Salary Advice for those Finishing up residency!

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doc1107

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Hello,

I would like to offer some Salary advice. As you are finishing with your residency, and the notes from your loans come due. Undoubtedly, you will be starting to look for a job.

Please, I implore you. Negotiate for a higher wage! I know that salary has been discussed here many times and we have people questioning the salary we make.

Do not settle for the sub-par and unfair salaries! We are surgically trained as Podiatry Surgeons! We should not be accepting anything less than 100 K! Have some pride in yourself and in your (our) profession. If we all start to see $150,000+ as the norm for a starting salary then we as a profession will move forward in this issue and never again will we be underpaid!

If you are accepting 60K-80K, you may as well have not gone those last 7 years of post bachelor studies and just gotten a job at a company! In that 7 years, you would have climbed up the ranks and earn that much already!

In fact, if you have a bachelors degree, you could have risen up the ranks at McDonalds in the time it took you to complete schooling and residency and earn 60-80K as a manager without the 6 figure loans to repay!

Here is a great website for what Podiatrist should be making. These data is NOT self reported, they are from hospital and other groups data so they have no bias or agenda. I believe the actual book holds more detail. The actual book is about $400 and they come out annually. You can try a medical library at a university or buy one off of ebay

http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

Don't let Podiatry become what is happening all over America. Just look at the old days before Unions and worker's right laws. Companies were selling the work to the lowest bidder (mainly immigrants because thats all they can get). Stay strong and lets make the salary match the education we have!
 
doc1107 said:
Hello,

I would like to offer some Salary advice. As you are finishing with your residency, and the notes from your loans come due. Undoubtedly, you will be starting to look for a job.

Please, I implore you. Negotiate for a higher wage! I know that salary has been discussed here many times and we have people questioning the salary we make.

Do not settle for the sub-par and unfair salaries! We are surgically trained as Podiatry Surgeons! We should not be accepting anything less than 100 K! Have some pride in yourself and in your (our) profession. If we all start to see $150,000+ as the norm for a starting salary then we as a profession will move forward in this issue and never again will we be underpaid!

If you are accepting 60K-80K, you may as well have not gone those last 7 years of post bachelor studies and just gotten a job at a company! In that 7 years, you would have climbed up the ranks and earn that much already!

In fact, if you have a bachelors degree, you could have risen up the ranks at McDonalds in the time it took you to complete schooling and residency and earn 60-80K as a manager without the 6 figure loans to repay!

Here is a great website for what Podiatrist should be making. These data is NOT self reported, they are from hospital and other groups data so they have no bias or agenda. I believe the actual book holds more detail. The actual book is about $400 and they come out annually. You can try a medical library at a university or buy one off of ebay

http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

Don't let Podiatry become what is happening all over America. Just look at the old days before Unions and worker's right laws. Companies were selling the work to the lowest bidder (mainly immigrants because thats all they can get). Stay strong and lets make the salary match the education we have!
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Why would anyone settle for an unfair salary??? 60-80K may not be a bad deal if it a base salary and there are some reasonable incentives.
 
Well, some people may take the unfair salary because they think it is the norm. It is not and should not be seen as the norm. Also some graduates may be too worried about their 6 figure loan amount and take anything that is offered.
 
doc1107 said:
Well, some people may take the unfair salary because they think it is the norm. It is not and should not be seen as the norm. Also some graduates may be too worried about their 6 figure loan amount and take anything that is offered.
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That's an interesting take on it. Are there really people out there that think taking a low salary is the norm? I can't say I'm aware of anyone! Are you in practice?
 
I've said it before and I'll say it again. There are a lot of very high paying starting job salaries, AND there are a lot of low paying starting job salaries, and in my opinion, several years down the line most of them will eventually balance out.

As I've also stated many times, not so long ago, the "well trained"/3 year rearfoot/ankle trained podiatric resident was a novelty and was able to obtain the high powered positions and starting salaries, and obtained some great hospital based positions, positions with orthopedic groups, etc.

However, now that the 3 year trained DPM is becoming the norm and not the novelty, it's my belief that there will become a saturation point. Not every patient requires major surgical reconstructive surgery, and eventually those high power, high paying positions will be filled and the competition for those positions will become more fierce.

As that happens, there will be those left who will be seeking less glamorous and also less financially rewarding positions. These positions may not start out paying the "big bucks", but as per Jonwill's post may eventually offer bonuses or incentives that have the potential to increase the base salary.

I know as a partner in our group, that to bring on a new doctor and start that doc with $150,000 AND pay his/her malpractice, AND pay for hospital dues, AND pay for APMA dues, AND pay for ABPS dues AND pay for ACFAS dues AND pay for other ancillary benefits NOT even considering health benefits, etc., etc., AND considering our office overhead, that doctor will have to generate at LEAST $325,000 the first year for us just to break even.

And let's face it, we're not hiring any doctor to "break even". It's a business, and we're hiring another doctor to increase our revenue.

