The "old" salary question

[PADPM]

I obviously believe that with the quality of today's residency training and fellowships, the surgical skills of podiatric foot and ankle surgeons rivals any orthopedic foot and ankle surgeon.

I'm not sure all orthopedic surgeons believe that fact, even though many orthopedic groups have been hiring well trained DPMs more than ever. And I've expressed my personal opinion that I don't believe that orthopedic surgeons have suddenly given in to the fact that we can provide the same quality of care or that they suddenly have a great love or respect for DPMs. I've felt that it's simply a matter of economics, since hiring a well trained DPM is a lot less costly than hiring a foot and ankle orthopedist.

Once again, I sincerely believe the well trained DPM is at least as good, but believe that for MOST orthopedic groups the decision is an economic one, not a sudden love for DPMs.

And here is a great example. In the new issue of the Journal of Foot & Ankle Surgery I received today, there is an add on the last page for an Orthopedic Sugeon specializing in Foot & Ankle Surgery. It states that the compensation is $500k-$550k or commensurate with experience.

That's a LOT of money for a starting salary, and I don't know of any DPM's working for any podiatric group, hospital or orthopedic group who were ever offered that kind of money as a starting salary.

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[emericana]

I obviously believe that with the quality of today's residency training and fellowships, the surgical skills of podiatric foot and ankle surgeons rivals any orthopedic foot and ankle surgeon.

I'm not sure all orthopedic surgeons believe that fact, even though many orthopedic groups have been hiring well trained DPMs more than ever. And I've expressed my personal opinion that I don't believe that orthopedic surgeons have suddenly given in to the fact that we can provide the same quality of care or that they suddenly have a great love or respect for DPMs. I've felt that it's simply a matter of economics, since hiring a well trained DPM is a lot less costly than hiring a foot and ankle orthopedist.

Once again, I sincerely believe the well trained DPM is at least as good, but believe that for MOST orthopedic groups the decision is an economic one, not a sudden love for DPMs.

And here is a great example. In the new issue of the Journal of Foot & Ankle Surgery I received today, there is an add on the last page for an Orthopedic Sugeon specializing in Foot & Ankle Surgery. It states that the compensation is $500k-$550k or commensurate with experience.

That's a LOT of money for a starting salary, and I don't know of any DPM's working for any podiatric group, hospital or orthopedic group who were ever offered that kind of money as a starting salary.

Is this not what Vision 2015 strives to at least partially fix?

Sucks I know.

 

[PMSIII]

Is this not what Vision 2015 strives to at least partially fix?

Sucks I know.

Vision 2015 is not going to give you the training to take call for non-foot/ankle trauma or give you surgical privileges to operate on knees or hips - Yes foot and ankle orthopedic surgeons also operate on other joints by virtue of training. This is one of the factors why their compensation is higher. However, I certainly agree with PADPM in attributing economics and costs in the abundance of hirings of well-trained DPM's in orthopedic groups. The obvious drawback to hiring DPM's is the inability to take call for non-foot/ankle trauma. One observation that I am noting about DPM's in ortho practices as well is the inherent difficulty in attaining partnership status in groups. One of my respected mentors is a partner in an ortho group but he explained to me that this is a rare exception as he is involved with the orthopedic residency program. From my understanding and based on my limited experience as a resident of course, I am noting that foot and ankle procedures certainly do not pay as well as spine/total joints/etc. so for that reason, we'd have to see more to generate "our share" into the practice - maybe PADPM can shed some light on this since you have a lot of valuable experience in the field.

 

[DPMer]

Vision 2015 is not going to give you the training to take call for non-foot/ankle trauma or give you surgical privileges to operate on knees or hips - Yes foot and ankle orthopedic surgeons also operate on other joints by virtue of training. This is one of the factors why their compensation is higher. However, I certainly agree with PADPM in attributing economics and costs in the abundance of hirings of well-trained DPM's in orthopedic groups. The obvious drawback to hiring DPM's is the inability to take call for non-foot/ankle trauma. One observation that I am noting about DPM's in ortho practices as well is the inherent difficulty in attaining partnership status in groups. One of my respected mentors is a partner in an ortho group but he explained to me that this is a rare exception as he is involved with the orthopedic residency program. From my understanding and based on my limited experience as a resident of course, I am noting that foot and ankle procedures certainly do not pay as well as spine/total joints/etc. so for that reason, we'd have to see more to generate "our share" into the practice - maybe PADPM can shed some light on this since you have a lot of valuable experience in the field.

Hey PMS III: I notice you graduated in May 2009 from OCPM, and you are a PGY-1 for July 2010-June 2011 at a podiatry residency program. What did you do during June 2009 to May 2010? Just curious...

 

[Podfather]

I obviously believe that with the quality of today's residency training and fellowships, the surgical skills of podiatric foot and ankle surgeons rivals any orthopedic foot and ankle surgeon.

I'm not sure all orthopedic surgeons believe that fact, even though many orthopedic groups have been hiring well trained DPMs more than ever. And I've expressed my personal opinion that I don't believe that orthopedic surgeons have suddenly given in to the fact that we can provide the same quality of care or that they suddenly have a great love or respect for DPMs. I've felt that it's simply a matter of economics, since hiring a well trained DPM is a lot less costly than hiring a foot and ankle orthopedist.

Once again, I sincerely believe the well trained DPM is at least as good, but believe that for MOST orthopedic groups the decision is an economic one, not a sudden love for DPMs.

And here is a great example. In the new issue of the Journal of Foot & Ankle Surgery I received today, there is an add on the last page for an Orthopedic Sugeon specializing in Foot & Ankle Surgery. It states that the compensation is $500k-$550k or commensurate with experience.

That's a LOT of money for a starting salary, and I don't know of any DPM's working for any podiatric group, hospital or orthopedic group who were ever offered that kind of money as a starting salary.

I have 5 ex-residents doing extremely well within orthopedic practices. Some make the starting salary you mentioned after a few years. Economics plays a role but the supply of foot and ankle orthopods plays into it as well. Many of these groups tried to get a foot and ankle orthopedist and simply could not find one. Even in larger cities this can be a problem.

Orthopedic groups would like help with general call and often when they find a foot and ankle orthopedist they are told that they will only take foot/ankle call. Sounds like your associate applicants who don't want to do consults.

Another scenario is a group hired a foot and ankle orthopedist who was sub-optimal and the group gives a DPM a shot.

