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[dtrack22]

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I was going through yelp and maps of my area of interest, and saw 3 private practices on yelp that have no website or info on the doctor at all. Just their names as the business on yelp, or some generic "yada yada footcare".
I googled all of the docs, and there's no info on them at all, like school, training, etc. No hospital or industry affiliations. Nothing!!! lol

All of the pics on yelp or google reviews are like from 2009-2022 at the latest. All of the reviews seem to be relatively old, like from 2007-2022. Nothing from 2024 and beyond (which I find odd lol).

I blocked my number and called the listed # to see if these are closed down (and thus the older reviews and no websites), and each one is still open shockingly. (I just pretended to be a patient asking for the website lol)

These are the few practices in my area that either, (a) have not been bought by the PE-firms, or (b) aren't already ran by relatively younger, entrepreneurial type pods (who have websites, IG-pages, etc.)

How in the world do these places get business or stay open with no website or information or anything? lol
I am assuming these are all older docs. I am almost tempted to stop by and see if one of them wants to hire an associate for a sweat equity type buy-out deal lol.

When you see 15-20 RFC type patients daily, you don’t really have to advertise at some point. Your schedule is full with returning customers in perpetuity. You just have to run lean and squeeze as much money as you can out of Medicare during those visits…

 

[Boba Foot]

When you see 15-20 RFC type patients daily, you don’t really have to advertise at some point. Your schedule is full with returning customers in perpetuity. You just have to run lean and squeeze as much money as you can out of Medicare during those visits…

The only problem with this business model is that your clientele is actively dying off.

 

[Feli]

...How in the world do these places get business or stay open with no website or information or anything? lol
I am assuming these are all older docs. I am almost tempted to stop by and see if one of them wants to hire an associate for a sweat equity type buy-out deal lol.

There is no point to buy something you can easily just create. Do that.
Unless it's an area REALLY hard to break in, you don't want buy a bunch of C&C pts.
Better to start up, try to attract stuff you like (and the C&C and wound nonsense will still find you also).

Hospital DPMs rely mostly on forced refers (from their ER, hospital employed MDs in same facility/system, etc).

In PP, it's all community... all you really need is a few local PCP relationships.
The ads (fb, goog, etc) attract the worst and most drama pts typically. Best to work on PCPs.
I have lowered my marketing budget year to year... basically just minimum now. I have a long wait list... yet nearby supergroup shows up "sponsored result" and can see pts same/next day, hah).

 

[footpainhealer]

When you see 15-20 RFC type patients daily, you don’t really have to advertise at some point. Your schedule is full with returning customers in perpetuity. You just have to run lean and squeeze as much money as you can out of Medicare during those visits…

lol can a practice even survive on nail debridement codes. If they are seeing these return patients, they can't really bill a follow up office visit and are likely just billing the nail debridement code, but maybe that's enough for them to live the way they want.

Sometimes I see these practices pop up for sale on p.m. news or APMA website or whatever it was and the description says their gross revenue is like 250 K or 300 K and it never made sense to me cause that seems so little. That should be what you are actually making as net income, not your gross practice revenue but if a lot of the older docs are doing just 20 RFC per day then I guess it kind of makes sense???

"Description of Practice: Well-established, busy 27-year general practice for sale. Podiatric physician is retiring. Part of a small group practice with separate offices and staff. Has a wide physician referral base and a diversified patient base. Revenue is $350K."

Like this for example. Ad says it's a 2-5 practitioner office. 350K revenue for 1 person seems small. For 2-5 people, ridiculous lol

 

[footpainhealer]

In PP, it's all community... all you really need is a few local PCP relationships.
The ads (fb, goog, etc) attract the worst and most drama pts typically. Best to work on PCPs.

Yeah, I think when/if I open up my own, I'm going to have to look elsewhere from where I'm currently living to be able to build these relationships with PCP's.

I live in an area where the majority of PCP's are associated with a huge university (multiple med schools in this region), massive HMO, or large private group that has 30+ docs. The only small mom and pop primary care practices I see around here are in the hood, and I'm assuming they're getting some kind of state funding to see Medicaid or uninsured patients.

 

[heybrother]

lol can a practice even survive on nail debridement codes. If they are seeing these return patients, they can't really bill a follow up office visit and are likely just billing the nail debridement code, but maybe that's enough for them to live the way they want.

Sometimes I see these practices pop up for sale on p.m. news or APMA website or whatever it was and the description says their gross revenue is like 250 K or 300 K and it never made sense to me cause that seems so little. That should be what you are actually making as net income, not your gross practice revenue but if a lot of the older docs are doing just 20 RFC per day then I guess it kind of makes sense???

"Description of Practice: Well-established, busy 27-year general practice for sale. Podiatric physician is retiring. Part of a small group practice with separate offices and staff. Has a wide physician referral base and a diversified patient base. Revenue is $350K."

Like this for example. Ad says it's a 2-5 practitioner office. 350K revenue for 1 person seems small. For 2-5 people, ridiculous lol

dtrack already explained this. The practice will have 1-2 staff. It could just be a doctor and his wife. No fancy EHR. No upkeep on the office. Straight out of the 80s. No health insurance for employee(s). Shockwave machine sitting around gathering dust. Broken nail nippers duct taped back together. The patient's are scheduled every 61-65 days as opposed to 3-4 months or PRN so that the same patient generates the maximum encounters. Writes letter to PM News complaining about how expensive DEA license is. 11720 + 11056 + g0127 + 99212 as much as possible. Patients who are just nails are a bottom line loser ($30-50), but adding calluses can add like $75 and adding a 99212 adds $50ish. Somewhere out there right now is a old private practice doctor shaking his head wondering why the young pods are so miserable when he's making "easy money" - $100-150+ for an encounter in his office trimming nails/calluses and writing a lamisil topical prescription. Meanwhile, commercial insurances are paying $50-75 for a 99213. A few years ago a 11056+11720 was worth more than a BCBS 99214. No call. No hospitals. If all the patients pay for Medicare part B + supplement - no effort in collecting money beyond the deductible. This is the office equivalent of nursing homes which some people out there actually believe is god's work.

