If you had the chance to go back in time, would you still do Podiatry again?

[PADPM]

NatCh is 100% correct. He practices in a unique area, but unfortunately in the East Coast I don't know anyone that can practice 2.5 days and still pay the bills!! So I take my hat off to NatCh, who can find the time to work and play and maintain his happiness.

NatCh is also correct regarding taking several years prior to seeing an income of any appreciable amount when starting your own practice. However, many can not open their own practices, especially in today's economy. Loans are harder to obtain. Additionally, some feel that the day of the "solo" practice may eventually become a thing of the past.

And once again NatCh is correct and agrees with me that despite the BEST training, you are never "entitled" to any specific income, and that's a thought your'e simply going to have to change.

Your future income will ALWAYS be earned, despite your training and the intitials that follow your name.

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[215512]

Doesn't mean squat. No entitlement in the business world. I don't care how skilled or educated you are, if you can't make the practice any money then you're a liability.

You are right, I guess I just had this idea that the best trained students would get the most money-reality check welcome to the real world i guess. I suppose it would help to either open ones own practice OR go for less money starting, but with buy in possibilities so you can prove yourself...and later on make a lot more with ownership?

this coming from a guy in undergrad thats a bio major with no business background beyond the scope of common sense.

 

[215512]

NatCh is 100% correct. He practices in a unique area, but unfortunately in the East Coast I don't know anyone that can practice 2.5 days and still pay the bills!! So I take my hat off to NatCh, who can find the time to work and play and maintain his happiness.

NatCh is also correct regarding taking several years prior to seeing an income of any appreciable amount when starting your own practice. However, many can not open their own practices, especially in today's economy. Loans are harder to obtain. Additionally, some feel that the day of the "solo" practice may eventually become a thing of the past.

And once again NatCh is correct and agrees with me that despite the BEST training, you are never "entitled" to any specific income, and that's a thought your'e simply going to have to change.

Your future income will ALWAYS be earned, despite your training and the intitials that follow your name.

that makes perfect sense, i see you are from Bend, OR NatCH? you owning your pwn practice there, how is that possible? and in 7 years do you estimate that your market, or any big city on pac northwest for that matter, will be too saturated to do so? assuming one can get a loan in a ,*fingers crossed*, better economy 7 years from now..

The idea of entitlement is something I gathered from the idea that if you go to Hardvard for MBA you get an amazing job in business right away, I was coming from that background and figured things would be the same for podiatry. PADPM...your insight is educated and helpful-thank you-and I am glad that I can work these ideas out now rather than stress about them during the hell that is first year, yikes!

 

[NatCh]

that makes perfect sense, i see you are from Bend, OR NatCH? you owning your pwn practice there, how is that possible? and in 7 years do you estimate that your market, or any big city on pac northwest for that matter, will be too saturated to do so? assuming one can get a loan in a ,*fingers crossed*, better economy 7 years from now..

The idea of entitlement is something I gathered from the idea that if you go to Hardvard for MBA you get an amazing job in business right away, I was coming from that background and figured things would be the same for podiatry. PADPM...your insight is educated and helpful-thank you-and I am glad that I can work these ideas out now rather than stress about them during the hell that is first year, yikes!

I own my own practice but I am not in a solo practice. I am one of three partners in a small group. I believe that this is the ideal practice scenario because we can share overhead expenses yet we are small enough that we can keep our overhead low and make adaptive changes to our business on the fly with a minimum of fuss. We do not have multiple layers of administration through whom must pass ideas. With only three of us it is easy to make decisions without a lot of personality conflict between doctors. As groups grow larger it is easy to become inefficient. How many people do you know in your class that you can work with in total harmony? Now put sixty of you together in a legally binding business arrangement and try to come up with a consensus on a big decision. Have fun!

I don't know exactly what the threshold number is but at some point when the group gets so large you end up having to hire middle-management such as department heads, and upper management-types such as CEOs and CFOs who command six-figure salaries (and guess who gets to pay for those people?).

It's also easy for employees to slack off and hide their poor productivity in a very large group. Since each partner is not directly in control of the finances, it becomes easy to overspend. Some department head decides he wants to provide lunch for his staff -- ka-ching. Some other department head decides he wants fancier ball point pens -- ka-ching. A few dollars here, a few dollars there, they eventually all add up to a lot of dollars.

I know of a local multispecialty group who up until two years ago was spending $30,000 a year to fill the employee break rooms with fancy Jones Soda. Someone at some point in their history purchased several cappuccino machines for their doctors and decided to provide lunch for all the staff every day. It wasn't until their new administration decided to review exactly where all their money was going that they found out exactly how much they were hemorrhaging. They were bleeding out a little bit here, a little bit there, and nobody knew the entire extent of the until they really took the time to investigate. I have heard of some large multispecialty groups running at approximately 75% overhead. Ouch.

My market is already oversaturated! If you work under the notion that there should be only one practitioner per 20,000 population, then with my city's population of 80,000 we should have four foot and ankle specialists. Instead, Central Oregon has nine podiatrists with one more on the way (but supposedly she is replacing one of the guys who will be retiring). In addition, there are four Foot and Ankle orthopedic surgeons. I wrote a computer program that calculated that in total we have 13 foot specialists.

Since there are only so many patients to feed into the practices then there is a soft ceiling on how much money one can generate. That being the case, you have to adapt your practice to not spend every last dollar you collect. It's really not that much different than managing your own personal expenses (e.g., you have to live within your means and not spend every last penny on extravagances). Last year as we anticipated this economic downturn we did a line-by-line analysis of our expenses to see what we could streamline and what we could cut out altogether. In addition, since other businesses are in need of money, they are reducing prices on their products and services. As a result, our overhead has dropped several percent within the past two quarters and my own income went up. How do you like that? One man's crisis is another man's opportunity.

Nat

 

[Gryhu]

I agree with PADPM. Just because we finish a super duper 3 year surgical residency doesn't mean we're entitled to anything. You have to prove yourself and the money will follow. As a business savvy individual, this is the ABSOLUTE best course to take when hiring a new person in any field. If they can't produce good numbers then you lost money, but not as much as you would have lost if you started them out at what they were "worth."