 

[PADPM]

I have 5 ex-residents doing extremely well within orthopedic practices. Some make the starting salary you mentioned after a few years. Economics plays a role but the supply of foot and ankle orthopods plays into it as well. Many of these groups tried to get a foot and ankle orthopedist and simply could not find one. Even in larger cities this can be a problem.

Orthopedic groups would like help with general call and often when they find a foot and ankle orthopedist they are told that they will only take foot/ankle call. Sounds like your associate applicants who don't want to do consults.

Another scenario is a group hired a foot and ankle orthopedist who was sub-optimal and the group gives a DPM a shot.

I agree with your comments, but you and I have been around for a while, and I think you'll agree that although you've had some of your former residents approach those starting salary numbers in a few years with an orthopedic group, unfortunately I believe it's the exception and not the rule.

You have to generate a minimum of a million dollars to be able to bring home that kind of money, and with most insurance reimbursements in my geographic area, it's difficult for one doctor to generate over one million dollars himself/herself.

 

[Podfather]

I agree with your comments, but you and I have been around for a while, and I think you'll agree that although you've had some of your former residents approach those starting salary numbers in a few years with an orthopedic group, unfortunately I believe it's the exception and not the rule.

You have to generate a minimum of a million dollars to be able to bring home that kind of money, and with most insurance reimbursements in my geographic area, it's difficult for one doctor to generate over one million dollars himself/herself.

I agree for a majority of DPMs attaining those kind of numbers is difficult. I know some who make more than those numbers and many who make less. Our graduates leaving this year have decent DPM starting salaries with a base average around 150,000 plus bonuses/benefits.

The orthopedic practice is a different scenario all together. When a new DPM joins they are immediately busy simply from intragroup referrals. One ex-resident walked in and saw 25 patients his first day. The fact the group wants a foot and ankle specialist implies the group does not want to do this work. Their non surgical care is decent money generated care (heel pain, ankle sprains, etc.). Most do not do palliative care and minimal diabetic work ( the other DPMs in town do it). The smartest guy I had simply added ingrown toenails and orthotics to the typical ortho stuff and is making a killing.

 

[PADPM]

I agree for a majority of DPMs attaining those kind of numbers is difficult.................. The smartest guy I had simply added ingrown toenails and orthotics to the typical ortho stuff and is making a killing.

In my geographic area, with the large amount of managed care contracts, it is getting increasingly difficult to hit those numbers. As managed care contracts increase, it takes away our ability to get paid for x-rays, orthoses, Cam-Walkers, etc., all items that add to the bottom line and all necessary treatments (these insurance carriers cover these items but patients must be referred out).

The last sentence that I quoted from your post really hits the nail on the head. Just by utilizing some of the "smaller" things we are trained to do such as those you mentioned, these ortho groups can add a lot to their bottom line when hiring a DPM, but they often don't realize that fact. As I've stated several times, one of the largest producers in our group practice is one of our partners who is no longer performing surgery. Although he is ABPS certified, he is "winding down" and produces more than ever with his time spent in the office.

 

[Feli]

...The obvious drawback to hiring DPM's is the inability to take call for non-foot/ankle trauma...

Well, maybe a drawback for the other guys in the group... but definitely not a drawback for the DPM's spouse, family, friends, fly fishing gear, golf clubs, etc

 

[Feli]

...it is getting increasingly difficult to hit those numbers. As managed care contracts increase, it takes away our ability to get paid for x-rays, orthoses, Cam-Walkers, etc...

What ever happened to CPT code "cash" (for the visit, procedure, etc)?

Granted, the demographic is different in every area, but we are eventually going to have to draw the line in the sand:
Do you want to continue to see increasingly more patients (and paperwork) for decreasing returns with ObamaCare? Or do you want to drastically increase the quality (and cash cost) of your services and cater to the patients who are sick of waiting 45min to see a random ObamaCare doctor for 3mins (and have a sizable co-pay nonetheless)? Yes, you will start to walk the fine line between "seeing patients" and "serving clients" in some markets, but those who survive the best aren't necessarily the strongest or the smartest... they're just the most adaptable to change. Food for thought?

 

[Feli]

...To quickly rant on the ortho thing:
Count me out of the ortho F&A job hunt; I decided that long ago. To me, ortho (aside from maybe sports med) means bad hours, tough cases, and a broken back from wearing lead while standing on a tile OR floor all the time. Maybe it's just that I went into health care mostly to deal with patients, but that's how I feel. You do arrive at a point where you have to ask yourself, "how much $ do you really need" and "how much is this taking out of me?" Most of all, the trauma patients continue to irk me. The idea of low (sometimes "no") pay cases that aren't grateful patients - yet sue at a high rate - is not for me.

Additionally, the stereotypical (and unfortunately, quite prevalent) orthopedist with a workaholic lifestyle, anger issues, and meduim-to-super-sized megalomaniac attitude does not appeal to me. It just doesn't. There are exceptions to every rule, but stereotypes do persist for a reason. I'm certainly not saying I won't fix ER stuff, do RRA trauma, etc... but I sure won't be fighting tooth and nail over it like a suprising number of young residency grads seem eager to do. The only way I would ever envision myself in a fully orthopedic setting would be academic medicine, but I haven't figured out a logical way to do enough industry-sponsored research, implant design, etc to make that anywhere near as profitable as private podiatry practice +/- running a residency.

...Finally, I am gonna go ahead and suggest something I'm constantly in disbelief nobody talks about in these "career options" threads. If anything (besides a pod or multispec group), I would consider work in a vascular surgeons' group to do all their foot+ankle wound care and most of the amps/salvages, which vasc is generally to pass up so that they can do more carotids, fem/pop, angio, and dialysis access cases. There is also nothing to stop you from building an elective clinical F&A bone/joint patient base at the same time. You would make WAY more $ doing that than any ortho group, and I'd bet my bottom dollar on this. The cases (aside from Charcot) are much faster, easier, and more straightforward than the ortho cases. Additionally, you don't have to go chasing down vascular patients (hint: most visit dialysis center 3x/wk) like orthos do trauma, elective, and athlete patients. I'm very suprised a lot more young, well trained DPMs aren't considering that vascular surgery group as a serious career option. Oh, that's right... wound care, amps, I&Ds, and Charcot recons aren't the big balls and glory to the ego cases (aka a lot of podiatrists don't want to be podiatrists )

 

[NatCh]

the stereotypical (and unfortunately, quite prevalent) orthopedist with a workaholic lifestyle, anger issues, and meduim-to-super-sized megalomaniac attitude

You just described my brother-in-law, LOL!

