That crazy salary question.

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Weirdy said:
Seriously?

What Smurfey said was right, attending present or not.

Just because you can be rude doesn't mean you should.
Click to expand...

Im not even going to wonder how you can even say Smurfey is right when telling someone to stfu is obviously rude and what started this lol and it had nothing to do with him. I clearly was trying to be a bit sarcastic and not take things too seriously.

smurfeyD said:
Not all of us take selfies in front of public bathroom mirrors
Click to expand...

For the sake of the admin Im not even gonna say anything back nor do I care enough lol.. But just realize what could be said about your current picture and we will leave it at that.
 
That escalated quickly.


How do people know about people’s facebooks? Can people see my Facebook’s?
 
GypsyHummus said:
That escalated quickly.


How do people know about people’s facebooks? Can people see my Facebook’s?
Click to expand...

I only knew his because he has the same banner as his avatar on here. I better not wonder how he assumed mine... Making sure my doors are locked tonight
 
I'm back after a short hiatus.
I never understand these posts because it is all over the place.
They also don't help the profession. Paraphrasing... "you should accept a low income job because that's what it is"
This scares away our brightest students and puts our profession back one step.
Lets move forward and stop accepting those 80k/year jobs. These incomes bring the averages way down.
Despite what people say podiatry is very valuable and the referring medical community loves us. I'm booked out 3+ months and only into my career 6 months.
People pigeon hole themselves and make poor choices because "that's what podiatry pays".
I'm recent in the job market. I respect experiencedDPM because he/she has opinions from many years of experience and training residents.
But graduating in 2017... I had several jobs with 200k+ salaries lined up.
It really wasn't that hard. I had to put myself out there as these jobs were not handed to me but it took effort.
I did work insanely hard in residency and podiatry school. I also went to a pretty good residency.

Never forget... Retiring podiatrists eat their young. It's no secret and its no different than when I started browsing/posting 8 years ago and I read newly graduated residents post about it on this forum. I knew from then on I would not join a podiatry practice. Our retiring providers have no interest in promoting the profession. There may be an exception here and there but for the most part they are in it for themselves. Buyer (PMNews jobs...) beware.

Work hard, get the best residency you can, don't settle for a low salary, start the job hunt early, and don't rag on Natch - that's bad taste.
 
DYK343 said:
I'm back after a short hiatus.
I never understand these posts because it is all over the place.
They also don't help the profession. Paraphrasing... "you should accept a low income job because that's what it is"
This scares away our brightest students and puts our profession back one step.
Lets move forward and stop accepting those 80k/year jobs. These incomes bring the averages way down.
Despite what people say podiatry is very valuable and the referring medical community loves us. I'm booked out 3+ months and only into my career 6 months.
People pigeon hole themselves and make poor choices because "that's what podiatry pays".
I'm recent in the job market. I respect experiencedDPM because he/she has opinions from many years of experience and training residents.
But graduating in 2017... I had several jobs with 200k+ salaries lined up.
It really wasn't that hard. I had to put myself out there as these jobs were not handed to me but it took effort.
I did work insanely hard in residency and podiatry school. I also went to a pretty good residency.

Never forget... Retiring podiatrists eat their young. It's no secret and its no different than when I started browsing/posting 8 years ago and I read newly graduated residents post about it on this forum. I knew from then on I would not join a podiatry practice. Our retiring providers have no interest in promoting the profession. There may be an exception here and there but for the most part they are in it for themselves. Buyer (PMNews jobs...) beware.

Work hard, get the best residency you can, don't settle for a low salary, start the job hunt early, and don't rag on Natch - that's bad taste.
Click to expand...

As a new grad, this has also been my experience. I would listen to this before I listened to the undergrad student that got wait listed at Temple...

For every podiatrist that is a good businessman (or woman), there are 10 others that aren't. I will generalize here, but from my experience too many podiatrists make poor decisions in the ancillary revenue streams that they set up. And in turn end up increasing overhead for revenue that doesn't justify the expenses. An all too common example of this is using office space as a retail store. I recently interviewed with a DPM that has a whole section of his clinic devoted to retail products. It is staffed all the time and doesn't generate as much revenue as 4 patient rooms would, even if you were just leasing the space to another doc. Who has walked into an orthopedic office and seen a wall of braces and shoes and creams for sale in the lobby? This same doc with the retail store offers associates 25% of collections after they've made back their base salary (3x or whatever)...well yeah. he wastes too much money on crap that increases overhead to pay you any more than that. Podiatrists get sold on lasers and ABIs and other useless crap that they end up either losing money on or pushing patients towards in order to make that monthly payment on the device. And you wonder why they can only afford to pay you PA/NP money? There is a reason that most device and equipment reps will tell you that if you want to sell something, find a podiatrist.

It's just a different mindset from other medical professionals. I get that orthopedic surgeons have higher reimbursements (larger joints pay more), but their approach to hiring associates is different. A podiatrist is hiring you to make himself or herself money. Period. There is bad pay up front and a large buy in on the back end. Orthopedic groups grow, partly, in order to raise capital to invest in ancillary revenue streams that PAY (and obviously decrease call burden). Office space/real estate, surgery centers, imaging, etc. Not retail stores selling felt pads and compression socks. And in general you do not pay them hundreds of thousands of dollars to partner. Multispecialty groups are the same. They're investing in things that make money and they want you to contribute to that, not sling tchotchkes out of your office.

We are unfortunately still a profession of desperate people. Desperate to practice medicine without the grades or MCAT so we went to podiatry school. Desperate to work in a specific location and therefore end up getting abused by other podiatrists. Desperate to make money so we get suckered in to bad deals with equipment that doesn't end up reimbursing what we were promised. Desperate to have any patients so we fill up a schedule with folks that will reimburse <$40 a pop...It may or may not ever change, hopefully it does. In the mean time, get good training and find hospitals, groups, etc. that want you to use it and will pay you to do so.
 
