Letters to the Editor ***Salaries*** I too was wondering these same questions so I am very glad you addressed this topic. Also, I have found it difficult to find information on what a new practitioner as an associate can expect to make with a 3 year surgical degree (in the Midwest). Are hospital packages more lucrative from this standpoint as well? I thank you for bringing up these topics. Sincerely,         —Anonymous

Jarrod Shapiro, DPM Joined Mountain View Medical & Surgical Associates of Madras, Oregon July 2008

        —Carly Robbins, DPM
        Chair, APMA Young Members' Committee
        [email protected]

Carly and Jarrod, We too see the open discussion of such fundamental practice management issues as salary as a very valuable and healthy topic for young and seasoned podiatrists alike and are proud that PRESENT new Docs is hosting these topics. Thanks to Carly for directing us to the hard facts that they make available...we will certainly let our members know where this is available and who has provided it to them.

I want to clear up one possible misconception.  While access to PRESENT Courseware lectures is still limited to physicians associated with residency programs that provide PRESENT Courseware to their residents, ANYONE is welcomed to receive PRESENT ezine publications and our subscriber rolls are growing every day.  I am going to add Carly to our distribution list.  There is an unsubscribe link at the bottom of every email we send out, in case it gets to be too much.  We also archive all of our ezines...podiatry ezines are a available at https://www.podiatricresidency.com, use the Publications tab at the left.  They are all available for all to benefit from. 

Alan Sherman, DPM
CEO, PRESENT e-Learning Systems
[email protected]

My advice: start up as an associate. It is a good idea to learn from other people, to learn from those who already have some experience. Learn from other people's experiences and mistakes, and try not to repeat their present or past mistakes.

It is important to learn the business aspect of medicine, something that we are usually not exposed to during school or residency training. It is extremely important to learn about billing. You can provide great services and be the best surgeon, but not knowing how to bill may affect your ability to survive in private practice.

Even if you do not get paid as much as you may like or as much as you think you deserve, learning the business aspect of Medicine is priceless! Watch and learn as much as you can from a senior partner. A good employer would want you to learn as much as you can so you can be on your own treating patients and feel comfortable with the billing part.

A good employer would try to be fair to you while they make some money by having you in their practice. As somebody else had mentioned before, it would be best if they can show you the books as you learn how you can improve your productivity, especially if they are going to give you an incentive based on how much you can make for their practice. If they are really honest and have nothing to hide, you should have access to the Practice Management program that tells you in great detail the productivity of each provider (based on payments).

There are a lot more things when it comes to opening your own practice, but most of them you can learn as you go. You will make some mistakes, but you will learn from them as you go.

As many experienced colleagues may say, you don't make any money when you start and you need to make plans accordingly. Plan ahead and expect no true income for at least one year. Save as much as you can while you learn from someone who already has the experience, who had already made the mistakes and learned from the past. It is best to learn from others and not repeat their mistakes.

        —Jeannette Velazquez, D.P.M.
        [email protected]
 

I am 61 years old, previously in private practice for twenty five years, and now practicing within the VA system. I am a Past President of the Georgia Podiatric Medical Association, having served during a time when the orthopedists were actively questioning our scope of practice law in the state legislature. I believe strongly that the professional relationship a podiatrist may have with orthopedics within a practice community is directly proportional to two factors:

1. The orthopedist’s experience with podiatry during his/her own training and
2. The political environment the orthopedist experiences within the community where he/she currently practices.

In my opinion, podiatry should continue to encourage residency programs within institutions that house multidisciplinary residency programs so that our training is intertwined with all medical specialties. In these environments, orthopedists (and all other medical specialties) will come to realize the worth of podiatrists within the health care community and realize the scope and talent of podiatry. We need to continue efforts to standardize our own training so that the rest of the medical community is not confused about the length, scope, and worth of our programs. This way, eventually, all of the doctors within your community will have ‘grown up’ together and not be ignorant and therefore fearful about our profession.

        —Norman Field D.P.M.
        Past President GPMA
        [email protected]

Could you recommend some sources on how to find an orthopedic surgeon who will refer foot and ankle cases to me?

I am looking to join an orthopedic group that doesn't have a foot and ankle surgeon and is willing to work with a podiatrist. Because I cannot cover their ER calls for shoulders, spine, hips and knees I had several places say no.

Any advice?

