Podiatrist salary at hospital vs. private practice

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Hi everyone!

I have shadowed 5 (3 private prac, 2 hospital) Pods total and will be applying this year. I am not sure if I should ask them how much Pods make bc that may be too personal? Anyways can someone tell me the AVERAGE salary a pod makes at a hospital and how much a pod could make having their own clinic?

Look at old threads - this has been discussed to death. Depends on mostly how many years out, associate or partner, and what kind of "private practice" (podiatry vs ortho vs multispecialty) and also geographic region. I'd say from private practice podiatry group new associates of $80K - $180K/yr to hospital system associates of $120K - $230K/yr. In private practice with 3 plus years with the practice and a partner somewhere between maybe $200K - $400K depending on the situation. I started out as an associate in a podiatry practice first year out of residency taking home around $130K that year. I had turned down a hospital/university based position offering $130K/yr base plus incentive based bonus. I've been with an ortho practice now 3 years, am a partner and made over $400K last year.

http://www.bls.gov/oes/current/oes291081.htm
See the above for geographics statistics.

Additionally, thanks to the podiatrists (thanks newankle) who choose to respond to these sort of threads. Do they get done to death? Definitely. Do most people look around and do their own research? The applicant forum would have me believe no. From an applicants perspective, its just nice to see a respectable rewards down the road though we cannot appreciate the effort you had to put in to get where you are. Podiatry tuition is pretty scary (http://www.dmu.edu/financial-aid/tui...tric-medicine/), so while there's a great post about podiatry salaries at the top of this forum people - sometimes people just want to see a number.

$400,000? Is that because of maybe excessive surgeries? That # is great I just didn't think a podiatrist could make that much!


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Originally Posted by luckyfeet

$400,000? Is that because of maybe excessive surgeries? That # is great I just didn't think a podiatrist could make that much!


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I am certainly the exception, not the rule. DO NOT expect to be in my situation. I'm likely in the top 1%. Well-trained podiatrist who own their own practices for entire careers sometimes don't achieve these numbers. I happened to be in the right place at the right time and was well-prepared. I would realistically expect for a well-trained surgical podiatrist with good business and interpersonal skills to start out making a base of around $130-$175K plus some bonus, become partner around 2-3 years out and be making around $225 year 5 and around $25-$275 year 10 and maxing out somewhere around $300K. That is likely realistic and something to shoot for. I personally think going with a hospital-based system is a mistake. Such a system tried to buy us out and offered us each $400K/yr but I suspect once that contract was up 3 years I would be replaced by a new surgical pod just out of residency willing to happily take $175K/yr. I think the best opportunity is joining a multi-disciplinary group, working hard and becoming a partner (assuming this is an option offered).

Thank you for the insight, Dr. Newankle. Much appreciated.

Thanks so much for the detailed response! And hope you continue to be as successful in the future!


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Organically, why do you do this to me!?

Organically,

I love you, man. I really do.

I have no idea what you just said, but it's not the first time I've been likened to the Tazmanian Devil.

Oh, and also, I'm waiting for my wife to come home and bring me cake. I'm watching the kids tonight. Thanks for reminding me about the cake...I have to go find out where the eff my wife is.

You ROCK!

Oh and by the way...strike three...

I think we should keep Organically around for a while, just for entertainment value. As long as he doesn't say any naughty words, is there any harm in keeping a clown? We're still looking to fill the dip**** void that whiskers left behind.

Oh Organically...

Originally Posted by Ferocity

You've got to be kidding me. I've been further even more decided to use even go need to do look more as anyone can. Can you really be far even as decided half as much to use go wish for that? My guess is that when one really been far even as decided once to use even go want, it is then that he has really been far even as decided to use even go want to do look more like. It's just common sense.

A healthy sense of humor. So rare around here. Kudos, Ferocity! You just made my day!

-BigO

Originally Posted by Podophile

I think we should keep Organically around for a while, just for entertainment value. As long as he doesn't say any naughty words, is there any harm in keeping a clown? We're still looking to fill the dip**** void that whiskers left behind.

So weak. So pod-like.

Wait....so....you're pre-health and think your opinions matter?

Originally Posted by bobdolerson

Wait....so....you're pre-health and think your opinions matter?

Right up there with KF! Keep up the good work!

It is not that rare to make $400K. I know of people making even more.

As per the Bobs in Office Space, "What exactly is it ya' do here?"

Originally Posted by FACN

It is not that rare to make $400K. I know of people making even more.

