Hospital Employment Inquiry

[Shiyuan]

Hey all,

I may be interviewing soon for a hospital-based gig (full time). Quick synopsis:

- 25 bed Critical access hospital. Only 2 other specialty docs - both gen surg. Otherwise mostly ARNP family med types with 2-3 PCP MDs.

- Previously had a full-time surgical DPM. When I inquired about that doc’s case deversity, the CEO told me mostly just amputations.

- They now have a NON-SURGICAL DPM covering their podiatry clinic part-time (that DPM’s primary office 1 hr away at another office in the hospital’s network).

In terms of “selling myself” for the job... outside of the obvious that I am surgical (forefoot + some rearfoot) and the current guy is not, any other talking points I should bring up in terms of RVU generation, scope, etc.?

Appreciate y’all’s insight!

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[wakaflocka88]

I don't even know if you're joking rn ... and if I should waste time writing a few sentences in response ...

- The information desk person to the CEO of the hospital are non-revenue generating
- Everything needed to comply with local, state, and federal regulations
- The parking lot attendant
- The registration clerk
- The benefits verification person
- The painter who I see on some floor every day
- The janitors who clean your toilet
- The infection control nurse
- The nurse navigator
- The maintenance man(person)
- The biomed safety person that checks your equipment
- The millions of dollars per year for EHR
- Plus, plus, plus, plus ...

None of these people or things generate revenue for the hospital. You do.

Of course, you can say facility fees generate revenue too. But if you want to extricate yourself from the environment in which you can make a $310K base and think you can bring in $1.5-2M in revenue on your own and hire a single nurse, and have no other overhead, go ahead. It's just not based in reality.

And this whole conversation is sadly about your money. It's not about being part of a healthcare system, being a good representative for your profession, and taking care of people in need while you make a 5%er income.

[Many] SDNers poo-poo podiatry incessantly, claiming we're undervalued, and then gripe about a $310K base.

But look, it's an anonymous blog. I wouldn't expect much more.

Instead, there are some real issues with the profession that are noble and should be (and can be) fixed.

How can I be a role model representative for this profession when leadership failed me from day 1 in school? If a student or resident was to ask for my honest opinion on anything related to podiatry, I will tell them exactly as is with no fluff.

 

[air bud]

What are they paying you? It better be better than median gross pay for surgical podiatrists because that is all you are going to get. You won't bonus. You won't get good cases for boards.

Personally I would not take this job if you are fresh out of residency and getting board certified is important to you. If you have been practice for 5-10 years and are board certified then this is an ok job. Not great but just ok.

You won't bonus. But I got enough cases and diversity to get board certified at a rural gig doing 45 cases a year.

 

[air bud]

The way you communicate is rather condescending. Especially for a "leader".

You're reasoning is terrible on the salary explanation. This applies for every doctor. I will leave this alone as I won't get a real answer from you.

------

Please describe the real issues in podiatry. All I have seen you do is add more ambiguity to our training and definition of what podiatry certification is with the CAQ. I don't see people jumping up and down to get this credential.

Biggest issues in podiatry:
- No need for new schools but we added two more
- Too many bad residencies who double and triple scrub cases to meet numbers fraudulently; Poor oversight of residencies to maintain basic standards
- Too many podiatrists graduating each year without significant demand; Job saturation
- No universal scope for podiatry
- No "public" pushback against AOFAS and their slanderous journal articles in recent years
- huge disconnect between podiatry leadership and current practicing podiatrists
- Poor salaries for majority of practicing podiatrists. Especially private practice associates. Bad ROI

Every thing I've listed are things I think most would agree are major problems. This is not make believe. This is not a disgruntled podiatrist. I am addressing real issues that leadership continues to ignore then promotes "diabetes is increasing...podiatry is important..blah blah blah".

I think we just became best friends. Welcome aboard sir.

 

[diabeticfootdr]

The way you communicate is rather condescending. Especially for a "leader".

You only say this because I'm not afraid to sign my name to my comments. The posts by anonymous others are downright insulting.

You're reasoning is terrible on the salary explanation. This applies for every doctor. I will leave this alone as I won't get a real answer from you.

Ok. And which doctor at the hospital is bringing home the $1.5-2M you suggest the podiatrist is generating?

------

Please describe the real issues in podiatry.

Here are some ...

Lack of leadership at APMA
CPME's conflicts of interest influencing standards and enforcement (this includes everything CPME does, not just boards)
Having 2 boards for 1 residency program
The New York Scope of Practice dragging down the profession
The profession (CPME) focusing too much on creating "orthopedic foot and ankle surgeons" and not on what the public needs
Lack of unity and support for international podiatry
Lack of emphasis on academics, research and publishing in the profession

All I have seen you do is add more ambiguity to our training and definition of what podiatry certification is with the CAQ. I don't see people jumping up and down to get this credential.

There is no ambiguity in our training. It is clearly written in CPME 320. I just insist everyone acknowledge it.

Podiatrists did seek the CAQ ... and continue to do so. And we will continue to offer it.

Biggest issues in podiatry:
- No need for new schools but we added two more

Who are you blaming for this. You think "organized podiatry" did this? Podiatry is not organized. It's a free country and if you want to open a podiatry school and you can meet the criteria the profession published ... congratulations, you're the Dean!

CPME must approve any school that meets the criteria.

