Being on staff at a hospital

[jw123]

Hey, I was just wondering, besides being able to use the hospitals OR and other facilities, are there any benefits to being on staff at a hospital? I think that i'm getting this right, i don't mean working directly for the hospital, but the local pod i shadowed rotated call with other pods. Also, i know it depends on the hospital, but to pods usually get paid for taking call at hospitals or what is the incentive for taking call at hospitals, other than that they want to?

Thanks

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[PADPM]

I don't know of any doctor that gets paid for taking call, unless they are an employee of the hospital. When you take call for the ER, it simply means that if you get any cases, you can bill for the cases you obtain (though I'm not sure if I've ever actually been paid for any case I've performed through the ER, because most of those patients have not have insurance, have been indigent, etc.).

The purpose of having staff privileges at a hospital is to provide high quality care for your patients. It allows you to maintain continuity of care for your patients in the event that one of your patients requires hospitalization. It allows you to perform surgery, in patient care, outpatient care, consultations, etc. It also allows you to network with other physicians and become part of the "team", and allows other physicians to see YOU as part of the team, and not just the DPM that has "an office" down the street.

You will be taken more seriously and they will respect you for having a broader scope of practice, since many of the older physicians didn't even know DPM's could have hospital privileges.

When you are new in practice, there is no better place to "hang out" than the hospital for referrals and to develop a reputation.

 

[Darklord]

I like the idea of being employed by a hospital. I think the VA and IHS are big pod employers, am I correct (I think they pay very little as well 😀)?

 

[diabeticfootdr]

I don't know of any doctor that gets paid for taking call, unless they are an employee of the hospital. When you take call for the ER, it simply means that if you get any cases, you can bill for the cases you obtain (though I'm not sure if I've ever actually been paid for any case I've performed through the ER, because most of those patients have not have insurance, have been indigent, etc.).

I know of many docs, including pods that receive compensation for call - even if not an employee and just a "covering group".

There was an article recently that showed roughly 60% of docs in group practices get paid to be on-call.

I'm a hospital employee, as you mentioned is more likely to get compensated for call. I'm contracted to be on-call 1 day/week and 1 weekend/month. Any more than that and I get $100 per day and $150 per hour if I'm called in.

 

[G0dFather]

thats serious!!

 

[diabeticfootdr]

thats serious!!

here's the reference:

http://industry.bnet.com/healthcare/1000496/on-call-payments-to-physicians-reach-critical-mass/

 

[PADPM]

diabeticfootdr,

I guess things must be considerably different in your area, because where I practice, as a DPM I actually had to fight for the "privilege" for emergency room call. And I don't know too many DPM's in my area that get ER call, and I know of none that get remuneration for that "privilege".

I guess the trend may be changing because hospitals are starting to get less doctors willing to take call due to litigious patients and very poor reimbursement from many patients that end up in the ER. So many docs have opted out of the "on call" rotation. It's simply not worth the time or effort.

But as usual, it seems that no matter what I say, you say the opposite. I guess it's because my perspective may differ "slightly" from 23 years of private practice and your years of practice within the walls of an institution where there is a slightly different set of rules.

I've practiced in two states, and in 7 different hospitals and 5 different surgical centers and have significant experience, and have been extremely politically active in our profession. So I'm speaking from my experience, the experience of my group and my colleagues, so I'm certainly not insulated to just the "East Coast" point of view.

 

[Hernandez]

Something else to consider. the Podiatrists on staff at our hospital are far more likely to get out patient referrals from the physicians who work with them as opposed to someone we don't know. I know at my hospital, we refer almost exclusively to those pods we have on staff.

 

[diabeticfootdr]

diabeticfootdr,

I guess things must be considerably different in your area, because where I practice, as a DPM I actually had to fight for the "privilege" for emergency room call. And I don't know too many DPM's in my area that get ER call, and I know of none that get remuneration for that "privilege".

