The pod I shadow told me pods only work full-time in VA hospitals. On the other hand, I've had people tell me they think pods can work in all hospitals. Are these people confused by the pods that have private practices and are on call at hospitals?? Or do pods indeed work full-time in any and all hospitals, for the most part?
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Pods in hospitals
- Thread starter umass319
- Start date
Most pods do some type of work in hospitals, whether it's surgery, admissions, or consults. Not many are employed full time by hospitals. I am. Some primarily work in hospitals (wound center or medical office building), but are in private practice.
I shadowed a podiatrist for a while that worked in the orthopedic section of the hospital. His office was in the hospital. He was hired on there specifically for his experience in wound care as he is in charge of the entire wound clinic at the hospital. He did a little bit of everything. Surgery every other week, wound clinic every Wednesday. Consults and check-ups with the basic pod stuff the other days. He was busy constantly.
With the exception of diabeticfootdr, I personally know of very few DPM's that are actually employed by a hospital, other than VA hospitals.
There may be some in California that are employed by Kaiser Permanante (sp), which is actually a health plan that may run/own hospitals and/or practices.
So, although there may be a few DPM's that are hired by hospitals other than VA hospitals, I would say it's safe to say that the number is extremely small, and in 20+ years of practice, I have never personally met one.
There may be some in California that are employed by Kaiser Permanante (sp), which is actually a health plan that may run/own hospitals and/or practices.
So, although there may be a few DPM's that are hired by hospitals other than VA hospitals, I would say it's safe to say that the number is extremely small, and in 20+ years of practice, I have never personally met one.
the pod i shadowed told me this was the case and i was hoping maybe she just wasnt keeping up with the times; i visited a pod school recently and this was one of the main things i wanted to get cleared up. it's frustrating how many pod students didn't have a clue. what's more, a pod student i spoke a lot with, who i left with a ton of respect for, told me he intended to work for a hospital upon finishing his residency - he looked at me like i had 15 heads when i posed our VA question, and said they're in all the hospitals.... how do u miss something like that about your own profession.
anyways, 1) is this changing?? are hospitals trending towards increased pod positions?? 2) where are the orthopedic groups hiring pods located?? are they in clinics? orthopedic private practices??
anyways, 1) is this changing?? are hospitals trending towards increased pod positions?? 2) where are the orthopedic groups hiring pods located?? are they in clinics? orthopedic private practices??
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seriously?????
EDIT: SORRY, I thought the you asked what a VA hospital was. I was trying to be a jerk and it backfired. I was wondering how you seem to know what you are talking about and then don't know what a VA hospital is. I will try and be more accurate with my insults and disparaging remarks, as well as trying to limit the best ones to Theta and The Darklord
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I think you might find some DPMs employed full-time at Community hospitals, similar to Broadlawns where diabeticfootdr works.
umass, is it your desire to be employed by a hospital full-time (versus working for a private group and having privileges at a hospital)? If so, may I ask what it is about the arrangement that appeals to you?
umass, is it your desire to be employed by a hospital full-time (versus working for a private group and having privileges at a hospital)? If so, may I ask what it is about the arrangement that appeals to you?
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Living in Mass and in Boston i've gotten a lot of exposure to one of the greatest hospital systems in the world.. not sure if you've ever been in the boston area near Northeastern University, but longwood ave. is a street that runs between brigham and womens hospital, dana farber cancer institute, beth israel deaconess, joslin diabetes center and some others. at lunch time that street is literally filled with nurses and doctors. you go to state street in boston at lunch time, you find salesman and suits; longwood ave, you find nothing but doctors and scrubs - for me, it's mecca for all those interested in medicine and helping people and it appeals to me for too many reasons to list. the environment is just something i want to be around. to me, it seems like ground zero for the fight against pretty much everything that makes people sick, and I want to be a part of that. i would miss that in a private practice or in a practice where i had priviledges at a hospital.
What kind of pathologies do you think majority of Pods treat every day?
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I believe you may want to re-think your career choice, since at the PRESENT time, the number of hospital based podiatric practices are very limited.
And the number of hospital based podiatric practices at major prestigious institutions is even more limited. You are caught in a world of fantasy at the present time, walking around in an area of world famous medical institutions in Boston.
Yes, Harvard/New England Deaconess, Yale, do sponsor podiatric residency programs and employ DPM's, but those salaried positions are far and few between at the present time.
For those that are familiar with Philadelphia, the city is filled with amazing medical institutions and medical schools. There is University of Pennsylvania, Jefferson, Temple, Hahnemann, Children's Hospital, and all of these instituations are filled with great docs and the streets outside are bustling with docs, reps, students, residents, etc., just as you described.
However, NONE of these institutes employs a DPM. As a matter of fact, most aren't very "friendly" to DPM's. U of P has a division, Prespy, which does have the famous residency program with Dr. Downey, Hahnemann now has a residency program, but up until just a few years ago, NO DPM was allowed to perform surgery. Temple University has a 4 year program but the residents are actually scattering to find a place to call 'home" since the actual Temple University Hospital doesn't really have room for them or want them!