Also the Texas school (not affiliated with me) has more applicants than all the other schools combined.

- Too many bad residencies who double and triple scrub cases to meet numbers fraudulently; Poor oversight of residencies to maintain basic standards

Ok, if you have this evidence, do your job for the profession and the public and file a CPME 925 complaint.

- Too many podiatrists graduating each year without significant demand; Job saturation

This is your opinion.

- No universal scope for podiatry

This complaint is simply your misunderstanding on how US law works. There is no universal scope for MDs either. Any power not explicitly given to the federal government in the US Constitution, is given to the States. The practice of medicine is not part of the US Constitution, therefore, each state licenses ALL medical professionals independently and determines the scope of practice for each.

That being said, this year, scope bills passed in Alabama and Oregon. All but 2 states include the ankle for podiatry.

- No "public" pushback against AOFAS and their slanderous journal articles in recent years

Not only do some of us address them, we do so forcefully in the literature. Here is from the JBJS.

There are several other examples, including what almost every podiatric organization came together to do in Washington State.

What else do you want the "public" to do about these slanderous journal articles? If you have good suggestions, I'll recommend you for the committee that is handling this.

- huge disconnect between podiatry leadership and current practicing podiatrists

- Then run for something ...

- Poor salaries for majority of practicing podiatrists. Especially private practice associates. Bad ROI

Opinion unless you can provide evidence.

Every thing I've listed are things I think most would agree are major problems. This is not make believe. This is not a disgruntled podiatrist. I am addressing real issues that leadership continues to ignore then promotes "diabetes is increasing...podiatry is important..blah blah blah".

Yes, some of the things you bring up are major problems.

And I'll say the same thing I always say ... there are no lack of empty chairs at the "podiatry leadership table." If you have solutions to improve the profession, please take a seat.

 

[Adam Smasher]

[Many] SDNers poo-poo podiatry incessantly, claiming we're undervalued, and then gripe about a $310K base

As a PP guy I'm grossing about that much, but a very large chunk of it is going to my debt from my buyin. That in a nutshell is pur gripe: you can be successful in podiatry but it comes at a price. You shouldn't have to buy your job. You shouldn't have to relocate your entire life to Bent Armpit, Arkansas. You shouldn't have to waste your talents on menial tasks that are boring at best, degrading at worst.

 

[HardRoadPaved]

You shouldn't have to waste your talents on menial tasks that are boring at best, degrading at worst.

The podiatrist rubs the lotion on and always gets hosed

 

[Pronation]

Many] SDNers poo-poo podiatry incessantly, claiming we're undervalued, and then gripe about a $310K base.

This is a lie. Only RetrogradeNailingWithFury gripes about it.

Anyway, go ahead and disappear from this thread like you’ve done in every other thread when it comes to answering any real questions about what plagues this grossly oversaturated profession.

 

[newfeet]

As a PP guy I'm grossing about that much, but a very large chunk of it is going to my debt from my buyin. That in a nutshell is pur gripe: you can be successful in podiatry but it comes at a price. You shouldn't have to buy your job. You shouldn't have to relocate your entire life to Bent Armpit, Arkansas. You shouldn't have to waste your talents on menial tasks that are boring at best, degrading at worst.

This! ALL OF THIS! My grip with podiatry isn't the salary at this point I know I can make money... it's what I have done to get to this point. End of the day there are so many better ways to make money.

 

[Shiyuan]

When I (Lord Willing) sign on, i’ll make a new thread listing all the places I contacted to get a (good salary appropriate to my training) job.

It’s quite the list. Podiatry is saturated.

 

[Pronation]

Podiatry is saturated.

But bro, this is like totes just your opinion…

Even though a majority of people who have been in your shoes have mentioned that they desperately applied all over the country for many months or even years spanning many dozens or even hundreds of applications for organizational jobs (to try to avoid 100k PP garbage jobs).

 

[Adam Smasher]

Podiatry is saturated.

Opinion unless you can provide evidence.

LOL, this is memable

 

[Shiyuan]

But bro, this is like totes just your opinion…

Even though a majority of people who have been in your shoes have mentioned that they desperately applied all over the country for many months or even years spanning many dozens or even hundreds of applications for organizational jobs (to try to avoid 100k PP garbage jobs).

Yes, my list has ZERO pod groups for obvious reasons.

 

[newfeet]

Yes, my list has ZERO pop groups for obvious reasons.

3rd year I interviewed at 1 pod group. Never heard back. They don't need to be on your list.

 

[Pronation]

3rd year I interviewed at 1 pod group. Never heard back. They don't need to be on your list.

Well ackshually they do need to be on a resident’s list because they are competing with 100+ other applicants for the dozen or so hospital jobs posted throughout the entire country. 100k garbage PP job is still better than unemployment in this saturated trainwreck of a profession, of course the scummy PP owners know this too.

Of course this is all just personal opinion, as indicated by a podiatric politician.

 

[newfeet]

Well ackshually they do need to be on a resident’s list because they are competing with 100+ other applicants for the dozen or so hospital jobs posted throughout the entire country. 100k garbage PP job is still better than unemployment in this saturated trainwreck of a profession, of course the scummy PP owners know this too.

Of course this is all just personal opinion, as indicated by a podiatric politician.

Ugh. Then they will always claim there is no saturation because the crummy jobs are desirable over unemployed.

