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When I was down for my interviews, they paid for my hotel room in its entirety and some food. Guess I was fortunate.
Every hospital I interviewed at never told me the salary until the offer was officially given. That is when you start negotiations. I think its unprofessional to refuse to visit a hospital because they didn't tell you salary and benefits. It also gives the wrong impression. As a hospital employer that would be a red flag for me.3rd year resident here
Is it a red flag that a hospital system doesn't want to discuss salary until you visit?? Recently had a zoom interview with a rural hospital system (3 hospitals, about 50-100 beds each). When I asked about potential salary, they told me that can be discussed when I visit. This is a first for me.
I've been talking with 2 other hospitals in the same/bordering states, and they both told me salary/benefits BEFORE offering me to come visit. I'm unsure about going to visit somewhere for multiple days without knowing any salary. Any insight would be appreciated, thank you
This isn't a PP where you can get 20 offers and they are all under $140K. It seems stupid, but just visit them. I'm not hearing a lot of stories of being screwed by hospitals on here. If you can find a compelling lifestyle/location reason - that would be a win. A friend of mine was offered more money than I ever would have thought possible in a starting position by a rural hospital. The arrangement involved a series of streams of revenue from different responsibilities beyond clinical/surgical. Yes, you could visit a bunch of hospitals and they all might offer you $200-250 or whatever, but there might be wilder numbers out there for those inclined to look.
Appreciate both your responses! Glad this isn't abnormal. Every hospital I've already interviewed at so far told me the salary beforehand so this was just a first for meEvery hospital I interviewed at never told me the salary until the offer was officially given. That is when you start negotiations. I think its unprofessional to refuse to visit a hospital because they didn't tell you salary and benefits. It also gives the wrong impression. As a hospital employer that would be a red flag for me.
Most of the hospitals didn’t tell me the salary until after they were ready to offer me the job. One job or two listed the salary in the posting itself.3rd year resident here
Is it a red flag that a hospital system doesn't want to discuss salary until you visit?? Recently had a zoom interview with a rural hospital system (3 hospitals, about 50-100 beds each). When I asked about potential salary, they told me that can be discussed when I visit. This is a first for me.
I've been talking with 2 other hospitals in the same/bordering states, and they both told me salary/benefits BEFORE offering me to come visit. I'm unsure about going to visit somewhere for multiple days without knowing any salary. Any insight would be appreciated, thank you
It is not uncommon to not get the salary/benefits from a hospital until offered the FTE job.Appreciate both your responses! Glad this isn't abnormal. Every hospital I've already interviewed at so far told me the salary beforehand so this was just a first for me
I disagree with this 100%It is not uncommon to not get the salary/benefits from a hospital until offered the FTE job.
(they screen from a dozen or two dozen.... interview a half dozen or more... offer to A, same offer to B if A didn't accept, offer to C if B declined, etc)
Also not uncommon to have little or no negotiation with a hospital (not common, but not uncommon either... esp large hosp systems, popular areas, many apps). For smaller hospitals, definitely negotiate... for VA, Kaiser, etc types, you won't get far. Some will flat out tell you if you ask that what you got is their standardized offer for your specialty (take it or leave it).
Hospitals almost always pay good/great... go check them out if even somewhat interested. As mentioned, they should pay most/all costs of interview trip. The hospital potential problem with hospital jobs is on the back end: bad call, bad hours, paperwork reqs, bad clinic staffing, bad admin/boss, etc... and you have zero control over any of it. Try to talk to as many current and former DPMs or docs of any kind that work or worked there and sniff that stuff out. The pay is generally not the problem at FTE hospital jobs (it's just that the per hour pay and QOL may be sketchy).
How many private practice podiatry associates do you know that get employed and start changing the way the private practice operates to fit their needs? I've never seen or heard that.
Did they tell you they were interviewing other candidates still? It's possible they are still doing that. Usually dead silence is not a great indication you are getting the job. If it has been 2-3 weeks then it is appropriate to contact them. I would call the recruiter to see what is up.I recently interviewed w a hospital. Seemed great. Was told it would hear back for a second interview. It’s been a few weeks now and dead silence.
