Case Volume

[BioPod]

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Hello all. I have been out of residency and practicing for about a year. Looking back, my case volume is pretty low. I started work in a rural area originally for a multispeciality group which was then bought out by the local hospital. The cases I have done have had pretty good variety, but the volume is low. With in your first year how many cases did you do? What kind of group are you in and did you have to build your practice from scratch or was anyone feeding you cases (such as an old pod no longer wanting to do surgery).

Thanks!

 

[GreenHousePub]

I feel this has the potential to turn into a pissing contest extremely quickly. Just for curiosity, are you unhappy with your current situation and if so why?

To start the pissing contest, I got enough volume my first year to submit for Foot/RRA boards. Now that I'm done with that I give zero cares about how much volume I am doing, and the BC has changed nothing.

I'd focus more on lifestyle/financial compensation for the ideal situation versus surgical volume. Is your current job not providing that? What will increased volume change for you?

 

[dtrack22]

It’ll only turn into a pissing contest if someone gets butthurt about a hospital or large multi specialty group employed dpm inevitably doing a lot more surgery than themselves.

I think it is very appropriate to worry about surgical volume. This is a conversation I’ve had with my current boss numerous times. You have to get board certified, and more and more for surgical privileges, you have to get ABFAS certified. In the real world you have 5 years, not 7, because that’s when insurance plans and hospitals grace period ends. Someone will inevitably mention getting ABPM which is fine for insurance plans, and may be ok with hospitals in your area, but what happens when this young doc moves to an area where that’s not the case? He/she ends up being limited in their scope of practice. The fact that they are being limited by their own profession is what makes it most depressing...

I’ll edit/update this post later, I’ll post how many cases I’ve done in my first full year in my current gig which should be pretty reasonable and accurate for a majority of new grads. Working for a podiatrist, a few months of no surgery due to credentialing, though very few of my cases are inpatient pus which may be more abnormal. I will easily hit foot numbers, I’m short now on RRA I’m sure, but could hit before the November-ish deadline. I really need a flatfoot recon so I can get 3-4 rearfoot procedures in one case...

 

[GreenHousePub]

I’m short now on RRA I’m sure, but could hit before the November-ish deadline. I really need a flatfoot recon so I can get 3-4 rearfoot procedures in one case...

I don't know if they changed anything in the past few years, but I understood that if a case entails an evans, cotton and kouts then they all just count as 1 towards RRA

 

[DYK343]

I think it is very appropriate to worry about surgical volume. This is a conversation I’ve had with my current boss numerous times. You have to get board certified, and more and more for surgical privileges, you have to get ABFAS certified. In the real world you have 5 years, not 7, because that’s when insurance plans and hospitals grace period ends.

Yep. Dont wait. Get certified the second you get enough cases to submit. You only get so many years to pass the test. Why miss those chances?

 

[CutsWithFury]

I don't know if they changed anything in the past few years, but I understood that if a case entails an evans, cotton and kouts then they all just count as 1 towards RRA

I don't think that is correct. I think ABFAS can select that case and look at any of those procedures to see if fixation/indication was appropriate, etc

 

[air bud]

I don't think that is correct. I think ABFAS can select that case and look at any of those procedures to see if fixation/indication was appropriate, etc

Correct - they choose one procedure per case to evaluate.

 

[G0dFather]

Now that I'm done with that I give zero cares about how much volume I am doing, and the BC has changed nothing.

I'd focus more on lifestyle/financial compensation for the ideal situation versus surgical volume.

NOTHING MORE THAN THIS IS GOLD ADVICE CAN BE STATED HERE..... take it from those that are BC, the whole things is a raquet focus on yourself and what makes you the most comfortable, dont fall into the trap that your own peers set up fro you

Someone will inevitably mention getting ABPM which is fine for insurance plans, and may be ok with hospitals in your area, but what happens when this young doc moves to an area where that’s not the case?

Yes, im glad you mentioned it because i would have replied to you...... There are TWO ACKNOWLEDGED boards ( as sick as that is) in this profession and with either of them you can do whatever you need to do without being limited, stop pushing the BS ABFAS agenda it is not the be all end all... all this does is only divide and hurt the profession, real shame.

 

[dtrack22]

NOTHING MORE THAN THIS IS GOLD ADVICE CAN BE STATED HERE..... take it from those that are BC, the whole things is a raquet focus on yourself and what makes you the most comfortable, dont fall into the trap that your own peers set up fro you




Yes, im glad you mentioned it because i would have replied to you...... There are TWO ACKNOWLEDGED boards ( as sick as that is) in this profession and with either of them you can do whatever you need to do without being limited, stop pushing the BS ABFAS agenda it is not the be all end all... all this does is only divide and hurt the profession, real shame.

You can continue to pedal this false narrative all you want. I have privileges at 2 hospitals, 1 ambulatory surgery center, and 2 surgical hospitals (ASC’s that slap an ED and some obs rooms on so they can bill at higher rates). Not a single one of them will allow me to operate 3 years from now if I am not at least ABFAS foot certified. It is in every single one of their bylaws that for surgical privileges the only recognized board for podiatrists is ABFAS.

