Negotiating salary: Surgical podiatry vs Sports Medicine

[StressRisers]

We recently found out that our MSG is paying sports medicine about 40K more than they pay us. Personally, I find this quite ridiculous, but want to hear this community’s thoughts on whether this pay difference is warranted.

The sports medicine guys at my practice basically function as PCP half time and SM (essentially clinical orthos) the other half. We see about 5-7 more patients than them a day. We do surgery, they do not.

Given this information, would you try to fight for salary equality between podiatry and SM?

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[ExperiencedDPM]

Bad move. Don’t count other people’s money. If you negotiate an increased salary, do it based on your own merit and production and not on the salary of another specialty. You may talk your way out of a job.

 

[CutsWithFury]

Always argue knowing the MGMA figures. Know your production and where it falls in the percentiles nationally. That’s your only negotiating chip.

You can’t compare different specialties. They are real doctors and you’re not. Get over it.

I’m in a community hospital MSG so the volume is not that great across all the ortho specialties. I’m doing 75% MGMA work.

I’m actually busier than our ortho spine and hand docs but they make more than twice my base salary and have PAs to do their busy work. It’s not fair but that’s the way it is.

When I negotiate my new contract/figures it’s based on how I produced against other podiatrists nationally per MGMA. Not how I produced compared to my ortho colleagues.

 

[msuDPM]

Always argue knowing the MGMA figures. Know your production and where it falls in the percentiles nationally. That’s your only negotiating chip.

You can’t compare different specialties. They are real doctors and you’re not. Get over it.

I’m in a community hospital MSG so the volume is not that great across all the ortho specialties. I’m doing 75% MGMA work.

I’m actually busier than our ortho spine and hand docs but they make more than twice my base salary and have PAs to do their busy work. It’s not fair but that’s the way it is.

When I negotiate my new contract/figures it’s based on how I produced against other podiatrists nationally per MGMA. Not how I produced compared to my ortho colleagues.

Just here to echo this. Currently in the process of negotiating my 2nd contract with my system and anticipate a decent pay bump. MGMA/AGMA data exists to help you. If you think you're not reimbursed appropriately and the data agrees, use that, not what another specialty is making. If you think youre not reimbursed appropriately and the data disagrees...you're wrong. It's that simple.

 

[StressRisers]

Thank you for all your responses. I do want to clarify that sports medicine is not ortho, but family med with 1 additional year of fellowship in SM. Doesn’t seem like that would make a difference in your opinion on this matter, though, and I respect that.

If you are in MSG, does your group readily give you access to your productivity/reimbursement? I have a feeling mine would not be so keen on that idea.

Does anyone happen to have a recent MGMA/AGMA data? I only have 2015 version.

 

[AttackNME]

Thank you for all your responses. I do want to clarify that sports medicine is not ortho, but family med with 1 additional year of fellowship in SM. Doesn’t seem like that would make a difference in your opinion on this matter, though, and I respect that.

If you are in MSG, does your group readily give you access to your productivity/reimbursement? I have a feeling mine would not be so keen on that idea.

Does anyone happen to have a recent MGMA/AGMA data? I only have 2015 version.

If they aren't transparent with you regarding your productivity, then you might be getting taken advantage of

 

[PeaJay]

If you are in a msg the business staff should be providing frequent updates on wRVUs. If they are fail to do so, there is a big problem.

How else are you going to track financial performance?

How are you going to make sure the coder isn’t hosing you and underbilling?

How else do you know that they value your work and are compensating appropriately?

 

[dtrack22]

They are billing higher level e/m codes than you and then when they inject larger joints, they get reimbursed more. If you are MSG that doesn’t have any ownership in a surgery center then your one avenue of creating significantly more downstream revenue than clinical docs is gone.

That’s really just a mental exercise however, because everyone else is correct, you argue salary based on production compared to other podiatrists. Not compared to other physicians in your group. Feel free to PM me for some of the most recent MGMA data

 

[StressRisers]

If you are in a msg the business staff should be providing frequent updates on wRVUs. If they are fail to do so, there is a big problem.

How else are you going to track financial performance?

How are you going to make sure the coder isn’t hosing you and underbilling?

How else do you know that they value your work and are compensating appropriately?

Would it make a difference if I am straight salary with no productivity bonuses based on wRVUs?

 

[PeaJay]

Would it make a difference if I am straight salary with no productivity bonuses based on wRVUs?

They may argue that it does not.

I would argue otherwise. Your worth to the organization always comes to money and showing growth or at least staying at the same production level. Keeping an eye on billing is always worthwhile. I do my own coding but the billers have the ability to change/ alter per my MSG. I have had billers say I absolutely cannot bill a procedure and office visit at the same time,which is plainly false as long as you document appropriately. If I would have let the biller continually override me it would lead to significant decreases in productivity.

