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I missed the mustasche
Forum Members Official: Job Offer Thread
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Podiatrists do not qualify for EDRP at my VA
That’s crazy! I was under the impression all VAs qualify. That’s terrible
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Just a quick word on IHS jobs. There are technically three categories of these: Federal, Tribal, and Indian Urban Program.
Federal IHS - Federal employee that is very similar to the VA in compensation and benefits. Also has loan repayment ( I think 20k/year). Area dependent on what type of work you will be doing. I have heard of federal IHS jobs that are mostly nails and wounds and ones where they do lots of trauma and recons.
Tribal IHS - You are employed by the tribe directly. From what I can tell these are usually tribes near a larger metropolitan area where many of the members of the tribe don’t live on the actual reservation. I applied to a couple of these and was offered the position for one. The one that offered me the position pays mid 200s (supposedly they pay 50th percentile MGMA is what I was told), good benefits, loan repayment, potential for RVU bonus, but no pension. Patient population seems more normal but still plenty of diabetic foot care.
There is technically a third type of job where you work with Native American population. They are classified as Indian Urban programs where it is an FQHC that serves their usual medically underserved population and the healthcare needs of a Native American tribe.
Source: someone who is obligated to work for IHS after residency so exclusively researched and applied to these types of jobs.
Federal IHS - Federal employee that is very similar to the VA in compensation and benefits. Also has loan repayment ( I think 20k/year). Area dependent on what type of work you will be doing. I have heard of federal IHS jobs that are mostly nails and wounds and ones where they do lots of trauma and recons.
Tribal IHS - You are employed by the tribe directly. From what I can tell these are usually tribes near a larger metropolitan area where many of the members of the tribe don’t live on the actual reservation. I applied to a couple of these and was offered the position for one. The one that offered me the position pays mid 200s (supposedly they pay 50th percentile MGMA is what I was told), good benefits, loan repayment, potential for RVU bonus, but no pension. Patient population seems more normal but still plenty of diabetic foot care.
There is technically a third type of job where you work with Native American population. They are classified as Indian Urban programs where it is an FQHC that serves their usual medically underserved population and the healthcare needs of a Native American tribe.
Source: someone who is obligated to work for IHS after residency so exclusively researched and applied to these types of jobs.
Typically not well.
Low pay and high documentation required.
Patients are funneled into certain lab or imaging centers, pharmacy, PT, etc. Basically, it's much like a lower-paying version of work comp.
Those plans typically call offices to try to get them to see pts ("woud you be interested"), so that right there tells a lot. The only plans that need to actively search for docs/offices are basically these IHS and MCA carriers. They will find pod offices greedy enough or slow enough to accept contract, but it should generally be avoided by offices with other options.
Is it definitely bad? I got sent a contract asking me to see some sort of residential prisoner cohort the other day. They offered 180% of Medicare in the paperwork. My partner said absolutely not, but I can if I want to. I wonder if this will interfere with staffing ie. creep out my MAs. Part of me wants to ask for more and see what they say.
Go ahead, but the fact they're phoning you kinda tells a lot... ya?
They've obviously been rejected or dropped by other area peers.
I just do not see a point and trust my billers' exp that they pay low/slow/no. Then again, I'm not trying to expand or hire associates or anything... simply see a full sched, stay caught up on wait list, and max that. I'm sure it's a ymmv situation, depending on practice status, goals, area.
subiedriver
New Member
Currently working through two very different offers and wanted to hear some feedback. Both jobs are in the Midwest. I am currently 3.5 years out and RRA certified as of last year.
