Work-Life Balance

[CutsWithFury]

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I echo AttackNME. out of residency, I had an offer from a very ethical solid PP group - 6 pods in the group and all are well trained, honest good people. I chose to join an ortho group in town instead but looking back, I would have been happy in that group too.

How could you know if you never went through a year of working with this PP group and seeing how you would have been paid?

 

[icebreaker32]

This is a very strange post. I'm glad you were able to get find a gig that you are satisfied with. I just wanted to warn residents looking for jobs that this is not the norm - there is a high chance that you will get completely and utterly screwed when you join a pod private practice.

Yes, most PP associates do not have it this good. The ones I have seen that do have it this good almost always involved buying in as a partner after a couple years.

Even if one does have a boss and an opportunity this good, I caution you not to avoid the hassles of partnership too much longer, if this is an option. If you really want to stay in the community longterm anything could happen in the future. Your boss could hire another doctor and you.might not be as busy or business could slow down for other reasons beyond your control and suddenly the new patients with good insurance all start going to the owner etc.

 

[Pronation]

Yes, most PP associates do not have it this good.

They sure don't, but I bet a good amount of them thought they were going to as a result of smoke, mirrors, and straight up lies. 🤔

 

[Pronation]

When you are jotting down the equation at your interview for your proposed eventual $400k (but starting at $95k) pod private practice salary and it looks like this below:

Here's the result:

 

[AttackNME]

When you are jotting down the equation at your interview for your proposed eventual $400k (but starting at $95k) pod private practice salary and it looks like this below:

Here's the result:

Haha that’s actually pretty funny, time will tell but I’m betting on myself

 

[Feli]

This is a very strange post. I'm glad you were able to get find a gig that you are satisfied with. I just wanted to warn residents looking for jobs that this is not the norm - there is a high chance that you will get completely and utterly screwed when you join a pod private practice.

It's getting less rare to have good PP opportunities. It's not common or majority of PP postings, but it's far from rare.

There will always be the ones that offer peanuts and churn and burn associates. Of course solo practice Dr. X who has never had an associate can't and won't pay very well, and Dr. Y who has flipped through 4 associates in the past 6 years is probably a last resort only.

More and more of the big PP pod groups and even medium multi-office PP pod groups are offering good base, good hours, good productivity. They know what hospitals pay, MSGs, etc (since a lot of their employees might leave to or come from those jobs). They don't want the bottom-of-the-barrel DPMs who are minimally competent, not too likable, or just lazy. So, they can either pay up and give decent compensation and incentives/tool for the docs to earn a good living, or they will fail to attract/keep the good DPMs and lose them to other PP or hospitals - even local competition. The PPs don't offer the benefits hospitals do, but would you really buy that stuff if given the cash instead? I wouldn't. I would gladly have less call or better staffing in exchange for a 1% less 401 match and more mediocre health/life/disability (that I really don't and won't use anyways).

For the group I'm with now, we have a couple new grads starting up next month, and they have a very easy path to 200k (or they may have even arranged a base at/above that mark... I have no idea). I know that if they show up, see patients, use the tools readily available in terms of procedures and DME and many others, they can do well - in the first year and especially beyond that. As I said in other posts, there are a LOT of groups where it's good to be PP and there are many high pay jobs... good income, little or no call, minimal admin headaches, well staffed, flexible to make it what you want, etc. Probably still best to be owner in PP, but some associate and partner jobs are quite nice, conducive to living life, conducive to FIRE.

The notable difference is that the PPs that pay well will absolutely fire someone who doesn't produce, isn't likable to pts or refer docs, wiggles out of days, gets bad results, etc. Sure, they try not to hire those ones in on the front end, but sometimes they make a bad hire or absorb a practice in a buy out and get a bad apple or two within it. Those same sandpaper personality ppl or docs with low revenue and/or bad outcomes can hide almost indefinitely in the govt hospitals... or last awhile in some other private hospitals or MSGs if the admins aren't savvy to what a DPM should produce and they aren't causing any glaring conflict/harassment violations. But in any good PP, they will be gone... and gone very fast.

The old "never ever work for another podiatrist" and "MSG/ortho/hospital job or bust" are fine guidelines, but they're limiting dogma. PP is alive and well and always will be; a lot of patients don't want to park in a ramp, go to the 4th floor, wait an hour, get sent down the hall to xray, come back to wait more, pay tons of facility fees, etc. Hospital or MSG or ortho jobs - just like PP - can range from excellent to horrid. A lot of the bigger pod PP groups that pay well are technically run/owned by DPM(s), but they are basically team run with MBA/HR/MHA types and driven with VC or bank financing.

