After Residency

[GSfootdoc]

Hi y’all
I am 2 years out. I work in a large podiatry practice. Mix bag of office, nursing home and hospital work. Pay decent I am not happy nor am I miserable.

However I was evaluating my goals the other day and that’s what got me to post on here.
I don’t know if I am the only one but since school till residency there were goals to hit, there were attendings to ask or maybe mentor you, there were was always a check list of the stuff you have to get done to move on to the next stage.

Now that I am in PP as an associate I find myself just going about the motions with no goal in mind. Maybe the goal of hitting my numbers for boards or making my bonus. But nothing else….

I have my family to provide for and loans to pay off. Which I am doing through my job but I just don’t know what else I should be doing….

For the attendings who are few years out what are you doing ? What are your goals and how are you getting there

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[Pronation]

When I was an associate I only had 1 goal, and that was to not be an associate. After literally hundreds of applications, I was finally able to achieve that goal and now make approximately triple what I did as an associate doing the same amount of work. These days my goals are to never let a fart surprise me, and I’m getting there by doing pelvic floor exercises and maintaining prostate health.

 

[GSfootdoc]

congratulations on that. That’s amazing. How did you accomplish that ? Being employed by hospital?

Do you have a mentor ?

 

[Adam Smasher]

What are your goals and how are you getting there

Agree with @Pronation maximize income while minimizing work. If you're of an entrepreneurial bent, private practice as an owner presents you with interesting non-podiatric challenges--how do you grow the business? What service offerings are winners, what are losers? I work in a meh part of the country where podiatry is not saturated (as badly) so I at least have interesting business challenges to think about.

Above all else, find things that are not podiatry related to do in your downtime, then try to excel at them and those are your new goals. Don't aspire to be the best toenail trimmer you can be.

 

[Adam Smasher]

Also inb4 a politician says "chin up, don't listen to the cesspool of negativity and self-loathing on sdn, rah"

 

[Feli]

Goals:
core savings (emergency fund)
roth IRA max every year
develop practice style (cme, treat pts good, attract refers you want)
increase income (own office, hospital job, better job, etc)
board cert ABFAS (opens more hospital job options, esp if RRA)
student loans paid off
higher savings (retirement, alt invests, increase EF, etc)
develop hobbies/skills

Let's face it: at 95% of DPM associate jobs, you are making someone else rich. You're building their practice/name. You are doing the work/payers they don't want to do. Worse, at most of them, you won't get more than basic living expenses, basic savings, student loans paid off slooooow. It is almost impossible to be solo bread winner for a family at that pay grade. If you can manage to get decent pay as associate, you are probably working ungodly volume and/or doing shady stuff ("biopsy," "grafts," "custom" DME, etc). As said, you need to move past that associate work asap and into higher pay employed (usually hospital) or partner/owner roles where you'll basically double your % kept from what you generate... ABFAS helps, esp for the employed jobs or getting higher pay at them.

Being a good and skilled doc to the pts is paramount, but how many more years do you want to spend making someone else rich and building a biz you don't own? Life is finite. Retirement and freeing up time costs money. Time worked is money - but much more or less depending on your situ. Be an owner to work as hard/little as you want... or at least work towards getting paid VA wage or better yet MGMA.

 

[Hybrocure]

No professional goals tbh. I’ve already achieved it. I completed pod school and my residency. To me it’s just a job at this point. My goals do not involve work. Work is just something I do to pay for my lifestyle.

I just want to be healthy and happy.

 

[GreenHousePub]

Hi y’all
I am 2 years out. I work in a large podiatry practice. Mix bag of office, nursing home and hospital work. Pay decent I am not happy nor am I miserable.

However I was evaluating my goals the other day and that’s what got me to post on here.
I don’t know if I am the only one but since school till residency there were goals to hit, there were attendings to ask or maybe mentor you, there were was always a check list of the stuff you have to get done to move on to the next stage.

Now that I am in PP as an associate I find myself just going about the motions with no goal in mind. Maybe the goal of hitting my numbers for boards or making my bonus. But nothing else….

I have my family to provide for and loans to pay off. Which I am doing through my job but I just don’t know what else I should be doing….

For the attendings who are few years out what are you doing ? What are your goals and how are you getting there

That's just life.

People find different hobbies, goals, professional and personal achievements to undertake, family things. Time for you to find something to focus on.

I personally focus on family goals and supporting them.

 

[icebreaker32]

Lots of good answers.

I urge you not become complacent as an associate unless your spouse is a real high earner.

