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Hiring DPMs specializing in wound care

Discussion in 'Podiatric Residents & Physicians' started by Ankle Breaker, May 23, 2012.

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  1. Ankle Breaker

    Ankle Breaker Senior Member

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    It seems like most conversations about residencies on this forum often lead us to the quality of surgical training one should be hoping to land. It appears the mantra is: great surgical training = you are more valuable then the next person = better job offers. It appears young doctors coming out of residencies, that do a lot of cutting, is the meal ticket to landing the F/A position with an ortho group. Again it's been discussed numerous time on these boards but most recently here: http://forums.studentdoctor.net/showpost.php?p=12514595&postcount=8

    So I dare ask...what about the DPMs who graduate from residencies where they get superior wound care training? They get surgical training too, enough to sit for ABPS boards, etc. So why wouldn't an ortho group put a high value on an individual who can bring procedures that the group otherwise would have never seen?

    It's been pointed out that F/A positions with ortho groups won't be available forever so why wouldn't an ortho group be inclined to hire DPMs who can provide great wound care along with the obvious palliative care a DPM usually provides?

    Or is wound care over-rated? Would the ortho group be better off hiring a nurse or even a PT to do wound care? As a P3 student I am unsure if the quality of wound care training is similar across the board between a DPM vs. nurse vs. PT.
  2. UVAallday

    UVAallday

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    I shadowed a pod who worked at an ortho group where there was another dpm hired who specialized in wound care. The guy I shadowed was the surgery guy and the other guy was the wound guy.
  3. PADPM

    PADPM

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    Excellent question. It may be that they don't hire DPMs specializing in wound care because they don't see a major financial advantage. Wound care is very rewarding professionally, but is not always rewarding financially.

    Our office performs a lot of wound care and we staff a very busy wound care center. As a result, we treat a lot of patients at the wound care center, in our office and in the hospital for wounds. We obtain a lot of consults for wound care and perform a lot of debridements, I&D's, amputations, etc.

    The majority of these patients have less than optimal health insurance and the vast majority of these patients are not wealthy or well educated. Although diabetes and vascular disease don't play favorites, the well educated and wealthy tend to take better care of their health care needs. Most of these patients have the knowledge and resources to obtain prompt care when there is a problem, vs. those who have financial difficulties and less education. As a general rule, these patients often wait until a problem is almost unfixable. It's a shame, but it's true. Of course this isn't to say that bright, wealthy patients don't end up with significant problems, but in MY experience, the majority of our wound care patients are not wealthy and not well educated.

    These patients often can't AFFORD to take time from work to obtain care and often don't understand the potential sequelae.

    As a result, many of the wound care patients we treat have insurance coverage that isn't exactly making us wealthy. These patients often end up back in the hospital every few weeks with recurrent problems. The time spent at the hospital, performing consults, following up, performing surgical procedures at various times during the evening and weekend, doesn't always make economic sense. However, it's a service that these patients need and deserve.

    In my opinion, treating patients at a wound care center (or in the office) is often not economically "smart" and is not really a money maker. The best way to obtain a decent income from wound care is when you get reimbursed for supervising hyperbaric oxygen treatment dives. That's really where the money is regarding wound care.

    So, the short answer is that wound care is hard work, a terribly needed service, time consuming and not always very profitable, in the absence of a hyperbaric unit. So this MAY be a contributing reason why the orthopods aren't looking for a DPM specializing in wound care.
  4. newankle

    newankle Senior Member

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    I choose not do do wound care because I don't like it, it takes too much time and resources and pays poorly. My ortho practice doesn't want a bunch of wound care patients in the office contaminating things either. Would you want contaminated wounds near postop joint replacement patients?
  5. Ankle Breaker

    Ankle Breaker Senior Member

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    Makes sense.

    Thanks for your and PADPM's response. This is the kind of information I was looking for.
  6. Feli

    Feli ACFAS Member

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    If you have good wound care training and want a lot of those cases, your best bet would be multispecialty/hospital employment groups or vascular surg groups... not so much ortho groups, for reasons mentioned above. You could also just join or start a pod group and get busy pretty fast (but you'd want a few docs - either in your group or willing to provide call coverage - who will go the the hospital regularly and do those cases because there's a lot of night/weekend consults for abscess/gas/etc which probably get way too taxing for a solo doc). A situation where you have residents would also be ideal for obvious reasoning.

    There's a definite need for those services, and since a lot of DPMs - and other specialists - aren't crazy about wound care, it's fairly easy to get real busy REAL fast (much quicker than you could build up a bone/joint or sports med patient base that size). As PADPM mentioned, you will end up doing a lot of inpatient consulting and surgery if you go that limb salvage route, but it can get pretty lucrative if you can get in with the int med, ID, vasc, nephro, endocrine, cardiology, etc docs who also see those patients and monopolize the wound consults/surg at a big hospital or a couple nearby hospitals... as was mentioned, a lot of those pts are "frequent fliers" in both the clinic and the hospital due to multiple comorbidities.
    Last edited: May 24, 2012
  7. PADPM

    PADPM

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    No one wants a "bunch of wound care patients in the office contaminating things", but these patients do need care. I don't want these patients contaminating my post op patients either, so we take as many precautions as possible.

    There isn't a trail of pus from our waiting room to our treatment rooms, and most of our "contaminated" patients are in the hospital, not in our office. Yes, patients in our office do come in with infections, but I'm confident that even in an orthopedic practice, patients are seen with infections, post op infections/complications that can also have the potential to contaminate post op patients if the proper sanitary protocols are not implemented.

    However, I do agree that you must like wound care. I do a fair amount of wound care, though I do not treat patients at the wound care center our office staffs. But I still have to see wound patients who are in house, wound patients who require surgery, wound care consults, etc. And, I really DON'T enjoy wound care. But it is a part of what all the doctors in our office do on a regular basis.

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