Need job advice. Which offer would you take?

[Pod9]

Hello,

Third year resident here looking for advice in the job search process. Mostly looking in NJ and here are the some options that I have heard about thus far.

1st option -
120k with malpractice, health insurance, 401k match, no incentive and salary progression where next year salary is always 30% of previous year collections, no partnership - no buy in opportunity ever

2nd option -
150k salary no incentive no benefits, unclear future salary progression - no opportunity for buy in ever

3rd option -
70k base then 55% after I make double the 70k - with malpractice - no other benefits - possible buy in down the line - expected to get my own patients from get go, minimal help

4th option -
120 k with 25% after triple 120 k with benefits - very busy practice - no buy in

Please let me know your thoughts about these. The people are another factor. I fully trust the people giving me the 1st and 3rd while I don’t know anything about the other two and haven’t worked with them

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[heybrother]

(1) Have you seen contracts for any of these options. Nothing is real till the contact is in hand.
(2) Strangely, a number of my friends who are in the hunt are being told they will need pay for their own malpractice insurance. I'm personally ...confused by this. Its clearly a business expense. Only good thing is you can buy yourself a occurrence policy (which is more expensive) so you can avoid paying tail when you inevitably leave this job in 1 year.
(3) Do any of these contracts come with non-competes?
(4) 30% is a pretty common podiatry percentage - let's be clear about how bad it is. If you aren't busy your first year out you will suffer a paycut your 2nd year down from $120K.
(5) It gets worse - a number of practices my friends have spoken to are not calculating the "30%" in the way you would think. Theoretically it should be a straight your collections x 30%. You collect $400 - you get $120. However, many of these places try and confuse the issue or multiply the 30% against some sort of value that has been modified to have expenses for the practice taken out. Its designed to confuse you/steal your money.
(6) I personally don't understand any of these people who don't want you to buy in/motivate you etc. If in year 2-3 you are collecting somewhere in the $400-600 - you are making them a lot of money/reducing overhead as a percentage of collections. Why wouldn't people want a productive partner?
(7) Do you have a family? Benefits essentially have a cash value ie. you'll have to buy health insurance for your family on your own. A rough calculation tells me my insurance + my family is $14000 for the year. That's for 3 healthy people. Family deductible is $9000. Not HSA eligible. Bad co-insurance. A rough website calculation tells me the cost to have another baby will be $15000. I'm not really giving you more options here - I'm just telling you that bad health insurance is still expensive.
(8) Other costs. Malpractice. State licensing. Board certification/renewal etc. The list will go on.
(9) 55% obviously sounds tantalizing but be very careful. That's very high - so high it sort of raises eyebrows. I'd love to hear from anyone on here if they know of a practice with 45% overhead (Edit: I sound sort of incredulous here. It can likely be done with sufficient income/expense control - just seems wild to see if offered to someone). I met a guy who claimed 50% - no partner, but he paid no benefits at all to his employes, paid them $10 an hour, had enormous staff turn over, owned his own building, and had high collections through what seemed to me... shady behavior. A friend of mine was offered something similar and the practice was shady as heck. They were using paper charts and claiming they were electronic.
(10) What does get your own patients mean? There's obviously value in marketing yourself. When patients call my office and ask for my established boss the secretary says - sure, he can see you in 3 weeks. Or you can see me tomorrow. Will you get spillover? Will people have to request you by name?
(11) 25% after triple $120K and base of $120K means 33% up to $360K and 25% after. Essentially a paycut for working hard.

 

[Scrantonicity]

Yeah, if the 3rd option is legit, I'd say it's the best of the bunch...55% is freakin' incredible as an associate. You would just have to be patient for the first year or two as you build up your patients from scratch. If I was making 55% right now of all my collections after $140K, I would be making ridiculous money. Say, 3-4 years out, you're bringing in $700K-$800K a year into the practice consistently...800K-140K is 660K--55% of that is $363K a year (PLUS the original 70K salary!)....I wouldn't even want to buy in if I was making that much as an associate. I find it hard to believe that this would be sustainable though...it's pretty much partnership numbers without being a partner--he wouldn't be making any money off of you, which I find hard to believe... They may be counting on you not being that busy...and then when you start bringing in the crazy numbers they might have to say "OK look, we need to change your contract this year..."

