Is private practice the goal for anyone?

[mandrew]

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I was just wondering if there are any residents or employed pods out there whose ultimate goal is to own/run their own practice either by purchasing an existing one or opening cold somewhere.

 

[caliking87]

Yes
Most people just want hospital jobs though

 

[mandrew]

Yes
Most people just want hospital jobs though

And how many hospital jobs are out there for Podiatry? Twenty years ago it seemed like the only hospital jobs available were at VAs.

 

[icebreaker32]

And how many hospital jobs are out there for Podiatry? Twenty years ago it seemed like the only hospital jobs available were at VAs.

Maybe 20 percent, half of which are probably at VAs.

 

[Weirdy]

My goal was private practice/group coming out.
Will give more details once things are up and running.
Had a lot of help from this forum.

 

[bloxxeeey]

There are some. It's tough. If you want to live in a half decent metro area, almost none. If you're okay with a small town of 5000 people you can find a couple. Private practice is just the most bountiful option, you'll find plenty of positions.

 

[mandrew]

Maybe 20 percent, half of which are probably at VAs.

So there is about one hospital job available beyond the VA’s for every ten pods looking?

 

[icebreaker32]

So there is about one hospital job available beyond the VA’s for every ten pods looking?

Hard to say as you have fellows and established podiatrists looking also. Some apply everywhere, some regional and some only local.

The better the job and location the more that are applying.

You probably have a dozen applying even for a very non desirable location.

It is not uncommon for the first applicant offered the job in a remote location to turn down the job for lots of reasons. Maybe they got a better offer in a better location or maybe when living in the boonies became real they caved and took the typical associate job in their desired location.

 

[Hybrocure]

Private practice should be the goal IMO. I’ve seen too many good docs get deleted overnight at good hospital jobs for no real reason other than the numbers didn’t crunch, no different than a layoff at a desk job. Because that’s what your value is there. You’re a tag in an email from the grim reaper working from home.

 

[Feli]

PP ownership was my goal throughout pod school and residency.
Then, reality hit and it's very hard to get a loan. I worked jobs for years (PP, hospital, MSG, supergroup).
It helps to learn skills and save up some capital. For most, if you want to be owner, you need to be employed first.
I am PP solo owner now. That was the story for 3 of the 4 co-residents of my year also (I was last to go solo PP). The 4th is essentially out of podiatry.

It seems there are only a handful of pods in each school's grad class who want to do PP/owner.
Half of them have mom/dad as a DPM and/or a good amount of money in the family.
For most others, it's fairly tough (that was my exp). It's important to seek out those who do it for ideas, though.

I think the VAST majority of DPMs finishing training apply and aim for hospital/ortho group jobs, then MSG jobs, then VA/IHS jobs... then most end up unsuccessful with those and take pod supergroup jobs or plain pod PP jobs. You may have that one odd duck in a class who does mobile pod.

There are some. It's tough. If you want to live in a half decent metro area, almost none. If you're okay with a small town of 5000 people you can find a couple. Private practice is just the most bountiful option, you'll find plenty of positions.

For sure. ^^^

But just like hospital jobs, PP is somewhat to VERY competitive in some areas also. The refers from PCPs are a zero sum game, so to get going in a PP office, those refers basically have to be taken from other PP pods. It is dog eat dog... especially in the metros near the pod schools or the cities that are just very popular to live.

Plenty of solid docs have struggled a long while to get going in metro areas - and even longer to get the types of patients/refers they want. Even if they have the money to weather it, it can become a financial drag and a frustration with regard to boards, paying staff, marketing energy and cash, etc.

 

[Feli]

Maybe 20 percent, half of which are probably at VAs.

I would agree with this. ^

For all of the pods coming out, there are more hospital and VA/IHS jobs than ever before.
However, there are record numbers of "surgical" pods coming out also. Most of those jobs are taken.
VA and hospital jobs were fairly easy to get/create 20yrs ago, but only so many can be created.

Solid 3yr surgical training has been diminished now that every DPM has it (on paper).
The fellowships are clear evidence that the DPM job game is getting harder (even though many more DPMs hosp/MSG employed).
The debt is staggering, so many DPMs hold onto these jobs for decades (or keep applying if they can't get them).