This person also doesn't work 5 days a week. They don't worry about their post-ops cause they don't have any.

I'm not trying to put this person on a pedestal. I'm just telling you that a broken system creates bizarre incentives. There are people out there potentially grinding out $2-3 in collections a day doing very little who think they've somehow found a cheat code.

 

[footpainhealer]

dtrack already explained this. The practice will have 1-2 staff. It could just be a doctor and his wife. No fancy EHR. No upkeep on the office. Straight out of the 80s. No health insurance for employee(s). Shockwave machine sitting around gathering dust. Broken nail nippers duct taped back together. The patient's are scheduled every 61-65 days as opposed to 3-4 months or PRN so that the same patient generates the maximum encounters. Writes letter to PM News complaining about how expensive DEA license is. 11720 + 11056 + g0127 + 99212 as much as possible. Patients who are just nails are a bottom line loser ($30-50), but adding calluses can add like $75 and adding a 99212 adds $50ish. Somewhere out there right now is a old private practice doctor shaking his head wondering why the young pods are so miserable when he's making "easy money" - $100-150+ for an encounter in his office trimming nails/calluses and writing a lamisil topical prescription. Meanwhile, commercial insurances are paying $50-75 for a 99213. A few years ago a 11056+11720 was worth more than a BCBS 99214. No call. No hospitals. If all the patients pay for Medicare part B + supplement - no effort in collecting money beyond the deductible. This is the office equivalent of nursing homes which some people out there actually believe is god's work.

This person also doesn't work 5 days a week. They don't worry about their post-ops cause they don't have any.

I'm not trying to put this person on a pedestal. I'm just telling you that a broken system creates bizarre incentives. There are people out there potentially grinding out $2-3 in collections a day doing very little who think they've somehow found a cheat code.

Thank you for the detailed response. Makes much more sense now with numbers and scenarios.

These guys have to be embellishing their physical exams to be able to do this right. There were so many people in our clinic in residency who would come in for routine foot care cause their PCP or someone they know told them to, although they met zero class findings. So of course we always explain that to them and declined.

I'm gonna guess a practice in this scenario or one that does nursing homes calls everything atrophic skin, neuropathic, fungal, absent of hair, etc. regardless of if the patient actually has any of that. I was also told callus paring is not a service that gets reimbursed except under very specific conditions. For the people that were normally healthy, but had a painful callous, it was just an office visit with no follow ups scheduled.

 

[heybrother]

Thank you for the detailed response. Makes much more sense now with numbers and scenarios.

These guys have to be embellishing their physical exams to be able to do this right. There were so many people in our clinic in residency who would come in for routine foot care cause their PCP or someone they know told them to, although they met zero class findings. So of course we always explain that to them and declined.

I'm gonna guess a practice in this scenario or one that does nursing homes calls everything atrophic skin, neuropathic, fungal, absent of hair, etc. regardless of if the patient actually has any of that. I was also told callus paring is not a service that gets reimbursed except under very specific conditions. For the people that were normally healthy, but had a painful callous, it was just an office visit with no follow ups scheduled.

Yep. You've seen it already. I can't perfectly tell you this person's motivation. They may simply believe that all diabetics are high risk. The other more problematic answer is that they were already going to cut the calluses as a form of treatment/service to the patient and qualifying the patient means the service is reimbursed. The other possibility is the patient already told the doctor that another podiatrist cuts these for me and the podiatrist simply sees an easier path out of the room through acquiesence.

A similar fun scenario - a patient present with a lesion that is pretty clearly a callus, but the patient believes it is a plantar wart. The podiatrist has a financially compelling interest to also believe the lesion is a wart - calluses codes are uncovered, but 17110 can be paid near $200 even in my lower reimbursing area. Podiatrists aren't the only physicians doing this. PCPs and dermatologists in my area mercilessly freeze calluses and ulcers.

EDIT: "I was also told callus paring is not a service that gets reimbursed except under very specific conditions." - Yes, Q7-9.

 

[Dermato Fight Club]

dtrack already explained this. The practice will have 1-2 staff. It could just be a doctor and his wife. No fancy EHR. No upkeep on the office. Straight out of the 80s. No health insurance for employee(s). Shockwave machine sitting around gathering dust. Broken nail nippers duct taped back together. The patient's are scheduled every 61-65 days as opposed to 3-4 months or PRN so that the same patient generates the maximum encounters. Writes letter to PM News complaining about how expensive DEA license is. 11720 + 11056 + g0127 + 99212 as much as possible. Patients who are just nails are a bottom line loser ($30-50), but adding calluses can add like $75 and adding a 99212 adds $50ish. Somewhere out there right now is a old private practice doctor shaking his head wondering why the young pods are so miserable when he's making "easy money" - $100-150+ for an encounter in his office trimming nails/calluses and writing a lamisil topical prescription. Meanwhile, commercial insurances are paying $50-75 for a 99213. A few years ago a 11056+11720 was worth more than a BCBS 99214. No call. No hospitals. If all the patients pay for Medicare part B + supplement - no effort in collecting money beyond the deductible. This is the office equivalent of nursing homes which some people out there actually believe is god's work.

This person also doesn't work 5 days a week. They don't worry about their post-ops cause they don't have any.

I'm not trying to put this person on a pedestal. I'm just telling you that a broken system creates bizarre incentives. There are people out there potentially grinding out $2-3 in collections a day doing very little who think they've somehow found a cheat code.

And yes. Exactly this. And this is not like some small minority of the profession. Unfortunately it is a large percentage.

The problem is that I do not see it getting any better. It's really only going to get worse. We have implemented a 3 year residency for everyone and for what? Students come out thinking that the whole profession has changed and that they won't be like those old podiatrists doing that type of work. Well guess what. You know what hasn't changed? Just because we now graduate 500 foot and ankle surgeons does not mean that there are more people breaking their ankles.

At some point, you are going to need to eat (ok maybe not eat but vacation, buy a new sports car whatever you like to do with extra money). And you will learn that yeah you can make decent money doing pretty easy, mundane procedures (cutting nails, trimming callouses). Also, it is the reason that a lot of people come to see a podiatrist, because that is what they think a podiatrist does.

