You’ve been made, all 10 of you

[Foot&AnkleSurgeon]

.... didn’t get any credit for any of those collections because they were billed out under the owners name and the “EHR wouldn’t allow them to determine what I did vs what he did since it was all billed under his name.” Never mind the fact that I literally saw everyone in clinic, M-F for 3 months and there was nothing to determine or sort. If it was a day I was in the office, I delivered all of the care and did all of the charting. At $450k in collections I would have made $130k. At $750k in collections, I would have made $220k. In order to pull in what I make now, in this PP practice, I would have needed $1.3 million in collections.

We can look at my “best” PP offer which was 35% of collections. It didn’t include any DME reimbursements or any ancillary revenue. Just E/M and CPT codes. That would only take $1.1 million in collections to match my current pay. Now, with that job there was a defined partner track/buy in…of $650,000 for 25%. So I would get 1/4 of DME and ancillary revenue and pay would be collections minus overhead. Now, we’re talking. I’d only need to collect around $750k to make my current salary. That actually seems reasonable for an associate in a PP group 3-5 years out, as you suggested. But it would cost me $650,000 for the privilege.

""... billed out under the owners name and the “EHR wouldn’t allow them to determine what I did vs what he did since it was all billed under his name.” I believe this is illegal, especially for Federal plans like Medicare and TriCare. Whistleblower?

$650,000 to buy 25% is nuts. You can start your own deal for waaay less than that and own 100%! In my practice we pay 40% with clawbacks for DME. You get paid for the DME but the COGS are taken off the gross collections for the associate. We have health insurance, dental insurance and a retirement plan for all employees. The associate can take as much vacation as he/she wants with this eat what you kill situation. We also try very hard to keep overhead at 50 to 55%. All staff is cross-trained to keep staff to a minimum and is very helpful when someone is sick.

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[air bud]

""... billed out under the owners name and the “EHR wouldn’t allow them to determine what I did vs what he did since it was all billed under his name.” I believe this is illegal, especially for Federal plans like Medicare and TriCare. Whistleblower?

$650,000 to buy 25% is nuts. You can start your own deal for waaay less than that and own 100%! In my practice we pay 40% with clawbacks for DME. You get paid for the DME but the COGS are taken off the gross collections for the associate. We have health insurance, dental insurance and a retirement plan for all employees. The associate can take as much vacation as he/she wants with this eat what you kill situation. We also try very hard to keep overhead at 50 to 55%. All staff is cross-trained to keep staff to a minimum and is very helpful when someone is sick.

Your associates better watch their back or else you are going to be looking for some new ones who just so happen to be on SDN...

 

[Feeter]

Since everyone is writing their experience I'll put mine here. I have said this on SDN few times now

First job was hospital job with lot of call and limb salvage focus at a university. $46 per wRVU.

Now five years out and was going through interviews.

Had three VA jobs all great salary ranges considering amount of work involved
.Had two job offers in metro area with $55 wRVU and $275k startingt this year. All limb salvage and general podiatry offers

Ended up taking a director position for $325k at a different hospital that is not production based with lower FTE

I am pretty lucky and happy with my career choice but many of my friends weren't so lucky to have such career trajectory.

To prospective pre pods or pod residents start looking into academic jobs, focus on limb salvage, research, teaching etc. Seems like it pays off and definitely easier path than to try to become foot and ankle Ortho.

 

[newfeet]

Since everyone is writing their experience I'll put mine here. I have said this on SDN few times now

First job was hospital job with lot of call and limb salvage focus at a university. $46 per wRVU.

Now five years out and was going through interviews.

Had three VA jobs all great salary ranges considering amount of work involved
.Had two job offers in metro area with $55 wRVU and $275k startingt this year. All limb salvage and general podiatry offers

Ended up taking a director position for $325k at a different hospital that is not production based with lower FTE

I am pretty lucky and happy with my career choice but many of my friends weren't so lucky to have such career trajectory.

To prospective pre pods or pod residents start looking into academic jobs, focus on limb salvage, research, teaching etc. Seems like it pays off and definitely easier path than to try to become foot and ankle Ortho.

Congrats on the directorship!

 

[Feeter]

Congrats on the directorship!

Yeah thank you. It has been pretty good so far. Learning lots about leadership and how to manage people but it's been fun. I am hoping few years of this experience will lead to even better opportunities in the future specially in research and leadership. Gunning for a CMO position in 10 years. Or burn out and join VA and chill. Don't know.

 

[newfeet]

Yeah thank you. It has been pretty good so far. Learning lots about leadership and how to manage people but it's been fun. I am hoping few years of this experience will lead to even better opportunities in the future specially in research and leadership. Gunning for a CMO position in 10 years. Or burn out and join VA and chill. Don't know.

I would love to go for a CMO position one day too. I played with the idea of trying for CMIO and I got into a masters program for informatics but delayed it because it would require weekends away from home.

Good luck on the journey.

 

[air bud]

Since everyone is writing their experience I'll put mine here. I have said this on SDN few times now

First job was hospital job with lot of call and limb salvage focus at a university. $46 per wRVU.

Now five years out and was going through interviews.

Had three VA jobs all great salary ranges considering amount of work involved
.Had two job offers in metro area with $55 wRVU and $275k startingt this year. All limb salvage and general podiatry offers

Ended up taking a director position for $325k at a different hospital that is not production based with lower FTE

I am pretty lucky and happy with my career choice but many of my friends weren't so lucky to have such career trajectory.

To prospective pre pods or pod residents start looking into academic jobs, focus on limb salvage, research, teaching etc. Seems like it pays off and definitely easier path than to try to become foot and ankle Ortho.

💯 On limb salvage. Do what others don't want.

 

[HardRoadPaved]

💯 On limb salvage. Do what others don't want.

I like sleep. Hard pass for me. (along with thick toenails😜)

I love the ortho side of this field.

 

[Foot&AnkleSurgeon]

but it seems that many pods are not cut out to be business owners.

100%.

In my practice over 30 years here's how the numbers work. Bill $200,000 in a month and expect to collect $100,000 the next month. So 50%. We get very granular on the numbers each month and share numbers with our associates (they get a spreadsheet each month). Most commonly we collect about $180/pt visit (this includes surgeries and office visits/procedures) and to collect $100,000/month that's 26 patients/day in a 21 day work month. On the other side we monitor overhead closely.

