DPM job move question - urgent - need experienced input. Please and thank you!

[nnjjj]

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Hi good afternoon, I have a big decision to make and I have read your posts for a long time and figured I would reach out directly to avoid a long thread post that goes nowhere.
I understand you are a very experienced and well versed DPM. Possibly from Michigan as well?
If you are not able or willing to answer, I completely understand and do not want to bother you, not a problem.

I know I should talk to a therapist but really just need an experienced DPM input.

I am 33M - 4.5yrs out from high powered residency. From Detroit MI. First job was a PP bs grad mill job and I had other motivations. Toxic environment and low pay etc.
I left that after a year, and found the BEST job with an ortho group here in the NE. Small state, not to get too exact. I am FF/RRF/ankle certified. Am the secretary/streasurer of my state society and involved with APMA. I work with the Ivy League Uni residents as an outside attending. Small ortho group, partnered with local hospitals. I take no call except my own post ops which is minimal, and some side consults from the hospital ortho doesnt want to deal with, mostly outpatient. Great benefits, 195k salary, 35% bonus after 400k, hit it this last year but just barely and not expecting to see any money. But overall I have built a good reputation here in 3 years. MD/DO partners are (yes all aholes) but overall very nice and super supportive and trust me cus im good. I see 10-15 pts per day, not a lot. I am normally out my 1pm. Some weeks are stressful with surgery, we have a surgery center and local hospitals. But overall I do 2-15 cases a month. Not a ton, but enough. No small cases. 1 or 2 MIS bunion and 1st mpj fusions a month, otherwise its all what I like, sports med, scopes, ankles, trauma, a lot of nerve decompressions!! (get referrals from 3 states over and Uconn neuromuscular specialists for some reason..) midfoot/rearfoot ankle recon. No charcot, wound care, amps. I have 3 weeks PTO, and got 1 friday a month off for a long weekend.

I should be happy. But the state is not our forever home for me and my wife. She wants to move mack to Michigan to be enar my family, and infact already did move to Traverse City thinking I would find a job easily. Spoiler alert, no jobs....

I get offers all the time and am always looking as I am never satisfied, even though I should be, with a current great job. But we have talked about moving back to MI for the last year and so have been looking. As it stands either I stay here and she moves back and we stay for a while, or I take the best offer I am going to get back in MI. And I need to decide quickly here.

Job offer is in Houghton MI. in the UP at Michigan Tech Uni. 300in of snow per year. (I am from MI and lived here in NE so not a huge deal, but I get seasonal depression anyway unless im back in Miami...)
I have done hundreds of interviews with every type of practice
I cold called and created this position for myself
They gave me everything I asked for.
Orthos there are cool and want someone to handle the trimals and pilons and calc fx that they are currently sending out. General surgeon currently runs the WC center and does the toe amps.
3 year contract
310k base salary
50% bonus after RVU - about 6135 per year. (older orthos took me out for a beer and said get your money up front you will never hit your targets, but its a small town, small hospital, they have 45min patient encounters..)
15k up front, 15k year two start for sign on bonus/relocation
8-5 clinic
3 Wednesdays per month OR time
No call
Every other Friday off
17PTO days, 8 fed holidays, 5 CME days off, 7 days MI accrued sick leave days.

I think I could make it my own and basically function as I am now with my ortho group as the F&A surgeon in a tight knit smaller hospital. Town of 9k maybe, with transient 8k Uni student population. But I may have to do infections, wound care, charcot, etc.
I will have to work 8-5. Yes I know that adulting, but i lose function after 2pm, and I complain to my wife IDK how ppl work till 5pm.
I will have to see more patients and work harder and longer hours.
But I have more time off. More base salary, could be good to make it my own and build my practice.
D1 hockey team, D2 other athletics to be team provider
Only DPM in a 5 hour drive radius, aside from 1 ahole ortho in Marquette who stopped me from another hospital job there as "i was a threat"

Wife wants to be back in MI, planning for kids this year (or was-now near future). Traverse City, or Grosse Pointe, where I am from. But no good jobs there, I have tried. Only crappy PP jobs with crap pay and nail clipping.

My brother is a med mal defense attorney and his wife is a big corporate contract attorney so im covered there.

Any advice on what I should do?
Should I stay at good ortho job, in less desirable location/state?
Should I move back to MI - still undesirable location - up in the UP - Houghton Michigan. Literally 11 hour drive either from where i am now or if i am up there, to see my family...
Will the hospital eff me over?
Will i regret leaving everything I worked for here at current job? (I am done with my initial ego, i have done all the surgeries, i am good at it, prestige of ortho group is great and all...like working with residents, working with state and national societies etc.)
Should I take the hospital job for more money and chance the unknowns? or deny the contract offer and stay here for a few more years? eventually we will want to be back in MI to be near family esp if we have kid(s). But job prospects are crap in lower half of MI. Although I understand my priorities will shift once I have kids and a leisurely PP job may not be so undesirable then.

What is the state of podiatry at this point? I know I am complaining about a situation that most DPMs would only dream of either way. Just want to know what will I look back on in 10 years and say "I wish I had done it/not done it" - I fully understand the reality that after my 3 year hospital contract they will try to bone me and I will probably have to find a new job in MI but at least I will have networked and can find a decent one to settle for bu that point after making some money..

Sorry for long winded post. Any advice or perspective is much appreciated. Thank you very much in advance

 

[SubungualDebris]

If I was you, I would take the job.

New job has good benefits, closer to family, and WAY better salary. Grind it out for a few years, if you don't love it, move closer to family and start up your own practice. On the flip side, stay at the hospital job until you can leverage a hospital position/MSG/Ortho position closer to your desired destination. Your mileage will vary there as those types of opportunities are drying up given the saturation in our field.

To me it sounds like you like your current practice, mostly because you get paid a decent amount to barely work. 10-15 patients a day is really nothing man. That's easy. I totally get wanting work-life balance, and if that's what you are after and that is what makes you happy, then consider staying at your current practice. You will likely be working way harder at your next spot.

Think of it from the hospital's perspective. They are giving you 310K/yr. That is an investment on their end. They want to see you collect well over 310k so that they feel like their investment was worth it. That means seeing patients (probably more than 10-15/day) and $urgery (OR is a significant revenue generator for hospitals).

