dtrack22

10+ Year Member
Apr 20, 2008
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  1. Podiatrist
I thought the PMSR/RRA Residency Review thread was beneficial (though it kind of died after an initial wave of reviews), and after navigating the job search far outside of the geographic footprint of my own residency program, I wanted to have a centralized thread where you could read how others went through the process.

I will post my own experience soon once I've wrapped everything up, but there should be some new practitioners who are willing to share. If you would like to contribute anonymously, feel free to PM me and I will post for you.

*** You can also email anonymous posts to [email protected] ***

I think the more information about the search process (successful and unsuccessful contacts) and individual job info (type, salary, benefits, etc) the better this thread can be. I don't know if this will lend itself to a template, but I will post something basic in attempts to have some conformity.

***If you feel anything could be added to the template please PM me and I'll edit the original post. Please try and send specific questions to authors via PM, then they may update their post as they see fit. Thanks!***


Background info:
ie pertinent residency/training info, were you looking at fellowships or did you complete one, practice type desired, geographic constraints

Search timeline:
ie when did you start looking, when did you start getting interviews, how long were you given to accept a position

Job search strategies:
ie where did you look, did any source seem more or less beneficial, how did you go about contacting groups/hospitals or applying for jobs, networking tips/tricks, things that worked and didn't work, any problems with certain practice types not hiring podiatrists

Job offers:
ie practice set-up, salary, benefits, were you offered the job and did you take it or reject it, was it the job you wanted

Additional advice/experiences:
 
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dtrack22

10+ Year Member
Apr 20, 2008
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  1. Podiatrist
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.
 
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AttackNME

Podiatrist
10+ Year Member
Feb 22, 2007
466
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Background info:
Went to pod school in east coast, wanted to go west coast for residency, got mediocre training, no fellowship. Was sorta interested in fellowship but didn't pursue it too hard cus of family obligations. Weak rearfoot and ankle experience but don't care as long as I'm doing surgery and maybe a colleague can coscrub my rearfoot/ankle cases I'm happy

Search timeline:
started beginning of 3rd year residency, some attendings I worked with said they'd take me on but I wasn't too interested in staying in the area, started looking out of state mostly to find somewhere with a better cost of living.

Job search strategies:
looked at pm news and signed up on some generic job search websites for physicians which got me nowhere. Started just emailing my CV to pods in areas where I was interested in and got maybe some mild interest from 10% of them. I think I was asking way too early because most of the private practice docs were looking for immediate starts.

Job offers:
because the attending at my program has been recruiting prior residents, I got the scoop from those residents and figured the job wasn't right for me. At the same time while I was figuring which state my family and I would go, I met someone during fellowship search last year who ended up recruiting me to join a university and help start the limb salvage program, and yes in a state with low cost of living so my <200k salary is allowing me to live like a king

Additional advice/experiences:
Lee Rogers would say if you want to do trauma and rearfoot recon, most places would give pushback if there is any ortho presence, especially in the west coast. He said however if you advertise yourself as someone who wants to take call and see the diabetic foot infections, most hospitals will ask.. when can you start? Limb salvage has a huge impact in patients' lives and there is always a need for it.
 
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ldsrmdude

Back in the saddle again
Moderator Emeritus
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Feb 20, 2007
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  1. Podiatrist
I’ve been meaning to post my experiences in this thread, but haven’t for a few reasons. First, I’ve been way busier than I want over the past few weeks/months and haven’t taken the time to sit down and type it out. Second, my practice is changing and I’m going through a job search again. I considered waiting to post my new experience, but decided to post this now and update later



Background info:
I trained at a program that I would rate as above average, but not “big name.” I had good surgical exposure to almost every procedure except TAR which we started to get more of right as I graduated. I had great clinical/billing exposure. Essentially all of the previous graduates of my program joined podiatry groups. One went on to do a surgical fellowship and one did a research fellowship, but the others mainly joined podiatry groups straight out of residency. The training I prepared me very well for private practice, but I think if I had wanted to do lots of trauma or complex reconstructions, a fellowship would have been beneficial. I did consider pursuing a fellowship, but decided to not apply because I realized that I could do all the things I really wanted to do without a fellowship. I did apply to a few multispecialty jobs, but mostly looked at podiatry groups. The biggest reason is because the large majority of jobs are in podiatry groups and the majority of graduating residents will join podiatry groups. It’s changing, but podiatry groups are still the most common practice method currently. There are some great podiatry groups out there, so I would advise graduating residents to look at them too, even if you think you want an ortho/multispecialty group. I had some broad geographic restrictions which actually made my search a bit tough because I had a big enough area that I couldn’t justify taking the time to find every group and writing/calling them, but the area was small enough that there weren’t a lot of ads out there in the area.

Search timeline:
I started looking around the end of 2nd year. I had a few “soft offers” from groups that I trained with (“If you’re interested in staying around, let me know”), but I wasn’t interested in staying in the state I trained in. I saw an ad for a job in a neighboring state to the one I practice in now and applied, and then on a whim applied for the job I currently have. I talked to my current boss around August and the local hospital flew me out for an interview in September or October. This is pretty early in the year for interviews, but I needed enough time to get a state license, so it really wasn’t too early. I did have a couple of phone interviews after this, but this was the first (and only) in-person interview I had. I was scheduled to come to another practice for an interview around Thanksgiving time, but had to cancel. After I interviewed at my current job, I started discussing the job almost right away and got a formal offer around Christmas time, if I remember right. I spent the next several months slowly negotiating some aspects of my contract and I think I signed my actual contract around March or April. That may seem late, but I had been pretty sure this was where I was going to work since about January, so it seemed a bit of a mere formality to actually sign the contract.

Job search strategies:
I didn’t have any contacts in the areas where I was looking to work, so I mostly relied on posted jobs, athough I did contract a few hospital recruiters. The sites I have found to be the most helpful are the ACFAS job site, PracticeLink, APMA classifieds, and USAJobs.gov (if you’re interested in VA/HIS/Army civilian jobs). There are a few websites that list jobs that are old and outdated. I actually saw an ad for the job I currently have a few months ago (and yes, I’m sure it hasn’t been reposted to find a replacement for me). If you are using a website that isn’t very well-known, I would contract the hospital or practice listed directly if possible to see if it’s actually a valid position. I didn’t use a recruiter for my current job, and I have talked to a few recently, but haven’t found them to be very helpful honestly. I also didn’t have much luck blindly emailing or writing hospital recruiters, but didn’t try that hard since I didn’t have a strict geographic constraint. It’s a method that has worked for others, but I didn’t see any success from it.

Job offers:
I only went through the whole process and received an offer with my current practice, so can only speak from that experience. My practice is a small group practice in a rural area that is economically depressed and underserved. I see patients at 2 county hospitals. My week is about 2/3 clinic and 1/3 surgery and inpatient. My contract is set up in a pretty standard format, with a base salary plus bonus model. My bonus is based off of collections. I essentially get a certain percent of the profit I bring in as a bonus. Some of my expenses that get figured in are my salary, the salary of my receptionist/medical assistant, a percentage of my office managers salary, the supplies I order and use, and malpractice insurance. My profit is figured out monthly and I get a bonus quarterly, assuming I make a profit. I have made a profit every quarter except for my first quarter, which I expected. My bonus ends up being something like 25% of my annual income.