 

[Robin-jay]

After absolutely being slammed with ED consults, inpatient consults, etc., I can't see myself being a hospital podiatrist right now, and would love private practice. I work 12-16 hours a day. Even longer when on-call or weekends are involved.

6 am to 10 pm is the norm for my Mondays. Tuesday-Fridays are usually a couple hours less, but it really depends. Add in academics, PRR logging, etc. and the times are a little nuts imo.

 

[DYK343]

After absolutely being slammed with ED consults, inpatient consults, etc., I can't see myself being a hospital podiatrist right now, and would love private practice. I work 12-16 hours a day. Even longer when on-call or weekends are involved.

6 am to 10 pm is the norm for my Mondays. Tuesday-Fridays are usually a couple hours less, but it really depends. Add in academics, PRR logging, etc. and the times are a little nuts imo.

I hope youre clearing 600k+ working those hours.

If not you gotta find a way to make this more efficient.

Those hours are unsustainable and burnout is here and will only get worse.

Monday is always my busiest day. I get a lot of inpatient consults from over the weekend that were not emergent enough to call me in (Hospitalists in my area are very good that way towards specialists).

Regular 6AM - 10PM though? Thats either wildly inneficient or you need another DPM. Or youre making crazy cash and dont want to give it up but disgruntled about it.

- - -
Edit: Or are you a resident still?

 

[Robin-jay]

I hope youre clearing 600k+ working those hours.

If not you gotta find a way to make this more efficient.

Those hours are unsustainable and burnout is here and will only get worse.

Monday is always my busiest day. I get a lot of inpatient consults from over the weekend that were not emergent enough to call me in (Hospitalists in my area are very good that way towards specialists).

Regular 6AM - 10PM though? Thats either wildly inneficient or you need another DPM. Or youre making crazy cash and dont want to give it up but disgruntled about it.

- - -
Edit: Or are you a resident still?

Resident haha.

But yea, glad to hear that as an attending those hours are unrealistic.

 

[DYK343]

Resident haha.

But yea, glad to hear that an an attending those hours are unrealistic.

Sounds like youre getting good training. Congrats.

 

[Weirdy]

After absolutely being slammed with ED consults, inpatient consults, etc., I can't see myself being a hospital podiatrist right now, and would love private practice. I work 12-16 hours a day. Even longer when on-call or weekends are involved.

6 am to 10 pm is the norm for my Mondays. Tuesday-Fridays are usually a couple hours less, but it really depends. Add in academics, PRR logging, etc. and the times are a little nuts imo.

Welcome to residency.

 

[podwho]

private practice is the goal if you want a specific type of practice and life style. I wanted the lifestyle money and family, so I sacrificed half of what I trained for to make more money and do more boring cases occasionally. I miss the surgical diversity, but I like not being poor even more. What ever job pays you the most really is what you should aim for tbh out of training.

 

[PTPuser]

How sustainable and profitable is it to be 80% non-op and maybe 20% with wound / limb salvage stuff?

I don't know if I am hating big cases cause I don't like them or if I am just stressed out scrubbing with certain people and the training of it.

 

[Robin-jay]

Welcome to residency.

I know right, but I don't see the point in being overworked to that degree. All it does is make me question my life choices.

At least once I'm done with residency, I can choose a rural location and rake in money. That's all that keeps me going.

 

[Hybrocure]

I know right, but I don't see the point in being overworked to that degree. All it does is make me question my life choices.

At least once I'm done with residency, I can choose a rural location and rake in money. That's all that keeps me going.

I worked those hours in residency. I made it a point after residency was over that I wouldn’t do that as an attending. As you know - those attendings on call are available for those morning hours or late night surgeries.

I’ll take normal working hours for half or even a third the pay of that life any day

 

[BubbaWub]

How sustainable and profitable is it to be 80% non-op and maybe 20% with wound / limb salvage stuff?

I don't know if I am hating big cases cause I don't like them or if I am just stressed out scrubbing with certain people and the training of it.

Both sustainable/profitable. A hospital employed pod did basically this and was getting paid 390-420ish

 

[Hybrocure]

How sustainable and profitable is it to be 80% non-op and maybe 20% with wound / limb salvage stuff?

I don't know if I am hating big cases cause I don't like them or if I am just stressed out scrubbing with certain people and the training of it.

Pretty sustainable.