Hope this helps. For what its worth, there would be hundreds of other Podiatrists who would kill to be in the position you're in with this offer. Take that for what its worth

 

[nnjjj]

Thank you very much for your perspective and reply. Much appreciated.
Some weeks i work 50+ hours others a lot less, it comes in waves. Im lazy af, yes. but im also motivated and acheived more in 5 years than most dpms do their entire career. If i stay on this trajectory I will be those 50yo lecturing at acfas every year with a fellow, consult for device companies etc., but i do not want that anymore, im done with the ego part, i want family and work life balance, but also not clipping nails all day after everything i have achieved. i know i sound like the whiny teenager from the catcher in the rye... I know i will have to see more patients on the RVU system which is fine, for a lot more money up front. But i easily bring in more than that where i am currently at seeing 1/2 the patients and doing a fair amount of (what i consider big, fun, good cases)... so maybe hitting my RVU target isnt a pipe dream at the hospital then? I know we regret the things we did not do more at the end of the day, but i also know hospitals are know for screwing you over, and i currently am not in that position. i guess its the unknown. fear and anxiety is always just the unknown... appreciate your advice and taking the time to answer. thank you

 

[Feli]

... She wants to move mack to Michigan to be enar my family, and infact already did move to Traverse City thinking I would find a job easily. Spoiler alert, no jobs....

...As it stands either I stay here and she moves back and we stay for a while, or I take the best offer I am going to get back in MI. And I need to decide quickly here....

Wife wants to be back in MI, planning for kids this year (or was-now near future). Traverse City, or Grosse Pointe, where I am from. But no good jobs there...

...eventually we will want to be back in MI to be near family esp if we have kid(s)....

You have a pretty clear answer.
She already moved from New England with you... back to TC to live solo or with fam, then it doesn't get much clearer than that.
I doubt that there is any "eventually." She is there.

Houghton job may be fine if you don't mind terrible weather, but it's nowhere close enough to TC or Detroit area (unless you have a helicopter for commute?).

Your choices are pretty simple here:

• Take the best Mich job you can find in those two lower MI areas with her, and then keep looking for better work in the area. Some Mich hospitals do hire DPMs.
• Or stay/take whatever job you want elsewhere... and you are probably getting divorced soon (unless you believe long distance relationships "work"?).

...GL, you know the situation best and will figure it out.
You may want to just talk to personal friends... this is much more personal happiness/relationship decision than professional (which will be the Sdn answers).
Figure out what your priorities are and align your decisions and your "wants" with your real happiness. Only you know if your relationship is still fairly good, skull-n-crossbones status, or basically already over and just not pronounced dead? It is obviously not going great when she moved five or ten states away.

This is a very common pitfall of podiatry: serious lack of locations for good residency training, even bigger lack of choices/locations for good DPM jobs.
I got divorced in residency as I wanted good training, wife at the time said she was on board with that for a few years... but was basically attached to south Florida area (ultimately stayed behind there, we never got started). I also fully expected to lose my girlfriend of a few years when I went to a nowhere IHS job (after getting nowhere financially with metro Detroit pod jobs), but she toughed that out for a couple years and we are still together. It happens a lot, though... saturation is awesome. GL

 

[Bluecollarmed]

I think ultimately it depends on what you expect for a patient load at the new gig. If it’s a more rural spot and ortho is saying you won’t hit your rvu bonus, that’s fine if you have the hospital keep a 300k+ base indefinitely. I’m in a similar boat in that I’m hospital employed, escalator base that goes to 400k over 5 years and maintains some level indefinitely. We’ll see what that number is after I hit 5 years. I see 12-18 in a day and operate 4-6 cases per week, sometimes more depends on inpatient and trauma. I see how much the hospital makes on me alone and not the ancillary stuff like PT, lab, etc…trust me they do just fine (4-5x my base right now) at that patient load. If you can live with potentially not having the same case variety then collect your easy hospital check and go home to the family.

 

[nnjjj]

You have a pretty clear answer.
She already moved from New England with you... back to TC to live solo or with fam, then it doesn't get much clearer than that.
I doubt that there is any "eventually." She is there.

Houghton job may be fine if you don't mind terrible weather, but it's nowhere close enough to TC or Detroit area (unless you have a helicopter for commute?).

Your choices are pretty simple here:

• Take the best Mich job you can find in those two lower MI areas with her, and then keep looking for better work in the area. Some Mich hospitals do hire DPMs.
• Or stay/take whatever job you want elsewhere... and you are probably getting divorced soon (unless you believe long distance relationships "work"?).

...GL, you know the situation best and will figure it out.
You may want to just talk to personal friends... this is much more personal happiness/relationship decision than professional (which will be the Sdn answers).
Figure out what your priorities are and align your decisions and your "wants" with your real happiness. Only you know if your relationship is still fairly good, skull-n-crossbones status, or basically already over and just not pronounced dead? It is obviously not going great when she moved five or ten states away.

This is a very common pitfall of podiatry: serious lack of locations for good residency training, even bigger lack of choices/locations for good DPM jobs.
I got divorced in residency as I wanted good training, wife at the time said she was on board with that for a few years... but was basically attached to south Florida area (ultimately stayed behind there, we never got started). I also fully expected to lose my girlfriend of a few years when I went to a nowhere IHS job (after getting nowhere financially with metro Detroit pod jobs), but she toughed that out for a couple years and we are still together. It happens a lot, though... saturation is awesome. GL

Thank you appreciate you insight and reply. Just to be clear she moved cus her job went to **** (hospital politics..) and we were planning to go back to MI, i had been looking, without great success for a year and interviewing. We have been together for 10 years. We have moved all over (we seem to love to travel states and also internationally!!) miami 4 years, long island 1yr, Philly 2yrs, MI 1.5yrs, CT 3yrs...now figuring out next move for family and kids, plus taking care of her family in PA for which we are primary care givers to her mom and grandpa. We have been long distance and moved a lot. Its not for everyone, but we have seen the country and experienced more than most people do in their life (we say our husky-chow dog is the best traveled dog xD). We make it work. She has enough degrees to find a job anywhere, which is why I was *supposed to find a job first, then she moves since I am the rate limiting factor job/career-wise, but i owed her (a lot lol) and said go for it, just no jobs available in that area any time in the near future at least. She would be fine to move back and we would stay here long term-ish until i find a better opportunity, or she will come with me up to butt**** Siberia. 🙂 \o/ - relationship is fine, we are flexible and somewhat transient. BUT i do appreciate your insight and perspective, and appreciate the reply very much. thank you!

 

[nnjjj]

heli transport would be nice tho

 

[nnjjj]

I think ultimately it depends on what you expect for a patient load at the new gig. If it’s a more rural spot and ortho is saying you won’t hit your rvu bonus, that’s fine if you have the hospital keep a 300k+ base indefinitely. I’m in a similar boat in that I’m hospital employed, escalator base that goes to 400k over 5 years and maintains some level indefinitely. We’ll see what that number is after I hit 5 years. I see 12-18 in a day and operate 4-6 cases per week, sometimes more depends on inpatient and trauma. I see how much the hospital makes on me alone and not the ancillary stuff like PT, lab, etc…trust me they do just fine (4-5x my base right now) at that patient load. If you can live with potentially not having the same case variety then collect your easy hospital check and go home to the family.