One of my biggest annoyances that I encounter almost daily is a new patient coming in wanting their nails cut who has no risk factors yet they were seeing someone else for several years who had just retired or they recently moved. This happens on a weekly basis and I literally have to have a discussion with the patient regarding this. I feel like 90% of them have just retired from New York. "I don't understand why Medicare wouldn't cover it now. They've been covering it for years."

Do you know how much easier it would be to just go along and continue the fraud vs. arguing with them about how they do not meet the criteria?

I mean I totally understand why there are a large percentage of older podiatrists doing this and continuing to practice later in life. This work takes zero thought. You can literally copy/paste every note and be in and out of the room in less than 5 minutes. You could see 20 patients in like 4 hours 3 days a week and net probably 100-150k/year.

I'm just not sure why we continue to fight for this type of work. (Ok I know why we do. We literally can not survive without it.) Didn't the APMA recently contest nurses cutting toenails for people that are diabetic/too fat/blind/nails too thick etc. to cut them themself? (I'm sorry. I meant to say patients who are at risk). I'm really not sure what the APMA thinks I'm supposed to be? Am I an orthopedic surgeon or a pedicurist?

Meanwhile, while most of the profession is dealing with these types of issues on a daily basis, to get board certified we are expected to be up to date on TAR and Ankle fusion and OCD drilling techniques as if 90% of us have even sniffed this type of stuff since residency.

 

[Hybrocure]

I’m still trying to figure out why PCPs can bill 20 patient visits a day without any additional codes outside of a level 3 office visit and make 250-350k and we can’t.

The math doesn’t add up.

 

[footpainhealer]

I’m still trying to figure out why PCPs can bill 20 patient visits a day without any additional codes outside of a level 3 office visit and make 250-350k and we can’t.

The math doesn’t add up.

lol this is so true. We spent a month with medicine and covered their outpatient clinics sometimes (and they spent a month with us as an elective). Our schedule for the day was 30-45 patients, theirs was always 1 patient every 30 mins. The clinics are open the same 8 hours per day, so it was 16 patients MAX for them, sometimes less. It was funny when their residents came to spend the month with us cause they'd be startled at the volume and procedures we did in clinic.

I know what my hospital staff attendings made annually, and we figured out what the outpatient IM/FM docs make because one of their residents that spent a month with us signed with the hospital system to be outpatient PCP; it was 75K more. Yet our clinic was seeing 2x/3x the amount of patients, covering inpatient and ED call, doing cases, doing procedures, etc. These were not hospitalists BTW, strictly outpatient PCP's. The hospitalists were different.

One of my podiatry attendings said he always had a theory that we get paid less for the exact same codes by the insurers and the government. Like for both an office visit if we're comparing to PCP (same 99203) and for something like a STJ fusion if comparing to ortho. I think it must be true just based on the difference in salaries we can see between us and PCPs and us and foot/ankle ortho.

 

[Feli]

...One of my podiatry attendings said he always had a theory that we get paid less for the exact same codes by the insurers and the government. Like for both an office visit if we're comparing to PCP (same 99203) and for something like a STJ fusion if comparing to ortho. I think it must be true just based on the difference in salaries we can see between us and PCPs and us and foot/ankle ortho.

"Theory"?

It's called a fee schedule. They have them for each specialty. They are based mostly on area COL, relative need for that specialty in that area. It can be negotiated a bit on some of them, but they're usually standard for area/specialty (take it or leave it).

Humana pays podiatry different than derm or plastic for same ablation or excision lesion or etc codes in same county/area.
BCBS pays podiatry different than ortho or PM&R for ankle ORIF or intermediate joint inject or cast/wrap etc in same county/area.
MCR is standard... MCA is mostly through the companies ("carriers") and variable by area/specialty.

Fam/IM do have some other codes they can use o the office visits that pay more than standard 9920x and 9921x, though.

So hey, let's open some more pod schools!

 

[dtrack22]

"Theory"?

It's called a fee schedule. They have them for each specialty. They are based mostly on area COL, relative need for that specialty in that area. It can be negotiated a bit on some of them, but they're usually standard for area/specialty (take it or leave it).

Humana pays podiatry different than derm or plastic for same ablation or excision lesion or etc codes in same county/area.
BCBS pays podiatry different than ortho or PM&R for ankle ORIF or intermediate joint inject or cast/wrap etc in same county/area.
MCR is standard... MCA is mostly through the companies ("carriers") and variable by area/specialty.

Fam/IM do have some other codes they can use o the office visits that pay more than standard 9920x and 9921x, though.

So hey, let's open some more pod schools!

This is part of it. But the other poster was describing an employed family medicine doc. Family medicine generates nearly the same downstream revenue for a hospital as an orthopedic surgeon. They make higher salaries in employment models because the hospital can afford (or simply has to, in order to attract new hires) to give them a higher % of the professional fees that they generate. Especially when compared to a Podiatrist.

If we are specifically talking about hospital based practices (even “outpatient” clinics on the hospital “campus”), there are essentially 3 pools of money being generated by the physician. 1) Professional fees, aka the E/M and CPT codes that the physician bills. 2) facility fees, which generally cover most/all of the support staff and supply costs. 3) Downstream revenue, aka OR facility fees, Imaging, Labs, referrals to other docs in the system. A hospital cannot pay a physician more than they generate in professional fees, meaning, they can’t give you a cut of the facility fees or imaging/lab revenue that you generate. That’s illegal. But, since they can pay everyone else with that money, they can theoretically pay you every dollar you bring in for your services. A PCP can easily generate $400k in professional fees, and the hospital can give them most of that as salary because A) they have to in order to be competitive when trying to hire doctors where there is more demand than supply (practically everyone but Podiatry), and B) that PCP generates $2-3 million in downstream revenue. Hard to feed your lab and surgical specialists without the gatekeepers to those referrals.

Compare that to someone in a true outpatient, non-hospital based clinic. They generate the same professional fees, but have to pay all of their overhead out of those fees.

