What makes a podiatrist that earns 300k per year different from one that just makes 120k?

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Windom Earle

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Obviously they get paid more, but what specifically did they DO differently?

Does the 300k pod work in a certain state, is a certain age, knows how to negotiate better, work in a multi-specialty group or is it more than that?

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Obviously they get paid more, but what specifically did they DO differently?

Does the 300k pod work in a certain state, is a certain age, knows how to negotiate better, work in a multi-specialty group or is it more than that?
A lot of this answered on residents/attending thread. Browse through and read a bit, but its all of the above.

Years out of residency, location, population, saturation, surgical privileges, modality private practice/MSG/Hospital, personality, work ethic, certain procedures, inheritance.

Just browse through.
 
I'll give you a different thought - how do you think a podiatrist produces income for their business? What are the moments throughout the day that put money in your pocket?
 
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I'll give you a different thought - how do you think a podiatrist produces income for their business? What are the moments throughout the day that put money in your pocket?

Isn't it just fee for service? Nail clipping, xray, diabetic checkup, etc
 
Also, keep in mind since there are a lot of pods in private practice, a pod could say his “salary” is 120k and his business earnings are 50k, the 50k would be taxed at a lower rate (doesn’t have Medicaid, SS, other taxes) I believe the tax rate is something like 20%.

Also, Multispecilty groups vs Ortho, vs hospital, vs private practice all have different earning outcomes and paths to get there. You prolly have to be top dog in pod school and residency to land an Ortho gig, but those gigs pay 300k. You gotta be ready to do lots of surgery too.

Private practice you set the terms. You also get paid last.

Multispecilty seems to be the sweet spot.

Hospital seems like a lot of non conpliant patients.
 
Could you ever do a cash based practice? Or is that out of the realm of possibility for everything except plastics and the like?

I'll give you a different thought - how do you think a podiatrist produces income for their business? What are the moments throughout the day that put money in your pocket?
 
You're just posting the same old rehashed pre-pod "truths". I'm trying to help you - how does a podiatrist make a dollar.

Some situations - how do I get paid? (in each situation are their other services I could provide?)
Before ExperienceDPM comes along we'll assume I'm not in a capitated situation.

-An old diabetic with non-palpable pulses and a previous non-traumatic amputation presents to my office for fungal nails - I've seen them faithfully every 3-4 months and trim their nails.
-A new patient presents to my office with itchy scaling to their feet.
-A new patient presents with plantar fasciitis.
-A new patient presents with an ankle sprain - I decide to place them in a CAM boot.
-An old man with 1st MPJ arthritis presents to my clinic - 6 months ago I gave him a cortisone shot and he relates it just wore off. I provide another injection.
-I'm following a patient with a non-displaced 5th metatarsal avulsion fracture. They've returned for a follow-up visit.
-I perform a lapidus arthrodesis.
-I've performed a lapidus arthrodesis - its 5 weeks out from the original injury - I order X-rays.
-I send my resident to the emergency department to reduce an ankle fracture - I do not accompany them. A few days later I see them in the office and arrange for surgery
-A few days after I fixed the patients ankle fracture they fall down and are concerned that they've injured the surgery site. They present to the office.
-A new patient presents to the office with no other complaints other than an infected toenail requiring partial border hallux matrixectomy
 
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My school had a speaker come in (PharmD actually) and said that doctors can bill for providing information to people during a visit. Is that true? For instance, if someone wanted to know something about a medication, the doctor can give a background about said medication and bill for it because it is his knowledge that he is being paid for. Or I guess for podiatry relevant, if a person sprains an ankle, you can bill the insurance company for educating the patient about the science behind how the sprain will heal, because it is knowledge and a consultation. Is this true or is it just silly?

You're just posting the same old rehashed pre-pod "truths". I'm trying to help you - how does a podiatrist make a dollar.

Some situations - how do I get paid? (in each situation are their other services I could provide?)
Before ExperienceDPM comes along we'll assume I'm not in a capitated situation.

