Admitting Priviledges

[cool_vkb]

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I heard from someone that some hospitals give admitting priviledges based on quota. Lets say if they have a 5 DPM Quota and have 5DPMs on staff then thats it no one else gets priviledge even if the new applicant is a big shot from harward or INVOVA 😎 PM & S 36 while present docs on staff are 1yr residents or none. I heard same applies for insurance also. Some wont accept you on panel if the area is already saturated.

So lets say in city of chicago due to saturation of pods. all hospitals have met their quota and cant accomodate any more pods. A certain Podiatrist fails to get staff priviledges at any hospital (due to his failure or failure of hospital) and he ends up getting a Osteomyelisis patient which would really benifit if he is admitted but can also be managed outpatient. Pod thinks he cant admit on his own and has to refer. So he decides to keep manage the patient by himself and managing in his office. (its not serious case, he wud really benifit if admitted but cud be managed in office also).

Now godforbid if that patient looses his leg or even worse then isnt the hospital system also on fault here. I mean Podiatrist for sure is 100% at mistake for not thinking the best but the existing conditions foreced him to make the choices he made.

And what kind of options one has if they fail to get hospital priviledges. Do they have to refer out and loose patient or there is anyother way?

 

[Feli]

Why do you want admitting privileges? For your ego... or do you really like being paged at 2am because your patient is hypertensive or requesting a sleeping pill? Esp if there are int med or FP resident teams at your hospital taking overnight call, why not co-admit or admit under them and let pod surg be the consult doc/service? That lets everyone do what they're best trained for IMO, and that usually means better pt care and more efficiency overall. If you are a DPM who doesn't have pod residents taking night call for you, then being the consultant and not primary admitting doc for your inpatients is also a lot less likely to make you look like a Visene commercial in clinic or surgery the next morning. You will probably be quite suprised how many things that sound big and bad while you are a student or resident turn out to be essentially a chore and financial loss when you're an attending.

To answer your question, a DPM not getting privileges, assuming they successfully completed today's PG training, would be very rare. You may run into trouble getting mid/rearfoot surgery rights or the option of admitting as the primary doc at some facilities, but assuming you have a state license and today's training, being allowed to do consults and co-admit shouldn't be too difficult. You might not be able to get your foot in the door at every major hospital in town, but you will get at least some if you are trained for it.

For older DPMs who didn't do residency and didn't get/keep admit and consult privileges anywhere, then yes, they just send their patients who are beyond office care to the nearest ER and let them get admitted to staff physicians. Those situations are still out there, but they're getting fewer and further between.

 

[jonwill]

As Feli stated, admitting privileges can be a good and bad thing. I have never heard of a quota system though. At my last two interviews, podiatrists had full admitting privileges at the hospitals. That does make it much easier to take trauma because you don't have to find someone to admit the patient. It also makes it easier to do big cases where the patient may need admission afterwards. On a complex patient, I will definitely consult medicine as an interist is much better at medical management than me!

Podiatry has come a long way folks. We have admitting privileges and are at major hospitals. At one of my interviews last week, the podiatrist was actually the Chief of Surgery . Compare my experience with that of the dean of my podiatry school. He would often speak of his first contract in which it stated he was not aloud to break the skin!

 

[tracheatoedoc]

Who does the admission H & P?

 

[cool_vkb]

Why do you want admitting privileges? For your ego... or do you really like being paged at 2am because your patient is hypertensive or requesting a sleeping pill? Esp if there are int med or FP resident teams at your hospital taking overnight call, why not co-admit or admit under them and let pod surg be the consult doc/service? That lets everyone do what they're best trained for IMO, and that usually means better pt care and more efficiency overall. If you are a DPM who doesn't have pod residents taking night call for you, then being the consultant and not primary admitting doc for your inpatients is also a lot less likely to make you look like a Visene commercial in clinic or surgery the next morning. You will probably be quite suprised how many things that sound big and bad while you are a student or resident turn out to be essentially a chore and financial loss when you're an attending.