 

[Feli]

You just described my brother-in-law, LOL!

Lol... that's funny, because I thought I was describing you (or hopefully me in a few years) in this one:
http://forums.studentdoctor.net/showpost.php?p=11006260&postcount=9

...Long time, no see on these forums, NatCh... I'm sure all is well in the NWest. Here in midwest, it's a sunny day. I'm about to log off and go hit the disc golf fairways. Take care

 

[PADPM]

What ever happened to CPT code "cash" (for the visit, procedure, etc)?

Granted, the demographic is different in every area, but we are eventually going to have to draw the line in the sand:
Do you want to continue to see increasingly more patients (and paperwork) for decreasing returns with ObamaCare? Or do you want to drastically increase the quality (and cash cost) of your services and cater to the patients who are sick of waiting 45min to see a random ObamaCare doctor for 3mins (and have a sizable co-pay nonetheless)? Yes, you will start to walk the fine line between "seeing patients" and "serving clients" in some markets, but those who survive the best aren't necessarily the strongest or the smartest... they're just the most adaptable to change. Food for thought?

You are correct, cash is great, but when the economy isn't great many patients unfortunately don't always see the value in their feet. They spend the money on other things, and their feet often become second class citizens. Additionally, patients now are getting more demanding than ever with expectations. They expect their insurance to cover everything and expect you to get them better in one visit, even though a problem may have existed for years.

One example: I had a new patient enter with classic plantar fasciitis symptoms. I did the entire work up, yada, yada, yada and drew her pictures, showed her models, explained the etiology and options in detail AND handed her a 4 page explanation of plantar fasciitis/heel pain that I personally wrote. One of the treatments during the initial visit included taping/strapping (low dye) her foot to see if mechanical support of the fascia would provide relief. On her return visit, she related moderate relief with the taping, so I gave her an injection, recommended ice massage, stretching exercises and prescribed a night splint and recommended proper footwear. She called one week later and said she still had discomfort, and wanted to know if she came back to see me, would she still have to pay a copay????!!!! Yes, two weeks after starting treatment, she didn't understand why she wasn't completely better despite my verbal and written explanations, and doesn't understand why she has to pay a copay on her return visit.

Welcome to the NEW type of patient.

Another problem we have actually created is accepting too many crap insurance carriers. However, we have an extremely large referral base of primary care docs. They don't want to pick and choose which patients they can send and which they can't due to insurance. They want to know that they can send ANY patients with a foot/ankle problem.

Therefore, to maintain our large referral base, we have to accept what THEY accept to survive. We have a lot of docs and a staff of about 38, so we have a lot of mouths to feed, so we do what we have to do and we take the good with the bad.

But there is no denying that compared to years ago, we are working much harder to earn the same income.

 

[PADPM]

...To quickly rant on the ortho thing:
Count me out of the ortho F&A job hunt; I decided that long ago. To me, ortho (aside from maybe sports med) means bad hours, tough cases, and a broken back from wearing lead while standing on a tile OR floor all the time. Maybe it's just that I went into health care mostly to deal with patients, but that's how I feel. You do arrive at a point where you have to ask yourself, "how much $ do you really need" and "how much is this taking out of me?" Most of all, the trauma patients continue to irk me. The idea of low (sometimes "no") pay cases that aren't grateful patients - yet sue at a high rate - is not for me.

Additionally, the stereotypical (and unfortunately, quite prevalent) orthopedist with a workaholic lifestyle, anger issues, and meduim-to-super-sized megalomaniac attitude does not appeal to me. It just doesn't. There are exceptions to every rule, but stereotypes do persist for a reason. I'm certainly not saying I won't fix ER stuff, do RRA trauma, etc... but I sure won't be fighting tooth and nail over it like a suprising number of young residency grads seem eager to do. The only way I would ever envision myself in a fully orthopedic setting would be academic medicine, but I haven't figured out a logical way to do enough industry-sponsored research, implant design, etc to make that anywhere near as profitable as private podiatry practice +/- running a residency.

...Finally, I am gonna go ahead and suggest something I'm constantly in disbelief nobody talks about in these "career options" threads. If anything (besides a pod or multispec group), I would consider work in a vascular surgeons' group to do all their foot+ankle wound care and most of the amps/salvages, which vasc is generally to pass up so that they can do more carotids, fem/pop, angio, and dialysis access cases. There is also nothing to stop you from building an elective clinical F&A bone/joint patient base at the same time. You would make WAY more $ doing that than any ortho group, and I'd bet my bottom dollar on this. The cases (aside from Charcot) are much faster, easier, and more straightforward than the ortho cases. Additionally, you don't have to go chasing down vascular patients (hint: most visit dialysis center 3x/wk) like orthos do trauma, elective, and athlete patients. I'm very suprised a lot more young, well trained DPMs aren't considering that vascular surgery group as a serious career option. Oh, that's right... wound care, amps, I&Ds, and Charcot recons aren't the big balls and glory to the ego cases (aka a lot of podiatrists don't want to be podiatrists )

Feli,

As usual, you've got your head screwed on correctly. I'm afraid many of your colleagues may have a rude awakening when they realize that in private practice (not residency), performing all those major rearfoot/ankle reconstructive cases 'ain't always as great as it seems.

And as you stated, the trauma cases can be nasty and often end up being done for gratis.

The complicated cases can tie up a lot of your time in the O.R., can tie up a lot of your time in the office with follow ups and potential complications, have the potential to turn into legal nightmares AND have large global fees attached (the post period when you can not charge for follow up care).

That's exactly why only a few in our group are still performing surgical cases, while the others are busy producing high numbers IN the office.

Your idea about working for a vascular group sounds good, but I don't think it's practical. As you know, in some hospitals there is a turf war involving vascular, podiatry, orthopedics, etc. I am fortunate, because in our "main" hospital, vascular will revascularize a limb and want our group to perform the surgery. This hospital is part of a MAJOR teaching hospital with vascular surgical and orthopedic residents, yet they always defer I/D's, amputations, etc., to us (I think they only like clean cases!!). Just yesterday I received a consult for a patient that had undergone a triple arthrodesis (by a VERY well known DPM) and was now in our hospital with a ton of hardware and osteomyelitis. Ortho was initially consulted and they recommended I be consulted. (I don't know if that was a compliment or they dumped on me).