 

[dtrack22]

Which other medical specialty does less than 40% collection bonus.

None. Join the practicing physicians forum. One of the endocrinologists had “associate” jobs in some small private endocrine groups, 50% of collections. One of our ortho residents went into a smaller ortho group after fellowship and his pay was 40% of collections and had a 50% tier (don’t remember when it kicked in).

There is a practice in TX that basically runs a permanent add for associates in PMnews (pretty sure it was outed or discussed in another thread). New associates every year or two. The contract as of a few years ago had the first “bonus” tier at 15% of collections. 15%. And it topped out at 30%. Very similar to one of the contract examples I posted earlier.

My good friend had a $95k base salary at another TX podiatry group and was used as a scribe while the owners saw 100 patients (total) in clinic. Literally had zero of his own patients for 2-3 months.

In medicine, there is nothing else like podiatry associate contracts and jobs…and I don’t mean that in a good way

 

[podwho]

There is ZERO logic in podiatry contracts. MD go into private practice because it pays more than hospitals because they support each other, not rip them off.

For example. MD will get get contacts like this.. I know because I’ve seen them

200k base, 50% over 450k.
At 450 you covered your overhead and your salary. After that you get half of everything you bring in. Every dollar over 450 doesn’t carry the same over head, it goes down. For example rent doesn’t change because you bring in 700k vs 400k. Etc.

So giving 30% over 3x?!?! when you already covered your salary and overhead is a scam. You get the privilege of giving your employer 70 cents on the dollar of near profit. Only in podiatry and we call it a bonus. If you pay **** you’ll always get **** employees.

I think flat 40% is very fair. 50% over 3x is fair. Flat 180 for new grads. But what the hell do I know.

 

[air bud]

There is ZERO logic in podiatry contracts. MD go into private practice because it pays more than hospitals because they support each other, not rip them off.

For example. MD will get get contacts like this.. I know because I’ve seen them

200k base, 50% over 450k.
At 450 you covered your overhead and your salary. After that you get half of everything you bring in. Every dollar over 450 doesn’t carry the same over head, it goes down. For example rent doesn’t change because you bring in 700k vs 400k. Etc.

So giving 30% over 3x?!?! when you already covered your salary and overhead is a scam. You get the privilege of giving your employer 70 cents on the dollar of near profit. Only in podiatry and we call it a bonus. If you pay **** you’ll always get **** employees.

I think flat 40% is very fair. 50% over 3x is fair. Flat 180 for new grads. But what the hell do I know.

My contract with Ortho included 2 offices, xray tech in each one, full xray set up (like you can take spine xrays and stuff). There was a practice manager, a front of house manager, 3 front office, maybe 4-6 MA's. 2 ortho, me and a NP. NP would share space in 1 office with one ortho one day, me another. Never me and ortho or both ortho not big enough. They say 40-55 or 60 a day with 2 sx days.
Monthly overhead - 18k I don't know what that covered.
Billing company - 6% collections
Supplies - 5% collections
I paid employer side of payroll taxes via above the line stuff. Then paid employee side. Paid 100 percent of own health insurance. Got info to enroll in profit sharing/401k about a week before we "decided to separate."
EMR license was 12k spread out over 1 year, Dragon 1200 bucks over 1 year.

Whatever was left was mine. Some months collected 30k, some months 100k. They helped me out on slow months so I could at least gross 15k but then paid back the next month (I could go up to 40k loaned) Lot of up and down due to how some contracts worked. Surgery paid the bills. BCBS brostom - 1800 bucks, lapidus maybe 1500. A multiple procedure flatfoot was maybe 4k total. Pretty incredible contracts. Then again, when you are the only providers for a few hours in each direction, you can negotiate that stuff. I didn't see medicaid. Was fortunate enough that most of the medicaid had another type of insurance that paid me 2.5x medicare instead.

I saw 20-25 patients in office on Tuesdays, every other wednesday did outreach 1.5-2 hours away saw 15-20 which also included sx sometimes. 25-30 on Thursdays. Friday surgery 3-5 cases. End of the year I was doing 6-9 cases a week. Mondays was always off day, but often did admin stuff or added on infection if anesthesia was kind enough to allow me to do so. So I worked 3 days 1 week 4 days the next. Could take vacation whenever I wanted but if not seeing patients I didn't make money. I didn't take much vacation. I think I collected 7-800k don't remember my first 11 months there. Not sure where I am at for 2022. Still getting 85% of collections for a few months after leaving. That is why I got a check for 21k today even though haven't worked in 2 months. Last month I think I only got 12k. But it is all evening out since I didn't get a check for the first 4 or 5 months as it took time for money to come in but I still had to pay overhead. Been paid about 350k in the last rolling 12 months.

One issue with ortho clinic - xray tech - podiatry doesn't need them but I was helping pay for 2 of them. Instead of 25k for xray it was 150k setup in each location. Right as I was leaving they had hired a full time surgery scheduler and also a person that acted as CEO essentially. One benefit of working for yourself is you can decide where you want to splurge and skimp

Obviously very different than private practice podiatry. As I stated previously in the thread, I approached them about joining them at start of covid. So much was up in the air obviously. Took a year before I actually started. I took on all the risk, only way it could work. I bet on myself and it worked. Until it all fell apart...that store another time.

 

[Utvolsdpm]

My good friend had a $95k base salary at another TX podiatry group and was used as a scribe while the owners saw 100 patients (total) in clinic. Literally had zero of his own patients for 2-3 months.

In medicine, there is nothing else like podiatry associate contracts and jobs…and I don’t mean that in a good way

Why do podiatrists do this? This happened to my friend in Florida. He basically shadowed his employer for months while getting paid practically begging to see patients but the guy wouldn’t let him. Had to end up leaving.

 

[Foot&AnkleSurgeon]

I did hustle a lot though. I made jobs happen.

Bourbon. How about a separate thread on that...

You definately hustle! Any practice should be glad to have you. I love to hear these stories and we all have them. Early in my career I used to go to nursing homes to bust toe nails. smh... needed to pay the bills. Being a student of your profession and hard work will pay off.

 

[CutsWithFury]

Out of residency I worked for a hospital in the northeast. Started at 240k. Next contract 270k. Last contract 290k. $43 per RVU. Towards end of my time I did 800-1000 RVUs a month.

Left and did locum work at $150 per hour with $200 a day ER weekday call fee and $1200 a day weekend call fee for several months.

