• LecturehallConsiderations in Securing Your First Job as a Podiatrist
  • Lecture Transcript
  • TAPE STARTS – [00:00]

    Male Speaker: Welcome back to the podium, Dr. Shapiro. He is going to spend sometime in the life skill section under the topic of considerations in securing your first job as a podiatrist. I have four associates who work for me and it was definitely a growth experience when you hire people and I think that a lot of people don't really understand what an intimate fit. It's a marriage and I think that your comments particularly for the residents who manage to show up, it's invaluable information for them because it can go really good or really bad. So I want to welcome back Dr. Shapiro. Thank you.


    Dr. Jared Shapiro: Okay, so this is principally for residents. If you are in practice and you are really happy, then grab a cup of coffee or take a nap or something like that. So again, I don't have any disclosures. We are just going to talk about the job search. It's pretty much we are going to kind of talk about sort of how you might think through the different aspects of trying to get a job and do it right, I guess. So the first question is for those of you who are residents, when did you start looking for a job? So did you start before residency started, did you start in your first year, your second, your third? If third year and you haven't even started yet, that's the question that you want to ask yourself. So for me, I have had three different jobs since I started in podiatry and I did my training in the Detroit area in Michigan and then I practiced for a couple of years in Lansing, Michigan as an associate for another podiatrist. And through a series of my own mistakes, I ended up finding a job at the last minute and really nice guy who I did get along very well with but I wasn't really totally satisfied with where I was.


    So I then moved to Oregon. My family is mostly from the west, so we are trying to kind of get westward. So I moved to a hospital practice in a rural area in a town of 6500 people. That's a very small number of people. If you happen to live anywhere, that's not rural. So that didn't quite work and as that job was sort of evolving, I then received a phone call from Dr. Larry Harkless who offered me a position at Western University, which is where I am now. So each of these moves, they had their kind of -- each of them had their reasons and I felt Iike I have improved in my ability to find jobs as I went. So really talking about these things in generality here. The two real major things that you have to consider when you are looking at a job are the personal and family sort of situation and responsibilities and then your career satisfaction. So those two things, it's very hard to have a perfect balance and it's hard to have a 100% of both all the time you know. If you are travelling, you have all traveled to a conference and some of you probably don't have your family here, so your career satisfaction has to get really balanced against the family and personal life. So personal and family, you have to really think about these things beforehand and what I didn't do when I was first looking for a job was really think carefully about what my family needs were going to be. My wife was very supportive and said wherever you want to go, it's okay. You success is really important and we all wanted to be happy with that. But there are really significant factors that go into play with your family.


    So you know where you are in relation to your family may be important to you. Does your significant other have a career and are there limitations for that? What kind of recreational time are you looking for your family and for yourself and the cost of living? So that's going to become a pretty significant issue later. And then on the other side of that is your career satisfaction and of course there are multiple components that go into career satisfaction. It's really not just how much money you make. I know that's the first thing especially as a resident, you're not making giant amount of money and you want to come out and you hear about everybody who is making such great income and you want to make money and that's important and true. But it's not the only thing. So there are all these other things, location, what kind of staff and practice environment you are looking at, what kind of practice that you want for yourself, how stable is the practice if you are an associate going into a practice. You really have to think about these things consciously to figure out what you really want for yourself. So I'm going to get just a little philosophical and maybe a little bit corny here but one of the first things you might want to consider is what is your purpose in life in becoming a podiatrist. So I am an editorialist and I do that and so I'm going to editorialize a little bit. But this fellow here, this is Simon Sinek and he is a sort of motivational speaker and then marketer as well. He wrote this interesting book, which I would suggest, it's called "Start with Why". If you don't want to read a book, he has an 18-minute TedTalk, which is much faster than reading the book and he basically covers the whole thing. So he suggests that you consider your life and how business is run in this three kind of components. The most important one is why you do something.


