Do we really make more salary than a primary care doc? Or is this just a myth?

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This thread consists of mostly prepodiatry students, some pod students and 1 or 2 practicing pods speculating on what FPs make.
They probably on average make slightly more than pods on average.
Is that the point? That pods on average make less than FPs?
Surgery doesn't pay.
All these hotshot pod residents have a surprise in store for them. It's called private practice. The reality of private practice is lots of routine stuff and some surgery, and the surgery pays not enough to make it worthwhile.
The best procedures are the quick and easy ones that you do in your office .
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tracheatoedoc said:
This thread consists of mostly prepodiatry students, some pod students and 1 or 2 practicing pods speculating on what FPs make.
They probably on average make slightly more than pods on average.
Is that the point? That pods on average make less than FPs?
Surgery doesn't pay.
All these hotshot pod residents have a surprise in store for them. It's called private practice. The reality of private practice is lots of routine stuff and some surgery, and the surgery pays not enough to make it worthwhile.
The best procedures are the quick and easy ones that you do in your office .
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My speculation is based on seeing the actual financial reports of a group of FP's, but yes, you're accurate with the rest.

Surgical procedures pay, but we're talking about the slam-dunks with relatively minimal time involvement.
 
tracheatoedoc said:
Surgery doesn't pay.
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Of course surgery pays. It pays more than an E&M. That's why doctors who do any procedures (colonoscopies, angiography, wound debridement, bunions) make more than those who don't.

The current medical reimbursement system is set up to pay for procedures, not for performance or for prevention.
 
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First of all, let's all remember that regardless of whether surgery "pays"or not, it's the patient's well being that comes first and I'm sure we're all in agreement on that issue.

I believe it's really a matter of semantics when someone states that "surgery pays" or "surgery doesn't pay". I think what is REALLY meant is time vs. dollars. Yes, the actual surgical procedure does have a higher reimbursement than an E&M code, but there are other factors that have to be considered.

You also have to consider the time to travel to the facility (hospital or surgical center), time to perform the procedure, pre and post operative paper work (not all facilities have residents), travel from the facility back to the office, post operative care during the "global" period, etc. And of course that does not include any liability that is always attached to any surgical procedure.

So, when all those factors are added up, a practitioner must really step back and consider whether surgery "pays".

Some doctors have a very unique situation. A friend of mine has a high volume surgical practice and is a residency director of a 3 year program with 3 first year, 3 second year and 3 third year residents. As a result, he basically has NINE "free" employees that can help him out all the time. Therefore, he never has to perform his own paperwork pre or post operatively, and books several cases at a time. Therefore his day his "filled" and his time is well planned. Additionally, when he is back in the office to see these patients post operatively, he's got the residents to do his work while he can see other patients. His residents take off the casts, his residents remove the dressings, his residents take the post operative x-rays, his residents clean the wounds, his residents re-apply the dressings and casts, etc.

In a "normal" office this is very labor and time intensive and if the doctor is not performing these services he/she is PAYING a staff member to perform these services, therefore lessening the amount surgery "pays".

On the other hand, though E&M services pay less, while you are in the office you can simply perform more E&M services with low overhead, no global fee, etc.

There are also services such as orthoses and small office procedures that pay well vs. hospital surgery. Dollar for dollar, time for time there is probably no better procedure than a simple "P&A" for good income, great results and happy patients.

A well rounded practice is comprised of the full armamentrarium of services for our patients, and hopefully none of us will be strictly motivated by $$$$. So, although the actual surgical procedure does sometimes pay fairly well (depending on the insurance carrier) for the actual procedure, there are many factors involved that actually decrease that value when compared to other procedures performed in the office, when you consider the big picture.
 
Correct, it's a matter of dollars/time. If one's schedule is not already double-overbooked then adding surgeries will bring more income. In other words, if you see only X number of patients per week, then you will make more if you see X number of patients plus do a surgery on top of that. A new doctor just entering practice, if he or she is still trying to build up the practice, will have the time to do more cases. When you're so busy that you have a waiting list to see you several weeks out, then spending a lot of time working on a surgery plus doing all of the peripheral things will take up time that you could be spending seeing other patients in the office. Then again, if you're already paying staff to manage the peripheral duties then you may as well book the cases. Better to have them work on your cases than surf the internet.

There's a DPM I know who does quadruple the number of cases anyone else in town, but that doctor also has on the payroll triple the number of employees. Figure at least $30K/yr per employee (salary, benefits, taxes) that you have to make just to pay the staff before you can begin paying for anything else. If your patient volume supports it then everything is cool, but if your volume dips (say, during hard economic times) then you will feel it.

PADPM said:
Dollar for dollar, time for time there is probably no better procedure than a simple "P&A" for good income, great results and happy patients.
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Hallelujah! It's also the one thing podiatrists inarguably do better than any other type of practitioner. I'd advise getting really skilled at doing it with as little discomfort to the patient as possible, and you'll get a lot of patient referrals. Even if your schedule is jam-packed, it might be worth it to keep one or two slots open, reserved for those "emergency" calls from people with ingrown nails who want them fixed ASAP. If you offer an appointment three weeks from now, they'll probably call around until they find another doc who can do it sooner.
 