1st option and 4th option are pretty much par for the course--very common podiatry contracts...although, like heybrother said above--it's probably not going to be so cut and dry...

2nd option didn't look appealing at all. $150K with absolutely zero benefits really brings that number down--and with no incentive or salary progression it sounds like a dead-end/revolving door practice.


I also agree that having to pay for your own malpractice as an associate is crazy...it should be a basic business expense, just like your license, DEA registration, hospital dues, APMA dues, CME allowance...if the practice can't cover that, they aren't ready to hire an associate.

The benefits that are debatable in my mind would be health insurance (probably should be provided at least for the associate, if not his family) and clothing (I can buy my own scrubs).

 

[dtrack22]

Often times “collections” excludes DME which is where an owner would make a decent chunk of change off of you while still giving you an attractive % of collections in terms of compensation.

i.e. you collect $500k but $60k is DME which has a cost of $20k to the practice. So the owner keeps $40k from your DME and your compensation is figures from $440k in collections, not $500k.

 

[Pod9]

(9) 55% obviously sounds tantalizing but be very careful. That's very high - so high it sort of raises eyebrows. I'd love to hear from anyone on here if they know of a practice with 45% overhead (Edit: I sound sort of incredulous here. It can likely be done with sufficient income/expense control - just seems wild to see if offered to someone). I met a guy who claimed 50% - no partner, but he paid no benefits at all to his employes, paid them $10 an hour, had enormous staff turn over, owned his own building, and had high collections through what seemed to me... shady behavior. A friend of mine was offered something similar and the practice was shady as heck. They were using paper charts and claiming they were electronic.

So to give you more details about that offer i just said 55% to make it easier but its slightly closer to 50%. The contract basically says 50% for office payments and 60% for hospital payments and hospital visits are a big part of the practice probably 30% or so. There was one associate with the group that has been there for 5 or 6 years years and now taking home on average between 175-225k and now becoming partner. The person making the offer is an attending I know very well and fully trust. They did mention that if I do well down the line they'd like to split the malpractice insurance but only if im doing well enough. Also I am married, no kids and able to get health insurance through my wife's work. By get my own patients, they would give me very little spill over and expect me to market myself and make connections to get patients that would request me which i am not sure how doable that is.

 

[GreenHousePub]

Choose the one with the shortest contract and make sure there are no non-competes or whatever in your area. Maybe the one you can learn the most about business and billing from. Because you'll be jumping ship regardless.

 

[air bud]

Rent don't buy

 

[G0dFather]

I personally don't understand any of these people who don't want you to buy in/motivate you etc.

Because all they want to do is **** you and when you cant take it any more, on to the next ... that is the extent of their longterm thinking

Say, 3-4 years out, you're bringing in $700K-$800K a year into the practice consistently

Its sounds nice and easy when you type that but what that entails is HUGE!!... his/her share of the work in the office would be seeing consistently about 125 pts/week averaging about $135pp to gross those numbers ( you can play with both those values).. is the practice really that busy to supply him plus the others with that much? when they are already saying get your own pts from now


Im sorry that these offers are what is presented to you and are the reality/culmination of what you have strived hard to get to, they are the same deals in NY ... essentially 30% of the what you bring in deals when you analyze them at the end of the day ...... if I had to choose one, based on the circumstances you listed above i would go with number 1 and learn the business quick then set out on my own. 1 and 4 are essentially the same ... the one i would totally avoid is the 3rd option as they cant clearly afford you ( or if they can.... then just want to **** you ) and abuse you for free marketing/hustle ...... if you have NO business inclination then stick with deal 1 if you are comfortable there and they treat you well, but you will struggle on that salary in the long term in the tristate area especially if you have loans .... if you have business inclination and are in the tristate area looking to make money then the only way you i know that you will ever see 350k+ in podiatry is by owing or having equity stake in a practice that sees at least 100 pts per week, so that should be your main goal the moment you get out... what i have done and has personally worked out for me is to just buy people out (you search for deals that make SENSE) and that puts you ahead of the ball saving you time

 

[JewOnThis]

My only advice for you is don't work for a podiatrist.

 

[CutsWithFury]

My only advice for you is don't work for a podiatrist.