So, the "short" answer to your question is that at the PRESENT time, the amount of non VA hospitals hiring DPM's is minimal at best. So if your fantasy is to be at some major teaching university to save the world, you may be in for a disappointment.
As far as orthopedic groups hiring DPM's, there is no one answer to that question. There are all types of orthopedic groups hiring DPM's across the country, and it simply depends on the attitude of the orthopods. With the increasing amount of well trained DPM's graduating, those positions will eventually become more and more difficult to obtain. There are only X amount of positions available, and those are being filled each year.
There's nothing wrong with having a balance of a private practice and still having a strong presence at your hospital. It's a great way to have the best of both worlds. It's simply the quality of care you give, no matter where it's given.
And the number of hospital based podiatric practices at major prestigious institutions is even more limited. You are caught in a world of fantasy at the present time, walking around in an area of world famous medical institutions in Boston.
Yes, Harvard/New England Deaconess, Yale, do sponsor podiatric residency programs and employ DPM's, but those salaried positions are far and few between at the present time.
For those that are familiar with Philadelphia, the city is filled with amazing medical institutions and medical schools. There is University of Pennsylvania, Jefferson, Temple, Hahnemann, Children's Hospital, and all of these instituations are filled with great docs and the streets outside are bustling with docs, reps, students, residents, etc., just as you described.
However, NONE of these institutes employs a DPM. As a matter of fact, most aren't very "friendly" to DPM's. U of P has a division, Prespy, which does have the famous residency program with Dr. Downey, Hahnemann now has a residency program, but up until just a few years ago, NO DPM was allowed to perform surgery. Temple University has a 4 year program but the residents are actually scattering to find a place to call 'home" since the actual Temple University Hospital doesn't really have room for them or want them!
So, the "short" answer to your question is that at the PRESENT time, the amount of non VA hospitals hiring DPM's is minimal at best. So if your fantasy is to be at some major teaching university to save the world, you may be in for a disappointment.
As far as orthopedic groups hiring DPM's, there is no one answer to that question. There are all types of orthopedic groups hiring DPM's across the country, and it simply depends on the attitude of the orthopods. With the increasing amount of well trained DPM's graduating, those positions will eventually become more and more difficult to obtain. There are only X amount of positions available, and those are being filled each year.
There's nothing wrong with having a balance of a private practice and still having a strong presence at your hospital. It's a great way to have the best of both worlds. It's simply the quality of care you give, no matter where it's given.
Well you have pod residencies at Beth Israel Deaconess, Mass General, and Cambridge Health Alliance. Mass General only takes one person a year and does not have an active externship program - so you cannot rotate there 3rd/4th year (you can visit though). All these residencies are harvard teaching hospitals.
I believe there's a few others in the Boston area...Metrowest in Framingham & the Boston VA. Also one in Worcester.
You should contact Dr. John Giurini, chief of podiatry at Beth Israel Deaconess...allows students to shadow. They seem to be huge in wound care in that residency as well.
I can PM you the number + address if you would like.
PADPM,
I think I struck a nerve or something. First, thanks very much for this:
"So, the "short" answer to your question is that at the PRESENT time, the amount of non VA hospitals hiring DPM's is minimal at best."
But, second, I'm not sure what to think of all the extra BS you decided to add for some reason. I'm caught in a world of fantasy walking around medical institutions in boston?? My exposure there simply inspired me to want to go into medicine and I want to get back there someday. Regardless, it's a simple concept - I'm interested in medicine and helping people, so I want to work in hospitals.
Cool_vkb,
I see no reason why the main foot pathologies treated by podiatrists can't be considered with other pathologies treated in hospitals that make people sick. Feet are exceedingly important. You receive 8 years of education and you do a 3 year residency to become an expert on feet. You should be in demand in hospitals. Why shouldn't you be able to clip toenails and then reconstruct a Charcot foot next to the dermatologist that treats acne and then suppresses necrotising fasciitis? Regardless, I think your field is changing and I think you'll begin to see more pods hired full-time in hospitals, no thanks to people like you and PADPM. PADPM, you're telling me I should rethink podiatry because "AT PRESENT" (I used caps because I'm quoting you. I usually don't use caps because I think it looks ridiculous; I picture you mashing the keys as you type and yelling at the computer) hospital based pod practices are limited…. Did u insert "AT PRESESENT" because you anticipate increased positions in the future?? I'm not sure, but if you did, then I have to question where you're coming from when you tell me I should rethink podiatry. I think you guys need to embrace the changes that are coming your way.
I think I struck a nerve or something. First, thanks very much for this:
"So, the "short" answer to your question is that at the PRESENT time, the amount of non VA hospitals hiring DPM's is minimal at best."
But, second, I'm not sure what to think of all the extra BS you decided to add for some reason. I'm caught in a world of fantasy walking around medical institutions in boston?? My exposure there simply inspired me to want to go into medicine and I want to get back there someday. Regardless, it's a simple concept - I'm interested in medicine and helping people, so I want to work in hospitals.
