Base salary for Practicing Podiatrists

  • $70,000 - $100,000

    Votes: 13 23.6%
  • $100,000 - $130,000

    Votes: 9 16.4%
  • $130,000 - $160,000

    Votes: 5 9.1%
  • $160,000 - $190,000

    Votes: 9 16.4%
  • $200,000+

    Votes: 19 34.5%

  • Total voters
    55

msion

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This is a fact. But cost of living is astronomical in California. Kaiser employed DPMs are not getting the typical RVU incentive bonuses that one would see being employed at a non Kaiser hospital. If you blow it out of the water you can make some serious money with your bonuses. More money then you could ever earn at Kaiser.

Not in all parts of California. With that money you can live like a king in the central valley. The starting salary is actually higher than that. Plus the $0 premium and $0 copay for health insurance, and 40-50% of the highest pay when you retire. They give you some money for a downpayment, forgiven after you work there for a few years. They also tend to hire new grads, typically from Kaiser though.
 
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CutsWithFury

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Not in all parts of California. With that money you can live like a king in the central valley. The starting salary is actually higher than that. Plus the $0 premium and $0 copay for health insurance, and 40-50% of the highest pay when you retire. They give you some money for a downpayment, forgiven after you work there for a few years. They also tend to hire new grads, typically from Kaiser though.

These perks are only common to the Northern California Kaisers. I heard that Kaiser got rid of the 40-50% of your highest pay for each year of retirement as well. I could be wrong about that.

Kaiser is almost impossible to crack unless you graduate from one of the residency programs. Its very competitive.
 
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CutsWithFury

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The Chicago situation above (who gets hired first) made me wonder about this.

You're an established doctor in whatever city. Somewhere not east or west coast. Let's say you own a private practice. You do 5 elective surgeries a week at the hospital that you booked from your PP clinic - with more than 1/2 being Blue Cross and the rest being Medicare. You refer them your MRIs. You refer to their vascular team/cardiology and to their PT/neurology. Maybe you even come in to do an amp occasionally or do a 1/2 day in their WHC (which exists let's be honest - solely to feed hyperbarics).

Isn't the hospital already getting the best of it? Is there a "why buy the cow when the milk is free" to this? You're feeding their most profitable services without even being an employee?

Great questions...

Scenario 1:
Chicago is a very populous city. Lots of hospitals, patients and podiatrists in that city. In Chicago there really is no incentive for hospitals to hire podiatrists although some do. There are plenty of patients being fed into the system from outside providers and they are making plenty of money off them just like you highlighted above.

Scenario 2:
Now lets pick a large town in a boring state (doesn't have to be rural) where a community hospital serves it. There are not a lot of competing systems unless patients want to drive 45-60-90-120 minutes to the level 1 trauma center for care. Hospital has some community podiatrists around it that get scraps from the ER and who might come in for the random infection but try not to because they don't accept state insurance (most common reason private practice podiatrists refuse consults). Hospital doesn't have a provider on staff who manages foot and ankle outside of ortho doing the occasional ankle fracture. If there is complicated foot and ankle trauma the community hospital is sending it to the level 1 trauma center.

Now insert your well trained surgical podiatrist. How does your surgical podiatrist get busy in the beginning? Surgical podiatrist starts sucking up every wound/infection from the ER and optimizes it in the hospital (hospitalist eval, XR/MRI, possible ID consult, possible vascular surgery consult, OR debridement/amp). Then once said patient is improved this patient now follows your podiatrist to the outpatient clinic. Even better if there is a wound care center to send the patient to.

As your podiatrist starts to build a reputation they start getting referrals from PCPs affiliated with the hospital, possible referrals from internal medicine groups who also practice in the area. Now your podiatrist is starting to build up an elective case load. Guess what? Your podiatrist knows they are a podiatrist and not a "foot and ankle surgeon" and will cut diabetic toenails, treat warts, ingrown toenails, etc at will which take 10-15 minutes per patient. This furthers their reputation in the community.