Exactly. Don't work for a podiatrist. Go out on your own. It may seem daunting but its the only way you can succeed these days in private practice.

Get a hospital job. Get an ortho job. Go solo. Take an non surgical DPM job in a large ortho group (seems to be the norm now). BUT for the love of God please do not EVER work for another podiatrist.

You will never get a fair shake.

The young DPMs coming up these days need to open up their own practices and outshine these guys who have no business dealing with foot and ankle pathology anymore.

 

[Scrantonicity]

Its sounds nice and easy when you type that but what that entails is HUGE!!... his/her share of the work in the office would be seeing consistently about 125 pts/week averaging about $135pp to gross those numbers ( you can play with both those values).. is the practice really that busy to supply him plus the others with that much? when they are already saying get your own pts from now

I would say 125 pts/week is very doable from scratch after 3-4 years, but maybe that's because I don't have much competition where I am. I've been seeing at least that many for a long time so it seems pretty normal to me...I guess the point is, I'm not bringing home 55% of that as an associate. If I was, I'd stay an associate for life--no question. Why buy in and have to deal with all the headaches of business ownership when you're making crazy money without it?

 

[Pronation]

Exactly. Don't work for a podiatrist. Go out on your own. It may seem daunting but its the only way you can succeed these days in private practice.

Get a hospital job. Get an ortho job. Go solo. Take an non surgical DPM job in a large ortho group (seems to be the norm now). BUT for the love of God please do not EVER work for another podiatrist.

You will never get a fair shake.

The young DPMs coming up these days need to open up their own practices and outshine these guys who have no business dealing with foot and ankle pathology anymore.

How do you feel about joining pod groups with 5+ providers?

 

[CutsWithFury]

How do you feel about joining pod groups with 5+ providers?

I think you are going to have a hard time getting patients. That situation is only ideal if you’re the only surgical DPM of the group and those guys are feeding you MSK pathology


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[hematosis]

Exactly. Don't work for a podiatrist. Go out on your own. It may seem daunting but its the only way you can succeed these days in private practice.

Get a hospital job. Get an ortho job. Go solo. Take an non surgical DPM job in a large ortho group (seems to be the norm now). BUT for the love of God please do not EVER work for another podiatrist.

You will never get a fair shake.

The young DPMs coming up these days need to open up their own practices and outshine these guys who have no business dealing with foot and ankle pathology anymore.

100%.

No offense to OP, but threads like these are sad. 7 years of schooling / residency training to make less than a 2.5 year trained PA.
I would go to all those 4 podiatrist that are offering that (especially that trustable attending) , take out my left hand and punch them in the nuts. then go start my own practice, bust some nails in nursing home on the side, email every hospital / ortho group in america for a job.

 

[ExperiencedDPM]

In all the years I’ve practiced and all the contracts I’ve reviewed, I have never seen an offer that required the associate/employee to pay his or her own malpractice.

Run and don’t look back.

 

[Utvolsdpm]

In all the years I’ve practiced and all the contracts I’ve reviewed, I have never seen an offer that required the associate/employee to pay his or her own malpractice.

Run and don’t look back.

I definitely believe you, I’ve never run into an offer like that myself. However, I have talked to some recent residents looking for jobs and heard some very similar offers. Ones where the employer only pays malpractice the first year or two, or only a portion of the malpractice. Also, offers where the employee has to pay for their own health insurance, etc. essentially zero benefits. Unconscionable!

 

[G0dFather]

In all the years I’ve practiced and all the contracts I’ve reviewed, I have never seen an offer that required the associate/employee to pay his or her own malpractice.

Run and don’t look back.

I definitely believe you, I’ve never run into an offer like that myself. However, I have talked to some recent residents looking for jobs and heard some very similar offers. Ones where the employer only pays malpractice the first year or two, or only a portion of the malpractice. Also, offers where the employee has to pay for their own health insurance, etc. essentially zero benefits. Unconscionable!