Would you guys recommend I reach out and see what’s up? Or wait it out longer? I heard hospitals usually are slow and lag a lot but I’ve never been in the position so not sure
Yeah they said they some to get thru still ::: but who knowsDid they tell you they were interviewing other candidates still? It's possible they are still doing that. Usually dead silence is not a great indication you are getting the job. If it has been 2-3 weeks then it is appropriate to contact them. I would call the recruiter to see what is up.
Agree with cuts, it is most common they communicate well and move fast if they are highly interested wether it is an offer or making arrangements for another round of interviews.Yeah they said they some to get thru still ::: but who knows
I interviewed with a hospital in residency. Went well, they liked me, didn’t hear anything for months but knew they had a few interviews. Reached back out to a VP of something who I met during my interview about 1 month later. No response. Finally ran into the DPM who was leaving that hospital (the reason for the opening) and he let me know that the hospital had been purchased and every single admin I had met had been replaced and they were obviously on a hiring freeze. This was maybe 3 months later. I called the podiatry clinic manager because she was the only person I met who hadn’t been let go. That was depressing because she confirmed everyone had been let go and let me know I was going to be the hire. So instead I got to work for a total POS and make 50-75% less money for 2-3 years than I would have otherwise.
Not saying that’s why you haven’t heard anything but I would never hesitate to reach back out at least to a recruiter, preferably admin, and ask if they have a rough timeline so that you can plan appropriately with your current employer or other positions. They won’t be offended or think you are bugging them. But 2-3 weeks is nothing. Especially if they are doing more interviews. They don’t fly everyone in on back to back days or anything like that. It could take them a month to conduct 2-3 in person interviews. Easily.
Yes agreed. Didn’t hear back from my current gig after 2-3 weeks so I reached out to the ortho chief and they said they were re scheduling a few more interviews thus the delay. So - normal but do reach out.
Side note - spoke to a few pods today from prior connections when I was in pod school and they’re hiring for their large hospital group. Over 100 applicants. Fresh fellows from many of the “top” programs applied, new residents across the board from east coast to west coast applied. Guess what - they don’t want a new fellow or a new grad. They want someone with a few years of work experience. And prefer a candidate whom someone they know can vouch for. Podiatry is a very small profession. Network well and network early on.
Like we all have been saying…….we sure need another school.Side note - spoke to a few pods today from prior connections when I was in pod school and they’re hiring for their large hospital group. Over 100 applicants.
Weil…… it’s been stated too many times on this forum from multiple posters with real world experience on the other side of job posts/search - most groups (pod or ortho) want work experience and someone willing to do everything podiatry. If you think you’re coming in day 1 slapping in TARs and your lapiplasty 4 days a week in the OR, good luck - it ain’t happening. I looked over some of the job applications and their personal statements, CVs etc etc and for some reason they think they’re the next Schuberth and that this job posting desperately needs their expertise because they performed 2000+ procedures from a “top notch” program. Word of mouth and personal connections will most likely land you a good job, not because you went to Yale/Harvard/Weil’s fellowship.But Lowell Weil said if you do a fellowship you will be on par with foot and ankle orthopedists…
Podiatry…….the profession where doing a 3 year “surgical“ residency and being average is not good enough.Weil…… it’s been stated too many times on this forum from multiple posters with real world experience on the other side of job posts/search - most groups (pod or ortho) want work experience and someone willing to do everything podiatry. If you think you’re coming in day 1 slapping in TARs and your lapiplasty 4 days a week in the OR, good luck - it ain’t happening. I looked over some of the job applications and their personal statements, CVs etc etc and for some reason they think they’re the next Schuberth and that this job posting desperately needs their expertise because they performed 2000+ procedures from a “top notch” program. Word of mouth and personal connections will most likely land you a good job, not because you went to Yale/Harvard/Weil’s fellowship.