Plenty of pods balling with non op practices or partial op having the ability to debride/amp when needed, or do minor electives.

Big cases are competed over between ortho and fellowship trained pods or pods who like that stuff. As a regular podiatrist that stuff can be turfed easily to someone who would love to do it and likely do it better than you can

 

[Feli]

How sustainable and profitable is it to be 80% non-op and maybe 20% with wound / limb salvage stuff?

I don't know if I am hating big cases cause I don't like them or if I am just stressed out scrubbing with certain people and the training of

I agree with above. I wouldn't worry about it. You are a podiatrist. You will be 80% (or more) office at probably over 90% of podiatry jobs.

Most of the hospital jobs are just the wound/amp stuff, which is pretty easy.
Jobs for pods with a lot of real recon (trauma/deformity) or even a lot of DM recon (Charcot, DM fx, adv wound plastics, etc) are fairly rare. Most of those jobs are VA/IHS, where the volume is really low.

It helps to offer as many services as possible in PP group pod/ortho/msg, but you don't have to do them all personally.
If you are like the majority of DPM grads, you'll be kinda scared of surgery for a year or so, then you are comfortable with it and trying to do it for ego or boards or income or jobs or whatever... and then you are fairly bored with it and over it (more work for less income).

Personally, I'd love to do less surgery (esp bigger recons... adult flat foot starting in an hour today), but there simply aren't a lot options for it in my area (and/or they often don't stay long). The few guys I'd really trust to do the RRA well are all about 2 hours away, so it's not very practical for patients I see. As it is, I get sent surgery from a few pods nearby, but I'd be glad to give most of it up if a DPM or ortho who could do it well and communicated well arrived (and stuck in the area).

That said, I usually only do 2 or 3 mornings of surgery monthly (maybe 5 mornings in the Nov/Dec or some busier summer months). I am fairly fast at it, and I block the cases in groups. So I guess I'm 85% or 90% non-surgery overall, in terms of hours. Surgery's not a bad change of pace for me... I try to encourage and harvest refers for the well-paid office stuff, neutral on the bone/joint surgery and ER injuries, and try to discourage the nails/wounds/amp (but I'll see whatever). That's just me. Surgery - esp the bigger stuff - is far from necessary to make money and have a career, though. For the amount of training time and emphasis and testing that we put into it, it's a very low % of your time as an attending DPM... and we'd be a lot better with a low percent of pods doing much higher volume.

 

[PTPuser]

I’m glad to hear that and I’m hoping the trends continue. I’m at a work horse program. Before residency, I love the idea of big recon. Now as a resident, with trauma, calls, floor, clinic etc built in I am hating big cases.
I’m constantly anxious cause I’m with big personality attendings. I’m grateful for the opportunity cause I am doing and seeing more than a typical pod residency but I want a life post residency and I don’t want this stress anymore.

The job barely pays as it is. Like why am I putting myself through of all this.

Idk maybe things will change but I’m not enjoying this exhaustion at all.

 

[Flip-flop-flerpity]

I’m glad to hear that and I’m hoping the trends continue. I’m at a work horse program. Before residency, I love the idea of big recon. Now as a resident, with trauma, calls, floor, clinic etc built in I am hating big cases.
I’m constantly anxious cause I’m with big personality attendings. I’m grateful for the opportunity cause I am doing and seeing more than a typical pod residency but I want a life post residency and I don’t want this stress anymore.

The job barely pays as it is. Like why am I putting myself through of all this.

Idk maybe things will change but I’m not enjoying this exhaustion at all.

A good residency is much like swinging multiple bats before the real pitch. You'll be glad you did it.

 

[PTPuser]

A good residency is much like swinging multiple bats before the real pitch. You'll be glad you did it.

Everyone else works just as hard but have such good outlook after they’re done and our is just bleak. Just hard to keep motivated when there’s nothing to look forward to. The only thing I have control over is my personal life and I’d rather invest in that.

I don’t hate the work but I can’t commit and keep chasing this dream anymore. I don’t want any part of it and I want a life that can afford me to make a good living. If that means I have to give up surgery, then so be it.

 

[mandrew]

Both sustainable/profitable. A hospital employed pod did basically this and was getting paid 390-420ish

His/her salary was $400,000/year? How many hours working per week? How much does this same hospital pay the MD surgeons working there?