What can I expect from a PM&S 36????

[PADPM]

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By now most of you know a little about my practice and/or background. So I will attempt to give you a little more insight into our group practice to allow you to understand our "dilemma". I'm really reaching out to current residents and those like Jonwill, Feli, Krabmas, etc., who really have a feel for what's going on in the present time.

Our group has been very successful and we have a large group practice. We have 4-5 partners/shareholders (I'm trying not to get too specific to protect the identity) and the remaining docs are employees. We "trimmed" our operation, and now have about 4 offices (once again I'm being vague) and provide services at about 6 hospitals, nursing homes/assisted living facilities and 2 Wound Care centers.

Each doctor in our practice is ABPS certified. Our practice is a combination of individual practices that have merged over the past few years, and the partners are the docs that came into the practice with the largest volume practices. We presently have about 38-40 employees and a list of about 225 actively referring PCP's.

And THAT is where the problem begins.

Since all the partners have been in practice for at least 20 years, and some much longer, we have all (I'm the youngest) paid our dues. When we were building our individual practices from scratch (we all started our own practices), we did whatever it took. That means we did house calls, nursing homes as well as reconstructive surgery. And THAT's how we all built busy practices.

Now that we have a large number of PCP's, those doctors refer us major cases and also refer us diabetics for routine palliative care. They refer us ankle injuries and they refer us a kid with a splinter. They refer us severe injuies and they refer us someone with a fungal nail. When the PCP has a patient with ANY foot/ankle problem, it's simple. They send the patient to OUR group, and we're happy to see the patient......pronto.

Our "main" office treats about 450-500 patients weekly.

Some of our PCP's are also medical directors at local nursing homes, and have requested that our group provide services at these facilities. Would YOU turn down these docs? These patients need care, many have chronic wounds, etc. But most importantly, these docs send us other pathology and THEY treat nursing home patients.......if we say "no" it doesn't look good. And it's revenue.....nursing home patients don't cancel in bad weather, etc., etc.

So, now to the main "problem". We hire a hotshot well trained PM&S young doc. We pay this young doc over the $100,000 mark, plus all the other ancillary stuff, get the doc on all the hospitals, etc. This doc is busy enough to acquire ALL required cases for boards within ONE YEAR!!!!!

However, he/she tells us that he/she does not want to go to the nursing homes a few hours 1-2 mornings a week. Instead, one of the partners should change their schedules, after we've paid our dues ALL these years, etc., etc. Remember, I do some major surgery, and I STILL perform routine palliative care on a regular basis when needed.

We are not asking our new hire to do this 40 hours a week. He/she has been able to log enough cases in ONE YEAR to sit for boards. This would be 1-2 early mornings per week, and we have ALL done this for years. His/her schedule simply has the most openings, and he/she is going to leave the practice over this issue.

By the way, our last associate had the same issue with us. We let him go after a sexual harrassment problem with an employee.

So, after this lengthy post.......are we way off base???? Is it now beneath well trained residents to actually expect them to perform some palliative care, despite the fact that their employer is ABPS certified and well trained also???

You'll simply have to trust me that our associates are treated very well. Our office is state of the art, our associates are given assistants for all "finish" work (taping, strappings, drilling, x-rays, bandages, cast removal, dressing removal, etc.) and has assistant to go with him/her to the nursing homes. All notes are done via computer and he/she is given a lap top for nursing home use, home use, etc. They are even given a corporate car to travel to facilities so they don't have to use their own.

So, I'd like to hear from those who are in training, (not students) to hear your thoughts. Once again, you'll have to "trust me" that these docs are treated with kid gloves. Maybe THAT'S the problem!

Thanks

 

[347932]

PADPM,

I know I may not be your target response team, but I would like to chime in if I may.

All I can say is I wish I could have found an opportunity like the one you present in your post when I came out of residency. I would jumped on it, kept my mouth shut, head down and worked my tail off to "pay my dues".

I think you are being too hard on yourself. Any resident graduating who feels entitled is way off base. I'm not sure how someone in an associate position can "refuse" to do the work asked of him or her. They are required by contract, generally, to be available to do the work their bosses see fit. There is no choice in the matter. The problem I'm sure you have is its not cheap to hire and fire associates like that.

I was in a group practice, that ended very badly. I was woefully underpaid for the amount of work I was doing (the numbers don't lie), I kept this practitioner's practice afloat for a year while he was recalled to active duty, at which time he hired another doctor, and she basically replaced me. I then went into a very young practice as a partner and am struggling to make ends meet as a new practice tries to grow in this struggling economy.

Training does not equal riches. Residency is not a free pass to expect people to shower you with cash or accolades. This is something earned over time. Nothing should be beneath a new practitioner. I've been out eight years and still do two nursing homes and hospital consults for nail care. That along with all the fancy shmancy surgery I do keeps me busy and happy. The money will come, and I will own it. There is no better feeling in the world.

I think that the transition from residency to private practice is a difficult one. Especially when you graduate from a high faluting program that treats their senior residents like their you know what don't stink.

I think you should expect that these new associates are respectful to the needs of your practice. If they are not, they need a sit down with all the partners and give them the option of shaping up or getting lost. There are ways to protect yourself in your employment contract from them not producing or not helping out and then you booting them and them taking off without renumerating you for the money you gave them.

Its a tough world out here folks. You should cherish any opportunities given to you and be thankful for what you have. Those that start at the bottom of the totem pole should be thankful someone whose been there and done has taken them under their wing and protected them from the hardships of building your own private practice. Respect and honor is earned, but integrity is free, but VERY rare, so have some integrity and do what you need to do to succeed. Help out with even what you consider are the menial tasks. The rewards will engulf you sooner rather than later.

 

[jonwill]

My personal opinion is that there are a few factors at play. First, going through school and into residency, we are constantly bombarded with what becomes paranoia about “podiatrists eating their young.” We hear the stories about “so-and-so” signing some horrible contract and getting screwed. I admit that sometimes I started to think that working for ANY podiatrist was not the way to go, especially with the other ever increasing options of hospitals, ortho groups, multi-specialty groups, etc. So as I started the job hunt, I was very skeptical of any podiatrist. I honestly have to credit my residency director with settling me down. The advice he basically gave me after hours of talking with him on multiple occasions was that no matter the contract (within reason), if I worked my butt off and showed them that I was serious and was willing to do what it took to help the practice and myself succeed, I would be rewarded and they would take care of me. I have found that to be true. And I honestly believe that long term, private practice is the most lucrative of any options in most cases.

Now, I’m not advocating that a young podiatrist go out and sign some horrible contract because there are those that will take advantage of you. To give you an idea, my base salary is well into the six figures and I have a good bonus structure and all the benefits (health/dental, apma, acfas dues, cell phone, etc). And my partners always approach me with new ideas about ways to make revenue and to augment my schedule because three months in, I obviously have more time than they do. And they are always reasonable things that will fill some free time while still allowing my practice to grow. And whenever I get down on myself after the occasional slow week of only seeing 40-50 patients and only doing 1 case I try and think of how things would have been right now had I started my own practice! That usually makes me feel better pretty quick. I have worked my butt off and tried to put my best foot forward and they have taken great care of me and that is how I believe it will continue. I do realize that my partners worked very hard and sacrificed much to get the practice to where it is and I am very appreciative of that. And every new associate should be willing to “put their time in” as long as it is reasonable (ie not impeding their growth as a physician).

