Private practice salary offer...is it fair?

[jdm95ls2000]

I recently was offered an associate position from a solo practitioner in a local suburb far from the city. The base salary is $70,000, with bonus of 10% after making 3x base. This practitioner will pay for CME, malpractice, professional membership fees. No health insurance. 2 weeks sick/vacay. Practice is very busy, practitioner averages ~45 pts/day and there are nearby hospitals with very few podiatrists taking call, thus growth potential can be very fast and high. There's also option to buy-in at year 3. Is this a fair offer? If not, how can negotiate a fairer, more lucrative deal? thanks

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[heybrother]

Let's clarify what that 10% bonus means. You're base is 70K up to 3x (210K) which means you are starting at 33% which is probably already low. Does the 10% bonus mean that you are at 43% after 210K or does it just mean 10%. The former (43%) potentially has room for negotiation by evaluating the starting 33%. The latter (it really is just 10% after 3x) isn't worth discussing.

Your benefits appear quite meager. You should look finding out the costs of health insurance for yourself and your family since you'll be paying that out of your own pocket. This is one of those expenses that has been continuing to sky-rocket in price for the last several years. Know the dollar value of your benefits.

How long until the practitioner intends to retire? Does he intend for you and he to be partners for 20 years or is this really just a "buy me out" waiting to happen. Can the practice succeed with 2 people? Could you each be seeing 45 patients a day a year or two from now - in this case I suppose I mean facility wise but earlier on there's probably a question of what sort of backlog he has and how much cannibalizing of his patient stream you'll be doing. There's probably also a question of how patients will be assigned - the classic story on here is one of the new associate seeing other people's post-ops.

If you devote a significant amount of energy to building relationships at other hospitals and building new referral sources - how are you going to feel about that going into your boss' pocket?

Know exactly what the buy in means and for how much. That all probably needs to be defined now because otherwise you may be buying your own work back in 3 years - which seems like a tremendously long time. Of course, if the 10% really only means 10% it doesn't matter because you'll never be able to afford it.

 

[jdm95ls2000]

He does clinic 3x/week and surgery 2x/week. He mainly does trauma/reconstructive cases, I'll be doing a mix of all types of cases. Clinic patients are also a mix and not majority chip/clip. Yes, I had red flags when I was told the bonus is only 10% after 3x/base; my heart sank. Since this is the practitioner's first time hiring an associate, he said that he reviewed Dr. Ornstein's practice management article on new associate salaries...that's how he came up with that salary and bonus structure. What is a fair bonus % to counteroffer? He is open to renegotiate.

 

[jdm95ls2000]

Let's clarify what that 10% bonus means. You're base is 70K up to 3x (210K) which means you are starting at 33% which is probably already low. Does the 10% bonus mean that you are at 43% after 210K or does it just mean 10%. The former (43%) potentially has room for negotiation by evaluating the starting 33%. The latter (it really is just 10% after 3x) isn't worth discussing.

Your benefits appear quite meager. You should look finding out the costs of health insurance for yourself and your family since you'll be paying that out of your own pocket. This is one of those expenses that has been continuing to sky-rocket in price for the last several years. Know the dollar value of your benefits.

How long until the practitioner intends to retire? Does he intend for you and he to be partners for 20 years or is this really just a "buy me out" waiting to happen. Can the practice succeed with 2 people? Could you each be seeing 45 patients a day a year or two from now - in this case I suppose I mean facility wise but earlier on there's probably a question of what sort of backlog he has and how much cannibalizing of his patient stream you'll be doing. There's probably also a question of how patients will be assigned - the classic story on here is one of the new associate seeing other people's post-ops.

If you devote a significant amount of energy to building relationships at other hospitals and building new referral sources - how are you going to feel about that going into your boss' pocket?

Know exactly what the buy in means and for how much. That all probably needs to be defined now because otherwise you may be buying your own work back in 3 years - which seems like a tremendously long time. Of course, if the 10% really only means 10% it doesn't matter because you'll never be able to afford it.

Yes, I clarified with him that 10% means actually 10% after 210k. This doc is very young, 30' s retirement is not happening. Yes, the practice can succeed with 2 people, since he's only in clinic 3x/ week, whereas I will be in clinic 4x/ week and there are plentiful treatment rooms and 4 MAs. He states that any new patients that I acquire will go directly towards me.

 

[msuDPM]

Hey brother makes a lot of good points. To answer your most recent post though, 10% after 3x is not a bonus, it's a pay cut. As heybrother pointed out 3x 70k is 210k. So up to 210k you are making 33% of your collections, why would it make sense for you to make less as you make the practice more?

It sounds like the practitioner is young and still trying to aggressively grow his business. The question really becomes do you trust him to not try to take advantage of you and can you find a happy medium. Overhead varies alot by location, but in my opinion you should never make less than 30% of your collections whether Base or bonus. Some practices can't afford that, and my argument would be that they are not ready to hire an associate then.

Finally, if you are discussing buy in potential at the time of initial contract, you should get some terms of buy-in in the initial contract. Such as how may years or how much collections is required for buy in, how will the buy in price be calculated or what the actual price will be, can you buy in over time or does it have to be a lump sum, do you get paid like a partner the day you start buying in or not until you have paid off the sum?

That offer is pretty paltry in my opinion. It is extremely low on both salary and bonus. I went through all of this about a year ago and the going rate for private practice seemed to be ~90-120k base, 25-40% bonus at 2.5-4x base. Just keep in mind that you should either be paid a straight percentage (meaning if youre taking a 70k base you should get 33% after 210k) or your pay should increase after you hit a certain threshold, such as 35 or 40 % of collections after 210k in your scenario.

Good luck

 

[dtrack22]

No need to pile on what others have said about your "bonus" or % collections after 3x base. That's terrible for all the reasons mentioned. Just wanted to add that you need to think about that base salary too...

Take out taxes and spread that over 12 months and you are looking at $5k per month. Even if you get busy quickly, you aren't going to hit 3x base in collections for a few months. Your situation may vary significantly from mine but I think this at least illustrates potential problems with the guaranteed money: for my family of 3, I ran a budget when negotiating with a group. Housing expenses were a couple grand. Loans can continue to be IBR/PAYE but if you want to start paying the full amount you're looking at $1,600+ per month. My hospital payed $18k in premiums for my healthcare/dental/vision for my family last year, that's $1500 a month in premiums...I'm looking at over 5K before I get to food, clothing, car, cell phone, internet, disability ins, life ins, retirement plan contributions...

