Did any of you students out there decide to pursue a career in Podiatry with your goal being to open your own practice or buy and takeover an existing practice?
Going into private practice
- Thread starter mandrew
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I'm sure many of us would like to open a practice and be our own boss, and not work for someone else. That's definitely a bunch of us, but that cannot happen because starting out cold or even buying an existing practice is not achievable for most of us because of the debt involved, both student loans and the bank loans to buy/start a practice. The schools have done very well in advertising surgery (foot and ankle surgeons) and likely working in hospital based care. Many initially thought hospital jobs would be plenty and can be filled, but that's far from the truth, especially for podiatry. We are saturated and our choices are to work for someone or to open our own. So yes, it is in the best interest to open a practice in an already saturated field. For me, at least.
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Just graduated residency here.
I chose podiatry with the goal of opening my own private practice - Someday.
Financially it was not possible straight out. I had always said when I graduate I will get regular job for 200k after residency to pay off loans for 2 years, then start fresh opening a new office.
That dream has died. I am happily employed by a boss who is better than I am with money. Better yet, the vision they have for their office is the same vision I had, a fully comprehensive multispecialty group dedicated to limb salvage. Being a part of this team is as good as I will ever come to my original dream. My current situation is still very lucrative, but with a lot less headache. I focus on the medicine, the boss focuses on the money. We do what we are best at.
In this economy and job market it would be impossible for me to open up shop and do well without sacrificing another few years of my life. In that case I might as well go back to allopathic or osteopathic medical school and it would take the same amount of time
I chose podiatry with the goal of opening my own private practice - Someday.
Financially it was not possible straight out. I had always said when I graduate I will get regular job for 200k after residency to pay off loans for 2 years, then start fresh opening a new office.
That dream has died. I am happily employed by a boss who is better than I am with money. Better yet, the vision they have for their office is the same vision I had, a fully comprehensive multispecialty group dedicated to limb salvage. Being a part of this team is as good as I will ever come to my original dream. My current situation is still very lucrative, but with a lot less headache. I focus on the medicine, the boss focuses on the money. We do what we are best at.
In this economy and job market it would be impossible for me to open up shop and do well without sacrificing another few years of my life. In that case I might as well go back to allopathic or osteopathic medical school and it would take the same amount of time
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Sure, sure...
And be sure to refer back to this exact post in about two years. Please, do that.
Ever heard of 'honeymoon period'?
You will eventually come to realize that you get about $250k, yet you bring in 700k-900k+ ... and boss with inferior training and easier hours pockets 200k off your productivity. 😉
Right, because you were accepted to those yet chose podiatry... just like all podiatrists were. 🙂
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For OP topic, I wanted to open up a PP as soon as I saw how lucrative it could be (some of my residency attendings) and how few jobs hospital/ortho were for DPMs. It turned out that I went to a residency where a lot of grads do ortho/hospital jobs (and others do PP owner or employ), but I still wanted PP.
It took about a decade for me to have enough money and the right reason/area to do solo PP. I scouted locations and had ideas almost immediately out of residency, but I failed with biz plans at banks for years and years... other ideas to buy out DPMs (they'd finance) were just way too expensive or fraught with pitfalls.
It took about a decade for me to have enough money and the right reason/area to do solo PP. I scouted locations and had ideas almost immediately out of residency, but I failed with biz plans at banks for years and years... other ideas to buy out DPMs (they'd finance) were just way too expensive or fraught with pitfalls.
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If I bring in 700k in 1 year, then my take home is a little over 500k.
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Where are you getting these numbers from that he/she might be "bringing in" $800,000 per year? That is a tremendous amount of money.
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Typical full time podiatrist collects between 600k-800k per year.
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I'm talking gross collections on that pod services.
No first year associate would (not efficient enough, bad at coding, collections lag after seeing first pts)...
But it's not uncommon for a busy and efficient DPM associate in PP to be doing $500k-800k.... some even $1M+ if they work a lot and do "grafts," "custom braces," abd that stuff. (though they'd usually get 30-50% of that, depending on contract).
I would guess the average established pod associate probably collects $500k and keeps $200k? Not uncommon. But it's also not uncommon their owner "edits" those collections down (subtracts DME cost, "forgotten" copays, fudges figures, etc) to $400k collections and associate pay to $150k-$175k/yr or something.
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Nope, might be median (might)... not mean.
Even with ancillary services, that is higher end.
That's guys working a lot, probably mostly good payers, efficient office, some "creative" coding for most.
It's not to say it can't be done. I know solo guys who have collected $1M... but they're definitely hustling fairly hard and they're outliers.
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Briefly funny story. May or may not have any merit.
The other day I was contacted by a prison that is looking for a podiatrist to come out 1-2 times per month to perform "procedures".