Option 1: VAMC
- 270k after market pay. (Plus performance bonus)
- Four 10 hour shifts per week
- No inpatient or call
- Gov benefits
Option 2: PP ortho group (current practice is being absorbed)
- 140k with 50% collections over 280k (will not budge on base)
- Discussed buy-in to their surgery center
- Discussed buy-in practice after two years (no details available)
- They will be covering health insurance, CME, dues and malpractice
Option 1: VAMC
- 270k after market pay. (Plus performance bonus)
- Four 10 hour shifts per week
- No inpatient or call
- Gov benefits
Option 2: PP ortho group (current practice is being absorbed)
- 140k with 50% collections over 280k (will not budge on base)
- Discussed buy-in to their surgery center
- Discussed buy-in practice after two years (no details available)
- They will be covering health insurance, CME, dues and malpractice
Phoned and emailed the contract same day 🙂 Been a week. Haven't called back.
I don't know what their motivations are. We do have a hospital in town that takes care of prisoners. I think the funny thing about this is - there's no amount of money I will be paid that will be worth "complications" or weird issues like losing staff who don't want to see prisoners.
Slow pay is a real thing. I just got a claim back that took 5 months to send an EOB. Its one of those little companies that contracts the rate through another company who I have an awesome contract with through my IPA. Instead it paid at 45% of the contracted rate. I got their reps email through the IPA and after a month of wait time they acknowledged that I've been underpaid for all E&M, radiology, and CPT for over a year. They are processing, but catching this sort of stuff after the fact is killer.
I literally have piles of things like this going on:
-I have an in town contract that's supposed to pay at 175% of Medicare that's paying at sub-Medicare.
-I have the network above that's supposed to pay 185% of Medicare for CPT/radiology and is used by all sorts of small plans that is paying jack 6 months later.
-1/2 my Cigna contracts aren't paying in line with my IPA contract, 1/2 are. I've emailed the rep twice and he just says they are working on it.
-I had a large employer in town switch from Cigna to some sort of self insured plan. I wrote to them asking for the rates and after a month of waiting they said the rates are "above Medicare". Yes, I was aware of that because the card literally says "Provider, we pay above Medicare". How much though.
-I've finally been able to send in my United termination. They acknowledge that they've underpaid me for like 2.5 years. They were supposed to have fixed this and paid me a year ago but they simply never did. They refuse to pay for 1 of the years even though I called them on it but they claim I wasn't specific enough in my language. They say the list of underpaid claims with settlement is on the way.
-Tricare cut my rates. They restored the rates when I called and complained. My former office manager was told to do this and never did.
-Almost all of these claims above required me to sit down and pull EOBs, contracts etc and then email at least twice.
That said. I remain committed to seeing this garbage through and then hopefully going after Aetna next. Sub-Medicare bastards. In North Carolina Aetna has a "transparent" publically available fee schedule for teachers / state employees etc that pays 160% of Medicare. Blows my mind. Excel file on the internet.
hey brother, thanks for sharing your struggle with owning a business.
I want every pre-pod who constantly cry "I am business oriented and can totally see and be ok working for myself and blah blah blah" to understand how emotionally exhausting this is.
This is the stuff that no one in health care, esp pod talks to u about.
My MD/DO friends don't deal with any of this at all doing their PCP stuff working 4.5 days a week hitting 300K in decent area.
D
deleted1162946
VA all day
Yea that one seems like a no brainer especially if no call/inpt
Yes, clinic VA job is the dream for some (or any non op 4-5 day/wk job that pays well).
We really missed the boat on not having general/wound DPMs and then a subset of more surgically trained ones. (2 training tracks, dental model)
...I think the main/ only pitfall there is s/he will do ~10yrs in VA to do PSLF or pay loans off, and by then, they're pretty locked into VA culture. It's hard to pivot when youre that far in, so it's nearly impossible to go back to working/starting PP or private sector hospital or anything. It has to be considered that one is basically locking into a career trajectory before their career begins. That's a major decision for new grads.
It is much less risk for this person a few years out with Abfas done and maybe some billing/coding know-how that a new grad does not... that leaves the door cracked to return from VA to normal pod practice someday. I would fully expect them to retire VA once they start in, though.
