What would you do if you had to start over?

[Dermato Fight Club]

I've been extremely lucky with the profession so far. I really don't have too many complaints personally. I think there should be some pretty drastic changes to address some of the big concerns. Those mostly that are brought up on here.

Just for those pre-pods/students reading this, the consensus seems to be that after residency most will start out working as an associate (150k-250k?) and then eventually end up owning your own practice and doing very well (250k-400k?). Obviously these numbers could easily be larger/smaller but I would venture to guess that is about where 80% of practice owners are.

Anyway, my question goes to those current practice owners and current MSG/hospital podiatrists. Let's say you had to move across country due to a sick child/parent/spouse's job etc. How much of pay cut do you honestly think you would be taking? I'll go first and throw around a wild guess of atleast 150k. Of course, it would actually be a lot more because I would likely retire than have to work for another pod.

One of my pet peeves is the lack of job opportunities that seem to exist. A lot of people claim word of mouth but I just don't understand why anyone would not want to broadcast a job to receive as many candidates as possible. I went on gaswork.com and checked on CRNA job availability. Here is a screenshot of the 10th page (25 postings per page) ranked by highest minimum starting salary. You can see there are currently over 250 job postings that start over 300k. I wish our job market was as good as the CRNA market just in case I did have to pack up and move to a new area of the country.

So anyway, I would love to hear your thoughts and would definitely love to hear from some of the people that actually had to do this and how did it go?

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[Retrograde_Nail]

I've been extremely lucky with the profession so far. I really don't have too many complaints personally. I think there should be some pretty drastic changes to address some of the big concerns. Those mostly that are brought up on here.

Just for those pre-pods/students reading this, the consensus seems to be that after residency most will start out working as an associate (150k-250k?) and then eventually end up owning your own practice and doing very well (250k-400k?). Obviously these numbers could easily be larger/smaller but I would venture to guess that is about where 80% of practice owners are.

Anyway, my question goes to those current practice owners and current MSG/hospital podiatrists. Let's say you had to move across country due to a sick child/parent/spouse's job etc. How much of pay cut do you honestly think you would be taking? I'll go first and throw around a wild guess of atleast 150k. Of course, it would actually be a lot more because I would likely retire than have to work for another pod.

One of my pet peeves is the lack of job opportunities that seem to exist. A lot of people claim word of mouth but I just don't understand why anyone would not want to broadcast a job to receive as many candidates as possible. I went on gaswork.com and checked on CRNA job availability. Here is a screenshot of the 10th page (25 postings per page) ranked by highest minimum starting salary. You can see there are currently over 250 job postings that start over 300k. I wish our job market was as good as the CRNA market just in case I did have to pack up and move to a new area of the country.

So anyway, I would love to hear your thoughts and would definitely love to hear from some of the people that actually had to do this and how did it go?

You have missed the entire point. Podiatry is a luxury service. The dumping ground of ortho, plastics, wound care facilities, neurology, rheumatology. It's like the island of misfit toys. We get all the patients nobody wants to touch. All the charcot you want if you were going to treat these patients. All the morbidly obese diabetic, HIV+, homeless patients you want if you want to fix their trauma. Get it?

PCP dump their neuropathic pain patients on you because for some reason podiatry treats neuropathy?? Anything systemic that manifests in the foot will get dumped on you even when the foot pain really has no MSK pathology that correlates. Then you basically refer these patients back to wherever they came from.

Then you have the contingent of geriatric patients who were treated by another mustache podiatrist who billed their nail care unethically/fraud for years and then retires. They have no risk factors but they want their toenails trimmed. Then they throw a fit of rage when their insurance does not cover it. This literally happens everywhere that I have friends practicing all over the country. Which means podiatry is one giant toenail fraud scam. The next generation deals with the fall out of more strict insurance programs/audits.

There is a genuine need for CRNAs. That's why the job prospects are so phenomenal and pay more than ALL private practice podiatry jobs and starting to pay more than most hospital podiatrist starting salaries. A 300K starting salary for CRNA trumps most starting salaries for podiatrists who get hired at hospitals.

There are a lot podiatrists on the lecture circuit who act like they have it all but in reality they don't want to step on anyones toes back home at their hospital job. As soon as they are identified as a nuisance they are risk for getting fired or having their contract not renewed. There will be 300 surgically trained podiatrists clamoring for their position as soon as the job is posted.

 

[Homo sapien]

I'd do nursing or dentistry of I had to start over. Podiatry in the US is for the birds

 

[619]

Anyway, my question goes to those current practice owners and current MSG/hospital podiatrists. Let's say you had to move across country due to a sick child/parent/spouse's job etc. How much of pay cut do you honestly think you would be taking? I'll go first and throw around a wild guess of atleast 150k. Of course, it would actually be a lot more because I would likely retire than have to work for another pod.