So it's very easy to stand up and tell everyone how much you should demand or expect, but from an employer standpoint, you also must understand that there are very real expenses involved with hiring a new doctor, as well as a risk. That's why offers often involve a base with incentives.

In today's healthcare environment, with the increasing cost of overhead, the increasing cost of malpractice and the constantly decreasing rate of insurance reimbursement, it's not always easy to pay an associate what may be considered "fair" to new graduates.

I believe we pay our docs fairly for the geographic area, and the docs certainly have the option not to sign or accept our offer. We don't try to take advantage of anyone, but we attempt to make the contract attractive to both parties.
 
As the initial topic was centered around getting a fair shake as far as being compensated as an employee, I also urge those in the position to make these choices to consider more than just the money that is being offered.

Being involved in someone else's practice involves a significant sacrifice for all involved. Some owners see hiring an associate as a natural progression of their work, in that they have an overload of patients and start realizing that the patients are not being served as they should due to the doctor's volume. The natural progression is that they need another doctor around, who they trust enough with their legacy to include them in the future of their business. One that can help them to take care (not in a strictly medical sense) of their patient population, and assure that the patients get the one on one quality of care the owner feels may be lacking due to inadequate time available by them.

That's the kind of practice I would hope everyone strives to join. Yes, there needs to be financial incentive on both sides (making a living for the employee and make a profit for the employer/owner), but I've spoken to far too many on both sides who admit to getting into this without the proper ideals and goals in mind. Associates are given far too much as a starting salary without the due diligence done by the employer on whether or not they can actually afford this (as with the excellent example of what an new employee really costs a practice by PADPM above) or not. Associates are wowed by the money factor without doing their research and only after the fact realizing that things may not have been as rosy as they expected and that the money is not the only thing they should have sought.

Do your homework as a prospective employee. Find out about who you are merging your talents with. Its not just about the money. Its about your career and where you see yourself in the years to come. Making good money in the beginning is certainly great, but tread lightly if that's the only advantage to going where you are looking to go. Sometimes its worth initially overlooking a lower salary for a positive commitment for the future by all parties involved. Just my 2 cents.
 
I used to think that I deserved a huge salary when I finish a 3 year residency. But my eyes have been opened after talking with some VERY successful podiatrists and marketing managers. I would take a sub-6-figure salary working for a very successful podiatrist just to learn the way they run their office, protocols used, and other management tricks and strategies. Learning those principles and practice management skills is possibly worth lots of $ and time saved making mistakes later. I don't know of any current Podiatry school that prepares students for managing a practice (except Ohio, who just started a program last year).
 
Paulywog said:
I used to think that I deserved a huge salary when I finish a 3 year residency. But my eyes have been opened after talking with some VERY successful podiatrists and marketing managers. I would take a sub-6-figure salary working for a very successful podiatrist just to learn the way they run their office, protocols used, and other management tricks and strategies. Learning those principles and practice management skills is possibly worth lots of $ and time saved making mistakes later. I don't know of any current Podiatry school that prepares students for managing a practice (except Ohio, who just started a program last year).
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It has been explicitly stated that the goal of DMU is to prepare you to pass boards and to prepare you for residency. Thats all.
Yeah, I would like some practice management stuff, but i dont see it happening anytime soon. I think it is one of those things that you just have to figure out yourself once you get out there. I understand you can teach principles now, but in 3-5 years when students are practicing, a lot will change.
 
Paulywog said:
I used to think that I deserved a huge salary when I finish a 3 year residency. But my eyes have been opened after talking with some VERY successful podiatrists and marketing managers. I would take a sub-6-figure salary working for a very successful podiatrist just to learn the way they run their office, protocols used, and other management tricks and strategies. Learning those principles and practice management skills is possibly worth lots of $ and time saved making mistakes later. I don't know of any current Podiatry school that prepares students for managing a practice (except Ohio, who just started a program last year).
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I think that is one excellent way to look at the total picture. And as Kidsfeet stated in another thread, often starting salary is only a portion of the total picture. We pay the APMA dues for our associates, the ABPS dues, the ACFAS dues, all state and local society dues, malpractice premiums, we have an office vehicle for travel to and from one of our more "distant" offices so the associate doesn't have to put mileage on his/her car, we pay all hospital dues and a lot of other expenses I can't recall at the present time. Those numbers add up pretty quickly, and if you have to pay yourself can be a big chunk of change out of your pocket. Additionally, many times there is actually a tax advantage if you're not showing the large income.

