Timing the job search

[anotherpodperson]

Questions that have come from several different residents that I thought would be interesting to ask:

- What is your opinion for the best time to apply for jobs? I get that it's never to early to start looking, but what is everyone's thoughts on the best timing to get serious about reaching out to prospective employers. I see people torn about waiting to build the resume vs getting their name out there first / early.
- In your opinion, what is the best pay structure to aim for?
- Does the MGMA data seem realistic to most people currently employed?
- What are some of the best benefits you have been offered?
- If you are currently employed, what would you change about how you went about this process?

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[hypermobility]

Get your name out early and often. Let folks know what you’re looking for and what you’re not looking for. Network around the area you are looking to practice. Attend the state meetings where you want to practice to build relationships. There is no defined path, but that route worked for me

 

[dtrack22]

Get your name out early and often. Let folks know what you’re looking for and what you’re not looking for. Network around the area you are looking to practice. Attend the state meetings where you want to practice to build relationships. There is no defined path, but that route worked for me

Yup. There are large multi-specialty groups and hospitals that don't have positions now, but may end up having something open up when it's time for you to be looking. It can only help (so long as you don't annoy the crap out of them) to be on good terms and have spoken already with the recruiters, maybe a department head, medical director, etc.

As far as applications go, this isn't ortho, nobody thinks about hiring an associate/podiatrist 2 years in advance. There is not a small number of ortho residents that have a job lined up prior to finishing residency, waiting for them when they finish fellowship. It would be like you signing a contract as a 2nd year resident. You will be lucky to have a contract signed much earlier than Dec/Nov in your third year of residency. A lot of residents are signing contracts until March/April, 2-3 months before graduating. So in terms of "applying" for jobs you are totally wasting your time if its any time before fall of your 3rd year, in almost every instance.

MGMA data is only realistic if you're talking to a hospital, large multi-specialty group, or an ortho group. You will not find a podiatry group that pays you anywhere near even the bottom 10% of MGMA reported salaries. But $220-250k salary is absolutely something you should be looking for from the aforementioned employers. If it is a smaller, rural hospital maybe a $180-200k salary is reasonable but there is usually bigger signing bonuses (ask air bud) and better benefits (ie I have a buddy who's hospital funds his 401k with an amount that is 10% of his salary, without any contributions from him), oh and loan forgiveness stuff.

I wouldn't have done anything differently. I did what I could and didn't leave any stones unturned in the areas I was looking to live. I got screwed by a podiatrist for the first 8 months out of residency, but am in a better situation now. It did cause me to lose a lot of ground on my peers in terms of earnings. Well, those who were not silly enough to do a fellowship and then still go work for a podiatrist. They wasted a whole year of their life making $60k, as opposed to my 8 months (where I still made more than them). But there wasn't a job I missed out on or anything I could have done differently, again, in the areas my family was willing to live.

 

[air bud]

Get lucky

 

[ldsrmdude]

Questions that have come from several different residents that I thought would be interesting to ask:

- What is your opinion for the best time to apply for jobs? I get that it's never to early to start looking, but what is everyone's thoughts on the best timing to get serious about reaching out to prospective employers. I see people torn about waiting to build the resume vs getting their name out there first / early.
- In your opinion, what is the best pay structure to aim for?
- Does the MGMA data seem realistic to most people currently employed?
- What are some of the best benefits you have been offered?
- If you are currently employed, what would you change about how you went about this process?

You've gotten good advice so far.

I think I applied to the job I ultimately got around start of third year, interviewed in like September, and then spent the next few months beating my head against a wall trying to negotiate a contract. Ultimately signed a bad deal. But our practice got sold to a hospital system and now things are much better. I would have left had it remained private practice. I would say that not much you do in residency is going to build your resume that much that it's worth waiting for. I'd say by beginning of third year, you should start getting your name out there. If you know where you want to practice, hit up the state meetings as mentioned. If you have no geographic preference, start sending out CVs and calling.