Cool_vkb,
I see no reason why the main foot pathologies treated by podiatrists can't be considered with other pathologies treated in hospitals that make people sick. Feet are exceedingly important. You receive 8 years of education and you do a 3 year residency to become an expert on feet. You should be in demand in hospitals. Why shouldn't you be able to clip toenails and then reconstruct a Charcot foot next to the dermatologist that treats acne and then suppresses necrotising fasciitis? Regardless, I think your field is changing and I think you'll begin to see more pods hired full-time in hospitals, no thanks to people like you and PADPM. PADPM, you're telling me I should rethink podiatry because "AT PRESENT" (I used caps because I'm quoting you. I usually don't use caps because I think it looks ridiculous; I picture you mashing the keys as you type and yelling at the computer) hospital based pod practices are limited…. Did u insert "AT PRESESENT" because you anticipate increased positions in the future?? I'm not sure, but if you did, then I have to question where you're coming from when you tell me I should rethink podiatry. I think you guys need to embrace the changes that are coming your way.
Although you may never be a part of the "white coat fraternity" as a podiatrist and work at Havard. By dealing with DM wounds, and foot and ankle issues you will be a valued team member for the patients you care for. Given this, the medical community at large is beginning to understand what we can do and want to send us patients to take care of their problems. There are more opportunities for DPM's today than ever before. Don't discount what you want based on what someone has said on an internet forum. It will be almost a decade before you actually have your first job. Things will not be the same then, as they are now. If you want to work in a certain environment you should get to know guys doing what you want to do and build a relationship with them so you can have a mentor to help you get where you want to. Relationships are everything.
I think there may be a misunderstanding. There IS a big demand in many hospitals for DPM's. As PADPM stated, I also know of instances where DPM's are employed by hospitals but this is not the rule. However, DPM's are constantly consulted by hospitals. In other words, the DPM's have their own groups/practices but their offices are called by other Drs working in hospitals with consults. So they do hold hospital privileges and surgical privileges and do work within the hospitals. However, they are not employed by the hospitals. I'm currently in a huge hospital system where pods are consulted daily. Many podiatrists are on staff and take floor/ER call. But again, they are not employed by the hospital.
In my job search I have talked with many hospitals where this is the case. While many pods encorporate hospitals and ER's into their practice, they are not employed by them.
jonwill, thanks for your time and input, but no confusion here. we're talking specifically about full-time attending podiatric physicians in hospitals; I've learned here that they're very few and far between. You mention, "There IS a big demand in many hospitals for DPM's." do you see this translating into more full-time positions in the future at hospitals outside the VA system?
Possibly. Quite frankly, I'm not sure why more hospitals don't hire podiatrists. As it is procedural medicine, it can be quite lucrative. It may just be because it's the way its always been done. I know if an instance a few years ago where a hospital brought 4 different pods in a week until one of them went to the CEO and discussed hiring one pod full time. The hospital now has 3 full time podiatrists.
Iam writing what iam actually seeing on ground. Majority of Pods work in private practices and usually have affiliations with hospitals where they perform surgery or admit patients.
So basically you think interest in Medicine and helping people is only done in hospital. Other people in private practice are ...........
Whoa now "umass319",
Let's take a step back and not be a hypocrite. You blasted me for using capital letters when I used the term "PRESENT", though I wasn't "screaming", but simply attempting to emphasize the point that's the way it is "now" and not in the future.
Ironically, when jonwill provided an excellent answer and also used capital letters when he stated "There IS a big demand........" you didn't seem to have any problem with him "screaming at you".
I also take significant offense at your statement "I think your field is changing and I think youll begin to see more pods hired full-time in hospitals, no thanks to people like you and PADPM".
You know absolutely nothing about me, yet you take the liberty to insult me, simply because I decided to give you an honest answer based on my 20+ years of experience. I take significant offense at your comment because I have done a helluva lot for my profession to move it forward, and probably more than you will ever do for this profession. I've done a lot to assure the guys like you will have a three year residency. I've busted my ass to assure that guys like you will even have hospital privileges. If you want, I'll elaborate;
When I first arrived at some of the hospitals where I practice, they only allowed DPM's to perform trivial procedures, not admit patients, etc. After years of fighting, I opened up the hospital to ALL (yes I used capitals) qualified DPM's to perform their own H&P's, admit on their own service and perform foot & ankle surgery.
I served as a residency director for a surgical residency for many years and took the time, energy and lot of my own money to create that residency program, and never received one dime in return (some residency directors get a stipend). As a result, I've trained and/or have given many DPM's the opportunity to have an excellent residency training.
I've had hundreds of students, interns/externs and residents rotate through my office.
I've served on various levels of the American Podiatric Medical Association and it's component organizations. I've served on committees of the American College of Foot & Ankle Surgeons and I served as an examiner for the board certification exam for the American Board of Podiatric Surgery for over 10 years.
So I sincerely resent you telling me "no thanks to PADPM" when I've contributed countless hours of my time to my profession, in order for ungrateful people like you to sling unwarranted insults.