These are all items to take into consideration, and ultimately you have to be happy with your decision and most importantly your work environment and long term potential.
 
air bud said:
It has been explicitly stated that the goal of DMU is to prepare you to pass boards and to prepare you for residency. Thats all.
Yeah, I would like some practice management stuff, but i dont see it happening anytime soon. I think it is one of those things that you just have to figure out yourself once you get out there. I understand you can teach principles now, but in 3-5 years when students are practicing, a lot will change.
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Why figure it out later when you can get professional instruction now? Many Doctors that I have spoken to wish they would have started learning about the business side of podiatry when they were students. You will be better prepared and make less mistakes. Trying to learn as much as you can now will save you lots of time, money, and frustration later. I have heard this from many Doctors on many occasions and I will continue to be involved with my schools AAPPM club. Check out your schools club and get involved. It is the most practical and worth while club to be involved with while in school. I like Ohio's addition of a more rigorous business management curriculum. Other schools will integrate it when they see the success at Ohio. The Doctors involved with it are truly amazing and successful.
 
air bud said:
It has been explicitly stated that the goal of DMU is to prepare you to pass boards and to prepare you for residency. Thats all.
Yeah, I would like some practice management stuff, but i dont see it happening anytime soon. I think it is one of those things that you just have to figure out yourself once you get out there. I understand you can teach principles now, but in 3-5 years when students are practicing, a lot will change.
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I also have very strong opinions that every Podiatry School should have a Practice Management type course somewhere in their curriculum. You MUST go into practice with at least a vague idea of coding and billing and the business side of medicine. It will be a huge advantage to you to not only have an interest in this, but become somewhat proficient at it before its your neck on the chopping block. Talk to your profs and attendings about this every opportunity you get. I was very lucky in that where I did my PPMR, a one week practice management course for all interns was mandatory before graduating to the PGY-2 level. It was given by professionals that charge thousands for this same service to new docs.

The APMA is also a good resource for this type of information.
 
My question is what kind of billing/coding information could you get in your 4 years that would a) make any sense to you at all; or b) be the same #'s/procedure as when you go out into practice?

Don't get me wrong. I wouldn't mind practice management type coursework here and there. But I also don't need a current pod to tell me that if I can pay a PT $90k, and I have a large enough practice for them to bill out $200k, that I should look into hiring a PT.

I'd be curious to see what the OCPM program is actually covering and how effective the current students think it is. I would think a program like OCPM should take the few hours a week/month they spend in an AAPM course, and use it to get a higher % of their students to pass the boards. If you can't practice it kind of makes practice management worthless.

[edit] I personally would rather focus on boards/residency placement during school and pick the brains of my director and attendings during residency like kidsfeet did, in order to learn the intricacies of pm
 
I am not sure where you fit this into the curriculum. Maybe OCPM has it right in that it is a 4 year course and you learn a little bit as your other knowledge progresses. At DMU, I am not sure where you fit it in. We are only now (a few weeks) beginning to learn any pod related stuff. So up to this point, there would have been no use for a course in PM/Coding/Billing. It would be like a school teaching surgery techniques before teaching the anatomy. oh wait... DMU students are gone all 4th year, so that leaves you third year to fit in some course. We have other didactic stuff we need to do, as well as get as much clinical exposure as possible. Then the question is who teaches the course? This is not a knock on the faculty at DMU, but how much exposure do they have to running a practice? You can't bring in adjunct faculty to teach the entire course, they don't have the time.

I think having some type of elective would be the first step. I too am involved in the AAPPM and encourage all students to participate in it.
 
In the fourth year, have a mandatory intensive 3 day lecture series covering the basics of practice management (what an encounter forms looks like, the most used codes, the various bullets required for the office visit levels...etc), how to get a loan for opening a practice, what's required to get onto insurance plans, what the various insurance plans mean (HMO, PPO, Capitated plans...etc), some basic Medicare guidelines, the benefits of DME and dispensing, and the list can go on and on.

I realize that some of these things are likely to change in your three years of residency, but at least having some fundamentals will give you a spring board to start from.
 
kidsfeet said:
In the fourth year, have a mandatory intensive 3 day lecture series covering the basics of practice management (what an encounter forms looks like, the most used codes, the various bullets required for the office visit levels...etc), how to get a loan for opening a practice, what's required to get onto insurance plans, what the various insurance plans mean (HMO, PPO, Capitated plans...etc), some basic Medicare guidelines, the benefits of DME and dispensing, and the list can go on and on.

I realize that some of these things are likely to change in your three years of residency, but at least having some fundamentals will give you a spring board to start from.
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I think this idea sounds much more practical. Not only am I MUCH more likely to actually pay attention than I might be first/second year, but it comes at a time where things like loan info, insurance plans, billing/coding, etc. are less likely to change by the time you are ready to practice.

If you made it a national seminar for students, and get the schools to pony up $50-100 of each students' tuition money as a "fee" for the seminar. Then Ornstein and Co. still make money, while teaching most of our graduating students a lot of worthwhile information.
 
Absolutely agree with making it some type of 4th year seminar. At least you are planting the seed. I will run this by a few people i know.
 
air bud said:
I too am involved in the AAPPM and encourage all students to participate in it.
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The AAPPM has recently come under a good deal of scrutiny. It seems that the direction of what they are professing during their conferences revolves around some potentially unethical practices, with respect to in office dispensing and what is being recommended to patients for financial gain. I am not offering an opinion, but have been involved in some groups recently that have kept their distance from the AAPPM for a variety of reasons.

http://www.podiatrytoday.com/blogge...cs-behind-some-‘practice-management’-lectures

They would not be my first choice to help teach the new generation of practitioners the ins and outs of running a practice efficiently. I would prefer to have a professional group run the lecture series, or local, successful, practitioners willing to help out.
 