Got another hospital job in a state with no income taxes. 275k base. 75k sign on bonus. 12k moving stipend. $5000 CME annually. Full family Medical benefits costing me $130 per paycheck. Life insurance paid by hospital. $13750 annual retention bonus. 6 weeks PTO. Gas paid for when going to outreach clinics. $53 per RVU. 5% match of my salary for 403B contributions (save max 34250 per year).

I’ve been very lucky. I got good training and marketed myself. I refused to work for a PP podiatrist. A lot of these hospital jobs fall into place. Do good work and be likable and you will go far. On paper my career has been successful but you’ve never heard of me. I’m not involved with any podiatry circles and I don’t lecture.

Despite the above Im grossly unsatisfied because, like has been mentioned before, things can change. The hospital could do cutbacks. If you are not producing they could change my salary at the end of my 3 year term which I could either accept or I go ahead and try and get another hospital job in a saturated market. Def not as easy as it is for MD/DO. There’s always that “what if”. As a podiatrist you can’t throw your weight around. You have to take the BS. Again you need to be likable. If they hate you, despite you being productive, if you slip up they will find a way to get rid of you.

I’d say once you get a hospital job it’s easier to get another hospital job in the future compared to someone who just graduated residency or has been working in private practice for quite some time. That’s my two cents.

 

[newfeet]

My contract with Ortho included 2 offices, xray tech in each one, full xray set up (like you can take spine xrays and stuff). There was a practice manager, a front of house manager, 3 front office, maybe 4-6 MA's. 2 ortho, me and a NP. NP would share space in 1 office with one ortho one day, me another. Never me and ortho or both ortho not big enough. They say 40-55 or 60 a day with 2 sx days.
Monthly overhead - 18k I don't know what that covered.
Billing company - 6% collections
Supplies - 5% collections
I paid employer side of payroll taxes via above the line stuff. Then paid employee side. Paid 100 percent of own health insurance. Got info to enroll in profit sharing/401k about a week before we "decided to separate."
EMR license was 12k spread out over 1 year, Dragon 1200 bucks over 1 year.

Whatever was left was mine. Some months collected 30k, some months 100k. They helped me out on slow months so I could at least gross 15k but then paid back the next month (I could go up to 40k loaned) Lot of up and down due to how some contracts worked. Surgery paid the bills. BCBS brostom - 1800 bucks, lapidus maybe 1500. A multiple procedure flatfoot was maybe 4k total. Pretty incredible contracts. Then again, when you are the only providers for a few hours in each direction, you can negotiate that stuff. I didn't see medicaid. Was fortunate enough that most of the medicaid had another type of insurance that paid me 2.5x medicare instead.

I saw 20-25 patients in office on Tuesdays, every other wednesday did outreach 1.5-2 hours away saw 15-20 which also included sx sometimes. 25-30 on Thursdays. Friday surgery 3-5 cases. End of the year I was doing 6-9 cases a week. Mondays was always off day, but often did admin stuff or added on infection if anesthesia was kind enough to allow me to do so. So I worked 3 days 1 week 4 days the next. Could take vacation whenever I wanted but if not seeing patients I didn't make money. I didn't take much vacation. I think I collected 7-800k don't remember my first 11 months there. Not sure where I am at for 2022. Still getting 85% of collections for a few months after leaving. That is why I got a check for 21k today even though haven't worked in 2 months. Last month I think I only got 12k. But it is all evening out since I didn't get a check for the first 4 or 5 months as it took time for money to come in but I still had to pay overhead.

One issue with ortho clinic - xray tech - podiatry doesn't need them but I was helping pay for 2 of them. Instead of 25k for xray it was 150k setup in each location. Right as I was leaving they had hired a full time surgery scheduler and also a person that acted as CEO essentially. One benefit of working for yourself is you can decide where you want to splurge and skimp

Obviously very different than private practice podiatry. As I stated previously in the thread, I approached them about joining them at start of covid. So much was up in the air obviously. Took a year before I actually started. I took on all the risk, only way it could work. I bet on myself and it worked. Until it all fell apart...that store another time.

Out of residency I took a 150k hospital I was a seeing 25 to 30 patients at 3 locations at my first job. At wound care I was seeing about 10. 4 locations every week and a 5th once a month. I had 3 or days one at each location. But 2 of the locations didn’t always have anesthesia providers. I was starting to be my RVU goals and I was supposed to get a raise based on that and a bonus but it didn’t happen. They gave a system wide raise of 3% instead. I ended up leaving because of that for a 243k job. 5 years low bonus and no raises it was time. But the hospital was known for losing providers over not paying enough.

 

[air bud]

Out of residency I worked for a hospital in the northeast. Started at 240k. Next contract 270k. Last contract 290k. $43 per RVU. Towards end of my time I did 800-1000 RVUs a month.

Left and did locum work at $150 per hour with $200 a day ER weekday call fee and $1200 a day weekend call fee for several months.

Got another hospital job in a state with no income taxes. 275k base. 75k sign on bonus. 12k moving stipend. $5000 CME annually. Full family Medical benefits costing me $130 per paycheck. Life insurance paid by hospital. $13750 annual retention bonus. 6 weeks PTO. Gas paid for when going to outreach clinics. $53 per RVU. 5% match of my salary for 403B contributions (save max 34250 per year).

I’ve been very lucky. I got good training and marketed myself. I refused to work for a PP podiatrist. A lot of these hospital jobs fall into place. Do good work and be likable and you will go far. On paper my career has been successful but you’ve never heard of me. I’m not involved with any podiatry circles and I don’t lecture.

Despite the above Im grossly unsatisfied because, like has been mentioned before, things can change. The hospital could do cutbacks. If you are not producing they could change my salary at the end of my 3 year term which I could either accept or I go ahead and try and get another hospital job in a saturated market. Def not as easy as it is for MD/DO. There’s always that “what if”. As a podiatrist you can’t throw your weight around. You have to take the BS. Again you need to be likable. If they hate you, despite you being productive, if you slip up they will find a way to get rid of you.

I’d say once you get a hospital job it’s easier to get another hospital job in the future compared to someone who just graduated residency or has been working in private practice for quite some time. That’s my two cents.

Please comment on the hustle it took and the work you put it in to create these jobs. I know yours didn't happen by accident. Your job search was a full-time job.