Thank you for your perspective and reply. Very much appreciated!!
--Interesting set up with the 5 year escalator increase. Mine would be 3yr guarantee, then comes the contract renewal of - do i get screwed or am i valuable enough to negotiate same or hopefully more.
--I think it would give me free riegn to do cases I like and build my self up within basically a small tight knit ortho/gen surg department and be the lower extremity surgeon. And be part of the University team doctors. Yes that would mean i prob will have to take on the wound care, amps, infections, charcot, which I am not thrilled about, but am fine to take on - its podiatry and im a podiatrist, so doesnt matter really i can handle anything, just more preference. but if i am the only guy around i take whatever comes including the stuff i dont like and the stuff i like - foot, ankle, recon, trauma, sports, scopes, nerves, etc. The one thing is, in this area, I have some ability to say "i cannot do this, or needs to go to bigger medical center" and ship them out as the current surgeons are doing sometimes. esp if its best for the patient if they need total interdisciplinary management with ID, vasc, plastics etc... No plastic surgery there currently. So ill be doing my own flaps i guess. So some will inevitably need to be sent to U of M or Green Bay.

--but that seems like youre not overwhelmed and still making the hospital plenty of money in your set up. If i may ask, are you hitting your RVU targets or getting close?

 

[nnjjj]

Appreciate all the feedback, thank you.
I will probably take the job so we can eventually get closer to family even if we move again in 3 years to lower MI. or we may love it and stay.
Its just hard to give up the "coveted ortho" job that so many would jump at the chance for - for the unknown hospital position. Seems from the feedback everyone says go for it. So i likely will. I probably just wanted someone to say the opposite so i dont have to deal with 300in of snow every winter. But the position seems pretty good, more money, more time off, and the town is pretty nice and we are very into outdoor activities even in winter.

 

[Bluecollarmed]

Thank you for your perspective and reply. Very much appreciated!!
--Interesting set up with the 5 year escalator increase. Mine would be 3yr guarantee, then comes the contract renewal of - do i get screwed or am i valuable enough to negotiate same or hopefully more.
--I think it would give me free riegn to do cases I like and build my self up within basically a small tight knit ortho/gen surg department and be the lower extremity surgeon. And be part of the University team doctors. Yes that would mean i prob will have to take on the wound care, amps, infections, charcot, which I am not thrilled about, but am fine to take on - its podiatry and im a podiatrist, so doesnt matter really i can handle anything, just more preference. but if i am the only guy around i take whatever comes including the stuff i dont like and the stuff i like - foot, ankle, recon, trauma, sports, scopes, nerves, etc. The one thing is, in this area, I have some ability to say "i cannot do this, or needs to go to bigger medical center" and ship them out as the current surgeons are doing sometimes. esp if its best for the patient if they need total interdisciplinary management with ID, vasc, plastics etc... No plastic surgery there currently. So ill be doing my own flaps i guess. So some will inevitably need to be sent to U of M or Green Bay.

--but that seems like youre not overwhelmed and still making the hospital plenty of money in your set up. If i may ask, are you hitting your RVU targets or getting close?

I’m around 5.5-6k wRVUs in my 2nd year and don’t anticipate growing to much more than 7-8k max given the location. I have the luxury of saying send it out if I don’t wanna do something so I do similar stuff to your current set up plus some of the wound/pus as it comes. I also don’t do nailcare.

Honesty most of the friends I’ve known in ortho groups have transitioned to hospital or other setups so it’s not all it’s cracked up to be. Can be a good outcome but they work you hard for average hospital pay, especially in the Midwest.

 

[nnjjj]

Also, the 8-5 work was more of a joke with me and wife. I understand thats being an adult. I would not have two great options if i did not bust my *** to get to where I am. But to clarify, i am professionally very motivated and skilled. And personally very lazy in a lot of ways. see below pic. I calculated I will
be working 54.25% of the year 🙂 --> never underestimate lazy. lazy=finding the most efficient way

 

[nnjjj]

I’m around 5.5-6k wRVUs in my 2nd year and don’t anticipate growing to much more than 7-8k max given the location. I have the luxury of saying send it out if I don’t wanna do something so I do similar stuff to your current set up plus some of the wound/pus as it comes. I also don’t do nailcare.

Honesty most of the friends I’ve known in ortho groups have transitioned to hospital or other setups so it’s not all it’s cracked up to be. Can be a good outcome but they work you hard for average hospital pay, especially in the Midwest.

Cool thanks for the info, thats helpful!!
I know a lot of DPM ortho jobs are glorified PA or non-op positions. maybe thats a factor? From my understanding the sentiment has always seemed that 'good ortho' jobs are the peak for DMPs (although that is very subjective and individual for everyone). Maybe thats the ego of new grads.
And i will say its wayyy better than the PP podiatry supergroup job i took out of residency and better than all the PP/MSG prospects ive seen doing hundreds of interviews thus far. Again individual for everyone, i know, and a lot of factors at play. so maybe no fair to say that.
We dont have a F&A ortho so im it for the group. But as someone else told me, my current position the pay is not great. and with how they screw me over for surgery reimbursement at the surgery center its not gonna ever make me real money. Since i have not bought into the center *yet* the percent i get from my cases is absolutely dismal...so thats a factor as well i suppose

 

[Sybly]

Hi good afternoon, I have a big decision to make and I have read your posts for a long time and figured I would reach out directly to avoid a long thread post that goes nowhere.
I understand you are a very experienced and well versed DPM. Possibly from Michigan as well?
If you are not able or willing to answer, I completely understand and do not want to bother you, not a problem.

I know I should talk to a therapist but really just need an experienced DPM input.

I am 33M - 4.5yrs out from high powered residency. From Detroit MI. First job was a PP bs grad mill job and I had other motivations. Toxic environment and low pay etc.
I left that after a year, and found the BEST job with an ortho group here in the NE. Small state, not to get too exact. I am FF/RRF/ankle certified. Am the secretary/streasurer of my state society and involved with APMA. I work with the Ivy League Uni residents as an outside attending. Small ortho group, partnered with local hospitals. I take no call except my own post ops which is minimal, and some side consults from the hospital ortho doesnt want to deal with, mostly outpatient. Great benefits, 195k salary, 35% bonus after 400k, hit it this last year but just barely and not expecting to see any money. But overall I have built a good reputation here in 3 years. MD/DO partners are (yes all aholes) but overall very nice and super supportive and trust me cus im good. I see 10-15 pts per day, not a lot. I am normally out my 1pm. Some weeks are stressful with surgery, we have a surgery center and local hospitals. But overall I do 2-15 cases a month. Not a ton, but enough. No small cases. 1 or 2 MIS bunion and 1st mpj fusions a month, otherwise its all what I like, sports med, scopes, ankles, trauma, a lot of nerve decompressions!! (get referrals from 3 states over and Uconn neuromuscular specialists for some reason..) midfoot/rearfoot ankle recon. No charcot, wound care, amps. I have 3 weeks PTO, and got 1 friday a month off for a long weekend.

