How much can you make starting out of residency?

[NatCh]

Is this a uniquely Podiatry thing? Is there any other specialty that routinely sees 50+ patients a day?

Derm? Radiology (sort of, not really)?

There's no way I could do a good job seeing 50+ patients per day.

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[Scrantonicity]

Derm? Radiology (sort of, not really)?

There's no way I could do a good job seeing 50+ patients per day.

Only way see that many effectively requires you to have a crack staff, and not let patients talk your ear off. It's an art, and unfortunately the "crack staff" can get burned out easily, which translates into you doing more, which ends up burning you out. Then you train up another crack staff, and the cycle continues. That's been my experience anyway...

 

[NatCh]

Only way see that many effectively requires you to have a crack staff, and not let patients talk your ear off. It's an art, and unfortunately the "crack staff" can get burned out easily, which translates into you doing more, which ends up burning you out. Then you train up another crack staff, and the cycle continues. That's been my experience anyway...

Ooof. Redlining every day of your career would suck.

 

[VagabondDoc]

Only way see that many effectively requires you to have a crack staff, and not let patients talk your ear off. It's an art, and unfortunately the "crack staff" can get burned out easily, which translates into you doing more, which ends up burning you out. Then you train up another crack staff, and the cycle continues. That's been my experience anyway...

It definitely is an art lol

 

[Feli]

Only way see that many effectively requires you to have a crack staff, and not let patients talk your ear off. It's an art, and unfortunately the "crack staff" can get burned out easily, which translates into you doing more, which ends up burning you out. Then you train up another crack staff, and the cycle continues. That's been my experience anyway...

Yeah, it's only really possible in private practice (and rare exception of large school/residency clinic using them as PAs)... and still has to be fairly well-run office regardless. It is easy to see 50+ if it's a nail jail practice where the doc just pops in at the end to do a 2min exam and hello. Any podiatrist could do that C&C high volume... kinda like a DDS office with all just dental cleaning visits.
It is fairly tough for any DPM to see 50+ with actual mix pathology of derm/ortho/sports/diab and some surgery, but I have worked in a few of them that did it pretty well. There are some LONG days of charting, but you adjust and can keep up with the pt flow. It sounds and seems impossible until you are in that world and just adapt to it. A lot of it is just giving up control (which is tough if you like patients and can't retain good staff). Dtrack said it well with regard to call/availability, but I think we often assume we are more important than we really are... MAs can be trained to do basically everything except diagnostics and procedures if you are willing to create a system for a manager to train them... or them to train each other.
You definitely need a high staff, high volume setup with many MAs, good manager/trainer, many exam rooms, fairly quick visits, procedure setups done well, staff does all of the nail care, DME, bandage removals, all Rx, brings u/s in, etc with just verbal cues. It's the type of office were you walk into a new pt PF consult, and the MA already has the XR up on screen and also printed it, PF stretching handout ready, knows pt shoe size for possible insoles, injections are in top drawer, u/s is outside the door, etc.

I definitely prefer seeing about 30-40 and doing a bit more myself, though. Maybe it's just because I haven't finished boards yet, but I just don't like having that feeling of being behind all day, almost zero breaks, having to delay some procedures since I know I'm far behind, a ton of charts at the end. I would do it if I had a good scribe, and I might do it anyways once I finish boards and quit getting my charts nitpicked and blown apart.

...I don't think it's too uncommon to see 50+ in PP in other various MD specialties, though. A lot of them do it well. Almost any ortho or interv card doc I've ever met in PP does it. Many gen surg, ENT, derm, IM specialties like Endo or Rheum, and other procedure or non-procedure PP specialists average 50+ by spending 15-20+min with new pts but only 5-10min or less with f/u and having scribe in addition to many MAs. A lot of the surgeon/procedure doc office staff one or more PAs (or RN or residents), though... so it depends if you want to look at that as just staff or additional "provider" seeing their own pts. Regardless, patients often won't even see the doc at a routine f/u or post-op unless it's the hi-and-bye at the end. The doc basically just hits the new pts, complications, complex f/u ones.

The system for 50+ can be done, but the question is if you want it or if you can create it. I think that is the biggest scam running: hospitals (or mediocre PP with crap staffing or marketing) hiring docs with teaser of productivity pay, then giving them NO control over the staffing, marketing, supplies, scheduling, call schedule, or other stuff that can create efficiency. The clinic just withers on the vine, and the doc can do nothing but steam about it and enjoy their base salary. I don't fault the legitimately busy PPs that crank volume and want to pay docs who will work for good pay in that fast paced office setup, though.

 

[PTPuser]

I’m brand new out of residency and my first year gross is an inch north of $300K in a great location and aside from the $$ there’s benefits like holidays, sick, vacay, malpractice, flexibility etc. Dentistry probably wins hands down since you dont have to do a 3-year residency and also there’s probably more opportunity in more places I’d assume.

One thing that MD/DO and nursing specialities tend to do is calculate how much you’re paid for each hour & day that you are required to be at work. Locum assignments are an example that will tell you up front. If you think about it, this is the single most important factor when looking into any job. Really take a look into if late days or weekend are required and how much PTO you’re getting per year and do the math for both $/hr and $/day of work from your gross income. Compare that # to colleagues and people in other specialties. Things really start to come into perspective.

what kind of practice are you in? like, MSG, PP?