But, I do think that one reason for the “ego” is the “associate paranoia” of automatically assuming that any simple request is the beginning of being trampled upon. The other issue at play is surgeon ego. I’m sure that I won’t get any argument from the more seasoned podiatrists on this forum that my TRAINING was most likely superior to theirs. The profession has come a long way in the last 20 years as has scope of practice, hospital privileges, and just overall acceptance of the profession as allopathic, evidence based docs. The MISTAKE that is made by some of these associates is that they think that means that THEY are superior to all other older docs. That is obviously false and I know many older pods that had maybe one year of training (if any) and are phenomenal clinicians and surgeons. I can’t learn in 3 years what they have learned in 20 years of practice. And the irony is that it is because of these older docs that the profession has progressed so that our training is now superior to theirs!

The other part of surgeon ego is the fact that we hear a million times that “we are surgeons” and “are being trained as surgeons” which is largely true. You do start to feel entitled and feel that anything other than complex surgery is beneath you. But then you go to these conferences and some are walking around with huge egos dropping the F-bomb every other sentence (which must at least make them feel cool but they look like idiots) and acting extremely pompous because “that’s how surgeons act”. Emulation is the sincerest form of flattery. Now I’m not accusing anyone on this forum of that because I don’t know any of you. But you can’t create the problem and then complain about it. And some in our specialty have pretty big egos. The young ones who see that (and even train with them) then start acting that way.

The last factor is the “grass is greener” syndrome. Especially to a young associate in the early years of practice, one may start to focus on the cons as the newness wears off. Other options may seem more appealing even though that isn’t the case. I’ve seen those ahead of me bounce around to the next big thing but are never happy. In the end, it is a job meaning if they didn’t pay me, I wouldn’t do it. I realize I’m not always going to love everything about it. But that doesn’t mean that the next opportunity would really be any different.

That is my opinion and this is officially the longest post I have ever had!

 

[PADPM]

I understand and appreciate both of your comments. We believe that we have been more than fair with our associates, and have paid our associates more than anyone in our area.

We are also sensitive to the "idea" that the younger docs have the surgeon mentality, but the reality is that not all patients require surgery and all the docs in our practice, including the partners perform all procedures (although some of our docs have opted out of surgery to ALLOW the younger docs to have those cases).

As previously stated, with our referral base, we don't tell Dr. X, "sorry you'll have to send THAT to another DPM". Once that happens, the "other" DPM will get ALL the referrals....been there, done that.

We consider our office one stop shopping for all foot and ankle problems, and that has been the genesis of our success. We have attempted to let our associates know that when he/she gets SO busy that his/her schedule is filled, nursing homes, etc., will no longer be on the schedule and it will be passed onto the new associate.

But when he/she is treating 35, 45, 50 patients weekly, and I'm treating 55 patients or more daily, and one of my partners is treating 70 patients daily, we certainly don't have the time to start going to those facilities.

I have kids, and I really believe it's also a generation "thing". It's the age of instant gratification. When I was much younger, I had to go to the library to actually find literature.....now you do all research by pressing buttons on a computer. When I was younger and wanted to contact a friend, I picked up the phone (yeah, the one on the WALL) and called. I either got through or got a busy signal. If my friend wasn't home, I simply didn't speak with him/her. No instant gratification.

Now, there are cell phones, no busy signals. If someone doesn't answer, you simply text them, BBM them, etc., etc. Instant gratification. There's email, skype, Facebook, twitter, MySpace, ..........

It's a different world. That doesn't make it bad, but there are definitely different expectations and I truly believe that "instant gratification" is one problem that affects a large portion of the students and residents and recent grads I've met.

I'm technologically "ok", but I also remember when I had to walk uphill to school BOTH ways in the winter!

 

[347932]

I was one of those guys that got horribly screwed as an associate. The contract was sound, but was abused badly, and as a new practitioner, who has the cash to fight it out in court? I was also bound to my employer due to immigration issues. He had my by the cajones, knew it and took full advantage. He has been through 5 associates or so in the last 10 years. No big surprise there.

I'm not sure I agree with the generational analogy as I believe it more cultural than anything. Please read "The Millionaire Next Door" and see if that changes your views at all. The state of affairs for the youth in other countries is far different than in America. This is the greatest country in the world, no doubt, but statistics show that born Americans are rarely the most successful. Unless they are the first generation born Americans. Read the book for some more insight. Its really quite remarkable.

As I read this post and took some time thinking about it, I strongly believe that the future of our profession lies in very large Podiatry groups where those of us with experience and who "paid our dues" run large companies to limit costs and the only way to get in, is to be the very low person on that totem pole, and work your way up. And if that doesn't suit you, go at it on your own and really start your education.

Kudos to you PADPM, for putting up with what you have. Seriously, I'm thinking more and more that I will probably not consider doing what your practice has done by hiring fresh faces for a VERY long time. I just don't have the patience or time to put up and deal with that kind of BS.

 

[PADPM]

You may be correct about the generation differences and I may be wrong, that was just my observation. It just seems that a lot of today's "kids" need instant gratification.

Don't worry about our group putting up with the associate's BS......he/she has been given the boot a while ago.

We take advantage of no one, but we do expect our associates to work as hard as we do, and we don't expect them to make "demands" regarding work they decide is "beneath" them, while we are all providing those services. Bottom line.....we don't ask our associates to do anything we don't do or haven't recently done.

We don't want our associate to have a hissy fit if he/she is supposed to work until 6 pm and at 5:45 pm a PCP calls and asks if he/she can see an emergency as a favor. We don't want our associate to have a hissy fit if a new patient says that he/she is stuck in traffic and may be 5-10 minutes late for an appointment. We don't want our new associate to have a hissy fit if a patient comes in for a post operative appointment and asks "while I'm here, can you please trim my big toenail 'cause it's digging into my second toe". We don't want our associate to walk into the office at 8:20 am when his/her patient hours begin at 8 am. We don't want our associate flriting with our assistants or telling them dirty jokes in the office.

We've made it easy. Our associate doesn't have to wear a shirt and tie or skirt. Scrubs and a clean lab coat are fine. We have reps bring in lunch about 3-4 days a week, so meals are covered. We don't make our associate knock on doors to introduce him/herself to bring in business. We provide assistants for EVERYTHING, all equipment, a car for any non office work, etc. There are incentives down the line to become a shareholder in the corporation and there are plenty of surgical cases available for boards. ALL, yes ALL partners are willing to pass cases to the associate for board cases.

But, we expect the associate to work hard, respect the docs and office staff and treat patients ethically and with integrity and we WANT him/her to have fun and have a long term relationship with our group with the goal of becoming a partner. We do not want a revolving door of associates, that benefits no one.

If this sounds good to anyone, let me know!

 

[347932]

LOL wow!!! This sounds good to me!!! I jest, I jest!

What I think doesn't dawn on associates is that their integrity and behavior is a direct reflection on you, your partners and the practice you've worked hard to build up. Its not easy for someone "to get" unless they've been down that road themselves.

If they are habitually late, make crass jokes, have "hissy fits", don't want to cut some nails, expect to clock out at 5PM regardless of what's going on, they have no business in your practice. Period.

I'll keep my ear to the ground for you for sure. There are plenty of good graduates out there. I'm sorry you got stuck with some of the less favorable ones in your search. I feel for you.