 

[tracheatoedoc]

I have yet to see ANYBODY from my program sign for less than mid 100's. A few were guaranteed 200K. There is nothing wrong with a small pod group starting someone at a BASE of 60-70K because the group is assuming all of the risk and the new doc has no patient base. But they'd better have some sweet incentives that will reward the doc for production. One of my buddies signed for a base of 75K but with production incentives made double that his first year out.

No offense but I didn't go to school for 11 years and go into debt 6 figures to make 65K a year. I believe the correct terminology would be "sucker"!!!

Jon,
you're not only a sucker, you are a clueless sucker.
You seem to think someone is going to offer you a $200,000 contract out of residency.
Incidentally, I posted previously that the ave income of Pods was probably around $120,000. You jumped in and agreed that that was probably a reasonable starting salary. That's not what I said. I would guess that an ave starting salary is probably around $75,000. And, that may be as an independent contractor.
Let us know Jonwill how your contract negotiations go.

 

[dtrack22]

tracheatoedoc,
I thought I had you pinned as a bitter but informative poster who ultimately contributed positively to the board. But after this post I'm dumbfounded as to why you are still here? Why is jonwill a sucker? The man has seen (witnessed, experienced, beheld, examined, etc.) contracts offered to residents fresh out of their 3 year surgical residencies.

Aren't you the one who bailed on podiatry years ago to hang out in the Caribbean? What makes you the authority on "recent" podiatry contracts? And if anyone knows how much can be made in podiatry it should be you...I mean you were the one making bank at your practice before you went the MD route.

 

[JackedUp]

tracheatoedoc,
I thought I had you pinned as a bitter but informative poster who ultimately contributed positively to the board. But after this post I'm dumbfounded as to why you are still here? Why is jonwill a sucker? The man has seen (witnessed, experienced, beheld, examined, etc.) contracts offered to residents fresh out of their 3 year surgical residencies.

Aren't you the one who bailed on podiatry years ago to hang out in the Caribbean? What makes you the authority on "recent" podiatry contracts? And if anyone knows how much can be made in podiatry it should be you...I mean you were the one making bank at your practice before you went the MD route.

I completely agree. Why are you still here? You're not contributing positively and now your insulting a resident at a top residency and one of our SDN moderators.

I understand you went through podiatry, had a great practice and then you went to med school. That's fantastic it really is. I'm glad you're doing well but please don't persuade other people away from the profession.

 

[tracheatoedoc]

I guess that was a little harsh, and I apologize.
But, I also know Podiatry.
The big money offers are probably from large ortho practices which can funnel cases to the pod. I'm sure Jonwill is at a great program and will land nicely.
However, there are many podiatry residents around that aren't at Jonwill's program. They also shelled out $200,000 and years of their lives to train and most of them are not going to be offered $200,000 contracts. I would guess that the typical offer for a PMS 36 from an average program will be $80,000. Just pulled that out of my arse.
Also the "sucker" phase is Jonwill's not mine, so stop crying.

 

[dtrack22]

There's the tracheatoedoc we know and love. I just wanted some clarification as to why jonwill was wrong...and I'm not crying. There's no crying in podiatry

 

[jonwill]

Jon,
you're not only a sucker, you are a clueless sucker.
You seem to think someone is going to offer you a $200,000 contract out of residency.
Incidentally, I posted previously that the ave income of Pods was probably around $120,000. You jumped in and agreed that that was probably a reasonable starting salary. That's not what I said. I would guess that an ave starting salary is probably around $75,000. And, that may be as an independent contractor.
Let us know Jonwill how your contract negotiations go.

Yea, I'm clueless. You're not even in the profession nor have you ever been except for a brief time many years ago. It's fairly obvious you haven't kept up with the changes within the profession (why would you). The lowest contract I've seen in three years is mid-100's. But I'm clueless! I'll be more than happy to keep everybody in the loop as I start contract negotiations in a few months with multiple ortho and multispecialty groups.

In other news, one of my seniors received his signing bonus check today for $20,000. Being clueless sure sucks.

 

[PADPM]

jonwill,

Please understand this, after you take a deep breath. I'll state this again, but FIRST please understand that I sincerely hope that you sign a contract for $200,000 and that every future graduate does the same.

But reality is reality. Take a look at today's issue of the APMA news, and you will see several job offers in the 65K range. There was only ONE listing in the 6 figure range that I saw today.

Once again, I am in a practice with over 12 doctors (I'm not getting into specifics, because I don't want to identify the practice on this site). I will say it's safe to say that it's easily the largest practice on the East Coast and one of the largest practices in the country.

We saw over 100,000 patient visits last year and we could not afford to pay anyone close to $200,000 out of the gate.

That's not to say you don't "deserve" that money, but it's simply the fact that we are in business to make money, not lose money. To pay you $200K, you will have to gross at LEAST $450K just for me to make a few bucks. And I'm hiring you to MAKE me profitable, not out of the kindness of my heart. So, while I'm taking the liability of hiring you, paying all the bills, etc., and you're making $200K, I'm only making a small amount of profit.

And in my 20+ years of practice, I have NEVER once heard of any DPM signing a contract and receiving a "signing bonus".

I have no idea why any doctor would provide a graduating resident with a $20,000 "signing" bonus???? What motivation would there to GIVE away $20K??? That's an awful lot of money to be tossing around.

Does this graduating resident walk on water? There are a LOT of excellent and bright foot and ankle surgeons willing to sign contracts a lot less than $200K and without $20K signing bonuses.

So, I'm having a real hard time trying to figure out why any group hiring your friend would be tossing around $20k, when in reality they don't have to, and in today's real world, people simply don't hand out money.

The bottom line is that there MAY be a handful of docs that will fall into some great opportunities. You may be coming out of an excellent residency program, and there are many excellent 3 year programs across the nation.

Despite your limited experience with these contracts and recent grads, I've been in this business over 20 years and have trained hundreds of residents and have reviewed LOTS of contracts over the years, including recently from grads from prestigious programs.

And I can ASSURE you, that the contracts you have "witnessed" are by far the exception and not the rule, and that a signing bonus is something that not only I've never seen, but it's something I've never even heard in our profession.

But, believe what you will.....but remember this post.