To take it one step further, compare 20 visits where 99204 is billed vs 99203. The higher level office visits generate 20 more wRVUs. At $50 per wRVU, that’s $1000. The difference isn’t as drastic with established visits, but 20 99214 vs 99213 is still a 12 wRVU difference. Billing higher level E/M alone would account for somewhere around 10 less patient encounters every day while still generating the same revenue. A PCP does not need the same clinic volume as a DPM in order to generate the same $. And they aren’t replaceable to the same degree as a DPM. None of which has anything to do with insurance paying them more for the same code. In fact, in any employed model, it has absolutely nothing to do with compensation packages. In part because it isn’t happening (we all bill through the hospitals NPI and therefore your degree doesn’t change what any insurer reimburses for your services). And in part because, the hospital can’t find enough PCPs to hire but they can find 100 people to replace any of us. Except for the eye bro…he is, after all, one of us now…

 

[Adam Smasher]

Many good replies here.

This is why I keep saying we're running out of things to talk about. I keep coming back to my ecological metaphor about podiatry occupying the role of bottom feeder. Those docs with c&c operations found a niche doing the medical care that no one else wants to do. They don't need to hunt for it (advertise, maintain a website, network), it just settles to the bottom.

It's not hard to qualify people for nail/callus care. My LCD says you only need absent sensation at 2 monofilament sites to qualify for LOPS. And a decent percentage of 80+ year olds have idiopathic neuropathy. Even if they don't, everyone aged 70 and older grew up when smoking was cool, so pad findings are there if you just screen for it.

None of the above makes me smart or a good doctor, it just means I know how to scavenge for work where there really isn't that much. Because whenever there's an environmental upheaval, who survives? The bottom feeders. 🦞

 

[Weirdy]

A PCP can easily generate $400k in professional fees, and the hospital can give them most of that as salary because A) they have to in order to be competitive when trying to hire doctors where there is more demand than supply (practically everyone but Podiatry), and B) that PCP generates $2-3 million in downstream revenue. Hard to feed your lab and surgical specialists without the gatekeepers to those referrals.

Compare that to someone in a true outpatient, non-hospital based clinic. They generate the same professional fees, but have to pay all of their overhead out of those fees.

To take it one step further, compare 20 visits where 99204 is billed vs 99203. The higher level office visits generate 20 more wRVUs. At $50 per wRVU, that’s $1000. The difference isn’t as drastic with established visits, but 20 99214 vs 99213 is still a 12 wRVU difference. Billing higher level E/M alone would account for somewhere around 10 less patient encounters every day while still generating the same revenue. A PCP does not need the same clinic volume as a DPM in order to generate the same $. And they aren’t replaceable to the same degree as a DPM. None of which has anything to do with insurance paying them more for the same code. In fact, in any employed model, it has absolutely nothing to do with compensation packages. In part because it isn’t happening (we all bill through the hospitals NPI and therefore your degree doesn’t change what any insurer reimburses for your services). And in part because, the hospital can’t find enough PCPs to hire but they can find 100 people to replace any of us. Except for the eye bro…he is, after all, one of us now…

Dead on.

 

[heybrother]

I'm in an ACO and the impression I'm under is the PCPs receive the majority of the quality pot of money because they are the ones who have to hit the majority of the metrics. I'm now having to do depression screenings for mine which is a bummer. badum-pshh!

 

[Hybrocure]

Happy Halloween 🎃

 

[ExperiencedDPM]

Below are details on a job opening that meets your specialty and location preference.
If you would like to apply for this job, please reply to this email with a copy of your CV.

General Podiatry opening in Finger Lakes Region, NY
Preferred Specialty: Podiatry, Surgery
Would Also Consider: Podiatry
Type: Permanent-Full Time

Job Description:
Actively recruiting a Board Certified/Board Eligible General Podiatrist to join our collegial team of Orthopedic and Podiatric Surgeons and Advanced Practitioners. Enjoy a balanced professional and personal lifestyle in a suburban community that offers all the amenities of a larger metropolitan area. Connect with like-minded physicians sharing common goals. Blend your talents to enhance the practice, the health system, and the community in an environment where physicians, practices and families thrive. Arnot Health is committed to providing all our providers with state-of-the-art practice settings along with full support staff.

Opportunity Information:

Provide comprehensive foot and ankle care in outpatient and inpatient setting, including surgery when indicated
Participate in diabetic foot management and wound care
Collaborate with multispecialty groups such as orthopedics, endocrinology and wound care teams

Income Details / Benefits:

• Highly Competitive Salary Guarantee with Incentives
• $240k-$270k
• Employment Bonus
• Loan Repayment
• Generous PTO allowance
• CME Days
• Relocation
• Residency / Fellowship Stipend
• Full Malpractice Insurance
• Health, Vision, Dental Benefits
• 401(k) and/or 403(b)

Once your CV is received, we will work on coordinating a call for you to connect with the head of recruitment for this job.

If you would like to view our other job postings, you can do so at: AllPhysicianCareers

 

[footpainhealer]

Are fqhc jobs typically considered decent or poor overall? I went through some old post and it seems like most of them are non-op, but some of them are. I passed all 4 ABFAS exams and would like to work somewhere where I can actually operate and get cases for full certification.

There are a couple of clinics in areas that actually are not that rural that I've seen have posted ads for hiring.

There was also one that I saw in Winter 2024 - Spring 2025 for a HRSA PCP clinic that was looking to hire a podiatrist. For some reason, the ad is gone and the actual clinics never hired a podiatrist cause I just went on their website today and they either never found one or for some reason decided not to. Does anyone with more knowledge on FQHC/HRSA practices know why they would have an ad up for like eight months and then not hire anyone and not even keep the ad up?

 

[heybrother]

Are fqhc jobs typically considered decent or poor overall? I went through some old post and it seems like most of them are non-op, but some of them are. I passed all 4 ABFAS exams and would like to work somewhere where I can actually operate and get cases for full certification.

There are a couple of clinics in areas that actually are not that rural that I've seen have posted ads for hiring.

