The future of podiatry

[ExperiencedDPM]

Real billing and coding seminars and examples are what we need, as a podiatrist in PP I’ve been to seminars webinars conferences and asked the experts on apma coding resource but it’s all regurgitation of the definition of the CPT code and then ending their sentence with “this is my opinion”.

You are correct. Coding correctly is much more difficult than most understand. The problem with coding is that there are too many teaching and offering advice who THINK they understand coding.

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[dtrack22]

You give an injection to the right heel and code M72.2. Your ICD-10 code isn't sided. Neither is your CPT code. Some people think all they need to do is put M72.2, without the associated pain code M79.671.

I have yet to practice in an area where this example is a necessary way to bill. Plantar fasciitis doesn’t have laterality and no pain code was required in TX, or the Midwest or the West coast in order to get paid by Medicare or commercial insurers. So a new patient e/m with m72.2 as the dx with 20550/1 having the same attached dx code gets paid. Or at least it is supposed to.

Insurance companies do purposefully create rules to avoid payment and force appeals. BCBS did this in Texas where they auto-denied all claims with a 25 modifier while I was in practice there. They claimed at first it was some sort of computer software error, but then never fixed it. So despite accurate coding for services that they were contractually obligated to pay, they forced every provider to submit an appeal and notes to get any 25 modifier claim billed. They knew exactly what they were doing and that was evidenced by them admitting to the issue and then not fixing it over the course of 2-3 years.

Last year alone I turned away about $230,000 worth of legal work because I will not take a case against a peer.

Send those my way. While I wouldn’t take a case against a peer in most cases, I would be happy to do so when there is actual negligence/malpractice. You don’t think a patient who suffered due to gross negligence deserves your support/testimony?

 

[heybrother]

I don't understand people griping at ExpDPM for evaluating op notes for fraud. We should be paid for what we actually do and there's clearly fraud going on. It should be penalized. I'm sort of blown away that there are that many STJ implants put in since I saw -zero- done during my 4th year but maybe its regional. If a podiatrist performed the surgery I'm grateful that another podiatrist was asked to evaluate it. This forum seems to be rife with 25 modifier fraud so its probably hard for a lot of people to hear that yes - people are looking for fraud. But by all means, continue billing a 99214 + a procedure every single time you see a patient.

That said, the idea that insurance companies are "honest brokers" is like something out of a parallel universe where business majors don't exist.

The second I read that this morning I immediately typed in variations of "prior authorization fraud" and instantly found a report on a website where a government watchdog reviewed 1 week of an insurance companies processes (which still contained tens of thousands of claims) and found double digit numbers of inappropriate denials of prior authorizations and an even larger numbers of denied covered services.

You don't have to have a "written policy" of denying claims to have that intent. You create a culture of claim denial that you know benefits your bottom line. You purposely understaff. You create unmanned phone centers and processes for vital processes. You make the burden of proving the necessity of a claim fall on the practice instead of the burden of disproving the claim on the payor.

Last year my office manager was out of the office having surgery. I had an upcoming case with a weird BCBS from Minnesota that couldn't be checked through Availity. She told me she hadn't been able to check the prior authorization over the phone. I called to try and do it myself. I got disconnected 4 times in a row trying to make it through the menu and typing the patient's name and relevant bio infor in via a key pad. I ultimately reached the process whereby I could speak to a rep, but first I sat through 25 straight minutes of computer recordings reading to me information about the patient's policy. Literally none of it was relevant or useable and every 2-3 minutes it would ask me if I wanted to go on or be disconnected. I finally reached a 12 minute hold and then a rep who was very helpful. I asked if there was a way to call the rep directly in the future - nope. You have to go through the menu every time. I came in on a day I had off to do this. This sort of thing is purposely designed to eat time and make you pull the trigger. In my case - none of the codes were prior authorization required but if we made a habit of skipping the process we'd end up with even more free surgeries.

I had numerous MRIs denied (really just delayed) last year because we "hadn't done an x-ray yet" - except we had. Phonecall to resolve. This has happened to me so many times I find it hard to believe there isn't some sort of hard stop in place requiring a phonecall. I go out of my way to send notes and a detailed rationalization for why I'm ordering an MRI in my notes.

