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Discussion in 'Podiatry Students' started by helpfuldoc2b, May 1, 2007.
New grads, what types of salary offers are you getting?
I personally know 5 people finishing up residency in June (PM&S-36). 3 are starting mid 100's (ortho and multi-specialty groups),one is doing a fellowship in pediatric orthopaedics, and one is doing a fellowship in diabetic wound care (and I don't think fellowships pay a whole lot more than residency does).
I'm not aware of any 3rd year residents that frequent the forum but maybe you'll get lucky.
Jonwill I was wondeirng if you could explain to me how a fellowship is different than a residency if at all? Also what are the benefits of doing a fellowship? More money, more experience in a certain area? Thanks!
Though some residencies have more of a focus on certain things, all PM&S-36 residency programs must guarantee minimal competency in all areas of podiatric medicine and surgery including digital surgery, forefoot surgery, rearfoot surgery, etc. All residents must complete at least the minimal number of surgeries in each area.
Fellowships are much more focused. For instance, I am aware of fellowships in diabetic wound care/limb salvage, trauma, and sports medicine. After residency, docs can get further training in these specific areas.
I think people generally do fellowships because 1) they felt their training in a certain area was not sufficient for their needs or 2) they enjoy it and want to focus more on that area after they are done. Generally, doing a fellowship won't lead to more $$$. It is usually done for the interest and educational experience of the individual.
where is the peds ortho fellowship? Is it just peds foot and ankle?
It is in Michigan and is actually a pediatric orthopaedics fellowship (MD) but I think he'll just be doing lower limb stuff.
Can you explain how, for example, getting an ACFAS fellowship is done? I know several Podiatrists that are FACFAS and was wondering if you qualify for something like that based on a certain number of rearfoot cases? Or do you apply after residency to separate fellowship? I'm very interested in pursuing an ACFAS fellowship and just don't know how that all works.
You apply for a fellowship while finishing up residency. It is a separate entity. For the most part, the only requirement is that you finish a residency. You then are/aren't granted an interview.
The senior resident at Broadlawns is going to Chicago to do a diabetic research fellowship. I'm not sure when she applied but I think she interviewed for it in February.
I've only looked into a few, but I think many pay less than the residency salaries in the same region. Most fellowships seem to be a labor of love which are done to work with top docs and gain elite skills...
FACFAS - as you stated is Fellow of ACFAS but hte fellow in this situation has nothing to do with doing or having done a fellowship. This is based on how much money you pay for dues and maybe some other credentialing stuff.
There is no such thing as an ACFAS Fellowship. ACFAS is a separate organization that various DPMs may join. There are different levels of ACFAS. Residents may join the ACFAS as a resident member. The next level of membership for ACFAS would be Associate member status. The qualification for Associate level are Board Qualified status with ABPS (Passing the written exam for either Foot Surgery and/or Reconstructive Rearfoot Surgery) and be a member of APMA. Another level of membership for ACFAS would be Fellow member status. The qualification for Fellow level are Board Certification status with ABPS (Passing both the written and oral exams for either Foot Surgery and/or Reconstructive Rearfoot Surgery) and be a member of APMA. I hope that this will clarify things about ACFAS membership levels.
A residency graduate may apply for Associate membership status with ACFAS if he/she passes the ABPS written exam. It is nearly impossible for a newly graduated resident can apply for the Fellow membership status with ACFAS unless they have a way to sit and pass both written and oral exams simultaneously.
You don't sit for oral exams until you submit a certain number of required cases to demonstrate experience. (65 cases in various categories for Foot Surgery and an additional 30 for Reconstructive Reafoot and Ankle Surgery.)
You are right in terms of the requirement to sit for the oral boards. This is why I wrote that it is nearly impossible for a newly graduated resident to obtain Fellow status with ACFAS. The only reason why I said nearly impossible is that I did know of a DPM whom sat for both the oral and written exam after completion of residency training. He was a DPM that had done a RPR in the past and was working for over 10 years. He was one of the "older podiatrist" that was able to do forefoot surgery without surgical training. When the hospital guidelines changed and required surgical board certification for surgical privileges, he went back to do a PSR-12 residency training. After his residency training, he sat for both the written and oral ABPS Foot Surgery exam. He had done enough forefoot cases prior to PSR-12 residency to qualify him to sit for the oral exam.
