SHOW ME THE MONEY!!!!- NEW GRADS/1st-3rd year practitioners

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Hi,

I am starting this thread to answer any questions regarding employment, buying a practice, becoming an associate, how to negotiate a salary, billing codes, malpractice insurance, buying equipment, hiring employees anything at all related on how to PUT MONEY IN YOUR POCKET or save money in your pocket- that most likely you were not taught during school or your residency.

You can PM here directly or start a new thread. I will try to answer all your questions with detail and accurate information.

I have been practicing 7 years and Unfortunately, I have been through all of these things, some of them with success and some of them with complete nightmare results.

I have polled the majority of my classmates to see what they have been through, some are doing great, some are out of the field completely.

The majority of new grads coming out are simply not prepared for the business end of podiatry and most will go through a trial/torture just to find meaningful employment.

I want to get the information OUT- so you can make better decisions for yourself and your families. You worked hard for your education and degree.

Now, its time for someone to SHOW YOU THE MONEY!!!!!!!

-Jttemp

 

A good organization to join in the USA is http://www.aappm.org. It has many resources to help. There are also many books out there on practice management.

Bounce off questions/ideas off many people and use your discernment on choosing the best course of action.

Building a practice is a process and if your focus is on improving your knowledge base and constantly networking with the medical community, your going in the right direction. Also, employ the best people you can find as your staff is a crucial part of your success.

Steven

 

What are yor thoughts on buying an established practice vs setting up your own? How do you value goodwiil ( if at all?)
Cheers,
Kara

 

docmoney,
To be quite frank I find your "in your face" posting both irritating and unprofessional.

Whilst I applaud your desire to help new graduates, (using the whole of your 7 years experience)I think that to place an emphasis on the financial side of private practice is not what it is all about.
Yes, we all want an acceptable remuneration for our efforts but I would value job satisfaction more than a fat pay packet. That is why many pods give up their time to help charities such as Crisis at Christmas.

Kara47,
"Goodwill" is an elusive commodity that is impossible to measure. People are conservative by nature and therefore do not like change. It is estimated that if you purchase an existing practice you should expect a loss of anything from 10% to 30% of the existing client base and this should be factored into the purchase price.
Many clients stay with a practitioner purely out of loyalty and when a business changes hands this gives them the excuse they need to go elsewhere. This is especially true if you are of a different gender from the previous owner.

The advantage of buying an existing practice is that people already know it is there and that will save a considerable amount of marketing. However, there will be a cost implication in the first instance.

There are a great many very experienced practitioners that post on this site that should be able to help you. I hope they do so.

But only you can choose which way to go.

Hope that helps.

regards

Catfoot

 

docmoney,
To be quite frank I find your "in your face" posting both irritating and unprofessional.

I agree Catwomen as he writes like a scam artist with his own secret agenda. I am surprised his post was not deleted or moved to trash.

I think if you can buy an existing practice at a very good price, that is the best way as it not only comes completely equipped but also with patients. Still, it only makes sense if the price is right as you do not want to overpay. 30% attrition also sounds right.

When buying a practice, you also have to figure out where the new patients are coming from. If the practice has a high physician referral base, you will probably lose those referrals since they do not know you.

When I purchased a practice many years ago, I tried to practice like the retiring Podiatrist and slowly integrate my way of doing things to make the transition easier. I also fired the entire staff the first day and brought in my own as the old staff will always compare you with the doc they used to work for and you will be on the losing end.

Steven

 

Kara 47,

I will give you 3 examples of recent graduates who have been practicing a few years:

Dr. Green (not real name)- decides to open his own practice with one employee. He rents office space from a MD using 2 treatment rooms. He gets on staff at a local hospital and a surgery center. He puts out some ads, talks to some PCP’s in the area. Within 2 years he is able to build a somewhat full-time patient schedule and is able to rent his own space with 3 treatment rooms and now has 2 full-time employees and one part-time. His 3rd completed year he grossed $250K, netting about 50% of that. His 4th and 5th years grossing $300K, $400K.

