Forum Members Official: Job Offer Thread

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Offer in East Coast, appears to be on those big acquisition groups.

No call, only rotating practice call. Operate at surgery center but credentialed at the nearby hospital. First yr is base salary 140-150k, once you hit 500k collections then you get 30% of collections. Second yr is only collections (30% of 500k, 750k 34%, etc.). Any dme is part of collections.

After getting 600k collections each year after 2 yrs is when you can become a partner with buy in 25k at least and the acquisition group will match that (it is a loan but paid back in contribution). Benefits include: 401k (need to be with them for 1 yr then they will start matching), malpractice, cme 1k (also has in house cme), pto (10 days for first year, 15 for second year, etc.), no healthcare paid (has hsa plans), short term disability paid.

What do you guys think? I hate the benefit structure.
That's terrible.
For some quick math:
500k is 3.33x your base of 150k.

Straight 30% of 500k is still only 150k for your 2nd year- so you're making essentially the same as your 1st year
Their overhead to add you should be minimal besides base salary +benefits + credentialing etc because they're not adding any additional rent space + staff.

There's also no way to know if you'll hit 500k collections if they don't have patients ready for you to see as soon as you join.
If you're responsible for building your own clientele and only starting with 8-10 patients a day, no way you're gonna hit that number.

Edit: Just realized healthcare isn't included which could be 5k+ a year.
 
If you're responsible for building your own clientele and only starting with 8-10 patients a day, no way you're gonna hit that number.
They said they have patients ready for me because one of the partners is retiring so I will be responsible for seeing their patients. I also asked to check the books or have more insight on how easy it is to collect 500k.
 
They said they have patients ready for me because one of the partners is retiring so I will be responsible for seeing their patients. I also asked to check the books or have more insight on how easy it is to collect 500k.
There's no guarantee those patients will want you, especially if they're used to a different doctor
 
My favorite is the in-house CME
 
@sdupre_apma

Here you go. You can have the above offer or you can have a hospital offering 300k base guarantee for 3 years, let's say $45 per RVU, 20K signing bonus 20K moving stipend 5% 401K match, healthcare, dental paid... Now You see why your data is going to be worthless?

You will not see the Grand canyon wide disparity in other specialties in terms of job offers. And to be clear, this will be an accepted job offer by somebody.
 
@sdupre_apma

Here you go. You can have the above offer or you can have a hospital offering 300k base guarantee for 3 years, let's say $45 per RVU, 20K signing bonus 20K moving stipend 5% 401K match, healthcare, dental paid... Now You see why your data is going to be worthless?

You will not see the Grand canyon wide disparity in other specialties in terms of job offers. And to be clear, this will be an accepted job offer by somebody.
Thanks, I appreciate you marking me on this.

Key point here, I wouldn't say this means my data will be worthless at all. I WOULD say that, if the results pan out to show a bimodal distribution of compensation as we might see, this would support treating the profession as two different "things" for the purpose of "You'll make $X as a podiatrist!". To put it another way, it would mean that reporting an overall compensation average AS a single average WOULD be problematic and misleading.
 
Thanks, I appreciate you marking me on this.

Key point here, I wouldn't say this means my data will be worthless at all. I WOULD say that, if the results pan out to show a bimodal distribution of compensation as we might see, this would support treating the profession as two different "things" for the purpose of "You'll make $X as a podiatrist!". To put it another way, it would mean that reporting an overall compensation average AS a single average WOULD be problematic and misleading.
And I agree. Not worthless. But hopefully we can educate you quickly on podiatry and some of the problems it has so you can interpret the data. Because we sure know APMA won't acknowledge any of this.
 
Hello! My name is Sam and I just joined this community on behalf of my father who is trying to retire and sell his private practice in Birmingham, AL, after serving this community since 1988.

We’re looking for the right person to take over his well-established, patient-centered private practice, Brookwood Foot Care.

There is flexibility for the incoming doctor:
  • Purchase the practice outright
  • Practice with the option to buy under a private owner
My dad is committed to staying on during the transition to help ensure continuity of care and a smooth handoff. His amazing office staff members also hope to stay and continue supporting the new physician.

This is a great opportunity for someone looking to step into a turnkey practice in an active, thriving community. We’re hoping to find someone who values patient relationships and wants to make an impact locally — just like he has for the past 35 years.