I had a few positive experiences with BCBS last year where they denied a CT. I managed to speak to a nurse within about 3 minutes of holding. The nurse was supposed to be the set-up person for a peer to peer but in each case when I explained to the nurse why I wanted a CT they authorized it on the spot. I didn't find that overly unreasonable since the imagery was being done by a hospital and not a imaging center.

People are free to believe what they want to be, but interact with an insurance company as a supplicant and see how you feel. Brass tacks - what really kills me is refusing payment after the fact. I can live in a world where everything is denied up front and you have to ask and explain to make it happen. I will not have a relationship with an insurance company that comes up with denials after the fact. Someone has to pay for those cases.

 

[dtrack22]

I don't understand people griping at ExpDPM for evaluating op notes for fraud.

They just keep arguing about two totally different things. One person is talking about office visits and procedures where the claim is denied, despite accurate coding, only to be paid when notes are sent, with no changes to the claim form being made. The other person is speaking ONLY of surgical billing.

Im honestly not sure why they haven’t figured this out yet…

 

[ExperiencedDPM]

They just keep arguing about two totally different things. One person is talking about office visits and procedures where the claim is denied, despite accurate coding, only to be paid when notes are sent, with no changes to the claim form being made. The other person is speaking ONLY of surgical billing.

Im honestly not sure why they haven’t figured this out yet…

I have figured it out. I’m just trying to let this guy know that not everything that doesn’t go his way is a conspiracy.

 

[ExperiencedDPM]

I have yet to practice in an area where this example is a necessary way to bill. Plantar fasciitis doesn’t have laterality and no pain code was required in TX, or the Midwest or the West coast in order to get paid by Medicare or commercial insurers. So a new patient e/m with m72.2 as the dx with 20550/1 having the same attached dx code gets paid. Or at least it is supposed to.

Insurance companies do purposefully create rules to avoid payment and force appeals. BCBS did this in Texas where they auto-denied all claims with a 25 modifier while I was in practice there. They claimed at first it was some sort of computer software error, but then never fixed it. So despite accurate coding for services that they were contractually obligated to pay, they forced every provider to submit an appeal and notes to get any 25 modifier claim billed. They knew exactly what they were doing and that was evidenced by them admitting to the issue and then not fixing it over the course of 2-3 years.



Send those my way. While I wouldn’t take a case against a peer in most cases, I would be happy to do so when there is actual negligence/malpractice. You don’t think a patient who suffered due to gross negligence deserves your support/testimony?

Your point is well taken. I do believe that these patients deserve support and expert testimony. That’s just not something I personally like to do, so I refer to someone else.

 

[deleted1149159]

This is a very obvious example that can be easily fixed. No one is talking about claims being denied for errors made in laterality. No one is complaining about claims getting denied for bad documentation or incorrect notes. Those claims should be denied and I 100% agree.

You are not commenting on the situation of getting prior-authorization approved and still getting the same claim denied. Everyone seems to skip this part and just complain of fraud fraud fraud.

If you read very carefully, it states in every insurance guideline book I have ever read, that prior-authorization IS NOT a guarantee of payment. So what are you complaining about again?

 

[deleted1149159]

I have yet to practice in an area where this example is a necessary way to bill. Plantar fasciitis doesn’t have laterality and no pain code was required in TX, or the Midwest or the West coast in order to get paid by Medicare or commercial insurers. So a new patient e/m with m72.2 as the dx with 20550/1 having the same attached dx code gets paid. Or at least it is supposed to.

Insurance companies do purposefully create rules to avoid payment and force appeals. BCBS did this in Texas where they auto-denied all claims with a 25 modifier while I was in practice there. They claimed at first it was some sort of computer software error, but then never fixed it. So despite accurate coding for services that they were contractually obligated to pay, they forced every provider to submit an appeal and notes to get any 25 modifier claim billed. They knew exactly what they were doing and that was evidenced by them admitting to the issue and then not fixing it over the course of 2-3 years.



Send those my way. While I wouldn’t take a case against a peer in most cases, I would be happy to do so when there is actual negligence/malpractice. You don’t think a patient who suffered due to gross negligence deserves your support/testimony?

I have practice in VA, PA and NJ. And in all of those places, laterality and more than one diagnosis code was required for payment. Is it possible your billing/coding people are just adding these diagnoses after the fact? If you employ certified coders, they could and would do that.