    So there is why, there is how and then there is what you do. So as a couple of examples, we have Microsoft, you all know who that is. One of the biggest companies on the planet and this is their kind of purpose statement to help individuals and businesses realize their full potential. Nowhere in that statement does it say they want to be the largest software company in the world. Alright. So their purpose is really something different and then their being a software company is sort of how and what of what they are doing. And the same thing is true for Amazon. They don't say we want to sell more products to everybody else in the planet. So this is my sort of why, I guess my purpose statement. So I want to make the world around me that I can affect a little bit better than it was when I was there. That's sort of my kind of overall why statement. And this is a little metaphor. So this is my house, my kitchen. This is about 5 o'clock in the morning. You can see the dark in the outside there. And so I come downstairs and I see that my kids have left out the cheerios box, the garbage can is open. I have two kids and they don't like to close doors, just I don't know why but they just really hate closing doors. So I get to walk into things in the middle of the night. There is a little thing here, little purse of my daughter laying around. I could elect to just skip these things and just move on my way. It's 5, I am tired, you know whatever or I could clean them up and try to make this room just a little bit better than it was when I found it. So that's sort of the general kind of way I think about doing these things. It doesn't have to be big things. It can be just like little things and this is really what I want to do as a podiatrist. So what I do is trying to create successful relationships that empower positive change and this happens both with students and residents that I work with as well as patients who come and see me.


    The how is very similar to what you guys do. So I am a podiatrist, I try to help patients, I try to make their lives a little bit better. I try to teach others to be physicians of the lower extremity just like we are and then I write about it. That's another part. So I'm trying to sort of expand as much as I can whatever influence that I might have on the positive sense. So everything I do I sort of filter through that and when you are looking for a job that may be sort of one of the ways that you consider that. So now when you are looking specifically for your job, the first step is to really know what you want out of practice. Of course, it's very important. But if you just think about I just want to be a podiatrist. Okay, that's great but what does that mean? We know that there is zillion different ways that you can practice podiatry. You can be a surgeon, or a non-surgeon. You can do all kinds of different things and all of those things will require some kinds of plans for you to get there. So you have to ask yourself this question. You know what do I want from my career? Again, do you want it to be surgical or not, do you want to a high or low volume? I like high volume clinic. That's something I have always looked for. I enjoy the sort of higher paced, if I can see 25 or more patients in half day or something, that's kind of a high pace and I like that and kind of the day goes by quickly and I like it. But not everybody is like that. Some people want maybe that many patients in a full day and that's okay too, but you have to know what you want. Do you want to do nursing homes? Lots of individual proprietor podiatry practices will have this as an extra part of their income and if you go into a practice like that, their expectation may be that you are going to go do their long-term facilities or their nursing homes and you may or may not want that.


    So you have to know what that is, okay? Do you want to be involved in others; wound care, politics, education, any of those things you have to know what you want. So then what kind of job is it going to be that you are really interested in? Do you want to be an associate to another podiatrist? Do you want to be a large podiatry group or multispecialty practice? Do you want to work for an orthopedist? There are all these different options that are available to you. I would suggest that academia route, so try to teach one of your colleges. As a person who teaches at a college now, I think we have a too few people who are interested in teaching and there is a giant number of us who are really good at that kind of thing. So I would suggest as much for you as can. The other option is a fellowship. If you are going to do a fellowship, you should have to start planning that during your second year. There are some fellowships that are taking applications now for next year. So is that something that you want to consider? If you are looking to be a sports medicine physician and you want to be really competitive, then you want to have that extra training under your belt so that you can say that you are special in some way and not just a podiatrist who is interested in taking care of athletes. That takes planning. So when should you actually start looking. So this survey from 2017 from Merritt Hawkins. They found that 28% of -- this is for MD residents. So 28% of them waited until less than six months before graduation. That's basically one in four people who waited until the last minute and six months is last minute. So the problem is that you are going to run out of time and then you are going to need a job and you got to pay off your financial aid, loans and all that kind of stuff and you start to become desperate. This is actually what happened to me.


    So I was looking for jobs during the beginning of my third year. I found somebody who told me I was going to do great. I was going to make all this money blah-blah-blah and he wouldn't show me a contract and I never knew exactly how much I was going to make or at least what my contractual part of things is going to be. And then at the last minute, it turns out he was going to rip me off. So then I of course didn't take the job and now I am with without one and I am getting close to retirement. I am getting closer -- that would be interesting. So I am getting closer to needing a job and not being unemployed and here I am running out of time. So that was a real issue. The other thing is that state licensing takes time. So the sooner you get into the job at position, the easier it is to start that process and in some states, it could be a year. In other states, it's a lot quicker. So the general recommendation in the MD world is to start looking for a job 12 to 18 months before you graduate. So you're talking about beginning to middle of your second year of residency. What about location? Everyone wants a specific location. These are kind of two different survey studies that were done and this Jackson and Coker study found that 50% of residents who went into a job left that first job within five years. And it turned out that looking for location is not a particularly successful way to find a job. I know what you are thinking. I want to be close to my family or I like this area. I am doing residency. I have gotten to know it really well. It's kind of scary to go looking for a job in some other location. But the statistics are saying that you have a decreased chance of actually at that first job.