LOL ... this is very common in these area of the woods... frankly im surprised he/she got "packages" like that ... what usually happens is one is offered 60-70 bucks per hour and thats it ... take it or leave it because that is what the market here is like, they know there will be others that will take it

 

[GreenHousePub]

LOL ... this is very common in these area of the woods... frankly im surprised he/she got "packages" like that ... what usually happens is one is offered 60-70 bucks per hour and thats it ... take it or leave it because that is what the market here is like, they know there will be others that will take it

Hell at that point might as well go to a trade school and become an auto mechanic. Better money that way and less risk.

 

[MyAnklesAreBroken]

Adding an offer idea and see what you guys think.

All allowances CME, licensing, insurance, malpractice no 401k

5k / month and 35% after collections on everything after salary is paid

Or

4k / month and 40%

I’m very put off by salary but may not be the most horrible overall

 

[ExperiencedDPM]

Adding an offer idea and see what you guys think.

All allowances CME, licensing, insurance, malpractice no 401k

5k / month and 35% after collections on everything after salary is paid

Or

4k / month and 40%

I’m very put off by salary but may not be the most horrible overall

I often suggest a guaranteed salary for year 1. Realistically, you may not obtain hospital or surgery center privileges for a delayed time. It may also be a while before you are up and running and busy. In these scenarios you can get beat up pretty badly.

I believe the fairest contract offers a fair salary for year one. This allows the associate to have the ability to plan and budget and gives the practice owner an incentive to keep the associate busy.

In year 2, I would switch it to some incentive or percentage basis with a guarantee of the prior year salary. Once the percentage formula exceeds the prior year salary, it’s switched to that percentage. I believe that’s very fair to the associate, but only if the initial salary isn’t ridiculously low.

If a practice won’t pay for your malpractice, insurance, CME, etc and 401k, I assure you that this is a practice that can’t afford you and/or a practice that will never treat you fairly.

Run.

 

[dtrack22]

Adding an offer idea and see what you guys think.

All allowances CME, licensing, insurance, malpractice no 401k

5k / month and 35% after collections on everything after salary is paid

Or

4k / month and 40%

I’m very put off by salary but may not be the most horrible overall

I saw a contract like that in the Seattle area when I was a 3rd year. It’s dumb. You couldnt afford to live off of the money they would pay you. $5k per month is a $60k yearly salary. What $ amount do you have to hit before your salary is paid each month? Or at what point each month are you earning 35 or 40 cents per dollar?

My parents are teachers, granted they are at the top of the pay scale, and they each make $90k per year. You are potentially going to get get paid less than a high school science teacher and an elementary school librarian.

you have the earning potential of many other medical specialties and you are getting paid significantly less than a pediatrician would by another peds group, coming out of residency.

does this sound ridiculous yet?

 

[deleted690619]

Hello,

Third year resident here looking for advice in the job search process. Mostly looking in NJ and here are the some options that I have heard about thus far.

1st option -
120k with malpractice, health insurance, 401k match, no incentive and salary progression where next year salary is always 30% of previous year collections, no partnership - no buy in opportunity ever

2nd option -
150k salary no incentive no benefits, unclear future salary progression - no opportunity for buy in ever

3rd option -
70k base then 55% after I make double the 70k - with malpractice - no other benefits - possible buy in down the line - expected to get my own patients from get go, minimal help

4th option -
120 k with 25% after triple 120 k with benefits - very busy practice - no buy in

Please let me know your thoughts about these. The people are another factor. I fully trust the people giving me the 1st and 3rd while I don’t know anything about the other two and haven’t worked with them

Is there a reason why you haven’t received more fair offers from MSGs, Hospitals?

 

[Pod9]

Hospitals around here don’t hire podiatrist.
What do you guys think of an offer like this:

40% no benefits w/ guaranteed 100k minimum in a very busy practice on average 10-20 inpatients at the hospital at all times which I would round on 3 times a week and in addition to that a clinic two half days a week that pays 30k per year which I keep entirely

 

[G0dFather]

you have the earning potential of many other medical specialties and you are getting paid significantly less

Thats exactly what i have been saying and noticing from the money coming in .... what steps can be taken to change this ??! Is it mostly because most of the pod job market is in private practice?