 

[PodunkUDPM]

jonwill,

But reality is reality. Take a look at today's issue of the APMA news, and you will see several job offers in the 65K range. There was only ONE listing in the 6 figure range that I saw today.

I just looked in my most recent issue of the APMA news to backup your claim, but most of the listings didn't post actual salary numbers. Actually, only a handful posted salaries, but I will post the ones listed just so everyone can get an idea.

Georgia - generous starting salary (90,000-100,000) based on training, experience, etc., malpractice insurance, health insurance, profit sharing, 401(k), etc.

Maryland - Excellent compensation package, which includes 60,000 + bonus, health, auto and other benefits.

New Jersey - starting 65,000 plus health, malpractice, CME, bonus incentive.

New York - starting 125,000 plus benefits

New York - base starting salary starting 85,000 plus bonus plan incentive, vacation, and health/mp insurance.

Virginia/DC - base salary of 60,000+ bonus, health, auto and other benefits.

Washington - starting salary 125,000 plus bonus, benefit package including health insurance and 401(k), generous vacation time and CME allowance.

These were the only postings listing salary (7/74 postings). So take it for what you will, but there are a few starting at or near the 100,000 mark. Technically, ~half the listings start at 100,000+.

 

[jonwill]

jonwill,

Please understand this, after you take a deep breath. I'll state this again, but FIRST please understand that I sincerely hope that you sign a contract for $200,000 and that every future graduate does the same.

But reality is reality. Take a look at today's issue of the APMA news, and you will see several job offers in the 65K range. There was only ONE listing in the 6 figure range that I saw today.

Once again, I am in a practice with over 12 doctors (I'm not getting into specifics, because I don't want to identify the practice on this site). I will say it's safe to say that it's easily the largest practice on the East Coast and one of the largest practices in the country.

We saw over 100,000 patient visits last year and we could not afford to pay anyone close to $200,000 out of the gate.

That's not to say you don't "deserve" that money, but it's simply the fact that we are in business to make money, not lose money. To pay you $200K, you will have to gross at LEAST $450K just for me to make a few bucks. And I'm hiring you to MAKE me profitable, not out of the kindness of my heart. So, while I'm taking the liability of hiring you, paying all the bills, etc., and you're making $200K, I'm only making a small amount of profit.

And in my 20+ years of practice, I have NEVER once heard of any DPM signing a contract and receiving a "signing bonus".

I have no idea why any doctor would provide a graduating resident with a $20,000 "signing" bonus???? What motivation would there to GIVE away $20K??? That's an awful lot of money to be tossing around.

Does this graduating resident walk on water? There are a LOT of excellent and bright foot and ankle surgeons willing to sign contracts a lot less than $200K and without $20K signing bonuses.

So, I'm having a real hard time trying to figure out why any group hiring your friend would be tossing around $20k, when in reality they don't have to, and in today's real world, people simply don't hand out money.

The bottom line is that there MAY be a handful of docs that will fall into some great opportunities. You may be coming out of an excellent residency program, and there are many excellent 3 year programs across the nation.

Despite your limited experience with these contracts and recent grads, I've been in this business over 20 years and have trained hundreds of residents and have reviewed LOTS of contracts over the years, including recently from grads from prestigious programs.

And I can ASSURE you, that the contracts you have "witnessed" are by far the exception and not the rule, and that a signing bonus is something that not only I've never seen, but it's something I've never even heard in our profession.

But, believe what you will.....but remember this post.

I understand where you are coming from and I'm not saying that I'm going to sign a contract for 200,000. As I've stated before, there is nothing wrong with signing a BASE of 65-70k as long as their are reasonable incentives.

But understand me when I say we have to stop this "old fashion" way of thinking in our profession. We pay 6 figures to go to school as do our MD counterparts. After residency, we are capable of producing as much, if not more revenue than our MD counterparts. Now, how many MD's start at 65K a year? It is absolutely absurd. I understand if a small podiatry group can't offer someone 150K salary. But I believe it is misleading to the younger students on here to say that they will start at 75K a year. Their base will be 75K a year. With most contract structures, they will most likely make much more than that. A recent contract I saw was a base of 75K but after they earned 2.5 times that, they made 40% of what the produced over that. So, if you're asking if I think a BASE of 60-70K is crazy, no I don't. NOW, do I think that making only 60-70K your first year out is crazy, yes I do. Correct me if I'm wrong but the APMA news offers are all base salaries.

I really am suprised that you have never seen a signing bonus. I've seen quite a few. It aids the resident in moving, securing a house, and living expenses during the lapse from residency to practice. Moving and getting started isn't cheap as I'm sure you're aware.

People, please, quit treating me like some 2nd year podiatry student dreaming about big money while I should be paying attention to my biomechanics lecture. I'm getting ready to enter my final year of training. I probably know more than anybody about what a realistic contract should be for someone coming out in this day and age BECAUSE I AM THERE! Realistically, I plan on making 120-150k my first year out. And that is the majority of what I've seen (with a few making more). Both of the 200K were hired on by ortho groups to do all the foot and ankle and the one is now in his 3rd year and making significantly more.

And for kicks, my "sucker" comment was actually from a pod in ACFAS leadership. I believe his exact words were, "If you make anything less then 6 figures your first year out, you're a sucker!"

 

[krabmas]

All 4 of the graduating residents last year signed for over $100,000 and all received either a signing bonus or moving expenses worth as much as a signing bonus.

 

[PADPM]

Okay,

Here are the listings that I JUST took off the APMA classifieds online that listed salaries:

Florida: $75,000 plus bonuses/incentives

Georgia: $90-100,00

Mass: "Six figures"

NJ: "Six figures"

NY: $125,000

Maryland: $60,000 plus bonuses

Virginia: 60,000


And I WILL admit, there was an ad that stated they were offering a "signing bonus", though it's still something I have never personally seen.

So, the bottom line is that there are 3 offers listing "6" figure incomes, though you also must consider the cost of living in the particular region. Some areas of NJ, particularly North Jersey can be extremely costly, and naturally the cost of living in most of NY is extremely high. If the Mass job is near Boston, once again the cost of living must be taken into consideration.

However, don't miss my point. There are STILL job offerings of $90,000, 60,000 x 2 and 75,000 and that's a very large distance from $200,000 and that's the point I was attempting to make.