I think the ABFAS is a clown show full of money hungry hypocrites. But that does not change the reality that you could one day find yourself unable to get employment at a hospital or for a multi-specialty group because their facilities require ABFAS and you never got it. You could find yourself in a podiatry practice where none of the facilities within 20-30 miles accept ABPM for surgical privileges of any kind.

This is the same concept you failed to grasp last time this was brought up. It’s not about your experience in your city, or your desire not to do certain procedures or any surgery at all. As long as there are a good number of places in this country where ABFAS is the only accepted board, it is in your best interest as a new grad to try and get ABFAS certified. Unless you are absolutely positive you will never change practices/locations and that your local facilities will never change their bylaws...

 

[CutsWithFury]

I’m hospital employed and I’m seriously considering getting ABPM written into the bylaws at the hospital for the sake of breaking up this self proclaimed superiority complex called the ABFAS certification process. Nobody in the MD/DO orthopedic world cares about ABFAS certification. Nobody knows what “FACFAS” means

Nobody cares.

 

[DYK343]

My hospital/surgery center does not recognize ABPM.
Board qualified/certified in ABFAS or I am unable to operate at their facilities.

 

[dtrack22]

And I didn’t even mention that in Oregon it is STATE LAW that for a podiatrist to do “ankle surgery,” he/she has to be certified by the ABFAS in RRA (or eligible to sit for the exam).

I can’t prevent anyone from listening to godfather and giving the middle finger to ABFAS (I would love to), but you are potentially limiting yourself in a big way in terms of scope of practice and potential job opportunities.

 

[DYK343]

I’m hospital employed and I’m seriously considering getting ABPM written into the bylaws at the hospital for the sake of breaking up this self proclaimed superiority complex called the ABFAS certification process. Nobody in the MD/DO orthopedic world cares about ABFAS certification. Nobody knows what “FACFAS” means

Nobody cares.

Many hospitals care. No ABFAS no surgery. My ortho collegues make the rules at our hospital as I am under the department of orthopedics. No ABFAS no surgery. No RRA no ankles/rearfoot. The orthos around here want nothing to do with the foot and most of the ankles come my way too. So it's not like they are out to stop me from gaining priveleges. They refer the cases from their office to me. ER calls ortho here for a foot problem they refuse to treat - call podiatry. But without that FACFAS (or qualified) its a big no go from their standpoint.

They will not accept ABPM under any circumstances. My understanding that if this becomes a problem you can contact ABPM and they will submit an appeal on your behalf for discrimination against their board but when it really comes down to it its ABFAS or bust.

 

[CutsWithFury]

Many hospitals care. No ABFAS no surgery. My ortho collegues make the rules at our hospital as I am under the department of orthopedics. No ABFAS no surgery. No RRA no ankles/rearfoot. The orthos around here want nothing to do with the foot and most of the ankles come my way too. So it's not like they are out to stop me from gaining priveleges. They refer the cases from their office to me. ER calls ortho here for a foot problem they refuse to treat - call podiatry. But without that FACFAS (or qualified) its a big no go from their standpoint.

They will not accept ABPM under any circumstances. My understanding that if this becomes a problem you can contact ABPM and they will submit an appeal on your behalf for discrimination against their board but when it really comes down to it its ABFAS or bust.

My hospital comes to me to for bylaw edits. I’m sure I can get ABPM into the bylaws. I just rewrote the bylaws to allow for online training to get a HBOT certification instead of having to burn PTO going to a course for 4 days. Anything is possible. Every hospital is unique

 

[DYK343]

. Every hospital is unique

I agree. See DTrack's comment above. I would not recommend pigeon holing yourself. The leading board is ABFAS nationwide.

@diabeticfootdoctor may be able to shed more light. Remembering his prior posts I believe he is ABPM and did not pursue ABFAS. He does not post much anymore.

Edit if anyone knowns how to tag someone on here pleast tag diabetic foot doctor

 

[heybrother]

To add something different. This is what my nearby hospital asks for during credentialing:

Class I&II: Must provide the following (1) Successful completion of 12 month residency (2) board qualified OR (3) certification by ABPAS or ABPOPPM
Admit/workup/care for with: fulgeration, curettage, wart excision, avulsion of nails, onychoplasty, I&D of superficial abscess, plantar/dorsal skin lesions excision, forefoot tenotmy/capsulotomy, forefoot tendon lengthening, digital tendon transfer, excision of neuroma/ganglion/synovial cyst, lipoma, subungual exostosis, correction of: hammertoe/malletoe, exostectomy, condylectomy, partial ostectomy of bone spurs, terminate syme digital amps.

Class III: must provide the following (1) successful completion of 12 month residency OR (2) documentation by surgical log from approved residency (3) Board eligibility or certification by the ABPS or ABPOPPM
-Manage osteo, remove foreign body, skin plasty, excision of fibromatosis/accessory ossicle, sesamoid, resection of metatatarsal exostosis, partial resection of hypertrophic tarsal bone, surgical sayndactylism, amputation of toes 1-5, ray amputation partial or complete), digital fusion, metatarsal head resection (partial/complete), osteotomy of lesser metatarsal bones, tailor bunionectomy (partial or complete) or by metatarsal parocedures such as arthroesis, capsulotendon balancing, osteotomy of toe or metatarsal, prostesis joint resection, metatarsal cuneiform fusion, fasciotomy, use of monofilament wire, kwire, staple, and screws as internal fixation.