I also performed 1 I/D and 2 amputations this week via consultations from infectious disease and vascular. However, I'm not sure that working for a vascular group would generate ENOUGH work performing wound care, I/D's, amputations, etc., to warrant hiring a DPM full time. That's why they get involved with wound care centers PART time!!!

Your idea is great, but that is really the role many DPM's already serve at Wound Care Centers when they work hand in hand with vascular specialists.

 

[NatCh]

Lol... that's funny, because I thought I was describing you (or hopefully me in a few years) in this one:
http://forums.studentdoctor.net/showpost.php?p=11006260&postcount=9

...Long time, no see on these forums, NatCh... I'm sure all is well in the NWest. Here in midwest, it's a sunny day. I'm about to log off and go hit the disc golf fairways. Take care

Like

 

[PMSIII]

Hey PMS III: I notice you graduated in May 2009 from OCPM, and you are a PGY-1 for July 2010-June 2011 at a podiatry residency program. What did you do during June 2009 to May 2010? Just curious...

I'm actually a PGY-II transitioning into PGY-III. I just haven't updated this signature in quite some time. So to answer your question, I was finishing my intern year around May 2010.

 

[jonwill]

Feli,

As usual, you've got your head screwed on correctly. I'm afraid many of your colleagues may have a rude awakening when they realize that in private practice (not residency), performing all those major rearfoot/ankle reconstructive cases 'ain't always as great as it seems.

And as you stated, the trauma cases can be nasty and often end up being done for gratis.

The complicated cases can tie up a lot of your time in the O.R., can tie up a lot of your time in the office with follow ups and potential complications, have the potential to turn into legal nightmares AND have large global fees attached (the post period when you can not charge for follow up care).

I guess it all depends on how you are wired. To me, that is the fun of it all. I enjoy the challenge. Especially after being out for only a year. I was on call a couple weeks ago at the hospital and did everything from open amps for gas gangrene to a closed reduction of a talonavicular dislocation to a pilon fracture. I did a cavus foot reconstruction last week and have two peds flatfoot cases coming up as well as an ankle scope, ankle stab, and then some forefoot stuff. I love the diversity. Some days are super melo in the OR while other days are quite challenging. It keeps things interesting.

Of course, I can't say I'll feel this way in 20 years!

 

[Footsurg]

I agree with Jon Will. I do a lot of bread and butter forefoot stuff. The big cases are challenging and make me think harder and prepare more. I like the satisfaction of taking a challenging deformity and making a difference in someone's life.

Yes, there is a higher risk of complications with the bigger cases, but they bring a litle more sense of accomplishment too.

 

[PADPM]

You are both correct, and please don't get me wrong. I also enjoy a challenge as well as the ability to surgically improve a patient. There certainly is no use of brain cells if you are performing routine care all day.

However, performing major reconstructive cases all day/week can become tedious mentally and physically, and does not always put a lot of food on the table. If you have a multi doctor practice and one doctor has the ability to provide that care, while another is filling a different void, that is ideal.

I had several scheduled surgeries this week and some add-ons that were not expected. Add-ons don't always get priority in the O.R. even if you have block time, so it can tie up a lot of your time.

Jonwill, consider yourself fortunate, because you are currently performing significantly more cases than the average DPM, I can tell you that as a fact. I'm on staff at several hospitals and know the REAL numbers.

You are also bright eyed and bushy tailed!!! There will never be a time when your energy level is as high as the present time, so enjoy and perform your best.

I guess after over 20+ years I have a slightly different perspective. I performed an ORIF on a non-union from another DPM this week. He mis-managed the fracture from day one, then finally ordered a bone stim unit when the fracture wasn't healing. And of course he kept the patient WEIGHTBEARING on the fracture while she was using the bone stim, and couldn't figure out why it wasn't healing???

Additionally, he created an addict out of this 29 year old female. He was prescribing 60 Percocet (10/650) every few weeks (whatever the law would allow) for FIVE months.

I was not only concerned about her possible addiction, but acetaminophen toxicity to her liver. I used a Marcaine block after the procedure, gave her 30 mg of Toradol IV post op and 20 minutes into the recovery room she was actually asking SPECIFICALLY for "10 mg of Percocet for my pain". Her heart rate and BP were normal, and she was in no pain.

I wrote her an RX for a different post op med (Nucynta) since it contained no acetaminophen, and of course she called me several times over the weekend about her "pain", then called every doctor in our practice.

THAT's the stuff that gets old after a while!!!

 

[jonwill]

Jonwill, consider yourself fortunate, because you are currently performing significantly more cases than the average DPM, I can tell you that as a fact. I'm on staff at several hospitals and know the REAL numbers.

I think this really depends on where you practice and what type of practice you have. We have a very surgically oriented practice and they actually still consider me to be "slow". My partners are doing a lot more than me still. And like everybody, I have really busy surgical months and slower ones. I practice in an area where there are a healthy amount of pods but we definitely aren't over-saturated.

How saturated is the area in which you practice? Is it one of those where "you can't throw a rock without hitting a podiatrist?"

 

[that1guyfromFL]

PADPM,

I'm really hesitant to accept that your personal observations amount to a diverse enough and large enough sample to support the kind of sweeping generalizations you choose to make.

A quick browse through previous threads on similar topics shows that many like Jonwill, Podfather and others often do not share your perspective.

It often seems like anyone who has a different experience to share is dismissed as an "outlier" or "the exception".

 

[PADPM]

PADPM,

I'm really hesitant to accept that your personal observations amount to a diverse enough and large enough sample to support the kind of sweeping generalizations you choose to make.

A quick browse through previous threads on similar topics shows that many like Jonwill, Podfather and others often do not share your perspective.

It often seems like anyone who has a different experience to share is dismissed as an "outlier" or "the exception".

1) I've expressed my opinion, and if you choose to make that a "sweeping generalization", I can't be responsible for that interpretation.

2) I highly respect Jonwill, but he is very new to practice and has yet to have significant experience. However, if you read a lot of threads, it's safe to say we agree on the majority of issues. I also highly respect Podfather, who has similar experience to me, and we also agree on most issues. His experience with some of his recent residents/graduates has difffered slightly from the residents I've been in touch with, but we are also in different geographic areas. That's not necessarily a different "perspective", it's simply different experiences. There's not always a right or wrong.