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dtrack22 said:
As a new grad, this has also been my experience. I would listen to this before I listened to the undergrad student that got wait listed at Temple...

For every podiatrist that is a good businessman (or woman), there are 10 others that aren't. I will generalize here, but from my experience too many podiatrists make poor decisions in the ancillary revenue streams that they set up. And in turn end up increasing overhead for revenue that doesn't justify the expenses. An all too common example of this is using office space as a retail store. I recently interviewed with a DPM that has a whole section of his clinic devoted to retail products. It is staffed all the time and doesn't generate as much revenue as 4 patient rooms would, even if you were just leasing the space to another doc. Who has walked into an orthopedic office and seen a wall of braces and shoes and creams for sale in the lobby? This same doc with the retail store offers associates 25% of collections after they've made back their base salary (3x or whatever)...well yeah. he wastes too much money on crap that increases overhead to pay you any more than that. Podiatrists get sold on lasers and ABIs and other useless crap that they end up either losing money on or pushing patients towards in order to make that monthly payment on the device. And you wonder why they can only afford to pay you PA/NP money? There is a reason that most device and equipment reps will tell you that if you want to sell something, find a podiatrist.

It's just a different mindset from other medical professionals. I get that orthopedic surgeons have higher reimbursements (larger joints pay more), but their approach to hiring associates is different. A podiatrist is hiring you to make himself or herself money. Period. There is bad pay up front and a large buy in on the back end. Orthopedic groups grow, partly, in order to raise capital to invest in ancillary revenue streams that PAY (and obviously decrease call burden). Office space/real estate, surgery centers, imaging, etc. Not retail stores selling felt pads and compression socks. And in general you do not pay them hundreds of thousands of dollars to partner. Multispecialty groups are the same. They're investing in things that make money and they want you to contribute to that, not sling tchotchkes out of your office.

We are unfortunately still a profession of desperate people. Desperate to practice medicine without the grades or MCAT so we went to podiatry school. Desperate to work in a specific location and therefore end up getting abused by other podiatrists. Desperate to make money so we get suckered in to bad deals with equipment that doesn't end up reimbursing what we were promised...It may or may not ever change, hopefully it does. In the mean time, get good training and find hospitals, groups, etc. that want you to use it and will pay you to do so.
Click to expand...


End all be all there is no guarantee of how much you make. But chances are that if you work hard in school, residency and practice good medicine it will be okay.

Sources- 4 pods that i have shadowed and also what everyone else has reiterated on this forum times infinity.
 
What is the solution to bad revenue streams? You mentioned one already (instead of a foot store, make new patient rooms) But is there a particular service pods can offer that make good money?

dtrack22 said:
As a new grad, this has also been my experience. I would listen to this before I listened to the undergrad student that got wait listed at Temple...

For every podiatrist that is a good businessman (or woman), there are 10 others that aren't. I will generalize here, but from my experience too many podiatrists make poor decisions in the ancillary revenue streams that they set up. And in turn end up increasing overhead for revenue that doesn't justify the expenses. An all too common example of this is using office space as a retail store. I recently interviewed with a DPM that has a whole section of his clinic devoted to retail products. It is staffed all the time and doesn't generate as much revenue as 4 patient rooms would, even if you were just leasing the space to another doc. Who has walked into an orthopedic office and seen a wall of braces and shoes and creams for sale in the lobby? This same doc with the retail store offers associates 25% of collections after they've made back their base salary (3x or whatever)...well yeah. he wastes too much money on crap that increases overhead to pay you any more than that. Podiatrists get sold on lasers and ABIs and other useless crap that they end up either losing money on or pushing patients towards in order to make that monthly payment on the device. And you wonder why they can only afford to pay you PA/NP money? There is a reason that most device and equipment reps will tell you that if you want to sell something, find a podiatrist.

It's just a different mindset from other medical professionals. I get that orthopedic surgeons have higher reimbursements (larger joints pay more), but their approach to hiring associates is different. A podiatrist is hiring you to make himself or herself money. Period. There is bad pay up front and a large buy in on the back end. Orthopedic groups grow, partly, in order to raise capital to invest in ancillary revenue streams that PAY (and obviously decrease call burden). Office space/real estate, surgery centers, imaging, etc. Not retail stores selling felt pads and compression socks. And in general you do not pay them hundreds of thousands of dollars to partner. Multispecialty groups are the same. They're investing in things that make money and they want you to contribute to that, not sling tchotchkes out of your office.

We are unfortunately still a profession of desperate people. Desperate to practice medicine without the grades or MCAT so we went to podiatry school. Desperate to work in a specific location and therefore end up getting abused by other podiatrists. Desperate to make money so we get suckered in to bad deals with equipment that doesn't end up reimbursing what we were promised. Desperate to have any patients so we fill up a schedule with folks that will reimburse <$40 a pop...It may or may not ever change, hopefully it does. In the mean time, get good training and find hospitals, groups, etc. that want you to use it and will pay you to do so.
Click to expand...
 
@dtrack22 is a good example of what he is talking about, but he can expand if he wants. Well trained, fixed on a location, could t find a job took a crappy job close to where he trained because needed something (before BTC paid for his kids education). In the end good training wins out but took some luck for a position to open. Up closer to where wants to be. So even somebody smart and well trained perpetuated the myth. Imagine what is happening in the Northeast with all the time and NY grads...
 
We do need good people in the field, that’s for sure. Better applicant pool yields a better image for this profession as well. We have really come a long way to make podiatry what it is today, and I personally believe the future is better. We are more integrated now and we do provide valuable services.

