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Attendings: After Residency, how much surgery do you do?

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benji808

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For those that don't do much surgery, is it because you choose not to or is it a lack of opportunity? What I love about the podiatric field is the balance between clinical and surgical work, the ability to not only treat your patient under the knife but get to know them in the office as well, at least that is what I've observed in my time shadowing podiatrists. So my question is, do you guys that don't do a lot of surgery simply choose not to, a lack of patients choosing surgery, or just not having the opportunity to do surgery after residency?
 

jellybean2020

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Interesting way to phrase your question. Most practitioners have 1-2 days a week where they go to the OR. If they work at a hospital they might have add-on cases randomly for those sick patients that need it. If you're concerned about wanting to do surgery when you're out, don't be. Want more cases? Work more hours and see more patients. Don't want that much? Refer cases to a colleague or space them out.
 
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bobtheweazel

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Surgery isn't all sex, drugs, and rock n' roll anyway. I believe the cost of follow up is built into the initial surgery so all of the follow up that you have to do you can't charge for and if there are any complications you might have to head out to the hospital to check on just that one patient outside of your normally scheduled OR days, maybe even on a weekend, and you can't bill for it. For all the hassle, I wouldn't want more than a day or two worth of surgeries a week anyway.

The podiatrist I shadowed was older and did some forefoot surgery but sent all of his rearfoot/ankle surgery to younger pods who are better trained for it. He said all the young pods are super excited about surgery and will take all the referrals you can throw at them but that it wears you out after a while of dealing with all the less exciting stuff that comes with it.

I guess he was referring most of his surgical cases out but he still had at least one day per week of nothing but surgeries, all forefoot though like I said.
 
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streetsweeper

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I'll be 2 years out in a few months. My day to day schedule is very busy. Surgery is not a big part of my practice even though I'm board qualified in foot/RRA surgery. I averaged 2 elective cases a month when I started out and now I'm up to 4. I've only requested one day of surgical block time a month, basically. When I'm on call, add about 2 non-elective cases in there. So I'd probably do 4-6 surgeries a month (average). My busiest times are during the winter season believe it or not.

It comes down to my own personal philosophy, really. I am conservative by choice and have found non-operative treatment to be quite superior to a lot of ailments. For every article that supports surgery you can also find a counter article supporting non-op treatments (not always but for the most part). And I think this was one of the main reasons why my current group hired me due to like mindedness. We also have a foot and ankle ortho surgeon in our group so I punt complex/difficult cases to him since he is hired specifically to deal with these type of cases.

Furthermore, the majority of my patient base are on capitated insurance plans. So the fee-for-service model doesn't apply and works out well for guys like me... forces me not to go fishing for unnecessary procedures, tests, etc. My productivity comes from the day to day consults.. The more I see, the more I make. I try to have open access slots on my schedule and not turn down patients wanting to be seen the same day. It can be a drag but that's how I make the dough.
 
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Creflo

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My pay isn't affected by how many surgeries I do. I typically do 1-3 cases per week, mostly elective. I could do more but am very selective on when to operate. If there is any sign of noncompliance I avoid elective surgery and if the patient can live with the pain (or not) I try to talk them out of elective surgery.
 
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MarquetteGuy

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I do 10-15 cases per week. I have a standard 2 full days in surgery per week, sometimes I have to add a third day when I need to get caught up on cases.
 
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ldsrmdude

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It sounds like I'm a year behind @streetsweeper since I'm about 8 months out of residency. I'm in a pretty small group and in a relatively poor, rural area. In an average week I probably do 3-5 surgeries, about half elective and half non-elective. It takes time to build up elective cases. I have a half day a week blocked for surgeries and fit in add-on cases where I need to.
 

newfeet

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I've been out 19 months or so. I'm doing about 2 t0 3 a week. Every month is different. I don't really look for cases or push patients to do anything. I will try conservative treatments first before recommending surgery.
 
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ExperiencedDPM

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I don't agree with jellybean. It's not as simple as "if you want to do more surgery, see more patients". That's a ridiculous statement. It depends on the type of patient you're seeing. If you build a routine palliative practice, "like refers like" which means seeing more patients may end up with no additional surgery.

