Forum Members Official: Job Offer Thread

[Scrantonicity]

I am currently hiring, please let me know if this offer is fair.
100k first year - then starting 2nd year 31% of total collections increasing 1% per year until 37%
401k, malpractice, health ins and cme included
location - Central Florida

37% of total collections is pretty good for PP associate--I think that part is fine after the associate has been working long enough to have a healthy patient base and consistently brings in money. The tough part is enticing a well trained podiatrist with student loans and (very likely) a family to raise. $100K is just not much these days, especially after taxes. It sounds exciting after making 40K as a resident, but man it just doesn't cut it.

Gotta take the hit the first couple of years and invest in the associate to make him stay...otherwise he'll leave after the first year when he figures out how little 100K is. I don't know what the exact number should be, but I would think at LEAST 140K (as was recommended above) to start (plus all those benefits). There are better offers out there, so you may not get the BEST candidate--but at least it wouldn't be an insult.

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[podiatryrookie]

Got a job offer today which I think is pretty bad. I wanted your opinion.
120 k base with 30% after 500k in revenue. However they have offices throughout my entire county and the next and their non compete is 2 years which means I’d I leave I won’t be able to work in my area.

 

[Feli]

Got a job offer today which I think is pretty bad. I wanted your opinion.
120 k base with 30% after 500k in revenue. However they have offices throughout my entire county and the next and their non compete is 2 years which means I’d I leave I won’t be able to work in my area.

This is real bad on many levels. You are correct. ^

$120k base is low-to-fair depending on COL in area... but that is honestly the only decent part of the deal. I don't ever care much about base since % amount and when it starts is what will matter if you're productive, but I understand you need a basic safety net, esp in early years after residency when you don't have e-fund, savings, retirement acounts, etc yet. The base doesn't really matter for PP and production -based jobs, though. It is all downhill for the offer from there on:

The bonus should start at 2-3x that base, so would mean $240k-360k, probably circa $300k aka 2.5x base (not 500k wtf!). That is miserable and robs you of nearly $100k. The percentage amount itself varies depending on group overhead (usually COL area), but their fixed expenses for the associate (EMR, licensing/dues, etc) are well covered after awhile and the % should not only start much earlier than your offer, but it should probably also escalate (eg, 35% over 300k and 40% over 500k, etc).

30% is pretty low end for for a standard PP podiatry group (not that you will never even sniff any bonus with the 500k threshold until probably year 3 anyways). Unless there are a LOT of ways to generate collections in that group (ancillary svcs profit share, DME, ultrasound, OTC profit share, etc), then the percentage should be higher... and start sooner.

Lastly, the non compete is a firm deal-breaker (assuming non-comp are enforced there and you like the area). There are some areas I wouldn't work regardless of the money offered (since I don't want to be locked out of them, and you can never forecast what will or won't work out)... so I would only do startup/buyout solo practice or nothing in those areas. The trouble of moving and then being locked out of an area I want is not worth the risk. If at all possible, only take employed jobs in areas with no non-comp enforcement or in areas that you wouldn't mind leaving if it didn't work out.

 

[Pronation]

Got a job offer today which I think is pretty bad. I wanted your opinion.
120 k base with 30% after 500k in revenue. However they have offices throughout my entire county and the next and their non compete is 2 years which means I’d I leave I won’t be able to work in my area.

This is the unfortunate state of affairs with these garbage private practice gigs. Tell them $140k base with 38% after 300k in revenue and the non compete only applies to the office where you actually practice or they can go pound sand. Or if this turd of a job is your only prospective option then I guess you'll just need to work there and apply for jobs in another state starting day 1.

 

[Feli]

...The tough part is enticing a well trained podiatrist with student loans and (very likely) a family to raise. $100K is just not much these days, especially after taxes. It sounds exciting after making 40K as a resident, but man it just doesn't cut it.

Gotta take the hit the first couple of years and invest in the associate to make him stay...otherwise he'll leave after the first year when he figures out how little 100K is. I don't know what the exact number should be, but I would think at LEAST 140K (as was recommended above) to start (plus all those benefits). There are better offers out there, so you may not get the BEST candidate--but at least it wouldn't be an insult.

Yep. $100k base was fairly average PP base salary offering when I came out (almost 10yrs ago now), but that number is basically the bare minimum now. I would say it was $75k-125k+ base offerings back then... but it is probably $100-$175k+ base now (larger PP groups tend to lean higher since they know they can make a new hire busy fast and want to attract good applicants).

The main factor is the increased loan burdens (bigger minimum payments) and the increasing number of hospital jobs with $200k+ guaranteed.