One of the local hospitals I work at assisted in recruiting me and as part of this plan, I got a signing bonus and my moving expenses paid. In return, I agreed to work there for a certain period of time. Overall, I have been pretty happy with my contract. As others have noted, private practice is typically less money up front when compared to hospital-employed or ortho groups. I’ve been offered partnership, which would increase my income quite a bit and allow me more flexibility in how I practice. First year for me ended up low to mid 100k range. I took a job without a lot of benefits, which is one thing I dislike a lot. I do get malpractice, CME time off and money, paid time off, and state and national dues paid (they count towards my expenses). I don’t have employer-provided insurance or retirement.

Additional advice/experiences:

Lots of good advice in this thread. I’ll add to this post or write another post once things settle down in the next few months and I know what my practice is going to look like next year. Feel free to PM me
 
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D

dyk343

It all starts with hard work starting day one of podiatry school up through residency.
Have a well thought out CV/Cover letter. I spent a lot of time putting them together and had multiple people proof read them.
I made all my own interviews by contacting hospitals/multi specialty groups/ortho. No luck with recruiters. I avoided PMNews/ACFAS/APMA listings (see below).
I personally did not apply to any podiatry groups. Mostly because of horror stories I have been told in the past from others and reported starting salaries.
Most communication was initially through emailing then phone interview followed by personal interview. If they don't email back initially they probably are not interested.
Interviewers paid for all my travel expenses.
Good training = confident (but not cocky) interview skills. Always study for interview. Sounds dumb but check out an interview prep book from the library. It helped.
Research everything about interviewing hospital/group. Research the geographic area as well. They WILL ask you what you know about their hospital/group.
Interviews were all social. Unfortunately medicine has become a business. All they care about is that you are serious about them and how much money you will generate.
I have paid close attention to the business side of my training and it paid off. Quite honestly financial knowledge and my ability to show what i'm worth got me my job.
Signed contract 280k + decent bonus structure/benefits. Expectation to handle all general podiatry, wound care, trauma, and elective surgery.


Work hard from day one, get good residency training, pay attention to business, study for interview, be personable/humble and you can do well in this profession.
 
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dyk343

Ortho vs Hospital vs multispecialty group?

Clarify your RVU bonus structure...

What is your expected annual work RVU?
What are you getting paid per RVU?


Sent from my iPhone using SDN mobile

Signed a confidentiality agreement so I'm not going to get too specific. I've already probably said too much.

But I wanted to dismiss the myth that there are not good paying jobs in podiatry because there are. I have a close friend from my class who is starting at ~200k + bonus in an incredibly low cost of living area. The recent residents from my program have all started in the 200k range + bonus structure living in a decent areas.

I do have a set # of RVU I have to meet before starting bonus. Not impossible to meet. Then after that I meet that number I start off around $40/RVU on a graduated scale.

More I generate the more the RVU is worth.

I want to point out that I did not sign a cushy agreement. I will be working my tail off and they were very up front with that. "Your clinic is already full." They are paying me a nice salary but they will be making money off me.

Also, always get a healthcare attorney to look over your contract. Cost me $800 but it was worth it. Great advice and I argued higher salary.

*Edit for wording clarification
 
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dyk343

My inbox has been blowing up so I thought I would make my opinion on arguing a starting salary public.

Keep in mind that this is my opinion and what I have picked up along the way. I am open to all challenges and corrections to my comments below. Below is how I argued my salary. Also, keep in mind that you as a provider should be treating PATIENTS not dollars. When practicing do not practice in a manner to solely make money. Practice ethically with best intentions to help a patient overcome their problem. Income will follow and you will be able to sleep at night. With that said...


Podiatrists are an incredible money maker for a hospital system. We are procedural which tends to pay much more than an evaluation and management physician (i.e. primary care). In certain instances (like initial encounter) we can also bill an E&M along with a procedure. Keep in mind the facility fee (~$200) a hospital is able to charge on a per visit encounter before the patient is even seen and we are a MAJOR money maker.

Example: First time encounter for an ingrowing nail? That's $200 facility fee + $~75 Level 2-3 E&M + $300 Nail avulsion procedure. That is a nice profit for the hospital for a 15-30 minute encounter. There is a 10 day global period so you see them back in a week and can NOT charge a level 2-3 E&M visit. But the hospital will still charge that $200 facility fee. Acid treatments for plantar wart pay about $400/encounter @2-3 encounters. Percutaneous flexor tenotomy pays about $500/toe, etc, etc. Dont forget that additional facility fee for that acid treatment.

Hospitals tend to have operating rooms and podiatrists are surgical. We also use facilities resources such as physical therapists and radiologists. Patient has completely failed all conservative treatments for plantar fasciitis, can not walk, and needs a plantar fasciotomy? That's several cortisone injections and visits + facility fees for stretching and advice (bill injections + facility fee), 3-6 weeks of the hospital's 3x a week physical therapy, radiology X-ray, then a surgery that pays the hospital 20-30k and takes 15 minutes.

<5% of patients will need a plantar fasciotomy and do well with conservative treatment so let's use the example of a Bunion: 1-3 preoperative E&M visits +1-3 facility fees to discuss care pending how conservative vs aggressive you are. You also need an X-ray and therefore radiologist's fee to read X-ray. Take patient to OR and they charge ~30k to do the procedure. You have to take out the cost of your salary, radiologist's salary, anesthesia's salary, OR staff salary, facility cost, and hardware costs. But the hospital still makes a nice chunk of money for a 30-60 min procedure. Especially if you do 2-3 in an afternoon.

During the 90 day global period for the bunionectomy you can not charge E&M fees. However the $200 facility fee still is charged with each encounter. Also postoperative physical therapy, radiology/X-ray fees are charged, and income for the hospital in the post operative global period is generated.

If you walk into an interview thumping your chest and sell yourself on your super skills to perform long and complicated charcot recon procedure and they will think "great this guy is well trained lets put him at the top of our list". Then the next guy walks in and says "Hey I can see patients all morning, avulse a few nails, treat plantar warts, order MRIs, PT, X-rays, and do a couple injections then do 3-5 bunion/hammertoe procedures in an afternoon in your OR. Oh, I can also do the more complicated stuff when needed" and they will likely hire the 2nd guy.

Private practices can simply not afford to pay these starting salaries for several reasons. Private practice can not charge a facility fee with each encounter. Most do not have their own MRI, physical therapists, and surgery center so that is lost income for the system. Private practice overhead is also around 50-60% of collections. A hospital system has many providers to spread the overhead cost + charge facility fees and is therefore much less overhead, about 30%.

