Jobs and Graduation... feeling dejected

[Pronation]

100% agree but then I am biased. The hospital employed folks despise solo PP owners however owners will never want to work for anyone (even for a hospital) once you get a true taste of freedom and keeping 100% of your earnings after expenses.

Despise is a strong word but I think there is some disdain from hospital employed pods towards some of these PP pods. I feel that this disconnects exists because the PP owner may be a TFP that sells the patient a bunch of lotions and potions and then dumps the patient, after they become a complete trainwreck, on a hospital employed pod to practice some real EBM.

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[Winograd1717]

Yes, that’s all correct.

sure is. This is a business after all, more-so than any other medical field. People don't realize this degree is only worth 120-150k out of residency. Learn the business and make the 350-400k I see all these 55 year olds making in the field, or work for them making change on the dollar so they can afford a nice vacation

 

[Pronation]

sure is. This is a business after all, more-so than any other medical field. People don't realize this degree is only worth 120-150k out of residency. Learn the business and make the 350-400k I see all these 55 year olds making in the field, or work for them making change on the dollar so they can afford a nice vacation

Uh, yeah no.

The pathetically garbage pay is because this field is massively oversaturated. You see all these 55 y/o TFPs making this kind of money in PP mostly because they’re con artists.

 

[Adam Smasher]

You see all these 55 y/o TFPs making this kind of money in PP mostly because they’re con artists.

Sticks and stones.

As a student, I had a mentor who was really keen on biomechanics. I won't name names, but you've probably heard of him. He was really charismatic and was a great salesman. One of the things that registered on my bs-meter was that he would push these dopy adhesive pads on patients and affix them to the insoles of their shoes to create what was basically a poor-man's extrinsic posting. They were made of some EVA like material but he sold it for $40 ($20/foot). He'd schedule a f/u appt and due to his personal magnetism people came back, at which time they were offered a $1k set of orthotics.

After being at this for not-what-I-consider-that-many years, I'm not going to judge. Personally I have what's known as a "bad personality" so I have to fall back on things like "evidence based medicine" and "ethics," so I'd never get away with all of that. But fools are out there looking to be separated from their money, why not to your benefit?

 

[GaftAndToe]

Uh, yeah no.

The pathetically garbage pay is because this field is massively oversaturated. You see all these 55 y/o TFPs making this kind of money in PP mostly because they’re con artists.

Business is business, you can be great at it and make great money and you can be bad at it and make none, or even get into horrible debt.
No matter what you do, podiatry, sell ice cream, real estate, plumbing, or crypto, you can make good money if you are business smart.
Problem comes with owning a business, you eventually have to choose between "reading another article about TAR, going to another RRA course" or deal with running the business issues (staff issues, insurance, billing). To run a successful business, most of the time, you probably will set aside your advanced ankle cases since you can make more money removing 5 toe nails.
Other doctors have that issue as well, GI docs as example can work in PP and do scopes all day and make tone of money, or they can go to the big academic institution, do research, publish, get involved in more interesting work, etc and make significantly less.
Problem with podiatry PP is that owners often times super greedy, and they know they do not need a top notch doc to do laser nail fungus treatments and removing ingrowns. They can hire anyone who takes 100K with 6 days workweek and no bonus, so they can go on the 10th vacation of the year.

 

[Winograd1717]

Uh, yeah no.

The pathetically garbage pay is because this field is massively oversaturated. You see all these 55 y/o TFPs making this kind of money in PP mostly because they’re con artists.

Uh yeah, yeah. These people make this money because they are good business people. They may walk a fine line, but they do it with intention; to make money.

Again, don't go into this field or any medical field to make money... but the money is indeed here for those who can get it.

- EDIT: Pronation, I see your posts/history and its apparent your view on podiatry is set in stone... quite pessimistic but hey, make the newcomers believe they will be making 50k out of residency... will make it easier to hire associates for less if this is what they expect!

 

[PatchAdamsFan]

i've learned a lot from my coeds - its very sad that many podiatry graduates/residents have not an inkling of business sense. lots come from backgrounds of rejected MD/DO applicants desperate to be a "doctor" with a white coat, and that is their only motivation. or their parents, who might also be physicians, forced them to become some kind of "doctor".

I can assure you that all this applies to many MD/DO students as well. But I agree with the broader point that it is a salesman's world. I think it's important to not confuse what constitutes "business savvy" and what is despicable behavior, and what is fraud. I could care less if someone charges $1k for orthotics that is their prerogative. Plastic surgeons charge whatever cash price they want, because they can, ethics aside. Fraud is absolutely rampant in our field - unbundling procedures, 90% of "qualifying" nail care, etc. Half of "business smart" PP owners would crumble and shut down if this all went away whether they realize it or not. And we cannot ignore the "smart" (i.e.. despicable) behavior of keeping 80% of associates production. But as mentioned above, they do it because they can given the saturation issue. Bottom line there is a fine boundary between "smart" and "fraud". Many practices deserve ridicule, and fraud deserves fines and jail. I think most posters refer to the latter.

 

[prepod2016]

I can assure you that all this applies to many MD/DO students as well. But I agree with the broader point that it is a salesman's world. I think it's important to not confuse what constitutes "business savvy" and what is despicable behavior, and what is fraud. I could care less if someone charges $1k for orthotics that is their prerogative. Plastic surgeons charge whatever cash price they want, because they can, ethics aside. Fraud is absolutely rampant in our field - unbundling procedures, 90% of "qualifying" nail care, etc. Half of "business smart" PP owners would crumble and shut down if this all went away whether they realize it or not. And we cannot ignore the "smart" (i.e.. despicable) behavior of keeping 80% of associates production. But as mentioned above, they do it because they can given the saturation issue. Bottom line there is a fine boundary between "smart" and "fraud". Many practices deserve ridicule, and fraud deserves fines and jail. I think most posters refer to the latter.

the fact you have to make that distinction for any readers kind of proves my point. anyone in the field of podiatry (or any other advanced degree as you mentioned), whether a student or doctor, is taught in such a linear way of how to think. hyperfocusing on the field itself and doing what others are doing, such as risky fraudulent billing as a way to obtain wealth is an example of this.

