Job Offer during Covid good?

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bing12

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Hello everyone!

I am posting this for a friend of mine who is in their 3rd year pod residency. They are in the Northeast region of the US. They are not sure what a typical job offer looks like in terms of % collection for payment. This one doc offered them 32% collection, but not sure if they can give them a gaurentee because of all this covid situation. under normal market conditions, what is the range of % of collection and base salary? I know it can range depending on the region, I would just like some sort of baseline.

Thank you!

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These are just a few random thoughts in the era of Covid.

(1) In normal times and busier case loads its almost always a win for the owner to have the associate see patients unless volume is fantastically low. These are the sort of situations where the owner says variations of - "I have to see all the patients". That makes "no base" situations trickier. Not a lawyer - probably beneficial to have a short time table escape hatch in the contract. The last thing you want is to be trapped in some sort of 3 months scenario where you aren't being paid at all, no base, seeing no patients - waiting to quit.

(2) Does the person in question have a family? Benefits in podiatry practices tend to be sparse. For example, my health insurance is paid for as an employee of the practice. My family is also on the plan, but the payment for them comes out of my salary. That comes out to about $1000 a month - if you have no collections/base/guarantee - how will that be paid for?

(3) There is some relatively decent information on this forum if they look around for it though its a little all over the place.

(4) Be careful that the owner doesn't try and say - well you are actually a contractor as opposed to a W2 employee due to the no-base. There are variations of pros and cons to each, but contractors pay both sides of social security (like another 6.5% tax). They do have the ability to have a solo 401k. My big issue with the contractor offer whenever I hear about it - everyone always seems to get offered a usual podiatry bullcrap collections percentage even though their expenses will be substantially higher since they'll pay more taxes and have to pay for their own benefits. A contractor needs to be paid substantially more. Additionally, the way most podiatrist owners run their practices and treat their associates is not how the relationship with a contractor works. Contractors work for multiple people. They take work where they can get it. They don't sit for hours not getting paid 5 days a week in someone's office.

(5) You will inevitably receive some feedback consisting of the following:
(a) the northeast sucks
(b) hospital/multi-specialty pay is better
(c) private practice is awful

We have a vibrant and opinionated community! All of the above are true :)

(6) No matter the "generosity" of the % collections in a no-base situation - your friend will need a plan to deal with the fact that they may not have any substantial cash flow for several months. I looked back at my billing quite a bit when I first started and while ultimately we did collect the majority of our "allowed" it still took quite awhile for money to come in. Consider a claim through private insurance. Perhaps the patient pays a $40 co-pay. You charge an E&M and X-rays. The billing has to go through the insurance company, who reduces the fee schedule to the allowed amount, who then potentially passes the unmet deductible portion to the patient, who then maybe, eventually pays it. That isn't a 2 week turn. In fact, that patient may return for a 3 week follow-up and the insurance company still hasn't adjusted the visit - so you can't even say - oh btw, you have a $85 balance from last time, would you like to pay that today.

During that time your friend will have student loan payments, apartment/mortgage bills, etc.

(7)
-Bases/guaranteed salary are all over the place. I've seen $65, $75, $100, $120, $145(k). Others will know of different variations/values etc. If you are sitting at $120K base that's probably about as good as most people get. Not saying better isn't out there. But believe it - sub-$100K is and it isn't always associated with higher % collections amount.

-% collection values tend to be much lower in podiatry than other professions. I was offered 17% once. Probably normal spectrum of values is 30-40% with anything breaking 35% being considered decent as compared to what most have. A poster on here has advocated that more than 40% should be what you fight for. Most I've seen anyone get was 40% (and they actually had the best base I'd seen).

-We could draw a line in the sand and say anything under 30% is unacceptable/terrible, but the simple truth is someone else could come along and say the same for anything under 35%.

-With "no base" - I think I'd ask for 40% (someone may come along and say 42-45%). Course the higher you ask the more likely the pod is to ask their friends what they are paying and tell you that you are crazy. To which you say - you aren't paying me a base. I don't work for free.

-Probably would also be helpful to have an occurrence malpractice policy so that when you have to quit because you never got paid there is no tail.