Now in his 1st year his income was slow and the patient flow was unpredictable, but what helped him was that he negotiated with a HMO contract of who agreed to pay him $6,000/month to be one of the few podiatry providers in that area. (This was a capped plan) therefore whether he saw 10 patients or he saw a 100 and whether he performed surgery or not he received that same $6,000 per month and he still does today. But being new in practice that $6,000 was a nice safety net to have to at least pay for rent, 1st employee, some ads, equipment, etc.

Dr. Blue decides to work for a podiatry group that has 3 other podiatrists already and he will be the 4th. They start him off at 40% of his billing with no salary and no paid malpractice. They start feeding him a few patients and eventually in his 7th to 8th month he starts making a steady $6,000-$8,000 (his 40%) which is consistent after the 8th month. The 1st 6 months he was only making $1K-$2K/month and was living at home with his parents.

After 2 years they agree to make him partner. For this Dr. Blue has to pay them $15K in cash and agree for the next 5 years to remain making 40% of his billing while paying them (deducting from his monthly 40%) around $3K/month for a total payment to them of $200K to be made partner. Then after 5 years he will be made partner and I am assuming then he will just be just responsible for a portion of the overhead divided by 4 partners and he gets to keep the rest of his earnings.

Dr. Black decides to take out a loan straight of residency and buy a practice. He borrows $200K and buys a practice that is grossing around $300K. His 1st year after acquisition he is able to maintain that gross. So he makes $300K. His 2nd year he increases that to $350K, his 3rd yr. $425K, his 4th yr. $450K, his 5th yr. this past yr. he grossed over $500K. His monthly overhead is locked at $15K/month. If you do the math a gross of $300K/yr. equals $25K/month minus $15K/month locked overhead gave Dr. Black a $10K/month personal salary (before taxes) in his 1st yr. That means in his 2nd yr. he had an average $14K/salary per month based on a gross of $29K/month and again a locked overhead of $15K/month.
His salaries for the 3rd-5th years are $20K/month, $22K/month, $27K/month (I know you can do math too!).

Now, put the 3 podiatrists side by side:

Dr. Green starts a practice with a $6,000/month salary contract from a HMO. For the 1st 6 months he is probably breaking even to a small income/profit of let’s say $1,500/month. The next 6 months he is making a little more of let’s say $3,000-$4,000/month on average. His 2nd yr. he is steady at $5,000-$6,000 profit (before taxes) and then his 3rd year he jumps to $9,000-$10,000/month profit with his gross being $250K and his net being 50% of that which I stated earlier.

Dr. Blue decides to join a group and make 40% of his billing as I stated earlier. This starts out as zero income his 1 month to about $1,000 income his 2nd month to about $3,000-$4,000 months 3-7 and then jumping to $6K-$8K profit average from his 8th month on through his 2nd yr.
The end of his 2nd yr. Dr. Blue has to pay the group $15K and then have $3K/month deducted from his monthly 40% income from his billing. So, Dr. Blue makes $250K/gross billings in his 3rd year, which translates to $100K (40%) personal income for the year, about $8,300/month. But wait, He now has to deduct $3,000/month because he is now paying them to become a partner. So now his total income is now down to $5,300/month for his 3rd yr. His 4th year he grosses $300K for a yearly $120K (40%) income and monthly $10K, (but wait) minus $3K now equals $7K/month. His 5th yr. he grossed $350K and you do the math again.

Dr. Black decides to take out a loan and buy out a practice. He takes out a loan for $200K. (Terms up to 120 months (10yrs.), around $1800/month for re-payment) I stated earlier he is able to net $10K/month his 1st year. Now minus the loan and he is left with $8,200/month the 1st year. The 2nd yr.- $12,200, 3RD- $18,200, 4th-$20,200, 5th yr. -$25,200.