My MSG is open with production, salaried or not. They want you to know where you stand against other providers in the same specialty on both production and compensation. That way there is no questions on why compensation is where it is.

 

[azfootdoc]

I am a hospital employed Podiatrist. I work for our hospital MSG. I also am on our hospitals Board of Trustees. It has been very eye opening to see things from this point of view. By way of example our hospital recently brought in a Total Joint Ortho. He has significantly helped raise the volume in our OR. The point was made that the medical group could lose 100k or more on his practice but still do very well based on the increased OR volumes. So when talking about hospital employed doctors one needs to take this into account. Hospital ancillary services are also taken into account. My hospital absolutely knows how much business I send their way in MRI's and diagnostic imaging as well as Physical Therapy and HBO utilization in the wound clinic. My point is Hospitals sometimes view what we bring to the table differently than we might.

Also I would agree that MGMA is your bench mark you should be using. I'll try to get you a copy of most recent MGMA sheet but I think it was the 2016 report based on 2015 data. My hospital network (Large national company) has gone to a hybrid valuation that blends MGMA with a couple others to get a larger sample size. I still think its quite fair. See attached.

 

[CutsWithFury]

I am a hospital employed Podiatrist. I work for our hospital MSG. I also am on our hospitals Board of Trustees. It has been very eye opening to see things from this point of view. By way of example our hospital recently brought in a Total Joint Ortho. He has significantly helped raise the volume in our OR. The point was made that the medical group could lose 100k or more on his practice but still do very well based on the increased OR volumes. So when talking about hospital employed doctors one needs to take this into account. Hospital ancillary services are also taken into account. My hospital absolutely knows how much business I send their way in MRI's and diagnostic imaging as well as Physical Therapy and HBO utilization in the wound clinic. My point is Hospitals sometimes view what we bring to the table differently than we might.

All good points. My hospital tracks every X-ray, MRI, CT scan I order. Hospital tracks every physical therapy referral. They track every referral to other specialists in the MSG. The fact the MSG hired as their first podiatrist, within two years I have single handily increased the vascular surgery volume with all my referrals. Hospital loves it.

The hospital tracks everything. Blow it out with all your referrals and imaging orders. It's called job security. If you are super productive in the OR and clinic with procedures then that is icing on the cake.

I am in contract negotiation with hospital right now. Its been ongoing for 6 weeks now. We haven't moved forward. They are going to use every trick in the book to underpay you. You need to know your data (production numbers and keep a log of all the XRs/MRIs/CTs) when you come to the table to negotiate. Know your worth and don't accept the first contract offering. Don't settle until you are happy.

 

[ExperiencedDPM]

All good points. My hospital tracks every X-ray, MRI, CT scan I order. Hospital tracks every physical therapy referral. They track every referral to other specialists in the MSG. The fact the MSG hired as their first podiatrist, within two years I have single handily increased the vascular surgery volume with all my referrals. Hospital loves it.

The hospital tracks everything. Blow it out with all your referrals and imaging orders. It's called job security. If you are super productive in the OR and clinic with procedures then that is icing on the cake.

I am in contract negotiation with hospital right now. Its been ongoing for 6 weeks now. We haven't moved forward. They are going to use every trick in the book to underpay you. You need to know your data (production numbers and keep a log of all the XRs/MRIs/CTs) when you come to the table to negotiate. Know your worth and don't accept the first contract offering. Don't settle until you are happy.

This is generally great advice. However, with our profession there is always someone knocking on the door to work for a dollar less.

This began many years ago when HMO products hit the market. These programs were capitated and the rates were insultingly low. So a few colleagues and I refused to accept those low rates and were negotiating a fairer rate. While this was happening, a bunch of other pods worked their way in and accepted a LOWER rate than the initial offer. Then they spent the next 10 years whining about having to see patients for pennies per visit.

I’ve seen more than one of my former residents negotiate their way OUT of employment. These hospital and MSG systems aren’t stupid. They know exactly what you’re worth and every penny you bring in from ancillary services.

They also know that there are LOTS of DPMs who are making a crappy living and would jump on a low ball offer that’s better than they are making. Even if you’re a stud, don’t think for a second you’re not considered replaceable and disposable to them. It’s all about the money.

The exceptions are world known cardiac surgeons, neurosurgeons, etc.

You certainly should be remunerated fairly for your production, but behind some closed door is a douchebag with a pencil and calculator willing to toss you aside for a cheaper option.

Medicine is now a business. And loyalty is a thing of the past. Be careful during your negotiations.

 

[CutsWithFury]

I think it depends on the hospital you are negotiating a contract with. If I was employed by a large university hospital then I wouldn’t have much to hang my hat on when it comes to negotiating. Their physician recruitment would be strong and I could be replaced pretty easily.