What percentage of practicing podiatrists do you think take home over $400K net? I would be interested to know. The APMA data suggests not many although I'm not sure how accurate that data is. In my case I increased my production from year one to two 35%. I expected that to half each year as between year two and three I increased 16%. However this year my production has increased 15% compared to the average run rate of last year.

Originally Posted by newankle

What percentage of practicing podiatrists do you think take home over $400K net? I would be interested to know. The APMA data suggests not many although I'm not sure how accurate that data is. In my case I increased my production from year one to two 35%. I expected that to half each year as between year two and three I increased 16%. However this year my production has increased 15% compared to the average run rate of last year.

I agree with newankle that there are certainly DPMs netting $400K, but I personally believe those are relatively few. I know doctors making significantly more than that, but I believe it's the exception and my experience over the years ( our group evaluates and sometimes purchases existing practices), along with the APMA data supports my feelings.

Yes, you can make an excellent living, but it does take dedication and hard work. Geographic regions also play a role in income, since some areas reimburse greater, some areas have high amounts of capitation and some areas are more liberal regarding scope of practice.

As newankle has stated, his case is an exception. If I remember correctly, some of his income is also derived as a share holder in an orthopedic goups which generates income via ancillary services such as MRI, physical therapy, etc. I believe he is relatively young and has achieved his success in a relatively short time. He obviously is well trained and well respected or he would not be in the position he's in at this time.

Yes, he is fortunate and landed in a great situation, but he also had to maintain that position to succeed.

Originally Posted by PADPM

Yes, you can make an excellent living, but it does take dedication and hard work.

Amen.

As PADPM stated geography is a major factor. A wise man once told me it is not what you do but how often you do it. So many young podiatrist want to do big reconstructive cases but they do not pay much more than some simple and easy cases.

I like rearfoot recon and ankle surgery but I know it costs me money. This is an important factor for young podiatrist (including myself) to remember.

Originally Posted by FACN

As PADPM stated geography is a major factor. A wise man once told me it is not what you do but how often you do it. So many young podiatrist want to do big reconstructive cases but they do not pay much more than some simple and easy cases.

I like rearfoot recon and ankle surgery but I know it costs me money. This is an important factor for young podiatrist (including myself) to remember.

Amen. I've been preaching those thoughts for a while on this site. When you factor in the travel time to the hospital, the wait time to turn an OR room, the time to perform the procedure, speaking with the family post op, completing paperwork, driving home or to the office, the global fee for the surgery, etc., it is really NOT a way to make money.

I've also stated that in our large group, our new associate and I perform the majority of the surgery, yet one of our partners who does NOT perform surgery anymore out-produces both of us. While we're spending all the time as outlined above to perform a case, he's seeing 20 or more patients in that same time span. YOU do the math.

Originally Posted by luckyfeet

$400,000? Is that because of maybe excessive surgeries? That # is great I just didn't think a podiatrist could make that much!


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What do you mean by "excessive surgeries" exactly?

I worked at a couple clinics and some pods did more surgery than the other so I assume if you do more surgeries you get paid more? Correct?


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Originally Posted by luckyfeet

I worked at a couple clinics and some pods did more surgery than the other so I assume if you do more surgeries you get paid more? Correct?


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I'm still a student but I'll add in my two cents.

More surgeries is correlated with higher income but it is not a direct cause and effect. IMO what you are seeing is a byproduct of a few other factors and ultimately a huge factor is how much training you have. The more training you have, the more pathologies you are able to recognize, as well as the more treatment options you are able to offer the patient. This leads to more billable treatments and more patients which means higher income.

Here's an example. Let's say a patient comes in for osteoarthritis of the subtalar joint. You lay out the treatment options from most conservative to surgical (UCBL orthoses +/- cortisone shot, AFO, fusion surgery). On this visit the patient opts for the UCBL and cortisone shot. 6 months - 1 year down the road the patient comes back for another cortisone shot. Maybe 5 years down the road the arthritis has gotten so bad that the patient now wants surgery. If you don't have the training on this surgery then you just lost that income and that patient.

Another example is what I saw while shadowing a very well trained podiatrist this past winter break. We saw a follow up pediatric patient who had very hypotonic, hyper-pronated feet. The podiatrist had a hunch and referred the patient to a neurologist. The neurologist ordered a spine x ray. The kid was missing 3 vertebrae. The follow up was because he had already surgically corrected the left foot and now the family was back to get the right foot surgically corrected. In addition, he has referred several neuromuscular pediatric patients to this neurologist and now the neurologist refers his patient back to him for all of their foot and ankle needs.