Dr. Green- 1st yr. - $3,000/month, 2nd yr.-5-6,000/month, 3rd- $9-10K, 4th- $10-12K, 5th -$14-15K
Dr. Blue- 1st yr.- $5,000/month, 2nd yr.- $8,000/month, 3rd yr.- $5,300, 4th yr.- $7,000, 5th yr.- $8,000.
Dr. Black- 1st yr. $8,200 ,2nd yr- $12,200, 3rd-$18,200, 4th yr.- $20,200, 5th- $25,200.

-These are all real examples taken into consideration that they all practice in different states.

-Nevertheless you cannot ignore that Dr. Green and Dr. Black seem to have made investments in their time that have more immediate results than Dr. Blue who has to wait another 2 years to be made “partner”.
-Also take into consideration that many new grads take on this “associate path” only to be let go 2 yrs. later by that group giving some ambiguous reason on why the new grad underperformed when in reality they simply want to start the cycle over with a new grad to keep their profit margin as high as possible.

Kara47,
- starting your own practice or buying someone out will give you the most control over how you practice, your finances, and your life. No one can ever fire you, but your struggle will now be to keep patients coming in and having enough income to offset overhead, personal living expenses/your family expenses, and a new loan if you take one out.

It may be hard for you to find a contract like Dr. Green found to help you get started, but you can always start something part-time while you have income from another place, or simply work and save money until you have enough to help you get started. Start-up loans are tough to get.

Buying a practice seems to get more immediate results. Just make sure there are no IPA or HMO contracts that you cannot be transferred on as part of the sale. The practice may be worthless if these make up the majority of income for that practice. Also, if the practice is heavy on referrals, make sure you are comfortable treating patients 100% alone and you can do all the procedures the previous doctor was doing, otherwise they may not consider referring those patients anymore if let’s say the last doctor was heavy on placing external fixators and you can not put one on.

Let me know what you decide, feel free to PM to me directly for any further questions.
-docmoney




Catfoot,

Interesting comments-which I would like to comment on.

1. How long have you been in practice?? 15,20,30 years??- look at my answer to Kara47 and look at yours. In your 15,20,30 years that’s the BEST answer you could give her?? Do you think that helps her at all?? Did you take 50 sec to write that??
2. I am not promoting the notion that “money” is the only thing that a new doctor should be after. I am also not promoting material wealth such as fancy cars, exotic vacations as something that should be sought after. I am promoting “money” as security, as means to support and raise their families, as a way to put a roof over their heads and pay back their loans. Today’s young doctors are struggling. As of today I have 3 classmates who are no longer in the field of podiatry. I have one who became a drug rep because she simply could not find employment and she did not want to go down that road of starting a practice. So it was simpler for her to take a salaried position in another field.

Michael Rosenblatt, DPM –a retired podiatrist of 30 yrs. wrote an article entitled “Are associateships failing podiatry graduates” which appeared in one of the podiatry management magazines 3-4 yrs. ago. This is a compelling article which every new graduate and yourself should read. He states how senior podiatrists take advantage of young graduates, pays them minimally then discards them after 2 years after “mentioning” partnership in the beginning of their relationship. This leads to depression, the podiatrist has to relocate themselves and their families. That can lead to divorce and more emotional distress. (I did not write the article)

In this article he quotes the amount of “defaulted” podiatry student loans and the amount is staggering!! Which further confirms how unprepared
new graduates are facing tough business and financial decisions.

New graduates are coming out during a tough economic time. We are living during a recession, a changing healthcare market. The U.S. dollar is not worth what it once was. All this and the new graduate does not have one good class on business, billing, markets, something that can help him navigate and get his career established.

So, no CATFOOT I am not promoting greed, or material wealth. I simply want the new graduate to have the knowledge, the education, on ‘money’ issues like billing codes, how to obtain a loan, what kind of income can I expect my 1st yr. so they can make calculated decisions for them and their families and so they can “make it” in the field that they spent so much time and money on their education on.