 

[air bud]

PADPM,
What was the reason you hired this person in the first place? Was it where they did their residency/how they were trained? Were they just a good interviewer? How quickly did you start seeing the problem develop? Is there anything you could have done to address the problem earlier?

 

[MarquetteGuy]

This is an interesting topic. As long as the incoming associate was fully aware of his or her expected roles and duties, as I'm sure they were, there should be absolutely no complaints upon acceptance of the job opportunity. They should know what they're accepting before signing on the dotted line, so to speak. However, speaking from personal experience of my program's track record of recent graduates over the past several years, every one of them have joined orthopedic groups for base salaries ranging from $200,000-$225,000 plus production bonuses, plus signing bonuses, with a strictly surgical/ortho type of job description. They are not expected to do any palliative care and choose not to, as they were hired mainly for their surgical skills. This was their prerogative, their choice. My point is that if a job offer doesn't fit what you're looking for, then move on, no hard feelings. It's your choice to accept an offer, and you have to live with it. You'd be wise to really do your homework and make sure the offer fits what you're looking for prior to accepting, if not, it's nobody's fault but his/her own. I'm quite sure these associates knew what they were signing up for prior to accepting the offer, so the blame lies with them, it was their decision to accept. If that wasn't what they were looking for, there are other offers out there, look elsewhere. Just my two cents.

 

[hightower]

However, speaking from personal experience of my program's track record of recent graduates over the past several years, every one of them have joined orthopedic groups for base salaries ranging from $200,000-$225,000 plus production bonuses, plus signing bonuses, with a strictly surgical/ortho type of job description.

What program? You can PM me if needed, thanks

 

[krabmas]

I have a questin about the nursing home situation...

When the associate is at the nursing home, if the patient does not qualify for routine care are they allowed to charge the patient, or deny care? I see this as a sticky situation for the associate. I see nothing wrong with providing routine care when it is needed and appropriately billed. It is much easier in the office setting to ensure this than in a nursing home when the patient's are mearly lined up waiting for your services.

I recently saw a patient that was in a nursing home afte THA. She had her nails cut in the nursing home by a podiatrist who billed her insurance for the services. I only know the patient's side of the story. She was discharged from the nursing home and made an appointment with me to "have her nails cut" She has no DM, no PVD, hair growth on her toes, no nail deformity, no fungus. She just can't reach her nails since having the THA and as she put it her "belly gets in the way" - she is overweight. I explained that her nails care would not be covered and if I billed the insurance company it was called fraud and I could potentially go to jail for this. She was not upset that I could not cut her nails, she was upset that the other podiatrist billed for cutting her nails and wondered how he could get away with that.

I'm not suggesting that you or your practice is committing fraud at the nursing home, but as a new associate it needs to be explained that they have the right to deny care if they think it is appropriate.

I am not so happy about routine care, but sometimes it is necessary and I am happy to do it in those cases. I also would not want to go to nursing homes, but would not sign a contract or join a practice if that was part of the deal.

It sounds like there was more than just the nursing home issue with the last associate.

I think as long as you are up front with the new associate before they sign the contract, they should know what they are getting themselves into, and there should be no questions at that point about the nursing homes.

If it is something new and sprung upon the new associate after signing I could see their concern. Also, they may be concerned on how long they will have to continue visiting nursing homes. What if you don't hire a new associate every year, might they get stuck going to nursing homes for 5 years?

Just putting it in the associates perspective. I can also see your point of view.

 

[PADPM]

Excellent points. First of all, despite our group's success, we can not afford to pay any associate even close to $200,000 or more as the orthopedic practices offer.

As "newankle" will tell you, there is simply no way to compare the revenue brought in by orthopedic groups vs podiatric groups, no matter how large the podiatric group. Orthopedic groups get just about every trauma and injury referral, etc. Have you EVER seen a struggling orthopedic surgeon???

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".

As far as billing "routine" podiatric services in nursing facilities or our offices.....we do not bill for any service for "routine" care unless a patient qualifies with "class findings". One of the doctors in our practice is a Medicare consultant, and as a result that leaves us open for more than the average amount of audits. Additionally, due to our pure volume, that also makes us a target for audits.

We NEVER dictate what a new associate does or does not do or does or does not bill. When our associate visits patients in a facility, the majority of those patients have been seen already in the past by another doctor in our practice and a note is already in the computer documenting the class findings, etc.

If the associate does not agree with those class findings, he/she has the right to bill the service as "non-covered". We have an agreement with some facilities that non-covered services will be paid a set rate by the facility, and in other facilities our office will simply bill the estate/responsible party. Many of the patients have an insurance we do not participate with or have an HMO and we are not capitated to that particular doctor, so we are paid for that service by the facility or the family/responsible party.

We NEVER place our associates in a position where we ask him/her to commit any fraudulent billing, procedures, etc. Our office has no "skeletons" in our closet. No associate that ever left our practice can ever say that while working for our group he/she ever saw ANYTHING that wasn't 100% by the rules.

However, I find it amusing that you stated that the patient you treated wasn't upset that you couldn't cut her nails, but was upset that her other DPM billed for fraudulent services. In my many years of practice, my experience has been the COMPLETE opposite. Patients get angry at ME for being honest!!!! They storm out of my office when I inform the patient that routine palliative care will not be covered on future visits (I will do the first visit as a courtesy and eat the visit), and they tell me "well my OTHER doctor always covered it!!!" So, I end up looking like the bad guy, despite the fact that I show them the written rules and guidelines. More often than not, the patient will tell me "just make something up, I don't care, I just don't want to pay."

The patient will then go down the street to one of our competitors who will gladly "make something up".

 

[347932]

This is an interesting topic. As long as the incoming associate was fully aware of his or her expected roles and duties, as I'm sure they were, there should be absolutely no complaints upon acceptance of the job opportunity. They should know what they're accepting before signing on the dotted line, so to speak. However, speaking from personal experience of my program's track record of recent graduates over the past several years, every one of them have joined orthopedic groups for base salaries ranging from $200,000-$225,000 plus production bonuses, plus signing bonuses, with a strictly surgical/ortho type of job description. They are not expected to do any palliative care and choose not to, as they were hired mainly for their surgical skills. This was their prerogative, their choice. My point is that if a job offer doesn't fit what you're looking for, then move on, no hard feelings. It's your choice to accept an offer, and you have to live with it. You'd be wise to really do your homework and make sure the offer fits what you're looking for prior to accepting, if not, it's nobody's fault but his/her own. I'm quite sure these associates knew what they were signing up for prior to accepting the offer, so the blame lies with them, it was their decision to accept. If that wasn't what they were looking for, there are other offers out there, look elsewhere. Just my two cents.

I'm very interested how this will play out. This is a relatively new trend with Ortho groups hiring Podiatrists to take care of the foot and ankle needs of the practice.

Are these Podiatrists ever offered partnership in these practices? If not, what's the incentive to stay. I got into Medicine to be my own boss, not be a pawn forever.

What's interesting to me is what would happen if these Pods ever get let go? Not only will their income drastically reduce if they are forced to go out on their own, but they won't have a clue how to run a medical business. Life will be extremely difficult for them given this scenario. I'd rather struggle when I'm young and able, not after being in practice 15 years.