What I was advised a good offer to accept (in a hosptial system) is about 20-25% of the collections your hiring provider makes. Collections meaning income before they subtract overhead.

Starting at 80-140k for a private practice does not sound absurd when you take into account the above. Keep in mind 80k-140k for private practice is for an associate. As a partner you should be making closer to the 40% of what you collect (assuming 60% overhead) and there is where people make money in private practice. You should also be profiting about 20-30% off your associate.

Starting at 240-280k base + incentive does not sound absurd in a hospital system when you take the above into account. Conservative estimate a hospital will make about 1 million a year off of your treatments, facility fees, operations, and ancillary services (before overhead).

Healthcare is so expensive.... It's insane.
 
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TimmyTurner

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Mar 9, 2014
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Just a lowly first year perusing this thread b/t fumbling around w/ Physio and Neuro on a lonely Saturday night.

Thanks to all the posters above and those yet to come for shining the light at the end of the tunnel.
 

Cranjis McBasketball

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Jul 20, 2015
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My inbox has been blowing up so I thought I would make my opinion on arguing a starting salary public.

Keep in mind that this is my opinion and what I have picked up along the way. I am open to all challenges and corrections to my comments below. Below is how I argued my salary. Also, keep in mind that you as a provider should be treating PATIENTS not dollars. When practicing do not practice in a manner to solely make money. Practice ethically with best intentions to help a patient overcome their problem. Income will follow and you will be able to sleep at night. With that said...


Podiatrists are an incredible money maker for a hospital system. We are procedural which tends to pay much more than an evaluation and management physician (i.e. primary care). In certain instances (like initial encounter) we can also bill an E&M along with a procedure. Keep in mind the facility fee (~$200) a hospital is able to charge on a per visit encounter before the patient is even seen and we are a MAJOR money maker.

Example: First time encounter for an ingrowing nail? That's $200 facility fee + $~75 Level 2-3 E&M + $300 Nail avulsion procedure. That is a nice profit for the hospital for a 15-30 minute encounter. There is a 10 day global period so you see them back in a week and can NOT charge a level 2-3 E&M visit. But the hospital will still charge that $200 facility fee. Acid treatments for plantar wart pay about $400/encounter @2-3 encounters. Percutaneous flexor tenotomy pays about $500/toe, etc, etc. Dont forget that additional facility fee for that acid treatment.

Hospitals tend to have operating rooms and podiatrists are surgical. We also use facilities resources such as physical therapists and radiologists. Patient has completely failed all conservative treatments for plantar fasciitis, can not walk, and needs a plantar fasciotomy? That's several cortisone injections and visits + facility fees for stretching and advice (bill injections + facility fee), 3-6 weeks of the hospital's 3x a week physical therapy, radiology X-ray, then a surgery that pays the hospital 20-30k and takes 15 minutes.

<5% of patients will need a plantar fasciotomy and do well with conservative treatment so let's use the example of a Bunion: 1-3 preoperative E&M visits +1-3 facility fees to discuss care pending how conservative vs aggressive you are. You also need an X-ray and therefore radiologist's fee to read X-ray. Take patient to OR and they charge ~30k to do the procedure. You have to take out the cost of your salary, radiologist's salary, anesthesia's salary, OR staff salary, facility cost, and hardware costs. But the hospital still makes a nice chunk of money for a 30-60 min procedure. Especially if you do 2-3 in an afternoon.

During the 90 day global period for the bunionectomy you can not charge E&M fees. However the $200 facility fee still is charged with each encounter. Also postoperative physical therapy, radiology/X-ray fees are charged, and income for the hospital in the post operative global period is generated.

If you walk into an interview thumping your chest and sell yourself on your super skills to perform long and complicated charcot recon procedure and they will think "great this guy is well trained lets put him at the top of our list". Then the next guy walks in and says "Hey I can see patients all morning, avulse a few nails, treat plantar warts, order MRIs, PT, X-rays, and do a couple injections then do 3-5 bunion/hammertoe procedures in an afternoon in your OR. Oh, I can also do the more complicated stuff when needed" and they will likely hire the 2nd guy.

Private practices can simply not afford to pay these starting salaries for several reasons. Private practice can not charge a facility fee with each encounter. Most do not have their own MRI, physical therapists, and surgery center so that is lost income for the system. Private practice overhead is also around 50-60% of collections. A hospital system has many providers to spread the overhead cost + charge facility fees and is therefore much less overhead, about 30%.

What I was advised a good offer to accept (in a hosptial system) is about 20-25% of the collections your hiring provider makes. Collections meaning income before they subtract overhead.

Starting at 80-140k for a private practice does not sound absurd when you take into account the above. Keep in mind 80k-140k for private practice is for an associate. As a partner you should be making closer to the 40% of what you collect (assuming 60% overhead) and there is where people make money in private practice. You should also be profiting about 20-30% off your associate.

Starting at 240-280k base + incentive does not sound absurd in a hospital system when you take the above into account. Conservative estimate a hospital will make about 1 million a year off of your treatments, facility fees, operations, and ancillary services (before overhead).

Healthcare is so expensive.... It's insane.
Are the hospital based jobs pretty autonomous and secure? Or is it more of a "hit this quota and do what we say or else you will be replaced/let go."?
 
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dtrack22

10+ Year Member
Apr 20, 2008
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I'll update this with some thoughts as I finished up the job search process...

-When people tell you "no" in July or August or September, or if they tell you "we'll let you know if something opens up" don't believe them. Not because they are lying, but because they are busy and the random 3rd year podiatry resident doesn't matter very much to them. I would probably go through my whole list of contacts (at least the ones that said they weren't sure yet and would let you know) and get in touch with them again ~3 months after the initial contact just to see if anything changed. Or maybe if you talked to them in July, try once more in Nov/Dec.

-Even if you have multiple interviews set up and feel good about a position, keep looking for jobs. I didn't get totally burned by this either, but here's an example (personal experience) of why it could be important. I interviewed with a hospital in the fall. Went great, CMO liked me, dept manager liked me, I was genuinely interested in the area and had ties to it, etc. I got an email a few weeks later saying they had another individual already scheduled to interview but they thought I was great and were looking forward to speaking with me again. Now I'm sure they say that to a lot of people but that's not really the point...I didn't hear anything for 2 months after that. Apparently every single executive of the hospital had been fired, re-assigned or demoted. The recruiter that I initially worked with had left. Literally nobody (except for the dept manager who had apparently asked about me) currently employed at the hospital knew who I was and the only way I found out about this was because of a chance encounter with their former employee at a surgical skills course. I then understood why my follow up email to the CMO I interviewed with went unanswered. Sure enough, with interim CEO, CFO, CMO, COO, etc. the position was put on an indefinite hold. Once I finally got a hold of one of the new recruiters, it still took a month to get that answer. Interview in Nov, find out in late February that they aren't hiring. Had I sat on my butt and done nothing thinking I had it in the bag, I'd be in bad shape. It's kinda like a student only ranking 2 programs because he/she is sure he/she is ranked #1 somewhere.

