Private practice salary offer...is it fair?

[ExperiencedDPM]

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).

I don't agree with some of your comments. It's very easy to tell the OP to open up next door..... However, opening up next door will include having the ability to pay rent/lease, purchase/lease office equipment, purchase/lease computers, and an EHR system. It will include having to purchase office and medical supplies. It will include having to pay for his/her own malpractice insurance. It will include having to pay for office liability insurance. It will include having to pay for office overhead insurance if there is ever a disruption of services due to catastrophe or illness. It will include having to pay for fire, theft, etc., insurance. It will require having to pay for internet connections and for a phone system and phone lines and fax machine. It will require having to hire and PAY staff. It will require having to obtain facility privileges on his/her own and having to get credentialed on insurance panels on his/her own. It will require the doctor to have to pay all hospital and organization dues. And that's just the beginning of the list. Unless a doctor is independently wealthy or comes from a wealthy family, this scenario simply isn't realistic given the fact that most graduating residents are in serious debt. And that's not even considering that the doctor won't have any patient base and will have to wait for the schedule to fill.

So "opening next door" isn't as simple as putting up your diploma. There is serious cost/expense and no immediate return. So in all reality, opening next door isn't an option in today's medical climate.

In my opinion, a bonus of 10% after hitting 3x base truly sucks. The standard is in the 30% range.

Dr. Rogers wrote that you should make sure your contract also does NOT contain a non compete agreement. Unless a state does not allow non competes (such as California) I think it's also unrealistic for any employer to remove a non compete. Contrary to many urban legends, if legal in a particular state, non compete agreements ARE enforceable and can cost thousands and thousands to "fight". That statement is fact.

Over the years I have reviewed several hundred contracts for colleagues, graduating residents, friends, etc., and our practice has offered contracts to many doctors. And in states that a non compete is legal, I have NEVER reviewed a contract that didn't contain a non compete. Every contract we offered associates had a non compete and in EVERY contract I've reviewed the non compete was not negotiable. It's usually quite simple to the employer. If you don't like the non compete, don't sign the contract.

That being said, there are negotiable aspects to a non compete if the employer is reasonable. That includes reduction of the distance of the non compete and/or amount of years. Most importantly is if you are signing a contact with a practice that has several offices over a large geographic area. You can in essence, screw yourself by signing a non compete if there are many offices over a large area. It can potentially limit you from practicing in a major portion of the state.

I always recommend that when in this situation, ask the employer to only have a non compete for the office locations you actually work. That is a much more reasonable approach.

The bottom line is that non competes are legal in most states and are enforceable. And challenging a non compete in court is extremely expensive and is a long and drawn out process.

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[Cranjis McBasketball]

I don't agree with some of your comments. It's very easy to tell the OP to open up next door..... However, opening up next door will include having the ability to pay rent/lease, purchase/lease office equipment, purchase/lease computers, and an EHR system. It will include having to purchase office and medical supplies. It will include having to pay for his/her own malpractice insurance. It will include having to pay for office liability insurance. It will include having to pay for office overhead insurance if there is ever a disruption of services due to catastrophe or illness. It will include having to pay for fire, theft, etc., insurance. It will require having to pay for internet connections and for a phone system and phone lines and fax machine. It will require having to hire and PAY staff. It will require having to obtain facility privileges on his/her own and having to get credentialed on insurance panels on his/her own. It will require the doctor to have to pay all hospital and organization dues. And that's just the beginning of the list. Unless a doctor is independently wealthy or comes from a wealthy family, this scenario simply isn't realistic given the fact that most graduating residents are in serious debt. And that's not even considering that the doctor won't have any patient base and will have to wait for the schedule to fill.

So "opening next door" isn't as simple as putting up your diploma. There is serious cost/expense and no immediate return. So in all reality, opening next door isn't an option in today's medical climate.

In my opinion, a bonus of 10% after hitting 3x base truly sucks. The standard is in the 30% range.

Dr. Rogers wrote that you should make sure your contract also does NOT contain a non compete agreement. Unless a state does not allow non competes (such as California) I think it's also unrealistic for any employer to remove a non compete. Contrary to many urban legends, if legal in a particular state, non compete agreements ARE enforceable and can cost thousands and thousands to "fight". That statement is fact.

