Forum Members Official: Job Offer Thread

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Nurse Practitioner - Commonwealth Medical Services | Billings, MT

www.simplyhired.com

Nurse Practitioner job. Seeing 2-5 pts per day. Basically doing physicals. Home by 1pm. My friend actually got this job. Got his online mill NP degree. And got a job right away in home town 140k salary seeing 2-5 pts per day doing basically nothing. How many pods will get 140k out of residency?

 

[GreenHousePub]

Nurse Practitioner - Commonwealth Medical Services | Billings, MT

www.simplyhired.com

Nurse Practitioner job. Seeing 2-5 pts per day. Basically doing physicals. Home by 1pm. My friend actually got this job. Got his online mill NP degree. And got a job right away in home town 140k salary seeing 2-5 pts per day doing basically nothing. How many pods will get 140k out of residency?

This is for VA disability exams. I would bet the company is VES or LHI? Those exams are at minimum an hour long, with sometimes extensive exams based on body system claimed and require a lot of paperwork. Much, much more work than a basic high-school sports physical. Also, the listing shows its only 120k if you don't take any weeks off.

 

[deleted285117]

In terms of hospital employment, can I increase my wRVUs by reading/reporting foot/ankle radiographs MYSELF (so no radiologist “overread”)?

EDIT: I find radiologists miss stuff anyway. Makes more sense for me to get the RVUs, not them(?).

 

[Feli]

In terms of hospital employment, can I increase my wRVUs by reading/reporting foot/ankle radiographs MYSELF (so no radiologist “overread”)?

EDIT: I find radiologists miss stuff anyway. Makes more sense for me to get the RVUs, not them(?).

If this is a serious question, no... not a chance.

1) Even the lowest worth rads are worth more than the top DPMs (main reason rads very seldom work for hospitals and just contract in groups for coverage).

2) Liability.

 

[deleted285117]

Bummer. Oh well.

 

[msuDPM]

In terms of hospital employment, can I increase my wRVUs by reading/reporting foot/ankle radiographs MYSELF (so no radiologist “overread”)?

EDIT: I find radiologists miss stuff anyway. Makes more sense for me to get the RVUs, not them(?).

Feli is probably correct in most cases, but I did it at my last gig.

Forewarning: it isn't worth it. If memory serves, the wRVU for the technical component of 3 view foot or ankle is like 0.16. Having to get into a separate area of Epic from the encounter note to enter a formal xray read was cumbersome. I constantly had a rolling list of 30 or so reads I needed to do. Most weeks I would probably spend an extra hour and a half or so on xrays alone all to see no difference in my wRVU total over, say doing another ray amp that week/month.

Before I left, I gave that gig back to the radiologists.

 

[DYK343]

Feli is probably correct in most cases, but I did it at my last gig.

Forewarning: it isn't worth it. If memory serves, the wRVU for the technical component of 3 view foot or ankle is like 0.16. Having to get into a separate area of Epic from the encounter note to enter a formal xray read was cumbersome. I constantly had a rolling list of 30 or so reads I needed to do. Most weeks I would probably spend an extra hour and a half or so on xrays alone all to see no difference in my wRVU total over, say doing another ray amp that week/month.

Before I left, I gave that gig back to the radiologists.

just curious. How much (roughly) for mri or ct reads?

 

[FedPod]

In terms of hospital employment, can I increase my wRVUs by reading/reporting foot/ankle radiographs MYSELF (so no radiologist “overread”)?

EDIT: I find radiologists miss stuff anyway. Makes more sense for me to get the RVUs, not them(?).

I did my own reads on Epic emr for several years at previous employer.

Minimal financial payoff. Maybe 100 X-ray series / mo getting the professional component.

The benefit was not having to call the radiologist at a large hospital system to have a report addended. I had to sign off on their reads anyway , so the increase work was minimal on that emr.
This was very helpful for surgical boards.

I never pursued for ct/ mri

 

[msuDPM]

just curious. How much (roughly) for mri or ct reads?

Sorry, only read plain films. Not sure what the wRVU is for MRI.

