Enough negativity about podiatry!

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msa786

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A few friends of mine that shadow podiatrists were telling me how the profession really doesn't pay well and how their pod's have to work three times as hard to make just what an M.D. might make. 2 out of the 3 pods told my friend to NOT go into podiatry as its a life ling struggle and only a true pod can tell you what its really like on the other side.

Might the recession have anything to do with the income of a pod these days? Why does it take so much to make a decent living with podiatry?

If you have serious replies then post only. I don't want a lecture about how you are not in podiatry for the money because I am pretty sure one would think twice about going into this field if they knew a pod made minimum wage. So yes salary DOES make a difference. Especially after all that hard work and commitment, I better be getting my bang for the buck.
 
The Podiatrist I shadow makes over 200 thousand a year and he only sees about 25 patients a day and does surgeries on fridays. He's always telling me that in podiatry you can make as much as you want. He has friends who works from 7 to 7 and see 50 patients a day and make close to 800 thousand a year so, it's all up to you.
 
my pod sees 45 patients a day, does mostly procedural stuff (half day a week surgery) and has made 600k 7 years in a row.
 
What kind of situation is your pod in air bud? single doc private prac? Tell us about his setup if ya would.
 
pods making amounts around 600K and 800K are in a private practice setting, and they are good businessmen/women. If you're not a good business man, and want to work for someone, or a hospital, you will make 60K + incentives. If you are a good businessman, then the sky is the limit.
 
pods making lots of money are good businessmen eh? thanks for clearing that up. whew!

Im curious to hear about any specifics of this pods situation that aidbud might like to share.
 
4 guys, private practice. he is 2nd in seniority. hired a 4th guy a few years ago to do pretty much exclusive surgery. brilliant businessman. also, from day one, he has developed a great relationship with the ortho guys in town. the ortho guys send all foot/ankle to him and anytime he is going a procedure and someone says "oh, my back/arm/shoulder/knee/hip hurts" he sends them his way.
he is in his mid 40's. most importantly i would think, he loves his job and is great with people.

also, connected to a hospital with use of surgery center.
 
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Sorry to disappoint you, but it is a life-long struggle. A struggle to keep your greed and bad behaviors from turning off your patients, who have an option and will leave.

Getting past school/residency is just a very small part of the big picture and grades and where you did your residency, really don't matter.

If you have a big ego and talk constantly about yourself, no one is going to want to be your patient. This is the honest truth.


As far as you, I can tell right now, you don't have what it takes to be a top income pod as you are now, why you ask?

Because I think you have poor manners and the wrong motivation. People can sense that and will not be back.

BTW, when you hit 30,40,50,60,70yrs old and if money is one of YOUR main motivators, you have failed miserably at life.





Good luck.
 
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msa786 said:
A few friends of mine that shadow podiatrists were telling me how the profession really doesn't pay well and how their pod's have to work three times as hard to make just what an M.D. might make. 2 out of the 3 pods told my friend to NOT go into podiatry as its a life ling struggle and only a true pod can tell you what its really like on the other side.

Might the recession have anything to do with the income of a pod these days? Why does it take so much to make a decent living with podiatry?

If you have serious replies then post only. I don't want a lecture about how you are not in podiatry for the money because I am pretty sure one would think twice about going into this field if they knew a pod made minimum wage. So yes salary DOES make a difference. Especially after all that hard work and commitment, I better be getting my bang for the buck.
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I think your concerns are valid. You are investing alot of money and time into your education and future, so you have every right to investigate the "return" on this investment. I will tell you that from my short experience in this field, I have seen both ends of the spectrum - those who do very well, and those who struggle. The level of training has evolved immensly over the past 10-15 years, as we now enter an era where 2-3 years of surgical training is a must. I find that alot of the "not so happy" docs don't have the training or ability to offer their patients the most comprehensive array of treatment options. Yes being business savy helps alot as well - I hate to admit this but medicine in general has become very consumer-based with employers looking to hire you for your 'expertise' and ability to generate their practice income. The people whom I've seen succeed in our field have three major factors going for them: strong social skills, business minds, and are good doctors.

The recession and current economic state with new healthcare plans will definitely take a toll on health care providers (not just podiatrists), but I think people who fail at our profession would genuinely fail at other professions as well. That's just my 2 cents.
 
