Forum Members Official: Job Offer Thread

[thefootfixer]

You made an assumption that you will earn $120k doing mobile/nurs work. I have done mobile/nursing home work and I can tell you from first hand experience that very unlikely you will make $120k regardless of the false advertisement you see on job postings. Nails pays like $20 lol. Calculate how many nails you will trim (to make $120k) and remember you get about 40% of the collections assuming you work for one of those organizations. At best you get beer money from nursing home work.

I respect your input. Even if 120k is on the HIGH end you will certainly make more than 80k. Yeah it’s grimy and demeaning , but that’s real life podiatry. The ultra lucrative PP jobs, if their fairly created, are rare. You will bust your ass for the owner, and get paid change on the dollar. Losing out on that early stage in your career financially is daunting.

Making $120k , after paying the 2 ends of social taxes and rest of taxes, then gas and car maintenance etc, you will not be maxing out any retirement account let alone save money to "open you own gig". We are talking about $120k in 2023 dollars not $120k in 1923.

Obviously maxing out accounts is a goal but not a necessity. It’s still better to be able to save SOMETHING for the future and lower your AGI in doing so. A PP that has a flat salary and no benefits will come Bite you in the ass when you’re in your 50s and looking at your retirement portfolio. Sure u “fine tuned” your surgery, learned “billing” etc. Congrats. The owner is doing very well because of that. What happens to you? After many years in the role, I hope your salary will have gone up. But that’s likely just a w2 income with only immediate fulfillment. Nothing left over.my 2 cents

This is 100% correct.

I’m glad we agree here.

---

Members don't see this ad.

 

[619]

Obviously maxing out accounts is a goal but not a necessity. It’s still better to be able to save SOMETHING for the future and lower your AGI in doing so. A PP that has a flat salary and no benefits will come Bite you in the ass when you’re in your 50s and looking at your retirement portfolio. Sure u “fine tuned” your surgery, learned “billing” etc. Congrats. The owner is doing very well because of that. What happens to you? After many years in the role, I hope your salary will have gone up. But that’s likely just a w2 income with only immediate fulfillment. Nothing left over.my 2 cents

With the end goal in mind, a new grad starts out working in PP and after you have "fine tuned" your surgery, learned billing and coding then you can move onwards to an organizational job (hospital, MSG etc) or open your own practice. That's what me and everyone preaches on sdn.

You cannot get the surgery fine tuning or office experience from doing mobile/nursing home as a new grad. Ever heard of anyone starting out doing nursing home jobs and then somehow land a hospital job? Maybe by family connections or luck but definitely not by work experience.

After many years in the role, I hope your salary will have gone up. But that’s likely just a w2 income with only immediate fulfillment. Nothing left over.my 2 cents

No reason to be 50 y/o and still be an associate at a PP. You literally have no one to blame than the man (or woman) in the mirror.

 

[dtrack22]

You made an assumption that you will earn $120k doing mobile/nurs work. I have done mobile/nursing home work and I can tell you from first hand experience that very unlikely you will make $120k regardless of the false advertisement you see on job postings. Nails pays like $20 lol. Calculate how many nails you will trim (to make $120k) and remember you get about 40% of the collections assuming you work for one of those organizations. At best you get beer money from nursing home work.

That’s a bingo

A PP that has a flat salary and no benefits will come Bite you in the ass when you’re in your 50s and looking at your retirement portfolio. Sure u “fine tuned” your surgery, learned “billing” etc. Congrats. The owner is doing very well because of that. What happens to you?

Nobody is suggesting PP vs nursing home work forever. We are talking a year or three while you find something else or open your own practice. The reality is that experience AND income ceilings as a PP associate are higher than nursing home nail work with Healthdrive.

 

[619]

Nobody is suggesting PP vs nursing home work forever. We are talking a year or three while you find something else or open your own practice. The reality is that experience AND income ceilings as a PP associate are higher than nursing home nail work with Healthdrive.

Also to add, After 2-3 years working as an associate with surgical case logs, an associate position is 10 times better on your CV than doing toenails at health drive or 360.

 

[Feli]

That’s a bingo

...

Nobody is suggesting PP vs nursing home work forever. We are talking a year or three while you find something else or open your own practice. The reality is that experience AND income ceilings as a PP associate are higher than nursing home nail work with Healthdrive.

This is the most important thing to realize, right here.^

In order to be a success and own a practice or comfortably look for high pay employ jobs, one first needs A JOB. It doesn't have to be the end of the road job... just the best one can do in the interim.

To start a business (solo PP), one needs a 100k+ job (hopefully +++) to be able to save up and to learn how to invest a bit.
Most important, they need to learn how to bill and how an office runs (hopefully the get a good model/mentor office).
The nursing home type jobs are not ideal in that no help for skill/boards/exp, but they do make $ if goal is PP or to own solo nursing home biz.

The people who start a solo PP right of training are RAAARE, and they typically have seriou$ family help to start from scratch or buy a DPM out, rare situation of a buyout plan from a residency attending, parent who is a DPM and they take over, etc.

...For the vast majority of folk, it goes like this:
Get the best job one can > try for hospital jobs or better job or save for solo PP
Get the dream job > look for other jobs if it doesn't pan out

Also to add, After 2-3 years working as an associate with surgical case logs, an associate position is 10 times better on your CV than doing toenails at health drive or 360.

Yes.

 

[HardRoadPaved]

Most important, they need to learn how to bill

most DPMs have no idea what a Q modifier is or how to look at a CMS-1500. It sucks to spend 7 years in training for this field only to come out and have to learn this crap.