 

[PeaJay]

The gain in wRVU from reading doesn’t seem to makeup for loss in complexity. It is my understanding that you cannot do the official read and claim independent interpretation for billing of the office visit.

 

[heybrother]

Save that time and do some extra foot care. 🤣

 

[dtrack22]

In terms of hospital employment, can I increase my wRVUs by reading/reporting foot/ankle radiographs MYSELF (so no radiologist “overread”)?

EDIT: I find radiologists miss stuff anyway. Makes more sense for me to get the RVUs, not them(?).

Yes, you can. Though in my experience it would be in an outpatient clinic setting where the hospital/MSG covering radiology group does not cover reads, and it will be Xray only.

Feli is wrong. Don’t listen to him on this.

The gain in wRVU from reading doesn’t seem to makeup for loss in complexity. It is my understanding that you cannot do the official read and claim independent interpretation for billing of the office visit.

A single xray interpretation is rarely going to bump you from a level 3 to a 4 all by itself. Someone else already said it, but the professional component for a 3 view study of the foot (and ankle I believe) is 0.16 wRVU. Personally I would rather get the wRVU credit than the once in a blue moon E/M bump, but it’s also not worth enough $ that I would go out of my way to read my own clinic X-rays if it wasn’t already set up that way.

 

[staffdoc]

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.

However it is completely legit to bill for these patients since my resident is seeing the patient under my name and discussing with me

 

[PeaJay]

However it is completely legit to bill for these patients since my resident is seeing the patient under my name and discussing with me

CMS rules

Check page 4. Discussion is not justification for billing. You need to be physically present for key portions of procedure or examination.

 

[Pronation]

Yes, you can. Though in my experience it would be in an outpatient clinic setting where the hospital/MSG covering radiology group does not cover reads, and it will be Xray only.

Feli is wrong. Don’t listen to him on this.



A single xray interpretation is rarely going to bump you from a level 3 to a 4 all by itself. Someone else already said it, but the professional component for a 3 view study of the foot (and ankle I believe) is 0.16 wRVU. Personally I would rather get the wRVU credit than the once in a blue moon E/M bump, but it’s also not worth enough $ that I would go out of my way to read my own clinic X-rays if it wasn’t already set up that way.

I fly through the X-ray interpretation using smart phrases. Takes me maybe 10 seconds to do the interpretation and it goes directly into my note.

 

[HardRoadPaved]

It is my understanding that you cannot do the official read and claim independent interpretation for billing of the office visit.

Agreed.

But you can get Level 4s pretty easy without worrying about points from xrays. Surgery discussion, rx management.

 

[PodGuy19]

Hey all.

With a the job market saturation and negativity, I was wondering what the job income would be like in three years? Honestly I know 300k and these crazy numbers are wild but I never expected that when I entered pod school. I was hoping more like 150k after residency but it seems like even that is hard to attain. What advice would you y’all give to someone in or about to start residency about the job market and what a decent salary should be ?

 

[HardRoadPaved]

3 years... gotta allow more time for Vision 21st century!

If you're entering residency, just be hungry, learn all you can, and hunt for jobs aggressively.....or you can just sit back and get absorbed into a PP group for 100k and hope you bonus up another 50-75k once "you market yourself"

 

[Pronation]

Hey all.

With a the job market saturation and negativity, I was wondering what the job income would be like in three years? Honestly I know 300k and these crazy numbers are wild but I never expected that when I entered pod school. I was hoping more like 150k after residency but it seems like even that is hard to attain. What advice would you y’all give to someone in or about to start residency about the job market and what a decent salary should be ?

My best guess is that you have about a 50/50 chance of making 150k vs 100k in PP depending on how greedy your boss is. Just understand that for the same amount of work that you put in while in PP, you would get paid double this in a hospital/MSG setting, and this is not an exaggeration.

 

[ExperiencedDPM]

However it is completely legit to bill for these patients since my resident is seeing the patient under my name and discussing with me

1) Wrong. It’s called fraud.

2) I’m sure the hospital and other staff would love to know it’s “your” resident.

3) simply discussing a patient with a resident is absolutely NOT justification for you to bill it under your name. The resident is not employed by you or your practice.