Fast forward 10 months and now your podiatrist is handling all the infections in the hospital. DPM has a busy outpatient wound care practice. DPM a growing elective case load. DPM starts to get more foot and ankle trauma from ortho. Your ER no longer refers complicated stuff to the level 1 trauma hospital. Your DPM is busy and it happens fast.

Scenario 2 is very doable and can be replicated anywhere. A well trained podiatrist will always be busy because we can do all the basic podiatry procedures in clinic, handle all the infections/wounds/charcot that ortho wants nothing to do with and honestly can't handle and we are trained to handle the elective and non elective pathology. It turns out to be a lot of patients and possible pathologies.

If you can convince a community hospital to hire you I guarantee you will be successful and busy. You don't need to go rural to achieve this.
 
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air bud

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The Chicago situation above (who gets hired first) made me wonder about this.

You're an established doctor in whatever city. Somewhere not east or west coast. Let's say you own a private practice. You do 5 elective surgeries a week at the hospital that you booked from your PP clinic - with more than 1/2 being Blue Cross and the rest being Medicare. You refer them your MRIs. You refer to their vascular team/cardiology and to their PT/neurology. Maybe you even come in to do an amp occasionally or do a 1/2 day in their WHC (which exists let's be honest - solely to feed hyperbarics).

Isn't the hospital already getting the best of it? Is there a "why buy the cow when the milk is free" to this? You're feeding their most profitable services without even being an employee?
Agree. Start doing or threaten to do stuff at other places if it makes sense. You have to make them want you. I am doing that right now. As I renegotiate with my current employer, all I did is point out that I will just do cases at the hospital 30 mins closer to my new home. Not to be dick, but just because it makes sense. That got them thinking about alternatives real quick.
 

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Agree. Start doing or threaten to do stuff at other places if it makes sense. You have to make them want you. I am doing that right now. As I renegotiate with my current employer, all I did is point out that I will just do cases at the hospital 30 mins closer to my new home. Not to be dick, but just because it makes sense. That got them thinking about alternatives real quick.

I hope you are on good terms with your employer. If you are then hopefully they won’t be offended by your comment/renegotiation. Sometimes I think it’s safe to say that “we need them more than they need us” . If I was to lose my current job, I would probably have to join Healthdrive lol.
 

DYK343

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Facility fees can make a hosptial a fair amount of money with each patient encounter

Even post op visits (as far as I know) charge facility fee even if the provider bills a 99024. The hospital still collects $$$.

Yes they make most of their money on HBO, Surgery time, and MRI/imaging but dont discredit the cash they make for billing out a 99213 + facility fee + whatever else you ordered that day x 30+ patients a day.

I know for a fact I pull in over a million a year for the MSG I work for and we dont have the facility fee or an MRI machine.

If hospitals researched it better podiatry would be a cash cow for them and they would hire us left and right. Hospitals that due hire podiatry tend to continue to expand with time and hire more.
 
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Pronation

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I hope you are on good terms with your employer. If you are then hopefully they won’t be offended by your comment/renegotiation. Sometimes I think it’s safe to say that “we need them more than they need us” . If I was to lose my current job, I would probably have to join Healthdrive lol.

what happened to everyone saying to just start a practice
 
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air bud

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I hope you are on good terms with your employer. If you are then hopefully they won’t be offended by your comment/renegotiation. Sometimes I think it’s safe to say that “we need them more than they need us” . If I was to lose my current job, I would probably have to join Healthdrive lol.
My employer can't replace me. I am moving two hours away to join an ortho group. Non compete allows me to come back day one if am solo or single practice group (lawyer said Ortho would qualify). Even if they wanted to be a dick and not let me do cases there, I can take people 30 mins away to another Hospital. Who is going to take the job knowing that the last person left because they weren't busy enough, is 2 hours away and comes back to this same town for outreach? Hey, come take this job new grad. It will take many years to get enough cases for boards ( I think I did 50 cases last year. I had enough for both from first job, just needed RRA diversity i got here), you won't keep up competence due to lack of volume, you will never be able to bonus, you will have no security because if they decide you aren't worth it, you have to pick up and move because PP can't survive there. Sorry, nope.