(8) Podiatrists do have a tendency to create bullcrap salary tiers in which people make less money the harder they work. With a no base the tiers either need to not exist or get substantially better with each level.

(9) Podiatrists also have a tendency to want to with hold percent collection money until the end of the year, call it a bonus, and string you along on your base. If your salary specifies 35% etc - and the money you'd ultimately be owed for that exceeds your base - that's not a bonus. In a no base situation you must absolutely be paid your % collections throughout the year. The owner can sort his bonus out at the end of the year. Throughout the year the associated should be able to receive timely information on their collections - on the whole and from each patient so they can adjust/modify their billing.

(10) Your friend must absolutely have a lawyer review their contract. That said - a friend of mine had a lawyer review theirs. The friend had been told all sorts of things by the practice owner - an almost endless litany of verbal promises were made and none of these were in the contract. The resident attempted to provide feedback from their lawyer and the offer was rescinded. You must use a lawyer, but private practice owners are often not going to negotiate. My personal contract experience was that the owners accepted almost none of my modifications.

(11) Your friend should temper their expectations concerning how their future private practice will be. The people who trained me were I think very successful - hospital based, practicing essentially full spectrum, reasonably interested in billing and coding/adopting their practices - collections exceeding a million each. I met many successful people during 4th year - young doctors a few years into their practice busting their tails with collections approaching a million. I think there are plenty of practices out there whether the doctor thinks they are working hard and potentially their collections are only $400ish. A person like that can't pay a base of $120K. They can't image paying a collections percentage of 35% or more because often their overhead is 65% or more.

(12) Get all the "benefits" and costs and what not sorted out/detailed and have the owner spell out their interpretation of what it actually means to be paid a % collections - how does that work, what counts towards it ie. E&M, X-ray, CPT, DME
-There's been a bunch of crap lately of people being offered contracts where they had to pay their own malpractice
-A lot of owners are conniving bullcrappers who will try and manipulate what collections are or state that practice overhead expenses are yours etc. ie. well after the collections are added up we subtract the secretary overhead cost before we multiple by the %#. Bullcrap.

Good luck to your friend.
 
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These are just a few random thoughts in the era of Covid.

(1) In normal times and busier case loads its almost always a win for the owner to have the associate see patients unless volume is fantastically low. These are the sort of situations where the owner says variations of - "I have to see all the patients". That makes "no base" situations trickier. Not a lawyer - probably beneficial to have a short time table escape hatch in the contract. The last thing you want is to be trapped in some sort of 3 months scenario where you aren't being paid at all, no base, seeing no patients - waiting to quit.

(2) Does the person in question have a family? Benefits in podiatry practices tend to be sparse. For example, my health insurance is paid for as an employee of the practice. My family is also on the plan, but the payment for them comes out of my salary. That comes out to about $1000 a month - if you have no collections/base/guarantee - how will that be paid for?

(3) There is some relatively decent information on this forum if they look around for it though its a little all over the place.

(4) Be careful that the owner doesn't try and say - well you are actually a contractor as opposed to a W2 employee due to the no-base. There are variations of pros and cons to each, but contractors pay both sides of social security (like another 6.5% tax). They do have the ability to have a solo 401k. My big issue with the contractor offer whenever I hear about it - everyone always seems to get offered a usual podiatry bullcrap collections percentage even though their expenses will be substantially higher since they'll pay more taxes and have to pay for their own benefits. A contractor needs to be paid substantially more. Additionally, the way most podiatrist owners run their practices and treat their associates is not how the relationship with a contractor works. Contractors work for multiple people. They take work where they can get it. They don't sit for hours not getting paid 5 days a week in someone's office.

(5) You will inevitably receive some feedback consisting of the following:
(a) the northeast sucks
(b) hospital/multi-specialty pay is better
(c) private practice is awful

We have a vibrant and opinionated community! All of the above are true :)

(6) No matter the "generosity" of the % collections in a no-base situation - your friend will need a plan to deal with the fact that they may not have any substantial cash flow for several months. I looked back at my billing quite a bit when I first started and while ultimately we did collect the majority of our "allowed" it still took quite awhile for money to come in. Consider a claim through private insurance. Perhaps the patient pays a $40 co-pay. You charge an E&M and X-rays. The billing has to go through the insurance company, who reduces the fee schedule to the allowed amount, who then potentially passes the unmet deductible portion to the patient, who then maybe, eventually pays it. That isn't a 2 week turn. In fact, that patient may return for a 3 week follow-up and the insurance company still hasn't adjusted the visit - so you can't even say - oh btw, you have a $85 balance from last time, would you like to pay that today.