3) I don't dismiss anyone as an outlier, but I will continue to state that the DPM who is earning $500,000 after 2-3 years is the exception, and ALL statistics and surveys will confirm that fact. That's not to say it doesn't occur, it's simply to say it's not the "rule".

If you have a personal problem with me or my posts, you can PM me anytime and I'd be happy to address your concerns.

 

[PADPM]

I think this really depends on where you practice and what type of practice you have. We have a very surgically oriented practice and they actually still consider me to be "slow". My partners are doing a lot more than me still. And like everybody, I have really busy surgical months and slower ones. I practice in an area where there are a healthy amount of pods but we definitely aren't over-saturated.

How saturated is the area in which you practice? Is it one of those where "you can't throw a rock without hitting a podiatrist?"

We are in a very saturated area, but the skill level in the area is extremely diversified. At "our" hospital, there are a LOT of DPM's on staff but my parrtner and I are responsible for about 60% of the cases between the two of us. Not all of our docs are performing surgery, and some of our docs cover other hospitals.

There are a lot of DPM's in our area who really don't perform surgery or perform little surgery. If a patient develops a complicated problem, it's not unusual for these docs to send the patient to the ER. We don't always get these patients directly from the ER, but when these patients are admitted to the service of the hospitalist, we are consulted.

So we end up "cleaning up" a lot of other DPMs crap. Additionally, with the high amount of managed care, a lot of guys are trying NOT to perform surgery. Our practice treats patients, not insurance companies, so we perform surgery when it's indicated, regardless of insurance company.

I believe a few of us have lost a little of our surgical "mojo" due to the hours in the O.R. AND the business of our office. At times we are just overwhelmed. One of my partners saw 68 patients in the office today and then he had to cover the hospital.

We do not have a primarily surgical practice, though "my" portion of the practice is primarily surgical/injuries/pain, etc., and very, very little "routine" care. We are definitely the busiest practice in the region, and probably one of the busiest surgically, but not THE busiest surgically.

That's why we just hired another doc. Hopefully he'll take some of the burden off of some of us and we'll be able to balance things out a little better.

My previous statement that I know the "real" numbers was referring to all the BS I hear at meetings. I hear guys telling other docs that they are doing X number of cases per week, yet I'm in the O.R. all the time and the O.R. nurses say the doc hasn't been there in 6 months. I'm also on a committee that SEES the numbers, and knows the REAL numbers, despite all the exaggeration.

That's why I said that you are ahead of the curve. Enjoy and have fun.

 

[that1guyfromFL]

If you have a personal problem with me or my posts, you can PM me anytime and I'd be happy to address your concerns.

No need for all that, I'm not upset and I wasn't trying to upset you.

Thanks for taking the time to respond, I appreciate your willingness to restate and clarify.

 

[dtrack22]

Jonwill, consider yourself fortunate, because you are currently performing significantly more cases than the average DPM, I can tell you that as a fact. I'm on staff at several hospitals and know the REAL numbers.

This should read: "you are currently performing significantly more cases than the average DPM in the northeast"

The point is that you have no idea what an average case load is like for an attending outside of your area. You did sort of congratulate and encourage Jonwill, but you had to take that little jab and let us all know that his situation isn't normal first.

I appreciate your insight and agree with your posts a majority of the time. But your experience, when it comes to job opportunities and compensation, isn't any more valuable than a new practitioner's considering how heavily affected they are by type of practice and geographic location. Everyone on here has basically agreed to the fact that geography has a huge impact on reimbursement. Podfather's residents are nothing more than the exception to the rule in your area. Jonwill's don't exist where you practice because of crappy insurance. $150k plus a bonus structure isn't normal where you're from but that doesn't mean that it isn't the "norm" in 30 other states.

It's like basing a gubernatorial election result off of the votes tallied in one county. And then every time someone tries to say that the votes will be different in their county, you immediately tell them that their county is the exception and not the rule.

I know "the rule" in a few geographic areas, and I know for a fact based on some of your posts that they would be quickly dismissed as "exceptions"...

 

[347932]

This should read: "you are currently performing significantly more cases than the average DPM in the northeast"

The point is that you have no idea what an average case load is like for an attending outside of your area. You did sort of congratulate and encourage Jonwill, but you had to take that little jab and let us all know that his situation isn't normal first.

I appreciate your insight and agree with your posts a majority of the time. But your experience, when it comes to job opportunities and compensation, isn't any more valuable than a new practitioner's considering how heavily affected they are by type of practice and geographic location. Everyone on here has basically agreed to the fact that geography has a huge impact on reimbursement. Podfather's residents are nothing more than the exception to the rule in your area. Jonwill's don't exist where you practice because of crappy insurance. $150k plus a bonus structure isn't normal where you're from but that doesn't mean that it isn't the "norm" in 30 other states.

It's like basing a gubernatorial election result off of the votes tallied in one county. And then every time someone tries to say that the votes will be different in their county, you immediately tell them that their county is the exception and not the rule.

I know "the rule" in a few geographic areas, and I know for a fact based on some of your posts that they would be quickly dismissed as "exceptions"...

Oy vey, dtrack, here we go again. Seriously?

All you have to do is do some research via the last three years or so of the APMA annual practitioners' survey to see that the inflated numbers some post on these forums ARE the exception. These surveys talk AVERAGES, which are nowhere near these huge numbers. When I read these forums, I generally find that the geographic regions are very limited. Texas, California and some other areas in the North East and Mid West. If you seriously think that areas like Alaska, Hawaii, Montana, South and North Dakota, Oregan, Utah, West Virginia, Idaho, New Hampshire, Connecticut and many other states have these huge salary numbers, I'd love to see the data. Show it to me and I'll shut up. I promise.

The fact of the matter is that these big number salaries ARE the exception.

The way to measure sheer volume of cases by practitioner is to get a line to the ABPS and see how long it takes the AVERAGE new practitioner to get Board Certified. I would say anywhere between 3-5 years based on the volume and diversity of cases. There are practices where the newb gets all the cases and also some practices where the surgical volume is very high, but again, on AVERAGE, I would say not and have to agree with PADPM.

Come on man. Keep it real. We are trying to stabilize the "ZOMFG, I can make how much when I get out of residency??!!" back to the AVERAGES. I do hope for you that you get that obscenely high initial salary and in a few years you can point the finger at me and say"SEE!!?? I told you so!" I would love that. But until then, I'll stick to what I know, which happens to coincide with PADPM.

