Associate position w/ MSG versus hospital gig

[podiatryinsearchof]

Opinions:

1) Option to join MSG, part of Optum. Geographical location is very important to me, this is exactly where I’d like to be. Offer not solidified yet but can expect base minimum 120k. RVU based (side note: opinions on RVU based associate jobs?)

2) option to become third pod part of large medical system Northeast. Would be taking call, a lot of inpatient care, possible incorporation into wound care center. Own clinic set up to see “whatever I want or don’t want to”. HAvent gottan base salary offer yet.


just hoping to get non biased opinions/information on these two very different potential routes.

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[dtrack22]

What’s the non compete on #1?

 

[podiatryinsearchof]

What’s the non compete on #1?

Still awaiting an official contract, so that is yet to be seen. One of my biggest, if not only concern about this scenario. Location is where I would like to live basically my entire life, start family etc. if I don’t enjoy it, I’ll basically be screwed if the non compete is extensive. Which with a large group like Optum, I’m sure it would be.

 

[dtrack22]

I mean if you don’t have two contracts sitting in front of you then you realize nobody can give you a half way decent answer, right?

 

[heybrother]

Perhaps I'm missing something - when I hear MSG I think some variation of a podiatry-orthopedics-multi-specialty-sports-med conglomerate where podiatry isn't in charge and therefore you are slightly more likely to get a straight deal. I might have an overly positive perception of these groups and obviously anything is possible.

But this is a podiatry group isn't it? You reference it in your prior post - a large 13 member podiatry group with a focus on surgery? You state the same salary. Also you last posted on November 24th so - get a contract already. Time be ticking!

 

[dtrack22]

Perhaps I'm missing something - when I hear MSG I think some variation of a podiatry-orthopedics-multi-specialty-sports-med conglomerate where podiatry isn't in charge and therefore you are slightly more likely to get a straight deal. I might have an overly positive perception of these groups and obviously anything is possible.

But this is a podiatry group isn't it? You reference it in your prior post - a large 13 member podiatry group with a focus on surgery? You state the same salary. Also you last posted on November 24th so - get a contract already. Time be ticking!

Sounds like you’re right.

But the OPs question is essentially asking us which Truck he should buy without giving us the model, engine, trim/features, etc. I have no idea what he/she expects anyone to say...

I mean I’d get the Ford over the Chevy, until we later find out that the Ford is actually a Ranger and you have a 12,000lb 5th wheel you need to tow.

 

[air bud]

Sounds like you’re right.

But the OPs question is essentially asking us which Truck he should buy without giving us the model, engine, trim/features, etc. I have no idea what he/she expects anyone to say...

I mean I’d get the Ford over the Chevy, until we later find out that the Ford is actually a Ranger and you have a 12,000lb 5th wheel you need to tow.

Get the Raptor. Can't tow **** but it's fast.

 

[GreenHousePub]

It's a large multispecialty group of the following specialties:

• Primary Care And Foot And Ankle Surgery
• Limb Preservation And Salvage
• Diabetic Foot Wounds And Footwear
• International Designation
• Lower Extremity Geriatric Medicine
• Minimally Invasive Foot and Ankle Surgery
• Podiatric Sports Medicine
• Foot And Ankle Surgery

 

[Shiyuan]

Option 3 - Dr. Timothy Franklin Palmer (friends call him TFP), 74 y/o looking to have you join as an associate doing NH and clinic only and being paid 60k + “generous” bonus structure. Wife oversees the office’s books. You have to buy your own Dyson to clean the rooms.

sry couldnt help myself...

 

[air bud]

It's a large multispecialty group of the following specialties:

• Primary Care And Foot And Ankle Surgery
• Limb Preservation And Salvage
• Diabetic Foot Wounds And Footwear
• International Designation
• Lower Extremity Geriatric Medicine
• Minimally Invasive Foot and Ankle Surgery
• Podiatric Sports Medicine
• Foot And Ankle Surgery

I feel like footwear deserves it's own dept. Also where is the specialization in orthoses?

And then there is the noninvasive regenerative podiatric interventionist

 

[619]

base minimum 120k.