Negotiating with a small unknown community hospital is a different animal entirely. Especially since these facilities usually struggle recruiting docs in the first place. It’s better for them to bend during negotiations than to allow it to drag out or potentially not work out at the last minute then go without the service for 4-6 months while they try to recruit another doc. Losing money and possibly the entire practice.

Patient satisfactions scores mean something as well. If you are productive and have excellent patient satisfaction scores that goes a long way with job security.

 

[Feli]

ExpDPM has real good advice here... if you like the job, don't rock the boat.

Sports Med docs (or semi-retired non-op orthos) generate a LOT of money you don't see. They order MRIs and ulstrasounds, feed PT early and often, do a lot of DME, they basically set up very lucrative ortho surg, most important: they free up the orthos to produce more since they do the conservative care and the orthos can just skip to surgery quicker (therefore making orthos worth more per hour).

While it's true that, on avg, Sports Med don't usually in and of themselves generate nearly as much as a good surgical podiatrist, they indirectly might be smoking you. Basically, it is not a road you want to go down... use your own productivity and your own collections as the starting ground.

 

[CutsWithFury]

ExpDPM has real good advice here... if you like the job, don't rock the boat.

Sports Med docs (or semi-retired non-op orthos) generate a LOT of money you don't see. They order MRIs and ulstrasounds, feed PT early and often, do a lot of DME, they basically set up very lucrative ortho surg, most important: they free up the orthos to produce more since they do the conservative care and the orthos can just skip to surgery quicker (therefore making orthos worth more per hour).

While it's true that, on avg, Sports Med don't usually in and of themselves generate nearly as much as a good surgical podiatrist, they indirectly might be smoking you. Basically, it is not a road you want to go down... use your own productivity and your own collections as the starting ground.

I am highly confused by this. I am a hospital employed podiatrist who does all of the above. On top of that I do surgery for elective and non elective foot and ankle pathology (all procedures). I also commandeer the pus bus from the ER. Oh and I do all the foot and ankle wounds for the hospital at our wound care facility.

Please explain how non op ortho or family medicine sports med doc produces more than me?

Please explain how the hospital doesn't make more money with me rather than a non op ortho who's base salary will still be 1.5-2x my starting base salary.

Please explain how the hospital doesn't make more money with me since I am reimbursed a less dollar amount per RVU compared to my MD/DO colleagues

Please and thanks

 

[HardRoadPaved]

Please explain how non op ortho or family medicine sports med doc produces more than me?

Please explain how the hospital doesn't make more money with me rather than a non op ortho who's base salary will still be 1.5-2x my starting base salary.

Please explain how the hospital doesn't make more money with me since I am reimbursed a less dollar amount per RVU compared to my MD/DO colleagues

Please and thanks

I can already see the MBA sitting across from you in negotiations: You are limited to F&A. While you may be paid on an RVU model, the insurance pays the health clinic/system in money. The MD/DO has accepted a higher reimbursement tier with insurances; this can easily be minimum of 20% difference. When you order ancillary testing it is limited to F&A pathology; this pays lower than a back/hip/knee. The non-op doc doesnt have to cover surgical emergencies whereas you have to leave clinic and cancel your schedule to cover emergencies. Lastly the patient retention to non-op ortho is greater: they hurt a knee, back, shoulder whatever...see the same doc. When a patient walks in the door or calls, the secretary doesnt have to think if the general ortho can see a problem. The MD/DO is easier to market.

 

[Feli]

I am highly confused by this. I am a hospital employed podiatrist who does all of the above. On top of that I do surgery for elective and non elective foot and ankle pathology (all procedures). I also commandeer the pus bus from the ER. Oh and I do all the foot and ankle wounds for the hospital at our wound care facility.

Please explain how non op ortho or family medicine sports med doc produces more than me?

Please explain how the hospital doesn't make more money with me rather than a non op ortho who's base salary will still be 1.5-2x my starting base salary.

Please explain how the hospital doesn't make more money with me since I am reimbursed a less dollar amount per RVU compared to my MD/DO colleagues

Please and thanks

I'm saying they add value to other docs which is hard to quantify.... ie Total joint Tom can go in, "so, you've had injects, brace, PT from Conservative Calvin already? Welp, time for a TKA/THA/etc." So, the non-op or Sports Med or midlevel guy enabled that efficiency... and did decent collections in the process too.

Yes, you or I certainly do more in terms of CPTs (and maybe DME/imaging also) than non-op Sports med or Orthos, but they are enabling a bigger whale to focus on the big kills since they have already chased the guppies for them. We don't really feed any other big $$$ surgeons... aside from the periodic Vasc for revasc or occasional Vasc BKA or Onco surgeon or Pedi Ortho (maybe, if your hospital/group even has those).