My take on this matter is...get the best training you can so that you can offer your patients the widest array of treatment options. The patient will come back to you when the time comes for surgery, they will refer family and friends, you will turn away fewer and fewer patients, and you're practice/income will grow.

I've browsed these boards before but I've never posted, however as a PGY3 who has signed a contract with a hospital I can speak on my hiring process and what I've seen from friends/coresidents. First of all I signed with a hospital system, Its a multi-hospital regional health system which is very "podiatry friendly" with on staff podiatrists including one who treats a large amount of lower extremity trauma. I have been hired to provide that same level of care at second largest hospital in the system about 40 miles away. I'll be expected to treat all foot ankle pathology and help decrease the need for transfers from my hospital to the level 1 center. All that aside, this health system uses MGMA salay statistics for staffing of all physicians, podiatrists included. They were very upfront about how they compensate their doctors and how they motivate for quality and performance with their bonus structure. When I started the job search I looked at a few private practice groups, all with the same base salary range of around 130K-160K plus benefits, bonus, etc... with potential for partnership and increased pay. The hospital, based on MGMA numbers, is starting me at 250K plus bonus structure that would put me in the 300K range BEFORE performance bonus. Beyond the humble brag that I just wrote, I know how frustrating the job search can be and wondering if I was going to be compensated fairly for my training, but two of my coresidents were offered similar jobs with similar pay scales, one with a hospital system, one with an ortho group.....so my numbers are not anything completely out of the norm.

Originally Posted by footdocva

I've browsed these boards before but I've never posted, however as a PGY3 who has signed a contract with a hospital I can speak on my hiring process and what I've seen from friends/coresidents. First of all I signed with a hospital system, Its a multi-hospital regional health system which is very "podiatry friendly" with on staff podiatrists including one who treats a large amount of lower extremity trauma. I have been hired to provide that same level of care at second largest hospital in the system about 40 miles away. I'll be expected to treat all foot ankle pathology and help decrease the need for transfers from my hospital to the level 1 center. All that aside, this health system uses MGMA salay statistics for staffing of all physicians, podiatrists included. They were very upfront about how they compensate their doctors and how they motivate for quality and performance with their bonus structure. When I started the job search I looked at a few private practice groups, all with the same base salary range of around 130K-160K plus benefits, bonus, etc... with potential for partnership and increased pay. The hospital, based on MGMA numbers, is starting me at 250K plus bonus structure that would put me in the 300K range BEFORE performance bonus. Beyond the humble brag that I just wrote, I know how frustrating the job search can be and wondering if I was going to be compensated fairly for my training, but two of my coresidents were offered similar jobs with similar pay scales, one with a hospital system, one with an ortho group.....so my numbers are not anything completely out of the norm.

Were you trained at a very good residency program? Or should I say, a residency program that is regarded as being very good within the medical community? I ask because although these numbers are awesome it still doesn't help students gauge how realistic it is to achieve a position like this. If you graduated from a top residency program then you will have elite surgical skills which opens up great job opportunities like the ones you've spoken about. Now if you came from an average program with average numbers THEN that would be impressive.

Those are great numbers however I'd be interested in what things you end up doing. If it's a big hospital system that can pay you this much I'd suspect that they have orthopods on staff including foot & ankle orthopod(s). Make sure you get to do what you like. If you don't like wound care will you get assigned to doing that, etc.? In the end the hospital systems want to acquire you to control all the ancillary services - you use their labs, their radiology, their DME, and refer between their docs, etc. Remember that big salaries are attractive/good but you will have to produce beyond that level for them to be happy and keep you. If they lose money then your salary will be decreased or they may even not renew your contract. Job security can be an issue in that also you can't buy in/own the practice. Also the call schedule should be defined. You want to share call with ortho for acute trauma. You don't want a separate podiatry and ortho call where the orthopods get the acute ankle/foot fractures and podiatry gets the diabetic wounds/infections only (unless that is what you want of course). Also consider how long your contract is for, is it automatically renewable, who is going to review you at the end of that term and how are they going to decide if to renew you and how to pay you at that time/restructure your contract. Remember also if they value you based only on RVUs then that doesn't take into account all the ancillary services/money you bring into the system and puts more stress on you to perform at a high level. Things to consider but definitely a great salary - congrats.

Originally Posted by luckyfeet

I worked at a couple clinics and some pods did more surgery than the other so I assume if you do more surgeries you get paid more? Correct?