I wanted to respond to the comments on salary coming out of residency. You should speak to both residents coming out now and to practice management experts to obtain truthful information. I interviewed at many places during the process and can comment on my experience. My advice is to not focus on what your starting salary will be. You won't know that you'll be happy there until you're actually there and that is in regard to not just the job but also the area, how you family adjusts, and many many other factors. The fact is that training does not always equate to dollars - medicine is a business, period. I did a four year surgical residency and I'm not entitled to anything - I have to again earn it. If you have great skills, you will have a step up and treating patients effectively and compassionately will equate to demand for you but you have to know how to make everyone happy and that doesn't just include patients. I received offers from podiatrists offereing no base and only a percentage of collections all the way up to ortho groups offering me $150 w/great benefits. You have to consider the entire package. Although many times you don't stay with your first job, you'd like to avoid this because moving means starting all over and having to establish new relationships which take time. The most common offer will be a base with incentive (right now an example for a PM&S36 person would be a base of $65-75K and an incentive of 20% of collections over a certain amount likely to be near $300-400K). Many times they will then slowly increase your base yearly based on what you produced in the previous year - so for example if you grossed $100K in year one (base and bonus), you may have your base increased to 90% of that - so year two would be a base of $90K and the same incentive, etc, etc. You should look at not what you will make in the first 2-3 years so much as what is the long-term plan of the practice and where will you be in 5-10 years. You want job security and increasing income. When negotiating for partnership you should address that early on and have provisions in the contract for when it may be offered and at what amount - are you paying the value of the practice at the time of buy-in or from when you start? Remember you will increase the value of the practice while you are there and buying in at the increased price is buying what you already brought to the table. Be careful with ortho practices - some are good and some are not. Ask why are they bringing you in. Sometimes they will limit what you are allowed to do - maybe making you do orthotics or just forefoot surgery if they already have someone who is doing their rearfoot and ankle cases. If they legitimately have a need for you to do what you want then make sure you have job security. You don't want them to replace you with an orthopod in the future. Their point of view commonly is that hiring a podiatrist is good in that they can pay you less to do the same job (if you are competent) but hiring you is bad because you can't participate in the general ortho call. The salaries of fellowship trained foot & ankle orthopods is much higher because they can share in the general ortho call which is a huge deal, especially in smaller group practices. I decided to join a podiatry practice in an area I wanted to live with a decent base and high incentive with easily attainable kick-in. Feel free to contact me regarding specific situations/questions.
Great post. I agree with you.
As do I. I was very enlightened by this thread.
So are these ortho fellowships you mention podiatry fellowships?
If not, what are they, how many are there and where are they? Thanks for the reply.
I think that presby was referring to the Foot and Ankle Orthopedic Fellowships that an Orthopedic Surgery residency graduate can participate in for specialized foot and ankle surgery training. I do not think that presby was referring to podiatry fellowship.
To clarify, you can do a fellowship in whatever - there are many different ones offered. In my previous post I was referring to orthopaedic surgeons with fellowship training in foot & ankle which can vary from 6 months to a year. The fact is, as a podiatrist no matter if you did my four year residency then a surgical fellowship with Dror Paley and married Mark Myerson's daughter and practiced the most liberal state, you are still a DPM and can't take general ortho call. You could agree to take just all the foot & ankle call all the time but most places have whoever is on call do it all - so if a hand guy is on call and he gets a pilon, he does it or offers it to the foot & ankle guy BUT he is responsible for the care. The ortho practices are great for the trauma aspect but the question is will you have job security, can you be a partner and how can they guarantee this to you. You have to look at how much money you geberate versus the total joint guys and unfortunately the numbers are not in your favor. Be happy with what you do - you provide a valuable service that cannot and will not be replaced.
I thought for sure that after I married Mark Myerson's daughter I would automatically be welcomed into the AOFAS and able to do shoulder surgery. Why did you have to crush my dreams, presby?
I wouldn't mind working with and ortho group. My situation was such that I couldn't negotiate the deal I wanted with such a group in the place I wanted to live. I had multiple opportunities to negotiate ortho deals however in rural areas or areas I wasn't as excited about living in. Most (not all) of the time if an ortho group is going to take in an podiatrist to actually have a surgical practice it will be a larger group practice that has a need - they are sending out all their foot/ankle stuff and realize they can keep it in the practice. They want someone who is very well trained especially someone who has good trauma experience and has worked with ortho in the past with the same mind set as them. It will likely not be in a major metropolitain area and will not be associated with a training/education program. You will not likely ever be offered partnership (there are rare situations though). The reason to do it is for the cases you will be getting/trauma and not for the money. The relationships between ortho and podiatry are also very geographic specific. The newer ortho grads realize that there are well trained podiatrists out there especially if they trained with you. At our place the ortho guys see what we have on our surgery schedules and they respect what we do just like we respect what they do. As time goes on, the playing field will become more level.
