First job: what was your take home pay?

[MortonExtension]

This is the amount you brought home in total. Whether it’s collection based or salary, whatever.. this is the money you got to deposit in your bank. Include how long ago your first job was as well in the replies or any other details. If you had a side hustle busting crumblies at nursing homes please don’t include.

Thanks

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[Bored Snorlax]

Whoever voted for that $75-100k has got some explaining to do. Maybe they misread it as first month out?

 

[Feli]

"Explaining to do" : I made 80k base first job (about 10ys ago). I left base as offered and negotiated on bonus % and when it started... never hit bonus.

Made base 100k at the next job a year after first. I hit a bit of bonus at that 2nd job. Most PP owners seem to calc bonus differently than math does. Its funny how you find your collections % and per visit and etc suddenly jump when youre doing the math yourself, as opposed to somebody else who subtracts DME cost, forgets things, accidentally assigns other stuff to owner. Dunno

...The important thing is that you learn from every exp. I actually use a lot of what I learned at first job, and I make far more seeing far fewer pts/day.

 

[Forcewielder]

...The important thing is that you learn from every exp. I actually use a lot of what I learned at first job, and I make far more seeing far fewer pts/day.

This.

 

[619]

he important thing is that you learn from every exp. I actually use a lot of what I learned at first job, and I make far more seeing far fewer pts/day.

I also agree but then this can only happen if you end of opening your own practice aka being a small business owner.

Majority do not end up becoming a small business owner due to various reasons. Honestly we all just went into medicine to take care of patients, safe lives (cough cough save limbs) and earn a good income.

It means that majority of current and future podiatrists will get stuck in private practice starting with low (or below) six figures and making mid six figures for the rest of their lives. Very few associate podiatrists are making $200k and above working in private practice.

 

[Feli]

I also agree but then this can only happen if you end of opening your own practice aka being a small business owner.
Majority do not end up becoming a small business owner due to various reasons. ...

100%^

Learning can still be billing, how to negotiate a better contract next job, how to get numbers for ABFAS to be competitive for an org job, how an office runs, how to deal with annoying boss/admins, whatever.

Even those DPMs who just float from associate job to associate job for 35 years (a lot of DPMs, sadly) can still increase their production and efficiency if they take parts of good systems with them.

 

[heybrother]

Wish I knew then, what I know now

First year collections from day 1 to day 365 - $284K. 30% paid out. So $85K. Base was $75K so I guess I did better than Feli. They threw me some cash at Christmas. Shouldn't have been hired. How did I survive - the largess of family. If I had more debt or a poor wife - I would be in a totally different situation.

Here's an example of my first year existence.

See established HRFC Humana patient. Bill 11056 and 11720. Contract pays 65%. Humana denies the 11720 as inclusive to the 11056. Office manager refuses to appeal because "what are we going to do, appeal 100+ claims to fight and get back 65% of $32?" Jokingly, she wasn't wrong cause I appealed them all and they still never paid. So an encounter that should have been worth $97 was worth like $42.

I was reading an article in the Atlantic the other day on happiness and the simple truth is - my life is pretty good. I should have no reservations saying I am very happy. That said, the behavior of insurance companies remains a source of frustration to me even as I've cleaned up a lot of these issues. I've posted about this recently, but even now as someone who understands insurance contracts - I still find myself having to actively battle and beg to prevent contracts from getting worse. I still have insurance company scumbags saying to my face "looks fine" when they are paying me below contract.

The owner telling you they are "booked out for weeks" doesn't mean there will be enough patients for you. A practice existing for like 50 years doesn't mean they know what they are doing. And visits are worth - what they are worth. Medicine is a volume game. And if you have bad contracts you are straight dead in the water screwed. There is money that can be made and good service that can be rendered, but it keeps getting harder.

 

[bigf00t1989]

Whoever voted for that $75-100k has got some explaining to do. Maybe they misread it as first month out?