I always tell hiring docs/groups that base doesn't really matter since you can just start the bonus later or lower bonus % to adjust for the base, but to most potential associates, base is their primary concern. They want to know their rent, loans, car, etc are paid without worry. Any job will get much better candidates if they can offer $150k instead of $100k.

Now, the funny part is that if that associate generates $400k their first year, they still get paid the same total if you did $100k base with 35% bonus starting at $250k... or if you did $150k base with 30% bonus starting at $400k. The $100k base deal actually makes a bit more with the $400k collections (and starts to make significantly more with higher collections in subsequent years), but almost any associate finds the $150k base deal MUCH more attractive. I am different, and most more established docs are (focused on % of total collections... tend to negotiate on the % and not so much base), but you would be surprised about how many folks simply want the security blanket even if it means trading away top end.

 

[dtrack22]

Got a job offer today which I think is pretty bad. I wanted your opinion.
120 k base with 30% after 500k in revenue. However they have offices throughout my entire county and the next and their non compete is 2 years which means I’d I leave I won’t be able to work in my area.

Hey at least the “bonus” is actually an increase in % of collections compared to the base! LOL

With a $500k production threshold your base amounts to 24% of collections. Only after $500k in collections do you start getting 30% of your collections.

Someone will take this job because they have no other options. But you (and every other new grad, young associate) should be told how bad this contract is. This job should sit empty forever.

 

[Pronation]

Yep. $100k base was fairly average PP base salary offering when I came out (almost 10yrs ago now), but that number is basically the bare minimum now. I would say it was $75k-125k+ base offerings back then... but it is probably $100-$175k+ base now (larger PP groups tend to lean higher since they know they can make a new hire busy fast and want to attract good applicants).

The main factor is the increased loan burdens (bigger minimum payments) and the increasing number of hospital jobs with $200k+ guaranteed.

I always tell hiring docs/groups that base doesn't really matter since you can just start the bonus later or lower bonus % to adjust for the base, but to most potential associates, base is their primary concern. They want to know their rent, loans, car, etc are paid without worry. Any job will get much better candidates if they can offer $150k instead of $100k.

Now, the funny part is that if that associate generates $400k their first year, they still get paid the same total if you did $100k base with 35% bonus starting at $250k... or if you did $150k base with 30% bonus starting at $400k. The $100k base deal actually makes a bit more with the $400k collections (and starts to make significantly more with higher collections in subsequent years), but almost any associate finds the $150k base deal MUCH more attractive. I am different, and most more established docs are (focused on % of total collections... tend to negotiate on the % and not so much base), but you would be surprised about how many folks simply want the security blanket even if it means trading away top end.

Sorry but all podiatry private practice job offerings are untrustworthy/sleazy/liars/opportunists until proven otherwise. You can expect to earn your base and not much more because the likelihood that the patient load will be there within the first 2 years is slim to none.

Again, any trashy pod PP job that states "Your base is $$ but you could be making $$$$ with bonus if you work your tail off" = hot garbage lie

Pro-tip for current job seekers: Make sure you get an occurrence based malpractice insurance so that when you inevitably leave this crappy private practice gig that you don't get a surprise $10k bill for tail coverage...

 

[Shiyuan]

Got a job offer today which I think is pretty bad. I wanted your opinion.
120 k base with 30% after 500k in revenue. However they have offices throughout my entire county and the next and their non compete is 2 years which means I’d I leave I won’t be able to work in my area.

Oof... yah pretty bad. Look into MSG, hospital, FQHC, VA, ortho, etc...

 

[Pronation]

Oof... yah pretty bad. Look into MSG, hospital, FQHC, VA, ortho, etc...

Honest question here - is it not universally known within our profession that 99.9% of "ASSociate" positions in private practice podiatry are complete trash?

 

[Shiyuan]

Honest question here - is it not universally known within our profession that 99.9% of "ASSociate" positions in private practice podiatry are complete trash?

You would think it was...

 

[PodSquad2022]

What is the website to check the podiatry licensing rules for each state? Like how many attempts to each/total APMLE exam portion/total attempts for all 3 parts

 

[nikkisorous]

Got a job offer today which I think is pretty bad. I wanted your opinion.
120 k base with 30% after 500k in revenue. However they have offices throughout my entire county and the next and their non compete is 2 years which means I’d I leave I won’t be able to work in my area.

Your thoughts are spot on.

It's a bad offer.

It's a terrible cycle. PPs sometimes offer low wages like this get and away with it because they're just looking for a body to see patients. They don't care if you're a good applicant or not. They know within 1-2 years you'll be gone, and they'll just replace you with another desperate body looking for a job. :/

 

[nikkisorous]

Curiosity has the best of me. A friend proposed a scenario regarding income. Let's say you live in a small rural area, where you can get a nice home for around 150k. Is that incentive to try and offer new associates less under the rouse of cost of living? Or are small rural areas paying more to incentivize good candidates to move out and bring their craft to the community. I can see both scenarios playing out. What has been ya'lls experience?