As far as the negligence/malpractice cases, there are doctors that are professional witnesses. And they take less than savory cases just to make money. I'm 100% sure that @ExperiencedDPM will gladly take on cases of gross negligence, but you'd be surprised what some of these extraordinarily frivolous cases are about and who serves as witnesses. You do not want to be that guy. They are downright loathed by their peers. Unless you don't care about that.

 

[Feli]

Real billing and coding seminars and examples are what we need, as a podiatrist in PP I’ve been to seminars webinars conferences and asked the experts on apma coding resource but it’s all regurgitation of the definition of the CPT code and then ending their sentence with “this is my opinion”.

This sounds logical, but 90% of the people over-coding, upcoding, and flat out fraudulently coding know exactly what they're doing. It's not unique to podiatry... although possibly more common? Regardless, they've been doing it for years. They won't change.

The guys doing 99214 + 11721 + 11730 + 11755 + lab histo PCR for simple clipping a grandpa's toenails or submitting Lapidus/Akin surgery bill with 28740 + 28740 + 28292 + 28310 + 20900 + 64704 or nursing home RFC nails and calluses with 11730 + 11732 + 11721 + 97597 + 11056 are going to do that stuff no matter what they were taught or will be taught.

All you have to look at is how the use of alcohol sclerosing injects for neuromas, subtalar arthroeresis, "hot" wound grafts and amnio, etc etc etc dropped way off in usage once the code RVUs for them were drastically reduced - or even banned - by payers. It's usually a derm or neuro or DME code that is tried in podiatry and becomes the current fad. A lot of ppl simply do what pays and hit that button until it breaks... find a new button, repeat. It would be great if docs did what the pts need and coded it accurately, but that's just not reality.

...I agree 100% that APMA Coding RC is useful and you want to do the best you can, though. I have not been too impressed with AAPPM or ACFAS coding stuff... nearly all non-surgical or all surgical. My first job was near the AAPPM prez at the time, Jeff Frederick, and I saw some of his pts. He had a funny - and very true - quote at one of the meetings: "Coding is a lot like sex. You hear some stuff on the bus or at the meetings or in the locker room. You hear stuff from friends and classmates. You read a few things. Some is true, other stuff... not so much. In the end, you mostly do trial and error."

 

[deleted1149159]

This sounds logical, but 90% of the people over-coding, upcoding, and flat out fraudulently coding know exactly what they're doing. It's not unique to podiatry... although possibly more common? Regardless, they've been doing it for years. They won't change.

The guys doing 99214 + 11721 + 11730 + 11755 + lab histo PCR for simple clipping a grandpa's toenails or submitting Lapidus/Akin surgery bill with 28740 + 28740 + 28292 + 28310 + 20900 + 64704 or nursing home RFC nails and calluses with 11730 + 11732 + 11721 + 97597 + 11056 are going to do that stuff no matter what they were taught or will be taught.

All you have to look at is how the use of alcohol sclerosing injects for neuromas, subtalar arthroeresis, "hot" wound grafts and amnio, etc etc etc dropped way off in usage once the code RVUs for them were drastically reduced - or even banned - by payers. It's usually a derm or neuro or DME code that is tried in podiatry and becomes the current fad. A lot of ppl simply do what pays and hit that button until it breaks... find a new button, repeat. It would be great if docs did what the pts need and coded it accurately, but that's just not reality.

...I agree 100% that APMA Coding RC is useful and you want to do the best you can, though. I have not been too impressed with AAPPM or ACFAS coding stuff... nearly all non-surgical or all surgical. My first job was near the AAPPM prez at the time, Jeff Frederick, and I saw some of his pts. He had a funny - and very true - quote at one of the meetings: "Coding is a lot like sex. You hear some stuff on the bus or at the meetings or in the locker room. You hear stuff from friends and classmates. You read a few things. Some is true, other stuff... not so much. In the end, you mostly do trial and error."

I don't know where you get this. Which payers "banned" the payment for sclerosing injections, properly coded arthroereisis, amnio grafts, etc? You have to know how to code them and provide documentation. Do you do sclerosing injections? Any experience with them?

And podiatry isn't near the most common profession that miscodes. PCPs do this all the time with the level of E/M visits they code for.