I am currently solo and own my practice in one of the top 10 metro areas in the country. I am very happy and content with my income and day-day life. If I had to move across country, I will still open up a new practice rather than work for anyone be it another pod or MSG/ Hospital. Once anyone taste the holy grail of freedom (and tax benefits) of owning your own practice then it's very hard to go back to being an employee. Only exception is if I am close to retiring then I could consider being an employee and that will probably be a part time gig to keep me busy. With what I am earning and saving, I don't think I will be close to retirement and still be in of money except if something drastic befalls me on the road to retirement like loss of license to practice medicine, divorce or sickness/injury.

To answer OP question, I pray never to start over again. My pay cut will be hundreds of thousands.

I am not even trying to grow my practice anymore, it is steady and not too busy or stressful. I like the way things are so I am not one of those trying to retire by 45 or 50. I want to work till 65 and retire gracefully. I still get emails from job boards and there is almost nothing out there in terms of good jobs. I continue to wonder how the over 500 pod grad each year all get jobs. The word of mouth must be really strong.

 

[BubbaWub]

I've been extremely lucky with the profession so far. I really don't have too many complaints personally. I think there should be some pretty drastic changes to address some of the big concerns. Those mostly that are brought up on here.

Just for those pre-pods/students reading this, the consensus seems to be that after residency most will start out working as an associate (150k-250k?) and then eventually end up owning your own practice and doing very well (250k-400k?). Obviously these numbers could easily be larger/smaller but I would venture to guess that is about where 80% of practice owners are.

Anyway, my question goes to those current practice owners and current MSG/hospital podiatrists. Let's say you had to move across country due to a sick child/parent/spouse's job etc. How much of pay cut do you honestly think you would be taking? I'll go first and throw around a wild guess of atleast 150k. Of course, it would actually be a lot more because I would likely retire than have to work for another pod.

One of my pet peeves is the lack of job opportunities that seem to exist. A lot of people claim word of mouth but I just don't understand why anyone would not want to broadcast a job to receive as many candidates as possible. I went on gaswork.com and checked on CRNA job availability. Here is a screenshot of the 10th page (25 postings per page) ranked by highest minimum starting salary. You can see there are currently over 250 job postings that start over 300k. I wish our job market was as good as the CRNA market just in case I did have to pack up and move to a new area of the country.

So anyway, I would love to hear your thoughts and would definitely love to hear from some of the people that actually had to do this and how did it go?

It simply comes down to supply/demand in any given field. Just look how many foot & ankle surgeons are graduating each year, and the job boards. Something is not adding up. I would tend to agree, the word of mouth must be amazing in this field.

I know of a doc who forced his way into a healthcare system recently. The other podiatrists who worked for the hospital had no say in the matter, and now their volume is being decreased due to this new doc. This new doc is also fellowship trained, in one of the better fellowships in the country, yet had to use family connections to make a new position for themselves in a hospital where they already have plenty of podiatrists.

I have a friend who recently went to a meeting for compensation adjustment with his hospital administrator. Essentially, he asked for a raise and was laughed out of the room. The administrator told him they have podiatrists inquiring weekly regarding a possible open position.

The amount of new people that have started over the last 5 years has blown my mind. Especially since everyone now is a foot & ankle surgeon, it's becoming harder and harder to retain patients/gain new patient referrals.

The writing is on the walls. I am hoping we can develop a possible DPM -> RN transitional program, because there are some RNs making more than DPM associates in my local area. I feel like the latitude with jobs with the RN degree is significantly greater as well. I have a family member who recently asked about podiatry, and I told them to steer clear away.

I think we are just seeing the beginning of this problem. Watch what happens in 10 years...I believe it will be a completely different landscape with all the downward pressure on income. Start saving now, and developing an exit plan.

 

[bigf00t1989]

Would you all say that demand for family practice docs is still higher than demand for podiatrists even with PA/NP scope creep?

 

[Dermato Fight Club]

Would you all say that demand for family practice docs is still higher than demand for podiatrists even with PA/NP scope creep?

A quick search of indeed shows ample listings in my state in various cities for family practice docs starting at 200k. This is not the same for podiatry.

Podiatry had 2 listings total. One at 80-120k and another at 180-220k.

 

[MortonExtension]

Podiatry sucks. I would not do it again. There are so many groups in podiatry that scam. Let’s look into abfas for example:

1. Four exams you must take
2. Each exam costs $425.. but wait there’s more!
3. Application fee of $225 .. but wait there’s more!
4. For each exam you pass you must pay $300 to “convert it” .. but wait there’s more!
5. When you’re board qualified you must pay them $225 every year .. but wait there’s more!
6. For each case review you must pay $475 this includes being paid twice for foot and RRa
7. You’ll likely fail the case review at least once .. but wait there’s more!
8. When you’re board certified you must pay them $400 a year.

😂

 

[air bud]

It simply comes down to supply/demand in any given field. Just look how many foot & ankle surgeons are graduating each year, and the job boards. Something is not adding up. I would tend to agree, the word of mouth must be amazing in this field.

I know of a doc who forced his way into a healthcare system recently. The other podiatrists who worked for the hospital had no say in the matter, and now their volume is being decreased due to this new doc. This new doc is also fellowship trained, in one of the better fellowships in the country, yet had to use family connections to make a new position for themselves in a hospital where they already have plenty of podiatrists.