 

[air bud]

Curiosity has the best of me. A friend proposed a scenario regarding income. Let's say you live in a small rural area, where you can get a nice home for around 150k. Is that incentive to try and offer new associates less under the rouse of cost of living? Or are small rural areas paying more to incentivize good candidates to move out and bring their craft to the community. I can see both scenarios playing out. What has been ya'lls experience?

Small rural areas are precisely where you should be proposing employment to the hospital, not working for private practice. And if a CEO doesn't think it is necessary, you need to figure out how to big time them and go to their boss.

These days small rural private practice is a too risky. A few poor outcomes and you gotta go. If you have sunk capital into things, then it is even more costly.

As I have stated before, when I left my last job they said they would replace me even though I only serviced about 12k people.

We are too valuable


EDIT: - When I say rural...I mean RURAL. 5-15k, 45 to 60 mins to another town of similar or smaller size. Not some small town of 30k that is an hour outside a city of 200k.

Everything is relative. I used to say I grew up in a small town in the midwest....it was 60k people. My first job was in a city of 40k that was 1 hour outside of 500k city. Next came a SMALL town of 5k people that was 3 hours from a city of 150k....Now I am in a town of 7k that is 2.5 hours to city of 60k....then you gotta go 4.5 hours to hit anything above that.....this is rural.

 

[wakaflocka88]

Just to be clear - when we are talking about the "associate generating $400k their first year..." - is this what is billed to insurance or the amount reimbursed

Yep. $100k base was fairly average PP base salary offering when I came out (almost 10yrs ago now), but that number is basically the bare minimum now. I would say it was $75k-125k+ base offerings back then... but it is probably $100-$175k+ base now (larger PP groups tend to lean higher since they know they can make a new hire busy fast and want to attract good applicants).

The main factor is the increased loan burdens (bigger minimum payments) and the increasing number of hospital jobs with $200k+ guaranteed.

I always tell hiring docs/groups that base doesn't really matter since you can just start the bonus later or lower bonus % to adjust for the base, but to most potential associates, base is their primary concern. They want to know their rent, loans, car, etc are paid without worry. Any job will get much better candidates if they can offer $150k instead of $100k.

Now, the funny part is that if that associate generates $400k their first year, they still get paid the same total if you did $100k base with 35% bonus starting at $250k... or if you did $150k base with 30% bonus starting at $400k. The $100k base deal actually makes a bit more with the $400k collections (and starts to make significantly more with higher collections in subsequent years), but almost any associate finds the $150k base deal MUCH more attractive. I am different, and most more established docs are (focused on % of total collections... tend to negotiate on the % and not so much base), but you would be surprised about how many folks simply want the security blanket even if it means trading away top end.

 

[Feli]

Just to be clear - when we are talking about the "associate generating $400k their first year..." - is this what is billed to insurance or the amount reimbursed

It is all based on collections in PP (what you are calling reimbursed)... eat what you kill minus costs and minus whatever PP owner shaves off the top for their master system. I could bill $2k for my 99203, but what me or my group/biller sets its value at doesn't matter (unless it is a cash patient who actually pays). If that 99203 collects $125 (usually in that neighborhood) or $80 (bad but does happen with crap payers) or $0 (rare but happens if you hit deductible or someone with expired insurance or whatever). Obviously, I will get paid my base for the first couple of months on a new job (or definitely need a reserve or line of credit if I were owner) since the only collections actually coming in right away are copays and OTC stuff and a few claims that might get paid fairly fast.

After that early going, the gravy train starts and I should be on productivity, though (unless I or my employer set the carrot out of reach). Insurance checks should be arriving daily for your visits and injects and xrays after about 45days... and you should also have ancillary income (DME, path, OTC, testing, etc etc) if your group is well-run. Again, it doesn't matter if I do the work of a new patient with inject and xrays and orthotics, though... if they don't pay or the insurance was fake or whatever, I get nothing. That is why you typically do prior auth for orthotics, surgery, grafts, etc (but even that won't 100% ensure payment). That is why a lot of PP docs also don't like doing a ton of surgery (post-ops pay little and surgery takes them much time). Personally, I lucked out and hit some bonus even at my first job 10yr ago (probably since I negotiated on bonus % and not base), but since that, I have always tried to set my contracts monthly or bi-weekly: "Feli gets the greater of X monthly base or Y% of collections for his services during the prior 30day period, whichever is greater." JMO for what incentivizes me and tends to make my cash stock accounts overflow.