Also interestingly none of us comment and I don't know anybody who has ever actually worked for a hospital who has been replaced by somebody cheaper or has had administration come and say cool you were doing things for $50 an rvu well stuff happens now you're going to do it for 45. Not sure if we have all just been lucky or if that's more of an urban myth or what.

Agree completely about how once you get a hospital job it's easier to go to another. You are able to talk their lingo understand how the practice model works and you have a track record.

In regards to hustle and getting lucky, again create your own luck as has been described on here many times. You just pick up the phone and start calling. Determine an area and systematically everybody gets a phone call. You create a spreadsheet. One column is Ortho one column is multi-specialty group one column is hospital one column is Private practice. Left hand column is the city's name and then you just start calling and looking at websites etc and find out where podiatrists work and who needs one. All this stuff can be found online. For those of you looking to go rural don't be afraid of calling towns less than 10,000. That was the cutoff when I initially started and was looking for places in the mountain west. Turns out I've now been in two towns of less than 10,000 people on a map that have had hospitals and that have hired me. The large metro area where I trained historically has not hired podiatrist within the multiple large hospital systems. Everybody in the city was in private practice. There has now been a shift because of again how much money and how valuable podiatrist can be to hospital systems so they are finally beginning to hire their own. There is going to be a ton more employed podiatrists in the coming years but change takes time. There could easily be 20 employed podiatrists in this city within these hospitals in 10 years but again that takes time and that's only one URGTPV or whatever graduating class

Again, as has been stated you want some of these hospital jobs you may end up 10 hours North of Fargo in order to get it. Can always move from there. As I have stated, rural living is hard you really have to be the right person and you need the right spouse. It's an means to an end can you do it for two or three years yeah 5 to 6 years and the future going forward that can be a little bit harder trust me. And does it suck that in order to get a lot of these jobs you have to go to the middle of nowhere as opposed to MD's who can find these jobs living in Atlanta or Chicago or San Diego -yeah it does but that's just the way it works. Are there podiatrists hospitals MSG Ortho etc in those same more desirable locations yes. It just so happens that most of the people on this forum who post a lot myself included did the rural route and so is there some anecdotal evidence about how you have to go rural in order to get those jobs yeah probably.

Hint: every state has a hospital association that lists every hospital in the state. If there is a hospital there, there is a population center there that could potentially hire you. They have a podiatrist? Cool don't be discouraged that means they hire podiatrists and could potentially add another. There is no podiatrist cool sounds like they need one you need to explain why they need you.

This works. It's worked for me multiple times and I can think of five or six people that I have personally talked to describing this model who have found and created jobs in rural locations for themselves using this. One guy it took 6 months and hundreds of phone calls. Another one of my friends literally took him three phone calls on his first day of calling and he found a hospital job paying 275k base with 100K student loan payback. He has now been there for about 5 years.

 

[Scrantonicity]

Trained at an awesome residency program, very well rounded--tripled the minimum numbers in everything. First job out of residency...$65K, but had what I considered a "generous" bonus structure (looking back it was crap)--and the other podiatrist was non-surgical...previously referred every bunion out...so I'd be busy right away with surgeries. Location was cool. I took it, thinking I could make it work a lot better after the first year. Well, worked in 3 locations, got super busy quickly, and also did a lot of surgeries. Turns out I also did a ton of free surgeries/consults from the nearby teaching hospital (my boss made me do these mostly no insurance consults, saying they created goodwill with all the other docs in town--pretty sure no one cared lol). Got pretty swamped with these after hours. 2nd year made $120K...figured out this was about the max I was gonna make, and the city was expensive. Also, got tired of working for free at that hospital.

2nd job I was lured in with a higher salary offer, 130K base--very rural area, and the local hospital was going to supplement my salary--anyways, didn't have it in writing. Moved in, everything fell apart with the hospital thing, and I was told my salary would be $90K...also had to pay my own malpractice insurance. We did it 1099 style... What??? OK, but I was desperate, and surely it would get much better after the first year. After all, this guy kept telling me he was leaving, and I would be his exit strategy. Nope, took 3 years for pay to get better (stayed because it was close to my wife's family, and the carrot on the stick of ownership). At 3 years I was finally making that 130K base, all benefits paid... Then I fought for better bonus structure so I could at least make what I thought was fair. I was seeing 75% of the patients, collecting around 600-700K per year. Anyways, never quite got to $200K (highest paid year was $195K when I brought in almost $850K)... I stuck it out with this guy for 8 years believing he was going to pack it up and leave, selling me the practice. Oh well...learned a lot, got Board Certified, kids got to grow up near their grandparents...

Anyways, about to start 3rd job...VA. From all I've heard and read online, I think it's gonna be the place for me to stick it out until the end. It's in a great location--I'm super excited about it, and I feel like it took going down this road of horrific PP to really appreciate what it has to offer. I think it would be different if I had started out with these high paying hospital jobs ($270K+). I'd probably look down my nose at it. Anyways, looking forward to it.

BTW--I had a couple sessions during those 8 years of "hustling" by phone and online--just didn't have any luck...but after reading @air bud description of how he did it...I didn't try hard enough. Definitely takes dogged determination...also, I wasn't interested in being rural anymore.

 

[deleted1138023]

^ depressing lol

 

[Scrantonicity]

^ depressing lol

Hey I think it has a happy ending. Gonna have my student loans paid off in less than a year thanks to PSLF, make a decent salary with amazing benefits...and never again worry about insurance or patient balances...and no selling anything.

 

[air bud]

Hey I think it has a happy ending. Gonna have my student loans paid off in less than a year thanks to PSLF, make a decent salary with amazing benefits...and never again worry about insurance or patient balances...and no selling anything.

I think VA is fantastic idea in today's market. And especially for all these kids on the tik toks...lifestyle/balance/etc VA is great.

And some of these horror stories are important. Gives new grads an idea of warning signs. As a new grad, being desperate it's going to be easy for you to talk your way into things and rationalize. DONT. This is going to be the value of people talking about their experiences. YMMV.

 

[heybrother]

What's funny to me about all of this is - this isn't how the forum started. People would show up here. They'd be pre-pods and they'd say - I don't understand what the pay is for this profession. Some people would throw out numbers of ridiculous variability. Then they'd be told the question had already been answered and the thread would go off topic. We'd quote some old surveys. People would question them. For example, like a decade+ ago there was a survey that basically said people in their first 3 years made $90K (hrrm) and people would say its too small or not reliable or too old.

