The Footnote
No. 5 · The resident edition
Monday, October 5, 2026. For PGY-2 and PGY-3 residents. Where to live, which model to join, eight open jobs with their sources, and the skill that will separate your CV from the stack.
Career · Essay

Pick the town and the model before you pick the offer

I have read a lot of offer letters as favors from friends, and I still catch myself asking them the wrong first question. I ask what the offer pays. The better question comes two steps earlier, and most residents skip it because the listings arrive before the thinking does.

Start with where you want to live. Your first job is usually your first mortgage, your kids' school district, and the referral network you will spend a decade building. Referral networks do not travel. A surgeon who leaves after three years starts over at zero patients in the new town. Choose the region you would be glad to stay in for ten years, then check its state rules. Licensure timelines differ, scope of practice differs, and the enforceability of the noncompete you are about to sign differs most of all.

Then decide what kind of practice you want to be inside. The three common models below reward different surgeons. None of them is the right answer for everyone. Each one is the wrong answer for someone.

Decision one

Where you will live for ten years

Family, cost of living, license, and the state's noncompete law. At least 18 states now generally ban or void physician noncompetes, and there is no federal ban.

Decision two

Which model you want to grow inside

Health system, podiatry group, or orthopedic practice. Each trades salary certainty, ownership, and surgical volume in a different mix.

$368,421ACFAS 2025 median total compensation, board-certified fellows
$160,300BLS median wage, all podiatrists, May 2025
50.2%of ACFAS fellows take ER call with no extra pay
35%have compensation tied to wRVUs

Read those numbers carefully. The ACFAS survey covers board-certified fellows, so it describes where a career can go rather than what a first contract pays. The BLS median includes everyone and excludes self-employed owners. Your first offer will likely land between the two, and the model you choose decides how fast you climb.

Sources: ACFAS 2025 Compensation Report (769 respondents) · BLS Occupational Outlook Handbook · Tucker Arensberg 50-state guide, via RamaOnHealthcare, Sept 2026

The three models

Employed

Health system

$433,109ACFAS average, hospital or health system employed
Why it worksA guaranteed salary while you ramp, full benefits with retirement match and malpractice paid, and a referral engine you did not have to build. Primary care feeds you from day one, and signing bonuses are common. One Albany listing this month offers up to $50,000.
What it costsA salary cap and no ownership. Health systems pay within fair market value limits, so the ceiling is set by a compensation survey you will never see. You will not own the ASC, the imaging, or the DME, and you will not build equity to sell later.
Get in writingThe wRVU conversion rate, whether a higher tier exists, how call is paid, and what happens when the guarantee ends.
Private

Podiatry group

$416,616ACFAS average, podiatric group practice. Owners average $483,690 across settings.
Why it worksA path to ownership. Partners share in profits and ancillaries. Among ACFAS fellows who earn more than 10% from ancillaries, an ASC stake was the top driver. You learn the business of medicine from people who run one, and you have the most say in how the clinic runs.
What it costsA lower start and more risk. Associate pay is often below a hospital guarantee for the first years, referrals come from marketing and reputation rather than a system, and the buy-in math can be opaque.
Get in writingThe partnership timeline, how the buy-in price is set, and what share of ancillaries partners receive.
Usually employed

Orthopedic practice

$484,613ACFAS average, multispecialty or orthopedic group, the highest outside academia
Why it worksPotentially high salary and real volume. Orthopedic groups bring imaging, therapy, and a patient stream already looking for a foot and ankle surgeon. Pay usually tracks production, and production can come fast.
What it costsYou are usually employed. Partnership, ASC shares, and the reconstructive cases may be reserved for orthopedic surgeons, and some groups hire a DPM to take the nail, wound, and nonoperative load off the schedule.
Get in writingYour expected case mix, whether DPMs can become partners, and your ASC block time.
Source: ACFAS 2025 Member Compensation & Practice Report (PDF)

Keys to finding the job

  1. PGY-1 to PGY-2Decide place and model firstWrite down the region and the model before you open a job board. It turns a search of 800 listings into a search of twenty.
  2. PGY-2Start the license earlyState licensure and hospital credentialing each take months. A job you cannot start on time is a job that goes to someone else.
  3. PGY-2Search where the listings actually areMany good jobs are never posted. Tell your attendings, your program director, and every rep in the OR which town you want. Use the society job boards for the rest. Call a surgeon in the area and get the local perspective. People will help you if you ask.
  4. PGY-2 to PGY-3Visit and talk to the last associateAsk the practice for the name of the surgeon who held the job before you. Their answer tells you more than the offer letter.
  5. PGY-3Read the contract with a lawyerHave a physician contract attorney in your state review the noncompete, tail coverage, termination terms, and the productivity formula before you sign.