-An old diabetic with non-palpable pulses and a previous non-traumatic amputation presents to my office for fungal nails - I've seen them faithfully every 3-4 months and trim their nails.
-A new patient presents to my office with itchy scaling to their feet.
-A new patient presents with plantar fasciitis.
-A new patient presents with an ankle sprain - I decide to place them in a CAM boot.
-An old man with 1st MPJ arthritis presents to my clinic - 6 months ago I gave him a cortisone shot and he relates it just wore off. I provide another injection.
-I'm following a patient with a non-displaced 5th metatarsal avulsion fracture. They've returned for a follow-up visit.
-I perform a lapidus arthrodesis.
-I've performed a lapidus arthrodesis - its 5 weeks out from the original injury - I order X-rays.
-I send my resident to the emergency department to reduce an ankle fracture - I do not accompany them. A few days later I see them in the office and arrange for surgery
-A few days after I fixed the patients ankle fracture they fall down and are concerned that they've injured the surgery site. They present to the office.
-A new patient presents to the office with no other complaints other than an infected toenail requiring partial border hallux matrixectomy
 
I can only speak from my experience but I believe a podiatrists income is multifactorial.

Factor 1:
Purchasing and owning shares in a profitable surgery center. By owning shares you will receive dividends (often quarterly). This varies depending on how many shares you own, and how much of a profit the Surgicenter is able to make (many factors determine the profit). Higher profit equals higher dividends. I know of some podiatrists that earn $50k a year from their surgery center dividends, I know of others that earn $150k a year at another. FYI shares are expensive these days...like $200k-$500k. In my area maybe 50% of podiatrists own shares, and they are all over 40 years old. It will likely take more than a few years to even get the option to buy in.

Factor 2:
Overhead. How lean is your practice? You have to pay the office rent/mortgage, electricity, EHR, staff, supplies, employee benefits, fax and phone lines, etc. This adds up fast. are you in a practice where you can share overhead? Do you have 4 part time employees rather than 2 full time so you can avoid paying benefits? Do you own the building and pay rent to yourself? Do you pay for advertising? Rainy day fund? There are so many things that can cut into your profit. Most podiatrists have an overhead of 50-65%.

Factor 3:
ED call pay. Does the hospital you take call for pay you for taking ED call? This is not as common but there are hospitals that will pay the podiatrist on call for the day somewhere between $300-$600 a day. If you're taking that call for 2-4 weeks out of the year thats another $4,200-$16,800 the Hospital will pay you. Taking ED call has the added financial bonus of being able to round on those inpatients and bill for it. But it takes time away from your life out of the office.

Factor 4:
Insurance/Patient population. Do you only participate with quality insurers? Do you accept medicaid? Is your practice in an affluent area where they nearly always pay the copay? Are you in a lower socioeconomic area where your Accounts Receivable is not so good?

Factor 5:
Production. Are you a new physician seeing 15-20 patients a day? Are you 10 years in seeing 35-45 patients a day? How much are you making per patient? Are there 8,000 podiatrists in your county to compete with?

So lets look at an example:

Morning Office -16 patients
1. Trim single callus (11055) ~$45, Diabetic nails (11721-51 modifier) ~$20
2. New Patient visit (99203) ~$105
3. Diabetic nails (11721) ~$45
4. New Patient visit (99203) ~$105, Ankle XR 3 views (73610) ~$35, Dispense CAM boot DME ~$125
5. Diabetic nails (11721) ~$45
6. 1st MTPJ injection (20600) ~$50
7. Established patient visit (99213) ~$70, Foot XR 3 views (73630) ~$30
8. Trim 2-4 Callus (11056) ~$50, Trim Dystrophic nails (G0127-51 modifier) ~$10
9. Post operative follow up (99204) $0, Foot XR 3 views (73630) ~$30
10. Diabetic nails (11721) ~$45
11. Diabetic nails (11721) ~$45
12. Established patient percutaneous flexor tenotomy (28010) ~$210
13. New Patient visit (99203) ~$105, Foot XR 3 views (73630) ~$30, Dispense OTC orthoses ~$10
14. Partial nail chemical matrixectomy (11750) ~$150
15. Diabetic nails (11721) ~$45
16. Cancelled patient
--Morning revenue = $1,405-- ($87.81 avg per pt)

Afternoon Surgery
Case 1: Retrocalcaneal Exostectomy (28118) ~$400, Secondary repair flexor tendon (28118-59 modifier) ~$150
Case 2: Hammertoe correction (28285) ~$370
Case 3: Endoscopic plantar fasciotomy (29893) ~$410
--Afternoon revenue = $1,330--

Hospital rounding
Subsequent inpatient visit (99221) ~$100

--Daily Revenue = $2,835--
Remember that overhead thing? Suddenly $2,835 becomes something between $1,417 or $992 depending on how lean your practice is.
Oh, and some of those patients wont pay their copay, insurance might not reimburse that office procedure, maybe the insurance doesn't pay what medicare does per the CMS physician fee schedule. All those things out of your control will reduce your revenue another 5-10%. So lets take that revenue multiply it by 4.5 days a week, 49 weeks a year.