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Sorry, P&A is the term that is well known in podiatry and stands for "phenol & alcohol". It denotes the chemicals that are commonly used for a chemical matrixectomy of a portion of the nail for a recurrent ingrown nail or for removal of the entire nail plate.

The procedure involves using phenol (89%) to chemically destroy the nail matrix and alcohol to flush/dilute the phenol. Many "believe" that the alcohol neutralizes the phenol, but chemically that's inaccurate. It really simply flushes out or dilutes the phenol to prevent continued "burning".

The procedure is fast, simple and most importantly extremely effective with a very high patient satisfaction.
 
I've been in practice 23 years and have NEVER heard anyone refer to a partial nail avulsion as a "PNA", similarly, I've NEVER heard anyone refer to a total nail avulsion as a "TNA"!!!

I think that it's pretty well established in the podiatric community that the term is P & A and it stands for phenol & (and) alcohol.

In the medical community P&A may be known as percussion and ausculation, but I usually don't perform that procedure often when a patient is complaining of a chronic ingrown toenail:laugh:
 
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Podmeister said:
I thought it was PNA...Partial Nail Avulsion.
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I've heard both "PNA" (partial nail avulsion) and "P&A" (phenol & alcohol).

I think it depends on where one was trained and how rowdy of a crowd one hangs out with.

I first heard the term "PNA" from some folks who went to school in California.

I've also heard the term "PU&M" (partial ungualectomy & matricectomy) and "TU&M" (total ungualectomy & matricectomy) from a podiatrist who trained in New York. That one had me scratching my head for awhile.

I used the term "P&A" when talking to a podiatrist who went to school in Chicago and she said, "What's that? Do you mean a 'MAT?'"

I guess some things still are not standardized across the board. I try to be flexible open to change.*



* Except for FaceBook. I'm having a hell of a time navigating their new layout.
 
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PADPM said:
I've been in practice 23 years and have NEVER heard anyone refer to a partial nail avulsion as a "PNA", similarly, I've NEVER heard anyone refer to a total nail avulsion as a "TNA"!!!

I think that it's pretty well established in the podiatric community that the term is P & A and it stands for phenol & (and) alcohol.

In the medical community P&A may be known as percussion and ausculation, but I usually don't perform that procedure often when a patient is complaining of a chronic ingrown toenail:laugh:
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In my office I say "TNA" for total nail avulsion, so you heard it here first!
 
PodunkUDPM said:
I think you can do a partial nail avulsion without phenol.
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There are several ways to skin this cat:

You can do it without any ablation of the matrix (growth root) and the nail will grow back.

You can destroy the matrix (aka - "matricectomy") using phenol then flush with alcohol. Some guys skip the alcohol in order to let the phenol cauterize longer, in order to help avoid recurrence.

You can do the matricectomy with sodium hydroxide then neutralize it with acetic acid.

You can do the matricectomy with electrocautery using a hyfrecator.

You can also remove the matrix with a scalpel.
 
NatCh

I went to school in Chicago and it was always called a "P&A". An MAT????? Isn't that something you wrestle on??

Now you say you actually call it a TNA........where I come from T & A has a WHOLE other meaning.....and I don't mean tonsillectomy and adenoidectomy:laugh:
 
PADPM said:
NatCh

I went to school in Chicago and it was always called a "P&A". An MAT????? Isn't that something you wrestle on??

Now you say you actually call it a TNA........where I come from T & A has a WHOLE other meaning.....and I don't mean tonsillectomy and adenoidectomy:laugh:
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Ha ha ha! "T&A in room 3...knock before entering." "If room 3 is a rockin'..."
 
PADPM said:
NatCh

Now you say you actually call it a TNA........where I come from T & A has a WHOLE other meaning.....and I don't mean tonsillectomy and adenoidectomy:laugh:
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Good one:thumbup:

In CA, we also use "matrix"...short for matrixectomy.
 
Ha ha ha! "T&A in room 3...knock before entering." "If room 3 is a rockin'..." :laugh:
 
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smartman716 said:
Ha ha ha! "T&A in room 3...knock before entering." "If room 3 is a rockin'..." :laugh:
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If I ever find that my patient panel has narrowed down to lonely old cougars, I'll know why...
 
NatCh,

Rumor has it that you keep a speculum and KY in treatment room #3.....just in case you have one of the "special" T&A's:laugh:
 
PADPM said:
NatCh,

Rumor has it that you keep a speculum and KY in treatment room #3.....just in case you have one of the "special" T&A's:laugh:
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Ha ha! Good one.

If anyone bursts in I just make as if I'm testing Babinski reflex...with the speculum.
 
Met a podiatrist yesterday who claims she made over a million last year. No surgery, no diabetes. PPO or cash only. Patient profiles aged 20-40 y/o.

