Miserable DPMs???

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StaphRx

StaphRx

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So, I went to the NY Clinical Conference this weekend, and met some DPM's. Why are they so miserable? They were all complaining about the economy and how bad they were doing in their practices, ie. Medicare issues.

Meanwhile, maybe because I'm just always so positive, I still think podiatry will be a great field for me. Do you all have any thoughts or know anything else about why these "older" DPM's are acting so miserable? It's not like they were happy to be in podiatry, and maybe I just happened to come across a grumpy crowd.

Any insights, and perceptions about how maybe the younger generations and the newer trends will be doing in this field? :thumbup:
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I think the economy is tough for everyone, DPMs and MDs alike. Keep in mind, however, that it will be 4-7 years before you are exposed to that same reality, and chances are, the status of the economy will have changed by then...I hope
 
also, the training of DPM's has improved and the older ones are finding themselves untrained in regards to new techniques.
 
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I've met miserable people in nearly every specialty in medicine and many other professions for that matter. These people were generally miserable before starting. I do have to admit that NY is a strange place for podiatry though.
 
StaphRx said:
So, I went to the NY Clinical Conference this weekend, and met some DPM's. Why are they so miserable? They were all complaining about the economy and how bad they were doing in their practices, ie. Medicare issues.

Meanwhile, maybe because I'm just always so positive, I still think podiatry will be a great field for me. Do you all have any thoughts or know anything else about why these "older" DPM's are acting so miserable? It's not like they were happy to be in podiatry, and maybe I just happened to come across a grumpy crowd.

Any insights, and perceptions about how maybe the younger generations and the newer trends will be doing in this field? :thumbup:
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I was there too but hung around with "Bahaa" and the DPM I shadow (he's 35 and already chief of podiatry at a long island hospital). He's got nothing to say but good things about the profession and where it's going.

Furthermore, didn't you notice that a huge majority of DPM's there were older (50+ yo)? AARP conference anyone? The only people in their 20's,30's I saw were NYCPM students and some venders. Probably a big chunk of those guys there didnt do residencies and if they did, 1 year or so in length or a "preceptorship." Pretty interesting bunch of dudes, some falling asleep during speeches, 1 guy cutting his fingernails during a lecture on offloading, few fanny pack wearers. Idk, I couldn't picture a lot them as F & A surgeons (or foot surgeons for NY) but maybe that's just me. Definitely an interesting experience to say the least.
 
I've noticed alot of negativity on another site (network54) and it made me think twice, but then again I've seen SO many people that are whiners and want things handed to them. You have to work to go anywhere in life!

The pods I shadowed had great things to say about the profession. I asked her what she thought about so many new podiatrists graduating and she brought up the baby boomer story and how the elderly are going to really need our help and that she didn't think we were graduating enough Pods for the future. That was just one Pod's opinion and I speculate that she has a good point.

P.S. I also shadowed another pod who was older, completed a 1 yr residency and he just wasnt a very nice man. Im not at all trying to offend anyone with a 1 yr residency im sure they have great skills, but he just seemed really grouchy and didn't care too much.
 
Very good points above. Thanks! :rolleyes:

The only "happier" older DPM's I witnessed this weekend were those presenting and they seemed a little bit more successful. The elder lady I sat with...the only thing that impressed me was her mink. :cool: Her hair, clothes, shoes...no comment.

Good luck to everyone. Didn't mean to sound so negative, but I wanted to see if it was just me experiencing the grumpy DPMs, and if I was missing out on something. ;)
 
JEWmongous said:
I was there too but hung around with "Bahaa" and the DPM I shadow (he's 35 and already chief of podiatry at a long island hospital). He's got nothing to say but good things about the profession and where it's going.