 

[CutsWithFury]

It's getting less rare to have good PP opportunities. It's not common or majority of PP postings, but it's far from rare.

There will always be the ones that offer peanuts and churn and burn associates. Of course solo practice Dr. X who has never had an associate can't and won't pay very well, and Dr. Y who has flipped through 4 associates in the past 6 years is probably a last resort only.

More and more of the big PP pod groups and even medium multi-office PP pod groups are offering good base, good hours, good productivity. They know what hospitals pay, MSGs, etc. They don't want the bottom-of-the-barrel DPMs who are minimally competent, not too likable, or just lazy. So, they can either pay up and give decent compensation and incentives/tool for the docs to earn a good living, or they will fail to attract/keep the good DPMs and lose them to other PP or hospitals - even local competition. The PPs don't offer the benefits, but would you really buy that stuff if given the cash instead? I wouldn't. I would gladly have less call or better staffing in exchange for a 1% less 401 match and more mediocre health/life/disability (that I really don't and won't use anyways).

For the group I'm with now, we have a couple new grads starting up next month, and they have a very easy path to 200k (or they may have even arranged a base at/above that mark... I have no idea). I know that if they show up, see patients, use the tools readily available in terms of procedures and DME and many others, they can do well - in the first year and especially beyond that. As I said in other posts, there are a LOT of groups where it's good to be PP and there are many high pay jobs... good income, little or no call, minimal admin headaches, well staffed, flexible to make it what you want, etc. Probably still best to be owner in PP, but some associate and partner jobs are quite nice, conducive to living life, conducive to FIRE.

The notable difference is that the PPs that pay well will absolutely fire someone who doesn't produce, isn't likable to pts or refer docs, wiggles out of days, gets bad results, etc. Sure, they try not to hire those ones in on the front end, but sometimes they make a bad hire or absorb a practice in a buy out and get a bad apple or two within it. Those same sandpaper personality ppl or docs who low revenue and/or bad outcomes can hide almost indefinitely in the govt hospitals... or last awhile in some other private hospitals or MSGs if the admins aren't savvy to what a DPM should produce.

The old "never ever work for another podiatrist" and "MSG/ortho/hospital job or bust" are fine guidelines, but they're limiting dogma. PP is alive and well and always will be; a lot of patients don't want to park in a ramp, go to the 4th floor, wait an hour, get sent down the hall to xray, come back to wait more, etc. Hospital or MSG or ortho jobs - just like PP - can range from excellent to horrid. A lot of the bigger pod PP groups that pay well are technically run/owned by DPM(s), but they are basically team run with MBA/HR/MHA types and driven with VC or bank financing.

I’d rather run into oncoming traffic than work for a podiatrist.

 

[Feli]

I’d rather run into oncoming traffic than work for a podiatrist.

It's a personal choice, but like Attack NME, I make a lot more in my current large PP job (and my MSG job way before that basically let me start my own PP within) than I did in IHS work. I have the tools to make even more depending how I use them. Both gigs also have better hours and no call unless I want it (IHS was q3 call - occasionally worse with colleague vacations or leave).

 

[wakaflocka88]

How could you know if you never went through a year of working with this PP group and seeing how you would have been paid?

They showed me their books. I know one of the partners well and she showed me her compensation. The other docs in the group know people within my circle well so they can be easily vouched for. They use Epic EMR so I was also able to see each providers billables for a given time frame. This is rare as I’m sure many PP will not show you these numbers. But if you choose this route, I encourage you to ask these questions because if they’re trying to dodge it or make excuses, then run. If they’re telling you you’ll make a ton of money and live in a house as big as theirs, run. Sadly I know someone whom just took
A job with this false premise and I warned them ahead of time too

 

[Feli]

They showed me their books. I know one of the partners well and she showed me her compensation. The other docs in the group know people within my circle well so they can be easily vouched for. They use Epic EMR so I was also able to see each providers billables for a given time frame. This is rare as I’m sure many PP will not show you these numbers. But if you choose this route, I encourage you to ask these questions because if they’re trying to dodge it or make excuses, then run. If they’re telling you you’ll make a ton of money and live in a house as big as theirs, run. Sadly I know someone whom just took
A job with this false premise and I warned them ahead of time too

Yeah, I do the same...
It is fairly non-threatening to ask a few of the current and former docs in that PP group what their rough avg monthly or annual collections are.