Your job can be taken away at anytime. Your compensation formula and benefits can change at anytime. When the owner decides to sell you may not be given any notice or might be given an ultimatum to buy the practice at their asking price.

Do you want geographic stability for your family? Are you living where you want to live forever?

Even if your employer is better than most if they are not offering a fair and guaranteed path to partnership you are very vulnerable over a long period of time. Our job market is horrible. If things go south as an associate they are likely to do so at the most inconvenient time possible in your life.

If you are close to ABFAS numbers at your current job you have to figure out how important that is to you.

Now is the time to plan even if it is a couple years away before you leave.

Do you want to open your own office?

Do you want an organizational job (might need ABFAS and connections or geographic flexibility……sometimes a little luck also (being the second choice when the first choice turns the job down is more common than you would think).

In addition to geographic stability, the ability to make more money than an associate allows you to do more for your family even if you are personally happy living a life more modest than a “doctor’s lifestyle”.

 

[GSfootdoc]

I do want to open a practice

However the idea terrifies me. I get anxious just thinking about it.

It’s a lot of risk and I know that there’s no glory without risk. However for the people who did open their own what steps did you take to mitigate that risk or did you dive in

 

[Feli]

I do want to open a practice

However the idea terrifies me. I get anxious just thinking about it.

It’s a lot of risk and I know that there’s no glory without risk. However for the people who did open their own what steps did you take to mitigate that risk or did you dive in

It is good to have a budget buffer and/or bank LOC (esp if you don't have high income romantic partner or wealth in family), but you get $ from copays faster than you think and insurances pay reasonably quick (esp in good insured/payer areas and with good biller). You can do it on a fairly low budget and get more/better stuff later. If there are no non-competes and you like exist area, it's easier... if there are non-comp (legally, not just owner tried it but state doesn't allow) in place or you want new area, you might have to buy out a doc where you want to go or work an associate job there if no non-comp there. Either and all paths work.

You will soon figure out that, as owner, you can see basically half the pts and make same $... or same pts volume and make twice the $ versus as associate job. The best part is just putting an end to being underpaid or stuck in a dumb system and/or bad help that you can't improve/change. It is long days and rough goings for awhile, but most associates do that forever with no end in sight.

It is never wrong to sit and learn (if your associate job owner is worth learning from) AND you are saving $. Some associate jobs pay better or have better learning value than others. But if you aren't getting ahead at associate job (savings, pay stud loans, save for own office)... and most associates are NOT, then you should be looking for better jobs or planning your own office. Too many DPMs chase their tail at a bad job, spend all they earn (or more by lease/credit use!), and then can't figure out how to break the cycle. Spending more than one makes is the fast track to perma-associate. The solution is live frugal, plan, save, plan... and then execute (new better job or become owner).

 

[Feeter]

I had the same experience as you but I have been hospital employed. I felt I lost lot of structure that I had since highschool and all of a sudden I was on my own without knowing what is next for my professional goals.

I have a fair number of mentors that I talk to on regular basis and was able to come up with some basic goals within the structure of academic hospital. They were divided into clinical, research, education and service. I try to come up with one or two things each year in those categories that I want to achieve and work with my mentors at the hospital on how to achieve them. Some I achieve some I never do because of time constraints or lack of infrastructure to actually achieve those goals.

It can feel overwhelming initially to not have the structure and goals that you had in training but I think it is natural. Most of my friends had similar experience. It really is up to you on what you want to do and certainly you've achieved enough already and don't necessarily have to create more professional goals. If you have a job you like and the work you do then that's enough for many and you've worked hard to get there so enjoy it!

 

[msion]

My goal is to save every penny to become a slumlord.
You gotta own assets in this world to produce generational wealth.
Find something to invest in and learn that something really well.

 

[icebreaker32]

Yes there is a real risk with opening an office for sure.

I wish I could be as positive as others about you just coasting with your current job, but as I mentioned there is also a very real risk to being an associate with no partnership path. If you are in that situation you have a tremendous amount of risk over a 10 year or longer time frame. Business could unexpectedly slow down and you are gone etc.

You certainly need to plan and there is a lot to do. You will not be bored or have lack of goals anymore if this is what you want to do.

You also need to be prepared for the possibility of negative or minimal cash flow for up to 6 months and it could take up to 2 years to be making as much as you were as an associate. By then if your business has made it you will likely have an income equal or possibly much greater and job stability greater than being an associate for the rest of your career. There are some risks to being an owner like employee theft (ideally you don't trust anyone with your money, but small businesses are not always the best at this) and a personal injury/illness where you can not work for awhile can be a real financial set back.