Weil…… it’s been stated too many times on this forum from multiple posters with real world experience on the other side of job posts/search - most groups (pod or ortho) want work experience and someone willing to do everything podiatry. If you think you’re coming in day 1 slapping in TARs and your lapiplasty 4 days a week in the OR, good luck - it ain’t happening. I looked over some of the job applications and their personal statements, CVs etc etc and for some reason they think they’re the next Schuberth and that this job posting desperately needs their expertise because they performed 2000+ procedures from a “top notch” program. Word of mouth and personal connections will most likely land you a good job, not because you went to Yale/Harvard/Weil’s fellowship.
What are the handful worthwhile ones?90%+ of fellowships are a scam. handful of worthwhile ones.
What are the handful worthwhile ones?
I mean there are some good one....but love this line from a new one I just looked up.....What are the handful worthwhile ones?
I mean there are some good one....but love this line from a new one I just looked up.....
The fellows will be responsible for all podiatry trauma call and in patient rounding before and after office and clinic
LOVE IT.
I don’t understand sarcasm. What iz it?You do know I was being sarcastic right?
there's more than that lol. but it's still just a handful that are worthwhile..Hyer, hyer…..hyer
That’s it.
Everything else won’t guarantee you anything. Not anymore.
The hospital potential problem with hospital jobs is on the back end: bad call, bad hours, paperwork reqs, bad clinic staffing, bad admin/boss, etc... and you have zero control over any of it. Try to talk to as many current and former DPMs or docs of any kind that work or worked there and sniff that stuff out. The pay is generally not the problem at FTE hospital jobs (it's just that the per hour pay and QOL may be sketchy).
Yes. People talk a lot about how amazing hospital jobs can be, but make sure you actually understand that's based mostly on the better pay. Personally I think inpatient SUCKS and it would take a VERY hefty salary to get me to consider it again
I don’t do inpatients. No call. Only private call if certain docs or ER docs need something. Better yet - start a fellowship and have your fellow do all inpatient work, as airbud mentioned above. Plenty of suckers will apply for a chance to be a fellow at a hospital system.Yes. People talk a lot about how amazing hospital jobs can be, but make sure you actually understand that's based mostly on the better pay. Personally I think inpatient SUCKS and it would take a VERY hefty salary to get me to consider it again
Not so sure the associate podiatrist loves it on the poorly insured or uninsured patients who case management is trying to approve for Medicaid.I love inpatient infections. That’s where you can make it rain RVUs. Anybody who says different must hate money.
Hospital employed with RVUs.... especially getting 100 percent....they don't care what type of insurance you have. Hell my last job my state Medicaid didn't cover podiatry and I still got paid on those RVUs...love infection.Not so sure the associate podiatrist loves it on the poorly insured or uninsured patients who case management is trying to approve for Medicaid.
Not so sure the associate podiatrist loves it on the poorly insured or uninsured patients who case management is trying to approve for Medicaid.
"based mostly on the better pay."Yes. People talk a lot about how amazing hospital jobs can be, but make sure you actually understand that's based mostly on the better pay. Personally I think inpatient SUCKS and it would take a VERY hefty salary to get me to consider it again
This is the way"based mostly on the better pay."
You mean based on one of the most important aspects of the job?
Just to clear things up, inpatient absolutely does suck for the podiatry associate who gets paid pennies on the dollar (or nothing for the tons of uninsured patients) however RVU based pods make an absolute killing off of inpatients.
Basically it goes like this...
RVU based = do as much surgery as possible
not RVU based = peddle as much crap in clinic as possible
"based mostly on the better pay."
You mean based on one of the most important aspects of the job?
Just to clear things up, inpatient absolutely does suck for the podiatry associate who gets paid pennies on the dollar (or nothing for the tons of uninsured patients) however RVU based pods make an absolute killing off of inpatients.
Basically it goes like this...
RVU based = do as much surgery as possible
not RVU based = peddle as much crap in clinic as possible
Can confirm this is true100% accurate. The amount of procedures you can generate is substantial.