During that time your friend will have student loan payments, apartment/mortgage bills, etc.

(7)
-Bases/guaranteed salary are all over the place. I've seen $65, $75, $100, $120, $145(k). Others will know of different variations/values etc. If you are sitting at $120K base that's probably about as good as most people get. Not saying better isn't out there. But believe it - sub-$100K is and it isn't always associated with higher % collections amount.

-% collection values tend to be much lower in podiatry than other professions. I was offered 17% once. Probably normal spectrum of values is 30-40% with anything breaking 35% being considered decent as compared to what most have. A poster on here has advocated that more than 40% should be what you fight for. Most I've seen anyone get was 40% (and they actually had the best base I'd seen).

-We could draw a line in the sand and say anything under 30% is unacceptable/terrible, but the simple truth is someone else could come along and say the same for anything under 35%.

-With "no base" - I think I'd ask for 40% (someone may come along and say 42-45%). Course the higher you ask the more likely the pod is to ask their friends what they are paying and tell you that you are crazy. To which you say - you aren't paying me a base. I don't work for free.

-Probably would also be helpful to have an occurrence malpractice policy so that when you have to quit because you never got paid there is no tail.

(8) Podiatrists do have a tendency to create bullcrap salary tiers in which people make less money the harder they work. With a no base the tiers either need to not exist or get substantially better with each level.

(9) Podiatrists also have a tendency to want to with hold percent collection money until the end of the year, call it a bonus, and string you along on your base. If your salary specifies 35% etc - and the money you'd ultimately be owed for that exceeds your base - that's not a bonus. In a no base situation you must absolutely be paid your % collections throughout the year. The owner can sort his bonus out at the end of the year. Throughout the year the associated should be able to receive timely information on their collections - on the whole and from each patient so they can adjust/modify their billing.

(10) Your friend must absolutely have a lawyer review their contract. That said - a friend of mine had a lawyer review theirs. The friend had been told all sorts of things by the practice owner - an almost endless litany of verbal promises were made and none of these were in the contract. The resident attempted to provide feedback from their lawyer and the offer was rescinded. You must use a lawyer, but private practice owners are often not going to negotiate. My personal contract experience was that the owners accepted almost none of my modifications.

(11) Your friend should temper their expectations concerning how their future private practice will be. The people who trained me were I think very successful - hospital based, practicing essentially full spectrum, reasonably interested in billing and coding/adopting their practices - collections exceeding a million each. I met many successful people during 4th year - young doctors a few years into their practice busting their tails with collections approaching a million. I think there are plenty of practices out there whether the doctor thinks they are working hard and potentially their collections are only $400ish. A person like that can't pay a base of $120K. They can't image paying a collections percentage of 35% or more because often their overhead is 65% or more.

(12) Get all the "benefits" and costs and what not sorted out/detailed and have the owner spell out their interpretation of what it actually means to be paid a % collections - how does that work, what counts towards it ie. E&M, X-ray, CPT, DME
-There's been a bunch of crap lately of people being offered contracts where they had to pay their own malpractice
-A lot of owners are conniving bullcrappers who will try and manipulate what collections are or state that practice overhead expenses are yours etc. ie. well after the collections are added up we subtract the secretary overhead cost before we multiple by the %#. Bullcrap.

Good luck to your friend.

Wow, great indepth post. What I would also add is that your first job may not necessarily be your last job. Learn how to do billing well, practice management on promoting your practice. I had a lawyer reviewed my contract and the employer decided to withdraw the offer, saved me a lot of headache for a small price. Non compete clause are not enforceable for some states. I would ask your employer if there has been anyone who left the practice for the past 5 years, if so, then why? Try searching this forum, you'll find a lot of good tips. Also, read White Coat investors book, like creating an S Corp or LLC for tax savings purpose. Malpractice insurance options with tail coverage once you decide to leave your current practice. Check out this article on how much you take home after taxes for a 200K job (if you're lucky first year out). Ben Franklin once said only two certainties in life are death and taxes. Podiatry is not all bad, just what you make of it. If it sounds too good to be true, it probably is.