GetnMyFtNtheDor said:
pods making amounts around 600K and 800K are in a private practice setting, and they are good businessmen/women. If you're not a good business man, and want to work for someone, or a hospital, you will make 60K + incentives. If you are a good businessman, then the sky is the limit.
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But what if not all of us want to go into private practice? Does that mean those in a partnership/working in a hospital/working in a nursing home will make around 60k? I don't understand?
 
whiskers said:
Sorry to disappoint you, but it is a life-long struggle. A struggle to keep your greed and bad behaviors from turning off your patients, who have an option and will leave.

Getting past school/residency is just a very small part of the big picture and grades and where you did your residency, really don't matter.

If you have a big ego and talk constantly about yourself, no one is going to want to be your patient. This is the honest truth.


As far as you, I can tell right now, you don't have what it takes to be a top income pod as you are now, why you ask?

Because I think you have poor manners and the wrong motivation. People can sense that and will not be back.

BTW, when you hit 30,40,50,60,70yrs old and if money is one of YOUR main motivators, you have failed miserably at life.





Good luck.
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👍
 
whiskers said:
Sorry to disappoint you, but it is a life-long struggle. A struggle to keep your greed and bad behaviors from turning off your patients, who have an option and will leave.

Getting past school/residency is just a very small part of the big picture and grades and where you did your residency, really don't matter.

If you have a big ego and talk constantly about yourself, no one is going to want to be your patient. This is the honest truth.


As far as you, I can tell right now, you don't have what it takes to be a top income pod as you are now, why you ask?

Because I think you have poor manners and the wrong motivation. People can sense that and will not be back.

BTW, when you hit 30,40,50,60,70yrs old and if money is one of YOUR main motivators, you have failed miserably at life.





Good luck.
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What you say is not pod specific but goes for ANY medical specialty. Thanks for you insight however.
 
Whiskers did state his point extremely well.

I constantly read posts regarding incomes on this website and can not stress to the students and residents out there that there are NO guarantees or easy answers.

I know excellent and brilliant DPM's that are bringing home $30,000 and I know DPM's that I wouldn't let cut my dog's toenails, who I consider "thieves", but they have thriving, busy practices and make 7 figure incomes.

Success does NOT always equate with competence or training, so please don't fool yourself. Yes, training plays an important role, as does personality.

However, location also plays an important role, luck plays a little bit of a role and ethics plays a significant role. Please don't emulate a doctor simply because he brings home a large paycheck. You may not realize that he/she may be ripping off the system or the patients.

Unfortunately, on a daily basis I'm reading about some DPM that is being arrested for insurance fraud.

You CAN make an excellent living as a DPM by providing high quality care, treating your patients as you would treat your family and practicing honestly and ethically. There is no easy way to make the money. It takes hard work and long hours and you do have to be a smart businessman, but you have to be a BETTER doctor.

Your primary goal has ALWAYS got to be the quality of care you deliver, and not just the bottom line, or you are in practice for the wrong reason and your patients will suffer. You don't take an x-ray or perform an ultrasound simply because a patient has "good" insurance. You perform a procedure WHEN it is indicated. PERIOD.

Treat patients, not insurance companies.

Once again, there is no magic answer. Does the doctor that sees 50 patients a day provide quality care to all 50 patients?? If he/she is working 7 hours a day (an hour for lunch) can he/she really provide high quality care seeing over 7 patients hourly?

Don't be so easily impressed by "numbers", and don't be so easily impressed by numbers that doctors discuss with you. I've been in practice for over 20 years, and I'm part of one of the largest practices on the East Coast if not the entire country, and I've NEVER discussed my income with one student, intern, extern or resident. NEVER.

Stop worrying about something you have no control of at the present time. Work hard, practice honestly and ethically and hopefully in the future you'll make a fair income. And the LAST person you should be impressed by is the doctor spewing out how much he/she is earning, because I can GUARANTEE you if he/she is telling you how much he/she is earning, he/she is full of XXXX!
 
thank you pad. hopefully these threads and people talking about them can stop. i agree most with the part about worrying about something we prepods have no control over right now.
thank you for all your contributions here on SDN
 
GetnMyFtNtheDor said:
pods making amounts around 600K and 800K are in a private practice setting, and they are good businessmen/women. If you're not a good business man, and want to work for someone, or a hospital, you will make 60K + incentives. If you are a good businessman, then the sky is the limit.
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Better be some pretty good incentives if they are going to pay you about the same amount that you make in residency.
 