 

[dtrack22]

If you seriously think that areas like Alaska, Hawaii, Montana, South and North Dakota, Oregan, Utah, West Virginia, Idaho, New Hampshire, Connecticut and many other states have these huge salary numbers, I'd love to see the data. Show it to me and I'll shut up. I promise.

I get your point, but you used some terrible examples. Oregon has some of the highest reimbursement rates in the country and if you look at any number of the sources for salary info you'll find that state near the top, in terms of average salary. Being from the area and knowing pods in Montana and Idaho as well I can tell you those too are bad examples of below average salary. Can't comment on the rest, but that's the whole point...can't comment on what you don't know...

This thread was a good read http://forums.studentdoctor.net/showthread.php?t=768384&highlight=average

The salary talk really got going when PADPM said...

It's often tough enough paying a new associate over the $100,000 mark, since we are also paying malpractice, hospital dues, insurance, APMA dues, ABPS dues, ACFAS dues and a zillion other fees and he/she doesn't even have a filled book and will take a while to earn his/her "keep".

The post diverged into big time ortho contracts $300k plus, which everyone agreed was plausible but the situation itself (getting the ortho job) was the "exception".

I then asked about geography and how it plays into salaries since

...just over 100k for a 1st year associate at a "large, busy, successful, etc." practice seems low.

Especially when you've heard first hand and in some cases seen contracts in the mid 100's (plus % of billable services incentives). Maybe it's because these students come from better residency programs (the ones coming to present at our school). But these contracts seem to be more than just "the exception".

your response...

All you are hearing is the MOST people get. This is nowhere near what is the norm nationwide for new doctors coming out of residency is. It has ZERO to do with where you do your residency.

Keep in mind my post said MID-100's...apparently that was way too rich for your blood.

Podfather chimes in with actual COTH data...

Guys sorry but 95% of our residents make six figures as a base right of residency. The average in a non multi-specialty/ortho practice is 125,000-150,000. For those joining multi-specialty/ortho they average 150-175,000. One this year, has already been offered 200,000.

Notice the word "base" in that post...

SO...according to PADPM it is borderline unreasonable for an associate to get paid much more than 100k. Kidsfeet agrees. Podfather comes in with more realistic data that is contradictory and shuts everyone up. Then newankle...he's the one who actually works with an ortho group...comes in and gives us credible info about starting salaries for MD ortho's and what it would take for a practice to recoup costs by hiring a pod. That basically ends the thread as nobody else has anything left to say now that they realize "the rule" isn't exactly what they thought.

Back to this thread...$500k is insane. But that wasn't my point. Posting about your own experiences is awesome and adds a great deal to the boards. PADPM's more detailed/intimate posts regarding running a larger group practice with multiple clinics are always great reads. My point is that commenting on things, such as nationwide average salaries based on your experience in one geographic area is rather ignorant and just as misleading as a pre-pod coming on here and talking about the DPM they shadowed who rakes in $700k...

 

[PADPM]

My point is that commenting on things, such as nationwide average salaries based on your experience in one geographic area is rather ignorant and just as misleading as a pre-pod coming on here and talking about the DPM they shadowed who rakes in $700k...

Rather ignorant? Are you kidding me? You've just stated that I'm "rather ignorant"?

It doesn't matter where I practice, whether it's New York, Washington D.C., Flordia, Washington state, etc. Do you really think that after well over 20 years in this profession I have my head in the sand and don't know what salaries and offers are across the entire country?

Do you think I gather all my information on this website? Our group has interviewed potential associates from all over the country and we are well aware of the starting salaries and expectations from all over the place. I'm aware of reimbursements from Florida to California and the issues in each state.

I also speak honestly, despite what you may WANT to hear. So don't you dare tell me I'm "ignorant" because I practice in one geographic region. I am well aware of the trends in the entire nation. I attend seminars, meetings, etc., and have been involved with committees and travel to offices across the country to learn from other successful practices.

I don't have my head up my ass or in the sand, and I'm FULLY aware of what's going on outside my office.

Choose your words and thoughts more wisely.

 

[Podfather]

Look, I think everyone who has posted on this topic is basically correct. It would be like talking about housing prices, cost of living, or back in the day scope of practice at your local hospital.

I was originally from the northeast and have many friends who practice there. It is much different than where I practice now and much harder to make a living. The age of the population, state of the economy (in some states like PA), perception of what we do, payer mix, and the history of our profession in those older areas makes for a different practice type and income. Many of my friends from there have busy practices like PADPM and have to see 50-100 (yes I know a DPM who with a lot of help sees 100 patients a day) to pay the bills. Capitation still exists and nursing homes, house calls, and RFC are the norm for many.

Where I practice now things are much different. Many average 20-30 patients a day. RFC is rare and when done is for cash. Nursing homes have trouble finding DPMs and our perception is more a surgical specialty that also treats fungus. The south has seen considerable growth from the younger people fleeing the north. Capitation is rare. Podiatric incomes and lifestyle are higher and less hectic.

Now to starting salaries. The numbers I have posted are a fact and the norm for our graduates. And yes I know many who grow into the big dollar incomes discussed. We have a well know residency which helps with employment but also we teach our residents about what they can command if they chose the area where they want to practice wisely and select the right opportunities. It is my opinion that if a practice can not offer a new associate a minimum of 100,000 base with benefits and a realistic bonus structure they may not need an associate. Now having said that, if a resident wants to be in an area with DPM saturation, where it is harder to make a living, or the average DPM income is lower they may have to accept whatever the market pays. For those attendings in those areas who are making offers of bases in the 60-80,000 range AND expecting someone who hustles, well that may be wishful thinking. The hustlers have also done their homework and have researched an area that can pay more. You will be looking at people who just need a job and probably waited to the last minute.

I came from a generation where there were no jobs. You borrowed money, opened a practice, and then busted your butt to make it. At the same time you had to fight to open hospitals and get privileges. So 15 years ago when I used to hear what some associates were getting and what residents were asking for I made comments implying that this wasn't the norm and these new kids are spoiled. Now, I realize things have changed. It's easier to get up to speed, there are few battles to fight, and better public perception do allow a associate to make it sooner. Ortho, large DPM, and multispecialty groups didn't exist in the past. MD referrals were a constant struggle when I started because of politics and now orthopedists routinely refer to me.