I posted to a related thread in the Pre-Podiatry Students forum, so I'll cut/paste my comments to here since it pertains:
Re: Reported $600K income
Reported income can be misleading too. As a private corporation you must pay yourself a "reasonable salary" as the IRS calls it. The more you can make purchases related to business, the more you benefit. For instance, say you and a colleague go out to eat. You talk shop and you pick up the tab on your Corporate card, which is legit. Your business entity spent the money on that dinner, not you the person. The money was spent before it actually became part of your personal income. Nonetheless, you got to eat the meal! By owning the business you can make use of such tax write-offs. The doctor who "officially" makes $100K per year might actually be getting to spend more than the other doctor who "officially" makes $130K salary.
$150K seems sky-high to students and Residents now, but it's honestly within reach of a basic podiatric surgical practice without glamorous rearfoot, ankle, or trauma work. Try not to be dazzled by high 1st-year offers; what happens 5-10 years down the road will make more difference in the long run.
- Start a separate real estate company, buy or build a medical office, then lease it back to yourself with your practice as the tenant.
- Own part of a surgery center, do your cases there, then collect dividends from the separate business.
- Get a DME number, add significant income by getting to bill for camwalkers, wound care supplies, etc.
- Become locally known for doing one thing better than anyone else in the community. You don't necessarily have to be better (you have to be good), but if you have the reputation then you get the referrals.
Great advise, I couldn't agree with you more. I appreciate my training and when you look at practitioners you realize that great training doesn't equate to great salary. Although your reputation is based on your ability, medicine is a business and image is important. I see practitioners that claim they are the "expert" in whatever but in fact they are not but if the public perceives that, they will get those referrals.
Here's one angle by which my Partners and I were surpised: We put up a shoe tree in our waiting room with those Rx Crocs shoes. As patients are sitting there they stare at the shoes until they buy them. We're netting over a thou per month profit from those wacky things! Bonus walking-around money!
Our biggest expense by far is payroll. Streamline your staff and you keep an extra $30K per year per staff in your pockie.
Thanks for the great post, NatCh. Can you tell us more about these two points? What is a DME number?
Just a guess from context, but it's probably "Distributor of Medical Equipment" or "Durable Medical Equipment" liscense?
A lot of pod clinics here in south Fla lose $ and have to do patients a disservice by sending them across town to pick up crutches/CAM/etc. There's legislation with aims to protect paitents from docs and clinics overcharging for the durable medical equipment, but, in the end, it just makes people walk or drive across town on a broken foot to save $5 on a pair of crutches
Yes, a pod clinic might charge a bit more for insoles, crutches, CAM, BioFreeze, etc than a big medical supply store, but that's because a small clinic can't buy in the volumes that the wholesalers do. I think that, to most patients, it's well worth the extra couple bucks to get the equipment they need right there in the office so they can save an extra trip and start treating their ailment right away...
So your saying that you need a DME # to sell these things out of your clinic. Why would some pods choose to lose $ and not get this DME, if thats the case?
Here's an article that tries to explain the DME thing:
It lets one bill for items so insurance will pay for it. Some docs don't do it because the application process is heinous, and it takes forever to get a license.
If you dispense a short leg air-cast with each osteotomy you perform, you can make an extra couple hundred bucks per case. Figure out how many osteotomies you do per year then do your own math.
There are numerous ways to make money in this business, and you'd exhaust yourself trying to do them all. One of my former partners for instance did lots of surgery and made a lot of money from it, so she couldn't be bothered to do orthotics. She sent out all of her orthotics to a local orthotist. She lost out on a lot of business there but made up for it with the time gained working up other patients. You eventually do the things that you like or the things with which you are comfortable and send out the rest.
I tried doing diabetic shoes for a bit but it was such a pain in my neck that I said "F-it." Mostly I do surgery, ingrown nails, and heel pain now and avoid the nail care and diabetic stuff.
The surgery center thing: A Surgery Center is a privately owned business that provides a place other than a hospital for surgeons to take ambulatory cases. You can own part of one and share in any profit it makes. You have to disclose ownership though to avoid kick-back law violations.
Maybe I should do a practice management tip-of-the-day thing?
I think you should Nat! It would be helpful to many I'm sure (myself included)!
Ha! I was half-joking because I probably have enough tips to last only about four days. In fact, have I used them all up yet? Yep...I'm out!
I don't think I'll log on every day, but if someone sends me a PM I'll catch it in my email inbox.