This is the issue with students, they hear about 70-80k salaries plus bonus and think “no way that’s real, after 7 years of training and 400k debt. AND my school told me those are just angry people on the internet.” They don’t understand that the market doesn’t care about length /cost of training. It’s all supply and demand and new pods can’t really demand more than that in desireable areas.

 

[Bored Snorlax]

I'm going to live like a monk during residency and pay off these loans.

This is the issue with students, they hear about 70-80k salaries plus bonus and think “no way that’s real, after 7 years of training and 400k debt. AND my school told me those are just angry people on the internet.” They don’t understand that the market doesn’t care about length /cost of training. It’s all supply and demand and new pods can’t really demand more than that in desireable areas.

 

[Sole Badguy]

Although most contracts are based on salary, consider instead how much you get per hour of work. Some people are getting fat contracts but they're likely getting worked like dogs with call/weekend hours. Can't be happy with the money you have if you don't have time/energy/availability to spend it.

Also consider cost of living in the area of practice; people here have mentioned the benefits of rural podiatry to escape saturation and get better job opportunities, but an $X salary will carry you farther in those places compared to the same salary in the cities.


...also, people are really getting $200k+ first year in? Absolute legends

 

[Feli]

Although most contracts are based on salary, consider instead how much you get per hour of work. Some people are getting fat contracts but they're likely getting worked like dogs with call/weekend hours. Can't be happy with the money you have if you don't have time/energy/availability to spend it. ...

One thing you can't underestimate is the bad financial behaviors that come with being stressed out from call, high patient/notes volume, overall job hours, etc.

In addition to all the physical things (bad sleep, premature aging, junk food, fast food, missed workouts) that stress causes, it causes bad financial decisions. I know that I definitely, in my young career, would party and date pretty hard and spend beyond my means on shows, dining, travel, whatever. The logic becomes that "well, I work hard and I deserve it (ftw)" when you do get those times to unwind, but taking that "f-it" approach really just wastes money and eats up your ability to knock down debt or build investments.

There is a reason even truly high earner MD/DO surgeons making $500k+ end up in money troubles - or relationship hardships. Stress is a beater.

Health is the first wealth. It's a lot easier to stay in shape, get enough sleep, and make level-headed budgets when you work more reasonable hours.

 

[Forcewielder]

I'll add that I had a handful of classmates I know that got hospital jobs straight out of residency making 250k base. Most were top 10% of the class and went to great residencies. One was actually near the bottom of the class and scrambled to his residency, yet pulled off a great gig in his hometown. It was pretty rural though. I also know guys that finished residency and must not have felt they had enough debt because they immediately bought a practice and have had to struggle with learning to be a new, independent doctor while also learning to be a business owner.

 

[MortonExtension]

How much do you guys collect annually? as a side discussion to the OP..

 

[Forcewielder]

 

[p100]

My first year was nursing homes for a big company and made $135k. Second year went to associate at a PP and pay was so bad I quit early, in 6 months I made $35k. It was worth the $15k early termination penalty. Now 6 months into starting my own practice I am on track to make $150k and I am only working 8 days a month.

 

[eyeeye_captain]

I’ll give a little perspective from outside the field. My subspecialty with 6 years of residency/fellowship, which makes around as much as ortho, had me <$300k my first year. The MGMA data has a pretty decent number of MD/DO specialties at around that for the median, though MGMA is weird for fields that tend not to be employed.

The USC dentistry school has an estimated COA of ~$625k. BLS says the median general dentist makes ~$166k. Now that’s a kick in the teeth.

 

[Retrograde_Nail]

My first year out was a hospital/MSG job. Base salary was 240K. My first year bonus was minimal due to not being too busy my first year. Probably after taxes it was a little more than half of that which hit my bank account.