 

[Feli]

...calculate how much you’re paid for each hour & day that you are required to be at work. Locum assignments are an example that will tell you up front. If you think about it, this is the single most important factor when looking into any job. Really take a look into if late days or weekend are required and how much PTO you’re getting per year and do the math for both $/hr and $/day of work from your gross income. Compare that # to colleagues and people in other specialties. Things really start to come into perspective.

Yes, it is critical to talk to every current and any past doc that you can who works for the hospital or group you may join (mostly just DPMs, but even try others if you can).

HUGE difference QOL between making $250k working 40hr/wk no call vs $300k for 70hr/wk and on-call 15 days/mo.

It blows my mind how many grads take a job based on their hopes or the promises of the hiring doc/HR person (easy hours, little call, partnership or bonuses, etc). Talk to the people who would know: current and recent past docs. Past ones tend to be the most helpful sometimes, but talk to as many as you can to weed out the occasional hospital-pumper, sour grapes guy, etc. The picture clears up pretty quick as to whether it's a good place to work and probably fits your needs.

 

[Pronation]

Yes, it is critical to talk to every current and any past doc that you can who works for the hospital or group you may join (mostly just DPMs, but even try others if you can).

HUGE difference QOL between making $250k working 40hr/wk no call vs $300k for 70hr/wk and on-call 15 days/mo.

It blows my mind how many grads take a job based on their hopes or the promises of the hiring doc/HR person (easy hours, little call, partnership or bonuses, etc). Talk to the people who would know: current and recent past docs. Past ones tend to be the most helpful sometimes, but talk to as many as you can to weed out the occasional hospital-pumper, sour grapes guy, etc. The picture clears up pretty quick as to whether it's a good place to work and probably fits your needs.

Some good points.

Do you have recommendations on how to find former pods at a hospital/practice?
My recommendation is to use Internet Archive: Wayback Machine to find previously archived physician profile pages.

About your $250k vs $300k comment. I doubt there are many hospital positions that pay less than $40/wRVU. Working something absurd like 70 hour weeks with 15 days of call would generate easily 1000 RVU per month… that’s $400k… and miserable.

 

[Feli]

Some good points.

Do you have recommendations on how to find former pods at a hospital/practice?
My recommendation is to use Internet Archive: Wayback Machine to find previously archived physician profile pages.

About your $250k vs $300k comment. I doubt there are many hospital positions that pay less than $40/wRVU. Working something absurd like 70 hour weeks with 15 days of call would generate easily 1000 RVU per month… that’s $400k… and miserable.

I just ask them at or after the interview (the hospital, the PP owner, current assoc/partners/employees, etc), "who would be good to talk to" and "I saw Dr. X worked here at this hospital until last year, what would she tell me." I call the clinic and ask for a doc call back (sometimes the disconnect between HR and the docs on the ground level is amazing). If they, esp the owner/chief, pretend to not know any contacts for an interviewee to talk to or flat out tell you you can't contact those former people, umm, yeah (I've had that happen a couple times... contacted the 'forbidden' person asap for laughs).

If you can get even one or two past employees/partners from web or employer or networking, you can ask those people and network for more and more. It's like those FBI/CIA background check calls I used to get for old classmates once in awhile to find out if the person partied, did drugs, who else they knew that they could talk to... you can figure out everything bwahahaha.

Yeah, that's a good point that most hospitals and groups or MSG have at least some rvu or collections that will somewhat negate too many hrs/pts per wk.
There are a few VA/IHS or other straight salary setups where it's understaffed and hard to be efficient. More common they might just work nearly that much, though - esp if someone quits and the call/clinic gets murderous for quite awhile (no rvu there either). Pretty much any hospital, esp govt, is terrible about replacing people in a timely manner. Those are the ones where remaining DPMs need to straight up refuse... do a bit of call as reasonable yet let the ER handle it as best they can until their molasses HR gets more docs hired to share the load.

 

[NatCh]

I am trying to consider pros and cons of podiatry and dentistry

My daughter is getting four wisdom teeth out in a couple of hours.

Total time = ~20 minutes

Total charge = $5000

Dentistry FTW

 

[heybrother]

My daughter is getting four wisdom teeth out in a couple of hours.

Total time = ~20 minutes

Total charge = $5000

Dentistry FTW

Lure him out to the backwoods slopes in your helicopter and then avalanche him.

 

[Feli]

My daughter is getting four wisdom teeth out in a couple of hours.

Total time = ~20 minutes

Total charge = $5000

Dentistry FTW

Them wisdom teeth also don't claw back years later like podiatry "practice management" things: balance braces, amnio injects, MBAs coded as STJ dislocation and arthrodesis 😇

 

[DYK343]

My daughter is getting four wisdom teeth out in a couple of hours.

Total time = ~20 minutes

Total charge = $5000

Dentistry FTW

To be fair if you owned your surgery center and did a 20minute cheilectomy medicare would pay $4441.