If you're interested or would like to talk further, feel free to reach out to my dad directly at [email protected] or (205)999-5965. Everything will be kept confidential.
 
Offer in East Coast, appears to be on those big acquisition groups.

No call, only rotating practice call. Operate at surgery center but credentialed at the nearby hospital. First yr is base salary 140-150k, once you hit 500k collections then you get 30% of collections. Second yr is only collections (30% of 500k, 750k 34%, etc.). Any dme is part of collections.

After getting 600k collections each year after 2 yrs is when you can become a partner with buy in 25k at least and the acquisition group will match that (it is a loan but paid back in contribution). Benefits include: 401k (need to be with them for 1 yr then they will start matching), malpractice, cme 1k (also has in house cme), pto (10 days for first year, 15 for second year, etc.), no healthcare paid (has hsa plans), short term disability paid.

What do you guys think? I hate the benefit structure.

If they aren’t covering any amount of a healthcare premiums (with the rest of the crappy benefits) Then their overhead is not nearly high enough to justify only giving you 30% of collections. With those benefits they should be able to offer 40% collections at a minimum.
 
Hello! My name is Sam and I just joined this community on behalf of my father who is trying to retire and sell his private practice in Birmingham, AL, after serving this community since 1988. ... ...If you're interested or would like to talk further, feel free to reach out to my dad directly at [email protected] ...
Foot & Ankle ABFAS cert.
Aol email address.
Owner himself is too tech inept to market/post the practice themself.

What could go wrong here? 🙂
 
If they aren’t covering any amount of a healthcare premiums (with the rest of the crappy benefits) Then their overhead is not nearly high enough to justify only giving you 30% of collections. With those benefits they should be able to offer 40% collections at a minimum.
That's terrible.
For some quick math:
500k is 3.33x your base of 150k.

Straight 30% of 500k is still only 150k for your 2nd year- so you're making essentially the same as your 1st year. ...
Offer in East Coast, appears to be on those big acquisition groups.

No call, only rotating practice call. Operate at surgery center but credentialed at the nearby hospital. First yr is base salary 140-150k, once you hit 500k collections then you get 30% of collections. Second yr is only collections (30% of 500k, 750k 34%, etc.). Any dme is part of collections. ...
Those setups are sadly SUPER common in podiatry, guys (supergroup with base then just 30%... little or no real benefits).

The group in NMex I worked with for about a year (largest in state, run from out of state, runs groups in other states... now since sold to VC and run by them) was $180k base 30%. I'd negotiated on both... base they bumped a bit, 30% they said was "won't change, actually more than we pay some other new docs" (sure hope not). Then, right at 1 year mark, my pay changed to 30% only. I think I got a check for about $6k when I was expecting $15k (paid twice monthly, second check each month was adjusted for 30% factor). They did not warn me or tell me in contract that it'd change ("we do that standard for all of the docs"), so I took a fairly big pay cut (I'd taken over for an unpopular doc they fired and was not full every day, questionable staffing). I was ok (high income partner, savings), but that surprise would've seriously damaged most associate new grads... miss car payment, struggle on student loan, miss rent, whatever. I was somewhat immune to that, so I just played along but went immediately into planning my own PP and did it a couple months later. 😎

The base discussed above $140k-150k discussed above is definitely low end, but these groups basically all do the same stuff:
  1. Attract DPMs (typically young ones - or older with few job options) with a base slightly higher than most typical PP.
  2. Once the base is pulled, and it's pure ~30% collections, worker bee DPM is trapped (income not good, not terrible either).
  3. Once they're trapped, it's easy to push "grafts" and "custom" DME and other refers the group benefits from (vasc, PT, "path lab," etc).
  4. Also easy to encourage little vacation, pushing more services, more u/s injects, etc etc for associate to pump collections.
These are uber common now. They all use the same model.... and 100+ new grads fall for it every year. Heck, some stay there 10+ years or even more. Some are dumb enough to buy a house or get kids in school, and they can become lifers for the supergroup. The saddest part of this is that in addition to taking 25% or more the collect off the docs (~45% overheard, 30% to associate, 25% profits), the associate also has zero hope for any meaningful partnership or ways to increase collections. In the group I was in, multiple docs quit immediately or in the months following the VC sellout (a couple years after I had resigned). Sad.