This VERY rough breakdown of efficient office and OR production can generate a gross pre tax income between...$196,862 and $296,825
I don't think this is an unrealistic expectation after you've honed your efficiency.

Maybe you can add another $10k from ED call if you're lucky, maybe you had the option to buy surgery center shares to add another $80k a year.

Clearly you can see why its so hard to put a number on a podiatrists income. In most cases, it will take a few years to build your practice and start generating this kind of productivity and revenue (hopefully a few years in you are no longer an associate, but a partner).

Dont forget to pay off that $350k student debt, that $200k buy-in to be partner, that $400k surgicenter buy-in, and your $500k mortgage, good luck.

PS I would love to hear the thoughts of those with multiple years in practice.
 
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Quality posting right there, really appreciate the insight. I’m surprised how much diabetic nails pay.

Gonna have to hold off on that 500k house myself lol.
I can only speak from my experience but I believe a podiatrists income is multifactorial.

Factor 1:
Purchasing and owning shares in a profitable surgery center. By owning shares you will receive dividends (often quarterly). This varies depending on how many shares you own, and how much of a profit the Surgicenter is able to make (many factors determine the profit). Higher profit equals higher dividends. I know of some podiatrists that earn $50k a year from their surgery center dividends, I know of others that earn $150k a year at another. FYI shares are expensive these days...like $200k-$500k. In my area maybe 50% of podiatrists own shares, and they are all over 40 years old. It will likely take more than a few years to even get the option to buy in.

Factor 2:
Overhead. How lean is your practice? You have to pay the office rent/mortgage, electricity, EHR, staff, supplies, employee benefits, fax and phone lines, etc. This adds up fast. are you in a practice where you can share overhead? Do you have 4 part time employees rather than 2 full time so you can avoid paying benefits? Do you own the building and pay rent to yourself? Do you pay for advertising? Rainy day fund? There are so many things that can cut into your profit. Most podiatrists have an overhead of 50-65%.

Factor 3:
ED call pay. Does the hospital you take call for pay you for taking ED call? This is not as common but there are hospitals that will pay the podiatrist on call for the day somewhere between $300-$600 a day. If you're taking that call for 2-4 weeks out of the year thats another $4,200-$16,800 the Hospital will pay you. Taking ED call has the added financial bonus of being able to round on those inpatients and bill for it. But it takes time away from your life out of the office.

Factor 4:
Insurance/Patient population. Do you only participate with quality insurers? Do you accept medicaid? Is your practice in an affluent area where they nearly always pay the copay? Are you in a lower socioeconomic area where your Accounts Receivable is not so good?

Factor 5:
Production. Are you a new physician seeing 15-20 patients a day? Are you 10 years in seeing 35-45 patients a day? How much are you making per patient? Are there 8,000 podiatrists in your county to compete with?

So lets look at an example:

Morning Office -16 patients
1. Trim single callus (11055) ~$45, Diabetic nails (11721-51 modifier) ~$20
2. New Patient visit (99203) ~$105
3. Diabetic nails (11721) ~$45
4. New Patient visit (99203) ~$105, Ankle XR 3 views (73610) ~$35, Dispense CAM boot DME ~$125
5. Diabetic nails (11721) ~$45
6. 1st MTPJ injection (20600) ~$50
7. Established patient visit (99213) ~$70, Foot XR 3 views (73630) ~$30
8. Trim 2-4 Callus (11056) ~$50, Trim Dystrophic nails (G0127-51 modifier) ~$10
9. Post operative follow up (99204) $0, Foot XR 3 views (73630) ~$30
10. Diabetic nails (11721) ~$45
11. Diabetic nails (11721) ~$45
12. Established patient percutaneous flexor tenotomy (28010) ~$210
13. New Patient visit (99203) ~$105, Foot XR 3 views (73630) ~$30, Dispense OTC orthoses ~$10
14. Partial nail chemical matrixectomy (11750) ~$150
15. Diabetic nails (11721) ~$45
16. Cancelled patient
--Morning revenue = $1,405-- ($87.81 avg per pt)