 

[pod squad]

If I owned a practice I would fire me.

 

[newfeet]

i've learned a lot from my coeds - its very sad that many podiatry graduates/residents have not an inkling of business sense. lots come from backgrounds of rejected MD/DO applicants desperate to be a "doctor" with a white coat, and that is their only motivation. or their parents, who might also be physicians, forced them to become some kind of "doctor".
they are immune to learning anything about money and the things that they do pick up, it is elementary methods of saving at best (usually complimentary of a "free lecture" offered by the school). podiatry can be lucrative and give you tools to be successful in this world if you know how to play it. most don't. my advice: try to be open-minded. otherwise you're guaranteed to get swallowed up by the system and end up like one of the many regular posters who log on here and bitch every day about how gloomy their professional life is.

If you are pro private practice that is great. I knew going in podiatry school I would rather be at a hospital before taking a PP job. I would only consider PP if I have to leave my current job or we decided to move to the US Virgin Islands or Hawaii.

 

[prepod2016]

If you are pro private practice that is great. I knew going in podiatry school I would rather be at a hospital before taking a PP job. I would only consider PP if I have to leave my current job or we decided to move to the US Virgin Islands or Hawaii.

im not necessarily pro-private practice or pro-hospital. I'm pro-thinking outside the box. Investing into other things than podiatry

 

[GaftAndToe]

I can assure you that all this applies to many MD/DO students as well. But I agree with the broader point that it is a salesman's world. I think it's important to not confuse what constitutes "business savvy" and what is despicable behavior, and what is fraud. I could care less if someone charges $1k for orthotics that is their prerogative. Plastic surgeons charge whatever cash price they want, because they can, ethics aside. Fraud is absolutely rampant in our field - unbundling procedures, 90% of "qualifying" nail care, etc. Half of "business smart" PP owners would crumble and shut down if this all went away whether they realize it or not. And we cannot ignore the "smart" (i.e.. despicable) behavior of keeping 80% of associates production. But as mentioned above, they do it because they can given the saturation issue. Bottom line there is a fine boundary between "smart" and "fraud". Many practices deserve ridicule, and fraud deserves fines and jail. I think most posters refer to the latter.

I think fraudulent behavior and poor business choices go hand in hand. People make bad choices (taking lots of debt), cannot generate any profit (because of poor planing) and they are "forced" to bill any new patient 99204, sell $500 inserts that cost them $50 to make, "qualify" any medicare patient for nail care, etc.

I have seen it with my own eyes: pod hired 6 staff members, bought 2 buildings, bought 2 x-ray machines, US, shockwave, etc, all with debt, meanwhile not enough patients, because 60K town does not need 8 podiatrists. And now pod needs to generate money out of nowhere. Simple evaluation of the area, competitors and town population/age would allow you to know that routine nail care will not pay off all that. Not a rocket science. But time to pay off all that.

 

[newfeet]

im not necessarily pro-private practice or pro-hospital. I'm pro-thinking outside the box. Investing into other things than podiatry

That is why I quote Captain Reynolds. I generally don't care about investing or wealth or running ****. Yes I am saving for my kids college. And yes I am building up my retirement funds. My wife wants to do investment properties soon which I don't look forward to. Podiatry stopped being my focus sometime after I had kids.

End of the day I won’t put myself in a position to do shady stuff or make risky investments. I was already risk adverse.

 

[Pronation]

EDIT: Pronation, I see your posts/history and its apparent your view on podiatry is set in stone... quite pessimistic but hey, make the newcomers believe they will be making 50k out of residency... will make it easier to hire associates for less if this is what they expect

Why twist my words and numbers? Yes the probability of making 100k as a new podiatrist for several years is very high.

I couldn’t care less about associates as I’m not in pod private practice.

 

[619]

Business is business, you can be great at it and make great money and you can be bad at it and make none, or even get into horrible debt.
No matter what you do, podiatry, sell ice cream, real estate, plumbing, or crypto, you can make good money if you are business smart.
Problem comes with owning a business, you eventually have to choose between "reading another article about TAR, going to another RRA course" or deal with running the business issues (staff issues, insurance, billing). To run a successful business, most of the time, you probably will set aside your advanced ankle cases since you can make more money removing 5 toe nails.
Other doctors have that issue as well, GI docs as example can work in PP and do scopes all day and make tone of money, or they can go to the big academic institution, do research, publish, get involved in more interesting work, etc and make significantly less.
Problem with podiatry PP is that owners often times super greedy, and they know they do not need a top notch doc to do laser nail fungus treatments and removing ingrowns. They can hire anyone who takes 100K with 6 days workweek and no bonus, so they can go on the 10th vacation of the year.

This is a summary of my life right there. I am not interested in taking on any challenging case because I have a business to run. Surgery at this point to me is like a side hubby. I only do the regular bread and butter podiatry cases; bunions, hammertoes, amps, met head resection, I&D, soft tissue mass etc. I stopped doing late add-on cases a long time ago once I saw how much surgery pays. I am not staying at the hospital till midnight to do a toe amp. I just schedule it it on my surgery day. I have clinic 4 days a week and I truly enjoy my clinic days.

