Building Practice in MSG/Hospital Setting

[Nard_Dog]

Wanted to get everyone's opinion on this. I just started in a hospital/MSG based orthopedic clinic with no other foot and ankle here. Do you treat it similar to how you would as a solo or PP provider? The business development team is supposed to help market me, just wanted to get opinions on things I may not think of, and they may not regularly do to market.

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[Feli]

It depends what your goal is.

You'd essentially just be building a podiatry patient base, setting up a clinic, market hard, get refers, make relationships, create systems, find supplies.... all for something you'll never own (and could be replaced at).

What is the long term goal here? What is in it for you?
Is this a path to save up a bit? Job you took/made to be in a certain area? Bridge to get a higher salary org job? Trying to get ABFAS? Are you a part-owner? Path to owner (rent your own space there)?

It seems a bit crazy to build a job and be slow awhile just to always get 40% or whatever. (exception is if they're doing a $200k+ with bonus and benefits comp package, like a hospital or good org job... then it'd help you to get fairly busy for job security... possibly very busy, assuming bonus is good)

If you have no path to job security or ownership, what is your incentive here? Marketing (and supplies, staffing, billing, every other facet) is their responsibility; you are just the talent if you're purely an associate. It is generally not wise to put a lot of sweat equity and low/zero paid time into a biz you don't now/ever own. Just things to think about.

 

[Nard_Dog]

So just to explain the set up:

I am technically employed by a medical group, but we staff the hospital's ortho department. I have a 3 year contract, with a 2 year guarantee of $300k with RVU threshold of 5500, bonus is $56/RVU after this number. I go to pure production after year 2, also at $56/RVU with no cap. This is in a large metro area.

There was someone here before me that has been gone for 4-5 months. I was hired around that time and they have been waiting for me to get here. From what I was told by everyone who had any info, he was busy and I should have absolutely no issue getting board cert within the year. Due to the fact that he has been gone and there has been nobody seeing foot and ankle since that time, I am obviously very slow right now.

 

[Feli]

So just to explain the set up:

I am technically employed by a medical group, but we staff the hospital's ortho department. I have a 3 year contract, with a 2 year guarantee of $300k with RVU threshold of 5500, bonus is $56/RVU after this number. I go to pure production after year 2, also at $56/RVU with no cap. This is in a large metro area.

There was someone here before me that has been gone for 4-5 months. I was hired around that time and they have been waiting for me to get here. From what I was told by everyone who had any info, he was busy and I should have absolutely no issue getting board cert within the year. Due to the fact that he has been gone and there has been nobody seeing foot and ankle since that time, I am obviously very slow right now.

Yeah, that's good enough compensation to invest your time a bit - or a lot - in the marketing... you are paid well enough to be more productive, esp if you get DME.

There are way too many DPMs with "MSG job" where they get some dinky base and % and work hard growing it when they have no good reason to. With those setups, you are just making other ppl rich.

You will just be somewhat hosed if they hire another DPM as soon as you hit 25-30+ pts/day and knock your volume back. Who knows what will happen, though. I would proceed as if it won't happen (or you'd get a good say if/when).

I would think it'd be worth it to get YOUR name out to PCPs and area docs, though... for sure. They should pay for the marketing materials, gifts for PCPs, etc. The hospital marketing ppl or office managers should help you with PCP and dept intros also as you will bring them MRI, surg, etc. GL

 

[Nard_Dog]

Yeah, that's good enough compensation to invest your time a bit - or a lot - in the marketing... you are paid well enough to be more productive, esp if you get DME.

There are way too many DPMs with "MSG job" where they get some dinky base and % and work hard growing it when they have no good reason to. With those setups, you are just making other ppl rich.

You will just be somewhat hosed if they hire another DPM as soon as you hit 25-30+ pts/day and knock your volume back. Who knows what will happen, though. I would proceed as if it won't happen (or you'd get a good say if/when).

I would think it'd be worth it to get YOUR name out to PCPs and area docs, though... for sure. They should pay for the marketing materials, gifts for PCPs, etc. The hospital marketing ppl or office managers should help you with PCP and dept intros also as you will bring them MRI, surg, etc. GL

Yeah I totally agree, I should have been more detailed with the set up at the beginning.

To my knowledge, there are no plans to add another anytime soon, but who knows.

And I am thinking the same thing. I am waiting for them to get me my business "cards" that have my headshot and a short bio on there with contact info so that I can give these to people. Im not sure if it would be more/less beneficial to go to places myself to make it feel more personable? Just trying think of things that I can do to ramp up my practice. I just started this week and I know it will be slow at first, I just want to have a plan in place to start building.

 

[Feli]

Yeah I totally agree, I should have been more detailed with the set up at the beginning.