This exemplifies one of the many issues that exist with residency programs and attendings.

 

[Feli]

My best guess is that you have about a 50/50 chance of making 150k vs 100k in PP depending on how greedy your boss is. Just understand that for the same amount of work that you put in while in PP, you would get paid double this in a hospital/MSG setting, and this is not an exaggeration.

And triple that in PP within a few years of true partnership or ownership... with better hours, no call unless you want it. 🙂

Hey all.

With a the job market saturation and negativity, I was wondering what the job income would be like in three years? Honestly I know 300k and these crazy numbers are wild but I never expected that when I entered pod school. I was hoping more like 150k after residency but it seems like even that is hard to attain. What advice would you y’all give to someone in or about to start residency about the job market and what a decent salary should be ?

It is highly variable. $150k (guaranteed) is not hard to attain from pod PPs, esp bigger pod ones (or ortho groups or MSGs), but you will be expected to produce well. Smaller RPM groups might have less base but sometimes more realistic bonus or actual partner/owner chance.

The hospital jobs are good and fairly comfortable, but they are a "make your own luck" opportunity for sure. Persistence pays. Some are burnout recipes with call or inpt or just overall volume (just like a few PPs can be with volume or hocus pocus "grafts" and "testing"), so watch out for that. GL

 

[Pronation]

true partnership or ownership...

No doubt, but we know the above is rarely offered to pod associates. There’s also the headaches of running a business, but this is going off on a tangent.

 

[619]

The hospital jobs are good and fairly comfortable, but they are a "make your own luck" opportunity for sure. Persistence pays. Some are burnout recipes with call or inpt or just overall volume (just like a few PPs can be with volume or hocus pocus "grafts" and "testing"), so watch out for that. GL

A burn recipe working at a hospital making $300k plus benefits is still 10 times better than an associate podiatrist working at a chill 9-5 clinic (no call, no nights, no weekends, 2 hour lunch break etc) but making $100k a year. No one went to school for over 10 years to settle for a chill schedule with low pay. Most people after finishing a 3 years rigorous residency are ready to grab the bull by the horns and start making very good $$$.

 

[AttackNME]

I’m curious what would be a desirable income for a PP associate? Map out what you think would be a good income trajectory for PP (assuming full benefits)

I’ll go first:

Year 1-5 - 200k
Year 5-10 - 275k
Year 10-15 - 350k

 

[heybrother]

1) Wrong. It’s called fraud.

2) I’m sure the hospital and other staff would love to know it’s “your” resident.

3) simply discussing a patient with a resident is absolutely NOT justification for you to bill it under your name. The resident is not employed by you or your practice.

This exemplifies one of the many issues that exist with residency programs and attendings.

When you attest your note and then leave Dragon on.

 

[thefootfixer]

I’m curious what would be a desirable income for a PP associate? Map out what you think would be a good income trajectory for PP (assuming full benefits)

I’ll go first:

Year 1-5 - 200k
Year 5-10 - 275k
Year 10-15 - 350k

350k as an associate??? Never. Even 275 is extremely unlikely without some type of partnership structure .
200k is possible maybe year 5-10 (strictly as an associate) but will be a unicorn of a job

 

[LossToFollowUp]

I’m curious what would be a desirable income for a PP associate? Map out what you think would be a good income trajectory for PP (assuming full benefits)

My opinion of course is a broad stroke due to variability of pending location and how big/successful the established practice is. I think a relatively reasonable PP associate salaries that new graduates need to fight for are as follows and Of course numbers are based on a hard working individual that is working diligently

- 1st year starting salary of ~150k
- 2nd-3rd year =180-200K after incentives
- 3rd year and on = 250-300k+ (if not on partnership track)

. Why must 350K be locked behind a partnership? An associate generating 700K+ absolutely deserves 350K+ regardless of partnership or not.

 

[Pronation]

Why must 350K be locked behind a partnership?

I think we all know the obvious answer to that. Mustache Pod greed + saturation.

