Beyond the Contract: Navigating Modern Podiatric Careers

In this Q&A, Christopher R. Hood Jr, DPM, FACFAS, discusses how podiatry residents and early-career physicians can approach employment contracts, interviews, and career decisions with greater clarity.

Key Takeaways

• Candidates should ask questions, seek knowledgeable contract review, and ensure that any negotiated terms or promises are documented in writing.
• Evaluating compensation requires looking beyond the starting salary to bonus thresholds, productivity expectations, growth opportunities, and the practice’s record of supporting new physicians.
• A successful job search depends on preparation and fit, including a tailored cover letter, a clear understanding of the prospective practice, and careful consideration of autonomy and work-life balance.

You've reviewed many CVs and employment agreements over the years. What are the mistakes you see most often from podiatry residents and early-career physicians? Do those mistakes change as one progresses throughout their career?

I want to first start by stating I do not want the prospective employee to feel like they made a mistake in missing something, especially the first time around. As crazy as it sounds, this person is probably in their early-thirties, and a smart, well-trained, medical professional—who also has never had to look for a podiatry job, nor read a medical contract before. To this point, too often I see a pattern of us being told what to do, including signing “contracts” without asking what we think, knowing what we want, or feeling we have the ability to make our voice and desires heard to change the situation we are heading into. Think about that scenario, from ones’ journey from undergrad to podiatry school to residency and fellowship. I cannot recall a single thing from my residency or fellowship contracts. I just signed on the dotted line.

The “mistake” is often that the prospective employee just does not know what to ask for and maybe does not even know what they want. This comes with time and experience while learning lessons along the way. The correction for this, in my experience, is asking questions and achieving as much clarity about items within the contract as possible.

Do not be afraid to ask questions. Have the employer explain something that does not make sense or may be ambiguous. Ask a lawyer friend, colleague, coresident, residency director or attending to review the contract to make sure it reads and sounds appropriate while also having them explain things that you may not understand. Often by having these discussions, more questions arise, which leads to more clarity and understanding of the contract (and contracts in general). It may even lead to changes in the contract from wording of items, metric changes (salary numbers, percents, relative value units (RVUs), paid time off (PTO) days, miles or practices included in noncompetes, etc), and so on. To that end, make sure all changes take place in writing, and not just verbally. To paraphrase a saying we all hear in the medical field, “if it is not in the [contract], it didn’t happen.”

I think the mistakes become less and less common and frequent as time goes on. Once you go through your second (or more) job search process, you learn the questions you should have been asking from the get-go that first time around to reduce potential “mistakes.”

Many residents focus heavily on compensation when evaluating a first position. In your experience, what contract provisions end up having the biggest impact on long-term career satisfaction but often receive the least attention?

Compensation is often the most looked-at item and compared between residents when discussing jobs. Unfortunately, this is probably the item that has the biggest impact because we often feel self-worth based on how much money we make. To stick with compensation, I think it is more important to think about it as a metric of “compensation potential” and future growth, not just the raw initial numbers.

Two examples of this include:

• Base/Collections Salary: One may get a higher starting salary, but the “metrics” are not favorable if one needs to collect a higher dollar amount to hit a bonus. That can result in a lower percentage of dollars collected above the “breakeven threshold.”
• RVU Salary: One may get a higher starting base salary for the first few years, but the RVU target may be so high that they may never achieve the bonus threshold. Or even worse, they may not produce an RVU level within the grace-level (often 95% of the target), and have to take a pay cut due to lack of production.

In both of these instances, you need to look at the practice as a whole. What was the trajectory of the last 2-3 hires yearly for their first 5 years (volume of patients, dollars or RVUs collected). Did the contract have an evolving metric like base/collections to just direct collections after a certain period? What is the practice plan for employee growth? Will they, for instance, inherit a retiring doctor’s practice? If so, what is the make-up of that practice? Are they starting a new location from scratch? How were these previous doctors supported for growth, from location to patient distribution, and so on?

Non-compensation related, I feel like autonomy is another item that relates to satisfaction. If you feel like you have no control or say in your practice, nor an ability to change things, eventually you will feel trapped and start to look for the greener grass.

The interview process itself has evolved, from virtual interviews to multisite health systems and private equity-backed practices. How should candidates be preparing differently today than they might have 5 or 10 years ago?

While yes, the landscape has changed from in-person to virtually held interviews, with multiple rounds, possible site visits, and speaking with both physicians and management/administration-types, I feel like in general the core principles of a successful job interview have not changed much.

Whether in-person or virtual, one needs to look the part and dress in formal attire for the meeting. A caveat for virtual interviews is considering where you are performing the interview with respect to background scenery and noise. Also, practice looking at the screen. Further, you still need to know your CV front to back to answer any possible questions about items contained within. Prepare by studying the prospective employer’s practice, know how you can add value, and be ready to not just answer questions, but to ask questions of the practice and what they are looking for.

When you're reviewing a CV, what immediately tells you that a candidate understands the type of position they're applying for, versus someone who's sending the same document to every employer?