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No. You have to balance your in office work with your surgical volume for the best financial outcome. You can make A LOT more money in your office than you can in the OR. There are loads of posts and threads that speak to this.

Originally Posted by footdocva

I've browsed these boards before but I've never posted, however as a PGY3 who has signed a contract with a hospital I can speak on my hiring process and what I've seen from friends/coresidents. First of all I signed with a hospital system, Its a multi-hospital regional health system which is very "podiatry friendly" with on staff podiatrists including one who treats a large amount of lower extremity trauma. I have been hired to provide that same level of care at second largest hospital in the system about 40 miles away. I'll be expected to treat all foot ankle pathology and help decrease the need for transfers from my hospital to the level 1 center. All that aside, this health system uses MGMA salay statistics for staffing of all physicians, podiatrists included. They were very upfront about how they compensate their doctors and how they motivate for quality and performance with their bonus structure. When I started the job search I looked at a few private practice groups, all with the same base salary range of around 130K-160K plus benefits, bonus, etc... with potential for partnership and increased pay. The hospital, based on MGMA numbers, is starting me at 250K plus bonus structure that would put me in the 300K range BEFORE performance bonus. Beyond the humble brag that I just wrote, I know how frustrating the job search can be and wondering if I was going to be compensated fairly for my training, but two of my coresidents were offered similar jobs with similar pay scales, one with a hospital system, one with an ortho group.....so my numbers are not anything completely out of the norm.

This all sounds great!

For me personally, my biggest problem with this is you will always be no more than an employee. Hospital goes belly up, you're out on the street. I've known MANY who have sold their practices to hospital groups and within 2-3 years are looking for ways to get out of the relationship. Not just in Podiatry either.

Also, as I've said in other posts, if the corporate structure of large Ortho groups allow for a DPM to have ownership in the practice, great. If not, see my statement above.

Talk to a good accountant and lawyer before making any of these decisions. I'm just a lowly Podiatrist trying to make my way.

Originally Posted by Ankle Breaker

Were you trained at a very good residency program? Or should I say, a residency program that is regarded as being very good within the medical community? I ask because although these numbers are awesome it still doesn't help students gauge how realistic it is to achieve a position like this. If you graduated from a top residency program then you will have elite surgical skills which opens up great job opportunities like the ones you've spoken about. Now if you came from an average program with average numbers THEN that would be impressive.

I feel very confident in my training, I guess you could say that I have been trained at a "very good residency program" but then again what some people think is good is different than others....my training has prepared me for every aspect of lower extremity medical and surgical care to where from an academic/surgical standpoint I feel like I can handle anything that comes my way.....but also my program prepared for an integrated environment where I interact with all types of specialties on a daily basis to provide the best patient care, which i think is more important....on my first interview with the hospital i will be employed by I had dinner with the orthopedist, and i didnt know what he thought of podiatry, so i started talking about ortho and supracondylar elbow fractures, asking if he treated them....he then loosened up and by the end of dinner he said he hoped I would join

i tell every student that i've encountered the following statement: don't let your training dictate what you do in practice, get the best, broadest education possible, and if you like certain aspects of podiatric surgery, pursue them further

Originally Posted by footdocva

i tell every student that i've encountered the following statement: don't let your training dictate what you do in practice, get the best, broadest education possible, and if you like certain aspects of podiatric surgery, pursue them further

Originally Posted by newankle

If it's a big hospital system that can pay you this much I'd suspect that they have orthopods on staff including foot & ankle orthopod(s). Make sure you get to do what you like. If you don't like wound care will you get assigned to doing that, etc.? In the end the hospital systems want to acquire you to control all the ancillary services - you use their labs, their radiology, their DME, and refer between their docs, etc .

they have other orthopods on staff, and at the level 1 they have one foot and ankle ortho, my hospital has 1 ortho who does hips and knees and for the most part refers out lower extremity, and they are looking to hire 2 more orthos in addition to me, one spine, and one sports med....but its a bit of a rural setting, so they make it known that we are all generalists in that i'll see everything below the knee: wounds, trauma, congenital deformities, arthritis, rearfoot, forefoot, you name it....and thats what i wanted

As PADPM often points out, the other thing to consider is geographical location. I have friends who signed STARTING contracts between 250K and 350K but they were in very expensive areas of the country so the cost of living is very high (usually east and west coast). Where I practice, a starting salary of 250K right out of residency is unheard of. However, earning that in a year or two is completely possible.