Over the years I have reviewed several hundred contracts for colleagues, graduating residents, friends, etc., and our practice has offered contracts to many doctors. And in states that a non compete is legal, I have NEVER reviewed a contract that didn't contain a non compete. Every contract we offered associates had a non compete and in EVERY contract I've reviewed the non compete was not negotiable. It's usually quite simple to the employer. If you don't like the non compete, don't sign the contract.

That being said, there are negotiable aspects to a non compete if the employer is reasonable. That includes reduction of the distance of the non compete and/or amount of years. Most importantly is if you are signing a contact with a practice that has several offices over a large geographic area. You can in essence, screw yourself by signing a non compete if there are many offices over a large area. It can potentially limit you from practicing in a major portion of the state.

I always recommend that when in this situation, ask the employer to only have a non compete for the office locations you actually work. That is a much more reasonable approach.

The bottom line is that non competes are legal in most states and are enforceable. And challenging a non compete in court is extremely expensive and is a long and drawn out process.

So is it very rare for a podiatrist to open a practice soon after graduating? Is the overhead similar or vastly different compared to dental? I know a few dentists who opened a practice after graduating and are doing well. However, it sounds like that isnt really an option in podiatry?

 

[bobtheweazel]

So is it very rare for a podiatrist to open a practice soon after graduating? Is the overhead similar or vastly different compared to dental? I know a few dentists who opened a practice after graduating and are doing well. However, it sounds like that isnt really an option in podiatry?

I think because it's harder all the time for small private practices to stay compliant. Groups are where it's at. There will probably be plenty of old pods looking to sell when we all graduate though, but that cycle of handing down private practices is being broken more and more as new pods gravitate towards groups and hospitals.

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[GypsyHummus]

Hopefully with the new administration, there will be a more "pro small buisness" environment. I forget which executive order it is, but I believe it states that to create a new regulation, the governing body must repeal 2 old ones.

Should this affect healthcare too, private practice wise?

 

[bobtheweazel]

Hopefully with the new administration, there will be a more "pro small buisness" environment. I forget which executive order it is, but I believe it states that to create a new regulation, the governing body must repeal 2 old ones.

Should this affect healthcare too, private practice wise?

I don't know how much pro-small business bills would help. It's really just like the paperwork and compliance requirements that are the issue. Also having to fight to get paid by insurance makes it difficult too. So just joining onto a group or hospital shifts a lot of that burden off the individual doctor.

If Trump deregulated healthcare to some extent, then I think far fewer would have reservations about going into private practice.

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[NatCh]

So is it very rare for a podiatrist to open a practice soon after graduating? Is the overhead similar or vastly different compared to dental? I know a few dentists who opened a practice after graduating and are doing well. However, it sounds like that isnt really an option in podiatry?

I don't hear/read about too many podiatrists going into solo private practice anymore. I do see colleagues going into group podiatry practices though. From what dentists have told me, their overhead is significantly higher than ours but they seem to be able to crank out more patients per day by using several hygienists.

 

[ExperiencedDPM]

So is it very rare for a podiatrist to open a practice soon after graduating? Is the overhead similar or vastly different compared to dental? I know a few dentists who opened a practice after graduating and are doing well. However, it sounds like that isnt really an option in podiatry?

It is rare, since there are considerable start up costs, and no immediate income. Dental practices generally have higher overhead due to the amount of products and materials they use. Additionally, start up costs are higher due to the equipment. However, the average dental bill per patient is higher than the average podiatric patient ( that's my opinion, and not based on fact) and many dental procedures are cash. And of course dentistry hasn't been hit by all the governmental regulations.

 

[NatCh]

However, the average dental bill per patient is higher than the average podiatric patient ( that's my opinion, and not based on fact) and many dental procedures are cash.

I paid $1500 cash for a new crown last year (then dragged my pwned ass back to my office to do a matricectomy for a fraction of that).

 

[NatCh]

Speaking of which...

My dentist told me I need a crown and I said, "I know, right?!"




Thanks, I'll be here all week.

 

[ExperiencedDPM]

I paid $1500 cash for a new crown last year (then dragged my pwned ass back to my office to do a matricectomy for a fraction of that).

Ha, forget about performing a matricectomy for a fraction of the cost. The last total ankle I did paid me a whopping $943. I was talking to an orthopedic buddy who had just returned from the dentist and he was shocked at the prices for some pretty basic dental work. And then he told me that Medicare reimburses him about $1300 for a total hip!!