Let me break it down from a hospital employed RVU podiatrist perspective.
Patient examples:
A) Uncontrolled diabetic with great toe abscess from non healing sub great toe ulcer. Osteomyelitis involving distal and proximal phalanx.
Case 1:
- great toe amputation (procedure 1)
- open bone biopsy, deep, of 1st met head (procedure 2)
Foot grossly contaminated so you pack open and bring back to OR in 1-2 days…
Case 2:
- secondary of surgical wound, extensive complicated (procedure 3)
- flexor tenotomies of toes 2-5 as lesser toes are more likely to hammer with loss of great toe leading to distal toe ulcers if left untreated (procedures 4-7)
—————
B) Uncontrolled diabetic with sub 1st MTP ulcer. Non healing despite wound care, TCC, diabetic shoes and inserts etc. No acute infection. No osteomyelitis on your imaging workup.
Case 1:
- tibial sesamoidectomy (procedure 1)
- strayer gastroc recession (procedure 2)
- peroneus longus tenotomy (procedure 3)
—————-
C) diabetic patient with multiple infected toes/ forefoot abscess with osteomyelitis due to non healing ulcers
Case 1:
- transmetatarsal amputation (procedure 1)
- open bone biopsy, deep, metatarsal bones 1-5 (procedure 2-6)
Pack TMA open due to grossly contaminated foot. Return to OR once biopsies result or in 1-2 days if you feel you got the bone infection controlled/removed
Case 2:
- strayer gastrocnemius recession (procedure 7)
- secondary of surgical wound, extensive complicated (procedure 8)
I gave you three typical limb salvage scenarios and generated 18 billable procedures from these 3 patients. It’s not fraud. It’s not even aggressive. It’s being thorough and can justified 100% of the time. If you are at a high volume hospital you can do this over and over and over and generate a ton of productivity for yourself and making the hospital a ton of money as these cases don’t require hardware. The hospital gets money from your imaging orders, vascular testing, consultations to vascular/ IR, and even consults to PT after you done doing surgery to determine safety to return home vs SNF. You order these things. Don’t tell medicine to do it because then you won’t get credit for it when the hospital reviews all these metrics. They track everything. Not just what you are doing in the clinic or OR but more importantly the other down stream revenue generators (imaging, DME, labs, referrals to other specialists, vascular testing, etc etc etc etc etc). PLAY THE GAME.
I just gave you a template for instant job security and how to make money at the same time as an employed podiatrist. This is why these jobs are coveted. You don’t have to be the next greatest “fellowship trained reconstructive foot and ankle surgeon”. When you pretend you are not a podiatrist and don’t or can’t do limb salvage you look dumber than you already are. You are not valuable to a hospital. If they wanted someone to do just MSK they would be better off hiring foot and ankle ortho because they can take general ortho call as well.
Also there is the added wRVU for the high level consults associated with the patients.100% accurate. The amount of procedures you can generate is substantial.
Let me break it down from a hospital employed RVU podiatrist perspective.
Patient examples:
A) Uncontrolled diabetic with great toe abscess from non healing sub great toe ulcer. Osteomyelitis involving distal and proximal phalanx.
Case 1:
- great toe amputation (procedure 1)
- open bone biopsy, deep, of 1st met head (procedure 2)
Foot grossly contaminated so you pack open and bring back to OR in 1-2 days…
Case 2:
- secondary of surgical wound, extensive complicated (procedure 3)
- flexor tenotomies of toes 2-5 as lesser toes are more likely to hammer with loss of great toe leading to distal toe ulcers if left untreated (procedures 4-7)
—————
B) Uncontrolled diabetic with sub 1st MTP ulcer. Non healing despite wound care, TCC, diabetic shoes and inserts etc. No acute infection. No osteomyelitis on your imaging workup.