To my knowledge, there are no plans to add another anytime soon, but who knows.

And I am thinking the same thing. I am waiting for them to get me my business "cards" that have my headshot and a short bio on there with contact info so that I can give these to people. Im not sure if it would be more/less beneficial to go to places myself to make it feel more personable? Just trying think of things that I can do to ramp up my practice. I just started this week and I know it will be slow at first, I just want to have a plan in place to start building.

It always is. It's a game of personal relationships... consults nsg station, hospital doc meetings, doc lounge, surgery lounge, CME, etc.
You don't really have to go to their offices (not a bad idea, if you have the time), but just put yourself where you'll bump into PCPs: send progress notes, hospital events, cafe, doc lounge, lobby or busy elevators, doc parties, gym other docs go to, community, etc.

The specialist docs who just do online or other ads and send marketing ppl do ok, but every PCP feels better with an actual face to the name. That's the next level that gets you to where it's very hard to take your refer sources away, makes them want to tell or intro other PCPs or midlevels to refer for you, and makes it somewhat ok if a pt reports a bad outcome to the PCP (since they know you and know you have many other good ones).

I would strongly suggest marketing YOUR name as well as your group... just in case things ever went sideways with the MSG or the hospital hired a DPM (you could easily go solo, assuming no non compete area).

 

[wakaflocka88]

Always rely on yourself and your own hustle. My MSG feeds me more than enough patients but I like to seek out certain pathologies and patient population so I do market myself time to time. In the end - especially in a MSG with a large referral source - doing good work will also spread your name very quickly. I have built up the MSK portion of my practice significantly within 1 year to the point where I say it's 90% MSK/9% wound care/1% nail care crap. I honestly don't mind more wounds, easy money and very gratifying off-loading surgeries but my patient population is healthier/controlled diabetics.

 

[Nard_Dog]

When those of you who went out to PCP offices and urgent cares, etc. did you ever bring anything with you such as food, cookies or anything? I get differing opinions on this, but it feels somewhat uncomfortable to me and makes me feel more like a rep than a provider trying to market.

Appreciate all opinions!

 

[GreenHousePub]

Would highly recommend delivery christmas cookies to referral sources dressed up as Santa. Several members of this forum can tell you about it.

 

[AttackNME]

If it feels unnatural or awkward then you may wanna have your staff do it. Or ditch that strategy altogether. You can make sure to send your notes to PCPs after seeing patients, easy way to remind them that you’re there. Or even call them up to have a conversation about a mutual patient, and then mention your services and availability at the end of the conversation.

 

[Utvolsdpm]

Foot shaped cookie, homemade if you want to seal the deal.

 

[Shiyuan]

Would highly recommend delivery christmas cookies to referral sources dressed up as Santa. Several members of this forum can tell you about it.

E. L. Fudge guarantees more consults from personal experience 😂😂😂

 

[Feli]

If it feels unnatural or awkward then you may wanna have your staff do it. Or ditch that strategy altogether. You can make sure to send your notes to PCPs after seeing patients, easy way to remind them that you’re there. Or even call them up to have a conversation about a mutual patient, and then mention your services and availability at the end of the conversation.

This is the way. ^^^

It's fine to send a few biz cards or small gifts to reinforce relationships. Sending that stuff with progress notes (for new pt, pre-op, post op, etc) is a good way.

It's cheezy and desperate to do gifts or flyers or stuff to docs/offices who have never sent you refers or corresponded with you. That's the job of marketing dept of the hospital or group.... and 90% of the time, those just get thrown in the trash. Some marketers are fairly savvy at getting their product/service considered, but even their success rate is not amazing as people with good looks and a marketing degree. Most offices know the docs/places doing a lot of that blanket marketing are making up for something - or won't be there long. Either way, those are expensive and time consuming yet largely ignored, and I would definitely not waste doc time with that type of 'cold call' marketing.

Doc time for marketing is best spent on personal relationships: in doc lounge, chatting with inpt docs on consults, reinforcing existing refers, surgery lounge, open house or CME event, med staff meetings, etc to shake hands.

 

[Hybrocure]

E. L. Fudge guarantees more consults from personal experience 😂😂😂

Truth. I would eat a fudge stripe cookie any day over unknown homemade stuff

 

[heybrother]

The other day someone sent me some fancy macaroons by Fedex to advertise one of those pay for patients services. They were disgusting.

I have a lady who brings me a Nothing Bundt Cake everytime she sees me. I wish I was seeing her for nailcare every 61 days instead of a once a year visit for plantar fasciitis.

But I recommend Tiff's Treats. Way better than Crumbl. You also can't go wrong with a local bakery but I recommend trying their wares first.