 

[619]

I’m curious what would be a desirable income for a PP associate? Map out what you think would be a good income trajectory for PP (assuming full benefits)

I’ll go first:

Year 1-5 - 200k
Year 5-10 - 275k
Year 10-15 - 350k

What everyone is leaving out is what is the contract negotiation? This determines current income and future income for an associate. There is a big difference between 20% vs 30% bonus after 3x collection vs 40% collection over 3x collection vs 20% collection over 2x collection ...... etc.

This is the ultimate decider in what maps out the current and future income of an associate.

So lets assume a typical podiatry associate contract. $100k and 25% to 30% "bonus" after 3x collection. I will let y'all do the maths. Assuming $700k collection after 3-5 years in practice.

Best case scenario for a podiatry contract: $100k base and 30% "bonus" collection. An associate collects $700k ( this is most likely not going to happen in the first 1-3 years) = Income will be $220,000.

I will also add. Everyone is magically assuming after 5 years or 10 years income will dramatically change. The best income change is between 1-3 or 5 years. After 5 years, your income is mostly the same (except for a new satellite clinic or dramatic patient volume change), the income is relatively the same after the 5 year mark ( I think even after 3 years). $275k to $350K is a little over a 25% increase in pay. Ask yourself if insurance reimbursement increased by 25% let alone 10%. We are facing a reduction in insurance reimbursement year after year. So where will the money come from?

It is comical to assume that reduction in insurance reimbursement will translate to increase in pay for an associate let alone business owner.

 

[Adam Smasher]

Why must 350K be locked behind a partnership? An associate generating 700K+ absolutely deserves 350K+ regardless of partnership or not.

I don't expect to make a lot of friends with this posting but here's a different perspective. I've been an associate and an owner, and I could probably hire an associate in a year or so.

In my business, my profit margins have been around 40% for the past few years. I would love to have 55% margins that some of you guys talk about but I just don't. Labor costs, less than desirable payer mix. If an associate generates 700k, and I pay this person half of that, I have a -10% return on this hire. May as well not bother.

OK fine but if the business margins are 40%, why not let the associate keep their 40%? That's like saying if you own a rental property, why would you charge the lessee any more than your operating costs? Reality is as an owner you are entitled to a slice of this person's income. Certainly, in a professional sense, we are all colleagues and equals, but within the structures of any organization, there exists a hierarchy that is subject to the forces of the labor market. And the labor market is ugg-leee.

In the past 10 years of my career, between finishing shool, going through residency, starting in PP, and becoming a partner, by far the LEAST stressful time in my life was when I was an associate. All you worry about is showing up on time and playing doctor. You don't have to worry about employees, or marketing, or setting office policy about COVID and other baloney. Yes I make a ton more as co-owner but I put in some hard hours, and my buy-in process wasn't exactly painless.

To be clear, I don't want to create a dead-end associate job. Nor do I want to offer an abusively low salary, just because there is value to me in not fostering resentment from my colleague. If I have a good doctor on my team I definitely want to give this person a reason to stick with me. I love the idea of creating a business opportunity where we can all succeed together. But just like I've seen it said on SDN and elsewhere not all of us are meant to be surgeons, neither are all of us meant to be business owners.

So anyway, to @LossToFollowUp I truly wish you the best of luck. If you're not satisfied with your salary and all offers are no better, pick yourself up and move to Bumblefunk, USA, start your business, generate your $700k and take your 40-55% home. This is the bitter sacrifice that our profession requires of us.

 

[Utvolsdpm]

I don't expect to make a lot of friends with this posting but here's a different perspective. I've been an associate and an owner, and I could probably hire an associate in a year or so.

In my business, my profit margins have been around 40% for the past few years. I would love to have 55% margins that some of you guys talk about but I just don't. Labor costs, less than desirable payer mix. If an associate generates 700k, and I pay this person half of that, I have a -10% return on this hire. May as well not bother.

OK fine but if the business margins are 40%, why not let the associate keep their 40%? That's like saying if you own a rental property, why would you charge the lessee any more than your operating costs? Reality is as an owner you are entitled to a slice of this person's income. Certainly, in a professional sense, we are all colleagues and equals, but within the structures of any organization, there exists a hierarchy that is subject to the forces of the labor market. And the labor market is ugg-leee.