I have a friend who recently went to a meeting for compensation adjustment with his hospital administrator. Essentially, he asked for a raise and was laughed out of the room. The administrator told him they have podiatrists inquiring weekly regarding a possible open position.

The amount of new people that have started over the last 5 years has blown my mind. Especially since everyone now is a foot & ankle surgeon, it's becoming harder and harder to retain patients/gain new patient referrals.

The writing is on the walls. I am hoping we can develop a possible DPM -> RN transitional program, because there are some RNs making more than DPM associates in my local area. I feel like the latitude with jobs with the RN degree is significantly greater as well. I have a family member who recently asked about podiatry, and I told them to steer clear away.

I think we are just seeing the beginning of this problem. Watch what happens in 10 years...I believe it will be a completely different landscape with all the downward pressure on income. Start saving now, and developing an exit plan.

Get out while you can, secure your future with guarantee work/income, pay raises cost of living....getting paid by RVU/collections is a losing fight....more to come.

 

[wakaflocka88]

I had a college grad student shadow me recently. On the first day I told her don’t do podiatry. She insisted she is still interested and she scored well on her MCAT as well. Haven’t seen her again since day 1 of the 3 shadowing days they scheduled her for. Excellent, saved her career hopefully.

 

[Feli]

The podiatry job market is absolutely horrible relative to any legit medical specialty.
We are insanely saturated. It's a shame. Our compensation clearly reflects this.
We covet and apply widely for jobs like VA and IHS that majority of MD/DO won't even consider to be legit good pay for a podiatrist (relative to what else we can find for pay + benefits). That tells you all you need to know.

I, and many ppl I know, "did everything right" in podiatry... near top of pod school class, a couple scholarships, good residency at my top choice, passed boards, work hard. Now, there are even fellowships to make the length and the debt even greater.

The ROI on the podiatry schooling is just not there.
I don't think there is anything I (or most people) could have done differently. I could've applied to some of the bigger name programs I clerked (Atlanta, West Penn, etc), but that still does almost nothing if I'd matched them. The training would be similar. The job market is still make-your-own-luck and requires 100 cold calls... even if you have elite training or skills. The 'just try harder' is hogwash. We have people on SDN and all over podiatry who are RRA cert and/or from some of the best podiatry residency/fellowship training who are still cutting their teeth working as associate, starting a solo office, or working for MSG/hospital or for pennies on the dollar to MD surgeons/specialists. I will fully say that I started my own office after awhile more out of desperation for decent job + income than desire or control or whatever.

...I would never recommend podiatry to anyone unless they have strong interest in the job and no concern for money... or if they have a direct path to ownership. I feel I've achieved a decent result, but we should have far more good employed options and bank lend options (ie, dent and MD/DO).

I feel it's an interesting job in podiatry (I realize I'm in minority on this), and I don't mind most of the pathology we treat (I don't encourage nails/wounds but don't reject them). However, it is simply ridiculous to have to go to the ends of the Earth and/or rely largely on "selling yourself" and blind luck for a decent job. There are far too many underpaid DPM jobs overall, and it is much harder to get good pay or choice locations versus other MD/DO career paths which have appropriate doc-to-population metrics and appropriate supply/demand. That's evident with nearly all of the poor husband/wife podiatrist teams (even if they both have good training) who almost always have one of them with a decent org job and one with a lesser PP associate gig that was all they could find in the same area.

There are simply waaay too many applicants for any decent pay/pathology DPM job, too many other pods who will do your job or accept insurance contracts for less. It's unfortunate.

If I were 18 again, I would do RN (safe, cheap, good ROI, tons of job options) or perhaps attorney (swinging for the fences, but at least you can set your own rates). It just needs to be a much better ROI than podiatry, though. Podiatry only really works [reliably] with a good connection and/or a high income partner. Way too many DPMs end up not making much, in a city/place they don't like, in a job they don't like, or even all of those. It's a very dicey play if one wants to live in certain place, live at high standard, be solo breadwinner, etc as a podiatrist.

 

[Homo sapien]

The podiatry job market is absolutely horrible relative to any legit medical specialty.
We are insanely saturated. It's a shame. Our compensation clearly reflects this.
We consider jobs like VA and IHS that majority of MD/DO won't even consider to be legit good pay for a podiatrist (relative to what else we can find for pay + benefits). That tells you all you need to know.

I, and many ppl I know, did "everything right" in podiatry... near top of pod school class, a couple scholarships, good residency at my top choice, passed boards, work hard. Now, there are even fellowships to make the length and the debt even greater.

The ROI on the podiatry schooling is just not there.
I don't think there is anything I (or most people) could have done differently. I could've applied to some of the bigger name programs I clerked (Atlanta, West Penn, etc), but that still does almost nothing if I'd matched them. The training would be similar. The job market is still make-your-own-luck and requires 100 cold calls... even if you have elite training or skills. The 'just try harder' is hogwash. We have people on SDN and all over podiatry who are RRA cert and/or from some of the best podiatry residency/fellowship training who are still cutting their teeth working as associate, starting a solo office, or working for MSG/hospital or for pennies on the dollar to MD surgeons/specialists. I will fully say that I started my own office after awhile more out of desperation for decent job + income than desire or control or whatever.