Problem comes with owning a business

It is a very good problem to have.

 

[Feli]

Here is a fun one. For all you hospital/MSG/Ortho employed pods making 250-300k plus...if you lose your job tomorrow.....in the next hell let's make it 9 months can you find a job that pays let's say 75 percent of your current income and allows you live in your same home? ...

Yup... question of the day right there. ^^
I would say 75% of even the venerable residency directors, ACFAS speakers, RRA cert, etc would be pretty far up a creek if they lost their job. Major stress.
Those who have "made it" in podaitry are still nearly as terrified of that as someone BQ one or two years out of training who found a low end hospital or high end PP job making $175k. The least afraid are probably the 90k associates... they have learned fast how to live low standards on limited budget, and they have basically nowhere to go but up.
...and that's too bad.

That is the BIG difference from DPM as opposed to MD surgeons ortho, vascular, plastics, ENT, uro, OB, etc etc.. they will be inundated with good PP offers, hospital offers, all kinds of options if they are ever without a job. Even the most crusty ortho with subpar CV, barely passed boards, resume gaps, a few big malprac settlements, etc may not be competitive for some univ jobs or strong PP gigs in desired areas... but that guy is still in high demand for locum, full-time, whatever. They will be flown to hospitals to be wined and dined and offered six-figure signing + relocate bonuses.

You just don't ever see MDs - especially well-trained ones - who got good grades and passed all boards, going to nursing homes or cold calling to get jobs. That happens every day in podiatry, though... this thread topic is common as common can be. There are way too many of us for the limited good hospital jobs (still too many for the bad hospital + good hospital jobs), and location choices are limited. PPs have no reason to pay with how many grads there are. Some of the big ones will pay fair, but you will work fairly hard (not as much evening/weekend as hospital DPMs, but more pts/day in office... just to make the owner rich). From the owner perspective, all grads applying say what the OP says (good residency, trauma trained, great skills, etc etc)... and sometimes it's true, sometimes it's not. What matters to most PP is that you can produce collections. Either way, the saturation rules the compensation and the demand for DPMs. It's all a numbers game... but heck, let's keep approving new pod schools and making fellowships when there aren't enough good residencies.

...Now this is not unique to podiatry and a huge reason to own your own practice - nobody can fire you.

Yeah, and nobody can stick you with bad assistants, too few assistants, bad EMR, put most of the good pathology on another doc's schedule, make you work bad hours, bad boss, bad boss' wife, force you to see pts with bad payers, steer you into shady billing or coding, lie to you about what your collections and bonus are, say no to vacation requests, cut your pay, choose your co-workers, construct the refer base you want to see, send you out to nursing homes or house calls or marketing nonsense you don't want to do, etc...
...you know, just to name one or two other reasons

 

[thefootfixer]

OP, know that you aren’t alone. Everything on this thread is the unfortunate truth. I started my practice cold about 6 months ago. This was after years of grinding as an associate. I still hold that associate job part time, just for some cash flow (which itself is bad. Basically comes out to about $275 a day flat fee), but I don’t have many options while I build my practice . Hope to breakout fully of the associate mill in the next year.

Here is how the job market will work, no ifs ands or buts.

This hospital and ortho job market is great, but very few options actually exist. You have about 500-600 new grads coming out per year. There are not and will never will be 500-600 new hospital /ortho group /MSG options seeking candidates yearly. The turnover there is much less . People tend to keep those jobs long term. Sure maybe more so if you want to move to middle of nowhere farms , but that’s much harder to do if you have parents to care for and/or trying to raise a family. Their quality of life and social development/mental health is actually more important. Living in isolated parts of the county is a no for me personally because that’s not the life I envision for my kids. But to each their own.

PP jobs will be more readily available, with the caveat being low to mediocre pay and a higher chance of job dissatisfaction , no clear cut matters on partnership (if if there is some of these old school owners think the practices are worth millions so the cost to buy in will be your life’s savings ).

NH gigs get a bad rep, but in reality they are very flexible for your needs. Time to swallow your pride with this one. You can live where you want, with pretty good pay. Maybe stay clear of the random new companies, but the established ones like PPG, maybe helathdrive etc could be viable if you have the mental grit for it. Few hours of work and your taking home probably at least $400 a day (assuming one makes $20 per patient based on how collections are).

Super group pods : great in the short term but probably bad for long term. Unless you’re some type of partner here, you’re a worker bee for life. You’ll get filled with patients and will have to provide like no other while the top guys eat the profits. To a new grad this seems good because on paper your salary will be 150k+. But trust me, once your salary is capped or converted to collections after your guarantees, you’ll burn out quick. Your collections will dwindle. One can sustain this for maybe 10 years. Which in my experience at that point you’ll really start itching for some authority and are unlikely to receive simply because partnerships aren’t available. These gigs work well in the short term for a new grad (1-6 years TOPS) and guys and gals looking for an out that have 3-5 years left in their careers. Everyone in between has no long term benefit. Again this is all my opinion.

Use the first couple years to get some real experience. Not bull**** residency experience. No one cares you do ankle surgery. This is the real world. Need to make a footprint, and more importantly create your money. I’m not saying bill fraudulently or so sketchy stuff. Gain the clinical AND business experience to make your own luck.

If hospitals/MSG/ortho is not happening you need to open you own practice. Maybe not right away but down the line in the next 3-5 years. Job market will continue to become saturated and owners will be more inclined to pay LESS because grads are a dime a dozen. What was once low 80k salary will become high because the bar will get lower and lower, with associates making 65k. I believe that’s where the profession is heading.