By the way, the last total ankle I did will likely be the last total ankle I perform. I just can't justify the time and liability for that reimbursement. My ego is well past doing those cases for bragging rights. I'd happily perform bunionectomies or P&As all day long.

Frames were macho and fun until you get a call from a crazed patient at 2:30 am with "cage rage" insisting that they NEED the ex fix off stat.

 

[Cranjis McBasketball]

Ha, forget about performing a matricectomy for a fraction of the cost. The last total ankle I did paid me a whopping $943. I was talking to an orthopedic buddy who had just returned from the dentist and he was shocked at the prices for some pretty basic dental work. And then he told me that Medicare reimburses him about $1300 for a total hip!!

By the way, the last total ankle I did will likely be the last total ankle I perform. I just can't justify the time and liability for that reimbursement. My ego is well past doing those cases for bragging rights. I'd happily perform bunionectomies or P&As all day long.

Frames were macho and fun until you get a call from a crazed patient at 2:30 am with "cage rage" insisting that they NEED the ex fix off stat.

How is that possible? How is the reimbursement for those procedures so low when a standard root canal is 1000-1200? Thats insane

 

[NatCh]

How is that possible? How is the reimbursement for those procedures so low when a standard root canal is 1000-1200? Thats insane

The health insurance industry = the devil. Much of dentistry is cash pay.


Become an orthodontist.

 

[bobtheweazel]

Also dental insurance is not medical insurance.

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[ExperiencedDPM]

How is that possible? How is the reimbursement for those procedures so low when a standard root canal is 1000-1200? Thats insane

The dentists are the smartest of all. They haven't rolled over and accepted ridiculously low reimbursements. I assure you that you will never find a poor orthodontist, oral surgeon, periodontist or prosthodontist.

My friend's son in law just finished up his oral surgery residency. He's gotten offers that would make a graduating orthopedic resident jealous.

Dental procedures are amazingly costly. A few years ago one of my kids needed wisdom teeth extracted. The procedure took 12 minutes under anesthesia in the office. The procedure wasn't complicated and there was no follow up appt needed. Any sutures were resorbable. The insurance paid $2,850. Not bad for 12 minutes and no follow up. Versus a hip replacement for 1.5-2 hours or OR time, at half the reimbursement and months of follow up.

Listen to Natch about being an orthodontist.

 

[GypsyHummus]

The dentists are the smartest of all. They haven't rolled over and accepted ridiculously low reimbursements. I assure you that you will never find a poor orthodontist, oral surgeon, periodontist or prosthodontist.

My friend's son in law just finished up his oral surgery residency. He's gotten offers that would make a graduating orthopedic resident jealous.

Dental procedures are amazingly costly. A few years ago one of my kids needed wisdom teeth extracted. The procedure took 12 minutes under anesthesia in the office. The procedure wasn't complicated and there was no follow up appt needed. Any sutures were resorbable. The insurance paid $2,850. Not bad for 12 minutes and no follow up. Versus a hip replacement for 1.5-2 hours or OR time, at half the reimbursement and months of follow up.

Listen to Natch about being an orthodontist.

How have dentists not been bullied into all these insurance regulations? Do they have better lobbying power? Has the government simply not turned their eyes to dental yet?

 

[Cranjis McBasketball]

How have dentists not been bullied into all these insurance regulations? Do they have better lobbying power? Has the government simply not turned their eyes to dental yet?

Theyve been hit in other ways. Everyone knows they werent as affected by insurance so I feel like everyone and their dog at my university was pre-dental (even me for a while). This has led to more and more schools opening up. Its led to tuition sky rocketing and tons of hidden fees. There is such a supply of pre dents that schools can do anything. Midwestern is 70k+ a year just for tuition!! There are tons of fees too. If I were to go there I would graduate with 500k+ of debt. If you can specialize in dentistry it seems like an amazing gig. However, when talking with and shadowing new GENERAL dentists, a lot of them were struggling because of the saturation and astronomical debt. Their salaries have slowly decreased. The trend is just going in the wrong direction

 

[NatCh]

^ The grass is always greener somewhere, isn't it? Thank goodness I get satisfaction from the work I do.

 

[Cranjis McBasketball]

^ The grass is always greener somewhere, isn't it? Thank goodness I get satisfaction from the work I do.