In the past 10 years of my career, between finishing shool, going through residency, starting in PP, and becoming a partner, by far the LEAST stressful time in my life was when I was an associate. All you worry about is showing up on time and playing doctor. You don't have to worry about employees, or marketing, or setting office policy about COVID and other baloney. Yes I make a ton more as co-owner but I put in some hard hours, and my buy-in process wasn't exactly painless.

To be clear, I don't want to create a dead-end associate job. Nor do I want to offer an abusively low salary, just because there is value to me in not fostering resentment from my colleague. If I have a good doctor on my team I definitely want to give this person a reason to stick with me. I love the idea of creating a business opportunity where we can all succeed together. But just like I've seen it said on SDN and elsewhere not all of us are meant to be surgeons, neither are all of us meant to be business owners.

So anyway, to @LossToFollowUp I truly wish you the best of luck. If you're not satisfied with your salary and all offers are no better, pick yourself up and move to Bumblefunk, USA, start your business, generate your $700k and take your 40-55% home. This is the bitter sacrifice that our profession requires of us.

So is it really impossible to reduce overhead? It seems like a lot of costs would already be taken care of when hiring an associate making profit margins better?

 

[Aeki]

So is it really impossible to reduce overhead? It seems like a lot of costs would already be taken care of when hiring an associate making profit margins better?

Exactly. This is what practice owners love to leave out of the conversation. The moment you bring in an associate your overhead just got split in half (maybe not quite) because you are both contributing to the rent/staff/billing/emr/etc.

 

[dtrack22]

In my business, my profit margins have been around 40% for the past few years. I would love to have 55% margins that some of you guys talk about but I just don't.

You certainly aren’t wrong about making money off of an associate. As an associate I would personally prefer the practice owner(s) cook whatever “admin fee” into my overhead and then let me keep the rest. 10% of my collections isn’t enough when I bring in $300k? Fine. Take whatever monetary value you feel your extra work as an owner is, divide it over 12 months, and make it a part of my monthly overhead and then let me keep what I make beyond that.

The above quote is your big problem though. 60% overhead is awful. It’s unnecessary. If it’s absolutely necessary then your costs are too high, your billing/RCM is bad, or you need to stop taking sub Medicare payers.

Annnnd as someone mentioned above, adding an associate will decrease your overhead. You likely have to hire an additional MA, but you certainly don’t need any additional front office staff or management staff. EMR cost increases are negligible and billing is also negligible.

 

[Adam Smasher]

My biggest expenses are taxes, wages and benefits. (Yes I provide benefits.) Another doc = need another MA to clean rooms, another secretary to handle appts, possibly another biller for claims (depending on what you already have). I'll have other expense runups I don't want to get into for the sake of anonymity. Suffice to say overhead isn't static.

I acknowledge, however, there are economies of scale from having multiple docs under the same roof.

@dtrack22 , your example of a predetermined chunk of overhead to be carved out of the associate collectiond is disadvantageous to the owners, because it will disincentivize the associate from accepting an eventual buy-in offer. Ownership comes with perquisites.

And yes my practice is in a lousy part of the country where everything is expensive yet no one has money to pay their podiatrist.

 

[dtrack22]

another secretary to handle appts, possibly another biller for claims

There can be tipping points (ie going from 2 docs to 3) where additional staff is needed. But going from 1 to 2 does not require anything more than 1 additional part time MA. Now you might need a full time MA because you can’t find anyone to work limited hours in a lower paying position. But hiring an associate does not require you to increase staff proportionally across the board. It is not a 1:1 ratio of doctor to all staff. Especially not office manager, front office, or whatever billing staff/company you use.

If you are solo and you add an associate, once the associate has a reasonable schedule (4-5 months), your overhead as a % of revenue should decrease 100% of the time

your example of a predetermined chunk of overhead to be carved out of the associate collectiond is disadvantageous to the owners, because it will disincentivize the associate from accepting an eventual buy-in offer.