 

[eyeeye_captain]

You are essentially bonusing at $360k in collections. I guess determining that quarterly is good from the standpoint of a more consistent stream of increased income above base, compared to a lump sum check at the end of the year. But this is still a normal podiatry contract….

$120k base, 30% of collections at 3x your base. Just like many of us have experienced, you get to take a pay cut on your “bonus” pay. You get 33% of collections in base pay (assuming you collect $360k) and then you “bonus” at only 30% of collections. You cover your cost to the practice and then they start reimbursing you LESS per $ you bring in. How very Podiatry of them.

Chiming in from the sidelines, and out of order of the thread. Dirty little secret: the pay may be different, but the terms are pretty much the same across most medical fields in private practice, not just podiatry. Most with us are give or take what you'd make with 2.5-3x collections at a partners' rate for the base, and then you bonus less, though the bonus percentage is variable. A LOT of this depends on overhead as well, which will also vary widely.

Why? Because in most cases they're floating you for at least a little bit of time to reach your threshold, you're raising overhead to at least a small degree, and then you hit them back. In theory, hiring an associate means partners get fewer patients/cash flow and lose money on the back end, so it's an ongoing cost for a bit.

Is it a good system? Meh, I don't think so, but it could be worse. Do you want to walk into a clinic eating what you kill when you're low volume building your board, or would you like some insurance with a reasonable base (although the crazy low ones quoted are, well, uh, I'll leave that alone).

The biggest problem that I've gleaned from my lurking is just atmosphere/attitude toward associates. When I hire somebody, I want them to be a partner in 2 years, so we basically break even on both sides. There definitely are "spectacles ophthos" (we don't tend to have mustaches), but there aren't a ton of associate mills. We just worry about practices getting sold to private equity before the chance of partnership, like your supergroups.

I'd genuinely be interested in an associate contract model that folks feel is ideal, think it would be a good discussion.

 

[eyeeye_captain]

Some things outside of financials that really should be in associate contracts (and often aren't):

• Full benefits (malpractice, medical, CME, 401k, etc.)
• Clear timeline to partnership
• Equal vote on practice matters after a certain amount of time (staffing, equipment, etc.)
• Description of the buy-in/out process, with the practice paying for an outside evaluation of the value
• Equal call schedule
• Equal payor mix guarantee
• Scope guarantee (partners don't hoard certain diagnoses, hard to put in a contract though)

 

[air bud]

Chiming in from the sidelines, and out of order of the thread. Dirty little secret: the pay may be different, but the terms are pretty much the same across most medical fields in private practice, not just podiatry. Most with us are give or take what you'd make with 2.5-3x collections at a partners' rate for the base, and then you bonus less, though the bonus percentage is variable. A LOT of this depends on overhead as well, which will also vary widely.

Why? Because in most cases they're floating you for at least a little bit of time to reach your threshold, you're raising overhead to at least a small degree, and then you hit them back. In theory, hiring an associate means partners get fewer patients/cash flow and lose money on the back end, so it's an ongoing cost for a bit.

Is it a good system? Meh, I don't think so, but it could be worse. Do you want to walk into a clinic eating what you kill when you're low volume building your board, or would you like some insurance with a reasonable base (although the crazy low ones quoted are, well, uh, I'll leave that alone).

The biggest problem that I've gleaned from my lurking is just atmosphere/attitude toward associates. When I hire somebody, I want them to be a partner in 2 years, so we basically break even on both sides. There definitely are "spectacles ophthos" (we don't tend to have mustaches), but there aren't a ton of associate mills. We just worry about practices getting sold to private equity before the chance of partnership, like your supergroups.

I'd genuinely be interested in an associate contract model that folks feel is ideal, think it would be a good discussion.

You highlight the fundamental problem in private practice podiatry and the overall profession. The oversaturation and lack of abundance mentality. Look at small business Twitter and other places (Twitter is amazing) the amount of info that is shared these days is phenomenal. The idea of abundance mentality is also captured in the saying a rising tide lifts all ships. You can say too many pods = too many realtors....but the barrier to entry is a little more expensive. If not for the significant costs more pods would walk away. However we are stuck with too many pods most in private practice and the goal is look out for number 1 and how to put food on the table. That comes with taking advantage of others. The more time you spend in MSGs or hospitals the further you get from it and see much more how MDs/DOs work. There is plenty to go around. Some might have more than others, but everyone is going to eat. I will throw a bone your way you get me back bro.

 

[icebreaker32]

Some things outside of financials that really should be in associate contracts (and often aren't):

• Full benefits (malpractice, medical, CME, 401k, etc.)
• Clear timeline to partnership
• Equal vote on practice matters after a certain amount of time (staffing, equipment, etc.)
• Description of the buy-in/out process, with the practice paying for an outside evaluation of the value
• Equal call schedule
• Equal payor mix guarantee
• Scope guarantee (partners don't hoard certain diagnoses, hard to put in a contract though)

The problem is way too many podiatry contracts lack most of these items.

Sometimes partnership is never on the table.

Across many industries you might say it is 1/3 overhead for an employe, 1/3 to cover salary and benefits and 1/3 profit for owner Is somewhat typical. I do not think most disagree here. If there were bases of 160 - 180 or more and GOOD benefits with a clear and fair short track to partnership, I doubt people would be complaining about a few percent difference in bonus structure beyond 3 times their collections. If they were making the good base and benefits they would be partner soon enough and enter a more eat what they kill situation beyond overhead in a couple years anyways. Young doctors are just trying to pay their bills and have something a little beyond a middle class lifestyle.

I am not denying the owners are taking a risk. They are and I am sure some have been burned before. The question is why are they not taking a larger risk and offering up a better base and better benefits. There is no simple answer but it is probably one of a few things.

