Income Thoughts

[icebreaker32]

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Podiatry has an increase in salary with experience more than any other speciality?

Thoughts as to why?

Mainly private practice (more income as practice grows)

Saturation with underpaid associate jobs

Other reasons?

 

[Hybrocure]

No way the average pod salary is nearly equal to internal medicine mid career.

Let’s say this poll is legit though. My guess? Mid career graft frauding and dgaf billing practices. Most med specialties can bill office visits alone, or simple surgery coding without unbundling and still rake in big bucks.

Podiatrists have to be “creative”.

Also anything that lumps podiatry into MD/DO income info should always be treated with a shaker of salt. White coat investor isnt relevant to the average podiatrist. They dont even know what a podiatrist is or can do.


Tell me, when our average new grad income is 225+ and mid career 365k (supposedly) how come VA and hospital employ jobs get 100+ applications immediately and are super competitive, for salaries less than our mid career average. This was happening even before the VA pay scale.

 

[Adam Smasher]

There's a learning curve to podiatry billing and coding, between q modifiers, 25 mods, wound care.

Also I'm way more efficient at patient care now, used to be that 18 pts in a day was a hard day for me, now I'm cruising along at 30ish. So learning to work efficiently brings up collections and income with it.

And most obviously the trajectory has been start out as an associate and grind your way to solo owner/partner/hospital employed. This trajectory might not work so great as PE supergroups expand.

Just some hypotheses. No idea really. Like hybrocure, I am skeptical of these figures.

 

[heybrother]

1. Over on the dental forum the ADA is showing that dental salaries are coming down and that expenses are increasing. The trend is negative. I have a hard time believing that the same expense related trends don't apply to us. Us being private practice doctors.
2. Over like the last 3 years, we are on a negative trendline for Medicare reimbursement. Next year may be a temporary pause, but the 2.5% increase in the OBBB was a 1 year increase only and it comes in the face of a multi-year decrease in reimbursement. If you take a 50% decrease in 1 year and then a 50% increase in the next year you don't get back to where you started.
3. I have no idea how much graft reimbursement influenced people's private practice experience, but the numbers people describe on here seem absolutely unbelievable. Like it seems like doing 1-2 grafts a month could have been worth more than doing a dozen well reimbursing cases. Meanwhile, Dr. Rodgers/Armstrong would tell you that a lot of the graft reimbursement was ultra-concentrated in the hands a small cohort of super-users. I hope the APMA is as diligent in surveying salaries next years as they were this year and I'm very curious to see where macro trends on this go.
4. Marit data is self reported. I submitted mine. There's no verification. You can say whatever you want. You can claim a base $800K salary, which some people did.
5. After the Marit data came out - there was an adjustment performed where the overall average came down. I assumed - they had dropped a bunch of the people who had reported ridiculous numbers that seemed artificial/inflated. Instead, they came down because Marit had excluded low reported values and decided to include them. Color me skeptical of some of the stupidly high values, but I suppose if they are reporting medians that these don't really matter.
6. CMS is taking baby steps to try and address the systemic issus that result from site of service discrimination, but some of the changes that they are implementing at the same time will be a net negative for us. The country has not been well served by allowing hospitals to buy up physicians and maximize their HOPD fee schedule billing.
7. It will be interesting to see how next year plays with the subsidies. I've already had a patient tell me they have to have an issue resolved this year because they won't have insurance next year. When I checked the pricing in my area for marketplace insurance what I found was that insurance for younger/middle aged people like myself stayed relatively similar, but that prices had gone up substantially for older patients which are a substantial component of my clientele.
8. Everyone on here who has been in the game knows the most straight forward path to higher income is hospital employment.
9. Marit actually underrepresents physician income growth. After all, I went from $75K to $250K - a 333% increase. Truly podiatry has been so good to me. I think about it when I throw away the cheap furniture and things that I bought when I was broke-ass poor my first year out. Boba Foot would definitely look down on me for driving a 10 year old car though it was an upgrade from my 13 year old car.

 

[sdupre_apma]

Podiatry has an increase in salary with experience more than any other speciality?

Thoughts as to why?

Mainly private practice (more income as practice grows)

Saturation with underpaid associate jobs
View attachment 412790
Other reasons?

Hey all, Sam from APMA here. This graph is from this document on the Marit site: Physician Salary Growth: How Pay Changes Throughout Your Career. This is based on Sept 2025 data, so before we started the APMA/Marit compensation survey. This is NOT the updated data. The full APMA/Marit report should be going out... today? Or so?