The heart of it was - there was nothing to go on. Overall salary discussions were extremely dissatisfying. Underlying it all was that the unreliable surveys and state specific salary figures still show - very low numbers-. There's no other MD/DO specialty where a salary survey on a random clickbait website is showing sub-$100K but for podiatry - its very real.

Along the way we had posters start describing their experiences - the residency review threads was probably the start of this forum really publically putting reality out there where everyone could read it. There was a historic CPME or whoever survey of residencies, but it was written by residents who were very motivated to lie. DMU would ask students to survey residencies but the contents of this was by no means public or available.

The natural progression of this was discussion of trying to find a job and the catastrophe that this entails and soon - we started explaining how the sausage was made. People would post their experiences. Pre-pods would come along and say "ugh, no, you make more than that - you make bonuses." We'd then have to explain how an associates pay is actually determined. Base is often all there is. Owners lie. Yes, someone can hire you and have you see 2 patients a day until you quit (happened to 2 people I know).

Is it helpful to just fill threads with "f^&* podiatry". Obviously not however great it feels. But people in this profession are suffering. You don't have believe it. You can sit around waiting for a formal salary survey. While you're waiting - enrollment is collapsing. I don't know that its associated with pay, but I bet students vomit a little on the inside when they these associate numbers. If it isn't abundantly clear - none of the regulars on this forum are going to shed a tear if Ohio, NY, Kent, Sammuel go out of business.

Its a spectrum, but I can only think of one person I know in PP who hasn't been in some way screwed/mistreated. I'm also very amused when I look at the websites of people who gave me terrible offers. I see them hire someone and I see their hire gone in a few months.

 

[Scrantonicity]

What's funny to me about all of this is - this isn't how the forum started. People would show up here. They'd be pre-pods and they'd say - I don't understand what the pay is for this profession. Some people would throw out numbers of ridiculous variability. Then they'd be told the question had already been answered and the thread would go off topic. We'd quote some old surveys. People would question them. For example, like a decade+ ago there was a survey that basically said people in their first 3 years made $90K (hrrm) and people would say its too small or not reliable or too old.

The heart of it was - there was nothing to go on. Overall salary discussions were extremely dissatisfying. Underlying it all was that the unreliable surveys and state specific salary figures still show - very low numbers-. There's no other MD/DO specialty where a salary survey on a random clickbait website is showing sub-$100K but for podiatry - its very real.

Along the way we had posters start describing their experiences - the residency review threads was probably the start of this forum really publically putting reality out there where everyone could read it. There was a historic CPME or whoever survey of residencies, but it was written by residents who were very motivated to lie. DMU would ask students to survey residencies but the contents of this was by no means public or available.

The natural progression of this was discussion of trying to find a job and the catastrophe that this entails and soon - we started explaining how the sausage was made. People would post their experiences. Pre-pods would come along and say "ugh, no, you make more than that - you make bonuses." We'd then have to explain how an associates pay is actually determined. Base is often all there is. Owners lie. Yes, someone can hire you and have you see 2 patients a day until you quit (happened to 2 people I know).

Is it helpful to just fill threads with "f^&* podiatry". Obviously not however great it feels. But people in this profession are suffering. You don't have believe it. You can sit around waiting for a formal salary survey. While you're waiting - enrollment is collapsing. I don't know that its associated with pay, but I bet students vomit a little on the inside when they these associate numbers. If it isn't abundantly clear - none of the regulars on this forum are going to shed a tear if Ohio, NY, Kent, Sammuel go out of business.

Its a spectrum, but I can only think of one person I know in PP who hasn't been in some way screwed/mistreated. I'm also very amused when I look at the websites of people who gave me terrible offers. I see them hire someone and I see their hire gone in a few months.

You summed it all up pretty well.

Also, why do some of us stick it out so long in these bad situations? I think it's a mixture of desire to be near family, and optimism that things are going to get better. Also, Stockholm Syndrome is real.

 

[deleted1138023]

I think VA is fantastic idea in today's market. And especially for all these kids on the tik toks...lifestyle/balance/etc VA is great.

And some of these horror stories are important. Gives new grads an idea of warning signs. As a new grad, being desperate it's going to be easy for you to talk your way into things and rationalize. DONT. This is going to be the value of people talking about their experiences. YMMV.

seems really hard to get a VA job..

 

[Scrantonicity]

seems really hard to get a VA job..

It is. Took me 2 years, and I feel like I won some kind of lottery. I wasn't even the first choice. I think they tried to hire 2 other people before me.

 

[deleted1138023]

It is. Took me 2 years, and I feel like I won some kind of lottery. I wasn't even the first choice. I think they tried to hire 2 other people before me.

any tips?

 

[Scrantonicity]

any tips?

Well, not sure how I stood out at all other than being ABFAS Certified and 10 years our.

Other than that. Just being patient. I wrote this VA off many times thinking surely I would have heard something after getting the email saying my application had been referred to the hiring manager. It was like 6 months later I got a phone interview...then almost a year later I was invited to go interview in person...then it was another month or so before I got the "tentative offer"....then had to get credentialed and background checked and onboarding done before I got the "firm" offer (also took months).

They. Are. Slow.

 

[CutsWithFury]

Typically hospitals will show favoritism to candidates that are local to the area. In my case I was completing residency in the Pacific Northwest. I started looking for jobs in the middle of my 2nd year of residency.

I cold called hospitals. Reached out to recruiters of hospital systems I wanted to get a job at on LinkedIn. Tried to get any tips I could. Nothing ever materialized.

Started snooping around private practice offers. Saw one in NY for 100k base but you needed to work 6 days a week from 8am to 5pm. I got an offer from a guy in Bakersfield who was offering 125k but the bonus structure made zero sense and he told me I would be “lucky” to get the job. Another PP offer was in Delaware where I was offered 100k salary 30% collections after 600k gross collections. That offer was only 1 year contracts at a time.

So after I saw those offers I really kicked it into high gear and started spamming every hospital job I could find online looking for foot and ankle orthos or just a general orthopedist. If they didn’t have a podiatrist on staff I was sending them my CV.

I sent my CV to a hospital in the northeast who was looking for a general orthopedist and the hospital did not have a podiatrist on staff. The recruiter ended up calling me back and asked me why did I apply as a podiatrist. This was in the middle of residency clinic. I gave the recruiter my premeditated speech on my training and skill set and what I could offer. They listened and didn’t say much. Then they hung up. Two weeks later I got a call from the same hospital who wanted to bring me in for an interview and I ended up getting the job.