double dipped sorry
 
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GetnMyFtNtheDor said:
pods making amounts around 600K and 800K are in a private practice setting, and they are good businessmen/women. If you're not a good business man, and want to work for someone, or a hospital, you will make 60K + incentives. If you are a good businessman, then the sky is the limit.
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Can you show proof of this 6ok per year please? The average podiatrist working in a hospital makes about 150k a year. during your residency you make about 40-55k per year.

http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_HC07000103.html

http://www.bls.gov/oes/2007/may/oes291081.htm#msa
 
If you're a good doctor, the patients will come back and maybe bring more folks w/ them. What is the key? learn whatever you can about your chosen profession. Don't dismiss biomechanics, don't dismiss wound care, don't dismiss surgery. Even if you suck in those subspecialties, recognize what you can do (refer). There is money to be made in all those subspecialties if you become THE expert in them (with some innate business abilities).

And know how to talk to people....patient education is very important. Some docs don't even look at their patients and prescribe medication (personal experience). Goodluck if you're that type of doctor. We're podiatrists, there is physical contact when you touch a patient's feet. So you have to know how to communicate. If you can somehow write down whatever you say in lay terms and put it in the patient's hand before they leave, then you know you've done your part in making sure they understand their conditions. (speaking out of my ass here but you get the point).

Speaking from a patient's perspective, I'd stick to a doctor who genuinely cares about my condition and will recommend him/her to everybody I know, bottom line. *HINT HINT.

"Treat patients, not insurance companies." - PADPM
 
moldovantis, the 60k + incentives is the most common starting salary. I apologize for not clarifying that in my previous post. But depending on the incentives packages, I imagine it could be around 150K. I won't dispute that. The point I was trying to make is that private practice=bigger bucks if you work hard, work smart, and have a nack for business
 
GetnMyFtNtheDor said:
moldovantis, the 60k + incentives is the most common starting salary. I apologize for not clarifying that in my previous post. But depending on the incentives packages, I imagine it could be around 150K. I won't dispute that. The point I was trying to make is that private practice=bigger bucks if you work hard, work smart, and have a nack for business
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Oic no problem its just 60k is way too low for so much school and 250k debt.
 
I've said it over and over again on this forum on different threads. No matter what you BELIEVE is too low, you simply have to prove yourself.

Rarely is a group practice simply going to hand you a paycheck carte blanche.

For our group to pay you $150,000, you would have to generate about $400,000 for it to make it worth our while or profitable for us. We are a business and don't simply hire new doctors just because we're nice guys.

In addition to your salary, there are other perks including professional dues, vacation time, CME credits, malpractice insurance, etc., not to mention the everyday cost of doing business......called overhead.

Therefore, a package of starting low with some incentives is not outrageous. When you PROVE yourself and your schedule becomes filled your income increases accordingly. Until that time, our practice is not going to simply "finance" you because you're skilled or nice. Our practice is filled with skilled and nice doctors, and that's why we have about 20 offices.

However, we are very careful to NOT give incentives based on surgical procedures performed, orthotics, etc., because we are not encouraging our new doctors to provide unnecessary services to our patients. Providing incentives based on surgery, orthotics, etc., often leads to over-utilization of these services and that's not what our practice is about.

So you can pound your chest and tell everyone how much you are worth, but there comes a point in life that you have to prove your worth. And as I've said dozens of times....if you are good, and honest and work hard the rewarding income WILL eventually follow.

But, if you're not happy with the offers you receive and you think you're worth more than open your own practice and take a loan, pay all your own overhead and expenses and sit and wait for patients to come in your door. And then see how many years it may take for you to bring home ANY money.

Once again, you are still a student. Forget about your income at the present time, which is something you have absolutely no control over right now. My recommendation would be to concentrate on the things you CAN control, such as your academics and clinical skills. Prioritize.
 
moldovanits said:
Oic no problem its just 60k is way too low for so much school and 250k debt.
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You're right. No self-respecting DPM would take a salary for $60k a year. If that's all you're being offered, you're not looking in the right place.

I turned down jobs for $90k and $110k right out of fellowship.