 

[347932]

However, I find it amusing that you stated that the patient you treated wasn't upset that you couldn't cut her nails, but was upset that her other DPM billed for fraudulent services. In my many years of practice, my experience has been the COMPLETE opposite. Patients get angry at ME for being honest!!!! They storm out of my office when I inform the patient that routine palliative care will not be covered on future visits (I will do the first visit as a courtesy and eat the visit), and they tell me "well my OTHER doctor always covered it!!!" So, I end up looking like the bad guy, despite the fact that I show them the written rules and guidelines. More often than not, the patient will tell me "just make something up, I don't care, I just don't want to pay."

The patient will then go down the street to one of our competitors who will gladly "make something up".

I've had the same experience as PADPM with this. Patients get mad that you won't make sure that their insurance will cover the service and leave the office in a huff.

I know what the rules are and won't break them and jeopordize my license to satisfy a patient's needs to save some money. We are doctors and provide medical services. If there is no justification for that medical service its cash and carry.

I'll gladly let someone else take that risk and "make something up".

 

[MarquetteGuy]

I'm very interested how this will play out. This is a relatively new trend with Ortho groups hiring Podiatrists to take care of the foot and ankle needs of the practice.

Are these Podiatrists ever offered partnership in these practices? If not, what's the incentive to stay. I got into Medicine to be my own boss, not be a pawn forever.

What's interesting to me is what would happen if these Pods ever get let go? Not only will their income drastically reduce if they are forced to go out on their own, but they won't have a clue how to run a medical business. Life will be extremely difficult for them given this scenario. I'd rather struggle when I'm young and able, not after being in practice 15 years.

That's a great point. I can't comment on the partnership details for all of the recent graduates, but I do know the three most recent guys all had contracts granting partnership opportunities within the first 2-3 years of practice. I have no idea how common this is, I just know this was part of their contracts. They all wanted to focus on cutting/medicine and had no interest in running their own business, this was their choice. Everyone has their own perspective as to what they're looking for in a job. If you want to be your own boss and take on the added benefits and responsibility, great...if not, also great. To each their own. We'll see how it works out for them I guess.

 

[krabmas]

However, I find it amusing that you stated that the patient you treated wasn't upset that you couldn't cut her nails, but was upset that her other DPM billed for fraudulent services. In my many years of practice, my experience has been the COMPLETE opposite. Patients get angry at ME for being honest!!!! They storm out of my office when I inform the patient that routine palliative care will not be covered on future visits (I will do the first visit as a courtesy and eat the visit), and they tell me "well my OTHER doctor always covered it!!!" So, I end up looking like the bad guy, despite the fact that I show them the written rules and guidelines. More often than not, the patient will tell me "just make something up, I don't care, I just don't want to pay."

The patient will then go down the street to one of our competitors who will gladly "make something up".

Luckily I work in a very affluent area in one of the covetted positions under a large umbrella company that I can use/blame for billing. Also, I think once I mention the jail issue it really gets to the patient. I also, do the chipping/clipping on the first visit and let them know it will not be covered in the future, that I am more than happy to do it for the fee that the large company will charge which is prohibitively expensive.

 

[347932]

That's a great point. I can't comment on the partnership details for all of the recent graduates, but I do know the three most recent guys all had contracts granting partnership opportunities within the first 2-3 years of practice. I have no idea how common this is, I just know this was part of their contracts. They all wanted to focus on cutting/medicine and had no interest in running their own business, this was their choice. Everyone has their own perspective as to what they're looking for in a job. If you want to be your own boss and take on the added benefits and responsibility, great...if not, also great. To each their own. We'll see how it works out for them I guess.

The question isn't whether the opportunity is in the contract. The question is whether it actually happens or not. The contract can say anything, but if the time comes and its not offered, what then? Walk? Then you either decide to continue to be the peon, or start your own business anyway with a really nice non compete clause to deal with.

Cynical? Yes? Reality? Yes.

 

[MarquetteGuy]

The question isn't whether the opportunity is in the contract. The question is whether it actually happens or not. The contract can say anything, but if the time comes and its not offered, what then? Walk? Then you either decide to continue to be the peon, or start your own business anyway with a really nice non compete clause to deal with.

Cynical? Yes? Reality? Yes.

First, I'd sure hope you take due diligence when preparing your contract. Spend the money and have a contract attorney go through it with a fine-toothed comb. No rocks should be left unturned. I know these graduates went through many revisions with their current contracts to make sure everything was included/worded to their liking, as well as their group's liking. Once signed, the contract becomes a legal binding document, so the ortho group is going to be hard-pressed to go back on that contract without legal issues. None of them have had any problems going forward. Also, I'm not quite sure how they are being treated as a peon? With their guaranteed increases in annual salary and production bonuses, they are all on pace to make a very comfortable living in the upper 200,000's, one reaching 300,000 this year while they all have a very surgical/orthopedic type of practice with no palliative care of any kind. They have no interest in running a business. I don't really see how they're being taken advantage of, it seems like a very fair deal to me. If you want to be your own boss, terrific, but it's something that comes with a lot of added headaches and isn't for everyone. Just trying to look at it from the other side of things, that's all.

 

[347932]

First, I'd sure hope you take due diligence when preparing your contract. Spend the money and have a contract attorney go through it with a fine-toothed comb. No rocks should be left unturned. I know these graduates went through many revisions with their current contracts to make sure everything was included/worded to their liking, as well as their group's liking. Once signed, the contract becomes a legal binding document, so the ortho group is going to be hard-pressed to go back on that contract without legal issues. None of them have had any problems going forward. Also, I'm not quite sure how they are being treated as a peon? With their guaranteed increases in annual salary and production bonuses, they are all on pace to make a very comfortable living in the upper 200,000's, one reaching 300,000 this year while they all have a very surgical/orthopedic type of practice with no palliative care of any kind. They have no interest in running a business. I don't really see how they're being taken advantage of, it seems like a very fair deal to me. If you want to be your own boss, terrific, but it's something that comes with a lot of added headaches and isn't for everyone. Just trying to look at it from the other side of things, that's all.

Oh there is no doubt that some do not want to be their own boss.

The reality of the situation is that a lone Podiatrist has no chance when trying to fight against a large group. Do you know how much it costs to fight that battle? Tens of thousands of dollars. Again, I've been there done that. You want to go bankrupt fighting a contract? I had a rock steady contract when I was an associate, that was abused to the nth degree. I spent a significant amount of money trying to get my deserved compensation after the fact and the reality is you have better things to spend you time and money on than on lawyers and in the courtroom.

Once your time, contract wise has elapsed on you becoming an associate, and no offer of partnership is made to you, my peon statement stands. In my eyes you will always be "just" an employee to these people, or you're around until they can find someone to replace you. If you're not one of the bosses you can be replaced. Simple as that.

If you find the right group to work with and love them and what you do, its easy. There is a statistic out there I read awhile back that stated that only 50% of people end up staying at the first practice they work with out of residency. I personally think that's rather high talking to all the residents and young doctors that I do in my travels.

I'm just saying to be prepared. I'm not saying go after your dream. I'm not suggesting taking that awesome job offer. I'm just adding some caution to the wind and saying that whether you want to believe it or not, you may find yourself in a situation you never could have anticipated and if you're prepared, it will make whatever that transition is seem MUCH easier.

 

[Feli]

I'm probably not typical, but I'd be looking more at the practice's referral base and growth potential, buy-in terms, and the non-compete than the short term associate salary and signing bonus.