When you account for denials, varied insurance, etc... $500k collections [ethically] is no cake walk. It can be done, but in these supergroups, you have basically no control of marketing, staffing, billing/collections. To hit those marks, you have to see MANY per day (with questionable staff/system), do scammy stuff, and hope for good admin support (and that they aren't stating your collections lower than real amounts!). They basically coach and steer associates to doing the "high ticket items" just to make fair pay.

Get used to this stuff... it is sadly the new normal (podiatry supergroups).
It's our version of what Walgreens and CVS and Walmart were (are) for PharmD grads. 💩
 
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If they aren’t covering any amount of a healthcare premiums (with the rest of the crappy benefits) Then their overhead is not nearly high enough to justify only giving you 30% of collections. With those benefits they should be able to offer 40% collections at a minimum.
Sorry, investors need to be paid before the doctor.
 
How do you guys recommend starting my own practice because all these crap offers are making me rethink things. I am just afraid that I don't have any experience whatsoever and not really sure where to start. I also wanna live in bigger cities so I am sure cost is higher. I did get an offer from one of the DPMs that they will pay for my startup and I would have half ownership until I can be on my own few years later when I can buy them out. However, I will have to work for them for few months to learn the gist of things.
 
Also, what are your thoughts on non-complete clause? Is that very common?
 
Also, what are your thoughts on non-complete clause? Is that very common?
These are a tool used by the people in power to keep you out of power. They are not allowed in certain states and they can be found unreasonable/problematic in size / length of time. There is still significant virtue in going out of your way not to sign them. I'm of the opinion that everything about them is terrible - take a circle and make the radius a mile. You'll cover an incredible area. I don't want to dox myself but if I had a non-compete of a "few miles" when you do pi*r^2 you lose the entire town.
How do you guys recommend starting my own practice because all these crap offers are making me rethink things. I am just afraid that I don't have any experience whatsoever and not really sure where to start. I also wanna live in bigger cities so I am sure cost is higher. I did get an offer from one of the DPMs that they will pay for my startup and I would have half ownership until I can be on my own few years later when I can buy them out. However, I will have to work for them for few months to learn the gist of things.
I would go back through this forum and read @619 's posts. Specifically read their description about how they set up their insurance billing / e-clinical works etc. They are doing something very right because my EHR / billing costs are outrageous and they seem to have owned this issue. In general though - you need to in my opinion work somewhere a year and then leave to start your own thing. Learn everything you can about credentialing and contracting with insurance companies. I don't mean this unkindly, but so many people on here ask "should I start a private practice" and my suspicion is that if you asked Google AI how to start a PP you'd appreciate that its an endeavor. I just did it now and it has like 8 big bullet points with a ton of subpoints under each of them. One of them being secure financing and I'm assuming that post residency you aren't super flush. Meanwhile, you've presumably never had employees before. You've never spoken to an insurance company. You've probably never signed a lease etc. A lot of these things are going to be new and you'll never do them until you do them. There are a lot of websites out there about starting a private practice and if you want to do it - you should start reading and making a business plan.

I own half a practice right now. I didn't start it. Were my office to be hit by a meteor tomorrow I'd immediately start building my next office (while praying for a VA job to open up in my town).
 
...I'd immediately start building my next office (while praying for a VA job to open up in my town).
dont you say that adam sandler GIF
 
...secure financing ...
...start reading and making a business plan. ...
Yep,

All it really takes to start a PP is about $50k-250k (depends on area COL, area competition, LOC/savings, etc).
All you need is a bit of a space, supplies, one employee, a bit of marketing early.
XRay and nicer furniture and big marketing campaign and bigger office(s) and all that are optional... they can come later on.
It can cost a lot more if you do buyout... but that can occasionally be worth it to do it that way also (busier much quicker in some localities).

Make a plan. Make lists of supplies and costs. Do a budget.
Read The Medical Entrepreneur, then read it again. Revise your plan.

Submit your plan and app for a med/biz loan from a bank or CU. Try a few of them.
Fyi, you will get rejected offhand or after a cursory glance due to your student loans (but you will have learned!).
But yeah, those days of pre-2007 where banks gave grad docs - even podiatrists - a big bag to go start or buy a practice are LONG gone.
Plan to save and save and save until you can do it. Learn all the way.