-If there is a pathway to partnership make sure you know what the practice is valued at/what the buy in is. Too many old podiatrists, in particular, think their practice is worth dang near one year's worth of gross collections. This isn't 1990, no practice is worth that. Goodwill valuations just don't exist anymore among specialty practices because the local hospital network likely has already bought up your referral sources and they can keep those referrals in house overnight by hiring a DPM. This seems to be only an issue with podiatrists and while you can always negotiate, I think you'll find that most will be offended when you suggest that a % of net revenue or a small multiplier of profits or a pure asset valuation would be more appropriate. This problem presents you with a couple options a) walk away, don't ever work for him/her/them. This is what I recommend every one do until these old guys realize what year it is and sell for pennies on the dollar. b) take the job knowing you'll never buy in and use it as a start in a location you'd like to be permanently (watch out for non competes in some states) c) take the job assuming that when you are productive and valuable to the practice, you'll have more leverage and can get a reasonable valuation/buy in.

-negotiate everything. Ask for a larger % of collections, ask for more benefits, ask for a lower start to your production bonus, ask for a better non compete, ask for more relocation money or just relocation money in general. All they can do is say no. I got one group to pay for healthcare that they weren't going to cover (podiatrists are still the worst), to increase % collections I got to keep, got them to agree to let me keep my AR after resigning or after they terminated me with or without cause, greatly improved the terms of the non compete, and got a small relocation allowance that was also non existent before hand. I didn't take the job for many reasons, one of them being that making these improvements still made it a crappy deal, but it would have equated to tens of thousands of dollars in my pocket just because I asked.

-Jobs are still opening in March and will continue to do so in April. Even if you have a verbal promise or a contract being sent to you in January, keep looking around until you've actually signed.

-You need to understand more about the business of running a practice or at least the business of medicine than you do right now. Even if you are going for a hospital job. Overhead, gross collections, accounts receivable, downstream revenue, net collections, profit, wRVU, ancillary revenue, independent contractor, employee, S corp, etc are all terms you need to understand. If you can't quickly understand how a potential employer has calculated your pay/bonus based on production and overhead, and what it means for you and the practice in terms of income, you are probably going to get ripped off (by a podiatrist at least). You have to understand who is taking most of the risk in any particular employee/employer relationship and who will be reaping the rewards because of it. I've had a contract in my hand where I (the employee) was taking on a significant portion of the initial risk and the group would be the one benefiting greatly off of my labor in the long run. Read anything you can get your hands on regarding the business of medicine, listen to podcasts, talk to alumni of your residency program, talk to attendings, talk to practice consultants (if you can do it for free), talk with people that may post stuff on message boards and seem to know what they are talking about, get financials from the docs/practices/hospitals you are talking to or interviewing with. If you are like me and have certain constraints, you may end up getting ripped off (I didn't but it was a possibility for awhile). It can be ok to get ripped off to some extent, if its for some sort of greater good...like making your wife happy...I just feel like you need to know enough to know that you are getting a raw deal and you need to be ok with it before you sign a contract.

Sorry, that turned out to be a lot longer than I had planned...
 
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jehjr

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Thanks for this. The only general guideline I have seen on practice valuation is 50% of gross collections averaged over the preceding x years. This is typically for purchasing a practice outright. As far as buy-ins for partnership go, what have been your experiences? Thoughts on fair metrics to use for buy-in?
 

dtrack22

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Thanks for this. The only general guideline I have seen on practice valuation is 50% of gross collections averaged over the preceding x years. This is typically for purchasing a practice outright. As far as buy-ins for partnership go, what have been your experiences? Thoughts on fair metrics to use for buy-in?

That is also high. But let's pretend the number itself isn't too bad, valuations using any % of gross collections are a bad way to actually assess "value" IMO (and in many others' as well). Gross collections don't factor in the things in the practice that are actually worth money (chairs, instruments, computer hardware and software, appliances, art work, etc), and gross collections don't tell you anything about fixed and variable expenses (overhead). Gross collections is a goodwill valuation, meaning you are giving value to a practice based on receipts from a past patient population that may or may not be there when you take over. You are, to some extent, paying for charts which just aren't worth anything anymore.

I can add more soon when I have some more experience with how an independent, outside firm (consulting, accounting, etc) places value on a practice. In any case, never let a podiatrist put a value on his/her own clinic without having someone who does this for a living look at it. Unless the doc or group is only asking you to contribute a % of total assets. That's a good deal.
 
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GeauxT

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Okay, my job hunt has finally come to an end so I can share my experiences.

Background info
My program has an above average surgical volume. We see a lot of bread and butter, recon, and limb salvage. We don't do an inordinate amount of complex trauma. Also, no TARs. We also get a lot of private practice experience. I did not consider a fellowship. I felt adequately prepared to get out and practice.

I was open to most any practice type. They all have their positives and negatives. Most important to me was being in a position to practice the full scope of podiatry, and not be limited to just wounds, or c&c, or crap like that.

Initially, I was looking basically all over the country, with a focus on the southeast. However, due to some life changes (baby on the way now) I limited my search to basically the immediate vicinity of my residency program.

Search timeline
At the beginning of August I had my CV and several cover letters (for different practice types) ready to go. I waited start sending everything out until the beginning of September after I had completed another course (one more thing to put on there).


Job search strategies
I made profiles on basically every job site that comes up on a Google search for "podiatry jobs". A lot of them are just a waste of time, but I figured why not.

I contacted recruiters at some of the large national recruiting firms. I also contacted recruiters at all of the major national hospital systems.

Most of my early searching was strictly at hospitals. I did a heck of a lot of cold calling. I found it incredibly frustrating as many people hospital recruiters, at least in my experience, do even return your calls and/or emails.

I called a couple of multi-specialty groups and ortho groups. I did not reach out to any podiatry practices.

Job offers
I did not get any firm offers from my national search. I had 2 multi-specialty groups who were interested in moving forward, but when I had to narrow my search area those did not work out.

I was contacted by several practices in my area. Some of them included current attendings.

My first offer was from a multi-specialty group consisting of orthos, neurologists, and podiatrists (they were planning on expanding to other specialties). The group was very nice, and they also had their own surgical hospital and 2 MRIs. The offer was basically 100% eat what you kill. There was no buy in for partnership (I would be an equal partner the day I signed my contract). Partnership included a portion of the imaging profits and a set of shares for the surgical hospital set aside for me. This offer was initially very exciting, however when I started crunching the numbers it got scary. As partner my monthly portion of the group expenses was $20-25k. Coming out of residency with no assets and no patient base this was way too big of a gamble, so I did not accept this offer.

I received another offer from a podiatry group with 3 other podiatrists. They have 4 offices currently. The offer was pretty standard but the salary was just way too low. The offer was $80k salary, then 33% after tripling that in collections. Also included malpractice, health insurance, etc. There was also no real track for partnership in this deal.