Furthermore, didn't you notice that a huge majority of DPM's there were older (50+ yo)? AARP conference anyone? The only people in their 20's,30's I saw were NYCPM students and some venders. Probably a big chunk of those guys there didnt do residencies and if they did, 1 year or so in length or a "preceptorship." Pretty interesting bunch of dudes, some falling asleep during speeches, 1 guy cutting his fingernails during a lecture on offloading, few fanny pack wearers. Idk, I couldn't picture a lot them as F & A surgeons (or foot surgeons for NY) but maybe that's just me. Definitely an interesting experience to say the least.
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I def thought I was at the wrong conference. AARP's for sure! :laugh: And they were all upset about sitting around at the long lectures and most were pretty pissed about getting their cards scanned for credit before they could leave.

I was there Sunday, and I definitely witnessed a good amount of cute old men/ladies and the interesting little things they were doing at the conference. :confused:
 
My man jew hit it right on the head. I was telling him everyone was an oldie there.

Overall it was a really good experience. Awesome lectures as well.
 
Bahaa said:
My man jew hit it right on the head. I was telling him everyone was an oldie there.

Overall it was a really good experience. Awesome lectures as well.
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Yup, we did have a good time Bahaa (minus $10 bagels). The other thing I noticed was that it was a super-majority of men. It seems the pod schools now have a lot of women (not so much Azpod) that make up their class. This was definitely not the case for back in the day.

I am really curious how much surgery those older pods actually do. The speakers were talking about these up and coming techniques in wound healing + all different types of amputations involved. This was the 2 hour lecture that Bahaa and I really enjoyed (Dr.Donohue)...seemed like most of the people there were asleep :sleep: The guy we shadow specifically focuses on wound care, so we have been exposed to this for a while already.
 
This is really funny b/c I went to the NYC clinical conference as a student and thought the same thing - look at all these old unhappy people.

Then I went to an ACFAS meeting and a DLS meeting and the crowd is completely different. Younger, still mostly men, no fanny packs, and better dressed, happier and more interested in the lectures.

NY is probably the worst state for podiatry. Limited scope, pod hating ortho docs, strong ortho lobbying group, nobody in NY thinks pods are real docs ( I think including some of the pods).

It is funny to read this thread and see that nothing really changes.

Before anyone yells at me - I am not saying that there are not good pods in NYC. There are, but that is not the majority of what comes across at the conference.
 
I will clue you into why some are miserable.

~. They are so far in debt they are screwed. Student loans, personal loans, car loans, house loans, business loans, equipment loans, office rent, utilities, insurance, billing companies, cleaning ladies, office staff, health insurance, property liability, personal liability, professional liability, membership dues, hospital dues, continuing education credits, office supplies.

And to top it off since they were so leveraged with credit, they are now screwed if they can't access that same credit to keep them afloat.


The debt is a killer esp for younger pods. When I see a younger pod that is well dressed and driving a fancy car, I automatically think, "I wonder where he got the loans from, I'm NOT going to bank there anymore as they will lend my money out for anything!-."

It has absolutely nothing to do with being trained or not trained to do surgery. I love it when the young pods think of the old ones as idiots.

anyway,

I think we are going to see some serious adjustments to reimbursements and it isn't going to be pretty.

BTW, yes the babyboomers will need lots of medical care, but I am telling you right now, there is NO money to pay for it. So guess what, you might be swamped with patients but getting paid very little.
 
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This was the perfect thread for whiskers. I was wondering when he was going to come in and enlighten us.
 
One of my seniors signed a contract for $175,000 a year and a $25,000 signing bonus so I don't think he's too miserable right now. :D
 
well the fact of the matter is that there will be miserable and very happy people in any profession. I know lawyers, dentists, doctors, accountants, who have all told me to look at something else, and others have told me they love their job.

You can't please everyone, worry about yourself and whether or not you will be happy.

On another note, i have spoken to couple students who are currently in residency after graduating from DMU and Barry. (I guess they aren't really students anymore..) All of them said that they have offers on the table of 100k+. But of course I am sure there are some residents who are dreaming of that salary... ive just never heard/met them...
 
G0dFather said:
lmaoo i belive no matter where u are in the next few yr after serving a 3yr residency anyone should easily obtain at least a 110K yr contract at the least!!!
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Interesting choice of verbiage. Residency is kind of like doing time in a penal colony.
 