Like @heybrother and others, I get messages all the time from ppl who want to do solo startup (aka want better income and ROI on their degree and are sick of having a boss). Problem is, many have no money and don't want to save harder or cut costs ("can't"), won't (again, "can't") downsize or borrow against or sell house the never should've "bought," won't borrow from fam or make any move to get or save the $$ needed. Well, then keep enjoying that associate gig... maybe you'll eventually start saving? If you want it, you'll make it happen. There is no miracle way to do it. The cavalry is not coming. You don't have to eat ramen every night, but you do have to find ways to save up if you want to start a solo PP (or any biz).

Just work a PP job or supergroup or PP MSG/ortho or whatever and learn every day. You will have to save hard.
[fwiw, I'm normally for paying student loans fast and hard with everything but max to Roth IRA... but saving HARD for startup PP is the only reason to pay low/minimum on edu debts or cash our retirement, because the PP will rocket your income and job satisfaction... but yeah, underpaying edu loans to buy house or consumer stuff is bonkers]
If you work a hospital job, you won't learn much about PP and will have to read a LOT, but you'll probably get to the startup $aving$ faster.
Either way, you'll learn as you go. You have to.

The steps to being rich are and always have been:
  1. Get a 100k+ job. ...podiatrists all have one of those.
  2. Learn to invest. ...biz, stocks, RE, part owner in biz, anything that makes regular income
  3. Start your own scalable business. ...for podiatrists, that's nearly always podiatry clinic(s), do what you know
  4. Scale up the biz, invest profits from business(es). ...unlimited potential obviously
Step #1 can be skipped if you have family wealth. Step #4 is obviously optional.But yeah, that's how it goes.
Employees can be comfortable, but they'll never get mega-rich like biz owners can. They just do step #1 and maybe some of #2 for decades.

...When you do start a pod biz, you will do tons. You will do ton of stuff you haven't done (but hopefully read about most).
You will learn a lot on your team (attorney, biller, accountant, buddy DPMs who have done it). Find good people and lean on them.

Hint: if you're asking if you should, you aren't driven. Keep reading.
Once you're nailing down how, then where, then when... yaaaaaaa.

Season 5 Disguise GIF by Rick and Morty
 
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If you're interested or would like to talk further, feel free to reach out to my dad directly at [email protected] or (205)999-5965. Everything will be kept confidential.
AOL email... probably still using paper charts. Good luck with modernizing that practice.
How do you guys recommend starting my own practice because all these crap offers are making me rethink things. I am just afraid that I don't have any experience whatsoever and not really sure where to start.
If you think you don't any experience, then you don't. Bite the bullet and find least worst PP job and start planning ASAP. Only decent part of associate gigs is learning the billing, intricacies of different insurances, etc. etc. You're destined to fail if you don't know what you're doing. Had the same thought if starting my own immediately out of residency, but I would have failed hard. You either need to have experience, or pay someone who knows what they're doing to hold your hand.
 
What about purchasing from someone who has an established practice but they are willing to stay with you as an associate until you are comfortable on your own?
 
183k base pay with ~30% collections from what I bring in. First year has 52k bonus. Free call 3-4 weeks per year at one of the hospitals (senior partners don't take any call lol). Path to partnership seemed pretty hazy, sounded like they didn't want another partner and just wanted us to work as associates. Saturday clinic every 8th week or so. Located in a big city-ish not NYC or Houston big. May need to travel to go to multiple clinics. Able to perform surgery if needed at the surgery center. All benefits paid. Clinic sounds pretty busy, they see on average 30-40 pts a day. Senior partner sounded a bit brash at times when I asked for certain clarifications. What is your take on this? The money seems nice but I have a feeling lots of hard work with long hours. Also, is it appropriate to ever reach out to an ex-associate at the practice you're thinking of joining?
 
183k base pay with ~30% collections from what I bring in. First year has 52k bonus. Free call 3-4 weeks per year at one of the hospitals (senior partners don't take any call lol). Path to partnership seemed pretty hazy, sounded like they didn't want another partner and just wanted us to work as associates. Saturday clinic every 8th week or so. Located in a big city-ish not NYC or Houston big. May need to travel to go to multiple clinics. Able to perform surgery if needed at the surgery center. All benefits paid. Clinic sounds pretty busy, they see on average 30-40 pts a day. Senior partner sounded a bit brash at times when I asked for certain clarifications. What is your take on this? The money seems nice but I have a feeling lots of hard work with long hours. Also, is it appropriate to ever reach out to an ex-associate at the practice you're thinking of joining?
Also use a website to look at archived webpages of that practice to see if they cycle through associates and contact them.
 

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