Afternoon Surgery
Case 1: Retrocalcaneal Exostectomy (28118) ~$400, Secondary repair flexor tendon (28118-59 modifier) ~$150
Case 2: Hammertoe correction (28285) ~$370
Case 3: Endoscopic plantar fasciotomy (29893) ~$410
--Afternoon revenue = $1,330--

Hospital rounding
Subsequent inpatient visit (99221) ~$100

--Daily Revenue = $2,835--
Remember that overhead thing? Suddenly $2,835 becomes something between $1,417 or $992 depending on how lean your practice is.
Oh, and some of those patients wont pay their copay, insurance might not reimburse that office procedure, maybe the insurance doesn't pay what medicare does per the CMS physician fee schedule. All those things out of your control will reduce your revenue another 5-10%. So lets take that revenue multiply it by 4.5 days a week, 49 weeks a year.

This VERY rough breakdown of efficient office and OR production can generate a gross pre tax income between...$196,862 and $296,825
I don't think this is an unrealistic expectation after you've honed your efficiency.

Maybe you can add another $10k from ED call if you're lucky, maybe you had the option to buy surgery center shares to add another $80k a year.

Clearly you can see why its so hard to put a number on a podiatrists income. In most cases, it will take a few years to build your practice and start generating this kind of productivity and revenue (hopefully a few years in you are no longer an associate, but a partner).

Dont forget to pay off that $350k student debt, that $200k buy-in to be partner, that $400k surgicenter buy-in, and your $500k mortgage, good luck.

PS I would love to hear the thoughts of those with multiple years in practice.
 
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I can only speak from my experience but I believe a podiatrists income is multifactorial.

Factor 1:
Purchasing and owning shares in a profitable surgery center. By owning shares you will receive dividends (often quarterly). This varies depending on how many shares you own, and how much of a profit the Surgicenter is able to make (many factors determine the profit). Higher profit equals higher dividends. I know of some podiatrists that earn $50k a year from their surgery center dividends, I know of others that earn $150k a year at another. FYI shares are expensive these days...like $200k-$500k. In my area maybe 50% of podiatrists own shares, and they are all over 40 years old. It will likely take more than a few years to even get the option to buy in.

Factor 2:
Overhead. How lean is your practice? You have to pay the office rent/mortgage, electricity, EHR, staff, supplies, employee benefits, fax and phone lines, etc. This adds up fast. are you in a practice where you can share overhead? Do you have 4 part time employees rather than 2 full time so you can avoid paying benefits? Do you own the building and pay rent to yourself? Do you pay for advertising? Rainy day fund? There are so many things that can cut into your profit. Most podiatrists have an overhead of 50-65%.

Factor 3:
ED call pay. Does the hospital you take call for pay you for taking ED call? This is not as common but there are hospitals that will pay the podiatrist on call for the day somewhere between $300-$600 a day. If you're taking that call for 2-4 weeks out of the year thats another $4,200-$16,800 the Hospital will pay you. Taking ED call has the added financial bonus of being able to round on those inpatients and bill for it. But it takes time away from your life out of the office.

Factor 4:
Insurance/Patient population. Do you only participate with quality insurers? Do you accept medicaid? Is your practice in an affluent area where they nearly always pay the copay? Are you in a lower socioeconomic area where your Accounts Receivable is not so good?

Factor 5:
Production. Are you a new physician seeing 15-20 patients a day? Are you 10 years in seeing 35-45 patients a day? How much are you making per patient? Are there 8,000 podiatrists in your county to compete with?