As a DPM that's been practicing a long time, I'd like to chime in with my perspective on this matter. I'm actually a little "insulted" by the lack of respect that some of you seem to show for many of the "old farts" that paved the way for some of the significant privileges and extensive rearfoot procedures you are now trained to perform.

I'm glad that you're all now pounding your chests with the fact that you've obtained 3 year residency programs. But please don't forget that it's guys like me that fought our asses off so YOU can have that training. Please show some modicum of respect, and realize that a 3 year residency didn't just happen over night.

When I graduated only 45% of my class were able to obtain residency programs. Even the best and the brightest. Guys in my class that were much brighter than guys graduating NOW that are getting PSR 36 programs, were unable to land a program.

Some of them worked extremely hard, and became excellent surgeons the HARD way. I did obtain a residency and I am board certified by the ABPS and I was an examiner for ther oral portion of the ABPS certification exam for over a decade. I'm a residency director for a surgical residency program, and I've done pretty well academically.

However, our system is putting out a LOT of PSR 36 trained residents, all set to perform major rearfoot reconstructive procedures, apply ex-fixators, etc. But they forget several factors. There are only a finite number of these surgeries to be performed, and in the "real" world, (not in a clinic setting), these procedures don't always pay the bills, when considering the time in the O.R. and the prolonged follow up, etc.

Not every PSR 36 grad is going to land a high six figure income. 'Ain't gonna happen. There are still many patients that need routine podiatric care, care for aches, sprains, verrucae, plantar fasciitis, tinea, etc., and not just surgical care.

Many of the "old timers" you've been making fun of are complaining due to the fact that insurance reimbursements are at an all time low, while malpractice premiums are at an all time high. All aspects of overhead have increased, therefore making profits less than in the past. Many of these doctors were planning on a retirement that may have been delayed due to these increased costs and recent losses of their investments.

Additionally, many of these conferences are new and novel to you, but please consider that many of these DPM's have been going to conferences for 20 or 30 years, and sometimes it gets a little "old".

Please show a little respect and humility. And don't for one minute fool yourself into thinking that there aren't a LOT of DPM's in their 40's, 50's and 60's that aren't capable of performing MAJOR rearfoot reconstructive surgical procedures. Someone DID lay the foundation.
 
I was hoping a DPM would post this. My uncle is an MD and tells me stories about how hard it was before all the residency regulations. 100+ hour weeks. I have much respect for older healthcare professionals who paved the way for us and I hope one day I can do the same for the next generation.

Again, Thanks!
 
PADPM said:
However, our system is putting out a LOT of PSR 36 trained residents, all set to perform major rearfoot reconstructive procedures, apply ex-fixators, etc. But they forget several factors. There are only a finite number of these surgeries to be performed, and in the "real" world, (not in a clinic setting), these procedures don't always pay the bills
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I've been curious about this. With basically everyone going to have a PSR 36 in the future, why will it be like that? There are plenty of pods who don't do half the surgery they used to due to reimbursement (and the $3k, now $700 bunionectomy example everyone uses), and rearfoot doesn't seem very common, anyways.

Why train everyone for PSR 36 surgery when a lot of reimbursement isn't great, especially considering followup, when doing well doing mostly surgery involves high volume, or working as part of a larger practice, and when rearfoot surg isn't very common? Just curious, and new to this.
 
It seems that everyone WANTS to be trained as a PSR 36 due to the glamor of surgery vs. "routine" care. The more complex surgery that is learned and performed, the more parity we have with orthopedic surgeons.

Additionally, it never hurts to be skilled in all phases of care. However, reality is that unlike many residency programs that are associated with clinics, in private practice many patients simply don't opt for these major reconstructive procedures.

Patients often can not commit to the prolonged convalescence associated with these procedures due to family or work commitments, etc. Additionally, from a simply practice management standpoint, it's not always as financially rewarding as one would like to believe.