 

[air bud]

Wanted to get everyone's opinion on this. I just started in a hospital/MSG based orthopedic clinic with no other foot and ankle here. Do you treat it similar to how you would as a solo or PP provider? The business development team is supposed to help market me, just wanted to get opinions on things I may not think of, and they may not regularly do to market.

Dude, you are overthinking this. The whole point of being in the MSG is that all of your referring docs are built into the system. Do a good job give docs good follow-up including updates post-op. Your software is likely going to automatically send your initial note but once somebody is better make sure you remember to send that note as well showing that you're resolving problems. Talk to them in the doctor's lounge, see them at the country club or other functions that they will likely have for you as a new DOC and just be a good person and do a good job. Leave the cookies to the PP associates.

 

[Shiyuan]

Leave the cookies to the PP associates.

Blasphemy. Don’t listen to him. Go to Costco and stock up on them E. L. Fudges 😅😂🤪

 

[Feeter]

Your practice will boom by year three. Hospital call, ED f/u, all the MSG docs referring you etc. You will also add a great deal into the MSG or hospital with all your labs, x rays, MRIs and PT. It is a symbiotic relationship

I would advise to not rush your first two years and enjoy the guarantee period. By year three you'll easily hit 6 to 7k in wRVUs. With my first job I spent a lot of time and effort networking, marketing and taking on extra call or patients and led to burnout. I was too busy by year three.

Seems like a very good set up. Congratulations!

 

[Feli]

Your practice will boom by year three. Hospital call, ED f/u, all the MSG docs referring you etc. You will also add a great deal into the MSG or hospital with all your labs, x rays, MRIs and PT. It is a symbiotic relationship

I would advise to not rush your first two years and enjoy the guarantee period. By year three you'll easily hit 6 to 7k in wRVUs. With my first job I spent a lot of time and effort networking, marketing and taking on extra call or patients and led to burnout. I was too busy by year three.

Seems like a very good set up. Congratulations!

Yeah, that's the employed pod mentality, but some ppl want to carve the type of refers they like, get cases for ABFAS faster, don't like seeing low "very slow" sched, etc.

Plus, it's not like he can't bonus 2nd year - or even first - if he wants to.

In his situation, I don't think it's bad at all to create bone/joint pod rep... and let their next DPM hire who does nothing to promote themself be the wound/nail guy

 

[Retrograde_Nail]

Dude, you are overthinking this. The whole point of being in the MSG is that all of your referring docs are built into the system. Do a good job give docs good follow-up including updates post-op. Your software is likely going to automatically send your initial note but once somebody is better make sure you remember to send that note as well showing that you're resolving problems. Talk to them in the doctor's lounge, see them at the country club or other functions that they will likely have for you as a new DOC and just be a good person and do a good job. Leave the cookies to the PP associates.

Don’t listen to this guy.

You need to promote yourself. This idea that docs should refer to you because you are in the group is idiotic. They don’t even know what a well trained podiatrist does. Nobody does.

If you leave it up to them then you are going to get toes and toenails only.

 

[Retrograde_Nail]

Your practice will boom by year three. Hospital call, ED f/u, all the MSG docs referring you etc. You will also add a great deal into the MSG or hospital with all your labs, x rays, MRIs and PT. It is a symbiotic relationship

I would advise to not rush your first two years and enjoy the guarantee period. By year three you'll easily hit 6 to 7k in wRVUs. With my first job I spent a lot of time and effort networking, marketing and taking on extra call or patients and led to burnout. I was too busy by year three.

Seems like a very good set up. Congratulations!

6-7k RVUs annually is not busy

 

[air bud]

Don’t listen to this guy.

You need to promote yourself. This idea that docs should refer to you because you are in the group is idiotic. They don’t even know what a well trained podiatrist does. Nobody does.

If you leave it up to them then you are going to get toes and toenails only.

I don't mean sit back and wait for the referrals to come in and put things on cruise control. But the referrala will come in. From there you develop and build relationships with what you do. 100 percent they don't know what a well trained pod does. But give the referring docs time. They will send the stuff they know. Do a good job with that. Play the long game and then build from there. Except for 💅. Stop that s h I * from day one. I grow stronger each day denying nail care. I used to be a sucker for some 93 year old non diabetic lady coming in with her 70 year old son. Not any more. Debride as a courtesy, tell them to go to nail salon buh bye. I would rather do nothing than 0.5 RVUs for nail care. I am less than 5 percent nail care and that is too high.

Edit- and to clarify I believe in this situation you are the only pod?

