While looking for a job, it was my experience that ortho groups and hospitals could offer you more in the beginning (for obvious reasons). That was extremely attractive. The problem I found with those offers I received was that your pay didn't increase very much after that. So in the end, I took a private practice job that started out a little lower but had much
more potential down the road. I guess the exception with ortho would be if you were somehow able to become a partner which is rare due to call and production issues but is possible (newankle). I think in MOST cases, private practice is much more lucrative in the long run.
As is the case with pre-pods, students, and residents (I was just there), it is sometimes hard to look down the road a couple years when you see a "big" number in the beginning
Well said^^
Every resident is focused on paying off their loans, getting 6 figures base and sign bonus off the bat, etc. If you try to see the forest through the trees, chances are that you'll be much happier in the end. Personally, I'd sure take 50k/yr + 30% and guaranteed expedited partnership with another well trained and well networked DPM or two who have a well run, ethical, and reputable practice with a booming referral base before I'd sign for 150k/yr + 10% to be the bunion and forefoot fracture guy with no available buy in with an ortho group or hospital system any day. Those ortho/hospital businesses obviously wouldn't be offering you those salaries if they weren't going to make money off of you as their employee. It all depends on the situation, your desires, and doing your homework, though...
The "ultimate" practice depends on what you want, what you do well, and what you do efficiently. You can't do it all yourself, so it's clearly important to surround yourself with the right people (skills, reputation, networking, politics, etc). Ideally, I think you'd want to achieve an efficient, low overhead group which has garnered a large volume of insured bunion, neuroma, fasciitis, paronychia, etc elective surgery patients... stuff you can easily do 4-6 cases of in a half day at the surg center without needing fancy sets, expert scrub tech, etc. You'd also want some wound care and a center to do it at for obvious reasoning of more services for your group to offer and a reliable, steady income source for a service that many ppl need.
Yeah, you still want some rearfoot elective and trauma also flowing through the office. In my honest estimation, though, the RF recon and trauma we all gawk about in conferences is mostly just to pad your ego and increase your practice's offerings since you'd want all the PCPs in the area to know that they can send your office consults or clinic pts for pretty much any pathology below the knee. You only really want acute trauma (FF or RF) if you get paid by the hospital to take the trauma call, it's a hospital/area where insured/working pts are fairly prevalent, or you feel you enjoy those cases so much you don't mind a dip in earnings/sleep. JMO
Ortho groups are neat since the venerable "orthopedic office" umbrella would tend to eliminate any MD/DPM referral bias which persists, but I think a lot of pod groups are honestly better just being the symbiotic "consulting group" for local ortho groups that they send knees, hips, etc and get sent some foot surg in return. That way, there's no bickering with your trauma, F&A, etc partners over who gets the Achilles, ankle fx, ankle desis, Jones fx, etc. There's also no needing to come up with a million plus for a buy in (if you are even offered buy-in?).