I should be happy. But the state is not our forever home for me and my wife. She wants to move mack to Michigan to be enar my family, and infact already did move to Traverse City thinking I would find a job easily. Spoiler alert, no jobs....

I get offers all the time and am always looking as I am never satisfied, even though I should be, with a current great job. But we have talked about moving back to MI for the last year and so have been looking. As it stands either I stay here and she moves back and we stay for a while, or I take the best offer I am going to get back in MI. And I need to decide quickly here.

Job offer is in Houghton MI. in the UP at Michigan Tech Uni. 300in of snow per year. (I am from MI and lived here in NE so not a huge deal, but I get seasonal depression anyway unless im back in Miami...)
I have done hundreds of interviews with every type of practice
I cold called and created this position for myself
They gave me everything I asked for.
Orthos there are cool and want someone to handle the trimals and pilons and calc fx that they are currently sending out. General surgeon currently runs the WC center and does the toe amps.
3 year contract
310k base salary
50% bonus after RVU - about 6135 per year. (older orthos took me out for a beer and said get your money up front you will never hit your targets, but its a small town, small hospital, they have 45min patient encounters..)
15k up front, 15k year two start for sign on bonus/relocation
8-5 clinic
3 Wednesdays per month OR time
No call
Every other Friday off
17PTO days, 8 fed holidays, 5 CME days off, 7 days MI accrued sick leave days.

I think I could make it my own and basically function as I am now with my ortho group as the F&A surgeon in a tight knit smaller hospital. Town of 9k maybe, with transient 8k Uni student population. But I may have to do infections, wound care, charcot, etc.
I will have to work 8-5. Yes I know that adulting, but i lose function after 2pm, and I complain to my wife IDK how ppl work till 5pm.
I will have to see more patients and work harder and longer hours.
But I have more time off. More base salary, could be good to make it my own and build my practice.
D1 hockey team, D2 other athletics to be team provider
Only DPM in a 5 hour drive radius, aside from 1 ahole ortho in Marquette who stopped me from another hospital job there as "i was a threat"

Wife wants to be back in MI, planning for kids this year (or was-now near future). Traverse City, or Grosse Pointe, where I am from. But no good jobs there, I have tried. Only crappy PP jobs with crap pay and nail clipping.

My brother is a med mal defense attorney and his wife is a big corporate contract attorney so im covered there.

Any advice on what I should do?
Should I stay at good ortho job, in less desirable location/state?
Should I move back to MI - still undesirable location - up in the UP - Houghton Michigan. Literally 11 hour drive either from where i am now or if i am up there, to see my family...
Will the hospital eff me over?
Will i regret leaving everything I worked for here at current job? (I am done with my initial ego, i have done all the surgeries, i am good at it, prestige of ortho group is great and all...like working with residents, working with state and national societies etc.)
Should I take the hospital job for more money and chance the unknowns? or deny the contract offer and stay here for a few more years? eventually we will want to be back in MI to be near family esp if we have kid(s). But job prospects are crap in lower half of MI. Although I understand my priorities will shift once I have kids and a leisurely PP job may not be so undesirable then.

What is the state of podiatry at this point? I know I am complaining about a situation that most DPMs would only dream of either way. Just want to know what will I look back on in 10 years and say "I wish I had done it/not done it" - I fully understand the reality that after my 3 year hospital contract they will try to bone me and I will probably have to find a new job in MI but at least I will have networked and can find a decent one to settle for bu that point after making some money..

Sorry for long winded post. Any advice or perspective is much appreciated. Thank you very much in advance

Great deal take it

 

[Stormblest]

Sounds like a good deal. I know a guy who took a similar deal in rural New Mexico. Never hits RVU bonus but the hospital doesn’t want to lose their docs because it’s hard to keep them, so they kept his base about the same with small increases every year. Hope you get a similar deal!

 

[air bud]

Cool thanks for the info, thats helpful!!
I know a lot of DPM ortho jobs are glorified PA or non-op positions. maybe thats a factor? From my understanding the sentiment has always seemed that 'good ortho' jobs are the peak for DMPs (although that is very subjective and individual for everyone). Maybe thats the ego of new grads.
And i will say its wayyy better than the PP podiatry supergroup job i took out of residency and better than all the PP/MSG prospects ive seen doing hundreds of interviews thus far. Again individual for everyone, i know, and a lot of factors at play. so maybe no fair to say that.
We dont have a F&A ortho so im it for the group. But as someone else told me, my current position the pay is not great. and with how they screw me over for surgery reimbursement at the surgery center its not gonna ever make me real money. Since i have not bought into the center *yet* the percent i get from my cases is absolutely dismal...so thats a factor as well i suppose

These days Ortho jobs are not great. You can always be replaced and you're surrounded by people who don't treat you as an equal. In hospital jobs, you have administrators and they treat you like any other doctor You produce and they like you. They don't care if you're a podiatrist they're about production and numbers. It goes back to being a lobster. In the ortho group they're just going to look at you as somebody who can't share the call load. They're going to see you as all the things that you can't do not the things that you do to make their life easier

 

[deleted1235332]

At the end of the day whatever makes your family happy. Eventually they’re going to get sick and tired of moving every three years. I’ve come to realize the only freedom from the dreaded job hopping across the state/country is to open up my own..

Also agree with the ortho job evaluation. Definitely depends on the group, but you’re going to be either dumped on/thought as lesser than or both.

 

[nnjjj]

These days Ortho jobs are not great. You can always be replaced and you're surrounded by people who don't treat you as an equal. In hospital jobs, you have administrators and they treat you like any other doctor You produce and they like you. They don't care if you're a podiatrist they're about production and numbers. It goes back to being a lobster. In the ortho group they're just going to look at you as somebody who can't share the call load. They're going to see you as all the things that you can't do not the things that you do to make their life easier