Even $100,000 is a far cry from $200,000.

It's not unreasonable for many grads to get a contract in the range of $100K but to REGULARLY see contracts for new grads in the mid to high 100's or up is NOT the norm, it is the exception.

If you are referring to moving expenses, etc., than yes, that is often an added "bonus", but that's not what I was considering a "signing bonus", so I guess it's simply a matter of semantics.

Often, in professions that have hard-to-fill positions, they offer signing bonuses as an incentive to attract candidates. This was/is often applicable to physical therapists and used to be applicable to nurses when there was a shortage. That's what I was referring to when I meant a "signing bonus".

Naturally, there aren't a shortage of DPM's looking for jobs, and they really don't need to "entice" DPM's with bonus offers!!

 

[jonwill]

All 4 of the graduating residents last year signed for over $100,000 and all received either a signing bonus or moving expenses worth as much as a signing bonus.

Thank you!

 

[jonwill]

Okay,

Here are the listings that I JUST took off the APMA classifieds online that listed salaries:

Florida: $75,000 plus bonuses/incentives

Georgia: $90-100,00

Mass: "Six figures"

NJ: "Six figures"

NY: $125,000

Maryland: $60,000 plus bonuses

Virginia: 60,000


And I WILL admit, there was an ad that stated they were offering a "signing bonus", though it's still something I have never personally seen.

So, the bottom line is that there are 3 offers listing "6" figure incomes, though you also must consider the cost of living in the particular region. Some areas of NJ, particularly North Jersey can be extremely costly, and naturally the cost of living in most of NY is extremely high. If the Mass job is near Boston, once again the cost of living must be taken into consideration.

However, don't miss my point. There are STILL job offerings of $90,000, 60,000 x 2 and 75,000 and that's a very large distance from $200,000 and that's the point I was attempting to make.

Even $100,000 is a far cry from $200,000.

It's not unreasonable for many grads to get a contract in the range of $100K but to REGULARLY see contracts for new grads in the mid to high 100's or up is NOT the norm, it is the exception.

If you are referring to moving expenses, etc., than yes, that is often an added "bonus", but that's not what I was considering a "signing bonus", so I guess it's simply a matter of semantics.

Often, in professions that have hard-to-fill positions, they offer signing bonuses as an incentive to attract candidates. This was/is often applicable to physical therapists and used to be applicable to nurses when there was a shortage. That's what I was referring to when I meant a "signing bonus".

Naturally, there aren't a shortage of DPM's looking for jobs, and they really don't need to "entice" DPM's with bonus offers!!

I think it is also important to differentiate between podiatry groups, multispecialty groups, hospitals, and ortho groups. Podiatry groups (especially small ones) don't have the revenue to offer a huge contract so they will offer a base with incentives. I've seen larger contracts from multispecialty groups and ortho groups, as well as hospitals because they have the money to do it. HOWEVER, their incentives were less. One contract one of our grads signed was with a multispecialty group for 140K. However, regardless of how much he produced, his salary was basically 140 and his new salary the following year was based on a percentage of what he produced the year before. So, he is steadly increasing his salary yearly but many would argue that he could make more money taking a smaller base salary with greater incentives for production. And the numbers game begins!!!

PADPM and a few others keep quoting APMA news. I honestly don't know anyone who has ever gotten a job through APMA news (mostly word of mouth) but you guys do agree that these are not yearly salaries but BASE salaries?

 

[PADPM]

Yes, these are usually base salaries. The only reason I was quoting APMA classifieds, is because that was the only readily available source with multiple listings.

The bottom line is that I sincerely hope you can sign for mucho dinero. But I just want everyone to realize that realistically, the odds are that not all grads, even those coming out of top-notch programs are going to offered big bucks right from the start.

However, several years down the line it usually evens out and with hard work and HOPEFULLY honest work, a fair income will eventually come your way. Today's economy is tough and is even having a trickle down effect in medicine.

In our practice, patients are spacing out appointments or cancelling follow up appts if they are feeling better because they don't want to pay the $40 co-pay as often or to come in to the office just to tell you that they're doing much better. This all tranlates into less revenue if they aren't coming in, etc., etc.

Additonally, as patients lose their jobs, they also lose their insurance. When they lose their insurance, they cancel appointments, and so on and so on......

So, unfortunately, I don't believe salaries are on the upswing, and in our practice we've tightened our belts and have done all we can to reduce over-head. Fortunately, due to our size we can often dictate to vendors what WE want if they want OUR business.

 

[tracheatoedoc]

Yes, I'm still embarrased about my 'you suckee' post.
I think it might mislead students. Those contracts are exceptional.
An ortho group or hospital would more likely offer a signing bonus.
MDs normally receive them and they come attached with strings.
The stings are beneficial to the employer.
To prospective podiatrists I say don't go into pods for the money.
There really isn't alot of money in podiatry and there will be less in the near future. Don't assume that just because Jon's fellow resident got a nice contract you will do the same.
Jonwill, may I ask where you are training?

 

[215512]

what about future practice buy in potential with a HUGE practice? i mean if you had partial ownership in a practice maybe even after like 10-15ish years, a partner type status, wouldnt one be making a HECK of a lot more than 200K a year I mean are the podiatrists you hear that are making well over 400-500K a year the ones with ownership, if only at least partial? I mean signing a contract is great and all but wouldnt one want to make sure they have the opportunity to own part or all or half or whatever of the practice later on in life and/or have the same opportunity with like surgical facitlity ownership?

 

[PADPM]

Yes, having ownership in a practice is the key to making bigger bucks, but it is also the key to assuming debt. Buying into a practice can be structured many different ways, including taking less money each year and having that money credited to your buy in, simply taking a loan and paying for your buy in, etc.

But once you are a partner, you are now responsible for the debt and bills of the practice. So, when times are good, they are VERY good and when times are bad, they aren't so good! What that means is that you have a responsibility to your staff/employees to make sure that they ALL receive their paychecks on time, even if you don't.

In large practices there are large bills. Even though there are large bucks coming in the door, insurance checks don't always arrive as expected or promised. Sometimes money has to be juggled around, and partners don't always take checks every week.