There was also one that I saw in Winter 2024 - Spring 2025 for a HRSA PCP clinic that was looking to hire a podiatrist. For some reason, the ad is gone and the actual clinics never hired a podiatrist cause I just went on their website today and they either never found one or for some reason decided not to. Does anyone with more knowledge on FQHC/HRSA practices know why they would have an ad up for like eight months and then not hire anyone and not even keep the ad up?

Maybe they weren't able to secure funding for the position.

 

[Aresnebula]

Does anyone have an idea regarding these military jobs? How are they compensated and is it better than private office jobs?

 

[DYK343]

Are fqhc jobs typically considered decent or poor overall? I went through some old post and it seems like most of them are non-op, but some of them are. I passed all 4 ABFAS exams and would like to work somewhere where I can actually operate and get cases for full certification.

There are a couple of clinics in areas that actually are not that rural that I've seen have posted ads for hiring.

There was also one that I saw in Winter 2024 - Spring 2025 for a HRSA PCP clinic that was looking to hire a podiatrist. For some reason, the ad is gone and the actual clinics never hired a podiatrist cause I just went on their website today and they either never found one or for some reason decided not to. Does anyone with more knowledge on FQHC/HRSA practices know why they would have an ad up for like eight months and then not hire anyone and not even keep the ad up?

I have a little experience here.

You can negotiate operative abilities outside the FQHC.

You might have to purchase your own malpractice insurance if you want to operate.

Or take call at hospital and present to FQHC how many new patients they can bring in if youre on call and operating.

FQHC gets federal grants if they continue to grow. So new patient visits are vital to their model. A 99024/post op does not matter. They still get reimbursed a flat fee per head (99024/992x3/992x4/992x5 all pay the same) and still get to check the box that they have a new patient which is very important to their overall longevity. On paper they are growing even if only 1-2 post ops before the patient leaves the system.

They will eat this up. Tell them to cover your malpractice insurance for surgery if you bring in more patients and they will. Negotiate reimbursement for surgery. Shoot for 95% of surgeon fee going to surgeon with a 5% billing fee. Something along those lines. FQHC is typically a flat salary in clinic. Sometimes a small bonus structure. But if you add in 95% of surgery fee it can be decent income.

 

[ParNoMoney]

I have worked for two different FQHCs over the last sixteen years. At one of the FQHCs I worked at it was not unusual for ads to remain posted long after the position was filled. FQHC podiatry is typically non-surgical. At my previous FQHC I did minor bone procedures: hammertoes, exostoses. My current facility is not equipped to perform these procedures. As for surgical opportunities, 70-80% of the patients are Medicaid or Medicare insured. Additionally, many have multiple morbidities and make for poor surgical candidates. Compliance is another issue. Also, FQHCs are seen as a primary care facility. Most administrators would rather you spend your time onsite. Lastly, you won't get rich at a FQHC but the pay and benefits allow you to maintain a stable income. There are little out of work responsibilities.

 

[footpainhealer]

I have a little experience here.

You can negotiate operative abilities outside the FQHC.

You might have to purchase your own malpractice insurance if you want to operate.

Or take call at hospital and present to FQHC how many new patients they can bring in if youre on call and operating.

FQHC gets federal grants if they continue to grow. So new patient visits are vital to their model. A 99024/post op does not matter. They still get reimbursed a flat fee per head (99024/992x3/992x4/992x5 all pay the same) and still get to check the box that they have a new patient which is very important to their overall longevity. On paper they are growing even if only 1-2 post ops before the patient leaves the system.

They will eat this up. Tell them to cover your malpractice insurance for surgery if you bring in more patients and they will. Negotiate reimbursement for surgery. Shoot for 95% of surgeon fee going to surgeon with a 5% billing fee. Something along those lines. FQHC is typically a flat salary in clinic. Sometimes a small bonus structure. But if you add in 95% of surgery fee it can be decent income.

Thank you for the detailed explanation.
So are these a private company that is doing all this or is it a state and/or federal run clinic? Either way, sounds like there is potential for the centers to lose grants and funding with the current political structure????. So maybe sketchy in the short and long run.

So if I am understanding this correctly, wherever I would operate, the FQHC has nothing to do with that at all? So like if I asked to get privileges at a hospital or at a surgery center, that's all on my own and the FQHC doesn't care or help with on boarding or privileging fees or anything like that? And for follow ups, I would be allowed to give the clinic address at the FQHC for let's say inpatient cases at a hospital that I covered?
And let's say a patient does have private insurance and they're admitted and I do a toe amp, are those patients still allowed to come to the FQHC clinic for follow ups or are they not allowed to because they have private insurance?

 

[footpainhealer]

I have worked for two different FQHCs over the last sixteen years. At one of the FQHCs I worked at it was not unusual for ads to remain posted long after the position was filled. FQHC podiatry is typically non-surgical. At my previous FQHC I did minor bone procedures: hammertoes, exostoses. My current facility is not equipped to perform these procedures. As for surgical opportunities, 70-80% of the patients are Medicaid or Medicare insured. Additionally, many have multiple morbidities and make for poor surgical candidates. Compliance is another issue. Also, FQHCs are seen as a primary care facility. Most administrators would rather you spend your time onsite. Lastly, you won't get rich at a FQHC but the pay and benefits allow you to maintain a stable income. There are little out of work responsibilities.

Hmmm interesting. So they tend to be more clinic based and don't really care about surgery? That defeats the purpose for me then lol.

Not saying I want to be someone that operates all the time, but I have a limited window of time to get abfas cert so I don't want to waste time somewhere for a year or two where I'm not even getting cases.

 

[Aresnebula]

MSG group: 1099 with 60% collection (production based). First few months they will pay me based on market value (TBD but room to negotiate). Issue is no medical malpractice paid. After 1 year, can buy in for partnership and then you can collect 40% of the leftover profits (so if GI earns more than me, I still get to reap their profits). I can set my own hours since I am production based. Operate at surgery center. Call is TBD but don't think it's required since it's internal referral source mostly. They pay for marketing, etc. What do you guys think?

 

[DYK343]

Thank you for the detailed explanation.
So are these a private company that is doing all this or is it a state and/or federal run clinic? Either way, sounds like there is potential for the centers to lose grants and funding with the current political structure????. So maybe sketchy in the short and long run.