But yeah, 100% agree take the VA job if you like that enough to have applied and considered it. And esp if you trained VA and know (and like) how that world works. 👍
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subiedriver
New Member
Never trained VA. Just applied since it was close and organizational jobs aren’t common in my area (too saturated). I graduated from a program 25 mins from the one you did so I have more trauma and recon training than most. Part of me is just wondering if I should turn down guaranteed money to be an associate for a couple more years, even though this opportunity has more ancillary ways to generate income.
D
deleted285117
Do VA for sure. Good salary, awesome bennies and quality of life. 😎
I wouldn’t put the VA income cap on myself that early in my career personally. The ceiling is much higher in the ortho group and despite the $140k base, you’re still getting 50% of what you bring in with basic benefits and the ability to double VA pay (and relatively quickly).
Yeah, I would never do VA just personal pref, but they're both good choices. VA is "safer," other one is probably more interesting and uses more of your training.
...The thing I don't get on the ortho/msg arrangement is what "buy in" could do when you make 50% collections already. You clan't really go too far past that, even if the offices are ultra-efficient. What could you really gain... % of adv imaging? Job security? Tiny % of associate or midlevel collections? Slightly higher % of your own collections? 50% of gross is good, but not much room to roam.
You will do good either way. 👍
So - a classmate of mine has worked for the VA for almost 5 years. My in town podiatrist is also closing in on 5 years. The first is in the $150s and the second in the $160s. The values I'm describing come from open source salary websites. Are the websites wrong or are they just "stuck"?
I watched the X-files as a child.
*ominous theme song plays*
subiedriver
New Member
That is their base salary before market pay. As I understand, market pay varies by facility and changes per year.
For longevity of your career, peace of mind, work life balance and unique opportunities that are offered by the VA I recommend you do VA.
PP jobs can change of the CEO, president, partners change. Or if they sell to private equity firm.
VA will win out in the long run because you'll have an easier and probably longer career with VA than PP given current job market for podiatry.
My total compensation (market + base) is listed on the federal pay website.
Ortho. You are getting 50 percent of collections. You have the training. Bet on yourself. 140 will be plenty for you to play the bills to start. Our problem with working for another podiatrist as oftentimes the pathology seen and then more importantly the compensation structure. In an ortho group where you're seeing MSK and 50% of collections it's a no-brainer Don't listen to these clowns saying VA. Especially as a new grad.
Insert Bryce Harper 🤡 meme
Insert Bryce Harper 🤡 meme
I think it’s a matter of personal preference. Do you want to see your skill set grow, make use of your full potential, like surgery, and are ambitious or a Type A personality? Do the ortho job.
Do you just want to collect a check and go home, likely your skill set will get stagnant, you’ll forget how to do harder cases but don’t care, go VA
Do you just want to collect a check and go home, likely your skill set will get stagnant, you’ll forget how to do harder cases but don’t care, go VA
How important is your current location and how big of a deal would a move be for you/ family (if applicable)?
How important is work/life balance?
How important is it to do big procedures?
How important is it to make more money than what the VA is offering (consider total compensation) and possibly make much more money if partnership would eventually be offered?
I know podiatrists making serious $$$ with great job stability as Ortho partners. Being an associate, even a highly compensated one at an Ortho group rarely works out long term though for podiatrists. It most likely will not be your forever job unless partnership is eventually offered.
There are other benefits to starting young at the VA such as pension and loan repayment. The job is already where you live.
If this job Otho does not work out longterm you will still very likely be able to find another good job with ABFAS RRA. It might not be local or in a desirable location. You can always open your own office if necessary I suppose which has its own pros/cons.
How important is work/life balance?
How important is it to do big procedures?
How important is it to make more money than what the VA is offering (consider total compensation) and possibly make much more money if partnership would eventually be offered?
I know podiatrists making serious $$$ with great job stability as Ortho partners. Being an associate, even a highly compensated one at an Ortho group rarely works out long term though for podiatrists. It most likely will not be your forever job unless partnership is eventually offered.
