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Pod groups? You cool with making 100k after 7 years of post bac training?
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Pod groups? You cool with making 100k after 7 years of post bac training?
Lots of bad contracts out there but how’s a resident gonna really know unless they find out? I mean some of us could be internet trolls from another country
This.
Better start in mid 2nd year looking/sending apps. For MSG/hospital straight out of residency you will get 90% rejection, 8% interested, 2% offer (my experience).
Also my experience applying hospital with 5 years experience with ABFAS foot/RRA 40% interest/offer.
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D
deleted285117
You must look like a stud on paper. When I was a few years out, RRA cert, and applying MSG/hospital I estimate I got about 33.33_% interest but maybe about 10% offer. Maybe it’s because I breathe heavily through my mouth on the phone. Or maybe there’s a touch of saturation in this field.
You might be answering the questions wrong on the hospital employment quiz.
You subcutaneously debride a wound in clinic after signing out a #15 blade from the locked cabinet and performing a full signed consent with witnesses. After the procedure you realize the patient would benefit from the small application of a topical antibiotic.
Do you
(a) get the topical antibiotic out of an unlocked drawer in the room
(b) ask your MA to get a packet for you from the locked cabinet when they get back from their lunch break
(c) go down to the pharmacy yourself with a signed prescription in hand to get the antibiotic
(d) whatever is the most inconvenient for me the doctor
Thinking D for big energy
This is my life in a nutshell. The answer is “d”. ID and derm actually outlawed antibiotic ointment in clinics. So petroleum jelly only….
E) walk out of the room, tell one of the army of wound nurses what the patient needs, go into next room, rinse and repeat and continue the RVU gravy train
toetransplant
Full Member
Lololol. When you go to get a consent for a slant back/injection/nail avulsion and the hosp medical assistant is too busy to witness the consent. I just call the clinic admin and make them witness. After 5x of that in 1 days admin decided to hire another MA. Still same issues, but we get yelled at because turnover time is delayed. Hospitals are the worst, because 80% of these people are useless. We can’t even get our MAs to clean exam rooms or retrieve crutches/cam boot/surgical shoes, even make sure the rooms are stocked. It’s ok if the residents or Attendings to spend an extra 4-5 hours, miss lunch. Crazy lol.
Do you want to be commended for not billing for a patient you never saw? That would be equal to commending you for not committing fraud.
I always wonder where the rule came from that the doctor cannot witness his own consent for office procedure.
However for OR consent, the doctor must sign the consent form.
Congrats on finding two very good job offers coming out of residency! I personally would go with the hospital position--I do think it would make you a better candidate for future hospital jobs, yes. It's also RVU based, so you don't have to worry about insurance, running a business, marketing for your life, any of that extra stuff. You just do what you were trained to do, and make decent money doing it. Plus the Student Loan assistance makes it a no brainer in my opinion.
On the flip side, if all of that extra stuff is appealing to you, go for the MSG job. Even though that sounds horrible in comparison to me, I really don't think you would be dead wrong either way with those two opportunities. I have no idea what the partnership thing would entail--sounds like you wouldn't be profit sharing with the rest of them?? It would only be eat what you kill in podiatry I guess.
Yes congratulations!!
Unless location is better for you I would go with hospital job.
Getting numbers and having mentors is definitely a positive the first few years.
It will be easier in the future to switch job settings if you grow tired of the call/hours with the hospital job. Job stability sounds better also. Loan repayment assistance is a positive.
In the MSG you are their experiment. What if it does not work out or you do not get numbers for boards.? What if you bust your ?!@& and they never follow through with partnership? Possibly, higher income ceiling. I would say possibly better hours, but if you are doing a day of wound care with no other podiatrists in group I am not sure about that.
What's the rationale for axing abx ointment?
Probably costs a brand new solo podiatrist less than 200k to start up. You do have to study the documentation and billing guidelines and LCDs for 2 weeks like as if you’re studying for boards but it’s doable. If you work hard and you get a ton of referrals, learn how to bill and willing to take call, you can easily do 700k+ collections in your first year
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ID: if you think it is infected use oral abx. Development of resistance.
Derm: high level of sensitivity reactions apparently.
Limited literature supporting use for wounds without infection.
What's the tax benefit for the practice for having an associate as 1099 vs W2?Or fraudulent if not done right.