You can't be expected to live like a pauper and be taken advantage of. You're already being taken advantage of by the medical education system for leaving school with $250k of loans. Medical tuition has increased by 720% since the early 80's (according to a recent NYT article) faster than any other education sector. The reason you leave with $250k of loans is because YOU CAN. The universities will charge you the maximum of whatever the government will allow you to borrow. Why is that? Why does it cost the same amount of money to attend podiatry school in Des Moines and in New York City (or San Francisco)? Certainly the cost of living is higher for the professors in NYC, and the property costs are greater, as are the taxes, but it's because they all charge at the HIGHEST common denominator.

Then someone who owns a practice attempts to rip you off by paying you pennies after you get out of residency.

The average DPM bills $415k/year (non surgical) $598k/year (surgical) according to the Medical Group Management Association (MGMA), who keeps unbiased numbers on all specialties. The MGMA publishes a book annually on average physician compensation. Look for it in your library.

Of course you're going to bill less your first year when you're getting started, but that's understood and the practice/hospital incurs that cost. They need to ensure that you're there long enough to recoup this initial loss, by offering you a retention bonus (after 3-5 years), etc.

I work for a hospital and my salary is equivalent to other specialists.

If you're outgoing and entrepreneurial, you'll find the same opportunities. Keep in mind, sometimes you have to create your opportunities.
 
PADPM said:
Whiskers did state his point extremely well.

I constantly read posts regarding incomes on this website and can not stress to the students and residents out there that there are NO guarantees or easy answers.

I know excellent and brilliant DPM's that are bringing home $30,000 and I know DPM's that I wouldn't let cut my dog's toenails, who I consider "thieves", but they have thriving, busy practices and make 7 figure incomes.

Success does NOT always equate with competence or training, so please don't fool yourself. Yes, training plays an important role, as does personality.

However, location also plays an important role, luck plays a little bit of a role and ethics plays a significant role. Please don't emulate a doctor simply because he brings home a large paycheck. You may not realize that he/she may be ripping off the system or the patients.

Unfortunately, on a daily basis I'm reading about some DPM that is being arrested for insurance fraud.

You CAN make an excellent living as a DPM by providing high quality care, treating your patients as you would treat your family and practicing honestly and ethically. There is no easy way to make the money. It takes hard work and long hours and you do have to be a smart businessman, but you have to be a BETTER doctor.

Your primary goal has ALWAYS got to be the quality of care you deliver, and not just the bottom line, or you are in practice for the wrong reason and your patients will suffer. You don't take an x-ray or perform an ultrasound simply because a patient has "good" insurance. You perform a procedure WHEN it is indicated. PERIOD.

Treat patients, not insurance companies.

Once again, there is no magic answer. Does the doctor that sees 50 patients a day provide quality care to all 50 patients?? If he/she is working 7 hours a day (an hour for lunch) can he/she really provide high quality care seeing over 7 patients hourly?

Don't be so easily impressed by "numbers", and don't be so easily impressed by numbers that doctors discuss with you. I've been in practice for over 20 years, and I'm part of one of the largest practices on the East Coast if not the entire country, and I've NEVER discussed my income with one student, intern, extern or resident. NEVER.

Stop worrying about something you have no control of at the present time. Work hard, practice honestly and ethically and hopefully in the future you'll make a fair income. And the LAST person you should be impressed by is the doctor spewing out how much he/she is earning, because I can GUARANTEE you if he/she is telling you how much he/she is earning, he/she is full of XXXX!
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You can't possibly be serious.
 
diabeticfootdr said:
You're right. No self-respecting DPM would take a salary for $60k a year. If that's all you're being offered, you're not looking in the right place.

I turned down jobs for $90k and $110k right out of fellowship.

You can't be expected to live like a pauper and be taken advantage of. You're already being taken advantage of by the medical education system for leaving school with $250k of loans. Medical tuition has increased by 720% since the early 80's (according to a recent NYT article) faster than any other education sector. The reason you leave with $250k of loans is because YOU CAN. The universities will charge you the maximum of whatever the government will allow you to borrow. Why is that? Why does it cost the same amount of money to attend podiatry school in Des Moines and in New York City (or San Francisco)? Certainly the cost of living is higher for the professors in NYC, and the property costs are greater, as are the taxes, but it's because they all charge at the HIGHEST common denominator.

Then someone who owns a practice attempts to rip you off by paying you pennies after you get out of residency.

The average DPM bills $415k/year (non surgical) $598k/year (surgical) according to the Medical Group Management Association (MGMA), who keeps unbiased numbers on all specialties. The MGMA publishes a book annually on average physician compensation. Look for it in your library.