There are other benefits to starting young at the VA such as pension and loan repayment. The job is already where you live.
If this job Otho does not work out longterm you will still very likely be able to find another good job with ABFAS RRA. It might not be local or in a desirable location. You can always open your own office if necessary I suppose which has its own pros/cons.
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In a group like that your personal share of the overhead shouldn’t be more than 40% of what you collect. A reasonably busy DPM in an ortho group should collect $60-80k per month no problems. $25k in overhead every month (fair, if not on the high side) means your overhead is only 33% collections. There’s plenty of profit there that could be beneficial to “buy.” Depending on how much it costs. But more importantly is the profit sharing from imaging, PT, group owned surgery center, etc. as you alluded to.
You could easily be “buying” $150k in additional income every year. And generally ortho group buy ins are reasonable. I haven’t seen or heard of a situation where it didn’t make sense to partner in these groups when it’s an option.
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Id say make your own luck but truth is atleast 75% of my collegues have literally no clue how to be business savy and will either learn the hard way or be lucky to get a employed VA/MSG type job. Just because you can grow doesnt mean you will. Some people are better off taking a salary, and thats is OKAY.
Theres nothing wrong with that. Its worse to pretend that youll make 40% of what you generate and then only generate only 300k in a small practice with NO benefits and then maybe 500 the next year and 600 the year after. So you net 560 before license, credentialling, health insurance, tax, vacation, child care, student loans, retirement............. Now your 3 years further behind on debt, retirement, and not much to show for it. Would be WAY better off at the VA with 230k+benefits in those 3 years. Its not even close.
Theres nothing wrong with that. Its worse to pretend that youll make 40% of what you generate and then only generate only 300k in a small practice with NO benefits and then maybe 500 the next year and 600 the year after. So you net 560 before license, credentialling, health insurance, tax, vacation, child care, student loans, retirement............. Now your 3 years further behind on debt, retirement, and not much to show for it. Would be WAY better off at the VA with 230k+benefits in those 3 years. Its not even close.
Oh look a great job in….Maine
Go to podiatry school, do a residency, do a fellowship so you can officially drop the podiatry in your title and refer to yourself as a “fellowship trained foot and ankle surgeon” on LinkedIn and earn yourself a fabulous job in…Maine.
Have fun in…Maine
Have fun Don the recruiter you are about to get 300 applications today and tomorrow
I know somebody who talked to a recruiter yesterday and it was the same old story, we were overwhelmed with applications in a couple days meanwhile we've been trying to recruit and endocrinologist for 2 years and can't get anybody to even come and visit lol. Podiatry!!!
Best kept secret in medicine.
I talked to my hospital admin today also...
They have been trying to recruit ortho, GI, cardiology for years... rare visits, might get one, lose them... another multi-year and high costs undertaking for a new recruiting effort.
Me: "Looking to employ podiatry? I know some good people."