1. There are scared there is not enough business to offer a higher base. Perhaps they were not really busy enough to hire an associate and pay them more than a nurses salary, They are constantly putting pressure on the associate to market and take unpaid call. Not that a little hustle is a bad thing, especially if one feels it is a longterm opportunity and they are not just building the practice for the owner and the next associate when they leave

2. History repeats itself. They are ether trying to make money of an associate like someone did on them or they just feel it is a rite of passage to offer a low base or eat what you kill structure even when real opportunity to do well financially is there. Unfortunately many will say the opportunity is there to far exceed their base or make a fortune on a straight percentage when hiring and the promised potential too often is not there. Podiatry is not like Ortho where an eat what you will kill contract most often results in more than 500,000. We have saturation, take too many poor insurers, perform too many low paying services that should be performed by nurses in the office and have to peddle too many products in the office as a profession. Some podiatrists practice much like an orthopedic surgeon, but for way too many it is more like a a chiropractor having to hustle, sell, and do scammy things.

Are there some podiatry groups that offer a fair situation and are really looking to add another partner? Certainly. They have no associates other than their newest and no turnover. The associate mill has many associates. Lots of these opportunities are also a solo podiatrist looking to add an associate. These could be great opportunities in theory, but often are not. Either the owner is not willing to give up control and ownership or risk their salary going down at all when hiring a new associate or they meant well but were not as busy as they thought. Either way is much more risky than working for a group with a clear history of adding partners but are the more common job opportunities available.

If an associate moved for a job that never really payed them enough to save anything....well they often have to move again for their next job also with no relocation assistance. You can not always find another job in the same city for podiatry unless it is a large metro and many metros are saturated and where associate mills are even more common.

There are also these supergroups. Not sure if they are a good thing or a bad thing for the profession longterm, but are better than many associate jobs as far as base, benefits and being busy enough to get surgical boards knocked out.

I feel saturation is the problem. There are more of the good jobs everyone wants than in the past for podiatry, but not nearly enough. For too many it is still the start out at a dead end and low paying associate job, build your CV and plan your next move, start your own practice (certainly not without a lot of risk) or remain an associate contemplating if staying in the profession is even worth it.

 

[Adam Smasher]

We have saturation, take too many poor insurers, perform too many low paying services that should be performed by nurses in the office

 

[thefootfixer]

Some things outside of financials that really should be in associate contracts (and often aren't):

• Full benefits (malpractice, medical, CME, 401k, etc.)
• Clear timeline to partnership
• Equal vote on practice matters after a certain amount of time (staffing, equipment, etc.)
• Description of the buy-in/out process, with the practice paying for an outside evaluation of the value
• Equal call schedule
• Equal payor mix guarantee
• Scope guarantee (partners don't hoard certain diagnoses, hard to put in a contract though)

What would you tell associates of have very few or NONE of these clauses? Becauses that’s the unfortunate reality in a majority of podiatry associate contracts. Again I’m not saying all are bad, but far too many are Just mediocre or poor.

 

[wakaflocka88]

The problem is way too many podiatry contracts lack most of these items.

Sometimes partnership is never on the table.

Across many industries you might say it is 1/3 overhead for an employe, 1/3 to cover salary and benefits and 1/3 profit for owner Is somewhat typical. I do not think most disagree here. If there were bases of 160 - 180 or more and GOOD benefits with a clear and fair short track to partnership, I doubt people would be complaining about a few percent difference in bonus structure beyond 3 times their collections. If they were making the good base and benefits they would be partner soon enough and enter a more eat what they kill situation beyond overhead in a couple years anyways. Young doctors are just trying to pay their bills and have something a little beyond a middle class lifestyle.

I am not denying the owners are taking a risk. They are and I am sure some have been burned before. The question is why are they not taking a larger risk and offering up a better base and better benefits. There is no simple answer but it is probably one of a few things.

1. There are scared there is not enough business to offer a higher base. Perhaps they were not really busy enough to hire an associate and pay them more than a nurses salary, They are constantly putting pressure on the associate to market and take unpaid call. Not that a little hustle is a bad thing, especially if one feels it is a longterm opportunity and they are not just building the practice for the owner and the next associate when they leave

2. History repeats itself. They are ether trying to make money of an associate like someone did on them or they just feel it is a rite of passage to offer a low base or eat what you kill structure even when real opportunity to do well financially is there. Unfortunately many will say the opportunity is there to far exceed their base or make a fortune on a straight percentage when hiring and the promised potential too often is not there. Podiatry is not like Ortho where an eat what you will kill contract most often results in more than 500,000. We have saturation, take too many poor insurers, perform too many low paying services that should be performed by nurses in the office and have to peddle too many products in the office as a profession. Some podiatrists practice much like an orthopedic surgeon, but for way too many it is more like a a chiropractor having to hustle, sell, and do scammy things.

Are there some podiatry groups that offer a fair situation and are really looking to add another partner? Certainly. They have no associates other than their newest and no turnover. The associate mill has many associates. Lots of these opportunities are also a solo podiatrist looking to add an associate. These could be great opportunities in theory, but often are not. Either the owner is not willing to give up control and ownership or risk their salary going down at all when hiring a new associate or they meant well but were not as busy as they thought. Either way is much more risky than working for a group with a clear history of adding partners but are the more common job opportunities available.

If an associate moved for a job that never really payed them enough to save anything....well they often have to move again for their next job also with no relocation assistance. You can not always find another job in the same city for podiatry unless it is a large metro and many metros are saturated and where associate mills are even more common.