I ask docs that've been there awhile, newer ones, former ones. I've never had anyone refuse to at least give a rough range and some guidance as to what's possible (usually new ones who haven't fully tapped their potential yet). Other good questions are how many MAs and front desk, approx how many new pts per day, nails vs ortho/sports pt mix, payer mix, hospitals or ASCs, etc.

Everyone knows PP isn't about the base salary and benefits... it comes down to % of collections and being able to consistently produce good collections with the doc's talents and the PP tools and volume. It's also typically a QOL decision for many DPMs. It would be crazy not to ask as many docs as possible about numbers for any job one is considering - goes for pod PP or any PP MSG or ortho (though many ppl sadly are afraid to ask or afraid to rock the boat and just sign by the dozen spots on the job offer letter).

You don't know the other doc's exact base, % bonus, etc, so it's not asking them exactly what they make or what their contract is.... but you can extrapolate approximately where you'll land knowing what your % offer is and if you'll do same or similar hours/services. It gets a little more tricky (and sometimes pointless) talking money for some hospital jobs when base is their majority/whole salary and it is more standardized in the govt or the hosp system, but anyone can still ask rough RVUs, pts per day, call schedule, etc from as many docs as reasonably possible. 👍

 

[air bud]

What a happened to quality of life?

 

[Pronation]

Everyone knows PP isn't about the base salary and benefits... it comes down to % of collections and being able to consistently produce good collections with the doc's talents and the PP tools and volume. It's also typically a QOL decision for many DPMs. It would be crazy not to ask as many docs as possible about numbers for any job one is considering - goes for pod PP or any PP MSG or ortho (though many ppl sadly are afraid to ask or afraid to rock the boat and just sign by the dozen spots on the job offer letter).

I'm replying to this again as a warning to graduating residents...

Why don't these private practices offer 180-200k salary?

This is exactly the sales pitch that these PP owners give to an unsuspecting sucker.

Unsurprisingly when the 100k base salaried associate hits their absurd threshold for "bonus" then the PP owner hires yet another sucker, rinse and repeat.

I don't buy this crap of "well we don't know if the associate is going to be lazy or not".

Protip: if the base salary is 100k and the PP owner is saying you'll make close to 200k after bonus, expect to make 100k.

 

[CutsWithFury]

Even though I’ve never worked for PP podiatry group I have sat through some interviews. If you walk away from the interview and it doesn’t feel right then it won’t be.

If you ask to see their books and they say no then don’t bother.

If you ask for a bonus breakdown and it’s so convoluted or nonsensical that you would need them to go over it again then don’t bother. They are trying to screw you over.

If you are board certified and the hiring docs are not be prepared to be forced to operate on their patients and you get no credit for it.

If you have seen significant turnover in associates every 1-2 years then don’t bother.

If they only offer you 1 year renewable contracts then RUN OUT OF THE OFFICE

If the owners wife or family runs the office then RUN OUT OF THE OFFICE.

No offense to anyone who comes on here and describes their “unique” PP podiatry experience stating they have it pretty good but in the same sentence asserts about making 200-240k per year with bonuses I really do NOT find that to be too impressive or fair compensation for our time and energy to becoming physicians. Especially being a speciality that generates so much revenue from in office procedures, surgery, DME, or any other kind of downstream revenue for the office.

I’ve been completely underwhelmed with the private practices I interviewed with in the past and it felt like outright disrespect. Majority of my colleagues are getting railed by their private practices.

 

[Pronation]

There is just no way that any pod private practice can compete with the hourly rate earned at an MSG (with surgery center) or hospital. The ability to incorporate the facility fees and all ancillary services into your base salary (plus easily achievable bonus) just blows away crappy private practice reimbursement where you get 50% of every additional procedure that you do in the same sitting - so now you have to sell a bunch of cash pod crap and custom orthotics etc. Yuck.

 

[dtrack22]

The ability to incorporate the facility fees and all ancillary services into your base salary (plus easily achievable bonus) just blows away crappy private practice reimbursement

Hospitals and MSGs can be different animals when it comes to income ceilings. In general, employers in either setting cannot legally pay you more than you bring in from a e/m, CPT standpoint. You aren’t getting a cut of the facility fees or ancillary services (though in physician owned MSGs with partnership opportunities there can be profit sharing). The reason the base and pay is higher for the same amount of work is that the hospital or MSG can pay you a much higher % of the E/M and CPT revenue you generate since facility fees and ancillaries are covering your overhead. Whereas in PP 30-50% the money you get from an E/M goes just to pay the bills, before you can pay yourself.