 

[Pronation]

Ugh. Then they will always claim there is no saturation because the crummy jobs are desirable over unemployed.

And then we go full circle when we say there is a high risk for garbage ROI in this profession based on the above. Of course, and again, this is just opinion and clearly not factual, as per that one guy who stands to benefit from the continued glut of students to feed his residency and fellowship.

 

[Hybrocure]

310k salary is like 3 podiatrists

 

[BubbaWub]

This is your opinion.

I applaud Dr. Rogers for his insight, and I fully agree with him on this point. I keep hearing about saturation on this forum but I am incredibly busy in my practice. I see routine care for approximately 80% of my patients, and new patients often have to wait months to see me. The new fellow in my practice only wishes to see nail patients 1 day a week, and will often cap how much he will see. The new wave seems to think that nail care is not important but it is what has built my practice into a pinnacle of success.

I think we need more podiatrists for practices such as mine, where there is an ever growing need for routine foot care and preventative care. I am beyond busy, as I am sure most of you are. I think the saturation argument is a little overblown. Thank you.

 

[dtrack22]

I applaud Dr. Rogers for his insight, and I fully agree with him on this point. I keep hearing about saturation on this forum but I am incredibly busy in my practice. I see routine care for approximately 80% of my patients, and new patients often have to wait months to see me. The new fellow in my practice only wishes to see nail patients 1 day a week, and will often cap how much he will see. The new wave seems to think that nail care is not important but it is what has built my practice into a pinnacle of success.

I think we need more podiatrists for practices such as mine, where there is an ever growing need for routine foot care and preventative care. I am beyond busy, as I am sure most of you are. I think the saturation argument is a little overblown. Thank you.

This is my new favorite account 🍻

 

[Pronation]

I’ve been had.

 

[dtrack22]

On a serious note. The $310k salary pissing match between LazarusWithFury and LCR above is pointless. In a full scope, hospital or MSG employed podiatry position, the only thing we should be discussing (in terms of our “worth”) is $/wRVU compensation.

You can’t poo-poo downstream revenue generated by a physician. It’s a large part of why $/wRVU compensation can vary from one surgical specialist to another. It’s a large part of the reason Urology and Gen Surg and Ortho and (probably) even OB gets paid more per wRVU generated than we do. They generate more $ for the hospital in facility fees with higher OR utilization and/or more ancillary services utilized. That allows the employer to give them a much higher % of the actual professional fees (e/m and CPT codes) that they bring in. Employers love to talk about being legally in trouble for paying you more than MGMA median. But that’s a load of crap. They could theoretically compensate you 100% of your professional fees. The only thing they can’t give you is a cut of the downstream/ancillary revenue you generate. We are all worth more than even $55 per wRVU. In one year of me having daily clinic in our wound care center, their revenue increased around $1 million. A majority of which can be attributed to increased visits, fees, utilization, etc. from my orders/patients.

People should be focusing more on negotiating higher $/wRVU numbers. Salary is generally meaningless. Unless maybe in academics where there are positions with no production related compensation, or it is minimal. Unfortunately…you have no leverage as a podiatrist. Because if you turn down an offer that ends up paying you $49 per wRVU, there is a 100% chance that a line of DPMs is standing there waiting to accept it.

 

[Shiyuan]

I think we need more podiatrists for practices such as mine, where there is an ever growing need for routine foot care and preventative care... I think the saturation argument is a little overblown.

I am happy for your success. As for the above statement, however:

 

[icebreaker32]

This is a lie. Only RetrogradeNailingWithFury gripes about it.

Anyway, go ahead and disappear from this thread like you’ve done in every other thread when it comes to answering any real questions about what plagues this grossly oversaturated profession.

He does give good advice about tactics to obtain hospital employment. He deserves credit for that in IMO and seems sincere in how his advice has helped others. As far as saturation, I disagree but he is entitled to his opinion.

The problem is finding a good organizational job often takes "guerrilla tactics" if one does not really standout or have connections.

Sure there are still a few potential organizational opportunities out there not listed for someone who tries much longer and harder, is willing to live in bear country and can sell themselves better than most to create their own job. This has been proven true time and time again on this forum. Can most new residency graduates do this and land a job? Absolutely not. There are limited potential jobs to be had/created this way.

The way most most will go onto to earn an average or above salary for podiatry is basically working as an underpaid associate for a couple years then using some capital (if they can save or source it) to open their own office. Not all offices that open will be successful.

There is a low basement with podiatry with very few good employed jobs out there. For as low as the basement is the ceiling is fairly high.

Many other healthcare professions do not have a low basement. There are good organizational jobs to be had with good salaries and good benefits in most locations. With most of those professions no one is stopping them from opening their own office or company either if they so had the desire.

 

[Adam Smasher]

I think we need more podiatrists for practices such as mine, where there is an ever growing need for routine foot care and preventative care.

Then do the profession a favor. Tell high school students and pre-health undergrads that this is what podiatry is and must continue to be. Show them your passion. Tell them what a great life it will yield. Make sure you are able to explain why it takes 7 years and 300k in loans to do it.

 

[Weirdy]

This is a lie. Only RetrogradeNailingWithFury gripes about it.

Anyway, go ahead and disappear from this thread like you’ve done in every other thread when it comes to answering any real questions about what plagues this grossly oversaturated profession.