I guess the trend may be changing because hospitals are starting to get less doctors willing to take call due to litigious patients and very poor reimbursement from many patients that end up in the ER. So many docs have opted out of the "on call" rotation. It's simply not worth the time or effort.

But as usual, it seems that no matter what I say, you say the opposite. I guess it's because my perspective may differ "slightly" from 23 years of private practice and your years of practice within the walls of an institution where there is a slightly different set of rules.

I've practiced in two states, and in 7 different hospitals and 5 different surgical centers and have significant experience, and have been extremely politically active in our profession. So I'm speaking from my experience, the experience of my group and my colleagues, so I'm certainly not insulated to just the "East Coast" point of view.

Actually, you have a very reasoned opinion and perspective - from your posts which I've read.

I agree with most of what you say.

I'm just pointing out that there are other opportunities. Most of my friends in the Midwest get compensation for call.

I pointed out the East Coast difference in an earlier post, because there are significant geographical differences in the acceptance of podiatry by other health professionals and also the way young pods are treated by their elders.

In my hospital, the Chief Medical Officer is a DPM. While this is certainly a great benefit to me, it's not entirely unique. I know there are other situations like that around the US.

I think that discrimination (I hate to use that term, because I'm not one to go about claiming persecution) against DPMs is decreasing and will continue to decrease over time.

I'm happy you post and can give your perspective based on your experience. Keep it going!

Lee

 

[NatCh]

Podiatrists here are not required to take ER call. Every time I hear of a doctor in another specialty griping about being on call, or paying someone else to take call for them, I say a little silent "hallelujah" to myself for being exempted. I know a good thing when I see it.

General Surgeons at my hospital get $500 for each day on call. ICU docs get $1000. Ortho, Radiology, and Anesthesia also get paid, but I don't know how much. These are not employees of the hospital, but rather just docs on staff. Each specialty negotiated with the hospital for their remuneration, mostly because ER call work often involves high liability/uninsured/low reimbursement patients.

To the OP: being on staff at a hospital allows you to do work there. You don't have to take your cases there, but surgery centers may require that you have hospital privileges in case they need to transfer a patient in an emergency. Also, insurance companies might require you to have hospital privileges in order to participate on their panel, and that's probably the most influential factor on the welfare of your practice. Beyond that, the benefits of being on staff are less concrete: gaining legitimacy in the eyes of the community, being known by other doctors, and networking.

 

[NatCh]

diabeticfootdr,

I guess things must be considerably different in your area, because where I practice, as a DPM I actually had to fight for the "privilege" for emergency room call. And I don't know too many DPM's in my area that get ER call, and I know of none that get remuneration for that "privilege".

I guess the trend may be changing because hospitals are starting to get less doctors willing to take call due to litigious patients and very poor reimbursement from many patients that end up in the ER. So many docs have opted out of the "on call" rotation. It's simply not worth the time or effort.

But as usual, it seems that no matter what I say, you say the opposite. I guess it's because my perspective may differ "slightly" from 23 years of private practice and your years of practice within the walls of an institution where there is a slightly different set of rules.

I've practiced in two states, and in 7 different hospitals and 5 different surgical centers and have significant experience, and have been extremely politically active in our profession. So I'm speaking from my experience, the experience of my group and my colleagues, so I'm certainly not insulated to just the "East Coast" point of view.

I was just thinking that the pre-pod, pod student, and Resident members are being exposed to quite the array of different practice models, and are getting the perspective of several different practicing podiatrists including but not limited to:

• PADPM -- An old-school (sorry PADPM, hehhh), east coast, traditional, big city, large group practice model
• Diabeticfootdr -- A younger, academically-inclined, hospital-based, midwest practice model
• SportPOD -- A desert southwest, solo practice model
• Myself -- A pacific northwest, small city, part-time, small group, work-to-live practice model

I think the take-home message here is that you can make what you want out of this profession. Pretty awesome if you as me!

