True to form, salaries and starting packages for new physicians is the hot topic on our New Docs forum. It makes perfect sense, of course – we spend so many years and defer gratification for such a significant period of our lives that when it’s finally time to start practice, salary and benefits become the most important issue.

Unfortunately, in podiatry there’s no basic scale or system to determine fairness to both job applicant and potential employer. We have some very interesting and enlightening viewpoints below.

***Opening Own Practice***

I want to make a few comments about young podiatrists opening their own office. I too, just opened up on my own after 4 years of being an associate. I do think the 4 years was a great learning experience, and I have made better decisions, I think, after having that experience.

I am a BIG bargain shopper. The cost of opening from scratch will floor you. I will share with you some of the things that I did that allowed me to save tons of money. There are a lot of podiatrists looking to get rid of their old stuff...either going out of business, upgrading, downgrading, or various other reasons. They post their equipment on state association websites, the APMA website, Podiatry Management, craigslist and ebay.

This is what I did: I bought 2 PDM podiatry chairs, old but in very good condition, on ebay for $400 each. The retail price for used chairs like these ranges from $1600 to $2500. I bought used instruments and an Xcel Xray machine from a podiatrist going out of business in Texas (I am in Ohio). It was a PAIN to find someone to ship it, but I saved more than $7000. Her stuff was listed on the podiatry management website. She put a lot of extra stuff in the shipment just to get rid of it.

Craigslist was a great place for me to find office furniture. There are a lot of businesses going out of business these days looking to unload everything for cheap. I bought 8 waiting room chairs, 2 executive desk chairs and 2 guest chairs for the treatment rooms for $120 total. The chairs are black leather, very nice, retail for $200 apiece. I bought a refrigerator from the same company for $40. It works great.

Also on craiglist, I bought 2 rolling dr. chairs for $15/each from a tattoo parlor going out of business.

I bought an x-ray view box for $25 from a podiatrist close to my town that closed her office. She also sold me a couple of odds and ends very inexpensively and gave me stuff just to get rid of it. The only thing I paid full price for was my computer.

The rest of my equipment I purchased from Universal FootCare Products. Mike Moscow gave me 10% off of the x-ray processor, sani-grinder, and any other remaining items. I would have bought a used processor, but never found one.

So, for anyone out there getting ready to open up on their own practice, my biggest piece of advice is take your time and bargain shop. Even if you have unlimited funds, don't spend frivolously. There are great deals out there. I shopped for months before I opened up my doors. And I saved thousands.

Oh, and I also saved on my lease. I am in a medical building in a great location. I stood my ground on the lease rate and made out like a bandit. This is a great time for deals. I would love to help anyone taking on the challenge if they need some tips. It is great to read stories about fellow colleagues taking the risk and succeeding. Good luck to all.

—Kerry L. Temar, DPM
[email protected]

***Podiatry Salaries***

Attached are some copies of the pages from the Medical Group Management Association (MGMA) survey on physician compensation 2007. This is the "go to" book for hospital and group administrators. Look at the DPM data in here. I attached the pages for 'academic salaries', 'private practice', 'years in practice', and 'podiatry general info'.

—Lee C. Rogers
[email protected]

***Starting Salaries***

Thank you for taking time from your family and practice to inform new practitioners.  I think this is of paramount importance as knowledge truly is power.

I believe there is a caveat to the ideology that "salary is important, but so is your quality of life and overall happiness" especially when considering one's first employment after residency.  I can think of few things more painful than a noncompetition clause in a souring employment relationship which happens to be where you want to be geographically.  Take it from personal experience: consider "hovering" near where you want to be until you are in a practice arrangement that has stood the test of time.

—Anonymous

I think it's unrealistic to expect that EVERY new podiatrist should make 6 figures, as you claim, and then admit that nobody knows what that figure really is and that there are variables. Any practice will initially lose money. The prospective employer may stress this too much (in poor taste) but perhaps they're just trying to balance the attitude so many new doctors bring with them. Most practices are doing well and don't need to hear how some new doc is going to "save them." That's the attitude that I turn away. And, it turns me off when a potential new doc looks down at my employees and sneers at bread and butter podiatry. That kind of snobbery shouldn't get you anywhere. Also, podiatrists historically sign any insurance contract they get and are manipulated by payers, which might explain why new podiatrists are offered bases below 6 figures, compared to other medical specialties. I suspect that's why dentists are at the top of the list in your APMA link.

Having said that, I'm a firm believer in lower base pay with substantial bonus. You'll be rewarded for working.

