Male Speaker: So thereâs different types of work that you can do and itâs not only a primary work, thatâs going to be whether youâre employed, whether an employee and I think [indecipherable] [00:17] employeed which I made that word up. You have to know the MGMA numbers who want to negotiate your insurance contracts so that you are â itâs hard to negotiate in insurance contract when youâre just one person. But if you have a group of people and you kind of corner the market in a certain area, you can go back to a payer and you can tell the payer, âLook, weâre the ones to see all these patients in this area with diabetic foot ulcers. And we do at the best outcomes or the best and we want to negotiate this insurance contracts, so that not only now are we getting a 105% Medicare, we want a 111% of Medicare.â And so thatâs how you negotiate insurance contracts. But then you can also do consulting then you can do consulting by either lecturing for industry and thatâs pretty lucrative but you have to set yourself as an expert. You canât just be a normal podiatrist and not have any expertise in not be seen as an expert in one area or another and expect to get a contract lecturing for industries. So you have to be a good lecturer and then you also have to be seen as an expert and then that increases the amount of money that theyâre willing to pay you to be a consultant and lecturer as well. So you lecture at meetings and now lecturing in meetings might be a little different, meetings like this where at CME meetings where you and your own state society or county society, theyâll ask you to talk on a certain topic. But they donât pay you as much as you do if youâre lecturing at â for industry. Then you could do general consulting where if youâre seen as an expert in a certain area, they will â a company will come to you and say, âHey, Iâd like your opinion on a few products that weâre developing and maybe how to introduce them to the market or how to talk to podiatrist about them.â And so then you charge $500 an hour or something for consulting and then you would have them â they can come and either come and talk to you, bring you to an advisory board meeting. And they pay you to be in an advisory board, go over a lot of these things. You can also do expert witness work and there are a lot of podiatrist that do expert witness work, testifying in law suits. I do a lot of it as well. Thereâs just a few keys to that; one is never advertise those services. Because if you ever advertise them like Iâm an expert witness, Iâm going to put a note in a trial lawyer magazine. Thatâs always going to come back to bite you because theyâll bring that and theyâll show that ad to a jury. And theyâll tell the jury that youâre not a credible witness because youâre advertising for the service. So you donât want to advertise those services and thatâs a questioning always asked every time that I testify that go through the first five or six questions when they asked you these questions. And a lawyer is asking you these questions because one, they want to see how experienced you are as an expert witness. So some of the questions are like a really inexperience person would answer a certain way and an experience person would answer another way. One of those questions is, âDoctor, are you being paid for your testimonies today?â And an inexperienced person would say, âOf course, Iâm being paid for my testimony. So you have me come here, Iâm sitting here. Why would I not.â But thatâs not the right answer because you â the words that they use because theyâre lawyers and theyâre tricky. Words they used are you being paid for your testimony? Youâre never being paid for your testimony because you canât be paid for your testimony. Youâre being paid for your time away from your office and reviewing this case and for your expertise. So instead the correct way to answer a question like that is, âNo, I can never be paid for my testimony but Iâm being paid for my time away from my practice and for my expertise.â And they know that youâre more experience then â but another question they ask you is, âDid you advertise your services as an expert?â And then theyâll take that and you donât even see it because youâre going to be doing the closure arguments with the jury but theyâll say, âThis doctor admitted that he is being paid for his testimony, and he is being â he advertises his services,â then that looks bad. So you donât want to do that. And then you want to take both plaintiff and defense cases. You may hear people say, âIâll never take a plaintiffâs case because thatâs just bad to testify against somebody.â But there are a lot of podiatrist who are doing the wrong thing. And some of them are really dangerous and itâs not bad to take plaintiffâs cases. But if you only take one or the other, if you only take only plaintiffâs cases or only defense cases, the attorneys are going to paint you as a shell for one side or the other. So itâs best to have a mix between them, so you can say when they asked you, âWhat percent of your cases are plaintiffâs cases and what percent for defense cases?â You can say itâs around 50-50 but I donât care which side of the court Iâm arguing on. I only care with whatâs true and Iâll review any case and look at the case. And if thereâs merit in the case, I will agree to testify in that case just like this one. In a jury â the juryâs always listening to that.