Anyways, @CutsWithFury is 100 percent right.
 
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air bud

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Facility fees can make a hosptial a fair amount of money with each patient encounter

Even post op visits (as far as I know) charge facility fee even if the provider bills a 99024. The hospital still collects $$$.

Yes they make most of their money on HBO, Surgery time, and MRI/imaging but dont discredit the cash they make for billing out a 99213 + facility fee + whatever else you ordered that day x 30+ patients a day.

I know for a fact I pull in over a million a year for the MSG I work for and we dont have the facility fee or an MRI machine.

If hospitals researched it better podiatry would be a cash cow for them and they would hire us left and right. Hospitals that due hire podiatry tend to continue to expand with time and hire more.
Agree. The problem for new grads is that often they come to the first pod and say hey anyone you want to bring in? But yes, when looking for a jobs, do NOT be discouraged when you see a location already has a podiatrist. Pick up the phone and call anyways. You already know they are pro podiatry.

And yes, it's all about the facility fee. It doesn't matter if I bill a level 2 or a level 4, they get paid the same.
 

DYK343

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Who is going to take the job knowing that the last person left because they weren't busy enough,

To work 10hrs a week and 200+k? Sign me up....

Grass is always greener. Coming off a crazy busy week (9 cases plus clinic) that sounds amazing.
 
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JewOnThis

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My employer can't replace me. I am moving two hours away to join an ortho group. Non compete allows me to come back day one if am solo or single practice group (lawyer said Ortho would qualify). Even if they wanted to be a dick and not let me do cases there, I can take people 30 mins away to another Hospital. Who is going to take the job knowing that the last person left because they weren't busy enough, is 2 hours away and comes back to this same town for outreach? Hey, come take this job new grad. It will take many years to get enough cases for boards ( I think I did 50 cases last year. I had enough for both from first job, just needed RRA diversity i got here), you won't keep up competence due to lack of volume, you will never be able to bonus, you will have no security because if they decide you aren't worth it, you have to pick up and move because PP can't survive there. Sorry, nope.

Anyways, @CutsWithFury is 100 percent right.

Don’t underestimate the hunger of podiatry! If you post your old job on SDN, I will guarantee you that many many many pods willApply, especially those in PP. My friend in one of those nursing home jobs said they are getting more competitive which is not surprising since they work 4 days a week and make 130k+ with benefits.
 
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shadesofgrey

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To work 10hrs a week and 200+k? Sign me up....

Grass is always greener. Coming off a crazy busy week (9 cases plus clinic) that sounds amazing.

Seriously, if the legends are true about air bud's schedule and pay I'd take that job in a heartbeat. Just polished off a six clinic day week in my associate job trying to pay down some of these loans. Assuming he also gets PSLF, the job sounds like a wet dream.
 

air bud

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Seriously, if the legends are true about air bud's schedule and pay I'd take that job in a heartbeat. Just polished off a six clinic day week in my associate job trying to pay down some of these loans. Assuming he also gets PSLF, the job sounds like a wet dream.

Lol what I am saying is the job doesn't exist if I leave because there won't be any patients. Not that nobody wants it.

And yes the legend is true.

And it's not like I am leaving to work as an associate, it is for what I perceive to be a better opportunity. It is just going to involve actual work.
 
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DYK343

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There’s a real need for limb salvage and Podiatric pathologies in the academic setting. You could make Ortho, vascular, ID all happy.

Sounded great until this part. The never ending train of pus, I&Ds, TMAs and late nights at the hospital followed by early AM rounding/rounding at lunch meanwhile the well paying pathology (trauma) gets sent to ortho.

For the time I dont make anything off diabetic stuff at the hospital/ER and I spent many hours doing it. Half of them are uninsured. The ones that are insured Ill get paid a couple hundred bucks but its hours of my time (mostly due to extreme hospital inefficiency) and free care for 90 days after. Emergent diabetic foot care should really reimburse more. There is a reason vascular, general surgery, ortho doesn't want to do it and its because it doesn't pay.
 