The problem with the typical associate deals is that they typically have only an annual threshold and annual base figure. The associate usually wants it that way since the base looks big (so they feel secure) as I put in that example. Those first couple months of very minimal collections hamstring them when the bonus calc is done at the end of that first year, though. Owners know that. In reality, you always want it quarterly or monthly and the larger base almost always has its downside for any PP pod or MSG or ortho setup (they will usually drop your % and delay when the % starts to "even out" the risk they take with high base... high used veeery loosely, esp for most pod group associate offers). But regardless, any PP bonus % is always based on actual collections (reimbursed). So, in line with that, if the payers are bad or billers suck or your coding is not good... you are gonna be hosed and doing a lot for free. I have been in all of those situ at one time or another and learned from it 🥴. You obviously need to work in a savvy group, code well, be efficient, and find an area with good payers and little competition to max out PP. When you do, it rocks like nothing else imaginable. When you don't, you might make $100k with crap benefits.

For hospitals, it is usually RVU or wRVU more commonly... collections don't really matter (for the doc). For some setups, it is even straight salary and wRVU are tracked not for bonus but only to check if you are roughly keeping up with your peers. That is the nightmare you see in a lot of VA/IHS where it is a race to the bottom (many docs do just the minimum they need to keep the job and take the max vacation/personal/etc). So, if you did a 1.5 wRVU visit, you get credited for that... whether the patient or insurance pays and what they pay is irrelevant (for you and your compensation). That is why hospital jobs typically have large base + benefits and fairly little bonus. They tend to be kinda the opposite of PP group.

 

[Feli]

Small rural areas are precisely where you should be proposing employment to the hospital, not working for private practice. And if a CEO doesn't think it is necessary, you need to figure out how to big time them and go to their boss.

These days small rural private practice is a too risky. A few poor outcomes and you gotta go. If you have sunk capital into things, then it is even more costly.

As I have stated before, when I left my last job they said they would replace me even though I only serviced about 12k people.

We are too valuable

🔥🧨❤️‍🔥👨‍🚒🔥🔥🧨❤️‍🔥👨‍🚒🔥

 

[air bud]

Did this as an edit on my last post but decided to make its own post

When I say rural...I mean RURAL. 5-15k, 45 to 60 mins to another town of similar or smaller size. Not some small town of 30k that is an hour outside a city of 200k.

Everything is relative. I used to say I grew up in a small town in the midwest....it was 60k people. My first job was in a city of 40k that was 1 hour outside of 500k city. Next came a SMALL town of 5k people that was 3 hours from a city of 150k....Now I am in a town of 7k that is 2.5 hours to city of 60k....then you gotta go 4.5 hours to hit anything above that.....this is rural. I can survive because of my ortho partners in a town like this. Just too much at stake to do on my own.

 

[newfeet]

Did this as an edit on my last post but decided to make its own post

When I say rural...I mean RURAL. 5-15k, 45 to 60 mins to another town of similar or smaller size. Not some small town of 30k that is an hour outside a city of 200k.

Everything is relative. I used to say I grew up in a small town in the midwest....it was 60k people. My first job was in a city of 40k that was 1 hour outside of 500k city. Next came a SMALL town of 5k people that was 3 hours from a city of 150k....Now I am in a town of 7k that is 2.5 hours to city of 60k....then you gotta go 4.5 hours to hit anything above that.....this is rural. I can survive because of my ortho partners in a town like this. Just too much at stake to do on my own.

I work in one of those towns. I think. The closest big city is a Canadian city and the closest American big city is over 2 hours away. We moved to a bigger town that's closer ( an hour) to a city but I kept the job. I am driving over an hour everyday.

 

[Feli]

Did this as an edit on my last post but decided to make its own post

When I say rural...I mean RURAL. 5-15k, 45 to 60 mins to another town of similar or smaller size. Not some small town of 30k that is an hour outside a city of 200k.

Everything is relative. I used to say I grew up in a small town in the midwest....it was 60k people. My first job was in a city of 40k that was 1 hour outside of 500k city. Next came a SMALL town of 5k people that was 3 hours from a city of 150k....Now I am in a town of 7k that is 2.5 hours to city of 60k....then you gotta go 4.5 hours to hit anything above that.....this is rural. I can survive because of my ortho partners in a town like this. Just too much at stake to do on my own.

I agree fully. I was saying your advice on that was en fuego and quite good for the younglings. Maybe I need to brush up on tween age emoji translations. Who knows. But dinosaurs can still spit hot fire advice (or fuse ankles).