Class IV privileges - successful (1) completion of 12 month residency (2) board eligibility or certification by the ABS or ABPOPPM
Posterior heel spur excision/repair, release of tarsal tunnel, calcaneal osteotomy, talonavicular joint fusion, metatarsal adductus correction, TMA

Rear Foot and Ankle Surgery (no procedures specified) - (1) successful completion of a 4 year pod school (2) 3 year surgical residency (PM & S 36) (3) Sufficient education and training in order to be eligible to take the board exam in RRA

================

The typos are not mine - they are on the sheet. I personally found the whole thing ... inconsistent.

Anyway, I sort of feel like my volume will be low. No one I'm seeing has really been worked up or treated at all. I've been pleasantly surprised by the amount of pathology though a lot of the stuff I've been seeing is complicated. My first patient assuredly had undiagnosed CMT.

I passed my 4 quals which was very satisfying. I don't see getting foot as an issue - the main requirement is basically doing like ..30 bunions. One of my favorite procedures and something I feel is a great addendum to most surgery is a gastrocnemius recession which apparently I won't be able to get without being rearfoot certified. So ... rearfoot here I come. My practice does not seem to be the referral point for any sort of trauma but a out of town rural hospital (annoying drive) contacted me looking for someone so I may be driving a bit to try and secure my future.

My final thing - I really feel like ..MDs and everybody put the ankle up on the pedestal. I feel like there's so many procedures in the forefoot midfoot that can just ruin someone. Hell, talonavicular fusion above is easier to get than doing a fibula fracture.

 

[DYK343]

And to answer your question I do about 3 cases on a slow week and 4-6 cases on a typical week. Rarely do 7 or more cases a week but it has happened.

 

[G0dFather]

You can continue to pedal this false narrative all you want. I have privileges at 2 hospitals, 1 ambulatory surgery center, and 2 surgical hospitals (ASC’s that slap an ED and some obs rooms on so they can bill at higher rates). Not a single one of them will allow me to operate 3 years from now if I am not at least ABFAS foot certified. It is in every single one of their bylaws that for surgical privileges the only recognized board for podiatrists is ABFAS.

Yes, because this is such a great sample size that we can use to extrapolate all across the US ? Come on now, stop it .....

I think the ABFAS is a clown show full of money hungry hypocrites. But that does not change the reality that you could one day find yourself unable to get employment at a hospital or for a multi-specialty group because their facilities require ABFAS and you never got it. You could find yourself in a podiatry practice where none of the facilities within 20-30 miles accept ABPM for surgical privileges of any kind.

I agree with you on this... and one can easily make a phone call to ABPM and have then petition on your behalf as someone stated above, BYLAYS can be changed.. they were written by pods that work against and eat their young! Shouldn't we stand up to that and fight back? This complacency is the reason why this happened in the first place, but now things can be different if we put a bit of effort... Im not denying the reality, im saying that its incorrect to discriminate and anyone that is being forced into something they should say something and fightback! Its how change happens...

This is the same concept you failed to grasp last time this was brought up

I don't fail at things, I win ...

 

[air bud]

I work for one of the top 7 non profit health care systems. They require ABFAS. And do you think a podiatrist has any say in that? No.

 

[CutsWithFury]

I work for one of the top 7 non profit health care systems. They require ABFAS. And do you think a podiatrist has any say in that? No.

I disagree on your reasoning here. I’m pretty sure that in the history of your health care system, when they were trying to figure out bylaws for podiatrists, an old time podiatrist, who was grandfathered in, prob suggested ABPS (now ABFAS). Or I’m sure they went to the APMA or some other group of podiatrists looking for suggestions.

I think people need to understand how confused and clueless hospital admin and MD/DO are about what podiatrists can do and not do.

I work in a historically unfavorable section of the USA for podiatry and I’m still explaining what I do even after I’ve done a lot of big rearfoot and ankle cases since I’ve been here. People can’t wrap their heads around it.

I did my residency training at a historically well know program. I used to listen to my attendings stories of “how it was” back in the day trying to fight for privileges. It’s like I went back in a time machine 20 years and I’m living their lives now.

 

[air bud]

Right. That may be history. Now we are in the present. So do you think this large bureaucracy is going to change because some podiatrist wants it to? First, any existing ones of influence are already ABFAS certified and are going to tow the party line. 2nd because Ortho. And C, status quo is easier for most involved.
I agree there is room for possible success at smaller independent community hospitals

 

[air bud]

To the OP, case volume is so hard to talk about. So many circumstances go into it. Anything anyone says here is so anecdotal. There is no normal, at least this earlyin your career. The only way I would evaluate if doing enough surgery is are you getting enough cases to sit for boards 3 years out. If you are barely getting some diversity to qualify then that could be a problem. Remember if you don't pass then those cases are used up and not eligible anymore. So if you failed RRA and only applied with 2 traumas in 3 years....then is it going to take you another 3 years to get 2 more of those? Then that's a problem.