Currently, good $/wRVU reimbursements are lower than what a PP doc would get for billing the same code to Medicare. So people getting $40-45 per wRVU are still getting screwed to some extent. Podiatry could easily command closer to $60 per wRVU but new contracts are based off of current median figures so it’s gonna take awhile for those to rise while current employed docs negotiate increases in their contracted rates. The problem for the PP doc is that they have to use such a large chunk of that reimbursement to pay rent, staff, EMR, supply costs, etc. That’s why you generally come out ahead as an employed doc for the same amount of work (though PP certainly can have large tax advantages). But it’s not as if you’re actually getting a cut of the facility fees in your pay check (in almost all cases). You’re simply getting a higher % of every E/M and CPT $ you bring in.

 

[DYK343]

Currently, good $/wRVU reimbursements are lower than what a PP doc would get for billing the same code to Medicare. So people getting $40-45 per wRVU are still getting screwed to some extent.

Yes and no surgical wise. It really depends if each procedure you do is billed out as 100% wRVU for each or graduated downwards like a PP doc would get billing medicare individually.

Lapidus, Akin, 2nd toe PIPJ fusion, and Weil osteotomy.

If you get paid 100% wRVU for each procedure vs a PP pod who gets 100% first procedure then 50%, 25%, for each procedure after then youre making less.

 

[air bud]

I know MSG/hospital employed who get 100 % of each RVU (I used to) and those that are also tiered like PP.

 

[Feli]

Ok, well, just to play devil's advocate, why do we think the vast majority of MDs and DOs were in private practice?

Why don't they all work for hospitals if the PP economics are so impossible?

It was way over half of MD/DOs in PP historically, now roughly half... even in the age of crazy tuitions, PSLF, COVID, EMRs, ObamaCare, etc.
(Any areas with good payers are still majority in PP, bad payer areas are majority hospital-employed / minority PP.)

The MDs and even DOs obviously have a lot more hospital employ jobs available than DPMs, yet they did and still do very often choose PP. Pero por que?

Is it that they don't screw one another over? (partnership more viable, PP associates paid better, etc)
They can make more overall in PP? (owners, partners, associates, staff... everyone)
They want the control of hours/environment/staff?
They don't want call and consults the hospital would mandate?
Etc?

 

[zircushio]

Anecdotal but recent additional data from my own perspective:

I interviewed with 20 or so PP's and while some were good honest people, every single one of them balked at the salary I asked for. Some said "well we can get you to that number with your bonus for sure, but our base is 80-120k". I think the highest PP salary I negotiated to (with their counter negotiation downwards) was 140k base with 25% bonus after 300k collections in Tampa, FL. That involved working for their 3-5 clinics in the area. I get it, Florida has no income tax and cost of living is probably less than the tri-state, but the offers from PP have been a complete joke as a whole. No one talks about it in residency up here, or the attending's try and make it "normal" by saying "so many associates accept 100-120k for the area, and thats the average. Aim for 120k" - no way man lol

As a whole, 85k was the lowest offered (Miami, FL). 140k was the highest (Tampa and NYC).
NJ the range was from 100-120k on average (about 10 practices), there were two places that offered 130k.
Connecticut guy offered 140k and was genuinely a nice guy and upfront about everything, but did not negotiate above that.
NY in Hudson Valley, they offered 120k but you had to work 7 days a week and cover call every other week. The other practice was similar set up.
NYC was a crap shoot, 120-140k but cost of living is insane and they made you go to Long Island as one of their satellite offices.
Many of these offers above did not offer more than 2 weeks of vacation, did tail-end malpractice (where you'd owe 10k if you left), had difficult to reach bonus structure (especially as first year), and you had to work at MINIMUM six days a week, and usually between 3 offices. Quality of life seemed abysmal IMO.

Compare that to my MSG offers
180-200k with bonus structure, malpractice, full benefits, 4 weeks vacation with "unlimited" sick call (they were flexible and understood), no call. They respected me more during the interview, asked me what I'd want or need from them. 1 mile non-compete. Generous CME. Bonus structure was fantastic for what I have seen on here.