Like one of the comments under the article said, this isn't unique to podiatry. But if that's what you get from an AAPPM seminar then I would at least have a group like the AACPM review the "curriculum"/lecture series an give it an OK before it is presented. I would think that would weed out the types of presentations Dr. Jacobs is referring to.

What do you mean by professional group?
 
PADPM said:
I know as a partner in our group, that to bring on a new doctor and start that doc with $150,000 AND pay his/her malpractice, AND pay for hospital dues, AND pay for APMA dues, AND pay for ABPS dues AND pay for ACFAS dues AND pay for other ancillary benefits NOT even considering health benefits, etc., etc., AND considering our office overhead, that doctor will have to generate at LEAST $325,000 the first year for us just to break even.
QUOTE]

So does the website that gives all these salary figures take these expenses into account? In other words, is the median salary on the website the amount after these expenses are deducted from total income? Or must we take the malpractice, dues, health benefits, etc. from the salary on the website to see the median take home pay?
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dtrack22 said:
What do you mean by professional group?
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There are professional consulting groups just about everywhere that specialize in helping doctors get off the ground and teach them the ins and outs of running a practice, billing and coding, helping them find staff...etc. Some will even go so far as to apply for all the insurances for docs, get them set up with a billing company, actually find them staff...etc. They do this at a premium price, but they do do an excellent job of it mostly.

A company like this did the practice management course I took as a PGY-1. They also gave out a 3 inch binder FULL of very useful information for a new, clueless doctor about to start practice.
 
QUOTE]
So does the website that gives all these salary figures take these expenses into account? In other words, is the median salary on the website the amount after these expenses are deducted from total income? Or must we take the malpractice, dues, health benefits, etc. from the salary on the website to see the median take home pay?[/QUOTE]

No. The numbers you see are the gross collections only. Or that is how I'm reading the chart at least.
 
dtrack22 said:
Like one of the comments under the article said, this isn't unique to podiatry. But if that's what you get from an AAPPM seminar then I would at least have a group like the AACPM review the "curriculum"/lecture series an give it an OK before it is presented. I would think that would weed out the types of presentations Dr. Jacobs is referring to.
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You would think, but sadly, this is not always the case.
 
I couldn't agree with Dr. Jacob's blog more. There's nothing wrong with providing patients with what they need, but at some point it gets ridiculous trying to "sell" a patient every item in the world.

I keep hearing the same rationale regarding dermatologists selling lotions and creams, etc., but that still doesn't justify DPM's overselling patients products. I have no problem if you sell a patient a moisture lotion in your office IF it's indicated, but some docs are going way too far.

Additionally, there is gross over-utilization. I'm waiting for some DPM to get into trouble with diagnostic ultrasound. In reality, diagnostic ultrasound interpretation can be very difficult, though it is often over simplified. Radiologists are specially trained and fellowship trained in diagnostic ultrasound. Now some DPM purchases a unit, takes a course for a few HOURS, and becomes an "expert". I'm waiting for a large lawsuit when a significant pathology is missed, and that DPM is put on a witness stand in court and is grilled on how he/she was "trained" on interpreting diagnostic ultrasound. He/she will discuss the weekend course that was taken, or the in office training provided by the ultrasound company that encompassed a few "hours", and the expert witness on the other side will be a board certified radiologist who is FELLOWSHIP trained, having spent at least 1-2 years training in diagnostic ultrasound.

And many of these docs simply purchased the units as a way to add to the bottom line, not to provide better care for their patients. Yes, many docs have bought these units to enhance patient care, but I can state without a doubt, that a LOT of docs bought these units simply to increase billing.
 
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PADPM said:
I'm waiting for some DPM to get into trouble with diagnostic ultrasound. In reality, diagnostic ultrasound interpretation can be very difficult, though it is often over simplified. Radiologists are specially trained and fellowship trained in diagnostic ultrasound. Now some DPM purchases a unit, takes a course for a few HOURS, and becomes an "expert". I'm waiting for a large lawsuit when a significant pathology is missed, and that DPM is put on a witness stand in court and is grilled on how he/she was "trained" on interpreting diagnostic ultrasound. He/she will discuss the weekend course that was taken, or the in office training provided by the ultrasound company that encompassed a few "hours", and the expert witness on the other side will be a board certified radiologist who is FELLOWSHIP trained, having spent at least 1-2 years training in diagnostic ultrasound.
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100% agree with this. I was VERY lucky in my residency when US was in its infancy in our profession, and was lucky enough to have a progressive attending who purchased a unit to "play" with and together we did several hundred on each other and on "volunteer" patients and only when he felt he was VERY comfortable with this, did he start charging for this service. At the time the company who sold him the unit offered a radiologist service to "check" our work, and needless to say, for the first bunch, we were WAY off. Happily for the first few months, they offered this service for free as they knew there was a significant learning curve. He and I then trained many of the docs in the area over a year's time, but none of them felt comfortable enough to purchase a unit and then start using it diagnositcally.