If you are single, or have a wife that works, or had family that paid for your schooling, etc. that monthly income may work. If it were me I would say $70k for the first 6 months or so and then straight production at 40% of gross collections (if you're confident that you can be running a full clinic in 6 months which doesn't sound unreasonable given the info you provided). If he's not paying your healthcare he should be able to keep overhead at 50% meaning he's still profitable paying you 45% of your gross collections.

There are way to many variables to know what this guy is able to pay you or what you need to live. But the contractual pay he has proposed is a terrible deal for you. Hopefully you have the leverage to get more or say no and move on.

 

[ldsrmdude]

I recently was offered an associate position from a solo practitioner in a local suburb far from the city. The base salary is $70,000, with bonus of 10% after making 3x base. This practitioner will pay for CME, malpractice, professional membership fees. No health insurance. 2 weeks sick/vacay. Practice is very busy, practitioner averages ~45 pts/day and there are nearby hospitals with very few podiatrists taking call, thus growth potential can be very fast and high. There's also option to buy-in at year 3. Is this a fair offer? If not, how can negotiate a fairer, more lucrative deal? thanks

You've gotten some good advice so far and I'll avoid rehashing it, but just say the base salary could potentially be workable, but the bonus would need to make up for it or at least give you the potential to make up for it. As has been mentioned in other threads these contracts, especially this first offer, are designed for the employers benefit, not yours. Right or wrong, the AAPPM contract is designed to benefit the employer and get the most advantage for them, not for the employee. Another thing to consider is the volume of patients. 45 patients is a lot to jump into, especially if a good number of those patients are new. I would find it incredibly challenging to see that many patients in a day. There are ways to make it happen (nail tech, multiple MA's, scribe, etc) but I would prefer to spend more time with less patients. I've shadowed/rotated in practices that almost seem like a nail mill or like they're just trying to herd cattle in and out and that's not how I want to practice. Just a reminder that salary isn't the only thing you should be looking at. Good luck

 

[deleted690619]

I recently was offered an associate position from a solo practitioner in a local suburb far from the city. The base salary is $70,000, with bonus of 10% after making 3x base. This practitioner will pay for CME, malpractice, professional membership fees. No health insurance. 2 weeks sick/vacay. Practice is very busy, practitioner averages ~45 pts/day and there are nearby hospitals with very few podiatrists taking call, thus growth potential can be very fast and high. There's also option to buy-in at year 3. Is this a fair offer? If not, how can negotiate a fairer, more lucrative deal? thanks

This post makes it seem as if this is the best offer you've received. Just curious, what's stopping you from obtaining a $200K+ offer whether it be in private practice, hospital? Was it your residency training? Is it location stubbornness?

 

[heybrother]

This is from 13 years ago...

http://www.podiatrytoday.com/article/1407

“The first question that’s asked whenever I talk to young practitioners is, ‘What’s the standard we should be getting paid?’” explains Dr. Ornstein. “I tell them the truth—there is no standard—there are many variables. A fluffy estimate would probably be $60,000 or $70,000. There are people getting paid $30,000 and there are people getting $100,000, but $60,000 or $70,000 is a pretty good guess at an average. It’s not a lot of money.” Dr. Ornstein notes there are three basic models of compensation for associates. These include straight pay, straight incentive and a hybrid of straight and incentive pay. “The most logical model I’ve seen out there is if you base their salary and incentives on what they collect, usually one-third of that amount,” adds Dr. Ornstein. “For example, if I pay the associate $40,000, they must collect $120,000. If they collect anything above that, they get a percentage of the take—probably 20 to 30 percent.”

 

[ExperiencedDPM]

The more standard would be that after you hit 3x your base you would receive 30% of the amount over 3x

So my feeling is that:

1). He is low balling you on your base

2). He is low balling you on your percentage after hitting 3x your base. Standard is around the 30% mark.

Don't let anklebreaker make you feel bad. I'm happy he's starting with $240 k, but I ASSURE you that is the exception and not the rule. Otherwise the avg pod salary wouldn't be in the $120k range.

 

[GypsyHummus]

The more standard would be that after you hit 3x your base you would receive 30% of the amount over 3x

So my feeling is that:

1). He is low balling you on your base

2). He is low balling you on your percentage after hitting 3x your base. Standard is around the 30% mark.

Don't let anklebreaker make you feel bad. I'm happy he's starting with $240 k, but I ASSURE you that is the exception and not the rule. Otherwise the avg pod salary wouldn't be in the $120k range.

What would you guesstimate a more reasonable offer to be as a starting foot and ankle surgeon? 120K plus 30% production?

 

[that1guyfromFL]

Don't let anklebreaker make you feel bad. I'm happy he's starting with $240 k, but I ASSURE you that is the exception and not the rule. Otherwise the avg pod salary wouldn't be in the $120k range.

It's within the ballpark for many hospital employed positions for the graduating class of 2017. Not geographically specific, I know of contracts from all over the US that are similar.

 

[dtrack22]

It's within the ballpark for many hospital employed positions for the graduating class of 2017. Not geographically specific, I know of contracts from all over the US that are similar.

Right, Ankle Breaker's base salary is totally normal for a salaried hospital position, even for new grads. Hospitals across the country use essentially the same formula for figuring out base and incentive pay. They take some salary/production survey data (ie MGMA) and start around the 50th %-ile which for "surgical podiatrists" was right around $240k in 2013. They then take the corresponding %-ile wRVU and start your $ per RVU bonus there. They typically also tie in ~10% of your salary that relies on patient satisfaction scores (so you can lose money year to year based on how much your patients liked you). To add to the anecdotal evidence, I interviewed with 2 hospitals on the opposite side of the country from AB that both had similarly structured contracts. The variations were minor, a few thousand $ salary difference and a couple hundred wRVU difference when it came to bonus/production pay.

So a $240k base with a $45 per wRVU bonus that starts around 6000 wRVU's is the norm for these salaried positions, not the exception. Of course, salaried hospital positions themselves still aren't the norm, but they are becoming more prevalent. And there are still hospitals that will contract out work instead of directly employing the specialist which comes with its own structure, but I would put a lot of money on those becoming more rare while salaried-employee models become more common.