Additionally, as stated by another forum member, surgery isn't really the way to make money. It requires travel to and from the facility, pre, intra and post op time at the facility and global post op fees, meaning that you only receive the surgical fee and no post op fees for 30,60 or 90 days post op depending on the procedure. So by the time you add it up, it's not a get rich quick plan.
 
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dtrack22

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Additionally, as stated by another forum member, surgery isn't really the way to make money. It requires travel to and from the facility, pre, intra and post op time at the facility and global post op fees, meaning that you only receive the surgical fee and no post op fees for 30,60 or 90 days post op depending on the procedure. So by the time you add it up, it's not a get rich quick plan.

Sorry, but I hate when practicing pods say this...usually AAPPM type folk. Only because its so often used as an excuse as to why they CHOOSE not to do surgery when in fact they didn't receive the training to do surgery in the first place. This isn't at all directed at ExperiencedDPM BTW. Look, making money in medicine is about ownership. Owning a practice or office space, having a stake in a surgery center, imaging center, owning IP with a device/hardware company, etc. But then this TFP comes along and says "surgery doesn't pay." He/she is partly right, inefficient surgery doesn't pay, and at some point big recons that are taking a lot of time in the OR and don't reimburse much more than a fibula ORIF are more for professional satisfaction than for economy purposes. But the TFP isn't accounting for the additional revenue streams that go along with surgery, or the fact that if this second year resident can fix a bimal in under an hour skin to skin with relative ease, a seasoned surgeon can do it quicker (that's ~$800-900 from medicare) and it only takes 3, 5 min post-op visits before you are out of the global in nearly every case. If you are in a group where the office and its staff are running a clinic every day then your OR $ have significantly lower overhead too. Tell Hyer that surgery doesn't pay...guy received $658,413.27 in 2014 for consulting fees, royalties, speaking fees, travel expenses, meals, etc...all because he does surgery. That's on top of his actual collections from the care he provided. And if you think that is impressive, look up a few of the big dog ortho guys who receive millions each year.

Surgery can definitely pay. So can nothing but in office procedures. You never hear a DPM who does a lot of surgery say "clinic doesn't pay," which is funny because the other guys always want to talk about surgery not making you any money. The truth is you can make good money in a well run, busy practice no matter how aggressive you are booking cases. Heck, Barry Block makes a butt ton of money and he does nothing other than pump spam into your inbox every day (let us all just pray that no other medical professionals subscribe to PMnews in fear that it somehow goes mainstream). /rant
 
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ExperiencedDPM

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Sorry, but I hate when practicing pods say this...usually AAPPM type folk. Only because its so often used as an excuse as to why they CHOOSE not to do surgery when in fact they didn't receive the training to do surgery in the first place. This isn't at all directed at ExperiencedDPM BTW. Look, making money in medicine is about ownership. Owning a practice or office space, having a stake in a surgery center, imaging center, owning IP with a device/hardware company, etc. But then this TFP comes along and says "surgery doesn't pay." He/she is partly right, inefficient surgery doesn't pay, and at some point big recons that are taking a lot of time in the OR and don't reimburse much more than a fibula ORIF are more for professional satisfaction than for economy purposes. But the TFP isn't accounting for the additional revenue streams that go along with surgery, or the fact that if this second year resident can fix a bimal in under an hour skin to skin with relative ease, a seasoned surgeon can do it quicker (that's ~$800-900 from medicare) and it only takes 3, 5 min post-op visits before you are out of the global in nearly every case. If you are in a group where the office and its staff are running a clinic every day then your OR $ have significantly lower overhead too. Tell Hyer that surgery doesn't pay...guy received $658,413.27 in 2014 for consulting fees, royalties, speaking fees, travel expenses, meals, etc...all because he does surgery. That's on top of his actual collections from the care he provided. And if you think that is impressive, look up a few of the big dog ortho guys who receive millions each year.

Surgery can definitely pay. So can nothing but in office procedures. You never hear a DPM who does a lot of surgery say "clinic doesn't pay," which is funny because the other guys always want to talk about surgery not making you any money. The truth is you can make good money in a well run, busy practice no matter how aggressive you are booking cases. Heck, Barry Block makes a butt ton of money and he does nothing other than pump spam into your inbox every day (let us all just pray that no other medical professionals subscribe to PMnews in fear that it somehow goes mainstream). /rant

First let me state that I have never and will never be part of the AAPPM. That organization is a joke. Their founder and former guru was basically chased out by the group for some very fishy actions. From what I know, he's lucky he wasn't arrested. And the new president or head of the organization that teaches you how to make millions, is a guy who filed bankruptcy.