Can you deal with no income for 6 months? You might say no, but what if your boss told you tomorrow he was not busy and you were out of a job....you might have no cash flow for 6 months and have to move. Your spouse would have to find another job also. What a mess. How many podiatrists can find a good job within a couple weeks without moving? Not many unless you live near a large city and are very established/well liked by patients and peers. What are your other options if you don't want to move? Mobile podiatry or opening an office most likely.

When you realize this whole profession has an element of risk greater than many other healthcare professions what choice do you have? Being an associate would be fine if it paid a bit more and you could get another job across the street if necessary within a couple weeks. The only way to mitigate that risk is to take a job making so much money like a hospital job and have a very large emergency fund and become ABFAS RRA or become an owner.

 

[billBOB213]

Agree with @Pronation maximize income while minimizing work. If you're of an entrepreneurial bent, private practice as an owner presents you with interesting

Maximize income and minimize work as much as I can

That’s not to say I don’t really like my job, and get good satisfaction out of it-because I do.
But at the end of the day it is a job and I want to provide good for my family and spend as much time as possible with them. For me that is a happy life. Keep it simple, so more of what I like (bunion surgery, simple controllable surgery) and less of what I don’t, and call it a day.

So for me it was getting out of taking call and PP, and joining an FQHC where i can make good hospital-type money but with working 40hr or less a week.
I will never be a surgical juggernaut or walk around a hospital as 'the man' (no pod will sorry), but i am very very happy with my job. For others it might mean starting a practice, going hospital, or joining a MSG . just depends what you want.

But now is the time to figure it out and go towards that with all you got.

 

[newfeet]

Hi y’all
I am 2 years out. I work in a large podiatry practice. Mix bag of office, nursing home and hospital work. Pay decent I am not happy nor am I miserable.

However I was evaluating my goals the other day and that’s what got me to post on here.
I don’t know if I am the only one but since school till residency there were goals to hit, there were attendings to ask or maybe mentor you, there were was always a check list of the stuff you have to get done to move on to the next stage.

Now that I am in PP as an associate I find myself just going about the motions with no goal in mind. Maybe the goal of hitting my numbers for boards or making my bonus. But nothing else….

I have my family to provide for and loans to pay off. Which I am doing through my job but I just don’t know what else I should be doing….

For the attendings who are few years out what are you doing ? What are your goals and how are you getting there

I'm 9 years out. I am not in PP. My goal is retirement and going through the ranks of professor (assistant, associate, full) if I stay at my current job. I am doing lectures when they ask. I have one in November have to start working on. I have no interest in owning a practice or running a residency/fellowship.

 

[Hybrocure]

Lots of good answers.

I urge you not become complacent as an associate unless your spouse is a real high earner.

You job can be taken away at anytime. Your compensation formula and benefits can change at anytime. When the owner decides to sell you may be given any notice or might be given an ultimatum to buy the practice at their asking price.

Do you want geographic stability for your family? Are you living where you want to live forever?

Even if your employer is better than most if they are not offering a fair and guaranteed path to partnership you are very vulnerable over a long period of time. Our job market is horrible. If things go south as an associate they are likely to do so at the most inconvenient time possible in your life.

If you are close to ABFAS numbers at your current job you have to figure out how important that is to you.

Now is the time to plan even if it is a couple years away before you leave.

Do you want to open your own office?

Do you want an organizational job (might need ABFAS and connections or geographic flexibility……sometimes a little luck also (being the second choice when the first choice turns the job down is more common than you would think).

In addition to geographic stability, the ability to make more money than an associate allows you to do more for your family even if you are personally happy living a life more modest than a “doctor’s lifestyle”.

This is a great post and I agree with you - but hospital employed podiatrists aren’t immune to being sacked either though. You’re at the mercy of the bean counters

 

[619]

I concur with what every one is saying. To summarize in a single sentence; The goal after residency is to focus on your wealth and health. Wealth is your source of income be it an associate, solo, or organization job. Be financially responsible and the rest will fall into place. Health is self explanatory but can also include family life, mental well being, hobbies, friends etc.

To touch more on wealth, there are many roads to get there. We can all agree that being an associate is the slowest, longest and most painful way to build wealth in podiatry. This is simply because of the low income. No short cut around that. And not surprisingly, being an associate is also the least fulfilling and can be downright depressing. So we can see how wealth and health are interconnected.