Agreed. Grass is always greener. However, I think everyone in the healthcare field (MD, DO, DDS, DPM, DPT, OD, NP, PA, etc) should realize that the grass there in IS green enough. haha

 

[JewOnThis]

Some good info on this thread! I have been a practicing podiatrist for less than 10 years so my experience might be a little different than some of you.

In my area (a large metro city), 70k a year is considered fair. Most contacts are around 70-80k a year. I've been offered 5-6 plus jobs from all over the u.s. I can say that so far, larger cities in the Florida State has given me the worse offers.

 

[738177]

Some good info on this thread! I have been a practicing podiatrist for less than 10 years so my experience might be a little different than some of you.

In my area (a large metro city), 70k a year is considered fair. Most contacts are around 70-80k a year. I've been offered 5-6 plus jobs from all over the u.s. I can say that so far, larger cities in the Florida State has given me the worse offers.

I hope the new grads aren't taking these offers. That's basically DPT/OTD level salary.

 

[GypsyHummus]

That's a horrible return on investment.

Some good info on this thread! I have been a practicing podiatrist for less than 10 years so my experience might be a little different than some of you.

In my area (a large metro city), 70k a year is considered fair. Most contacts are around 70-80k a year. I've been offered 5-6 plus jobs from all over the u.s. I can say that so far, larger cities in the Florida State has given me the worse offers.

 

[GypsyHummus]

These low ball offers will stop once recent graduates stop being dumb enough to accept them.



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70k/year is insulting for a podiatrist.

 

[josebiwasabi]

It depends on how the bonus/incentive structure is set up but I agree that 70k base in general is very low.

 

[Weirdy]

Might as well have gone PA for that level.

 

[DexterMorganSK]

Might as well have gone PA for that level.

A new grad NP/PA is making 80K+ here in NY. For a Pod that salary is an insult compared to the 7 years in training and the 250K+ debt!

 

[Weirdy]

A new grad NP/PA is making 80K+ here in NY. For a Pod that salary is an insult compared to the 7 years in training and the 250K+ debt!

Completely agree.

Even here in Texas you're seeing 70k+ starting PA, 90k+ for NP. Combined with low cost of living I'm not sure why pod practices overvalue their offers so much.

 

[Cranjis McBasketball]

Completely agree.

Even here in Texas you're seeing 70k+ starting PA, 90k+ for NP. Combined with low cost of living I'm not sure why pod practices overvalue their offers so much.

How is there such a huge gap between starting salaries? Wouldnt those offering horrible starting offers never get applicanta? I cant even comprehend how someone can accept an offer that low after a 7 year commitment with a high debt to pay back?

 

[marinepod]

I have multiple friends that are PAs and all of their starting offers were 80+!!!! My sister is a BSN and makes more than 70+!! While shadowing, when the discussion came up about salaries, the podiatrist told me "not to accept an offer out of residency that can't at least triple your last year of resident pay & if they can't make this offer, then they have no business hiring a new associate" his words to me!

 

[GypsyHummus]

My cousin got offered a job at the hospital she did her residency at for 60k\year. Needless to say, she did not take it and ended up working for the local hospital at our old hometown making around 150k.

Like, do they intentionally low ball for some reason?

I have multiple friends that are PAs and all of their starting offers were 80+!!!! My sister is a BSN and makes more than 70+!! While shadowing, when the discussion came up about salaries, the podiatrist told me "not to accept an offer out of residency that can't at least triple your last year of resident pay & if they can't make this offer, then they have no business hiring a new associate" his words to me!

 

[dtrack22]

These low ball offers will stop once recent graduates stop being dumb enough to accept them.

This x1000

 

[NatCh]

$70K without strong incentives is terrible. I have friends who never finished undergrad who make more than that.

 

[ExperiencedDPM]

These low ball offers will stop once recent graduates stop being dumb enough to accept them.



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I wish that was true, but desperate people do desperate things. That's one of the reasons podiatry (and medicine) is hurting.

When insurance companies came out with capitated fees, they went lower and lower regarding what they would accept. In some areas of the country capitated fees were driven ridiculously low because there were fools who accepted it.

In an ideal world you are correct and those low offers would no longer exist if they were no longer accepted. It's unfortunate, but a reality that they keep filling these low paying jobs because they are still be accepted. I personally don't see it ending soon.

