by Jarrod Shapiro, DPM
Joined practice July 2006 of
John K Throckmorton, DPM
Lansing, Michigan

LETTERS TO THE EDITOR

***Bringing Income into the Practice – A Dermatologist Responds***

I am a dermatologist, although medical. We do provide products such as acne related and some topical steroids, as well as some skin lightening agents. This is done for the patients as it is much cheaper for those not on insurance or with high copays.

Our group does take offense that some of our colleagues have high pressure sales and are very cosmetic practices. Is this medicine? Is this today’s culture?

I agree with your comments. Who does it benefit and does it work?

Paul Rehder, MD
Renewed Nail
[email protected]


***DPM Requests Salary Advice to Join Orthopedic Group***

I have just been offered a position as the DPM in an established orthopedic group in Texas. I am a new physician fresh out of residency. I am in the process of reviewing the compensation package and was hoping you would answer a few questions for me. First, what can I expect to bill/collect my first year practicing? What is the usual overhead expenses? What base salary do you think is fair for a three-year surgically trained? Any advice/suggestions you can offer would be so helpful and GREATLY appreciated as I have always found your editorials very helpful.

Thank you so much,
Dr. Rebecca Rosado
[email protected]

EDITOR’S RESPONSE

Great questions! I’d love to hear responses from the community on these questions. First, billing and collections. Your first year billing really depends on the specific situation, more precisely how busy you are and how fast your practice grows. When I was a resident my attendings told me the collections should be around 55-60%. That is what I’ve seen in practice. I’ve heard overhead usually runs around 55%. The lower it is the better for you. These aren’t hard and fast numbers, but they should at least give you an idea.

Base salary. Now that one’s easier to answer for me but much more controversial. >$100,000/year. That should be the base salary for a 3 year surgically trained podiatrist. Others will vehemently argue this point with me. A strong argument is to accept a low base with as high of an incentive package as possible. Then, the harder you work, the more you make. If you can negotiate a high base and high incentive then good for you. Why are we the only specialists who still hire at less than $100,000? Remember this: if you work hard your first year you WILL make your employer money. No matter what they tell you during negotiations, they will profit by having an associate. Negotiate hard and don’t be afraid to walk away if you’re not happy with the offer. Keep looking while you’re negotiating and have a backup plan! Also, don’t be awed by the orthopedists. Your training is the best a lower extremity specialist can have, and you have a marketable skill. Good luck.

—Jarrod Shapiro, DPM

I find that your column is true in that there are always those out there who are out for themselves. We tend to hear about them and the bad experiences that new associates have more than the many good experiences that are out there. I will be starting my new practice on Monday, Oct. 1, 2007, as a result of a "learning" experience. What I found, is that ego most often gets in the way as it did with my boss. I heard the requisite "You didn’t have it as hard as I did.” Never mind the midnight and other odd hour surgery, long calls and the pager that never quits. My boss never had a residency, so he doesn’t know what we all went through. My boss believes that I am a "green, non-business minded, just out of school" person and I could not possibly know more then him in any topic. The list could go on and on, but that would be dwelling on the past. Instead, I picked up a few books, talked to the mentors I had from residency and even former co-residents and extricated myself from the toxic situation. It generally is more about the doc who is attempting to do the eating in the end. For whatever reason, they feel inadequate and hope to make the new associate feel the same way in order to validate themselves. The question is whether the young associate is going to allow it to continue.

I prefer to applaud the many fantastic mentors in our field.
Thanks,
Elizabeth Kurtz, DPM
Chicago, IL


***A New Doc’s Experience***

I read your editorial and felt compelled to write with...believe it or not... a good new practitioner experience!

I graduated residency in June and joined a large podiatric practice in Western Colorado. What a great group of people! From day one they had a full patient schedule for me, though they were very good about not overloading me. They have made it clear since the beginning that they want me to succeed and will do all they can to help me grow a great patient base. There is no dog-eat-dog attitude here at all. I bounce questions off of them all of the time about billing issues, what would you do for this patient, etc. and they are fabulously helpful and patient. And they bounce stuff - usually wound care questions - off of me as well. They are wise enough to realize that if I do well and make money, so does the practice as a whole.

I had always heard the old adage about podiatrists eating their young and what a "fend-for-yourself" field this is. I am very happy to say that, unlike some of my friends, I have not once experienced this attitude. I only wish that all new practitioners could have as great an experience as what I am having so far!

Heather Kaufman, DPM, AACFAS
Grand Valley Foot and Ankle Center
Grand Junction, CO
[email protected]