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04/26/2016 Dieter J Fellner, DPM
Current Compensation Rates for New Practitioners Out of Residency
My first reaction is to ask who is posting this anonymous question and why? Is this yet another furtive attempt to curtail expectations for a fair & reasonable salary? The graduating Podiatrist will have endured 7 years of long, hard training. Now burdened with student loans, to the absolute breaking point, the job seeking graduate despairs with lowly paid job offers, or sometimes no salary at all! A doctor of podiatric medicine and surgery ought to have a reasonable expectation that all the hard work, training and expense has some merit, over and above a salary befitting a low to middle management position in Costco. Nurses are regularly paid six figures. But the Doctor should not entertain such a lofty expectation?
I respectfully ask only this: if there is no vacancy, in your office, with a commensurate work load to provide an associate with a fair salary, then why are you advertising a job opportunity? Here is why: because there is no 'real' job. All too often the job advert is a fallacy, a trap designed to lure in those new to the job market. One such 'business' owner explained to me recently "I'm not paying a salary - if those new graduating people want a loan they can go to the bank". Yes Sir, maybe I would, if I could. But then I'd start my own business and wouldn't need you, right? Alas, no bank will offer a loan when there is a $330K student loan heavily draped over the shoulders.
So many of your 'jobs' are in fact a deception, designed to make more money and less work for you, the owner. The job market, all too often considers the new Associate a cash cow, plump and fit to be exploited. Now, I fully appreciate this is not always the case, and there are many other genuine, sincere opportunities provided by very reasonable and honest employers.
Personally, I did seek advice about what constitutes a reasonable salary, such is required to survive in one of the most expensive cities in the world. But, in reality, we do not need such advice to know how much it costs to rent an apartment, pay for travel, pay taxes, manage the student loan, dress, pay bills, eat etc. We know already, from our residency pay, that today's dollar does not stretch in the same way as the dollar of old. As for my graduating class, salaries range from $100,000 to $180,000 - yup, you heard that right. In the first year.
Dieter J Fellner, DPM, NY, NY
Other messages in this thread:
05/02/2016 Jeff Kittay, DPM
Current Compensation Rates for New Practitioners Out of Residency (Name Withheld)
I was very disappointed to read today's PM News and see that the discussion of compensation rates for new practitioners had deteriorated into a pissing match among our colleagues, one of whom regularly contributes valuable insights in this forum, a Dr. Withheld who claims to be making $500K+ after four years on the job, and another DPM who perpetuates the myth that DPMs who have just completed their residencies should expect at least $100K to $200K to start. Nurses do NOT routinely make six figures as was stated. There may indeed be some positions out there for group or hospital employed podiatrists that will pay that kind of money but I suspect that they are the exceptions. Solo/group practices that can afford to take a $150K gamble on a doc who may have impeccable surgical skills but zero experience in practice management will be few and far between. The experience of the Dr. who worked for two years for a group practice and did nothing but raise their income and was then fired for requesting a modest and deserved increase in his percentage is more like the experience I heard about during my years in practice.
Raising the expectations of residents throughout the country, only so that they can find out that much of what they were told was exaggeration or falsehood, is much like the problem of enticing new podiatric students into schools that demand their tuition money and then abandon them after graduation with "we never promised you could make a living." Patently unfair and clearly degrading. The Dr. from Mississippi may indeed be right about the future of solo practices. I do not see how an individual, with all of the ongoing and proposed rules and regulations which are and will continue to be extremely expensive to implement, can survive in this marketplace, and I for one am glad to be out of it. I wish you all well and hope that the level of discourse here in PM News can be brought back to a more civil level.
Jeff Kittay, DPM (retired), San Isidro, Costa Rica
04/29/2016 Dieter J Fellner, DPM
Current Compensation Rates for New Practitioners Out of Residency
I want, firstly, to thank the anonymous poster for instilling a sense of reality, common sense, and hope, with his contribution, to this debate. Now, on to Dr. Sullivan: please be assured I was wide awake when I read your response. And I am sorry that you seem to struggle so much in making ends meet, towards the end of your career. It is possible, perhaps, that you might have benefited from the advice of our anonymous poster.
As for the source of my data, I will refer you back to my original posting. Seemingly, you found yourself in a state of indecent haste, and hurried to pen your righteous rebuke, but failed to read and/or comprehend the source of the data are my soon-to-graduate-colleagues, who indeed have successfully secured such a contract.
It is very re-assuring then to know that you are, by your estimation, not a BAD guy. I will re-iterate the following, for your benefit, since this also seems to have escaped your attention: "I fully appreciate this is not always the case and there are many other, genuine, sincere opportunities provided by very reasonable and honest employers." Unfortunately, the BAD guys seem to outnumber the GOOD guys.
