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Job search season is upon us... and for most DPMs, it continues 24/7/365.
Most DPMs are working as associates.
Most grads, no matter what they target or want, will take those DPM associate positions.
There's a ton of negativity (most of it founded!) in podiatry with higher tuitions and few good jobs.
The saturation for the surgery and high income jobs for DPMs is quite real.
The competition in private practice pts is quite high already, and the newest schools are just gettin started.
Here's ten ideas for making it work early on - both mentally and financially... anyone feel free to add or discuss.
1) Get over it.
Most of us start out in PP... as associates. Meh. Most SDN users - and DPMs overall - do statistically start in PP, but most wanted hospital/ortho/MSG jobs with more income and more surgery. I actually did want PP and realized I'd need to do associate a little while to learn and to save... or until I could get a loan. Podiatry is historically a private practice profession, just like dentistry. Sure, I was always was open to hospital jobs for $ or for ABFAS numbers, but I did want to learn in a good PP and eventually own a PP even back when I was in pod school.
Realize that learning PP does have its serious advantages, and even a PP associate learns things and sees angles they never would if they took a VA job or a mobile podiatry job or other gigs right out of training. Even ppl who have family $ or prior career or whatever might be smart to do a year of PP associate to learn the biz (and get onto plans+hospitals if it's an area without enforceable non-competes).
Still, most of us definitely didn't plan on the PP associate and sure didn't want to do it for any serious time span, but come to terms and get the most enjoyment and learning out of doing it. There are positives to doing it for awhile. "It's not having what you want, it's wanting what you have"... and all that.
2) Find the best PP associate job you can.
This doesn't just mean money. The higher paid PP associate jobs actually get more decent apps and make you more replaceable, and the supergroup jobs with higher end PP base will usually just press you into doing shady stuff and internal refers with no hope of partnership and no negotiating power. Contracts are only as good as the people signing them. Money helps, but mentors and non-compete laws and some autonomy and area you like - or want to end up - all matter also. Gauge the satisfaction of other associates and past ones. Don't discount those non-money factors.
Sometimes it's best to think of the first job or two like a fellowship to learn billing and how an office runs. You learn how to hustle, and how to make notes ok but not too time consuming. Mainly, learn how to treat patients, build your scripts, and interact with PCPs. You will communicate with staff, learn what to look for in staff, and figure out how to train and motivate them.
A well-run office to model and learn and get paid fair can be better than a junk one or a fraud billing one that pays 10% more. All that said, if there are going to be any "mobile podiatry" nursing homes or house calls, know that the billing on that stuff costs maybe 3-5% and the scheduling same 5% or less... so places that try to pay you your standard associate 40% on mobile podiatry stuff are nuts, and it should be 70 or 80% on that stuff (depending on if you have an assistant with you who they pay for).
3) Make a budget.
This is key. Read books. Watch vids. Even if you can only pay your loan minimums IBR and put the $6.5k/yr in a Roth and maybe $500/mo into savings and $500 into cash stock account or 401 or something, do it. Get a decent cash emergency fund. Have a car that runs and a few nice outfits for interviews or meetings, a few little vacations per year... but don't go wild. You may work hard and wear scrubs or a white coat, but you are a PP associate podiatrist... NOT a real doctor in salary terms. You make less than most RNs, and you have tons more debt. Get OUT OF the stupid student/resident habit of, "poor me, I work too hard... I will buy dumb stuff or party or reward myself to drown my sorrows. I will have more money soon." That's a good way to be stuck in that credit card debt and check-to-check life forever.
4) Learn all you can.
The billing and coding and the office logistics and marketing are important to understand. If you are trying to get away to a hospital/MSG job, you don't know when that'll be... and you'll still need to code there. You might need much more info if you are going to MSG or hospital that has never had podiatry or you replace a PPMR type. If you're saving up for your own PP, soak it all up... you will need it.
Make supply lists. Make favorite code lists or surgery code lists or draft your own superbill. Work on your templates. Max your efficiency. You can learn from everybody. You probably won't be on a time clock, but do most of any document creation on your own home or laptop; it's poor form to take any documents or intellectual property from the employer office.
5) Have goals.
The most common young DPM goal is ABFAS cert, so take all case records + XRs if there's any chance you might leave. Others include starting own PP, raising volume/income, finding hospital job, getting savings built, etc etc. Re-evaluate them every 3mo or so (I find it works good for me to have a list of my top 5 priorities - health, wealth, relationships, freedom of time, and experiences and then top 5 goals related to those... but do what works for you). However you do it, it helps to know what you want and how to track towards it and when it might be reached. A goal without a deadline is just a dream.