Case 1:
- tibial sesamoidectomy (procedure 1)
- strayer gastroc recession (procedure 2)
- peroneus longus tenotomy (procedure 3)
—————-
C) diabetic patient with multiple infected toes/ forefoot abscess with osteomyelitis due to non healing ulcers
Case 1:
- transmetatarsal amputation (procedure 1)
- open bone biopsy, deep, metatarsal bones 1-5 (procedure 2-6)
Pack TMA open due to grossly contaminated foot. Return to OR once biopsies result or in 1-2 days if you feel you got the bone infection controlled/removed
Case 2:
- strayer gastrocnemius recession (procedure 7)
- secondary of surgical wound, extensive complicated (procedure 8)
I gave you three typical limb salvage scenarios and generated 18 billable procedures from these 3 patients. It’s not fraud. It’s not even aggressive. It’s being thorough and can justified 100% of the time. If you are at a high volume hospital you can do this over and over and over and generate a ton of productivity for yourself and making the hospital a ton of money as these cases don’t require hardware. The hospital gets money from your imaging orders, vascular testing, consultations to vascular/ IR, and even consults to PT after you done doing surgery to determine safety to return home vs SNF. You order these things. Don’t tell medicine to do it because then you won’t get credit for it when the hospital reviews all these metrics. They track everything. Not just what you are doing in the clinic or OR but more importantly the other down stream revenue generators (imaging, DME, labs, referrals to other specialists, vascular testing, etc etc etc etc etc). PLAY THE GAME.
I just gave you a template for instant job security and how to make money at the same time as an employed podiatrist. This is why these jobs are coveted. You don’t have to be the next greatest “fellowship trained reconstructive foot and ankle surgeon”. When you pretend you are not a podiatrist and don’t or can’t do limb salvage you look dumber than you already are. You are not valuable to a hospital. If they wanted someone to do just MSK they would be better off hiring foot and ankle ortho because they can take general ortho call as well.
Also there is the added wRVU for the high level consults associated with the patients.
-Multiple tests orders and independently interpreted
-Discussion of management with another health care professional
-Assessment requiring independent historian
-Treatment complicated by social determinants of heath
-Surgery with identified risk factors
Spoken like someone who has never been offered a hospital job. Let me tell you, I would NEVER go back to PP. MSG/Hospital is the way to go For podiatrists.Yes. People talk a lot about how amazing hospital jobs can be, but make sure you actually understand that's based mostly on the better pay. Personally I think inpatient SUCKS and it would take a VERY hefty salary to get me to consider it again
Agree with Cutswithfury. Easy to do 7k wRVU in limb salvage hospital practice specially if you are doing charcots and general podiatry as well. Need a good team of colleagues and wound care RNs and management team. Otherwise you'll wanna throw yourself off of a cliff. Currently do 7k wRVUs but definitely feel the fatigue/burnout. I guess the trick is longevity of your career as there is opportunity cost with early burnout in ****ty hospital job even with higher initial payout.
Sounds great until your claims are reviewed. Please read NCCI policy 2022, I believe it’s chapter 4.100% accurate. The amount of procedures you can generate is substantial.
Let me break it down from a hospital employed RVU podiatrist perspective.
Patient examples:
A) Uncontrolled diabetic with great toe abscess from non healing sub great toe ulcer. Osteomyelitis involving distal and proximal phalanx.
Case 1:
- great toe amputation (procedure 1)
- open bone biopsy, deep, of 1st met head (procedure 2)
Foot grossly contaminated so you pack open and bring back to OR in 1-2 days…
Case 2:
- secondary of surgical wound, extensive complicated (procedure 3)
- flexor tenotomies of toes 2-5 as lesser toes are more likely to hammer with loss of great toe leading to distal toe ulcers if left untreated (procedures 4-7)
—————
B) Uncontrolled diabetic with sub 1st MTP ulcer. Non healing despite wound care, TCC, diabetic shoes and inserts etc. No acute infection. No osteomyelitis on your imaging workup.