 

[SportPOD]

Natch Lifestyles, LLC?

What's that your promoting in your sig? 😀

 

[NatCh]

Natch Lifestyles, LLC?

What's that your promoting in your sig? 😀

It's my foundation that I've started. Would you like to make a donation?

 

[SportPOD]

Just my two cents since I've been kindly included by NatCh.

Here we do not necessarily need to be on hospital staff for any specific reasons. That being said, in order to perform surgery at the hospital you need to be on staff. As it has been alluded to in previous posts by diabeticdr and padpm, if you want to have good continuity of care you should get on staff at the hospital, especially if you practice in an area with a high number of non-compliant diabetics who like to step on things!

I am on staff at hospitals so that I can take ER call and so I can also work at a wound care center. A side benefit for being on staff at a particular hospitals is that they have office space exclusively for docs on staff at that hospital. The rent is a little cheaper and you have other docs in the building who will refer to you.

 

[NatCh]

Just my two cents since I've been kindly included by NatCh.

Here we do not necessarily need to be on hospital staff for any specific reasons. That being said, in order to perform surgery at the hospital you need to be on staff. As it has been alluded to in previous posts by diabeticdr and padpm, if you want to have good continuity of care you should get on staff at the hospital, especially if you practice in an area with a high number of non-compliant diabetics who like to step on things!

I am on staff at hospitals so that I can take ER call and so I can also work at a wound care center. A side benefit for being on staff at a particular hospitals is that they have office space exclusively for docs on staff at that hospital. The rent is a little cheaper and you have other docs in the building who will refer to you.

Oh yes, the continuity of care issue: a lot of hospitals have adopted using Hospitalists. Some study (don't ask me for the exact reference please) found that using the Hospitalists resulted in better outcomes and shorter hospital stays. They determined that using a physician who does nothing other than treat inpatients will result in more effective inpatient treatment than using a doctor who only treats a few inpatients once in awhile (makes sense to me I suppose).

 

[PADPM]

diabeticfootdr,

I thank you for your "graciousness" and apparent respect. The article you cited basically supports what I stated in my post. And that's the fact that the reason there is a trend to have to actually remunerate docs for ER call is because of low or no reimbursement, compounded by increased liability.

As I had also stated in my post, I don't know if I ever actually received payment for any patient I ever treated in the ER. Sure, it was a great teaching tool for the residents, since our service received the gunshot wounds instead of orthopedics, but at the same time I worked for 0 dollars.

And once again, not so long ago, obtaining ER on call "privileges" was just that.....a "privilege" that had to be earned by actually having X number of admissions or surgical cases.

I'm also not sure of the policy of hospitals in the midwest, but in the East, although I'm generating income for the hospital every time I perform a surgery or admit a patient, I still have to pay staff dues annually and every 2 years when I have to fill out new paper work for "re-appointment" I have to pay another fee. Those fees vary, but are usually between $350-500 per hospital.

So, it does add up and I'm not sure our younger forum members realize that many hospitals actually have staff fees, application fees, etc., to maintain staff "privileges" at their hospitals.


NatCH,

Just as a quick update on this "old timer" (I'm not nearly as old as you think), although we do have a few offices in the "big city", we also have MANY suburban practices, and I have also been heavily involved with "academics", as a surgical residency director and as an examiner for the ABPS certification examination. So I do come to the table with a relatively broad spectrum of experience, even though I'm "office based".

Though I do envy your part time status and status as a "kept man"

 

[NatCh]

Though I do envy your part time status and status as a "kept man"

Ha ha! "Kept man," that's a good one! I prefer "spa guy" but I'll have to remember that.

Just as a quick update on this "old timer" (I'm not nearly as old as you think)

As someone who has been in practice 23 years and started when Residency was not necessary, I think the bylaws state that you earn the rank of Old School regardless of your actual age. I'm 41 years old. How old are you?