6) Be cool to area DPMs.
I can't say this enough: podiatry is saturated. Saturated as f***. That is just how it is. Decent jobs get hundreds of apps and close within a week. Employers universally know they can whip through associates, freeze raises, cut pay due to the big surplus. If they don't, all they have to do is post a job with fair pay and find out by the next week. You will have to deal with area competition and colleagues for both PP new patients and return patients and also in the hospitals. A lot of them are scared and insecure - not without reason. They need to eat. They need to pay loans. It was always dog-eat-dog in the popular metros, but now it's that way almost everywhere.
Historically, the few 2 year PSR-24 guys - and even some 1yr PSR-12 ones - got us into the hospitals and ortho groups decades ago and became residency directors and got fed much F&A surgery from other PPMR podiatrists or ones with no residency at all. Not much anymore. The PM&S-24 and PM&S-36 like me took the few remaining hospital jobs and made some other or MSG jobs and expanded many of the potential VA/IHS (surgical) jobs... and even grabbed up any unfilled PP areas/groups that needed a surgical guy.
Now, in 2023, being 3yr surgical (PMSR-36) means basically nothing. That's the norm. Fellowship means very little... trade a year and lost income and 600+ more "surgically trained" and "fellowship trained" grads to compete with... just to get something on your CV that might help a bit with jobs? There will probably be more 2yr fellowships soon, lol. It's a numbers game, there are just way too many surgical DPMs, and it gets worse every year. It's very hard to find the organizational jobs, and it'll only get harder. Keep trying for the hospital or ortho gigs, but the well is basically dry. We've met the market and hospitals' demand for "F&A surgery" many times over and continue to flood it. Most MSGs that don't even have a general surgeon or ortho or cardiologist now have a DPM who convinced them to hire them. Realize that.
...In terms of podiatry associate PP, that shift means probably half the overall DPMs in PP offices do their own surgery now (for all but the very biggest rarest cases). Pretty soon, that'll be 90% of them will do their own. Awhile ago, it was only 50% doing forefoot and maybe 20% or less who did any RRA... no more. Be aware of that.
It doesn't matter if you did top DPM residency in a large hospital and they did some joke wound and triple scrub hammertoe "surgical" program at the VA and are now trying to do Lapidus or peds flat foot... just smile and nod. Be cool. You have to. Some of your pts will seek second opinion from your area DPMs or even ones in your group (or ortho), and that works both ways. It might be most of the surgery going one way, but it's a still two way street to at least some extent. Patients have tons of "foot and ankle" options on Google. Way more than ever before... and growing.
This means being friendly with the other DPMs on staff at the hospital, in the area, at meetings, etc. Some are actually very cool and it's easy to like. Other DPMs/groups are reclusive or you will hear from patients or MDs or elsewhere that they like to smear competitors, or you might just see firsthand they overbill or do bad work. It's best to just leave those ones alone. It is frustrating, but it's always best to not engage or try to block or limit their privileges or talk poorly of them (it looks petty, and smart MDs and pts will figure out soon enough anyways). The obvious exception is truly terrible work that is gross malpractice (usually most visible when you're a hospital employ or admin role)... and that is never bad to report to the appropriate facility channels or state board.
7 )Be very cool to hospitals and local MDs.
This is obvious, but those are relationships you need to cultivate. They want good patient results and somebody who's easy to work with... plain and simple. Be visible. Go to the doc lounge and send progress notes and go to meetings when you can. This is especially key if you are a DPM associate in an area without non-compete who might stay there - and many hospitals can also buy our or negate a non-compete from your DPM group if they hired you. Even if you are just making a stop there in that city/facility, it's good to practice those PCP and hospital and admin relationships. And yeah, it absolutely sucks to go around "building the practice" and trying to grow and solidify refer base for a group that just gives you 40% and you will never have any actual ownership in, but consider it important practice for the next chapter.
8) Have a life and self esteem outside work.