Of course you're going to bill less your first year when you're getting started, but that's understood and the practice/hospital incurs that cost. They need to ensure that you're there long enough to recoup this initial loss, by offering you a retention bonus (after 3-5 years), etc.

I work for a hospital and my salary is equivalent to other specialists.

If you're outgoing and entrepreneurial, you'll find the same opportunities. Keep in mind, sometimes you have to create your opportunities.
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👍👍 Good Find nice post.
 
msa786 said:
You can't possibly be serious.
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Unfortunately, I'm very serious. These docs didn't start out making this kind of money, but economics change and so do demographics. Unfortunately, in some urban areas, neighborhoods undergo significant transitions and insurance carriers can change. Sometimes managed care companies come in and if your practice happens to NOT get some of the big contracts, you can get shut out.

This particular doctor saw a huge change in the neighborhood, and his practice started to suffer. Than managed care came into town and offered large capitated contracts. So a majority of his practice was capitated, actual a few hundred thousand dollars. Although he was an excellent doctor, he never sat for his boards and the insurance carrier suddenly required ABPS certification.

Therefore, with the swoop of a pen, he literally lost 75% of his practice (the managed care capitated contracts) in one day.

Yes, this is the exception and not the rule.

Additionally, diabeticfootdr is the exception and not the rule. I think it's great that he is well respected and hospital employed, but the fact remains that nationally, there are very few hospitals that employ DPM's. Other than Veteran's Hospitals, there simply are not that many hospitals at the PRESENT time employing DPM's.

Those positions are very limited, though I hope I am proven wrong and we soon gain parity with our allopathic colleagues.

But the reality is that there are more positions being offered with "relatively" low base salaries, with incentives to increase those numbers based on various incentives depending on the contract. There will be an exception to every rule, but once again, if you have confidence and work hard, the income will follow.
 
diabeticfootdr said:
.

If you're outgoing and entrepreneurial, you'll find the same opportunities. Keep in mind, sometimes you have to create your opportunities.
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I agree.👍

You can not sit around and expect a golden parachute to drop in your lap. You need to get out there, introduce and market yourself to the surrounding medical community in order to seek better practice opportunities.
 
diabeticfootdr said:
You're right.

If you're outgoing and entrepreneurial, you'll find the same opportunities. Keep in mind, sometimes you have to create your opportunities.
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I agree and same goes for any other specialties out their its all about character.
 
Once again, I sincerely applaud Dr. Rogers and all DPM's similar to Dr. Rogers that have had the ability to gain parity with allopathic physicians and receive offers from hospitals to sign contracts of employment.

But in reality, if you do a true overview of the CURRENT practicing DPM's, Dr. Rogers, Dr. Armstrong, etc., are the exceptions and not the rule. As I stated in my prior post, I hope that the tide turns and that more DPM's obtain positions such as Dr. Rogers.

However the majority of DPM's do practice more "general" podiatric medicine and surgery than Dr. Rogers and don't have his present opportunity. Nor do most private practitioners have the opportunity to receive 7 weeks of vacation to lecture, dedicate to research, etc.

Our profession NEEDS more doctors like Dr. Rogers, Dr. Armstrong, etc., and more opportunities such as they have CREATED.

But I know that until that happens, the reality remains that the overwhelming majority of graduating residents will still have to obtain positions in existing podiatric or orthopedic practices, unless they open on their own.

And in today's economic environment, with increased malpractice premiums, decreased insurance reimbursements and increased overhead, some graduates may INITIALLY be offered contracts that don't seem that appealling, though if they are patient, hard working and ethical, those contracts will eventually pay-off the vast majority of the time.

There IS a light at the end of the tunnel. Right now focus on your education, set your goals and aim high, and usually the rest will follow.
 
I understand that Dr. Rogers is an exception, and I am trying to find the norm.

The average DPM will start out with 60K + Incentives correct? What is the range for the incentives?

The next question is what will the average salary be 2 years down the road? what about 5 years? and 10 years?

Medical Group Management Association (MGMA) says we bill for about 400-500k, on average. Thus, we can have a salary $150,000-180,000 according to PADPMs calculations? (Obviously different if you are solo or in group)

I think we are having problems differentiating between starting salary and average salary.
 
Darklord said:
I understand that Dr. Rogers is an exception, and I am trying to find the norm.

The average DPM will start out with 60K + Incentives correct? What is the range for the incentives?