Case 1:
- tibial sesamoidectomy (procedure 1)
- strayer gastroc recession (procedure 2)
- peroneus longus tenotomy (procedure 3)
—————-
C) diabetic patient with multiple infected toes/ forefoot abscess with osteomyelitis due to non healing ulcers
Case 1:
- transmetatarsal amputation (procedure 1)
- open bone biopsy, deep, metatarsal bones 1-5 (procedure 2-6)
Pack TMA open due to grossly contaminated foot. Return to OR once biopsies result or in 1-2 days if you feel you got the bone infection controlled/removed
Case 2:
- strayer gastrocnemius recession (procedure 7)
- secondary of surgical wound, extensive complicated (procedure 8)
I gave you three typical limb salvage scenarios and generated 18 billable procedures from these 3 patients. It’s not fraud. It’s not even aggressive. It’s being thorough and can justified 100% of the time. If you are at a high volume hospital you can do this over and over and over and generate a ton of productivity for yourself and making the hospital a ton of money as these cases don’t require hardware. The hospital gets money from your imaging orders, vascular testing, consultations to vascular/ IR, and even consults to PT after you done doing surgery to determine safety to return home vs SNF. You order these things. Don’t tell medicine to do it because then you won’t get credit for it when the hospital reviews all these metrics. They track everything. Not just what you are doing in the clinic or OR but more importantly the other down stream revenue generators (imaging, DME, labs, referrals to other specialists, vascular testing, etc etc etc etc etc). PLAY THE GAME.
I just gave you a template for instant job security and how to make money at the same time as an employed podiatrist. This is why these jobs are coveted. You don’t have to be the next greatest “fellowship trained reconstructive foot and ankle surgeon”. When you pretend you are not a podiatrist and don’t or can’t do limb salvage you look dumber than you already are. You are not valuable to a hospital. If they wanted someone to do just MSK they would be better off hiring foot and ankle ortho because they can take general ortho call as well.
Sounds great until your claims are reviewed. Please read NCCI policy 2022, I believe it’s chapter 4.
Biopsy at the time of another surgical procedure (in the same anatomical region) is inclusive to the primary procedure UNLESS you are waiting in the OR for the results.
So if you perform a TMA and then bill a biopsy to assess margins in the remaining metatarsal stumps and to send for micro/pathology, that is inappropriate billing and unbundling.
Even if there is no CCI edit, NCCI policy overrules CCI. Even in commercial insurers.
If someone tells me that they get paid for this all the time, my answer is that getting paid is no indication the billing was proper.
There are loads of docs billing for an ORIF of a talo tarsal dislocation and they are performing an arthroereisis.
So the bottom line is I understand the points Cuts is trying to make, but I will HIGHLY advise against some of his/hers billing examples.
About a month ago I was involved with reviewing a case where a provider billed a bone biopsy for every procedure and she got paid for most.
She now owes the insurance enough money that she may file bankruptcy.
Remember, she bills a bone biopsy for every single bone case she’s ever performed.
Don’t do it.
No it is not correct. The biopsy is in the “field” of surgery. You are performing the biopsy to assess margins. And unless you are waiting for those results prior to leaving the OR, it would be inclusive to the amputation. And it would not be appropriate to use the 59 modifier.I understand for TMA since the metatarsals have been cut then billing biopsy is not billable.
But if a great toe amputation is performed and an open biopsy is performed of the 1st metatarsal head this should be billable as it is a different bone. Correct?
The government/CMS hasn’t solicited your opinion or my opinion. NCCI is a government policy that is also used by commercial insurers.let's take a step back and just realize how stupid this is....
Inpatient consults still basically require you to bill on time though. For now. Unless you are like air bud and faking full physical exams. Luckily next year inpatient e/m drops HPI and exam requirements next year and goes to straight MDM/Complexity like the outpatient codes.
Define "field"No it is not correct. The biopsy is in the “field” of surgery. You are performing the biopsy to assess margins. And unless you are waiting for those results prior to leaving the OR, it would be inclusive to the amputation. And it would not be appropriate to use the 59 modifier.