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CutsWithFury

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Sounded great until this part. The never ending train of pus, I&Ds, TMAs and late nights at the hospital followed by early AM rounding/rounding at lunch meanwhile the well paying pathology (trauma) gets sent to ortho.

For the time I dont make anything off diabetic stuff at the hospital/ER and I spent many hours doing it. Half of them are uninsured. The ones that are insured Ill get paid a couple hundred bucks but its hours of my time (mostly due to extreme hospital inefficiency) and free care for 90 days after. Emergent diabetic foot care should really reimburse more. There is a reason vascular, general surgery, ortho doesn't want to do it and its because it doesn't pay.

Agreed on all of the above

But if you are in a favorable RVU reimbursement system in a hospital gig you can do quite well in terms of generating production from these patients. Especially if you take the patient back for multiple OR debridements or if you do additional ancillary procedures such as diabetic offloading surgery (gastroc recessions, tenotomies, etc) or plastic procedures (STSG, rotational skin plasties, toe fillet flaps, etc).

RVU models don't care about what the patient's insurance is. You still get the same number of RVUs per procedure.
 
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air bud

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Agreed on all of the above

But if you are in a favorable RVU reimbursement system in a hospital gig you can do quite well in terms of generating production from these patients. Especially if you take the patient back for multiple OR debridements or if you do additional ancillary procedures such as diabetic offloading surgery (gastroc recessions, tenotomies, etc) or plastic procedures (STSG, rotational skin plasties, toe fillet flaps, etc).

RVU models don't care about what the patient's insurance is. You still get the same number of RVUs per procedure.
Correct. I get 100% of all wRVUs generated (no 50 percent second procedure crap). Doesn't matter of they have insurance or not. Obviously this is one of the benefits of being in a RVU system. Now if only I had patients to generate RVUs...
 
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LittleBirdy123

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Want to get some thoughts from the experts on here such as @air bud and the others:

1) What are the chances of getting a job in an ortho group if you have VERY MINIMAL geographic constraints coming out of residency(willing to look at 5-6 different states for an ortho group job)?
2) Is it frowned upon to work in an ortho group that already has an ortho foot and ankle surgeon? I’m guessing this would limit the podiatrist to just foot surgeries?
 
D

deleted1061086

Want to get some thoughts from the experts on here such as @air bud and the others:

1) What are the chances of getting a job in an ortho group if you have VERY MINIMAL geographic constraints coming out of residency(willing to look at 5-6 different states for an ortho group job)?
2) Is it frowned upon to work in an ortho group that already has an ortho foot and ankle surgeon? I’m guessing this would limit the podiatrist to just foot surgeries?
Even if you are looking at all 50 states an ortho group job right out of residency is pretty unlikely. If you are limiting yourself to five or six states, it’s very unlikely. There are probably less than 20 or 30 residents or less that graduate into these types of jobs in the country. The job market due to covid is terrible, so these odds are even worse right now and for the foreseeable future.
 
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Redsting

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Last year my, which was my first calendar year out of residency, meaning I was fairly slow for the first half of it. Just off professional fees the hospital collected 500k. Thats 3.5 days a week. No call. Only podiatrist here. That dollar amount doesn't include money collected from MRIs, CT, xray, facility fees, money made on grafts, money from the OR (ex, I had a HT HWR with revision and the hospital collected 10k on something that took 35 min, and I was credited something like $500 towards the pro fee), PT that I refer, pts that stayed in the hospital cause I was there vs sending them out, DME, etc.
So I agree, money is being made by the hospitals. Some know it, some don't.
There are things that are nice being at the hospital,there are other things that make me wish I was private practice. Nothing is perfect.
I have friends that sign some PP deals that make me question their sanity. Why do 4 years of school,3 residency to come out and make 60k? Those practice are using you and will not help you build to hit production. I've seen a couple friends sign production for 20% once they hit 3x. 20%! You are making them so much money and not making yourself anything. That means to hit 200k you collect 1mil. Sometimes I hate podiatry.
 