What's crazy is that the 240K base was 7 years ago before bad inflation from COVID. When I started my second hospital job almost 2 years ago they started me at 275K post COVID. So the buying power of that 275K was probably still around 240K from 7 years ago. On paper it was progress but in reality it is not. MGMA does not take inflation into account.

I eventually did negotiate up to 325K base which is where I am at now with hefty bonuses since I am busy.

 

[GreenHousePub]

$15k early termination penalty.

Private practice owners are scumbags

 

[MicroPod]

Got lucky and will make around 260k base first year out. There is also a performance bonus and possibility of RVU bonus. They also give 25k/year for loans after I have worked for one year.

Other co-residents who got hospital jobs are similar. I have heard of some decent to terrible private practice associate offers though.

For the second years now becoming third years, start looking now if you haven’t. The better jobs from what I have seen tend to come from either good connections or from willingness to go rural (call those community hospitals and get in touch with someone in leadership).

 

[Hybrocure]

As has been mentioned in the past a lot of the higher salary jobs either bring call, high clinic volume, or increased surgical volume and difficulty of cases. Usually all three. This means more work and more stress.

Not suitable for everyone’s lifestyle. For me, I’m done with wanting to be challenged in day to day life. Got enough of that with school and residency over the majority of my existing life. I just want to work and go home. I don’t care if it pays sub 200k to do so.

Most new grads who go into these high paying ortho or hospital jobs get worked to death. There’s also a lot of predatory low paying PP jobs that’ll work you to death too. You have to choose carefully.

Generally, if you’re making a lot of money in podiatry, there’s a good chance you’re working pretty damn hard, and if they’re making a ton of money and not working hard, they’re usually carrying stress in other ways (aka worrying about when the feds will find you for grafts).


It’s really not so different from other surgical fields. We all know the general surgeons, orthos or vascular docs in our hospitals that make a ton but when you see their cases on the board and see them having to run around the hospital all day, and do 5+ hour long cases that could result in death it looks like absolute hell to live as a life. Having to work harder and have more responsibility generally pays more and that comes with stress.

 

[Hybrocure]

One thing you can't underestimate is the bad financial behaviors that come with being stressed out from call, high patient/notes volume, overall job hours, etc.

In addition to all the physical things (bad sleep, premature aging, junk food, fast food, missed workouts) that stress causes, it causes bad financial decisions. I know that I definitely, in my young career, would party and date pretty hard and spend beyond my means on shows, dining, travel, whatever. The logic becomes that "well, I work hard and I deserve it (ftw)" when you do get those times to unwind, but taking that "f-it" approach really just wastes money and eats up your ability to knock down debt or build investments.

There is a reason even truly high earner MD/DO surgeons making $500k+ end up in money troubles - or relationship hardships. Stress is a beater.

Health is the first wealth. It's a lot easier to stay in shape, get enough sleep, and make level-headed budgets when you work more reasonable hours.

🙌

 

[wakaflocka88]

$65k ish take home first job. Could not build up volume.

Second job and on pace for about $400k with bonuses TBD

In my residency grad cohort, the others are doing very well too.

Where you do residency matters. Network network network from day 1. No one in my close circle did a fellowship and all are doing very well. Hang out with peeps that do not complain and work hard.

 

[Retrograde_Nail]

$65k ish take home first job. Could not build up volume.

Second job and on pace for about $400k with bonuses TBD

In my residency grad cohort, the others are doing very well too.

Where you do residency matters. Network network network from day 1. No one in my close circle did a fellowship and all are doing very well. Hang out with peeps that do not complain and work hard.

400K gross or after taxes?

 

[Homo sapien]

As has been mentioned in the past a lot of the higher salary jobs either bring call, high clinic volume, or increased surgical volume and difficulty of cases. Usually all three. This means more work and more stress.

Not suitable for everyone’s lifestyle. For me, I’m done with wanting to be challenged in day to day life. Got enough of that with school and residency over the majority of my existing life. I just want to work and go home. I don’t care if it pays sub 200k to do so.