In the real world you may have a major case booked at your local hospital. So you arrange your schedule accordingly to perform the case at 7 am. Then, your case is "bumped" for an emergency aneurysm case, and your case goes off 2-3 hours late. And your complicated case takes 2+ hours. You don't have any residents at the hospital, so you are responsible for ALL pre and post operative paperwork, etc., etc.

Now you've got to drive back to your office, after rescheduling the patients since you are running late. Several weeks later you are STUNNED to see the disappointing reimbursement from the insurance company AND there is a 90-120 day global fee for the surgery. That means that you can not bill any additional charges (other than x-rays) for follow up care for those 90-120 days. So that surgical fee covers all that care.

So when you add up ALL that cumulative time......your trip to the hospital, your time at the hospital, your trip back to the office, and all your follow up care, the overall profit from surgical care breaks down to be not as high as many imagine.

A pair of orthoses is much more profitable!! For that matter, so is performing a few P & A's in your office!

Additionally, I practice in Philadelphia and we have the highest malpractice rates in the country. Many doctors have greatly backed off the amount of complicated procedures performed out of fear of a bad outcome or legal case. ONE case can result in a malpractice premium that would be so high it would be unaffordable.

I personally know of a young aggressive DPM that did a strong program. He was out 3 years and had 2 cases against him (one involved a triple arthrodesis and one involved a flatfoot reconstruction). At the end of the day, in order for him to obtain surgical malpractice it would cost him $56,000, so now he is performing palliative care only!!

I think it's GREAT that our residents are obtaining PSR 36 training, but I sincerely hope that we don't have a group of well trained residents that are on medication for depression if they aren't all performing a lot of surgery every week for major cases.

You CAN also make a good living with a well balanced practice, performing surgery and providing relief for patients without surgical intervention.
 
Excuse me for the "inaccuracy", I meant to say PM&S 36. You know what I meant. Just what we need, another disrespectful "punk" in the profession.
 
PADPM said:
Excuse me for the "inaccuracy", I meant to say PM&S 36. You know what I meant. Just what we need, another disrespectful "punk" in the profession.
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because you obviously know everything. :rolleyes:
 
Listen DPM STUDENT. When you achieve what I've achieved, then you can speak to me at my level. You're still a student who hasn't even graduated, let alone obtained a residency, job, etc.

Not only have I graduated, gone through residency training, become ABPS board certified, but I've also served as an EXAMINER for that certification process, I've been a residency director for a surgical residency program, I've published peer reviewed articles in podiatric AND allopathic journals, I've trained countless residents that have shown their appreciation by filling my office walls with plaques, I've lectured, I've held high positions in State societies, I've run a successful practice, I've performed volunteer work and last but certainly not least.......I've FORGOTTEN more about the foot & ankle than you presently know.

So go back to your books and learn how to show some respect. If and when you ever accomplish anything, then let me know.
 
For someone with so many great accomplishments you seem very insecure.
 
PADPM said:
Listen DPM STUDENT. When you achieve what I've achieved, then you can speak to me at my level. You're still a student who hasn't even graduated, let alone obtained a residency, job, etc.

Not only have I graduated, gone through residency training, become ABPS board certified, but I've also served as an EXAMINER for that certification process, I've been a residency director for a surgical residency program, I've published peer reviewed articles in podiatric AND allopathic journals, I've trained countless residents that have shown their appreciation by filling my office walls with plaques, I've lectured, I've held high positions in State societies, I've run a successful practice, I've performed volunteer work and last but certainly not least.......I've FORGOTTEN more about the foot & ankle than you presently know.

So go back to your books and learn how to show some respect. If and when you ever accomplish anything, then let me know.
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You've definitely earned your place in the world, but I'm afraid that scolding is likely to fall on deaf ears these days. These so-called "punks" are just not likely to listen to the message. Online flame wars pretty much go nowhere accomplish nothing. Before this thread turns really ugly may I suggest that everyone pick a different topic?

http://www.cio.com.au/article/205772/gen_y_gen_x_baby_boomers_workplace_generation_wars?pp=1

http://www.cio.com/article/149053/M..._Bringing_Out_the_Best_in_Generation_Y?page=1

http://www.cio.com.au/article/201670/bringing_best_generation_y
 
DPMstudent said:
For someone with so many great accomplishments you seem very insecure.
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See what I mean? This will accomplish nothing other than make a few people hot-in-the-head and draw negative attention.
 