...I would never recommend podiatry to anyone unless they have strong interest in the job and no concern for money... or if they have a direct path to ownership. I feel I've achieved a decent result, but we should have far more good employed options and bank lend options (ie, dent and MD/DO).

I feel it's an interesting job in podiatry (I realize I'm in minority on this), and I don't mind most of the pathology we treat (I don't encourage nails/wounds but don't reject them). However, it is simply ridiculous to have to go to the ends of the Earth and/or rely largely on "selling yourself" and blind luck for a decent job. There are far too many underpaid DPM jobs overall, and it is much harder to get good pay or choice locations versus other MD/DO career paths which have appropriate doc-to-population metrics and appropriate supply/demand. That's evident with nearly all of the poor husband/wife podiatrist teams (even if they both have good training) who almost always have one of them with a decent org job and one with a lesser PP associate gig that was all they could find in the same area.

There are simply waaay too many applicants for any decent pay/pathology DPM job, too many other pods who will do your job or accept insurance contracts for less. It's unfortunate.

If I were 18 again, I would do RN (safe, cheap, good ROI, tons of job options) or perhaps attorney (swinging for the fences, but at least you can set your own rates). It just needs to be a much better ROI than podiatry, though. Podiatry only really works [reliably] with a good connection and/or a high income partner. Way too many DPMs end up not making much, in a city/place they don't like, in a job they don't like, or even all of those. It's a very dicey play if one wants to live in certain place, live at high standard, be solo breadwinner, etc.

This! Podiatry the work is fine. Podiatry the administered and financed profession is bull**** and oversaturated. There should be at most 3000 4000 of us

 

[MortonExtension]

This! Podiatry the work is fine. Podiatry the administered and financed profession is bull**** and oversaturated. There should be at most 3000 4000 of us

“The work is fine”

clip clip clip

 

[Weirdy]

Would you all say that demand for family practice docs is still higher than demand for podiatrists even with PA/NP scope creep?

Absolutely. Its not even close.
There are hospitals in major cities offering 280k starting salaries for fresh IM grads who want to be hospitalists.
If you want to go private FM- skies the limit as soon as you get up and running.
Sure you may work like a dog- but the opportunities are endless and the ceiling is higher than the hospital salaries.
There is a significantly bigger need for PCPs.

 

[air bud]

Absolutely. Its not even close.
There are hospitals in major cities offering 280k starting salaries for fresh IM grads who want to be hospitalists.
If you want to go private FM- skies the limit as soon as you get up and running.
Sure you may work like a dog- but the opportunities are endless and the ceiling is higher than the hospital salaries.
There is a significantly bigger need for PCPs.

Houston and Dallas, huge cities....literally ZERO hospital employed positions available, only a handful even are employed....why? Because too many PP pods will do the work for them for free.... because of oversaturation.

 

[Adam Smasher]

You have missed the entire point. Podiatry is a luxury service. The dumping ground of ortho, plastics, wound care facilities, neurology, rheumatology. It's like the island of misfit toys. We get all the patients nobody wants to touch. All the charcot you want if you were going to treat these patients. All the morbidly obese diabetic, HIV+, homeless patients you want if you want to fix their trauma. Get it?

We're the bottom feeders, which is a bitter pill to swallow. But remember, the asteroid killed the dinosaurs but not the lobsters!

Anyway, my question goes to those current practice owners and current MSG/hospital podiatrists. Let's say you had to move across country due to a sick child/parent/spouse's job etc. How much of pay cut do you honestly think you would be taking? I'll go first and throw around a wild guess of atleast 150k. Of course, it would actually be a lot more because I would likely retire than have to work for another pod.

If I had to relocate, it would absolutely be a $200k pay cut. If population density allowed it, I would start a mobile podiatry business out of my garage, build up to starting a practice. It would be years before I did another elective case, small loss that that would be, basically forcing me into a non-operative role. I could probably bounce back financially after 5 years depending on luck/business savvy (note I didn't say being a smart/good doctor). But it's the lobster work that will be my best chance to recovery.

 

[Weirdy]

Agree about the hospital employed podiatry positions being far and few with little room to "get in".
The new IM hospitalist offers my friends are referring to were in North DFW.

 

[Feli]

Houston and Dallas, huge cities....literally ZERO hospital employed positions available, only a handful even are employed....why? Because too many PP pods will do the work for them for free.... because of oversaturation.

Bah! Ok, no hospital jobs for powe die a tree. Buuut, if you had done the very berry best podiatry fellowship in the country and been willing to go to the furthest outskirts, you could've been hired by a micro-ortho group. You shoulda tried harder?

 

[Adam Smasher]

Bah! Ok, no hospital jobs for powe die a tree. Buuut, if you had done the very berry best podiatry fellowship in the country and been willing to go to the furthest outskirts, you could've been hired by a micro-ortho group. You shoulda tried harder?

wow, both orthopedic and orthopaedic surgery, this guy's legit

 

[Bored Snorlax]

View attachment 390218
wow, both orthopedic and orthopaedic surgery, this guy's legit

Spiderman pointing at another Spiderman meme. Too easy.