I don't think Retrograde is CutsWithFury.

Too calm. Hasn't blown up or accused mods of picking sides yet.

 

[Pronation]

They must’ve upped his geodon

 

[Scrantonicity]

I don't think Retrograde is CutsWithFury.

Too calm. Hasn't blown up or accused mods of picking sides yet.

Also, hasn't told us to buy Cardano yet.

 

[Retrograde_Nail]

I don't think Retrograde is CutsWithFury.

Too calm. Hasn't blown up or accused mods of picking sides yet.

No in my short time here I see mods are not held to the same standards as community members and they close threads that seem to be too negative for podiatry. But other than that this community seems great. Happy to be here.

 

[Feli]

I believe we have already established that even in the upper echelon of podiatry that is hospital employment, we are severely underpaid. We fight for a low $54/wRVU while [e]very surgical sub-specialist hits 2-4x our income. And this is top 1% of our job market. Yes, our investment is very poor and the hospitals take full advantage. It's all a question of if you would rather not be paid your worth in a hospital or PP setting. That criminal 310k base would be taken every time. Because podiatry.

Game. Set. Match. ^^

 

[diabeticfootdr]

I applaud Dr. Rogers for his insight, and I fully agree with him on this point. … Thank you.

You’re welcome.

 

[DYK343]

I applaud Dr. Rogers for his insight, and I fully agree with him on this point. I keep hearing about saturation on this forum but I am incredibly busy in my practice. I see routine care for approximately 80% of my patients, and new patients often have to wait months to see me. The new fellow in my practice only wishes to see nail patients 1 day a week, and will often cap how much he will see. The new wave seems to think that nail care is not important but it is what has built my practice into a pinnacle of success.

I think we need more podiatrists for practices such as mine, where there is an ever growing need for routine foot care and preventative care. I am beyond busy, as I am sure most of you are. I think the saturation argument is a little overblown. Thank you.

Biggest difference here is many of the routine posters on here are wRVU model
0.51 wRVU for nails does not pay well.
Private practice can be a different story.

Private practice nail jails can do quite well financially (if not an associate...).

 

[diabeticfootdr]

Biggest difference here is many of the routine posters on here are wRVU model
0.51 wRVU for nails does not pay well.
Private practice can be a different story.

Private practice nail jails can do quite well financially (if not an associate...).

The system needs to change to award the intellectual knowledge for doing a comprehensive diabetic foot exam and not the actual procedure of nail care. Then a doctor can supervise a nail tech for the actual debridement, but document a CDFE.

In a high volume university-based clinic with various payers and sometimes no payer, we can already do this to some degree.

But to change it with CMS will be a process, and certainly won’t have the support of some in our profession afraid of change, but needs to be done and will be better for the profession and patients.

 

[Boba Foot]

It doesn’t really matter because PCPs seem to think anyone with an elevated A1C shouldn’t cut their own nails and send them to a pod, regardless of actual risk, and patients don’t really care about their diabetic risk stratification. All patients and PCPs think about is getting nails cut. The association has been made and that bell can’t be un-rung. As many others have said before, explaining CMS class findings, etc to patients and PCPs is exhausting.

 

[Retrograde_Nail]

It doesn’t really matter because PCPs seem to think anyone with an elevated A1C shouldn’t cut their own nails and send them to a pod, regardless of actual risk, and patients don’t really care about their diabetic risk stratification. All patients and PCPs think about is getting nails cut. The association has been made and that bell can’t be un-rung. As many others have said before, explaining CMS class findings, etc to patients and PCPs is exhausting.

Nobody cares. I do a ton of outreach and a lot of these routine nail patients don’t even have diabetes, neuropathy, PVD. Nothing. They just want their nails trimmed. Then they get pissed when they get a bill. Then they say “I never got a bill when I went to my old podiatrist”.

I have zero response for these patients other than saying “I’m employed doc, take it up with our billing department. I just document what I do”.

They either accept that or stop coming.

 

[air bud]

The system needs to change to award the intellectual knowledge for doing a comprehensive diabetic foot exam and not the actual procedure of nail care. Then a doctor can supervise a nail tech for the actual debridement, but document a CDFE.

In a high volume university-based clinic with various payers and sometimes no payer, we can already do this to some degree.

But to change it with CMS will be a process, and certainly won’t have the support of some in our profession afraid of change, but needs to be done and will be better for the profession and patients.

My intellectual knowledge rewards me when I turn that diabetic foot exam into a level 4 visit because I ordered a arterial Doppler due to ischemic rest pain and put them gabapentin and told them to come back in 3 weeks for medication management. Meanwhile I performed nail care, billed for appropriately but told them they don't qualify and won't do it again in the future.....level 4 new, 11721 level 3 established buh bye. Rinse repeat.

 

[Retrograde_Nail]

You only say this because I'm not afraid to sign my name to my comments. The posts by anonymous others are downright insulting.

They really aren't. The majority of the profession is tired of being labeled ungrateful, entitled, etc by older podiatrists who control a lot of the things the profession does but is also responsible for the saturation we see which creates poor ROI due to this saturation. Leadership is unwilling to curtail formation of schools and admissions. Leadership unwilling to hold residency programs more accountable for their lack of quality in training. We get podiatry today articles that really nobody can relate to.