However, over the years I have seen that number climbing. While I agree that 70-80 used to be offered, over the past few years I've seen that increase to 90-120 grand for a starting salary, with most also offering additionally incentive money.

 

[dtrack22]

The future of this profession will trend towards hospitals hiring their own DPM(s).

Maybe not at every level 1 trauma center but there are plenty community, rural, lower level trauma hospitals all over the country that can't get a foot and ankle ortho to join. These hospitals could all use a well trained DPM on staff. A DPM can generate a considerable amount of income for a hospital if they they are willing to practice full spectrum podiatry (surgery, derm, wounds, injections, nails, etc).

It is through hospital based podiatry that the rest of the medical community will finally appreciate the breadth of our training (and limitations) in my opinion.

Yes residency programs are accomplishing this goal too but there isn't a podiatry residency program or a podiatrist on staff at every hospital either.


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To add, a DPM who is above average in terms of production (wRVU) is worth around $3 million to a hospital in direct and downstream revenue (CPT/E&M, OR facility fees, PT referrals, imaging and non invasive cardio diagnostic studies, etc.).

Salaried positions in hospital systems will continue to become more prevalent. Which may help some with starting salaries. The real problem is that the current podiatrists who take on zero risk and get people to sign these low ball offers just don't care. If they get zero applicants, who cares, they were likely never busy enough to hire in the first place and they have no qualms with turning and burning associates anyways. I think a younger group of practice owners has to come along and pay more than the current podiatric slumlords, because that's the only way for there to be enough jobs to allow new grads to tell the $70k type practices to pound sand.

 

[JewOnThis]

The future of this profession will trend towards hospitals hiring their own DPM(s).

Maybe not at every level 1 trauma center but there are plenty community, rural, lower level trauma hospitals all over the country that can't get a foot and ankle ortho to join. These hospitals could all use a well trained DPM on staff. A DPM can generate a considerable amount of income for a hospital if they they are willing to practice full spectrum podiatry (surgery, derm, wounds, injections, nails, etc).

It is through hospital based podiatry that the rest of the medical community will finally appreciate the breadth of our training (and limitations) in my opinion.

Yes residency programs are accomplishing this goal too but there isn't a podiatry residency program or a podiatrist on staff at every hospital either.


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Hospital Podiatrists are definitely becoming more prevelant, but not everyone can get into a hospital system. With the being said, not every hospital wants to hire a Podiatrist.


Also, to the prepods, Podiatry students, and residents: 70k salaries are real, and they are not going away any time soon. And guess what? They will also be competitive because there's always someone needing a job, end of story.

Here's a true story: one of my friends resident just signed a 60k salary in Miami working for a private practice with minimal incentives.

 

[ExperiencedDPM]

The future of this profession will trend towards hospitals hiring their own DPM(s).

Maybe not at every level 1 trauma center but there are plenty community, rural, lower level trauma hospitals all over the country that can't get a foot and ankle ortho to join. These hospitals could all use a well trained DPM on staff. A DPM can generate a considerable amount of income for a hospital if they they are willing to practice full spectrum podiatry (surgery, derm, wounds, injections, nails, etc).

It is through hospital based podiatry that the rest of the medical community will finally appreciate the breadth of our training (and limitations) in my opinion.

Yes residency programs are accomplishing this goal too but there isn't a podiatry residency program or a podiatrist on staff at every hospital either.


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I'm already starting to see some greater acceptance from those doctors who see DPMs in the hospital setting. Many weren't biased, they simply had a different perception of podiatry.

Podiatry has made great strides with vascular surgeons who learn to appreciate that there can be a great symbiotic relationship between the two specialties. I have a great relationship with the vascular team and the vascular fellow. And most of my friends who practice across the country have similar relationships with vascular. None of them are employed by the hospital.

When I first started seeing patients as consults in the intensive care unit, I got strange looks. But it was a great way to meet cardiologists, intensivists, nephrologists, etc.

At the present time most podiatrists who I know who have in patients, also have great relationships with infectious disease, radiology and vascular.

We ARE making strides.

My concern with hospital employed DPMs is lack of loyalty. Hospitals are businesses and I've seen great DPMs lose their positions to "cheaper" docs who took over. That's also why you often see hospitalists coming and going at hospitals. There's not always a lot of security in hospital positions.