Yes we are not unique, but so are the other specialties. The turf wars between vascular, IR and cardiology are getting insane at some places. Not to mention that oncology and neurology are also getting their shares in some of the interventional procedures. Get this: procedures pay more no matter how medicine changes, and people want to do more procedures. In fact IR is its own specialty now, and some IR fellows also worry about the future for IR as they are not “unique”. But eventually everyone will find their own niche.

Again, keep reading and learning, practice good medicine, contribute to meaningful research, and you will be well respected in your community and make a comfortable living.
 
dtrack22 said:
As a new grad, this has also been my experience. I would listen to this before I listened to the undergrad student that got wait listed at Temple...

For every podiatrist that is a good businessman (or woman), there are 10 others that aren't. I will generalize here, but from my experience too many podiatrists make poor decisions in the ancillary revenue streams that they set up. And in turn end up increasing overhead for revenue that doesn't justify the expenses. An all too common example of this is using office space as a retail store. I recently interviewed with a DPM that has a whole section of his clinic devoted to retail products. It is staffed all the time and doesn't generate as much revenue as 4 patient rooms would, even if you were just leasing the space to another doc. Who has walked into an orthopedic office and seen a wall of braces and shoes and creams for sale in the lobby? This same doc with the retail store offers associates 25% of collections after they've made back their base salary (3x or whatever)...well yeah. he wastes too much money on crap that increases overhead to pay you any more than that. Podiatrists get sold on lasers and ABIs and other useless crap that they end up either losing money on or pushing patients towards in order to make that monthly payment on the device. And you wonder why they can only afford to pay you PA/NP money? There is a reason that most device and equipment reps will tell you that if you want to sell something, find a podiatrist.

It's just a different mindset from other medical professionals. I get that orthopedic surgeons have higher reimbursements (larger joints pay more), but their approach to hiring associates is different. A podiatrist is hiring you to make himself or herself money. Period. There is bad pay up front and a large buy in on the back end. Orthopedic groups grow, partly, in order to raise capital to invest in ancillary revenue streams that PAY (and obviously decrease call burden). Office space/real estate, surgery centers, imaging, etc. Not retail stores selling felt pads and compression socks. And in general you do not pay them hundreds of thousands of dollars to partner. Multispecialty groups are the same. They're investing in things that make money and they want you to contribute to that, not sling tchotchkes out of your office.

We are unfortunately still a profession of desperate people. Desperate to practice medicine without the grades or MCAT so we went to podiatry school. Desperate to work in a specific location and therefore end up getting abused by other podiatrists. Desperate to make money so we get suckered in to bad deals with equipment that doesn't end up reimbursing what we were promised. Desperate to have any patients so we fill up a schedule with folks that will reimburse <$40 a pop...It may or may not ever change, hopefully it does. In the mean time, get good training and find hospitals, groups, etc. that want you to use it and will pay you to do so.
Click to expand...

One of the best and most accurate posts I’ve ever read on this site. It’s nice to know that dtrack “gets it” in the short time he’s been in practice. His points are more accurate than most of you want to believe.
 
DYK343 said:
I'm back after a short hiatus.
I never understand these posts because it is all over the place.
They also don't help the profession. Paraphrasing... "you should accept a low income job because that's what it is"
This scares away our brightest students and puts our profession back one step.
Lets move forward and stop accepting those 80k/year jobs. These incomes bring the averages way down.
Despite what people say podiatry is very valuable and the referring medical community loves us. I'm booked out 3+ months and only into my career 6 months.
People pigeon hole themselves and make poor choices because "that's what podiatry pays".
I'm recent in the job market. I respect experiencedDPM because he/she has opinions from many years of experience and training residents.
But graduating in 2017... I had several jobs with 200k+ salaries lined up.
It really wasn't that hard. I had to put myself out there as these jobs were not handed to me but it took effort.
I did work insanely hard in residency and podiatry school. I also went to a pretty good residency.

Never forget... Retiring podiatrists eat their young. It's no secret and its no different than when I started browsing/posting 8 years ago and I read newly graduated residents post about it on this forum. I knew from then on I would not join a podiatry practice. Our retiring providers have no interest in promoting the profession. There may be an exception here and there but for the most part they are in it for themselves. Buyer (PMNews jobs...) beware.

Work hard, get the best residency you can, don't settle for a low salary, start the job hunt early, and don't rag on Natch - that's bad taste.
Click to expand...

As a new grad, my experience with the job search has been consistent with DYK343. Every multi specialty/hospital group that I've interviewed with offered salaries in the 200k+ range. I've been offered as high as $270K fresh out of residency for a hospital employed podiatrist.

My overall thoughts on the salary discrepancy is that MGMA salary data is fairly accurate for hospital/multi specialty employed podiatrist. The number of podiatrist employed in these positions are so few comparison to the number of pods in private practice/podiatry groups. Those podiatrist in private practice have starting salaries that are significant lower. Eventually with time/experience/business savvy private practice podiatrist can make more. Listen to Dtrack's advice.
 