    So quality of practice from that first Jackson and Coker study was the one sort of common indicator that people who stayed in their jobs for longer than 10 years had found. So looking for things by looking at your job like the actual job, the quality of that job is really something that's a better option than trying to look for location. I'm not suggesting don't look for location at all. Just keep that in mind that finding a crappy practice but in a really good location and you are spending 40+ hours a week at that practice is not going to be conducive to your happiness. So be careful also of metropolitan areas. I know I am speaking in a metropolitan area. So you have to keep in mind, yes, there is a lot of people and yes, there are people moving to metropolitan areas but there also tends to be your saturation of doctors in large metropolitan areas and the need may be a little bit less. You may be competing with ortho a bit more and so that could create some problem. So just something to consider. I had this question asked of me multiple times. Should a newly hired podiatrist make six figures going straight into practice? And my answer to this is yes, but there is a little bit more detail to it. So Medscape recently did a physician compensation survey just this year and so I found it interesting to look at what they make. So this is kind of their average. This is not new physicians entering into practice, this is everybody. This is all variations of time and practice. So specialties were making an average of 330,000, primary care about 223,000. I think it might be interesting to know that podiatrist generally are making about as much as primary care doctors.


    So this is breaking it down into specialty. Of course, plastic surgeries are at the top of the bar here. They are making a lot of money because everybody likes to look good. So if you are doing podiatry, plastic surgery maybe you will be up in this range, I don't know. I am probably not going to be there. So you can kind of see there is a real broad range but the one thing I think that's worth taking away from here is that every doctor makes almost more than 200,000 but they are all making six figures and above. We are doctors, we are surgeons. We have the same risk for our patients. We have great education. Why should we not be making six figures going into practice? What about us? So podiatry management puts out a survey every year and this is kind of -- I will let you take a second to look at these -- but these are their gross and net averages of podiatrist around the country. You can see like up here in the East Coast, their net is about 123, the South 146. The thing to consider about these is remember about cost of living, right? New York has a high cost of living, California, I can tell you, has very high cost of living. I am slave to my checkbook I think most of the time. Maybe it's my wife's checkbook, I am not sure. So our net and gross are really greater than 600. But it really does depend on a lot of other factors. The location where you are will make a big difference. If you happen to be in a location in a country that the cost of living is not as high, then maybe making less than six figures is not that big of a deal. Maybe you are still going to live like a king or queen. Your time in practice, we know that physicians in general including podiatrist tend to make more money the longer that they are in practice. So you hit a certain peak at whatever it is, the 15-20 year level and in some cases it drops a little bit as it gets closer to retirement. But you do make more money the longer you are in practice.


    So solo versus groupism is one that is important to know and then your personal effort, what you put into your practice makes a giant difference in how successful you really are. And then luck, there is a component of that too. So where do you look and how? Well, you are here at a conference. I saw a plenty of really good experienced practitioners here and my suggestion would be to speak to them. There is the Fabi group. You guys have probably heard of this group. They do a lot of practice management things. There are lot of groups who do this kind of thing and then they do a great job. And you can gain experience and how to look for jobs and even gain contact through working with them. There are recruiters. My second job when I went to Oregon, I had a recruiter and that worked out reasonably well. And then there is podiatrycareers.org, which is another one. There is plenty of these online ones. Podiatry management has something, all the magazines list different ones. So there are bunch of different places you can look. I think most important for our small profession is speaking to your mentors and speaking to those folks who are around, who have been here are and can give you good information and even in some cases give you jobs. So what about the contract? So you think you found a job and you are looking at a contract. Hopefully, they have offered to give you a job and you are going to see the contract. So every aspect of your employment should be included in the contract. My suggestion is to not stop looking until the contract is signed and you really are going to that practice. I have had plenty of folks who I have either heard or seen even some of my own residents who signed a contract or in some cases a letter of intent and then they stop looking and then things fall through because the contract is not signed, the relationship hasn't been solidified yet and then they end up again scrambling for job at the last minute.