This gives off the vibe of a Podiatry group. No honorable MSG group would pay a doctor or surgeon 120K base. Only pod groups do that and we can only do it to ourselves.

As other have said, if option #1 location is where you want to live, start family etc. What are the chances that your first Job will be your last job? Dabble with option 2 and worst case scenario, you can move back to your hometown and open your own practice. Live like a resident, save your cash and don't buy a house or any fancy toys.

Opening a practice is not as scary as it sounds especially after practicing for a year or 2. All you need to open a podiatry practice is your brain, table & chairs and 1 staff upfront. That's all you need to get started and you build up from there.

 

[PTPuser]

This gives off the vibe of a Podiatry group. No honorable MSG group would pay a doctor or surgeon 120K base. Only pod groups do that and we can only do it to ourselves.

As other have said, if option #1 location is where you want to live, start family etc. What are the chances that your first Job will be your last job? Dabble with option 2 and worst case scenario, you can move back to your hometown and open your own practice. Live like a resident, save your cash and don't buy a house or any fancy toys.

Opening a practice is not as scary as it sounds especially after practicing for a year or 2. All you need to open a podiatry practice is your brain, table & chairs and 1 staff upfront. That's all you need to get started and you build up from there.

Forgive me if this is a dumb question but no one talks to us about this nor it ever came up during shadowing etc. but why is this the case with podiatry other than "eating your young" situation.

I'm a lowly student and I'm trying to learn more as I go along but I am under the assumption that if you own your own practice, you bill for what you do, correct? And the billing code is the CPT codes, no? So for simplicity why is there such a huge differences between ortho FA and podiatry other than the fact that ortho FA can do general ortho to supplement. Are their pay rate different for the same procedures / surgery than ours?

Again, I'm just trying to figure out where the disconnect is when it comes to payment system and I'm trying to learn more and be familiar with all the different reimbursement plans out there.

 

[SouthPod7]

Forgive me if this is a dumb question but no one talks to us about this nor it ever came up during shadowing etc. but why is this the case with podiatry other than "eating your young" situation.

I'm a lowly student and I'm trying to learn more as I go along but I am under the assumption that if you own your own practice, you bill for what you do, correct? And the billing code is the CPT codes, no? So for simplicity why is there such a huge differences between ortho FA and podiatry other than the fact that ortho FA can do general ortho to supplement. Are their pay rate different for the same procedures / surgery than ours?

Again, I'm just trying to figure out where the disconnect is when it comes to payment system and I'm trying to learn more and be familiar with all the different reimbursement plans out there.

Podiatry groups underpay their associates because they can. More specifically, its because there are associates that will accept that pay. As a general rule, DPM is not as marketable as a DO or MD degree. Not even close. When you look at the overall job market for each speciality, DPM has far fewer opportunities available.

Your options are either start your own practice or secure employment. Most of us spent 4 years in Pod school being told over and over again that you can't open up shop anymore for XYZ reasons. So, most people end up looking for employment when they graduate.

Employment usually comes in one of a few flavors, either a hospital, MSG, or Pod group. There are tons of old pods in PP today so there are plenty of jobs out there working for them. MSG and hospital jobs are far fewer in comparison and typically need to be seeked out or created, but they typically pay far closer to fair market value or MGMA data.

Pod groups know this. They know what the market is like for graduating Pods and they take full advantage. That's why you see horrible pay, crappy non-competes, etc for these contracts. It's not like if you were a graduating MD anesthesiologist or dermatologist where they would have to compete with competitive hospital and MSG offers that you would likely be getting left and right. They offer 80k salaries because they only have to compete with each other, and there are million crappy associate jobs available at any given time.

 

[HardRoadPaved]

Forgive me if this is a dumb question but no one talks to us about this nor it ever came up during shadowing etc. but why is this the case with podiatry other than "eating your young" situation.

you're just more aware of it since you're in the mix. talk to a graduating GP dentist about their first offer.

as for lower reimbursement, you can blame the large PP groups again. they accept the $40 level 2 reimbursement because they can overfill their underpaid associate with terrible visits. its simple how to avoid it when you get out: dont join an associate mill and dont take on crappy contracts. see patients from panels that pay your "fairly."

