- Joined
- Dec 6, 2006
- Messages
- 429
- Reaction score
- 1
New grads, what types of salary offers are you getting?
Jonwill I was wondeirng if you could explain to me how a fellowship is different than a residency if at all? Also what are the benefits of doing a fellowship? More money, more experience in a certain area? Thanks!
I personally know 5 people finishing up residency in June (PM&S-36). 3 are starting mid 100's (ortho and multi-specialty groups),one is doing a fellowship in pediatric orthopaedics, and one is doing a fellowship in diabetic wound care (and I don't think fellowships pay a whole lot more than residency does).
I'm not aware of any 3rd year residents that frequent the forum but maybe you'll get lucky.
where is the peds ortho fellowship? Is it just peds foot and ankle?
Can you explain how, for example, getting an ACFAS fellowship is done? I know several Podiatrists that are FACFAS and was wondering if you qualify for something like that based on a certain number of rearfoot cases? Or do you apply after residency to separate fellowship? I'm very interested in pursuing an ACFAS fellowship and just don't know how that all works.
Thanks!
I've only looked into a few, but I think many pay less than the residency salaries in the same region. Most fellowships seem to be a labor of love which are done to work with top docs and gain elite skills......I don't think fellowships pay a whole lot more than residency does...
Can you explain how, for example, getting an ACFAS fellowship is done? I know several Podiatrists that are FACFAS and was wondering if you qualify for something like that based on a certain number of rearfoot cases? Or do you apply after residency to separate fellowship? I'm very interested in pursuing an ACFAS fellowship and just don't know how that all works.
Thanks!
Can you explain how, for example, getting an ACFAS fellowship is done? I know several Podiatrists that are FACFAS and was wondering if you qualify for something like that based on a certain number of rearfoot cases? Or do you apply after residency to separate fellowship? I'm very interested in pursuing an ACFAS fellowship and just don't know how that all works.
Thanks!
A residency graduate may apply for Associate membership status with ACFAS if he/she passes the ABPS written exam. It is nearly impossible for a newly graduated resident can apply for the Fellow membership status with ACFAS unless they have a way to sit and pass both written and oral exams simultaneously.
You don't sit for oral exams until you submit a certain number of required cases to demonstrate experience. (65 cases in various categories for Foot Surgery and an additional 30 for Reconstructive Reafoot and Ankle Surgery.)
I wanted to respond to the comments on salary coming out of residency. You should speak to both residents coming out now and to practice management experts to obtain truthful information. I interviewed at many places during the process and can comment on my experience. My advice is to not focus on what your starting salary will be. You won't know that you'll be happy there until you're actually there and that is in regard to not just the job but also the area, how you family adjusts, and many many other factors. The fact is that training does not always equate to dollars - medicine is a business, period. I did a four year surgical residency and I'm not entitled to anything - I have to again earn it. If you have great skills, you will have a step up and treating patients effectively and compassionately will equate to demand for you but you have to know how to make everyone happy and that doesn't just include patients. I received offers from podiatrists offereing no base and only a percentage of collections all the way up to ortho groups offering me $150 w/great benefits. You have to consider the entire package. Although many times you don't stay with your first job, you'd like to avoid this because moving means starting all over and having to establish new relationships which take time. The most common offer will be a base with incentive (right now an example for a PM&S36 person would be a base of $65-75K and an incentive of 20% of collections over a certain amount likely to be near $300-400K). Many times they will then slowly increase your base yearly based on what you produced in the previous year - so for example if you grossed $100K in year one (base and bonus), you may have your base increased to 90% of that - so year two would be a base of $90K and the same incentive, etc, etc. You should look at not what you will make in the first 2-3 years so much as what is the long-term plan of the practice and where will you be in 5-10 years. You want job security and increasing income. When negotiating for partnership you should address that early on and have provisions in the contract for when it may be offered and at what amount - are you paying the value of the practice at the time of buy-in or from when you start? Remember you will increase the value of the practice while you are there and buying in at the increased price is buying what you already brought to the table. Be careful with ortho practices - some are good and some are not. Ask why are they bringing you in. Sometimes they will limit what you are allowed to do - maybe making you do orthotics or just forefoot surgery if they already have someone who is doing their rearfoot and ankle cases. If they legitimately have a need for you to do what you want then make sure you have job security. You don't want them to replace you with an orthopod in the future. Their point of view commonly is that hiring a podiatrist is good in that they can pay you less to do the same job (if you are competent) but hiring you is bad because you can't participate in the general ortho call. The salaries of fellowship trained foot & ankle orthopods is much higher because they can share in the general ortho call which is a huge deal, especially in smaller group practices. I decided to join a podiatry practice in an area I wanted to live with a decent base and high incentive with easily attainable kick-in. Feel free to contact me regarding specific situations/questions.