 

[cool_vkb]

Ha ha! "Kept man," that's a good one! I prefer "spa guy" but I'll have to remember that.



As someone who has been in practice 23 years and started when Residency was not necessary, I think the bylaws state that you earn the rank of Old School regardless of your actual age. I'm 41 years old. How old are you?

Doesnt the state calls it "Grandfather" law🙂

 

[NatCh]

Doesnt the state calls it "Grandfather" law🙂

Zing!

 

[air bud]

just wanted to say thanks for the discussion going on in this thread. this is the true purpose of SDN and it is incredibly valuable and interesting. keep it up.

 

[Feli]

just wanted to say thanks for the discussion going on in this thread. this is the true purpose of SDN and it is incredibly valuable and interesting. keep it up.

Yep... I agree.

On clerkships and residency, you sorta just assume all DPMs are on hospital staff and do a fair amount of rounding, consults, and ER call since most of your attendings practice that way, but it's good to see the pro/con/alternatives of that.

 

[Podmeister]

I recently got on staff at a local hospital and was invited to a luncheon to meet some of the new doctors. There I met an endocrinologist who wants to refer patients to my office, a nephrologist who wants me to see patients at the dialysis center, a vascular surgeon who wants podiatry involvement at the outpatient wound care center, and a plastic surgeon who wants podiatry involvement at a cosmetic center. Being on staff is a great opportunity to network with local doctors and be part of the multi-disciplinary team. It seems more MDs are awared of our profession than ever before and their reactions toward podiatry thus far have been quite positive.

 

[G0dFather]

I recently got on staff at a local hospital and was invited to a luncheon to meet some of the new doctors. There I met an endocrinologist who wants to refer patients to my office, a nephrologist who wants me to see patients at the dialysis center, a vascular surgeon who wants podiatry involvement at the outpatient wound care center, and a plastic surgeon who wants podiatry involvement at a cosmetic center. Being on staff is a great opportunity to network with local doctors and be part of the multi-disciplinary team. It seems more MDs are awared of our profession than ever before and their reactions toward podiatry thus far have been quite positive.

This is indeed profound news, i hope this upward fame continues towards the future...

 

[Podmeister]

This is indeed profound news, i hope this upward fame continues towards the future...

Afterwards, a family practice doc even commented that I was the most popular one there at the luncheon.

Let me just add that I am not a big time surgeon, do not belong to any well known or high earning medical group in the area, have never published anything in my life, have never been a residency director, and not politically active. I am just an average Joe podiatrist who is friendly, polite, humble, considerate and enthusiastic about patient care, although I do yap a lot about politics, current affairs and make lots of wise cracks.

 

[G0dFather]

Afterwards, a family practice doc even commented that I was the most popular one there at the luncheon.

Let me just add that I am not a big time surgeon, do not belong to any well known or high earning medical group in the area, have never published anything in my life, have never been a residency director, and not politically active. I am just an average Joe podiatrist who is friendly, polite, humble, considerate and enthusiastic about patient care, although I do yap a lot about politics, current affairs and make lots of wise cracks.

Lol it seems those are the foundations that anyone needs doctor... this is by far great advice and motivation thank you so much for sharing...

 

[NatCh]

Afterwards, a family practice doc even commented that I was the most popular one there at the luncheon.

Your fly wasn't open, was it?

 

[malleolusman]

I don't know of any doctor that gets paid for taking call, unless they are an employee of the hospital. When you take call for the ER, it simply means that if you get any cases, you can bill for the cases you obtain (though I'm not sure if I've ever actually been paid for any case I've performed through the ER, because most of those patients have not have insurance, have been indigent, etc.).

The purpose of having staff privileges at a hospital is to provide high quality care for your patients. It allows you to maintain continuity of care for your patients in the event that one of your patients requires hospitalization. It allows you to perform surgery, in patient care, outpatient care, consultations, etc. It also allows you to network with other physicians and become part of the "team", and allows other physicians to see YOU as part of the team, and not just the DPM that has "an office" down the street.