Most new grads who go into these high paying ortho or hospital jobs get worked to death. There’s also a lot of predatory low paying PP jobs that’ll work you to death too. You have to choose carefully.

Generally, if you’re making a lot of money in podiatry, there’s a good chance you’re working pretty damn hard, and if they’re making a ton of money and not working hard, they’re usually carrying stress in other ways (aka worrying about when the feds will find you for grafts).


It’s really not so different from other surgical fields. We all know the general surgeons, orthos or vascular docs in our hospitals that make a ton but when you see their cases on the board and see them having to run around the hospital all day, and do 5+ hour long cases that could result in death it looks like absolute hell to live as a life. Having to work harder and have more responsibility generally pays more and that comes with stress.

Not a word of a lie. I just want to work and go. Not be the limb saving hero king. I'm not Clark Kent, I'm just Billy from Mississippi

 

[icebreaker32]

$65k ish take home first job. Could not build up volume.

Second job and on pace for about $400k with bonuses TBD

Pretty much sums up the profession.

Most start at an embarrassing low salary with poor benefits and somehow, someway eventually get to a better or much better situation.

A "lucky" few immediately start off at a great situation and more than the profession likes to admit never make it out of their low salary/poor benefit situation.

 

[MicroPod]

I wonder what percentage of pods are still making 100-150k or less when they are 5-10 years out.

 

[Bored Snorlax]

I wonder what percentage of pods are still making 100-150k or less when they are 5-10 years out.

@JustAPedicurist New poll idea ☝️

 

[Dr.PatchAdams]

250k base in a large metro area.

 

[Podstar]

275k base with bonus structure in a small city with a small town satellite location.

 

[Feli]

I wonder what percentage of pods are still making 100-150k or less when they are 5-10 years out.

Very few (absolutely not 0%) exp pods make that little after 5+ years of practice, and hopefully they're actively looking for a new job...
But a ton are exp DPMs who are still stuck in the $150k-200k range (associates, supergroups, VC groups, some MSG or ortho DPMs who aren't busy or have bad contract, house calls pods, etc). Tuitions go up and up again; interest rates are high.

You still have to keep in perspective the real problem: how bad it is to make only $160k or $180k or $200k return on $400k debt (and 7-8yrs). That's a garbage ROI.... WCI is spot on to say anything over 3:1 debt : income is basically considered impossible to ever get out of debt... and a large number of DPMs are unfortunately in that exact boat.

With student loan interest ~30k/yr and taxes ~70k, that $200k gross just turned into $100k take-home (and you haven't even touched your $400k loan principal + residency/fellow interest... or paid any rent/bills yet). See the ROI link above for how it's nearly impossible to ever pay the loans off unless you get to at least 2:1 debt : income level.

Also, don't underestimate commuting. That is a seriously underrated consideration in how good/bad (and how lucrative) a job can be. Many PP associates (and even hospital DPMs) are made to go to two or more clinic locations weekly that are 10mi or even 25+ miles apart. Some owners do it also, but it's most/all deductible for them. It is nothing for a boss or admin to assign a doc to a satellite office or outreach clinic or new clinic or whatever, but that really grinds on the doc time, gas, car, etc. That's time away from gym or family or hobbies. It is terrible to be spending 30min or more in the car each way M-F (plus any weekend/call driving!), and then you also have all the associated gas, oil, shop, tire, etc time on your weekend "off" also. Transportation is most ppl's #2 expense after housing (rent/mortgage), so commute and work location(s) has to be considered, esp on a very limited budget where you're trying to knock down debt - or just get by.

 

[Homo sapien]

Very few (absolutely not 0%) exp pods make that little after 5+ years of practice, and hopefully they're actively looking for a new job...
But a ton are exp DPMs who are still stuck in the $150k-200k range (associates, supergroups, VC groups, some MSG or ortho DPMs who aren't busy or have bad contract, house calls pods, etc). Tuitions go up and up again; interest rates are high.