Yeah, I think hospital employ is best route in small/medium town (5k-10k) areas since there are big risks (changes with major local employer, payers, hospital, etc) that can render a practice crippled if there is not much else nearby. Their 'catch' area is large but not much significant within it. Sure, those events and changes are unlikely, but you just can't completely hitch your wagon to places with 5k or 10k people and nothing else within and hour by buying real estate, building, taking loans, etc for PP. I agree it's not smart... let the hospital pay you a relocate bonus and stay nimble. (what airbud does)

Large towns (~10k-50k) and small cities (50k-250k) can be real good for PP, esp growing ones on major freeways, near growing metro, and with little/no competition. Those are the ones you tend to see DPMs retired well and retired young and practice buyout (or solo startup if you find a large town with no DPM) being a very good strategy to use. Employed or partner into a small or large PP/MSG group is also fine. The population size is usually the limiting factor, but there are plenty of people with low number of DPMs for the catch area. (what feli does... but stay the heck away from where I practice, obviously.... those are very bad choices for practicing with all having bad insurance, worse hospitals, and terrible patients and weather... also many many fat chicks and high taxes and no Starbucks or Taco Bells or anything else a prospective competing DPM would like is allowed by county laws).

Big cities (250k+) and metros (500k+) are fine for whatever (hosp employee, large pod/MSG/ortho group, small PP) depending on the city and suburbs demographics. Solo startup is possible but very hard due to costs and competition for referrals. Catch areas are small but dense unless you really market to a certain niche or have a lot of locations. Some job types are 'safer' and some others will have higher upside. Competition from every angle is obviously the limiting factor. (this is what majority of DPMs do)

All can work well. But the PP in a 10k town far from everything is one freeway re-route construction or largest local employer layoff away from being done for. I echo that is a definite hospital employ situation if at all possible.

 

[DPM Shredder]

Hi All, what would be a good offer for a part time surgical podiatrist in a PP? I am currently in talks with a well established and busy PP in a more rural area. Currently the owner is looking to hire an associate to take off some of the load so that he can work less, he would ideally like someone to take over the surgical side of his practice. They are looking to hire me part time (2 weeks on, 2 weeks off), which is what I prefer as I would like time to travel and experience and enjoy life as COVID really sucked the life out of me.

The guy hasn't sent me a contract or an offer but has said things like possibly paying me with a solely revenue based model and/or only having me see Medicare patients. Is only seeing Medicare patients a bad or good thing? Is solely revenue based not feasible? If I were to be solely revenue based, what type of models are there? And what kind of percentage of my revenue should I be shooting for?

Currently graduating from a residency that is based in a county hospital and many of my attendings don't have much insight into this.

Thanks in Advance!

 

[wakaflocka88]

Hi All, what would be a good offer for a part time surgical podiatrist in a PP? I am currently in talks with a well established and busy PP in a more rural area. Currently the owner is looking to hire an associate to take off some of the load so that he can work less, he would ideally like someone to take over the surgical side of his practice. They are looking to hire me part time (2 weeks on, 2 weeks off), which is what I prefer as I would like time to travel and experience and enjoy life as COVID really sucked the life out of me.

The guy hasn't sent me a contract or an offer but has said things like possibly paying me with a solely revenue based model and/or only having me see Medicare patients. Is only seeing Medicare patients a bad or good thing? Is solely revenue based not feasible? If I were to be solely revenue based, what type of models are there? And what kind of percentage of my revenue should I be shooting for?

Currently graduating from a residency that is based in a county hospital and many of my attendings don't have much insight into this.

Thanks in Advance!

Ideally you want a portfolio of various insurance plans including Medicare to maximize the patients you are able to see and operate on. But you realize if you just cut and run 2 weeks later, what is your plan for your post op patients while you're gone? Not sure if your group is going to be happy cleaning up any post-op mess.

Don't expect to make much $$ in this model however you dice it up - surgery itself does not reimburse well in addition to only working part time. Remember, if you get paid solely based on your production and no salary, you won't see $ coming in for at least the first 2-3 months.

Gotta work hard to play hard, unless you got some Bitcoins laying around ready to be liquidated.

 

[DPM Shredder]

I guess I forgot to say that the other physician will also be working 2 weeks on and 2 weeks off, so when he is away I will be seeing his patients and vice versa.

I am fortunate to not have to worry about making money, mostly working out of enjoyment from the job, but do not want to work completely for free.

 

[Feli]

...I am fortunate to not have to worry about making money, mostly working out of enjoyment from the job, but do not want to work completely for free.

That is how I approach dating.

 

[dtrack22]

so when he is away I will be seeing his patients and vice versa.

That is bound to cause problems. But if you don’t need the money then who gives a ****?

 

[Feli]

... other physician will also be working 2 weeks on and 2 weeks off, so when he is away I will be seeing his patients and vice versa....

That is bound to cause problems...

Yeah, about 99% of the time you will get problems in my exp.