My take is it is even more confusion than has been addressed thus far. First off, many solo practitioners have finances deeply intertwined with business expenses. Vacations, transportation, and supplies are intentionally intertwined with business expenses so they do not show as taxable income. That said, I have been around for a decade or so and have gotten the gist of other salaries.
How much money you make will depend on the following (list of course not all inclusive):

1. How many patients you can see on your schedule and provide adequate care-
Challenges to over come:
a.This is becoming increasingly more difficult as hospitals are buying out all referral sources and keeping business where they collect some or most of the money.
b. Wound care centers with bigger marketing budgets than you
c. Decreases in patients due to higher deductibles
d. Government regulations in HIPAA and MACRA require extensive documentation and disclosures
e. Med Mal carriers and due prudence demand that notes identify a vast swath of pertinent negative findings and timely disclosures reviewed before rendering any treatments
f. Overschedule and you piss people off under schedule and you are paying staff to look at Facebook rather than treating patients
g. Explaining proper care takes time and cuts into point number 1 and you get little or no more money for taking time to explain complicated health care issues to patients and even more complicated coverage issues

2. How much you can bill per visit
Challenges:
a. if you are unbundling codes inappropriately you will be audited, jailed and or fined
b. Being a nice target for referrals requires seeing some low paying/ high needs patients so that you will also be referred strait forward bunion surgeries.
c. Racking up charges in a high deductible environment angers patients---He charged for what? an office visit and a procedure? I'll go somewhere else... same thing happens, because we are all trying to make a living and get what we can get when we can get it legally, because the insurance company is going to deny the next three claims and overhead keeps going up.

3. How much surgery you do
Challenges:
a. Not everyone needs or is a proper candidate for elective foot surgery
b. When risks are thoroughly explained, many patients would rather do without elective surgery
c. taking time to explain the recovery of most of what we do is likely to dissuade elective surgery patients and most of what we do is elective- taking time reduces point #1

4. Orthotics
Challenges:
a. Insurance does not cover
b. Honest disclosure as to why they are not covered necessitates a discussion about studies that fail to prove utility and value over prefab devices
this takes time and cuts into point number 1
c. Out of pocket cost generate expectations that often cannot be fulfilled

5. Diabetic Shoes
Challenges:
a. Not everyone qualifies and trying to explain why someone does not qualify is time consuming cutting into #1
b. Catering to patients desire to be covered is fraud and will leave you fined or in jail
c. you have to dispense shoes before you can get paid- if Medicare denies and you bill the patient you will loose the patient and the money you spent on the shoes.
d. Because of the above many DPMs find DM shoes to be a loosing proposition

6. Toenail and corn debridement
Advantages: can be worked in between other patients to maximize use of schedule time
Challenges:
a. Patients think your office is the bar in Cheers, and are not prepared to shuttled out after 5 minutes.
b. Many patients are not covered
c. Many patients were covered when treated by another podiatrist- so you must no know what you are doing or trying to rip him or her off
d. It does not pay much and requires a large volume to generate revenue
e. If you try and make it pay, you will cover patients inappropriately or inflate your billing a la 11730 codes and likely end up fined or in jail.
f. The denied bastard step child of podiatry, but the most billed code by numbers and dollars in the entire profession, if you are not trimming nails you may not eat, while waiting to build that surgical practice

7. Patients that get better
Advantages: Patients that get better make room for more new patients exams which are higher paying visits
Challenges:
a. patients that get better are no longer a source of revenue but are hopefully a source of advertising.
b. Multiple follow ups may seem like you are very concerned for the patients well being or may be perceived as generating quick visits for revenue by the patient
c. If you do not follow up a patient enough they feel deserted and see another doctor
d. trying to respect this balance is not good for office revenue and some doctors will use low potency steroids to generate multiple and quick injection visits.
e. If you can eliminate a patients symptoms concerns in 1-2 visits they will never appreciate that you saved them 6 copays and 12 weeks of pain, they will just complain about the copay for a follow up when they feel fine.

8. In office sales- these are unnecessary for patients and should be prohibited when the product is available over the counter or there is inadequate literature to support its use. You are exploiting your patients trust in you as a medical professional and you are betraying that trust if you are doing this.

Most the folks I know do general podiatry. The guys I know that are making > 300k are seeing 60-80 patients a day. They are generally older and economize on charting because they are not worried about lawyers and audits as they approach retirement.

30-40 patients/ day, 5 days a week (or 4 and an OR day) probably puts you in to 180-300K category.

20-25 patients per day puts you in the 125-175K/year category

PM Mgmt last survey indicated an average of about 18 visits per day of all respondents. So I think the numbers fall into the categories outlined by Exp DPM
 
Not a real fight until they take out the Lightsabers.

jehjr said:
I recently went to a conference where the vascular surgeons and the interventional radiologists and cardiologists nearly came to blows. It was awesome.
Click to expand...
 
bunNfxr said:
Most the folks I know do general podiatry. The guys I know that are making > 300k are seeing 60-80 patients a day. They are generally older and economize on charting because they are not worried about lawyers and audits as they approach retirement.

30-40 patients/ day, 5 days a week (or 4 and an OR day) probably puts you in to 180-300K category.

20-25 patients per day puts you in the 125-175K/year category
Click to expand...


Gross or Net ?
It's region specific but I've known several DPM's in a couple different states that gross between 5-600K while averaging 30 pts / day and 2-3 elective forefoot surgeries a week. However, those are mostly quality clinic patients. The DPMs I know that pump out 55 / day are flooded with RTC.
 
bunNfxr said:
My take is it is even more confusion than has been addressed thus far. First off, many solo practitioners have finances deeply intertwined with business expenses. Vacations, transportation, and supplies are intentionally intertwined with business expenses so they do not show as taxable income. That said, I have been around for a decade or so and have gotten the gist of other salaries.
How much money you make will depend on the following (list of course not all inclusive):

1. How many patients you can see on your schedule and provide adequate care-
Challenges to over come:
a.This is becoming increasingly more difficult as hospitals are buying out all referral sources and keeping business where they collect some or most of the money.
b. Wound care centers with bigger marketing budgets than you
c. Decreases in patients due to higher deductibles
d. Government regulations in HIPAA and MACRA require extensive documentation and disclosures
e. Med Mal carriers and due prudence demand that notes identify a vast swath of pertinent negative findings and timely disclosures reviewed before rendering any treatments
f. Overschedule and you piss people off under schedule and you are paying staff to look at Facebook rather than treating patients
g. Explaining proper care takes time and cuts into point number 1 and you get little or no more money for taking time to explain complicated health care issues to patients and even more complicated coverage issues

2. How much you can bill per visit
Challenges:
a. if you are unbundling codes inappropriately you will be audited, jailed and or fined
b. Being a nice target for referrals requires seeing some low paying/ high needs patients so that you will also be referred strait forward bunion surgeries.
c. Racking up charges in a high deductible environment angers patients---He charged for what? an office visit and a procedure? I'll go somewhere else... same thing happens, because we are all trying to make a living and get what we can get when we can get it legally, because the insurance company is going to deny the next three claims and overhead keeps going up.