I am going to assume the dentist is doing this in their office?

My dentist is ALWAYS on vacation. She makes fun of me all the time for working the hours I work while she tells me about all her trips she takes. I should have been a dentist.

- -
Edit this post is in error. The 4441 includes use of implant. A chilectomy reimburses surgery center $1335

 

[NatCh]

Lure him out to the backwoods slopes in your helicopter and then avalanche him.

Dentist helicopter:

My helicopter:

 

[dtrack22]

Neither one of those are the “helicopter” I saw on your onlyfans page…

 

[NatCh]

Neither one of those are the “helicopter” I saw on your onlyfans page…

LMAO

 

[heybrother]

To be fair if you owned your surgery center and did a 20minute cheilectomy medicare would pay $4441.

I am going to assume the dentist is doing this in their office?

My dentist is ALWAYS on vacation. She makes fun of me all the time for working the hours I work while she tells me about all her trips she takes. I should have been a dentist.

Can you elaborate on this ie. did someone at a surgery center tell you this or do you know how to calculate this / where it comes from?

This was quite a bit more than I thought they received for this service. I went poking around and downloaded most of the zip files on Medicare's ambulatory surgical center websites, but I can't seem to find where they spell this out.

My take home if this is true is our cases are worth more than I thought they were worth.

 

[dtrack22]

My take home if this is true is our cases are worth more than I thought they were worth.

As long as you aren’t opening up lapiplasty kits on every case…

 

[DYK343]

Can you elaborate on this ie. did someone at a surgery center tell you this or do you know how to calculate this / where it comes from?

This was quite a bit more than I thought they received for this service. I went poking around and downloaded most of the zip files on Medicare's ambulatory surgical center websites, but I can't seem to find where they spell this out.

My take home if this is true is our cases are worth more than I thought they were worth.

page 11

Maybe not the best source from synthes hardware company. Rates are 2021. But thats my source.

- - -

But now that I look closer. I made an error. Thats "with implant". Missed that part.

The actual reimbursement is $1335 which is substantially lower. Which is also why we should have all been dentists - or use criminal implants.

 

[air bud]

As long as you aren’t opening up lapiplasty kits on every case…

How else do you fix a bunion? Also make sure doing it for 1st mpj fusions. My rep told me it was a good idea.

 

[heybrother]

How else do you fix a bunion? Also make sure doing it for 1st mpj fusions. My rep told me it was a good idea.

That way you get to use the positioner. Not sure why you need it but it's in there.

 

[Pronation]

As long as you aren’t opening up lapiplasty kits on every case…

At a surgery center that I’ve invested in? Lapidus with k wires. In fact save a little extra money by cutting 1 k wire in half and using both ends.

 

[wakaflocka88]

At a surgery center that I’ve invested in? Lapidus with k wires. In fact save a little extra money by cutting 1 k wire in half and using both ends.

Lapidus with 2 Synthes 3.5 screws. $100 or so? We’re still waiting for Treace to post post-op laterals for the bunions they advertise.

 

[CutsWithFury]

Lapidus with 2 Synthes 3.5 screws. $100 or so? We’re still waiting for Treace to post post-op laterals for the bunions they advertise.

Good eye. I took over a fellowship trained DPM's practice on a locum contract and followed a lot of the lapiplasty surgeries they did. A couple of them had elevated first rays. I could see this happening if the jig is not put on properly.

 

[air bud]

Lapidus with 2 Synthes 3.5 screws. $100 or so? We’re still waiting for Treace to post post-op laterals for the bunions they advertise.

Whatas wrong with lapiplasty laterals? Elevation? Haven't seen any problems other than the massive amounts of shortening....jk but there is but nobody has had an issue with n =9 for me.

 

[CutsWithFury]

Whatas wrong with lapiplasty laterals? Elevation? Haven't seen any problems other than the massive amounts of shortening....jk but there is but nobody has had an issue with n =9 for me.

I’ve seen some elevated first rays

 

[podgod22]

Welp, I'll chime in with my conundrum. I've been out of residency 6 years now and I hope new grads can use my experience for their own planning/knowledge and that even more seasoned practitioners than myself can help advise me on what the next steps may be, because frankly, I feel burned and at a dead end.

Backstory:

Finished residency 6 years ago, found a nice office job in a major city and its surrounding suburbs. Small, myself and the owner. Practice was and is still going well clinically, but lately I feel like I'm not certain what the future is.

I started slow, a few patients etc. Owner had me on a full salary (albeit very low, less than 100K), At the time I was like hey its an opportunity . The guy has been around a while and is well versed with a ton, and he's a smart guy. Maybe I can learn a lot. But I had this low salary and I took it decided I can work my tail off. Which is did and currently and still do. I was given scenarios for raises with salary base and via percentages.
Practice consisted of a mix of office work, surgeries, nursing homes/living facilities and hospital consults blah blah. He barely takes call. I kid you not, I do 99.9% of it. All the time. My days vary quite a bit due to this. Some days I leave my home at 430 AM, just so I can hit up hospitals, head to clinic then finish off my day and hopefully try to make it back by 6 pm so my kids know I'm around. Some weeks I'm easily working 7 days a week, just to catch up.