The next question is what will the average salary be 2 years down the road? what about 5 years? and 10 years?

Medical Group Management Association (MGMA) says we bill for about 400-500k, on average. Thus, we can have a salary $150,000-180,000 according to PADPMs calculations? (Obviously different if you are solo or in group)

I think we are having problems differentiating between starting salary and average salary.
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I certainly appreciate PADPM's perspective, as he/she has been in the field a long time and has seen many changes, but I think he/she may have an East coast view of podiatry (I'm not denigrating that, just pointing out that podiatry functions differently in different geographical areas).

Let me explain this a second. I did my residency in NYC, so I was exposed to it as well. The East coast seems to be saturated with DPMs (given NYCPM and TUSPM are old schools). The East coast seems to be an "eat your young" environment for podiatrists.

I don't know any of my close young friends in the profession (roughly 20) that started less than $100k per year. This is also reflected in the Young Members Survey published recently by the APMA. Most of these friends joined multi-specialty groups or orthopedic groups. A few joined multi-DPM groups. I'd surmise that the ones who joined multi-DPM groups were paid less than those that joined the other groups. Most of these friends are in the Midwest or the West.

I agree with PADPM that institutional jobs for DPMs are not common (but also not a rarity).

I still stand by my earlier comment that you make your own opportunities. If you see a need, convince a hospital administrator it exists, back it up with data, and fill it!
 
PADPM and Dr. Rogers give thoughtful, insightful posts. Meanwhile the best I can come up with is, "West coast baby!"

Ha haw hooowhee!
 
Darklord said:
I understand that Dr. Rogers is an exception, and I am trying to find the norm.

The average DPM will start out with 60K + Incentives correct? What is the range for the incentives?

The next question is what will the average salary be 2 years down the road? what about 5 years? and 10 years?

Medical Group Management Association (MGMA) says we bill for about 400-500k, on average. Thus, we can have a salary $150,000-180,000 according to PADPMs calculations? (Obviously different if you are solo or in group)

I think we are having problems differentiating between starting salary and average salary.
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Don't obsfucate the statistic. The earlier post says nonsurgical pods BILL $415,000 a year on average. It also says surgipods BILL $598,000 yearly on average. What you need to understand is you don't collect what you bill. People don't pay their balances and insurance companies slash your fees before they pay a percentage of what they allow. Let's take a typical example, say your fee for a Chevron bunionectomy is $2100. You participate in medicare so technically you can bill your medicare pt this amount. The EOB clips the allowed amount to $540 and pays you $388. The patient may or may not pay the remainder.(don't count on it)
So in this entirely fictitious encounter you have billed $2100 and collected $388. That's less than 20% of what you billed.
Let's say you operate on the patient's daughter who has good insurance. Same procedure same $2100 fee. Her good insurance allows $1200, applies $760 and you have to balance bill. The daughter can't believe you charged so much for just a bunionectomy and thinks you've already been overpaid, her indignation is a defense mechanism to justify her not paying the balance. So on good insurance you collect 33% of your fee.
I'd be interested in other practitioners opinions. (not prepods, or pod students, or residents)
The general question is what margin of your total billings do you collect?
 
This is an excellent point. The amount a practice bills out vs. the amount collected is a world of difference. The amount billed is almost a "fictitious" number in today's world if you participate with most insurance carriers.

You can literally "bill" any amount you want, but unless a patient is paying you out of his/her own pocket, you only receive the amount that is allowed by the insurance carrier if you participate with the company.

If I actually RECEIVED what I billed, I'd be retired a few years ago, and I'd be polishing my Ferrari collection and my butler would be polishing my Lambo collection.

In reality, I receive less reimbursement for a bunionectomy with osteotomy and internal fixation in 2009, than I did in 1989, though obviously overhead and all other practice expenses have significantly increased.

However, this is not a "negative" post, but it is a reality post. And the reality is that you can make a good living by working hard and practicing honestly as I've stated before. There are no shortcuts. Those that take shortcuts usually, and should, end up in jail.

So remember, there is quite a difference between the amount billed and the amount actually received. Next time you shadow a doctor, ask him/her politely to look at some insurance "EOB's"/explanation of benefits and you'll see the proof.
 
First of all, I'm sure the billing issue goes for every medical profession and is not specific to podiatry.