Ok. And which doctor at the hospital is bringing home the $1.5-2M you suggest the podiatrist is generating?

Nobody is bringing home 1.5-2 million at a hospital job but there are plenty of podiatrists who generate that kind of income for their hospitals. It is a significant amount of money. At some hospitals (like community hospitals are the few independent hospitals left in this country) the podiatry service is a lot busier than some of the other surgical services. I generated these figures at my last job which was a small community hospital and I am track to do the same now that I've joined a much larger system.

Lack of leadership at APMA
CPME's conflicts of interest influencing standards and enforcement (this includes everything CPME does, not just boards)
Having 2 boards for 1 residency program
The New York Scope of Practice dragging down the profession
The profession (CPME) focusing too much on creating "orthopedic foot and ankle surgeons" and not on what the public needs
Lack of unity and support for international podiatry
Lack of emphasis on academics, research and publishing in the profession

I agree with a lot with what you are saying here. As I have been in practice now for almost 7 years I can certainly see the need for podiatrists who provide certain services in a hospital system. I think the "perfect" podiatrist in a hospital system is someone who is competent in all facets of surgery of the foot and ankle but when asked is most likely doing forefoot to ankle recon as ortho trauma and general ortho is not interested in it. Podiatrists should be doing wound care as this is something we excel at. Podiatrists should be doing limb salvage work (diabetic offloading surgeries, ex-fix and charcot). There will always be a need for diabetic limb salvage and wound care work. Always. Podiatrists really should be focusing less on TARs as only a handful of DPMs will be able to actually use this training. But the diabetic limb salvage and wound care will always be available and hospitals will need someone to do it. It is a good living and profitable from a wRVU standpoint as well.

I do think the New York scope of practice is a detriment. It always has.

I don't feel strongly about international podiatry. I think more people would embrace it if our education in the USA could allow for opportunities to work internationally in a seamless fashion.

Podiatrists did seek the CAQ ... and continue to do so. And we will continue to offer it.

For what purpose? What did it achieve? How are these people actually using the CAQ credental?

Who are you blaming for this. You think "organized podiatry" did this? Podiatry is not organized. It's a free country and if you want to open a podiatry school and you can meet the criteria the profession published ... congratulations, you're the Dean!

CPME must approve any school that meets the criteria.

Also the Texas school (not affiliated with me) has more applicants than all the other schools combined.

Clearly not you but apparently the CPME is the biggest culprit here and really should be getting more grief than they currently are right now.

Ok, if you have this evidence, do your job for the profession and the public and file a CPME 925 complaint.

This is good information

This is your opinion.

My opinion? Are we serious right now? What kind of offers are your graduates from the residency program getting? I bet a lot only have private practice jobs to turn to which are offering 75k-125K base salary with some convoluted bonus structure that nobody can hit. The fact you are unwilling to even acknowledge there is saturation in the podiatry job market really makes everything you say disingenuous whether you are correct or not. Not a great look.

This complaint is simply your misunderstanding on how US law works. There is no universal scope for MDs either. Any power not explicitly given to the federal government in the US Constitution, is given to the States. The practice of medicine is not part of the US Constitution, therefore, each state licenses ALL medical professionals independently and determines the scope of practice for each.

The cold hard facts are that if an orthopedist, who has not done an ankle fracture in 10 years but did a lot of them in residency, wants to get ankle privileges at the hospital most likely they will get them if they check the box on their application. I've never seen another orthopedist step in and say "Wait a minute, let's check this guys logs".

BUT I've seen NUMEROUS times podiatrists blocking other podiatrists from obtaining certain privileges despite the residency training and work experience of the podiatrist applying for said privileges being rather robust. It is not for the safety of the public either. It is because podiatrists are just terrible to each other and can't push anyone else around except themselves. Rather pathetic.

That being said, this year, scope bills passed in Alabama and Oregon. All but 2 states include the ankle for podiatry.

Congrats, especially for Alabama. Never thought that would happen.

Not only do some of us address them, we do so forcefully in the literature. Here is from the JBJS.

Wrong. You and others may have responded but we had to ask for this. It should have been disseminated to the entire profession via a podiatry today article, etc. To let the profession know that we didn't just sit back and take this on the chin. Would have been great for morale and possibly unifying the profession a little bit.

There are several other examples, including what almost every podiatric organization came together to do in Washington State.

That situation was way more public than how the profession handled the articles in my opinion. That was a great response.

- Then run for something ...

What position? What is the most direct way to get involved that actually would give someone some real responsibilities?

Opinion unless you can provide evidence.

Patrick DeHeer quoted 157K average for BLS statistics. That is not very good considering the cost of education and training. Anybody who thinks that is great ROI on 7 years of education and training with 300-400K debt is nuts. But we know that most private practice jobs are not even offering close to 157K average salary. We know that PP jobs are not even offering reasonable bonuses. I think this has been lamented numerous times on here but our opinion doesn't matter of course. I ask you to maybe put some data together from your own residents who graduate and most likely end up in PP jobs and let's see what kind of offers they are getting. I doubt any PP offers they are getting even touch 157K base salary to start.

And I'll say the same thing I always say ... there are no lack of empty chairs at the "podiatry leadership table." If you have solutions to improve the profession, please take a seat.

Where

 

[Pronation]

Guaranteed that the podiatry influencer will ignore the above post.