I slowly built my part of the practice . I stated off seeing maybe 5-6 patients a day that were hand offs. Today I'm easily at 25-35 depending on the day. Throughout the years, I became board certified by ABPM that same year I started, and slowly chipped away at ABFAS and obtained that certification as well. This was actually a stipulation that I had to meet per my contract. Anyone that's been in this boat knows how intense this pressure is.

I've been doing a ton of surgeries, procedures orthotics , consults, home visits, NH visits, etc. Been easily bringing in upwards of 400-500k in production. Never missed a beat or a days of work.

Pandemic we took a hit, luckily my boss never really cut salary. I thought he was looking out for me but now that Im thinking it might have been because he was required to keep me around to receive those government funds. But that's another story who knows. I
My raises promotions percentages etc were all put off then. Which I understood. Always said hey thank you for all you've done for me don't worry about my contract stuff lets just get the office running. Im just happy to be practicing.
So we kept that up he was appreciative (obviously).

Fast forward 2.5 years.

There has been no increase thus far. I make the same as I did 6 years ago. Every time I bring it up, it just kinda of gets brushed off. I've busted my tail and Im starting to feel it. Bare in mind I don't have ANY other benefits with this gig. No 401, IRA, etc. I get the minimal 1 week of PTO, minimal CME etc. which when I try to use, I get a little push back on. Honestly I think as I built seniority my situation wound change. We discussed partnerships and ownerships etc, which honestly the prices seem exceeding ludacris. I don't necessarily need to get into great detail about that. What's important is that I'm fairly certain partnership/ownership at this group is not what's best for me.

I've looked at other practices but I could never be another associate. A couple guys I spoke with seem to have nicely running practices. Very intrigued but a little nervous about giving up a steady salary for something that may or may not be. With all the changes in insurances, the thought of being solo is a little intimidating, but ownership has always been something I strived for.

Any seasoned docs, newer docs or anything care to chime in on both my current arrangement, and with the nervousness of buying/becoming owner in todays medical world?

Appreciate any and all input, praise and criticism welcome.

PG

 

[Pronation]

Welp, I'll chime in with my conundrum. I've been out of residency 6 years now and I hope new grads can use my experience for their own planning/knowledge and that even more seasoned practitioners than myself can help advise me on what the next steps may be, because frankly, I feel burned and at a dead end.

Backstory:

Finished residency 6 years ago, found a nice office job in a major city and its surrounding suburbs. Small, myself and the owner. Practice was and is still going well clinically, but lately I feel like I'm not certain what the future is.

I started slow, a few patients etc. Owner had me on a full salary (albeit very low, less than 100K), At the time I was like hey its an opportunity . The guy has been around a while and is well versed with a ton, and he's a smart guy. Maybe I can learn a lot. But I had this low salary and I took it decided I can work my tail off. Which is did and currently and still do. I was given scenarios for raises with salary base and via percentages.
Practice consisted of a mix of office work, surgeries, nursing homes/living facilities and hospital consults blah blah. He barely takes call. I kid you not, I do 99.9% of it. All the time. My days vary quite a bit due to this. Some days I leave my home at 430 AM, just so I can hit up hospitals, head to clinic then finish off my day and hopefully try to make it back by 6 pm so my kids know I'm around. Some weeks I'm easily working 7 days a week, just to catch up.

I slowly built my part of the practice . I stated off seeing maybe 5-6 patients a day that were hand offs. Today I'm easily at 25-35 depending on the day. Throughout the years, I became board certified by ABPM that same year I started, and slowly chipped away at ABFAS and obtained that certification as well. This was actually a stipulation that I had to meet per my contract. Anyone that's been in this boat knows how intense this pressure is.

I've been doing a ton of surgeries, procedures orthotics , consults, home visits, NH visits, etc. Been easily bringing in upwards of 400-500k in production. Never missed a beat or a days of work.

Pandemic we took a hit, luckily my boss never really cut salary. I thought he was looking out for me but now that Im thinking it might have been because he was required to keep me around to receive those government funds. But that's another story who knows. I
My raises promotions percentages etc were all put off then. Which I understood. Always said hey thank you for all you've done for me don't worry about my contract stuff lets just get the office running. Im just happy to be practicing.
So we kept that up he was appreciative (obviously).

Fast forward 2.5 years.

There has been no increase thus far. I make the same as I did 6 years ago. Every time I bring it up, it just kinda of gets brushed off. I've busted my tail and Im starting to feel it. Bare in mind I don't have ANY other benefits with this gig. No 401, IRA, etc. I get the minimal 1 week of PTO, minimal CME etc. which when I try to use, I get a little push back on. Honestly I think as I built seniority my situation wound change. We discussed partnerships and ownerships etc, which honestly the prices seem exceeding ludacris. I don't necessarily need to get into great detail about that. What's important is that I'm fairly certain partnership/ownership at this group is not what's best for me.

I've looked at other practices but I could never be another associate. A couple guys I spoke with seem to have nicely running practices. Very intrigued but a little nervous about giving up a steady salary for something that may or may not be. With all the changes in insurances, the thought of being solo is a little intimidating, but ownership has always been something I strived for.