I started as an associate (like most here) and my goal was to increase my income. I decided to go solo after a year. I did not want to wait 4-7 years trying to get ABFAS and then hope to get a hospital job. I own my practice and I get maximum fulfillment from running my practice and maximum income too. My practice keeps me excited every morning, even on slow days with less patients, I am always busy because there are things to do. Lots of stuffs to catch up on and I enjoy it. I think the same goes for folks who are hospital employed, MSG or academic center, the work could be stressful but then again you are grateful because only a few gets the high pay organizational jobs.

Hi y’all
I am 2 years out. I work in a large podiatry practice. Mix bag of office, nursing home and hospital work. Pay decent I am not happy nor am I miserable.

I will say for now but as you get older, needs changes and you need that financial cushion.

Now that I am in PP as an associate I find myself just going about the motions with no goal in mind. Maybe the goal of hitting my numbers for boards or making my bonus. But nothing else….

Add looking for a better paying job, your income can double for literally doing the same work if you get a hospital job. That's a worthwhile goal right there. You can start applying now and testing the waters even without abfas. The more interviews you do, the more experience you get interviewing.

I have my family to provide for and loans to pay off. Which I am doing through my job but I just don’t know what else I should be doing….

Do you have a 3-6 months emergency fund, are you maxing out 401k, any life insurance to protect your family, etc. So much financial things to be doing but then again, with an associate pay, only so far you can stretch your $$. That's why getting a higher paying job at the hospital should be your #1 goal.
Think of this, there are folks on this forum (myself included) practicing the exact same podiatry stuff that we all do but they are taking home $300k-$400k a year. And we are not breaking our backs to bring home these numbers. Almost impossible to make even $250k as an associate except if you are seeing high volume, taking calls at 4 different hospital, going to multiple clinics etc.

Mix bag of office, nursing home and hospital work

Just a last word. Anyone or any place doing nursing home work is not busy enough in clinic. Have you seen the EOB reimbursement for the work you do at the nursing home? As an associate you may not have access to the billing. I am not even busy enough in clinic but will never venture into nursing home work. You can make more money doing uber or door dash than nursing home.

 

[Hybrocure]

On a side note - where would you guys place disability insurance into the hierarchy of things to manage?

I’m a new grad (relatively speaking) in PP. Still don’t have it. To me I just see money that can be better spent being put toward loans..but idk

 

[619]

On a side note - where would you guys place disability insurance into the hierarchy of things to manage?

I’m a new grad (relatively speaking) in PP. Still don’t have it. To me I just see money that can be better spent being put toward loans..but idk

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[Hybrocure]

How to Buy Disability Insurance | White Coat Investor

Long-term disability can be a financial catastrophe for doctors. Here's how to buy the best disability insurance plan for you.

www.whitecoatinvestor.com

Understanding Disability Insurance for Doctors | White Coat Investor

Disability insurance protects your biggest financial risk. Find out how DI works, how much you should buy, and when you should cancel.

www.whitecoatinvestor.com

Kinda beating myself up now about how cheap it is. Just saw some quotes.

For some reason I thought it was a student loan payment level of cost

 

[Feli]

On a side note - where would you guys place disability insurance into the hierarchy of things to manage?

I’m a new grad (relatively speaking) in PP. Still don’t have it. To me I just see money that can be better spent being put toward loans..but idk

The money's better spent just taking care of yourself (gym/vaca/diet/etc) and investing it (in you/biz, pay loans, in retirement/roth, partner's edu/biz, etc).

Insurance is all crap that is sold on appeal to fear (whereas lottery is sold on greed)... the math's been done, and you lose big.
There is a reason insurances are advertised and stats spouted to frighten you, yet you just don't hear docs going around recommending insurance and saying how they 'won big' on it (as they might with stocks, ASC invests, etc) by making faithful monthly payments for years. You do see a lot of docs faking injury/pain late career to try to recoup their tons of money paid to premiums. The math has been done many times over. Even if you 'win' on insurance via disability or house flooded or early death whatever... good luck collecting what you expected.

Buy the required malprac, auto liability, property (if you don't own the house), work comp or biz insure, etc... but let other fools overspend on the optional insurances.
If you have a family that couldn't get by at same/similar level without your income, look into term life. Much cheaper than disability if you really need that peace of mind. Don't overspend on that either.

 

[dtrack22]

The money's better spent just taking care of yourself (gym/vaca/diet/etc) and investing it (in you/biz, pay loans, in retirement/roth, partner's edu/biz, etc).