For example......if on July 1st a practice of 15 doctors owes their malpractice payment for all 15 doctors, that's a HUGE check to write. That's no problem when you are expecting a HUGE check from insurance company ABC and DEF for over 6 figures. But when that week is also payroll, and neither one of those checks rolls in, well.......the malpractice insurance company MUST get paid, and the payroll MUST get paid, so the partners MUST wait for their checks.

It's a balancing act. So the grass is always greener on the other side, but with partnership comes responsibility and worries. Big checks aren't automatic and practices don't run themselves. It's a business and as many of you will see, sometimes it's nice to take a little less money and simply collect a paycheck, go home and have less worry.

In my personal opinion, the days of making big dollars as an investor in a surgical center are over, at least in the East Coast area. The market is saturated and the insurance companies have figured out the "game". The time to have invested was about 5-10 years ago, but that's in my area, and I don't know the climate across the country.

Once again, practice hard, practice honestly/ethically and you have the potential to make a better than average income. You won't keep up with your friend who is the CEO of a major company, but you will be able to live a nice lifestyle. Don't let money be your motivator and you'll be much more successful and content....and probably a better doctor.

 

[NatCh]

what about future practice buy in potential with a HUGE practice? i mean if you had partial ownership in a practice maybe even after like 10-15ish years, a partner type status, wouldnt one be making a HECK of a lot more than 200K a year I mean are the podiatrists you hear that are making well over 400-500K a year the ones with ownership, if only at least partial? I mean signing a contract is great and all but wouldnt one want to make sure they have the opportunity to own part or all or half or whatever of the practice later on in life and/or have the same opportunity with like surgical facitlity ownership?

There's no way you'd make half a mill a year without being an owner. Even as a full Partner, half a mill a year is in the far upper end of the bell curve for our profession. Like PADPM explained, being an employee on a contract means you have less responsibility and therefore less worry. A limited income comes with that "easier" way of life. However, even with the increased responsibility of Partnership once I got a taste of it I knew there was no going back to working for The Man.

 

[hyperpodia]

However, even with the increased responsibility of Partnership once I got a taste of it I knew there was no going back to working for The Man.

Especially, if The Man is paying you 65k per year
I think (no sure) if a Pod worked I day a week (8hrs) you could still gross more than 65k

 

[Podmeister]

An ortho group or hospital would more likely offer a signing bonus.
MDs normally receive them and they come attached with strings.

True. I know a rheumatologist who signed with Kaiser Permanente hospital for $180, plus $20K signing bonus.

 

[215512]

signing bonuses usually come attached with strings? such as?

 

[Gryhu]

signing bonuses usually come attached with strings? such as?

In exchange for the signing bonus, you must give up your soul.

 

[tracheatoedoc]

The signing bonus is part of the contract. It will have a specific amount of time you need to stay with the practice. Generally accepting a bonus will obligate you to stay at the practice for, let's say 3 years. If you leave early you have to repay the bonus. Theoretically it makes your noncompete more valid.
I'm not an expert at contract law, but one may find oneself confined to a practice situation for lack of funds to repay a signing bonus.
I would focus more on salary and favorable noncompete language, rather than salivate over a small signing bonus. Also insist on occurance malpractice rather than claims made.

 

[tracheatoedoc]

From what the Jonwill posted it seems that some of these contracts are a little vague after the first year. Let's say you sign with Big City Podiatry for $120,000 a year and they give you $20,000 signing bonus. You buy a $240,000 condo. Everyone is excited you have a mortgage. The second year of your contract is some formula based on productivity and your just not as busy as you thought you might be, and by this time you realize that you are spending 90% of your time in clinic doing rather mundane things and that the practice is grossing $260,000 yearly. Perhaps you will be looking at suddenly making $80,000 a year. You can't leave early because you would have to repay $20,000 and pay a tail of $20,000, so you are stuck. You can't sale your condo, you can't afford the tail, you can't repay the signing bonus. You're stuck.

 

[ItsGavinC]

Even $100,000 is a far cry from $200,000.

Sorry to bump this thread up. I'm graduating from my residency in a couple of months, but not in pod. I did an SDN search for some topics and this thread came up. Interesting read.

I will remind the upcoming grads about something that has become a harsh reality to my wife and I: state and federal taxes. All those incomes sounds nice and pretty until you figure in taxes.

A nice 100k income isn't that great after taxes. $100,000 after state and federal taxes is about 65,000. That's roughly $5,500 a month.

Anyway, good luck to all of you! You guys are lucky to have some practicing pods posting their knowledge here, as well as some upper-level pod residents.

 

[dpmgrad]

Sorry to bump this thread up. I'm graduating from my residency in a couple of months, but not in pod. I did an SDN search for some topics and this thread came up. Interesting read.

I will remind the upcoming grads about something that has become a harsh reality to my wife and I: state and federal taxes. All those incomes sounds nice and pretty until you figure in taxes.

A nice 100k income isn't that great after taxes. $100,000 after state and federal taxes is about 65,000. That's roughly $5,500 a month.

Anyway, good luck to all of you! You guys are lucky to have some practicing pods posting their knowledge here, as well as some upper-level pod residents.

Good point. Many of us just look at the salary numbers without considering taxes. I learn this quickly when I got my first pay check. The only people that will not get hurt by this as much are the people living and working in states that do not have an income tax. Those people only have to worry about Federal taxes. Unfortunately for me, I am stuck with Federal, State, and Municipal tax.

 

[cg2a93]

Everyones experiences are different. Dont let anyone tell you what you can or cannot achieve. With that being said, listen and research. PaDPM and the others are not giving bad information, its what they see as the norm which sound about right. That doesnt mean it is going to apply to you. If you want to make big money your going to have to start your own practice in a good location. You will have to add alot of C&C until you are able to build up your surgical load, but it can be done. I am a testament to this. I remember my attending telling me I was going to make less my first year than I did as a resident. That scared the heck out of me and if I stayed in that area he would have been right, but I left and my first year on paper I did great. Then taxes, practice expense, mortgage and other bills showed up and ruined everything. If you are going to be a solo practice podiatrist you are going to have to be a doctor/business man. Its hard to get a avg for Pod salaries because you have good business people and bad ones. Some of us will make huge amounts of money and others will not make as much. I think the majority of pods will make above average money so dont be to discouraged.