3. How much surgery you do
Challenges:
a. Not everyone needs or is a proper candidate for elective foot surgery
b. When risks are thoroughly explained, many patients would rather do without elective surgery
c. taking time to explain the recovery of most of what we do is likely to dissuade elective surgery patients and most of what we do is elective- taking time reduces point #1

4. Orthotics
Challenges:
a. Insurance does not cover
b. Honest disclosure as to why they are not covered necessitates a discussion about studies that fail to prove utility and value over prefab devices
this takes time and cuts into point number 1
c. Out of pocket cost generate expectations that often cannot be fulfilled

5. Diabetic Shoes
Challenges:
a. Not everyone qualifies and trying to explain why someone does not qualify is time consuming cutting into #1
b. Catering to patients desire to be covered is fraud and will leave you fined or in jail
c. you have to dispense shoes before you can get paid- if Medicare denies and you bill the patient you will loose the patient and the money you spent on the shoes.
d. Because of the above many DPMs find DM shoes to be a loosing proposition

6. Toenail and corn debridement
Advantages: can be worked in between other patients to maximize use of schedule time
Challenges:
a. Patients think your office is the bar in Cheers, and are not prepared to shuttled out after 5 minutes.
b. Many patients are not covered
c. Many patients were covered when treated by another podiatrist- so you must no know what you are doing or trying to rip him or her off
d. It does not pay much and requires a large volume to generate revenue
e. If you try and make it pay, you will cover patients inappropriately or inflate your billing a la 11730 codes and likely end up fined or in jail.
f. The denied bastard step child of podiatry, but the most billed code by numbers and dollars in the entire profession, if you are not trimming nails you may not eat, while waiting to build that surgical practice

7. Patients that get better
Advantages: Patients that get better make room for more new patients exams which are higher paying visits
Challenges:
a. patients that get better are no longer a source of revenue but are hopefully a source of advertising.
b. Multiple follow ups may seem like you are very concerned for the patients well being or may be perceived as generating quick visits for revenue by the patient
c. If you do not follow up a patient enough they feel deserted and see another doctor
d. trying to respect this balance is not good for office revenue and some doctors will use low potency steroids to generate multiple and quick injection visits.
e. If you can eliminate a patients symptoms concerns in 1-2 visits they will never appreciate that you saved them 6 copays and 12 weeks of pain, they will just complain about the copay for a follow up when they feel fine.

8. In office sales- these are unnecessary for patients and should be prohibited when the product is available over the counter or there is inadequate literature to support its use. You are exploiting your patients trust in you as a medical professional and you are betraying that trust if you are doing this.

Most the folks I know do general podiatry. The guys I know that are making > 300k are seeing 60-80 patients a day. They are generally older and economize on charting because they are not worried about lawyers and audits as they approach retirement.

30-40 patients/ day, 5 days a week (or 4 and an OR day) probably puts you in to 180-300K category.

20-25 patients per day puts you in the 125-175K/year category

PM Mgmt last survey indicated an average of about 18 visits per day of all respondents. So I think the numbers fall into the categories outlined by Exp DPM
Click to expand...
Fantastic. Thanks for input and effort into this post.
 
bunNfxr said:
My take is it is even more confusion than has been addressed thus far. First off, many solo practitioners have finances deeply intertwined with business expenses. Vacations, transportation, and supplies are intentionally intertwined with business expenses so they do not show as taxable income. That said, I have been around for a decade or so and have gotten the gist of other salaries.
How much money you make will depend on the following (list of course not all inclusive):

1. How many patients you can see on your schedule and provide adequate care-
Challenges to over come:
a.This is becoming increasingly more difficult as hospitals are buying out all referral sources and keeping business where they collect some or most of the money.
b. Wound care centers with bigger marketing budgets than you
c. Decreases in patients due to higher deductibles
d. Government regulations in HIPAA and MACRA require extensive documentation and disclosures
e. Med Mal carriers and due prudence demand that notes identify a vast swath of pertinent negative findings and timely disclosures reviewed before rendering any treatments
f. Overschedule and you piss people off under schedule and you are paying staff to look at Facebook rather than treating patients
g. Explaining proper care takes time and cuts into point number 1 and you get little or no more money for taking time to explain complicated health care issues to patients and even more complicated coverage issues

2. How much you can bill per visit
Challenges:
a. if you are unbundling codes inappropriately you will be audited, jailed and or fined
b. Being a nice target for referrals requires seeing some low paying/ high needs patients so that you will also be referred strait forward bunion surgeries.
c. Racking up charges in a high deductible environment angers patients---He charged for what? an office visit and a procedure? I'll go somewhere else... same thing happens, because we are all trying to make a living and get what we can get when we can get it legally, because the insurance company is going to deny the next three claims and overhead keeps going up.