Second of all, it is very difficult to become a podiatrist. We go through extremely tough and rigorous schooling, have to pass numerous boards along the way, then go through residency. During residency we have to log all of procedures, and become board certified. A process that generally takes 7-8 after an undergraduate degree all the while generating 200K in debt.

I find it hard to believe that anyone in their right mind would go through all that just for 30K a year. I understand that if you go into solo practice it is building a business from scratch and of course it will take time to build up a salary.For the first few years you will be making little money. That goes for anyone starting up a restaurant or any other type of company. Again my point being this is not significant to podiatry.

I don't mean to sound like someone who is arrogant and going into podiatry for the money and think i'm going to some day be partying with Jay-Z and LeBron James on my Yacht, because i don't. But honestly from my experience shadowing and talking to different podiatrists and residents it seems as though 100+K to start out is the rule and not the exception.

PADPM: Thank you for all your posts you definitely provide some information about podiatry that is definitely overlooked. I'm glad that you are a successful podiatrist and have one of the largest groups in the country, but like deiabeticfootdr says i think you may have a limited perspective. Just out of curiosity if your group was thinking of adding another DPM due to increased demand, or someone in your group was leaving how much would you offer and what would the contract be like?
 
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Our group has discovered that using an honor system has produced the best collections. We send our patients a letter showing the balance of their charges and instructions that say, "Pay us if you'd like. Or not. Only you and your conscience will know." Using this simple method we collect close to 90% of what we bill.
 
PADPM said:
Unfortunately, I'm very serious. These docs didn't start out making this kind of money, but economics change and so do demographics. Unfortunately, in some urban areas, neighborhoods undergo significant transitions and insurance carriers can change. Sometimes managed care companies come in and if your practice happens to NOT get some of the big contracts, you can get shut out.

This particular doctor saw a huge change in the neighborhood, and his practice started to suffer. Than managed care came into town and offered large capitated contracts. So a majority of his practice was capitated, actual a few hundred thousand dollars. Although he was an excellent doctor, he never sat for his boards and the insurance carrier suddenly required ABPS certification.

Therefore, with the swoop of a pen, he literally lost 75% of his practice (the managed care capitated contracts) in one day.

Yes, this is the exception and not the rule.
Click to expand...

For the sake of reference, what you describe above occurred in the late 1970s-early 1980s.
 
tracheatoedoc said:
Don't obsfucate the statistic. The earlier post says nonsurgical pods BILL $415,000 a year on average. It also says surgipods BILL $598,000 yearly on average.
The general question is what margin of your total billings do you collect?
Click to expand...

I made an error in my earlier post. I wrote that non-surgical DPMs bill $415k and surgical DPMs bill $598k - the MGMA data is actually for collections, not billing. This is from Table 13, Page 95 of the 2008 MGMA Physician Compensation Survey.

Mean gross charges were $774k (non-surgical DPMs) and $927k (surgical) from Table 33, Page 121. This data was averaged from 95 non surgical DPMs and 41 surgical DPMs.

Mean compensation for surgical DPMs $244k and non-surgical $207k. This data was averaged from 135 surgical DPMs and 145 non-surgical DPMs. Table 1, Page 39.

I guess my point is that you have to do your own negotiations. No one is going to offer you your dream salary from the start. You have to enter the negotiation process armed with data. The MGMA is standard data used by every healthcare administrator deciding how to compensate physicians (whether you're a pulmonologist or a podiatrist). I brought copies from this book when I went to negotiate my salary. Having access to this book is a must. Make sure your libraries carry it.
 
NatCh said:
Our group has discovered that using an honor system has produced the best collections. We send our patients a letter showing the balance of their charges and instructions that say, "Pay us if you'd like. Or not. Only you and your conscience will know." Using this simple method we collect close to 90% of what we bill.
Click to expand...

Phooey. No one took the above April Fools bait that I posted yesterday. I'll have to come up with better next year.

Our average collection is 2/3 - 3/4 of what we bill. Medicare pays squat, but fortunately most of our patients have private insurance.
 
*An ecstatic* Thanks Dr. Rogers! and JackedUp I was just going to look into the AGMA.

NatCh, I took that post literally 😱.
 
Poddyman,

You are incorrect. In the East Coast and in areas like Philadelphia, there are many practices that have a very high percentage of patients that are managed care and the practice is overwhelmingly filled with managed care capitated providers.

Therefore, on a daily basis it is not only feasible, but reality that with the "swoop of a pen" a practice can loose a significant amount of money if a large group decides to switch their capitation contract.