Originally Posted by newankle

... Depends on mostly how many years out, associate or partner, and what kind of "private practice" (podiatry vs ortho vs multispecialty) and also geographic region. I'd say from private practice podiatry group new associates of $80K - $180K/yr to hospital system associates of $120K - $230K/yr. In private practice with 3 plus years with the practice and a partner somewhere between maybe $200K - $400K depending on the situation...

This is about right in my experience with the job search. It varies significantly based on situations and geography.

For private practice podiatry, you are looking at basic benefits and roughly 60-120k base with usually 20-40% bonus for productivity collections over 2-3x the base salary. More salary is more risk on the part of the practice, and more % is more risk on the part of the associate (but often better in the long run if you are joining a busy practice).

Hospitals or large multi-specialty groups usually have higher base salary (close to double) and nice benefits... but with significantly less productivity % bonus (usually either RVU system, collections based, or even pretty much straight salary). As you'd figure, you will usually make more in the initial few years as a hospital/multispecialty employee, but you usually have higher top end and more control of hours, practice focus, billing accuracy, in private practice settings.

The main thing that really gets you to a much higher ceiling in private practice is the ancillary services (PT, imaging, DME etc), product dispensing, and tax deductions you can eventually get a piece of as a partner. As a hospital employee, you can really only make money off your patient services (while the hospital gets most of the $ for other services), and since most of your income is salary for a company you don't own, there's limited tax shelters. In the end, most DPMs you talk to will try to convince you that what works for them is the best way to go, but you have to decide what your goals are and what fits for you. There's definitely pros and cons to either situation and many good opportunities on both sides.

I think that making $250,000 out of the gate is an incredible offer and a generous offer. I know there are many exceptions, etc., but I know residents signing for SIGNIFICANTLY less than half of that amount. It depends on location, need, expectations, etc. And apparently my thought must be more of the norm when your look at APMA's own stats or surveys in some of the podiatric journals. But I think these new high starting salaries are amazing and hope the trend continues.

I know that in our practice, with our overhead, etc., an associate making $250,000 would have to generate about $600,000 for us to make any profit (you don't hire an associate to break even), and realistically in our area, it is difficult to generate that amount for quite a while. So although we are VERY busy and successful, we simply can not compete with institutions or orthopedic groups who have the ability to generate income via other ancillary services such as MRI's, in house PT, etc.

However, we do offer a pretty solid future with the largest practice in the region. We are stable and are looking for quality new associates to become partners, where they will some day be the boss or at least have job security. To some, that's not an advantage and they really don't want to have the responsibility of ownership, and I can full understand that mentality. It's nice to collect a large paycheck, obtain great benefits and not have to put up with the daily B.S. of owning a business.

There's a lot of talk about how surgery "doesn't pay". And I get it, the procedure itself will not reimburse you as well as a PNA on a per/hour basis. Especially when you take into account global billing periods and possible complications with surgery.

My feeling (and maybe it's more of a question to see if I'm completely wrong) is that the above statement can be misleading. Surgery itself might not pay, but there are a lot more opportunities to make money on a surgical patient depending on what you "own". It is not uncommon for an ortho group to own an imaging center, so they are making money on every pre-op MRI they order. A surgeon may also own (or at least have partial ownership) a surgical center, so they are making money every time a procedure is performed. A lot of surgical procedures = a lot of PT...so an in-house PT makes you money. You get the point. Am I way off base?

I would bet the hospital is going to make plenty off of footdocva to justify the starting salary...

Originally Posted by dtrack22

You get the point. Am I way off base?

Not way off, but off base none the less.

How many Podiatrists nationally take advantage of what you are suggesting? You are talking about the exception, not the majority. If you fall under the exception, great for you, but don't expect that for everyone. It just doesn't happen that way for most of us.

Let's take your surgery center example. If you get into a type of arrangement like that, as a new guy, how much disposable income will you have to invest in such a venture? If you have a only a little, then your market share will be small. If you are on your own or in a small practice, your investment return will be based on your productivity., which will be small as a new guy. It takes YEARS to start making the big checks with that. Five to Seven years before a free standing Surgery Center starts seeing major returns IF it can survive. And that also depends on you. How busy do you think you're going to be right out of the gate. With some employment contracts will not be ALLOWED as an associate to make such an investment as your boss may feel you are profiting from his or her work by getting money back from patients he or she sent you to do surgery on. You see? It's never that simple.

Originally Posted by Kidsfeet

Not way off, but off base none the less.

How many Podiatrists nationally take advantage of what you are suggesting? You are talking about the exception, not the majority. If you fall under the exception, great for you, but don't expect that for everyone. It just doesn't happen that way for most of us.