But take both cases, I wouldnât take plaintiff cases in your hometown. Itâs not a good idea because other people are going to refer to you. You never testify against somebody that refer to you and you donât take cases in the geography of whether theyâre going to refer to you. But you take cases in â I do a lot of cases in Chicago for some reason. But I donât live in Chicago so itâs okay. And then they get training, you never want to â and this works with lecturing too. Youâre going to be trained how to do it because you can always get better. And as an expert witness, there are things that you can do to be a better expert witness, a lot of that being an expert witness is acting. The attorneys are literally acting but these two attorneys are friends and they know each other. Theyâre on either side of cases all the time. They go out drinking together and their wives probably meet up and the kids go to the same school and their friends. But you would never know that in a court case because theyâre arguing and yelling at one another. And theyâre acting because thatâs what the jury expects to see and theyâre doing that. But you as an expert should also be acting. You should act like a very trustworthy doctor that the jury would want to see you as a doctor. And if the jury can see you as their doctor, then you won that case. And so there are things you can do to just act better as an expert that will help you to win more cases. So look at MGMA, Medical Group Management Association publishes the average reimbursement or â I mean they publish in different ways. They publish both salaries. They publish the take home pay, net income, et cetera for multiple specialties. But one of them is podiatry and they break up podiatry and the general and foot and ankle surgery. And you can see that these are the MGMA, and you can get this book. So all you have to do is look up on line MGMA physician compensation book and itâs a really expensive book. Itâs about thousand dollars to get this book. So what I would do is I would just get it as a residency program, for your whole program. Itâll be good for a few years get the numbers donât have â you can see they change a bit but not sufficiently to warrant spending a thousand dollars every year. But you split it among a bunch of people, you get this book and now everybody in the residency has access to it. So when theyâre going out looking for a job, they all know what the real numbers are. So this is for podiatry for general or foot and ankle surgery. And you can see the trend changes between 2013 and 2015. And this is better than any podiatry management survey or any APMA survey or any of this. Because this is actually what medical groups are paying for podiatrist. So the MGMA, this what it would looks like whenever you see in the book. But you can see that here we have podiatry, foot and ankle surgery and orthopedic foot and ankle surgery. And this makes you mad that that somebodyâs doing the same work as you and look at the median column which is that median column which is in the â kind of over towards the right a bit. And you can see that a median orthopedic surgeons is making $566,000 and the median foot and ankle surgeons is making about $280,000. It is a little bit different with the RVUs and these are the relative value units. Itâs the amount worth that theyâre doing, theyâre generally doing â you can see 8,000 RVUs and the median versus 5,500 RVUs in the foot and ankle surgery. And some hospitals will gauge amount of work especially if youâre employed based on the RVUs for that. And so you gotta know those numbers as well. You can get all these stuff from the MGMA book. So looking at the â podiatry actually is in a pretty good position. This is on the 10 best paying jobs of 2014, podiatrist were number 9 in that case. And this is all podiatrist â this is a bureau of labor statistics survey. Thatâs why I say trust the MGMA survey better because the MGMAâs what these medical groups are actually reporting. That they actually did pay and these surveys are a little bit different. US News and World Report rank podiatry number 12 in best paying jobs for salary, job market, future growth. And then you can also look at the highest paying markets for podiatrist. And you can see some areas like Fort Myers where I think they have an older population. Itâs more lucrative to be in those areas than some of the other areas. Michael Jordan said that some people want it to happen. Some people wish it would happen and others make it happen. And I think thatâs what you have to think about here. You can think about stuff happening but itâll never happen unless you do it for yourself.