What’s your “buy in” offer going to be? Let’s say it’s the usual, insane podiatry buy in, $500k. And let’s pretend that number doesn’t disincentivize them from buying in on its own (which it would). If your yearly management/admin/owner fee is $50k, then why do you care if the associate buys in? You lose equity in the stuff you actually own, and in 10 years they have given you as much in admin fees as they would give you for a buy in. Why would you even want that person to buy in? Unless you want less business responsibilities, but that is going to come at a price.

Now let’s pretend you have a reasonable buy in, $200k. Your admin fee is $50k yearly. You think an associate won’t want to buy in for $200k when they are going to pay that out to you any ways over 4 years?

I don’t get why so many people here struggle with numbers. They can be manipulated in ways that are reasonable and borderline advantageous for everyone involved. Clearly the typical podiatry associate contract and buy in process doesn’t work that well. We all see the high associate turnover that exists within podiatry groups everywhere. Something isn’t working. My example is much more common in groups full of real doctors (ie ortho), but hey, everyone feel free to keep using contracts and partnership structures that haven’t worked over and over again for other podiatry practices. Seems like a winning formula…

 

[rrra]

Hello,
what are your guys thoughts on VA offer for 175K? Thank in advance for your input. Need some help sorting out options

 

[Adam Smasher]

@dtrack22 , unless you want me to relegate my associate to being a dremel, they're going to order imaging, the imaging is going to need PA, they're going to schedule cases, they're going to prescribe drugs pts/pharmacies will have questions about, etc. Someone's got to sit on the phone all day scheduling this. I want a doctor to be able to be a doctor and to have the support staff to coordinate that. We don't need 1-1 ratios, you're right.

And yes I already acknowledged there are economies of scale to having multiple docs under the same roof, otherwise multi-doc groups wouldn't exist.

@dtrack22 Do us both a favor and don't get sarcastic with me about struggling with numbers. I never suggested I was going do anything abusive. Just saying ownership comes with rights and privileges. Under a typical contract where a % of every $ the associate owns goes to the house, there's a strong incentive to buy in. Under the "admin fee" model, the incentive isn't as strong since they're already taking home much of what they would as partner with half the self-employment tax and zero admin obligations or liabilities.

 

[deleted285117]

Hello,
what are your guys thoughts on VA offer for 175K? Thank in advance for your input. Need some help sorting out options

Not a bad salary, amazing benefits and great quality of life. If you don’t have better options I would certainly take it. Your job security is also amazing.

 

[rrra]

Not a bad salary, amazing benefits and great quality of life. If you don’t have better options I would certainly take it. Your job security is also amazing.

Thank you for the feedback. Currently in a University position. Pay is based off of percentage (50%) and benefits are similar but not up to par with federal

 

[HardRoadPaved]

Reality is as an owner you are entitled to a slice of this person's income.

Life aint fair. Dont hate the player, hate the game.

 

[icebreaker32]

Thank you for the feedback. Currently in a University position. Pay is based off of percentage (50%) and benefits are similar but not up to par with federal

Remember you get COL increases annually and retention increases every couple years also. Maybe a few extra K for annual incentive bonuses.

The pension is not amazing, but nice (you do pay for it) and student loan programs if applicable. The vacation time is generous from year one.

 

[Pronation]

Hello,
what are your guys thoughts on VA offer for 175K? Thank in advance for your input. Need some help sorting out options

Isn’t the VA starting folks out at 200+ now? Either way I would take this gig in a heartbeat over working for another podiatrist.

 

[rrra]

The VA has a wide range in pay from what I'm experiencing. My current gig is comfortable and it has some potential to move up the ladder (ie assistant director at a residency) but the VA seems to be a jump in pay instantly at the moment. I have been in my current position 1 yr

 

[Pronation]

The VA has a wide range in pay from what I'm experiencing. My current gig is comfortable and it has some potential to move up the ladder (ie assistant director at a residency) but the VA seems to be a jump in pay instantly at the moment. I have been in my current position 1 yr

I hear nothing is more comfortable than the VA. If you are currently making less than 175k then this is a no brainer, unless you’re moving to a significantly crappier area.