 

[heybrother]

I'm hoping to start over. At an outpatient VA clinic.

 

[Feli]

...I am not even trying to grow my practice anymore, it is steady and not too busy or stressful. I like the way things are so I am not one of those trying to retire by 45 or 50. I want to work till 65 and retire gracefully...

 

[Hybrocure]

Military probably. It’s crazy how nice life can be if you have a brain. And I don’t mean military podiatrist but just some officer position

 

[HeySister]

If I had to move and it was to an area with great insurance reimbursement I would probably open my own office. If reimbursement was poor and military podiatrist was an option in the area I would consider that for at least a period of time. If somebody offered me 50% collections I would join a practice even if I was not a true "partner." I would still stress about my true collections being hidden from me. My pay cut would probably be $100,000 or more for at least a year in any of those situations.

Save those options and barring that I don't get lucky with some hospital job, I would quit and figure out something else. No chance I would work for anyone again.

 

[wakaflocka88]

We are a bunch of bitter disgruntled podiatrists spewing false information.

I would never do podiatry again. Probably start my own pressure washing business. Not glorious but can do well

I will never work for another private group. Good luck new grads.

 

[air bud]

Whispers....IHS/commission corps

 

[Hybrocure]

Whispers....IHS/Uniformed Health

Those are highly coveted and competitive positions as it is

 

[air bud]

Those are highly coveted and competitive positions as it is

Well...

 

[MortonExtension]

I'm hoping to start over. At an outpatient VA clinic.

They have it the best truly

 

[heybrother]

They have it the best truly

I don't want to put something on a pedestal that I haven't done - but there's just a lot of market forces that are bearing on me each day.

Part of me sort of laughs at this thread. I'm like - yeah podiatry is terrible. Then I bill 15-20 OV + procedure visits in a row, go home at 4, and play with my kids all weekend without my phone ringing. Course, other medical specialities could do the same thing, for more money.

That said - I've been giving my lunch away every day to insurance phonecalls.

I've got a 165% contract with a small insurance company. So of course they paid $167 for a 11750. Athena also botched the EOB read and deleted the copay so at first glance I got $57 for the 99203. Even adding the $60 copay back in - I wasn't paid the contracted rate there either. So I've now had a phonecall where I got disconnected, another hold and phonecall and then 6 emails to try and get this fixed / resolved. Because this hasn't been properly resolved and will take forever to process - there's basically a zero percent chance the patient will ever pay because he'll get the real bill 3-9 months from now and say screw it.

I spent hours working on underpaid Cigna claims. Cigna gets 150 business days to reprocess claims. I looked the other day and from February when everything got sent - it still hasn't been done.

Got Tricare fixed. Then they broke it again. Another lunch.

Another insurance company told me they'd reprocess all my claims in January. Never happened. I looked and 4 months this conversation I saw more surgeries that were paid below the contracted rate which means they never fixed the fee schedule.

A different insurance company finally fixed my rates in their system, but I found 2 claims that slipped through before the fix where I was supposed to be paid 175% of Medicare and instead got paid sub-Medicare. Essentially I'm fighting for $100.

Somehow when insurance companies botch your claim its always paid below the rate. Never above.

It would just be really nice to do a good job and not be dependent on the bill getting paid. Meanwhile, my family's health insurance went up $200 a month for a crap plan.

 

[diabeticfootdr]

I had a college grad student shadow me recently. On the first day I told her don’t do podiatry. She insisted she is still interested and she scored well on her MCAT as well. Haven’t seen her again since day 1 of the 3 shadowing days they scheduled her for. Excellent, saved her career hopefully.

Just … wow! Everyone is entitled to their opinion, but being the flag-bearer for professional self-loathing is really a disgusting attribute. This was probably evident during Day 1 of shadowing and, thus, useless to spend the remaining 2 days there.

 

[wakaflocka88]

Just … wow! Everyone is entitled to their opinion, but being the flag-bearer for professional self-loathing is really a disgusting attribute. This was probably evident during Day 1 of shadowing and, thus, useless to spend the remaining 2 days there.

I laid out facts for her:

-tuition cost relative to potential income
-poor job market as evident by a quick online search
-limited scope compared to MD/DO
-highly variable residency training programs across the board
-poor structural organization in the profession at the top
-multiple boards fighting within the profession without clarity in the future
-two new schools opening up
-showed her how many pods are in our local county relative to ortho foot and ankle to demonstrate what saturation is

So not sure what I said or did that may have caused her to stop coming.

She enjoyed the pathology I had that day and was genuinely impressed how happy my patients were and said she rarely saw this in other specialties she shadowed. I’m such a bad person

@diabeticfootdr what would you do if you had to start over and not be in an employed position? As seen in this thread many don’t have a clear option. So how can I honestly recommend this professsion to this smart student and potentially compromise her future on a gamble that new grads currently face?