On this point:
"4. Marit data is self reported. I submitted mine. There's no verification. You can say whatever you want. You can claim a base $800K salary, which some people did.
5. After the Marit data came out - there was an adjustment performed where the overall average came down. I assumed - they had dropped a bunch of the people who had reported ridiculous numbers that seemed artificial/inflated. Instead, they came down because Marit had excluded low reported values and decided to include them. Color me skeptical of some of the stupidly high values, but I suppose if they are reporting medians that these don't really matter."

So, we actually did two things on the top end to keep any especially high values from affecting the central measures (mean, median). First, on point 4, we checked some of the details around the highest reported values as part of data validation checks and there's reason to think they're legitimate. Second, and this is the most impactful, I applied winsorization to the top 1% of values, basically capping the highest possible value at just over $1M. This kept the 1% who reported more than that from dragging up the means. You might say, "$1M! That's a lot!". Yup, sure is. Still, it's a small set of people making even that much and there's reason to think it's legitimate,

Warmly,
Sam

Editing briefly to say: Thanks @heybrother, you're spot on in many of these points. As you mention, we switch almost entirely to reporting the median instead of the mean as our primary metric throughout the report which will be released shortly. That goes a LONG way towards reducing the influence of those top-end outliers. We also report a broader range of statistics than you normally see in this stuff. Everywhere (I think?) we report mean we also report median, along with measures like min/max, 25th/75th percentile, etc. Our goal was to actually contextualize the summary metrics that you usually see.

@heybrother makes some good points here on income growth over time in the profession, pay difference as a hospitalist, etc. I think the survey data we're presenting will make a lot of sense to many of you here based on what you might expect from your experience.

Lastly, for clarity, the data on the Marit site doesn't have post-survey measures applied (e.g., winsorization). The APMA report which is coming out very, very, very soon does. Marit will be shortly releasing a version of that report for anyone registered on their platform (aka you submitted data for the survey) that is a bit simplified and without a fair amount of APMA's analysis as that's part of the membership benefit. Finally, still planning on releasing a last short brief that covers big picture stuff for non-APMA members.

 

[Creflo]

Some new grads may be making $228k, but I doubt most are.

 

[Sybly]

Some new grads may be making $228k, but I doubt most are.

Depends on overbilling … and pathology finds..,

 

[Stormblest]

Got a hospital gig right out the gate and made base salary 260k, now up to 290k before bonuses 1.5 years out. Coresidents who graduated at the same time also got hospital jobs, one with base salary 245k and the other was 310k (rural). It does happen but not sure how common. Not a top tier residency either, no fellowships.

 

[footpainhealer]

Im glad the hospital employed people are doing well, but I hate (as heybrother alludes to) that the current system favors employees of a hospital/HOPD with how reimbursement works. PP should ALWAYS be the highest earning avenue of any specialty imo. A solo, self-owned pharmacy, podiatrist, dentist, pediatrician, plastic surgeon, cardiologist, whatever, should not be making less than an employed person of the same occupation. And for my whole life, that has always been the case.

When I applied to pod school, the 2 docs I shadowed in undergrad were making more than the hospital employed salaries I have seen thrown around here and on reddit. They worked great hours, and were never stressed. I spent 4 months at one the practices as an "assistant" and saw the day in and day out. That lifestyle is what I wanted, and why I applied podiatry in the first place. I know most PP owners, whether solo or not, are still are doing well....

But this trend of decreasing money coming in, with increasing labor/electricity/supplies/insurance/emr/billing costs is really annoying and pisses me off.
I get why costs of have gone up for everything, but what specifically happened in the last 20 years that caused the money coming IN to the practice to go down? Why is the dollar amount that insurance/MC pays for any given CPT to a HOPD going up every year, and not the private practice guys? The amount of comments on here from pods that have been practicing for years saying "bunions aren't even worth it anymore, I used to get $X for it, and now I get 0.5X for it" etc. is crazy.
This isn't even a podiatry issue, it's an everything issue (as heybrother mentions with dental). There's gotta be a tangible, identifiable reason. This isn't sustainable.

 

[podwho]

This is a very typical case of response bias.

Pods are not filling out survays or reporting when they make embarrising money. The ones who landed that hospital gig are happy to because they need access to more data to make sure their comps are accurate.

Everyone knows majority of pods work in private practice in small groups.

