Do you do lots of surgery?

[harkkam]

I wanted to ask the podiatrists who had already graduated and I wanted to know if podiatry was surgery mostly and thats what most Podiatrists did once they opened up their own practice.

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[PADPM]

Your question is very ambiguous. What is "mostly surgery?" If the average work week involves 40 hours, what do you consider "mostly" surgery?

Do you mean do most DPM's spend the majority of their time in the O.R.? Do you mean do most DPM's end up performing surgery on a majority of the percentage of patients seen?

From my experience, with knowledge of hundreds of small and large practices across the country, I would say it's very safe to say that the overwhelming majority of podiatric practices are not strictly surgical or do not rely on surgery as their strongest/main source of income.

Realistically, there a VERY few percentage of "surgical" podiatric practices. They do exist, but I can assure you that at the present time they are the exception, not the rule. There are also DPM's employed by orthopedic groups who focus more on surgical care.

I would say, that an HONEST response, despite any "surveys" would be that the AVERAGE DPM at the present time probably performs between 1-4 surgical/hospital cases per week.

This is based on my experience on several hospital staffs/surgical centers and witnessing the practice patterns of staff podiatrists at those hospitals in several different states over a 20+ year period.

I know of some DPM's who perform 1-2 surgical cases monthly and others that perform 10-12 cases weekly. But as previously stated, on AVERAGE, I would say the number I previously stated is probably realistic at this time.

 

[PMSIII]

I wanted to ask the podiatrists who had already graduated and I wanted to know if podiatry was surgery mostly and thats what most Podiatrists did once they opened up their own practice.

PADM is definitely spot-on with his answer because there's a lot of variety depending on the level of training, type of practice, and where that practitioner is with their experience. I've seen and worked with DPM's in ortho groups who were essentially "end-of the line" consultants, meaning, patients came to them on a referral basis after having tried conservative modalities and other surgical consultations with other physicians - so essentially they presented for a final/definitive surgical "answer". Those practices typically saw heavy surgical volumes as you can imagine. Also, some practices are more conducive to having you see "surgical patients". So if you are in a practice were you see a fair amount of referrals then you're more likely to have more surgical patients (when indicated and depending on the patient's subjective status of course). The ER call is another factor to be considered in this equation as well - if you or your group are on the schedule for foot/ankle call then you're adding a large source of referrals to pathology and trauma, so more cases. Additionally, if your practices allows for you to be on staff at the hospital, take floor consults, and even see patients at wound care centers then you have another source of cases via diabetic foot infections/limb salvage management.

So again, a fair amount of factors are involved so you're training, level of experience, reputation, referral-base, and type of practice you have are large determinants for surgical volume.

 

[Podfather]

PADM is definitely spot-on with his answer because there's a lot of variety depending on the level of training, type of practice, and where that practitioner is with their experience. I've seen and worked with DPM's in ortho groups who were essentially "end-of the line" consultants, meaning, patients came to them on a referral basis after having tried conservative modalities and other surgical consultations with other physicians - so essentially they presented for a final/definitive surgical "answer". Those practices typically saw heavy surgical volumes as you can imagine. Also, some practices are more conducive to having you see "surgical patients". So if you are in a practice were you see a fair amount of referrals then you're more likely to have more surgical patients (when indicated and depending on the patient's subjective status of course). The ER call is another factor to be considered in this equation as well - if you or your group are on the schedule for foot/ankle call then you're adding a large source of referrals to pathology and trauma, so more cases. Additionally, if your practices allows for you to be on staff at the hospital, take floor consults, and even see patients at wound care centers then you have another source of cases via diabetic foot infections/limb salvage management.

So again, a fair amount of factors are involved so you're training, level of experience, reputation, referral-base, and type of practice you have are large determinants for surgical volume.

I agree with PADPM as well. Any surgical practice of any degree (assuming an ethical doctor and excluding specialties that treat emergent problems or cancer) perform primarily non-operative care. Orthopedists, ENTs, opthamalogy, etc. will see and treat many of their patients medically or by non-surgical means. Podiatric practices vary in their surgical volume by choice, patient volume or locale. If you are seeing say 20 patients a day you will perform (in most cases) less surgery than someone who sees say 40-60 patients a day. I know of DPMs that do 4-5 cases a month and some that do 10-15 a week. Both are surgeons one is just busier. As PADPM and others have pointed out surgery in most cases has a lower profit margin than office care. I would guesstimate that a DPM who did 10 nail procedures, 5 heel pain patients, a 5 brace or orthotics every day would make as much if not more than a DPM who did 3-5 surgical cases a week.

 

[PADPM]

Podfather is also 100% correct. I performed a bunionectomy with osteotomy and screw fixation, and a "bumpectomy" for a "tailor's" bunion on a patient today, and via our office computer we were able to determine our reimbursement.

Our FEE was $1,400 for the bunionectomy with osteotomy/screw fixation and the $1,000 for the tailor's bunionectomy. The insurance company TOTAL reimbursement was $535.00 with the patient having an out of pocket additional cost of $199. So the TOTAL reimbursement for these procedures will be $734. And that includes all post op visits for 60 days.

And I just received a check for a subtalar arthrodesis, (not arthroreisis) that I performed. I received a WHOPPING $348 for that procedure and it was not on a Medicaid/public assistance patient. It was a well known private carrier.

I can perform 2 P&A's in a matter of minutes and make that amount of money and have VERY satisfied patients with one follow up visit. I can make one pair of orthoses and make MORE than that amount of money and never leave my office.

Surgery is a very important part of my practice and something I enjoy. However, it's not the portion of my practice that is the most cost effective.

So the bottom line is that I hope that the younger docs understand that our profession includes a LOT of non surgical care unless you are in a very unique practice/situation. And you can earn an excellent living without performing a LOT of surgery regularly.

 

[sinustarsi]

That is very true that you dont really need to do alot of surgery to make $$. However, after residency, you just dont want your skill to atrophy. Just be ethical with your patient care. I dont want my next triple or complex case be 9 yrs out after residency. Exhaust non sx care initially and tackle with surgery for all elective case with confidence. But it takes a lot of practice.

 

[Skippygonenuts]

I know this is an old thread but I noticed salary discussed and had a question regarding x-rays. In private practice if the pod owns his own x-ray machine, is he/she legally required to have a radiologist read the X-rays and pay him for it or can the pod bill for the X-ray and read it himself?

 

[UNMorBUST]

http://www.nycpm.edu/curriculum.asp
You do clincals in radiology your 3rd and 4th year. So im assuming a DPM can read x-rays within their scope. Correct me if im wrong.

 

[Skippygonenuts]

thanks for the link!! I hadn't had the chance to look up the different curriculums for all the schools yet, but nycpm is my #1 choice since i live in NJ, so thanks!

 

[krabmas]

as a podiatrist you can take x-rays within your state's scope and bill for them as well as reading them.

Most podiatrists have their own x-ray, some (few) have a mini MRI for the foot, many also have ultra-sound.

If you end up being a pod that does not have your own x-ray or your patient has to go somewhere else due to insurance for x-rays you will still want a copy of the films or disk, for MRI's too so you can read them yourself, even if you cannot bill for it. The radiologist gets an x-ray/ image but no or minimal clinical info. Often times the read on the image is not even localized to the patient's symptom. This is more likely on MRI, but happens on x-ray as well.