I started the podiatry program at this hospital that historically didn’t let podiatrists do very much. I broke down walls and kicked and screamed and clawed my way to the top while fighting with ortho and getting zero support from the podiatrists in my state who resented I got a hospital job in their backyard. It was my experience at this hospital which has made me as jaded as I am. I could have handled it better but it was hard considering this was my first job out of residency and I was facing, at times, unfair odds.

I’ve learned a great deal from these experiences. I did get cases to become board certified in foot and rearfoot/ankle and I had a bunch of productivity and positive patient review data that I saved which I would use to add to my application packet for new hospital jobs that applied for.

 

[air bud]

And this is the thing that the prepods don't understand. You are investing an additional 7 to 8 years of your life and hundreds of thousands of dollars. There should be at least some baseline that you can expect for that significant amount of time and money. You go into emergency medicine if you have a pulse you're going to make $300,000 sure the particulars of the job will be different. If you somehow get into Ortho cool $500,000 minimum if you have a pulse. Particulars of the job May differ. Go into podiatry you may be stuck in nail jail and make $100,000 a year or you may get $300,000 a year. That's a pretty big difference in a terrible return on your investment. Sure of course people who succeed in life often are going to get that success due to betting on themselves. But you need to put yourself in the best position in order to succeed. And I don't think some of these schools and residencies are doing that.
Not thinkknow.

 

[malleolusman]

Typically hospitals will show favoritism to candidates that are local to the area. In my case I was completing residency in the Pacific Northwest. I started looking for jobs in the middle of my 2nd year of residency.

I cold called hospitals. Reached out to recruiters of hospital systems I wanted to get a job at on LinkedIn. Tried to get any tips I could. Nothing ever materialized.

Started snooping around private practice offers. Saw one in NY for 100k base but you needed to work 6 days a week from 8am to 5pm. I got an offer from a guy in Bakersfield who was offering 125k but the bonus structure made zero sense and he told me I would be “lucky” to get the job. Another PP offer was in Delaware where I was offered 100k salary 30% collections after 600k gross collections. That offer was only 1 year contracts at a time.

So after I saw those offers I really kicked it into high gear and started spamming every hospital job I could find online looking for foot and ankle orthos or just a general orthopedist. If they didn’t have a podiatrist on staff I was sending them my CV.

I sent my CV to a hospital in the northeast who was looking for a general orthopedist and the hospital did not have a podiatrist on staff. The recruiter ended up calling me back and asked me why did I apply as a podiatrist. This was in the middle of residency clinic. I gave the recruiter my premeditated speech on my training and skill set and what I could offer. They listened and didn’t say much. Then they hung up. Two weeks later I got a call from the same hospital who wanted to bring me in for an interview and I ended up getting the job.

I started the podiatry program at this hospital that historically didn’t let podiatrists do very much. I broke down walls and kicked and screamed and clawed my way to the top while fighting with ortho and getting zero support from the podiatrists in my state who resented I got a hospital job in their backyard. It was my experience at this hospital which has made me as jaded as I am. I could have handled it better but it was hard considering this was my first job out of residency and I was facing, at times, unfair odds.

I’ve learned a great deal from these experiences. I did get cases to become board certified in foot and rearfoot/ankle and I had a bunch of productivity and positive patient review data that I saved which I would use to add to my application packet for new hospital jobs that applied for.

Same circumstances. I was first pod to join Hospital based group to join the group that was acquired by hospital a year earlier.

Colleagues did nothing but create difficulty and undermine what I “should” be allowed to do. Right down to the fact they would refer midfoot fusions to ortho and not their own colleague who could do this stuff. The training between partners in our group was worlds apart. We had some guys who did whirlpool soaks and others who created lobster foot masterpieces out of diabetics.

Money isn't everything. All of us will (hopefully) make good money at some point. Going back to the marvel theme and quoting Gamora, “but what did it cost?” - seemingly endless professional frustration. Which for most of us, is continuing.

 

[newfeet]

Going back to the marvel theme and quoting Gamora, “but what did it cost?” - seemingly endless professional frustration. Which for most of us, is continuing.

My soul…but no one got a fancy stone to save the world. 🤔

 

[CutsWithFury]

Money isn't everything. All of us will (hopefully) make good money at some point. Going back to the marvel theme and quoting Gamora, “but what did it cost?” - seemingly endless professional frustration. Which for most of us, is continuing.

100%

I could not ask for a better hospital gig than I have now. I really do love it. I just don't love the profession.

I don't love how podiatrists treat each other. There has always been a hierarchy where podiatrists with 1-2 years of residency training look down on DPMs with none. Then its 3 year trained podiatrists who look down on the 1-2 year trained DPMs. Now it is turning into the fellowship trained podiatrists looking down on the 3 year trained DPMs. The cycle continues. As well as the continuous back stabbing that occurs and podiatrists defaming other podiatrists. The only people we can push around are each other because the MD/DO world doesn't take us seriously.

I don't love our leadership which is fragmented and doesn't care about the greater good of podiatry as a whole but rather is more invested in their own interests and goals. There is no universal scope in podiatry which is by FAR THE BIGGEST issue this profession faces and is literally source of the majority of podiatrists frustrations in some way shape or form. The APMA does nothing.

I don't like how AOFAS is clearly making a push to discredit this profession with their research articles on ankle fractures and TARs done by FA ortho vs podiatrists and there is literally no pushback from our profession. The AOFAS agenda is so clear but our leaders will not do anything for fear of retribution that might cost them their orthopedic group jobs. AOFAS is able to lecture freely on our training and unprofessionally attack us but when we stick up for ourselves we get no support from the MD/DO world because they are still unsure what we do as podiatrists due to the scope variability and our training variability.

 

[PTPuser]

Well, not sure how I stood out at all other than being ABFAS Certified and 10 years our.

Other than that. Just being patient. I wrote this VA off many times thinking surely I would have heard something after getting the email saying my application had been referred to the hiring manager. It was like 6 months later I got a phone interview...then almost a year later I was invited to go interview in person...then it was another month or so before I got the "tentative offer"....then had to get credentialed and background checked and onboarding done before I got the "firm" offer (also took months).

They. Are. Slow.