Understood and agree.
--I will say I am still growing my practice within the practice. I took over for a DPM who was seeing 25-30pts per day. So i kinda had to rebuild/still am. So long term it would really be like any other position in that regard. I will also say that, yes I will always be the DPM with MD/DO partners. But I really lucked out. It could have been an ok to poor situation taking the job not knowing much going in, but with this specific group, yeah i cannot take call, but i get side consults, they do the easy fib fx/bimals when on call, and do a **** job fixing them lol, but any difficult stuff they send to me. Its a good group of guys both the older partners and esp the 2 new younger guys who are cool with podiatry and know what we (some of us) can do, and do very well.
--They have had a DPM in the group for the last 30 years (im the 3rd). **They also had a stint a few years ago where they hired a 'F&A orthopod' and let her go after 1 year, and still talk **** about her as she is still in the area/hospital as a solo practice (and i get a lot of 2nd opinions and revisions from her). They know I was trained well and see my results and know im good. YMMV of course. And every group is different and every opinion is different. I get **** from surrounding F&A orthopods, but thats cus I get their unhappy 2nd opinions and revisions and do a better job than them, but yes that still makes me a DPM in the hospital/ortho world - some things never change. And I will say the local region and state I am in - the apathy of podiatry is comically ridiculous. Being in the state board, lecturing, and working with residents, outside the few residency programs, podiatry is overall terrible compared to a lot of other states. I lectured on complex cases once, and other than the few residency faculty DPMs, the room of C&C DPMs were looking at me like I had 1000 heads and couldnt fathom that I was doing that stuff (it was all what i consider normal complex RF, ankle, leg surgeries...). So that tells you a lot about podiatry in general.
--Yeah i will never take call or be their equal but I have them call me when they need help, we double scrub cases, they lean on my expertise as the LE surgeon, if they have a patient they have treated for 20yrs that suddenly has a foot or ankle issue and the patient really likes them and wants them to do the surgery, they will come ask me what i think/help plan, or we will do the case together. So many variables I know, and not every ortho group is like this. in fact i would assume most are not. Which is why I said I really lucked out at my current position.
--And this is the internet. I was looking for career advice from more experienced DPMs. But of course I did not paint a full picture of both options, its impossible to do so here, really. And things tend to get distorted on the internet and forums, as they say - opinions are like aholes, everyone's got one.
--Thus, my conundrum of: do i leave a good position, where I am supported and valued, still with growth potential, and doing what I like and am good at - for the unknown hospital position for more pay (geographic location sucks either way at my current life stage)... really just looking for pros and cons of stable ortho job vs unknown hospital job, as I have never been employed by a hospital with RVU system.

 

[nnjjj]

I do, however, sincerely appreciate all the replies and advice from everyone. Truly appreciate everyone taking the time to give their input. And always open to hearing more! 🙂

 

[nnjjj]

At the end of the day whatever makes your family happy. Eventually they’re going to get sick and tired of moving every three years. I’ve come to realize the only freedom from the dreaded job hopping across the state/country is to open up my own..

Also agree with the ortho job evaluation. Definitely depends on the group, but you’re going to be either dumped on/thought as lesser than or both.

Thanks for advice!
Yeah i cam close twice to buying a solo practice in 2 very desirable areas. Prob should have pulled the trigger on those options. But at the end of the day, my mom, dad, and stepmom are all general dentists with their own practices, and I have seen the benefits of owning a solo practice, but also the cons, and after discussing with them, i realized I am not the type to own a solo practice. Just not for me. But def has a lot of upsides.
(should have just been a dentist and bought their 3 practices and been set, but even in their world, like all medicine, everything is going towards the big Aspen dental groups..and also very over saturated field-my mom recently retired and had a tough time selling her practice, my other parents will as well)

 

[air bud]

Understood and agree.
--I will say I am still growing my practice within the practice. I took over for a DPM who was seeing 25-30pts per day. So i kinda had to rebuild/still am. So long term it would really be like any other position in that regard. I will also say that, yes I will always be the DPM with MD/DO partners. But I really lucked out. It could have been an ok to poor situation taking the job not knowing much going in, but with this specific group, yeah i cannot take call, but i get side consults, they do the easy fib fx/bimals when on call, and do a **** job fixing them lol, but any difficult stuff they send to me. Its a good group of guys both the older partners and esp the 2 new younger guys who are cool with podiatry and know what we (some of us) can do, and do very well.
--They have had a DPM in the group for the last 30 years (im the 3rd). **They also had a stint a few years ago where they hired a 'F&A orthopod' and let her go after 1 year, and still talk **** about her as she is still in the area/hospital as a solo practice (and i get a lot of 2nd opinions and revisions from her). They know I was trained well and see my results and know im good. YMMV of course. And every group is different and every opinion is different. I get **** from surrounding F&A orthopods, but thats cus I get their unhappy 2nd opinions and revisions and do a better job than them, but yes that still makes me a DPM in the hospital/ortho world - some things never change. And I will say the local region and state I am in - the apathy of podiatry is comically ridiculous. Being in the state board, lecturing, and working with residents, outside the few residency programs, podiatry is overall terrible compared to a lot of other states. I lectured on complex cases once, and other than the few residency faculty DPMs, the room of C&C DPMs were looking at me like I had 1000 heads and couldnt fathom that I was doing that stuff (it was all what i consider normal complex RF, ankle, leg surgeries...). So that tells you a lot about podiatry in general.
--Yeah i will never take call or be their equal but I have them call me when they need help, we double scrub cases, they lean on my expertise as the LE surgeon, if they have a patient they have treated for 20yrs that suddenly has a foot or ankle issue and the patient really likes them and wants them to do the surgery, they will come ask me what i think/help plan, or we will do the case together. So many variables I know, and not every ortho group is like this. in fact i would assume most are not. Which is why I said I really lucked out at my current position.
--And this is the internet. I was looking for career advice from more experienced DPMs. But of course I did not paint a full picture of both options, its impossible to do so here, really. And things tend to get distorted on the internet and forums, as they say - opinions are like aholes, everyone's got one.
--Thus, my conundrum of: do i leave a good position, where I am supported and valued, still with growth potential, and doing what I like and am good at - for the unknown hospital position for more pay (geographic location sucks either way at my current life stage)... really just looking for pros and cons of stable ortho job vs unknown hospital job, as I have never been employed by a hospital with RVU system.

35% of collections dude. If they respected you you'd get paid more. The fact that you're in ortho group and probably cut less toenails than somebody in a private practice is cool makes you feel better but you're still not getting paid for your work.

 

[nnjjj]

35% of collections dude. If they respected you you'd get paid more. The fact that you're in ortho group and probably cut less toenails than somebody in a private practice is cool makes you feel better but you're still not getting paid for your work.

whether i see 1 pt a day or 50 pts a day, my salary is 195k base, until i hit 400k, after that i get 35% "bonus".
Therefore i am getting paid 48.75% up until 400k in collections, at which point my percent drops to 35% "bonus"
48.75% not too bad. Bonus is a fake term.

No need to be that negative man. I have thick skin, i dont really care. Constructive criticism is fine. Your sentiment may be true in some regards but not really helpful to deliberately be negative to the point where it contributes nothing to an open discourse. Some ppl like clinic and cutting nails, some like surgery, and thats fine either way. No ego involved, its personal preference. Thats the beauty of podiatry - you can be surgical or non-surgical and work in many different environments. All i was asking is pros and cons between 2 very different job types. This is how the internet goes off the rails.

Also, none of us are getting paid what we should, unless you own your own practice and dont take insurance and only take cash pay.
Unless youre owner or partner, you are always an indentured servant making someone else rich.
If you want to make 450k per year you are seeing 50-60 pts a day forever and getting burnt out.
Most PP groups are gonna offer 30-40% with **** benefits.
Including my salary I get about 287k in total (salary+benefits). Everything is paid for, mal ins, health ins, license fees, 4 organization dues, CME, 401k, etc., everything. Lucky if you find a PP job that will pay for half of that stuff.