But podiatry, like most surgical specialties, are generating the most revenue when they are in the OR and wound care center. Those pods are underpaid for the amount of profit they generate. I’d argue a busy hospital pod fair compensation is probably closer to 500k if your going to the OR multiple times a week. Go ask the head of your OR how profitable podiatry cases are.

Believe it or not people, the reimbursement is the same as most other doctors. So what’s the difference with outpt ?

Outpatient complexity of problems is very low. We are not the main doctor managing pvd or diabetes even with all the screening we do just to keep the schedule full and milk Medicare. So just like everyone you have to get creative.

 

[Toenail]

So what’s the difference with outpt ?

Outpatient complexity of problems is very low. We are not the main doctor managing pvd or diabetes even with all the screening we do just to keep the schedule full and milk Medicare. So just like everyone you have to get creative.

It’s so easy to hit level 4 visits now. I’m about 50% level 4 visits in clinic. Split between recon MSK stuff, limb salvage, and train wreck trauma stuff.

 

[air bud]

It’s so easy to hit level 4 visits now. I’m about 50% level 4 visits in clinic. Split between recon MSK stuff, limb salvage, and train wreck trauma stuff.

Yes

 

[Feli]

This is a very typical case of response bias.

Pods are not filling out survays or reporting when they make embarrassing money. The ones who landed that hospital gig are happy to because they need access to more data to make sure their comps are accurate.

Everyone knows majority of pods work in private practice in small groups. ...

Correct... and an increasing percent of podiatrists now work in supergroups, which also pay below the "average."

Some new grads may be making $228k, but I doubt most are.

No, not a chance.
As @Stormblest said, some new grads get VA/IHS (nearly all below that avg) or rural/CAH hospital or even private hospital jobs or whatever, but the minority. Most who take MSG or ortho group jobs (and nearly all who take pod PP and pod superrgoup jobs) are under that. Even if you have the occasional new grad who gets $300k, you are still well under that fake "average" if you have even two or three of their peers making common $175k or $150k or $200k etc pod job offerings (as the majority do indeed take).

I'd think that mark is probably roughly the average for DPMs overall (all ages and exp levels). There are tons of 40s, 50s, 60+ DPMs working in supergroups or typical small/medium PP associate gigs and not clearing $200k unless they work a ton or do a lot of questionable stuff. It is amazingly hard to take home a lot when you only get 30% or 35% (especially if ownership is hiding/minimizing collections also). You'd need to collect $760k at 30% or $650k at 35% to get that supposed "new grad average" money... simply not happening 95% of places in the first year out (or even happening for over half of seasoned DPMs in PP).

 

[Hybrocure]

This is a very typical case of response bias.

Pods are not filling out survays or reporting when they make embarrising money. The ones who landed that hospital gig are happy to because they need access to more data to make sure their comps are accurate.

Everyone knows majority of pods work in private practice in small groups.

But podiatry, like most surgical specialties, are generating the most revenue when they are in the OR and wound care center. Those pods are underpaid for the amount of profit they generate. I’d argue a busy hospital pod fair compensation is probably closer to 500k if your going to the OR multiple times a week. Go ask the head of your OR how profitable podiatry cases are.

Believe it or not people, the reimbursement is the same as most other doctors. So what’s the difference with outpt ?

Outpatient complexity of problems is very low. We are not the main doctor managing pvd or diabetes even with all the screening we do just to keep the schedule full and milk Medicare. So just like everyone you have to get creative.

PP doesn’t make jack in surgery compared to hospital employed.

I have a hospital employed buddy who makes full 100 on every procedure code and doesn’t get the diminishing returns for subsequent procedures in the same case. Dude can do multiple hammertoes with full reimbursement for each toe.

Hospital money math compared to PP is regarded.

 

[Hybrocure]

Correct... and an increasing percent of podiatrists now work in supergroups, which also pay below the "average."


No, not a chance.
As @Stormblest said, some new grads get VA/IHS (nearly all below that avg) or rural/CAH hospital or even private hospital jobs or whatever, but the minority. Most who take MSG or ortho group jobs (and nearly all who take pod PP and pod superrgoup jobs) are under that. Even if you have the occasional new grad who gets $300k, you are still well under that fake "average" if you have even two or three of their peers making common $175k or $150k or $200k etc pod job offerings (as the majority do indeed take).