I get the respect issue PADPM has with some of the "younger" posters, but I think the real reason he feels the need to scold us and self-inflate his own status in the pod community is the fact that he's on the East Coast...

Relax, this is a message board. Come out to the PacNW with NatCh and I. The laid back attitude and beautiful scenery is contagious...:)
 
NatCH,

You are 100% correct and those links hit the nail right on the head. "DPMstudent" just doesn't get it, and we both know his/her kind. Always has to get in the last word, shows no respect, etc., etc.

This is exactly the type of person that will get eaten alive in most residency programs, I interview these types all the time. They turn out to be the scariest types of DPM's because they never actually realize how little they actually know.
 
Dood what difference does it makes if its PSR-36 or PSY-36 or PM&S-36. we all exactly know what he is trying to say.

Please lets not disrespect the Senior students/Residents or Attendings. May be not in first year but as you begin your second year and start meeting third yrs/fourth yrs and then eventually residents in rotatations & attendings in externships. All that you posted on SDN is gonna come back and haunt you. You may not take this seriously just wait till you start your clinics in 2nd yr and start interactions with senior students/residents/attendings.
 
dtrack22,

Sorry, but I'm mellow enough without a visit to the Pacific NW. And apparently you don't get it either if you think I'm "self-inflating". I was simply letting DPMstudent know that at this point in his career, in comparison, I really do "know it all".

You've got a large set of stones considering you're not even in podiatry school YET!!!

I've got underwear older than you.:laugh:
 
This turned out to be a pretty comical thread. Somehow this statement was deemed disrespectful "There is no such thing as a PSR-36" and now I have to hear about the younger generation and their hippity hoppin bippitty boppin and get called a punk. Not an attending I would want anyway. Sounds like the slightest statement could send the man postal.
 
DPMstudent said:
This turned out to be a pretty comical thread. Somehow this statement was deemed disrespectful "There is no such thing as a PSR-36" and now I have to hear about the younger generation and their hippity hoppin bippitty boppin and get called a punk. Not an attending I would want anyway. Sounds like the slightest statement could send the man postal.
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I have nothing against you but am just wondering, what exactly was the point of your "PSR-36" post. we all knew what he meant. whats the point of correcting him or this sacarsm?

Didnt we just finished fighting with DOs because some pre-pods & newbies decided to be PODIATRY PR people and corrected someone there (i still dont knw why a prepod was trolling pre-med forums) and then brought that DO thread to Pod forum and then things went out of control. why do we need to waste threads on pointless comments or topics?
 
DPMstudent,

I have some strong advice for you. Learn when to stop and keep your tongue in your mouth. Your insults just keep on coming. Now you accuse me of going postal.

When will you finally learn? You are in the very early stages of your "career", and despite what you may or may not want to "hear", I've been exposed to a lot of students, externs, preceptors, residents, fellows and colleagues in my years of practice. As a result, at this point in my career, I'm a relatively good judge of character via personal interview, letters, email, etc.

And I can tell you as a fact, that I highly recommend that you sit back, learn some humility and do not feel that you have to continue insulting someone that has years of experience on you.

Show some level of control and maturity, stop flinging insults and ATTEMPT to learn something from this experience. You may actually learn something valuable that will benefit you in the future.
 
PADPM:

I think its time to get some new undies! :laugh: Although maybe I could pick your brain on how you keep underwear that long? Mine always get holes in the crotch...must be my large stones ;)

But seriously, come out West and I'll show you around the Selkirks (backpacking, mountain biking, skiing, boarding, you name it). Primo tour (for free, no senior discount needed), gotta be better than hanging with the Amish in PA!
 
dtrack22,

Actually, the real solution is to not wear any undies. And in reality, I'd probably disappoint you because I'd hardly be considered a "senior". Sorry, I don't qualify for any discounts at the movies, but can still run circles around most of the students and residents I encounter. I've got QUITE a few years before I'll be going out for "early bird" dinner specials or getting those discounts. You'll be out of school, out of residency and a seasoned attending with a few kids before that happens.