Ortho was even better but that might have been a one-off. One ortho practice discussed upwards of 280k with no call but then told me they would consider adding podiatry next year - it was more of a luxury boutique ortho/physical therapy group that tailored towards firefighters/police officers. The other which specialized only in Hand, shoulder, hips, knees the talks didn't progress far enough for salary discussions. Unfortunately, ortho in the Northeast is very anti-podiatry and would rather eat the foots than give any to a pod. It be what it be I guess.

I did not apply to any hospitalist position, I wish I did though just to get more data.

As for fellowship training, none of the MSG, Ortho, or Vascular places I interviewed at asked me about it. PP's did which I found funny. PP held an infinitely higher standard in terms of education and surgical prowess, but when it came down to negotiating salary, call schedule, etc - they all want to give you crumbs.

I respect all those who got an incredible PP position, but from my own anecdotal experience, you will not be compensated fairly at 99% of the places you look at. Even if you are learning and building yourself up - you will inevitably build resentment towards the group because a bulk of your salary will go to taxes, student loans, gas, etc while you work 15 hour days, 6 days a week. only to leave in a year or two after paying you 10k in tail end malpractice and trying to relocate 50 miles from your non-compete. My 2 cents.

 

[heybrother]

Anecdotal but recent additional data from my own perspective:

I interviewed with 20 or so PP's and while some were good honest people, every single one of them balked at the salary I asked for. Some said "well we can get you to that number with your bonus for sure, but our base is 80-120k". I think the highest PP salary I negotiated to (with their counter negotiation downwards) was 140k base with 25% bonus after 300k collections in Tampa, FL. That involved working for their 3-5 clinics in the area. I get it, Florida has no income tax and cost of living is probably less than the tri-state, but the offers from PP have been a complete joke as a whole. No one talks about it in residency up here, or the attending's try and make it "normal" by saying "so many associates accept 100-120k for the area, and thats the average. Aim for 120k" - no way man lol

As a whole, 85k was the lowest offered (Miami, FL). 140k was the highest (Tampa and NYC).
NJ the range was from 100-120k on average (about 10 practices), there were two places that offered 130k.
Connecticut guy offered 140k and was genuinely a nice guy and upfront about everything, but did not negotiate above that.
NY in Hudson Valley, they offered 120k but you had to work 7 days a week and cover call every other week. The other practice was similar set up.
NYC was a crap shoot, 120-140k but cost of living is insane and they made you go to Long Island as one of their satellite offices.
Many of these offers above did not offer more than 2 weeks of vacation, did tail-end malpractice (where you'd owe 10k if you left), had difficult to reach bonus structure (especially as first year), and you had to work at MINIMUM six days a week, and usually between 3 offices. Quality of life seemed abysmal IMO.

Compare that to my MSG offers
180-200k with bonus structure, malpractice, full benefits, 4 weeks vacation with "unlimited" sick call (they were flexible and understood), no call. They respected me more during the interview, asked me what I'd want or need from them. 1 mile non-compete. Generous CME. Bonus structure was fantastic for what I have seen on here.

Ortho was even better but that might have been a one-off. One ortho practice discussed upwards of 280k with no call but then told me they would consider adding podiatry next year - it was more of a luxury boutique ortho/physical therapy group that tailored towards firefighters/police officers. The other which specialized only in Hand, shoulder, hips, knees the talks didn't progress far enough for salary discussions. Unfortunately, ortho in the Northeast is very anti-podiatry and would rather eat the foots than give any to a pod. It be what it be I guess.

I did not apply to any hospitalist position, I wish I did though just to get more data.

As for fellowship training, none of the MSG, Ortho, or Vascular places I interviewed at asked me about it. PP's did which I found funny. PP held an infinitely higher standard in terms of education and surgical prowess, but when it came down to negotiating salary, call schedule, etc - they all want to give you crumbs.

I respect all those who got an incredible PP position, but from my own anecdotal experience, you will not be compensated fairly at 99% of the places you look at. Even if you are learning and building yourself up - you will inevitably build resentment towards the group because a bulk of your salary will go to taxes, student loans, gas, etc while you work 15 hour days, 6 days a week. only to leave in a year or two after paying you 10k in tail end malpractice and trying to relocate 50 miles from your non-compete. My 2 cents.

Damn. Props to you for doing that many interviews.