A busy podiatrist in a hospital system may not have the same production as orthos in other subspecialties, largely due to differences in RVU values for the procedures we do. But downstream revenue (which matters just as much to a hospital) is equivalent. Again, (anecdotally) both hospitals I interviewed with and another that was thinking about opening another position already despite having hired last August, had hired their first podiatrist within the last couple years and now want to add another one. Clearly they are seeing value in podiatrists as employees.

 

[Rop]

Right, Ankle Breaker's base salary is totally normal for a salaried hospital position, even for new grads. Hospitals across the country use essentially the same formula for figuring out base and incentive pay. They take some salary/production survey data (ie MGMA) and start around the 50th %-ile which for "surgical podiatrists" was right around $240k in 2013. They then take the corresponding %-ile wRVU and start your $ per RVU bonus there. They typically also tie in ~10% of your salary that relies on patient satisfaction scores (so you can lose money year to year based on how much your patient's liked you). To add to the anecdotal evidence, I interviewed with 2 hospitals on the opposite side of the country from AB that both had similarly structured contracts. The variations were minor, a few thousand $ salary difference and a couple hundred wRVU difference when it came to bonus/production pay.

So a $240k base with a $45 per wRVU bonus that starts around 6000 wRVU's is the norm for these salaried positions, not the exception. Of course, salaried hospital positions themselves still aren't the norm, but they are becoming more prevalent. And there are still hospitals that will contract out work instead of directly employing the specialist which comes with its own structure, but I would put a lot of money on those becoming more rare while salaried-employee models become more common.

A busy podiatrist in a hospital system may not have the same production as orthos in other subspecialties, largely due to differences in RVU values for the procedures we do. But downstream revenue (which matters just as much to a hospital) is equivalent. Again, (anecdotally) both hospitals I interviewed with and another that was thinking about opening another position already despite having hired last August, had hired their first podiatrist within the last couple years and now want to add another one. Clearly they are seeing value in podiatrists as employees.

Would graduating from a PMSR without RRA prevent a doc from getting these types of hospital offers?

 

[hematosis]

I'd like to echo some of the other posts here about the starting salary. 230-250k is what most hospitals are starting out freshly graduated Podiatrist from 3 year residency programs. My best friend graduated last year and accepted a job with Kaiser starting at 255k.

To the OP, this is a terrible offer. I am amazed that people are still considering contracts like these. Hal Ornstein is a businessman.

 

[Weirdy]

Probably


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Quick question, sorry if this sounds naive- do podiatry programs in general (with necessary work on your part) prepare you well for finishing PMSR + RRA cert?
Is it synonymous to doing well in residency overall? Or is it a different ball game?

 

[I post PRN]

Quick question, sorry if this sounds naive- do podiatry programs in general (with necessary work on your part) prepare you well for finishing PMSR + RRA cert?
Is it synonymous to doing well in residency overall? Or is it a different ball game?

I think it does, when you work up 50 flatfoot recons, you see it and do it, sticks better than some PowerPoint.

 

[ExperiencedDPM]

I'm not disputing that hospital salaries generally start in that range. But you are realistically talking about a very small percentage of overall positions or offers.

If you toss out the high and toss out the low, the average is still in the low 100 range. Likely between 90-110,000. I have personally reviewed dozens and dozens of contracts over the past few years. These include residents from varied geographical areas and offers from different geographical areas. The range I've seen spans from 55,000-270,000. The vast majority are in the 90-110,000 range with incentives.

Most of the grads who went into hospital practices were happy. A few had less than great experiences. Some complained they spent the day performing routine foot care and wound care. And were on call and called upon a lot for diabetic wounds, amputations, I & Ds, etc, with no glory work. That went to Ortho. Others had issues with high starting salaries that were renegotiated after 2-3 years to a lower number based on RVU production. Remember, the hospital can control what you see, they control the situation. It depends on what they send you or allow you to do.

Starting offers with ortho groups are generally higher and most are happy. Some were overworked, since ALL foot and ankle came their way, including being the only doc on call 52 weeks a year for foot and ankle call. Others are unhappy because in some states a DPM can not be a partner in an ortho group.

There are always highs and always lows. I've been around for a few more years than most on this site. I'm sincerely happy that some on this site are getting great offers. But I still hold to the opinion based on contracts I've reviewed, that the average offerss are between 90-110,000 plus incentives or 120-130,000 as a straight salary.

 

[deleted690619]

I don't know about anybody else on this forum but there would be no way in hell I would ever accept a contract from the hospital if I wasn't getting all the foot and ankle consults...including trauma. It was something I specifically asked during my interview and was told by the chief of orthopedics that he nor any of his colleagues had no intention of touching the foot and ankle because none of them have extensive experience in that area. He even asked me how far up the leg I wanted to go. The day of my interview he showed me an x-ray of a calcaneal fracture that came into the emergency department the night before and asked me how I would fixate it. He then went on to tell me that the orthopedic traumatologist on staff didn't want to even touch it and they referred it out. Right then and there I knew I was in a good situation.

But I am not naïve. My hospital is only a level III trauma center so the trauma I will be getting won't be that exciting. The hospital is banking on me on producing in the areas of elective foot and ankle reconstructive surgery and also handling all the infections and amputations. Which I would be more than happy to do considering I am making more money than I ever would or could with the "typical podiatry group" who just take advantage of associate after associate after associate. Yes I understand not all podiatry groups are like that but a lot of them are. That's the culture of our profession.

When I interviewed for this hospital position, much to my amazement… they treated me like a real doctor! They talked to me like a real doctor, they negotiated with me like I was a real doctor. They told me..."you're a partner now of this group, go out there and earn!".

I didn't get the typical DPM spiel, when discussing contracts, that pretty much sounds like this..."your contract is more than fair and you should just deal with it" because that's what they went through when they were coming out of residency (if they did one).

MD/DOs take care of their own and feel some sort of responsibility for their partners success or demise. A DPM getting involved with a hospital is a good thing once you hammer out what the expectations are for the incoming podiatrist. I'm not saying that all DPMs who got involved with a hospital were 100 percent successful but I'm willing to bet that the majority of them are.

Because if you came out of residency with any type of REAL foot and ankle surgery training, have a brain, have common sense and are not the typical DPM, ACFAS podium, egomaniac who thinks they are a "real surgeon"... you can have a damn nice life working for a hospital and be able to put food on your table for the rest of your career. You can utilize all the skills from the residency training to help a lot of people in the community and you won't piss off any of the real surgeons on staff. You know your role and don't act like a dickweed.