You still have to keep in perspective the real problem: how bad it is to make only $160k or $180k or $200k return on $400k debt (and 7-8yrs). That's a garbage ROI.... WCI is spot on to say anything over 3:1 debt : income is basically considered impossible to ever get out of debt... and a large number of DPMs are unfortunately in that exact boat.

With student loan interest ~30k/yr and taxes ~70k, that $200k gross just turned into $100k take-home (and you haven't even touched your $400k loan principal + residency/fellow interest... or paid any rent/bills yet). See the ROI link above for how it's nearly impossible to ever pay the loans off unless you get to at least 2:1 debt : income level.

Also, don't underestimate commuting. That is a seriously underrated consideration in how good/bad (and how lucrative) a job can be. Many PP associates (and even hospital DPMs) are made to go to two or more clinic locations weekly that are 10mi or even 25+ miles apart. Some owners do it also, but it's most/all deductible for them. It is nothing for a boss or admin to assign a doc to a satellite office or outreach clinic or new clinic or whatever, but that really grinds on the doc time, gas, car, etc. That's time away from gym or family or hobbies. It is terrible to be spending 30min or more in the car each way M-F (plus any weekend/call driving!), and then you also have all the associated gas, oil, shop, tire, etc time on your weekend "off" also. Transportation is most ppl's #2 expense after housing (rent/mortgage), so commute and work location(s) has to be considered, esp on a very limited budget where you're trying to knock down debt - or just get by.

So podiatry is a *******

 

[PODIATRYCRAZE]

275k base with bonus structure in a small city with a small town satellite location.

250k base in a large metro area.

Got lucky and will make around 260k base first year out. There is also a performance bonus and possibility of RVU bonus. They also give 25k/year for loans after I have worked for one year.

Other co-residents who got hospital jobs are similar. I have heard of some decent to terrible private practice associate offers though.

For the second years now becoming third years, start looking now if you haven’t. The better jobs from what I have seen tend to come from either good connections or from willingness to go rural (call those community hospitals and get in touch with someone in leadership).

Thank you all for sharing. I would share but since my contract is very bonus heavy, I won’t actually know until next year how much I will make. But on to the real question:

Did your jobs require ABFAS? Or did they also take ABPM?

 

[MicroPod]

Thank you all for sharing. I would share but since my contract is very bonus heavy, I won’t actually know until next year how much I will make. But on to the real question:

Did your jobs require ABFAS? Or did they also take ABPM?

Mine is ok with ABPM which I am planning to take later this year.

 

[Dr.PatchAdams]

Thank you all for sharing. I would share but since my contract is very bonus heavy, I won’t actually know until next year how much I will make. But on to the real question:

Did your jobs require ABFAS? Or did they also take ABPM?

They were okay with either; but, I was ABPM cert and ABFAS foot & RRA qual at time of hire.

I've since changed jobs and certified in both.

 

[Podstar]

Thank you all for sharing. I would share but since my contract is very bonus heavy, I won’t actually know until next year how much I will make. But on to the real question:

Did your jobs require ABFAS? Or did they also take ABPM?

I don’t think they care either way but I’ll be ABFAS foot and ankle board qualified after residency ends this week and am taking ABPM in October and told them this so not sure if they actually had a preference or not since I already had progress towards both. All of my state laws and regulations from the medical board mention ABFAS though.

 

[PodDude12345]

My 252k before interest in student loan debt is sobbing right now.

 

[Flip-flop-flerpity]

First job $180k working as an "associate" at a predatory private practice in a major metro area. Huge volume, triple booked all day (even with that could never meet the rediculously high bonus threahold they set), call, lousy benefits, late night add ons, weekend add ons, 2 weeks vacation, endless nights and weekends spent on documentation etc. BUT, it got me abfas certified and gave me a true perspective on how bad our profession feasts on its own. Second job rural hospital, 300k, 4 day work week, no call, phenomenal benefits, 10 weeks vacation, awesome quality of life, wayyyy lower stress.