So that means youâre going to have to go and make yourself worth more because you canât just expect to walk in and get the best salary right at the beginning. So how do you make yourself worth more? Well you can do a fellowship and you may get different opinions on this but I did a fellowship and I did a fellowship with Armstrong. I did â I only made $75,000 for that year in my fellowship. So people will say, âWhy would you do something like that? You make â you could be â youâre taking away one year of your top income for $75,000, when you look at your overall work life. And it doesnât make any difference.â But I think it does make a big difference when you do a fellowship with somebody who is one, mentoring you and two, youâre going to be able to use that fellowship at always the rest of your life as a way to say that youâre providing better care than somebody else who doesnât have a fellowship. And it really resulted in my case in a big change in my income from not doing a fellowship to doing a fellowship. And that change in income goes for every year afterwards. So I think that that makes a big difference. Doing a fellowship itâs â youâre not quite as busy as you are in practice and youâre not working so hard just to make ends meet. So you do have time to meet a lot of people. You have time to write papers which establishes you as an expert. So that when you do get out, youâre an expert in whatever category it is, whatever subspecialty in podiatry. And then you have to embody the â what an expert is if you want to be an expert. And you have to write papers, you give lectures. You know they say, dress for the job that you want not the job that you have. I know youâve heard that before, but you want to. When I was in your shoes, every meeting I went to I always dress in a suit and tie. I wasnât lecturing but I would dress as suit and tie because what I wanted them to see me just as the speakers, as an expert. And now, you can see the way I dress now. I never wear suit and tie but I am dressing for the job I want now which is like semi-retired. Itâs the job I want. But you should dress for the job that you want not the job that you have. And then do things like press releases through the hospital, engaging social media. You can even hire a publicist. This is very common in LA practice where you hire a publicist to do all these things. Youâre on the doctor show. Youâre doing all these things so that then people really do think youâre an expert because you should really be an expert too but people can just think youâre an expert, and you get the same effect. So have better outcomes. If you keep track of your outcomes and you can prove that you do things and it results in a better outcome and especially a lower cost, than what the national leverage is then youâre going to be able to go to people and say â and payers and theyâll be willing to contract with you for that. So become a better speaker, you gotta go to speaker training, learn how to make a professional presentation. Some presentations are really bad. You gotta learn how to make a professional presentation that things like the type of background that you use. The type of font, how big the font should be, how many words should be on a slide whether or not to have more than one picture and animations. All these things are important and some lectures that you see are a really bad lecturers. And other lecturers are better lecturers because the speaker knows how to create a slide deck that looks well. And be generous so people will always come up afterwards and theyâll say, âHey, can I get a copy of your presentation,â and then that really irritates speakers. It really does because speakers will they put a lot of time and effort into their presentations. And the first thing a speaker would normally think about is that, âThis punk just want to rip off my presentation and just give it themselves.â Well, maybe that would happen sometimes but in a majority of the cases, if youâre generous with things and Armstrong does this as well a lot. If youâre generous with things, you mark it with your water mark with things with your name on it, I donât care if somebody uses my presentation if they give you credit for it. That actually â if theyâre giving you credit for using your presentation, that even makes you a bigger expert than you were before. Because somebodyâs using your information and getting it out there, so just the same thing with writing papers. You write papers you want everybody else to cite your paper and use your paper. So anybody ask me for a copy of my paper, Iâm happy to send it to them and Iâll send a PDF, et cetera. So you can be a wound care provider, you can work on a wound center. Wound center what we find, Iâm the Medical Director for Restore itself which is a large group of wound centers. We have 200 centers in 30 states. And thatâs why I spend so much traveling. But this is another reason why I donât wear suits anymore because Iâm on the road for 25 days and I canât pack a suit for 25 days.