My third offer, the one I accepted, was from one of my attendings. His partner recently retired and he's not a spring chicken either. He's currently seeing 50+ pts a day with room to expand, so the volume is already there. The offer is a hospital income guarantee model. The hospital is guaranteeing a salary of $150k with a $20k signing bonus. I basically work as an independent contractor in his clinic next year. After one year I switch to pure collections as a partner in the practice.


All in all things fell into place nicely. I am certainly lucky since I ended up having such a narrow geographic window. My advice the residents is start early and be persistent. You'll hear people talk about "creating a position" at institutions not currently looking for podiatrists. I can tell you that's definitely easier said than done, but you MUST be persistent. Don't make one call or send one email and then move on.
 
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GeauxT

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I'd also like to add, as has been said many times on this board, that offers of <100k better have some serious bonus structure attached to them.

If a practice is truly busy enough to hire a new associate there is no way a halfway decent new practitioner can't cover a salary >100k. Any practice that tells you otherwise is either not busy enough or trying to take advantage of you.
 
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ldsrmdude

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As I mentioned in my original post in the thread, things are changing for me so I thought I would update things with my second job search. I'm going to limit this information to my second job search and try not to repeat stuff I said the first time.

Background info:
I started at my current practice right out of residency in 2015. I decided fairly early on that this wasn't the permanent situation for me. At that point, I knew that my options were either to become a partner where I would have more control over how things ran or I wound need to find a new job. So I started looking for a new job because I wasn't sure I wanted partnership. I have always wanted to get into academics so I decided that I would look for academic positions or positions at larger hospitals that would allow me to make it an academic position ie start a residency or work with MD/DO residents.

Search timeline:
I started looking more than a year before my contract allowed me to leave. I started fairly slow with just a few emails and applications sent out and picked up steam as time went on. I decided that wanted to look for a specific type of position so even though I didn't really have any geographic limitations, I did have limitations as far as the type of place I wanted to work. I flew out for an interview in the fall of last year for an interview at a university that had an affiliated residency program. I didn't end up getting offered the position, but it did lead to me applying for another position at a separate hospital within the same system that I was offered several months later.

Job search strategies:
Because I had a good idea about what type of position I was interested in, it made things a bit easier. I also already had a job that if worst came to worst, I could continue with so although there was some pressure, I knew that I wasn't going to out on the street if things didn't work out. I mostly scoured job boards and applied to basically every university position there was. One thing I did was look at individual university job posting boards and found a few positions that didn't get widely advertised. I didn't apply to any private practice jobs. I also applied to a few hospital positions that I felt might fit what I was looking for. I did send out a few unsolicited emails to hospitals that I thought may be interested and even talked to a few recruiters, but neither of those yielded much for me. There were a few local positions that I thought about applying for, but even though my boss knew I was considering leaving, I didn't really want him up to date on my every move and knew that he had enough connections around that if I applied for jobs in the same state, the first call would be to him.

Job offers:
Like I mentioned above, I got offered a position at a university hospital. There is no podiatry residency, but there has been talk of starting one. There are other residencies in the hospital. The position was mostly clinical with some teaching responsibilities and some administrative time. Benefits package was pretty standard and included medical/life/disability etc. Base salary was a bit less than 200k. Around the same time, I was approached by a local hospital system that was trying to move into some new territory. Their initial offer was pretty low, but after some negotiation, the final offer was 180k with bonuses offered for production and quality. The format is fairly standard for hospital jobs with the production bonus kicking in after a set number of wRVU and each wRVU being worth a set dollar amount. Unlike some, this bonus has a flat wRVU and is not graduated. Again pretty standard benefits package. No residency, but have some medical students rotate through the main hospital. I ended up turning down the university hospital position and signed a contract with the hospital system that keeps me where I already am. Beyond just the gut-feeling aspect of it which told me to stay where I am, the bonus was the big kicker. Being in practice already for a few years, I have a decent idea about how busy I will be and what type of work I will be doing and I have a good idea about how many wRVU I'm going to produce. If I continue to grow my practice like I have been, with the quality and production bonuses, I'll probably end somewhere around 250k my first year with the hospital

Additional advice/experiences:
First jobs don't always work out. Don't be afraid to keep looking if you're not satisfied with where you are at. Sometimes it takes trying something out to realize it's not what you want. Also, don't just be overcome with a big base salary offer. Look at what you need to do to keep making that salary. I personally know a few people who signed with hospitals at a good base salary, only to find their salary offer the next year significantly decreased. Some hospital job offers will set your base salary at something like 80-90% of what you earned the previous year. A base salary of 280k sounds great but if you figure your wRVU is set at $45, that's 6200 wRVU before you break even and 6900 to keep your base salary from decreasing. The average yearly wRVU is somewhere between 5500 and 6000 so that means you would need to be very busy (and probably very savvy) to keep that salary going up. I'm certainly not saying this to convince people not to sign with a hospital - I mean, I'm signing with a hospital. I've just seen it happen a few times
 
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Cranjis McBasketball

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Jul 20, 2015
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As I mentioned in my original post in the thread, things are changing for me so I thought I would update things with my second job search. I'm going to limit this information to my second job search and try not to repeat stuff I said the first time.

Background info:
I started at my current practice right out of residency in 2015. I decided fairly early on that this wasn't the permanent situation for me. At that point, I knew that my options were either to become a partner where I would have more control over how things ran or I wound need to find a new job. So I started looking for a new job because I wasn't sure I wanted partnership. I have always wanted to get into academics so I decided that I would look for academic positions or positions at larger hospitals that would allow me to make it an academic position ie start a residency or work with MD/DO residents.

Search timeline:
I started looking more than a year before my contract allowed me to leave. I started fairly slow with just a few emails and applications sent out and picked up steam as time went on. I decided that wanted to look for a specific type of position so even though I didn't really have any geographic limitations, I did have limitations as far as the type of place I wanted to work. I flew out for an interview in the fall of last year for an interview at a university that had an affiliated residency program. I didn't end up getting offered the position, but it did lead to me applying for another position at a separate hospital within the same system that I was offered several months later.

Job search strategies:
Because I had a good idea about what type of position I was interested in, it made things a bit easier. I also already had a job that if worst came to worst, I could continue with so although there was some pressure, I knew that I wasn't going to out on the street if things didn't work out. I mostly scoured job boards and applied to basically every university position there was. One thing I did was look at individual university job posting boards and found a few positions that didn't get widely advertised. I didn't apply to any private practice jobs. I also applied to a few hospital positions that I felt might fit what I was looking for. I did send out a few unsolicited emails to hospitals that I thought may be interested and even talked to a few recruiters, but neither of those yielded much for me. There were a few local positions that I thought about applying for, but even though my boss new I was considering leaving, I didn't really want him up to date on my every move and knew that he had enough connections around that if I applied for jobs in the same state, the first call would be to him.