My life is pretty chill so its hard to justify adding something unusual like this. We've been contacted in the past by people looking for workers comp examinations or to render medical care to prisoners in the office etc - but we've never pursued it. The prisoner in the office contract they sent was for 185% of Medicare - I wondered if it could have been negotiated higher, but I didn't pursue it. Another podiatrist offered to advice me on how much money to ask for disability exams, but it seemed like a possible time bomb.
Anyway, I was curious - "what are we worth" especially in light of hearing what a friend was being paid to go out to a hospital.
I wrote back to the person who contacted me and said I'd be happy to do a phonecall to find out what they needed. They immediately wanted to schedule an in person meeting at my office. I had them come to the office a few days later.
We made small talk. They told me the work would be contract and said it paid Medicare rates.
I thanked them for their time and told them Medicare was much too low and that I wasn't interested in leaving my office to lose money. I explained that I had negotiated much better rates with payors. This is sort of true.
They immediately caved and told they'd be open to a variety of possibilities. I could come up with a fee schedule. Set rates for new and follow-ups. I'd be paid more for surgery - they really want someone to do procedures. I would be paid if the facility was locked down without notice. I would be paid for no shows on the scheduleup to 72 hours out. I told them I'd want a daily minimum base rate to ensure it was worth my time. I didn't say a number but they immediately agreed that was doable.
I still have no idea where this will go, but I've negotiated with insurance before and - they don't cave. If they offer you 90% of Medicare, the counter offer is 95% or 85%.
There are some very interesting resources out there on the internet about prison work. I intend to do some research this weekend. Maybe this all blows up in my face, but here's my tie in for the thread. New associates don't know what they are worth. When the insurance says take it or leave it they often have to take it. Its amusing to be a situation where I can say - no thanks, good luck, if you think I'm expensive - feel free to fly someone in 12-24 times a year.
I'll bump this if I ever get "shivved".
The other day I was contacted by a prison that is looking for a podiatrist to come out 1-2 times per month to perform "procedures".
My life is pretty chill so its hard to justify adding something unusual like this. We've been contacted in the past by people looking for workers comp examinations or to render medical care to prisoners in the office etc - but we've never pursued it. The prisoner in the office contract they sent was for 185% of Medicare - I wondered if it could have been negotiated higher, but I didn't pursue it. Another podiatrist offered to advice me on how much money to ask for disability exams, but it seemed like a possible time bomb.
Anyway, I was curious - "what are we worth" especially in light of hearing what a friend was being paid to go out to a hospital.
I wrote back to the person who contacted me and said I'd be happy to do a phonecall to find out what they needed. They immediately wanted to schedule an in person meeting at my office. I had them come to the office a few days later.
We made small talk. They told me the work would be contract and said it paid Medicare rates.
I thanked them for their time and told them Medicare was much too low and that I wasn't interested in leaving my office to lose money. I explained that I had negotiated much better rates with payors. This is sort of true.
They immediately caved and told they'd be open to a variety of possibilities. I could come up with a fee schedule. Set rates for new and follow-ups. I'd be paid more for surgery - they really want someone to do procedures. I would be paid if the facility was locked down without notice. I would be paid for no shows on the scheduleup to 72 hours out. I told them I'd want a daily minimum base rate to ensure it was worth my time. I didn't say a number but they immediately agreed that was doable.
I still have no idea where this will go, but I've negotiated with insurance before and - they don't cave. If they offer you 90% of Medicare, the counter offer is 95% or 85%.
There are some very interesting resources out there on the internet about prison work. I intend to do some research this weekend. Maybe this all blows up in my face, but here's my tie in for the thread. New associates don't know what they are worth. When the insurance says take it or leave it they often have to take it. Its amusing to be a situation where I can say - no thanks, good luck, if you think I'm expensive - feel free to fly someone in 12-24 times a year.
I'll bump this if I ever get "shivved".
You didn’t answer the question, where are you getting these numbers from?
I would say the exact opposite is more accurate, i.e., Very few “typical” full time podiatrists collect > $600,000 per year.
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I did my own personal audit on some of my attendings. With their permission of course.
This was a very standard podiatry office. Super saturated city. Between on average 20-25 patients per day. Inpatient and outpatient surgeries in the mix. Lots of routine. Lots of medicaid. Split call but almost never get called in. Got roughly 33-35% of what they billed. (Pretty sure this is a bad reimbursement rate)
All 3 were collecting just around 700k. Keep in mind this is just an average podiatry office. Not in a wealthy neighborhood with good payers. No skin subs, not a high amount of big ticket surgeries.
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600k collections is normal.
Doing the math for a normal podiatry contract of 140k base + 30% collections after 420,000. Annual bonus yields 54k. Total income 194k. Still sub 200, so I would say very normal and very achievable as long as you see 20+ patients a day.
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All of this implies that collections are accurately tracked... And saying you focus on clinic and the boss focuses on money sounds like many of us here know how this turns out. Make sure you are doing everything to protect yourself and document appropriately.