So lets look at an example:

Morning Office -16 patients
1. Trim single callus (11055) ~$45, Diabetic nails (11721-51 modifier) ~$20
2. New Patient visit (99203) ~$105
3. Diabetic nails (11721) ~$45
4. New Patient visit (99203) ~$105, Ankle XR 3 views (73610) ~$35, Dispense CAM boot DME ~$125
5. Diabetic nails (11721) ~$45
6. 1st MTPJ injection (20600) ~$50
7. Established patient visit (99213) ~$70, Foot XR 3 views (73630) ~$30
8. Trim 2-4 Callus (11056) ~$50, Trim Dystrophic nails (G0127-51 modifier) ~$10
9. Post operative follow up (99204) $0, Foot XR 3 views (73630) ~$30
10. Diabetic nails (11721) ~$45
11. Diabetic nails (11721) ~$45
12. Established patient percutaneous flexor tenotomy (28010) ~$210
13. New Patient visit (99203) ~$105, Foot XR 3 views (73630) ~$30, Dispense OTC orthoses ~$10
14. Partial nail chemical matrixectomy (11750) ~$150
15. Diabetic nails (11721) ~$45
16. Cancelled patient
--Morning revenue = $1,405-- ($87.81 avg per pt)

Afternoon Surgery
Case 1: Retrocalcaneal Exostectomy (28118) ~$400, Secondary repair flexor tendon (28118-59 modifier) ~$150
Case 2: Hammertoe correction (28285) ~$370
Case 3: Endoscopic plantar fasciotomy (29893) ~$410
--Afternoon revenue = $1,330--

Hospital rounding
Subsequent inpatient visit (99221) ~$100

--Daily Revenue = $2,835--
Remember that overhead thing? Suddenly $2,835 becomes something between $1,417 or $992 depending on how lean your practice is.
Oh, and some of those patients wont pay their copay, insurance might not reimburse that office procedure, maybe the insurance doesn't pay what medicare does per the CMS physician fee schedule. All those things out of your control will reduce your revenue another 5-10%. So lets take that revenue multiply it by 4.5 days a week, 49 weeks a year.

This VERY rough breakdown of efficient office and OR production can generate a gross pre tax income between...$196,862 and $296,825
I don't think this is an unrealistic expectation after you've honed your efficiency.

Maybe you can add another $10k from ED call if you're lucky, maybe you had the option to buy surgery center shares to add another $80k a year.

Clearly you can see why its so hard to put a number on a podiatrists income. In most cases, it will take a few years to build your practice and start generating this kind of productivity and revenue (hopefully a few years in you are no longer an associate, but a partner).

Dont forget to pay off that $350k student debt, that $200k buy-in to be partner, that $400k surgicenter buy-in, and your $500k mortgage, good luck.

PS I would love to hear the thoughts of those with multiple years in practice.
I appreciate this post, really helpful.
 
Before ExperienceDPM comes along we'll assume I'm not in a capitated situation.

LOL, he's gonna get you!

PS I would love to hear the thoughts of those with multiple years in practice.

I thought you broke things down pretty nicely. One other source of income I didn't see you mention was the employment of other providers (DPMs, PTs, PAs, nail techs, etc.) who can generate more income than they cost. If you were the owner of a practice that employs multiple providers who can work without supervision (DPMs, NPs) then you could hypothetically make a very large income without providing any labor (treating patients) yourself or without even showing up to the office except occasionally. Passive income wins.

Dont forget to pay off that $350k student debt, that $200k buy-in to be partner, that $400k surgicenter buy-in, and your $500k mortgage, good luck.

I think your comment here is important. It's not only how much you make but also how much you don't spend. If a colleague can boast making $400K but her partnership buy-in was $1M then what's left in the bank account at month's end might be no different or even less than someone who makes half the salary without the big business loan for the buy-in (and her income tax bracket might be higher too). Mind your ins/outs.
 
I can only speak from my experience but I believe a podiatrists income is multifactorial.

Factor 1:
Purchasing and owning shares in a profitable surgery center. By owning shares you will receive dividends (often quarterly). This varies depending on how many shares you own, and how much of a profit the Surgicenter is able to make (many factors determine the profit). Higher profit equals higher dividends. I know of some podiatrists that earn $50k a year from their surgery center dividends, I know of others that earn $150k a year at another. FYI shares are expensive these days...like $200k-$500k. In my area maybe 50% of podiatrists own shares, and they are all over 40 years old. It will likely take more than a few years to even get the option to buy in.