The only exception might be where it's a nursing home thing or RFC practice. If you get into any injuries, sports med, surgery, hospital consult, etc pts... you will have problems when you don't at least try to have docs follow their own patient pool whenever possible.

 

[Feli]

I am working on a new contract.
How far above (if at all) should the “bonus” wRVU start counting based off the salary.

The offer is to be paid at 33rd percentile MGMA and bonus starts accounting at 50th percentile. Then then it’s $9 less per wRVU according to MGMA.
Last year I did over 50th percentile adjusted to 2020 wRVUs. I work at this hospital 3.5 days a week and moving forward will be 3 days a week, I have other clinic a day a week but that’s another story.
I think the bonus should start right at 33rd if that’s what they are wanting to pay me or I’d be willing to give a few percent but waiting to 50th seems like a stupid big spread.

Any insight is helpful.

I'm surprised it's so negotiable with a hospital. I assume you're probably the only DPM?
If that's the case (they tend to flex and you are their only foot doc), you could consult and attorney (pref one who has dealt with that facility before, not necessarily podiatry) and be fairly aggressive.

The $ per wRVU is probably the most obviously negotiation point in my eyes (your idea of when bonus starts is also good but might be standard for many specialties they employ... again, ask attorney who has dealt with their doc offers?). The facility knows they will have already made their money off of you and some significant profits from your testing, surg, etc by that time your bonus starts, so it's all gravy to them there. They are unlikely to be too greedy on giving you a few more bucks per wRVU. That also shows them you intend to work and plow well into that range.

 

[Redsting]

I am working on a new contract.
How far above (if at all) should the “bonus” wRVU start counting based off the salary.

Deleted the last one on accident, repost.

The offer is to be paid at 33rd percentile MGMA and bonus starts accounting at 50th percentile. Then then it’s $9 less per wRVU according to MGMA.
Last year I did over 50th percentile adjusted to 2020 wRVUs. I work at this hospital 3.5 days a week and moving forward will be 3 days a week, I have other clinic a day a week but that’s another story.
I think the bonus should start right at 33rd if that’s what they are wanting to pay me or I’d be willing to give a few percent but waiting to 50th seems like a stupid big spread.

Any insight is helpful.

 

[Redsting]

I'm surprised it's so negotiable with a hospital. I assume you're probably the only DPM?
If that's the case (they tend to flex and you are their only foot doc), you could consult and attorney (pref one who has dealt with that facility before, not necessarily podiatry) and be fairly aggressive.

The $ per wRVU is probably the most obviously negotiation point in my eyes (your idea of when bonus starts is also good but might be standard for many specialties they employ... again, ask attorney who has dealt with their doc offers?). The facility knows they will have already made their money off of you and some significant profits from your testing, surg, etc by that time your bonus starts, so it's all gravy to them there. They are unlikely to be too greedy on giving you a few more bucks per wRVU. That also shows them you intend to work and plow well into that range.

I am the only foot guy. I make them lots of money off surgery and MRIs as well as a pretty busy clinic especially for the size of the town.
They signed a family doc to basically the same contract but I have more money being brought on. So I would think they wouldn’t care about a few thousand if it means working hard and staying around.
I just don’t know how being paid and when the bonus comes in is decided. It seems off to me here

 

[dtrack22]

I am working on a new contract.
How far above (if at all) should the “bonus” wRVU start counting based off the salary.

Deleted the last one on accident, repost.

The offer is to be paid at 33rd percentile MGMA and bonus starts accounting at 50th percentile. Then then it’s $9 less per wRVU according to MGMA.
Last year I did over 50th percentile adjusted to 2020 wRVUs. I work at this hospital 3.5 days a week and moving forward will be 3 days a week, I have other clinic a day a week but that’s another story.
I think the bonus should start right at 33rd if that’s what they are wanting to pay me or I’d be willing to give a few percent but waiting to 50th seems like a stupid big spread.

Any insight is helpful.

At minimum your production, $/wRVU threshold needs to match your base pay %-ile

So base pay of 33% ile means wRVU threshold begins at that same %-ile, not a higher one

You can think of it this way, production pay should start once you have generated enough revenue to pay for yourself/cover the overhead your hire caused. If your base pay is 33%-ile then approximately the 33rd%-ile of wRVU production (something like 4,900-5,100 wRVU) is the production needed to cover your base salary (from the hospitals standpoint). But they don’t start paying you for your production until more like 5,800 wRVU. You are basically not getting paid for 700-900 wRVU worth of work. That’s a busy month to most employed docs.

 

[wakaflocka88]

Been seeing more jobs being posted which is a good thing for upcoming grads. But the solid ones are still far and few unfortunately.

Signed an offer a few months ago with a large MSG in a large metro city. $320k + RVU and other productivity bonuses with support of ortho for full scope. I do have work experience already so that helped they were able to see my case log and what I’ve been doing.