There are also these supergroups. Not sure if they are a good thing or a bad thing for the profession longterm, but are better than many associate jobs as far as base, benefits and being busy enough to get surgical boards knocked out.

I feel saturation is the problem. There are more of the good jobs everyone wants than in the past for podiatry, but not nearly enough. For too many it is still the start out at a dead end and low paying associate job, build your CV and plan your next move, start your own practice (certainly not without a lot of risk) or remain an associate contemplating if staying in the profession is even worth it.

Icebreaker, next time you’re at a conference, can you just take the mic and repeat this to all the crummy pods in the room?

 

[eyeeye_captain]

What would you tell associates of have very few or NONE of these clauses? Becauses that’s the unfortunate reality in a majority of podiatry associate contracts. Again I’m not saying all are bad, but far too many are Just mediocre or poor.

I’d tell them they’re getting a Civic instead of a Ferrari, but it’s still a car. If you don’t have any other options, drive what you have to.

As air bud and icebreaker said, sounds like you guys are oversaturated. It’s supply and demand. We have tons of open jobs which leads to more bells and whistles for applicants. You have fewer jobs, so they can drive incentives down. At the end of the day, folks know you need a job and can snag a warm body.

 

[de Ribas]

I’d tell them they’re getting a Civic instead of a Ferrari, but it’s still a car. If you don’t have any other options, drive what you have to.

As air bud and icebreaker said, sounds like you guys are oversaturated. It’s supply and demand. We have tons of open jobs which leads to more bells and whistles for applicants. You have fewer jobs, so they can drive incentives down. At the end of the day, folks know you need a job and can snag a warm body.

Podiatry is very much oversaturated. This is the only subspecialty where providers are ok with settling in small towns and seeing fungal toenails and wound all day even though their training is much more advanced than that. I have not seen F/A ortho in a place with less than 150k. F/A ortho will only go to a place where they will be busy utilizing their skills.

Would you see neurosurgeon, critical care trama surgeon, GI, CT surgeon, IR or any other subspecialist in a place less than 250k? No. I have seen around 15 podiatrists in towns of less than 100k, most of them clip nails half a day. What a shame for a profession. That's insane. Podiatrists are the only subspecialsits that are ready to go anywhere and settle for less money and do way less than they were trained for due to one fact. That's oversaturation. There is not enough jobs. Period.

 

[air bud]

Podiatry is very much oversaturated. This is the only subspecialty where providers are ok with settling in small towns and seeing fungal toenails and wound all day even though their training is much more advanced than that. I have not seen F/A ortho in a place with less than 150k. F/A ortho will only go to a place where they will be busy utilizing their skills.

Would you see neurosurgeon, critical care trama surgeon, GI, CT surgeon, IR or any other subspecialist in a place less than 250k? No. I have seen around 15 podiatrists in towns of less than 100k, most of them clip nails half a day. What a shame for a profession. That's insane. Podiatrists are the only subspecialsits that are ready to go anywhere and settle for less money and do way less than they were trained for due to one fact. That's oversaturation. There is not enough jobs. Period.

For the record I am in a town of 17k (30k county) and pull from like 100k. Foot and ankle Ortho in my group. But only of 2 Ortho in town.

 

[de Ribas]

For the record I am in a town of 17k (30k county) and pull from like 100k. Foot and ankle Ortho in my group. But only of 2 Ortho in town.

But then that F/A does knees, hips, shoulders too then? Or bunch of other non f/a patients?

 

[air bud]

But then that F/A does knees, hips, shoulders too then? Or bunch of other non f/a patients?

Yeah he does all trauma and then lower extremities elective. Trauma/shoulder guy does trauma and all upper extremity elective. Now that I am here he will transition to more joints and stuff. Still do some foot and ankle like TAR and some sports med stuff on young athletes but doesn't do flatfoot bunions etc. But again only Ortho in town.

But back to the topic of oversaturation yeah you wouldn't have someone doing true F/A with some shared trauma call 1/5 in a town less than 100 or so.

 

[thefootfixer]

Yeah he does all trauma and then lower extremities elective. Trauma/shoulder guy does trauma and all upper extremity elective. Now that I am here he will transition to more joints and stuff. Still do some foot and ankle like TAR and some sports med stuff on young athletes but doesn't do flatfoot bunions etc. But again only Ortho in town.

But back to the topic of oversaturation yeah you wouldn't have someone doing true F/A with some shared trauma call 1/5 in a town less than 100 or so.

Associates : especially new ones (1-2 ) years: plan the next 5 years NOW. It’s not all rainbows and unicorns because you’re doing “surgery” or are proficient in “lapiplasty”. Make sure you know damn well what the owners plans are , whether it’s selling to you, offering partnership, or even selling to supergroup (supergroup may say ok we’ll keep the owner but everyone else is not needed). Yes there’s those that are lucky enough h to find true honest mentors . But the vast majority of pod owners (60 years +) are not like this. Know what you’re getting into BEFORE getting into it

 

[PMG03470]

Podiatry is very much oversaturated. This is the only subspecialty where providers are ok with settling in small towns and seeing fungal toenails and wound all day even though their training is much more advanced than that. I have not seen F/A ortho in a place with less than 150k. F/A ortho will only go to a place where they will be busy utilizing their skills.

Would you see neurosurgeon, critical care trama surgeon, GI, CT surgeon, IR or any other subspecialist in a place less than 250k? No. I have seen around 15 podiatrists in towns of less than 100k, most of them clip nails half a day. What a shame for a profession. That's insane. Podiatrists are the only subspecialsits that are ready to go anywhere and settle for less money and do way less than they were trained for due to one fact. That's oversaturation. There is not enough jobs. Period.