I feel like this one is easy to answer—it is the cover letter. Generally, the CV will be the same for whatever job that one is applying for, whether private practice (small or large group, podiatry to multispeciality), academic, or hospital employed. The word curriculum vitae (ie, CV) is defined as “course of life” and therefore should be a detailed multipage document that outlines and demonstrates the entire academic and professional history.

The cover letter, which should accompany each CV sent out to each prospective employer, should be specific and individualized to the job one is applying for. First and foremost, the cover letter should be titled to someone specific (“To Dr. John M. Smith, DPM” or “To the Practice Manager of Podiatry Practice USA”) and not a generic “To Whom It May Concern.” Right from the start, the prospective employee is showing lack of personalization to the job they are applying for. From there, the cover letter should highlight items from the CV that demonstrate an understanding of the job they are applying for from highlighting CV-relevant items, discussing the practice and how they could fit in or help, and so forth. If relevant, use key buzz words from the job posting back in your cover letter. If they are looking for someone to fill a certain role (ie. “wound care” or “total ankle replacement”) and that is part of your future practice desire or skills set, actively state this. For instance, “I spent 6 elective months working at my residency’s wound care center,” or “I was first assist in over 50 total ankle replacements with course-completion and certification from X-company.”

When I applied for jobs, I had 3 general cover letters (one each for a podiatry practice job, and orthopaedic practice job, and an academic-minded practice job) that demonstrated points of my CV relevant to each (practice management skills, case logs/performed surgeries, research performed, academic teaching/resident education, etc). Then, I would take each of these and make a job-specific cover letter for the particular job I was applying for with even more detailed points to the prospective employer, even if the changes were minor. I stated relevant experience. I used numbers. I took key words from the job posting and directly inserted them back into my cover letter. If I applied for 30 jobs, I had 30 different cover letters.

You've been through the job search yourself several times and now advise others through that process. Has there been a piece of career advice you once believed that you've completely changed your mind about?

I think coming out of residency and fellowship into my first job, the goal was to be as busy as possible as fast as possible. Personal pressures of generating “real” income, providing for a family, paying off loans, trying to catch up in retirement savings to friends who had been working since graduating undergrad all became real. Practice pressures of long hours, always being available as desired by your employer (and often expected by your patients), and never saying no was an often-preached approach by those who forged their path before me.

But as time went on, and now into my fourth job, your practice will grow and build with time regardless. “Rome wasn’t built in a day,” and neither is a physician's practice.

• Yes, there are bills to pay and people to provide for (but this never goes away, it just changes as far as who you are paying and providing for).
• Yes, you need to put in the work (but have work-life-family-friends-personal balance). Yes you need to be available (but not always and it is okay to “log-out” of work mentally and digitally/communication wise).
• Yes, you often will find yourself wanting to say yes out of desire, need, or guilt (but it is definitely okay to say “no”).

Take time to enjoy the life you have both in and out of work, be thankful for the things this career has given and will give you, and don’t sweat the small stuff. My career as a podiatrist, even after 4 jobs and starting over 4 times, has given me so much I am thankful for, and 10 years into practice I do not feel behind at all. What I do feel and have is a happy and healthy family that I get to enjoy this life with, and have the time, means, and energy to do so. All because, as time went on, I sweated the small stuff less and less.

If you could give every graduating podiatry resident one piece of advice before they sign their first employment agreement or walk into their first interview, what would it be—and why?

It would be to have an open mind and not compare yourself to your peers going through the same process receiving different contracts. Go into each employment opportunity without comparing it to other jobs you have or may be interviewing for. Each job will have its own personality from the nature of the work, type of patients, coworkers (from assistants and physicians to management), to the contract itself. Try to think about how you would fit into this practice, how you would fit into and enjoy the community. Ultimately you are looking for the right overall fit for you (and your family) and not a few small details within the contract. Further, make sure you understand the contract and are comfortable with signing it. You may not agree with everything, and some items you will not be able to change. You just have to be comfortable with achieving a maximal understanding of what you are signing because you have to presume that, for that job, there may be no going back.

You've worked with residents from across the country. What do you think this next generation of podiatrists values differently than previous generations when they're evaluating career opportunities?

Many things come to mind, but I think overall the core values are work-life balance and personal control, despite being “just an employee” in an already existing/functioning system. One wants to feel like they can forge their own path and make their own decisions from the type of practice they want to have, patients they want to see, surgeries they want to do (or not do). They want to be able to have a say in practice matters, even if not a “partner.” When not at work, they want to be able to get away. They want personal control to keep that work-life balance because if that is not there, it's not the work or the life that suffers, it's both.

Dr. Hood is a foot and ankle surgical podiatrist at MidJersey Orthopaedics in Flemington, NJ. While clinically practicing, additional pursuits include running a podiatry-specific CV/Resume and Employment Contract review website (www.PodiatryContractReview.com), offering his time at the ACFAS ASC yearly for these items, while also moderating the Board Wizards (www.boardwizards.com) and DPMQuestions (www.DPMquestions.com) podiatry test-preparation websites.

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