 

[Adam Smasher]

Patrick DeHeer quoted 157K average for BLS statistics. That is not very good considering the cost of education and training. Anybody who thinks that is great ROI on 7 years of education and training with 300-400K debt is nuts. But we know that most private practice jobs are not even offering close to 157K average salary. We know that PP jobs are not even offering reasonable bonuses. I think this has been lamented numerous times on here but our opinion doesn't matter of course. I ask you to maybe put some data together from your own residents who graduate and most likely end up in PP jobs and let's see what kind of offers they are getting. I doubt any PP offers they are getting even touch 157K base salary to start.

First off, thanks for a well reasoned response.

Secondly, in fairness to Dr Daheer, he quotes 157k in the context of that figure being averaged down by (1) resident salaries and (2) PP owners expensing a lot of stuff to bring down their reported gross.

Exception (1) is stupid, I figure residents make up about 10% of all podiatrists in practice. If you weigh out resident salaries at around 65k (totally guessing here), that brings the average gross up to 167k. Is that better?

Exception (2) is also stupid. What can you expense? Cell phone at $1k/year? CME and licenses at say $3k? I vaguely understand you can expense a "company car" but don't know how to do it legitimately. So maybe there are hundreds of thousands in write-offs I don't know about in which case I acknowledge I'm the stupid one.

Meanwhile any PP owner spends their prime years managing practice debt with post tax dollars.

Better question is whats does the podiatry wage curve look like? How much does a podiatrist earn first year out? at 5 years out? 10 years?

 

[diabeticfootdr]

Exception (2) is also stupid. What can you expense? Cell phone at $1k/year? CME and licenses at say $3k? I vaguely understand you can expense a "company car" but don't know how to do it legitimately. So maybe there are hundreds of thousands in write-offs I don't know about in which case I acknowledge I'm the stupid one.

Meanwhile any PP owner spends their prime years managing practice debt with post tax dollars.

Actually it’s not stupid, and not all about expenses, per se. It’s about what you declare as W-2 income vs dividends from a business you own.

Dividends are paid on 1099-DIV and still taxed at the ordinary income tax rate, but not subject to payroll tax, which if you’re self-employed is 12.4%.

So self-employed business owners divide up their income in reportable salary vs investment income for the business.

Disclaimer:
*qualified dividends are taxed at capital gains rates under certain circumstances, but podiatry practices would rarely (if ever) be a qualified dividend so they would be taxed at ordinary rates, just minus payroll taxes*

*please consult your tax professional*

 

[diabeticfootdr]

Secondly, in fairness to Dr Daheer, he quotes 157k in the context of that figure being averaged down by (1) resident salaries and (2) PP owners expensing a lot of stuff to bring down their reported gross.

Dr. DeHeer doesn’t address another issue that reduces the BLS reported W-2 income for podiatrists.

Occupations are self reported on tax forms.

What do you or your accountant declare?

Podiatrist or …

Physician
Surgeon
Foot and Ankle Surgeon
Doctor
Etc.

These are coded by the IRS into an occupation taxonomy and reported in the BLS. Data from the lower list ends up in a different profession.

 

[Adam Smasher]

My practice as well as that of almost everyone else I know is organized as a LLC and not an S-corp, so I have no dividends. @Feli is better connected than I am so maybe s-corps are the norm. I understand there are advantages in terms of retirement contributions being an LLC but someone else can educate me if I'm wrong.

I report myself as a podiatrist just because it's most accurate, for better or for worse.

Also, I'm 90% sure Dr Rogers knows better but: as co-owner in private practice you don't get W2 income, you report a K1.

Anyway, this is an important question "how much money are podiatrists really making?" If it's underestimated by the bls, wouldn't the best way to recruit prehealth students be to get an accurate statistic?

 

[diabeticfootdr]

My practice as well as that of almost everyone else I know is organized as a LLC and not an S-corp, so I have no dividends. @Feli is better connected than I am so maybe s-corps are the norm. I understand there are advantages in terms of retirement contributions being an LLC but someone else can educate me if I'm wrong.

I report myself as a podiatrist just because it's most accurate, for better or for worse.

Also, I'm 90% sure Dr Rogers knows better but: as co-owner in private practice you don't get W2 income, you report a K1.

Anyway, this is an important question "how much money are podiatrists really making?" If it's underestimated by the bls, wouldn't the best way to recruit prehealth students be to get an accurate statistic?

Professional corporations (doctors, lawyers, accountants) in most states are S-corps.

But even if you’re an LLC you have to declare how to be treated by the IRS and your account probably checks the box for S-corp election. So you file your taxes as an S-corp.

K-1 is for ownership interest, usually a loss or break-even, but 1099-DIV is a more common way to take distributions from a business. But you must have some W-2 income if you’re employed (even self-employed).

 

[air bud]

Correct, this has inherently been one of the issues with this BLS data is with such a large percentage employed in private practice you either have low paying W-2 salaries or inaccurate numbers as the goal of any business owner is to show your reported income as small as possible. Contrast this with other specialties where you have a much higher percentage of W-2 employees you can get a better idea of numbers. And also orthopedics, dermatology etc is going to have a much much smaller standard deviation than Podiatry will because..... podiatry.