Job offers:
Like I mentioned above, I got offered a position at a university hospital. There is no podiatry residency, but there has been talk of starting one. There are other residencies in the hospital. The position was mostly clinical with some teaching responsibilities and some administrative time. Benefits package was pretty standard and included medical/life/disability etc. Base salary was a bit less than 200k. Around the same time, I was approached by a local hospital system that was trying to move into some new territory. Their initial offer was pretty low, but after some negotiation, the final offer was 180k with bonuses offered for production and quality. The format is fairly standard for hospital jobs with the production bonus kicking in after a set number of wRVU and each wRVU being worth a set dollar amount. Unlike some, this bonus has a flat wRVU and is not graduated. Again pretty standard benefits package. No residency, but have some medical students rotate through the main hospital. I ended up turning down the university hospital position and signed a contract with the hospital system that keeps me where I already am. Beyond just the gut-feeling aspect of it which told me to stay where I am, the bonus was the big kicker. Being in practice already for a few years, I have a decent idea about how busy I will be and what type of work I will be doing and I have a good idea about how many wRVU I'm going to produce. If I continue to grow my practice like I have been, with the quality and production bonuses, I'll probably end somewhere around 250k my first year with the hospital

Additional advice/experiences:
First jobs don't always work out. Don't be afraid to keep looking if you're not satisfied with where you are at. Sometimes it takes trying something out to realize it's not what you want. Also, don't just be overcome with a big base salary offer. Look at what you need to do to keep making that salary. I personally know a few people who signed with hospitals at a good base salary, only to find their salary offer the next year significantly decreased. Some hospital job offers will set your base salary at something like 80-90% of what you earned the previous year. A base salary of 280k sounds great but if you figure your wRVU is set at $45, that's 6200 wRVU before you break even and 6900 to keep your base salary from decreasing. The average yearly wRVU is somewhere between 5500 and 6000 so that means you would need to be very busy (and probably very savvy) to keep that salary going up. I'm certainly not saying this to convince people not to sign with a hospital - I mean, I'm signing with a hospital. I've just seen it happen a few times
I cant wait til I am in pod school and can understand all the different income terms haha
 
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Rop

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I can't recall a single poster who's received a hospital offer that's not in line with MGMA. Very fair and (somewhat?) standardized just like what would see in any other physician specialty!!
 

ldsrmdude

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I don't think all hospitals are crooked like you describe. It could be the bigger hospital systems are a little bit more rough on DPMs in terms of their salaries compared to smaller community hospitals that have less resources and a little bit more personable from the hiring aspect. My hospital is about 160 beds. I feel like I have an ongoing personal relationship with my CEO and the chief of orthopedics as I've been communicating with them throughout this year since I signed my contract in December. I find it hard to believe with that kind of communication and building rapport with these people that they would low ball me when we go back and negotiate my next contract in two years.

That is just my opinion and not fact at this time. I certainly will let you all know how it works out for me two years from now.

Lastly, I feel 5500 RVUs it's not that high of a value and if you are busy it is certainly reasonable to achieve. I have personally witnessed DPMs through shadowing experiences that are working for hospitals and private orthopedic groups that are hitting RVU values in the 10,000 range. If you were the only DPM in the entire hospital system like I am there's no reason why I can't hit that number and go far above that. Maybe I will be proven wrong.

I scrub surgeries with attending's that are part of the hospital system at a neighboring hospital system outside of Swedish. There's about five DPMs within this hospital system and they're hitting their annual RVU goals of 5500 and they all share work. The hospital system itself is a large community system with multiple hospitals therefore there is plenty to go around.



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Well, I didn't say the hospitals are crooked and I didn't mean to imply it either, my point was just to look beyond the initial salary. Look at what you need to do to keep increasing your salary and not get a pay cut. I'm assuming the hospital isn't just going to cut your pay arbitrarily, although there are probably some that will try. Most likely it will be based on how busy you are, so try to get an honest assessment of how busy you will be. If you're looking to work 4-day weeks 9-4 with no call, you'll have a tough time hitting your wRVU threshold. And I agree with you, 5500 wRVU is certainly achievable. I just did the math really quick and it comes out to around 23 wRVU per weekday if you work 48 weeks per year. If you're busy, that well within reach. Make sure you're in a position to be that busy otherwise you won't be getting your contract renewed or at least not at that salary.
 
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streetsweeper

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Dec 5, 2008
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I'm currently settled into my second job of my career.

Background info:
I did a "country club" residency in the east coast. Graduated in 2014 and landed with a multispecialty group that was a part of my residency program. The process to get that job wasn't hard. I was basically the better liked resident and all the attendings knew me, MD and DPM alike. It didn't hurt that I had a good reputation for hard work. I left the practice last year in 2016 on very good terms. I didn't want to leave but my wife was miserable and she wanted to go back "home." Happy wife happy life...

Search timeline:
I did a google search around May close to my home town in California on Indeed.com. Surprisingly, there was a position open with a big multispecialty group in the region which on the Ad description sounded perfect for us. Sent in my CV. Didn't hear anything for a good 2 months. And then I just cold called the place because my wife had another homesick episode - I was told they had 40 applicants that needed reviewing. I pretty much didn't have high hopes but I told them that I was a local kid and that I already have experience in big multispecialty group. 3 days later, I got a call back from head of orthopedics and he gave me a 20-30 minute phone interview. He asked me questions like what I am comfortable with and what my current practice was like. At the end of the phone convo, he stated that I sound like a good fit. I was then offered an in person interview. That's when I started notifying my colleagues of potentially leaving the group. The new group flew me out. I had to schedule interview in the middle of August so it doesn't conflict with too many patients getting rescheduled. At the interview, everything was broken down for me from pay structure (MGMA) to benefits, where I would be working, what support I have, etc etc. At the end of the interview day, I was surrounded by future colleagues in a panel type setting and was asked a bunch of questions. Nothing about my surgical cases but how I handle certain situations - mostly ethical questions and dealing with difficult patients. One podiatrist on the panel, the rest were orthos. A week later, I was given a formal letter of a job offer. I had to sign for acceptance and anticipated start date. It was perfect for me because it gave me 3 months notice for my old job - they didn't want to let me go but they wanted me to be happy. Great guys. My new job paid for my moving expenses - it was awesome.

Job search strategies:
Google search which led to indeed.com and then cold calling the place. Having good recommendations also helped. All my references that I listed in my CV were called. All my references vouched for me which was great.

Job specs:
Big multispecialty group. tons of autonomy. Ortho is really supportive of what I do. They want me to max out my scope of practice. I did take a pay cut. 2 year contract with base of $200k a year but bonus after hitting 4600 wRVU. I'll be paid based on wRVU and MGMA data after that. At the 2 year mark, I become automatic partner and start receiving dividends every quarter. CME, Business expense account, all professional dues paid, paid time off.