 
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Thank you so much for the great feedback!

Additional information on the practice, the doc is 70yo, wants to work forever, its 2 ops, and the doc used to work 4 days a week, with an associate on saturdays. Doc wants to take some time off ( possibly a year) due to corona and wants my friend to work and take over for a bit. Total collections of the practice is about 575 a year. I informed my friend it may be difficult to have 2 full time podiatrist work at the same time, but since I am not in the field and I am a dentist, I am not sure if this is the case.
 
So, a lot of people on here get offered something that sounds good and turns out to be terrible. Sure, come, join, be an associate. Get paid. Have benefits. Practice will be great. You be so happy. And then its awful. They can at least say - it sounded good, but it wasn't what I was promised.

That above is a straight turd.

There's already an associate of sorts. Maybe its just some pod hustling for a little weekend work, but that person theoretically would be the 1st offer. Why did they pass?

70 eh. So, not to be ageist, but old podiatrists are awful. At least when you take over from one (bye!) you can draw a line in the sand:

No, I'm not going to do the stupid crap that they did.
No, I won't dremmel your nails or calluses.
No, I won't let you bring in garbage OTC inserts from the street and stick pads on them and grind them.
No, I won't cover your feet in moleskin after your trimming.
No, you don't qualify. No, you don't get a discount. The uncovered price is $X.
No, I won't bill your nails as a level 2 established visit to your garbage Medicare Advantage plan that pays me $24 to see you.
No, the nurses won't be coming in to rub you down with oils afterwards.
No, you don't have rheumatoid arthritis and no it isn't the reason the bunion came back after all those crap surgeries.

So see someone else's patients AND have to give them back - which means have to keep them happy.
And he thinks the practice runs a certain way and will want you to bill like he billed - and who knows what sort of shady stuff he is doing.
Old Pod: I don't get it - this young kid isn't cranking out the collections the way I used to!

And he doesn't know if he can pay you, but you essentially will be running the practice, but he only wants to pay you 32% even though you are the person essentially keeping the doors open.

Also, 2 ops = 2 rooms? Ugh. And yeah, no room for your friend when he "comes back".

The only world where you take a job here is if you receive a guarantee for the GREATER of the following:
-all of the profits from the office
-or an already established excellent guaranteed salary.
And there's no non-compete and you take all the new patient records with you.
A substantial number of the patients will probably walk when he leaves regardless.

Run away.

I think the joke around here is - set up shop next door.
 
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So, a lot of people on here get offered something that sounds good and turns out to be terrible. Sure, come, join, be an associate. Get paid. Have benefits. Practice will be great. You be so happy. And then its awful. They can at least say - it sounded good, but it wasn't what I was promised.

That above is a straight turd.

There's already an associate of sorts. Maybe its just some pod hustling for a little weekend work, but that person theoretically would be the 1st offer. Why did they pass?

70 eh. So, not to be ageist, but old podiatrists are awful. At least when you take over from one (bye!) you can draw a line in the sand:

No, I'm not going to do the stupid crap that they did.
No, I won't dremmel your nails or calluses.
No, I won't let you bring in garbage OTC inserts from the street and stick pads on them and grind them.
No, I won't cover your feet in moleskin after your trimming.
No, you don't qualify. No, you don't get a discount. The uncovered price is $X.
No, I won't bill your nails as a level 2 established visit to your garbage Medicare Advantage plan that pays me $24 to see you.
No, the nurses won't be coming in to rub you down with oils afterwards.
No, you don't have rheumatoid arthritis and no it isn't the reason the bunion came back after all those crap surgeries.

So see someone else's patients AND have to give them back - which means have to keep them happy.
And he thinks the practice runs a certain way and will want you to bill like he billed - and who knows what sort of shady stuff he is doing.
Old Pod: I don't get it - this young kid isn't cranking out the collections the way I used to!

