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heybrother

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I may have laughed a bit too hard reading this. The answer to all of these scenarios is - the associate isn't being paid.

I get. She was asked to write an article. But its like a focus group gathered around to talk and the only rule was don't talk about the main issue more than once. There is no world where any of the other things are happening - and the associate is being paid. Talking down to your associate? Yeah, I bet he's being paid well. Overworked? More like, working for free.

Let's write a missive to the black heart and soul of this profession as if a person who doesn't let their associate see new patients can be reasoned with.

Anyway, empty garbage podiatry publications aside - my thanks to this forum for always telling it like it is. For letting people know - yeah, you should be unhappy.
 
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Scrantonicity

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I may have laughed a bit too hard reading this. The answer to all of these scenarios is - the associate isn't being paid.

I get. She was asked to write an article. But its like a focus group gathered around to talk and the only rule was don't talk about the main issue more than once. There is no world where any of the other things are happening - and the associate is being paid. Talking down to your associate? Yeah, I bet he's being paid well. Overworked? More like, working for free.

Let's write a missive to the black heart and soul of this profession as if a person who doesn't let their associate see new patients can be reasoned with.

Anyway, empty garbage podiatry publications aside - my thanks to this forum for always telling it like it is. For letting people know - yeah, you should be unhappy.

Haha yeah...pretty much glossed over the main issue. I did like the part about the handcuffed associate along with the micromanagement, though--those are definitely issues that would make someone want to leave no matter what the pay was.
 
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PTPuser

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This is a silly question, but all these things that makes one want to leave, if the same effort was placed in their own shop/solo PP, would that be worth it and compensated properly? I'm sure it can lead to burnout and it's grueling but all those aside, would one see the fruits of their labor if one says screw this I'm opening my own clinic and eat what I kill?
 
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CutsWithFury

I like to cut
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I may have laughed a bit too hard reading this. The answer to all of these scenarios is - the associate isn't being paid.

I get. She was asked to write an article. But its like a focus group gathered around to talk and the only rule was don't talk about the main issue more than once. There is no world where any of the other things are happening - and the associate is being paid. Talking down to your associate? Yeah, I bet he's being paid well. Overworked? More like, working for free.

Let's write a missive to the black heart and soul of this profession as if a person who doesn't let their associate see new patients can be reasoned with.

Anyway, empty garbage podiatry publications aside - my thanks to this forum for always telling it like it is. For letting people know - yeah, you should be unhappy.

Agreed

Skipped the biggest issue which is the crappy pay. It's terrible. I mean awful.

If all private practice associates got paid what they were worth I would have no doubt this profession would have the highest rate of satisfaction among all healthcare specialties.
 
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heybrother

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I talked to the deans of Western and DMU recently and they said that they biggest thing that the profession has is the challenge of fairness/respect for equivalent pay.

What do you think they are talking about when they say things like that?

I assume what they are saying is - do we get paid the same for a bunion that an orthopedist gets paid? I suppose on some broad level that impacts the profession; however, for you personally, when you sign an associate 75K/30% deal - it won't matter to you whether the orthopedist gets paid $200 more for a bunion since you won't be making any money off of anything you do.

Its been asked before - do orthopedists get paid more per procedure than we do. I won't offer any sort of definitive yes or no because I can't say. These are things I've seen:

-When you are in private practice my big thing is - are your insurance contracts well negotiated. We have another thread on this elsewhere. I have a Medicare advantage contract that pays 65%/75% of the Medicare fee schedule for E&M/Procedures. A friend in town is part of a group that negotiated 100%. So for any procedure he receives 33% more than we do. He's not an orthopedist. He's part of a group that fights and I'm part of a group that complains nothing pays anymore. I tried to fight. I lost. Was offered actually a pay cut by the insurance company.

-That said - I recently went to a dermatologist. He billed me a 99203. My practice's fee schedule for this service is $130. His fee schedule for this was $230. My insurance allowed $128 which I think is what we get paid from this insurance for that service. Presumably his fee structure is setup this way to capture higher billing on cash pay patients and out of network.