I reject out of hand your statement that seeks to justify financial abuse and profiteering, off the back of a new Associate, on the basis of historical precedent. Two wrongs do not make a right. And, of course, I will gladly pass on your sage "don't worry about the money thing" advice to the Federal Government when the student loan repayment is hopelessly delinquent.
Now it is my turn, to ask you to wake up. Seemingly, it has been decades since you were in the job market. It is deeply patronizing that you would want to wave away those genuine financial concerns with a glib comment about 'entitlement' and 'unrealistic' expectations. And, just for the record, Dr. Sullivan, I am not so green behind the ears.
Dieter J Fellner, DPM, NY, NY
04/28/2016 Marc Katz, DPM
Current Compensation Rates for New Practitioners Out of Residency (Name Withheld)
I think there are a few important points to make. I think the profession has issues with schools putting students over 300K in debt and presenting misleading information about the earning potential of podiatrists. That needs to be addressed by the profession.
Here is my advice. Everyone needs to stop complaining and take responsibility for their career choice. We all chose this profession. If you did your research, here should be no surprises You need to make the best of it. Everyone is complaining like they have such terrible lives, its not true.
Many podiatrists will not make more than a nurse or NP or PA ever. A few will make millions. This is not necessarily a high compensation profession for many. Where do you want to be? It's all about working hard, getting some business experience and making connections. If you want to be successful realize that this is not a 9-5 job and it is going to get harder and harder each year as there will be massive changes.
Podiatry is like any other business. If you don't like the offers out there or you feel you are being abused then go open your own practice. Hospitals and Orthopedic groups may be good for some people but are often not what you thought they would be. You are fortunate that you have the option to run a practice the way you would like it to happen. You have that ability, so work hard and make it a reality. Nobody deserves or is entitled to someone else's patient's or practice unless they meet the terms of that doctor or group. That is true for all businesses and jobs. And that doctor or group has the right to any terms that they feel are appropriate. You don't have to agree. Go to Apple and tell them you've been in school 7 years and are 300K in debt and watch their blank faces as they offer you an entry level position and tell you to work your way up to be a success. That's life!
Reach out to experienced podiatrists for help if you want to start a practice. Ignore the podiatrists that are threatened by your presence. Stop listening to the person who has a friend who makes 500k there first year and had the doctor hand them the practice for free. All of this second-hand information is a distraction.
Thankfully, I have had a great career in podiatry and I am happy with my choice. I am willing to help others, so feel free to contact me.
Marc Katz, DPM, Tampa, FL
04/28/2016 David N. Helfman, DPM
Current Compensation Rates for New Practitioners Out of Residency (Dieter J Fellner, DPM)
I have been quiet over the past couple of years for many personal reasons, but mainly because I was focusing on transforming our industry, testing new concepts and truly enhancing the group model experience. I always find it interesting when doctors ask:” How much should a new associate make?” How much should a partner make?
To truly answer this question, it’s imperative new doctors and established doctors realize that this answer is truly a moving target and most statistics you read about salary usually have a small sample size. Therefore, the data you obtain is probably not the most accurate number. The reality is that most very high earning doctors aren’t going to fill out what they truly make on surveys because they are too busy working and often times are very private about their true earned income.
I personally have no issue telling you what I think an associate should make or a physician, but I can’t be honest unless you are comparing apples to apples. If you go into a solo practitioner’s office who is retiring in 5 years with no ancillaries, that will be much different than joining a group like ours where we own many ancillaries as part of the group practice. Also, hospitals can pay you more but you truly are now at their mercy and have now become a “high paid employee” and are locked into a system that will restrict your upside and future. Some associates can start at 120K, 140K, and end up at 350K in any environment and some doctors can make 400K-1.0M per year. However, every contract comes with conditions and different opportunities, some good and some not so good. The reality is that residents these days expect big paychecks because their co- residents tell them how much they are being offered. Every time I have asked a resident to show me their friends contract taking off all their names, and I would match their offer, I have yet to receive a copy. That says to me their friends are not being 100% transparent and if they are, you need to read the entire agreement. Everything comes down to business and economics and if you read all the major research reports from firms like Deloitte, PWC and Equity Research publications, you will see that with 3.0 Trillion being spent on healthcare, getting close to 17% of GDP, our current system is unsustainable. My suggestion is look at the big picture and not just what you will make year 1, year 2 or year 3. Look at your opportunities and decide where you want to make a life. Once you decide on that, you will be paid based on your abilities and contribution to an organization's success.