This goes without saying, but you will get beat uppp in terms of DPM associate workload and pay. You get few days off. Some days are long. Every MD and most DPMs do better than you on paychecks. You will likely have an owner who lies about collection or presses you for more production or even cuts your pay or lets you go due to the glut of DPMs available now. You might even have to do house calls or nursing home. It sucks. So, have delts and biceps or campfires and a dog or volleyball and crafts or whatever that you can smile about... even when work gives you a steaming pile to deal with. I find that, in healthcare in general, we are nice to ppl and fixing things all day, so it helps to have some fairly destructive/outlet hobbies... training boxing or MMA, shooting range, firecraft, splitting wood, weightlifting... basically a yin and yang thing.
9) Be open to staying awhile.
No joke. You might be an associate for awhile. You might luck out be in a place where you you don't love it, but it's still a profitable and busy office where you can learn a lot. Less likely, you could have a decent owner of the PP who likes you and treats you fair on pay. Much less likely, you could get offered partnership or reasonable price to buy out or buy your own office in a meaningful PP (not in supergroup).
Back in reality, I'm just saying that you have to frame the associate job in a decent light simply because you might take a lot longer to find that hospital job or save up for opening your own PP or get ABFAS cert than you thought. Don't forget: TONS more 'surgical podiatrist' apps coming out every year. If you think working PP associate for $120k or $150k base + bonus in an average pod group is lame, how'd you feel about mobile nursing home HealthDrive work every day... or a PP job with almost no surgery refers and just C&C after C&C patient??? Hmm, could always be worse.
Essentially, It's like the two masons working side-by-side where one is frying in the sun and dislikes lifting the heavy bricks... while the other knows he's building the chimney for the most beautiful cathedral in Rome. Frame it that you're helping patients or learning your style/protocols/scrips or whatever makes you a bit happy at work. Have an abundance mindset on that next job and ABFAS stuff, but also realize that you are are going to feel better at work if you try to want what you have (for now... to some extent).
10) Plan your exit.
Seems contradictory to have one foot always out the door while also being open to staying, but podiatry is just too saturated to truly depend on any employment (esp associate PP - but even hospital FTE podiatrist or admin or whatever) or thinking you will find same quality/income again if you have to move. Even a successful PP owner could have the local hospitals bring in a few DPMs or buy a competing group... and be in very big trouble. This abundance of DPMs means buying a house or laying any serious roots is at your own risk. Get used to keeping connections live, keeping state license in other states you're applying to or looking for jobs in, keeping CV up to date, being a bit of a minimalist, all that fun stuff.
...You will do well. Eventually. Probably.
Most DPMs are working as associates.
Most grads, no matter what they target or want, will take those DPM associate positions.
There's a ton of negativity (most of it founded!) in podiatry with higher tuitions and few good jobs.
The saturation for the surgery and high income jobs for DPMs is quite real.
The competition in private practice pts is quite high already, and the newest schools are just gettin started.
Here's ten ideas for making it work early on - both mentally and financially... anyone feel free to add or discuss.
1) Get over it.
Most of us start out in PP... as associates. Meh. Most SDN users - and DPMs overall - do statistically start in PP, but most wanted hospital/ortho/MSG jobs with more income and more surgery. I actually did want PP and realized I'd need to do associate a little while to learn and to save... or until I could get a loan. Podiatry is historically a private practice profession, just like dentistry. Sure, I was always was open to hospital jobs for $ or for ABFAS numbers, but I did want to learn in a good PP and eventually own a PP even back when I was in pod school.
Realize that learning PP does have its serious advantages, and even a PP associate learns things and sees angles they never would if they took a VA job or a mobile podiatry job or other gigs right out of training. Even ppl who have family $ or prior career or whatever might be smart to do a year of PP associate to learn the biz (and get onto plans+hospitals if it's an area without enforceable non-competes).
Still, most of us definitely didn't plan on the PP associate and sure didn't want to do it for any serious time span, but come to terms and get the most enjoyment and learning out of doing it. There are positives to doing it for awhile. "It's not having what you want, it's wanting what you have"... and all that.
2) Find the best PP associate job you can.
This doesn't just mean money. The higher paid PP associate jobs actually get more decent apps and make you more replaceable, and the supergroup jobs with higher end PP base will usually just press you into doing shady stuff and internal refers with no hope of partnership and no negotiating power. Contracts are only as good as the people signing them. Money helps, but mentors and non-compete laws and some autonomy and area you like - or want to end up - all matter also. Gauge the satisfaction of other associates and past ones. Don't discount those non-money factors.
Sometimes it's best to think of the first job or two like a fellowship to learn billing and how an office runs. You learn how to hustle, and how to make notes ok but not too time consuming. Mainly, learn how to treat patients, build your scripts, and interact with PCPs. You will communicate with staff, learn what to look for in staff, and figure out how to train and motivate them.