-Hospital employed? Well, hospital people tend to be on RVUs. This is an oversimplification, but the procedure is associated with a relative value unit (RVU) which essentially can be assigned to any procedure or service to describe the level of effort, complexity, risk etc. So let's say you do something and its worth 7 RVUs. The RVU will have a dollar value also - the value could be fixed or there could be tiers where the RVUs are worth more as your RVU accumulation increases. If the orthopedist outcollects you in total RVUs and his RVUs scored at a higher tier than you could argue that he was paid more for the procedure, but the real issue is just the total value for the orthopedist was greater for the organization. The simple truth is those RVUs were at their heart based on the ultimate reimbursement that was received by the organization from different payors, medicare, and anything could fluctuate in time.

This is a silly question, but all these things that makes one want to leave, if the same effort was placed in their own shop/solo PP, would that be worth it and compensated properly? I'm sure it can lead to burnout and it's grueling but all those aside, would one see the fruits of their labor if one says screw this I'm opening my own clinic and eat what I kill?

Forget even for a second its a podiatry shop. Its a business. Can you get it started, borrow, find, setup, do the regulatory game, buy, hire, do payroll, get equipment, inventory, bring in customers, do good service, get on insurance panels, submit, get paid, run it efficiently controlling costs, etc.
 
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CutsWithFury

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Hospital employed? Well, hospital people tend to be on RVUs. This is an oversimplification, but the procedure is associated with a relative value unit (RVU) which essentially can be assigned to any procedure or service to describe the level of effort, complexity, risk etc. So let's say you do something and its worth 7 RVUs. The RVU will have a dollar value also - the value could be fixed or there could be tiers where the RVUs are worth more as your RVU accumulation increases. If the orthopedist outcollects you in total RVUs and his RVUs scored at a higher tier than you could argue that he was paid more for the procedure, but the real issue is just the total value for the orthopedist was greater for the organization. The simple truth is those RVUs were at their heart based on the ultimate reimbursement that was received by the organization from different payors, medicare, and anything could fluctuate in time.

Correct. In straightforward hospital contracts an ortho will typically get paid 10-15 dollars more per RVU. That is on top of a salary that typically is 2-3x that of hospital employed podiatrists. This has been my experience.

The longer you are with an organization and demonstrate you are productive you can negotiate tiers of payment. This is a way you can get the organization to pay you more by showing them you can/will work harder for your money.

For example if my threshold to bonus annually is 5500 RVUs. A typical contract can look like

- 5500-6250 (bonus RVUs paid $45 per RVU)
- 6251-7500 (bonus RVUs paid $50 per RVU)
- 7501 and above (bonus RVUs paid $55 per RVU)


Sent from my iPhone using SDN
 
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PTPuser

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I truly hope they teach us these things in school / residency.
 
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Pronation

Do the calc slide
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Correct. In straightforward hospital contracts an ortho will typically get paid 10-15 dollars more per RVU. That is on top of a salary that typically is 2-3x that of hospital employed podiatrists. This has been my experience.

The longer you are with an organization and demonstrate you are productive you can negotiate tiers of payment. This is a way you can get the organization to pay you more by showing them you can/will work harder for your money.

For example if my threshold to bonus annually is 5500 RVUs. A typical contract can look like

- 5500-6250 (bonus RVUs paid $45 per RVU)
- 6251-7500 (bonus RVUs paid $50 per RVU)
- 7501 and above (bonus RVUs paid $55 per RVU)


Sent from my iPhone using SDN

The podiatry private practice model is similar to this, except in reverse. The more your produce, the less you get paid!
 
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heybrother

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People regularly have contracts that are "$100K up to $300K collections and then 30% of collections thereafter". So they are taking a paycut as their productivity increases since they actually drop from 33% to 30%. While expenses can increase - at a certain point in time - many of the key portions of overhead are paid for. Rent, lights, malpractice, nurses health insurance, etc - the classic big ticket overhead things don't keep increasing just because collections went up. The increased collections theoretically are more profitable and of course you don't see any of it as an associate. If you add another day you'll owe more hourly wages to your staff, but ideally the collections for that day should more than cover this. Additionally, the clinic presumably is paying for 365 days a year of rent so adding a Saturday for example is just bringing in a day you previously didn't have collections but paid to be there.
 

Utvolsdpm

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Nov 9, 2017
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The VA parity was a big joke for a lot of folks, definitely not a big win. Most pods are still paid less than PCPs. They are definitely the lowest paid surgical specialty at the VA by far.
 
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