Cons:
I'm building my base from scratch. Where I was placed was quite unorganized at a satellite location that is 40 miles away from the main hub. So I had to set up my practice in a way that made things more efficient. Nearest ID doc in the same medical group is 40 miles away so at times I am my own infectious disease doctor. Had to teach radiology department how to perform a hanging mortise view or calcaneal axial view. Had to set up my tray in the OR from scratch. Most of the podiatry instruments I ordered are fresh. I did borrow a good chunk of resources from ortho - I.e., ortho cast tech, OR assistants, etc. Although there are a lot of automatic internal referrals, I really had to reach out to private PCP offices and advertise that I'm in town. Did this for weeks. It paid off though because I am much busier today than I was 6 months ago so I'm feeling pretty good about everything. It's getting there.

Additional Advice/Experiences:
I didn't think finding a new job was hard at all. Once you're out in practice for a good 2 years, it becomes easier because you don't really have a deadline - unless you've given yourself one. Also, when you have a good reputation I think that helped with the job hunt even more. My current practice is very different than the one I left...in a good way. I went from a place that was mostly bread and butter to being the only guy really in my radius that can do flatfoot/cavus foot recons. I had to be proctored for 5 cases on every hospital I applied for privileges at but that was a piece of cake. I was allowed to do everything I applied for even ankles. My surgical numbers pretty much quadrupled compared to the east coast out of necessity. Wife no longer complains of being homesick. Professionally, I feel like I'm where I should be. Overall, that was a good move.
 
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air bud

I am a dog and play basketball
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Nov 11, 2008
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I have not yet signed my contract, due to legal reasons we have to wait until mid-January as it is a standard contract that all employed physicians in the multi-state group sign. The compensation model has recently been changed across the group and goes into effect January first. Here goes:

My new position has been created for me. I am the first podiatrist in they system in a rural location. It is a rural health clinic, thus reimbursement is different. Because of this a pro forma had to be done which has taken considerable time.

This all started at ACFAS Las Vegas. I was 1 year into my job. I was sitting at a table with random people (my friends were gambling/hung over/actively drinking while hungover and gambling). I saw a guy with a tag that was in city I looked at during the job search in residency. It didn't work out for me as the city is anti-pod and only private practice exists. I struck up conversation with him and he said "actually I go to a rural hospital a few days a month and they were thinking about hiring somebody." After our conversation I went back to the hotel and called the hospital immediately. I asked for HR, then asked for the CEO. I told them who I was and what I wanted. They sent me to his assistants voicemail. I left a message. 2 hours later I got a message literally saying "Airbud, this is a sign. I literally just had a meeting with other people in our hospital system about hiring a podiatrist. I would love to talk to you." I had a 1 hour conversation with him and he was sold. I was his guy. I had family nearby, wanted to be in a rural setting, liked farming/bees etc.

At this time he was the local CEO. They had an ortho guy who did foot and ankle but was open to the idea of a pod. Long story short, they did pro-formas and decided it wasn't going to work out. Well this CEO was now promoted within the hospital system to a much higher position. He said "Airbud, I think you are great, we are opening up more rural locations across the US, you are my guy I will find you a position where do you want to go?" I talked to him for a grand total of maybe 1.5 hours and had a few emails.

This happened in August. There was a possibility of a podiatrist in a state which is EXACTLY the state I want to live in. It isn't perfect for a lot of people, most people in fact, but it was perfect in my mind as well as my wife's mind. Somebody from New York City may think it is hell. I think it is paradise. Anything I could want to do outdoors (except surfing) is available within 30-90 minutes. The nearest Walmart is 90 minutes away - this makes me happy.

It will be an employed position. There is ortho that visits. They have never had a podiatrist there. The closest one is a TFP about 1.5-2 hours away. Anything major and people drive about 3 hours. The hospital has brand new state of the art equipment, including digital mini-c arm, big c-arm, ultrasound, MRI, CT. OR is brand new. Arthrex scope equipment. I am being given full privileges for what I am trained to do. I will take no call. I will get the majority of foot and ankle trauma. I will get all foot and ankle from the referring providers. They are beyond thrilled to have me. I told them what my training is, what I can do and what I want to do. Nobody has asked or cared where I did my training. Nobody has asked to see logs. Nobody has contacted my current employer. Obviously I will have to provide this when I begin the credentialing process. I got this job because of my personality, my confidence in myself and through my non-traditional life experiences. Realistically this would not have been able to be done by new graduate. But anyone who got any halfway decent training could have gotten this job. No fellowship was needed. You didn't need to go the Harvard of Podiatry for school or residency. You had to be smart, personable, knowledagble and willing to work hard (and in a rural location). Part of what I sold them on is that I already know how to code. I already have done some stuff in semi-rural locations where you have to learn to get by with no infectious disease consult or vascular consult immediately available. I had ideas on how to build a program from scratch within the confines of a rural setting.

I just found out contract details yesterday. It will be base salary with RVU bonus (which I fully expect to obtain first year based on the population and some other friends in rural health settings experience). The base is average with MGMA data, the RVU threshold is VERY low and will be at $45 a RVU produced after that. This state does not cover medicaid for podiatry, but contract is for RVU produced regardless of collections, so it doesn't matter to me if they have insurance or not. They offer a significant signing bonus that only rural health can provide. They offer significant loan payback. Basically it is in the 99% percentile of contracts. I will see about 20 patients a day M-Th. Surgery friday morning and afternoons off.

Edit - In terms of beginning contract is in 99%- not opportunity. Side note - My coresident took a average hospital group position - 200k 5500 RVU base. 1.5 years out this year he will do 10500 RVU's. BIG bonus. Where you start with a contract is not where you end up - too many people on here get focused on the up front money - long term it is about the opportunity.... but back to topic at hand

In summary - there are great jobs out there. They don't exist in San Diego or New York City or Austin. You never know where life will take you. You may need to take the first thing available coming out of residency. Learn, grow and move on if you need to. Nothing is forever. Write your life in pencil, not pen. DON'T buy a house right away coming out of residency. I did, but it cost me 70k and I may lose 1 or 2k when I sell it, not the end of the world. Live like a resident, read white-coat investor, Passive IncomeMD, PhysicianONFIRE. Podiatry will have a role going forward, but it will continue to evolve. Right now there is a big need in rural health as they realize you can provide a large range of services that they need and you will make them money and they will pay you well.

This was never a posted position. Most good jobs are not posted. Either somebody knew somebody or somebody already had a leg up by contacting the right person before.


You never know what will happen in life. I randomly sat at a table that another person randomly sat at. Things worked out from there.
 
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Dec 12, 2017
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Hoping to get some opinions from this board...
Does anyone have any experience with buying into a multispeciality group practice?
I am currently an associate at a private practice...realizing that this isn't for me. Been offered a position from a multispecialty group and considering jumping ship. I really don't want to be in the same position as I am in now and want to be able to buy shares of the practice. to keep things simple, I will have a base salary with equal division of net profits quarterly. Money isn't a big factor for me. I am more concerned about job stability/security, especially with hospitals now buying out more groups and employing docs.