When you're ready and if you're down to pass the wonderful word of wisdom and experience at the VA to us lowly student peasants, please share. Would love to hear it. 👏
👏

 

[air bud]

There are some good VA threads out there

 

[PTPuser]

There are some good VA threads out there

haha I read them all cause I'm psycho

 

[PMG03470]

Hey I think it has a happy ending. Gonna have my student loans paid off in less than a year thanks to PSLF, make a decent salary with amazing benefits...and never again worry about insurance or patient balances...and no selling anything.

How do you get PSLF if you were in PP? I’m
Confused… you have to be employed by non-profit organization I thought?

 

[Scrantonicity]

How do you get PSLF if you were in PP? I’m
Confused… you have to be employed by non-profit organization I thought?

Under the current waiver, if I get on the program before October 31st, it's as if all the payments I've made so far count--which would put me at about the required 10 years. This is how it's been explained to me by my loan people, and from everything I've read it seems legit. I hope I'm not wrong haha

 

[tacoboutit]

any tips?

To be honest I think it’s just luck. My residency was a non-VA residency. I did some rotations at the VA so I mentioned that in my cover letter. My VA needed someone that could do RF/ankles and I was decently trained it in. Tripled my numbers. But looking back at it I wished I had more training. I’ve learned a lot on the job and from my peers now. Im very lucky I get to work with amazing docs who have a lot more experience than I do. Anyway, my VA is not in a desirable area so that’s the downside. The salary and benefits were way more important to me than the location because I know how hard it is to get into the VA. I was willing to sacrifice it. And with holidays off, no calls, 13 sicks days and 5 weeks PTO I tend to travel a lot! Also, I have a better chance transferring to another VA or IHS now that I am in one. You just gotta be flexible!

 

[tacoboutit]

Under the current waiver, if I get on the program before October 31st, it's as if all the payments I've made so far count--which would put me at about the required 10 years. This is how it's been explained to me by my loan people, and from everything I've read it seems legit. I hope I'm not wrong haha

Woohoo let us know if you get it paid off! Great timing! 6 more years for me.

 

[tacoboutit]

Well, not sure how I stood out at all other than being ABFAS Certified and 10 years our.

Other than that. Just being patient. I wrote this VA off many times thinking surely I would have heard something after getting the email saying my application had been referred to the hiring manager. It was like 6 months later I got a phone interview...then almost a year later I was invited to go interview in person...then it was another month or so before I got the "tentative offer"....then had to get credentialed and background checked and onboarding done before I got the "firm" offer (also took months).

They. Are. Slow.

Wow that IS SLOW! My experience was the opposite. Everything was done in about 2 months.

 

[Scrantonicity]

Wow that IS SLOW! My experience was the opposite. Everything was done in about 2 months.

Yeah...maybe Covid had something to do with it, and the fact that I was not their first choice.

 

[Feli]

Wow that IS SLOW! My experience was the opposite. Everything was done in about 2 months.

You had a serious exception there. Not typical.

VA/IHS jobs in general are not particularly hard to get... there are a ton of them, more pop up every week. Some are filled but still posted, others have been vacant awhile yet not posted yet. Either way, should be a dozen spots to a few dozen listed and taking apps at any given time.

The issue is sloooooow HR screening, interviews, ref checks, offer letters, on-board, etc for nearly all govt doc jobs. That is the "hard to get" part.

The problem is that most good candidates will get tired of waiting and take another job. They take another job, and the VA goes back to searching again... since the rest of their app pool also didn't want to wait a year. Thats why you see the same VA job listed for 6-12+ mo fairly often, yet that's almost never the case for private sector. VAs employ way more DPMs (and MD/DOs) that are non surg or trying to do surgery/practice without BC than private hospitals do, though. Many, even those in charge of hiring, have faaar from an amazing resume. The difference is that it's mediocre/low pay for the MDs but viewed as good by DPMs (now).

For anyone who wants those jobs, just apply on usajobs.gov, but BE PATIENT. The better your resume or connections are, try more popular cities. Apply 2nd year of residency or knowing you'll likely be at your current job at least a year before any possible offer letter. If you have a decent CV and are flexible on location, it'll happen... eventually, maybe 2yrs-ish. Scranton timeline is unfortunately fairly average. I get interview invites or references check calls from VA/IHS apps that I or the applicant probably long forget about... that's how behind the govt hirings are (happens with private hospitals too - but far rarer).

Also, be fairly sure what you're getting into. "If you've seen one VA, you've seen one VA." I'd be very tentative to take a sketchy location/hospital with plans to transfer later... takes awhile and no sure thing. Some IHS/VA have little or no surgery... most are wound/amp heavy... and some do real RRA or even fair volume elective (moreso IHS since many more female pts). Some govt DPM jobs have cush banker hours, and some significant volume or call thats akin to private hospitals where you make about 2x compensation. Ortho relationships may be supportive or adversarial. Staffing might be fine or might be pathetic. Boss/supervisor being competent is very very key in govt setups. One VA is not all... eval them individual as you would a private hosp or PPs.

As said, a few good threads on VA jobs. GL

 

[icebreaker32]

When you're ready and if you're down to pass the wonderful word of wisdom and experience at the VA to us lowly student peasants, please share. Would love to hear it. 👏
👏

You had a serious exception there. Not typical.

VA/IHS jobs in general are not particularly hard to get... there are a ton of them, more pop up every week. Some are filled but still posted, others have been vacant awhile yet not posted yet. Either way, should be a dozen spots to a few dozen listed and taking apps at any given time.

The issue is sloooooow HR screening, interviews, ref checks, offer letters, on-board, etc for nearly all govt doc jobs. That is the "hard to get" part.

The problem is that most good candidates will get tired of waiting and take another job. They take another job, and the VA goes back to searching again... since the rest of their app pool also didn't want to wait a year. Thats why you see the same VA job listed for 6-12+ mo fairly often, yet that's almost never the case for private sector. VAs employ way more DPMs (and MD/DOs) that are non surg or trying to do surgery/practice without BC than private hospitals do, though. Many, even those in charge of hiring, have faaar from an amazing resume. The difference is that it's mediocre/low pay for the MDs but viewed as good by DPMs (now).

For anyone who wants those jobs, just apply on usajobs.gov, but BE PATIENT. The better your resume or connections are, try more popular cities. Apply 2nd year of residency or knowing you'll likely be at your current job at least a year before any possible offer letter. If you have a decent CV and are flexible on location, it'll happen... eventually, maybe 2yrs-ish. Scranton timeline is unfortunately fairly average. I get interview invites or references check calls from VA/IHS apps that I or the applicant probably long forget about... that's how behind the govt hirings are (happens with private hospitals too - but far rarer).