3. On your notion that my 7yrs. experience is meager and not credible to be giving information/advice on this subject. 1st- I am simply trying to give facts and examples of real life practices out there without judging. There are clearly financial scenarios that are better than others but I am just trying to present examples to give residents/graduates options on how best to get their careers going. I wish it was done for me.
4. I know clearly I would have made several decisions differently if I were given more information on associateships, loans, buying a practice, even billing codes which would have impacted where I am today financially and on a more personal level with my family. The majority of my classmates agree formal business classes would have made a difference in their careers today. Some of them joined good groups which mentored them well. Others are on the complete opposite end where I know someone who has lost their medicare number because the guy he worked for taught him how to bill inappropriately. He is now divorced and working at Mcdonalds as a result.
5. As far as having more senior podiatrists commenting or giving advice with this subject, I welcome it!! Starting with you, Catfoot. Don’t you have some sort of financial difficult situation you had when you got started that you could share with us??........ You see I tried to get this information during residency from my attendings. I would ask them about billing codes and how to start a practice and their answer to me was “you don’t need to know it right now”. So when is a good time?? After you work for some guy who teaches you the wrong codes and then you lose your billing privileges?? They did not want to teach the information like it’s some secret.

Michael Rosenblatt, DPM was the 1st senior podiatrist who really took issue with our lack of financial education to our students and it needs to be addressed.

As far as my 7 years vs. your 20-30yrs. A person who has been in practice 7 yrs. has recently gone through obstacles that the new graduate will be going through during a time where the economy is the same, the challenges are similar. If you started practicing 20-30 yrs. ago, times were different and you may simply be out of touch with what it’s like to be a new practitioner and perhaps struggle a bit. Also, senior podiatrists tend to condescend to new graduates and don’t want to help them. It’s nice you can volunteer during Christmas but most of us newer graduates have to work extra during Christmas just to pay our bills.

6. I started this post to help and perhaps someday eliminate the “guessing” and “stress” that goes along with making long term financial decisions in our field starting day one from graduation. I am by no means stating that the didactic, clinical, surgical experiences during this critical time should be ignored. This is a time when a young podiatrist will come into his own and really put together all his training and education into practice. He should study for boards and prepare all the necessary cases that are required. What I AM saying is that the financial side has to be studied as well.
7. If there is a more senior podiatrist who wants to take time and place effort into educating young graduates, where is he?? I will be his 1st student!! No one??....... Well, Catfoot, before you call me “irritating and unprofessional” consider the amount of time and effort I have placed in this post. I am not getting paid to do this. I simply think it’s an injustice to our field that we are not educating properly and I simply want to help.

LABGUY- there is no secret agenda, I simply have passion and I want to help. If you have a better way to do it, I will listen and stop posting.
-docmoney

 

Fair call and well said.

There is a lot more to experience than time.
There is a poor understanding of how taking care of your business is one of the primary factors to becoming a good practitioner and building a good Practice, that is able to offer value to a large number of patients.

 

docmoney,
We don't have "billing codes" over here in UK, and I think you will find that the agressive American marketing model doesn't work over here either. Not many people in UK have private medical insurance. We have a National Health Service where patients can obtain podiatry care that is free at the point of delivery - it's whole different system.

The system in Australia is also different to UK.

Kara 47 asked a question about goodwill and I answered that.

Catfoot

 

Docmoney well said....there will be many differences between the US and other countries the same as differences between every country.

I've always found it odd the professions outlook on an ethical profit being a negative thing.

 

M Weber,
I don't think that ethical profit is a bad thing - if I did I wouldn't be in private practice.