I stated and will continue to state the facts. You can still be a "real" doctor and not be employed by a hospital. I provide the highest quality of care available, and perform the entire spectrum of procedures from nail care to applying external frames. I spend time in my office and spend time in the hospital and all my patients appreciate the care given just as much.
You made the inference that you're interested in helping people, so you want to work in hospitals. Does that mean that I'm not helping patients when I'm not in the hospital? Does that mean that my neighbor who is one of the most respected internists in my geographic area isn't "helping people" when he's not in the hospital and is "only" in his office?
You certainly don't need to tell me how to embrace changes or what changes to embrace. As previously stated, when I started practice I had to fight just to perform minor surgeries at some hospitals, and now I'm performing major reconstructive surgeries at those same hospitals.
But change doesn't happen simply because you want it to, but it's something you have to work for and fight for over a long time.
Health care is changing drastically, and although I would LOVE (yes I used capitals again) to see DPM's employed by every hospital, it's something I simply don't foresee happening in the near future. Hospitals are cutting back costs and simply don't "need" to hire DPM's. They are hiring hospitalists for inpatient care because internists are actually limiting their time in the hospital.
The bottom line is that the harsh reality is that at the present time there are very few hospitals hiring full time DPM's other than VA's. Yes, there are always exceptions, but presently those are minimal.
I hope that changes and I have worked my ass off in the past to advance this profession, but I simply don't see that change coming soon.
If you don't want or like honest answers, or only want to read answers that you're "looking" for, don't ask the question.
And in the future you may want to show a modicum of respect to those that have preceded you.
There are people on this messageboard who can help you immensely, but your above response to an Attending (and a seasoned one at that) is inappropriate. Consider that PADPM is someone who has "been there." Even cool_vkb, as a podiatry student, is further along the process than you and has insight from which you could benefit. Even though this is an anonymous forum, it is still a professional forum and I think it would be helpful for you to pretend that you are addressing your potential colleagues face-to-face.
ya'll done made the man so mad, he had to state his credentials AGAIN (in capital letters) LOL.....i love this capital letter yelling system.
NatCH,
Thanks for your support. As usual, your wisdom is appreciated.
phillypd,
As usual, your post is pointless. Although you may not understand it because you've accomplished nothing in this profession, when I'm insulted by someone like you, or like umass who hasn't even entered the profession yet, I feel obligated to regurgitate my credentials "again", especially when I'm basically accused of doing nothing for my profession. If I have to remind you or let someone like umass know that I didn't spend my career simply sitting in the background apathetically, I'll keep reminding you.
It's amazing that despite NatCH's post regarding showing some level of respect and professionalism, you still chose to post your comments.
And if you or anyone else read my post, the use of capital letters was not to "scream" at anyone, but was used in lieu of using bold letters to simply emphasize my point.
Now if you don't have anything constructive to add to a thread, why don't you simply find something better to do with your time?
Thanks for your support. As usual, your wisdom is appreciated.
phillypd,
As usual, your post is pointless. Although you may not understand it because you've accomplished nothing in this profession, when I'm insulted by someone like you, or like umass who hasn't even entered the profession yet, I feel obligated to regurgitate my credentials "again", especially when I'm basically accused of doing nothing for my profession. If I have to remind you or let someone like umass know that I didn't spend my career simply sitting in the background apathetically, I'll keep reminding you.
It's amazing that despite NatCH's post regarding showing some level of respect and professionalism, you still chose to post your comments.
And if you or anyone else read my post, the use of capital letters was not to "scream" at anyone, but was used in lieu of using bold letters to simply emphasize my point.
Now if you don't have anything constructive to add to a thread, why don't you simply find something better to do with your time?
I was waiting to reply to the original question until I heard back from a colleague to whom I passed your query this morning. He just replied to me that he is employed by Boston University and works at Boston Medical Center. He said that there are "quite a few situations like that" in Boston, for instance BI Deaconess. He does a lot of diabetic inpatient limb salvage type work and likes it pretty well.
The drawbacks of working for a hospital would be similar to those working for any large group: lack of control over administrative factors.
The drawbacks of working for a hospital would be similar to those working for any large group: lack of control over administrative factors.
To the OP:
If your dream is to work for the hospital as a DPM then go to pod school, do the best you can and learn as much as you can, get a great residency in a large hospital system - like a University Hospital or the one you may want to practice at one day. Make sure the program is very well integrated with all the specialties that you rotate on, that those specialties treat you just like any other resident and have the same expectations of as anyother resident.
Join your GME (graduate medical education) association and attend the meetings. Also ensure that the hospital that you are a resident at is equal between the ACGME sponsered programs and the CPME sponsored programs.
The important thing about the GME is that you can get to know those involved with hospital policy and medical education.
This will probably help you reach your goal, but it is not a garuntee. If you will be miserable not practicing in a hospital then I suggest going into internal medicine and becoming and internist. Then there is an almost garuntee of ending up in a hospital, especially the ones in Boston, that really are not terribly podiatry friendly.