3. How much surgery you do
Challenges:
a. Not everyone needs or is a proper candidate for elective foot surgery
b. When risks are thoroughly explained, many patients would rather do without elective surgery
c. taking time to explain the recovery of most of what we do is likely to dissuade elective surgery patients and most of what we do is elective- taking time reduces point #1

4. Orthotics
Challenges:
a. Insurance does not cover
b. Honest disclosure as to why they are not covered necessitates a discussion about studies that fail to prove utility and value over prefab devices
this takes time and cuts into point number 1
c. Out of pocket cost generate expectations that often cannot be fulfilled

5. Diabetic Shoes
Challenges:
a. Not everyone qualifies and trying to explain why someone does not qualify is time consuming cutting into #1
b. Catering to patients desire to be covered is fraud and will leave you fined or in jail
c. you have to dispense shoes before you can get paid- if Medicare denies and you bill the patient you will loose the patient and the money you spent on the shoes.
d. Because of the above many DPMs find DM shoes to be a loosing proposition

6. Toenail and corn debridement
Advantages: can be worked in between other patients to maximize use of schedule time
Challenges:
a. Patients think your office is the bar in Cheers, and are not prepared to shuttled out after 5 minutes.
b. Many patients are not covered
c. Many patients were covered when treated by another podiatrist- so you must no know what you are doing or trying to rip him or her off
d. It does not pay much and requires a large volume to generate revenue
e. If you try and make it pay, you will cover patients inappropriately or inflate your billing a la 11730 codes and likely end up fined or in jail.
f. The denied bastard step child of podiatry, but the most billed code by numbers and dollars in the entire profession, if you are not trimming nails you may not eat, while waiting to build that surgical practice

7. Patients that get better
Advantages: Patients that get better make room for more new patients exams which are higher paying visits
Challenges:
a. patients that get better are no longer a source of revenue but are hopefully a source of advertising.
b. Multiple follow ups may seem like you are very concerned for the patients well being or may be perceived as generating quick visits for revenue by the patient
c. If you do not follow up a patient enough they feel deserted and see another doctor
d. trying to respect this balance is not good for office revenue and some doctors will use low potency steroids to generate multiple and quick injection visits.
e. If you can eliminate a patients symptoms concerns in 1-2 visits they will never appreciate that you saved them 6 copays and 12 weeks of pain, they will just complain about the copay for a follow up when they feel fine.

8. In office sales- these are unnecessary for patients and should be prohibited when the product is available over the counter or there is inadequate literature to support its use. You are exploiting your patients trust in you as a medical professional and you are betraying that trust if you are doing this.

Most the folks I know do general podiatry. The guys I know that are making > 300k are seeing 60-80 patients a day. They are generally older and economize on charting because they are not worried about lawyers and audits as they approach retirement.

30-40 patients/ day, 5 days a week (or 4 and an OR day) probably puts you in to 180-300K category.

20-25 patients per day puts you in the 125-175K/year category

PM Mgmt last survey indicated an average of about 18 visits per day of all respondents. So I think the numbers fall into the categories outlined by Exp DPM
Click to expand...

Bunfxr hit every possible point that can be discussed. Incredibly comprehensive post. Now hopefully the post will be read and appreciated for the no nonsense content. Well done.
 
BunNfxr that was a great post.

...Nothing worse than someone coming in wanting their diabetic shoes renewed (Or nails trimmed) with zero qualifying factors. It happens to me almost weekly. As I know it I am technically supposed to turn in the podiatrist who wrote for the shoes and committed medicare fraud. I have not figured out how to explain to patients they do not qualify other than be blunt about it. Which never goes well.
 
DYK343 said:
I have not figured out how to explain to patients they do not qualify other than be blunt about it. Which never goes well.
Click to expand...

Meaning that they get upset and never come back to have their time-wasting, money-losing, medically unnecessary nail trimming again? Some of us might say that qualifies as “went well.”

You can explain to them that it’s like going to a dermatologist to get a haircut.
 
Do people actually pay out of pocket to get the routine foot care done if they don’t qualify?

Ankle Breaker said:
What I don't understand about routine foot care while reading some of these posts is that...why not make them pay out of pocket for this? I do not understand the pressure to commit fraud to cut nails. Just be honest. Set a precedent.

I created a form to give to patients looking for Routine foot care with set prices for certain routine foot care codes.

I look at the weekly schedule and speak with my MA about any patients looking for routine foot care that do not have any qualifying factors. I instruct her to give the form to patients while they are in the waiting room. Patients must sign the form if they want to be seen for routine foot care.

Right then and there eliminates a lot of problem patients from my practice. If they proceed and are roomed they agree to be billed for the visit and routine foot care.

I have the luxury of a salaried hospital position to be able to pull this off.
Click to expand...
 
Hm. Seems nice. Cuts out the insurance middleman.

Ankle Breaker said:
Yes they do actually. People that are sensate that have random extremely thickened callouses or dystrophic toenails (negative PAS test) have pain. A lot of patients who are willing to pay are elderly patients who are healthy but can't bend over to cut their nails.

I don't do charity work. If granny wants her nails cut she's got to fork over some cash. Sorry granny.
Click to expand...
 
Over the years my schedule has changed and I simply don’t perform a lot of routine palliative care. But I can tell you that over the years I’ve lost MANY patients because I wouldn’t play the game.

If the patient wasn’t diabetic with true class findings or didn’t have significant PVD, I didn’t look for a way to get it covered. However, as we’ve all experienced the patients often got angry telling me that their friends all get their nails cut for free. I told them that won’t happen in my office. Or of course they tell me that the prior doctor always covered the service.

It always amazes me that these patients do not care that I’m honest or that I have integrity. All they care about is getting “free” care.
 
That’s really good collection. Are the rest of you guys all able to get $100 for RFC? I wouldn’t be able to compete where I live with those prices. The hospital used to have a nail clinic that charged $25. They shut it down and now there’s an R.N. who does it for $30 at the senior center plus house calls. Not to mention there's a good chance one of our colleagues in town would find a way to make the service covered by insurance.