A well-run office to model and learn and get paid fair can be better than a junk one or a fraud billing one that pays 10% more. All that said, if there are going to be any "mobile podiatry" nursing homes or house calls, know that the billing on that stuff costs maybe 3-5% and the scheduling same 5% or less... so places that try to pay you your standard associate 40% on mobile podiatry stuff are nuts, and it should be 70 or 80% on that stuff (depending on if you have an assistant with you who they pay for).
3) Make a budget.
This is key. Read books. Watch vids. Even if you can only pay your loan minimums IBR and put the $6.5k/yr in a Roth and maybe $500/mo into savings and $500 into cash stock account or 401 or something, do it. Get a decent cash emergency fund. Have a car that runs and a few nice outfits for interviews or meetings, a few little vacations per year... but don't go wild. You may work hard and wear scrubs or a white coat, but you are a PP associate podiatrist... NOT a real doctor in salary terms. You make less than most RNs, and you have tons more debt. Get OUT OF the stupid student/resident habit of, "poor me, I work too hard... I will buy dumb stuff or party or reward myself to drown my sorrows. I will have more money soon." That's a good way to be stuck in that credit card debt and check-to-check life forever.
4) Learn all you can.
The billing and coding and the office logistics and marketing are important to understand. If you are trying to get away to a hospital/MSG job, you don't know when that'll be... and you'll still need to code there. You might need much more info if you are going to MSG or hospital that has never had podiatry or you replace a PPMR type. If you're saving up for your own PP, soak it all up... you will need it.
Make supply lists. Make favorite code lists or surgery code lists or draft your own superbill. Work on your templates. Max your efficiency. You can learn from everybody. You probably won't be on a time clock, but do most of any document creation on your own home or laptop; it's poor form to take any documents or intellectual property from the employer office.
5) Have goals.
The most common young DPM goal is ABFAS cert, so take all case records + XRs if there's any chance you might leave. Others include starting own PP, raising volume/income, finding hospital job, getting savings built, etc etc. Re-evaluate them every 3mo or so (I find it works good for me to have a list of my top 5 priorities - health, wealth, relationships, freedom of time, and experiences and then top 5 goals related to those... but do what works for you). However you do it, it helps to know what you want and how to track towards it and when it might be reached. A goal without a deadline is just a dream.
6) Be cool to area DPMs.
I can't say this enough: podiatry is saturated. Saturated as f***. That is just how it is. Decent jobs get hundreds of apps and close within a week. Employers universally know they can whip through associates, freeze raises, cut pay due to the big surplus. If they don't, all they have to do is post a job with fair pay and find out by the next week. You will have to deal with area competition and colleagues for both PP new patients and return patients and also in the hospitals. A lot of them are scared and insecure - not without reason. They need to eat. They need to pay loans. It was always dog-eat-dog in the popular metros, but now it's that way almost everywhere.
Historically, the few 2 year PSR-24 guys - and even some 1yr PSR-12 ones - got us into the hospitals and ortho groups decades ago and became residency directors and got fed much F&A surgery from other PPMR podiatrists or ones with no residency at all. Not much anymore. The PM&S-24 and PM&S-36 like me took the few remaining hospital jobs and made some other or MSG jobs and expanded many of the potential VA/IHS (surgical) jobs... and even grabbed up any unfilled PP areas/groups that needed a surgical guy.
Now, in 2023, being 3yr surgical (PMSR-36) means basically nothing. That's the norm. Fellowship means very little... trade a year and lost income and 600+ more "surgically trained" and "fellowship trained" grads to compete with... just to get something on your CV that might help a bit with jobs? There will probably be more 2yr fellowships soon, lol. It's a numbers game, there are just way too many surgical DPMs, and it gets worse every year. It's very hard to find the organizational jobs, and it'll only get harder. Keep trying for the hospital or ortho gigs, but the well is basically dry. We've met the market and hospitals' demand for "F&A surgery" many times over and continue to flood it. Most MSGs that don't even have a general surgeon or ortho or cardiologist now have a DPM who convinced them to hire them. Realize that.
...In terms of podiatry associate PP, that shift means probably half the overall DPMs in PP offices do their own surgery now (for all but the very biggest rarest cases). Pretty soon, that'll be 90% of them will do their own. Awhile ago, it was only 50% doing forefoot and maybe 20% or less who did any RRA... no more. Be aware of that.