 

[CutsWithFury]

Right. That may be history. Now we are in the present. So do you think this large bureaucracy is going to change because some podiatrist wants it to? First, any existing ones of influence are already ABFAS certified and are going to tow the party line. 2nd because Ortho. And C, status quo is easier for most involved.
I agree there is room for possible success at smaller independent community hospitals

I am not saying it will ever change. They won. Its game over. But it's not because it's a legitimate board or one that is respected by other medical specialties. It's because they played politics better than the ABPM. That's all.

 

[dtrack22]

Yes, because this is such a great sample size that we can use to extrapolate all across the US ? Come on now, stop it .....

You stated, and I quote, “There are TWO ACKNOWLEDGED boards ( as sick as that is) in this profession and with either of them you can do whatever you need to do without being limited...”

All it takes is one example of being limited by board certification to make your statement false. You’ve already received several, in 3 very distinct regions of the country. The fact of the matter is, there are numerous facilities and health networks all over the country that do not accept ABPM certification for surgical privileges.

I agree with you on this... and one can easily make a phone call to ABPM and have then petition on your behalf as someone stated above, BYLAYS can be changed.. they were written by pods that work against and eat their young! Shouldn't we stand up to that and fight back? This complacency is the reason why this happened in the first place, but now things can be different if we put a bit of effort... Im not denying the reality, im saying that its incorrect to discriminate and anyone that is being forced into something they should say something and fightback! Its how change happens...

So in every instance when one calls the ABPM to have bylaws changed at a facility or within a national corporation (HCA, for example), they are successful? Because if ABPM is not batting 1.00 and there is no guarantee Bylaws WILL change, then again it is in your best interest to work towards ABFAS

I’m not the genius who decided to name the board the American Board of Podiatric MEDICINE and leave off the word surgery (or at least not update it), giving hospitals and the ABFAS all the ammunition they need to deny ABPM members from some, if not all, surgical privileges.

Your opinion of how it should work is meaningless. Not to mention working towards ABFAS AND trying to get facilities to allow ABPM (fighting against the oppression ) are NOT mutually exclusive. Why can’t you do both? Any new grad who says “I’m only gonna get ABPM because every employer everywhere and every facility SHOULD accept it,” is going to lose out on certain job opportunities and potentially the ability to perform certain procedures outside of the office. That’s dumb. But I guess that makes it a very podiatry thing to do...

 

[BioPod]

Thanks all. Sorry it took me so long to respond. I work in an area of about 14k in my town. We service a larger area than that, but probably only around 20k total patients. I don't know if I am getting enough this early on in my career to sit for boards in 3 years. As time has gone by over this year my surgical volume has increased, but I don't know if it's increased enough. It's hard to say.

Overall, I am happy here and I like my job. I rather not move. I do believe that this hospital requires ABFAS certification to do surgeries. I plan on sitting for ABPM as well just to at least have that. I am currently ABFAS qualified. I also do get trauma here. There is 1 other podiatrist in this area and they typically have multiple cases a week, which gives me hope. They do outreach and such in different towns which helps. I am currently not doing any outreach. Hopefully that will change. My clinic days are almost always full and I do have a small wait period for new patients to schedule.

I have a friend who works in private practice who has the same number of cases as I do. I also have another friend who has done like 8x more cases than me in a similar situation (small town hospital/multi-specialty group). I know every situation is different, but it just makes me a little anxious when it comes to getting certified. If I didn't need the certification to keep my job I wouldn't even care, but it seems like I do.

Thanks everyone for their input. Much appreciated. Does my situation seem familiar to any of you? Small town, slowly increase surgical number, full clinic, etc?

 

[GreenHousePub]

Thanks all. Sorry it took me so long to respond. I work in an area of about 14k in my town. We service a larger area than that, but probably only around 20k total patients. I don't know if I am getting enough this early on in my career to sit for boards in 3 years. As time has gone by over this year my surgical volume has increased, but I don't know if it's increased enough. It's hard to say.

Overall, I am happy here and I like my job. I rather not move. I do believe that this hospital requires ABFAS certification to do surgeries. I plan on sitting for ABPM as well just to at least have that. I am currently ABFAS qualified. I also do get trauma here. There is 1 other podiatrist in this area and they typically have multiple cases a week, which gives me hope. They do outreach and such in different towns which helps. I am currently not doing any outreach. Hopefully that will change. My clinic days are almost always full and I do have a small wait period for new patients to schedule.

I have a friend who works in private practice who has the same number of cases as I do. I also have another friend who has done like 8x more cases than me in a similar situation (small town hospital/multi-specialty group). I know every situation is different, but it just makes me a little anxious when it comes to getting certified. If I didn't need the certification to keep my job I wouldn't even care, but it seems like I do.

Thanks everyone for their input. Much appreciated. Does my situation seem familiar to any of you? Small town, slowly increase surgical number, full clinic, etc?

I'd recommend getting the ABPM at the very least while you wait, and possibly lobbying the hospital to add ABPM to the privileges. And although everyone toots the horn of 3 years, in reality you have 7 before you lose BQ. That's essentially 9 cases a year.

But if you are doing that few of cases a year you really need to be honest with yourself about if you should be doing procedures, as hard as that is to realize. Skill atrophy is a real thing, and you may be doing a disservice to your patients by operating on them. Besides, if you are happy with your situation and are doing well financially I see no reason to change.