    So you want to make sure that who pays your malpractice tail coverage. Now if you don't know what tail coverage is, you need to read about this. This is very important. There is malpractice coverage and then there is tail, which covers you after you leave a job and generally for a period of time like three years and if you get sued for seeing patients at that practice, your tail coverage protects you for those patients, for that period after you leave a job. You might have to pay that yourself, so that's important to know. You have to watch out for noncompete causes. Sometimes you can fight them but if you are in area that's relatively small geographically with a large number of patients, this could become real problem. So you are in Manhattan and you are practicing and you sign a 10-mile noncompete clause. Well, that's going to pretty much eliminate you in the city. Now you could fight that in court because that really wouldn't be reasonable but do you want to spend your time in court fighting your prior boss instead of just advancing your own career. It's not necessarily a fun situation to be in. You have to watch for termination clauses and claw backs where if they give you benefits, there may be things that you have to actually pay back if the contract ends. My suggestion is to trust your instincts. If something doesn't feel right, just like Chris mentioned, this is like a marriage. It's like a relationship and if you get a bad feeling about this relationship, then don't go into it in the first place. Don't be desperate. Just don't do it. And then finally, just remember some people are young and they are afraid to ask for things. But if you never ask for something, it's not going to go into your contract.


    If you think you are worth six figures and a bonus and all that other stuff, then ask for it and then negotiate. It's an adult relationship, so if you never ask for anything and you just think well, this personal has all the power and they are going to hire me or not. Well, that may be true and that may not be the person for you but on the other hand, you might actually get something that you ask for and that's good. So don't rush in. Do your due diligence on your contract, even have a contract lawyer take a look at it their medical malpractice lawyers who are well versed in taking care of these. And if you happen to have a mentor, one of your residency attendings, have them look at these things, talk to everybody, really get a good feel for what's going on. I also think you should be competitive. So you have 36 months to finish your training and you want to maximize it as much as you can. You want to think, well, I'm going to be the best trained resident that there is. You better train than everybody else. You want to make sure that you bring that to the table because that's something that you have that gives you value. You want to learn practice management. If you are going out into practice, you have to be able to bill and code and understand how practice runs. If your program doesn't teach you that, then go to many places that are available and get that extra information. There is a lot of places for that. So you started working in board certification so that's become potentially an issue. I'm going to talk about two boards that I know about. So there is ABPM, which you can be board certified within essentially October of the year of your starting practice. That test is a little bit easier in the sense that you don't have to supply privilege cases. So my suggestion is to get certified with ABPM. That will take a little bit of the pressure off of you as far as certification goes and then you can focus on if your surgeon getting your surgical boards taken care of.


    And there is a lot more work. There is a lot too that you have to supply your cases to that. It is a mountain of work, so keep that in mind. So there is a logging service that you will be part of and you have to log all of your cases and there is a whole process to prove that you have logged all of your cases and all that kind of stuff but the one thing I would suggest is to archive your cases. So take copies of x-rays, MRIs, patient notes, hospital charts and PDF them or put them into whatever you know protected file system you have because if you move, you could potentially lose your ability to access those cases and you don't want to do that. So that would be my one suggestion. I lost a good number of my cases from Michigan because I hadn't taken any of those and I was not able to get access to the four other hospitals I was working at when I was in Michigan. So better to have those at your disposal. So few thoughts here at the end. My suggestions are to listen to those who are more experienced. They have been through the process, their successes and their failures. Say yes to as many opportunities as you can. If somebody asks you to do something or participate in some way, do it. It will advance your practice and giving back is a very good way of getting something for yourself as well. Be comfortable with the unknown. Explore. Really see what's out there and you'd be surprised. So know yourself, really think about what you want in a practice and what you are looking for. Do that by exploring as many options as you can. Start early. My suggestion is at the beginning of your second year, start planting those seeds. You're not going to sign the contract but you are really going to start looking at that time. Research different locations, part of the country, different practices. If there is somebody who is interested in having you, then definitely research them. They should be willing to open their books to you. You can see what's going on. Can they afford you? All of these kinds of things are really important piece of information. And then be flexible and competitive. If you do that, you will have hopefully lots of opportunities. Thank you very much.


    I think we have a couple of minutes so any questions. Okay, thank you.

    TAPE ENDS [26:43]