Best ways to build up a practice

[Retrograde_Nail]

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I will continue to preach the same gospel: If you are hospital/MSG employed with wRVU payment model then doing surgery/big OR cases favors you however if you are PP employed with collections/% bonus payment model then increased clinic volume favors you.

You can't be in PP and be trying to do big charcot/recon cases on a patient with MCR/MCA with long post-op course. You can't be in PP doing 2am toe amps and seeing hospital consults/ER consults on patients with no insurance. Let the hospital employed folks take care of that and be highly rewarded.

Excellent post

 

[air bud]

I will continue to preach the same gospel: If you are hospital/MSG employed with wRVU payment model then doing surgery/big OR cases favors you however if you are PP employed with collections/% bonus payment model then increased clinic volume favors you.

You can't be in PP and be trying to do big charcot/recon cases on a patient with MCR/MCA with long post-op course. You can't be in PP doing 2am toe amps and seeing hospital consults/ER consults on patients with no insurance. Let the hospital employed folks take care of that and be highly rewarded.

I am not saying do surgery as an attending. I am saying do a lot of surgery as a resident, know your anatomy, know how and when to fix and that will make you a good clinician and build your practice. You don't know what you don't know. If you don't know what a flatfoot recon can do and how to do it ..then some orthotics is the answer to everything. That may work short term but not long term in regards to your reputation in the community and healing people . At some point outcomes matter. Not just how much can you bill the patient's insurance in a 2-3 visit time period

 

[619]

I am not saying do surgery as an attending. I am saying do a lot of surgery as a resident, know your anatomy, know how and when to fix and that will make you a good clinician and build your practice. You don't know what you don't know. If you don't know what a flatfoot recon can do and how to do it ..then some orthotics is the answer to everything. That may work short term but not long term in regards to your reputation in the community and healing people . At some point outcomes matter. Not just how much can you bill the patient's insurance in a 2-3 visit time period

100% agree.

 

[mandrew]

I am not saying do surgery as an attending. I am saying do a lot of surgery as a resident, know your anatomy, know how and when to fix and that will make you a good clinician and build your practice. You don't know what you don't know. If you don't know what a flatfoot recon can do and how to do it ..then some orthotics is the answer to everything. That may work short term but not long term in regards to your reputation in the community and healing people . At some point outcomes matter. Not just how much can you bill the patient's insurance in a 2-3 visit time period

And choose your patients carefully if you are contemplating a flatfoot recon.

 

[air bud]

And choose your patients carefully if you are contemplating a flatfoot recon.

Yeah absolutely. But you do that will all surgical patients. Dont do elective surgery on smokers. Non negotiable. With flatfoots - follow the 4 fs. Flat, fat fifty fuse it. Whenever I have violated that I have been burned. I do a pretty great Evans/FDL adjunct procedure flatfoot....and I am fusing more and doing less of those. More TN fuse, MCDO leave the STJ alone. More powerful more predictable especially with hypermobility. Don't operate on people that are going to be non compliant. Always place enough hardware that if patient is non compliant a stronger construct will hold up. Don't do sinus tarsi implants. Set appropriate expectations. Don't be a *****. Don't operate on *****s.