Many docs are using it as a cash cow and also don't realise that if you've taken an x-ray that same day, you can't charge for an US. They are also using it and billing for US directed injections or arthrocenteses, and getting paid more for those "procedures", but like everything else, I'm afraid the cash cow will soon run out and the use of the diagnostic tool will become VERY highly scrutinized.
 
Kidsfeet said:
QUOTE]
So does the website that gives all these salary figures take these expenses into account? In other words, is the median salary on the website the amount after these expenses are deducted from total income? Or must we take the malpractice, dues, health benefits, etc. from the salary on the website to see the median take home pay?
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No. The numbers you see are the gross collections only. Or that is how I'm reading the chart at least.[/QUOTE]

So the take-home pay must minimal. If PADPM says it costs over $300K to bring in a new doc, and the website says $190-250K salary depending on if you're in a surgical practice or not, then the numbers aren't adding up. Help!
 
Remember, as a very "general" rule, most practices have an overhead running in the range of approximately 50%. Naturally, some are greater and some are less. However, when a practice brings in an associate, the ultimate goal is to also have that associate INCREASE profits for the practice, not just break even.

So, once again, as a very GENERAL rule, an associate will usually have to generate about twice his/her income for the practice to break even, and I don't know any practices hiring an associate with the goal of breaking even!
 
Kidsfeet said:
There are professional consulting groups just about everywhere that specialize in helping doctors get off the ground and teach them the ins and outs of running a practice, billing and coding, helping them find staff...etc. Some will even go so far as to apply for all the insurances for docs, get them set up with a billing company, actually find them staff...etc. They do this at a premium price, but they do do an excellent job of it mostly.

A company like this did the practice management course I took as a PGY-1. They also gave out a 3 inch binder FULL of very useful information for a new, clueless doctor about to start practice.
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That's what I thought. It's good to hear that they are helpful. We had a marketing guy for a pod practice come talk to us and it was pretty worthless, so I've become kind of skeptical of non-pod "professionals" giving advice on how to run/market a podiatry practice.

Kidsfeet said:
You would think, but sadly, this is not always the case.
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I'm sure nobody "previews" the lecture when it is given to practicing podiatrists. You are all big boys and girls and I would bet they assume you can decide wether or not to utilize what you learn. Once it is being given to students, as a program that is paid for and sponsored by the schools, that's when I think the presidents would want to look at what is being taught...since their names are going to be plastered all over it.

PADPM and Kidsfeet,
At what point does over-utilizing various treatments in order to increase your billings backfire? There has to be some point when the patient finally says, "this idiot can't fix me. My cousin Suzy just had to get an injection and did some stretching. Why do I have to come back 15 times?" Wouldn't a happy patient (and the referrals they may bring in) and a quick, successful treatment plan be more beneficial to your practice (and wallet)?
 
dtrack22 said:
PADPM and Kidsfeet,
At what point does over-utilizing various treatments in order to increase your billings backfire? There has to be some point when the patient finally says, "this idiot can't fix me. My cousin Suzy just had to get an injection and did some stretching. Why do I have to come back 15 times?" Wouldn't a happy patient (and the referrals they may bring in) and a quick, successful treatment plan be more beneficial to your practice (and wallet)?
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I agree with what you are saying dtrack. There are some less scrupulous Pods out there who think that they need to milk every patient while they can, so they throw everything and the kitchen sink at them while they are in the office. In today's age of "shopping around", particularly if you're in a large urban area where there are a lot of doctors, some feel that each patient may or may not return so they make everything they can off them every time they show up. This is a self fulfilling prophecy however, as, just like you say, these patients DO end up going elsewhere for better care. Those of us with confidence in our patient relationships and confidence in the way we care for our patients don't have to resort to these kind of tactics to maintain not only our patient flow, but also our cash flow.
 
That's actually a very complicated question, and I'm afraid my answer isn't as simple as Kidsfeet.

Unfortunately, not all patients are that "bright", and there's a sucker born every minute. In actuality, SOME patients are very impressed with these doctors when every treatment in the world is thrown at them, even some that may not be necessary.

At times, I'm asked the opposite of your "Suzy" question. When I keep a treatment simple, honest and ethical, I'm often asked why I DIDN'T do X,Y and Z, just like "Suzy's" doctor did for her. Suzy's doctor dispensed a useless night splint (some are great and some are useless), Suzy's doctor sold her some cream that would "help" her heel pain, Suzy's doctor has her coming in 3 times a week for "whirlpool" and some other useless office PT that she could do at home herself, Suzy's doctor sold her a "Pro-Stretch", rather than just instructing her on some simple home stretching exercises, Suzy's doctor sold her some frozen rolling device instead of just telling her to put a water bottle in the freezer, etc., etc., etc.