Not bad!
 
As I stated in a post in another thread, I simply wouldn't give much credit to ANY podiatrist that openly discusses his/her income.

Making a million dollars is a LOT of money and means seeing a LOT of patients, especially when not performing any large ticket surgical procedures.

However, once again I don't give much credit to anyone that discusses personal income openly.

I practice with one of the largest (if not the largest) group practices on the East Coast, and probably one of the largest practices in the country. I've been in practice for over 20 years and can tell you that our practice is VERY successful.

Not ONCE in the past 20 years have I EVER discussed my earnings or income with any student, extern, intern or resident, nor have any members of my practice. NEVER.

And, I know how much ONE doctor has to produce to earn ONE MILLION dollars.....so believe me, take what she says with a grain of salt and please don't be overly impressed.

The most TRULY successful doctors and other professionals I know NEVER discuss their incomes and are actually very modest. So, basically, I believe she's full of ..........
 
streetsweeper said:
Met a podiatrist yesterday who claims she made over a million last year. No surgery, no diabetes. PPO or cash only. Patient profiles aged 20-40 y/o.

Not bad!
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That's really good! 20-40 y/o cash-pay patients...does she have a boutique cosmetic-focus practice?


West Coast, baby!
 
Dr. PADPM: Of course we should take what people say w/ a grain of salt .... that's just life for me. I clarified some thangs. Her practice is split between 3 people so collectively they made over a million. Plus she didn't mention overhead.

I was given a card if I wanted to do a clerkship w/ her next semester. I should if I want to learn how to make money.....But my goal isn't to learn how to make money! I want to be a better doctor.......even with rationed food.


Dr. Natch: Strictly sports medicine (the only one out of the 3). She'll cut people some slack if they can't pay right away, she'll do a monthly plan. She also does consultations for ProLab and she is the podiatrist for several local sports team. Not to mention practice is in the financial district of SF so you can probably tell what are the socioeconomic backgrounds of these patients. People actually fly in from all over to get shoe advice. I've spoken to several upperclassmen who have already done private office clerkships w/ her...and they can confirm. they tell me they get exhausted simply from keeping up w/ her pace. And her patients love her. So in her circle, she is the go to person for biomechanics.

WEST COAST, BABY!
 
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That's a HUGE difference. A one doctor practice vs. a three doctor practice bringing in a million dollars paints a whole different scenario.
 
Someone said to me that Internists and FP's make in $220K-250K if they work fulltime. Hospitalists make even more. Thats pretty high for a non-procedural field comparable to our humble $120K average (lets just say we are taking average of 65k----200K range). I mean we pods have so many procedures and modalities to bill yet we cant gross over $120K-150K. :-(


I have worked with few MDs and I can say with a great deal of certainty that no Hospital piston for IM or FP would offer $220-250. The hospital positions I came across were $125-150 for IM or FP (including at least 2-3 nights on call). On the other hand, FP & IM can gross up to 500K in private practice but this comes after years of practice and building up and patient base, however, the overhead expenses (staff, rent, supplies, malpractice,...) for a large practice like this should be overwhelming as well besides that they kill themselves working!!!

Bottom line, form being exposed to many practicing MDs and DPMs. It all depends on you; how you plan your practice and how much effort you are willing invest.

Some MD I know in practice makes more than double of another with same education and training just for better planning and more effort in his practice. You cannot just sit on your lazy ass (sorry for my language) and expect to make that much money because people say that MDs or DPMs do so. You can have a very lucrative practice in any specialty you just have to do it right.
 
Black Surgeon said:
You are wrong in assuming that MSs with high boards do not go into FM and IM, not everyone wants to get into a ROAD program and the only alternative to those is surgery or a surgical subspecialty which mandate sacrificing family time for work. Lifestyle is listed as one of the major factors students take into consideration when deciding on a specialty. Don't get me wrong, FM and IM specialties still keep physicians pretty busy but in comparison to different surgical specialties, they aren't as torturous.

Really? you think an FP grossing over 200K is rare? You would be hard pressed to find an FP netting below 180K. An FP netting 200K or an FP w/OB netting 250K is the norm and not the exception.





Like Natch stated, these guys are bringng home salaries way over 200k. In fact, most of these guys easily start at 350K which is still at the low end for Ortho, NeuroSx and IR. However, the exception arises for academic physicians. Those in academia take a pay cut for zebras, the love of teaching and the prestige of being world renowned.
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"World Renowned?" LMAO. You are delusional. I can't think of more than 10 famous physicians out of the millions.

As far as salary pods can make much more than FP and FP pays pretty well.

But the famous physician thing made me spew my beer out of my mouth about 10 feet.

These famous doctors are mostly legends in their own minds and not famous at all except to some 22 year old naieve pre med student.
 
A good source for income of various specialties is Merrit & Hawkins. They are a firm that places physicians in jobs. I will occassionally see figures from them on the ave anesthesia income they placed in the last 12 months. They have also released info on most other specialties.
 
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