Also, be fairly sure what you're getting into. "If you've seen one VA, you've seen one VA." I'd be very tentative to take a sketchy location/hospital with plans to transfer later... takes awhile and no sure thing. Some IHS/VA have little or no surgery... most are wound/amp heavy... and some do real RRA or even fair volume elective (moreso IHS since many more female pts). Some govt DPM jobs have cush banker hours, and some significant volume or call thats akin to private hospitals where you make about 2x compensation. Ortho relationships may be supportive or adversarial. Staffing might be fine or might be pathetic. Boss/supervisor being competent is very very key in govt setups. One VA is not all... eval them individual as you would a private hosp or PPs.

As said, a few good threads on VA jobs. GL

One of the best summaries of the VA and podiatry jobs. I would say the jobs, especially in desirable areas are more competitive than they used to be.

The chief/committee have a good bit of leverage to choose who they want, but only to an extent.....it is hard to pick one very similar candidate over another if one of them served for 4 years in the military before going to college/podiatry school as an example.

They prefer a couple years of experience in general, but some do get VA jobs straight out of residencies.

UnlIke your CV in the private sector don’t be brief. List all your experience and strengths in great detail, and even leadership roles in your life outside of podiatry. Your CV might not be what gets you the job, but it could be what helps you get the interview......you can not get the job if you don’t get the interview. It might also help with your salary determination. There are guidelines they have for salary (base + market pay) that include COL, experience, board certification, leadership, publications academic positions and probably a dozen other factors. Even with all those factors there is more local discretion for salary than you would expect…….usually it might be 20K give or take for one similar candidate and similar COL area for one VA versus another, but it could be double that or even more sometimes also.

I was the first choice at the VA I interviewed at, but they had gone through all the interviewing many months before I interviewed and their candidate did not work out for some reason. Same exact story for my prior hospital job actually. I was their first choice, but they had chosen someone else many months before my interview and their chosen candidate did not work out for some reason.

If you are a strong candidate, you will eventually get a job if you are geographically open and patient…….that is the podiatry way. It might be hard, but don’t get your heart set on any particular job opening or try to figure out why at one jon posting you were interviewed and at other similar postings you don't even get an e-mail response ......this holds true for any job setting and podiatry.

 

[msuDPM]

Under the current waiver, if I get on the program before October 31st, it's as if all the payments I've made so far count--which would put me at about the required 10 years. This is how it's been explained to me by my loan people, and from everything I've read it seems legit. I hope I'm not wrong haha

Ouch. Sad, but you are misinformed (I believe) the waiver counts all periods of forbearance (up to 36 months) and periods where you made payments other than IBR, but still ALL payments must have been made while employed by a 501 (c) (3). All payments while employed by a for profit org will not be counted.

Sounds like you're with a VA now, so will eventually qualify, but I wouldn't expect it soon.

 

[Scrantonicity]

Ouch. Sad, but you are misinformed (I believe) the waiver counts all periods of forbearance (up to 36 months) and periods where you made payments other than IBR, but still ALL payments must have been made while employed by a 501 (c) (3). All payments while employed by a for profit org will not be counted.

Sounds like you're with a VA now, so will eventually qualify, but I wouldn't expect it soon.

I sure hope you're wrong 😂. You're the first person to actually tell me this, and I've asked a lot of people (including my loan servicer). Sigh...guess I'll go back and read the fine print...

It has always seemed too good to be true, so I would not be too surprised...I will report back on this by the end of the year.

 

[air bud]

Got that hospital job. My friends joke about me just moving around collecting signing bonuses.
Definitely agree with earlier sentiments about once in one hospital job seems easier to go to another. Can talk the talk etc. Have worked in close environment with other colleagues, etc. Also, can't discount the familiarity it breeds when talking to other doctors at the interview process.

Anyways see previous post about how to find hospitals.

260k base, 25k metrics and stuff easy to obtain. Only 10k signing, 10k moving. RVU bonus but don't know threshold. so 285 plus bonus. No state income tax. 5k cme yearly. 2.5k licensing. No doubt will bonus signifcantly first year, there is plenty of work to be done.
All the standard stuff like short term/long term disability, life insurance, health care, 4% match, 401k and 457 options. 5 year contract but I actually don't like that part. Ever hear of inflation bro? Will ask for 2 or 3. Building new ASC with ability to invest in.

 

[PTPuser]

Got that hospital job. My friends joke about me just moving around collecting signing bonuses.
Definitely agree with earlier sentiments about once in one hospital job seems easier to go to another. Can talk the talk etc. Have worked in close environment with other colleagues, etc. Also, can't discount the familiarity it breeds when talking to other doctors at the interview process.

Anyways see previous post about how to find hospitals.

260k base, 25k metrics and stuff easy to obtain. Only 10k signing, 10k moving. RVU bonus but don't know threshold or other Benny's.. so 285 plus bonus. No state income tax. 5 year contract but I actually don't like that part. Ever hear of inflation bro? Will ask for 2 or 3. Building new ASC with ability to invest in.

Please hire me if you need extra hands on deck in like 3 years

 

[air bud]

Please hire me if you need extra hands on deck in like 3 years

Yes plan is to hire another in few years, right now have about 80k people reach.

 

[dtrack22]

right now have about 80k people reach.

Plenty for two full time pods who are willing to do a little bit of everything and still want a reasonable surgery load. Not enough for 3 no matter what anyone says. Sure, you can have one DPM per 20,000 people or whatever number leadership and older DPMs want to throw out, but if you are really that saturated at least one of you will be poorly compensated and/or be doing a lot more routine foot care than anyone who went through 7 years of school and training would like

 

[de Ribas]

Plenty for two full time pods who are willing to do a little bit of everything and still want a reasonable surgery load. Not enough for 3 no matter what anyone says. Sure, you can have one DPM per 20,000 people or whatever number leadership and older DPMs want to throw out, but if you are really that saturated at least one of you will be poorly compensated and/or be doing a lot more routine foot care than anyone who went through 7 years of school and training would like

If foot/RRA pod is working in a hospital serving 30k-50k population area. Will they be limited on what they can do at that hospital, (assuming pod has great training and it's not a limiting factor)?