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deleted1054119

Last year my, which was my first calendar year out of residency, meaning I was fairly slow for the first half of it. Just off professional fees the hospital collected 500k. Thats 3.5 days a week. No call. Only podiatrist here. That dollar amount doesn't include money collected from MRIs, CT, xray, facility fees, money made on grafts, money from the OR (ex, I had a HT HWR with revision and the hospital collected 10k on something that took 35 min, and I was credited something like $500 towards the pro fee), PT that I refer, pts that stayed in the hospital cause I was there vs sending them out, DME, etc.
So I agree, money is being made by the hospitals. Some know it, some don't.
There are things that are nice being at the hospital,there are other things that make me wish I was private practice. Nothing is perfect.
I have friends that sign some PP deals that make me question their sanity. Why do 4 years of school,3 residency to come out and make 60k? Those practice are using you and will not help you build to hit production. I've seen a couple friends sign production for 20% once they hit 3x. 20%! You are making them so much money and not making yourself anything. That means to hit 200k you collect 1mil. Sometimes I hate podiatry.

Good stuff. Are you in the boonies? Can you give us an estimate of the surrounding population? I’m pretty sure those crappy PP contracts were in half mil pop + areas
 

Redsting

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Good stuff. Are you in the boonies? Can you give us an estimate of the surrounding population? I’m pretty sure those crappy PP contracts were in half mil pop + areas
Sure, I'll try.
I am in town of 5500. My county is about 10k. There are two pods and a foot/ankle ortho about 40 min north of me in a town of 35k. I pull from a little larger area than the 10k since there is no established pod in some areas other than one that has a couple satellite clinics. But I have patients from from the town of 30k that drive to see me or even drive through that town to see me (I don't know why, I don't do huge cases and I am no a genius). I would say not including the bigger town that I pull from about 15k-20k people. The primary docs are referring more and more, they were so use to doing everything they could on their own for so long that changing their referral pastern takes a little while.
And yeah those contracts i mentioned are in big cities and their suburbs.
 
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Question about these hospital jobs/rural hospital jobs. Do they want “fellowship trained DPM’s, or those who trained at well known programs, or have extensive training in RRA/ deformity correction etc.?
I’m training at an average program in the Midwest but am interested in going rural if it means better paying job. is this possible?
thanks
 

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They likely have no clue about podiatric fellowships, which programs are “well-known” and/or if you are RRA certified. Same goes with Board certification, just so long as what Board you have is on the hospital bylaws so you can perform surgery.
 
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heybrother

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Question about these hospital jobs/rural hospital jobs. Do they want “fellowship trained DPM’s, or those who trained at well known programs, or have extensive training in RRA/ deformity correction etc.?
I’m training at an average program in the Midwest but am interested in going rural if it means better paying job. is this possible?
thanks
Theoretically, true rural is underserved. Also, how would hospital administrators know what is a good program or a bad program?

A friend of mine picked up an awesome opportunity in a rural hospital about 1.5 hours from a "big?" city (500K). What the hospital really wanted was - a surgeon who would keep cases in the hospital. They had a traveling private practice that was coming and cherrypicking the private insurance cases back to a surgery center in the town they came from and dumping everything else on the hospital.

I doubt the hospital knows much about deformity correction. What they do understand I suspect is utilization. This hospital was rural critical access - OR use generated dollars for them. As people above have described - I suspect the language we use to impress each other and the language that should impress a hospital administrator are probably quite different. I know external fixation is probably less interesting than I will generate facility fees. I will generate 7 cases on my block is probably less interesting than - I do big 3 hours cases.

Side bar. My partner essentially exclusively does Austins. Won't fuse. Revises failed Austin's with more Austin. Head must not have moved enough! I prefer MPJ fusion or lapidus. He regularly fixates with just a k-wire. I prefer a plate and screws. I'm pretty certain if you went to the hospital boss and said - what do you think of these people they'd say - Austin guy is a hero. Low hardware cost. Quick room turn-over. He's great!