—Shay Fish, DPM
President, Texas Foot Surgeons, P.A.
Diplomate, American Board of Podiatric Surgery
Fellow, American College of Foot " Ankle Surgeons
[email protected]

Editor’s Response:

I would disagree that it’s unrealistic to expect a 6 figure salary. Again, I’ll point out that we are the only specialty that starts out below that threshold. However, in the real world we’re often forced to take less than we’re worth. It sounds like you may have experienced an associate with a “holier than thou” attitude. I agree that an associate should enter a practice with mutual respect, not only for the employing doctor but also his or her staff. The golden rule applies to us all. I have also heard of young docs coming out of surgical programs with unrealistic expectations about practice type. Very few people entering practice will have a heavy surgical practice to start. This takes time and lots of effort. If you’re not willing to start with at least some general podiatry work, then get ready to starve. Toenails and calluses are part of the job. My personal philosophy is that I wanted to be a general practice podiatrist treating whatever problems the community needed. As it turns out that boils down to some palliative care, wound care, biomechanics, sports medicine, pediatrics, and surgery – the broad base of foot and ankle care. The bottom line: work hard no matter what you’re paid!

—Jarrod Shapiro, DPM

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I believe that what you have explained is very realistic. I just hope that people were not being taken advantage of by our elders, as a lot of us do at some point or another. I (along with my partners) own a practice in southeast Michigan, which, considering that it has only been two years going on our third, we are doing pretty well. We offer $85000 to start, with bonuses, health insurance, malpractice, gas stipend, all supplies, and expenses that go along with getting credentialed in hospitals and insurance plans. The only problem we have had is finding people that actually want to work. Our practice is a unique situation. We do a lot of home care (~ 70%) and the rest is office work. And there are a lot of people who are finishing who don’t want to do this when they come out because they believe that they will be in the OR 24/7 from the beginning. You understand the reality of this to not be the case. We still manage to do close to 200-250 cases per year. If you know of anyone that is interested, my phone number is in the bottom of this email.

—Fernando L. Quirindongo, DPM
248-752-8616
[email protected]

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I do agree every employment situation is unique. A base plus bonus is the best formula for a young practitioner. I find that if a new associate is willing to work hard it is usually a good indication that in the long run this individual will ultimately be a winner for the practice and for themselves. I agree that finding the right location to live is very important and hopefully not to many sacrifices are given to live and practice in that location

—Marshall G. Solomon, DPM
Chairman Department of Podiatric Medicine & Surgery
Director of Podiatric Medical Education
Botsford Hospital
[email protected]

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I read your article regarding hiring in as an associate and agree with mostly everything. One thing that residents fail to consider is the amount of money the hiring physician/group has to pay out in initial expenses to bring in an associate. Remember, in most states you cannot get your insurance numbers until after residency, so essentially, the podiatrist has to cover your entire salary for about 6 months until your billing charges start coming in. Also, all of your expenses are upfront...insurance plan fees, hospital fees, malpractice fees, increased rent fees, increased equipment, advertising, stationary, etc... (I am sure I’m missing a bunch more).

This can really strap a solo practitioner and put financial strain on the practice. So, I think it is much different negotiating with a one- or two- person group versus a multispecialty group or a larger group. As a solo practitioner, it would be difficult to pay out some huge "signing bonus", plus moving expenses, plus all the other startup costs, plus cover your salary for the first 6 months (without making a dime from the associate).

So I think you need to be careful in what you are expecting when coming out. If you ask for too much, the smaller groups will not hire you. In these situations, I think a lower base salary with incentives to be made on the backside are a better way for the solo podiatrist to structure the deal, thus enabling the practice to "make up" for the initial outlay of expenses, and make for a healthier business for both docs.

—Anonymous

Editor’s Response:

I agree with the expense of hiring a new associate. However, I've heard the stats that a practice with 2 docs makes more than one with 1 doc. So many practicing docs don't take a hard look at their practice to be sure they can sustain that initial investment. I think it's like any other investment: you want to have the money to ride out the initial time period, anticipating profit at the end. On the other hand, new physicians often don't have a realistic understanding about what is required to hire a new doc. Again, I call on the APMA to create a committee to investigate all the factors that go into this process so we can all be clear.

—Jarrod Shapiro, DPM

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As past Chairman of the Young Members Committee of the APMA, I would like to direct your readership to the Young Members Practice Survey. This is a comprehensive survey asking some of the same questions that were raised by readers of your article. Please direct them to call the APMA (1-800-ASK-APMA) and see if they can get a copy. Please make sure they are members before they call. This is just another added bonus of membership in the APMA! Keep up the good work and thank you.

—David A. Yeager, DPM
Dixon, Illinois
[email protected]

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