Factor 2:
Overhead. How lean is your practice? You have to pay the office rent/mortgage, electricity, EHR, staff, supplies, employee benefits, fax and phone lines, etc. This adds up fast. are you in a practice where you can share overhead? Do you have 4 part time employees rather than 2 full time so you can avoid paying benefits? Do you own the building and pay rent to yourself? Do you pay for advertising? Rainy day fund? There are so many things that can cut into your profit. Most podiatrists have an overhead of 50-65%.

Factor 3:
ED call pay. Does the hospital you take call for pay you for taking ED call? This is not as common but there are hospitals that will pay the podiatrist on call for the day somewhere between $300-$600 a day. If you're taking that call for 2-4 weeks out of the year thats another $4,200-$16,800 the Hospital will pay you. Taking ED call has the added financial bonus of being able to round on those inpatients and bill for it. But it takes time away from your life out of the office.

Factor 4:
Insurance/Patient population. Do you only participate with quality insurers? Do you accept medicaid? Is your practice in an affluent area where they nearly always pay the copay? Are you in a lower socioeconomic area where your Accounts Receivable is not so good?

Factor 5:
Production. Are you a new physician seeing 15-20 patients a day? Are you 10 years in seeing 35-45 patients a day? How much are you making per patient? Are there 8,000 podiatrists in your county to compete with?

So lets look at an example:

Morning Office -16 patients
1. Trim single callus (11055) ~$45, Diabetic nails (11721-51 modifier) ~$20
2. New Patient visit (99203) ~$105
3. Diabetic nails (11721) ~$45
4. New Patient visit (99203) ~$105, Ankle XR 3 views (73610) ~$35, Dispense CAM boot DME ~$125
5. Diabetic nails (11721) ~$45
6. 1st MTPJ injection (20600) ~$50
7. Established patient visit (99213) ~$70, Foot XR 3 views (73630) ~$30
8. Trim 2-4 Callus (11056) ~$50, Trim Dystrophic nails (G0127-51 modifier) ~$10
9. Post operative follow up (99204) $0, Foot XR 3 views (73630) ~$30
10. Diabetic nails (11721) ~$45
11. Diabetic nails (11721) ~$45
12. Established patient percutaneous flexor tenotomy (28010) ~$210
13. New Patient visit (99203) ~$105, Foot XR 3 views (73630) ~$30, Dispense OTC orthoses ~$10
14. Partial nail chemical matrixectomy (11750) ~$150
15. Diabetic nails (11721) ~$45
16. Cancelled patient
--Morning revenue = $1,405-- ($87.81 avg per pt)

Afternoon Surgery
Case 1: Retrocalcaneal Exostectomy (28118) ~$400, Secondary repair flexor tendon (28118-59 modifier) ~$150
Case 2: Hammertoe correction (28285) ~$370
Case 3: Endoscopic plantar fasciotomy (29893) ~$410
--Afternoon revenue = $1,330--

Hospital rounding
Subsequent inpatient visit (99221) ~$100

--Daily Revenue = $2,835--
Remember that overhead thing? Suddenly $2,835 becomes something between $1,417 or $992 depending on how lean your practice is.
Oh, and some of those patients wont pay their copay, insurance might not reimburse that office procedure, maybe the insurance doesn't pay what medicare does per the CMS physician fee schedule. All those things out of your control will reduce your revenue another 5-10%. So lets take that revenue multiply it by 4.5 days a week, 49 weeks a year.

This VERY rough breakdown of efficient office and OR production can generate a gross pre tax income between...$196,862 and $296,825
I don't think this is an unrealistic expectation after you've honed your efficiency.

Maybe you can add another $10k from ED call if you're lucky, maybe you had the option to buy surgery center shares to add another $80k a year.

Clearly you can see why its so hard to put a number on a podiatrists income. In most cases, it will take a few years to build your practice and start generating this kind of productivity and revenue (hopefully a few years in you are no longer an associate, but a partner).

Dont forget to pay off that $350k student debt, that $200k buy-in to be partner, that $400k surgicenter buy-in, and your $500k mortgage, good luck.

PS I would love to hear the thoughts of those with multiple years in practice.


JAJE,
this is the BEST post I've seen so far on this forum.
THANK YOU for sharing this information!

:) :D ;)
 
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