I'm not sure why so many people live in this podiatry bubble where they think that podiatrists are this shady mess and other professions are gleaming. They aren't this is as common in other professions.

 

[msion]

Let's not deny that there are insurance companies out there that will reject claims without a fair review process, no matter how many coding experts you hire. Molina, for example, is known to deny clean claims. They are just there to keep the profits. It's a horrible company.

The "no auth needed" and then denying claims saying auth doesn't equal payment really irritates me. Again, not something the coding expert can fix.

For all the younger doctors, just save yourself some money on these coding seminars or courses. Get a podiatry coding book. All the CPTs, descriptions, and associated ICD 10s are all in there. Anyone billing outside of these codes/ICD 10s is probably committing fraud anyway. Like, a lapidus is 28297. Do not bill a 28292 and 28740. That's fraud.

 

[AttackNME]

If you read very carefully, it states in every insurance guideline book I have ever read, that prior-authorization IS NOT a guarantee of payment. So what are you complaining about again?

I didn’t know that, what’s the point of prior auth? is the most common reason for not paying then from inadequate documentation?

 

[dtrack22]

Is it possible your billing/coding people are just adding these diagnoses after the fact? If you employ certified coders, they could and would do that.

No. I was doing it myself in my own practice and prior to that I would review the 1500 forms to try and catch shady crap (I worked for a podiatrist after all) and also to learn. In my practice, I used ModMed and I had a 98% first pass rate with no biller or coder. It was just me and the EHR.

The whole, you need a different dx for e/m and CPT is a myth that I only ever hear older podiatrists say. I will concede it is possible that it may be regional but I’ve been in 3 completely different regions, and neither commercial payers, nor Medicare have required a pain code with laterality to justify an injection in the case of M72.2. And if that is getting through payer software first pass, then it is not an actual CPT guideline or it would be built in to said software everywhere.

Don’t get me wrong. I always try and have separate codes for e/m and CPTs when possible, but it is completely unnecessary for PF and ingrowns, for example. I generally use a “pain in joint” code for intra-articular injections, but that’s become habit from some old podiatrist who told me I needed to. I know one of my ortho partners doesn’t. The hospital coders are not making him add it to his arthritis codes. I’ve asked. And CMS doesn’t require this separate pain in joint code when the condition is first diagnosed/treated, osteoarthritis codes work for both the e/m and CPT

“An E&M service may be appropriate if the decision to start the series of injections is made after an evaluation during the same visit. Indicate this by using an E&M code with modifier -25.”

properly coded arthroereisis

The only way to do that is to submit an unlisted code and pray

amnio grafts

Will be bundled soon, reducing a PP’s ability to profit off of their rebate/discount/kickback from the vendor on the graft itself.

So yeah, they are definitely cracking down on the latter at least, to cut costs. Personally I have no problem with that. They should take the millions wasted on grafts and apply it to things that actually take time, energy, and effort, like surgical CPT codes. I hope someday you can’t make a penny off of the graft itself and only get reimbursed for the application.

 

[deleted1149159]

I didn’t know that, what’s the point of prior auth? is the most common reason for not paying then from inadequate documentation?

Yes. Or inaccurate coding. Like you get one code pre-authorized and do something else.

 

[ExperiencedDPM]

Yes. Or inaccurate coding. Like you get one code pre-authorized and do something else.

That’s only partially correct. If you got pre auth for code X but make an intra op decision to perform code Y, you can request a post service reconsideration.

The verbiage “pre auth is not a guarantee of payment” is a CYA for the insurer. It covers them in case the patient’s coverage has been canceled, the provider is no longer in network, the specific plan has restrictions, etc.

For example, there is pre auth for 12/31/22 and that was approved on 11/25/22. If the patient cancels the policy or any other scenario prior to the date of surgery (and the patient doesn’t tell the provider) the payment is not guaranteed.

 

[619]

There is something seriously wrong with you. You question my integrity and question my honesty.

I can back up everything I wrote and if you want to put your money where your mouth is I can prove it. Unlike your baseless insults.

Show me where I insulted you? Truth is, no one here believe you turned away $230,000 worth of legal work so you can redact that baseless claim. You are not going to prove anything because you and I know it's bogus.