Lastly, if a DPM isn't producing enough work RVUs I believe most hospitals would go ahead and fire them rather than negotiate. Hospitals are businesses and if you're not making money they will find somebody else. Why continue on with losing product?


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First I'd like to say that your approach to employment has help set a minimum standard for many of us that will be following in your footsteps in the coming years.
For clarification did you partner with an ortho group that is contracted for all ortho care at the hospital? Also is this position in an area that you intended on living in or was it morso a move to where the job/money was? Lastly, did you have solid alternative options that were in your current package range? Greatly appreciated.

 

[that1guyfromFL]

...you are not the typical "DPM jerk who thumps their chest acting like they are a real surgeon and just piss people off daily" ...

I noticed this sort of sentiment in a couple of your recent posts, I'm not entirely sure where you are coming from.

Have you dealt with a lot of chest thumping jerks in our profession? (I haven't, I'm asking honestly.)


What constitutes a "real surgeon" vs (I assume) a fake one?

 

[ExperiencedDPM]

If you want to meet a chest thumping DPM, he or she is very easy to spot. He or she is the one who will tell people that they are foot and ankle surgeons and never use the "p" word.

I work with orthopedic surgeons, neurosurgeons and physiatrists. I believe I get their respect and so do many of my podiatric colleagues, but I will tell you that they do often joke about three things......and I agree.

They laugh at the DPM who introduces him/herself as a foot and ankle surgeon.

They laugh at the DPM who has Dr. Joe Shmo on the lab coat instead of Joe Shmo D.P.M. (and they laugh at D.O.s who do the same).

They laugh at DPMs who have a website or promo pic with a stethoscope around their necks.

Once again, I'm very glad that ankle breaker worked hard and had enough drive to land the job he pursued. As I said in the past, there are presently a very finite number of ortho jobs and a very finite number of hospital jobs. And they don't offer jobs to those who haven't proven to be at the top of their game. If they did hire someone not qualified, the person would be exposed quickly.

Most private DPM offer **** contracts because they simply can't afford to pay more. They are legends in their own minds and most are all smoke and mirrors.

But for some, private practice jobs may be all they are offered. It's unfortunate, but it's factual.

 

[RockyIV]

I haven't posted in years but I still read and there are a few real interesting discussions going on in a couple of threads. I'll bite...

But I am not naïve. My hospital is only a level III trauma center so the trauma I will be getting won't be that exciting. The hospital is banking on me on producing in the areas of elective foot and ankle reconstructive surgery and also handling all the infections and amputations. Which I would be more than happy to do considering I am making more money than I ever would or could with the "typical podiatry group" who just take advantage of associate after associate after associate. Yes I understand not all podiatry groups are like that but a lot of them are. That's the culture of our profession.

As a podiatrist in a hospital system, I have to point out that the bolded part is wrong more often than not. They key word being "could," because sure in year 1 and maybe even 2 you will probably make more money than your colleagues in private or group practice. But you will have friends in various group practices and you will find that the ones in practices that are decently run, make more money than you. It's not a big deal at all, and people in our situation typically agree that our friends' business type obligations and stresses aren't worth the extra money they make. I'm sure there are a couple hospital DPMs making a half million dollars, but for every one of those there are 2 or 3 in a non hospital setting that make more. I like my job and do very well, but if my goal was to maximize my income I never would have taken a job like yours or like mine. You will likely argue with me, because that is what you do, and when that happens we will discuss ancillary revenue streams, profit sharing, admins capping your clinic either directly or indirectly by refusing to hire more staff or give you enough rooms to increase patient volume...usually under the guise of patient satisfaction surveys. Be ready.

Because if you came out of residency with any type of REAL foot and ankle surgery training, have a brain, have common sense and are not the typical DPM, ACFAS podium, egomaniac who thinks they are a "real surgeon"... you can have a damn nice life working for a hospital and be able to put food on your table for the rest of your career. You can utilize all the skills from the residency training to help a lot of people in the community and you won't piss off any of the real surgeons on staff. You know your role and don't act like a dickweed.

I'm confused as to what that means? I mean, most of those "ACFAS podium" guys and gals work in ortho groups, multi-specialty groups, and are employed by hospitals. It seems to me that if they were the ones pissing off the "real surgeons" that they would no longer have their jobs? Like I said, I still read the forums, so I know you are at Swedish where I know podiatrists are often treated as second class citizens by those who you seem to believe are the "real surgeons." It feels like you are projecting some angst that you have towards your own training situation and maybe the failures of your attendings on everyone who lectures on the ACFAS circuit? I'll be the first one to rail against some of the superiority complexes that ACFAS projects, but I'm having trouble understanding what exactly you are trying to say with the above comment. I'm sure this sounds mean but it's an honest question that I'm trying to understand because my experience with some of the DPMs I assume you are referring to has been very different.

First I'd like to say that your approach to employment has help set a minimum standard for many of us that will be following in your footsteps in the coming years.

Personally I would take a different approach than someone who had a single interview despite casting a very wide net. Anyone can PM me if they want any more of my opinion about any of the above topics.

 

[RockyIV]

If you want to meet a chest thumping DPM, he or she is very easy to spot. He or she is the one who will tell people that they are foot and ankle surgeons and never use the "p" word.

I work with orthopedic surgeons, neurosurgeons and physiatrists. I believe I get their respect and so do many of my podiatric colleagues, but I will tell you that they do often joke about three things......and I agree.

They laugh at the DPM who introduces him/herself as a foot and ankle surgeon.

They laugh at the DPM who has Dr. Joe Shmo on the lab coat instead of Joe Shmo D.P.M. (and they laugh at D.O.s who do the same).

They laugh at DPMs who have a website or promo pic with a stethoscope around their necks.

Once again, I'm very glad that ankle breaker worked hard and had enough drive to land the job he pursued. As I said in the past, there are presently a very finite number of ortho jobs and a very finite number of hospital jobs. And they don't offer jobs to those who haven't proven to be at the top of their game. If they did hire someone not qualified, the person would be exposed quickly.

Most private DPM offer **** contracts because they simply can't afford to pay more. They are legends in their own minds and most are all smoke and mirrors.

But for some, private practice jobs may be all they are offered. It's unfortunate, but it's factual.