You’re early. Get the knowledge you need and the skills required to develop your own gig. Find a market and kill it!

 

[deleted1138023]

most depressing thread of all time

 

[Pronation]

No one cares you do ankle surgery. This is the real world. Need to make a footprint, and more importantly create your money.

Just wanted to hammer this point home for our freshly minted foot & ankle sturgeons.

 

[Feli]

... Super group pods : great in the short term but probably bad for long term. Unless you’re some type of partner here, you’re a worker bee for life. You’ll get filled with patients and will have to provide like no other while the top guys eat the profits. To a new grad this seems good because on paper your salary will be 150k+. But trust me, once your salary is capped or converted to collections after your guarantees, you’ll burn out quick. Your collections will dwindle. One can sustain this for maybe 10 years. Which in my experience at that point you’ll really start itching for some authority and are unlikely to receive simply because partnerships aren’t available. These gigs work well in the short term for a new grad (1-6 years TOPS) and guys and gals looking for an out that have 3-5 years left in their careers. Everyone in between has no long term benefit. Again this is all my opinion...

Very good post overall, particularly here. ^^^

There are ethical pod super groups, legit hospital jobs and admins, etc... but even a lot of the 'good' podiatry jobs are dicey long term. They can change. Any DPM is only as valuable to them as a similar replacement. They can see exactly how many DPM applications they get, and they know they can pull the bait-n-switch.

With large groups, it can be the decent base (usually 150-200k), then 'adjust' that and you're on straight percentage. You basically have choices of doing the shady path lab or fake wound grafts stuff, seeing a ton of patients, doing both, or struggling. That happened to me. I sure won't tolerate a pay cut or bomb patients with unneeded services, so I left for solo. Other guys in the group who were actually playing their game and doing nail path sampling, much testing, etc saw 'changes' to their bonus % or that some things (OTC items, etc) suddenly didn't count... and if they complained or questioned the new contract changes, they're fired. The reality is just is thar there's a whole army of new grad residents (some fellowship) who think that a base a bit higher than small PP is a miracle and will HASTILY sign up for it.

The hospital job pitfalls are varied forms of the same: raises dry up yet workload always increases ("budget constraints"). Maybe q4 call becomes q3... or q3 call becomes q2 when somebody quits and is not replaced quick or at all (or a senior/chief DPM simply decides they don't want to take much, if any, call due to 'admin' duties). It could be hospital admin changes with various beauracracy or politics that sap the fun of the job or the staffing/supplies from the pod dept. It can frequently be ortho or other factors which drastically change the cases and referrals pod gets sent.

These are great thing to bring up, and congrats on your new office

 

[PTPuser]

most depressing thread of all time

I get daily chest pain. If my loans could be erased I think I'll leave.

 

[thefootfixer]

Just wanted to hammer this point home for our freshly minted foot & ankle sturgeons.

I truly dislike discouraging anyone, but this is in fact the absolute truth. No one cares. The facets preached to us as students and as residents is a facade. I’ve been out long enough to know this. From my associate job to now being an owner. To my younger colleagues, please use this forum for some true advice. It seems like the people on here are true and all within 10-12 years of practice.

 

[thefootfixer]

Very good post overall, particularly here. ^^^

There are ethical pod super groups, legit hospital jobs and admins, etc... but even a lot of the 'good' podiatry jobs are dicey long term. They can change. Any DPM is only as valuable to them as a similar replacement. They can see exactly how many DPM applications they get, and they know they can pull the bait-n-switch.

With large groups, it can be the decent base (usually 150-200k), then 'adjust' that and you're on straight percentage. You basically have choices of doing the shady path lab or fake wound grafts stuff, seeing a ton of patients, doing both, or struggling. That happened to me. I sure won't tolerate a pay cut or bomb patients with unneeded services, so I left for solo. Other guys in the group who were actually playing their game and doing nail path sampling, much testing, etc saw 'changes' to their bonus % or that some things (OTC items, etc) suddenly didn't count... and if they complained or questioned the new contract changes, they're fired. The reality is just is thar there's a whole army of new grad residents (some fellowship) who think that a base a bit higher than small PP is a miracle and will hastily sign up for it.

The hospital job pitfalls are varied forms of the same: raises dry up yet workload always increases ("budget constraints"). Maybe q4 call becomes q3... or q3 call becomes q2 when somebody quits and is not replaced quick or at all (or a senior/chief DPM simply decides they don't want to take much, if any, call due to 'admin' duties). It could be hospital admin changes with various beauracracy or politics that sap the fun of the job or the staffing/supplies from the pod dept. It can frequently be ortho or other factors which drastically change the cases and referrals pod gets sent.

These are great thing to bring up, and congrats on your new office

Thanks feli much appreciated .certainly feels good to have some say and control in this career. Younger docs, don’t despair. The low pay you’re seeing is common, more common that it should be. But if you’re faced with a 80k or 90k job offer, see it as an extension of your training. Use it to gain inside knowledge as you plan your next move, god knowing we all need to .

 

[air bud]

I have no idea how the kids taking associate jobs are paying back loans making 115k a year ....and also building wealth at the same time. Either make 3x the money hospital or open up your own place. Only 2 options.

Edit - and doing this in a high COL area.

 

[deleted1138023]

I have no idea how the kids taking associate jobs are paying back loans making 115k a year ....and also building wealth at the same time. Either make 3x the money hospital or open up your own place. Only 2 options.

Loans have been paused for like 3 years. Feel like a hard reality is about to hit some of the new grads in the face

 

[icebreaker32]

I have no idea how the kids taking associate jobs are paying back loans making 115k a year ....and also building wealth at the same time. Either make 3x the money hospital or open up your own place. Only 2 options.