I also want everyone to realize, that there are a LOT of orthopedic surgeons performing Foot and ankle surgery. I know the stats that orthopedic foot and ankle fellowships aren't always filled,you'd be surprised how much foot and ankle surgery is done by orthopedic surgeons.

I do consulting for 3 insurance carriers who send me random cases for review. Obviously they are only foot and ankle cases. I don't review orthopedic cases, but I do see the list of cases before they are sent to the respective specialists. I was shocked to see the number of Foot and ankle cases being done by orthopedic surgeons. Everything from total ankles to simple hammertoes.

Although I believe many DPMs will work for hosptials, in the scheme of things those positions are relatively finite. I believe you will also see more multi specialty groups hiring pods.

 

[Cranjis McBasketball]

Hospital Podiatrists are definitely becoming more prevelant, but not everyone can get into a hospital system. With the being said, not every hospital wants to hire a Podiatrist.


Also, to the prepods, Podiatry students, and residents: 70k salaries are real, and they are not going away any time soon. And guess what? They will also be competitive because there's always someone needing a job, end of story.

Here's a true story: one of my friends resident just signed a 60k salary in Miami working for a private practice with minimal incentives.

Why in the world did he accept that and how does he plan on paying back his school loans

 

[JewOnThis]

I'm already starting to see some greater acceptance from those doctors who see DPMs in the hospital setting. Many weren't biased, they simply had a different perception of podiatry.

Podiatry has made great strides with vascular surgeons who learn to appreciate that there can be a great symbiotic relationship between the two specialties. I have a great relationship with the vascular team and the vascular fellow. And most of my friends who practice across the country have similar relationships with vascular. None of them are employed by the hospital.

When I first started seeing patients as consults in the intensive care unit, I got strange looks. But it was a great way to meet cardiologists, intensivists, nephrologists, etc.

At the present time most podiatrists who I know who have in patients, also have great relationships with infectious disease, radiology and vascular.

We ARE making strides.

My concern with hospital employed DPMs is lack of loyalty. Hospitals are businesses and I've seen great DPMs lose their positions to "cheaper" docs who took over. That's also why you often see hospitalists coming and going at hospitals. There's not always a lot of security in hospital positions.

I also want everyone to realize, that there are a LOT of orthopedic surgeons performing Foot and ankle surgery. I know the stats that orthopedic foot and ankle fellowships aren't always filled,you'd be surprised how much foot and ankle surgery is done by orthopedic surgeons.

I do consulting for 3 insurance carriers who send me random cases for review. Obviously they are only foot and ankle cases. I don't review orthopedic cases, but I do see the list of cases before they are sent to the respective specialists. I was shocked to see the number of Foot and ankle cases being done by orthopedic surgeons. Everything from total ankles to simple hammertoes.

Although I believe many DPMs will work for hosptials, in the scheme of things those positions are relatively finite. I believe you will also see more multi specialty groups hiring pods.

I agree with everything you said. Also, you have to look closely at the hospital or MS groups hiring podiatrists. A lot of them are hiring you to see patients that orthos don't want to see. And yes, a lot of those jobs are nonsurgical.

Also, I know a lot of the residents here think taking straight percentage based pay is better than a 70K salary with horrible incentives. I can tell you that in most cases that is not true at all. Podiatrists know that a 70K base salary is insulting, so how do we cover ourselves up? OFFER percentage based pay- A LOT less risk on the owners side and it will make most of you think it's a better package. I actually know quite of pods signing percentage based with little or no bonuses and no benefits.

Some examples of why percentage based can be worse than salary

1) all the patients with good insurances will most likely go to the boss (trust me the front desk receptionist will make this happen)
2) you will get mostly patients with DM foot care
3) there will be a lag in collection time frame (medicare vs private insurance reimbursement time frame), and if you are somewhat busy, it is hard to keep up insurance reimbursements.
4) I can go on and on, but most of you got the point by now.

 

[JewOnThis]

Why in the world did he accept that and how does he plan on paying back his school loans

There's a lot of questions you have to ask yourself.

Well, do you want a job or not?

A lot of us dont have options. A lot of us have families and loans.
Can you go 6 months or more without a job to look for a good one?

What are you really bringing to the table in a private practice?

"Oh I did a fellowship"
So whats so special about doing a fellowship?

I did 4-10 TARS a month in my 3rd year of residency. How many TARS did you do in your fellowship?

 

[Cranjis McBasketball]

There's a lot of questions you have to ask yourself.