Every part of this post is true

 

[dyk343]

There is a hospital in the area where I am in residency who is famous for hiring pods at a great starting salary (~220k + incentives). Then when 3 year renewal comes around their salary is magically cut in half. Take it or leave it. They also sign a non-compete agreement so they can't practice within 50 miles for x number of years or something like that if they leave. So in that 3 years you have established your family, bought a house, started kids in school, etc, etc. You're stuck.

I was nudged one day coming out of surgery with a "hey, you want to work for us?" I politely declined.

Cross my fingers I don't find myself in the same position. I'm not buying a home right away....

 

[Weirdy]

I noticed this sort of sentiment in a couple of your recent posts, I'm not entirely sure where you are coming from.

Have you dealt with a lot of chest thumping jerks in our profession? (I haven't, I'm asking honestly.)


What constitutes a "real surgeon" vs (I assume) a fake one?

Great training does not equal a great podiatrist.

Some have brilliant skill sets and minds but will scratch, climb and kick their colleagues for the power trip and prestige.

I believe they are referring more to a character judgement call than a "fake surgeon".

 

[ExperiencedDPM]

There is a hospital in the area where I am in residency who is famous for hiring pods at a great starting salary (~220k + incentives). Then when 3 year renewal comes around their salary is magically cut in half. Take it or leave it. They also sign a non-compete agreement so they can't practice within 50 miles for x number of years or something like that if they leave. So in that 3 years you have established your family, bought a house, started kids in school, etc, etc. You're stuck.

I was nudged one day coming out of surgery with a "hey, you want to work for us?" I politely declined.

Cross my fingers I don't find myself in the same position. I'm not buying a home right away....

This is 100% spot on. I hope that ankle breaker has nothing but great experiences in his new position. But I've seen many former residents go in bright eyed and bushy tailed only to have eventual disappointment. A few got screwed royally by the hospital system and mirrored the comments you've made. Two were part of a relatively small hospital system that was swallowed up by a large university system. They didn't see the value in podiatry since they had very large and well respected orthopods, including two foot and ankle orthopods.

The bottom line is that you never know what is really going to happen until it plays out. You can set up scenarios and be pleasantly surprised or very disappointed.

Again, I hope that ankle breaker kicks butt and proves his value and lays the foundation for those who follow. Do I personally believe a hospital DPM is going to make 500k? The answer is "no". Of course there will always be exceptions, but medicine isn't in a great place financially at the present time.

And I will again repeat that the avg pod is making about 130,000. Quote MGMA, etc., but I'm speaking honestly from my many years of experience.

I'm fortunate and have done relatively well, but I've also received calls, emails and letters from new DPMs, and some in practice over 20 years looking for a job and sadly willing to work for ridiculously low amounts of money.

Pod salaries are truly ALL over the place with little consistency. On the other hand, allopathic medicine is much more consistent and predictable. If you are a graduating anesthesiologist, it's a sure bet you're starting at about 300k. There is no sure bet with podiatry. It's a roll of the dice.

 

[Cranjis McBasketball]

And I will again repeat that the avg pod is making about 130,000.
There is no sure bet with podiatry. It's a roll of the dice.

Will it always be like that or are there trends that show increasing salaries that are pretty consistent and increasing respect/autonomy among fellow surgeons/MDs? And how to people pay of their debts with starting salaries like that?

 

[dyk343]

Will it always be like that or are there trends that show increasing salaries that are pretty consistent and increasing respect/autonomy among fellow surgeons/MDs? And how to people pay of their debts with starting salaries like that?

I didn't have any issues getting offers in the 200+ range starting. There are good jobs out there. But if you go to a low volume residency you may find it harder to obtain these offers. As above always risk either private vs MSG/hospital.

I feel private practice is slowly dying. Primary care doctors are being bought up in the cities by large hospitals. These PCPs now have to refer within their system. Rural private practice will continue on for quite some time but I predict many private practices to flounder in the next 20 years. Medicine is changing and becoming corporate. I see this trend happening rapidly in the area I am currently in. It would be financial suicide to join a private practice around here.

Others see this trend?

 

[RockyIV]

Totally understand where you coming from but are we talking about a hospital employed DPM who is also employed with other DPMs or are we talking about a DPM who is employed by a hospital all by himself? If it is the former then I can appreciate your sentiment but if it is the latter...especially if this is the first DPM the hospital has ever hired then the "sky is limit" in my opinion.

It doesn't matter. And if you don't understand why it doesn't matter, then the real problem is you don't know what you don't know.

You did a good job of toning down the rhetoric, but you still didn't answer the question about "ACFAS podium douchebags" or whatever you called them. Your residency experience is obviously part of the reason you feel that way. Reading through some other posts, it looks like you interviewed for a few of those egomaniacs' fellowship programs too? I guess being mad at them would be another reason to lash out. Unless you have some other explanation about why you think the way you do about these ACFAS members?

 

[Boodspremed]

I didn't have any issues getting offers in the 200+ range starting. There are good jobs out there. But if you go to a low volume residency you may find it harder to obtain these offers. As above always risk either private vs MSG/hospital.

I feel private practice is slowly dying. Primary care doctors are being bought up in the cities by large hospitals. These PCPs now have to refer within their system. Rural private practice will continue on for quite some time but I predict many private practices to flounder in the next 20 years. Medicine is changing and becoming corporate. I see this trend happening rapidly in the area I am currently in. It would be financial suicide to join a private practice around here.

Others see this trend?

Working in the consulting area, I have noticed this trend increasing. Do we blame it on Meaningful Use and now MACRA? Maybe. I think there is a definite sense of being cost effective involved in this trend as well. This corporate structure is the reason I've chosen to reenter healthcare and apply to Pod school. I think from a provider perspective, we can educate ourselves more to become better business people and be proactive in the trends of medical practice.

 

[GypsyHummus]

This is 100% spot on. I hope that ankle breaker has nothing but great experiences in his new position. But I've seen many former residents go in bright eyed and bushy tailed only to have eventual disappointment. A few got screwed royally by the hospital system and mirrored the comments you've made. Two were part of a relatively small hospital system that was swallowed up by a large university system. They didn't see the value in podiatry since they had very large and well respected orthopods, including two foot and ankle orthopods.

The bottom line is that you never know what is really going to happen until it plays out. You can set up scenarios and be pleasantly surprised or very disappointed.