One final note: Student loans today are at an all time high. Interest rates are lower but principals are mind boggling. Add that to the fact that many PGY-3s are making 50+ thousand a year with benefits and you can see why many simply could not accept a salary of 60-80,000. Yes the APMA data is available but IMO skewed. The number of responses compared to the total number of DPMs makes it a guesstimation at best. It's like the Podiatry Management survey that shows payments by code each year and I wonder what planet is paying those fees since my reimbursement is no where near those numbers.

 

[347932]

Yes the APMA data is available but IMO skewed. The number of responses compared to the total number of DPMs makes it a guesstimation at best.

Sorry, but not NEARLY as skewed as a "few" of us talking numbers on this forum, or giving out numbers based on a "few" elite residents graduating with new jobs.

Students read this site and get stars in their eyes with regard to this topic. Come back down to to earth. Seriously. What is the percentage of new graduates being offered these huge numbers. Even if it's one hundred out of of six hundred or so residency graduates, that STILL means that MOST DON'T make the big numbers.

Finally, who really cares at this point. Are you going to bail out of Podiatry School or Residency because you THINK you might not make a living? You will make a living. If you want to drive a Porsche right out of residency, you should have become a Neurosurgeon. Be happy with your choice of profession, make the most of it and enjoy your life. Who cares what others make?

 

[347932]

I get your point, but you used some terrible examples. Oregon has some of the highest reimbursement rates in the country and if you look at any number of the sources for salary info you'll find that state near the top, in terms of average salary. Being from the area and knowing pods in Montana and Idaho as well I can tell you those too are bad examples of below average salary. Can't comment on the rest, but that's the whole point...can't comment on what you don't know...

So wait, where are all the states (I think you said 30?) with these state wide high salaries and huge reimbursements? Even states like Texas where some of these huge numbers are thrown around have areas that don't fair so well. Want to practice in Laredo or Lubbock and make $180 000 starting out? I doubt it. As I said, show me the hard data and I'll shut up forever. Otherwise, I just don't see it.

Btw NEVER eat waffles with maple syrup while trying to type on a laptop. It's really bad for the aftermath of stickiness.

 

[347932]

SO...according to PADPM it is borderline unreasonable for an associate to get paid much more than 100k. Kidsfeet agrees...My point is that commenting on things, such as nationwide average salaries based on your experience in one geographic area is rather ignorant and just as misleading as a pre-pod coming on here and talking about the DPM they shadowed who rakes in $700k...

Both PADPM and I travel around the whole country to conferences where we discuss these things with our colleagues and friends in the profession from all over the country. We actually talk to the people doing the hiring, not the one in the midst of being hired. How many interviews did these new practitioners have before they struck gold? How long did this "golden goose" relationship last?

We don't rely on what read on these forums and from information from someone who knows someone who said they know someone who is making $250K right of residency."Where is s/he in practice?", "Oh hell, I don't know, but isn't that great!!??".

Dtrack, you criticize from the stance that PADPM points out that many of these examples are the exception. You say they are not. How so? How do you know? As I've mentioned, and will mention again, show me the data. Please.

 

[dtrack22]

PADPM,

ignorance is simply being uninformed. Maybe it has a much more negative connotation than I had thought. But we are all ignorant of certain topics/subjects...nothing wrong with that. But you are right, should have spoken more carefully. What I was trying to say should have sounded more like Podfather's post.

Kidsfeet,

Come back down to to earth. Seriously. What is the percentage of new graduates being offered these huge numbers.

I'll post this again since you didn't read it earlier...

Guys sorry but 95% of our residents make six figures as a base right of residency. The average in a non multi-specialty/ortho practice is 125,000-150,000. For those joining multi-specialty/ortho they average 150-175,000. One this year, has already been offered 200,000.

Remember, "base" was the word used here. And we are talking "nationwide" with these numbers. If $100k is normal somewhere, then there are obviously many more places where $150k+ is normal in order to "average" everything out.

So wait, where are all the states (I think you said 30?) with these state wide high salaries and huge reimbursements?

Again, please read what I actually posted.

$150k plus a bonus structure isn't normal where you're from but that doesn't mean that it isn't the "norm" in 30 other states

It isn't about listing 30 actual states. I could have said 20, 25, 40, etc. The point is that you have no idea what's normal outside of a handful of areas. Who's to say what is normal in North Carolina is normal in Colorado? I can't, but I know you can't either.

Your precious data says that anything below a $120k base, starting out, is the exception and not the rule. Pre-pods should be on these forums reading that, as opposed to sub-100k, capitated, doomsday scenarios often written by people who have never known anything else.

 

[PADPM]

dtrack,

I'm not even sure why I'm wasting the time and energy replying to you, because you can be assured I won't in the future, but you have taken the liberty of quoting me by you stating "SO...according to PADPM it is borderline unreasonable for an associate to get paid much more than 100k".

Sorry, the words borderline unreasonable NEVER came out of my mouth or off my keyboard. However, I did take the time to try to explain why it is often difficult to offer a new associate much more than that number, with all the other added expenses (malpractice, dues, etc., etc.) UNTIL that associate starts to bring money into the practice. That comment is a lot different than me saying it's "borderline unreasonable". So don't twist my words.

It's ironic, since our group DID just hire a new associate and we are STARTING this new doc with $86,000 MORE than he made as an associate with his former employer, who is not in my geographic area. (and no, it wasn't a residency position)

So I am fully aware of competing starting salaries across the nation, and our group obviously pays very fairly for the right doctor. The doctor we just hired certainly is very happy, since this doc's starting contract is slightly less than 6 figures MORE than the previous doctor was paying.

 

[dtrack22]

Thank you for saving a young DPM from getting ripped off.

 

[347932]

It isn't about listing 30 actual states. I could have said 20, 25, 40, etc. The point is that you have no idea what's normal outside of a handful of areas. Who's to say what is normal in North Carolina is normal in Colorado? I can't, but I know you can't either.

Your precious data says that anything below a $120k base, starting out, is the exception and not the rule. Pre-pods should be on these forums reading that, as opposed to sub-100k, capitated, doomsday scenarios often written by people who have never known anything else.

Dtrack,

Firstly, I specifically mentioned Texas when referring to some that make the high numbers out of residency. Podfather's residency has some of the elite who graduate, but how many residents does he have? 10? 12? So what percentage of the total pool of graduating residents is that exactly?

YOU brought up the numbers and states. Point me to a large majority of large cities in all the states where someone can make that kind of money coming out, and I'll show you just as many areas where people aren't making that money. I can actually tell you what is the norm in most parts of the country. Just because you don't like what hear, doesn't make it untrue. It's mostly based on cost of living and reimbursement issues. There IS a way to calculate what's reasonable you know.