You are right from the over saturation standpoint but your statement about certain specialists not being in suburban/rural areas is just plain wrong. I am from NH, not a single city or town in NH has over 100k population and guess what… NH has every single type of physician you mentioned

 

[de Ribas]

You are right from the over saturation standpoint but your statement about certain specialists not being in suburban/rural areas is just plain wrong. I am from NH, not a single city or town in NH has over 100k population and guess what… NH has every single type of physician you mentioned

I guess it might be different in east or west coast. I mainly checked Midwest states and I have done my research when I look for potential jobs. I look at specialists available on staff at hospitals in cities towns of around 200k or less and very rarely I would see neurosurgeon, f/a ortho, CT surgeon, IR or fellowship trained General surgeon or GI. I guess it might be different in west or east coasts as well as in desirable places even if they are with low population like nearby ocean, beaches, mountains, lakes, skiing, hiking.

Even if there is one f/a ortho per 100k, there will probably be 5-10 podiatrists clipping nails. Mainly, my point was that podiatry is oversaturated contrary to what some people in leadership trying to say. If podiatrist settles in a town with 100k with other 10 podiatrists already there and most of his clientele is fungal, diabetic nails with wound care in between - that is not demand for podiatry. This job should be done by wound care nurses or something but not highly trained foot and ankle specialist with 3 years of residency or even additional fellowship training.

 

[podwho]

In my area all the podiatrists just wait till hiring season … March-June and lowball everyone at the same time. I mean what choice do they have when 40 new grads looking to be in the same state at the same time. Every..single..year.

Next few months you’ll see people come on here and complain about their offers and truth is … medicine is a business and you’re not owed anything, certainly not a good salary. The faster new grads realize this the sooner they will start telling these old pods, who are are exclusively the ones abusing their own, to screw off and move or open up shop.

On that note I have found lots of people open to hiring but most simply needed part time coverage because there’s so much competition there’s no guarantee they will reach full time status for a whole year but it allows the owners lots of quality of life benefits.

On a side note there are plenty of owners clearing 300k every year no issue. 500k is not unheard of in well established places. Those people typically don’t post because… well fk everyone else, they are happy.

 

[underwood]

In my area all the podiatrists just wait till hiring season … March-June and lowball everyone at the same time. I mean what choice do they have when 40 new grads looking to be in the same state at the same time. Every..single..year.

Next few months you’ll see people come on here and complain about their offers and truth is … medicine is a business and you’re not owed anything, certainly not a good salary. The faster new grads realize this the sooner they will start telling these old pods, who are are exclusively the ones abusing their own, to screw off and move or open up shop.

On that note I have found lots of people open to hiring but most simply needed part time coverage because there’s so much competition there’s no guarantee they will reach full time status for a whole year but it allows the owners lots of quality of life benefits.

On a side note there are plenty of owners clearing 300k every year no issue. 500k is not unheard of in well established places. Those people typically don’t post because… well fk everyone else, they are happy.

Sounds like a big city…. With a lot of residency programs.

 

[Feli]

I’d tell them they’re getting a Civic instead of a Ferrari, but it’s still a car. If you don’t have any other options, drive what you have to.

As air bud and icebreaker said, sounds like you guys are oversaturated. It’s supply and demand...

Yes, again.... 100% spot on. It could be worse. ^^

Supply and demand means different things to different professions:
Ophtho, derm, ortho, etc get good job offers (sign/relocate $, partner path, benefits, etc... mainly good/great job offers).
Podiatry, dent, FP, etc gets ok job offers (less benefits, rare defined path to partner... many screwy jobs w poor benefits or pay).
Chiro, therapy, etc get almost NO job offers posted; a majority are forced into startup solo. Colleagues rarely have enough work to hire them.

It is supply and demand... through and through.
It's a Ferrari vs Civic vs assemble-your-own-Huffy-bike.

It's interesting to see the professions that recognize the saturations and take measures to avoid or correct them... and those which do not seem to care. The podiatry training is getting to higher and higher levels, but the saturation and new schools will cripple the careers and finances and surgical volume of many podiatrists. I was talking to a metro PP owner last week, and I mentioned the idea of having a PA to see post-ops and routine care. He laughed and said, "in podiatry, you'd be crazy to not just hire associates for that." It hurts the "have nots" with lesser training or qualifications the most, but it still hurts every DPM - even elite training or owners. We are judged by our lowest common denominators. I still like the work very much and am grateful for my skills, but it is sad to see the abuses which go on which simply would not happen if a more logical grads : jobs/need ratio had been cultivated.

 

[air bud]

I guess it might be different in east or west coast. I mainly checked Midwest states and I have done my research when I look for potential jobs. I look at specialists available on staff at hospitals in cities towns of around 200k or less and very rarely I would see neurosurgeon, f/a ortho, CT surgeon, IR or fellowship trained General surgeon or GI. I guess it might be different in west or east coasts as well as in desirable places even if they are with low population like nearby ocean, beaches, mountains, lakes, skiing, hiking.

Even if there is one f/a ortho per 100k, there will probably be 5-10 podiatrists clipping nails. Mainly, my point was that podiatry is oversaturated contrary to what some people in leadership trying to say. If podiatrist settles in a town with 100k with other 10 podiatrists already there and most of his clientele is fungal, diabetic nails with wound care in between - that is not demand for podiatry. This job should be done by wound care nurses or something but not highly trained foot and ankle specialist with 3 years of residency or even additional fellowship training.

Big difference of 100k in NH vs Nebraska. You have 100k then corn for 100 miles vs 50k, a few miles some maple syrup then another 50k etc. The previous county I worked in, COUNTY was bigger than the state of NH.