 

[JewOnThis]

I am currently hiring, please let me know if this offer is fair.
100k first year - then starting 2nd year 31% of total collections increasing 1% per year until 37%
401k, malpractice, health ins and cme included
location - Central Florida

This is actually pretty good for PP in Florida. Most of the PP contracts I’ve seen in Florida are from 65k-80k with little to no benefits.

 

[JewOnThis]

Been seeing more jobs being posted which is a good thing for upcoming grads. But the solid ones are still far and few unfortunately.

Signed an offer a few months ago with a large MSG in a large metro city. $320k + RVU and other productivity bonuses with support of ortho for full scope. I do have work experience already so that helped they were able to see my case log and what I’ve been doing.

320k is definitely not the norm for podiatry salary at a MSG. You did very well.

 

[air bud]

This is actually pretty good for PP in Florida. Most of the PP contracts I’ve seen in Florida are from 65k-80k with little to no benefits.

Yeah but Kevin Lam fellowship trained....

 

[JewOnThis]

Yeah but Kevin Lam fellowship trained....

I know Kevin Lam. He doesnt seem like a bad guy, then again I have never worked for him.

 

[deleted664048]

37% of total collections is pretty good for PP associate--I think that part is fine after the associate has been working long enough to have a healthy patient base and consistently brings in money. The tough part is enticing a well trained podiatrist with student loans and (very likely) a family to raise. $100K is just not much these days, especially after taxes. It sounds exciting after making 40K as a resident, but man it just doesn't cut it.

Gotta take the hit the first couple of years and invest in the associate to make him stay...otherwise he'll leave after the first year when he figures out how little 100K is. I don't know what the exact number should be, but I would think at LEAST 140K (as was recommended above) to start (plus all those benefits). There are better offers out there, so you may not get the BEST candidate--but at least it wouldn't be an insult.

Not sure what residency you are in, but in NY we are getting paid 85K to 90K as a chief resident so 100K does not sound good at all, for no one.

 

[air bud]

Not sure what residency you are in, but in NY we are getting paid 85K to 90K as a chief resident so 100K does not sound good at all, for no one.

Lol take a pay cut to work as an associate...

 

[deleted664048]

This is actually pretty good for PP in Florida. Most of the PP contracts I’ve seen in Florida are from 65k-80k with little to no benefits.

I am applying to Florida and no! Everyone is offering over 100K. This offer is horrible.

 

[deleted664048]

Lol take a pay cut to work as an associate...

I know! Lol
All those old people tell you “but I made 20K in residency” well, I fell bad for you but time changed, so adapt accordingly

 

[underwood]

At what time during residency is it best to start actually applying for jobs/ sending out CV to groups or hospitals etc?

 

[Shiyuan]

At what time during residency is it best to start actually applying for jobs/ sending out CV to groups or hospitals etc?

Start inquiring (in the very least... searching) in your first year. That is how I landed my sweet MSG gig. It never hurts to network early.

 

[underwood]

Start inquiring (in the very least... searching) in your first year. That is how I landed my sweet MSG gig. It never hurts to network early.

thanks for the reply. How about midway second year residents? If we applied now what if these jobs are looking for someone to start in the next few months? Is it common to be in the talks with a position for over a year?

 

[DYK343]

thanks for the reply. How about midway second year residents? If we applied now what if these jobs are looking for someone to start in the next few months? Is it common to be in the talks with a position for over a year?

Start mid 2nd year at the latest. 1st year is a bit early but it cant hurt to get a feel for the market. I started heavily mid 2nd year and had my current job lined up at the start of my 3rd year.

Whatever you do dont wait until the last 3 months of residency

 

[Pronation]

At what time during residency is it best to start actually applying for jobs/ sending out CV to groups or hospitals etc?

Start casually looking/applying towards end of 2nd year. Begin aggressively applying with a well polished CV at the beginning of 3rd year. As mentioned above, if you start your search any later than middle of 3rd year then run a much higher risk of ending up with some crappy low paying private practice slavery job.

 

[wakaflocka88]

Start mid 2nd year at the latest. 1st year is a bit early but it cant hurt to get a feel for the market. I started heavily mid 2nd year and had my current job lined up at the start of my 3rd year.

Whatever you do dont wait until the last 3 months of residency

This. I have friends and residents asking me about jobs right now, 5 months prior to graduating. Sorry but that’s no bueno. Always try to network as early as you can. Look at all options, even PP groups and don’t just assume that superior training/program will automatically get you your dream job. Doesn’t happen.

 

[shezadeh]

Nothing in particular. It is just not something I am interested in pursuing anymore. Can someone add input for alternative career options that pay well ($80k+ after taxes)?