During this whole process as someone else has mentioned before find someone that does something similar to what you want to do and shadow them and make them your mentor.
Good Luck.
Dream big, then work hard to achieve it!
If your dream is to work for the hospital as a DPM then go to pod school, do the best you can and learn as much as you can, get a great residency in a large hospital system - like a University Hospital or the one you may want to practice at one day. Make sure the program is very well integrated with all the specialties that you rotate on, that those specialties treat you just like any other resident and have the same expectations of as anyother resident.
Join your GME (graduate medical education) association and attend the meetings. Also ensure that the hospital that you are a resident at is equal between the ACGME sponsered programs and the CPME sponsored programs.
The important thing about the GME is that you can get to know those involved with hospital policy and medical education.
This will probably help you reach your goal, but it is not a garuntee. If you will be miserable not practicing in a hospital then I suggest going into internal medicine and becoming and internist. Then there is an almost garuntee of ending up in a hospital, especially the ones in Boston, that really are not terribly podiatry friendly.
During this whole process as someone else has mentioned before find someone that does something similar to what you want to do and shadow them and make them your mentor.
Good Luck.
Dream big, then work hard to achieve it!
Very interesting stuff. There have to be more stories out there like this one. Thanks for that.
Thanks for pointing this out. I'm trying to figure out if there is a trend in hospitals where they're absolutely hiring more and more pods each year, so in that in a decade those jobs indeed will be there for me. thanks for the advice.
It can be quite lucrative to whoever owns the business. If you work for a hospital, then a lot of the money goes to the hospital. If you work for a group, then a lot of the money goes to the group. If you own your own practice, then that money goes to you. In jonwill's example above, the hospital recognized that podiatry was providing enough revenue to make it worthwhile to hire three full-time podiatrists. If those three podiatrists had formed their own group, then I bet the hospital would still have consulted them to do work there, but more of the profit would've ended up going to the doctors rather than to the hospital.
I think that more hospitals do not hire podiatrists because up until recently most podiatrists recognized that by owning the practice they receive the fruits of their labor, and the idea of owning one's own practice was enticing. In the last ten years it seems as though most newly minted podiatrists would rather work for a multispecialty group, an orthopedic group, or a hospital. Maybe it is an aversion to being a business owner, or simply fear of the unknown, but I don't hear about new podiatrists wanting to enter small practice arrangements anymore.
I'm not sure I understand why people would rather work for someone else, because you can do the same type of work regardless of the business arrangement. Whatever type of podiatric medicine and surgery you know how to do, you can do it anywhere (laws and bylaws permitting). If you picture yourself doing a lot of trauma, reconstructive foot and ankle procedures, then you can do it whether working for an orthopedic group or by yourself. If you have the skills, then the skills go wherever you go.
Would someone please try to explain to me what is the appeal of working for someone else? Is it simply to avoid having to deal with the administrative tasks? Either way, you would probably pay someone else to do those administrative tasks, but in a larger group or hospital it will cost you a lot more. Is it to have a ready referral source? If you are highly skilled and personable, and develop a reputation in your community as a good podiatrist, then those referrals will come to you whether or not you happen to be within the same building.
Your skills are portable. You can do the same level of work regardless of the business structure behind your employment.
It may seem like an ephemeral concept now, but once you start seeing where your money goes then it will hurt when you see that you are paying for several layers of middle managers to walk around the building doing who-knows-what for eight hours a day.
PADPM,
I can't believe you're one of podiatry's leaders. I won't say anything more than that.
While I have you here, any chance I can get you to respond to the good number of posts here that lead me to at least be somewhat optimistic that pods will be in hospitals in decent numbers sometime in the near future, say ~10 yrs?
I can't believe you're one of podiatry's leaders. I won't say anything more than that.
While I have you here, any chance I can get you to respond to the good number of posts here that lead me to at least be somewhat optimistic that pods will be in hospitals in decent numbers sometime in the near future, say ~10 yrs?
As someone in a situation where I'm trying to decide what to do, I think I can answer the question from my perspective. I'm speaking with multiple people right now and in fact just spoke with an ortho group today. For me, working for a group is appealing because it is a lot less risky. I'm speaking with a few ortho groups, a hospital, and even a pod group right now. They all generally offer a nice salary (but with fewer incentives). It's guaranteed 6 figure income and a fairly secure setup. Overhead is split, benefits are good, and their is little risk involved. The downside is (besides working for someone else) that though I feel it is more secure, I'll hit a financial ceiling in 4-5 years and most likely (unless I become a partner), that is where I will stay. Sure, many will argue that the ceiling is still a lot of money and a nice living. But after ten years, when I'm looking at Joe Blow podiatry practice down the road working just as hard as I am and making more $$$, I'm inclined to think that telling myself that I make a nice living will hardly ease the pain!
On the other hand, I have an opportunity to open up with a buddy of mine in a very underserved area. I can work for a local guy part time and will have a guaranteed salary of nearly 6 figures and then use the rest of the time to build my practice. 5 years down the road, I'm quite sure that I'd be making more than I would in an ortho group. I would love being my own boss and building my practice. However, I'm concerned about borrowing more money, this crappy economy, and all of this uneasyness with healthcare right now.