Again, I hope that ankle breaker kicks butt and proves his value and lays the foundation for those who follow. Do I personally believe a hospital DPM is going to make 500k? The answer is "no". Of course there will always be exceptions, but medicine isn't in a great place financially at the present time.

And I will again repeat that the avg pod is making about 130,000. Quote MGMA, etc., but I'm speaking honestly from my many years of experience.

I'm fortunate and have done relatively well, but I've also received calls, emails and letters from new DPMs, and some in practice over 20 years looking for a job and sadly willing to work for ridiculously low amounts of money.

Pod salaries are truly ALL over the place with little consistency. On the other hand, allopathic medicine is much more consistent and predictable. If you are a graduating anesthesiologist, it's a sure bet you're starting at about 300k. There is no sure bet with podiatry. It's a roll of the dice.

What in your professional opinion is "ridiculously low amounts of money"?

130k starting out isn't too shabby! I'm assuming that increases after years of experience within a private practice setting?

And idk if it's all cherry for other docs out there. Most pods aren't pulling the 65+ hour workweek that general surgeons are.

 

[Weirdy]

What in your professional opinion is "ridiculously low amounts of money"?

130k starting out isn't too shabby! I'm assuming that increases after years of experience within a private practice setting?

And idk if it's all cherry for other docs out there. Most pods aren't pulling the 65+ hour workweek that general surgeons are.

There were quotes of 60-70k

 

[heybrother]

What in your professional opinion is "ridiculously low amounts of money"?

130k starting out isn't too shabby! I'm assuming that increases after years of experience within a private practice setting?

And idk if it's all cherry for other docs out there. Most pods aren't pulling the 65+ hour workweek that general surgeons are.

You'd potentially be assuming wrong. That's the heart of this thread - ie. the original poster's deal. If you sign a bad deal someone else will take the money you collected. To over-spell it out a little more - if we're identical twins who are co-residents at the same program who are hired by the same private practice and I sign for 40% when you sign for 20% - I will crush you. Ridiculous you might say, but when the time comes everyone will have fight for what they are worth.

Its early for you, but in time you'll want to empower yourself to understand where "money" comes from. How does a podiatrist get paid. Someone getting paid $130K may be getting exactly what they deserve or grossly underpaid. Worth a look for some basics is group_theory's thread: https://forums.studentdoctor.net/threads/how-a-doctor-makes-money.1170226/

Also worth wondering is - what does a person who is 20 years out have that a guy fresh out or 5 years out doesn't have.

 

[GypsyHummus]

You'd potentially be assuming wrong. That's the heart of this thread - ie. the original poster's deal. If you sign a bad deal someone else will take the money you collected. To over-spell it out a little more - if we're identical twins who are co-residents at the same program who are hired by the same private practice and I sign for 40% when you sign for 20% - I will crush you. Ridiculous you might say, but when the time comes everyone will have fight for what they are worth.

Its early for you, but in time you'll want to empower yourself to understand where "money" comes from. How does a podiatrist get paid. Someone getting paid $130K may be getting exactly what they deserve or grossly underpaid. Worth a look for some basics is group_theory's thread: https://forums.studentdoctor.net/threads/how-a-doctor-makes-money.1170226/

Also worth wondering is - what does a person who is 20 years out have that a guy fresh out or 5 years out doesn't have.

Why are podiatrists in the private practice paid so low? I would assume that since pods do a ton of procedural based things that they could charge much more than a family doc.

The hospital pods seem to have it better money wise.

 

[ldsrmdude]

Why are podiatrists in the private practice paid so low? I would assume that since pods do a ton of procedural based things that they could charge much more than a family doc.

The hospital pods seem to have it better money wise.

There are pros/cons to both options. @dyk343 had some great points in this post: https://forums.studentdoctor.net/th...tricks-and-experiences.1222811/#post-18534355

 

[RockyIV]

Are you a podiatric psychologist? Sounds like you are trying to be. You are reading into things way way way too deeply. Being mad at fellowship directors for not getting accepted to fellowships? Are you kidding me? Wow. I won't engage you. You are clearly trying to bait me. I think you have clearly made your point of trying to put me in my place. Feel free to PM me with further comments.


Sent from my iPhone using SDN mobile

Oh c'mon, you got called out for making a dumb comment that you still haven't explained despite multiple people asking for clarification.

You know your role and don't act like a dickweed.

Well isn't this the pot calling the kettle black

 

[bobtheweazel]

Dang, people popping up out of nowhere just to hate on Ankle Breaker. Whatever his/her opinions, I still appreciate Ankle Breaker's regular contributions to the forum. That is all.

Sent from my Nexus 5X using SDN mobile

 

[GypsyHummus]

What I don't like are attendings, I've come across, that say they are "surgeons". I don't buy it. An orthopedist who specializes in the spine is a surgeon, a neurosurgeon is a surgeon, general surgeons are surgeons, plastic surgeons are surgeons, cardiothoracic surgeons are surgeons. These people are "surgeons". On top of that some of "surgeons" can medically manage their own patients...because their smart. They went to medical school. They achieved the rigorous standards to get into medical school. They take and scored very high on REAL board exams during medical school to land the specialties they trained in residency in...which are all longer than podiatry residency btw. Then they do/can do fellowship training after residency training. They do surgery everyday that significantly impacts and/or can potentially kill patients. They are the real surgeons. They are real doctors. If you can't appreciate that or refuse to agree with that sentiment or can't understand my opinion then I can't help you nor am I going to explain in another way that your podiatry brain can comprehend.

I won't deviate too much from the starting salary thread, but I feel that this point is tangentially related.

I agree that Podiatry school is probably a bit easier than Medical School, but at least at Midwestern and DMU, we take all the same 2 years classes with all the DO students. There is no curve for us. In the beginning, we start off worse than the DOs and at the end of second year we start to out perform them. The only different class we take is Pod practices and they take OMM.

When you proclaim that MD/DO are "Real Doctors" in your mind, are dentists "Real Doctors"?

When you proclaim that MD/DO are "Real Surgeons", why are you saying that podiatrists are not foot and ankle surgeons? When I shadowed, that is literally what the podiatrist did, she was in the OR, doing a hammertoe surgery. She opened up the patient under anesthesia, broke the bones, and reset them. How is that not surgery?