And the last time I checked there weren't too many "Amish" carting around the Philadelphia area. The majority of the Amish are a few hours away, but I'll try to refrain from insulting an entire group of people and their beliefs. I guess they have their own form of "fun".

Your offer sounds great......but sometimes in a busy practice it's hard to find that much time to "play". Hopefully, in a couple of years you'll understand that dilemma.

Good luck with your education and with your search for quality underwear.
 
You'll be out of school, out of residency and a seasoned attending with a few kids before that happens.
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I like the way you think PADPM. Finally, someone other than my mother who believes in me :laugh:

And as for the Amish, there is nothing to be ashamed of when it comes to partying like its 1699. But I'd imagine you'd be hard pressed getting around Philly traffic in a buggy, probably the reason you don't see them? Also may be because of that whole Christ against culture thing they got going (man the theology dep. at my University would be proud of that reference).

In all honesty I hope I have time to "play". Its part of the reason I got hooked on Podiatry...plenty of happily married men with time for their families. Sorry MD's but even the surgeon who repaired my ACL didn't have a lot of time outside of work. And he's in a private group with about 20 surgeons, they have their own surgical center on the top floor (no need to do procedures in the hospital for the most part), a PT/rehab center that they own near the bottom floors and two floors of offices and exam rooms. If you can't find the time to date/keep your first wife then I'd imagine you'd have trouble in almost any situation. Of course it could have been the 5 years of residency and 1-2 year fellowships that got 'em. All to scope knees for the rest of their lives? Ok, you can get away with two joints but thats about max in our area...you try to do more and there is someone better than you who's going to get a majority of the cases. I said no thanks.

Its been fun PAPDM...and from here on out I will respect my elders and go commando!
 
Now for a business lesson.

The reason the orthopedic surgeons you know have a surgical center, a rehab center, etc., is not simply for convenience. It's also to keep the moolah in their pockets. A very wise business decision.

Often, the surgical facility receives greater reimbursement for the surgical procedure being performed than the surgeon actually receives for the actual performance of the procedure. Every procedure has a "professional" component and a "technical" component. One is for the actual performance of the procedure and one is a facility fee. In the case of radiology, one is for the actual "taking" of the films, and one fee is for the radiologist to actually "read" the films. (You can not charge both fees when taking x-rays in your office.)

So, when I perform a surgery in the hospital, I may receive X dollars for the surgery, and the hospital may receive 2X for the "facility" fee for the procedure. Doctors got tired of watching those dollars get paid to the facilities, therefore wanted to start collecting money on BOTH ends.

This was particularly true of gastroenterologists who were performing a gazillion colonoscopies. Now that most of them own their own surgical centers, or are partners in the centers, they only get a couple hundred bucks for the actual scope up the wazoo, (which takes 10 minutes), but they get big bucks for the facility fee.

So a lot of docs starting investing in surgical centers to start getting in on the action, because the BIG money was not in the surgical fee, but in the facility fee. Add the two together and you can purchase that summer home and Lambo Gallardo much faster.

Add a PT center to your office, and keep additional $$$$ in your office instead of having to refer to a physical therapist. So these orthpods aren't just good doctors, they are very smart business people.

And you also hit the nail right on the head. These guys often make fun of us that we are "limited" to the foot/ankle with our limited scope of practice, when in reality, the majority of orthopedic surgeons really now specialize in one or two joints. Excellent observation.

Once again, good luck.....and if you plan on having a family.....stay away from those tighty whities.
 
PADPM,

Thank you for voicing your concerns. It is good to hear someone who has busted their ass and become successful voice complaints about many people of my generation who seem to think that success and great training will be handed to them. My hat is off to you for improving the standing of podiatry and our scope of practice for us young punks. You sound like my father, and uncle's who're physicians...I'm glad to hear they're not full of it.
 