"Hmm, there are already so many on staff and in the area." *
* fwiw, I am 500+ miles from any podiatry school ... over 100 miles from any pod residency
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Associate Podiatrist
Four Corners Foot & AnkleColorado
Full-time
Benefits
•$120000.0 / Annually - $120000.0 / Annually
Job description
Come join our practice, We are a group of hard working specialists with a passion for podiatry. Please follow the link to our website! 4cornersfeet.com Compensation Information: $120000.0 / Annually - $120000.0 / Annually Details: Please contact us for more information Starting At: 120000.0 Annually Up To: 150000.0 Annually
ahh yes, the ol' leaving the comma out so it looks like they're paying you a lot trick. Very Clever
Posting this to show the other spectrum aka upper extremity
Orthopedic Surgery: Hand & Wrist at Saint Alphonsus
Saint Alphonsus Health SystemNampa, ID
Full time
Requirements Doctor of Medicine (MD) or Doctor of Osteopathy (DO) degree
•Successful completion of accredited orthopedic surgery residency
•Board certification through the American Board of Orthopaedic Surgery (ABOS) - or obtain within 3 years
•Obtain Idaho & Oregon medical licensure and granting of privileges at SAMC- Nampa and other health system affiliated hospitals as needed
•Valid controlled substance registration with Board of Pharmacy and DEA
•Willingness to take general orthopedic call
Responsibilities
•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 Specialty and Primary Care clinics
Benefits
•$80K -- $100K
Job description
Practice Highlights Practice Highlights: Saint Alphonsus Medical Group (SAMG) is a physician-led 500 provider multispecialty group seeking a fellowship-trained Hand & Wrist surgeon to join a growing practice in Nampa, Idaho. The group consists of non-operative Sports Medicine, Foot & Ankle Surgery, Podiatry, Orthopedic Spine, and Adult Reconstruction, and is supported by a team of Advanced Practice Providers. Support: 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 Specialty and Primary Care clinics. Requirements Doctor of Medicine (MD) or Doctor of Osteopathy (DO) degree. Successful completion of accredited orthopedic surgery residency. Completion of Hand Fellowship preferred. Board certification through the American Board of Orthopaedic Surgery (ABOS) - or obtain within 3 years. Obtain Idaho & Oregon medical licensure and granting of privileges at SAMC- Nampa and other health system affiliated hospitals as needed. Valid controlled substance registration with Board of Pharmacy and DEA. Willingness to take general orthopedic call. Salary Range: $80K -- $100K
Nampa. Like Tampa, but worse.
They (whatever recruiter is re-posting) probably mixed up and put the sign bonus instead of salary as being 80k-100k. Not joking.
It seems their direct hospital job posting format does not list salaries:
Foot & Ankle Orthopedic Surgery Opening in Nampa, ID (Saint Alphonsus)
Agree. Has to be a mistake. Hand ortho is not making 80-100k.
No one ever hurt themself lifting a heavy arm.
How big is the ortho group? Is there a foot and ankle orthopedist there? If so how many? If there are no foot and ankle orthos then this would be a pretty attractive deal.
Regardless what the details are I would try the ortho group first before accepting a VA job where you literally only make a salary and get no type of bonus.
It's not that hard to gross 600-800K. You be making way more at the ortho job than sticking with the VA
subiedriver
New Member
The head of a the practice is a f&a ortho who hasn’t done f&a in years. Total of 7 ortho docs with a pod who does forefoot. Currently two offices with plans to continue growing.
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I'd pick that over the VA but personal preference.
Depends on what your personality is like.
If you just want to collect your paycheck and go home, are ok with skill atrophy, a regular 9-5 where you may not have a lot of say in how you run things- go VA.
If you know you're going to outwork and out produce any of the pods around you, are comfortable doing rear foot, want a higher earning potential- go ortho. I'm going to go on a limb and say you should be earning more at the ortho gig than the VA gig over time.
This.
If you want to work 60 hours per week and make twice as much, keep your skills up and take 3 weeks of vacation versus 6. You might be able to take 6 weeks in Ortho (in theory or even unlimited as a partner) but few do due to trying to produce.
Again starting young at VA PSLF and pension are something to consider.
Also consider job stability. If you are a partner at Ortho you will have good job stability and even be able to possibly make up to 3 or 4 times as much as at the VA depending on the particular Ortho group and their ownership in ancillary income sources. If you are an associate who produces they will have no desires to get rid of you unless you cause lots of other issues, but they could cut your percentage of collections or hire more podiatrists at anytime and you have no real input and if you complain they will let you go.
I don't know how many big ortho groups are ready to make a podiatrist a partner. I think your potential to earn a lot is great with a Ortho group but 5-10 years in are you going to want to work long hours with big cases or just collect your money and go home to relax with your family.
The beauty of this style is you've now developed your name within the community and you have a ton more options you have no idea which direction things can go in. Best to put in the work make the money young and just give yourself more options in the future. VA is all about limiting yourself.