Edit: sorry, NH wins by a hair....9346 to 9266 square miles.

 

[619]

Podiatry - Foot & Ankle Opportunity​

Caldwell, Idaho​

Sign-On Bonus
Relocation Assistance
Loan Repayment
Full Time
Saint Alphonsus Medical Group (SAMG) – a physician led multispecialty group – is seeking a Residency trained and experienced Podiatrist to join a busy surgical practice located in Caldwell, Idaho.
This opportunity requires a proactive approach to practice development for the population of Idaho and its neighboring states. Additional emphasis of this practice is to advance the knowledge of foot and ankle orthopedics through research and education. This growing practice provides a full range of orthopedic services focusing on the foot and ankle. From the management of arthritis, tendinitis, and ingrown toenails to surgical management of fractures and deformities, the focus is always on the patient. This opportunity may also support the Wound Care program in Nampa. Requires Idaho and Oregon medical licensure to support the health system's regional surgical needs and programs across all of the communities served.
Support includes 24/7 CRNA Anesthesia; general surgery, orthopedics, ENT, gynecology, urology, and endoscopy; Hospital-based imaging services: 24/7 radiology department; in-house coverage for general radiology and CT; after hours call coverage for Ultrasound and Nuclear Medicine (NM); MRI; Breast Care Center; X-ray (CR and DR image capture); ED; Saint Alphonsus network of 70+ Specialty and Primary Care clinics.
The schedule for this full-time opportunity is a typical clinic schedule, Monday – Friday, with a minimum of 34 patient contact hours per week, plus procedures, rounding, and consults. The practice shares group call.
Requirements for this opportunity include:

• Doctor of Podiatric Medicine (DPM)
• Successful completion of an accredited Podiatry residency program
• Board certification through the American Board of Podiatric Surgery – or obtain within three years
• Obtain Idaho & Oregon medical licensure and granting of privileges at Saint Alphonsus Medical Center – Nampa; and other health system affiliated hospitals as needed
• Valid controlled substance registration with Board of Pharmacy and DEA

This is an exciting opportunity for the right Podiatrist to join a growing team and be part of Saint Alphonsus Medical Group.
RECRUITMENT PACKAGE
An excellent compensation and benefits package is available for the right candidate including:

• Sign-on Incentives
• Student Loan Repayment
• Relocation
• PTO & CME Allocation
• Malpractice Insurance (Incl. Tail)
• Health/Dental/Vision
• Retirement (403b)

ABOUT THE FACILITY
Saint Alphonsus Health System is a growing four-hospital, 714-bed, 74 clinic integrated healthcare system serving southwestern Idaho, eastern Oregon, and northern Nevada. It is also the region’s only ACS verified Level II Trauma Center. Along with Saint Alphonsus Medical Group’s 500+ providers at many clinic locations, we serve the full range of the health and wellness needs of our communities. Saint Alphonsus is a member of Trinity Health, the second largest Catholic health care system in the nation.

Contact Information

If you are interested in this opportunity and would like to submit your CV, please email [email protected] or call Trinity Health Physician Recruitment at (734) 343-2300 .

 

[deleted1138023]

^ ok that’s cool but what’s the pay

 

[pod squad]

I mentioned the idea of having a PA to see post-ops and routine care. He laughed and said, "in podiatry, you'd be crazy to not just hire associates for that."

Interesting...I've often wondered about this. On the one hand, there's a fresh supply of new pod grads every year that would probably take a low paying associate job. But if you didn't want to be a typical PP owner that churns through associates every 1-3 years, wouldn't it make sense to hire a PA at 100-120k? I assume most of them don't have the expectation to make much more than that (unlike the lies that pod school tells us)

 

[Pronation]

Interesting...I've often wondered about this. On the one hand, there's a fresh supply of new pod grads every year that would probably take a low paying associate job. But if you didn't want to be a typical PP owner that churns through associates every 1-3 years, wouldn't it make sense to hire a PA at 100-120k? I assume most of them don't have the expectation to make much more than that (unlike the lies that pod school tells us)

PA profession isn’t saturated. Good luck finding a PA wanting to do crap, especially if it’s not in a desirable area.

 

[icebreaker32]

Podiatry - Foot & Ankle Opportunity​

Caldwell, Idaho​

Sign-On Bonus
Relocation Assistance
Loan Repayment
Full Time
Saint Alphonsus Medical Group (SAMG) – a physician led multispecialty group – is seeking a Residency trained and experienced Podiatrist to join a busy surgical practice located in Caldwell, Idaho.

• Board certification through the American Board of Podiatric Surgery – or obtain within three years

As for those who wonder why you should get ABFAS………if you want an organizational jobs that is a reason. They need someway to pick a few to interview from the stacks of CVs they get. If anyone does not know ABPS is now ABFAS……..sometimes you still see ABPS listed as required on a job listing. Organizations have a hard time keeping up with our profession‘s constant changes.

We can argue amongst ourselves and will continue to do so, but the reality is that we are a saturated profession. The ones hiring for good jobs can ask for whatever they want and get it as long as we remain saturated.

Has one job like this EVER failed to recruit a podiatrist? I think we all know the answer.

 

[dtrack22]

PA profession isn’t saturated. Good luck finding a PA wanting to do crap, especially if it’s not in a desirable area.

I’m sure there are plenty of PAs who would prefer a 9-5 type schedule buuuut they can make $100-150/hour doing ED/Inpatient work. Ortho and Derm will pay more than any podiatry practice is going to as well. Employed as a family medicine provider in a hospital group would also likely pay more than a DPM practice will pay.