To answer your question, a DPM not getting privileges, assuming they successfully completed today's PG training, would be very rare. You may run into trouble getting mid/rearfoot surgery rights or the option of admitting as the primary doc at some facilities, but assuming you have a state license and today's training, being allowed to do consults and co-admit shouldn't be too difficult. You might not be able to get your foot in the door at every major hospital in town, but you will get at least some if you are trained for it.

For older DPMs who didn't do residency and didn't get/keep admit and consult privileges anywhere, then yes, they just send their patients who are beyond office care to the nearest ER and let them get admitted to staff physicians. Those situations are still out there, but they're getting fewer and further between.

Thanks bro. Now that iam in 3rd year and see clinical cases iam getting these new new thoughts and questions. 🙂

 

[jonwill]

Who does the admission H & P?

The podiatrist does the admit h&p.

 

[PADPM]

Feli and Jonwill,

Excellent posts. Some hospitals will allow DPM's to perform their own H&P's and some will not, and some DPM's simply do not want the responsibility of performing their own H&P's. Sometimes, it's actually a little political.

I believe I have excellent overall training, and I'm very confident in the O.R. However, my training really preceded the comprehensive H&P training current residents receive. Yes, I've taken H&P courses and I'm allowed to perform H&P's, but I don't really believe that I'm that well versed in listening to heart sounds and I may miss some pathology, etc. I do what I do best and allow the F.P's, G.P's, and internists to do what THEY do best. Additionally, in private practice it's always good "practice management" to allow the patient's PCP to perform his/her job and not take revenue out of his/her pocket. Unfortunately, it's a game that has to be played if you want to keep getting referrals from that doctor. If that doc finds out YOU are doing the H&P on his/her patient, it MAY ruffle some feathers. It's sad, but it is a fact of private practice.

As I've stated on this site many times, I have witnessed podiatric privileges come a very long way. That's often why I get "upset" when some of the younger guys/gals make fun of the older pods. They often forget that the older pods in the polyester suits were the ones that fought hard for the privileges that formed the foundation for the plethora of privileges YOU now enjoy.

When I obtained priviliges at a few hospitals, my original privilege list LITERALLY stated; "consults, including nail cutting, skin lesions such as corns, calluses, etc., and surgical procedures involving the skin, nails and hammertoe repair and simple bunion repair, NOT including osteotomy or the use of internal fixation.

I fought just to perform an osteotomy and pissed off the existing DPM staff who told me not to "make waves". I finally made "enough waves" to prove my point. The chief of podiatry and orthopedics and to "observe me" perform THREE of every procedure prior to being approved for that surgery. This is despite the fact that both of these docs had never been exposed to half the procedures I was performing, especially the DPM who didn't even have priviliges to perform these procedures. And I had to schedule these procdures when it was convenient for them, not me.

There are definitely hospitals and insurance companies that may have "closed" panels. This was much more prevalent with hospitals years ago, but not as prevalent now, since it can be challenged. However, insurance companies often have "closed panels" due to over saturation and no "geographic need" in a given area.

As Feli stated, there is no glory in having admitting privileges. I used to be involved with a large hospital with lots of residents where I did all sorts of "major" stuff. The hospital is about 25 miles away from my home. When I had several patients in-house, it was great to rely on the residents if there were minor problems or over the weekend. I would come in on Saturday, but wouldn't have to come in on Sunday or for every little problem. The same was true for ER problems. The resident(s) would call if I needed to come in.

Well, there were political problems, budget problems, and the hospital was taken over by a big corporation and the residency was dissolved. So, it became a significant chore for me to care for these patients by myself with my other office/hospital responsibilities and the distance. Having these admitting privileges was no longer "fun", but was a burden.

Therefore, the glory of admitting privilges is great if you aren't real busy and want to spend a lot of time at the hospital and get called a lot. Unfortunately, it's not realistically a great way to put food on your table. It's a good way to network in the beginning, but when you get busy, there are much better ways to spend your time and earn income.

If your hospital has residents, it is an excellent way to take away some of that burden. But you MUST remember, residents must be watched like a hawk. They are in their training and learning stage and will make errors, and you are ultimately the captain of the ship and are responsible for YOUR patient, regardless of the decision of the resident.