 

[AttackNME]

First job $180k working as an "associate" at a predatory private practice in a major metro area. Huge volume, triple booked all day (even with that could never meet the rediculously high bonus threahold they set), call, lousy benefits, late night add ons, weekend add ons, 2 weeks vacation, endless nights and weekends spent on documentation etc. BUT, it got me abfas certified and gave me a true perspective on how bad our profession feasts on its own. Second job rural hospital, 300k, 4 day work week, no call, phenomenal benefits, 10 weeks vacation, awesome quality of life, wayyyy lower stress.

Whose doing the podiatry call work for your hospital?

 

[Flip-flop-flerpity]

Complex trauma (pilon, etc) goes to ortho which is fine by me, I don't feel I have anything I need to prove by doing that work and I have a good relationship with them. Bimals, foot/hindfoot fractures etc get splinted or booted and next day follow up with me in clinic. Wounds with vascular component get shipped off elsewhere where vascular is available. The best part about working rural is minimal commute for me. I feel like I spent years of my life driving between hospitals and satellite clinics that could have been much better spent with my family.

 

[HeySister]

Also clocked in at 185k at a predatory private practice my first year. It was a lot more than others were making in my area though. Did a lot of surgery and learned how economically non-viable surgery can be. Even with doing higher volumes my lesser operate co-associates were bringing in more than me. In the years after I maxed out just over 200k. I could've scraped some more but this would have required burnout level efforts or riskier billing that would've benefited practice owners more than me. Or I could have squeezed in more patients per day and just had awful documentation. I wrote strong notes on 30-45 patients a day. Had I been less detail oriented I probably could have seen 35-50. Funny thing is despite this I was still pretty happy because I like this job but the frustrations were growing over time.

I eventually left this job for a small hospital. I make around 250 now and don't work too hard most days.

One thing that always bothered me is that I never fully trusted the practice about my collections. It just seemed they were hiding dollars. My reimbursements always were much lower than my friends in other areas and even a bit lower than some other associates practicing in my area in other practices. The two things to remember is that owners will always minimize their risk (and maximize yours), and they will always minimize dollars out of their pocket. If they can push a cost off on you they will.

My favorite owner grift was writing off my unpaid collections. If I had 50,000 pending, they write it off and get a tax deduction, and I never get paid. None of this would be discussed with me but I would find it on the billing statements. When I brought this up they said this was just the "cost of doing business."

If I ever leave employed practice I will open up my own or partner with someone else. No chance I work for anyone ever again. I don't think I can offer what I want based on current reimbursements. If I had my own practice I would want it to be in a nice building with nice supplies and quality staff. I would take every aspect of the patient experience personally. But how do to that at $80-$90 for 99214?

If I was coming out as an associate again, I would ask to see their collections. I would also ask to see what they are paid by the major insurers for the most common codes. If it was viable I would ask for 40% straight collections increasing by 1.5% each year until it reached 49%. At that point you are essentially a partner from a financial standpoint. It is not perfect but I think you would find some traction with some private practice docs with this contract. They will make money off of you for 7 years with almost no risk to them.

 

[Feli]

...One thing that always bothered me is that I never fully trusted the practice about my collections. It just seemed they were hiding dollars. ...

They were.

 

[Hybrocure]

Also clocked in at 185k at a predatory private practice my first year. It was a lot more than others were making in my area though. Did a lot of surgery and learned how economically non-viable surgery can be. Even with doing higher volumes my lesser operate co-associates were bringing in more than me. In the years after I maxed out just over 200k. I could've scraped some more but this would have required burnout level efforts or riskier billing that would've benefited practice owners more than me. Or I could have squeezed in more patients per day and just had awful documentation. I wrote strong notes on 30-45 patients a day. Had I been less detail oriented I probably could have seen 35-50. Funny thing is despite this I was still pretty happy because I like this job but the frustrations were growing over time.