So that is kind of where I am at. OK all wise podiatry attendings, any advice??? It's kind of like little risk with a modest reward OR greater risk with a greater reward.
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My Theory:
Some people find security in working for someone else
Some people are afraid of venturing in to start their own business; they may not have the capital, especially in an unstable economy
Some people are so into being affiliated with a big name, like the aforementioned hospitals
Some people equate big names with success, they do not understand the rewards of ownership. It is very likely that some of those who practice in those hospitals, envy those who have their own practice. It would be nice if they made more profit, it would be nice if they could be more vocal about what should or should not be, it would be nice to pick and choose when and when not to go for a vacation in Belize
Some people may have interests outside of private practice. They may be of the opinion that these demands can only be satisfied in a hospital setting
I'd like to have my own practice someday.
I can understand the apprehension behind entering practice; I was in the same spot fewer than ten years ago. I did have to stumble a couple of times before I got myself into the right practice situation, but now that I am here I am thankful that I took the risk of Partnership in a small podiatric group.
The biggest down side of joining a large practice, in my opinion, is the tremendous overhead expense. When you initially join the practice your thoughts might go something like, "I'm busy seeing patients all day, I'm getting calls from the ER, I'm getting consulted by the floors, lots of people are calling me, and I'm making $150,000 per year! Sweet!"
Two years later and the new car smell might start wearing off.
Five years down the road and your thoughts might go something like, "I'm busy seeing patients all day, I'm getting calls from the ER, I'm getting consult by the floors, lots of people are calling me...how come I'm only making $150,000 per year? According to the Accounting Department, I'm generating $600,000 per year. How come my buddy in his Joe Blow Podiatry Group, who works 2/3 as many hours as I do, only generates $400,000 per year yet takes home $200,000 per year? Suck!"
jonwill, based on what I know of you and your training gleaned from this website, I think you would be in the most ideal situation if you were to sign on with an orthopedic group to work for at least a few years, while having a backup plan of moving elsewhere to either start up your own practice or join up with a couple of colleagues in a small group practice.
Working for the orthopedic group for a few years will give you the guaranteed six-figure starting income and you will likely be able to submit cases for board certification quickly. As long as you don't spend all of that money as quickly as you earn it, you will be able to pay off your student loans within a few years and perhaps save up some money to be applied towards opening a private practice or joining a group. If the orthopedic group offers you a good partnership deal, then you are golden. If the orthopedic group does not offer you a satisfactory deal, then you will have put yourself in a good situation to depart the practice and enter a new one. Perhaps your friend in the underserved area will find himself so busy that in four or five years he will need a partner. Score!
What I see in other large groups are a lot of physicians coming and going. They join right out of residency because it's easy and they leave a few years later because they feel as if they are working too hard for the money they're making. They realize that a lot of the money that they are generating is getting "left on the table" and going towards paying for overhead. They realized that the administrative tasks that they were once afraid of no longer appear so scary.
jonwill,
As a doc in a very large group practice with over a dozen doctors and growing, I would probably recommend that you highly consider the offer from an orthopedic group.
Although the salary may "cap off" after a few years, there is no real guarantee in any situation where your salary will be a few years down the road. It's certainly great to plan ahead, but if you have a strong offer now, and it's the type of practice that you want, I'd say to take the offer.
Once you show the orthopedic group your true value, and obtain a patient following, they may not be so quick to toss you aside if you are generating income. In my experience, orthopedic groups are generally not cheap, and understand the value of a good doc and won't jeopardize losing you for a couple of bucks.
On the other hand, there are a lot of proposals for health care reform and even in the best situation, you may not know what your income will be in another situation a few years from now. Therefore, it's basically a gamble.
It's also safe to say that in most podiatric groups or if you are on your own you'll probably be providing a wider scope of podiatric services vs. working for an orthopedic group where you will probably not be providing palliative care, etc.
Additionally, although I am a member of a large podiatric group, I personally believe that most orthopedic groups are a little more generous, because if they don't hire a well trained DPM, they would have to hire a foot/ankle trained orthopedic surgeon at 2-3 times the cost!! Therefore, the DPM foot/ankle surgeon is a bargain.
With the advent of the 3 year residency programs, more and more DPM's are being offered positions with orthopedic groups which I believe is a great opportunity. However, since the competition is going to be getting progressively tougher for these jobs, since there are only a finite number of these jobs, I would jump on the opportunity while it's available. There will be a saturation point.
I think the next few years of grads will have it great, but after that there may be a a huge amount of extremely well trained DPM's looking for great jobs, with a lot of competition for fewer and fewer available positions, and many of these grads will have to create their own opportunities.
As a doc in a very large group practice with over a dozen doctors and growing, I would probably recommend that you highly consider the offer from an orthopedic group.