I think a lot of the heroics and considerations we have that don't pay out for the individual doctor probably don't play out for the hospital either. Could be wrong but consider - in my area BCBS PPO pays a little under $1K for an Austin and a little over $1K for a lapidus. The difference in reimbursement is like $160 bucks. On the hospital end one of these cases is probably 30 minutes and the other is one to ..3 hours (yikes!). One has hardware costs of potentially a k-wire or a $50-100 screw and the other could cost $100-$4000 in hardware.

Last of all - if you market yourself as trauma capable you probably are going to need to put up or shut up. My residency hospital went through a huge disastrous fight with orthopedics. They brought in an orthopedist, paid him a fortune and he refused to operate - on anything. Refused all consults. Refused all transfers. Podiatry was out of town and I got call from a hospital up the road from me that was essentially a large family medicine clinic merged with an ER. Wanted to know if they could transfer a dislocated ankle - we were at our 1 conference of the year. Had to turn it down - I suggested they refer to the orthopedist above and got a long ugly laugh followed by - "that guy has never accepted a transfer from our hospital". He then related to me how he was really bummed for the patient because if I didn't accept the transfer the patient was going to have drive 2 hours just to be reduced. I don't think most places are that underserved - but rural would be the place where that happens.
 
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Question about these hospital jobs/rural hospital jobs. Do they want “fellowship trained DPM’s, or those who trained at well known programs, or have extensive training in RRA/ deformity correction etc.?
I’m training at an average program in the Midwest but am interested in going rural if it means better paying job. is this possible?
thanks
Do they want “fellowshiptrained DPM’s, or those who trained at well known programs, or have extensive training in RRA/ deformity correction etc.?

No, no one cares. Hell, I don't even know the "big names" in podiatry and I've been doing this for over 11 years lol.

Why go rural if you're in the midwest? You could do just fine where you are.
 
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dtrack22

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Question about these hospital jobs/rural hospital jobs. Do they want “fellowship trained DPM’s, or those who trained at well known programs, or have extensive training in RRA/ deformity correction etc.?
I’m training at an average program in the Midwest but am interested in going rural if it means better paying job. is this possible?
thanks

as someone who has some experience with rural healthcare, I can tell you they care more about getting someone good who they think is retainable, than any aspect of your training. And they’ll often times sacrifice “good” in exchange for “this person won’t get bored and leave in 2 years.”

Very few jobs will know anything about where you did residency. That really won’t matter outside of some personal connection (ie a few of the family medicine docs also did their residency at UPMC) helping you out a little. If you are applying for a job with a big health network or their affiliated MSG, then the fellowship trained person certainly holds an edge in the battle of paper applicants. Some groups may put a lot of stock in that. Not because of the actual fellowship they did, but because “fellowship training” is essentially a standard in any other surgical sub specialty. It would be naive to think that a fellowship, if for no other reason than it makes you look better on paper, wouldn’t be beneficial when applying for a job against other podiatrists.

Are these employers seeking out or only considering fellowship trained podiatrists? Absolutely not.

I have friends who had average at best training, and they’ve been the ones saying that, who have had better jobs and made a lot more money than I have since finishing residency. Training did not matter at all. Geography and luck played bigger roles to be honest. A willingness to go rural will create more job opportunities than most (if not all) podiatry fellowships will...in my opinion
 
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Feli

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as someone who has some experience with rural healthcare, I can tell you they care more about getting someone good who they think is retainable, than any aspect of your training. And they’ll often times sacrifice “good” in exchange for “this person won’t get bored and leave in 2 years.

Very few jobs will know anything about where you did residency. That really won’t matter outside of some personal connection (ie a few of the family medicine docs also did their residency at UPMC) helping you out a little. If you are applying for a job with a big health network or their affiliated MSG, then the fellowship trained person certainly holds an edge in the battle of paper applicants. Some groups may put a lot of stock in that. Not because of the actual fellowship they did, but because “fellowship training” is essentially a standard in any other surgical sub specialty. It would be naive to think that a fellowship, if for no other reason than it makes you look better on paper, wouldn’t be beneficial when applying for a job against other podiatrists.