I have a lot of empathy for new docs, but I also know what is coming down the road. The biggest mistake new doctors make is to be short sighted and stuck on their first year salary. Focus on how much value you can bring to an organization and if you are able to deliver and get along with others, your upside and future is unlimited. If you would like some advice, feel free to contract me. As I have learned when you focus on yourself rather than others, you never really achieve true success! David N. Helfman, DPM, Atlanta, GA
04/27/2016 Name Withheld
Re: Current Compensation Rates for New Practitioners out of Residency (Dieter J Fellner, DPM)
I’ve been reading the responses to this question and felt as a fairly new practitioner (on my 4th year of practice) that I should chime in. I feel that my answer not only addresses this question but also dives into a fairly recent debate on PM News about “where are the new graduates finding jobs.”
I think that starting salaries greatly depend on the type of practice this new graduate is joining. If the graduate is joining a solo or single specialty group practice they may not be able to absorb losses as well on the front end as say a hospital employed position could. However, when I came out I interviewed with several private practices and on more than one occasion I heard “now there will not be patients waiting on you and I myself don’t want to slow down so you will be responsible for building your own client base.”
This was typically followed by a salary offer closer to what an RN is offered when they graduate from nursing school. My thought is, if you do not have the patient excess to give someone a footing you are in no way ready to take on an associate/partner.
The majority of my private practice offers were around $60,000 per year for 1 or 2 years. Then you would get 20-30% of collections over $300,000 with no promise of partnership. This is insane. If you see a contract like this then run far and fast because your max earning potential will be in the mid 100's. Now, if you see this contract and the money made off you, for say 5 years, is considered your practice buy-in then that might be a different story but I bet you don’t see that contract (Please note that when an ortho group brings in a new associate once they hit a certain revenue threshold then they are considered a full partner. No money exchanges hands on a "buy- in").
Please don’t reply about the expenses you’ve incurred bringing this associate on board. I do not want to hear it. My father was in private practice for 44 years. I know exactly the ups and downs involved and he never once brought someone in under such deplorable terms and they always turned out to be equally beneficial relationships.
So, in my opinion no one should start at less than $100,000-$120,000 annually. If your practice can not support this then you are not ready for an associate. I joined a multi- specialty group owned by a hospital and showed many of my orthopedic partners some of the contracts I received and they all just laughed. They found it funny that the other doctor wanted to view the associate as a cash cow and not as a needed addition to their practice. With this said, I would encourage all new graduates to equally look into joining an established solo practice, multispecialty practice, orthopedic group, and hospital employment. I went the multispecialty/hospital route and it has been the best decision I ever made for me and my family.
As for myself, my starting salary was $200,000. I made $298,000 my first year in practice after my bonus. I just started my 4th year in practice and made $507,000 my 3rd year in practice. Naysayers wondering if this is sustainable or if the hospital just baited me in? Well, I just signed another 5 year contract under even better terms financially. Now, I do have the benefit of ER consults, hospital consults, and a strong surgical referral base making my out-patient surgery schedule much busier than most people in private practice will ever encounter (approximately 30-40 cases per month).
I am not saying that everyone should expect to make ½ a million dollars per year. You must realize, I work at least 60+ hours per week but what I do know is to earn and cover a $100,000 salary with benefits does not take much work at all.
Name Withheld
04/27/2016 Tip Sullivan, DPM
Current Compensation Rates for New Practitioners Out of Residency (Dieter J Fellner, DPM)
100K$ to 180K$? Where does Dr. Fellner get his data? I would hope that the APMA had this type of data. I don’t take home that much money and I did three years post-graduate studies (PSR24 and a fellowship) and have been in solo private practice for 27 years! There are some of us that are considering retirement and developing a plan to that end. We are not BAD people. We want our young associates to be successful.
There have always been those practitioners who try to take advantage of podiatrists right out of residency. Wake up Dr. Fellner - this is not a new dilemma. I will give you some advice that was given to me some 30 years ago by a doctor whom I have great respect for—(Bruce Dobbs, DPM). Don’t worry too much about the money thing. Be smart. Practice where you want to live and be happy. If you are good at what you do you will be able to make enough to get by.
While I understand that the practice environment is changing—and that fault is on all of our shoulders—the reality is that the financial demands made on us older guys by the recent residency graduates is going to be a big part of why private practices will be doomed. I hear all the time about how our profession is devouring our young—hogwash, just look at the changes we have made in our profession that benefit the new podiatrist! — from my perspective I see our young having an entitlement issue and unrealistic expectations. Tip Sullivan, DPM, Jackson, MS
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