There IS a trick to assure that your patients KNOW you are up to date on the latest treatments and fads, but you simply choose not to utilize them all at once. On the initial visit, my patients with plantar fasciitis receive a hand out that I wrote myself. In that handout it explains the cause of PF and some common misconceptions (such as the "spur" causing pain). I also outline about 18 common treatments from NSAID's, to tapings, to orthoses, to ESWT to RFA, to Topaz and everything in between. Then I explain to the patient how I will proceed. This way my patient understands the treatment plan, and if "A" does not work, we can move to "B", then "C", etc.

This allows my patient to understand that I DO know the treatment options that cousin Suzy has had with her doctor, but I've chosen to take a step wise approach. An additional advantage to this approach is that many patients seek information on the internet. And if you have not already discussed a particular treatment option with a patient, that patient MAY assume you don't know about that treatment and seek care elsewhere.

By informing my patients that I am aware of all treatments, they at least know that there are many options available and I give them no reason to shop around, unless of course they simply don't like ME. But that's rarely the case, because they can't resist my charm😀

I can HONESTLY state that I've never performed a surgery, taken an x-ray, sold a product or performed any treatment that I did not believe was necessary and wouldn't have performed on a family member. I treat patients, not insurance companies, and unfortunately there's a lot of my colleagues who simply see $$$$$$ when treating patients. And that's unfortunate for all involved, because that negatively effects your thinking and ultimately your integrity.
 
Kidsfeet said:
In the fourth year, have a mandatory intensive 3 day lecture series covering the basics of practice management (what an encounter forms looks like, the most used codes, the various bullets required for the office visit levels...etc), how to get a loan for opening a practice, what's required to get onto insurance plans, what the various insurance plans mean (HMO, PPO, Capitated plans...etc), some basic Medicare guidelines, the benefits of DME and dispensing, and the list can go on and on.

I realize that some of these things are likely to change in your three years of residency, but at least having some fundamentals will give you a spring board to start from.
Click to expand...

When I was at NYCPM we had practice management and research discussions on friday mornings during one of the clinic rotations.

In the clinic a superbill had to be filled out for each patient. This was done by the student with the guidance of the profs.

I think this was a very practical way of doing it.

ACFAS also offers billing and coding courses, somewhat useful for modifyers and updates.

It was certainly helpful to learn some coding and billing in school, especially the E/M codes and the #of bullet points needed for each in the HPI, PE, A/P.

Residency is where you should learn more about surgical billing. When you dictate for your attendings, ask them what diagnosis and procedure codes they will use for billing. This way your dictation matches their billing and you learn what really counts as a diagnosis.
 
Anything less than 90k with full benefits is horrible IMO.

There is no excuse for that.

If a practice hires someone it should be bc they have ample pts to sustain the new dr.

New grads can opt NOT to work podiatry and do another job while they save a few bucks for their OWN practice.

No need to work for nothing when you can say screw these old cheap abusers and work outside the field....

Seriously, I would never work for 60k or even 80k as a pod... this only enriches the greedy pod hiring them. There's no benefit.

The ones that do this are basically the lowest level pods who probably suck anyway and have yet to master their skills and are insecure. They are a bane on the profession.
 
GiftedPoster22 said:
Anything less than 90k with full benefits is horrible IMO.

There is no excuse for that.

If a practice hires someone it should be bc they have ample pts to sustain the new dr.

What should happen and what actually happens are sometimes two very different things. As I've said in numerous posts, it is up the the prospective new employee to do the homework and make sure that the new employer is in fact hiring them for the right reasons. Too often these relationships fall apart because the expectations in this regard on both sides is not reasonable and its only discovered after the fact.

New grads can opt NOT to work podiatry and do another job while they save a few bucks for their OWN practice.

This is an unreasonable expectation imho. Opening a new practice is a VERY expensive endeavor and working another job to "save up" would take years. If its done correctly, the funds needed to open an office can be borrowed.

No need to work for nothing when you can say screw these old cheap abusers and work outside the field....

Sorry, but when you open on your own, your are working for less than nothing. The money you pay yourself for the first little while is borrowed. So basically you are paying yourself with money you are paying interest on. "These old cheap abusers" did it when they started, so I would be a little more careful how you address the generation that paved the way for everyone else.

Seriously, I would never work for 60k or even 80k as a pod... this only enriches the greedy pod hiring them. There's no benefit.

See the above comment about opening on your own. How much do you want to borrow to open up? Are you going to borrow $100K more so you can pay yourself more in the beginning?

The ones that do this are basically the lowest level pods who probably suck anyway and have yet to master their skills and are insecure. They are a bane on the profession.

I disagree with this comment as well. Most who hire new associates have very good intentions. Their expectations, however, are unreasonable and they didn't do their due diligence in finding out the minutia required for this type of relationship to work well. Remember that this relationship needs to be fruitful for both parties involved.
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One of the interesting things to me after reading a post such as this, is that no one really points to the business side of running a practice. Run a medical practice for awhile. Get to the point where you think you may need to hire another doctor. Deal with your accountant and lawyer about the feasability of getting another doctor on board. Pay an attorney to draft a contract. Then pay the same attorney again to redraft another contract once you've negotiated some of the terms of this contract with your prospective employee. Once the deal is done, then get this new doctor licensed in your state, get them on all the insurances, get them on all the hospitals, pay for malpractice insurance, pay all kinds of dues, give them the monthly benefits you are contractually bound to, and remember that you are paying for all this before you even make a penny from the patients this doctor is seeing.