 

[GreenHousePub]

I laid out facts for her:

-tuition cost relative to potential income
-poor job market as evident by a quick online search
-limited scope compared to MD/DO
-highly variable residency training programs across the board
-poor structural organization in the profession at the top
-multiple boards fighting within the profession without clarity in the future
-two new schools opening up
-showed her how many pods are in our local county relative to ortho foot and ankle to demonstrate what saturation is

So not sure what I said or did that may have caused her to stop coming.

She enjoyed the pathology I had that day and was genuinely impressed how happy my patients were and said she rarely saw this in other specialties she shadowed. I’m such a bad person

@diabeticfootdr what would you do if you had to start over and not be in an employed position? As seen in this thread many don’t have a clear option. So how can I honestly recommend this professsion to this smart student and potentially compromise her future on a gamble that new grads currently face?

Did you mention her the fellowship opportunities?? That might have sold her.

 

[wakaflocka88]

Did you mention her the fellowship opportunities?? That might have sold her.

Even more cruel to sell an extra year of hope and debt.

 

[Adam Smasher]

Here's what I have to say about the "self-loathing" retort we hear so often.

I own some custom foot orthotics. I'm generally happy with them. They help me through my day on my feet.
Are they the best things that I own? No.
Do I have boundless enthusiasm about them? No.
Are they reasonably priced to the general public? No.
Do I try to sell them to all of my patients? No.
Do I feel ethically obligated to dissuade patients from purchasing custom foot orthotics who won't meaningfully benefit from them above and beyond other treatments? Yes.
Do I feel bad for other patients who do get sold overpriced orthotics before they come to me? (ahem Good Feet Store) Yes.
Do I suspect that many purveyors of custom foot orthotics are acting in bad faith? Yes.

Now replace "patients" with "students" and "orthotics" with "career in podiatry." There ya go. Not self loathing. Just giving knowledgeable advice for how people can spend their money.

Bookmark this post and re-reference it next time anyone thinks we're being self-loathing, some of us have selective memories

 

[HeySister]

I agree I had a student shadow me. I told her the truth. She was aware that I was making far less than most doing 275 surgical cases a year. I explained to her that my student debt far exceeded my income. I told her I enjoyed the work and it was clear I did, she saw a day of MSK work with mostly happy patients. We did injections and booked surgery and saw post ops. The staff were fun to be around. Now she's at nycpm.

I told her repeatedly if she had other options she should move towards those, but if she had no or minimal debt this is reasonable. Hopefully she has minimal student debt.

If you are not educating them of the risks of this career don't let them shadow you. It's not self loathing, it's treating another human being with respect.

When I was in college I shadowed a few lecture circuit podiatrists. I've since watched them start labor based fellowships and sell to private equity and consult with the flavor of the weak hardware. I have no problem with people making business decisions and making money. Fine by me, that's how markets work. But these types of opportunities are to be rare or non existent to these kids coming out with $400,000 debt.

This thread is all about supply and demand. If you had to leave your current position, wherever you go or need to go, the supply outpaces the demand. Often by a signicant amount. That's just the truth, not self loathing. Anyone here what to chance it and just quit their job and go somewhere to try to find something else? Not me.

 

[Hybrocure]

I agree I had a student shadow me. I told her the truth. She was aware that I was making far less than most doing 275 surgical cases a year. I explained to her that my student debt far exceeded my income. I told her I enjoyed the work and it was clear I did, she saw a day of MSK work with mostly happy patients. We did injections and booked surgery and saw post ops. The staff were fun to be around. Now she's at nycpm.

I told her repeatedly if she had other options she should move towards those, but if she had no or minimal debt this is reasonable. Hopefully she has minimal student debt.

If you are not educating them of the risks of this career don't let them shadow you. It's not self loathing, it's treating another human being with respect.

When I was in college I shadowed a few lecture circuit podiatrists. I've since watched them start labor based fellowships and sell to private equity and consult with the flavor of the weak hardware. I have no problem with people making business decisions and making money. Fine by me, that's how markets work. But these types of opportunities are to be rare or non existent to these kids coming out with $400,000 debt.

This thread is all about supply and demand. If you had to leave your current position, wherever you go or need to go, the supply outpaces the demand. Often by a signicant amount. That's just the truth, not self loathing. Anyone here what to chance it and just quit their job and go somewhere to try to find something else? Not me.

I operate probably twice a month. Bulk of the money is made in clinic. This is private practice. I’m not balling but it’s comfortable. There’s too much hype that our profession places on surgery = money. And I think that is mostly for image and parity sake as a whole. In reality it only works out for a certain portion of well trained podiatrists who land into good jobs. Mostly either working their butt off on call, doing shady surgery billing with unbundling in PP, or hospital contracts for better pay.

 

[Retrograde_Nail]

I operate probably twice a month. Bulk of the money is made in clinic. This is private practice. I’m not balling but it’s comfortable. There’s too much hype that our profession places on surgery = money. And I think that is mostly for image and parity sake as a whole. In reality it only works out for a certain portion of well trained podiatrists who land into good jobs. Mostly either working their butt off on call, doing shady surgery billing with unbundling in PP, or hospital contracts for better pay.