Orthotics/Prosthetics/Pedorthics lab?

Small rural areas are precisely where you should be proposing employment to the hospital, not working for private practice. And if a CEO doesn't think it is necessary, you need to figure out how to big time them and go to their boss.

These days small rural private practice is a too risky. A few poor outcomes and you gotta go. If you have sunk capital into things, then it is even more costly.

As I have stated before, when I left my last job they said they would replace me even though I only serviced about 12k people.

We are too valuable


EDIT: - When I say rural...I mean RURAL. 5-15k, 45 to 60 mins to another town of similar or smaller size. Not some small town of 30k that is an hour outside a city of 200k.

Everything is relative. I used to say I grew up in a small town in the midwest....it was 60k people. My first job was in a city of 40k that was 1 hour outside of 500k city. Next came a SMALL town of 5k people that was 3 hours from a city of 150k....Now I am in a town of 7k that is 2.5 hours to city of 60k....then you gotta go 4.5 hours to hit anything above that.....this is rural.

I work in one of those towns. I think. The closest big city is a Canadian city and the closest American big city is over 2 hours away. We moved to a bigger town that's closer ( an hour) to a city but I kept the job. I am driving over an hour everyday.

Wait until you see towns with 1k people or less....

 

[newfeet]

Orthotics/Prosthetics/Pedorthics lab?





Wait until you see towns with 1k people or less....

I work in one of those towns 1 to 2 times a month.

 

[Boba Foot]

Does anyone have advice on how to tactfully negotiate a higher salary than offered, without risking future PP employer telling you to get lost?

 

[Feli]

Does anyone have advice on how to tactfully negotiate a higher salary than offered, without risking future PP employer telling you to get lost?

It often helps to just tell (diplomatically but clearly), as opposed to just weakly asking... kinda a compliment sandwich approach below. This will get you an answer and save both sides time:

"Ok, that seems like a good fit. I would be agreeable to the offer if the base were X and would look to get my clinic busy quickly."

"Sure, it seems like a good and successful group. If the bonus is made to be 40%, then we can proceed to figuring out a start date."

"I received the contract and all seems good. I will need a $1k monthly health care and health insurance allowance added in, and then we are good to go."

If they don't do it, ok. You need to have the abundance mentality. You can set it up with phrasing (these work best in type/written forms) so that you are ready to work, and it's their choice if they want that to happen. Blame your attorney for your conditions if you like, but affirm that you feel that is what will make the hiring happen. They have already invested time and thought in you, so if they like you and you are not too far from their threshold of compensation, you will likely have a deal. You have to act clearly on their team and force them to break rapport by not being in agreement with your win-win mentality (which goes against common human nature and norm for them not to simply agree with).

Works 100%? Heck no. 60% of the time, it works every time. But regardless, you will have your answer (many PP job negotiations can go in circles for weeks if you let them with the applicant happy to maybe have a job and the owner happy to maybe have a real cheap associate and both avoiding direct communication about compensation). When you get down to brass tacks, if you set it correctly after you decide and they reject, then they are then the one who gave the thumbs down to the win-win you'd tried to create. If they counter (most won't if you communicate your terms well), you can simply act a bit disappointed they don't understand your offer was well-thougtht and is the only offer you would be agreeing to. Either way, they will take it or they won't. Learn the lesson and move on. "You don't get what you deserve, you get what you negotiate."

The book 7 Habits (Covey) or X (Aarnio) are good. Some people like Art of the Deal (Trump), but it was pretty verbose for me... X is a more fun and shorter version with more current examples.

Personally, I kinda learned this stuff from a giant Ukranian guy I was buying a used car from. I drove it and looked it over and decided I'd make an offer, and he said "there is only one price! Price is fair. There is ONLY ONE PRICE!" The price was good, car was good, and we had a done deal. I was young and trying to be cheap even though price was already below KBB and the car was clean and good. From 7 habits: you need to make deals everyone's happy with, cut the cake not necessarily so that you get the biggest slice but so that all are happy. Getting to that deal point (or to moving on to other deals) does take one or both parties drawing a line in the sand. I think that refusing to name a price and trying to make the other party offer something first is garbage unless it is an item where the price is very vague... in podiatry, that approach will simply get you lowball 100k + 30% offers (or worse) time and time again. Know your worth, present it in a positive way, give them a bit of time to figure out if they agree, and stick to it. For large groups/hospitals, you have much less wiggle room... almost zero for university or VA or etc type jobs. GL

 

[Podstar]

I started first month of 2nd year and was hired first month of 3rd year. Came down to two hospitals and a msg group. I think that‘s the most ideal method.

Did you cold call for these offers? How would you sell to them committing to hiring someone who is only a second year resident? Thanks!