Sorry that you are apparently an unsuccessful practitioner. But I assure you (and I’m willing to put money up) that I have changed and created national policies for several companies (and received no money for those changes) and each one of those changes decreased the difficulty of getting certain procedures approved.

This is a big LOL. I will leave your ignorance at that.

 

[deleted1149159]

That’s only partially correct. If you got pre auth for code X but make an intra op decision to perform code Y, you can request a post service reconsideration.

The verbiage “pre auth is not a guarantee of payment” is a CYA for the insurer. It covers them in case the patient’s coverage has been canceled, the provider is no longer in network, the specific plan has restrictions, etc.

For example, there is pre auth for 12/31/22 and that was approved on 11/25/22. If the patient cancels the policy or any other scenario prior to the date of surgery (and the patient doesn’t tell the provider) the payment is not guaranteed.

Fair enough!

 

[Pronation]

That’s only partially correct. If you got pre auth for code X but make an intra op decision to perform code Y, you can request a post service reconsideration.

The verbiage “pre auth is not a guarantee of payment” is a CYA for the insurer. It covers them in case the patient’s coverage has been canceled, the provider is no longer in network, the specific plan has restrictions, etc.

For example, there is pre auth for 12/31/22 and that was approved on 11/25/22. If the patient cancels the policy or any other scenario prior to the date of surgery (and the patient doesn’t tell the provider) the payment is not guaranteed.

Due to the severe instability of the midfoot, an intraoperative decision was made to proceed with multiple midfoot fusion and a spot weld of the intercuneiform joint. At this juncture, I proceeding with applying my welding face shield…

 

[NatCh]

Yes, just call 1-800-11NatCH

HEYYYYY!

 

[619]

https://www.hmpgloballearningnetwork.com/site/podiatry/blog/advancing-aco-model-podiatry

The future of podiatry is bright

 

[619]

"Of all the other specialties in medicine, for a podiatric group to get the first specialty ACO contract and then deliver the results envisioned by CMMI is monumental for the profession."

 

[ExperiencedDPM]

Due to the severe instability of the midfoot, an intraoperative decision was made to proceed with multiple midfoot fusion and a spot weld of the intercuneiform joint. At this juncture, I proceeding with applying my welding face shield…

Gotta love that spot weld crap. Either it’s an arthrodesis or it’s not. They say there is bony growth at the screw interface, blah, blah, blah. Take that screw out and see if it’s still “welded”. When you see it’s not you’ll spot weld your underoos

 

[ExperiencedDPM]

Show me where I insulted you? Truth is, no one here believe you turned away $230,000 worth of legal work so you can redact that baseless claim. You are not going to prove anything because you and I know it's bogus.

This is a big LOL. I will leave your ignorance at that.

You’re correct. It was likely much more than $230,000.

I already said I’m willing to prove it. I have no reason to make bogus claims. I don’t accept those legal cases. And I honestly could care less what you believe.

Go spin a few new conspiracy theories.

My ignorance? I’m confident that I’ve already forgotten more than you’ve ever known.

Isn’t it time to have some cheese with your whine?

 

[619]

You’re correct. It was likely much more than $230,000.

I already said I’m willing to prove it. I have no reason to make bogus claims. I don’t accept those legal cases. And I honestly could care less what you believe.

Go spin a few new conspiracy theories.

My ignorance? I’m confident that I’ve already forgotten more than you’ve ever known.

Isn’t it time to have some cheese with your whine?

I will give you the last word and leave it at that. I am more of an IPA beer guy. Have a glass of wine for me.

 

[ExperiencedDPM]

I will give you the last word and leave it at that. I am more of an IPA beer guy. Have a glass of wine for me.

Single malt scotch, but thanks.

 

[air bud]

Single malt scotch, but thanks.

Just picked up that new balvenie 16

 

[NatCh]

Alcohol is bad for you!








Ssssip.

 

[thefootfixer]

Just got off the phone w a colleague. New grad. Got offered a base salary of 70k.

“Benefits”
5 days vacation.
1 CME conference
Malpractice coverage (no tail)
Hospital dues and state dues
License Dea etc fees

Colleague will apparently be “fed” patients from existing docs schedule. And will be scheduled new patients. Position includes NH (no reimbursement for gas etc due to it being W2. Pretty busy place case wise I’m told. Abfas feet required at a certain point .