Although the salary may "cap off" after a few years, there is no real guarantee in any situation where your salary will be a few years down the road. It's certainly great to plan ahead, but if you have a strong offer now, and it's the type of practice that you want, I'd say to take the offer.
Once you show the orthopedic group your true value, and obtain a patient following, they may not be so quick to toss you aside if you are generating income. In my experience, orthopedic groups are generally not cheap, and understand the value of a good doc and won't jeopardize losing you for a couple of bucks.
On the other hand, there are a lot of proposals for health care reform and even in the best situation, you may not know what your income will be in another situation a few years from now. Therefore, it's basically a gamble.
It's also safe to say that in most podiatric groups or if you are on your own you'll probably be providing a wider scope of podiatric services vs. working for an orthopedic group where you will probably not be providing palliative care, etc.
Additionally, although I am a member of a large podiatric group, I personally believe that most orthopedic groups are a little more generous, because if they don't hire a well trained DPM, they would have to hire a foot/ankle trained orthopedic surgeon at 2-3 times the cost!! Therefore, the DPM foot/ankle surgeon is a bargain.
With the advent of the 3 year residency programs, more and more DPM's are being offered positions with orthopedic groups which I believe is a great opportunity. However, since the competition is going to be getting progressively tougher for these jobs, since there are only a finite number of these jobs, I would jump on the opportunity while it's available. There will be a saturation point.
I think the next few years of grads will have it great, but after that there may be a a huge amount of extremely well trained DPM's looking for great jobs, with a lot of competition for fewer and fewer available positions, and many of these grads will have to create their own opportunities.
Here in California, hospital employed podiatrists usually work for either the VA system or Kaiser Permanente (HMO health plan).
I know at least 10 pods who work for Kaiser and from what I hear, the clinic schedule is quite hectic and pods sit around hoping that patients don't show up. Whether you see 40 or 50 patients a day or perform more surgeries, you're still paid by a fix salary so really no incentive to work harder. Patients are usually disgruntled because they had to wait 3 months for a podiatry referral and of course they take their frustrations out on you.
I know at least 10 pods who work for Kaiser and from what I hear, the clinic schedule is quite hectic and pods sit around hoping that patients don't show up. Whether you see 40 or 50 patients a day or perform more surgeries, you're still paid by a fix salary so really no incentive to work harder. Patients are usually disgruntled because they had to wait 3 months for a podiatry referral and of course they take their frustrations out on you.
I would join the established orthopedic group, get a few years of experience under my belt, get enough cases for the boards, and then venture from there. Starting out cold turkey is tough and you're unlikely to see much trauma cases.
Podmeister,
That's similar to what I stated in my earlier post as per the quote above. However, since I have no personal experience with the Kaiser Permanente system, I had no idea it operated the way you describe.
But since it's an HMO system, I can't really say I'm surprised. The problem with any salaried position, is that the doctor has no "incentive" to work harder, though ideally the doctor really is supposed to do what's best for the patient in all situations. Please note that I said "ideally".
Many graduating DPM's may sign large contracts with orthopedic groups that don't offer incentives, so theoretically they will be in the same boat by providing total care and services no matter how many patients they see or treat, all for one "lump sum", though the practice will be making money. On the other hand, many podiatric practices pay a lower initial salary but do pay incentives based on production. However, many young grads want that guaranteed salary, and I can't say I blame them, with the huge debt following graduation.
Yes, you did. I must have been distracted by the juvenile rant and personal attacks on your honest response.
I have family members who used to work for Kaiser, and once they switched over to private practice, they were much much more satisfied with the freedom to make their own decisions instead of being bogged down with bureaucratic red tape.
I couldn't agree more.
It's a trade off for the required surgical cases to sit for the board so I believe it is necessary during the initial phase of one's career. Of course, some large podiatric practices are capable of offering similar surgical volume as well.
I don't mean to wreck a lot of dreams for people, but I don't think that many DPM's will end up working at orthopedic groups. Mainly, because many DPMs just out of residency will either lack the surgical skills, and knowledge, or the personal connections to the orthopaedic community. Most DPM's who get jobs with ortho groups know somebody who helps them get the job. Lastly, what's going to start happening is ortho groups are going to want people with fellowship training. This is what I have been told by my uncle an orthopaedic surgeon, and a podiatrist who works in another ortho group in my hometown. Lastly, not that many podiatrists get hired each year by ortho groups. From what I remember of the young members servey less than 10% of all residency grads got position with an ortho group, and further more the year to year change was less than 1%. Demand by ortho groups for foot and ankle surgery will probably increase as the babyboomers age, and foot and ankle surgeons retire creating spots for new grads.
XCdude,
Excellent post. It sort of echoes what I've been saying. For many years, a lot of ortho groups didn't want anything to do with DPM's no matter how well we were trained. Suddenly they realized they could obtain high quality foot/ankle surgeons (DPM's) at a fraction of the cost of hiring a foot/ankle orthopedic surgeon, without compromising quality.