Great post. I agree with you.
I wanted to respond to the comments on salary coming out of residency. You should speak to both residents coming out now and to practice management experts to obtain truthful information. I interviewed at many places during the process and can comment on my experience. My advice is to not focus on what your starting salary will be. You won't know that you'll be happy there until you're actually there and that is in regard to not just the job but also the area, how you family adjusts, and many many other factors. The fact is that training does not always equate to dollars - medicine is a business, period. I did a four year surgical residency and I'm not entitled to anything - I have to again earn it. If you have great skills, you will have a step up and treating patients effectively and compassionately will equate to demand for you but you have to know how to make everyone happy and that doesn't just include patients. I received offers from podiatrists offereing no base and only a percentage of collections all the way up to ortho groups offering me $150 w/great benefits. You have to consider the entire package. Although many times you don't stay with your first job, you'd like to avoid this because moving means starting all over and having to establish new relationships which take time. The most common offer will be a base with incentive (right now an example for a PM&S36 person would be a base of $65-75K and an incentive of 20% of collections over a certain amount likely to be near $300-400K). Many times they will then slowly increase your base yearly based on what you produced in the previous year - so for example if you grossed $100K in year one (base and bonus), you may have your base increased to 90% of that - so year two would be a base of $90K and the same incentive, etc, etc. You should look at not what you will make in the first 2-3 years so much as what is the long-term plan of the practice and where will you be in 5-10 years. You want job security and increasing income. When negotiating for partnership you should address that early on and have provisions in the contract for when it may be offered and at what amount - are you paying the value of the practice at the time of buy-in or from when you start? Remember you will increase the value of the practice while you are there and buying in at the increased price is buying what you already brought to the table. Be careful with ortho practices - some are good and some are not. Ask why are they bringing you in. Sometimes they will limit what you are allowed to do - maybe making you do orthotics or just forefoot surgery if they already have someone who is doing their rearfoot and ankle cases. If they legitimately have a need for you to do what you want then make sure you have job security. You don't want them to replace you with an orthopod in the future. Their point of view commonly is that hiring a podiatrist is good in that they can pay you less to do the same job (if you are competent) but hiring you is bad because you can't participate in the general ortho call. The salaries of fellowship trained foot & ankle orthopods is much higher because they can share in the general ortho call which is a huge deal, especially in smaller group practices. I decided to join a podiatry practice in an area I wanted to live with a decent base and high incentive with easily attainable kick-in. Feel free to contact me regarding specific situations/questions.
So are these ortho fellowships you mention podiatry fellowships?
If not, what are they, how many are there and where are they? Thanks for the reply.
To clarify, you can do a fellowship in whatever - there are many different ones offered. In my previous post I was referring to orthopaedic surgeons with fellowship training in foot & ankle which can vary from 6 months to a year. The fact is, as a podiatrist no matter if you did my four year residency then a surgical fellowship with Dror Paley and married Mark Myerson's daughter and practiced the most liberal state, you are still a DPM and can't take general ortho call. You could agree to take just all the foot & ankle call all the time but most places have whoever is on call do it all - so if a hand guy is on call and he gets a pilon, he does it or offers it to the foot & ankle guy BUT he is responsible for the care. The ortho practices are great for the trauma aspect but the question is will you have job security, can you be a partner and how can they guarantee this to you. You have to look at how much money you geberate versus the total joint guys and unfortunately the numbers are not in your favor. Be happy with what you do - you provide a valuable service that cannot and will not be replaced.