 

[Adam Smasher]

We definitely file as an LLC and not an S-corp, I don't get a 1099-DIV, I definitely don't get a W2, and obviously this is all something I need to bring to our tax advisor's attention if we're overexposed to taxation. I freely admit, how we organize ourselves in my particular situation was a decision made by my partners who've been at this for decades who could very well have been doing everything wrong...because podiatry.

I return the discussion, @diabeticfootdr , to my salient question how much money are podiatrists making really? what's our wage curve really look like? If you're talking to a college junior who just sat for the MCAT and don't know anything about what trajectory their career will take, what do you tell them the pot of gold at the end of the rainbow is going to look like? Don't say the question is unanswerable, it depends on XYZ, because that young person who is wagering their life deserves an answer.

I just checked, UT San Antonio has a school of business/economics. Reach out to someone and coauthor a paper on this. Then submit the results in JAPMA who loves to publish navel-gazy topics like this. Then plaster the results all over the pre-health communications and I will be the first to admit that we were all wrong to have ever complained about the ROI in podiatry.

 

[air bud]

We definitely file as an LLC and not an S-corp, I don't get a 1099-DIV, I definitely don't get a W2, and obviously this is all something I need to bring to our tax advisor's attention if we're overexposed to taxation. I freely admit, how we organize ourselves in my particular situation was a decision made by my partners who've been at this for decades who could very well have been doing everything wrong...because podiatry.

I return the discussion, @diabeticfootdr , to my salient question how much money are podiatrists making really? what's our wage curve really look like? If you're talking to a college junior who just sat for the MCAT and don't know anything about what trajectory their career will take, what do you tell them the pot of gold at the end of the rainbow is going to look like? Don't say the question is unanswerable, it depends on XYZ, because that young person who is wagering their life deserves an answer.

I just checked, UT San Antonio has a school of business/economics. Reach out to someone and coauthor a paper on this. Then submit the results in JAPMA who loves to publish navel-gazy topics like this. Then plaster the results all over the pre-health communications and I will be the first to admit that we were all wrong to have ever complained about the ROI in podiatry.

He just has all his resident do a fellowship year then hires them so they never hit the market.

 

[Feli]

My practice as well as that of almost everyone else I know is organized as a LLC and not an S-corp, so I have no dividends. @Feli is better connected than I am so maybe s-corps are the norm. I understand there are advantages in terms of retirement contributions being an LLC but someone else can educate me if I'm wrong...

LLC taxed as S-corp is what you want.
Talk to accountant... allows a lot more legit deducts, it's two or three IRS forms when you form the LLC or PLLC (depends on state).

 

[dtrack22]

LLC taxed as S-corp is what you want.
Talk to accountant... allows a lot more legit deducts, it's two or three IRS forms when you form the LLC or PLLC (depends on state).

I would do it this way. You want to be able to have as much of your income taxed as a dividend/distribution as you reasonably can. As opposed to having it all taxed as regular income.

LLC taxed as S-Corp seems to be the most tax-efficient way to pay yourself

 

[Adam Smasher]

I love that we've spent a day ignoring retrogradenailwithfury's smart comments and instead debated my troll post

 

[diabeticfootdr]

Sorry, I just saw your reply ... been busy winning for all DPMs in Oregon.




But seriously, below ...

I agree with a lot with what you are saying here. As I have been in practice now for almost 7 years I can certainly see the need for podiatrists who provide certain services in a hospital system. I think the "perfect" podiatrist in a hospital system is someone who is competent in all facets of surgery of the foot and ankle but when asked is most likely doing forefoot to ankle recon as ortho trauma and general ortho is not interested in it. Podiatrists should be doing wound care as this is something we excel at. Podiatrists should be doing limb salvage work (diabetic offloading surgeries, ex-fix and charcot). There will always be a need for diabetic limb salvage and wound care work. Always. Podiatrists really should be focusing less on TARs as only a handful of DPMs will be able to actually use this training. But the diabetic limb salvage and wound care will always be available and hospitals will need someone to do it. It is a good living and profitable from a wRVU standpoint as well.

Appreciate that we can find common ground to agree upon.

I do think the New York scope of practice is a detriment. It always has.

Needs to change ASAP. Any further delay harms the profession and each year we "wait" we're giving up on a whole class of DPMs who choose to practice in NYS. Because if you don't do what you're trained to do for 2 years, you're like to never do it again in your career. I'm not willing to wait any longer. NYSPMA has tried for ~17 years to fix this legislatively. It hasn't worked. They claim to have some new momentum, we're monitoring, but not for long.

I don't feel strongly about international podiatry. I think more people would embrace it if our education in the USA could allow for opportunities to work internationally in a seamless fashion.

There are 51 podiatry schools in Europe, 9 in Australia, 1 in New Zealand, 1 in South Africa, and 2 in Canada.

International Pods in Commonwealth countries (UK, Australia, NZ, South Africa, Malta) and Ireland have achieved parity with their medical colleagues, as far as their degree is concerned. Physicians in those countries have an MBBS (Medicine Bachelors/Bachelors of Surgery). The have a BPod. Some of them have prescribing rights and surgical privileges.

Spain has a new expanded scope of practice and the only country really seeing big increases in podiatry applicants. The pods there have unlimited prescribing rights and surgical privileges. They're also producing some great (and voluminous) literature.