 

[CutsWithFury]

Currently, good $/wRVU reimbursements are lower than what a PP doc would get for billing the same code to Medicare. So people getting $40-45 per wRVU are still getting screwed to some extent. Podiatry could easily command closer to $60 per wRVU but new contracts are based off of current median figures so it’s gonna take awhile for those to rise while current employed docs negotiate increases in their contracted rates. The problem for the PP doc is that they have to use such a large chunk of that reimbursement to pay rent, staff, EMR, supply costs, etc. That’s why you generally come out ahead as an employed doc for the same amount of work (though PP certainly can have large tax advantages). But it’s not as if you’re actually getting a cut of the facility fees in your pay check (in almost all cases). You’re simply getting a higher % of every E/M and CPT $ you bring in.

I think this is a well thought out breakdown but majority of employed docs I know get 100% RVU reimbursement for each procedure they do. If you are in this kind of a set up its really easy to rack up the RVUs which in the end gives you these giant bonuses on top of a strong base salary. Ultimately that ends up being a lot more money than any successful private practice that I know of. Unless the private practice is really one of the top podiatry practices in the state or they are really aggressive billing fraudulent in office procedures they didn't do, etc.

9 times out of 10 the hospital/MSG employed doc is going to make significant more money than PP podiatrist. Even if they are only being given $40-45 per RVU. I worked in this environment for 4.5 years and made a killing while my colleagues bounced around from PP to PP trying to not get railed as badly as their previous position.

 

[DYK343]

Anecdotal but recent additional data from my own perspective:

I interviewed with 20 or so PP's and while some were good honest people, every single one of them balked at the salary I asked for. Some said "well we can get you to that number with your bonus for sure, but our base is 80-120k". I think the highest PP salary I negotiated to (with their counter negotiation downwards) was 140k base with 25% bonus after 300k collections in Tampa, FL. That involved working for their 3-5 clinics in the area. I get it, Florida has no income tax and cost of living is probably less than the tri-state, but the offers from PP have been a complete joke as a whole. No one talks about it in residency up here, or the attending's try and make it "normal" by saying "so many associates accept 100-120k for the area, and thats the average. Aim for 120k" - no way man lol

As a whole, 85k was the lowest offered (Miami, FL). 140k was the highest (Tampa and NYC).
NJ the range was from 100-120k on average (about 10 practices), there were two places that offered 130k.
Connecticut guy offered 140k and was genuinely a nice guy and upfront about everything, but did not negotiate above that.
NY in Hudson Valley, they offered 120k but you had to work 7 days a week and cover call every other week. The other practice was similar set up.
NYC was a crap shoot, 120-140k but cost of living is insane and they made you go to Long Island as one of their satellite offices.
Many of these offers above did not offer more than 2 weeks of vacation, did tail-end malpractice (where you'd owe 10k if you left), had difficult to reach bonus structure (especially as first year), and you had to work at MINIMUM six days a week, and usually between 3 offices. Quality of life seemed abysmal IMO.

Compare that to my MSG offers
180-200k with bonus structure, malpractice, full benefits, 4 weeks vacation with "unlimited" sick call (they were flexible and understood), no call. They respected me more during the interview, asked me what I'd want or need from them. 1 mile non-compete. Generous CME. Bonus structure was fantastic for what I have seen on here.

Ortho was even better but that might have been a one-off. One ortho practice discussed upwards of 280k with no call but then told me they would consider adding podiatry next year - it was more of a luxury boutique ortho/physical therapy group that tailored towards firefighters/police officers. The other which specialized only in Hand, shoulder, hips, knees the talks didn't progress far enough for salary discussions. Unfortunately, ortho in the Northeast is very anti-podiatry and would rather eat the foots than give any to a pod. It be what it be I guess.

I did not apply to any hospitalist position, I wish I did though just to get more data.

As for fellowship training, none of the MSG, Ortho, or Vascular places I interviewed at asked me about it. PP's did which I found funny. PP held an infinitely higher standard in terms of education and surgical prowess, but when it came down to negotiating salary, call schedule, etc - they all want to give you crumbs.

I respect all those who got an incredible PP position, but from my own anecdotal experience, you will not be compensated fairly at 99% of the places you look at. Even if you are learning and building yourself up - you will inevitably build resentment towards the group because a bulk of your salary will go to taxes, student loans, gas, etc while you work 15 hour days, 6 days a week. only to leave in a year or two after paying you 10k in tail end malpractice and trying to relocate 50 miles from your non-compete. My 2 cents.

This made me sad inside.

 

[zircushio]

Damn. Props to you for doing that many interviews.

I could probably write an article on it, but in today's age of virtual interviews, it takes about 10 minutes. Some of which I did on vacation in the hotel room before going to the beach.