It's docmoney's approach I find unprofessional.

regards

Catfoot

 

Thanks all for your input.
Docmoney, being an Aussie we tend to get our hackles up with the "in your face American salesmanship" spiel. Obviously the Brits do too. Forgive us if we first judge you by the cliche.
You, however, have some great points, which I have found really helpful.
As you say, a new grad has a whole different set of hurdles to face to someone who has been established 15+ years. I think the longer you do something the easier it is to forget what it was like when you started out.
Still, I envy the experience of established practitioners, those who are kind and generous enough to share their experiences are like gold.
There is always something to learn, be it the business side or the podiatry side. A lot of practitioners I have seen obviously only deal with the business side when it's really necessary.
I'm not out to make a fortune, but would like to think I can make a better living than I have in my previous career. If not the years at Uni, lost wages & HECS fees will have all been for nothing!! I'd also like to buy a house, something that was unattainable in my previous job.
I see no reason why you can't maintain your ethics & eat too!
Your patients won't thank you for years of cheap rates when you go broke - they'll just find someone else.
Any more advice greatly appreciated - keep up the good work!!
By the way, what part of the U.S. are you from?
Thanks,
Kara

 

Kara47,
While I agree with you that there is always something to learn about IPP we do have a wealth of experience on this site that we can tap into.
What we don't need is some in-your-face unknown person from across the pond being allowed to set themselves up as some kind of a guru.
If you look at the scenarios he has described not one is relevent to UK, all are full of "puff" - no substance to any of them.
If you stay around long enough he will no doubt have something to sell.

If this site is going to become a showcase for any passing entrepreneur to peddle their wares - I'm out.

I've asked Amin to delete my account - but it seems they haven't done so yet.

regards

Catfoot

 

Here is the PDF mentioned above....

Are Associateships Failing Podiatry Graduates?

 

"If this site is going to become a showcase for any passing entrepreneur to peddle their wares - I'm out......I've asked Amin to delete my account - but it seems they haven't done so yet..."

Seems a bit extreme if it's in relation to this one thread! If it's a protest then pointless and you only serve any one sales persons purpose then. Not suggesting the OP is a salesperson, at this point.

 

Why??

 

"I've asked Amin to delete my account - but it seems they haven't done so yet"

I'm for putting the cat out....

 

What rubbed me the wrong way with DocMoney's Post?

1. The moniker, DocMoney is poor taste. Making a profit is important but should not be in your face.
2. DocMoney joins the Podiatry Arena on March 15th, 2011 and in his first post, he appoints himself as the master of practice management.
3. DocMoney does not do research to find that the vast majority of Podiatry Arena members are not from the USA and thus have different needs.
4. Podiatry-Arnea is the premier international biomechanical site in the world and it does not appear that DocMoney has any interest in biomechanics but his own private agenda.

Steven

 

Yeah okay, but it should be remembered that the poster is simply a product of his/her environment. The USA does things differently. The dollar is still king despite the monetary system failures and the poster is not suggesting or encouraging anything fraudulent or illegal - they simply sggest a way for clinicians to maximise their income. Whether or not it holds any substance is another matter altogether. Colleagues in other countries should try not adopt a parochial view and recognise that clinical practice binds a profession diverse in its delivery and remuneration. The latter, although perhaps a little distateful to some, is really not all that important.

 

Yes, I largely agree. However, such posts are clearly directed at our colleagues in the USA and would be better located under that area on the site. Different countries do have slightly different attitudes/views and the OP should have (as has been said) done his homework before posting.

All the best

Bill

 

Thank-you for the positive feedback, many of you have sent back great comments. I have also received several PMs from new graduates who have said this little thread/forum has helped them and given them some clarity and direction into their careers which is what I had intended.

I will be transferring my discussions to the U.S.A. section which a few of you have pointed out is where my subject belongs. (which I agree and yes I should have done some research to post in the correct area)

To my new friends, Lab Guy, Catfoot,- I am not declaring myself “guru” or “master”, I am not selling anything. Our little discussions helped a few doctors in which they are thankful!! Perhaps maybe, that could be the reason why I am doing this??