Let's take your surgery center example. If you get into a type of arrangement like that, as a new guy, how much disposable income will you have to invest in such a venture? If you have a only a little, then your market share will be small. If you are on your own or in a small practice, your investment return will be based on your productivity., which will be small as a new guy. It takes YEARS to start making the big checks with that. Five to Seven years before a free standing Surgery Center starts seeing major returns IF it can survive. And that also depends on you. How busy do you think you're going to be right out of the gate. With some employment contracts will not be ALLOWED as an associate to make such an investment as your boss may feel you are profiting from his or her work by getting money back from patients he or she sent you to do surgery on. You see? It's never that simple.

Can't his be solved by starting off with a small share which would increase as the associate brings in more cases and maybe a provision in the contract to sell the shares back at a predetermined amount if the associate were terminated or leaves?

Originally Posted by Kidsfeet

How many Podiatrists nationally take advantage of what you are suggesting? ...It just doesn't happen that way for most of us.

Then the "average" Podiatrist clearly has no idea how to market him/herself or their services. I will be working for a hospital system (has multicare in the name due to large number of clinics and specialty offices outside of the two main hospitals). My contract is just under $225k and includes benefits. the bonus structure isn't very aggressive but there are performance based incentives that can greatly increase my yearly salary (first opportunity is in my 3rd year). I have a co-resident that will be joining an Ortho group that performs many procedures in-office as the floor above the clinic is a surgical center. He has the opportunity to buy additional shares (essentially) as well.

Why didn't you take advantage of the growing opportunities outside of podiatry practices when relocating? Our services can make a lot of other people a lot of money. And if you and the rest of the "average" podiatrists can't sell other medical specialists on this fact, then I feel sorry for you.

Originally Posted by janV88

Can't his be solved by starting off with a small share which would increase as the associate brings in more cases and maybe a provision in the contract to sell the shares back at a predetermined amount if the associate were terminated or leaves?

Ahhh, yes. Sure it can, BUT as the center becomes more successful, the share value increases, so to buy more shares would cost much more than the initial outlays. Then yes, if you are "bought out" it ends up at the amount you initially gave in, rather than the CURRENT market value of your shares.

You know how many people I know that got burned exactly this way? The answer is MANY.

Originally Posted by RockyIV

Then the "average" Podiatrist clearly has no idea how to market him/herself or their services. I will be working for a hospital system (has multicare in the name due to large number of clinics and specialty offices outside of the two main hospitals). My contract is just under $225k and includes benefits. the bonus structure isn't very aggressive but there are performance based incentives that can greatly increase my yearly salary (first opportunity is in my 3rd year). I have a co-resident that will be joining an Ortho group that performs many procedures in-office as the floor above the clinic is a surgical center. He has the opportunity to buy additional shares (essentially) as well.

Why didn't you take advantage of the growing opportunities outside of podiatry practices when relocating? Our services can make a lot of other people a lot of money. And if you and the rest of the "average" podiatrists can't sell other medical specialists on this fact, then I feel sorry for you.

Firstly, I find it very interesting that you criticize others for something you won't have to do at all. You won't have to do any of that stuff and have no idea how difficult what you propose really is. It's very easy from your position to think what an easy time it is to market yourself, blah, blah, blah. Try it first and then come back here and explain to me what I'm doing wrong. You were successful in an interview at getting a job. Awesome stuff! I'm being honest. Congratulations. Some suit is going to do all that stuff you're talking about for you.

I didn't take advantage of these growing opportunities because they weren't what I wanted. I wanted to be surrounded by my peers and that's what I have now. I didn't want to be a hospital employee as you will be. I didn't want to be in a situation where I bust my tail in a group and then because of a glitch in corporate structure, I wouldn't be offered a partnership opportunity. Do all those guys getting into Ortho groups realize that maybe they are getting a carrot? Maybe not, but you better know for sure before going for it. I know for sure in my situation which helps me sleep at night.

Am I making less money because of it? Probably. The difference is one day it will be partially mine and I will be surrounded with peers who care just as much about our business of medicine as I do. Your hospital system goes belly up, what are you going to do? Ten years down the road you're unemployed with no idea how to run a business because you were a hospital guy and didn't bother learning all that stuff because you thought you wouldn't need it?

I'm not saying these are bad opportunities or that it isn't something to strive for. However, you saying that we don't know how to market ourselves, and then saying you got a job as a hospital employee is hilarious to me. I hope for your sake that this job is one you will be in for your career. That is the best of all worlds. For you. Not for me. If it's not, I think you'll learn a harsh reality of what it's like to be out there on your own without a suit and a nice contract to back you up.