 

[dtrack22]

So for simplicity why is there such a huge differences between ortho FA and podiatry other than the fact that ortho FA can do general ortho to supplement. Are their pay rate different for the same procedures / surgery than ours?

There are lots of reasons why. Call pay is a big factor, that could be worth $80k every year. Negotiated contracts with insurance companies often have higher reimbursements than small podiatry groups or solo podiatrists. Higher surgical volume increases their ancillary revenue stream (surgery center ownership, DME, imaging centers or in house imaging, etc.). Because of higher surgical volume and the ability to do a lot of general ortho trauma, they typically produce more (ie median wRVU production is higher for F/A ortho than podiatry in MGMA surveys I've seen). And of course, they can't get an F/A ortho for $120k.

Now, I bet there are small ortho groups who are not providing huge hospital-like base salaries to new F/A surgeons. But they are certainly paying more than podiatrists AND they are often times getting paid their collections minus overhead right off the bat. Meaning, ortho groups are more likely to hire someone to decrease their workload, call burden, share overhead (It's not uncommon for an ortho group to have double the overhead of a podiatry group with $120k PA salaries, for example), and increase ancillaries. They just don't seem to care that they made a certain $ amount off of the new associate's collections. They already make 5-6x that on their own. They want less call, a smaller share of the group overhead and they want to protect their investments in their building, surgery center, etc.

 

[Feli]

I mean if you don’t have two contracts sitting in front of you then you realize nobody can give you a half way decent answer, right?

Yes, you need to have the full picture. If this is your first job out of training, don't overthink it... you will learn a lot about how the "real world" works at any place. It is impossible to even start without the contract and salary offer and having visited the place a few times, though.

In the end, it's up to the person to decide for them self. There are a lot of things that are not reflected simply in the contract numbers, though:

-Does this place have the tools for you to succeed? Staffing, enough space, supplies you need, marketing, skill/training of staff, in-office services/imaging, staff morale, good mgmt, etc. Staffing the place with enough people and positive people is KEY and canNOT be taken for granted. Just because the owner doc seems to have plenty of MAs doesn't mean the associates do. Aim for at least 1 scheduler and 2 MAs per doc with high training level and low turnover among them if you want to consistently see any kind of good volume.
-Are the owners/managers honorable people? (treated past associates well, current assoc/partners are happy, good rep in community, etc)
-Is there room for your professional growth? (skilled docs to work/learn/share with... prac mgmt and surgical/clinical decision making)
-Is it an area you like?
-Is it an area where you can get ahead? (compensation vs COL, podiatry saturation, etc)
-Do you fit the office culture? (C&C vs highly surgical vs $$$ vs wound heavy vs ???)

Good luck.... you will make the best choice once you have the info you need. Re-visit the ones you are considering as much as you can. Life is decisions.

 

[wakaflocka88]

Yes, you need to have the full picture. If this is your first job out of training, don't overthink it... you will learn a lot about how the "real world" works at any place. It is impossible to even start without the contract and salary offer and having visited the place a few times, though.

In the end, it's up to the person to decide for them self. There are a lot of things that are not reflected simply in the contract numbers, though:

-Does this place have the tools for you to succeed? Staffing, enough space, supplies you need, marketing, skill/training of staff, in-office services/imaging, staff morale, good mgmt, etc. Staffing the place with enough people and positive people is KEY and canNOT be taken for granted. Just because the owner doc seems to have plenty of MAs doesn't mean the associates do. Aim for at least 1 scheduler and 2 MAs per doc with high training level and low turnover among them if you want to consistently see any kind of good volume.
-Are the owners/managers honorable people? (treated past associates well, current assoc/partners are happy, good rep in community, etc)
-Is there room for your professional growth? (skilled docs to work/learn/share with... prac mgmt and surgical/clinical decision making)
-Is it an area you like?
-Is it an area where you can get ahead? (compensation vs COL, podiatry saturation, etc)
-Do you fit the office culture? (C&C vs highly surgical vs $$$ vs wound heavy vs ???)

Good luck.... you will make the best choice once you have the info you need. Re-visit the ones you are considering as much as you can. Life is decisions.

Feli 100% nailed it. Print this out, put under pillow nightly and let the information flow in.