Seems like a bust. Except for maybe quick case collection. Colleague isn’t on SDN so they have asked me to post on their behalf. Colleague will be graduating in July 2023.

 

[deleted1149159]

Just got off the phone w a colleague. New grad. Got offered a base salary of 70k.

“Benefits”
5 days vacation.
1 CME conference
Malpractice coverage (no tail)
Hospital dues and state dues
License Dea etc fees

Colleague will apparently be “fed” patients from existing docs schedule. And will be scheduled new patients. Position includes NH (no reimbursement for gas etc due to it being W2. Pretty busy place case wise I’m told. Abfas feet required at a certain point .

Seems like a bust. Except for maybe quick case collection. Colleague isn’t on SDN so they have asked me to post on their behalf. Colleague will be graduating in July 2023.

No. Vacation time sucks. Base is way too low. No health insurance with that low of a salary? LOL.

 

[deleted1138023]

Just got off the phone w a colleague. New grad. Got offered a base salary of 70k.

“Benefits”
5 days vacation.
1 CME conference
Malpractice coverage (no tail)
Hospital dues and state dues
License Dea etc fees

Colleague will apparently be “fed” patients from existing docs schedule. And will be scheduled new patients. Position includes NH (no reimbursement for gas etc due to it being W2. Pretty busy place case wise I’m told. Abfas feet required at a certain point .

Seems like a bust. Except for maybe quick case collection. Colleague isn’t on SDN so they have asked me to post on their behalf. Colleague will be graduating in July 2023.

may as well do a fellowship so you can brag you're fellowship trained

 

[icebreaker32]

Sounds like the stereotypical SDN associate PP job.

With great jobs like this available I can only draw one conclusion .....we need a lot more schools.

 

[Shiyuan]

Wow. Too say that’s insulting isn’t even coming close.

 

[bloxxeeey]

It’s sad that I made more as an intern, with better benefits and vacation time.

 

[heybrother]

Just got off the phone w a colleague. New grad. Got offered a base salary of 70k.

“Benefits”
5 days vacation.
1 CME conference
Malpractice coverage (no tail)
Hospital dues and state dues
License Dea etc fees

Colleague will apparently be “fed” patients from existing docs schedule. And will be scheduled new patients. Position includes NH (no reimbursement for gas etc due to it being W2. Pretty busy place case wise I’m told. Abfas feet required at a certain point .

Seems like a bust. Except for maybe quick case collection. Colleague isn’t on SDN so they have asked me to post on their behalf. Colleague will be graduating in July 2023.

About as bad an offer you can get. A person being overly kind will try and say "yes, but what's the bonus". The answer is - it will be garbage because no one who offers you $70K/no benefits is going to offer you 40% and a defined straight forward buy in at 2 years. You are their idiot puppet to be used and abused. They should keep looking. Offers under $100K are sadly "common" but I think "statistically" if your friend interviewed at 5 more offices they likely could still beat this offer. $100K is meh, but its still a common offer and substantially better than $70K.

Someone out there will over $100-120K / 30% / health insurance / 2 weeks off if they keep looking but it may take 10-20 interviews. How sad is that.

I could not imagine working a terrible job just to build cases. Being an owner and doing cases for the right reasons is stress enough.

 

[de Ribas]

Just got off the phone w a colleague. New grad. Got offered a base salary of 70k.

“Benefits”
5 days vacation.
1 CME conference
Malpractice coverage (no tail)
Hospital dues and state dues
License Dea etc fees

Colleague will apparently be “fed” patients from existing docs schedule. And will be scheduled new patients. Position includes NH (no reimbursement for gas etc due to it being W2. Pretty busy place case wise I’m told. Abfas feet required at a certain point .

Seems like a bust. Except for maybe quick case collection. Colleague isn’t on SDN so they have asked me to post on their behalf. Colleague will be graduating in July 2023.

Fake. That's just so bad it can't be true. But sad part is that it is true. I guess better stay resident for life. Many residencies pay around 70k now for PGY-3 with 3 weeks of vacation.

 

[Utvolsdpm]

Fake. That's just so bad it can't be true. But sad part is that it is true. I guess better stay resident for life. Many residencies pay around 70k now for PGY-3 with 3 weeks of vacation.