I eventually left this job for a small hospital. I make around 250 now and don't work too hard most days.

One thing that always bothered me is that I never fully trusted the practice about my collections. It just seemed they were hiding dollars. My reimbursements always were much lower than my friends in other areas and even a bit lower than some other associates practicing in my area in other practices. The two things to remember is that owners will always minimize their risk (and maximize yours), and they will always minimize dollars out of their pocket. If they can push a cost off on you they will.

My favorite owner grift was writing off my unpaid collections. If I had 50,000 pending, they write it off and get a tax deduction, and I never get paid. None of this would be discussed with me but I would find it on the billing statements. When I brought this up they said this was just the "cost of doing business."

If I ever leave employed practice I will open up my own or partner with someone else. No chance I work for anyone ever again. I don't think I can offer what I want based on current reimbursements. If I had my own practice I would want it to be in a nice building with nice supplies and quality staff. I would take every aspect of the patient experience personally. But how do to that at $80-$90 for 99214?

If I was coming out as an associate again, I would ask to see their collections. I would also ask to see what they are paid by the major insurers for the most common codes. If it was viable I would ask for 40% straight collections increasing by 1.5% each year until it reached 49%. At that point you are essentially a partner from a financial standpoint. It is not perfect but I think you would find some traction with some private practice docs with this contract. They will make money off of you for 7 years with almost no risk to them.

That number of patients a day as a pod is nuts. Anything above 25-30 is a tough day for me. Even with templated notes and quick patient times just having to talk to that many people is exhausting

 

[MortonExtension]

Yeah if you were making $180k and seeing 40 patients a day you were probably getting big time screwed it would seem

 

[Retrograde_Nail]

Also clocked in at 185k at a predatory private practice my first year. It was a lot more than others were making in my area though. Did a lot of surgery and learned how economically non-viable surgery can be. Even with doing higher volumes my lesser operate co-associates were bringing in more than me. In the years after I maxed out just over 200k. I could've scraped some more but this would have required burnout level efforts or riskier billing that would've benefited practice owners more than me. Or I could have squeezed in more patients per day and just had awful documentation. I wrote strong notes on 30-45 patients a day. Had I been less detail oriented I probably could have seen 35-50. Funny thing is despite this I was still pretty happy because I like this job but the frustrations were growing over time.

I eventually left this job for a small hospital. I make around 250 now and don't work too hard most days.

One thing that always bothered me is that I never fully trusted the practice about my collections. It just seemed they were hiding dollars. My reimbursements always were much lower than my friends in other areas and even a bit lower than some other associates practicing in my area in other practices. The two things to remember is that owners will always minimize their risk (and maximize yours), and they will always minimize dollars out of their pocket. If they can push a cost off on you they will.

My favorite owner grift was writing off my unpaid collections. If I had 50,000 pending, they write it off and get a tax deduction, and I never get paid. None of this would be discussed with me but I would find it on the billing statements. When I brought this up they said this was just the "cost of doing business."

If I ever leave employed practice I will open up my own or partner with someone else. No chance I work for anyone ever again. I don't think I can offer what I want based on current reimbursements. If I had my own practice I would want it to be in a nice building with nice supplies and quality staff. I would take every aspect of the patient experience personally. But how do to that at $80-$90 for 99214?

If I was coming out as an associate again, I would ask to see their collections. I would also ask to see what they are paid by the major insurers for the most common codes. If it was viable I would ask for 40% straight collections increasing by 1.5% each year until it reached 49%. At that point you are essentially a partner from a financial standpoint. It is not perfect but I think you would find some traction with some private practice docs with this contract. They will make money off of you for 7 years with almost no risk to them.

To add more perspective. I am hospital employed.