What were some of your experiences and what is considered fair? Thoughts are appreciated.
 

dtrack22

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How big is the group? How long have they been around? What is the offer? How much is a share? What has the return been per share in recent years? Does ownership get you a peice of physical assets owned by the group? I mean without any other information it sounds like you got a good deal...or maybe its a bad deal...or...
 
Dec 12, 2017
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How big is the group? How long have they been around? What is the offer? How much is a share? What has the return been per share in recent years? Does ownership get you a peice of physical assets owned by the group? I mean without any other information it sounds like you got a good deal...or maybe its a bad deal...or...

Im in very beginning stages of negotiation with them but there is 2 other Pods and 2 MD's in the group. Only 2 of the 4 have ownership stakes in the practice. As far as the buy-in opportunity, it is not yet set in stone and they are thinking about it also.

Some i have spoke to said that buying in to a practice is now a waste because practices really have no value (good will, etc) these days. No sure if this is true or not.

I am just curious what other people have experienced in a "buy-in" situation.
 

dtrack22

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I am just curious what other people have experienced in a "buy-in" situation.

It depends entirely on what you are purchasing. Assets have value. Profit sharing has some value. Using pre-tax money on car payments, utilities at your house, cell phone bills, entertainment, etc. has value.

If they are valuing the "practice" like a podiatrist does, it will probably be some amount gross collections, which depending on assets is largely goodwill and usually a ripoff. If they are like large MSGs then the buy in is small and nothing more than them asking you to have some skin in the game. Ownership doesn't change much in how much money you make per year (like it often times does in a podiatry group), and the returns or your cut of the profits are small since everyone is essentially eating what they kill. It sounds like you really don't know enough about the group or the contract for anyone here to help you much.
 
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dtrack22

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This is stickied so I don't feel bad about bumping an old thread...

I have worked for two different podiatry practices since residency. Both had fairly significant issues/problems/warnings for anyone else considering working there. Of course, both clinics found brand new grads, desperate for a job in the area to take my place. In NEITHER instance did the individuals interviewing for the position reach out to me. They didn't ask me for my phone number when they met me while touring the office. They didn't find me on facebook and send me a message. They didn't call the office and ask for Dr. dtrack...nothing.

You have to be a special kind of stupid (no offense) to make zero attempt at discussing the job with a current associate or the last associate to leave. The practice owner can tell you all they want, "Oh well he/she loved it here, but needed to leave and move/on for family reasons" or some other BS. Doesn't mean its true.

When joining a podiatry group, you should ALWAYS make an attempt to speak with someone who recently left or the newest/youngest associate still at the practice. Even if you have convinced yourself that you have to take the job because of location, or your 2-3 months out of residency and still don't have a job so you need the first thing you can find. You still need to try and figure out what you're getting yourself into.

It's really been mind bottling....

 
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ldsrmdude

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When joining a podiatry group, you should ALWAYS make an attempt to speak with someone who recently left or the newest/youngest associate still at the practice. Even if you have convinced yourself that you have to take the job because of location, or your 2-3 months out of residency and still don't have a job so you need the first thing you can find. You still need to try and figure out what you're getting yourself into.
Good advice. When I was looking to join my first practice, I reached out to the previous associate who I had been told had left because they just wanted to start their own practice. I found them on LinkedIn I think and messaged them and later talked over the phone a few times. He even sent me a copy of his contract from when he was an associate. I found it really helpful. Turns out they didn't want to start their own practice as much as they wanted to not work with that boss. Then when my private practice was looking to hire another associate, I actually reached out to one of the candidates who came for an interview to let them know the true story. They didn't end up joining the practice.
 
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Weirdy

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In terms of my job search thus far, I reached out to recruiters at most major hospital systems in the area. Some have gotten back to me and basically told me that they don't currently have openings and would let me know if that changes or that there might be positions later in the year. I also searched every online job site and found nothing in the area. I haven't reached out to podiatry groups yet, mostly due above noted reasons of new grads getting bad offers/contracts. Some hospitals/multi-speciality groups I reached out to have numerous clinic locations with only one or two podiatrists, so there must be room for growth. They say positions get created, but other than contacting recruiters and sending my CV to places of interest what other strategies can I implement without being too intrusive?

With all due respect:
- Make a geographical map of all the places within X amount of miles and list them.
- Dress up, cold call them, visit their location with CV ready, speak to their staff
- Network. Start calling people you know.

I do not believe you will get the job you want shotgunning your app online and relying on recruiters.
Get personal. There is no such thing as being too intrusive when it comes to a job hunt. Do what is necessary within limits.
 
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dtrack22

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Due to my husband's work obligations we are looking to stay local and moving would really be an absolute last option.

This will be your problem. You better start calling local podiatry offices now. Whether you like it or not, you are not a hospitalist or PCP or Ortho or any other specialty who has universal demand even in "saturated" cities where living/working is desirable to many people.

You can't say, "I'm going to live in one location" as a podiatrist and not expect to work for another podiatrist. At least for a few years until something better opens up. Anything else will be dumb luck, i.e. you graduated in the same year as some hospital or MSG decided to hire. What I'm getting at is, your expectations are very unrealistic and they probably need to come back down to earth sooner rather than later. However, since you insist on living in one specific location, and don't want to work in a Podiatry office...recruiters are great to contact but they cannot and will not create jobs for you. They really will take your CV to the next meeting they have with the department you would be working for and ask if there is any interest in hiring, but they have no pull or power to create something or start the process of evaluating the need for your service. They could reach back out to you if a position does become available, but that job is still going to be posted and you will inevitably be competing against a hundred other podiatrists, many of whom are significantly more qualified than you are. If you want to have a chance of something being created you need to call admin. That may be the clinic administrator (for whatever dept podiatry falls under). It may be the physician group VP. It may be the facility's COO. It may be the CEO. But recruiters, while serving as a good first point of contact, aren't going to move the needle much for you if there isn't already something in the works.
 

air bud

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Yep, you are going to work for another local pod most likey.

My advice would be like already given, get out there and talk in person to someone. You can't be too intrusive. Honestly I would take your lack of training and turn it into an advantage. Are you willing to be non op ? Or just limited wounds and maybe some forefoot stuff? All these ortho groups and msg are used to everyone coming into thing they are hot crap.and want to do TARS. So propose something to them where you take all the crap they don't want. They may think that's a great idea and never considered that someone may want to do that .Not trying to be too sexist, but I think that would come off well in your situation as they might not find you too threatening or that you will want to push for more (assuming you are a woman married to man...). So if you are going to settle due to geography locations, would you rather
A. Sign a crappy podiatry contract and not do much surgery and hate your job?
B Sign a good contract that has good Benny's with a group but not so surgery?

There is going to be some sacrifice. So go out and create your position.
 
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CutsWithFury

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Recruiters for podiatry don't really exist. The market for podiatry is not strong. There is no money in it for recruiters. I have talked to hundreds of recruiters who just go through the motions. They ask for you CV and tell you they will let you know if someone is looking to hire. Then they dissapear for the most part.
 
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