I never wanted to be "just" an employee. I went into medicine to help people AND be a business owner. It's a difficult road. I chose it for myself and am and will be willing to make the necessary sacrifices for it. What about you?

Originally Posted by Kidsfeet

You won't have to do any of that stuff and have no idea how difficult what you propose really is. It's very easy from your position to think what an easy time it is to market yourself, blah, blah, blah. Try it first and then come back here and explain to me what I'm doing wrong. You were successful in an interview at getting a job.

You are right. Convincing a very large group of doctors that own this multicare hospital system that they needed my services and how much revenue I would be able to generate for them, on top of what makes me qualified to provide these services over my peers as well as MD/DO grads had nothing to do with "marketing" myself or my degree. I guess the only thing I "know" is how to sell my abilities to a group of very successful docs who were very hesitant about not only my salary (must have been buddies with PADPM) but their need for a Podiatrist to take over what "real physicians" have been doing for them all along...I am clearly clueless and off base with my previous critique.

Originally Posted by Kidsfeet

However, you saying that we don't know how to market ourselves, and then saying you got a job as a hospital employee is hilarious to me

What is funny about some of the ownership opportunities provided to me as facilities and offices expand? Regardless, you realize that the job hunt is, in fact, "marketing" yourself right?

Originally Posted by Kidsfeet

Your hospital system goes belly up, what are you going to do?

I guess I'm going to do the same thing you would do if your practice went belly up...find another job/practice opportunity. Move on. S*** happens and no practice (not even yours) is immune.

Originally Posted by Kidsfeet

I never wanted to be "just" an employee. I went into medicine to help people AND be a business owner. It's a difficult road. I chose it for myself and am and will be willing to make the necessary sacrifices for it. What about you?

What about me? I chose to work smarter rather than harder. I chose to make money off of other people, medical equipment, etc. while still having the opportunity to have my earnings be based off of my own hard work and performance. I know, it's hard to believe that the evil hospital would actually increase my pay with increased performance grades and patient satisfaction. But I guess thats the crazy mixed up world we live in

Originally Posted by Kidsfeet

I'm not saying these are bad opportunities or that it isn't something to strive for

Then maybe you need to ask yourself, why are you constantly downplaying these positions, salaries, etc.? More often than not you paint a doom and gloom scenario and are quick to point out the negatives of any situation that is not identical to yours.

Originally Posted by RockyIV

I guess the only thing I "know" is how to sell my abilities to a group of very successful docs who were very hesitant about not only my salary (must have been buddies with PADPM) but their need for a Podiatrist to take over what "real physicians" have been doing for them all along...I am clearly clueless and off base with my previous critique.

What's with the cheap shot at me? Is there a problem with me simply being honest? I said many private podiatric practices are not able to compete with the starting salaries offered by institutions and large orthopedic groups. That doesn't mean we're cheap or hesitant to offer a high salary, it simply means that we can not take the risk of paying a new associate $225,000 out of the gate. As previously stated, that would mean that doc has to generate almost $600,000 for us to make a profit, and we DO have a right to make a profit and not lose money. We don't own an MRI and don't have that many ancillary services to offer. Certainly not as many as an institution or large orthopedic group that has the ability to generate referrals from multiple sources.

So don't cheap shot me. We offer a fair deal, and if a candidate doesn't believe it's worth his/her while, the answer is simple. Walk away and find a better position. Our group offers an associate a significant amount of autonomy, a very stable practice and the road to partnership. Are intention is never to screw anyone, so if our package isn't good enough, the job hunt continues.

But don't slam me about not having the ability to start a new associate with the numbers you've mentioned. I'm pretty in-tune with starting salaries across the nation, and it's a fact that institutions and orthopedic groups pay more than podiatric groups. I'd like to know of any graduates you know who landed a position with a podiatric group and is getting that kind of salary right away.

Don't take my word for it, just look at the APMA's statistics regarding salaries, associate salaries, etc.

Pick and choose your battles, but don't rag on me for honesty and reality. I've never stated that high paying jobs weren't available, just that the vast majority of private podiatric practices can't compete with those numbers.

Originally Posted by Kidsfeet

Ahhh, yes. Sure it can, BUT as the center becomes more successful, the share value increases, so to buy more shares would cost much more than the initial outlays. Then yes, if you are "bought out" it ends up at the amount you initially gave in, rather than the CURRENT market value of your shares.

