Background info:
I trained at a fairly well known program (nationally) approximately half way across the country from where I knew I wanted to practice. We are a level one trauma center with an orthopedic residency program, where Podiatry is the foot and ankle service within the department. We certainly have a high volume of trauma (as a service we do between 300-400 ankle fractures per year). Few, if any, of our current residents chose the program because we thought that it would somehow lead to a job doing nothing but foot and ankle trauma, rather we wanted the autonomy that came with the program. The service is very resident run. From clinic (which we have more of than most programs in the country), to inpatients on the floor, to the OR, the residents are "doing" and the attendings are observing and assisting and teaching from afar (not literally, they are usually somewhere in the room).
All that being said, I was not picky with the type of practice I was looking for. That may have been in large part due to geographic constraints and understanding that if I was going to limit myself to jobs in one and a half states, there was virtually no way I could search for only one type of practice setting. At first I found it interesting that most of the graduates of our residency program ended up in podiatry group practice, coming from an academic hospital setting with a bunch of trauma and a lot of sick patients. But the farther along I got in the job search process, the more I realized that: a) podiatrists in successful groups make very good money and b) most of the jobs available are podiatry groups or solo practitioners looking to hire. Podiatry is certainly more entrenched within hospital systems, ortho groups, multi-specialty groups/clinics than it ever has been in the past, but I'm sure that a majority of podiatrists still work outside of those settings/systems. Every year more and more Podiatrists are gaining employment outside of the traditional private and group practice models, therefore I don't necessarily think my previous assumption will be true forever.
Search timeline:
I started looking at the very beginning of my 3rd year, in July. Our program is set up in a way that I was outside the hospital for the first 6 months of my third year and had a lot of flexibility with my schedule. It made it easy to sit down one day and get a lot done. I don't think a single practice or hospital that I called in July knew they were going to be hiring the following summer, but I did make good contacts and quickly found out the hospitals systems that still don't hire podiatrists, narrowing my search some right away. I had my first interviews in October (both with podiatry groups), a hospital interview early November and another phone interview later that month. I still have meetings/interviews/follow-ups later this month (December), and there are still a handful of potential openings that haven't been listed yet. Those individuals have said that if they do open a position, it would likely be in January or February. I only mention that to point out that having a job in October or November is atypical. That doesn't mean you should sit around and do nothing all fall because "something will be there in February," rather don't freak out when one classmate or colleague has a job and you haven't had an interview yet.
Job search strategies:
Because my job search had such a small geographic constraint, it was very easy for me to cold call hospitals and groups. Between those two, hospitals were the easiest to get a hold of. The first thing I did was find every hospital organization in the area I wanted to practice, found the careers section of their website, and called one of the recruiters. Their phone number is made public and they get paid to find and talk to potential employees. They were all very nice and typically very good about emailing or calling you back. Even the ones working for hospitals that didn't hire Podiatrists were helpful. They took my CV and offered to share it with local docs that worked with (not for) the hospital. It took me basically one afternoon to get in contact with every hospital in the state...it also helped that there are only around 4-5 health systems that own or manage all of these hospitals.
I took the same approach for finding group/private practice jobs. I searched [insert city name] "foot and ankle," "podiatrist," "orthopedic," "multi-specialty clinic," etc. and called most of the practices that popped up. I simply asked for the practice manager or office manager, usually explained I was a resident looking to come back to the area for work when they asked, then talked with the back office staff or left a voicemail. The practice managers were also very nice and easy to talk to. Typically they had me send them a CV, then met with the partners in the group, then called back to tell me "no thanks"
I will admit, these folks take a little more follow-up than the hospital recruiters. They are busy and have a lot of responsibilities that don't include trying to help a 3rd year podiatry resident get a job. At this point, I've probably had 3-4 practices that I've interviewed with or plan on interviewing with that did NOT have any job posted and were simply considering hiring or wanting to hire and waiting for someone to call them. I know its been mentioned before, but that has been one of the most important things to potential employers, they want to know that you WANT to be there.
I've rejected one offer, though I am still in contact with that practice because each passing day gives me more leverage. I have one offer that for now is indefinite but will likely have a firm acceptance/rejection date in the coming months. I have one interview that is complete but the practice has 1-2 more to do before they will move forward with an offer. I'm in the middle of an interview process, and have a couple more coming up. I've already been told "no" after going through a portion of the interview process, and that was with a job that I had talked to in July, kept in contact with, and had a phone interview a day before they even made the job public. Again, being on top of stuff helps and I would recommend it, but its no guarantee that the employer doesn't just move forward with someone who has some practice experience...get used to that.
I've also occasionally monitored job boards (ACFAS job board, ziprecruiter, practicelink, etc.) but I haven't found them to be of much help to me because of geographic constraints. I think I found one job on the ACFAS website that I actually contacted. By far, for me, the least successful traditional job search method was using a recruiter. Recruiters are free to you (they get paid by the employer), and if you post your CV on any of the physician job sites...they will find you and email you. I probably got 5-6 emails from recruiters, spoke with all of them, have yet to have a single one email or call me with an actual job. I actually think this is a great way to find a job if you have almost NO preference on WHERE you want to work. But if want to end up somewhere specific, they will be useless. You will accomplish much more on your own.
Job offers:
I'll keep this generic since I haven't signed on any dotted lines yet...
I have seen a few different contract structures within podiatry groups. One was ~$100k base with 40% of collections minus overhead once the practice made their money back on you (around 2-3x base). Another was $60k guaranteed salary over your first 6 months ($10k per month), and then straight production minus overhead after that. If at any point in those first 6 months you produced an amount that would have been more than your $10k, you got whatever that production amount was. Not on top of the $10k, so the $60k was a "base" salary but more of a guaranteed minimum. Another was to buy in from day 1, you get 50% of gross collections and participated in profit sharing (DME items, MSO, cash products, etc.). There would have been some sort of guaranteed or base salary for a few months but we never made it that far...
Hospital jobs have been anywhere from $215-$240k base salary with some sort of RVU production bonus. It does seem like with these positions, you aren't always eligible for the same bonuses in year 1 as you are in year 3, for example. In general, however, these contracts all seem pretty similar.
I'm talking with an Ortho group as well as a multi-specialty group now, but have no idea what they would pay IF they decided to hire.
Additional advice/experiences:
Of course, I would also recommend having an attorney look over your contract. It will be worth the money. If you are willing to go anywhere, physician recruiters and job search boards are probably the best way to go. Otherwise, I found cold calling as I described it to be efficient and effective. Watch out for podiatry practices who overvalue their practices when it comes to buying in, or buying out a retiring doc. Practices aren't worth what some older podiatrists think they are. It is not impossible to start your own practice, I have 3 friends/colleagues who have or will be doing this. Just know that you need a year to work that out, so start early. Be careful getting doe-eyed over a hospital contract because of the big base salary. You often times surrender a lot of decision making capacity and autonomy in the name of "not having to worry about the business of medicine." You also may surrender long term income potential. I hope this post is beneficial to someone. Good luck.