Insurance is all crap that is sold on appeal to fear (whereas lottery is sold on greed)... the math's been done, and you lose big.
There is a reason insurances are advertised and stats spouted to frighten you, yet you just don't hear docs going around recommending them and saying how they 'won big' on it (as they might with stocks, ASC invests, etc) by making faithful insurance payments for years. The math has been done many times over.

Buy the required malprac, auto liability, property (if you don't own the house), work comp or biz insure, etc... but let other fools overspend on the optional insurances.
If you have a family that couldn't get by at same/similar level without your income, look into term life. Much cheaper than disability if you really need that peace of mind. Don't overspend on that either.

I don’t agree all of this. Comparing term and a disability policy is dumb. There are financially indefensible insurance policies (ie whole life policies), but there certainly are policies that make a lot of sense (ie homeowners insurance in Gulf states).

Insurance is really simple, it is there to protect against financial troubles that you personally can’t afford. If you can’t afford to take care of yourself or your family (financially) if you were to become disabled and unable to work (or at least do your current job) then you should consider a disability policy. It’s not the same as term life insurance, they aren’t comparable as Feli claims in the last paragraph. Sure, government has regulated some insurances, but in a world where they didn’t, you would still be wise to pay for an auto insurance policy if you couldn’t afford to repair your car, or someone else’s, or pay for medical care following an accident. 99% of people in Louisiana should have a homeowners policy even if it wasn’t a mandated part of homeownership (at least while you have a mortgage). Disability is no different.

If you can afford to become disabled and do other work or live on social security/disability or survive on spouse’s income then don’t get disability insurance. If you wouldn’t be able to pay back loans, afford your rent/mortgage, pay for your own medical expenses, childcare, etc. then you would be wise to have a disability policy even in the majority of cases where you never need or use it. You can drop any of these policies when you get to the point that you feel comfortable “self insuring” which is what anyone without a particular insurance policy is doing.

 

[Feli]

I don’t agree all of this. Comparing term and a disability policy is dumb. There are financially indefensible insurance policies (ie whole life policies), but there certainly are policies that make a lot of sense (ie homeowners insurance in Gulf states).

Insurance is really simple, it is there to protect against financial troubles that you personally can’t afford. If you can’t afford to take care of yourself or your family (financially) if you were to become disabled and unable to work (or at least do your current job) then you should consider a disability policy. It’s not the same as term life insurance, they aren’t comparable as Feli claims in the last paragraph. Sure, government has regulated some insurances, but in a world where they didn’t, you would still be wise to pay for an auto insurance policy if you couldn’t afford to repair your car, or someone else’s, or pay for medical care following an accident. 99% of people in Louisiana should have a homeowners policy even if it wasn’t a mandated part of homeownership (at least while you have a mortgage). Disability is no different.

If you can afford to become disabled and do other work or live on social security/disability or survive on spouse’s income then don’t get disability insurance. If you wouldn’t be able to pay back loans, afford your rent/mortgage, pay for your own medical expenses, childcare, etc. then you would be wise to have a disability policy even in the majority of cases where you never need or use it. You can drop any of these policies when you get to the point that you feel comfortable “self insuring” which is what anyone without a particular insurance policy is doing.

I agree. The problem with any insurance is that anyone who really needs it can't afford it.
Insurance has a negative rate of return by its nature (because of admin, ad, etc fees to the insurance company). It's a financial product. You don't want to overspend on something with negative expected returns. I wouldn't encourage anyone to go buck wild on acquiring or beefing insurance policies unless they had some scheme to scam them and collect (which still may be found out on enroll or on making claims).

Life insurance is straightforward, and term life is cheap and focused. It is useful sometimes if the person doesn't have a high-earning partner (or at least one who has that capability).

Disability is expensive, and a lot of the premiums unfortunately go to ppl who scammed the company (bogus enroll exam to disable soon after, faked disability, milked severity of minor disability, etc). There is serious subjectivity and questionable doc eval at play.

Both life and disability play to fear to sell a financial product... with negative rate of return.

...Investing VTI or SPY or QQQ or whatever in a Roth or cash acct or investing your own biz gives serious expected and historical positive return... hopefully many fold.
Paying student loans is instant positive return by preventing future interest.
Heck some ppl even hit on BitCoin or whatever. I don't love that risk, but it might beat dumping into a proven negative return. Dealer's choice.

 

[heybrother]

5 few years ago I bought $1.5 million dollars of term life for $600 a year. Probably should have bought more. I will be financially independent long before it expires. It was the easiest decision I ever made. Its trivially cheap. Anyone who talks themself out of buying term is doing the math wrong.