I'd think that mark is probably roughly the average for DPMs overall (all ages and exp levels). There are tons of 40s, 50s, 60+ DPMs working in supergroups or typical small/medium PP associate gigs and not clearing $200k unless they work a ton or do a lot of questionable stuff. It is amazingly hard to take home a lot when you only get 30% or 35% (especially if ownership is hiding/minimizing collections also). You'd need to collect $760k at 30% or $650k at 35% to get that supposed "new grad average" money... simply not happening 95% of places in the first year out (or even happening for over half of seasoned DPMs in PP).

Preach. Feli knows the real ****

 

[Weirdy]

PP doesn’t make jack in surgery compared to hospital employed.

I have a hospital employed buddy who makes full 100 on every procedure code and doesn’t get the diminishing returns for subsequent procedures in the same case. Dude can do multiple hammertoes with full reimbursement for each toe.

Hospital money math compared to PP is regarded.

Yup
Have hospital hired guys who will crank out easy pus buss and whatever inpatient stuff comes their way.
Make a killing and do good work.
Meanwhile I just wasted time and resources doing an outpatient elective when I could've cranked out 3x as many patients in clinic.

Not hating, just very different worlds and returns for hospital hired vs outpatient practice.
I am grateful my residency made me work with the outpatient guys. As a resident it didn't make any sense why they did what they did.
Now that I'm out I appreciate it a little more.

 

[eyeeye_captain]

Meanwhile I just wasted time and resources doing an outpatient elective when I could've cranked out 3x as many patients in clinic.

It’s unkind to hit me that hard in the feels right before the holidays

 

[Adam Smasher]

The way I look at it is that lesser reimbursing procedures in OR are an extension of what we do in clinic. In other words, if you cut out the OR then a lot of people wouldn't have any reason to come to clinic to begin with. Obviously it creates a perverse incentive to slow-walk surgical treatment while you give easy placebo treatments like custom foot orthoses in hallux valgus.

My newest life-hack for avoiding the OR is when pts have a distal toe ulceration 2/2 rigid hammertoe (i.e. flexor tenotomy not an option), I'll do an ostectomy of the distal portion of the distal phalanx and bill it as a bone debridement. If it's infected without systemic sepsis, I can still do this outpatient and order infusions of dalbavancin (2 doses 1 week apart at 1.5g each) while billing serial 11044s. Make sure the cx grows gram positive organisms and that you diagnose cellulitis because that's the on-label indication.

 

[Weirdy]

The way I look at it is that lesser reimbursing procedures in OR are an extension of what we do in clinic. In other words, if you cut out the OR then a lot of people wouldn't have any reason to come to clinic to begin with. Obviously it creates a perverse incentive to slow-walk surgical treatment while you give easy placebo treatments like custom foot orthoses in hallux valgus.

My newest life-hack for avoiding the OR is when pts have a distal toe ulceration 2/2 rigid hammertoe (i.e. flexor tenotomy not an option), I'll do an ostectomy of the distal portion of the distal phalanx and bill it as a bone debridement. If it's infected without systemic sepsis, I can still do this outpatient and order infusions of dalbavancin (2 doses 1 week apart at 1.5g each) while billing serial 11044s. Make sure the cx grows gram positive organisms and that you diagnose cellulitis because that's the on-label indication.

I've had 2 patients with tip of toe down to bone wounds. Did bone debridement (just around the wound, not even ostectomies with bone nippers or anything) and started them on orals- culture directed while waiting for everyone else to get their **** together so I can take them to OR for outpatient amp (vascular, cards, PCP).

Both healed their wounds with zero radiographic progression of osteo.
Gonna start debriding bone more.

 

[Retrograde_Nail]

This is a very typical case of response bias.

Pods are not filling out survays or reporting when they make embarrising money. The ones who landed that hospital gig are happy to because they need access to more data to make sure their comps are accurate.

Everyone knows majority of pods work in private practice in small groups.

But podiatry, like most surgical specialties, are generating the most revenue when they are in the OR and wound care center. Those pods are underpaid for the amount of profit they generate. I’d argue a busy hospital pod fair compensation is probably closer to 500k if your going to the OR multiple times a week. Go ask the head of your OR how profitable podiatry cases are.

Believe it or not people, the reimbursement is the same as most other doctors. So what’s the difference with outpt ?

Outpatient complexity of problems is very low. We are not the main doctor managing pvd or diabetes even with all the screening we do just to keep the schedule full and milk Medicare. So just like everyone you have to get creative.

Correct.

My base is around 650K but thats after many years of crushing it. I generated the hospital close to 3 million last year.

If I was foot and ankle ortho or just ortho (any specialty) their base would start at 650K without ever doing anything. Oh and they get a PA or NP first day as well....