You are w2 if the place you works at manages your patient schedule and you just show up to work. I'm not sure why everyone thinks they're 1099 so easily. This should be discussed with attorney or tax professional.
W-2 vs. Self-Employed | White Coat Investor
Is it better to take a job as an employee or as an independent contractor? The short answer is "it depends." The best answer may be "both."www.whitecoatinvestor.com
If you are "self employed" you pay a 12.4% social security tax + 2.9% for Medicare. If you were employed the practice the businesss would have paid 1/2 of that.
Worth a look.
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deleted1138023
Congratulations! Could you please share your experience about how to get these job offers ? Please 🙂
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deleted285117
Cold calling places.
I recently had a hospital interview... was set up after I emailed the CEO inquiring on adding podiatry services.
You will find many hospitals without/lacking podiatry will at least look into your request.
Network. Network. Network. Work hard. You get as much as what you’re willing to put in, sometimes.
Heard from a colleague a few weeks ago Kaiser NorCal had quite a few openings for full scope pods. Can’t hurt to apply but they are very selective (tend to prefer their own grads) but do consider strong grads from good programs too.
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Would love some advice about a job offer.
Private small/medium sized ortho group.
No real “starting salary”. I can set my income at what I want and it’s treated as a “loan” with no interest. The difference is paid back as I collect more than my salary + cost.
Income is 45% of gross collections with no cap, no tiered structure. Practice typically collects 40-45% of what’s billed.
Can become partner once collections exceed overhead. No buy in. Profit sharing would include MRI and 2 PT clinics.
Surgery center just opened in December. Ability to buy in, $21k per 1%. still waiting to hear how many shares I can buy and for proforma.
Bennies include medical, dental and vision, malpractice, all licensing, marketing material, website, credentialing, 3% match on 401k.
I would basically be building practice from the ground up. They will help me market and whatnot, but obviously a lot of that will be on me. Kinda scary trying to figure out what I would set my income level at, and a reasonable expectation for what my production/collections can be so that I won’t stack up a big “loan”.
All input is appreciated!
Private small/medium sized ortho group.
No real “starting salary”. I can set my income at what I want and it’s treated as a “loan” with no interest. The difference is paid back as I collect more than my salary + cost.
Income is 45% of gross collections with no cap, no tiered structure. Practice typically collects 40-45% of what’s billed.
Can become partner once collections exceed overhead. No buy in. Profit sharing would include MRI and 2 PT clinics.
Surgery center just opened in December. Ability to buy in, $21k per 1%. still waiting to hear how many shares I can buy and for proforma.
Bennies include medical, dental and vision, malpractice, all licensing, marketing material, website, credentialing, 3% match on 401k.
I would basically be building practice from the ground up. They will help me market and whatnot, but obviously a lot of that will be on me. Kinda scary trying to figure out what I would set my income level at, and a reasonable expectation for what my production/collections can be so that I won’t stack up a big “loan”.
All input is appreciated!
I would want to know what their per provider monthly overhead is. Or your individual projected monthly overhead, depending on how they divvy it all up.
In general, Ortho will run much higher overhead than a podiatry practice. They generally have larger spaces (higher rent), more staff (higher labor costs which is your largest expense), more expensive equipment/capital projects (their X-ray units cost a lot more than ours and many have PT services in house which means more equipment). Couple that with the fact that they are all getting reimbursed more money than you for the sole reason that bigger joints pay more than foot/ankle (ie You can spend an hour scoping an ankle and they can spend an hour scoping a knee and they can make nearly 2x the $ you did). And it means that they can collect $80-100k per month and not have any issue with $25-30k in overhead. Well when you are getting a reasonably busy schedule you may still only collect $40-50k and all of a sudden you’re looking at paychecks that aren’t as great as you thought they would be. And the Ortho partners don’t understand why it’s taking you so long to generate money like they do to cover your costs. After a few years you all agree it isn’t really working and you’re on to the next gig.
Don’t get me wrong. What you have is a great job that you should probably definitely take. And I had an attending in a situation just like you describe who collected $70-80k every month, covered his overhead easy, ortho partners were happy, fantastic situation for everyone involved. I’m maybe just trying to highlight a very real scenario that I’ve seen play out a few times, and that I don’t think I’ve seen mentioned around here before.
Completely understand all of this. And I’m waiting to hear back on what each provider’s overhead is currently.