Job board: eight openings

Checked October 2, 2026. Recruiter listings close without notice, so confirm with the source before you apply. Pay is shown only where the posting states it.

Health system

Podiatrist, established hospital group

Albany, New York · via Curare Physician Recruiting

Join two general podiatrists and four podiatric surgeons at a 180-bed Level III trauma hospital affiliated with Columbia. Call 1 in 5.

Up to $50K sign-on
Source: HospitalRecruiting listing
Health system

Surgicalist, minimal call

Bloomington, Indiana · via Curare Physician Recruiting

Hospital employed and clinic based, with outpatient surgery Monday through Friday at a 25-bed critical access hospital across the street. Surgical fellowship and board certified or eligible required. Close to Indianapolis.

Sign-on and relocation bonus, amounts not posted
Source: HospitalRecruiting listing
Health system

Reconstructive foot and ankle fellowship, 2027 to 2028

San Antonio, Texas · Methodist Hospital (HCA Healthcare)

A one-year reconstructive fellowship for this year's PGY-3s, August 2027 through July 2028, under fellowship director Thomas Zgonis, DPM. Requires a CPME-approved residency, ABFAS board eligibility, and a Texas license.

Salary, not posted
Source: HospitalRecruiting listing
Health system

Build a new podiatry service line

Near Fayetteville, North Carolina · via Curare Physician Recruiting

Hospital-owned practice across from the hospital, inpatient and outpatient access, broad scope, and the chance to shape the program. Easy reach to Raleigh and Durham.

Not posted
Source: HospitalRecruiting listing
Podiatry group

Associate with partnership track

Hudson Valley, New York · via Inspire Healthcare

Established group with Orange and Sullivan County offices, about 30 patients a day, ankle privileges at the local health system hospital, malpractice covered.

Base plus bonus, not posted
Source: HospitalRecruiting listing
Podiatry group

Podiatrist and foot and ankle surgeon

Indiana · Foot and Ankle Centers of Indiana

Full-time, on-site, one year of experience minimum, 10 to 25% travel between offices. Indiana bars noncompetes only for hospital-affiliated employers, so read this contract closely.

$150K–$165K
Source: AOFAS Career Center, podiatry listings
Podiatry group

Surgical podiatrist, community hospital

Clinton, North Carolina · via Inspire Healthcare

Multi-county patient base and an independent hospital. Wants an experienced surgeon who can build a surgical practice, so it suits a resident with a fellowship or strong case logs.

Not posted
Source: HospitalRecruiting listing
Podiatry group

Part-time podiatrist, private practice

The Woodlands, Texas · via Inspire Healthcare

An established practice with a large patient panel and steady primary care referrals wants 12 to 20 hours a week. Private insurance only, malpractice provided, schedule and pay negotiable.

Not posted
Source: HospitalRecruiting listing

AI fluency sets you apart

Every applicant in the stack finished a residency, logged the cases, and sat the boards. The line on a CV that still stands out is proof that you can use AI well in a clinic. Employers are starting to ask for it. Adtalem's chief digital officer told PracticeMatch that health systems now prioritize AI-fluent clinicians who work alongside the technology instead of resisting it, and a Burning Glass Institute analysis found healthcare job postings mentioning AI skills grew 42% in a year.

Fluency does not mean writing code. It means you can hand the right work to a tool and stay accountable for the result. I teach it as four gates.

DelegateKnow which tasks to hand off: the note draft, the prior authorization letter, the patient handout.
VerifyCheck every output against the chart and the literature before it touches a patient.
DiscloseTell patients and colleagues when AI helped, in plain language.
OwnYour signature means you own the result, whatever drafted it.

Show it in the interview. Name the ambient scribe you used in residency and what it changed about your clinic day. Bring a patient education piece you built with AI and verified yourself. Ask how the practice plans to use AI in documentation and prior authorization. A practice weighing two equal surgeons will hire the one who makes the whole clinic faster.

The surgeons who build the career they want chose the place and the practice before they chose the number.

Disclosure: Andrew Lundquist, DPM, MBA, is Chief Medical Officer of Mankato Clinic, an independent multispecialty group, and Clinical Director at Nabla Technologies, which makes an ambient AI scribe.
Sources: PracticeMatch, Jan 2026 · Hunter Recruiting, citing Burning Glass Institute