So if I am understanding this correctly, wherever I would operate, the FQHC has nothing to do with that at all? So like if I asked to get privileges at a hospital or at a surgery center, that's all on my own and the FQHC doesn't care or help with on boarding or privileging fees or anything like that? And for follow ups, I would be allowed to give the clinic address at the FQHC for let's say inpatient cases at a hospital that I covered?
And let's say a patient does have private insurance and they're admitted and I do a toe amp, are those patients still allowed to come to the FQHC clinic for follow ups or are they not allowed to because they have private insurance?

Its hard to say. They are all individual but also all under the government umbrella at the same time. There may be variances in clinic to clinic. You're going to have to ask these questions with admin. But pitch the above strongly.

FQHCs are proven to be huge money savers for the system and typically have strong bipartisan support. Who knows what will happen in the future. Things can change.

 

[footpainhealer]

Its hard to say. They are all individual but also all under the government umbrella at the same time. There may be variances in clinic to clinic. You're going to have to ask these questions with admin. But pitch the above strongly.

FQHCs are proven to be huge money savers for the system and typically have strong bipartisan support. Who knows what will happen in the future. Things can change.

Yeah that's why it's confusing to me as to figuring out what they are lol. They seem like private, physician owned practices or groups. They have a CEO, COO, CFO, etc., so they maybe some investors or group owns them??? lol

The ones I was interested in look like any medium PCP group with multiple location, but they also have optometry, dentistry, and even do aesthetic medicine like botox, lip filler, weight loss etc. Which doesn't seem very "FQHC is for the underserved population" to me lol.

From what I gathered from the FM/IM world, these places are for people that truly went into healthcare to help people. They left or turned down jobs offering significantly more income, to help the underserved. I like that idea and would very much be interested in this at some point, but I think as a new grad, I need to use this time to learn coding, billing, surgery without the backup of an attending, etc. All the normal stuff.

It does seem like a good gig for when you're older (aka loans paid off and ABFAS certified) and wanting to slow down and help people in the community that would otherwise get left behind.

 

[DYK343]

Yeah that's why it's confusing to me as to figuring out what they are lol. They seem like private, physician owned practices or groups. They have a CEO, COO, CFO, etc., so they maybe some investors or group owns them??? lol

The ones I was interested in look like any medium PCP group with multiple location, but they also have optometry, dentistry, and even do aesthetic medicine like botox, lip filler, weight loss etc. Which doesn't seem very "FQHC is for the underserved population" to me lol.

From what I gathered from the FM/IM world, these places are for people that truly went into healthcare to help people. They left or turned down jobs offering significantly more income, to help the underserved. I like that idea and would very much be interested in this at some point, but I think as a new grad, I need to use this time to learn coding, billing, surgery without the backup of an attending, etc. All the normal stuff.

It does seem like a good gig for when you're older (aka loans paid off and ABFAS certified) and wanting to slow down and help people in the community that would otherwise get left behind.

FQHC have very interesting pathology that walks in the door. They can be very academic.

ABFAS numbers shouldn't be an issue.

You also have a lot of crack heads and homeless.

Also, don't take MD/DO advice on job prospects. Their job market is a million-fold better than DPMs.

You should be able to clear 300+k as a new grad at a FQHC if you play your cards right with yearly increase in salary.

 

[med2345]

MSG group: 1099 with 60% collection (production based). First few months they will pay me based on market value (TBD but room to negotiate). Issue is no medical malpractice paid. After 1 year, can buy in for partnership and then you can collect 40% of the leftover profits (so if GI earns more than me, I still get to reap their profits). I can set my own hours since I am production based. Operate at surgery center. Call is TBD but don't think it's required since it's internal referral source mostly. They pay for marketing, etc. What do you guys think?

Health benefits ect since you’re 1099 or no?

 

[heybrother]

MSG group: 1099 with 60% collection (production based). First few months they will pay me based on market value (TBD but room to negotiate). Issue is no medical malpractice paid. After 1 year, can buy in for partnership and then you can collect 40% of the leftover profits (so if GI earns more than me, I still get to reap their profits). I can set my own hours since I am production based. Operate at surgery center. Call is TBD but don't think it's required since it's internal referral source mostly. They pay for marketing, etc. What do you guys think?

Imagine you are offered one of the following:
40% + health insurance + malpractice + 4% 401k match
or
60% and you pay for all of the above yourself.

Your ability to make an extra 20% is unconstrained - the more you bring in the more you keep and you are keeping 50% more than most practice arrangements. Meanwhile, your benefits can be quantified ie. a malpractice plan, health insurance plan have fixed costs. A crappy health insurance plan costs $6-8K. Or you could do a Christian plan or Crowd Health to try and save money and take advantage of being young and healthy. Additionally, paying for your own malpractice means you control ie. they can't simply purchase a crappy claims made and dump tail on you. At some point the extra 20% in collections should cover these costs which are fixed.

What's the catch. I don't know. People have described "predatory" orthopedic practices in the past where you had to cover your own overhead and overhead became overwhelming unless you could immediately produce. People who could produce though might view these practices as amazing since once overhead is covered their income is unlimited.

My suspicion - they'll immediately expect you to produce/work hard. How do you build a practice where people keep 60%. Presumably great contracts and people wanting to grind.

 

[footpainhealer]

FQHC have very interesting pathology that walks in the door. They can be very academic.

ABFAS numbers shouldn't be an issue.

You also have a lot of crack heads and homeless.

Also, don't take MD/DO advice on job prospects. Their job market is a million-fold better than DPMs.

You should be able to clear 300+k as a new grad at a FQHC if you play your cards right with yearly increase in salary.

The other person that replied to me said they (FQHC's) are mostly non-op, and if they are op, its small things.
The old posts on this podiatry forum about fqhc say they're basically all non-op and low paying.

And here you are throwing a wrench in that with that # and good amount of interesting cases lol. Even 200K as new grad would be decent.

Alot to think about. I may call the place tomorrow and ask to talk to HR or the CMO and ask about surgery. The ad only lists 8-4pm clinic 4 days per week and does not mention surgery at all.