 

[dtrack22]

in reality you have 7 before you lose BQ

In the real world, hospitals and insurance panels give you 5 years in most cases. Not 7, even though that's what the ABFAS allows. That is because Medical and Surgical boards for MD/DOs give them 5 years to certify and therefore facilities and insurance panels have traditionally followed suit.

 

[G0dFather]

That’s dumb. But I guess that makes it a very podiatry thing to do..

LMAO!... Classic!! ... Its a real shame that we even have to discuss and debate this, this really needs to be fixed but unfortunate it doesn't look like it will in our lifetimes ... just ONE board ...


At the end of the day ... I always promote working for yourself in private practice, its definitely a grind but that is where the flexibility, real reward is and biggest bang for your buck ( assuming you know what your doing )... then getting out early and when you are ahead ... there is no equity in anything else unfortunately ... the degree isn't given the value it deserves outside of PP ... ABFAS or No ABFAS

 

[air bud]

How do you square working for yourself and getting out early? I can't imagine it's an overnight process to be successful in PP. And then after investing all this money into capital, how are you selling and getting a decent ROI? I would say the opposite is true. Hospital based you can get out early, mainly because you have no expenses or obligations. Get your loans paid off in a few years, max out retirement accounts, then walk away when ready.

 

[BioPod]

I'd recommend getting the ABPM at the very least while you wait, and possibly lobbying the hospital to add ABPM to the privileges. And although everyone toots the horn of 3 years, in reality you have 7 before you lose BQ. That's essentially 9 cases a year.

But if you are doing that few of cases a year you really need to be honest with yourself about if you should be doing procedures, as hard as that is to realize. Skill atrophy is a real thing, and you may be doing a disservice to your patients by operating on them. Besides, if you are happy with your situation and are doing well financially I see no reason to change.

I do more than 9 cases a year, thankfully. I do plan on getting ABPM and going from there and seeing what the hospital says about that. Thanks for the advice.

In the real world, hospitals and insurance panels give you 5 years in most cases. Not 7, even though that's what the ABFAS allows. That is because Medical and Surgical boards for MD/DOs give them 5 years to certify and therefore facilities and insurance panels have traditionally followed suit.

This is true for me as well. I only have 5 years per the hospital.

 

[G0dFather]

How do you square working for yourself and getting out early? I can't imagine it's an overnight process to be successful in PP. And then after investing all this money into capital, how are you selling and getting a decent ROI? I would say the opposite is true. Hospital based you can get out early, mainly because you have no expenses or obligations. Get your loans paid off in a few years, max out retirement accounts, then walk away when ready.

No no my friend, you can get an office busy in about a year starting from scratch with simple marketing principles and technology these days have made the process even easier or you can buy out someone and have existing cashflow to support you from the start ... you can compound your wealth alot faster when you are in control of the taxes your paying, contribute WAY more to your retirement accounts, and making WAY more than say a W2 250k salaried position with benefits at a hospital thats not paying you what you are worth or for the value that your bringing in, then being at their mercy every time your contract is up on the table (and that salary btw is TOP of the line for what we do not the normal, most people make 100-125k unfortunately) hence reaching FI alot faster ... and when i said get out i meant being financially independent and not having to work yourself, running it like a real business ( but there are many PP pods that can get out in their late 40s and early 50s but choose not too because money is rolling in at that point) ... there is a reason why PP jobs pay 60$ an hour ( supply and demand)

All that being said, you need to have somewhat of a business inclination and be able to tolerate risk. I am glad that this avenue is available to take in this profession because making what a PA would have made after all this is a disaster.

Feel Free to PM, anyone that needs help in this area

 

[air bud]

I agree with what you said

 

[CutsWithFury]

No no my friend, you can get an office busy in about a year starting from scratch with simple marketing principles and technology these days have made the process even easier or you can buy out someone and have existing cashflow to support you from the start ... you can compound your wealth alot faster when you are in control of the taxes your paying, contribute WAY more to your retirement accounts, and making WAY more than say a W2 250k salaried position with benefits at a hospital thats not paying you what you are worth or for the value that your bringing in, then being at their mercy every time your contract is up on the table (and that salary btw is TOP of the line for what we do not the normal, most people make 100-125k unfortunately) hence reaching FI alot faster ... and when i said get out i meant being financially independent and not having to work yourself, running it like a real business ( but there are many PP pods that can get out in their late 40s and early 50s but choose not too because money is rolling in at that point) ... there is a reason why PP jobs pay 60$ an hour ( supply and demand)

All that being said, you need to have somewhat of a business inclination and be able to tolerate risk. I am glad that this avenue is available to take in this profession because making what a PA would have made after all this is a disaster.

Feel Free to PM, anyone that needs help in this area

I make more than 250k as a salaried physician. My base is 280k. An additional 20k in quality care bonuses then add whatever I make on my RVU incentive bonus. Potential to make almost half a million once my volume really cranks. I’m on my second contract. If you generate the hospital will pay you. You can make great money being apart of a hospital. I wear scrubs everyday and just show up. I do a lot of promotion on my own. I do a lot of community events which has been key building up a presence and a reputation in the area. If you treat your hospital position like a private practice gig you can be successful very quickly.