-docmoney

 

hi doc money i live part or the year in sarasota and am an english podiatrist my colleagues in england do not understand your business we have private practices for sale in the uk which only turn over50 000 us dollars per year .My nieghbours in casey key pay more property tax than these businesses earn in a year. Podiatry in the usa is massivley more professional and well renumerated than here in the uk . when people on the beach ask me what i do for ajob and i reply podiatrist they all assume im mega loaded i wish it were true . we brits are slightly embarrased when it comes to money talk . we ;ll catch up with you guys one day

 

Possibly true. I remain unconvinced that this is a good thing however.

As others have said, there is nothing wrong with an ethical profit. However, in my quaint little English way, I find such aggressive pursuit of profit somewhat distastful. That is just a personal view.

In the NHS we are victims of the old adage, what gets measured gets managed, what gets managed gets done. Often the pursuit of these targets, set with the best intentions, overshadows the object of the exercise and does great harm. As Catfoot said, some things like goodwill, job satisfaction and ones sense of appropriateness and form, cannot be easily measured. Notwithstanding this they are still important. Profit on the other hand is easily measured, and often we see people so fixated on profit that they neglect these other elements.

I am reminded of the now defunct parish and bell. Profitable, certainly! But in pursuing profit so aggressively one loses much else which is of importance. I do not wish to be rich if that is the price I would pay.

Good luck to "Doc Money" and any acolytes he may gain. I suspect you will make a lot of money. But I'm afraid I find the whole concept a little crass, and the way it has been advertised on this forum a little lacking in professionalism and class. So in the words of dragons den, I'm out.

 

Your assesment and opinion of UK podiatric practice is on par with your command of the English language. If you think that "Podiatry in the usa is massivley more professional and well renumerated than here in the uk " then I would suggest that is probably more of a reflection of yourself than of your colleagues in the UK.

 

In the U.S.A. the insurance, collection system is so complicated that new graduates do not even know where to begin. There is endless paperwork and "holes" in the system that if you do not know how to navigate through them and how to look for the 'money' you will surely not receive any. That is what there term "show me the money" means.


Take this passage from a concerned U.S. medical doctor:


Imagine going to your favorite restaurant. You are greeted at the door by the hostess, who seats you and takes your drink order. You order through your favorite waiter, Andrew, who recommends the special of the day: prime rib with a dinner salad and a chocolate tort for dessert. Soon after, the food is brought out and it is delicious. You have time to enjoy your food. You then receive the bill and pay for your meal, returning to your home satisfied, all your dining needs met. Let’s say you paid $75 for this meal:$50 for the steak, $10 for the salad and $15 for the dessert.

A change then occurs in the restaurant industry. A new form of eating out has been adopted. Your favorite restaurant has now contracted with over 30 different ”restaurant insurance companies.”

Anticipating another pleasant dining experience, your return to the restaurant with your new “subscribers card.” You pay your $5 “copay” and sit down in the foyer of the restaurant. After waiting an hour, even though you made reservations, a harried Andrew greets you and quickly takes your order after you briefly glance at the menu. The food arrives at your table, but before you have time to truly enjoy it, Andrew informs you that “your time is up” and the table is reserved for another party. You are escorted outside with your hastily boxed left-overs.

What has happened to the restaurant? Behind the scenes, the restaurant owner has learned some tough realities of the “new system.” During the first month of taking insurance, the owner submits the charges for the $75 steak dinner. The contract with this particular insurance company already states that they will only pay $45 for the $50 steak, but the owner decides that the extra customers brought to the restaurant by contracting with this insurance company will more than off-set this small loss.

The first attempt at collecting the $75 dollars for the full meal is returned unpaid due to a clerical error. The owner mistakenly used the number assigned by another insurance company. The owner mails the corrected form.