 

[eyeeye_captain]

Weirdly got an email asking for locums in Houghton recently, but sadly there’s zero chance of future collaboration. I never think about the UP except when one of my friends mentions camping up there every summer or so for some reason.

The actual pods are obviously better resources for the actual jobs, but a few things from the MD side per usual.

Honestly, I’ll be a surrogate dad - you need a come to the deity of your choice moment about if career advancement, or money, or your family matters more. You’re talking about having kids when your wife has already moved out and your plan is to not wind up in the same ZIP code at the moment. Wake up, kiddo. Cake, eating it too, not happening, no matter how much the relationship seems to be sunshine and rainbows.

If the UP is a good enough speed for you and the wife, cool. If it’s her preference, even better after all that bouncing around. Probably enough catchment to be worthwhile, especially with the pay that will go a long way in a LCOL area. If she’s already gone back home-ish, do you value your professional advancement over your relationship? Agree with Feli that that looks way far away from Traverse if that’s her longer term plan. Clearly the current locale wasn’t/won’t work out as you’ve said.

Small btw’s, surgery pays absolute **** for everyone except maybe employed folks. I’m fairly busy with eyes and I think it will be 5% of my collections this year. Being a team doc also pays little to usually nothing (I’ve done some pro work), but at least it would give you something to do in a place that small if they give you the usual free tickets. Sadly they’re usually corners in the lower bowl, so not the nicest. Might get free food with the press, but less likely with D2.

 

[air bud]

whether i see 1 pt a day or 50 pts a day, my salary is 195k base, until i hit 400k, after that i get 35% "bonus".
Therefore i am getting paid 48.75% up until 400k in collections, at which point my percent drops to 35% "bonus"
48.75% not too bad. Bonus is a fake term.

No need to be that negative man. I have thick skin, i dont really care. Constructive criticism is fine. Your sentiment may be true in some regards but not really helpful to deliberately be negative to the point where it contributes nothing to an open discourse. Some ppl like clinic and cutting nails, some like surgery, and thats fine either way. No ego involved, its personal preference. Thats the beauty of podiatry - you can be surgical or non-surgical and work in many different environments. All i was asking is pros and cons between 2 very different job types. This is how the internet goes off the rails.

Also, none of us are getting paid what we should, unless you own your own practice and dont take insurance and only take cash pay.
Unless youre owner or partner, you are always an indentured servant making someone else rich.
If you want to make 450k per year you are seeing 50-60 pts a day forever and getting burnt out.
Most PP groups are gonna offer 30-40% with **** benefits.
Including my salary I get about 287k in total (salary+benefits). Everything is paid for, mal ins, health ins, license fees, 4 organization dues, CME, 401k, etc., everything. Lucky if you find a PP job that will pay for half of that stuff.

Your job is better than private practice podiatry yes. Stick with it if you want.

If you want to make 200k and not have to work much and get all those Benny's and have security then get a VA job.

In a hospital setting you make 450k seeing 20 to 25 patients a day it's just a different game.

Also I guarantee somebody's already contacted that hospital and said they will take that job.

Okay just read the part about wife moved to traverse City... You're cooked man I'm sorry. I've seen this game.. I lived part of it. Forget about the UP things won't survive. Time for you to open up shop in traverse City and be your own boss.

 

[nnjjj]

Thank you for the input and perspective everyone.
Appreciate you Eye-Captain for surrogate dad advice 🙂 🙂

I should have left out anything with the family or relationship and phrased it: current job vs hospital job. But I appreciate the concern. We have moved a lot for our various training and degrees and jobs and family. We travel a lot for fun. She is from PA, I am from MI. We care for her mom who is in a home and grandpa in PA - two different cities in PA. Her dad and stepmom are back and forth between FL and NC. My parents are in 2 different places in MI. Thats life.

We travel. A lot. Not for everyone. We can have kid(s) anywhere. Then its time to settle down for good when they are in school. I get it.

As i said before either stay here and she will come back without issue, or I take hospital job and she moves with me without issue, and maybe we love it there and stay or in 3 years move south.

There is a lot of speculation on relationship etc. I am sorry it did not work out for some. I only included that as we are planning to move to be closer to family and are caring for family-but thats part of life. We can make it work either place.

Just purely looking for pros and cons to staying at a stable private group vs going to a rural-ish hospital job. And advice from those who have transitioned/worked being hospital employed as that is new to me.

 

[air bud]

Thank you for the input and perspective everyone.
Appreciate you Eye-Captain for surrogate dad advice 🙂 🙂

I should have left out anything with the family or relationship and phrased it: current job vs hospital job. But I appreciate the concern. We have moved a lot for our various training and degrees and jobs and family. We travel a lot for fun. She is from PA, I am from MI. We care for her mom who is in a home and grandpa in PA - two different cities in PA. Her dad and stepmom are back and forth between FL and NC. My parents are in 2 different places in MI. Thats life.

We travel. A lot. Not for everyone. We can have kid(s) anywhere. Then its time to settle down for good when they are in school. I get it.

As i said before either stay here and she will come back without issue, or I take hospital job and she moves with me without issue, and maybe we love it there and stay or in 3 years move south.

There is a lot of speculation on relationship etc. I am sorry it did not work out for some. I only included that as we are planning to move to be closer to family and are caring for family-but thats part of life. We can make it work either place.

Just purely looking for pros and cons to staying at a stable private group vs going to a rural-ish hospital job. And advice from those who have transitioned/worked being hospital employed as that is new to me.

Then go get that hospital job locked down now. You will grow immensely from that. Will give you the skills to get any job you want after that. " Hey I was the main podiatrist for a 5 hour radius doing trauma, infection, reconstruction. When you are the only option, you see all your follow-ups you see all your successes and all your failures. I became a better surgeon as a result of it nobody was going to go to the other guy down the street when they were unhappy with me. There was nobody to bail me out or refer to"

That's going to get any job you want if you ever decide to leave that hospital.

Some days are going to be slow some days are going to be busy. You're on an island there is no break. You see these people at the grocery store kids go to school together You play rec league hockey with them. That's how I spent my whole career being the only pod in town in rural settings. I love it. If you want to just hide and go to work and go home and check out and be anonymous then this is not the job if you enjoy that set up then this is a great job.

 

[nnjjj]

Then go get that hospital job locked down now. You will grow immensely from that. Will give you the skills to get any job you want after that. " Hey I was the main podiatrist for a 5 hour radius doing trauma, infection, reconstruction. When you are the only option, you see all your follow-ups you see all your successes and all your failures. I became a better surgeon as a result of it nobody was going to go to the other guy down the street when they were unhappy with me. There was nobody to bail me out or refer to"

That's going to get any job you want if you ever decide to leave that hospital.

Some days are going to be slow some days are going to be busy. You're on an island there is no break. You see these people at the grocery store kids go to school together You play rec league hockey with them. That's how I spent my whole career being the only pod in town in rural settings. I love it. If you want to just hide and go to work and go home and check out and be anonymous then this is not the job if you enjoy that set up then this is a great job.