They did tell me that there is no set timeline to me trying to attain collections to cover overhead, and no requirement to even become a partner and share in overhead if my collections don’t reach that number.
Basically, they said if I’m happy there I can indefinitely stay on the 45% of gross collections unless I make enough and choose otherwise. At least nice to know there isn’t pressure in that aspect.
This could be a good situ... 40-45% collections is pretty standard for MSG/ortho.
One thing to evaluate seriously is how good you are at coding from residency or past jobs. You'd be on an island here with little ICD/CPT help if there are no other DPMs. Even little things like coming up with protocols for common things and f/u visit timespans matter to throttle your schedule up/down. That stuff can slow you down a lot and you can miss a lot of $ that way early on, esp if you do full spectrum cares and surgery (anybody can learn just C&C and inject codes). The billers for ortho/MSG can't usually help too much if they haven't seen your specialty and family of codes before.
The "loan" from the office will add up fairly quick with staffing, your salary, many benefits, etc. They didn't hire you to lose money. The ancillary services are a pipe dream in the beginning... consider whether you can work with the docs/team and how they support and treat you first and foremost. You can beat the 'loan' down if you get even reasonably busy, but you definitely want to hit the ground running.
What dtrack mentioned is a real possibility with larger groups or hospitals (gross/net collections or RVUs not meeting expectations, for various reasons). If you are doing a job like this right out of residency, you might highly consider going to AACPM or ACFAS Coding or etc meetings or taking in a good amount of articles/vids. It's a lot easier to excel in these 'new startup' roles if you already know all of the podiatry tips and tricks on coding, mainly office but also OR stuff. 👍
Lots of great input here. I am currently doing a fellowship with attendings who are production based, so I’ve been trying to soak in all of the coding tricks I can thus far throughout the year. That being said, I definitely have more to learn as there’s still things behind the scene that I don’t see.
I would certainly set my starting income as low as reasonably possible while still making a living, just to keep the “loan” cost down until I start producing and getting busier. I have turned down other offers with good starting salaries, so this is definitely scary to me but feels like the ceiling is higher in this situation. It’s also a good location for my family, and they will give me full autonomy to do basically whatever I want practice wise, and use my training to full potential
Your second sentence sent chills down my spine. I would highly recommend that you never listen to attendings offer coding TRICKS, as quoted from your post.
There are no coding “tricks” I assure you. There is correct coding and incorrect coding, but no “tricks”.
Many providers get away with coding tricks or coding/ billing fraud. The insurance companies can’t possibly review every case. But when they review a case with tricks or fraud they will often do a retrospective review of past cases. And that’s when you call your attorney and change your underwear.
Getting paid for procedures you coded with tricks doesn’t mean it was billed correctly. It simply means you weren’t caught…..yet.
Ok but let’s say I wanted to do a lot of surgery on a toe. What’s the most amount of codes you can think of that I can submit at one time for a toe? I’m thinking like 2-3 codes if ABPM cert but easily 6+ codes if ABFAS cert.
One code-28285 if you want to stay out of jail.
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Just wondering how often does this happen? I mean getting caught for fraudulent surgical billing and having to pay or go to jail, rather than the act of committing fraud. I hear about a podiatrist getting charged for fraud maybe 2-3 times a year, but it always seems to be fungus baths or toenails issues rather than surgery. I assume I'm just not hearing about it.
Going to jail is just my “scared straight” comment. Few go to jail, but I know of quite a few. It depends on the level of fraud. The chances are much greater if it’s a government plan like Medicare, Tricare, etc.
They don’t play games and they are very patient. They will build an airtight case even if it takes years. When they pounce it’s usually game over. And they will seek money and jail time.
Podiatrist
Timonium, Maryland
Loan RepaymentMalpractice Insurance
Full Time
BE or BC
The Mid-Atlantic Permanente Medical Group, PC (MAPMG) of Kaiser Permanente is seeking a full-timePodiatrist to join our team in Baltimore, Maryland. This opportunity will be based out of the Kaiser Permanente Lutherville-Timonium Medical Center. Experience challenging cases, immediate access to primary care and specialist physician consults and freedom from prior authorizations and RVU's.
Now offering a $50,000 forgivable loan!