The way I see it, if it's a good practice, I will learn how it operates (and get on the local health plans + hospital staffs). If things work out in a mutual sense, then partnership will be a good possibility. If things don't work out, I have made roots in the area, got most/all of my numbers for ABPS cert, and can always leave and start up solo or leave for a competing local practice. Therefore, I would be inclined to take a moderate associate deal with well defined and reasonable partnership layout (incl noncompete invalid if that partnership timeline + practice valuation is not adhered to) over a higher salary and sign bonus yet "we'll talk about partnership after the associate period." I guess that's why ortho group probably doesn't appeal to me nearly as much as most grads: possibility for meaningful partnership % is usually prohibitively expensive or even nonexistant.

 

[347932]

I'm probably not typical, but I'd be looking more at the practice's referral base and growth potential, buy-in terms, and the non-compete than the short term associate salary and signing bonus.

The way I see it, if it's a good practice, I will learn how it operates (and get on the local health plans + hospital staffs). If things work out in a mutual sense, then partnership will be a good possibility. If things don't work out, I have made roots in the area and can always leave and start up solo or leave for a competing local practice. Therefore, I would be inclined to take a moderate associate deal with well defined and reasonable partnership layout (incl noncompete invalid if that partnership timeline + practice valuation is not adhered to) over a higher salary and sign bonus yet "we'll talk about partnership after the associate period." I guess that's why ortho group probably doesn't appeal to me nearly as much as most grads: possibility for meaningful partnership % is usually prohibitively expensive or even nonexistant.

You are wise beyond your years Grasshopper.

Just as an aside, the new Stark Law revisions say that if you are "recruited", a non compete can be rendered invalid in any situation.

 

[PADPM]

By the way, I don't doubt your word, but I simply can not fathom any DPM earning upwards of $300,000 his/her first year out. That simply boggles my mind.

Overhead in almost any practice is at least 50%, and that means that this young doctor would have to generate at least $600,000 in revenue by himself/herself the first year or second year, just for the practice to break even. And that doesn't count paying for malpractice, hospital dues, and all the other expenses and perks. And I don't know of ANY practice that survives by just breaking even.

I KNOW what it takes to generate that type of income, the amount of patients that have to be seen and the amount of surgical procedures that have to be performed and the quality of the insurance that has to be prevalent to make those kinds of bucks, and as I originally stated.....those numbers really don't seem realistic.

 

[MarquetteGuy]

By the way, I don't doubt your word, but I simply can not fathom any DPM earning upwards of $300,000 his/her first year out. That simply boggles my mind.

Overhead in almost any practice is at least 50%, and that means that this young doctor would have to generate at least $600,000 in revenue by himself/herself the first year or second year, just for the practice to break even. And that doesn't count paying for malpractice, hospital dues, and all the other expenses and perks. And I don't know of ANY practice that survives by just breaking even.

I KNOW what it takes to generate that type of income, the amount of patients that have to be seen and the amount of surgical procedures that have to be performed and the quality of the insurance that has to be prevalent to make those kinds of bucks, and as I originally stated.....those numbers really don't seem realistic.

Well, I can promise you I'm not making it up. That's straight from the horse's mouth. As for the guy hitting the 300,000 mark, he graduated from our program three years ago, so he's the farthest out and therefore the most busy. They are all killing it surgically and seeing a ton of patients in the office. Maybe this is abnormally unique, but this is what they're experiencing. Granted, the areas they are practicing in consists primarily of private insurance patients, which makes a big difference. Also, they are fed all foot/ankle cases seen by their partners. I'm not trying to ruffle any feathers, I'm just passing along the experiences of recent graduates from my program. Take it for what it's worth, one way or another.

 

[PADPM]

Please note, the first words of my prior post were "By the way, I don't doubt your word........"

I'm just speaking from over 20 years of experience in a pretty successful practice. I know what it takes to have to generate enough revenue to pay someone in the $300,000 range and STILL profit on that individual, and believe me, the orthopedic group, just like any group, did not hire this doctor simply for altruistic reasons. They want to make money on his/her billings.

Please remember, that there are only a finite number of hours in a week. During those hours, you must allocate a certain amount to see new patients (and not all require surgery), returning patients (once again not all patients will require surgery), spend time travelling to and from the O.R. in what ever facilities you perform surgery, spend time performing the surgery and/or seeing in hospital patients, spend time seeing these patients in the office post operatively (which does NOT generate income due to post operative global periods) and of course spend time to document all these visits, and also time in the office to dedicate for any administrative responsibilities.

When you add all this up, it can be difficult for one single podiatric practitioner to generate huge dollars by himself. That's why we have a group practice.

Once again, I am not doubting the information you have received. However, sometimes the source of the information can be not so accurate.

If I'm wrong, this or these doctors should count their blessings, because I can guarantee you they are way ahead of the curve for young DPM's 2-3 years out of the gate. And if you check APMA stats or any stats, they are way ahead of the curve period!!

 

[MarquetteGuy]

Please note, the first words of my prior post were "By the way, I don't doubt your word........"

I'm just speaking from over 20 years of experience in a pretty successful practice. I know what it takes to have to generate enough revenue to pay someone in the $300,000 range and STILL profit on that individual, and believe me, the orthopedic group, just like any group, did not hire this doctor simply for altruistic reasons. They want to make money on his/her billings.

Please remember, that there are only a finite number of hours in a week. During those hours, you must allocate a certain amount to see new patients (and not all require surgery), returning patients (once again not all patients will require surgery), spend time travelling to and from the O.R. in what ever facilities you perform surgery, spend time performing the surgery and/or seeing in hospital patients, spend time seeing these patients in the office post operatively (which does NOT generate income due to post operative global periods) and of course spend time to document all these visits, and also time in the office to dedicate for any administrative responsibilities.

When you add all this up, it can be difficult for one single podiatric practitioner to generate huge dollars by himself. That's why we have a group practice.

Once again, I am not doubting the information you have received. However, sometimes the source of the information can be not so accurate.

If I'm wrong, this or these doctors should count their blessings, because I can guarantee you they are way ahead of the curve for young DPM's 2-3 years out of the gate. And if you check APMA stats or any stats, they are way ahead of the curve period!!

I couldn't agree more. They all walked into some pretty nice setups, no question. I've seen their numbers though, so I know it's accurate. I'm not trying to suggest this is the norm by any stretch of the imagination, far from it, but at least it's nice to know these positions are out there in some type of capacity. Just giving my experience from my program, that's all.

 

[347932]

The problem with throwing those numbers around is that no one else reads further than that. Now every student/resident/fellow is going to be talking to their buddies about how you can make $300 000 after being out 3 years, not realizing how unique of a situation this really is.

Not every college basketball star is MJ. Not every college QB is Joe Montana. Not every kid surfing at my break who is an awesome surfer is Kelly Slater.

Be realistic folks. I hate to tell you, but what PADPM is offering is far from the norm either. Solid group, seemingly good intention with a stellar practice track record. The only real variable here is if you can get along with him and his partners and if you're willing to do the work presented. Some lucky resident out there should open up their eyes and ears and PM PADPM to talk to him about his offer.

 

[densmore22]

I'm very interested how this will play out. This is a relatively new trend with Ortho groups hiring Podiatrists to take care of the foot and ankle needs of the practice.

Are these Podiatrists ever offered partnership in these practices? If not, what's the incentive to stay. I got into Medicine to be my own boss, not be a pawn forever.