If you operate at high volumes and can actually operate quickly then there is way more money to be made in the OR. The people who push the “clinic is where the money is at” narrative are podiatrists who spend an hour doing an akin.

I do 40-60 cases a month.

I’m on pace to generate 3 million this year for the hospital. Tell me there is no money in surgery.

 

[Hybrocure]

If you operate at high volumes and can actually operate quickly then there is way more money to be made in the OR. The people who push the “clinic is where the money is at” narrative are podiatrists who spend an hour doing an akin.

I do 40-60 cases a month.

I’m on pace to generate 3 million this year for the hospital. Tell me there is no money in surgery.

“For the hospital”

We don’t get paid what you do for those cases. And you’re the biggest outlier out of all of us. You don’t work a realistic podiatry job and you know it.

You’re exceptionally trained and in a top tier job. That’s not the norm.

 

[BubbaWub]

I am not super proud to admit this, but my most complex case is a Lapiplasty.
Typically, I run to about 4-5 hours. The nurses have now started putting foleys into my patients as a requirement during a Lapiplasty.

Clinic is where the money is made friends.
My patients love me, and my results speak for themselves.

Thank you

 

[Retrograde_Nail]

“For the hospital”

We don’t get paid what you do for those cases. And you’re the biggest outlier out of all of us. You don’t work a realistic podiatry job and you know it.

You’re exceptionally trained and in a top tier job. That’s not the norm.

You are right for the hospital…I’m not taking that home but with my bonuses on top of my salary I’m doing well.

My point is if you have a high volume surgical practice and you are efficient you can certainly bill out more in the OR than in clinic.

 

[Hybrocure]

You are right for the hospital…I’m not taking that home but with my bonuses on top of my salary I’m doing well.

My point is if you have a high volume surgical practice and you are efficient you can certainly bill out more in the OR than in clinic.

That just circles around to the problem we all complain about though. There aren’t enough of these jobs to go around. Say we graduate enough podiatrists every year who can do what you do with the training you have - that patient volume for surgery per doctor drops across the board.

Our profession doesn’t have a sustainable model as a surgical specialty at the volume our schools pump grads out at

 

[Homo sapien]

Just … wow! Everyone is entitled to their opinion, but being the flag-bearer for professional self-loathing is really a disgusting attribute. This was probably evident during Day 1 of shadowing and, thus, useless to spend the remaining 2 days there.

Until the profession works it's kinks out a lot more of this will be happening. Instead of quality income and training to go with the debt, so many of us are left with substandard training and job hopping with bums and poor pay. Prospective students should know all of it. You don't see MD/DO/DDS out here cold calling begging for jobs or being happy for 120k jobs, but podiatry is and does

 

[Feli]

“For the hospital”

We don’t get paid what you do for those cases. And you’re the biggest outlier out of all of us. You don’t work a realistic podiatry job and you know it.

You’re exceptionally trained and in a top tier job. That’s not the norm.

You can make fine money doing elective and a good bit of trauma F&A surgery in PP pod/msg/ortho group also if you operate efficiently. You have to cluster the cases with multiple in a morning, have a hospital or ASC near office, and consider all of the e/m and DME and goodwill that comes with the surgery. It is more than average office (per hour) for days or half-days of most podiatry surgery if you do it right and efficiently. I would say the biggest drag on it imo is just the paperwork... boarding sheets, FMLA, temp disability, RTW, etc... for ankle fx and elective and etc.

It is wholly inefficient to be going to the hospital to do one ray amp, back to office... to a surgery center to do one Austin, back to office. The worst is the DM inpt add on cases at medium/large hospitals "to follow" and "after 5pm" or whatever... leave that stuff to the local associate pods or the hospital FTE pods. Those are as bad as it gets for your efficiency (and often poor payers also).

If you can fill up the office with appointments, that's fine too. But with as saturated as podiatry is in most places, it's typically good for income and rep of the office to offer as many services as you reasonably can - particularly if you have other docs in group to help cover office.

 

[619]

If you operate at high volumes and can actually operate quickly then there is way more money to be made in the OR. The people who push the “clinic is where the money is at” narrative are podiatrists who spend an hour doing an akin.

This is a false statement if you work in private practice. wRVU model and insurance collection model in PP is very different. That's what most new pod "3 year trained foot and ankle surgery" grad don't understand. I have said it before, if you work for MSG/Hospital and you are paid in wRVU model then OR favors you however if you work in typical private practice and your income is based on insurance collection then clinic favors you. It's simple as that.

t is wholly inefficient to be going to the hospital to do one ray amp, back to office... to a surgery center to do one Austin, back to office. The worst is the DM inpt add on cases at medium/large hospitals "to follow" and "after 5pm" or whatever... leave that stuff to the local associate pods or the hospital FTE pods. Those are as bad as it gets for your efficiency (and often poor payers also).