Thanks that is a great perspective as well, much appreciated!

 

[Sendin_Toes_2market]

whether i see 1 pt a day or 50 pts a day, my salary is 195k base, until i hit 400k, after that i get 35% "bonus".
Therefore i am getting paid 48.75% up until 400k in collections, at which point my percent drops to 35% "bonus"
48.75% not too bad. Bonus is a fake term.

No need to be that negative man. I have thick skin, i dont really care. Constructive criticism is fine. Your sentiment may be true in some regards but not really helpful to deliberately be negative to the point where it contributes nothing to an open discourse. Some ppl like clinic and cutting nails, some like surgery, and thats fine either way. No ego involved, its personal preference. Thats the beauty of podiatry - you can be surgical or non-surgical and work in many different environments. All i was asking is pros and cons between 2 very different job types. This is how the internet goes off the rails.

Also, none of us are getting paid what we should, unless you own your own practice and dont take insurance and only take cash pay.
Unless youre owner or partner, you are always an indentured servant making someone else rich.
If you want to make 450k per year you are seeing 50-60 pts a day forever and getting burnt out.
Most PP groups are gonna offer 30-40% with **** benefits.
Including my salary I get about 287k in total (salary+benefits). Everything is paid for, mal ins, health ins, license fees, 4 organization dues, CME, 401k, etc., everything. Lucky if you find a PP job that will pay for half of that stuff.

You will not be cost effective at a hospital for 10-15 patients a day. Thats not a good pace for 4 years out. I do 7000wrvu in clinic alone, 2000 literally from PF… I see 22.5 a day from this weeks numbers. DO NAIL initial consults and see 2x a year for that e/m wRVU.

12.5 Pt per day x 4 days a week x 48 weeks x 1.5 wrvu per patient is 3600 wRVU.

Do you have vascular?

[edit] Family is everything I would take the job. You will hit 6000+ RVU, if you keep the same case load a month and increase clinic to 20. But it is up to you how you build it. Depends on inpatient need. Never underestimate how far people will drive to see a podiatrist.

 

[air bud]

You will not be cost effective at a hospital for 10-15 patients a day. Thats not a good pace for 4 years out. I do 7000wrvu in clinic alone, 2000 literally from PF… I see 22.5 a day from this weeks numbers. DO NAIL initial consults and see 2x a year for that e/m wRVU.

12.5 Pt per day x 4 days a week x 48 weeks x 1.5 wrvu per patient is 3600 wRVU.

Do you have vascular?

[edit] Family is everything I would take the job. You will hit 6000+ RVU, if you keep the same case load a month and increase clinic to 20. But it is up to you how you build it. Depends on inpatient need. Never underestimate how far people will drive to see a podiatrist.

1.5 is low ....you should be 2 plus.

And yes when you are the only pod at a hospital 20ish is all you can see in a day doing all new patients.

But also I have been at really rural hospitalals... It's a different animal and 12 to 15's not unreasonable at some point there's only so many people there.

 

[Stormblest]

I see about 15-20 a day but it’s usually about 8-10 new patients. I try to make people prn as much as possible so I can get more new patients in.

 

[Hybrocure]

I see about 15-20 a day but it’s usually about 8-10 new patients. I try to make people prn as much as possible so I can get more new patients in.

Having half your patients being new patients is wild. Is this normal? Tbh like a quarter of my patients are new patients day to day in PP

 

[Sendin_Toes_2market]

Having half your patients being new patients is wild. Is this normal? Tbh like a quarter of my patients are new patients day to day in PP

Right now i have 25% new.

I see about 15-20 a day but it’s usually about 8-10 new patients. I try to make people prn as much as possible so I can get more new patients in.

Competing hospital pod does this and scheduler didnt let their infected bunion make an emergency visit a while back. So they went to my ER. Never underestimate how incompetent hospital secretaries are.

 

[Bluecollarmed]

I’m in the 12-15 patient most days. Last clinic day was 14 and 10 were new patients, 2 were established new problem so new imaging or referral to PT etc . It’s nice to talk about just see more up to 20-25 and you’ll make better money. But like airbud said there’s only so many people. It not like I’m capping my schedule at 15. I have days that will be over 20 but it’s post op days where half are in a global. Again, hospitals just want to own the foot and ankle production if they haven’t had a position before. They also get a facility fee for all patients because it’s likely a hospital based clinic and not a standalone (YMMV).

 

[air bud]

Right now i have 25% new.


Competing hospital pod does this and scheduler didnt let their infected bunion make an emergency visit a while back. So they went to my ER. Never underestimate how incompetent hospital secretaries are.

Oh yeah I forgot about other pod in group....still 1.5 seems low.

 

[air bud]

I see about 15-20 a day but it’s usually about 8-10 new patients. I try to make people prn as much as possible so I can get more new patients in.

This is the way. Same. I am at 20-22 a day and 10-12 new. I have only been here 14 months and am only surgical pod in area and only pod in system. Does it stay that way forever....maybe. remember 3 years is time period for a "new" patient.

 

[Sendin_Toes_2market]

Oh yeah I forgot about other pod in group....still 1.5 seems low.

I am a actually averaging. 1.8 per encounter at a community hospital. Very minimal in house work maybe. 1-2 cases a week max. I am getting flooded with nails at one location. Working on limiting those. For me I do diabetics/pvd and I basically do the group home for people with cognitive disabilities(almost 800 people in our county system). The issue is my staff blocking off 30+ minutes for new nail visit and 20 minute for follow up when it should be 15 min. I also do not see nails in afternoon clinic.

Will not hit bonus significantly this year due to anesthesia issues in hospital. Currently only doing MIS floating osteotomies, wound care sx and offloading hammettoes. If I had vascular and anesthesia regularly would doing more. I have 25-30 bunions/1st mtpj fusions, 4 evans/cottons, PTT transfer for drop foot, 9 haglunds/zadek, 2-3 bronstroms, a few ankle stabilization stuff booked out. Limited to 2 cases a week for electives .5 day. 1 if I do a flat foot. I should be doing about 15 cases a month and was at about 13 per month. I realistically do not want to 20+. I hate sitting around OR.

It’s rough in smaller hospitals is why people on here judged me for my contract with low RVU but 300k+ base. I am happy with my 30k bonus.

 

[dtrack22]

Does it stay that way forever....maybe.

No, it does not. But if you can limit what pathology you get in clinic and you don’t get much Medicaid then it doesn’t get much worse. But your wRVU per encounter will drop with increased surgical volume and length of employment.

 

[air bud]

No, it does not. But if you can limit what pathology you get in clinic and you don’t get much Medicaid then it doesn’t get much worse. But your wRVU per encounter will drop with increased surgical volume and length of employment.