What's interesting to me is what would happen if these Pods ever get let go? Not only will their income drastically reduce if they are forced to go out on their own, but they won't have a clue how to run a medical business. Life will be extremely difficult for them given this scenario. I'd rather struggle when I'm young and able, not after being in practice 15 years.

I think the big deal with Ortho groups hiring pods instead of FA Ortho's is the fact that they can pay Pods substantially less compared to a FA ortho, that's the bottom line. Beyond the fact that a lot of FA fellowships have closed, it seems to be a dying subspecialty. We offer the same (and, again, IMO, better foot and ankle care), but no orthopod would ever work for a base of $150k + incentives, it just wouldn't happen.

 

[347932]

I think the big deal with Ortho groups hiring pods instead of FA Ortho's is the fact that they can pay Pods substantially less compared to a FA ortho, that's the bottom line. Beyond the fact that a lot of FA fellowships have closed, it seems to be a dying subspecialty. We offer the same (and, again, IMO, better foot and ankle care), but no orthopod would ever work for a base of $150k + incentives, it just wouldn't happen.

As a new associate in a large practice right out of residency, ummmm yeah they would.

 

[densmore22]

As a new associate in a large practice right out of residency, ummmm yeah they would.

I would say for 1st year out, yes. But as soon as that period is over and the hospital/group they're at doesn't ante up with a bigger salaried contract, they'll be looking at other opportunities where they will be compensated for what they want. I've seen it in my home town. About an hour north of a major American city, rural hospital setting (town is about 30K), attractive offers for ortho's right out, guaranteed salary, then that initial year is up and they want to resign that same ortho for the same base salary then they leave to the big city or go down the street to an ortho group that pays them 2-4 times that amount. Why wouldn't they? I can't blame them, plus the ortho groups most likely have a surgery center, they're still getting called from the ER for trauma, referal base is high, don't have to deal with hospital OR's, etc. I can't lie, I would do it if I could. Oh wait, I've got this residency thing tying me up for the next 2.5 years...

 

[347932]

I would say for 1st year out, yes. But as soon as that period is over and the hospital/group they're at doesn't ante up with a bigger salaried contract, they'll be looking at other opportunities where they will be compensated for what they want. I've seen it in my home town. About an hour north of a major American city, rural hospital setting (town is about 30K), attractive offers for ortho's right out, guaranteed salary, then that initial year is up and they want to resign that same ortho for the same base salary then they leave to the big city or go down the street to an ortho group that pays them 2-4 times that amount. Why wouldn't they? I can't blame them, plus the ortho groups most likely have a surgery center, they're still getting called from the ER for trauma, referal base is high, don't have to deal with hospital OR's, etc. I can't lie, I would do it if I could. Oh wait, I've got this residency thing tying me up for the next 2.5 years...

So then what I said is accurate.

Unless you are an Ortho Specialist (Spine, Shoulder, Knee, Hand), you are not making $300K-$600k your second year out. Sorry, but you're dreaming in technicolor. This is the salary of a partner in a large group, not a peon in his second year in private practice.

It takes a group 2-3 years to recoup what they put out for a new associate in any specialty. Whether you realise it or not, it is VERY expensive to hire and maintain a new doctor in a practice. That's why employment contracts are the way they are.

If some hotshot gets out of residency and they don't want salary+incentive, you know what that means? It means they suspect they may not make that incentive figure. You know why? Because they can't. Regardless of how busy they are, due to the initial cost of hiring them, the practice can't recoup what they spent so quickly. Its simple economics really.

When a practice hires an associate they hope that that associate will stay with them AT LEAST long enough for them to recoup their costs. Why do you think there is generally a 3-5 year wait before partnership becomes an option. Can this doctor pay for him/herself and generate a profit for the company or not. If not...no partnership. If so, COME ON IN!This goes for any practice of any medical specialty. Medicine is a business too. As all of our parents have told us...money doesn't grow on trees, you have to earn it and prove yourself. Or go out on your own, and see what that's like.

 

[PADPM]

I agree 100% with densmore22 on this issue. In my opinion, orthopedic surgeons haven't had a sudden interest or love for DPM's over the past few years, nor have they had a sudden epipheny regarding our new better training.

In my opinion, it's simply a matter of economics (yes there will always be exceptions). They can hire a well trained DPM at $100,000, $150,000 or slightly more (I know some of you know residents offered much more, but those are truly the exceptions), while hiring a fellowship trained orthopedic surgeon will cost them at LEAST twice that amount.

Kidsfeet, I'm not sure if you read densmore22's post correctly, and I usually agree with your comments, but I don't know of any orthopedic surgeon who will work at a starting salary of $150,000. I would say a conservative starting salary for most orthopedic surgeons is at least $300,000, and that's probably on the very low side.

 

[347932]

I agree 100% with densmore22 on this issue. In my opinion, orthopedic surgeons haven't had a sudden interest or love for DPM's over the past few years, nor have they had a sudden epipheny regarding our new better training.

In my opinion, it's simply a matter of economics (yes there will always be exceptions). They can hire a well trained DPM at $100,000, $150,000 or slightly more (I know some of you know residents offered much more, but those are truly the exceptions), while hiring a fellowship trained orthopedic surgeon will cost them at LEAST twice that amount.

Kidsfeet, I'm not sure if you read densmore22's post correctly, and I usually agree with your comments, but I don't know of any orthopedic surgeon who will work at a starting salary of $150,000. I would say a conservative starting salary for most orthopedic surgeons is at least $300,000, and that's probably on the very low side.

That's what general orthopods get in my community to start with unless they have specialty fellowship training.

 

[densmore22]

From mysalary.com (via a google search):

The median expected salary for a typical Surgeon - Orthopedic in the United States is $406,827. This basic market pricing report was prepared using our Certified Compensation Professionals' analysis of survey data collected from thousands of HR departments at employers of all sizes, industries and geographies.
Source: HR Reported data as of October 2010

OR:

Cejka Search (another google search):

Orthopedic Surgery: $500,672

I highly doubt these numbers are randomly made up, but one says 400 and one says 500, a range agreed, but hardly 150.
It will only go up from there as an orthopod specializes. Again, it depends on the contract, but generally 1st year out is a very basic salary to get the person hooked or for the employer to see who this person really is/work ethic/etc, but I'd say any orthopod (regardless of specialty) who signs on for $150 after that 1st year is incredibly uniformed, IMO.

 

[347932]

From mysalary.com (via a google search):

The median expected salary for a typical Surgeon - Orthopedic in the United States is $406,827. This basic market pricing report was prepared using our Certified Compensation Professionals' analysis of survey data collected from thousands of HR departments at employers of all sizes, industries and geographies.
Source: HR Reported data as of October 2010

OR:

Cejka Search (another google search):

Orthopedic Surgery: $500,672

I highly doubt these numbers are randomly made up, but one says 400 and one says 500, a range agreed, but hardly 150.
It will only go up from there as an orthopod specializes. Again, it depends on the contract, but generally 1st year out is a very basic salary to get the person hooked or for the employer to see who this person really is/work ethic/etc, but I'd say any orthopod (regardless of specialty) who signs on for $150 after that 1st year is incredibly uniformed, IMO.

This is not the starting salary and represents the median. Median = average. There are some on the higher end of the bell curve and others on the low end. I would like to see 1st year/2nd year associates' numbers, not nationwide salaries over the spectrum of the career of the Ortho Surgeon.

Also, don't forget that these median numbers are generally several years old and don't take into account the ever changing insurance fees (generally for the lower) and also don't take into account the starting cost for hiring a new doctor into the practice.