As PADPM has stated in previous posts, there is a HUGE financial outlay to get a new doctor integrated into a practice. This new doctor sees a patient on day one, and the practice doesn't see any of that for about three months depending on billing and insurance turnaround. That's three months of salary and all the benefits YOU have to pay out. Hopefully if things work out well, that outlay is returned in spades. Hopefully...
 
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One of the attendings can correct me if I'm wrong but you have to remember that buying into a practice or starting your own requires a rather large business loan. Those loans have to be paid back in a relatively short time frame (8 years-ish) vs the 30 years you can stretch out student loans (why you'd want to take that long is beyond me). That means if you are buying in at say $500k, you are gonna have $7k monthly payments. That's not terrible if you have been an associate, have your own patients and solid referral sources and are recieving income from a practice owned surgical center...but starting on your own means you have to have an airtight business plan to repay the bank on time.

Note: those numbers were from a pod I shadowed and I'm sure vary widely depending on each individual situation.
 
dtrack22 said:
One of the attendings can correct me if I'm wrong but you have to remember that buying into a practice or starting your own requires a rather large business loan. Those loans have to be paid back in a relatively short time frame (8 years-ish) vs the 30 years you can stretch out student loans (why you'd want to take that long is beyond me). That means if you are buying in at say $500k, you are gonna have $7k monthly payments. That's not terrible if you have been an associate, have your own patients and solid referral sources and are recieving income from a practice owned surgical center...but starting on your own means you have to have an airtight business plan to repay the bank on time.

Note: those numbers were from a pod I shadowed and I'm sure vary widely depending on each individual situation.
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Why in the world would you pay $500K to buy into a practice? Even to buy out a doctor's practice, that seems very high. You can start your own, rather well equipped office, for about half of that depending on how much you want to pay yourself. Don't think getting a loan for that kind of money is easy. Also, I would think you would spend several years with a practice before anyone would offer an ownership share. I would be VERY leary of any practice looking for an immediate partner without some sort of trial period, particularly if they are looking for that type of investment on a new doctor's part. That just doesn't make sense to me.

Also, your statement about a "practice owned surgery center" needs to be clarified. In my experience these facilities which are physician owned (not practice owned, which is a big difference legally), will not sell shares to a very young doctor as they are looking for high surgical volume investors to contribute to the pot. Most require a certain number of cases just to maintain privileging with the facility and many new, young doctors just can't fill those criteria.
 
Here are my thoughts. If some "old cheap abusers" are offering low paying contracts, no one is twisting anyone's arm to sign these contracts. Therefore, no one is to blame other than the doctor signing the contract. If you don't "feed the monster", the offer will be ignored. If someone takes the offer, who is to blame?

While our practice does not offer low ball contracts, we also don't offer crazy high numbers to start. As per Kidsfeet's comments, we are taking a risk when we hire a new associate, with a lot of "unknowns". I also agree that a practice or doctor should not hire a new associate if the need isn't there. However, even when the stars are all well aligned, it still is a risk on the hiring practice. It is hopefully an investment, since you are in essence laying out money (salary), paying dues, insurance premiums, etc., etc., prior to that doctor ever earning a penny. It can take months for a penny to start showing up, and as I've stated many times, no practice is hiring an associate to "break even".

On the other hand, if you're not happy with the offers received or on the table, you can attempt to open on your own. Then you may be lucky enough to actually pay your bills the first year and maybe, yes maybe bring home a pittance of an income. It's very difficult in some areas to even obtain a loan, and very difficult to get on insurance panels as a new solo practitioner. Waiting for your appointment book to fill up can take a VERY long time, despite any amazing training you may have.

OR you can take a fairly decent offer with the hope that the future will be bright with hard work and perseverance. That's why you have to not always jump on the highest number offered, but evaluate WHO is making the offer. The long term potential is more important than the initial starting salary in my experience and opinion. And I've witnessed a WHOLE lot of graduating residents go through the process.
 
PADPM said:
OR you can take a fairly decent offer with the hope that the future will be bright with hard work and perseverance. That's why you have to not always jump on the highest number offered, but evaluate WHO is making the offer. The long term potential is more important than the initial starting salary in my experience and opinion. And I've witnessed a WHOLE lot of graduating residents go through the process.
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This is the most poignant advice I think anyone can offer. If you keep this in mind, you will go very far.
 
The DPM had been an associate for a number of years, plus he was the only one of the 4 interested in the complicated RRA procedures so he was valuable to the practice. The price included a new office space and some equipment as well, maybe that's why it was high? Or maybe their reimbursements were higher than those in VA? I never brought up money and didn't want to probe further when it was brought up while he was talking about repaying loans.