So I can wear Lululemon pants and I can wear a polo and that works for me. But if youâre working in a wound center, what we find is that if you only work a half a day a week in a wound center, it increases the amount of money that you bring in to yourself by $50,000 in a year. By just half a day a week because these are all procedures that are being done. Youâre booking surgeries out of this. If youâre supervising hyperbaric oxygen, youâre getting paid to do that as well. So you can make an extra $50,000 a year just with a half a day a week in a wound center. And those patients from the wound center after they healed, they never want you to take the patients out with a wound because youâre getting them in the wound center. But once theyâve healed they canât stay in the wound center anymore. And theyâre going to need to go to your office and you can provide longitudinal care and shoes, et cetera. And then become more involved in the professions. You gotta make connections and have opportunities be involved in the boards. I donât get paid anything to be on ABPM. You know it say, itâs actually the big use of my time I spent countless hours bringing the other test and doing this thing. But it actually results in other things that are beneficial to me. When Iâm an expert in a trial. Thereâs a board member from the certification board, thatâs an expert in the trial. Theyâre going to pay you more to be an expert in the trial. Theyâre going to pay me more to speak or be a consultant thatâs something even though Iâm wasting a lot of usable time by being on the board. So people will look at that and theyâll say, âI donât want to do that. That doesnât pay any money. And Iâm just wasting my time.â Well itâs not a waste when you look at the overall picture. I want to get to questions so I donât want to go through all of this but these â Iâve only been out technically for 10 years. And I was able to build all of this just in 10 years but it was always because I was constantly looking for other things to do and moving through my life and being involved in one way or another. And then the other thing was just concentrating on academics. This is over the past 10 years. Thereâs a number of papers that Iâve written in a number of lectures that Iâve given. And you can see some years like 2011, I had a really good year. And thatâs actually because your papers get â you write a paper and it doesnât get published for a year and a half after you write because it goes through this whole process and everything. So in my fellowship, my fellowship year which was 2006 to 2007 with David Armstrong. I wrote 30 papers in that year. But they didnât get published for a year and a half and so Iâm already out working and people think youâre a rock star because youâre cranking a lot of these papers. But I wrote them a long time ago and theyâre just getting published now. And so you have the time to do it in your residency and you have the time to do it in your fellowship that you may not find that time later on. So you should be concentrating on doing that now because finally when they do get published, you will be on practice. And so write on something that youâre interested in practicing, making your practice about. I think this is the last part which is you just come and contract mistakes. When youâre looking at getting a job anywhere whether itâs you created it yourself or anything, you have to negotiate a contract. The first thing I tell you is never negotiate your own contract. You can look at the contract, you can make points about it but always hire a lawyer to do it for you. A lawyer is going to cost you about $1,500 to negotiate a contract for you and review it. And thatâs $1,500 that you probably donât have. But it will mean so much more in the amount not only the amount of money that you might make like theyâre going to help to negotiate your salary higher. Theyâre going to negotiate your benefits but theyâre also going to work on things like your termination, because thatâs what lawyers think about. When this relationship goes sour, because relationships in many cases unfortunately do go sour or thereâs going to be a â youâre never going to work in that place the rest of your life. Thereâs going to be a point where thereâs going to be termination. How is that termination going to affect you? And so they will focus on things like the non-compete. These are things you might not even think about but there might be a non-compete in your contract that says, âYou cannot work in a 10-mile radius from this place.â Now if youâre in the west side of Chicago and you have a 10-mile radius thatâs â you get to move your whole family out of that area to then work somewhere else. So thatâs really disruptive to you so theyâre going to focus on things like that. Some states non-competes are not even an enforceable like in California. You can write in all the non-competes you want but itâs not enforceable in the State of California. So they canât enforce it. They can say, âYou canât practice in California.â Doesnât matter. They wonât do it. But whatâs going to happen to the account receivable after you leave, you did all this work and you know you donât get paid for months sometimes after you did the work. But thatâs worth that you did and you might just think, âOh, Iâm leaving this job.â Well youâve got $150,000 and an outstanding account receivable, you should â thatâs your money. You did the work for that. So those are things you might not think about but thatâs what a lawyer is going to negotiate for you. Mutual non-disparagement clauses. These are things â so if the relationship does go sour and you leave, you would say, âThe mutual non-disparagement clauses, you donât say anything bad about me.