Any seasoned docs, newer docs or anything care to chime in on both my current arrangement, and with the nervousness of buying/becoming owner in todays medical world?

Appreciate any and all input, praise and criticism welcome.

PG

Bam, never work for another podiatrist.

 

[Shiyuan]

Time to avoid that slave labor and find another (better) gig where you are appreciated and paid your worth.

 

[icebreaker32]

His actions prove he views you only as an easily replaceable employee. Sadly he probably can find another employee for what you are making, but not one that will be producing as much as you. Do not stay and build his practice any longer.

You are board certified in surgery, experienced and have a strong work ethic. You are worth more. You will find a job that pays at least 150K, most likely with a real opportunity to make even more while also offering better benefits and more vacation time.

Start looking for another job now. Use any connections you have, pound the pavement looking for a job and also search the internet and apply to any Hospital, MSG, Ortho or VA job that is in a location you are willing to live. It might take up to a year or possibly longer, but you will find something much better.

When you put in your notice you will be offered 150K and 2 weeks of vacation to stay with more false promises of partnership, but not before then. Thank him as you leave for the opportunity he gave you.

If by some chance you do not take an employed job and start your own practice, do not repeat the cycle if you hire an associate someday.

 

[HardRoadPaved]

Wow I'm sorry but your hard work isn't paying off. You will and are burning out and will continue to resent this profession. You out grew this scheme. It cannot make you any more money. Run and run fast. And sleep at 4:30am.

255 work weekdays not including call x 25 patients x $75 avg reimbursement (blahhhhhhh) gets you 400-500k gross

Open your own shop... You clearly have the drive.

 

[air bud]

This is just nucking futs. If you would ever consider staying you deserve all that you get. Leave for any opportunity, if nothing else that out of spite for this person. You have worked for 6 years and have nothing (yes board cert), what do you have to lose.

 

[DYK343]

Wow I'm sorry but your hard work isn't paying off. You will and are burning out and will continue to resent this profession. You out grew this scheme. It cannot make you any more money. Run and run fast. And sleep at 4:30am.

255 work weekdays not including call x 25 patients x $75 avg reimbursement (blahhhhhhh) gets you 400-500k gross

Open your own shop... You clearly have the drive.

Yep time to open your own practice.
You are getting 100% screwed over. 1000% actually.
Get out. Get out tomorrow. Dont show up Monday.
Its not like you make any meaningul income anyway Monday so might as not go.


You could easily be pulling in 500k. Minus overhead 250-300k salary.
Others in private can correct me, but I think i am low balling the income with the hours described/work performed.

 

[dtrack22]

Been easily bringing in upwards of 400-500k in production

Not to **** on anyone’s parade, but anyone working as much as you say you are working should be bringing in more than $400-500k in collections. A lot more. Hundreds of thousands of $ more.

but a little nervous about giving up a steady salary for something that may or may not be.

Why would you be nervous giving up the salary you claimed you got, quoted below?

Owner had me on a full salary (albeit very low, less than 100K)

You have your board certs, this job will not get any better. If you are willing to move then start networking and applying to employed positions. If you aren’t geographically flexible, start working on finding your own office space and start your own practice. You should be out of there and up and running somewhere else by this time next year.

 

[dtrack22]

Get out tomorrow. Dont show up Monday.
Its not like you make any meaningul income anyway Monday so might as not go

Probably not a realistic option but if he/she really is salaried I would at least voluntarily withdraw my privileges, stop taking call, stop doing surgery as of next week.

I’ve gotten multiple phone calls from an old locums company, could just be a new recruiter/sales person trying to find applicants (they have turnover like any sales job, especially with podiatry where they aren’t filling as many positions as they do with real doctors). But it also may mean there are some more locums opportunities popping up again. They will take 1-2 months to start since you’ll likely have to get a state license you don’t already have (unless it’s IHS), but the pay can be fantastic and it will free you from the hell hole you’re currently at sooner than if you have to wait for a new permanent gig or to start your own practice.

 

[AttackNME]

Not to **** on anyone’s parade, but anyone working as much as you say you are working should be bringing in more than $400-500k in collections. A lot more. Hundreds of thousands of $ more.

I thought the same, OP, did he show you the original books or is this a number he printed or wrote down on a sticky note to show your production? $1m in collections is normal for a hard worker

 

[dtrack22]

$1m in collections is normal for a hard worker

Not if you’re an associate doing free inpatient work and taking Medicaid patients in clinic that your boss forces you to see.

 

[icebreaker32]

Not if you’re an associate doing free inpatient work and taking Medicaid patients in clinic that your boss forces you to see.

Agree

While his boss is ungrateful and views him as replaceable, there is no way he would not be throwing him a few more "crumbs" if he was grossing a million.

It does not matter how much he is grossing in this setting. The reality is he can make much more money elsewhere or on his on own with a better quality of life.

If this was another profession and not PP podiatry......where most the jobs are, we would think a troll was posting on here.

The podiatry schools supposedly have less applicants this year. When potential students read of jobs like this can you blame them for choosing other professions?