I know someone who took a similar offer in North Texas. I had heard of 80k offers before but that was the first time I had heard of 70k. The person took the offer.

 

[underwood]

Also third year here looking for work. Have seen 100k base, saw straight 30% collections. Most base salaries came with 30% collections after 3x. PTO 10-15 days.
So far saw nothing over 30%… I don’t even try negotiating that since it seems to be the norm.

 

[bloxxeeey]

Also third year here looking for work. Have seen 100k base, saw straight 30% collections. Most base salaries came with 30% collections after 3x. PTO 10-15 days.
So far saw nothing over 30%… I don’t even try negotiating that since it seems to be the norm.

What are the offers you've seen so far that have been decent?

 

[underwood]

What are the offers you've seen so far that have been decent?

For private practice I’ve accepted that 100-120 base and 30% after 3x is a “good” offer. The ones with decent benefits/PTO is a plus. Main goal is to find a busy clinic so that hopefully can hit collections first year

 

[bloxxeeey]

For private practice I’ve accepted that 100-120 base and 30% after 3x is a “good” offer. The ones with decent benefits/PTO is a plus. Main goal is to find a busy clinic so that hopefully can hit collections first year

Have any practices been open to you becoming a partner or is that something they avoid talking about? Just trying to look for general advice as a 2nd year resident.

 

[Boba Foot]

I know someone who took a similar offer in North Texas. I had heard of 80k offers before but that was the first time I had heard of 70k. The person took the offer.

What’s the practice?

 

[dtrack22]

What’s the practice?

It sounds similar to a contract from this one…

Academy Foot & Ankle Specialists

They seem to have a perma-ad running on PMnews. But there plenty of other DFW podiatry practices offering similar bases and then this awful tiered bonus system. So it really could be any number of them.

 

[deleted1149159]

Have any practices been open to you becoming a partner or is that something they avoid talking about? Just trying to look for general advice as a 2nd year resident.

If they are looking at you becoming a partner, you need to know the terms immediately. If they say something to the effect of "fair market value" or "50% of the average of three years of gross", they are deluded. Private practice should be evaluated like any other business. And they don't evaluate this by gross, unless it's publicly traded. What are the tangible assets? What are the financial liabilities? What are the "partners" getting as far as value per share? I'll cover this in a blog eventually.

 

[Utvolsdpm]

It sounds similar to a contract from this one…

Academy Foot & Ankle Specialists

They seem to have a perma-ad running on PMnews. But there plenty of other DFW podiatry practices offering similar bases and then this awful tiered bonus system. So it really could be any number of them.

It was a smaller place, but I think a lot of the PP offers in that area are similar. This person ended up leaving and the next person came in and left as well. Sets up a revolving door. Not sure how that could benefit the practice owner or the associates.

 

[PTPuser]

I really want to leave. But I'm in so much debt.

 

[Tens Years Out]

'

 

[bloxxeeey]

It was a smaller place, but I think a lot of the PP offers in that area are similar. This person ended up leaving and the next person came in and left as well. Sets up a revolving door. Not sure how that could benefit the practice owner or the associates.

Is the market that saturated in the area that they pay 70k base?

 

[Pronation]

It was a smaller place, but I think a lot of the PP offers in that area are similar. This person ended up leaving and the next person came in and left as well. Sets up a revolving door. Not sure how that could benefit the practice owner or the associates.

With such incredibly low salaries there is very little risk for the practice owner - especially once these practices have the routine in place for regular flow of associates entering and exiting. I’m hoping to start a pod associate mill in a few years so I can take advantage of this surge of students from these unneeded schools and make millions while paying the associates peanuts. This just seems like the most logical podiatric move to me.

 

[deleted1149159]

With such incredibly low salaries there is very little risk for the practice owner - especially once these practices have the routine in place for regular flow of associates entering and exiting. I’m hoping to start a pod associate mill in a few years so I can take advantage of this surge of students from these unneeded schools and make millions while paying the associates peanuts. This just seems like the most logical podiatric move to me.

Yes and no. It takes a long while before a practice becomes profitable through a brand new doctor. And there is quite a large up front cost. Going through associates every year can become very costly. You're not getting the return you think so quickly.

 

[deleted1149159]

I really want to leave. But I'm in so much debt.

Why do you want to leave?