 

[dtrack22]

The problem with any insurance is that anyone who really needs it can't afford it.
Insurance has a negative rate of return by its nature (because of admin, ad, etc fees to the insurance company). It's a financial product.

But your argument is the one you should be making against an insurance salesman who is selling you on whole life, Universal Life, etc. type policies where they claim that they are some investment vehicle. Obviously nobody should be looking at an insurance policy as an investment vehicle.

But auto insurance having a “negative rate of return” is irrelevant to the discussion or consideration of someone having auto insurance. Or homeowners. Or boat/RV. Or term life. Or disability. You can’t put even $300 per month into a taxable account, buying shares of VTI, and afford to cover your medical expenses after being paralyzed in an auto accident 3 years into practice as a podiatrist. A scenario which happened to a young DPM just a few years ago.

Arguing that insurance policies aren’t a good investment vehicle in this thread is dumb. Nobody is claiming that they are. Unless there is a Northwestern Mutual agent in here I don’t know about.

Can you afford the thing that you are insuring against on your own? If yes, you don’t need it. If no, there is a good argument to have the policy. Disability included.

 

[HardRoadPaved]

Northwestern Mutual

run the other way....

 

[GSfootdoc]

You guys are all doing the **** I dream of doing one day.

If you had to give advice to someone wants to open up a practice but lives in a saturated expensive area what would you say ?

 

[Adam Smasher]

You guys are all doing the **** I dream of doing one day.

If you had to give advice to someone wants to open up a practice but lives in a saturated expensive area what would you say ?

I would say figure out an outside the box way of branding/differentiating yourself, some kind of hook to make people come to you vs the rest. If you've got a flashy personality, you could build a sports/biomechanics focused practice and put everyone in orthotics, and probably convince them that they needed them all along. If you're really flashy, incorporate holistic/alternative medicine and upsell all your patients. On the other hand, if you're average or boring, and if you can stomach the idea, I've always thought mobile podiatry was an interesting low-overhead business approach.

Otherwise my advice to you would be the same to someone thinking of opening a burger joint in a town full of burger joints...don't do it

 

[Feli]

You guys are all doing the **** I dream of doing one day.

If you had to give advice to someone wants to open up a practice but lives in a saturated expensive area what would you say ?

I would say almost every area you - or almost anyone - wants to be in is saturated for podiatry. Exact opposite for MD specialists. Keep in mind, with the new pod schools, there will soon be more practicing DPMs than orthos (total orthos - not simply F&A orthos). There are more DPMs practicing than ENTs... urologists... neurologists... endocrinology ("diabetes is growing!!! lol)... more than dermatology. Fun facts.

You are just going to have a better podiatry service, better marketing, work harder, etc than the next guy. Try for all of the above. Competition will be there, and more might come in (probably DPMs, possibly even ortho or F&A ortho, MDs or midlevels who do wound care, etc). Default to cooperate with local colleagues but ignore those who don't do the same. That's just how it is for DPMs.... not quite as bad a chiro cutthroat, but definitely not just planting your flag wherever you reasonably want a la MDs. Saturation is an interesting thing.

Consider saving up and making reasonable offers to buy out retiring docs transitioning pts to you over 6-12months span if it's a saturated city. You will overpay, but you will also have some pts to pay the bills. You can always change location, staff, office equip gradually. It is very very hard to start with zero pts and zero refer connects in a metro (esp one with pod school or residencies) if you're - or your partner/fam- is not independently wealthy. A few ppl on SDN have done each of those start scratch in metro or buyout options.

If there are no non-competes allowed, work in the area awhile, make community/PCP/facility relationships, and then go solo. Get the pts and connections that way. That is what I did (although I was open to staying with the group had they treated me well). Tale as old as time.

Success in podiatry PP always comes down to the trifecta of good area payers + little area competition + trust/respect of area PCPs. It is hard to get all three, but in any successful PP, you will find 2/3 or 3/3 of those factors well groomed. In any struggling PP office, you will find deficiency in 2 or all 3 areas... or at minimum, a MAJOR defect in one of those areas. Keep that in mind as you eval offices and areas to practice.

So, to review... multiple choice:

• buy out a moustache and use those pts for a foothold... then build from there
• start solo and be slow and in the red for potentially quite awhile
• go to the middle of noooowhere (you'd be sadly surprised how many tiny towns have DPM or one nearby enough - sometimes a few)
• work employed, make connects, then start nearby if no non-competes