 

[DYK343]

The other person that replied to me said they (FQHC's) are mostly non-op, and if they are op, its small things.
The old posts on this podiatry forum about fqhc say they're basically all non-op and low paying.

And here you are throwing a wrench in that with that # and good amount of interesting cases lol. Even 200K as new grad would be decent.

Alot to think about. I may call the place tomorrow and ask to talk to HR or the CMO and ask about surgery. The ad only lists 8-4pm clinic 4 days per week and does not mention surgery at all.

Yep call and ask.

I did 10+ cases a week of all difficulty at a FQHC. It was a good gig at the time. Saw some wild stuff.

I did four 8hr days of clinic for a set stipend (with a small production bonus - which really wasnt worth working extra hard for). All new patients 30 min. All follow ups 15 min (company standard). I didnt care because it was basically salaried. I sat in my office a lot because FQHCs have a high no show rate.

Fridays were mine to take off or schedule surgery and make extra cash. I usually did a few cases at hospital during week and stacked friday cases at the surgery center.

I did eventually run into a salary cap where I wasnt going to produce much more in terms of money so I moved on.

But for a new grad it was good and I got ABFAS foot/ankle cert within 1 year.

When I left I was making circa 350k a year (base salary at FQHC + surgery income).

 

[footpainhealer]

Yep call and ask.

I did 10+ cases a week of all difficulty at a FQHC. It was a good gig at the time. Saw some wild stuff.

I did four 8hr days of clinic for a set stipend (with a small production bonus - which really wasnt worth working extra hard for). All new patients 30 min. All follow ups 15 min (company standard). I didnt care because it was basically salaried. I sat in my office a lot because FQHCs have a high no show rate.

Fridays were mine to take off or schedule surgery and make extra cash. I usually did a few cases at hospital during week and stacked friday cases at the surgery center.

But for a new grad it was good and I got ABFAS foot/ankle cert within 1 year.

When I left I was making circa 350k a year (base salary at FQHC + surgery income).

I'm sorry, what in the actual *beeeeep*. Most pods 20 years deep in the game don't even pull those numbers (/s, but I suspect its actually true lol)

Why are these jobs not talked about more frequently or more positively on SDN? The few times FQHC's are mentioned in the podiatry forums, it's all negative "patient suck, the work sucks, the money sucks, no surgery" blah blah.
I will say the 2 I'm looking at have starting salaries of 130-180k. Doesn't say anything about bonus. Was yours higher? 350K sounds like a huge jump from ~150k (if we guesstimate 150k is the avg. hrsa/gqhc salary).

Are they rare or competitive?

1 patient every 15 mins is light work, 1 every 30 is insane (even if they are new) lol.
Just one resident at our clinic was seeing 2-3 people at the same time that were slotted in 15 min sections (didn't matter if new or f/u), including having to do the coding (just not the billing).

1 patient at a time would be heaven

 

[air bud]

I'm sorry, what in the actual *beeeeep*. Most pods 20 years deep in the game don't even pull those numbers (/s, but I suspect its actually true lol)

Why are these jobs not talked about more frequently or more positively on SDN? The few times FQHC's are mentioned in the podiatry forums, it's all negative "patient suck, the work sucks, the money sucks, no surgery" blah blah.
I will say the 2 I'm looking at have starting salaries of 130-180k. Doesn't say anything about bonus. Was yours higher? 350K sounds like a huge jump from ~150k (if we guesstimate 150k is the avg. hrsa/gqhc salary).

Are they rare or competitive?

1 patient every 15 mins is light work, 1 every 30 is insane (even if they are new) lol.
Just one resident at our clinic was seeing 2-3 people at the same time that were slotted in 15 min sections (didn't matter if new or f/u), including having to do the coding (just not the billing).

1 patient at a time would be heaven

Lol. 1 new patient every 30 and 15 established is the norm bro. If you are seeing real pathology and not just busting crumblies. I see 18 to 22 a day, usually 12ish new every day. Maybe 1 new nail patient every other day and maybe 1 repeat nail patient a week. No nails bros, just say no.

Seeing 2 to 3 at a time....tell me you are in nail jail without telling me you are in nail jail.

 

[ParNoMoney]

Could you share the name of the FQHC you worked at that paid you 350,000$? That is about twice the salary of any other podiatry FQHC. (Was this a FQHC-look alike?) Just for comparison, the last FQHC I worked at the highest paid employees were the OB about 290000$ and the CMO 275000$. Thank you.

 

[Aresnebula]

Health benefits ect since you’re 1099 or no?

No benefits. Got more clarification today: I can come on in as a W2 as well but that would be 40-45% collections with all benefits paid including malpractice. So I have the option to be 1099 or W2. Unsure which one would be the best.

 

[med2345]

No benefits. Got more clarification today: I can come on in as a W2 as well but that would be 40-45% collections with all benefits paid including malpractice. So I have the option to be 1099 or W2. Unsure which one would be the best.

Pretty good percentage either way. As the above has said depends on if you’d eat more than you kill with percentage and pay yourself or have a decent/good collection and baseline benefits. My deal is pretty similar.

 

[heybrother]

Start pricing health insurance and malpractice policies.

 

[DYK343]

I'm sorry, what in the actual *beeeeep*. Most pods 20 years deep in the game don't even pull those numbers (/s, but I suspect its actually true lol)

Why are these jobs not talked about more frequently or more positively on SDN? The few times FQHC's are mentioned in the podiatry forums, it's all negative "patient suck, the work sucks, the money sucks, no surgery" blah blah.
I will say the 2 I'm looking at have starting salaries of 130-180k. Doesn't say anything about bonus. Was yours higher? 350K sounds like a huge jump from ~150k (if we guesstimate 150k is the avg. hrsa/gqhc salary).

Are they rare or competitive?

1 patient every 15 mins is light work, 1 every 30 is insane (even if they are new) lol.
Just one resident at our clinic was seeing 2-3 people at the same time that were slotted in 15 min sections (didn't matter if new or f/u), including having to do the coding (just not the billing).