 

[zircushio]

Agree

While his boss is ungrateful and views him as replaceable, there is no way he would not be throwing him a few more "crumbs" if he was grossing a million.

It does not matter how much he is grossing in this setting. The reality is he can make much more money elsewhere or on his on own with a better quality of life.

If this was another profession and not PP podiatry......where most the jobs are, we would think a troll was posting on here.

The podiatry schools supposedly have less applicants this year. When potential students read of jobs like this can you blame them for choosing other professions?

It's hard for me to recommend podiatry to students or externs who shadow. Medicine as a whole is rough, but podiatry has such limited advantages to it, that I don't think I can get behind endorsing it as a career for the younger generation. The education is absurdly expensive, the quality of life during residency is abysmal, the outlook of our field is limited. Your starting salary (unless you are the lucky few who gets into Ortho/MSG/etc) is less than what a 24 year old PA makes with no experience. We are paid pennies on the dollar and expect to work 80 hour 7-day-weeks if we are unfortunate enough to join someone's pod practice. This was definitely not the "lifestyle" I was told about in high school lol

A lot of you are saying they would never do that (and I'd agree), but when you have 200k+ in student loans, a family, a kid, and expenses to pay, you have no choice but to take something if you can't manage to pull another job in on time. Sometimes the stars don't align and you don't have the benefit to job search for 3 months to find the cushy job. We have so much work to do to improve our field, and unfortunately, the longer I'm in podiatry, the less I think we are able to ever achieve such things.

That being said, I think if I didn't get the job I currently fought for, I would have tried and pulled the best loan I could to open up my own practice than to waste six years growing someone else's. Even if that meant I had to see 300 medicare patient's for nail clippings.

 

[podgod22]

I thought the same, OP, did he show you the original books or is this a number he printed or wrote down on a sticky note to show your production? $1m in collections is normal for a hard worker

nope not original books. I rarely ever saw those. And when I did it was back when I was new maybe 1-2 years in. Lately its all just scribbles on some scratch paper. or "verbally during a conversation"

 

[podgod22]

Agree

While his boss is ungrateful and views him as replaceable, there is no way he would not be throwing him a few more "crumbs" if he was grossing a million.

It does not matter how much he is grossing in this setting. The reality is he can make much more money elsewhere or on his on own with a better quality of life.

If this was another profession and not PP podiatry......where most the jobs are, we would think a troll was posting on here.

The podiatry schools supposedly have less applicants this year. When potential students read of jobs like this can you blame them for choosing other professions?

thank you I appreciate this. And yes, the post would typically sound like some ungrateful troll, but unfortunately, it real. I have been doing ok because I have a spouse that works, and I've been doing some side work with one of those large nursing groups (which when its broken down, the daily wages I earn are greater) to cover up loose ends.

But yeah I can't do it forever. It grueling in its own way

 

[podgod22]

Probably not a realistic option but if he/she really is salaried I would at least voluntarily withdraw my privileges, stop taking call, stop doing surgery as of next week.

I’ve gotten multiple phone calls from an old locums company, could just be a new recruiter/sales person trying to find applicants (they have turnover like any sales job, especially with podiatry where they aren’t filling as many positions as they do with real doctors). But it also may mean there are some more locums opportunities popping up again. They will take 1-2 months to start since you’ll likely have to get a state license you don’t already have (unless it’s IHS), but the pay can be fantastic and it will free you from the hell hole you’re currently at sooner than if you have to wait for a new permanent gig or to start your own practice.

yup. just salaried (small salary). I might be able to even just cover the difference by doing NH on my own while I search for a new practice

 

[podgod22]

Not to **** on anyone’s parade, but anyone working as much as you say you are working should be bringing in more than $400-500k in collections. A lot more. Hundreds of thousands of $ more.

I might be. But I don't get the full picture. Only casually during convo, or some scribbles I get to see, or, if I happen to see some paper on the owner's desk.

Why would you be nervous giving up the salary you claimed you got, quoted below?

Although the salary is low, its still a salary. It's still money I can count on every other week.Although the salary is low, its still a salary. It's still money I can count on every other week.

You have your board certs, this job will not get any better. If you are willing to move then start networking and applying to employed positions. If you aren’t geographically flexible, start working on finding your own office space and start your own practice. You should be out of there and up and running somewhere else by this time next year.

Love this statement

 

[heybrother]

Move on. Review your contract. Is it still in effect (my initial contract was set to be 3 years)? Even if you ask for 50% of the practice for free tomorrow he'll still want you to buy the other half in a few years at something inflated.

You've unfortunately put yourself in a situation where you haven't learned what you should about how a practice works. I don't mean this in a mean way so I'll clarify further. Some people on this forum - Feli, 619 etc have posted in the past that everyone should work as an associate for just a little to learn some lessons on someone else's dime. The problem is - you haven't learned any lessons because you haven't seen the books. A significant portion of what you learn about billing is to see what a practice gets paid and how a practice gets paid. I have Athena (overcharging douchebags) and I can see the entirety of the billing threads / how the appeals happen / what insurance says when they fight you etc. I could see these things from the get go so I knew that when I saw good insurance I sometimes got $400 for a new nail surgery in the office. When I saw that - I knew I offered a service of value. A service that even if I wasn't extremely busy could still translate into real earnings if expenses are controlled. I learned other interesting things like even dreary nail callus stuff done in the office is actually worth something if the patient has a callus, Medicare, and the service is rendered appropriately and efficiently. It ain't hospital people money - but it crushes the $25 an hour I made working for a corp for 3 years before podiatry school.