You can't just "be efficient" and operate at high volume in PP and make bank, you will burn out and barely break into $200k. We all know most PP pods who are busy in the OR are not doing 90% elective and 10% in-patient diabetic infection. We know it's the opposite. A busy PP surgical pod is taking calls at like 2-3 different hospital and riding the pus bus day and night. A busy surgical PP pod is doing maybe 20% elective/recon and 80% in-patient diabetic train-wreck that no other specialty wants. Those add-ons and 2am toe amps does not make you a busy top surgeon. I am not even going to get into how most of those in-patients have no insurance or high deductible. Because you are busy in the OR (day and night) does not mean it's getting paid. But for the wRVU model, you get paid regardless of patient insurance.

However in clinic, you can have a nice clinic schedule with high volume and make over $200k without the burn out. Why do we see the older experienced pods cut back on surgery and hospital work to focus on clinic. Because that's where the money is at with less stress. Surgery is basically about getting boards numbers, ego and prestige.

Feli this response is not even directed at you because we are both solo PP owners and we both know this. This post is to new grads and residents coming out soon.

 

[heybrother]

Surgery is worth money if the patient has primo insurance and has already met their deductible.

Otherwise - you have to collect money up front. But the surgery center wants a big wad of cash so a lot of patient's don't want to put money down. I've had patient's have a plantar fascial release, tell me it was amazing, owe me $700 and stiff me. "I"ll pay you when the surgery center gives me my refund". They don't.

All of the coding games I see - are hospital pod games. If you try to get clever with commercial insurance in PP they'll demand op notes and then deny the unbundling. The hospital pod essentially gets paid up front regardless of whether the codes ever get paid because the facility fee is so high.

I've done the math before - hospital pods essentially get paid like every patient has BCBS PPO and if they get full value 2nd procedure and on - it isn't even close. I might make more money on a 1 procedure case from solid insurance than a hospital pod but the second you add more procedures its no where close.

I'm currently on a Medicare stretch. I haven't done a good commercial case in like 2 months - everything is free.

99203 + 11750 x 2 or 99203 + 73630x2 + 20550 x 2 are the reason that clinic crushes OR. A lot of these cases are worth some variation of $300-500, you can have plural of them in a day and they are worth more than most Medicare forefoot codes and they have no liability. They also have no global so you just get to keep billing for them at every follow-up.

The other day I had a legit 11044 in the office. Pays better than a toe amp.

 

[Retrograde_Nail]

This is a false statement if you work in private practice. wRVU model and insurance collection model in PP is very different. That's what most new pod "3 year trained foot and ankle surgery" grad don't understand. I have said it before, if you work for MSG/Hospital and you are paid in wRVU model then OR favors you however if you work in typical private practice and your income is based on insurance collection then clinic favors you. It's simple as that.

What are you talking about?

Yes I get RVU credit for a surgery which is more favorable than a cash payout in PP but the hospital still gets a crappy medicaid reimbursement if I operate on a medicaid patient.

A hospital based podiatrist will get a ton of medicaid and even uninsured patients along with all the commercial plans.

I'm still generating almost 3 million dollars in collections for the hospital. Majority from surgery. There is still money to be made in the OR if you operate quickly and efficiently.

 

[MortonExtension]

What are you talking about?

Yes I get RVU credit for a surgery which is more favorable than a cash payout in PP but the hospital still gets a crappy medicaid reimbursement if I operate on a medicaid patient.

A hospital based podiatrist will get a ton of medicaid and even uninsured patients along with all the commercial plans.

I'm still generating almost 3 million dollars in collections for the hospital. Majority from surgery. There is still money to be made in the OR if you operate quickly and efficiently.

If you make them 3 million, you must get paid at least $500,000?

 

[Retrograde_Nail]

If you make them 3 million, you must get paid at least $500,000?

Higher.

What's truly sad is if I was a foot and ankle ortho you can multiple my gross income by 1.5-2x as they typically make like $75-80 per RVU where pods are $50-60. Sometimes even into the $40-49 range based on geography. Plus I'd have a PA or NP if I was a foot and ankle MD.

Again points to podiatry being a luxury profession. If I left my job or did not get a new contract there would be 500 pods scrambling to apply.

What I fully expect is admin to hire another podiatrist in the near future rather than give me real help. So they don't have to pay me as much. That is the reality.

 

[619]

What are you talking about?

Yes I get RVU credit for a surgery which is more favorable than a cash payout in PP but the hospital still gets a crappy medicaid reimbursement if I operate on a medicaid patient.

A hospital based podiatrist will get a ton of medicaid and even uninsured patients along with all the commercial plans.

I'm still generating almost 3 million dollars in collections for the hospital. Majority from surgery. There is still money to be made in the OR if you operate quickly and efficiently.

You said you made the hospital almost 3 million dollars in collections. My question is if you did similar work for a PP, will you still generate the same 3 million dollars in collections?

I really don't get what your argument is. You have never worked in PP or worked in the insurance collection model so you can't speak confidently about how PP model works. Just like I have never worked for MSG/Hospital in wRVU system so I can't say much either.

But the fact remains the same and I will repeat "if you work for MSG/Hospital and you are paid in wRVU model then OR favors you however if you work in typical private practice and your income is based on insurance collection then clinic favors you. It's simple as that."