Oh, and depending on your state you might not even be allowed to supervise the PA as a Podiatrist.

Seems like something the APMA should have made progress on over the last 10-15 years…NPs and PAs have gone from requiring supervision to performing diagnostic endoscopies and colonoscopies without supervision during that time…

 

[pod squad]

I’m sure there are plenty of PAs who would prefer a 9-5 type schedule buuuut they can make $100-150/hour doing ED/Inpatient work. Ortho and Derm will pay more than any podiatry practice is going to as well. Employed as a family medicine provider in a hospital group would also likely pay more than a DPM practice will pay.

Oh, and depending on your state you might not even be allowed to supervise the PA as a Podiatrist.

Seems like something the APMA should have made progress on over the last 10-15 years…NPs and PAs have gone from requiring supervision to performing diagnostic endoscopies and colonoscopies without supervision during that time…

Side note: I've seen more and more hospitals/healthcare systems hiring for 'Podiatry PA/NP' as opposed to DPMs...this should be extremely alarming to our profession...

 

[PTPuser]

Side note: I've seen more and more hospitals/healthcare systems hiring for 'Podiatry PA/NP' as opposed to DPMs...this should be extremely alarming to our profession...

We have the podiatry NP at the local VA here...it's toxic AF.

 

[pod squad]

We have the podiatry NP at the local VA here...it's toxic AF.

I'm sure, care to elaborate on the 'toxicity'? It'll be a sad scene in 5 years (probably less) when DPM grads are competing with PA/NP/RNs for a 100k job offer

 

[PatchAdamsFan]

I'm sure, care to elaborate on the 'toxicity'? It'll be a sad scene in 5 years (probably less) when DPM grads are competing with PA/NP/RNs for a 100k job offer

Currently DPM associates fight for 70-100k offers and PA/NPs have no reason accepting a low 100k offer anymore. Not really a competition, and not the far-in-the-future dystopia.

 

[de Ribas]

Side note: I've seen more and more hospitals/healthcare systems hiring for 'Podiatry PA/NP' as opposed to DPMs...this should be extremely alarming to our profession...

It should be alarming. Most pods do minimal to no surgery. Meaning that anything pod does PA/NP can do. But PA/NP can also cover urgent care, call, etc. for the same money or less.

Smart move by hospitals. PA/NPs can do a lot of things and more than podiatry with no limit to foot and ankle making them more versalltile for the hospitals. Whatever they can't do, surgical cases can be done by Gen surg or ortho. Basically there is no need for pod. In hospitals and ortho groups PAs see non-surgical visits (casts, injections, splints, non-op fractures, sprains, etc) and post-op. Basically ortho patient list is mostly surgical consults. That's another reason why they make more money. They don't have to fill half of their clinic with post-ops.

If more PA/NPs come into foot and ankle market it would get darker for podiatry. With more and more urgent care popping up here and there PA/NPs are seeing many non-op f/a pts. Diabetic ulcers and nails don't really go there. They go straight to their beloved podiatrist. Podiatry is oversaturdated. There is no need in 600 pod graduates every year. That's obvious.

We need to reduce pods to no more than 400 per year. Then salaries will go up, more job options will be there.

 

[dtrack22]

Side note: I've seen more and more hospitals/healthcare systems hiring for 'Podiatry PA/NP' as opposed to DPMs...this should be extremely alarming to our profession...

It makes sense though. Think of all the low acuity stuff we see daily that can be treated by someone with no education at a strip mall foot spa, let alone a PA or NP. That’s really the point of midlevels, free you up to dx and treat actual complex problems that take significant education/brain power/technical skill.

The best thing that could happen to our profession (from a long term benefit standpoint) would be to eliminate nail and callus codes from being reimbursable. We would quickly find out how many people with a doctorate level education in feet are needed in this country. There would be so much short term pain for an unfortunately large % of our profession, but everyone else would flourish and make more $ in the long run.

 

[DYK343]

It makes sense though. Think of all the low acuity stuff we see daily that can be treated by someone with no education at a strip mall foot spa, let alone a PA or NP. That’s really the point of midlevels, free you up to dx and treat actual complex problems that take significant education/brain power/technical skill.

From what I've heard the reason some states dont alllow PAs to work under DPMs is podiatrists trying to "protect" the field from mid levels.

At least thats what Ive been told by the state APMA higer ups of one of the states I used to practice in.

Long ago mustasche Pods lobbied against hiring PAs under DPMs and won. At least in that state.

 

[podoloco]

I The best thing that could happen to our profession (from a long term benefit standpoint) would be to eliminate nail and callus codes from being reimbursable. We would quickly find out how many people with a doctorate level education in feet are needed in this country. There would be so much short term pain for an unfortunately large % of our profession, but everyone else would flourish and make more $ in the long run.

This has already started to happen, and it is spreading, thanks to the Advantage plans. In my state, there is a group of RNs doing home foot care. When I looked into how they could possibly be providing this service, the answer was simply because they do cash pay, it is okay for RNs to cut nails and trim calluses, but if you want to bill insurance, then a DPM is required. Not that it was medically necessary. DM shoes will be going that way also before too long. All the DME suppliers here are getting out of it. Take away nails and shoes, what's left for some practices? All these C&C practices are in for a world of trouble if they don't start expanding their patient base, sooner than later.

 

[DYK343]

This has already started to happen, and it is spreading, thanks to the Advantage plans. In my state, there is a group of RNs doing home foot care. When I looked into how they could possibly be providing this service, the answer was simply because they do cash pay, it is okay for RNs to cut nails and trim calluses, but if you want to bill insurance, then a DPM is required. Not that it was medically necessary. DM shoes will be going that way also before too long. All the DME suppliers here are getting out of it. Take away nails and shoes, what's left for some practices? All these C&C practices are in for a world of trouble if they don't start expanding their patient base, sooner than later.