In response to the second request for payment, the insurance company does not send a check, but a detailed questionnaire: Was basil used in seasoning the steak? Was it necessary to use basil for this particular recipe? Did the restaurant ask for permission to use basil from the insurance company before serving the steak? The owner submits the answers, emphasizing that the basil is part of a family recipe that made the restaurant famous.

The owner waits another week (it has now been 3 weeks since the dinner was served). The check arrives three and a half weeks after the meal was served. The check is for $20 and states that it is specifically for the steak. The check also comes with a letter stating that no billing of the patron may occur for the salad, but no other explanation is enclosed. No mention is made of the $15 dessert.

The now frustrated restaurant owner calls the provider service number listed in the contract. After five separate phone calls to five different numbers (The harried voice behind phone call number four explains that the insurance company has merged with another insurance company and the phone numbers had all changed last week, sorry for the inconvenience…), the owner gets to ask why, when the contract says the steak will be paid at $45, has the check only been written for $20? And what happened to the payment for the salad and the dessert?

As it turns out, this particular patron’s insurance contract only pays $45 when the patron has reached their deductible, which this patron has not at this time. The remaining portion of the steak must now be billed by the restaurant to the patron directly.

The $10 for the salad would have been paid if the patron had ordered it on a different day, but, per page 35 in the contract, because it was billed on the same day as the steak, it is considered to be part of the payment for the steak and no extra money can be collected from the patron or the insurance company.

The dessert should have had a “modifier” number put with its particular billing code in order to receive payment when billed with the steak and the salad.

Realizing that the billing is quite a bit harder than anticipated, the restaurant owner hires a person to specifically make sure these errors do not occur again. The owner must lay off the hostess and the bus boy to hire the biller, but feels these duties can be added to the waiter’s other responsibilities.

In the meantime, the restaurant owner has now had to have the waiter take on the job of answering the phones due to the now high volume of phone calls from patrons questioning why they are receiving bills for meals they ate over 2 months ago and why did their insurance company not pay for this portion of the meal. This extra work is now resulting in longer times patrons must wait to be seated and served, and grumblings from the waiters who “were not hired or trained to do this kind of work.”

The owner now realizes that, although the dinner originally cost $75 to make, only $22 has been paid. The remaining $30 billed to the patron has now cost $10 in overtime for the biller and mailing a second bill to the patron after the first bill went unpaid. By the third billing cycle, the owner realizes a collection agency must be employed in order to have any hope of receiving any portion of payment from the patron.

In order to meet costs, the restaurant owner now must seat twice as many patrons in the same amount of time. The owner has now over-extended the waiter, who was an excellent waiter, but is now taking on the roles of host, phone answering and table bussing, as the pay for these employees has been shifted to the biller and the collection agency.

What was once an outstanding business that focused on fine dining and customer service has now been turned into a business in the business of trying to get paid.

Alas, I wish this were a fictional tale, but it is not. The only fictional portion is that this is not your favorite restaurant, but your favorite doctor’s office, who is responsible not for meeting your dining needs, but those of your health.

Megan Lewis, M.D.
A family doctor in rural Colorado.


-In addition graduating podiatrists are unaware of the complicated business relationships that they are entering and think they are simply working a job when in reality they could be subject to certain laws such as fee-splitting, kick-back, simply due to the agreement they entered with the group they are working for and the way 'money' is collected here through insurances.

-There are many young U.S. graduates who can not make it in podiatry. Many have given up, defaulted on their loans, and are now working in a non-medical industry.

-This post is for them, so someone can "show them the money" so they can simply have a "job" and work in their field that they studied so hard for.

-It's not meant to be a proponent or advocate of greed or lust to be wealthy.

-docmoney

 

This all seems a bit complicated for me.

I've found that simply working hard, investing time and money into my own knowledge and development, always trying to do the best for my patients, and being a 'people person' has allowed me to always maintain busy private clinic lists and put food on the table.