This is the way

 

[OncePreDent]

most importantly which RN's do you know with 300k student loan debt and a 11 year time commitment? podiatry blows. people need to just flat out say it on here sometimes.

travel x-ray techs make more than most podiatry associates.

Podiatry may not be the best income, but it's still significantly better than DPT, starting PTs make around $50-$70k, and they usually max out at around $90k-$110k a year. These are people that did 4 years of undergrad and 3 years of PT school to earn their doctorate. Brutal income for the grind they go through, IMO not worth it. Podiatry is significantly better than PT in my books.

 

[Feli]

Podiatry may not be the best income, but it's still significantly better than DPT, starting PTs make around $50-$70k, and they usually max out at around $90k-$110k a year. These are people that did 4 years of undergrad and 3 years of PT school to earn their doctorate. Brutal income for the grind they go through, IMO not worth it. Podiatry is significantly better than PT in my books.

That is a good point... PT and DVM are somewhat labors of love when you consider the time, work, tuition invested. That's for sure.

I think most going into those two fields know roughly what they're stepping into, but many in podiatry or pharma or chiro get a huge blast of cold water onto their picnic when they realize how little $ and how few decent job options a "doctor" can have.

I feel like podiatry basically copied pharma on the additional training? (they try "residency" to get out of the retail pharma and into inpatient hospital gigs, and now DPMs try fellowship to try to beef CV and get out of PP and apply to hospital jobs).

 

[HardRoadPaved]

and they are "forced" to bill any new patient 99204

So you're saying that the B35.1 that has worsened to the matrix on penlac and giving rx for Lamisil after checking LFTs and haivng Bako make sure there isn't drug resistance isn't a 99204?


Moderate
• 1 or more chronic illnesses with exacerbation,
progression, or side effects of treatment;
or
• 2 or more stable chronic illnesses;
or
• 1 undiagnosed new problem with uncertain prognosis;
or
• 1 acute illness with systemic symptoms;
or
• 1 acute complicated injury
Moderate
(Must meet the requirements of at least 1 out of 3 categories)
Category 1: Tests, documents, or independent historian(s)
• Any combination of 3 from the following:
• Review of prior external note(s) from each unique source*;
• Review of the result(s) of each unique test*;
• Ordering of each unique test*;
• Assessment requiring an independent historian(s)
or
Category 2: Independent interpretation of tests
• Independent interpretation of a test performed by another physician/other qualified health care professional (not
separately reported);
or
Category 3: Discussion of management or test interpretation
• Discussion of management or test interpretation with external physician/other qualified health care
professional\appropriate source (not separately reported)

 

[FutureDPM323]

I’m not a new grad or up coming grad but currently in residency and figured it wouldn’t hurt to start getting an idea of what to expect which right now is all a bunch of depressing job offers.

I’m also in an unfortunate situation in that I’m doing residency on the opposite side of the country that I’d like to practice so talking to my attendings to see if they know anyone in the area is off the table.

Do you guys have any recommendations on how to go about looking for/applying for jobs when in this kind of situation? I assume I’d need to cold call practices and probably ask friends who are there if they know anyone hiring but I just don’t know how early is too early to start doing this. Any tips would be appreciated

 

[icebreaker32]

Podiatry may not be the best income, but it's still significantly better than DPT, starting PTs make around $50-$70k, and they usually max out at around $90k-$110k a year. These are people that did 4 years of undergrad and 3 years of PT school to earn their doctorate. Brutal income for the grind they go through, IMO not worth it. Podiatry is significantly better than PT in my books.

Yah there are a few other healthcare professions where the ROI is not necessary great. That is why almost everyone that does not want to be a doctor these days wants to be an engineer, computers, RN or PA.

Most other healthcare jobs have a predictable salary and a job market better than podiatry (even if it is nothing like that of an RN) and offer good benefits.

Sure compared to a few other healthcare professions, the gamble of podiatry might be worth the risk. No need to even take that risk though, when an RN is good enough these days and you can advance the degree later.

 

[Creflo]

Podiatry is an excellent service for patients and much needed. Every week I see mismanaged foot problems that NP's, PA's, MD's and DO's don't know how to treat. We fill a much needed role. But economically the profession today is a no go for anyone coming out of college. The salary just does not pay the loans and leave enough left over to pay for the cost/effort of the education. Better to be a plumber or electrician. But at least for now I don't think the word is out that amputating a toe pays less than $200 so people keep going to podiatry school.

 

[GaftAndToe]

most depressing thread of all time

Just talked to a friend who works in a private practice. Her nail patients constantly complain that "I could have done the same nail cutting at home! You did not push cuticle, no hot water bath? No lotion? What is this service?" and one patient filed a dispute with insurance for nail cutting because "he could have done it himself". Imagine have to do all the paperwork to prove your services for $40...
I constantly getting asked why we don't offer nail polish 🙄
Also, a good number of patients would say "I have ankle sprain but I am seeing ortho for that, just need my nails to be cut", "I have toe fracture, but don't worry, I already see ortho for that who did my knees".
Also, so many are surprised that we do surgeries... I guess it is surprising that a pedicurist can do surgery.

Honestly, even if you do nails and calluses, the most you can get is $100 reimbursements. I am planning to open my own practice and say no to routine nail care. I have seen that few docs do that. Not sure if it is feasible especially at the beginning.

 

[OncePreDent]

Yah there are a few other healthcare professions where the ROI is not necessary great. That is why almost everyone that does not want to be a doctor these days wants to be an engineer, computers, RN or PA.

Most other healthcare jobs have a predictable salary and a job market better than podiatry (even if it is nothing like that of an RN) and offer good benefits.