NatCh said:That's a totally believable (albeit high) figure for gross collections before expenses, and an outstanding one if it's after expenses. It's definitely not the norm to take-home $600K though (but it's possible).
Making that kind of money takes more than having great surgical skill. It takes a lot of business savvy. My first few years out of Residency I made very little, but now (seven years later) I'm doing pretty well. Keeping overhead low is as important as billing high.
Most of the other DPMs I know made somewhere around $60k salary first year out as an Associate. It might be worth noting that NONE of the colleagues I know were satisfied with that first job, and ended up moving elsewhere eventually.
When asking about first year salary one also needs to have foresight to evaluate the cost of Partnership buy-in a few years down the road. Even if you get offered a high starting salary, it all goes back to your bosses if they have a high buy-in. "You want $150K + bennies now? No problem (we'll just get it back in three years by adding $200K to your Partnership buy-in)!
I posted to a related thread in the Pre-Podiatry Students forum, so I'll cut/paste my comments to here since it pertains:
Re: Reported $600K income
Reported income can be misleading too. As a private corporation you must pay yourself a "reasonable salary" as the IRS calls it. The more you can make purchases related to business, the more you benefit. For instance, say you and a colleague go out to eat. You talk shop and you pick up the tab on your Corporate card, which is legit. Your business entity spent the money on that dinner, not you the person. The money was spent before it actually became part of your personal income. Nonetheless, you got to eat the meal! By owning the business you can make use of such tax write-offs. The doctor who "officially" makes $100K per year might actually be getting to spend more than the other doctor who "officially" makes $130K salary.
$150K seems sky-high to students and Residents now, but it's honestly within reach of a basic podiatric surgical practice without glamorous rearfoot, ankle, or trauma work. Try not to be dazzled by high 1st-year offers; what happens 5-10 years down the road will make more difference in the long run.
Other pearls:
- Start a separate real estate company, buy or build a medical office, then lease it back to yourself with your practice as the tenant.
- Own part of a surgery center, do your cases there, then collect dividends from the separate business.
- Get a DME number, add significant income by getting to bill for camwalkers, wound care supplies, etc.
- Become locally known for doing one thing better than anyone else in the community. You don't necessarily have to be better (you have to be good), but if you have the reputation then you get the referrals.
Here's one angle by which my Partners and I were surpised: We put up a shoe tree in our waiting room with those Rx Crocs shoes. As patients are sitting there they stare at the shoes until they buy them. We're netting over a thou per month profit from those wacky things! Bonus walking-around money!
Our biggest expense by far is payroll. Streamline your staff and you keep an extra $30K per year per staff in your pockie.
- Own part of a surgery center, do your cases there, then collect dividends from the separate business.
- Get a DME number, add significant income by getting to bill for camwalkers, wound care supplies, etc.
Just a guess from context, but it's probably "Distributor of Medical Equipment" or "Durable Medical Equipment" liscense?Thanks for the great post, NatCh. Can you tell us more about these two points? What is a DME number?
Just a guess from context, but it's probably "Distributor of Medical Equipment" or "Durable Medical Equipment" liscense?
A lot of pod clinics here in south Fla lose $ and have to do patients a disservice by sending them across town to pick up crutches/CAM/etc. There's legislation with aims to protect paitents from docs and clinics overcharging for the durable medical equipment, but, in the end, it just makes people walk or drive across town on a broken foot to save $5 on a pair of crutches
Yes, a pod clinic might charge a bit more for insoles, crutches, CAM, BioFreeze, etc than a big medical supply store, but that's because a small clinic can't buy in the volumes that the wholesalers do. I think that, to most patients, it's well worth the extra couple bucks to get the equipment they need right there in the office so they can save an extra trip and start treating their ailment right away...
I think you should Nat! It would be helpful to many I'm sure (myself included)!