I'm not one of those guys who says that surgery isn't the way to get rich because I don't do surgery. I do more than the average number of cases weekly, and perform the full spectrum of cases. But if you break it down and count in the cost of malpractice and potential liability, it's not the most efficient way to make money. It's a necessary part of my practice, and I enjoy surgery, but it's not the most efficient money maker.

Using Hyer as an example is ridiculous. Look over that list of pods and you'll see that he's a very unique case. And since those numbers were released, ask someone why he resigned his ACFAS position. There are other big money makers on the list who have never touched a scalpel (Warren Joseph). Look up some well known and respected surgeons and you'll see they made nothing consulting. Hyer is a very smart businessman and talented surgeon. But we both know his number was off the charts, even though there are many other docs performing the same number of cases.

You are correct that the way to make money is ownership. I just don't want the young pods on this site to think they will all be performing 10-15 cases a week and raking it in with surgery. Surgical IS an integral part of my practice, but there are other ethical ways to make money in your office even if you don't have a heavy surgery schedule.
 
D

deleted690619

First let me state that I have never and will never be part of the AAPPM. That organization is a joke. Their founder and former guru was basically chased out by the group for some very fishy actions. From what I know, he's lucky he wasn't arrested. And the new president or head of the organization that teaches you how to make millions, is a guy who filed bankruptcy.

I'm not one of those guys who says that surgery isn't the way to get rich because I don't do surgery. I do more than the average number of cases weekly, and perform the full spectrum of cases. But if you break it down and count in the cost of malpractice and potential liability, it's not the most efficient way to make money. It's a necessary part of my practice, and I enjoy surgery, but it's not the most efficient money maker.

Using Hyer as an example is ridiculous. Look over that list of pods and you'll see that he's a very unique case. And since those numbers were released, ask someone why he resigned his ACFAS position. There are other big money makers on the list who have never touched a scalpel (Warren Joseph). Look up some well known and respected surgeons and you'll see they made nothing consulting. Hyer is a very smart businessman and talented surgeon. But we both know his number was off the charts, even though there are many other docs performing the same number of cases.

You are correct that the way to make money is ownership. I just don't want the young pods on this site to think they will all be performing 10-15 cases a week and raking it in with surgery. Surgical IS an integral part of my practice, but there are other ethical ways to make money in your office even if you don't have a heavy surgery schedule.

Ressurected PADPM? You can tell us:rolleyes:
 

jellybean2020

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I don't agree with jellybean. It's not as simple as "if you want to do more surgery, see more patients". That's a ridiculous statement. It depends on the type of patient you're seeing. If you build a routine palliative practice, "like refers like" which means seeing more patients may end up with no additional surgery.

Additionally, as stated by another forum member, surgery isn't really the way to make money. It requires travel to and from the facility, pre, intra and post op time at the facility and global post op fees, meaning that you only receive the surgical fee and no post op fees for 30,60 or 90 days post op depending on the procedure. So by the time you add it up, it's not a get rich quick plan.

You're certainly right. In the scenario you described - yes - seeing more palliative care patients wouldn't lead to more surgery. I was speaking very generally, in that the busier and more patients a doc sees, inevitably the more surgical candidates he/she will run into. Sorry for the confusion there!
 

ExperiencedDPM

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You're certainly right. In the scenario you described - yes - seeing more palliative care patients wouldn't lead to more surgery. I was speaking very generally, in that the busier and more patients a doc sees, inevitably the more surgical candidates he/she will run into. Sorry for the confusion there!

Understood. Over the years I've seen a lot of well trained docs back off performing major reconstructive cases. In addition to being potentially time consuming, the more complicated the case the more complicated the possible post op problems. There's that harsh reality that this patient is now yours, and not a clinic patient or patient of some attending. You are solely responsible for the patient, and in my experience this is often a game changer even with well trained docs.
 
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