Are these employers seeking out or only considering fellowship trained podiatrists? Absolutely not.

I have friends who had average at best training, and they’ve been the ones saying that, who have had better jobs and made a lot more money than I have since finishing residency. Training did not matter at all. Geography and luck played bigger roles to be honest. A willingness to go rural will create more job opportunities than most (if not all) podiatry fellowships will...in my opinion
I agree 110%... very good info here. ^

Rural hospitals are, on the whole, a lot easier to "bamboozle," and they certainly value potential for longevity of that doc position staying filled. You will usually find a mix of many young docs (all specialties) being frugal and paying off their loans fast (or FIRE) via low COL in rural... and many other rural docs who probably would never get a job in the city for various reasons, but there are also everything in between in rural medicine. You have some pretty sharp docs even way outside the metros, but facilities and patients in country areas are generally more comfortable with letting a doctor "do their best." It takes all kinds, and each facility is its own culture. Like dtrack said, the rural facilities tend to have not ever had a DPM, lost theirs, have one(s) desperate to lighten their call/clinic schedule and didn't get many applications (usually since they didn't post the job very well), etc.

Your credentialing/privileging and interviewing at rural places might be done by a FP/IM/etc Chief of Staff or a GSurg/Ortho/etc Chief of Surgery doc who has no real idea of our boards/training. Think how hard it is to stay up to date with all specialties... for MDs, DO, midlevels, dentists, etc etc... hard, hard job. The interview might be done by/with a DPM if they have one, but that doc might be minimally trained. It's not that they'll hire anyone for the rural positions, but most just don't get it if they don't have a DPM or two who knows/cares what's going on... the MDs mean well, but they might potentially think a 4yr at Wyckoff with ABLES cert is better than a 3yr at West Penn with ABFAS cert, lol. You never know... it is always up to you to sell your training and emphasize your logs and competence. It is a fairly sharp contrast if you are accustomed to the dog-eat-dog of the city where you are generally interviewing for the job or the privileges with a Chief of Podiatry who is a surgically, politically, and/or financially powerful DPM in that area.

The exception arises if they have a reasonably skilled DPM or two on staff (at that rural hospital or in their system who participates). Then, everything that matters at most city hospitals (ABFAS cert, residency, maybe fellowship, case logs, ABPM cert, etc) will also matter for that job. As that is already the norm in the vast majority of DPM groups and lion's share of MSG, ortho, hospitals, etc, you can bet it will gradually get to rural ones also. I'd always advise getting the best training possible and appropriate certs for that reason and the personal growth/satisfaction, but could a Chicago VA grad willing to go to rural northwest get a higher pay job than a Swedish grad who chose to only consider jobs in SanFran? Yep, for sure (esp with COL factored in).

*edit to add: Make sure you ask rural hospitals what they expect the podiatrist to do before you spend the time to apply. You will be surprised how many are minimal surgery allowed/capability or even non-op clinic podiatry postings (usually since maybe their prior podiatrist was non-op). Some of those can have podiatry services expanded by a DPM with more training, but some cannot. Some rural hospitals/systems won't have OR time for podiatry, some won't have the equipment/staff/etc (they send it "to the city" to another facility... which you may or may not be able/expected to get on staff at), and still others might not even have a facility with ORs close to the clinic building or location(s) they want you to cover patients at. You would be surprised how many of these just kinda want a C&C podiatrist who does heel pain, orthotics, etc. It is always good to call HR, talk to their podiatrist if they have one, ask about anything unclear, confirm anything important to you, and make sure they know you have surgical training and need numbers for boards, etc.
 
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NewPodGrad2019

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you would be surprised how many of these just kinda want a C&C podiatrist who does heel pain, orthotics, etc.
I agree with all that you said. However if a rural hospital group will pay a POD $200k with benefits (health insurance, 401K, paid vacation etc ) to do C&C, orthotics, heel pain etc, 99% of pod applicants will take it.

Most Podiatry groups pay an associate $100K base and expect you to do their charcot recon, ankle fractures, big fusions etc. These associate positions offer zero benefits, no health insurance, no paid sick days, no paid vacations days.