I definitely didn't need to do that many interviews, but doing so gave me two main advantages: 1) I knew PP were taking advantage of fresh graduates from residency. Even if there is the rare unicorn that pays well, it isn't nearly as good as MSG/Ortho/Vascular. 2) The expectations from PP of performing is 1000% higher than joining say an MSG. The MSG doesn't know what we do as a whole, just wants to refer foot and ankle stuff to you. Ton of respect, ton of equality. The hardest part about this is finding an MSG looking to hire, and that comes from cold-calling and hard work. If you put in zero effort, you will get trash offers from attending's who want your labor for minimal pay.

 

[CutsWithFury]

I could probably write an article on it, but in today's age of virtual interviews, it takes about 10 minutes. Some of which I did on vacation in the hotel room before going to the beach.

I definitely didn't need to do that many interviews, but doing so gave me two main advantages: 1) I knew PP were taking advantage of fresh graduates from residency. Even if there is the rare unicorn that pays well, it isn't nearly as good as MSG/Ortho/Vascular. 2) The expectations from PP of performing is 1000% higher than joining say an MSG. The MSG doesn't know what we do as a whole, just wants to refer foot and ankle stuff to you. Ton of respect, ton of equality. The hardest part about this is finding an MSG looking to hire, and that comes from cold-calling and hard work. If you put in zero effort, you will get trash offers from attending's who want your labor for minimal pay.

So where did you end up?

 

[zircushio]

So where did you end up?

MSG! I need to educate the staff and providers about what we do, but overall better pay with better hours. Let's see what happens

 

[wakaflocka88]

Anecdotal but recent additional data from my own perspective:

I interviewed with 20 or so PP's and while some were good honest people, every single one of them balked at the salary I asked for. Some said "well we can get you to that number with your bonus for sure, but our base is 80-120k". I think the highest PP salary I negotiated to (with their counter negotiation downwards) was 140k base with 25% bonus after 300k collections in Tampa, FL. That involved working for their 3-5 clinics in the area. I get it, Florida has no income tax and cost of living is probably less than the tri-state, but the offers from PP have been a complete joke as a whole. No one talks about it in residency up here, or the attending's try and make it "normal" by saying "so many associates accept 100-120k for the area, and thats the average. Aim for 120k" - no way man lol

As a whole, 85k was the lowest offered (Miami, FL). 140k was the highest (Tampa and NYC).
NJ the range was from 100-120k on average (about 10 practices), there were two places that offered 130k.
Connecticut guy offered 140k and was genuinely a nice guy and upfront about everything, but did not negotiate above that.
NY in Hudson Valley, they offered 120k but you had to work 7 days a week and cover call every other week. The other practice was similar set up.
NYC was a crap shoot, 120-140k but cost of living is insane and they made you go to Long Island as one of their satellite offices.
Many of these offers above did not offer more than 2 weeks of vacation, did tail-end malpractice (where you'd owe 10k if you left), had difficult to reach bonus structure (especially as first year), and you had to work at MINIMUM six days a week, and usually between 3 offices. Quality of life seemed abysmal IMO.

Compare that to my MSG offers
180-200k with bonus structure, malpractice, full benefits, 4 weeks vacation with "unlimited" sick call (they were flexible and understood), no call. They respected me more during the interview, asked me what I'd want or need from them. 1 mile non-compete. Generous CME. Bonus structure was fantastic for what I have seen on here.

Ortho was even better but that might have been a one-off. One ortho practice discussed upwards of 280k with no call but then told me they would consider adding podiatry next year - it was more of a luxury boutique ortho/physical therapy group that tailored towards firefighters/police officers. The other which specialized only in Hand, shoulder, hips, knees the talks didn't progress far enough for salary discussions. Unfortunately, ortho in the Northeast is very anti-podiatry and would rather eat the foots than give any to a pod. It be what it be I guess.

I did not apply to any hospitalist position, I wish I did though just to get more data.

As for fellowship training, none of the MSG, Ortho, or Vascular places I interviewed at asked me about it. PP's did which I found funny. PP held an infinitely higher standard in terms of education and surgical prowess, but when it came down to negotiating salary, call schedule, etc - they all want to give you crumbs.

I respect all those who got an incredible PP position, but from my own anecdotal experience, you will not be compensated fairly at 99% of the places you look at. Even if you are learning and building yourself up - you will inevitably build resentment towards the group because a bulk of your salary will go to taxes, student loans, gas, etc while you work 15 hour days, 6 days a week. only to leave in a year or two after paying you 10k in tail end malpractice and trying to relocate 50 miles from your non-compete. My 2 cents.