In one of our offices, we had an "HMO" capitated contract with a group of 8 primary care physicians that was worth approximately $65,000 in revenue a year to that one office. One of the partners in the practice had a son-in-law that finished a podiatric residency and opened a new practice in the area. So guess what.......although the group never had a problem with the care rendered by OUR group, with the "swoop of a pen" they discontinued our contract and rewarded that contract to the son-in-law of the partner.

So this is not a phenomena of the "70's or 80's", but is still prevalent with any practice that participates with managed care.

diabeticfootdr,

Although I don't doubt the information you provided regarding income and the statitistics you reference, those numbers are SIGNIFICANTLY higher, and I mean SIGNIFICANTLY higher than the numbers that even the APMA quotes or the numbers that are published annually in the Podiatry Management Survey. How do you account for that large discrepancy??


Jackedup;

I assure you, that despite diabeticfootdr's comments, I've consulted across the country and by no means have a "limited" perspective. I'm very well aware of exactly what's happening across the country, and I'm very realistic, it's simply that many don't want to hear the cold, hard reality.

I know the climate in each geographic area in this country, and understand that at the present time the East Coast probably offers the most challenging location to "make a buck". But I'm fully aware of the nuances and opportunities in the entire country, and I'm speaking in general terms and there will ALWAYS be exceptions. There will be those that sign poor contracts and those that sign $250,000 contracts. I'm speaking about what the MAJORITY of you can realistically expect, based on "only" 23 years of experience.

And I'm sorry, but as I've stated a few times on this site, I do not discuss our practice's remuneration policy. I will state that we pay fairly and do not offer incentives based on surgery or orthotics, etc., because we do not want to encourage unnecessary procedures. We do increase salary as production increases, and those salary increases are automatic without the new doctor every having to ask. He/she is automatically rewarded. If he/she brings in a new doctor, nursing home, referral, etc., he/she is immediately financially rewarded.

We have an extremely low turnover, with only 2 doctors leaving in the past several years, and that was to start a family (female doctors).
 
PADPM said:
diabeticfootdr,

Although I don't doubt the information you provided regarding income and the statitistics you reference, those numbers are SIGNIFICANTLY higher, and I mean SIGNIFICANTLY higher than the numbers that even the APMA quotes or the numbers that are published annually in the Podiatry Management Survey. How do you account for that large discrepancy??
Click to expand...

I don't know how to account for it. Perhaps there is a survey bias in the MGMA because they are looking at medical groups?

I'm paid based on these data (as is every other physician in our hospital) and the hospital reviews the data with me yearly. The MGMA also has private practice data, but it is only gross charges - I guess they have no way to calculate your "take home pay" because it depends on each doctor's particular overhead.
 
PADPM said:
Poddyman,

You are incorrect. In the East Coast and in areas like Philadelphia, there are many practices that have a very high percentage of patients that are managed care and the practice is overwhelmingly filled with managed care capitated providers.

Therefore, on a daily basis it is not only feasible, but reality that with the "swoop of a pen" a practice can loose a significant amount of money if a large group decides to switch their capitation contract.

In one of our offices, we had an "HMO" capitated contract with a group of 8 primary care physicians that was worth approximately $65,000 in revenue a year to that one office. One of the partners in the practice had a son-in-law that finished a podiatric residency and opened a new practice in the area. So guess what.......although the group never had a problem with the care rendered by OUR group, with the "swoop of a pen" they discontinued our contract and rewarded that contract to the son-in-law of the partner.

So this is not a phenomena of the "70's or 80's", but is still prevalent with any practice that participates with managed care.
Click to expand...

I was originally referring in particular to your original statement "the insurance carrier suddenly required ABPS certification", which is what happened 30 years ago.
 
Yes, I would agree with that statement. Unfortunately, a lot of doctors were suddenly dropped or eliminated from insurance panels or could not gain access to insurance panels due to a lack of ABPS certification, and that came on relatively quickly in the era you mentioned. It did have a major economic impact on a LOT of practices.

I didn't even start practice until the late 80's and fortunately obtained ABPS certification shortly after that time, but at that time was still "shut out" of many panels because at that time many insurance companies had closed panels based on "geographic need". So many practitioners, even if well qualified had a very hard time obtaining access to patients.

Fortunately, in most areas both of those issues are a thing of the past.
 
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