 

[G0dFather]

I make more than 250k as a salaried physician. My base is 280k. An additional 20k in quality care bonuses then add whatever I make on my RVU incentive bonus. Potential to make almost half a million once my volume really cranks. I’m on my second contract. If you generate the hospital will pay you. You can make great money being apart of a hospital. I wear scrubs everyday and just show up. I do a lot of promotion on my own. I do a lot of community events which has been key building up a presence and a reputation in the area. If you treat your hospital position like a private practice gig you can be successful very quickly.

Yes I agree with you and Im very happy for you actually, I wish we continue to hear things like this across the nation ... there is NO reason why you shouldn't be getting 500K+ if you are busy and doing a variety of things that the profession has to offer... DERM and ORTHO are two of the highest paid specialties and POD is LITERALLY a fusion of both of them ( albeit limited to a single body part ) and we can bill many codes that they bill yet our value is not represented correctly and uniformly, i just dont get it! Is it just from the letters after our names? ( and you dont need to do crazy sx to generate money, just need to be busy with patients generating E&M and procedures codes)......


BUT that being said three things come to mind... you are not the normal ( to make 500K+ in podiatry you have to have some kind of ownership stake in PP) ... you ultimately don't have equity in what you are building and promoting.... you are HEAVILY taxed (assuming you dont have other "things" to offset that high of a W-2 salary)....

 

[CutsWithFury]

BUT that being said three things come to mind... you are not the normal ( to make 500K+ in podiatry you have to have some kind of ownership stake in PP) ... you ultimately don't have equity in what you are building and promoting.... you are HEAVILY taxed (assuming you dont have other "things" to offset that high of a W-2 salary)....

1) Yes I am not bringing in 500K in net income. I am talking about gross figures. Still a lot better than most

2) I don't have equity in what I am building and promoting? I totally disagree. I am the reason my service is successful. I am doing surgeries and procedures nobody on staff can do. I am having good outcomes which spreads the word to other potential patients. I am actually going to these community events compared to most physicians on staff. I bring value to the service that was NEVER there before I was hired. I bring a source of income that was NEVER there before I was hired by the hospital. Theoretically the hospital can replace me whenever they want but they would have to be a reason. There is verbage in my contract that protects me. If my hospital let me go without reason then I have protection in my contract which would allow me to open up shop right in the town I am practicing in. I have some protection from my hospital. Nothing is for certain. But I've made it really difficult for them to let me go. That is why you negotiate during contracts. In the grand scheme of things their return of investment on my service far exceeds certain orthopedic specialities in the hospital. This may NOT be true in all hospital systems but it is true for my current situation, at my current hospital. My base salary is lower compared to ortho (they are making more than twice my base salary), I see more patients than certain ortho specialties and I am billing out aggressively. This is a money game. It's not about healthcare anymore. This is where hospital employed medicine has been going.

3) Taxed? See response 1. Yes I am taxed out the ass. But I get great benefits through the hospital and I have 401K which I am adding too aggressively. A 401K that no private practice podiatry group would ever give me

Private practice podiatry is awful. Plain and simple. It's harder to bill more than ever. Most associates are getting screwed over by the owner. Nobody is getting a fair shake.

I'd rather go solo and struggle and lose my shirt than work for another podiatrist.

 

[GreenHousePub]

I feel like the pissing contest has launched into full swing. Someone get the yard sticks.

 

[CutsWithFury]

I feel like the pissing contest has launched into full swing. Someone get the yard sticks.

Just talking and sharing knowledge. Sorry you got so offended easily. I would expect nothing less from this society.

 

[G0dFather]

I'd rather go solo and struggle and lose my shirt than work for another podiatrist.

Yes, solo/owner that is what Im talking about!! ... working for someone in PP youll get what ultimately amounts to about 60$ an hour no matter what way shape or form your offer is presented.. its good for the owner, there are many people that accept that because of market demands

I hear what your saying ... but there is just NO comparison between being an employee vs. owning your own successful PP business

 

[G0dFather]

It's harder to bill more than ever.

I will take issue with things said like this however... what is meant by this ? You send a claim and it gets paid 90% of the time if you know what your doing .. its that simple, its even easier now if you outsource to a billing company ... its always boggled my mind how doctors are not experts at the very thing that will generate their revenue

Not attacking you... but its generalizations like this throughout the profession that scares people into doing things or even just taking a look further into something

 

[Scrantonicity]

I will take issue with things said like this however... what is meant by this ? You send a claim and it gets paid 90% of the time if you know what your doing .. its that simple, its even easier now if you outsource to a billing company ... its always boggled my mind how doctors are not experts at the very thing that will generate their revenue

Not attacking you... but its generalizations like this throughout the profession that scares people into doing things or even just taking a look further into something

I second this...billing is pretty easy.

 

[air bud]

Ok, so I pulled my numbers to start logging for boards. I am in a rural location, my reach is maybe 15k people. I am the only pod, get all trauma from my hospital. There is a ortho PA in my town who treats some foot and ankle, and his ortho does minimal foot/ankle surgery. There is another visiting ortho who has a lot of F/A training but I have no idea how much surgery he does since doesn't do at my hospital and takes it back to his.
I did 27 cases in the 8 months of 2018 I was here. So far in 2019 (another 8 months) I have done 30 cases. I see between 20 and 35 patients a week usually.