I am on pace to collect significantly more than my base salary this year with my bonuses. My base is 325K. I will have generated the hospital almost 2.8-3 million dollars based on my numbers. Despite making a great a salary I am bringing the hospital 8-9x return on my the salary they are paying me.

Whether its private practice or hospital. You still get worked like a dog and the your master always makes a killing. Pretty sure your former employer made crazy money off you.

MD/DO get PAs and NPs do to all their orders, scut work, rounding and see their patients for them. They make a killing without much effort. Podiatry gets low cost associates to do the same while the podiatry owner makes killing.

 

[HeySister]

Yeah if you were making $180k and seeing 40 patients a day you were probably getting big time screwed it would seem

I should clarify my first year I was probably averaging 12-20. By second year 20-30 and third year 30-45 depending on show rates. I had clinic 3.5 days a week, OR one day a week, and wound care center 1 afternoon. Those 3.5 days were packed full by the time I left. It took rain, snow, or blistering heat to drop my schedule to less than 30. One of the biggest issues I had was the global period. Because I was busy from a surgical standpoint even if I was seeing 35, inevitably 5-10 would be post ops. We did not have X-rays at every office either so post ops at those offices I turned in mostly zeros.

Anyways, something was not adding up. I tried to uncover it for months but I never got to the bottom of it. It seemed like reimbursements were consistently showing up 10% less than they should have been.

My first year I was seeing 12-20 patients that just paid more per patient than year 2 or 3. A higher percentage of new patients and a lower percentage of global patients. They also hired new doctors too and I saw less new patients as they started.

I still think it's good to find the best job you can and get started for a few years rather than going straight out alone. My happiness and QOL was high even with knowing things were off. I made survivable money and learned a lot. I think had I started on my own right away I would've had my teeth kicked in. I could do it now but not sure it's worth it.

 

[PMG03470]

I should clarify my first year I was probably averaging 12-20. By second year 20-30 and third year 30-45 depending on show rates. I had clinic 3.5 days a week, OR one day a week, and wound care center 1 afternoon. Those 3.5 days were packed full by the time I left. It took rain, snow, or blistering heat to drop my schedule to less than 30. One of the biggest issues I had was the global period. Because I was busy from a surgical standpoint even if I was seeing 35, inevitably 5-10 would be post ops. We did not have X-rays at every office either so post ops at those offices I turned in mostly zeros.

Anyways, something was not adding up. I tried to uncover it for months but I never got to the bottom of it. It seemed like reimbursements were consistently showing up 10% less than they should have been.

My first year I was seeing 12-20 patients that just paid more per patient than year 2 or 3. A higher percentage of new patients and a lower percentage of global patients. They also hired new doctors too and I saw less new patients as they started.

I still think it's good to find the best job you can and get started for a few years rather than going straight out alone. My happiness and QOL was high even with knowing things were off. I made survivable money and learned a lot. I think had I started on my own right away I would've had my teeth kicked in. I could do it now but not sure it's worth it.

Where in the country do you practice that 180k is just “survivable”?!?

Where I am you can live like a king on that salary.

 

[air bud]

Where in the country do you practice that 180k is just “survivable”?!?

Where I am you can live like a king on that salary.

Lol

 

[HeySister]

Where in the country do you practice that 180k is just “survivable”?!?

Where I am you can live like a king on that salary.

Kings do not have $325,000 of student loans

 

[PMG03470]

Kings do not have $325,000 of student loans

My comment in no way was disputing the fact that our ROI sucks. But I still think it’s unfair to say it is “survivable” lol. Tell my MA making 25k a year raising 3 kids that 180k is just survivable

 

[Forcewielder]

My comment in no way was disputing the fact that our ROI sucks. But I still think it’s unfair to say it is “survivable” lol. Tell my MA making 25k a year raising 3 kids that 180k is just survivable

You only pay your MA $25k/yr ($12/hr)? That's rough man. Where I'm at (Midwest) minimum wage is higher than that.