Salary for associate degree

I am considering hiring an associate for my office. I am curious about what other podiatrists lately have been offering their associates with regards to compensation/benefits etc. I understand there are multiple ways of compensating an associate (i.e., strictly salary, salary plus percentage) but, what might be the average compensation in a rural area for the first 2 years for someone just out of a residency?

Lara M. Allman, DPM

Dubois, PA

docnpharm@greatlite.com

Editor's Note: Readers are reminded to check with a healthcare attorney in their state regarding percentage arrangements, which in some states are considered an illegal form of fee splitting. Hired associates should be given a written contract with appropriate restrictive and non-solicitation of patients and referral source covenants. PM News does not provide legal advice.

Having three physicians in my family (a family practitioner, an orthopedic surgeon, and an ophthalmologist), I noticed at least one way in which podiatrists differ from physicians: When physicians become employed (they don't use the term associate) they are compensated to the level a physician should make at the beginning even though they are unlikely to generate that much income for the practice. Yes, it means a loss to the practice at first to pay someone over six-figures, but that's their investment.

On some other podiatry online site the editor reported that first year podiatry associates average somewhere around $35,000. An associate who knows how to manage his or her practice and bill for it can easily generate well over $200,000. What's wrong here?

I've also noticed that physicians treat their employed physicians as colleagues from the beginning; They just don't happen to own part of the practice. They aren't treated as scut monkeys on whom to dump their unwanted patients. I've never heard of physicians discussing how the old "eat their young."

I encourage Dr. Allman, and whomever else may be considering hiring a podiatrist for his or her practice, to make the compensation package a fair one, to include dignity and respect as a part of that package, and to treat one another as professionals. We cannot ask others to respect us if we don't respect ourselves first.

Nat Chotechuang, DPM

Bend, OR

natchot@hotmail.com

I must say that there are a lot of negative podiatrists out there who seem to be the most vocal. I have a new partner, and yes, he's an employee, but I hope that he feels as I do that we have both made an investment and that he is treated as an equal. We share irritating patients and difficult cases. We also have our share of no-pay ER patients that we both treat. I have perhaps asked him to take slightly more of the load as the new guy, but not in a scut manner, and he has boards to sit for. I think we're doing OK because I wanted him, I paid him fairly and I feel good about paying his bonuses because he is my investment as I am his. I may have built the practice over 20 years, but he will propagate it even further.

I have lots of MD, DO, DDS friends--even more than DPM's and in my humble opinion, everyone thinks just as we do, so I don't buy that "we eat our young" theorem. We are what we do, we are treated as we treat others.

I'm reminded of a story in 1987 when I took my ABPS board exam. A doctor at my school who had treated me as cowchips during my schooling offered to buy me a drink. I opined that I was surprised he wanted to sit with me at the bar and he replied "oh, but now you're not a lowly student anymore--now you're almost equal." I assure you he and I will never be equal. Live by the golden rule, it still works.

Sloan Gordon, DPM

Houston, TX

sgordondoc@aol.com

I think it is embarrassing for new practitioners just out of residency to get these ridiculous offers of 35 or even 45 thousand dollars per year. I was talking to one of the anesthesiologists at our ASC and he said they can't get any CRNA's for less than 110 thousand right out of school. That's not what they top out at either. This is an entry level position. Kind of seems like I picked the wrong profession. I have another very good friend who is an orthopedic PA who started out at 95K his 1st year and he gets his surgical assist fees in addition. Last year he made over 150K. He's been out for two years. I'm out for two years and I won't even come close to that. I'm seeing almost 30 people a day and doing about 5-6 cases per week. I'm making approximately 20% of collections.

We share office space with 5 orthopedic surgeons in a hospital-based clinic. The two new orthopedic surgeons fresh out of their fellowship have guaranteed incomes of 250K their 1st year plus 100% of their collections minus overhead once they reach 250K in collections. I'm not bitter about podiatry. I like what I do. I enjoy not getting a ton of ER call either. However, my question is: how come so many new graduates literally get taken advantage of by getting such low salaries? We can't pay our student loans. Credit card bills keep getting larger. You know we went into this field thinking that we were going make a better living, not live like a pauper for eternity.

I'm sure most new graduates and young associates feel the way I do. I think you should get your collections minus your overhead, period. If your overhead is 60% then you should retain the 40%. It's not that hard to calculate. Also, what's up with non-compete agreements? Do away with these too. How can an associate truly negatively impact an extremely busy, productive practice that's been in place for twenty years? They can't. The practice may lose a few patients but not to the point where it affects the practice in a negative way.

Matthew Etheridge, DPM

Pensacola, FL

mhetheridge@msn.com

I understand the frustration of young podiatrists like Dr. Etheridge. I think that his opinions have merit to the degree that they reflect those frustrations. I felt that way too. It is probably true that our profession has a slightly higher percentage of rogues, and it is always wrong to take advantage of those less fortunate than ourselves, but I agree with Dr. Gordon that things aren't really that different between the specialties. What he can't appreciate is the "other side of the story."

I hired an associate about 2 years ago at a reasonable salary, and I'm just beginning to see a return on my investment, i.e., I'm not losing money anymore. Happily, things are going very well for us. Many docs have horror stories about associates. I for one believe that I deserve some return on the investment that I made when I hung out my shingle and worried about going bankrupt for several years.

For all the young docs who are unhappy, I suggest you find a place to hang your shingle, go through the trials and tribulations of establishing your own practice, and then see how willing you are to give half of it away to someone.

Scott Hughes, DPM

Monroe, MI

soulking@ameritech.net

In order to put the topic of associate salaries in a context where it can be discussed with less emotion, I have two suggestions: 1) the focus of the discussion should change from trying to figure out "who is wrong," to understanding "what is wrong," and 2) in the majority of cases, the assumptions made about another person's intentions are wrong (we tend to perceive assumptions based on their impact on us). If an associateship does not work out for any reason, both parties will have stories that make the other appear as if s/he was the "doctor from hell"--much like a divorce. The established doctor is blamed for "eating his/her young" or thinking the practice is worth its weight in gold, while the associate is accused of being lazy or of secretly plotting to "steal" patients and gather referral sources in order to set up his/her own practice. Who is right and who is wrong in these situations? In my opinion, it doesn't matter because the discussion leads to a dead end. A more productive question is, "Where di d we go wrong?"--with emphasis on the "we".

This discussion can lead to "what is wrong." Discussing "what is wrong" should be considered in the context of two major issues faced by the typical podiatric practitioner. The first is that the average medical specialist produces greater revenue per hour than does the average podiatric physician (something that the profession can fix, but that's another topic). The second is that, historically, the majority of podiatric physicians practice solo or with a single partner, while a greater percentage of medical specialists practice in some type of group. The problem is further compounded by the fact that the typical podiatric practice is costly to run (related to high patient volume and complex management).