Sure compared to a few other healthcare professions, the gamble of podiatry might be worth the risk. No need to even take that risk though, when an RN is good enough these days and you can advance the degree later.

Yeah, very true, especially when you can be a software engineer sitting at home making good money, or if you like traveling, become a pilot & make $200k-$500k a year working 2-4 days a week.

Financially it doesn't make the most sense to become many of the jobs in healthcare - including dentistry lol. If you attend a private dental school, you can easily graduate with over $500k-$600k in debt; if you want to specialize you could add another $300k-$500k to your debt load (depending on the specialty). After accumulating $1M in debt, you aren't going to want to start your own practice, so you join a DSO and make $250k a year to pay down this outrageous debt, which will barely put a dent in it. In dentistry, you are lucky to graduate dental school with less than $300k in debt (not counting undergrad debt) and start making $150k-$185k (income hasn't changed in 10 years, but the cost of dental school has more than doubled).

The sad thing is some of my friends that graduated from undergrad 3 years ago are making $150k sitting on their computer at home doing digital marketing working 40 hours a week. Some of them believe in the next 3-5 years, they will be on track to $500k a year (who knows though). The money really isn't in healthcare anymore, at least not for a lot of the specialties like podiatry, PT, or dentistry. I feel like people are much better off partying it up in undergrad, doing finance or engineering, and working from home making $300k-500k a year (once established).

 

[Adam Smasher]

The money really isn't in healthcare anymore, at least not for a lot of the specialties like podiatry, PT, or dentistry.

I don't think the money necessarily needs to be there as long as the work is meaningful. Don't get me wrong, it's nice to earn big bucks, and it's essential that there's at least some payoff for your hard work. But we were all told in our pre-health days that if you're in it for the money, you're in it for the wrong reasons.

The problem with podiatry is that much of what we do is not particularly meaningful. It's genuinely upsetting to read experiences like those of @GaftAndToe and @NepsPod21 who probably both struggled and studied very hard in school and residency because they believed one day someone's well-being would depend on it. And then you enter practice and you find out it largely didn't matter, no one cares if you're smart or not so long as their nails get trimmed and smoothed over. This is why podiatry is such a dirty business, we prey on human ambition like this.

 

[heybrother]

Just talked to a friend who works in a private practice. Her nail patients constantly complain that "I could have done the same nail cutting at home! You did not push cuticle, no hot water bath? No lotion? What is this service?" and one patient filed a dispute with insurance for nail cutting because "he could have done it himself". Imagine have to do all the paperwork to prove your services for $40...
I constantly getting asked why we don't offer nail polish 🙄
Also, a good number of patients would say "I have ankle sprain but I am seeing ortho for that, just need my nails to be cut", "I have toe fracture, but don't worry, I already see ortho for that who did my knees".
Also, so many are surprised that we do surgeries... I guess it is surprising that a pedicurist can do surgery.

Honestly, even if you do nails and calluses, the most you can get is $100 reimbursements. I am planning to open my own practice and say no to routine nail care. I have seen that few docs do that. Not sure if it is feasible especially at the beginning.

Without attempting to be argumentative - its a little bit more than that. Here's a reimbursement story.

(a) I joined a practice. Not really a place to get mentored. They did what they did because its the right thing mentality. Becoming salty through time with the feeling that payment just keeps decreasing (it is). Never did anything about it though.

(b) I realized that the fee schedule wasn't even optimized for certain procedures - we were literally charging less than Medicare pays for 11056 etc. Free money fixing that.

(c) Then I started tackling the predatory payors - Humana, United, Scott and White, Cigna at times, Aetna. I can only make so much progress but what I've been doing is dropping the bottom and then filling the spaces. If you drop a 65% of Medicare encounter and fill it with Medicare - that's progress. Even better if you fill it with good BCBS.

(d) I joined an IPA. It resolved some local payors and it solved 1 national payor. It also gave me a LOT more perspective on payors in my region and my state because - I have their fee schedules going back years. Sadly, about 10 years ago joining would have solved 3 of my payors.

The overall impression I received from all of this is - the commercial payor environment is deteriorating. The Uniteds of the world are getting worse. Market place health plans are becoming more common. Medicare advantage plans are taking market from Medicare. The great 2021 change was really a Medicare only change in the vast majority of circumstances.

The second thing I came to understand is - there are really in the end only a handful of insurances that are actually good and even they are simply... fair if everything goes perfectly. Anything with a NWB recovery is probably underpaid because of how the base Medicare fee schedule is set. My best situation going forward is raise overall collections by
(a) raising the floor - drop the crap
(b) hopefully add more good BCBS surgery. Expand my first ray game.
(c) add new cash services
(d) try to within reason increase acuity or DME or something.

That said - the heart of it all though is ...Medicare is still a poor payor. Almost everything in the end is in some way based off of Medicare. One of the comments made on this forum routinely is "saturation" drives down pay. It does though how it does so is important. Obviously - saturation impacts the quality of the opportunities we each receive from other podiatrists (I can always replace her) and the degree of competitiveness with hospital jobs (200 people!?!?). It also likely drives down rates with insurance companies. Humana - thinks we're trash. United - thinks we're trash. Scott and White literally had a fee schedule in which common podiatric procedures are devalued. My S&W fee schedule was interestingly identical to the IPA fee schedule (both with devalued podiatry codes common codes) but they also paid me a fraction of what they paid the IPA for E&M. It means we see fewer patients than we should (how many podiatrists take 1-2 years to get busy) and we're all likely splitting a surgical case load that shouldn't be split. ie. if there are 5 podiatrists each doing 2 cases a week - how much better would it have been for 2 podiatrists to do 5 cases (and would this have improved opportunities for them to buy a surgery center, been better surgeons etc)