It is like if you or I had residents/fellows or non-op attending DPMs. They feed cases to us, which makes us able to generate more per hour (versus if we do every new pt and all conservative care ourself). That is not easily quantified, but they are still valuable nonetheless.

 

[sloh]

I am highly confused by this. I am a hospital employed podiatrist who does all of the above. On top of that I do surgery for elective and non elective foot and ankle pathology (all procedures). I also commandeer the pus bus from the ER. Oh and I do all the foot and ankle wounds for the hospital at our wound care facility.

Please explain how non op ortho or family medicine sports med doc produces more than me?

Please explain how the hospital doesn't make more money with me rather than a non op ortho who's base salary will still be 1.5-2x my starting base salary.

Please explain how the hospital doesn't make more money with me since I am reimbursed a less dollar amount per RVU compared to my MD/DO colleagues

Please and thanks

As PM&R, I agree with this. Non-op sports med is a lot of window dressing. I struggle to see the value for the patients—many of the interventions (injections) are at best placebos

 

[CutsWithFury]

I can already see the MBA sitting across from you in negotiations: You are limited to F&A. While you may be paid on an RVU model, the insurance pays the health clinic/system in money. The MD/DO has accepted a higher reimbursement tier with insurances; this can easily be minimum of 20% difference. When you order ancillary testing it is limited to F&A pathology; this pays lower than a back/hip/knee. The non-op doc doesnt have to cover surgical emergencies whereas you have to leave clinic and cancel your schedule to cover emergencies. Lastly the patient retention to non-op ortho is greater: they hurt a knee, back, shoulder whatever...see the same doc. When a patient walks in the door or calls, the secretary doesnt have to think if the general ortho can see a problem. The MD/DO is easier to market.

How mis-informed you are...

If I could post my data for production without breaking HIPPA I would but I will give you some "estimates". Last month I did 1125 RVUs. Gross charges for my surgeries, MSK clinic visit E/M and clinic procedures, Wound clinic vist E/M and clinic procedures, and Clinic XR orders during that month totalled $170,000 for the month.

Those figures do NOT include facility charges that hospital pockets for each patient visit to my outpatient clinics FOR THE MONTH

Those figures do NOT include INPATIENT charges I submit for consults, advanced imaging studies, XRs, FOR THE MONTH

Those figures do NOT include other frequently ordered OUTPATIENT tests FOR THE MONTH such as:

1) MRI foot
2) MRI ankle
3) CT foot
4) CT ankle
5) Arterial doppler lower extremity Duplex
6) EMG
7) Path analysis for fungal nail specimens
8) Path analysis for skin biopsies
9) uric acid levels when gout is considered etiology of pain
10) ESR/CRP for suspected osteomyelitis

Those figures do NOT include monies generated for referrals to frequent referral specialists FOR THE MONTH such as:

1) Physical therapy (all day everyday)
2) Vascular surgery (wound care patients)
3) Physiatry (for the EMG)
4) Neurology (for those hated neuropathic foot pain patients)
5) Pain management (for those I've done everything but these patients still hurt consults)
6) Ortho (when my foot pain patient complains of knee, hip and back)

$170,000 + monies generated from facility fees + monies generate from outpatient imaging/labs/path testing + monies generated from referrals to other specialists who are apart of your MSG = more money than family med sports med and non op ortho

A well trained surgical podiatrist who does any possible surgery and does wound care clinic sees so much more pathology and orders so many more tests/labs and does so many more procedures than these other specialties. We refer to way more diverse group of doctors as well because of this diverse pathology. At least I do.

AND guess WHAT? I am a stupid podiatrist so hospital admins can pay me half what they would give an MD/DO and there is nothing I can do about it because there is another desperate podiatrist trying to escape private practice and get into the hospital who will accept the low ball hospital salary because that is like 4x what they were making in private practice. Thanks podiatry.

 

[G0dFather]

A well trained surgical podiatrist who does any possible surgery and does wound care clinic sees so much more pathology and orders so many more tests/labs and does so many more procedures than these other specialties. We refer to way more diverse group of doctors as well because of this diverse pathology. At least I do.

AND guess WHAT? I am a stupid podiatrist so hospital admins can pay me half what they would give an MD/DO and there is nothing I can do about it because there is another desperate podiatrist trying to escape private practice and get into the hospital who will accept the low ball hospital salary because that is like 4x what they were making in private practice. Thanks podiatry.

With these two paragraphs you have summed up what is critically wrong with the profession, god bless you .... and its a shame because we are a very versatile specialty and earn heavy... like i said before the PR ( if it even exists) is targeted incorrectly by our professional bodies

Gross charges for my surgeries, MSK clinic visit E/M and clinic procedures, Wound clinic vist E/M and clinic procedures, and Clinic XR orders during that month totalled $170,000 for the month.

LOVE THESE NUMBERS BABY!