But whadda I know, I'm just another quaint little Englishman.

IG

 

I say old chap. Cup o' tea?

 

It is too complicated and ridiculous how they make physicians scrap to get paid.

U.S. doctors would love simply to just spend their time taking care of their patients and not have to worry about collection.

There is serious need for healthcare reform in the U.S.!!

It is tough for a young practitioner to get started over here.

-dm

 

And I thought Medicare was complicated....

 

dear robert isaacs im in the states now only 88 degrees, making money is not like parrish and bell they are scam artists not people who care about people you dont understand our cousins.im fishing with people who have not used scheduled airlines for 25 years they have 50 mill gulfstreams waiting for them its not britain and they only drink iced tea.and many thanks mark russell for reminding me i cant type you seem to think this skill is very important. you seem to know jack about podiatry in the states they are doctors not getting 33 grand ayear like my hard working nhs co workers wats your beef with reality they make more moneythan us and they do it ethically. to suggest anybody who is wealthy is not ethical is very silly you guys sound like socalists

 

For the record I didnt find docmoney's post offensive in any way. He has generated intrest and discussion.

We are trained as health professionals not business owners, docmoney high lights an important point. We are unprepared to start a business, and i believe our training should incorporate some business skills. I graduated 15 years ago and made many mistakes with business decisions, I cant remeber any business training through uni.

I would suggest new graduates do some form of small business course. I wish i did.

 

Dear All,

Us poor downtrodden embarrased health care professionals afraid to put our hand out for our crumbs of a fee should look at other healthcare professions which follow the american model.

I can think of two which have dramatically raised their fee profiles, primarily based upon cosmetic appearance.

The two would be Dentistry and Cosmetic Surgeons.

Now you are able to live quite happily without teeth, and also large tits.:deadhorse:

But losing a foot is going to adversely affect your life markedly.

But until we are able to surgically alter the foot till it matches the shape of the current footwear worn by those with dazzling teeth and gigantic tits.:butcher: we wont get rewarded handsomely.

To prevent morbidity in our patients we struggle to generate a decent fee structure and the concept of the NHS values health lower than appearance.

How many would pay for a repaired heart compared to those who would pay for big tits.:bang:

So perhaps DocMoney has it right and is pleased that a high level of training and skill is worth about £200,000.00 as opposed an NHS salary of about £35,000.00 as a band 7 clinical Specialist with an MSc or equivalent.

If we want to attract the best we need to have the financial rewards.

Otherwise X factor or similar will be the desire of most.

My God near me there are beauticians using Botox and silicone fillers and not for £20.00 quid either.

David:drinks

 

thanks davohorn finally a poster who understands the us i thought nobody could figure it.all the best hoping for some lunker bass tomorow.

 

Well said Ian G, on the nose, the voice of reason! It works for me too!

 

Hi Docmoney
What do you think about having a private clinic only for once a month and then slowly build it up?is it worth it?

 

I would just like to make some points... My experience is limited but good...

My life last year as a new grad was bad, good and scary... a roller coaster

good
Finding jobs wasnt too bad like the uni helped out heaps - very lucky
In some of the jobs I did, the staff were awesome and helpful
Staff could help with CPD and patients

scary
I never felt secure in jobs or money wise...
At times I really wished I had a full-time basic job like a engineer or accountant... I never knew how much I would earn... I really hated working lots of small jobs ... Worse then being told "sorry, its a quiet day you only have 3 patients"

bad
The job market isnt too great
There are lots of jobs but not many great or good ones... You never know what a job is truly like till you really work it...

money-wise
Sorry to say... I wouldn't expect heaps
It depends sooo much too... I mean you will get work but :I
The economy isnt that great either
It does get better... I would focus on getting a nice helpful practice... when you become really good practices want you and need you
money can be as low as 35 k per yr to as high as 80 k for a new grad.... (you will have to work pretty hard for that 80 k) - it really depends