 

[G0dFather]

Hospitals around here don’t hire podiatrist.
What do you guys think of an offer like this:

40% no benefits w/ guaranteed 100k minimum in a very busy practice on average 10-20 inpatients at the hospital at all times which I would round on 3 times a week and in addition to that a clinic two half days a week that pays 30k per year which I keep entirely

If your in tristate area ... that will be one of the best jobs you can find .... that extra 30K can severe as benefits especially if you can get all this paid out to your corporation

 

[ExperiencedDPM]

Hospitals around here don’t hire podiatrist.
What do you guys think of an offer like this:

40% no benefits w/ guaranteed 100k minimum in a very busy practice on average 10-20 inpatients at the hospital at all times which I would round on 3 times a week and in addition to that a clinic two half days a week that pays 30k per year which I keep entirely

Our practice also had a large in house patient census. And it sucked. Rounding on 10-20 patients can take all day. The patient you want to see is down in the CT dept., is going to the bathroom or sitting on the commode, etc. It’s time consuming and doesn’t pay well. And when you’re rounding, you’re not making money in the office or OR. That’s one of the reasons most internists no longer round at the hospital and they rely on the hospitalists.

So rounding on that many patients is difficult, time consuming and not high paying.

 

[air bud]

Hospitals around here don’t hire podiatrist.
What do you guys think of an offer like this:

40% no benefits w/ guaranteed 100k minimum in a very busy practice on average 10-20 inpatients at the hospital at all times which I would round on 3 times a week and in addition to that a clinic two half days a week that pays 30k per year which I keep entirely

This sounds soul draining after like 2 months

 

[G0dFather]

This sounds soul draining after like 2 months

What field dealing with patients now a days isn't ? I was just talking to a vascular friend of mine who makes 600K+ as an associate in a group with no way for him to advance and they have him seeing 170 pts a week and taking call ... decent benefits package and 2 week off for the year

 

[dtrack22]

$30k yearly for 1 day of clinic per week is equivalent to $150k if it was a full time job, 5 days a week in clinic. Somebody is underpaying you or skimming money off the top of what you’re actually being compensated. Or you aren’t having to see many patients.

 

[JewOnThis]

To the op, I have seen this contract you have presented. My advice is to stay as far away as you can from these podiatrists.

 

[G0dFather]

To the op, I have seen this contract you have presented. My advice is to stay as far away as you can from these podiatrists.

LOL I think i know what your talking about ... are they that bad ?

 

[JewOnThis]

Bad enough to keep all the local residents away.

 

[Apolo106]

I would also recommend asking your employer if you can go over the amount collected each month to keep them honest if you get paid by a strict percentage. Also, ask whether if they will change the term of the contract i.e. asking you to take an unpaid leave of absence if you are on a salary due to lack of patients or give you some start up money and reduce the percentage for your salary. Happened to a few people I know. I paid a lawyer to review my contract, worth every penny. It's better to avoid a bad contract then starting all over again looking for another job while hating your current place. Nothing is forever, keep an eye out for a better opportunity and live like a resident first year out. Podiatry is what you make of it.

 

[dtrack22]

asking your employer if you can go over the amount collected each month

has anyone worked with an EHR that isn’t capable of running a report to see your own collections, AR, etc? If so, which one?

not saying checking with the practice regularly isn’t a good idea. Genuinely curious about any EHRs which don’t allow you to do this. My last job I ran my reports all the time and would compare codes billed between the providers, charge per visit, different providers’ accounts receivable, etc.

 

[ExperiencedDPM]

has anyone worked with an EHR that isn’t capable of running a report to see your own collections, AR, etc? If so, which one?

not saying checking with the practice regularly isn’t a good idea. Genuinely curious about any EHRs which don’t allow you to do this. My last job I ran my reports all the time and would compare codes billed between the providers, charge per visit, different providers’ accounts receivable, etc.

All EHRs should have the ability and our associates can check their numbers any time. However, most EHR programs also have an administrative option regarding who can access the numbers.

I know of many practices in many specialties where the associates do NOT have access. Our decision was to allow transparency so the associates can check their individual numbers whenever they want. We also allow their accountants to access those numbers if there are any questions or concerns.

 

[Shiyuan]

Avoid joining pod groups like the plague. Like others have said, look for ID, derm (yes, believe it or not), ortho, MSG and hospital jobs. Don’t look online for job offers, you’ll get crap. Aggressively email and call places to see if they are interested in adding/supplementing podiatry.