Candidate must be board eligible/certified and have or can obtain active Virginia, DC and Maryland Medical Licenses. The ideal candidate will haveextensive experience, residency and/or fellowship training in charcot reconstruction with training in external fixation techniques, complex diabetic foot/wound reconstruction, and reconstructive rearfoot and ankle surgery.He/she should have the expectation of becoming board certified in rearfoot surgery and forefoot surgery within an appropriate timeframe (if not already certified in both).Work visa sponsorship is available for eligible applicants.
MAPMG is a physician-owned and managed multi-specialty group with 1700 physicians serving over 800,000 patients at 33 + medical centers located throughout the Baltimore and Washington, DC metro areas. MAPMG offers a satisfying practice without the hassles of running an office and freedom from insurance billing. We have an integrated EMR system, which includes PACS (with remote access) and an excellent team approach to providing care.
We offer a competitive salary (based on MGMA data), exceptional benefits, paid occurrence malpractice insurance, and the opportunity to attain shareholder status in two years. 100% paid health and dental insurance premiums for themselves and their eligible dependents, as well as 4 weeks of vacation and 9 paid holidays. Multiple retirement options are offered, including a 401k (5% salary contribution) and vested pension plan after 5 years of service.
Living and working in the Mid-Atlantic Region offers you all of the convenience of two major metropolitan areas with easy access to the Chesapeake Bay, Shenandoah Mountains, and Atlantic Ocean. The region is great for families: the local public schools are considered among the finest in the country. Best of all, you are just minutes away from the cultural, historical, and entertainment venues of our nation's capital.
Medicare got some guy a few years ago for doing flexor/extensor tenotomies over and over again on the same patients claiming it had to be redone for the procedure to work. My suspicion is that if you are fraudulently billing surgery you are doing it in your office ie. "MIS exostectomies" and tenotomies and what not. Its not that unbundling doesn't exist anymore - I just strongly suspect the computers block a lot of it. I also wonder does Medicare look at the doctor's CPT codes verse what the facilities billed. If the facility submits Austin and you submit 16 things - it feels like that's pretty telling.
Ok but let’s also say that 1) I am a fellowship trained foot and ankle surgeon and I need to do a rotational skin flap to cover up the painful callus that formed on top of the PIPJ 2) I’m wearing 6.0x loupes telescopes because I do microvascular surgery and 3) I can pick up a bar of soap with my toes
I don’t know if you bend over when you pick up the soap with your toes, but if you do, billing will be the least of your concerns.
Depends if you trust some company's $15/hr worker guessing they know anything related to the foot let alone coding. Then dealing with the patients when they are mad that the billing is wrong bc they saw some TikTok video to ask for an "itemized bill"
I'll keep my 4-8% and just learn coding. It's really pretty basic. If youre making it complex then you're doing something wrong (or fraudulent)
I learned it on my own. YouTube videos on basics of E&M coding and modifiers, and I’m sure many members on here have cheat sheets on commonly used CPT codes they can share. Wound care limb salvage coding can get tricky but don’t try to get creative.
Yeah, it highly pays to know coding... even if you send it out to billing service/CPCs or if you work for a hospital/MSG that will do the coding (poorly) to determine your rVU bonus. I always put the codes in my SOAP notes and op reports so there's no question... EMR like Epic or most will usually try to do it anyways - but often fails or picks unspecified ICDs.
The hardest part IMO is the bone/joint or injury stuff you don't do very often... you have to look those up to make sure they're the right ones when boarding cases. Office is just the same few things over and over. Wound care is basically same codes again and again. Some trauma or recon surgery, esp RRA, is CPTs (and ICDs) you might only use every year or two. Anyone can tell you the codes for a plantar fasciitis inject, but how about for a TA tendon repair or an extra-articular calc fx ORIF? It's important to learn how to find that stuff fast from books/web and max RVUs or $$$ for those cases that take a lot of time to plan and do.
The basics aren't hard, and we all know the terminology or CPT illustrations/descriptions far better than any CPC or other quick-trained person. It's fairly easy to get a good foothold on making a superbill and looking things up in books or a website like APMA CodingRC fairly quick. The modifiers and links and combos are what takes time to master, but it's doable.
It happens in all specialties... common things occur commonly, but there is no getting around the CPT book if you want to do it right.
As much as we hate associate jobs, doing an associate job - or residency clinic rotations - with skilled PP attendings (preferably surgical and good at teaching... mentor value) in the same office or regularly discussing billing is the best way to learn coding inside and out.
At the end of the day, in any practice setup, you ideally want the best of both worlds:
Solid coding on the front end by the doc...