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Can you give us some insight on your background? Because some of the coding things you post seem like you may still be a resident.
Of note, there is a someone who is still in residency giving sage advice to others on this forum and are often completely off base.
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Just graduated residency 2 months ago. So yes not perfect with my coding or practice management yet.
First month out is pretty slow. My financial goal is to collect 250k for employer by the end of the 1st 6 months. Based off of July numbers I am behind and will probably only pull in 210k
Keep in mind, this is only my first year out. I expect schedule to pick up and be busier by year 2 so collecting 600k seem very possible once I am established. 800k is my goal, but I don't actually know if I can reach that. Have to see what the payer mix is like and if the city even has enough of a patient population to support me being around.
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I recommend keeping tabs of all your Billings and collections weekly and monthly and account for every dollar you bill. Don’t rely on the practice to tell you what it is, see for yourself. If they refuse to show or hide it (very common), then ya….
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No private practice podiatry group would allow their associate to take this much home. Sorry.
How many hours per week and how many patients do you think you will need to see per week to generate about $700,000 per year?
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He is just going to focus on seeing patients and let his boss worry about the money. Easy peazy
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52 weeks per year
-4 weeks for vacation, CME, holidays
=48 weeks
x5 working days
=240 working days
X8 hours
=1920 working hours
X4 patients per hour
=7680 patient encounters per year
X~$100 per encounter
=$768,000 annual collections
Of course there will be no shows, uninsured patients so let’s round that down to just $650,000. Or even worse $600,000.
Now add in some extra income from surgeries/weekend call/after or before hours inpatient. That will take you right back up there.
As mentioned before I once encountered an office that made on average ~$75 per encounter (from insurance). If this is you, you can make cash by selling orthotics, DME, antifungals, vitamins, lotions. It was a while ago, so I forget if I included radiology in the report. But ABI, XR, US can also help.
Even better move to a nicer location with better payers. Easier said than done though.
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It appears your assumption immediately includes 5 days a week, 8 hour days, 4 patients an hour. So - will there not be a defined surgery day?
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In this scenario, correct.
The way I have seen most offices work is that many don’t that have many outpatient surgeries to begin with. And if they do, it would more likely be a half day or 1 full day every 2-3 weeks. And on these surgery days, if nothing is scheduled then they would just return to the clinic and already have had patients scheduled in advance.
For inpatient surgeries I often see these being done outside work hours or between lunch.
As far as the income calculation goes, that 5th surgery day does not generate $0. Also maybe not making as much as a full clinic day around $3000. But in an 8 hour day, 5-6 surgeries if ur not making at least $2000, should probably reevaluate your time spent.
A full schedule of 30-32 patients per day for 5 days a week does take time to build up. But it is definitely not uncommon.
What about documentation? Phone calls? What about new patients and others that go well beyond 15 minutes, Your 8 hour workday is now a ten+ hour workday. Inpatient surgeries between lunch? How does that work?
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That is correct, for the amount of patients being seen, I calculate it as an 8 hour work day, from 8-12, and 1-5. But the actual working hours can go beyond that. from 12-1 or a little after 5.
In between lunch, I have often seen surgeries being done. There is no way I am the only one seeing this. Multiple of my attendings have. I do from time to time. Obviously the office needs to be near the surgery location.
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There are more than a couple errors in your calc, but this above is most glaring. 15min per pt visit + note + prep + f/u + etc is not going to happen. Even vet docs who do this "machine mode" don't do a very good job with patients of any complexity and run behind and/or get bad reviews... not to mention most are tired/grumpy all the time. Fat, bald, and angry is no way to go through life (add drunk when finally home or off work).
Even beyond that, no matter what you want or try for, your PP owner is very unlikely to let you get to that. For owners and partners, yes seeing 30+ (if they want to)... pretty but seldom for associates. If you get above 20 or 25/d as associate, they will typically just hire another associate (and knock your volume back down to 15-20 or whatever... cycle repeats and repeats).
Why wouldn't they encourage that growth for associate? Well, they don't want an associate to be at a volume/collect number where you can make good money (leave and start own office)... or they know you'll be working hard and try to demand raises. And mainly, they don't want to be high and dry if (when) you left for another job. They need them and/or other associates to be able to take the pt load you see if needed. They will spread the risk.
...Oh, and fwiw, I rarely see even 20/day (substantially less if any staff on vaca), pts 4d/wk (3.5d if week with surg), add a lot of extended weekends around holidays, and I avg well over $100/visit. I do fine. I could easily see 30+ daily, but I want to like my job (and retain solid staff).
So, your goals are ambitious (30+ per day, lunch surgery, etc), but they're just not too realistic assuming you like your pts, family, sanity. You'll also miss things (injects, DME, etc) if you are flying through visits because you're behind. But try it... have fun. That's how you learn. 🙂
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