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

Other messages in this thread:

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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

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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

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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

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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

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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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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