AND good coder who can do the mods, touch things up or ask when the doc might have missed something. 😎
So you're like a first year associate... except you make half as much? 😛
Thank you. I see the location which I want to practice has a lot of MSG without podiatry. I will try to email/call them if they're interested in expanding their group. Thanks again!
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deleted285117
Go for it. What do you have to lose?
You should definitely cold call places. I have probably called 60 orthopedic groups in places that I was interested in living, which is also how I got my current offer.
The advice in this forum has been instrumental for me in my job search. Biggest one, never underestimate the laziness of others. Pick up the phone and call. Worst thing they can say is no, and chances are they won’t answer, but you’ll never know if you don’t try.
When you call ortho group, who do you ask to talk to initially?
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I typically ask to talk to their practice manager or office administrator. Usually a front desk person will ask who you are or why you’re calling and you just explain it to them. Most are pretty receptive to it and I’ve hardly had anyone be rude to me about it. I typically always ask their name and for the practice manager’s name as well.
If you do get to actually speak to them, always ask if there’s a direct email or number that you can follow up with them. They’re busy people and will forget about you, so the burden is on you to follow through.
^^This is real good advice... this is how I set up a few MSG jobs also, even in saturated metro. The best PP podiatry jobs with quality co-workers/owners and legit income/partner path are usually same (never/seldom advertised). It is pretty lame to do 7yrs post grad, now sometimes even more, and still have to create your own jobs, but that is how it is for most grads. It will get even rougher when UTRGV and LECOM are cranking out DPMs in a couple years also.
Hospitals gigs (esp rural and/or less saturated areas) can sometimes be done also. I have created a few of those almost without trying over the past few years... much easier if you're already working and doing surgery in the area. It can be done with cold calling or digging postings far and wide also.
The key thing to remember is that just because they want you (aka want profit from your services), that doesn't mean they'll understand the compensation, billing, overhead, equipment startup needs. The pod groups will know and will look to snip a good chunk off one way or another. The non-pod groups often won't really know any of that unless they've had DPMs before, they'll probably assume DPM collections will be up with ENT or optho or ortho or something and that overhead will be easily overcome (when it likely won't for pod). A few, esp hospitals, might not know and way overpay you (but that'll come to a head after a couple years, typically). It is easier to talk those costs, collections numbers, monthly and annual RVU, etc with them if you've been in practice and seen it already, but it can be done nonetheless. 👍
What do you consider overpaying? Generating 5000 RVUs per year at a hospital system is very easy, like minimal work easy. At $50/RVU (slightly below average comp), that easily supports a 250k salary.
Thanks everyone for great information. I know cold calling ortho/pod group is common way for looking a job. Is there anyone here tried to call non-podiatry MSG ? How could you convince them to expand their group for podiatry @@ ? Thank you so much!
Yeah, I think the hard thing is knowing the group payers are not always the average area payers (if it's a private hospital or MSG/ortho/pod group) and how much call or how busy call will be. I have absolutely made that mistake of drastically overestimating how good of payers one MSG had... knew the nearby economics and avg/pt from pod group work, got my MSG job... then my % pay, and it was as promised yet very crummy... since the payers for MSG were almost all low end when looking at reports.
For public (trauma/govt) hospitals, it obviously doesn't matter a ton... they get the dump trucks of fed money and do their thing. For private hospitals (where most DPM jobs can be created and worked out, where I've been approached in the lounge or hall "have you considered hospital employment"), 400rvu/mo at one place is not the same as same 00rvu at another for the hospital. Even though it could be negotiated to be same $/rvu for the doc at either, one might be real happy and one looking to prod more production out of the podiatrist real soon. It also matters how much ancillary income the doc will do... a guy doing much surgery (esp inpt) and MRIs and even 300rvu/mo is worth more to them than one doing 500rvu/mo but mostly all office few admits or surgery.
I think how much that DPM (or any doc) production + ancillary generation is worth to the facility/group is the tough part to hash out and negotiate well even if there is general doc-admin agreement on wanting to create the DPM hire. It is more straightforward for public/govt hospitals with govt money and downtown/govt populations to just do MGMA or near that, but private hospitals and groups can be all over the board, depending on how they're run, if they've had DPMs prior, and what ancillary services they can do. That is a rough spot for a lot of new grads - obviously easier for docs with some exp and bill/collect knowledge.
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