So I'm not really sure if the orthopedic community suddenly fell in love with DPM's, or realized that we were a great economic alternative. But as I've stated in the past, as more and more quality DPM's graduate with the mandatory 3 year training, those orthopedic opportunities will be filled and competition for those spots will get tougher than ever. And of course there is always a saturation point.
The orthopedic foot/ankle surgeon is a "double edged sword". Some recent studies have shown that some of the fellowship spots for these MD's are going unfilled, and it may be because this may not be the most financially lucrative specialty within orthopedics (vs. hand surgery, spine surgery, etc.). On the other hand, I have seen orthopedic groups and have spoken with orthopedic groups that only want to hire an orthopedic foot/ankle surgeon so they can get more "bang for their buck". Their thought process is that although the DPM is certainly well trained and qualified, the orthopedic foot/ankle surgeon can take "call" for the entire group for all pathology, can cover the ER and can treat all the orthopedic ailments of the practice in case of an emergency.
That's why I stated in a prior post that all graduating residents must be ready to "create" their own opportunities. They also must make a lot of contacts with podiatric groups, orthopedic groups, hospitals, clinics, attending physicians, etc., and should never burn any bridges......including other students or doctors on this site. You never know when something you say or do can come back to haunt you.
Some of the members on this site should think about that....
Excellent post. It sort of echoes what I've been saying. For many years, a lot of ortho groups didn't want anything to do with DPM's no matter how well we were trained. Suddenly they realized they could obtain high quality foot/ankle surgeons (DPM's) at a fraction of the cost of hiring a foot/ankle orthopedic surgeon, without compromising quality.
So I'm not really sure if the orthopedic community suddenly fell in love with DPM's, or realized that we were a great economic alternative. But as I've stated in the past, as more and more quality DPM's graduate with the mandatory 3 year training, those orthopedic opportunities will be filled and competition for those spots will get tougher than ever. And of course there is always a saturation point.
The orthopedic foot/ankle surgeon is a "double edged sword". Some recent studies have shown that some of the fellowship spots for these MD's are going unfilled, and it may be because this may not be the most financially lucrative specialty within orthopedics (vs. hand surgery, spine surgery, etc.). On the other hand, I have seen orthopedic groups and have spoken with orthopedic groups that only want to hire an orthopedic foot/ankle surgeon so they can get more "bang for their buck". Their thought process is that although the DPM is certainly well trained and qualified, the orthopedic foot/ankle surgeon can take "call" for the entire group for all pathology, can cover the ER and can treat all the orthopedic ailments of the practice in case of an emergency.
That's why I stated in a prior post that all graduating residents must be ready to "create" their own opportunities. They also must make a lot of contacts with podiatric groups, orthopedic groups, hospitals, clinics, attending physicians, etc., and should never burn any bridges......including other students or doctors on this site. You never know when something you say or do can come back to haunt you.
Some of the members on this site should think about that....
In conclusion,
In about 10 years - when people that are just beginning to think about podiatry, now, will be entering the field - the number of positions available in ortho groups will be either 1) a lot less due to saturation and increased competition or 2) more due to retiring F&A orthos and baby boomer foot problems.
Can someone revisit the full-time positions available in hospitals? It'd be nice to get everyone's opinion on the board on that one, too. Thanks.
In about 10 years - when people that are just beginning to think about podiatry, now, will be entering the field - the number of positions available in ortho groups will be either 1) a lot less due to saturation and increased competition or 2) more due to retiring F&A orthos and baby boomer foot problems.
Can someone revisit the full-time positions available in hospitals? It'd be nice to get everyone's opinion on the board on that one, too. Thanks.
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My guess is that the Orthopedic community at large tolerates us more than embraces us. I think they hire DPM's because it means more to their bottom line, similar to how FP and multispecialty groups have discovered the economic benefits of hiring mid-levels such as PA's and NP's.
umass,
I don't think any of us can really answer what's going to happen in the future with hospitals hiring pods. With health reform in the possible future, lots of things are going to change. Please be more respectful to PADPM and the other podiatrist/residents on this forum. Without their knowledge and willingness to provide their experiences with the profession, you would recieve vague answers like "hard work will get you everything you want."
My suggestion would be to just google "podiatry" and where you live. Then look up the major hospitals that you live nearby online and see how many podiatrist are staff. Although this isn't the best foolproof method, you can see how many podiatry groups/private practice/ortho groups compared to those hired in hospitals. At least you'll be able to have somewhat of an idea of how many pods work in a hospital setting that you desire.
I don't think any of us can really answer what's going to happen in the future with hospitals hiring pods. With health reform in the possible future, lots of things are going to change. Please be more respectful to PADPM and the other podiatrist/residents on this forum. Without their knowledge and willingness to provide their experiences with the profession, you would recieve vague answers like "hard work will get you everything you want."
My suggestion would be to just google "podiatry" and where you live. Then look up the major hospitals that you live nearby online and see how many podiatrist are staff. Although this isn't the best foolproof method, you can see how many podiatry groups/private practice/ortho groups compared to those hired in hospitals. At least you'll be able to have somewhat of an idea of how many pods work in a hospital setting that you desire.