And he doesn't know if he can pay you, but you essentially will be running the practice, but he only wants to pay you 32% even though you are the person essentially keeping the doors open.

Also, 2 ops = 2 rooms? Ugh. And yeah, no room for your friend when he "comes back".

The only world where you take a job here is if you receive a guarantee for the GREATER of the following:
-all of the profits from the office
-or an already established excellent guaranteed salary.
And there's no non-compete and you take all the new patient records with you.
A substantial number of the patients will probably walk when he leaves regardless.

Run away.

I think the joke around here is - set up shop next door.

the OPs friend should really just make an account and post here so he/should could get better feedback. But yes, this sounds like a year long locums position essentially. Nothing that would be good long term. If the older doc is really going to bounce and not see any patients then even 40% of collections is laughable. Since it sounds like locums, I’d ask for locums pay. $120 /hour. your friend won’t get that from a 70 year old podiatrist even though it is very reasonable.
 
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Thank you so much for the great feedback!

Additional information on the practice, the doc is 70yo, wants to work forever, its 2 ops, and the doc used to work 4 days a week, with an associate on saturdays. Doc wants to take some time off ( possibly a year) due to corona and wants my friend to work and take over for a bit. Total collections of the practice is about 575 a year. I informed my friend it may be difficult to have 2 full time podiatrist work at the same time, but since I am not in the field and I am a dentist, I am not sure if this is the case.

he's only collecting 575 a year. Which means he's probably only taking home 231 after everything paid for. 300 at the most. And the associate is going to be paid how much lol?
 
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My friend just had a convo with the owner, who offered them 50/50 non equity partnership, with 10% equity given each year that they work. The owner plans to not come back and do any clinical work, mainly admin right now. 500 is actually the gross, net is about 175 pre covid. The owner said they are downsizing in terms of staff, etc. the owner lives in the same town as my friend, which makes it very convenient for both parties. the owner offered 100% of new pt payment(for the first year, after that its the practice pt) and for surgeries.

This seems better to me than just the 32%, but what do you guys think?

Thank you!
 
No. That sounds much, much worse. Time for your friend to lease the office space down the street. Not sure he/she needs the sage business advice of a guy that turns 500k into 175k.
 
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I don't think that sounds very good, BUT - nothing is real until you have the contract in your hand. Along with myself, I can think of two immediate close friends who were told that they would be receiving this or that and when they received the contract it in no way at all resembled what they had been told. So he could have been told the above but the contract can be an endless convoluted nightmare or say something completely different.

Complexity favors the person who writes the contract because they are the one who builds the complexity in and knows the practice.

There are no shortage of things that the controlling partner can do to screw your life. I literally had a guy tell me that I could be his partner but the practice only pays out profits / no salary and therefore he would be the only one to decide when profits would pay out. So I could be sitting there thinking oh I'm doing great I'm going to get paid and he could find a way to hold on to the money.

How will your friend feel if he sees 30 nail patients in a row and is paid $0 for that day.

At 10% a year, when does your friend plan to own this practice outright? How long do you think it would take for your friend to hire an associate if they started their own practice?

Also, 65% overhead. I feel like I predicted that.

Your friend really should post for themselves. When they will find is that there are plenty of people on this forum who have spoken to some crazy old owner with convoluted and complicated dreams of how you will overpay for their practice. I can't even remember all the insane variations someone offered me where I was supposed to bring money to the table first and buy certain days of the guys schedule and of course have no benefits but the practice was an amazing gold mine blah blah blah.
 
My friend just had a convo with the owner, who offered them 50/50 non equity partnership, with 10% equity given each year that they work. The owner plans to not come back and do any clinical work, mainly admin right now. 500 is actually the gross, net is about 175 pre covid. The owner said they are downsizing in terms of staff, etc. the owner lives in the same town as my friend, which makes it very convenient for both parties. the owner offered 100% of new pt payment(for the first year, after that its the practice pt) and for surgeries.

This seems better to me than just the 32%, but what do you guys think?

Thank you!
175k profit split two ways when only 1 person does the work is a horrible contract. Run away. Dont look back.
 