Most associates making $100K or $120K and doing so called big surgeries and spending hours in the OR will wake up someday and realize the money is in clinic (except if you buy-in to the surgery center).

I will tell any resident, 3 years of residency in the OR doing surgeries is fun and all. But in the real world, Clinic and billing properly is where the money is. And they don't teach that in residency, so the sooner you wake up and learn office billing and choosing the right procedure codes, the better.
 
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Feli

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I agree with all that you said. However if a rural hospital group will pay a POD $200k with benefits (health insurance, 401K, paid vacation etc ) to do C&C, orthotics, heel pain etc, 99% of pod applicants will take it...

...I will tell any resident, 3 years of residency in the OR doing surgeries is fun and all. But in the real world, Clinic and billing properly is where the money is. And they don't teach that in residency, so the sooner you wake up and learn office billing and choosing the right procedure codes, the better.
I concur with all of that, but I'm just saying that some rural positions just don't have the logistics to even do much/any surgery whether the DPM wants to or not. That is a deal-breaker for some pods, esp if they're not board cert yet or want to utilize most/all of the scope they trained for.

A C&C private practice associate or someone who buys out a C&C practice in the city with hospitals or surgery centers nearby can always gradually add more surgery and more services, but at some rural places, it is just not possible from a capabilities standpoint. You just have to be aware of that.... a fair amount of "medical center" or even "hospital" or "full spectrum podiatry" jobs in smaller town might have those limits, where they send out their foot and ankle surgery (or all surgery), or you would be driving a ton to ever do any cases due to ORs being few and far between.
 

air bud

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Also don't forget the volume is just not there for rural locations. That is why I am expanding my reach. I did 150 surgeries in my 2.75 years here so far. Yes have done ankle fx a few calcs, some flatfoot and fusions. But am as good/efficient as I could be with more reps? No. For the most part, rural means giving up some of your training. Yes they have paid me more money than they should have so far, but enough to give up some of my training for the rest of my life? No.


Also, and can't stress this enough, with rural you are one bad outcome/change in management/new ortho away from packing up and leaving. You can't survive there as an independent provider, only as an RVU based provider. So there is no long term security.
 

dtrack22

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For the most part, rural means giving up some of your training.

I think this is highly dependent on how "rural" you really are.

I work in a town of 20,000 people. There is another podiatrist but I get surgical referrals from him because he cannot do them or is not comfortable with them or just doesn't want to mess with managing the patient post-operatively. Really anything more proximal than a bunion gets sent to me. There is another town next door with 4-5k, one 30 miles away with just under 20k (also with podiatrists that don't do much surgery other than forefoot stuff). And then a few more 5-10k towns closer to 50-60 miles away. So I'm definitely "rural" but I draw from closer to 80,000 people and I work in the town with the regional critical access hospital that does very well financially. Marketing yourself is another story, but theoretically I'm the only person for hundreds of miles that can or will do a flatfoot recon. Or fuse an ankle. Or do any sort of surgical treatment of charcot. I did a cavus recon yesterday. That being said, I expect to end up sending total ankle candidates up to the larger metro where I live to a f/a ortho because he does the most in the area and I have a feeling I'm just not going to see enough of it. Which you have to be ok with if you go rural. But if you can get your name out to all of these surrounding communities, family med and ortho practices, other podiatrists then you could potentially practice with a relatively full scope. It's entirely possible to get plenty of surgical pathology if you are drawing from a large enough population and are the only person in the area capable of treating it.

I did locums in a town of 16,000. Regional hospital, drew from some large reservations and similar sized surrounding towns and within 3 months I had done a few ankle scopes, a few rearfoot recon procedures, a handful of bunions, etc. So my experience is that you have to be really rural or have an unexpected amount of competition to not get good pathology.

If "rural" means you are drawing from 20k total, then yeah, you might get a little rusty or not have the confidence or experience to be doing certain procedures. But I don't think that a large majority of "rural" jobs will limit you significantly. Air bud is right though in the sense that you have to consider that possibility.
 
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