Why would Medicaid drop that? I love my Medicaid clinic get great surgical pathology. And am getting a NP so less post ops. Also refusing almost all nails other than history of revasc (maybe not even them)....ok so if NP sees a patient first then sends to me...if that still a new patient? They will have their own taxonomy code line Ortho does if they send to podiatry

 

[dtrack22]

Why would Medicaid drop that?

Because they don’t pay for anything and come back for any and all BS that they complain about to their PCP or your receptionist just schedules them without checking on if they’ve exhausted their number of approved visits (or referral timeline depending on how the state handles that).

ok so if NP sees a patient first then sends to me...if that still a new patient?

Not if they are in your clinic. It’s a follow up visit.

 

[deleted1235332]

Not if they are in your clinic. It’s a follow up visit.

Really? Isn’t it a different taxonomy code so it’d be a new patient? How is this any different than a podiatrist in an ortho group billing a new visit when patient has seen other providers in the practice?

 

[Toenail]

Why would Medicaid drop that? I love my Medicaid clinic get great surgical pathology. And am getting a NP so less post ops. Also refusing almost all nails other than history of revasc (maybe not even them)....ok so if NP sees a patient first then sends to me...if that still a new patient? They will have their own taxonomy code line Ortho does if they send to podiatry

You cancel the nails on the schedule? Admin won’t let me so I see hordes of them once and PRN nearly all of them but there is an endless supply of nails. The new ones get no more than 10 mins of my time. “No it can’t be cured and no I won’t file them, and I have no idea if insurance will pay”

 

[Stormblest]

I have had issues with scheduler not stratifying patients well. I told them if there’s an ingrown, possible infection, wound, fracture, etc. they can double book or put them on at the end of the day if needed.

I get hardly any trauma because it mostly gets referred to ortho but every once in awhile there is a missed lisfranc or Jones fx that comes in. I’m kinda ok with it because it makes my life less stressful.

 

[Feli]

Having half your patients being new patients is wild. Is this normal? Tbh like a quarter of my patients are new patients day to day in PP

Now that a new pt 99203 pays less than 99214, there is fairly little incentive to see a ton of new in PP. New pts can definitely be more likely to be DME or OTC or procedure and the like, but they're also significantly more risk of problems with insurance, no show, drama, all that. It can be a risk to get rid of a proven winner in favor of an unknown. There are only a finite number of well-insured pts in any area/city/etc. Ergo, even before the E/M value changes, a lot of the goal in PP is to retain established patients with good insurance for quarterly injects, RFC, DM exams/shoes, verruca f/u, PT or DME checks, etc etc. If you want to see the most productive PP docs in any area, it's typically who has the best payer mix... not necessarily who see the most, sees the most new pts, does most surgery, does nonsense services ABC, etc. It's largely about attracting and retaining those good payer pts and that payer mix in the long run... even if you prn some and they come back for something else or send a friend/fam/colleague with same/similar good payer plan.

Hospital productivity/income is much more on procedures/surg (rvu) volume, so if pts don't need that stuff, usually good to prn them asap (or prn even some new pt proc like injects or nails etc). When insurance matters little/none, you really only want to keep wound care pts or pts tracking to surgery soon. It's a lot less about what insurance they have, so it's a whole lot easier to "go fish" and prn ppl.

 

[dtrack22]

Really? Isn’t it a different taxonomy code so it’d be a new patient? How is this any different than a podiatrist in an ortho group billing a new visit when patient has seen other providers in the practice?

Really. The Nurse Practitioner in this case is practicing in a podiatry clinic, and is considered to have already provided Podiatric care to the patient they are sending you, under the same group NPI. Regardless of their taxonomy code, It’s an established patient encounter. It’s only a new patient if the NP is not practicing the same specialty.

The taxonomy code will get a claim to get through first pass without being rejected. But the government could fine you and a commercial insurer can try and claw back money if they find out you billed a new patient encounter after your NP already billed a new patient encounter for the same patient. That’s fraudulent billing.

 

[air bud]

You cancel the nails on the schedule? Admin won’t let me so I see hordes of them once and PRN nearly all of them but there is an endless supply of nails. The new ones get no more than 10 mins of my time. “No it can’t be cured and no I won’t file them, and I have no idea if insurance will pay”

My front office lady is a boss and she doesn't put them on the schedule in the first place. My PCP are good about not sending.

 

[air bud]

I have had issues with scheduler not stratifying patients well. I told them if there’s an ingrown, possible infection, wound, fracture, etc. they can double book or put them on at the end of the day if needed.

I get hardly any trauma because it mostly gets referred to ortho but every once in awhile there is a missed lisfranc or Jones fx that comes in. I’m kinda ok with it because it makes my life less stressful.

Non op trauma is the best. Toe fractures....level 4 I reviewed the x-ray and we discussed nonoperative and operative care. I would recommend not operative treatment. Follow up PRN.

 

[Adam Smasher]

Non op trauma is the best. Toe fractures....level 4 I reviewed the x-ray and we discussed nonoperative and operative care. I would recommend not operative treatment. Follow up PRN.

I doubt that stands up to scrutiny. I don't know what is the official definition of an "acute complicated injury" but if it can be prn'ed it probably isn't that complicated. Maybe you're reporting data points and maybe that gets you over the edge. Or social dets of health. And maybe the decision to not operate counts as a decision regarding surgery.

FWIW I want you to be able to bill as much as you can, I want you to make as much money as possible, but it's the payers' decision, not mine.

 

[air bud]

I doubt that stands up to scrutiny. I don't know what is the official definition of an "acute complicated injury" but if it can be prn'ed it probably isn't that complicated. Maybe you're reporting data points and maybe that gets you over the edge. Or social dets of health. And maybe the decision to not operate counts as a decision regarding surgery.

FWIW I want you to be able to bill as much as you can, I want you to make as much money as possible, but it's the payers' decision, not mine.

I independently evaluated the x-ray. The hospital radiologist reads all xrays. I discussed operative and non-operative intervention. That's a level four. It's reasonable to fix a toe fracture I promise you can find some TFPs that do.

 

[Toenail]

My front office lady is a boss and she doesn't put them on the schedule in the first place. My PCP are good about not sending.

Lucky you. The hordes of nail zombies light up the PCPs when they can’t figure out where to send them and then this trickles up to administration who then passes the buck onto podiatry.

 

[Stormblest]

Lucky you. The hordes of nail zombies light up the PCPs when they can’t figure out where to send them and then this trickles up to administration who then passes the buck onto podiatry.

Running joke in residency was that DM nail patients will always show up to their appointment despite bad weather, death in the family, apocalyptic event, etc. Sadly it was kinda true even when there was terrible weather they were still coming in!

 

[air bud]

Lucky you. The hordes of nail zombies light up the PCPs when they can’t figure out where to send them and then this trickles up to administration who then passes the buck onto podiatry.

Your administration does not know your value then. They have zero interest in you seeing nails if they actually want to make money and want you to be happy. Yes I consider myself very lucky.