 

[Weirdy]

I won't deviate too much from the starting salary thread, but I feel that this point is tangentially related.

I agree that Podiatry school is probably a bit easier than Medical School, but at least at Midwestern and DMU, we take all the same 2 years classes with all the DO students. There is no curve for us. In the beginning, we start off worse than the DOs and at the end of second year we start to out perform them. The only different class we take is Pod practices and they take OMM.

When you proclaim that MD/DO are "Real Doctors" in your mind, are dentists "Real Doctors"?

When you proclaim that MD/DO are "Real Surgeons", why are you saying that podiatrists are not foot and ankle surgeons? When I shadowed, that is literally what the podiatrist did, she was in the OR, doing a hammertoe surgery. She opened up the patient under anesthesia, broke the bones, and reset them. How is that not surgery?

Rotation subjects.

Residency length and depth.

Board examination depth.

Extent of care and prescribing* power.

Those are the differences you are looking at.

 

[dyk343]

I try to stay out of the SDN trashtalk. But...

I don't understand how i'm not a surgeon. I don't understand how i'm not a real doctor.

I woke up at 3am last night for an elderly gentleman with nasty gas spreading up the leg (it was impressive). We as podiatrists, on a team of professionals including infectious disease to manage abx and intensivists to manage his sepsis, saved that person's life with a team approach.

That "real" doctor intensivist is not going to take a patient to the OR nor does he have the knowledge to do so. Neither is the "real doctor" infectious disease physician. But they did apply their medical knowledge to stabilize him for an emergent case while we went in and surgically removed the infection. Medicine has evolved to be teamwork.

If the ER would call ortho or general surgery at my institution they would say "call podiatry below the knee".

Patient is doing fine now btw. Still in ICU and a long road ahead but fine.

 

[dyk343]

Like I said, I don't like getting involved in the SDN trash talk. Especially since were all in a small profession and what we say/do on here can carry with us for years to come. But...

I'm really set back by the "best interest of the patient" comment. The patient clearly did not need below the knee amputation. Why is podiatry not in the best interest? Why is the ID doctor or the intensivist less of a doctor than a ortho/general surgeon?

You're at a really good program. One of the best. I wish you respected the profession (and yourself) a little more. Our best graduates (that's you) need to hold themselves to a high level. That is the only way to keep our profession moving forward. You have the background to be up on that ACFAS podium some day as an expert. That's not a bad thing.

You didn't get a job fixing ankle, calc, and putting in TARs because you're not a "real doctor".

 

[I post PRN]

I am a doctor of Podiatric medicine. I perform surgery on both the foot and ankle. I don't care what anyone else thinks or says, bottom line is I'm going to make a pretty good living doing what I love.

I know ankle breaker well outside of SDN, I respect his opinion, although I don't agree with everything he says, he does make some valid points.

Really the only thing he has done to upset me is use their, they're and there incorrectly from time to time. Haha. Lighten up everybody. We are supposed to be on the same team.

 

[Cranjis McBasketball]

Yes the intensivist and ID physician can't operate but the orthopedic surgeon (who would fight like crazy to defer the consult) or a general surgeon could do exactly what you did and have a broader scope right then and there to perform a below knee amputation if they felt it was in the best interest of the patient.

I am not some self loathing DPM wishing I was something else. I'm just calling it how I see it.

Gas gangrene, compartment syndrome, open fractures are the only emergencies we would ever face as DPMs. If we were not around they could be handled easily by other professions. The majority of what we go surgically is ELECTIVE surgery. Are there residencies predominately focused in trauma, limb salvage, etc? Yes definitely...but those training experiences do not translate into what DPMs do in reality (after residency) for the most part.

The typical DPM niche within a hospital, ortho group, podiatry group, etc is bread and butter podiatry and elective foot and ankle reconstruction.

Ok you are real surgeon now because you went in at 3am to decompress a terrible infection...will you be doing this in your future practice? If so then kudos to you. But what about the majority of the profession who won't be exposed to these experiences in practice? How would you define them?

Idk how this equates to not being a doctor. Family practice doctors do procedures that can be done by specialties. Yet they are still doctors. Idk what your definition of a doctor is

 

[DexterMorganSK]

You guys should visit Boston. They have great wine and cheese, besides being the 2017 Champs!

 

[that1guyfromFL]

I've been around these forums for a decent amount of time at this point, and it's pretty common to see what might be a decent discussion turn into a lot of people talking past each other and then, eventually, the defensiveness level rises and it becomes a useless rat hole.

In light of that, I'll only share one anecdotal point that came to mind reading a lot of the posts in this particular thread over the last couple of days.

If we were not around they [the surgery we as podiatrists perform] could be handled easily by other professions.

My residency is based out of a level 1 trauma center that is fed from a large geographic region.
We have, expectedly, every residency program imaginable and a coordinating number of fellowships.

I was on call when a very young, very sick DM patient with suspected acute gas gangrene in the foot and leg was worked up by ICU staff. Trauma was called by ICU because it was midnight and they are in house. The trauma fellow saw the patient, looked at the imaging and called podiatry.

This probably sounds like a "no thanks, call podiatry" but it wasn't. When I talked to the trauma fellow, he knew what the patient had, knew what needed to be done and called our service anyway.

He told me flat out that after seeing the patient and looking at the imaging he knew we would have a better understanding of the anatomy involved and likely had more practical experience than he did at doing the operation. He didn't let his ego get in the way of doing what he thought was best and, in this case, what he thought best was calling someone else.

I know the quote above is from Ankle Breaker, but I didn't share that story to directly rebut anything that's been said in this thread.

At least where I work, the trauma guys are absolutely amazing.
Easily the smartest, nerviest guys in the hospital.

My take away from that experience was simple: a real surgeon knows their limits and will do what is best for the patient every single time.

That trauma fellow came down to the OR and just kicked it for a bit, he was curious if his gut was right about what needed to be done. After the case he stuck around and asked a few questions about what we did and the approach and thought process. He thanked me for coming in the middle of the night and we went our separate ways.

In actual practice, the reality is that your reputation is literally all you have.
I think the best advice I've gotten went something like this:

Treat everyone with respect.
Know your limits.
Be honest with your patients.
Do good work.

The rest will take care of itself.

 

[dtrack22]

This thread has some interesting and entertaining posts...I don't think many good points have been made outside of the post directly above me. Against my better judgement I will comment, which is probably useless given than definitions and meanings are being changed within the thread and there has been back tracking and the goal posts keep moving...etc.