It doesn't matter if you did top DPM residency in a large hospital and they did some joke wound and triple scrub hammertoe "surgical" program at the VA and are now trying to do Lapidus or peds flat foot... just smile and nod. Be cool. You have to. Some of your pts will seek second opinion from your area DPMs or even ones in your group (or ortho), and that works both ways. It might be most of the surgery going one way, but it's a still two way street to at least some extent. Patients have tons of "foot and ankle" options on Google. Way more than ever before... and growing.
This means being friendly with the other DPMs on staff at the hospital, in the area, at meetings, etc. Some are actually very cool and it's easy to like. Other DPMs/groups are reclusive or you will hear from patients or MDs or elsewhere that they like to smear competitors, or you might just see firsthand they overbill or do bad work. It's best to just leave those ones alone. It is frustrating, but it's always best to not engage or try to block or limit their privileges or talk poorly of them (it looks petty, and smart MDs and pts will figure out soon enough anyways). The obvious exception is truly terrible work that is gross malpractice (usually most visible when you're a hospital employ or admin role)... and that is never bad to report to the appropriate facility channels or state board.
7 )Be very cool to hospitals and local MDs.
This is obvious, but those are relationships you need to cultivate. They want good patient results and somebody who's easy to work with... plain and simple. Be visible. Go to the doc lounge and send progress notes and go to meetings when you can. This is especially key if you are a DPM associate in an area without non-compete who might stay there - and many hospitals can also buy our or negate a non-compete from your DPM group if they hired you. Even if you are just making a stop there in that city/facility, it's good to practice those PCP and hospital and admin relationships. And yeah, it absolutely sucks to go around "building the practice" and trying to grow and solidify refer base for a group that just gives you 40% and you will never have any actual ownership in, but consider it important practice for the next chapter.
8) Have a life and self esteem outside work.
This goes without saying, but you will get beat uppp in terms of DPM associate workload and pay. You get few days off. Some days are long. Every MD and most DPMs do better than you on paychecks. You will likely have an owner who lies about collection or presses you for more production or even cuts your pay or lets you go due to the glut of DPMs available now. You might even have to do house calls or nursing home. It sucks. So, have delts and biceps or campfires and a dog or volleyball and crafts or whatever that you can smile about... even when work gives you a steaming pile to deal with. I find that, in healthcare in general, we are nice to ppl and fixing things all day, so it helps to have some fairly destructive/outlet hobbies... training boxing or MMA, shooting range, firecraft, splitting wood, weightlifting... basically a yin and yang thing.
9) Be open to staying awhile.
No joke. You might be an associate for awhile. You might luck out be in a place where you you don't love it, but it's still a profitable and busy office where you can learn a lot. Less likely, you could have a decent owner of the PP who likes you and treats you fair on pay. Much less likely, you could get offered partnership or reasonable price to buy out or buy your own office in a meaningful PP (not in supergroup).
Back in reality, I'm just saying that you have to frame the associate job in a decent light simply because you might take a lot longer to find that hospital job or save up for opening your own PP or get ABFAS cert than you thought. Don't forget: TONS more 'surgical podiatrist' apps coming out every year. If you think working PP associate for $120k or $150k base + bonus in an average pod group is lame, how'd you feel about mobile nursing home HealthDrive work every day... or a PP job with almost no surgery refers and just C&C after C&C patient??? Hmm, could always be worse.
Essentially, It's like the two masons working side-by-side where one is frying in the sun and dislikes lifting the heavy bricks... while the other knows he's building the chimney for the most beautiful cathedral in Rome. Frame it that you're helping patients or learning your style/protocols/scrips or whatever makes you a bit happy at work. Have an abundance mindset on that next job and ABFAS stuff, but also realize that you are are going to feel better at work if you try to want what you have (for now... to some extent).
10) Plan your exit.
Seems contradictory to have one foot always out the door while also being open to staying, but podiatry is just too saturated to truly depend on any employment (esp associate PP - but even hospital FTE podiatrist or admin or whatever) or thinking you will find same quality/income again if you have to move. Even a successful PP owner could have the local hospitals bring in a few DPMs or buy a competing group... and be in very big trouble. This abundance of DPMs means buying a house or laying any serious roots is at your own risk. Get used to keeping connections live, keeping state license in other states you're applying to or looking for jobs in, keeping CV up to date, being a bit of a minimalist, all that fun stuff.
...You will do well. Eventually. Probably.
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