Canada has a fragmented system with 3 levels of podiatry (chiropodists, BPods, and DPMs) and the differences in scope of practice between provinces is larger than the differences between countries. There are 2 schools in Canada, one offering a Diploma (Toronto) and the other a DPM (Quebec).

Belgium and France have great systems with BPods, but no OR surgical privileges. However, their education system is fantastic for podiatry.

Central and Northern European countries have a lower level of education/training and focus mostly (but not all) on biomechanics and orthoses.

Romania just added podiatry as a recognized profession and modeled after the Commonwealth, but no degree program yet in the country.

Barbados and Pakistan are preparing to start a degree program.

In addition to this, podiatrists practice in many countries, like Israel, Hong Kong, Saudi Arabia, UAE, Qatar, and in the Caribbean.

There are podiatric surgeons in India, however they are actually MD/MBBS surgeons who call themselves "podiatric" surgeons as a description of the anatomy, foot and ankle. Podiatry is not a legally protected profession in India, so anyone can use the word in their occupation.

*Apologies to anyone I left out or if I offended anyone with my characterization and anyone from these countries can chime in if they want opine.

My point is, we're only as strong as our weakest partner. We should support any country that wants to expand their education, training, and scope. It will improve the international reputation of podiatry. Standardized training/definitions also helps with career mobility across the EU and internationally.

This is the goal of ABPM International, to create a testing threshold for the Commonwealth BPod level.

I've had the honor of traveling the world and visiting many schools, as well as hosting international pods in the US. I have learned so much for our colleagues and have tremendous respect for them.

Clearly not you but apparently the CPME is the biggest culprit here and really should be getting more grief than they currently are right now.



This is good information

I agree, CPME is failing at its job(s). Plain and simple. Conflicts of interest abound.

CPME does 4 things (accredit schools, approve residencies/fellowships, recognize boards, approve CMEs) that the MD profession has 4 separate organizations to do (LCME, ACGME, ABMS, ACCME).

CPME's authority as an accrediting agency for podiatry schools is governed by federal law. If they don't follow their bylaws, they risk all students access to federal loans.

Sorry ... I wrote a lot here ...

 

[newfeet]

Sorry, I just saw your reply ... been busy winning for all DPMs in Oregon.

View attachment 374033


But seriously, below ...


Appreciate that we can find common ground to agree upon.


Needs to change ASAP. Any further delay harms the profession and each year we "wait" we're giving up on a whole class of DPMs who choose to practice in NYS. Because if you don't do what you're trained to do for 2 years, you're like to never do it again in your career. I'm not willing to wait any longer. NYSPMA has tried for ~17 years to fix this legislatively. It hasn't worked. They claim to have some new momentum, we're monitoring, but not for long.



There are 51 podiatry schools in Europe, 9 in Australia, 1 in New Zealand, 1 in South Africa, and 2 in Canada.

International Pods in Commonwealth countries (UK, Australia, NZ, South Africa, Malta) and Ireland have achieved parity with their medical colleagues, as far as their degree is concerned. Physicians in those countries have an MBBS (Medicine Bachelors/Bachelors of Surgery). The have a BPod. Some of them have prescribing rights and surgical privileges.

Spain has a new expanded scope of practice and the only country really seeing big increases in podiatry applicants. The pods there have unlimited prescribing rights and surgical privileges. They're also producing some great (and voluminous) literature.

Canada has a fragmented system with 3 levels of podiatry (chiropodists, BPods, and DPMs) and the differences in scope of practice between provinces is larger than the differences between countries. There are 2 schools in Canada, one offering a Diploma (Toronto) and the other a DPM (Quebec).

Belgium and France have great systems with BPods, but no OR surgical privileges. However, their education system is fantastic for podiatry.

Central and Northern European countries have a lower level of education/training and focus mostly (but not all) on biomechanics and orthoses.

Romania just added podiatry as a recognized profession and modeled after the Commonwealth, but no degree program yet in the country.

Barbados and Pakistan are preparing to start a degree program.

In addition to this, podiatrists practice in many countries, like Israel, Hong Kong, Saudi Arabia, UAE, Qatar, and in the Caribbean.

There are podiatric surgeons in India, however they are actually MD/MBBS surgeons who call themselves "podiatric" surgeons as a description of the anatomy, foot and ankle. Podiatry is not a legally protected profession in India, so anyone can use the word in their occupation.

*Apologies to anyone I left out or if I offended anyone with my characterization and anyone from these countries can chime in if they want opine.

My point is, we're only as strong as our weakest partner. We should support any country that wants to expand their education, training, and scope. It will improve the international reputation of podiatry. Standardized training/definitions also helps with career mobility across the EU and internationally.

This is the goal of ABPM International, to create a testing threshold for the Commonwealth BPod level.

I've had the honor of traveling the world and visiting many schools, as well as hosting international pods in the US. I have learned so much for our colleagues and have tremendous respect for them.



I agree, CPME is failing at its job(s). Plain and simple. Conflicts of interest abound.

CPME does 4 things (accredit schools, approve residencies/fellowships, recognize boards, approve CMEs) that the MD profession has 4 separate organizations to do (LCME, ACGME, ABMS, ACCME).

CPME's authority as an accrediting agency for podiatry schools is governed by federal law. If they don't follow their bylaws, they risk all students access to federal loans.


Sorry ... I wrote a lot here ...

Barbados? 🤔 I would signed up to teach there and everything bad I’ve said would be erased.