I hear these stories from my friends all the time. I feel sad for the suckers that fall for the story “well the owners showed me their million dollar house so they must be doing well” and end up joining only to find out they have to work 6 days a week, the owners have complete say on their schedule and practice style and must take call. Why the hell does podiatry still take call for free? The thirst is real. Anyways, these stories aren’t going away anytime soon. I also have friends that pigeon hole themselves into a very specific area of the country and still are jobless as I’m typing this. Either they’re hopeless optimistic or just delusional their top notch fellowship training is supposed to land them a job in a city they believe their services are needed.

 

[CutsWithFury]

I hear these stories from my friends all the time. I feel sad for the suckers that fall for the story “well the owners showed me their million dollar house so they must be doing well” and end up joining only to find out they have to work 6 days a week, the owners have complete say on their schedule and practice style and must take call. Why the hell does podiatry still take call for free? The thirst is real. Anyways, these stories aren’t going away anytime soon. I also have friends that pigeon hole themselves into a very specific area of the country and still are jobless as I’m typing this. Either they’re hopeless optimistic or just delusional their top notch fellowship training is supposed to land them a job in a city they believe their services are needed.

They take call for free because the owners are not taking the call. Their associates are. Podiatry is TERRIBLE.

The profession could be great. The people who lead it are not. As a profession we have no spine and ortho takes a crap on us whenever they want. If a new ortho comes into town or joins the hospital that is anti-podiatry consider your life about to be turned upside down and you will need to lawyer up to protect your practice.

Fellowship training is so overrated and is now being used as a device to further divide the profession. Fellowship trained DPMs now look down upon well trained 3 year DPMs. The viscous cycle continues.

 

[zircushio]

They take call for free because the owners are not taking the call. Their associates are. Podiatry is TERRIBLE.

The profession could be great. The people who lead it are not. As a profession we have no spine and ortho takes a crap on us whenever they want. If a new ortho comes into town or joins the hospital that is anti-podiatry consider your life about to be turned upside down and you will need to lawyer up to protect your practice.

Fellowship training is so overrated and is now being used as a device to further divide the profession. Fellowship trained DPMs now look down upon well trained 3 year DPMs. The viscous cycle continues.

Yeah, it is very sad but greed affects podiatry more than other specialties it seems. The worst is when I got a vascular offer and the guy said "I have a friend in podiatry who offers 100k for his associates, that's the going rate for you guys right?" To be frank, if I didn't get this MSG position, I'd probably suffer through starting my own practice than to deal with expanding another pod's practice

Unfortunately a lot of the fellows around here have gotten the same job they would have gotten if they just skipped fellowship. Guess we got the last laugh?

 

[Feli]

Anecdotal but recent additional data from my own perspective:

I interviewed with 20 or so PP's
... Tampa, FL...
....Florida ...
...Miami, FL...
...Tampa and NYC...
...NJ ...
...Connecticut ...
...NY in Hudson Valley...
...NYC ...
...I respect all those who got an incredible PP position, but from my own anecdotal experience, you will not be compensated fairly at 99% of the places you look at....

You are looking in terrible and saturated places, my man.
NYC/NJ is the most saturated metro for podiatry and home of many of the worst training programs in the country (and arguably the worst pod school for many decades), so salaries for associates will never do well if there are a great many of them and their skills/certs are often suspect. Florida has the worst ratio of DPMs per population, and while there are also a lot of seniors, it's still very hard to get ahead there. There is a huge advantage to employers in places such as those. It is good you went through the experience, but you are stacking the deck against you.

In places further from high concentration of pod schools and residencies, you will tend to get much better offers (for PP or MSG or hosp or anything). The only place you listed even remotely away from school/residency areas or saturated metros is Conn... and that was your best (tied?) base salary offer, right? That is no coincidence.

If you look where the advantage is to the employEEs, you will tend to get much better offers. Those places are generally suburban, rural, states with less DPMs, states with less doctors overall. Those places also tend to have lower COL, which is a boon to keeping more money for your pocket, loan pays, etc. You will just do much better in western Washington or in Alabama than in downtown Philly or Cleveland, you know? There are good jobs in saturated areas - but they're the exception. There are bad jobs in areas far from pod schools/residencies - again, the exception. Supply and demand.