You will be taken more seriously and they will respect you for having a broader scope of practice, since many of the older physicians didn't even know DPMs could have hospital privileges.

When you are new in practice, there is no better place to "hang out" than the hospital for referrals and to develop a reputation.

How does getting hospital/staff privileges exactly work? Is board qualified sufficient for hospital privileges as long as one is working towards certification, or does it vary state to state, hospital to hospital?

 

[dpmgrad]

How does getting hospital/staff privileges exactly work? Is board qualified sufficient for hospital privileges as long as one is working towards certification, or does it vary state to state, hospital to hospital?

In order for a physician to get privileges at a hospital, they will need to submit an application along with the appropriate credentialling paperwork to the medical staff office at the hospital. The hospital will also obtain verification of residency training, board qualification / certification status, podiatry school graduation, state license, malpractice history, and references from various people in regards to your clinical and surgical skills. Depending on the hospital, you may also need to meet with someone from the hospital as well. When all of the information have been gathered, your completed application along with supporting documents will be submitted to the credentialling committee at the hospital for approval or denial of your application.

Many of the hospitals and surgery centers do require some sort of board qualification or board certification status for privileges. This will vary from hospital to hospital and surgery center to surgery center.

 

[PADPM]

Yes, board qualified should not be a problem. When you apply for privileges, most hospitals, if not all hospitals will provide you with a list of "delineation of privileges" which includes a list of surgical procedures that you are applying for privileges to perform.

Some hospitals may have requirements based on years of residency training, board certification, etc., to obtain which "category" privileges you receive. Other hospitals may have some antiquated list of privileges. I applied to hospital years ago that had a very limited list, and I sent them 3 pages of procedures that I ADDED and the chief of orthopedics had to be resuscitated when he saw what I requested. But after I fought and challenged....I was granted all the privileges I requested.

Some hospitals will require you to be observed by the dept. chairman to be "cleared" for privileges in each category. Once again, this is all dependent on the hospital and politics.

The better you are trained, the better the odds of obtaining more privileges, especially if you have a good log of your procedures. But you still may run into obstacles and will have to "prove" yourself in some facilities.

 

[kwired]

From the Rural point of view: I am on staff at 4 small community hospitals each with a general surgeon but i am the only podiatrist. I have been chief of staff of one of the hospitals and have not had issues with privileges. There is increasing needs of the rural communities for podiatry care. The hospitals have been very accomodating in getting the necessary surgical equipment and supplies to provide for the patients. Rural health clinics are a good way to start as a new practitioner because the clinic is payed by the # of encounters with medicare and medicaid not by what is done. I am payed by the day in the rural health clinics while maintaining a private practice as well in one of the communities. The patients are so appreciative of having a foot doctor in their towns. I started my practice from scratch 6 years ago and have done very well. I have a good referral base from the family practice doc's because i am a part of the rural clinic but still can maintain my private office for the majority of the week.

 

[Feli]

... Rural health clinics are a good way to start as a new practitioner because the clinic is payed by the # of encounters with medicare and medicaid not by what is done. I am payed by the day in the rural health clinics while maintaining a private practice as well in one of the communities. The patients are so appreciative of having a foot doctor in their towns. I started my practice from scratch 6 years ago and have done very well. I have a good referral base from the family practice doc's because i am a part of the rural clinic but still can maintain my private office for the majority of the week.

Great info, thanks for sharing 👍

What you described is my basic (tentative) plan for after residency: start a private practice, but also join a multispecialty group/clinic and work a couple days per week so that I have a fair number of patients to see right from the start.

The main obstacles I've considered are cost (obviously) and getting enough cases for ABPS certification. Had you lived or trained in the area you set up shop, and did you have any problem getting your required surgery numbers and certification in your first few years?