As for the surgical center, I don't know who actually "owned" it. I just know as a partner he owned a portion of it, how the shares were dispersed between everyone I don't know either.
 
dtrack22 said:
The DPM had been an associate for a number of years, plus he was the only one of the 4 interested in the complicated RRA procedures so he was valuable to the practice. The price included a new office space and some equipment as well, maybe that's why it was high? Or maybe their reimbursements were higher than those in VA? I never brought up money and didn't want to probe further when it was brought up while he was talking about repaying loans.

As for the surgical center, I don't know who actually "owned" it. I just know as a partner he owned a portion of it, how the shares were dispersed between everyone I don't know either.
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Regardless who, what, how valuable or what the reimbursement is like, buying in for $500K is just plain unreasonable.

This partner's ownership in the surgery center likely had nothing to do with his role as a partner in that practice. It just so happened that he was a partner in that practice AND a shareholder in the Surgery Center. In most situations, these two issues are mutually exclusive i.e: whether you're a partner in a practice or an employee, you may be able to become a shareholder in such an endeavor (if your employment contract allows that sort of thing), or being a partner in that practice doesn't necessarily entitle you to shares in the Center. You see what I mean?
 
PADPM said:
OR you can take a fairly decent offer with the hope that the future will be bright with hard work and perseverance. That's why you have to not always jump on the highest number offered, but evaluate WHO is making the offer. The long term potential is more important than the initial starting salary in my experience and opinion. And I've witnessed a WHOLE lot of graduating residents go through the process.
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I also like this. It is hard to see through the first couple years when making decisions because we want results right now. Hard work, patience, and a positive mental attitude will go a long way.
Many students I talk to say they "deserve" a high salary with all the schooling and training they go through. I don't think I deserve anything until I bring that practice in a lot of patients and income, then I deserve it.
 
Paulywog said:
I also like this. It is hard to see through the first couple years when making decisions because we want results right now. Hard work, patience, and a positive mental attitude will go a long way.
Many students I talk to say they "deserve" a high salary with all the schooling and training they go through. I don't think I deserve anything until I bring that practice in a lot of patients and income, then I deserve it.
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Excellent observation/comments. Sorry, but I don't care who you are, what your training is or what your profession happens to be, but in my opinion, no one "deserves" anything. I believe that's where the problem begins. There's a sense among some, that the world owes them something or somehow they "deserve" something.

Sorry, but there are NO guarantees. Some will get amazing offers and some won't. Those are the facts. Some musicians are very talented and "deserve" to be recognized for their talents but never receive that recognition or big contract while other's less talented do receive that big break. And that is true in EVERY profession.

You can't always sit back and wait for something you believe you "deserve". If it doesn't happen, you can whine or MAKE IT happen. If you believe you DO deserve it, then take all the tools you have that make you believe you deserve it and utilize those tools to make it come to fruition.

Contrary to what many may think, I'm not "old school", nor am I as "old" as many may believe. However, it is true that many of the present generation does have a tendency to seek instant gratification. This is really as a result of today's technology. Instead of having to go to a library to research a topic and spend hours sifting through books, literature, etc., that can be done in minutes on a computer via search engines. Instead of writing letters or utilizing the postal service and waiting days or weeks for a response, there is email which can provide answers in minutes. Instead of making a phone call on a land line and getting a "busy signal" at someone's home phone, you can track that person down on his/her cell phone instantly. If you need to get the person a message and the person isn't answering, you can text the person, BBM the person, etc. There really is no "waiting". There is instant gratification.

Hey, when I was in school and I wanted Kraft macaroni and cheese I actually had to boil water and mix the crap up, now they have a microwavable version that takes a minute!!!!

It's no fault of the generation, it's simply the change of the times. The only thing that remains constant is that if you want to succeed, there is no guarantee. You must be responsible for your own destiny and can't count on others to be responsible for YOUR success. Whether you "deserve" to ultimately have a high income or not is not relevant. Actually MAKING that income happen is the only real point that is relevant.
 
PADPM said:
Hey, when I was in school and I wanted Kraft macaroni and cheese I actually had to boil water and mix the crap up, now they have a microwavable version that takes a minute!!!!
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I laughed so hard that I fell off my chair!!! I couldn't afford a microwave in school so I'm with you!
 
ItsGavinC said:
1.85% interest rate. Paying them off sooner might actually be an unwise thing to do if capital is hard to come by.
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That's a steal considering that inflation is approximately 2-3% each year. When were student loans this cheap?

Currently, Stafford Loans are at 6.5% and Plus Loans are at 7.9% (not 100% sure on the plus loans but its around there).
 
Jan beat me to it but I don't know how you get a sub 6% rate for graduate school. And I didn't take any GRAD Plus loans but they are up near 8.5%

In fact I don't know anyone who gives a loan with a sub 2% interest rate outside of Best Buy and Car Manufacterers....and if either of them will let me borrow about $100k then let me know. I promise I'll pay them back!
 
Hell, even my wife's Perkins loans which are for low income families in undergrad are at 4%. I'm real curious now about where you borrowed your money from
 
A fair amount of my loans for podiatry school are at like 2.8%. That was the interest rate at the time I was going through.
 
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