"Precious data"? I have it. Where's yours? Data is what people need. Hard facts about salaries. Not pipe dreams that maybe 10% of the population can achieve. Maybe, if you're in the right place at the right time, it could be you making that amount. I hope it is. But don't EXPECT it or you may just end up as one of the unhappy naysayers. Who knows.

 

[dtrack22]

The numbers that I have now quoted/posted twice are nationwide and include recent grads from programs all across the country...not just one or two programs in Texas. So the numbers posted are as accurate (if not more so) than the APMA surveys you referenced.

I don't get what is so hard to understand?

 

[347932]

The numbers that I have now quoted/posted twice are nationwide and include recent grads from programs all across the country...not just one or two programs in Texas. So the numbers posted are as accurate (if not more so) than the APMA surveys you referenced.

I don't get what is so hard to understand?

Please provide me a link to these numbers. You know where they are actually published. Like the data published by the APMA.

Word of mouth is a poor replacement and can be misconstrued.

I also don't get what you find so hard to understand.

 

[dtrack22]

You are right, Podfather is a liar.

Feel free to contact the COTH though if you have to hear it straight from the horses mouth.

 

[347932]

You are right, Podfather is a liar.

Feel free to contact the COTH though if you have to hear it straight from the horses mouth.

Although you're comment is dripping with sarcasm, which I usually appreciate, in this situation it is not only misplaced, but rather offensive to me given the numerous times I've mentioned that Podfather's situation is in fact reality in his part of the country.

COTH (Council on Teaching Hospitals) does not keep data about salaries for new residency graduates, do they? Please provide the link so I can verify this. Otherwise, where's the data? Come on dtrack, it's put up or shut up time.

 

[javajava]

This thread depicts quite well the real salary situation outside this forum.

No one knows and no one agrees. Although I hope what podfather and dtrack say are true.

 

[RockyIV]

Data is what people need. Hard facts about salaries.

Both PADPM and I travel around the whole country to conferences where we discuss these things with our colleagues and friends in the profession from all over the country. We actually talk to the people doing the hiring, not the one in the midst of being hired.

The double standard here is quite amusing. On one hand you need hard data, on the other hand most of your posts (no need to dig up more) use personal experience to justify your reasoning. Why is it that personal experience is ok for some and not others??

I read through that other thread, newankle said it best. "You respond to comments like you are the authority but on this one you have no clue."

 

[Podfather]

Like I said in actuality everyone posting is correct. I made over 30 profession related trips last year and receive calls and letters from all types of employers each year. Want to move to a saturated area, one that requires house calls, nursing homes, and a higher volume of RFC then yor starting salary will be lower. Move to an area (not just Texas) where the population is younger, growth is occuring, most patients are an E/M, xrays, treatment, and not capitated. Then your starting salary and income will be higher. Multispecialty usually higher and orthopedist group even higher.

To the young and recently trained 100,000 base minimum with bonuses is not unreasonable and within a few years (if you work hard) 200-300,000 obtainable. That is assuming you join a busy practice with overflow, hustle, and are in the right region. Want to be in a specific location because of family or personal choice that is not optimal then expect less but you may be happier.

PADPM is correct in his location and I am correct in mine. So young grads take the information and decide where you want to practice and know what to expect in offers based upon locale. Money, lifestyle, student loans, family, and your spouse all play into the decision.

 

[347932]

Why is it that personal experience is ok for some and not others??

Maybe because dtrack has no personal experience to speak of on this matter other than what he reads on these forums? The data on this topic is available to everyone in the profession. Whether you chose to believe it, even though you don't like what it has to say, or contradictory to what you read here, is entirely up to you.

Newankle was right in that thread you quoted. I didn't have a clue about the status of getting published as a student. I apologized and withdrew my statement about that topic. How exactly does that response in that thread (or my responses to other threads for that matter) have any bearing on this one? Nice try though.

Nice name btw. Temple maybe or where you born in Philly?

 

[RockyIV]

Not the right thread. You made some claim about ortho's starting out at 150k on top of some claim that it takes 2-3 years for "any" specialty to recoup costs from a new hire. Newankle shot both of those down pretty quick. Your only reply after that was about how that's what general orthos in your area start out as.

Which is the entire point of this thread. Your experience is unique to not only you, but also the area in which you practice.

The answer to your question is both.

 

[dtrack22]

Maybe because dtrack has no personal experience to speak of on this matter other than what he reads on these forums?

"Although you're comment is dripping with sarcasm, which I usually appreciate, in this situation it is not only misplaced, but rather offensive to me..."

I know plenty from working for a billing company. Of course, we worked with NW groups and hospitals. I know how busy a typical multi-specialty, ortho, or pod group is back home and what they are able to collect. Of course, I'm not you so my experience doesn't mean anything.

This is just like every other thread you post in. You are always right. Students can't publish research, ortho's would willingly start at 150k, all reps have malpractice, etc. It's always fun to see someone prove you wrong and then watch you backtrack and say "well, where I practice that's not how it is". It's getting old.

 

[DrMushroomFoot]

I thank you all for keeping me entertained during my summer break! Had this thread not existed, I would have created another Harvard of Podiatry thread to keep me busy.

 

[PADPM]

Thank you for saving a young DPM from getting ripped off.

I don't believe a young DPM can get "ripped off" unless he/she let's that happen. Every graduating DPM is an adult, and if a ridiculously low salary is offered, it's his/her own fault if that offer is accepted. You certainly can't blame an employer for "ripping" a new associate off if the associate signed the dotted line. I've yet to hear of a practice holding a gun to a new associate's head to sign a low ball contract.

I obviously do NOT agree with ridiculously low offers, but I didn't save a young DPM from getting ripped off, he/she would have to do that on his/her own. Our group simply pays fairly, despite what you may have thought. Paying this young doc $86,000 MORE than he/she made with his/her previous employer is very fair. Not to mention the opportunity for this doctor to hopefully be a partner in our practice in the near future, which is truly our ultimate goal.

 

[dtrack22]

Exactly, but knowing their previous salary could have allowed you to pay them less than you normally would have and still got them to sign on the dotted line because even your lower-than-normal contract was a much better deal. You didn't though. You paid what you thought they were worth to your practice regardless of what you knew about the previous agreement.

I don't think every other group would have done the same. "Saved" may have been a bit over the top but you get the idea.