 

[feets22]

Could you even make your loan payment while making 65k before taxes?

 

[215512]

Could you even make your loan payment while making 65k before taxes?

youd be living like a student - which defeats the purpose of going into a professional program

 

[dtrack22]

Could you even make your loan payment while making 65k before taxes?

A lot of pods payback their student loans over a period of 30 years...a $500-$600 monthly payment is very do-able and you can afford to live slightly better than a student.

From a discussion I had with a pod the big loans that get you in trouble are business loans taken out to buy into a practice. These typically have to be payed back in 8 years, give or take a year or two (I'm sure PADPM can shed A LOT more light on this subject), which means a $500,000 buy-in will run you a little over $7,000 in monthly payments. That's the loan you need to be wary of...at least from what I've seen in my limited shadowing exp.

 

[215512]

holy god its that expensive? do you make enough to make a profit or is it just throwing money at a practice that youll never see again for 20 years?


and one other slightly important thing on top of paying back student loans and business loans....MORTGAGE? are we all going to be renting until we are 40? LMAO

 

[krabmas]

A lot of pods payback their student loans over a period of 30 years...a $500-$600 monthly payment is very do-able and you can afford to live slightly better than a student.

From a discussion I had with a pod the big loans that get you in trouble are business loans taken out to buy into a practice. These typically have to be payed back in 8 years, give or take a year or two (I'm sure PADPM can shed A LOT more light on this subject), which means a $500,000 buy-in will run you a little over $7,000 in monthly payments. That's the loan you need to be wary of...at least from what I've seen in my limited shadowing exp.

I have about $200,000 in loans before all the interest that has acrued (sp?) over 3 years. With the graduated rate of paying back loans I am looking at ~$1000 a month to start out the the payments will increase every year or so. This is for paying back over 30 years. The longer that it takes to pay back a loan the more you'll spend over time due to interest. Ifyou can pay a little more than the payment due you'll spend less over the life of your loan. The other thing to think about is that it is an education loan which is non transferable so when you die, the loan dies. If you merge this loan with your mortgage I think it can then be transferred to the other name on the mortgage.

 

[NatCh]

I have about $200,000 in loans before all the interest that has acrued (sp?) over 3 years. With the graduated rate of paying back loans I am looking at ~$1000 a month to start out the the payments will increase every year or so. This is for paying back over 30 years. The longer that it takes to pay back a loan the more you'll spend over time due to interest. Ifyou can pay a little more than the payment due you'll spend less over the life of your loan. The other thing to think about is that it is an education loan which is non transferable so when you die, the loan dies. If you merge this loan with your mortgage I think it can then be transferred to the other name on the mortgage.

Depending on what the tax laws say by the time you guys start repayment, it might be better for you to take a cash-out mortgage and pay down a big part of the principal on your student loan even if your spouse becomes liable for the debt in the event of your death.

• Above a certain income you can no longer deduct student loan interest. I don't know what the student loan interest was when you guys took out your loans, but just for example 6% interest on $200K equals about $12,000 per year paid to interest.
• Mortgage interest might be your biggest tax deduction
• If you are worried about burdening your spouse with your debt in the event you die prematurely, your life insurance policy should cover your debts. You are not likely to die prematurely, but interest will accrue on your student loan debt no matter what. A $200K principal at 6% with a 30-year fixed loan equals ~$232,000 total interest. That would've bought an awful lot of life insurance.
• If home loans have lower interest rates then it's especially a good idea
• If you pay down your student loan quickly, then even if you were to get divorced and lose the house, at least your student loan would be paid off. In contrast, if you were to pay down your house quickly, get divorced and lose the house, you would still have to pay off your student loan in addition to giving half your paycheck to your ex- who's living with her boyfriend in the house that you bought. Ooof, double whammy.

Here's yet another case in which having a good CPA is worth its weight in gold.

 

[Creflo]

Taxes are part of the reason that the military option is tempting. The salary doesn't look great from the perspective of a pod student, but when you consider the effects of the HPSP scholarship related to tax and loan interest savings, it adds up very fast.

For example, once you finish residency and repay the loans, you repay for the most part with after tax dollars (of course there are deductions out there, but I'm talking in general here). So not only do you have to repay your tuition, interest, but you also have to pay Uncle Sam a chunk of your paycheck first. This means that if you make 100k out of residency, you pay 25% (or whatever your tax bracket is) of that 100k to Uncle Sam, then pay your loans off with the 75k that's left over. Military scholarship tuition isn't taxed, so you save not only interest but that chunk of your paycheck to Uncle Sam.

Another example, part of the military pay isn't taxable. A portion of pay (housing and food) isn't subject to income tax. It also isn't subject to Fica/Medicare/Social Security which is taken off of paychecks (been a while since I checked, but probably around 7-8% in addition to your federal and state income tax). Again, speaking in general here, there may be various miscellaneous deductions.

Plus, you will be in a lower tax bracket due to having less taxable income, so the chunk to Uncle Sam will be a smaller percentage versus making over 100k.

Add these up and you have to make considerably more in the private sector to come out ahead of the 60k salary in the military. By my calculations, you'd have to make over 160k in the private sector for each of your first 3 years out to come out ahead of doing a 3 year military scholarship, assuming you will pay off your loans to the point of what your loan balance would be at the end of a 3 year active duty commitment if you took the military route.

Of course, financial isn't the reason to join, but you have to consider the financial aspect of it before joining.

 

[krabmas]

Depending on what the tax laws say by the time you guys start repayment, it might be better for you to take a cash-out mortgage and pay down a big part of the principal on your student loan even if your spouse becomes liable for the debt in the event of your death.

• Above a certain income you can no longer deduct student loan interest. I don't know what the student loan interest was when you guys took out your loans, but just for example 6% interest on $200K equals about $12,000 per year paid to interest.
• Mortgage interest might be your biggest tax deduction
• If you are worried about burdening your spouse with your debt in the event you die prematurely, your life insurance policy should cover your debts. You are not likely to die prematurely, but interest will accrue on your student loan debt no matter what. A $200K principal at 6% with a 30-year fixed loan equals ~$232,000 total interest. That would've bought an awful lot of life insurance.
• If home loans have lower interest rates then it's especially a good idea
• If you pay down your student loan quickly, then even if you were to get divorced and lose the house, at least your student loan would be paid off. In contrast, if you were to pay down your house quickly, get divorced and lose the house, you would still have to pay off your student loan in addition to giving half your paycheck to your ex- who's living with her boyfriend in the house that you bought. Ooof, double whammy.