I agree with @dtrack22 about MGMA data. When we were discussing with the hospital about taking over the practice, my then-boss asked me what salary I thought was fair, and I told him. He told me I was crazy, they would never agree to pay that much. This was about twice what he was paying me at the time. Well, I ultimately signed with the hospital for around what I told him I would ask for, and I still get decent bonuses every 6 months. Private practice will laugh at you if you ask for anything related to MGMA.

That's pretty much all I have to offer, like I said, you've gotten good advice so far.

 

[dtrack22]

my then-boss asked me what salary I thought was fair, and I told him. He told me I was crazy, they would never agree to pay that much.

I'm not surprised. I think a lot of older DPMs fall into the PMnews, podiatry today, APMA type salary surveys and publications that are heavily skewed towards the end of the spectrum from which the readers and responses come from. PMnews has had a month long thread about cutting fingernails for god's sake. Or they run a practice that is either inefficient with unnecessarily high overhead, or they don't have any ancillary revenue streams, or they have a clinic full of stuff that doesn't pay as well. I'm also convinced that there is a group of DPMs in private practice who do very well and just don't want residents and new grads to know how much they make, so the new hires don't start asking for or expecting more. I mean, as a profession we have a much high earning potential than FPs and Pediatricians, yet they all pay their new associates more than virtually every podiatry practice will pay theirs. Its no wonder so many of the podiatry practices go through associates every 1-3 years.

This isn't even a "private practice" thing in general. The owner of the clinic I work at will collect upwards of $90k in months where there is no vacation taken or no missed work days. Let's pretend that for every $90-100k month, there is a $60-70k month ($60-something thousand is the lowest monthly collection amount I've seen and was in a month following like 10 days of vacation). The owner is collecting over $900k per year. Now some of that is self pay/retail type products which may have lower margins due to inventory/purchasing costs but let's assume the owner gets to keep only 38% of the money they bring in (that's an office with high overhead)...thats still $350,000 before taxes. That doesn't include a small cut of the associate's revenue. That doesn't include surgery center or MSO disbursements. If you are a podiatrist and are bringing in less money than a pediatrician, you are doing something wrong. And according to PMnews we average significantly lower salaries than even the lowest paying MD/DO specialty.

Look, there is a reason a large clinic or hospital network can pay you more up front and why MGMA data is what it is compared to other salary surveys. They can usually fill up your clinic much quicker than a podiatry group can (unless someone has left and there are patients to transfer to you right away). You also generate a lot of downstream revenue that can't be captured by a podiatry group (ie referrals to vascular, PT, imaging studies, facility fees in clinic or in the OR, all things that make a hospital money but wouldn't make your podiatry practice owners anything). But they need to stop pretending that a $100k salary (let alone the sub $100k salaries you find in S Florida) is reasonable or fair or some good deal for new hires. Its insulting. A new associate is more valuable than a PA and they should be paid as such. And if you can't afford to do that then you really don't need to be hiring or expanding your clinic.

 

[heybrother]

Ripped from the headlines of PMnews!

Query: Podiatrists' Median Income

I am writing questioning podiatrists’ annual median income. I read on PM News from Career Cast's top 10 highest paying jobs that podiatry is #8 at $124,830. My associate is starting his 4th year with me and is asking for a substantial raise. He is already making above this amount. He quoted research that he has done fromSalary.com that states the median base salary for our area is $192,738, which I can’t fathom is correct. Can anyone comment on this large discrepancy?

He is generating income for the practice but is falling short on some of his duties. He comes to work late. He works his shift but nothing more. He is not doing any marketing. He is not following protocols. He has a base salary and has a bonus structure. I am having a hard time giving him a raise with the information that I read on PM News.

Name Withheld

Editor's Note: The Annual Median income for a solo practitioner reported in Podiatry Management's Annual Survey was $123,250.

 

[heybrother]

Is there a way to cook the books or sort of shelter the money? I can recall getting an offer from one group that was sub 100k. They proceeded to show me their income from the practice (barely over 200k). But I have a hunch they were taking home probably more than twice that.

Not sure if you can hide collections, but the cynical part of me wonders if you can move the other values around.