Edit: I just opened your attachment. Those charges are similar to what our office charges, although I don't think my partners do 11719 for $24. I think they charge the same as they would for a 11721. Back when I did RFC most of those patients were there just for nails though (no calluses).
 
Last edited:
NatCh said:
That’s really good collection. Are the rest of you guys all able to get $100 for RFC? I wouldn’t be able to compete where I live with those prices. The hospital used to have a nail clinic that charged $25. They shut it down and now there’s an R.N. who does it for $30 at the senior center plus house calls.
Click to expand...

I don't think we could consistently, just based on the way non RFC patients scoff at just paying co-pays and deductibles. Though the office I'm at now should probably try and test the limits of cash pay prices since the next closest person to do it would be the other office we have 20 some odd miles away. There is no competition in the market and I personally would be doing a little "price discovery" as to the value of RFC to the people of this community.

You'll get a lot of DPMs saying "see, I told you nurses would take over this huge source of income," with your example. But I think that's something you should be totally ok with letting go of in many practices. Ours, for example, has enough RFC that we have an extra MA that does nothing but RFC. But the RFC schedule can be so sporadic that there are days where she isn't seeing enough patients to justify her cost and other days where a second MA has to bounce over to that side of the clinic to help out. So you can pay $30k a year for an MA to see RFC, or get rid of that MA, see less patients that reimburse higher per visit and end up making the same money. Or see less RFC at a higher $/visit because you're only charging cash, and adjust staffing costs accordingly. Some of that is a scheduling issue, but once you agree to do RFC you have to deal with this patient population and their scheduling/transportation needs. Once you bend over for them, you have to keep accommodating. It's honestly kinda like government entitlement programs IMO, good luck taking it away. Again, this doesn't make as much sense for a podiatrist that's cutting and dremeling nails him or herself. But I'm not doing that...

I have a really smart friend that shared a revenue spreadsheet/calculator. I may have to plug in some example numbers some time and post results so people can get a better idea of what does and doesn't make sense in terms of $/visit, patient volume, staffing costs, etc. I do it on my own every once in awhile as I'm still trying to learn what I should and shouldn't do if/when I have my own show to run.

Its 20 degrees in a place where its not supposed to be 20 degrees so patients are staying home and I'm bored. I hope people keep commenting for my own entertainment.
 
DrMushroomFoot said:
Those podiatrist in private practice have starting salaries that are significant lower. Eventually with time/experience/business savvy private practice podiatrist can make more. Listen to Dtrack's advice.
Click to expand...

I'm going to add to this. I still believe there are podiatry groups that are fair and profitable long term from a new associate's standpoint. I have no problem with people working for podiatrists, in theory, because I've seen the books for several well run practices. I would work for a podiatry group if the associate contract and buy in terms were favorable (most are not). Not to mention, the current job market necessitates most of us take jobs at podiatry clinics so I don't feel it responsible to tell everyone to run away from podiatry groups...they usually have nothing else to run to. I would prefer to hopefully give some helpful advice on how to evaluate the practice/job. DrMushroomFoot has an awesome job, I would take it, but his salary is essentially capped. I would bet money that someone like ExperiencedDPM spent many years making more money than DrMushroomFoot ever can. I also think that hospital politics can be just as much of a headache as those that come with running a practice. I have a friend with his own practice that opened up in a good location at the right time, making more money than almost all hospital based DPMs (with a capped salary or production limit which is most of them). Now, he's not doing hundreds of thousands of dollars worth of routine foot care like the PMnews survey participants and most of bunNfxr's colleagues, but he has an otherwise "normal" practice. We've discussed his plans to bring on an associate whenever that time comes and I believe that someone will do very well working for and eventually partnering with him.

The problem that I was trying to get at earlier is that too many are more businessman (and not necessarily a good one) than medical provider. And the deal is more often than not bad for the associate in both the short term and the long term because of how their employer has decided to set up his/her practice. I simply believe you need to be much more skeptical of podiatry practices when job hunting than you do MSG, ortho, hospital groups because of the reasons I outlined in my previous post. I wouldn't (and really, you can't) discount them entirely though.
 
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dtrack22 said:
You'll get a lot of DPMs saying "see, I told you nurses would take over this huge source of income," with your example. But I think that's something you should be totally ok with letting go of in many practices. Ours, for example, has enough RFC that we have an extra MA that does nothing but RFC. But the RFC schedule can be so sporadic that there are days where she isn't seeing enough patients to justify her cost and other days where a second MA has to bounce over to that side of the clinic to help out.
Click to expand...

I don't think the "nail nurse" here makes a huge income; Our population is too small and her senior center clinic is only once per month. She's semi-retired so I'm guessing it's just walking-around money.

We employed a nail tech for awhile to see our RFC patients and her work was quite sporadic. She had maybe two to three patients per week and we'd book those patients (clients?) when we were in surgery so it didn't fill a room that we could otherwise be using. After awhile it made no sense to continue.

Another local practice made a "foot spa" setup where they'd give pedis and soaks, massages and all. I heard through the grapevine that it attracted some very high need clients but I don't know first-hand.
 
Last edited:
NatCh said:
That’s really good collection. Are the rest of you guys all able to get $100 for RFC? I wouldn’t be able to compete where I live with those prices. The hospital used to have a nail clinic that charged $25. They shut it down and now there’s an R.N. who does it for $30 at the senior center plus house calls. Not to mention there's a good chance one of our colleagues in town would find a way to make the service covered by insurance.

Edit: I just opened your attachment. Those charges are similar to what our office charges, although I don't think my partners do 11719 for $24. I think they charge the same as they would for a 11721. Back when I did RFC most of those patients were there just for nails though (no calluses).
Click to expand...