Part of me still wants to believe you are a troll (sorry) because I don't understand how we could have such a shared experience and you just can't see the value in yourself.

I'm also just dumbfounded by your hours.

I do zero inpatient work. I do zero nursing homes. I do zero weekends. I do my surgeries on my surgery day and I go home. If I don't have surgery I take the day off. I take 1/2 of Friday off. I almost never work through lunch. I regularly get 1-1.5 hours at home at lunch with family cause I live 6 minutes from my job. I see 20-25 patients on T-R. I'm under the impression this is how most people function most places. If you aren't hospital employed this is what you should be doing. I have max 1-2 inefficient days a month where I do my surgeries at a county hospital. Thankfully some of these surgeries are on one of the best insurances I accept. I get a lot of new patients from nurses and surgery techs I interact with at the hospital for good bread and butter.

This really shouldn't be a bad job. Yes, insurance is going to hell. But PP people should make $200 (or more depending on how hard they work) and live very straight forward outpatient lives. The hospital based people should make $100-150K more but have terrible lives, get divorced a lot and lose all the money. That's how medicine is supposed to work.

 

[CutsWithFury]

Welp, I'll chime in with my conundrum. I've been out of residency 6 years now and I hope new grads can use my experience for their own planning/knowledge and that even more seasoned practitioners than myself can help advise me on what the next steps may be, because frankly, I feel burned and at a dead end.

Backstory:

Finished residency 6 years ago, found a nice office job in a major city and its surrounding suburbs. Small, myself and the owner. Practice was and is still going well clinically, but lately I feel like I'm not certain what the future is.

I started slow, a few patients etc. Owner had me on a full salary (albeit very low, less than 100K), At the time I was like hey its an opportunity . The guy has been around a while and is well versed with a ton, and he's a smart guy. Maybe I can learn a lot. But I had this low salary and I took it decided I can work my tail off. Which is did and currently and still do. I was given scenarios for raises with salary base and via percentages.
Practice consisted of a mix of office work, surgeries, nursing homes/living facilities and hospital consults blah blah. He barely takes call. I kid you not, I do 99.9% of it. All the time. My days vary quite a bit due to this. Some days I leave my home at 430 AM, just so I can hit up hospitals, head to clinic then finish off my day and hopefully try to make it back by 6 pm so my kids know I'm around. Some weeks I'm easily working 7 days a week, just to catch up.

I slowly built my part of the practice . I stated off seeing maybe 5-6 patients a day that were hand offs. Today I'm easily at 25-35 depending on the day. Throughout the years, I became board certified by ABPM that same year I started, and slowly chipped away at ABFAS and obtained that certification as well. This was actually a stipulation that I had to meet per my contract. Anyone that's been in this boat knows how intense this pressure is.

I've been doing a ton of surgeries, procedures orthotics , consults, home visits, NH visits, etc. Been easily bringing in upwards of 400-500k in production. Never missed a beat or a days of work.

Pandemic we took a hit, luckily my boss never really cut salary. I thought he was looking out for me but now that Im thinking it might have been because he was required to keep me around to receive those government funds. But that's another story who knows. I
My raises promotions percentages etc were all put off then. Which I understood. Always said hey thank you for all you've done for me don't worry about my contract stuff lets just get the office running. Im just happy to be practicing.
So we kept that up he was appreciative (obviously).

Fast forward 2.5 years.

There has been no increase thus far. I make the same as I did 6 years ago. Every time I bring it up, it just kinda of gets brushed off. I've busted my tail and Im starting to feel it. Bare in mind I don't have ANY other benefits with this gig. No 401, IRA, etc. I get the minimal 1 week of PTO, minimal CME etc. which when I try to use, I get a little push back on. Honestly I think as I built seniority my situation wound change. We discussed partnerships and ownerships etc, which honestly the prices seem exceeding ludacris. I don't necessarily need to get into great detail about that. What's important is that I'm fairly certain partnership/ownership at this group is not what's best for me.

I've looked at other practices but I could never be another associate. A couple guys I spoke with seem to have nicely running practices. Very intrigued but a little nervous about giving up a steady salary for something that may or may not be. With all the changes in insurances, the thought of being solo is a little intimidating, but ownership has always been something I strived for.

Any seasoned docs, newer docs or anything care to chime in on both my current arrangement, and with the nervousness of buying/becoming owner in todays medical world?

Appreciate any and all input, praise and criticism welcome.

PG

If he has not given you any raises or allows discussion to become a partner then he is PLAYING you. He will never give you what you deserve. He wants you to quit so he can take over your patients and find the next associate to take your place.

You should have gotten a raise 2-3 years after you started. I can not believe you stuck with this guy for 6 years making under 100K.