That said. Let's say you are an owner in a non-saturated area. Hopefully less competition though possibly smaller patient volume to draw from. Hopefully able to give the finger to the Humanas. You are still going to be subject to the same sort of caps other specialists may experience. Medicare still only pays so much. BCBS in my state apparently pays everyone the same though quite fairly for surgery now. In the end Medicine is a volume game. Nothing pays so well that you can just do one. Having a good "payor mix" usually just means - seeing lots of BCBS. The difference between seeing lots of BCBS and seeing lots of Medicare is enormous. If you show up to your surgery day and do 5 good BCBS cases its like doing 10 Medicare cases right now. Doing a lot of Medicare flexors and 11750s vs a lot of BCBS is again - thousands of dollars. Where am I going with this ramble. Raise your floor. Know that the ceiling is limited by your volume, payor mix, acuity, etc.

Most people will experience some of the negatives above. They'll have to add whatever they can add to fill the spots. They'll do surgery to round out the practice (I do everything) or because its "enjoyable", "a break from cutting nails", "the APMA told me I'd be a surgeon" or because the patient needs it even though on a $-time basis and what not the math often doesn't make sense or they'd have been better off being in clinic.

I've literally said this so many times that airbud makes fun of me, but Medicare 11056-11720 pays better than a BCBS 99214. That's the world's ultimate cringe gift. The world telling you - you are a podiatrist, not a foot an ankle surgeon. The great payday for your inability to feel palpable pulses.

That's enough for now. I told myself I was going to post some $ values but that gets involved / tricky.

 

[GaftAndToe]

Without attempting to be argumentative - its a little bit more than that. Here's a reimbursement story.

(a) I joined a practice. Not really a place to get mentored. They did what they did because its the right thing mentality. Becoming salty through time with the feeling that payment just keeps decreasing (it is). Never did anything about it though.

(b) I realized that the fee schedule wasn't even optimized for certain procedures - we were literally charging less than Medicare pays for 11056 etc. Free money fixing that.

(c) Then I started tackling the predatory payors - Humana, United, Scott and White, Cigna at times, Aetna. I can only make so much progress but what I've been doing is dropping the bottom and then filling the spaces. If you drop a 65% of Medicare encounter and fill it with Medicare - that's progress. Even better if you fill it with good BCBS.

(d) I joined an IPA. It resolved some local payors and it solved 1 national payor. It also gave me a LOT more perspective on payors in my region and my state because - I have their fee schedules going back years. Sadly, about 10 years ago joining would have solved 3 of my payors.

The overall impression I received from all of this is - the commercial payor environment is deteriorating. The Uniteds of the world are getting worse. Market place health plans are becoming more common. Medicare advantage plans are taking market from Medicare. The great 2021 change was really a Medicare only change in the vast majority of circumstances.

The second thing I came to understand is - there are really in the end only a handful of insurances that are actually good and even they are simply... fair if everything goes perfectly. Anything with a NWB recovery is probably underpaid because of how the base Medicare fee schedule is set. My best situation going forward is raise overall collections by
(a) raising the floor - drop the crap
(b) hopefully add more good BCBS surgery. Expand my first ray game.
(c) add new cash services
(d) try to within reason increase acuity or DME or something.

That said - the heart of it all though is ...Medicare is still a poor payor. Almost everything in the end is in some way based off of Medicare. One of the comments made on this forum routinely is "saturation" drives down pay. It does though how it does so is important. Obviously - saturation impacts the quality of the opportunities we each receive from other podiatrists (I can always replace her) and the degree of competitiveness with hospital jobs (200 people!?!?). It also likely drives down rates with insurance companies. Humana - thinks we're trash. United - thinks we're trash. Scott and White literally had a fee schedule in which common podiatric procedures are devalued. My S&W fee schedule was interestingly identical to the IPA fee schedule (both with devalued podiatry codes common codes) but they also paid me a fraction of what they paid the IPA for E&M. It means we see fewer patients than we should (how many podiatrists take 1-2 years to get busy) and we're all likely splitting a surgical case load that shouldn't be split. ie. if there are 5 podiatrists each doing 2 cases a week - how much better would it have been for 2 podiatrists to do 5 cases (and would this have improved opportunities for them to buy a surgery center, been better surgeons etc)

That said. Let's say you are an owner in a non-saturated area. Hopefully less competition though possibly smaller patient volume to draw from. Hopefully able to give the finger to the Humanas. You are still going to be subject to the same sort of caps other specialists may experience. Medicare still only pays so much. BCBS in my state apparently pays everyone the same though quite fairly for surgery now. In the end Medicine is a volume game. Nothing pays so well that you can just do one. Having a good "payor mix" usually just means - seeing lots of BCBS. The difference between seeing lots of BCBS and seeing lots of Medicare is enormous. If you show up to your surgery day and do 5 good BCBS cases its like doing 10 Medicare cases right now. Doing a lot of Medicare flexors and 11750s vs a lot of BCBS is again - thousands of dollars. Where am I going with this ramble. Raise your floor. Know that the ceiling is limited by your volume, payor mix, acuity, etc.

Most people will experience some of the negatives above. They'll have to add whatever they can add to fill the spots. They'll do surgery to round out the practice (I do everything) or because its "enjoyable", "a break from cutting nails", "the APMA told me I'd be a surgeon" or because the patient needs it even though on a $-time basis and what not the math often doesn't make sense or they'd have been better off being in clinic.