Here's yet another case in which having a good CPA is worth its weight in gold.

I sure hope my husband does not find a boyfriend. That would be awkward.

thanks for the advice.

 

[NatCh]

I sure hope my husband does not find a boyfriend. That would be awkward.

Ha ha!

 

[Student987]

.I’m a first year student with bad grades. Reading this thread, I can’t stop imagining myself as the guy at the very bottom of the spectrum who has the least earning potential coming out of school. I will probably be the one who can’t get a residency. So much debt and no relief in sight. Podiatry is starting to seem like far too risky of an investment. (for someone in my position.) PADPM, jonwill, and anyone else- Would you advise someone at the bottom of the 1st year class to quit instead of incurring more debt? Alternatively, what would a likely scenario be for someone graduating at the bottom and ultimately not matching with a residency- what do they do?
.

 

[southern dpm]

Absolutely. Both professionally and economically, it has been amazing. One year as associate 75K, plus benefits. No bonus structure. Eventually partner, promised me if I did well and bonus was available he would give it. Did well, they had not bonused in 5 years, 90k bonus available. 30K to me. Bought in, paid it off in a year and a half. Made goals by end of year five wanted to make 310K, passed that. Started june 2004. Jan to dec for 2009 if things continue the way they are going will be close to or at 400K. So when the complainers bitch and moan, it can be done. Would recommend anyone in residency to take advantage of the successful practices you scrub with. Pick their brains for practice management pearls. Unfortunately you a have to be a good physician and a good businessman. My residency made it a point to meet with the practice manager once a month. Made all the difference.
That is economics, patient treatment is great as well. Have to be versatile. Love it all, I dont bitch about diabetic with nails, potentially turn it into shoes, abi's, and diagnostic ultrasound for venous reflux disease. And if you think surgery pays the bills, change that thinking. We collected 1.85 million last year and less than 15% came from surgical collections. Two partners, we average 10-20 cases a week. The office work allows use to be able to afford to do surgery. I am not a podiatric surgeon, I am a podiatrist that specializing in reconstructive foot and ankle surgery, I am also an orthotist, a wound care specialist, signficantly knowledge on vascular disease, a dermatologist, sports medicine. Have to do it all at different times. Residents, things like taking advantage of your time with vascular surgeons, they used to drilled me on arteriograms and now I would put myself against most physicians in my town at reads. And god forbid some has a diabetic foot infection, my practice does it better than anyone in town, especially better than the MD/DO's. I have to compete against plastics and general surgeons for these cases, very different than my residency experience.

Those that complain, go get the training and do the work. hard work, DME, diagnostic testing, and custom orthotics made the differences. I sell very few products in my office. Kerasol, fungoid tincture. Dont do anything demeaning like nail friendly nail polish, though probably could add good profit to the business. I am also very fortunate, 200 new patients a month. But that is the point, went to an area that could support me. If you stay in the school areas, aka cleveland, 280 podiatrists or so in the city limits. Going to be hard with that much competition. Didnt go to my home town, too much competition. I do work hard. 8-5 monday-wednesday. I average 50-60 patients on monday, 40-50 tuesday and wednesday. Thursday 5-10 cases. 40 or so on friday 8-3. Average 1-5 patients in house at any one time. ABI, diagnostic ultrasound, products, shoes, orthotics (50-75 a month), ultrasound guided injections, surgery.
Good luck to all the residents coming out. Please email me if you need any help.

 

[PADPM]

With all due respect to SouthernDPM, please understand that not all DPM's are going to practice this way, nor to all DPM's want to practice this way.

I'm very happy that SouthernDPM has verified the fact that not all associate positions end up as nightmares.

However, I've stated many times on this site that I'm part of a very large group practice, probably one of the top 10 practices in the nation. And I've never given specifics about my income or how many surgical procedures I perform weekly, how many patients I treat daily, how many orthoses I make monthly, etc. I just don't see any point in spewing those numbers. It has no effect on anyone else.

Our office NEVER even mentions these numbers to our new associates. We have always been concerned that offering bonuses based on these procedures or "quotas" results in over-utilization. We do offer incentives based on hard work and production, but we closely monitor over-utilization and our doctors "selling" services. We do not promote "selling" in our practice and sell ZERO products in our office.

We do dispense DME equipment and we do perform diagnostic ultrasound, non-invasive vascular studies, etc., but we do not OVER-perform these procedures. It is very easy to justify performing these procedures on patients to help pay for the machine, etc., but our office policy is very strict and we have criteria that must be met prior to these tests being performed to prevent over-utilization and for "quality" control.

Although many doctors love to state that they've treated 60, 70 or more patients in an 8 hour day, I'm proud to say that I have "been there, done that" and refuse to practice that way. I do not believe I can provide quality care to my patients by treating 7-8 patients an hour. That averages out to 8 minutes per patient, including the amount of time you have to actually SPEAK with the patient to determine the problem, diagnose the problem, provide treatment for the problem and document the visit.

Yes, that's OK for a quick follow up visit, but in my practice I treat a lot of new patients and perform a minimal amount of nail care (though I'm happy to perform palliative care). I personally do not believe I can perform a thorough history, examination, explanation to the patient, provide treatment and educate my patient in 8 minutes, (not to mention document) especially for patients coming to my office for relatively complicated cases and/or multiple issues.

So I guess that's why ALL the doctors in our practice work everday of the week, at least 2 nights a week and almost every Saturday. We have a very busy schedule but always provide each patient with the time they deserve.

southern DPM is correct. If you want to be successful, give up the "attitude" and the "foot & ankle surgeon" mentality. I'm as happy trimming toenails as I am applying an external frame.......sometimes happier. Provide TOTAL care for your patients. That little old lady with the mycotic nails may have a young grand-daughter with a fresh juicy bunion, or a grand-son with a fresh fracture from a lacrosse injury.