        —Tim Chan, DPM
        Past President GPMA
        [email protected]

Unfortunately, there’s no such thing as a specific resource of orthopedists who like to refer to podiatrists. If you’re looking specifically for an orthopedic practice, I’d recommend calling all of the ortho practices in the area you’d like to work and speak to whomever administers the practice. If they don’t already have a podiatrist or foot and ankle orthopedist sell yourself to them. Explain how you can still cover hospital call for foot and ankle trauma while at the same time expanding the services their practice can provide. Talk to them about diabetic wound care, orthotics, prosthetics, hospital consultations, DME, and ancillary services (like dopplers, etc), as well as another referral source for them. You can assist during surgeries and bill an assistant fee (which they can’t do with a scrub tech). You must demonstrate how well you’re trained, your excellent bedside manner, and strong work ethic. If they seem willing, offer to present them with a quick Powerpoint lecture showing the various pathologies you’ve treated and services you can offer. One note of caution: be careful if you work for an ortho practice that you’re not being given the “scraps.” I knew a podiatrist in Michigan who had very little surgical work as a result of being the low man on the totem pole (they had a foot and ankle orthopedist). Good luck on your search.

Jarrod Shapiro, DPM
CEO, PRESENT e-Learning Systems
[email protected]

During my last year of PM&S-36 residency at "X" hospital I had the chance to work closely with orthopedic surgeons. They all did some foot and ankle work but there was one who was fellowship trained in foot and ankle surgery. When I newly met the latter one, he had little respect for podiatrists. He told me how bad the previous podiatry residents were; they didn't know their basic foot and ankle anatomy and had poor work ethics, and he would rely more on his ortho PA's than podiatry residents. But then things started to change as the year progressed. I and my junior residents were able to be first assistants in his cases and his PA's didn't scrub in when we were there. He turned out to be very nice to us; he would teach and go over the cases with you if he liked you. Toward the end of the residency year he even invited the senior podiatry residents to shadow him in his newly moved bigger office. He was very knowledgeable in foot and ankle pathologies and one of the best foot and ankle surgeons I have encountered.

        —Anonymous

I have witnessed situations in which Orthopedics and Podiatry worked well together, and other situations in which the relationships were sometimes strained. I have been very fortunate to have had some great mentors in BOTH podiatry and orthopedics, and was even offered a job at a medical college in the department of orthopedics this summer right after residency. I have chosen to do a fellowship instead. You might ask why? First of all, I have been given the opportunity to learn from one of the best teachers in our profession, thus fulfilling my desire for further specialization in my areas of interest. Secondly, the answer lies in this very simple fact: almost every orthopedic surgeon I ever have worked with has mentioned the value of education, specifically the length of post-graduate training after podiatry school. I have been asked questions by many orthopedists about the differences in the types of podiatry residencies, specifically regarding the length of training. Most of the time the dialogue transitioned into comparisons of the length of podiatric versus orthopedic residency training. Strangely enough, when I was considering whether or not I should even do a fellowship, many of the orthopedists that I worked with actually encouraged me to do so when others said it was unnecessary.

Now I admit that, like many of you reading this, I am just starting out and have very limited experience. But overall, I have to say that I believe that other healthcare professionals and people in general will respect you when you work hard and try to do the right thing, no matter where or how long you have trained.

Thanks again for all the helpful information you provide "New Docs on the Block."

        —Janice P. Clark, DPM
        Fellow, Southern Arizona Limb Salvage Alliance
        [email protected]

I have been in practice for about 23 years in the Boston area. It took some time to get a feeling for which Orthopedic Surgeons in our community I would be able to "work" with. I made it my business to attend Orthopedic Rounds and actually met some of these doctors face to face. It was a little awkward for me at the beginning but, with time, I felt more comfortable and developed good professional relationships with at least 6 Orthopedic Surgeons. Over the years, I have assisted two of these doctors in the O.R. doing Foot and Ankle cases. I have learned from them and they have learned from me. I have been asked to present cases at Rounds and also prepared lectures in topics such as Posterior Tibial Tendon Dysfunction. I also do receive referrals from them for orthotics but also to tackle some surgical cases that they seem to feel I can do well. These have ranged from Austin Bunionectomies to Endoscopic Plantar Fascial releases. I have also asked one of the Orthopedic Surgeons to help me on a case where bone had to be harvested to be used as a graft. He did not hesitate and was extremely helpful to me. There are other Orthopedic Surgeons in the area that have not been as friendly to me and I just simply have very little contact with them. But, in general, with patience and investing time to attend Rounds and other meetings, I have had a very positive experience with Orthopedic Surgeons.

        —George Ducach, DPM
        Quincy, MA
        [email protected]

As a podiatrist in practice for 33 yrs in Milwaukee, I would tell you the best bet for a young practitioner leaving residency is to look for a general podiatry practice to joint or purchase. By that I a mean a doc that does pretty much everything. I had a old patient of mine come back to me in Milwaukee from Chicago because she couldn't find anyone in her area in Chicago who would "trim her calluses". They only do surgery. In these times, you need to do it all. I was a residency director for 30 yrs, but I still can do it all. Don't limit yourself and think you are too good for these people because they may be most of what you get for awhile.

        —Louis R. Lapow, DPM, FACFAS     
       [email protected]

Keep writing in with your comments.  Best wishes.

Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]

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