 

[deleted285117]

The VA has a wide range in pay from what I'm experiencing. My current gig is comfortable and it has some potential to move up the ladder (ie assistant director at a residency) but the VA seems to be a jump in pay instantly at the moment. I have been in my current position 1 yr

Take it bro. Hard to get in the VA. Once you are in youre golden.

 

[bloxxeeey]

I’m curious what would be a desirable income for a PP associate? Map out what you think would be a good income trajectory for PP (assuming full benefits)

I’ll go first:

Year 1-5 - 200k
Year 5-10 - 275k
Year 10-15 - 350k

With student loan payments with the current tuition/cost of living and interest, you'd pay about 21K a year in interest assuming you don't pay down any of the loan. Current starting salary is 100k, after taxes in my state (lower income tax state) thats about 73K take home, subtract the student loans and thats 52K take home. If you would want to pay down the principal in 25 years that's about an extra 27k a year (I rounded down to be nice). So you'll have about 25k left to take home/spend on living. So I'd hope 150k starting at least so we could bump the take home to over 50k. I didn't factor in the costs for benefits/health insurance so take that out of your take home salary as well.

 

[dtrack22]

Under the "admin fee" model, the incentive isn't as strong since they're already taking home much of what they would as partner with half the self-employment tax and zero admin obligations or liabilities.

What if the admin fee is $100k? $200k?

That’s what I’m saying with making numbers work. A contract can be structured in such a way to incentivize or disincentivize whatever you want. Like I said, % of collections where associate has no idea where money is going, how much the practice is keeping, etc. is going really well for a lot of podiatry practices…

With your overhead running at 60%, what are you going to offer an associate? 30% of collections? That’s all you can afford and even then it’s questionable wether it’s worth it. So you take 10% of every dollar they bring in and they bring in $600k and you’ve added $60k to your personal gross pay. If your admin fee was $70k you come out ahead and associate knows exactly where their collections are going every month.

unless you want me to relegate my associate to being a dremel, they're going to order imaging, the imaging is going to need PA, they're going to schedule cases, they're going to prescribe drugs pts/pharmacies will have questions about, etc. Someone's got to sit on the phone all day scheduling this.

But they aren’t going to double your overhead. Your overhead will go down. You know this. I know this. Every group who has added docs or merged with other groups (which is done largely for overhead reasons, increasing take home pay for owners of the groups) knows this. So when you hire an associate and they get up to speed, which should be within a few months if you actually need an associate, without taking any of their collections you would see a bump in take home pay. Labor is your largest expense, if hiring one person doesn’t double labor costs then you get to keep more money. Why do you keep skirting around that fact and pretending like it isn’t true?

 

[Utvolsdpm]

Hello,
what are your guys thoughts on VA offer for 175K? Thank in advance for your input. Need some help sorting out options

It’s ok for a new grad with no experience

 

[Boba Foot]

With student loan payments with the current tuition/cost of living and interest, you'd pay about 21K a year in interest assuming you don't pay down any of the loan. Current starting salary is 100k, after taxes in my state (lower income tax state) thats about 73K take home, subtract the student loans and thats 52K take home. If you would want to pay down the principal in 25 years that's about an extra 27k a year (I rounded down to be nice). So you'll have about 25k left to take home/spend on living. So I'd hope 150k starting at least so we could bump the take home to over 50k. I didn't factor in the costs for benefits/health insurance so take that out of your take home salary as well.

If you graduated from school in 2019 like I did and repayments started right when the freeze began, you'd be a fool to pay back your loans. I've had a free 3 years of forgiveness toward 20 year forgiveness through PAYE and by the time loans start back up again it very well could turn a 20 year plan into a 15 year plan. In addition to not being able to take more than 10% of my income a year.

 

[PMG03470]

If you graduated from school in 2019 like I did and repayments started right when the freeze began, you'd be a fool to pay back your loans. I've had a free 3 years of forgiveness toward 20 year forgiveness through PAYE and by the time loans start back up again it very well could turn a 20 year plan into a 15 year plan. In addition to not being able to take more than 10% of my income a year.

I’m confused as to how you got 3 years of forgives when the payments stopped? I was told that you only got those years of forgiveness if you still MADE payments during the pause.