The hospital where I trained at also offered routine nail services for $35. This clinic was staffed by a MA. Callus debridement was not an offered service.
 
My group charges 56 for 11720 and 81 for 11721. 20 percent discount for cash so 45/65. Needless to say not many people do that. I am in a very poor city
 
Okay, so someone should set up a kiosk in the local mall and offer cash only nail and callus care. You’ve got a captured audience who are probably complaining about their feet hurting while shopping.

You can also have a mobile unit that sets up at affairs such as weddings, formals, proms, bar mitzvahs, etc and you can take care of all those women in high heels.

You can call it Foot and Toe on the Go.

Let me know when someone wants to sit down with me and get these franchises going.
 
ExperiencedDPM said:
Okay, so someone should set up a kiosk in the local mall and offer cash only nail and callus care. You’ve got a captured audience who are probably complaining about their feet hurting while shopping.

You can also have a mobile unit that sets up at affairs such as weddings, formals, proms, bar mitzvahs, etc and you can take care of all those women in high heels.

You can call it Foot and Toe on the Go.

Let me know when someone wants to sit down with me and get these franchises going.
Click to expand...

I think we just invented a nail salon.
 
Toes R Us.

ExperiencedDPM said:
Okay, so someone should set up a kiosk in the local mall and offer cash only nail and callus care. You’ve got a captured audience who are probably complaining about their feet hurting while shopping.

You can also have a mobile unit that sets up at affairs such as weddings, formals, proms, bar mitzvahs, etc and you can take care of all those women in high heels.

You can call it Foot and Toe on the Go.

Let me know when someone wants to sit down with me and get these franchises going.
Click to expand...
 
air bud said:
My group charges 56 for 11720 and 81 for 11721. 20 percent discount for cash so 45/65. Needless to say not many people do that. I am in a very poor city
Click to expand...
We used to charge a flat $40 fee for "non-covered" services. Now we charge $50 I think. I get a flat wRVU for non-covered services. I'll probably get 1 person a week that does that, maybe less.
 
does anyone think pod salary will be or have been decreasing? Now or in 5-10 years?
 
AudiLova619 said:
does anyone think pod salary will be or have been decreasing? Now or in 5-10 years?
Click to expand...
this is actually the important question for students and should probably be another thread. The answer is it depends on politics. Trump is not killing MACRA, MIPS, ACOs etc. But he is not likely to sit back and let this crush even a small portion of doctors. He is probably unaware of the changes from the ACA and ARRA that have pressured private practice and would likely act of if this was a palpable and newsworthy development. So I see it as a continued slow death of private practice leading to salary pressure and job competition in the multispecialty groups and hospitals. Private practice will likely get reprieves on MIPS vs fee for service arrangements as long as Trump is in office. Those in comfortable arrangements are probably stable for the foreseeable future.
I believe the Democrats next move is full government controlled healthcare, in which doctors again become the scapegoat for outrageous healthcare costs and get punished accordingly. By punished, I mean salaries capped with no foreseeable growth and increased pressure to justify billings with increased documentation requirements and inane quality measure systems that do nothing but keep you from seeing patient loads that pay your bills.
Your ability to make a living in this environment will depend upon how well you tolerate being controlled and doing your job according to a list of government protocols and whether or not some loan forgiveness gets worked into the next healthcare reform.

As far as Trumpcare, Ryancare, or whatever it is or might be called, I think it is dead in the water and the Republicans are content to leave this lingering unaddressed with the mandate repealed. Overall, I think this is + growth for podiatry for the next few years. But I don't think it can or will remain in this state. It only takes 1-3 people, in a country of millions, dying without health insurance to justify full national crisis management.

Of course the real answer is :No one knows, but there are changes coming. How they come about and how much impact is questionable. If the Dems win in the mid terms, and remain popular to 2020 healthcare will be back front and center. Eventually Republicans will be pushed to actually reform health care if they stay in power. They seem to have no actual plans that would actually accomplish low cost universal coverage, which would be the goal. So they will be challenged to support a Democrat plan that does as soon as someone dies or cries on Ryancare (or whatever).
 
MGMA is reported by the employers directly and it’s in the best self interests to report accurate numbers. Every hospital negotiation I’ve been a part of references MGMA. It is the most accurate for group or hospital employed situations.

APMA, BLS, PM News include all self employed podiatrists who spend down personal corporate accounts by shifting expenses to the corporation and take as low of a salary (or distribution) as possible to lower their tax liability. Some of these surveys (BLS) also include residents which is up to 5% of the Podiatric workforce. Also, APMA and PM News are self-reported figures.

If you’re getting out of residency and looking for guidance, I’d try to use the MGMA numbers, but be willing to accept something lower with growth potential if the right position comes along.


Sent from my iPhone using SDN mobile
 
FootGuy1 said:
I'm paid according to RVUs. $250k/year not including bonuses. MGMA average isn't that far off, in fact might be a little low.
Click to expand...
I had no idea you guys were paid so little relatively... When compared to other surgeons with years of residency similar to podiatrists (ortho, gen surg, optho, ent, OMFS, etc.) who average in the $500k range. Why is there such a difference? Insurance just doesn’t pay the same for foot procedures compared to everything else ? $250k is not a surgeon salary...
 
SnozzBerry said:
I had no idea you guys were paid so little relatively... When compared to other surgeons with years of residency similar to podiatrists (ortho, gen surg, optho, ent, OMFS, etc.) who average in the $500k range. Why is there such a difference? Insurance just doesn’t pay the same for foot procedures compared to everything else ? $250k is not a surgeon salary...
Click to expand...
first, 500K average is simply inaccurate.
second, some podiatrists either do not perform surgery at all or perform it 1 day of the week only compared to other surgical MD/Dao specialties
 
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