 

[Scrantonicity]

Ok, so I pulled my numbers to start logging for boards. I am in a rural location, my reach is maybe 15k people. I am the only pod, get all trauma from my hospital. There is a ortho PA in my town who treats some foot and ankle, and his ortho does minimal foot/ankle surgery. There is another visiting ortho who has a lot of F/A training but I have no idea how much surgery he does since doesn't do at my hospital and takes it back to his.
I did 27 cases in the 8 months of 2018 I was here. So far in 2019 (another 8 months) I have done 30 cases. I see between 20 and 35 patients a week usually.

Man, that's a totally different world...I'm rural too, but I (like many others I'm sure) see 35-40 patients a DAY (on Tuesdays usually 50 or so), and 4-5 surgeries per week...sometimes more--and I know I make less than you because I work for a pod.

I mean, what do you do all day?? Please tell me you also own a business on the side, or you have become an amazing musician...bitcoin day trading?...come on, tell me!! I wanna live vicariously through you haha.

 

[dtrack22]

Ok, so I was in a job out of residency where I only did a few cases because my morbidly obese boss had a very routine care type of practice and he was too busy playing call of duty in his office to actually see patients and let me go market to the other physicians in the small community. I then got to the point where I knew I was leaving and deferred a few surgical cases just because I didn't want them to get pulled and have to try and get the documentation for them when the time came.

That being said, my current job is a very common podiatry gig in terms of pathology, contract/compensation, etc. In the 1 year and 3-4 months I've been here, I've done 97 cases with all but 5-6 being elective. I do very little inpatient work (amps/I&Ds). The first case I did was around 3 months after I started due to credentialing which could be shortened/avoided coming out of residency as the credentialing process can sometimes start sooner and can be dependent on the patient population. ie medicare patients can be taken to the OR right away since anything you do on them can be back dated to the day you applied to be a medicare provider.

Obviously there are people here who do 100 cases in 3-4 months as opposed to the 12 months it took me.

 

[Scrantonicity]

Ok, so I was in a job out of residency where I only did a few cases because my morbidly obese boss had a very routine care type of practice and he was too busy playing call of duty in his office to actually see patients and let me go market to the other physicians in the small community. I then got to the point where I knew I was leaving and deferred a few surgical cases just because I didn't want them to get pulled and have to try and get the documentation for them when the time came.

That being said, my current job is a very common podiatry gig in terms of pathology, contract/compensation, etc. In the 1 year and 3-4 months I've been here, I've done 97 cases with all but 5-6 being elective. I do very little inpatient work (amps/I&Ds). The first case I did was around 3 months after I started due to credentialing which could be shortened/avoided coming out of residency as the credentialing process can sometimes start sooner and can be dependent on the patient population. ie medicare patients can be taken to the OR right away since anything you do on them can be back dated to the day you applied to be a medicare provider.

Obviously there are people here who do 100 cases in 3-4 months as opposed to the 12 months it took me.

Morbidly obese boss playing Call of Duty in his office?! Hahahahaha sometimes I love this forum--makes me feel better about my life in those moments when I feel like I'm in podiatry hell.

 

[air bud]

Man, that's a totally different world...I'm rural too, but I (like many others I'm sure) see 35-40 patients a DAY (on Tuesdays usually 50 or so), and 4-5 surgeries per week...sometimes more--and I know I make less than you because I work for a pod.

I mean, what do you do all day?? Please tell me you also own a business on the side, or you have become an amazing musician...bitcoin day trading?...come on, tell me!! I wanna live vicariously through you haha.

Rural as in rural health clinic/critical access hospital? or just small town. My previous job I was in a town of 40k that most people would consider rural that I was doing a little less volume than you.

As far as my days, I usually see first patient around 9am, then home for lunch then maybe 1 or 2 in the afternoon. Technically I work 730-530 4 days a week so I can get in 40 hours, but I am never scheduled then. Basically 9-4. Off on Mondays, so always have 3 day weekends. I feel bad that my MA is there and I am not, but there isn't anything for me to do, so why be there? If I need to sign something or someone walks in then I am there in like 30 secs. If I have more than 30 min break and no notes to do, I head home. I am off monday, have a typical day like that on Tuesday maybe 6-10 on a busy day. Then wed morning surgery. If not cases, then I don't go in until 1. Then maybe see 4-6. Thursday I see 7-10 depending on if at outreach or not, then maybe the same on Friday when I have another outreach. Varies by whats going on in town and what farmers are up to. So far this week I did 2 cases this morning (1st mpj fusion, 5th hammertoe) and have seen I think 6 total patients. Tomorrow I have an outreach clinic and have 11 or 12 total I think between there and home. But some days I see 2 people...it varies.

Right now its great because have newborn baby and can give my wife a break, as well as actually spend time with her and the baby. I have plenty of time to do all the cooking and cleaning and yardwork so that when she is taking a break from the baby she doesn't have anything else to do.