Again, its a median, which can rarely be used to calculate what a new doctor should be paid.

Look at the median salary for a Podiatrist, published by the APMA and see how many 1st year/2nd associates, fresh out of residency actually make that. I'm not asking for the exception to the rule, I'm asking for the median salary for a newbie, green out of residency. The average salary.

 

[dtrack22]

How much of posters' "experience" with salary offers has to do with geographic location? I ask because now that I'm a student, information I've gotten from current graduates doesn't add up with what PADPM and Kidsfeet regularly post.

I understand that PADPM is part of a large and successful practice, but I also know that he practices in PA/NJ. I'm assuming Kidsfeet is in the Northeast as well. But 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".

Maybe someone like Natch could chime in? Of course all the those people running around in Chacos probably drums up a lot of business...

 

[347932]

How much of posters' "experience" with salary offers has to do with geographic location? I ask because now that I'm a student, information I've gotten from current graduates doesn't add up with what PADPM and Kidsfeet regularly post.

I understand that PADPM is part of a large and successful practice, but I also know that he practices in PA/NJ. I'm assuming Kidsfeet is in the Northeast as well. But 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".

Maybe someone like Natch could chime in? Of course all the those people running around in Chacos probably drums up a lot of business...

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.

Big numbers are sexy. As I've said before, people hear of a few of their "friends" (of a friend, whose sister's, mother's brother told them so), who get big numbers out of residency and they think that everyone is going to get this out of their 3 year extravaganza of a residency. People. Please. Do your research and stop believe what you even read on the internet. Do some honest research and you'll see what the reality is. Don't look at statistics or what you "should" be getting paid.

Doesn't anyone want to go out on their own? Do all of you expect to piggy back on the coat tails of a large successful practice that you may or may not click with?

I'm afraid that many of the students and even the residents get stars in their eyes and expect people to be kicking down their door for all these opportunities. That's just not the case. I hate to say it, but the REAL work starts when you get out of residency. The REAL work is ahead of you folks. Not behind you.

As I've said in other posts, not everyone gets these opportunities. If you do stumble upon an opportunity like this, WONDERFUL! More power to you. Not every one will. Please don't worry about what everyone else is getting/doing. Do your thing. Those of you going into practice for yourselves will find that you will get those numbers eventually, but you will also have the satisfaction of knowing its yours. It will take years, but again, it will be yours.

I've said this before as well, if you do get a great opportunity, cherish it and don't mess it up. Be the bottom of the totem. Don't get paid a lot at first. It will come. I promise.

 

[dtrack22]

...

 

[347932]

We know you had a bad experience as an associate. Please stop making it the basis of every post. For everyone with a bad experience, there is someone who took their contract, did their work and bought in to the practice.

The ratio is indeed 1:1 for good to bad experiences. Are you going to take that 50% chance? That being said, I haven't seen anyone on these forums give glowing reviews of their associate experience as of yet (from both sides: employer and employee). I've also spoken to many in my travels about this. I'm not saying YOU will be better off on your own. I'm offering my life experience, dtrack22, of 8 years out of residency. Take it or leave it.

Also, its not the basis of EVERY post. Sorry.

 

[347932]

The numbers have been consistent from a number of people. Former graduates (of DMU), current and recently graduated residents, practicing podiatrists back home who are hiring, etc. My sample size might be small but there is definitely a trend.

What's your sample size? Trends are qualified by sample size versus the basis of that sample.

 

[Podfather]

I agree 100% with densmore22 on this issue. In my opinion, orthopedic surgeons haven't had a sudden interest or love for DPM's over the past few years, nor have they had a sudden epipheny regarding our new better training.

In my opinion, it's simply a matter of economics (yes there will always be exceptions). They can hire a well trained DPM at $100,000, $150,000 or slightly more (I know some of you know residents offered much more, but those are truly the exceptions), while hiring a fellowship trained orthopedic surgeon will cost them at LEAST twice that amount.

Kidsfeet, I'm not sure if you read densmore22's post correctly, and I usually agree with your comments, but I don't know of any orthopedic surgeon who will work at a starting salary of $150,000. I would say a conservative starting salary for most orthopedic surgeons is at least $300,000, and that's probably on the very low side.

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.

Most of the better offers are south and west because the average age of patients is two to three decades lower than the north/northeast. Therefore 40 patients with non palliative problems (most requiring xrays and other income producing care vs an E/M or RFC code) per day means higher reimbursement.

Also PADPM when we came out referrals were from patients vs MDs, we were fighting for hospital privileges, no jobs were available, and had to build our practice brick by brick. I am proud of those times and it built character. Todays grads just need to join a busy practice and the MDs refer, they can see better income producing patients, and spend their time treating patients rather than fighting for the privilege to practice. I make less than many of my graduates in recent years because they are starting fresh and without baggage.

 

[newankle]

As a new associate in a large practice right out of residency, ummmm yeah they would.

Sorry but ummmm, no they wouldn't. You respond to comments like you are the authority but on this one you have no clue. I'm close to this issue and the demand for fellowship trained F&A orthopods far exceeds the supply and so they have their choice of opportunities. They are in higher demand than a general orthopod beacause there are less of them so why would they (who can fill the needed F&A position AND take general ortho call) take a base salary of $150K? That's insane. There is little to no risk for a 'large ortho group' to take them on. They will be busy day one doing general ortho and slowly building their F&A practice until they can be busy with that.

 

[dtrack22]

The ratio is indeed 1:1 for good to bad experiences. Are you going to take that 50% chance?

You mean the same chance you take when you go out on you own? Absorb all of your own overhead? Work to get your own referrals and patients?


For every private practice success story there is a story about falling flat on one's face.

Not saying I won't go one way or the other...just saying that we get your opinion. One that is no better or worse than anyone else's.

And in this thread, a vast majority of your replies are centered around how terrible being an associate is...

 

[newankle]

So then what I said is accurate.

Unless you are an Ortho Specialist (Spine, Shoulder, Knee, Hand), you are not making $300K-$600k your second year out. Sorry, but you're dreaming in technicolor. This is the salary of a partner in a large group, not a peon in his second year in private practice.

It takes a group 2-3 years to recoup what they put out for a new associate in any specialty. Whether you realise it or not, it is VERY expensive to hire and maintain a new doctor in a practice. That's why employment contracts are the way they are.

If some hotshot gets out of residency and they don't want salary+incentive, you know what that means? It means they suspect they may not make that incentive figure. You know why? Because they can't. Regardless of how busy they are, due to the initial cost of hiring them, the practice can't recoup what they spent so quickly. Its simple economics really.

When a practice hires an associate they hope that that associate will stay with them AT LEAST long enough for them to recoup their costs. Why do you think there is generally a 3-5 year wait before partnership becomes an option. Can this doctor pay for him/herself and generate a profit for the company or not. If not...no partnership. If so, COME ON IN!This goes for any practice of any medical specialty. Medicine is a business too. As all of our parents have told us...money doesn't grow on trees, you have to earn it and prove yourself. Or go out on your own, and see what that's like.