I've literally said this so many times that airbud makes fun of me, but Medicare 11056-11720 pays better than a BCBS 99214. That's the world's ultimate cringe gift. The world telling you - you are a podiatrist, not a foot an ankle surgeon. The great payday for your inability to feel palpable pulses.

That's enough for now. I told myself I was going to post some $ values but that gets involved / tricky.

Thank you for your input.

Where I am, Medicare is actually the best for reimbursements and so many people who have "good carrier insurance" have like 6K in deductible. I am definitely trying to learn more about everything, but seems to me that people with 3K-6K deductible wouldn't mind just paying cash for the services. While Medicare patients even $10 copay they argue and try not to pay.

Others mentioned Physical Therapist, and how they do not make enough. I am seeing one and she charges $175 per visit (takes no insurance) and she is booked 3 months in advance. She is very well off. Being said that, she provides exceptional services and I do not mind paying her cash, even though I have insurance that would cover. He rent is $1500 She is actually encouraging me to open my practice and not take insurance at all.

House Calls Startup Manual: How to Run a Low-overhead, High-profit Practice and Get Your Life Back
by Segler, Christopher P also recommend no insurance.

If you calculate seeing just 10 patients a day, once a week, just once, and each pays you $200, and you pay $1000 to sublease a small office (once a week), with extremely low overhead (do everything yourself), you can make close to 90K, which is what associate position would pay you to see 30 patients a day and 5 days a week, and maybe even take call in the hospital.

Dr. Segler in his book mentioned that he charges $350 per visit (and book is 7 years old) and people are willing to pay, yes he drives to the patient's homes, but he has to see 4 patients a day and not 30-40.

It seems like you can make money, but requires more creativity than just applying to another dead end associate job.

 

[pod squad]

Dr. Segler in his book mentioned that he charges $350 per visit (and book is 7 years old)

If you look at his website today you'll see that he's charging $900 for a house call....either he's VERY greedy or he's run out of patient volume and is trying to make up for it by jacking up the prices. But you're right, if people will pay it then good for him.

Also charges $350 for a webcam consult lol

 

[GaftAndToe]

If you look at his website today you'll see that he's charging $900 for a house call....either he's VERY greedy or he's run out of patient volume and is trying to make up for it by jacking up the prices. But you're right, if people will pay it then good for him.

Also charges $350 for a webcam consult lol

Just looked at his website, he has a podcast, different courses, including "toe nail fungus course". Honestly, bunch of nobodies do "coaching" and people pay, so I am sure if he is semi-famous in the athletic world, people would pay him since he is a doctor and knows what he is talking about. Definitely a very smart guy. If he sees 40 patients a months, he is already making more than 90%of podiatrists.

Probably people in San Fransisco are willing to pay $900 not to drive to an office and not to wait in the waiting room, indeed good for him.

Nowadays "webcam jobs" can pay way over $350 and not involve any medical knowledge or education... 😁

 

[GreenHousePub]

sure is. This is a business after all, more-so than any other medical field. People don't realize this degree is only worth 120-150k out of residency. Learn the business and make the 350-400k I see all these 55 year olds making in the field, or work for them making change on the dollar so they can afford a nice vacation

Where I am at private practice owners are making around 600-800 with slower practices, 1 million plus with busier.

 

[Winograd1717]

Where I am at private practice owners are making around 600-800 with slower practices, 1 million plus with busier.

People on this forum will complain until they realize this

 

[Retrograde_Nail]

Where I am at private practice owners are making around 600-800 with slower practices, 1 million plus with busier.

Off the slave labor of underpaid associates. You left that part out

 

[Pronation]

People on this forum will complain until they realize this

This is not real life with how saturated podiatry is now and good luck getting the additional loan to start your own practice.

 

[icebreaker32]

People on this forum will complain until they realize this

Not hard at all if one has the capital to open an office and does mind worrying if they might lose their license and possibly be thrown in jail one day.

 

[MicroPod]

Is the 600-800 gross or net?

 

[icebreaker32]

Is the 600-800 gross or net?

Most recent net survey. Usually net is 45 percent of gross give or take 10 percent (lots of factors).

 

[Pronation]

Is the 600-800 gross or net?

Oh I thought that was the total amount of toenails

 

[bloxxeeey]

19% of us making less than 50k a year? Yeah maybe my 60k offers are looking pretty good now

 

[Pronation]

19% of us making less than 50k a year? Yeah maybe my 60k offers are looking pretty good now

That’s not real. That’s Dr. Mustache paying himself 50k and the rest going to his LLC

 

[icebreaker32]

That’s not real. That’s Dr. Mustache paying himself 50k and the rest going to his LLC

Yes some of those doing well will lower their income and take profits as distribution which are taxed at a lower rate. How many that reported like that there is no way to know. For survey purposes they may or may not have combined income and distributions for net income. They might have reported their lower net income as actually reported on tax forms. It might be someone just starting, struggling, nearing retirement or working part time.

You have to claim what is considered a reasonable salary to do that also....pick some accepted source. So maybe 120K in income then another 50K, 100K or 200K etc in distribution taxed at a lower rate. Not everyone will form an S corp, even some high earners for various reasons will not. A mustache pod claiming something as low as 50K is asking for an audit.


Bottom line as usual:

A certain amount are doing really well in this profession....at least 25 percent

Many in that in between zone where it really takes some combination of low debt, high earning spouse, no kids, low cost of living area to live the doctor's lifestyle

There is also a larger amount not doing good in this profession than the organizations will admit exists.....objective proof with this survey
IMO (regardless of tax angles or not) and 60K job offers. No significant projections for growth in our profession and more doing an extra year of training....which may help them individually but lowers the ROI of the profession further as a whole.