1 patient at a time would be heaven

I think I started at 240k but that was years ago and I cant really remember.

With yearly salary increases and 95% of the surgeon fees I was up to circa 350k by the time I left.

FQHCs are full of money. Dont let them trick you. They are rolling in dough.

Could you share the name of the FQHC you worked at that paid you 350,000$? That is about twice the salary of any other podiatry FQHC. (Was this a FQHC-look alike?) Just for comparison, the last FQHC I worked at the highest paid employees were the OB about 290000$ and the CMO 275000$. Thank you.

Not a FQHC looks alike. I worked for a FQHC.

 

[footpainhealer]

No benefits. Got more clarification today: I can come on in as a W2 as well but that would be 40-45% collections with all benefits paid including malpractice. So I have the option to be 1099 or W2. Unsure which one would be the best.

This is a MSG? For some reason I figured bigger groups like this would rather have you on as a full-time employee since they already have relationships and contracts with a health insurance company, as well as a malpractice company, etc. Plus, I'm sure it is easier from an accounting perspective to have all the employees be W2.

60% sounds really good. Overhead for a practice based on what I've read here seems to be ~50%. If they're paying you 60%, how are they making any money? Unless this is one of those situations where it's a hospital and they're getting higher facility fees for every thing you see.

 

[Aresnebula]

This is a MSG? For some reason I figured bigger groups like this would rather have you on as a full-time employee since they already have relationships and contracts with a health insurance company, as well as a malpractice company, etc. Plus, I'm sure it is easier from an accounting perspective to have all the employees be W2.

60% sounds really good. Overhead for a practice based on what I've read here seems to be ~50%. If they're paying you 60%, how are they making any money? Unless this is one of those situations where it's a hospital and they're getting higher facility fees for every thing you see.

They have other specialties there who are also on 1099. They also operate at their own surgery centers so I am guessing those other specialties are probably bringing in a lot more money wise. My only issue is no benefits are paid so I am unsure if I pay for my own benefits, do I end up making more in the long run? I don't know. There is also partnership after a year where you can tap into the leftover profits from all the other specialties which sounds very attractive to me. They are trying to expand and add other specialties but we will see.

 

[Aresnebula]

Start pricing health insurance and malpractice policies.

Should I cover my own tail right now? Because that is like 12k or more.

 

[FootPhalanges]

What would be reasonable call compensation per day for taking additional hospital call covering limb salvage/wounds? Currently we are required to be q3 call in a metro area. Does $500 seem reasonable or should I go higher? My base is $240K with rvu value of $40.00 above 5000. These numbers appear low to me.

Does anyone have the most recent MGMA or Sullivancotter data for 2024? I am looking to renegotiate.

 

[DYK343]

What would be reasonable call compensation per day for taking additional hospital call covering limb salvage/wounds? Currently we are required to be q3 call in a metro area. Does $500 seem reasonable or should I go higher? My base is $240K with rvu value of $40.00 above 5000. These numbers appear low to me.

Does anyone have the most recent MGMA or Sullivancotter data for 2024? I am looking to renegotiate.

Try to get a stipend for un or underinsured patients from hospital.

I got medicare rates when I was on paid call.

I got somwhere around that number daily.

 

[Feeter]

What would be reasonable call compensation per day for taking additional hospital call covering limb salvage/wounds? Currently we are required to be q3 call in a metro area. Does $500 seem reasonable or should I go higher? My base is $240K with rvu value of $40.00 above 5000. These numbers appear low to me.

Does anyone have the most recent MGMA or Sullivancotter data for 2024? I am looking to renegotiate.

Call is around 600$ per day in my area

wRVU should be $46 per wRVU at least to say it's reasonable in my opinion which is still low compared to surveys like MGMA. So If you do MGMA average wRVUs of 6800 annually with your base and bonus it ends up being just shy of 46. So it's an average offer.

Your call is too frequent and not sustainable long term without residents or APP.

 

[footpainhealer]

I feel like over all these years from undergrad through residency that I have been on SDN, I have seen a ton of posts and discussions saying podiatrists don't get paid to be on call at hospitals.

And now, I have seen questions of getting paid to take call on here and reddit. lol

Did something change? Are most pods in private practice that cover ED and inpatient call now getting paid? That would be awesome.

 

[dtrack22]

Did something change? Are most pods in private practice that cover ED and inpatient call now getting paid?

A majority of DPMs taking call are doing so for free. An increasing number of podiatrists are getting compensated for call coverage. Those statements are not mutually exclusive. Both can be true.

 

[Weirdy]

I feel like over all these years from undergrad through residency that I have been on SDN, I have seen a ton of posts and discussions saying podiatrists don't get paid to be on call at hospitals.

And now, I have seen questions of getting paid to take call on here and reddit. lol

Did something change? Are most pods in private practice that cover ED and inpatient call now getting paid? That would be awesome.

I don't get paid at all to cover ED
They still find my number somehow on the privileges list and call me on a Friday at 7pm for an uninsured toe amp that's not even my patient.

Its usually an ER resident who just needs some help so I give recs, try to remember the other groups around (who -surprise-also don't take call) and apologize.

Stressful enough running by yourself.

Why do I need to go back to residency days doing free *&^( while my kid wonders where dada is?
I never thought like this at all during residency. Just drink the Koolaid, keep your head down, work hard so you learn.

Now that I'm out.....I wish people told me what the real world is like when you don't have an army of residents doing the footwork for you.

 

[Adam Smasher]

Majority of DPMs in my community use weaponized incompetence to get out of call. They say something to the effect of "This is beyond my expertise and I do not do these types of surgeries. I would recommend consultation with vascular or orthopedics or transfer to a tertiary care facility." They'll write that in their note and then sign-off. If call participation is mandatory per your hospital bylaws, then that's how you weasel out of the work while following the letter of the rules, if not the spirit.

Usually the hospitalist then calls my partner or me in on a courtesy basis, and we both have mixed feelings about agreeing to do these consults, but if we were to ever flat out refuse then there would be some political turmoil between admin, the hospitalist service, and the rest of the DPMs around me that will bring me great amusement.