You know how many people I know that got burned exactly this way? The answer is MANY.

Ok I see what you mean but it seems like this deal still beats 1.) Starting your own surgery center (massive start up costs) and 2.) Relying solely on a hospital (Higher patient costs, higher risk of infection, and no "kick back"). Just gotta be careful with the fine print I guess.

Rocky V,

The position you marketed yourself for was already there. Did you approach this hospital with a proposal to start a NEW position for yourself or did you answer an ad and were offered an interview? If in fact you actually generated this position that is an incredible piece of marketing. Good for you! One of my close mentors tells me "Focus on the positive", which I do. I'm giving my experiences here. I'm not the end all be all, but have been around.

Please don't think that because you were selected for a job that was there and were looking for the best candidate and you happened to fit the bill you marketed yourself like those of us in private practice do everyday, all the time.

You missed the point of my saying about you being out on the street. I had a private practice that failed and I think if you talk to my new employers they would tell you I know a thing or two about how to run a business, but at the time I was in the wrong place at the wrong time and tried to make it work anyway. I was also wise enough to get out before things got really bad.

As I said, congratulations on your position. I hope to serves you well..

Originally Posted by janV88

Just gotta be careful with the fine print I guess.

Exactly right!

Originally Posted by RockyIV

Then maybe you need to ask yourself, why are you constantly downplaying these positions, salaries, etc.? More often than not you paint a doom and gloom scenario and are quick to point out the negatives of any situation that is not identical to yours.

I am not constantly downplaying anything. If you actually read what I write you will see that I mention on several occasion why I don't think these situations aren't right for ME.

I've been around the block a few times, bubba. I've seen with my own eyes how these situations play out. Have you? It is rare for these opportunities to work out how the employee sees them. Get a lawyer and get him or her to charge you thousands for the same advice I can give you here. It's your $225K not mine.

Soooo, that means I have job offers from PADPM and Kidsfeet? I know this is a bit of a silly (dumb) question because I'm just a lowly pre-pod, but in terms of success in the job environment, what sort of factors are needed? I'm hearing all these fantastic stories of how people are making well over 200 yada yada... Does it depend on the strength of your residency mostly? Or your graduating class rank? How do hospitals/ortho/pod groups ultimately determine whose the most qualified applicant? I do want to help people, but making a nice living (and paying off these ridiculous future loans) are a must as well. Again, I apologize if my question seems very unlearned, for I am planning to start my podiatric education this fall.

Originally Posted by SuperFeisty

Soooo, that means I have job offers from PADPM and Kidsfeet? I know this is a bit of a silly (dumb) question because I'm just a lowly pre-pod, but in terms of success in the job environment, what sort of factors are needed? I'm hearing all these fantastic stories of how people are making well over 200 yada yada... Does it depend on the strength of your residency mostly? Or your graduating class rank? How do hospitals/ortho/pod groups ultimately determine whose the most qualified applicant? I do want to help people, but making a nice living (and paying off these ridiculous future loans) are a must as well. Again, I apologize if my question seems very unlearned, for I am planning to start my podiatric education this fall.

I think that one of the greatest factors in starting salary is geographic location, and the other is the type of position accepted. As I've stated, I personally don't know any grads receiving those initial high salary offers at podiatric practices vs. institutions and orthopedic groups. As a general rule, the last 2 have deeper pockets.

Naturally, graduating a top program increases your chances of obtaining a great position, but honestly, many of these institutions or orthopedic groups may not have the knowledge regarding the quality of podiatric residency programs.

Your interview, appearance, attitude, etc., should be your greatest assests.

I spoke with a colleague the other day who was telling me about this incredible resident at his hospital. The kid apparently is the total package with great training, great skills, personality, etc. The residency program is VERY well known and respected. However, the kid wants to practice close to his family/home-town. As a result, he's accepted on offer with an older DPM who would like this young doc to build up the rearfoot/reconstructive side of the practice. I do NOT know the details of the contract, but the actually base salary was $85,000.

Yes, that seems low, but this young doc may see it as an opportunity to build a practice, own a piece of the practice and eventually own the practice,while at the same time serving his community. There are those who will say he's shortchanged himself, is crazy to take this offer, etc., but everyone has a different motivation, and initial salary isn't always the top factor.

I've stated many times on this site that if you are skilled, treat your patients well and are ethical, there is no reason why you won't make an excellent living. Additionally, although many of these grads are getting high offers initially, it's also been my experience that a few years down the line the numbers balance out among most of the grads, regardless of who they chose to work for initially.