Woah

 

[CutsWithFury]

It's hard for me to recommend podiatry to students or externs who shadow. Medicine as a whole is rough, but podiatry has such limited advantages to it, that I don't think I can get behind endorsing it as a career for the younger generation. The education is absurdly expensive, the quality of life during residency is abysmal, the outlook of our field is limited. Your starting salary (unless you are the lucky few who gets into Ortho/MSG/etc) is less than what a 24 year old PA makes with no experience. We are paid pennies on the dollar and expect to work 80 hour 7-day-weeks if we are unfortunate enough to join someone's pod practice. This was definitely not the "lifestyle" I was told about in high school lol

A lot of you are saying they would never do that (and I'd agree), but when you have 200k+ in student loans, a family, a kid, and expenses to pay, you have no choice but to take something if you can't manage to pull another job in on time. Sometimes the stars don't align and you don't have the benefit to job search for 3 months to find the cushy job. We have so much work to do to improve our field, and unfortunately, the longer I'm in podiatry, the less I think we are able to ever achieve such things.

That being said, I think if I didn't get the job I currently fought for, I would have tried and pulled the best loan I could to open up my own practice than to waste six years growing someone else's. Even if that meant I had to see 300 medicare patient's for nail clippings.

I would NEVER recommend becoming a podiatrist to anyone looking to get into the medical field. Our scope is too narrow. Leadership is weak and has no spine. We eat our own young. It's literally a war every day and you are battling your colleagues for the scraps that ortho lets us have.

I'm jaded as hell. I've been lucky to only work in hospitals and now locums but if I was doing private practice podiatry and that was my only option I honestly would be researching other careers. I'd rather be a nurse then a private practice podiatry associate.

 

[zircushio]

I would NEVER recommend becoming a podiatrist to anyone looking to get into the medical field. Our scope is too narrow. Leadership is weak and has no spine. We eat our own young. It's literally a war every day and you are battling your colleagues for the scraps that ortho lets us have.

I'm jaded as hell. I've been lucky to only work in hospitals and now locums but if I was doing private practice podiatry and that was my only option I honestly would be researching other careers. I'd rather be a nurse then a private practice podiatry associate.

Just saw a CRNA open position on LinkedIn, 200-250k salary with 500k retention bonus. LOL wut. Meanwhile our PP pods are paying associates 80-100k to perform surgery, take trauma call, work 7 days a week, cover 4 satellite offices, etc for 80-100k + possible bonus.. No way man. Had I known all of this I would have become a nurse/PA and basked in the 3-4 day work week. We don't deserve this kind of headache for the amount of stuff we provide for the hospital/community. Our leadership is lacking 100%.

 

[dtrack22]

Although the salary is low, its still a salary. It's still money I can count on every other week.

But it’s easily replaceable. You could go drive for UPS and make the same money. You could work for a nursing home company full time (gross) and make even more money than you are now. You can go work for another DPM and make more money. I wouldn’t do those things but the point is that steady income you are clinging to isn’t worth the hassle and isn’t something that can’t be replaced within a week if you were to finally decide to quit.

 

[dtrack22]

One of the real problems with our degree is that it is significantly less marketable when it comes to non clinical work. RNs have significantly more non clinical opportunities where they can leverage their degree into higher payi by salary or admin type positions. MD/DO can do insurance work or admin and completely replace their income without as much experience or effort as us. Not to mention the fact that many podiatrists will consider $200-250k doing very well while a CRNA now commands closer to $300k (assuming they do take some call). Oh and other than some more obscure medical sub specialties, all of these other healthcare providers can get a job anywhere in the country, any time they want. Not getting treated well as a family medicine doctor? You have 4-5 job openings around the country that recruiters will email you about every single day. Tired of clinical medicine? Sit at your home and review some claims for a few hundred grand per year. Need a little temporary income boost? Pick up some locums work or travel work and then go right back to the job you had before when you’re done. None of those things exist within our profession. You generally must own your practice or work for a company who employs other real doctors, if you want to be compensated fairly. And then you better like practicing podiatry because you really have no other options with the degree.

 

[CutsWithFury]

One of the real problems with our degree is that it is significantly less marketable when it comes to non clinical work. RNs have significantly more non clinical opportunities where they can leverage their degree into higher payi by salary or admin type positions. MD/DO can do insurance work or admin and completely replace their income without as much experience or effort as us. Not to mention the fact that many podiatrists will consider $200-250k doing very well while a CRNA now commands closer to $300k (assuming they do take some call). Oh and other than some more obscure medical sub specialties, all of these other healthcare providers can get a job anywhere in the country, any time they want. Not getting treated well as a family medicine doctor? You have 4-5 job openings around the country that recruiters will email you about every single day. Tired of clinical medicine? Sit at your home and review some claims for a few hundred grand per year. Need a little temporary income boost? Pick up some locums work or travel work and then go right back to the job you had before when you’re done. None of those things exist within our profession. You generally must own your practice or work for a company who employs other real doctors, if you want to be compensated fairly. And then you better like practicing podiatry because you really have no other options with the degree.

100% facts.

My only way out of this profession is for Cardano to replace ETH as the top blockchain and become the future of decentralized finance.