Not to mention that money is before the pandemic happened
Very few people who graduate and work for another DPM get a fair deal. It's just a sad fact about our profession.
 
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I say take it if it’s your only option. Can’t be worse than not having a job.
 
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This post has been helpful and I wanted to bump it with another scenario to see what others are experiencing. With the covid pandemic affecting small businesses, my previous job offer was revoked (no contract in hand yet) and now I am jobless. The offer I had was to join a growing practice as the 3rd associate, 100k base plus 35% production. Now he's saying he is unable to afford hiring another associate. Today I received a call that for the first 4-6 months he will hire me on a production only basis and no base pay. Then re-evaluate once things pick back up again. Curious to see what everyones thoughts and experiences are?
 
What about benefits?

regardless, it’s not good. But it’s better than not having a job so I’d take it if it was the only option I had. I would be asking for more than 35% collections in the absence of any base salary.
 
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What about benefits?

regardless, it’s not good. But it’s better than not having a job so I’d take it if it was the only option I had. I would be asking for more than 35% collections in the absence of any base salary.

Thanks for the reply. No benefits except malpractice is covered. I agree, its not ideal but I am keeping my options open in case something else opens up. I live in a saturated area so I dont have too many options.
 
Thanks for the reply. No benefits except malpractice is covered. I agree, its not ideal but I am keeping my options open in case something else opens up. I live in a saturated area so I dont have too many options.

so if you’re a residency grad you’re first year of malpractice is only going to cost $3-4K. The cost to bring you on, even if you have been in practice for a few years, is negligible. That 35% from the original contract is based on the practice paying CME, professional org dues, vacation, etc. as well as the fact that you have guaranteed base income which is overhead. Without any of that stuff, you can see why 35% (which isn’t good to begin with, but normal in podiatry) should be increased.

there is an individual in a physicians forum talking about job search for endocrinology. On average they do less wRVU than a podiatrist and in employed scenarios they make less money on average (MGMA median salaries). The poster had an offer to join a small group and as an associate, he/she would get 50% of collections. The income guarantee was only $100k but he/she would have to be very slow for 50% of collections to not top that guaranteed salary #. There is something very wrong with podiatry, at least in terms of non-hospital/MSG job compensation, when compared to every other medical specialty. Even lower paying ones have significantly better compensation models in small group practice settings, compared to podiatry.

I’ve said for a long time now, and I still believe it: The worst thing about podiatry is that it is harder to get “paid like a doctor” in our profession, than any other medical specialty. And it has nothing to do with a podiatrists ability to generate revenue/income.
 
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This post has been helpful and I wanted to bump it with another scenario to see what others are experiencing. With the covid pandemic affecting small businesses, my previous job offer was revoked (no contract in hand yet) and now I am jobless. The offer I had was to join a growing practice as the 3rd associate, 100k base plus 35% production. Now he's saying he is unable to afford hiring another associate. Today I received a call that for the first 4-6 months he will hire me on a production only basis and no base pay. Then re-evaluate once things pick back up again. Curious to see what everyones thoughts and experiences are?

I had the same thing happen. Dude wanted me to take out a loan to go work for him. My best advice is star applying to everything everywhere. I found some decent offers in places I never considered living. 100k+ bases with pretty standard bonus structures and benefits. I am accepting one with the thought I will stay for a few years then get to a more desirable location. Not ideal, but considering current events I'm happy. Getting ANY job right now should be considered a win.

It blows my mind how these guys think we are dying to go work for them for peanuts. Multiple people offered no base with <30% of collections and no current patient base for a new associate. I had one practice offer me 80k flat to just clip toenails all day. "We really like the idea of somebody coming in and building up the [nonexistent] rear foot surgery part of our practice" in the middle of nowhere. I also spoke with several people looking to hire who have no business bringing on another doc.

I know we joke a lot on here about podiatrists being shady but I think a lot of them are nice guys who are just completely out of touch and ignorant. We have some lucky guys coming out making over 200k in hospitals and ortho groups with no fellowship training. As that sort of thing is starts to become more prevalent these guys are not going to be able to get anyone worth hiring. Actually, after this whole COVID thing is over they will probably all be out of business and bought up by health systems or HMO's anyway.
 
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