Offer the associate a salary based on the overall practice overhead and then inflate the overhead by employing family members (for example, a spouse office manager) and offering them generous pay, benefits, health insurance, 401k.
Own the building and pay ...above market rent to a corporation you also own (the logistics of that might be complicated as the owner would then owe tax on that income elsewhere on their books) driving up overhead and decreasing expenditure elsewhere.

Not sure on the viability of the 2nd, but I think I was shown the above by someone I recently spoke with (alternatively, I'm being overly skeptical and the person in question is simply a very fair boss who is attempting to reduce turn-over of staff by paying them generously).

The other thing to keep in mind theoretically is - what does income mean. Medical practices theoretically don't have profit - they have discretionary income which can be dedicated to the use the owner decides - paying debt, capital expenditures, salary, perks for staff. Perhaps he gave himself a full 401k match (match both as the "employee" and the "business" and you can contribute up to like $52K - this requires a solo 401k which is another topic entirely). A business my wife once worked for employed a spouse of the owner, gave the employees a speech about how the business was making no money - look they said, here's my tax return - I'm only paying myself $2K. For those who know how to read a return the person had taken a full $18,000 401k contribution in small print further down the page.

Just some negative thoughts.

I'm doing my job hunt right now and ... not enjoying it. Dtrack has a killer post elsewhere on these forums about the fact that if you are married with a family you like have way higher expenses baseline than you know. I was recently given a low-ball (sub 100 offer) though it had an ...adequate collections bonus. When you add up mortgage/rent + disability insurance (you aren't paying this yet, but you will be) + health insurance for family (which assuredly won't be offered by a private practice and will likely exceed $1000 a month if you have a spouse/child) + loan payment on a non-IBRstyle-payment-plan it is entirely possible you have a baseline expense level of $50+K without any expansion of your lifestyle and without a dime towards retirement.

 

[msion]

Yet these same private practice podiatrists will advertise their practices as "busy, million-dollar practices" when they are ready to retire.

I really hope those people can just retire and vanish from the field without anyone to take over their practices. It's already happening. And please don't show up in some academic meetings and asking questions on a surgery they haven't done in five decades, or ever.

 

[PeaJay]

Yup. There are large multi-specialty groups and hospitals that don't have positions now, but may end up having something open up when it's time for you to be looking. It can only help (so long as you don't annoy the crap out of them) to be on good terms and have spoken already with the recruiters, maybe a department head, medical director, etc.

As far as applications go, this isn't ortho, nobody thinks about hiring an associate/podiatrist 2 years in advance. There is not a small number of ortho residents that have a job lined up prior to finishing residency, waiting for them when they finish fellowship. It would be like you signing a contract as a 2nd year resident. You will be lucky to have a contract signed much earlier than Dec/Nov in your third year of residency. A lot of residents are signing contracts until March/April, 2-3 months before graduating. So in terms of "applying" for jobs you are totally wasting your time if its any time before fall of your 3rd year, in almost every instance.

MGMA data is only realistic if you're talking to a hospital, large multi-specialty group, or an ortho group. You will not find a podiatry group that pays you anywhere near even the bottom 10% of MGMA reported salaries. But $220-250k salary is absolutely something you should be looking for from the aforementioned employers. If it is a smaller, rural hospital maybe a $180-200k salary is reasonable but there is usually bigger signing bonuses (ask air bud) and better benefits (ie I have a buddy who's hospital funds his 401k with an amount that is 10% of his salary, without any contributions from him), oh and loan forgiveness stuff.

I wouldn't have done anything differently. I did what I could and didn't leave any stones unturned in the areas I was looking to live. I got screwed by a podiatrist for the first 8 months out of residency, but am in a better situation now. It did cause me to lose a lot of ground on my peers in terms of earnings. Well, those who were not silly enough to do a fellowship and then still go work for a podiatrist. They wasted a whole year of their life making $60k, as opposed to my 8 months (where I still made more than them). But there wasn't a job I missed out on or anything I could have done differently, again, in the areas my family was willing to live.

As a recent grad that has dealt with the job market, I can confirm that the above hospital salaries are correct. I work at a small rural hospital and I am treated more than fairly. In my area of the midwest, private practice is long dead and hearing all these ridiculous job offers I am glad it is dead.