PADPM said:
Now for a business lesson.

The reason the orthopedic surgeons you know have a surgical center, a rehab center, etc., is not simply for convenience. It's also to keep the moolah in their pockets. A very wise business decision.
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Just a quick question about having ownership or partial ownership in a surgical center. Isn't there some sort of "conflict of interest" issue with referring to your own surgical center for the surgery, and if so how is it avoided? Do you just disclose that to the patient or what? Thanks for all your insight PADPM, we appreciate it.
 
PADPM said:
Now for a business lesson.

The reason the orthopedic surgeons you know have a surgical center, a rehab center, etc., is not simply for convenience. It's also to keep the moolah in their pockets. A very wise business decision.

They get big bucks for the facility fee.

So a lot of docs starting investing in surgical centers to start getting in on the action, because the BIG money was not in the surgical fee, but in the facility fee.

Add a PT center to your office, and keep additional $$$$ in your office instead of having to refer to a physical therapist. So these orthpods aren't just good doctors, they are very smart business people.
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hey PADPM,

this is fantastic advice that makes perfect sense I just never thought of it this way. How does a practicing podiatrist invest in a surgical center? do you mean that they get a contract with a large multispeciality corporation and invest in a surgical center here and another there? Also, for a podiatrist just getting out of a descent residency, how does one get into this sort of business of invest in a center, adding a PT to an existing one, etc?

thanks!
 
dpmPOD

Excellent question. Please understand that I'm not an attorney, so my answer may not be accurate. There are "Stark" laws that cover this issue, but I believe that it differs regarding the use of a surgical center.

My understanding is that if you refer a patient for x-rays, diagnostic studies, etc., and you are an owner/investor in the facility you are referring a patient to for that type of situation, you must disclose your personal interest.

However, if you are actually performing the surgical procedure in a surgery center that you are an owner/investor, I don't believe that you have the obligation to tell that to the patient. Naturally, if a patient insists or requests that a procedure be performed in another facility, and you "push" the procedure to be performed in "your" facility, in my opinion THAT constitutes a conflict of interest.

Once again, I'm not a health care attorney and for more information, "google" information regarding the Stark Laws and it may provide you with the information you are seeking. But I believe my interpretation may be accurate.


iceman69

Thanks. I really don't consider your generation "punks", but there are a handful that do fit that bill. I really don't like to "lecture" the newer doctors with the old... "I walked to school in the snow uphill both ways when I was your age" routine.

But it is nice for the younger doctors to understand that they have some excellent opportunities and privileges due to the hard work and efforts of the doctors that preceded them. And it's ironic that some of your peers sit back and ridicule the older generations for not having the knowledge or ability to perform major rearfoot reconstructive procedures or apply ex-fix frames.

Although I'm really not that "old", when I applied for privileges at a local hospital in 1994 (NOT that long ago), the privilege list said the following:

Bunion repair
Hammertoe repair
Wart removal
Toenail trimming
Callus trimming
Removal of soft tissue lesions

I added two pages of requested privileges in 1994 including rearfoot procedures, ORIF procedures, fracture repair, reconstructive procedures, etc., and even the chief of podiatry called me and asked me "not to stir the pot".

Well, the chief of orthopedic surgery bascially called me and asked me if I was CRAZY. So, I challenged him as to WHY he would limit my privileges if I could provide a log from a competing hospital that I had recently performed ALL of the procedures I requested. I than challenged him and asked if HE had similar privileges and asked to see the last time HE performed any of these foot/ankle surgeries.

I went all the way to administration, despite the fact that the chief of podiatry was NOT on my side. And lo and behold, after the credentials committee met and I provided all documentation, I was granted EVERY privilege I requested.

And naturally, every DPM that applied to the staff after me had my support and a much easier time obtaining privileges for more than the "basics".

I'm just one small example and there are many, many DPM's that did a LOT more than me for our profession.
 
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