This won't be productive, but I don't really feel like studying for boards. Nor do I feel the need to read for the calc I have to fix/revise tomorrow that was initially treated by a fellowship trained orthopedic surgeon (joints) 6 weeks ago...I won't be doing this in practice so who really gives a crap?

If you don't think their aren't podiatrists out there that practice unethically, ripping people off, have no idea how to articulate medical plans to our MD/DO colleagues then I don't know where the hell you externed, trained, practice...wake up.

In the context of y'alls discussion...ignoratio elenchi. What does this have to do with the price of tea in China? Nobody brought up the effects or stigma created by poorly trained podiatrists in the community.

As for ACFAS, I have no real hate towards them but they do have an agenda of promoting how they are foot and ankle surgeons...not podiatrists. I don't buy it. I don't buy how doing a PMSR/RRA + fellowship = equivalent training compared to ortho foot and ankle orthopedists. That's their message these days.

You are grasping at straws. Both 'foot and ankle surgeon' and 'podiatrist' appear all over the various ACFAS position statements. I guess you can be mad at ACFAS for marketing the fact that well trained podiatrist can surgically treat foot and ankle conditions, when there are still many podiatrists who can't (or shouldn't). But you are the one constantly complaining about how other medical professionals have no idea what we do. Why are you mad that ACFAS uses 4 words that make it easy for any other medical professional (and the public) to understand what it is you specialize in? Is it because it rubs you personally the wrong way? Or because it pisses off guys like Sangeorzan? Do you find it to be false advertising? As for how ACFAS feels our training is equivalent to F&A ortho...that requires a lot of context. Because I've personally managed more foot and ankle pathology from clinic visits to recon in 3 years than the most recent graduate from our ortho program who completed a very well known F&A fellowship. So if you mean I can't also fix olecranon fx, nail femurs, scope a knee, and take general ortho call then you are absolutely right, I'm nowhere near equivalent. If you don't think that podiatry graduates from strong programs that end up doing a worthwhile fellowship don't have more training in the foot and ankle than this particular F&A ortho, then you are an idiot.

An orthopedist who specializes in the spine is a surgeon, a neurosurgeon is a surgeon, general surgeons are surgeons, plastic surgeons are surgeons, cardiothoracic surgeons are surgeons. These people are "surgeons". On top of that some of "surgeons" can medically manage their own patients...because their smart. They went to medical school. They achieved the rigorous standards to get into medical school. They take and scored very high on REAL board exams during medical school to land the specialties they trained in residency in...which are all longer than podiatry residency btw. Then they do/can do fellowship training after residency training. They do surgery everyday that significantly impacts and/or can potentially kill patients. They are the real surgeons. They are real doctors. If you can't appreciate that or refuse to agree with that sentiment or can't understand my opinion then I can't help you nor am I going to explain in another way that your podiatry brain can comprehend.

Nice ad hominem at the end. I'm not sure what it says about your brain but that's another discussion for another time. This is the point I still don't really understand. I mean, I grasp the fact that they are "surgeons" and I don't disagree, but you have to have specific reasons to justify your claim that certain people who perform surgery are "surgeons" and other people who perform surgery are not. There has to be specific criteria that makes the ortho a surgeon and not the podiatrist. And what about OB's? They don't get enough respect as "real surgeons" IMO, but my neighbor is an OB/GYN resident at our hospital so I'm biased. I'm assuming your criteria is that real surgeons have an MD or DO degree and we do not, which is fine, but just say that at the beginning so we can end the discussion there since it leaves room for none. If you have some other criteria then lets create a checklist and see which surgical specialities/subspecialties meet your standards and which don't. That would actually be fun.

Gas gangrene, compartment syndrome, open fractures are the only emergencies we would ever face as DPMs. If we were not around they could be handled easily by other professions. The majority of what we go surgically is ELECTIVE surgery. Are there residencies predominately focused in trauma, limb salvage, etc? Yes definitely...but those training experiences do not translate into what DPMs do in reality (after residency) for the most part.

This is a constantly evolving profession. What DPMs do in reality today and 20 years from now may be very different. We all know that you will be the lone podiatrist in a hospital setting, and that those jobs are becoming more prevalent. You are going to poo-poo on training that is creating overly qualified podiatrists, that would be prepared to take a job like yours? Jobs that you admit are slowly popping up all over the country? Are you insane? I wish every podiatry got to see some bad trauma that required incredibly careful soft tissue considerations and often times complex and spontaneous intra-operative decision making. I wish they got to treat really sick patients too. And then a majority of them could still go into a group practice and do bunions, igtns, and achilles detach/reattaches. They would be better for it. Podiatry would be better for it. I wish every program produced overqualified graduates as opposed to what we have now...

Ok you are real surgeon now because you went in at 3am to decompress a terrible infection...will you be doing this in your future practice? If so then kudos to you. But what about the majority of the profession who won't be exposed to these experiences in practice? How would you define them?

I mean, do they perform surgery utilizing techniques that would be considered standard of care?

BTW, who pissed in your cheerios? There is a lot of anger in your posts the last couple of days.

 

[ldsrmdude]

Let me interject here to remind everybody to keep things civil and avoid attacking/harassing any single member. There have been good points made here, which is why we have left this thread open, but if it devolves into attacks, the thread will be locked. This is a general reminder and not directed at anybody in particular. Let me or @SLCpod know if you have questions

 

[I post PRN]

Poor OP got his thread hijacked!!!!

 

[NatCh]

Finding out I'm a pretend surgeon... F*&@.

 

[diabeticfootdr]

I recently was offered an associate position from a solo practitioner in a local suburb far from the city. The base salary is $70,000, with bonus of 10% after making 3x base. This practitioner will pay for CME, malpractice, professional membership fees. No health insurance. 2 weeks sick/vacay. Practice is very busy, practitioner averages ~45 pts/day and there are nearby hospitals with very few podiatrists taking call, thus growth potential can be very fast and high. There's also option to buy-in at year 3. Is this a fair offer? If not, how can negotiate a fairer, more lucrative deal? thanks

You could do better if you just opened up right next door and started from scratch.

In any case, working as an associate, make sure you get a lawyer to review your contract, there is no non-compete, no penalties for leaving early, and that you get all your A/R if you do leave (if it's a production based model).