 

[Hybrocure]

I don't mean sit back and wait for the referrals to come in and put things on cruise control. But the referrala will come in. From there you develop and build relationships with what you do. 100 percent they don't know what a well trained pod does. But give the referring docs time. They will send the stuff they know. Do a good job with that. Play the long game and then build from there. Except for 💅. Stop that s h I * from day one. I grow stronger each day denying nail care. I used to be a sucker for some 93 year old non diabetic lady coming in with her 70 year old son. Not any more. Debride as a courtesy, tell them to go to nail salon buh bye. I would rather do nothing than 0.5 RVUs for nail care. I am less than 5 percent nail care and that is too high.

Edit- and to clarify I believe in this situation you are the only pod?

Agree. Please direct the nail patients to those of us in private practice who can bill for more

 

[Shiyuan]

Agree. Please direct the nail patients to those of us in private practice who can bill for more

 

[Nard_Dog]

I don't mean sit back and wait for the referrals to come in and put things on cruise control. But the referrala will come in. From there you develop and build relationships with what you do. 100 percent they don't know what a well trained pod does. But give the referring docs time. They will send the stuff they know. Do a good job with that. Play the long game and then build from there. Except for 💅. Stop that s h I * from day one. I grow stronger each day denying nail care. I used to be a sucker for some 93 year old non diabetic lady coming in with her 70 year old son. Not any more. Debride as a courtesy, tell them to go to nail salon buh bye. I would rather do nothing than 0.5 RVUs for nail care. I am less than 5 percent nail care and that is too high.

Edit- and to clarify I believe in this situation you are the only pod?

I get what you mean. I have met with the PCP docs in the same building as me who referred to the person that was here prior to me. I also start taking F&A trauma call next month. But yes, I am the only pod here in the group. I see 0% nails. They asked when I was hired but things I was willing to see and not see and my schedulers/the call center won't add anyone calling about those things I said I won't see. I am in an orthopedic clinic, and they tailor 98% MSK pathology to me.

@Shiyuan I agree that 6-7K is not that busy. The person here before me was doing about 10k annually. I think the hardest part for me right now is being accustomed to being very busy, to starting my job and being very slow.

 

[air bud]

I get what you mean. I have met with the PCP docs in the same building as me who referred to the person that was here prior to me. I also start taking F&A trauma call next month. But yes, I am the only pod here in the group. I see 0% nails. They asked when I was hired but things I was willing to see and not see and my schedulers/the call center won't add anyone calling about those things I said I won't see. I am in an orthopedic clinic, and they tailor 98% MSK pathology to me.

@Shiyuan I agree that 6-7K is not that busy. The person here before me was doing about 10k annually. I think the hardest part for me right now is being accustomed to being very busy, to starting my job and being very slow.

If somebody before you was doing 10k you are fine relax it will all happen you aren't recreating the wheel. But doing that much in volume you have no idea how to manage pre-op post-op etc that's like trying to drink from a fire hose at this stage in your career.enjoy being slower, focus on protocols and what works for you. What you do now and what you do in 6 months 1 year 3 years is not going to be the same. Make mistakes learn from them it's part of the process.

 

[Feeter]

6-7k RVUs annually is not busy

I believe that is closer to the national median for surgical Podiatry. One can chose to be as busy as you wish.

 

[Feeter]

Yeah, that's the employed pod mentality, but some ppl want to carve the type of refers they like, get cases for ABFAS faster, don't like seeing low "very slow" sched, etc.

Plus, it's not like he can't bonus 2nd year - or even first - if he wants to.

In his situation, I don't think it's bad at all to create bone/joint pod rep... and let their next DPM hire who does nothing to promote themself be the wound/nail guy

Yeah productivity models has led to plenty of DPMs chasing their own tail and crash and burn. Several accounts of it here already including myself. Slow and steady wins the race.

 

[wakaflocka88]

I get what you mean. I have met with the PCP docs in the same building as me who referred to the person that was here prior to me. I also start taking F&A trauma call next month. But yes, I am the only pod here in the group. I see 0% nails. They asked when I was hired but things I was willing to see and not see and my schedulers/the call center won't add anyone calling about those things I said I won't see. I am in an orthopedic clinic, and they tailor 98% MSK pathology to me.

@Shiyuan I agree that 6-7K is not that busy. The person here before me was doing about 10k annually. I think the hardest part for me right now is being accustomed to being very busy, to starting my job and being very slow.

I highly recommend taking it easy first. Once you open the flood gates it is very hard to slow it down. You may or may not feel slow at first but as long as you have steady volume you will do fine. Don’t burn yourself out chasing the RVU because in the end it is not worth it.

Without doing much chasing, it took around 12 months for my practice in my msg to grow significantly

 

[NatCh]

Would highly recommend delivery christmas cookies to referral sources dressed up as Santa. Several members of this forum can tell you about it.

Why you remind me of that???