No bitcoin trading, but I should have learned from dtrack. I do have a side business that I am working on, but unfortunately it is a labor intensive job as opposed to something more passive. But its fun and lets me use my hands and learn new things. I easily spend more time on that that I do as a doctor, but thats not hard most weeks I don't put in 20 hours total at the hospital. Regardless, I have LOTS of free time. I live 30 mins from a mountain range, so I get plenty of hikes in during nicer weather.

 

[Scrantonicity]

Rural as in rural health clinic/critical access hospital? or just small town. My previous job I was in a town of 40k that most people would consider rural that I was doing a little less volume than you.

As far as my days, I usually see first patient around 9am, then home for lunch then maybe 1 or 2 in the afternoon. Technically I work 730-530 4 days a week so I can get in 40 hours, but I am never scheduled then. Basically 9-4. Off on Mondays, so always have 3 day weekends. I feel bad that my MA is there and I am not, but there isn't anything for me to do, so why be there? If I need to sign something or someone walks in then I am there in like 30 secs. If I have more than 30 min break and no notes to do, I head home. I am off monday, have a typical day like that on Tuesday maybe 6-10 on a busy day. Then wed morning surgery. If not cases, then I don't go in until 1. Then maybe see 4-6. Thursday I see 7-10 depending on if at outreach or not, then maybe the same on Friday when I have another outreach. Varies by whats going on in town and what farmers are up to. So far this week I did 2 cases this morning (1st mpj fusion, 5th hammertoe) and have seen I think 6 total patients. Tomorrow I have an outreach clinic and have 11 or 12 total I think between there and home. But some days I see 2 people...it varies.

Right now its great because have newborn baby and can give my wife a break, as well as actually spend time with her and the baby. I have plenty of time to do all the cooking and cleaning and yardwork so that when she is taking a break from the baby she doesn't have anything else to do.

No bitcoin trading, but I should have learned from dtrack. I do have a side business that I am working on, but unfortunately it is a labor intensive job as opposed to something more passive. But its fun and lets me use my hands and learn new things. I easily spend more time on that that I do as a doctor, but thats not hard most weeks I don't put in 20 hours total at the hospital. Regardless, I have LOTS of free time. I live 30 mins from a mountain range, so I get plenty of hikes in during nicer weather.

Yeah, rural as in small town--the town I practice in has less than 10K population--we get lots of patients from surrounding towns, many that drive over an hour to see us. There just isn't really any competition so we stay busy. Well, sounds like the life, man!

 

[DYK343]

Rural as in rural health clinic/critical access hospital? or just small town. My previous job I was in a town of 40k that most people would consider rural that I was doing a little less volume than you.

As far as my days, I usually see first patient around 9am, then home for lunch then maybe 1 or 2 in the afternoon. Technically I work 730-530 4 days a week so I can get in 40 hours, but I am never scheduled then. Basically 9-4. Off on Mondays, so always have 3 day weekends. I feel bad that my MA is there and I am not, but there isn't anything for me to do, so why be there? If I need to sign something or someone walks in then I am there in like 30 secs. If I have more than 30 min break and no notes to do, I head home. I am off monday, have a typical day like that on Tuesday maybe 6-10 on a busy day. Then wed morning surgery. If not cases, then I don't go in until 1. Then maybe see 4-6. Thursday I see 7-10 depending on if at outreach or not, then maybe the same on Friday when I have another outreach. Varies by whats going on in town and what farmers are up to. So far this week I did 2 cases this morning (1st mpj fusion, 5th hammertoe) and have seen I think 6 total patients. Tomorrow I have an outreach clinic and have 11 or 12 total I think between there and home. But some days I see 2 people...it varies.

Right now its great because have newborn baby and can give my wife a break, as well as actually spend time with her and the baby. I have plenty of time to do all the cooking and cleaning and yardwork so that when she is taking a break from the baby she doesn't have anything else to do.

No bitcoin trading, but I should have learned from dtrack. I do have a side business that I am working on, but unfortunately it is a labor intensive job as opposed to something more passive. But its fun and lets me use my hands and learn new things. I easily spend more time on that that I do as a doctor, but thats not hard most weeks I don't put in 20 hours total at the hospital. Regardless, I have LOTS of free time. I live 30 mins from a mountain range, so I get plenty of hikes in during nicer weather.

I want your life. I saw 37 patients today alone. Some easy some complex.

Teach me....

 

[Scrantonicity]

I want your life. I saw 37 patients today alone. Some easy some complex.

Teach me....

Seriously...it's like he's on welfare for podiatrists 🙂 Well....back to my day of seeing more patients than he sees in 2 weeks FML.

 

[air bud]

I want your life. I saw 37 patients today alone. Some easy some complex.

Teach me....

Seriously...it's like he's on welfare for podiatrists 🙂 Well....back to my day of seeing more patients than he sees in 2 weeks FML.

Just wait until I ask for and get a raise in a year...although by then I will be driving 2 hours each way every other week to add an outreach

 

[ExperiencedDPM]

Airbud,

How can anyone afford to pay you if you’re seeing 25 patients a week? Prior to slowing down I’d see 25 patients by 11 am and 55-60 daily.

Maybe I missed an earlier post explaining how anyone can pay you a decent salary seeing 25 patients weekly.