Well, do you want a job or not?

A lot of us dont have options. A lot of us have families and loans.
Can you go 6 months or more without a job to look for a good one?

What are you really bringing to the table in a private practice?

"Oh I did a fellowship"
So whats so special about doing a fellowship?

I did 4-10 TARS a month in my 3rd year of residency. How many TARS did you do in your fellowship?

He didnt have another job offer besides 60k a year?.. did he just wait til the last minute to find a job? Is he refusing to move anywhere else? Its hard to believe that a worthy candidate that was an ambitious pod student who did 7 years of training is making what a 20 year old RN is making..

 

[dyk343]

Maybe I'm naive or insanely lucky but I was just in the current market and I didn't find it that difficult.

I didn't have any issue getting multiple starting offers 200k+ with incentives. With that said I feel I am at a really good and well rounded program with very a high surgical volume. My director/attendings seem to actually care about us and guide us appropriately.

Bottom 1/3 to 1/2 of the residency graduates or those who are not willing to really put in the effort to find a good job may see themselves with less than stellar numbers. I could see graduates waiting too long to start applying to jobs and getting themselves in trouble. There is always just plain bad luck or something ugly on your record like a probationary period. Big cities will always be a tough market as well.

Work hard, get a good residency, be personable, and you should be able to find a good job. Being able to talk business and how you will make them money helps tremendously when negotiating a higher contract.

Maybe I'll get screwed down the road? I dunno.

 

[marinepod]

He didnt have another job offer besides 60k a year?.. did he just wait til the last minute to find a job? Is he refusing to move anywhere else? Its hard to believe that a worthy candidate that was an ambitious pod student who did 7 years of training is making what a 20 year old RN is making..

I had personal trainers that worked under me during my time as a personal training director make more than 60K. I even worked with PTAs that made more than that! During my shadowing which was in a private practice setting, the podiatrist told me flat out "don't even think about taking a job with a private practice".

 

[Rop]

Since so few senior residents participate in the forums, what kind of numbers are your graduating co-residents, last year graduates, or friends at other programs looking at?

 

[dyk343]

Since so few senior residents participate in the forums, what kind of numbers are your graduating co-residents, last year graduates, or friends at other programs looking at?

This forum has a very high number of senior residents who post. There are at least 6 of us on here.

All my good friends (the ones I talk salary with) are starting at really good jobs. They should all make 220-250k+ after incentives.

They are also all very well trained. My parents always told me to "Hang with the smart kids who work hard and don't complain a lot".

It's been solid advice.

 

[NatCh]

I wish that was true, but desperate people do desperate things.

That's true. You come out of training with student loans well into the 6 figures and the bank starts wanting you to pay back the money, it can be pretty scary. At least our student loan default rate isn't (or wasn't the last time I checked) nearly as high as chiropractors'.

I've read that dental hygienists average $70,000 per year. That only requires an Associates degree.

 

[tennischamp822]

This forum has a very high number of senior residents who post. There are at least 6 of us on here.

All my good friends (the ones I talk salary with) are starting at really good jobs. They should all make 220-250k+ after incentives.

They are also all very well trained. My parents always told me to "Hang with the smart kids who work hard and don't complain a lot".

It's been solid advice.

If I am not mistaken, pod school costs around 45k in tuition and 15k in living expenses. With a 240k loan over a four year period, how do newly graduated podiatrists afford to live life making 60-70k? Just the taxes and loan repayment would be a majority of your gross salary.

 

[dyk343]

If I am not mistaken, pod school costs around 45k in tuition and 15k in living expenses. With a 240k loan over a four year period, how do newly graduated podiatrists afford to live life making 60-70k? Just the taxes and loan repayment would be a majority of your gross salary.

You're living expenses are low for 1/2 of the pod schools. Most are in expensive areas with 1k rent minimum/month. Some areas will be much more (NY, CA). You are looking at closer to 300k after 4 years if you do not get scholarships.

Just a wake up 300k is about $3-3.5k/month for 10 years at graduation with the current interest rate. That is a minimum 36,000/year.

And to answer your question you can't which is why no one should accept those positions unless you absolutely have to or there is good incentives and/or partnership down the road.

The best case scenario with one of those crap jobs is to learn how to run a practice and then bail. But 70k job with poor incentives is a trap that is destined to fail. Too many jobs out there are designed to take advantage of new grads. Our profession is sad on that front. Even more sad is people are willing to take those jobs so those offers will never go away. Many people offering them think it is fair because that's what they were offered.