I dont think C&C will ever truely go away. It is a needed service. Its just soul sucking work

DM shoes are a nightmare. I refuse consults for patients that want shoes. They are told, on phone when they call, that they need to get them from their PCP. Im not playing medicare games.

 

[pod squad]

This has already started to happen, and it is spreading, thanks to the Advantage plans. In my state, there is a group of RNs doing home foot care. When I looked into how they could possibly be providing this service, the answer was simply because they do cash pay, it is okay for RNs to cut nails and trim calluses, but if you want to bill insurance, then a DPM is required. Not that it was medically necessary. DM shoes will be going that way also before too long. All the DME suppliers here are getting out of it. Take away nails and shoes, what's left for some practices? All these C&C practices are in for a world of trouble if they don't start expanding their patient base, sooner than later.

Also just saw a job posting for "High Risk Foot Care RN" at Kaiser....

 

[PMG03470]

I dont think C&C will ever truely go away. It is a needed service. Its just soul sucking work

DM shoes are a nightmare. I refuse consults for patients that want shoes. They are told, on phone when they call, that they need to get them from their PCP. Im not playing medicare games.

We still see them and bill a 99203 then refer them to a DME supplier for the shoes. That way we still get $$ but don’t have to deal with the headache of actually getting the PCP to sign off and dispensing the shoes Then I bring them back every 3 months for a DFE that takes about 5 minutes and bill 99213

 

[Pronation]

Then I bring them back every 3 months for a DFE that takes about 5 minutes and bill 99213

Insurance is gonna claw that back some day…

 

[dtrack22]

Then I bring them back every 3 months for a DFE that takes about 5 minutes and bill 99213

Yeah you might want to start telling people those visits take 20 min of your time…they aren’t level 3’s otherwise…

 

[PMG03470]

Yeah you might want to start telling people those visits take 20 min of your time…they aren’t level 3’s otherwise…

You can bill based on time spent, or based on treatment and diagnoses. It does not have to meet both. This is how my boss taught me to bill, if money gets taken back it’s taken back from him not me so I do what he says and make sure my documentation is bullet proof.

 

[staffdoc]

You made an assumption that you will earn $120k doing mobile/nurs work. I have done mobile/nursing home work and I can tell you from first hand experience that very unlikely you will make $120k regardless of the false advertisement you see on job postings. Nails pays like $20 lol. Calculate how many nails you will trim (to make $120k) and remember you get about 40% of the collections assuming you work for one of those organizations. At best you get beer money from nursing home work.


Making $120k , after paying the 2 ends of social taxes and rest of taxes, then gas and car maintenance etc, you will not be maxing out any retirement account let alone save money to "open you own gig". We are talking about $120k in 2023 dollars not $120k in 1923.


This is 100% correct.

Not sure why you have such a negative attitude towards podiatry. We have a 4 doctor practice with no one making less than $180k per year. Sure we trim nails for at risk patients but we provide wound care and are the specialty that is called for foot issues from the ED not PA or NP. We all do surgery and receive referrals from all specialties because they respect our ability. I know of NO general surgeons doing foot surgery as was suggested . We have podiatry residents that work with us and all have had excellent practice positions on graduation. Every specialty has minor procedures that they perform in office settings which may be less than exciting but that’s part of the job. Podiatry is a great profession and respected by the physicians in our community. Don’t hesitate to look into our schools for your future profession .

 

[HardRoadPaved]

Also just saw a job posting for "High Risk Foot Care RN" at Kaiser....

High Risk Foot Care RN at Kaiser Permanente

Learn more about and apply for the High Risk Foot Care RN job at Kaiser Permanente here.

www.kaiserpermanentejobs.org

$51/hr is $102k + benefits... better than most PP... just sad

 

[Pronation]

Not sure why you have such a negative attitude towards podiatry. We have a 4 doctor practice with no one making less than $180k per year. Sure we trim nails for at risk patients but we provide wound care and are the specialty that is called for foot issues from the ED not PA or NP. We all do surgery and receive referrals from all specialties because they respect our ability. I know of NO general surgeons doing foot surgery as was suggested . We have podiatry residents that work with us and all have had excellent practice positions on graduation. Every specialty has minor procedures that they perform in office settings which may be less than exciting but that’s part of the job. Podiatry is a great profession and respected by the physicians in our community. Don’t hesitate to look into our schools for your future profession .

Because anyone can take a look at pod jobs offered online right now and most of them are around 100k.

What is the pay structure for your associate making 180k? How many patients a day are they seeing to make that 180k?

You are getting calls from the ED for now… just wait until the hospital hires an NP to start doing limb salvage.

Of course you aren’t seeing general surgeons doing foot pus cases, they don’t want to do them.

 

[PatchAdamsFan]

You can bill based on time spent, or based on treatment and diagnoses. It does not have to meet both. This is how my boss taught me to bill, if money gets taken back it’s taken back from him not me so I do what he says and make sure my documentation is bullet proof.

Not job thread related, but - I don't know your situation but I would strongly recommend learning the CMS documents for RFC/wounds and not listening to the boss. More often than not PP associates are unknowingly learning fraudulent billing practices from their boss (myself included my first year out). They will absolutely throw you under the audit bus to save themselves.

 

[josebiwasabi]

if you get audited based off of time and you are claiming you spent 20 minutes per RFC patient to try and bill a 99213 E&M your schedule better not be booked for 15 minute encounters