hospital paying all these fees. He told me that they offer similar packages for Physicians, including Pods. I have heard that some of the best Pod jobs (in terms of compensation) out of residency are in these rural areas.

I don't question the validity of this based on his account and similar accounts I have heard- the questions I have are
1) How do these hospitals, that don't have huge volume, pay their providers these sums?
2) Are there consequences of practicing in these regions? ie, you may make a sizeable living, but may not be a desirable candidate in subsequent job apps due to low volume of these rural positions. He said that the staff Pod sees about 8 patients a day.

I only have some insight, but no personal knowledge of this. Critical access hospitals get additional money from the government to make up for low patient volumes. This prevents those hospitals from going bankrupt and makes them financially feasible. As far as consequences, I think you hit on the biggest one, although there are some small hospitals where the podiatrist does a decent amount of stuff. There are certainly some unique challenges. We looked at opening an office in a critical access hospital and one of the things that was a potential issue was the lack of anesthesia coverage. There was a CRNA, but no anesthesiologist and we don't have the privileges to supervise a CRNA. There are ways to work around that, but it is just an example. Oh, and I would hope that the packages offered for pods are much more lucrative, 105k base is very low for a hospital for a pod, maybe not for a PA though

 

[TimmyTurner]

Oh, and I would hope that the packages offered for pods are much more lucrative, 105k base is very low for a hospital for a pod, maybe not for a PA though

Yes, the 105 figure was mentioned as it is high for a newly minted PA. At the same hospital, the physician base was 220k, and that includes Pods. That is probably the highest I've heard of straight out of residency. And I wouldn't dream of starting an independent practice/group in this area, but if signing on with a major provider that can incur the risk- man, hard to say no to those figures.

 

[ldsrmdude]

Yes, the 105 figure was mentioned as it is high for a newly minted PA. At the same hospital, the physician base was 220k, and that includes Pods. That is probably the highest I've heard of straight out of residency. And I wouldn't dream of starting an independent practice/group in this area, but if signing on with a major provider that can incur the risk- man, hard to say no to those figures.

The 220k base salary is probably fairly routine for hospital-employed podiatrists. Not sure if you've read the most recent post by @dyk343 in the resident/attending forum, but he brings up some great points about why hospitals can afford to pay higher salaries. Here is the thread: https://forums.studentdoctor.net/threads/the-job-search-thread-tips-tricks-and-experiences.1222811/

 

[dtrack22]

A good friend from high school is graduating from PA school this spring. He has a couple of job offers already, but the best one by far is a small hospital on the Washington/Idaho border. It is in the epicenter of nowhere.

The offer: 105k base, 5k relocation expenses, 20k in loan repayment, on call pager, if called $105/hour, and here is the best part- housing stipend.

Pretty insane imo. This is not part of any subsidized government program, this is the hospital paying all these fees. He told me that they offer similar packages for Physicians, including Pods. I have heard that some of the best Pod jobs (in terms of compensation) out of residency are in these rural areas.

I don't question the validity of this based on his account and similar accounts I have heard- the questions I have are
1) How do these hospitals, that don't have huge volume, pay their providers these sums?
2) Are there consequences of practicing in these regions? ie, you may make a sizeable living, but may not be a desirable candidate in subsequent job apps due to low volume of these rural positions. He said that the staff Pod sees about 8 patients a day.

Sounds like Clarkston, WA and Lewiston, ID...if so, there is a population of around 50,000 people in the immediate area and probably draw another 20k or so from even more rural areas. The next closest towns that would offer any competition are Pullman, WA and Moscow, ID. Both have state universities but going to WSU for treatment would only be appealing if you are cattle or an exotic animal (they have a good vet school). That wasn't entirely relevant but to answer your question, having interviewed with a "rural" hospital system, I think hospital networks in those locations are able to pay competitive salaries for two reasons...1) they own everything in town. Where I interviewed there was a single PCP who wasn't employed by the hospital. Nearly everyone in a 100 mile radius goes to one of the hospital physicians for treatment, imaging, etc. There is no competition so despite a low overall population, they are a rather captive group. 2) They hire less docs. I think this one is common sense. Regardless of hospital size, it seems that when they decide to hire a practitioner, they are doing so with the expectation that he/she see's and treats X number of patient's per day. That "X" value is surprisingly consistent from one hospital system to the next. So hospital A that draws from a major metro may hire 3 PA's to do the same work as your buddy, while hospital B only hires 1...because they have 1/3 the numbers of potential patients to draw from.

You always hear about rural areas paying more in order to attract people to come live there, but I haven't found that to necessarily be the case in Podiatry. Hospitals go by MGMA or some similar practice management type survey, and pay structure is relatively similar. You get a base salary that is a certain %-ile of what the data says "surgical" podiatrists make, and then you bonus at an RVU value that is a similar %-ile according to the same surveys/data. NPs, PAs, PCPs and other specialists may be a different story, where the hospital NEEDS a general surgeon (for example) and has to take a little hit in profits in order to get someone into town. That could very well be a part of your friend's offer, I guarantee he is generating enough money for the hospital to justify the contract...otherwise there wouldn't be an offer.

 

[ldsrmdude]

I guarantee he is generating enough money for the hospital to justify the contract...otherwise there wouldn't be an offer.

This is something I think people tend to forget, both when talking about private practice jobs as well as hospital positions. Whoever is hiring you is going to anticipate making money off of you in some form or another, otherwise they wouldn't be hiring you. It's one of the reasons some doctors I've talked to in private practice won't join a hospital or employed position. If a hospital pays you a big salary, they expect you to make money for them and if you don't, the next contract they offer will be much smaller or they will get rid of you. I've seen it happen both at one of the hospitals I work at and in conversation when we've interviewed for a new associate.