Although it may sound corny, treat all your patients like they were family and it will keep your practice ethics intact and prevent you from crossing that line. When times are rough and bills pile up, it can get tempting to perform one more test, take one more x-ray, etc., but once you cross that line it makes it much easier to cross it again and again.

Always maintain your integrity and the income will follow. NEVER compare yourself to any colleague. Worry about yourself and your family and don't count anyone's money but your own.

 

[Podfather]

Jonwill,

As I said before my graduating residents almost always have a base salary over 100,000 plus benefits and a bonus structure. Last year we had 7 grads: 2 at 175K, 3 with 100-125K, one at 95K, and one at 80K. The 80K resident took a job in a DPM crowded city because of her husband's job. 65-70K offers tells me that practice probably can't afford or need an associate. In the past residents ahve been signing boneses or moving expenses. This is not "free money" it is meant to make sure the neww associate can get settled and not be stressed financially from the get go.

 

[southern dpm]

Excellent points made in your response but I put in some exact numbers to give an idea for those that are reading that both a good living is attainable and what one has to do in the beginning to produce that living. I am in complete agreement that not everyone wants to or is going practice this way. I dont want to have to keep up this pace forever nor will I be able to. I should have added that I am single, no children. So I dont not have all the family responsibilities that others in our field have. I do often work through the two hour lunch break in our schedule now in order to accomodate the load. Dictation for instance will be done tonight verses on the fly. I do treat my practice as a team approach, I often see more so the senior partner has the time for his family. I feel it is almost my obligation as a junior partner to provide this especially in my personal circumstances. I hope that the next partner will allow me the same opportunities.
The numbers were added once again to hopefully start putting to rest a little bit the notion that the patients are there and with hard work loans can be paid, partnerships can be paid, and a good life can be had.

As for quotas and over utilization of services, i completely agree with you. My bonus was not based on quotas but on hard work, and that first year when I was not seeing the amount of patients I spent my time pouring over office bills and ordering accounts trying to trim the fat that had not been followed closely before I was hired. Practice management was were I earned my keep in that first year.

I do feel like my size of practice represents the average southern practice. I do not over utilize services, would not compromise the practice for an extra dollar. I mention products to show that income was not generated by these things. I rotated in practices that their waiting room looked like a cvs or rite aid.

I will say that I do need to expand on the 8-5 thing. It does take more to see those numbers and provide the quality of care that each patient deserves and needs.

Example 52 patients 8-12 lunch 12-2 then 2-5
actually finished with morning patients at about 1245. 2-3 asistants helping (x-rays, putting patients in the rooms, etc) One of the assistants was in a separate room at times performing the abi's on a completely different schedule from the normal list. Quick lunch. Paperwork until 2. Finished the afternoon actually at 6. Ran behind due to some of the patients have multiple problems. Now have not completed any dictation yet. No EMR yet, so verbal dictation. So no I was not able to perform the total practice experience in that 8-5 framework. With your help I do realize that not everyonc can or wants to work this amount. I enjoy it.

I was trying to give some of the others some insight into my practice and what can be achieved. I should have been more giving into the sacrifices that have to be made but it also has its rewards. Just wanted to help try to put an end to the naysayers to our field.

The idea that nails is not just nails. Had a patient in today with nails. Diabetic. In office for her three month routine visit. Sugar has been out of wack in recent months. She has been cheating. Pulses are pretty poor. skin color changes. One could and I have seen in training leave it at that and collect the fee. Took the time to be thorough in my questions and evaluation while trimming the nails to determine that symptoms of intermittent claudication and rest pain were there. Had the ability to run the noninvasive vascular studies and they did not come out well. She is appointed with the vascular surgeon tomorrow for further eval. As well, diabetic shoes were needed. So patient got valuable treatment and turned a break even visit into a profitable visit. Patient was happy because we took the time to evaluate her problems other than just the nails. I think this situation comes from good training and working hard to take the extra step and also look beyond just the nails.

thank you for your insight and constructive criticism.

 

[PADPM]

Southern DPM,

First of all, I thank you for your maturity and ability to understand that my "criticism" was really not an attack but simply an example of how we all practice differently and make our own choices. Additionally, I was attempting to let the members of the site know that the amount we make in practice does not always equate with quality care.

In your case, it certainly seems as if you are delivering quality and ethical care while at the same time working extremely hard.

However, we both know of doctors that make huge bucks that practice horrible medicine with horrible ethics. That's why I attempt to stay away from discussing $$$$ on this site, since I know many docs that make huge money but I wouldn't let them trim my pet's toenails.

As I stated, I've "been there, done that" and have had days where I've treated 65-75 patients and I can not say I've enjoyed those days.

Additionally, I think it's safe to say that I'm MUCH less productive on those days, since I'm usually much more in a hurry to get to the next patient. When I have a more manageable schedule, it's much more productive because I can take my time, listen to ALL a patient's complaints and not hurry a patient. That always results in higher productivity AND happier patients.

Therefore, my schedule is now not over-booked, but I do work long hours and usually work 6 days a week to accommodate all the patients.

Our office recently opened a new satellite office (we have about 20 locations) and I'm in the new office one day a week. The office has only been open 5 weeks, therefore I've only been there 5 times and I'm already seeing about 15 patients a day and none of those patients are "routine" palliative care. So our practice knows and understands how to open and office and build it up pretty quickly.

As I stated and you have confirmed, I treat all conditions and welcome all patients, including routine nail care. I'm happy to share my skills with all those in need and you never know what pathology may be discovered.

I check my ego at the door. No member of my office staff is required to call me "doctor", but calls me my first name except in front of patients. ALL of my patients are treated equally, regardless of race, religion, sex and most importantly insurance. I do not treat insurance companies, I treat patients, and all my patients receive the exact same care and attention.

Practicing on the East Coast/Northeast is filled with challenges, especially regarding insurance restrictions and low reimbursements and high malpractice premiums. I envy my colleagues in the South, because I don't think you guys have been hit as hard economically as your Northern colleagues, because I know a LOT or practices up here are hurting big time.

Our practice receives calls and CV's from practices daily from doctors seeking an opportunity to join our practice, and I wish we were able to accommodate all the requests. Our practice is very large, but we expand as we see a geographic need and that's been our formula for success, in addition to providing consistent quality care.