And I wouldnât say anything bad about you.â Now you have to stick to the agreement because youâll get suit if you say, âThat hospital was a mess. People â you get sick over there. Iâm not working there anymore.â Instead you just say, âOh, it didnât work out in that hospital. Iâm over this hospital now.â And but they also canât say anything bad about you. If they do you can sue them. And Iâve done that before. I sued a hospital in California and I won $105,000 law suit against them for â when my lawyer put a mutual non-disparagement. And the doctors of the hospital said some bad things about me, and we wrote â first, we wrote them a cease and desist letter and then it didnât stop. Then we sued them and they settled for $105,000. So these are things that I would have never thought about but a lawyer put it in my contract. So my lawyer is a good lawyer because her husband is a podiatrist. Sheâs in California and she knows â sheâs like the lawyer to all the podiatrist in LA. So she knows how to do this stuff. Then how to do conflict resolution if you get in the conflict with them, how are you going to resolve that? So these â donât negotiate your own contract. Then the other thing too is that you â if you negotiate your own contract, you might be â you might not feel comfortable with it. But two, if you do feel comfortable with it, theyâre going to â youâre going to be kind of an asshole when youâre negotiating your own contract. Because the relationship might not start at the right â off on the right foot. And instead if your lawyer negotiates a contract for you, you can â theyâll say, âWow, youâre a lawyer.â And youâre like, âYeah, heâs an asshole, right?â But thatâs a good job. So Iâll leave you with this quote. We just have a few minutes for questions but this is Will Rogers no relationship to me says, âEven youâre on the right track, you get run over if you just sit there.â And so you could be on the right track of life, but if youâre not moving, you get run over by the train. So itâs important to always be thinking about where youâre going ahead and keep moving. Any questions? So the questions is about ABPM versus ABPS certification for hospitals. There are some hospitals that do care and thatâs because the people who helped to write those guidelines are the podiatrists because hospitals donât know the guidelines, right? And so if you have some podiatrists that are there, theyâre trying to keep other people off of stuff and youâll see that. They make very restrictive guidelines so that it only fits certain groups of people that want to keep everybody else off steps so that youâre not competition with them. The no right very stringent criteria, thatâs why you have to get the hospital bylaws which weâre happy to give you and thatâll describe what the criteria is for being on staff for the â for your medical staff. If you do see that it says specifically, ABPS then what you do is you call the ABPM board office and you tell them that Iâm trying to get privilege at this hospital. And they say that they require only ABPS and then the ABPM office writes a letter and calls them and tells them about the board certification. And that it is â thereâs only two boards in podiatry that are approved by CPME and thatâs one of two boards. They oftentimes donât know that because thereâs somebody else, some other podiatrist that said that, âIâm only taking ABPS people.â Now your board certification does not dictate whether or not you can do surgery. Thatâs that thing about it. Everybody in here is doing the same residency. Youâre all doing a three year APMS residency. So youâll have the same experience when you get out of your residency. Then you take your board certification and thatâs another box to get checked. But the way that you get surgical privileges at hospitals, so weâre talking about credentialing versus privileges. You get credentialed and then thatâs with either board and then you need to get privileges. And those privileges are â letâs say, you want to do an ankle replacement or you want to do Charcot reconstruction or any of these things that are on the privileging list. Your privileges are based on your education, your training and your experience. So you have to show that you have the cases in order to get privileges to do that. They wonât even if youâre ABPS, theyâre not going to say, âYou can do ankle replacements because,â â but if you have zero cases, youâve never done them before, itâs not the board that matters. Itâs what your experiences that matters. So in your residency you keep logs already. But youâre going to want to keep these logs, if theyâre podiatrist residency, whereâs the PR, whatâs the ARCH stands for, resource. Yeah, so youâre going to have those logs anyway. But even when youâre not in residency or going through board certification anymore, I still keep surgical logs. Because if I apply in a new hospital, I keep an Excel spreadsheet and Iâm going to print it out and Iâm going to give it to them so that I verify. Because I only operate within my scope of practice anyway, I never asked for privileges that are outside of my area.
I donât ask for arthroscopy or ankle replacements or anything. I do Charcot foot reconstruction. I do lots of split like a skin grafts. I do all types of partial foot amputations, some reconstructive surgery for diabetes. Those were all â I do a very, thereâs probably 10 common surgeries that I do and thatâs it. So thatâs why Iâm asking for and then a few other things that might come up. But I verify that with my experience and Iâm only ABPM. Iâm not ABPS at all. Because when I went through, I sat for ABPS but I couldnât pass the case qualification because I only do limb salvage. I didnât have any diversity. They told me that you need to have X number of different types of bunions and this and that and all this stuff. I said, âLook, I only â calcaneal fractures or whatever. So I donât do any of that stuff. I do only Charcot foot reconstruction. I do ankle arthrodesis. I do â I am for ankle Charcot. And I do more surgery than a lot of them did.â But I didnât qualify because I didnât have any diversity. So thatâs what really include me into all of this. But you can use other people to help you get that. But just know that itâs your case logs that determine your surgical privileges. Alright. Thank you.
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