Why is it such a burden it is to take on a new associate? I don't see how it takes 2-3 years for a group to recoup what they put in for a new associate in any specialty as you say. When I started as an associate in a podiatry practice I got paid a base of $80K plus incentive-based bonus. I took home around $120K on collections around $300K and so "the practice" made $180K and decreased their call burden. Aside from the value of sweat equity, referral sources, etc of which it's impossible to put a price tag on, they spent money on me for dues/malpractice/health insurance/supplies which totaled maybe $20-30K. Adding an associate to a larger practice really doesn't increase the overhead a lot as it may in a smaller practice and I actually lowered the overall health insurance rates for the practice being by far the youngest and healthiest. I "paid for myself" at about $220-230K in collections.
Now I must rant on partnerships. In my job with the podiatry practice partnership buy-in was going to be over $300K (in a small podiatry practice). In my job with the ortho practice my buy-in as a full/equal partner was less than that and this is in a large ortho practice that collects over $13 million a year. To me partnership is for job security, commitment to the practice and ability to have input/call the shots but not really to make more money. I don't understand why many podiatry practices I have seen make the partnership buy-in so expensive. It's set up so that the practice has to make money on you for a number of years before you may be offered partnership. I'd like to hear from others what their partnership buy-in situations are/were, what it's based on and how they feel about it.

 

[densmore22]

I'm in the Northwest and a pod I know right out of residency, now starting into their 2nd full year of practice, started their base salary for their 1st year at 140K + incentives, benefits, etc, from their mouth. Resigned the next year (the current year) with SUBSTANTIALLY higher salary. Although they would not tell me what it was, they said it was great. It's was a stand-alone multispecialty clinic during their 1st year out and has since been bought by a local Hospital. The 2 other pods in that group, one has been practicing ~15 years, the other ~5-6 years are well into the mid 200's.

Kidsfeet, I really respect where you're coming from. It sounds like you had a bad experience initially with setting up your practice, but your experience of being a "newbie" is from a few years ago. Things have and are currently changing and it should be the norm for the newer graduates coming out to expect to be paid at least your starting year in the mid 100k region and only go up as you gain experience and credibility. I hear more stories of recent grads and current R3's getting offered some pretty stellar contracts (not just high base salaray, but the incentives offered are pretty amazing as well) for their 1st year out and again, this is and should be the norm now, not the exception to the rule like it was when you started out. It's people like yourself and PADPM and Podfather that have made this possible for people like myself, when I'm getting done with residency in a couple of years, that I will allow me to have my cake and probably eat it too.

 

[densmore22]

Why is it such a burden it is to take on a new associate? I don't see how it takes 2-3 years for a group to recoup what they put in for a new associate in any specialty as you say. When I started as an associate in a podiatry practice I got paid a base of $80K plus incentive-based bonus. I took home around $120K on collections around $300K and so "the practice" made $180K and decreased their call burden. Aside from the value of sweat equity, referral sources, etc of which it's impossible to put a price tag on, they spent money on me for dues/malpractice/health insurance/supplies which totaled maybe $20-30K. Adding an associate to a larger practice really doesn't increase the overhead a lot as it may in a smaller practice and I actually lowered the overall health insurance rates for the practice being by far the youngest and healthiest. I "paid for myself" at about $220-230K in collections.
Now I must rant on partnerships. In my job with the podiatry practice partnership buy-in was going to be over $300K (in a small podiatry practice). In my job with the ortho practice my buy-in as a full/equal partner was less than that and this is in a large ortho practice that collects over $13 million a year. To me partnership is for job security, commitment to the practice and ability to have input/call the shots but not really to make more money. I don't understand why many podiatry practices I have seen make the partnership buy-in so expensive. It's set up so that the practice has to make money on you for a number of years before you may be offered partnership. I'd like to hear from others what their partnership buy-in situations are/were, what it's based on and how they feel about it.

I think it's more of the mentality of, "Well I had to jump through all of those hoops, so they should as well." Also, someone who is willing to pay that amount of money to join a small, independent practice is probably more trustworthy than someone who just wants to try and get a piece of the pie without any real financial risk to themselves. But, I'm just an R1 and that's just speculation by me at this point, I have no credible, tangible source or experience.

 

[GiftedPoster22]

I'll tell you why they act this way towards grunt work.

In the age of twitter, myspace and online social sites these kids genuinely think they are the next lady gaga of podiatry. They see themselves as superstars and the next big thing in their field.

They are on the internet and google themselves so they must be important.... but they fail to realise .... they put themselves on the internet.... no one else did it for them out of reverence.

But they honestly think they are going to write books and articles and do research and cure the foot of it's ailments.... And the boss is holding them back by making them go to a nursing home and clip nails.

The fact is this is a generation of self important nobodies. They are legends in their own twitter mind and think they are the lady gaga of podiatry.

They are just average podiatrists 99.9% of the time, in fact, they are just average middle class xerox block nobodies living a boring life where they really havent done anything significant or noteworthy.... even the ones we think are big in podiatry are really... insignificant in the scheme of things... But hey, it doesn't matter that no one knows who the hell you are, it just matters that you can google yourself and put your own name into a wikipedia article on podiatry etc.

No one major or significant cares about our most famous pods... trust me on this one.

Life of a 99.9% of pods is average to below average. Just another number in society. They will pass without notice. doing pod stuff face it is not noteworthy for almost 100% of americans.

They are just kind of the same as a factory worker or an office worker.... just another face....in a sea of faces. but they can't accept that... even some of our old guys are in the lady gaga of podiatry land. But we can all pretend. Its our right as lady gaga fans.

 

[dyk343]

:troll:

 

[itswiggles]

LMFAO @GiftedPoster22 (sorry dyk343 I had to feed... that post was at hilarious attempt at trying to put down Pod). I am sensing a Lady Gaga obsession...

 

[347932]

Sorry but ummmm, no they wouldn't. You respond to comments like you are the authority but on this one you have no clue. I'm close to this issue and the demand for fellowship trained F&A orthopods far exceeds the supply and so they have their choice of opportunities. They are in higher demand than a general orthopod beacause there are less of them so why would they (who can fill the needed F&A position AND take general ortho call) take a base salary of $150K? That's insane. There is little to no risk for a 'large ortho group' to take them on. They will be busy day one doing general ortho and slowly building their F&A practice until they can be busy with that.

As I've said in a previous post, that is what gen orthos get to start in my community.

 

[347932]

I'm in the Northwest and a pod I know right out of residency, now starting into their 2nd full year of practice, started their base salary for their 1st year at 140K + incentives, benefits, etc, from their mouth. Resigned the next year (the current year) with SUBSTANTIALLY higher salary. Although they would not tell me what it was, they said it was great. It's was a stand-alone multispecialty clinic during their 1st year out and has since been bought by a local Hospital. The 2 other pods in that group, one has been practicing ~15 years, the other ~5-6 years are well into the mid 200's.

Kidsfeet, I really respect where you're coming from. It sounds like you had a bad experience initially with setting up your practice, but your experience of being a "newbie" is from a few years ago. Things have and are currently changing and it should be the norm for the newer graduates coming out to expect to be paid at least your starting year in the mid 100k region and only go up as you gain experience and credibility. I hear more stories of recent grads and current R3's getting offered some pretty stellar contracts (not just high base salaray, but the incentives offered are pretty amazing as well) for their 1st year out and again, this is and should be the norm now, not the exception to the rule like it was when you started out. It's people like yourself and PADPM and Podfather that have made this possible for people like myself, when I'm getting done with residency in a couple of years, that I will allow me to have my cake and probably eat it too.

I think I seriously need to consider becoming an Associate again=)!

Thanks for enlightening me. You live and learn.