I personally did not apply to a single podiatry practice. In addition to poor reimbursement, It's my opinion that slowly but surely the private practice model will die off. Too many of the independent primary care doctors are getting bought up by big hospital systems. Once a PCP is in a large hospital system that provider no longer can refer to the podiatrist down the road. The PCP now has to refer within the hospital system.

The good thing is pods are also getting swallowed up by large hospital systems and these jobs are becoming more available. My area is almost exclusively hospital based podiatrists or with ortho practices. Private practice would be career suicide around here.

The bad thing is hospitals can fire and replace you at the drop of a dime or decide to pay you less for really no reason at all.

Rural small private practice will be viable for a long time. But city/suburbia I would think carefully about as your referral source is dwindling.

This is why I shake my head at all those "I have a 2.8gpa can I get into podiatry school?" threads. Yeah you might get in. You will likely fail out and if you do make it through but don't change your habits/just barely scrape by it is not likely to be a good investment. Always exceptions but bottom students get bottom jobs.

 

[dyk343]

Amen



I have never known a hospital based DPM that has ever had this happen to them.

I am sure it has but if you do good work, get along with everyone, you are generating income and carrying your weight I don't understand why this would happen.

If the patients like this particular DPM and that person has really built up the podiatry department...why would they risk throwing all that money away if they fire the DPM and replace him with someone who sucks. Why would a hospital even risk that?

I don't know anyone who has been outright fired.

I think I've said it on here before somewhere but there is a rival hospital in my residency area that is notorious for hiring you at a good salary/incentive structure with a 3yr contract. Then when that contract is up they half your salary and keep the same incentive structure. It is a large cut but in theory you should be established with a good patient population and can make it up.

With that said many of the pods over there are unhappy once 3 yrs comes around. They sign a non-compete too.

Also, rumor has it one of their bigger hospitals in the area will be shut down soon. I wouldn't want to work there...

My director advised me NOT to buy a home until my contract is renewed.

 

[Nowehjose]

Amen



I have never known a hospital based DPM that has ever had this happen to them.

I am sure it has but if you do good work, get along with everyone, you are generating income and carrying your weight I don't understand why this would happen.

If the patients like this particular DPM and that person has really built up the podiatry department...why would they risk throwing all that money away if they fire the DPM and replace him with someone who sucks. Why would a hospital even risk that?

So, would you say focus on applying to ortho and hospitals? I see that's the growing trend. Should we avoid residencies in NY and MA which limit our abilities to do things like TAR? I'm just curious, because 4 years of school ends quicker than you think studying all day.

 

[JewOnThis]

Amen



I have never known a hospital based DPM that has ever had this happen to them.

I am sure it has but if you do good work, get along with everyone, you are generating income and carrying your weight I don't understand why this would happen.

If the patients like this particular DPM and that person has really built up the podiatry department...why would they risk throwing all that money away if they fire the DPM and replace him with someone who sucks. Why would a hospital even risk that?

It's all politics. There is a very well known multi specialty in the city where I practice that only hires DPM for non surgical care. Many years ago, they had DPMs doing foot/rearfoot/ankle surgery. A couple of years later, they took in a foot and ankle orthopod, fired a few DPMs who didn't get along. Now they are left with a few DPMs and 1 F&A orthopod. There is a few other hospitals in my area that are doing the same - hiring FA orthopods and booting DPMs.

 

[JewOnThis]

So, would you say focus on applying to ortho and hospitals? I see that's the growing trend. Should we avoid residencies in NY and MA which limit our abilities to do things like TAR? I'm just curious, because 4 years of school ends quicker than you think studying all day.

If you are looking to do a lot of TARs, then leave podiatry school immediately. There's only a few of us who are qualified to do them, and we have to get privilege from the hospital to do them. So if the hospitals say "no, you're a podiatrist" then guess what? No TARs.



And oh, there's a hospital in my neck of woods that just closed its door a few months ago without informing any of their employees. They also had spaces leased to practitioners (Over 20 last I counted). Unfortunately for one of my pod buddies who just started leasing her space is now jobless.

As crazy as it sounds, this kind of stuff does happen. I guess the best part is there shouldn't be any non compete issues if you were an ex-employee there.