DPM Success Stories

[Sendin_Toes_2market]

Advertisement - Members don't see this ad

In PP I find it hard getting cases tbh unless you press patients into stuff. I’m curious how many of these hospital employed x call week cases per week are inpatient cases vs electives. I trained at a hospital where while you might be on call once a week every 6 weeks you still had to deal with some sort of inpatient bs at all times and rotating personal patients coming back in for hospital surgeries on your “off” weeks

I am hospital employed. No Vascular and our IR only does veins. I do 1.5 IP a week- amp and delayed closure at my lunch time. occasionally 2-3 for biopsy. I don't push people into surgery. I did an austin and a lapidus last week. We have a CRNA gap so I am limited to 2-3 cases elective a week. My OR wont let me do OP isolated hammertoe mis at lunch of my clinic day, even though that block is open. Its frustrating as this slightly tanks my RVUs with low RVU cases on my limited block time. I don't take call so a lot of stuff gets sent out. If I get a PA or NP who helps me with call and rounds I can probably do 10-12 cases a week. I dont think that will happen. I share ortho PAs available for scrubbing if need be and gensurg PA is lazy to see floor patients or do cases. I don't do a lot of ankle fractures due to ortho f&a all tendon stuff is mine. Bronstrom is 30 minutes skin to skin for me. Averaging 3.5 cases a week last 5 weeks due to external issues without patient shortage.

My hospital has facility owned urgent cares, but F&A ortho had been sending everything out. Currently working on getting those referrals to me.

My hospital is extremely happy. Their goal is 5 cases a week IP and OP long term year 3. By year 3 will probably be at 7.5 cases a week without any changes. Ortho PAs dont want go touch stinky feet, only my bunions and fractures.

Its not all peachy.

 

[air bud]

In PP I find it hard getting cases tbh unless you press patients into stuff. I’m curious how many of these hospital employed x call week cases per week are inpatient cases vs electives. I trained at a hospital where while you might be on call once a week every 6 weeks you still had to deal with some sort of inpatient bs at all times and rotating personal patients coming back in for hospital surgeries on your “off” weeks

When you see MSK all day it's easy to get surgery. Let's say I see tops 80 patients in a week.... I cut three maybe four toenails. If everybody's coming in for neuromas and bunions and ankle pain and Achilles pain etc eventually you're going to generate some surgery. Still surgery is what it is. Make more money in clinic. In my community everyone employed by one system. Ortho does most ankle fractures I do other foot trauma. But they send me all their non operative ankles. I will take non op ER trauma ALL DAY ERRR DAY. Easy level 4s. Review the ER note, independently evaluate the x-ray....oh Mrs jones here is conservative and surgical options but I recommend non op. Here is your boot, PT referral and a milkshake have a good day.

 

[eyeeye_captain]

Still surgery is what it is. Make more money in clinic…. I will take non op ALL DAY ERRR DAY.

 

[Toenail]

In PP I find it hard getting cases tbh unless you press patients into stuff. I’m curious how many of these hospital employed x call week cases per week are inpatient cases vs electives. I trained at a hospital where while you might be on call once a week every 6 weeks you still had to deal with some sort of inpatient bs at all times and rotating personal patients coming back in for hospital surgeries on your “off” weeks

I think it just comes more naturally to folks that went to good surgical residency programs where they did a large surgical volume involving the entire foot and ankle and not just the toes. When the only tool one has is a nipper then everything is a toenail.

 

[air bud]

I think it just comes more naturally to folks that went to good surgical residency programs where they did a large surgical volume involving the entire foot and ankle and not just the toes. When the only tool one has is a nipper then everything is a toenail.

Those are some strong words coming from this guy

And yes, I'm in a place with a lot of outdoor activity. The surgery I did the most this year was ankle scope and internal brace.... Well other than amputations. I should have final numbers in a few days I'll probably end up with 200 plus surgeries my very first year building this program from scratch. Will be interesting to see how much was hind foot. In my previous state where let's just say everybody was very robust.... I did a ton of hind foot fusions. I haven't done any hindfoot fusions here much more athletic population much more ankle scope lateral ankle repaired perineal tendon type stuff.

This is why we say training matters. This is why we say you got to get hind foot stuff and hind foot certification.

 

[Bluecollarmed]

In PP I find it hard getting cases tbh unless you press patients into stuff. I’m curious how many of these hospital employed x call week cases per week are inpatient cases vs electives. I trained at a hospital where while you might be on call once a week every 6 weeks you still had to deal with some sort of inpatient bs at all times and rotating personal patients coming back in for hospital surgeries on your “off” weeks

I'm in my second year out at a CAH so there's not much true inpatient load, maybe did 20 inpatient amp/I&D/ankle scope washouts. I have 4-6 elective/fracture cases every week. I do a decent amount of MIS which has been great and people come looking for it. Its the first time this hospital has had a pod employed (local PP did cases here occasionally prior) so build up was a little slow. Now 15 per day in clinic is average. When you're the foot and ankle doc in a system people funnel. I've done more ankle fractures than any other case so average OR day is ankle fx or other foot fx, MIS bunion or mtp fusion, and some variety of scope lat stab, etc. Quick easy HT, neuroma, deep peroneal neurectomy type stuff also funnels in so some of the OR days i'll stack heavy if I know I have vacation coming up. Helps having a flip rooms (lets start that thread and get people fired up).

 

[Sendin_Toes_2market]

I'm in my second year out at a CAH so there's not much true inpatient load, maybe did 20 inpatient amp/I&D/ankle scope washouts. I have 4-6 elective/fracture cases every week. I do a decent amount of MIS which has been great and people come looking for it. Its the first time this hospital has had a pod employed (local PP did cases here occasionally prior) so build up was a little slow. Now 15 per day in clinic is average. When you're the foot and ankle doc in a system people funnel. I've done more ankle fractures than any other case so average OR day is ankle fx or other foot fx, MIS bunion or mtp fusion, and some variety of scope lat stab, etc. Quick easy HT, neuroma, deep peroneal neurectomy type stuff also funnels in so some of the OR days i'll stack heavy if I know I have vacation coming up. Helps having a flip rooms (lets start that thread and get people fired up).

What was your time frame ramping up from
initial to the volume you are at now?

 

[Feli]

7 cases per week seeing 20 pts per day?

When you take call and inpt work, a much higher percentage of that is surgery.
Also keep in mind that a lot of hospital pods do nearly all I&D or amp as delay closure, so almost every amp or I&D becomes two cases (or more... for "grafts" and revisions and stuff).

It's just almost opposite day hospital pod to PP pod... hospial guy welcomes ER trauma and inpt or WCC wound care while PP usually avoids it (unless the need the scratch to start up or to compete in a satured area). Hospital guy doesn't mind the bad insurance or complications, but PP wants to steer around that to the greatest extent possible.

In PP I find it hard getting cases tbh unless you press patients into stuff. I’m curious how many of these hospital employed x call week cases per week are inpatient cases vs electives. ...

In PP, you're right that there is a lower rate of clinic pts that become surgery pts. (and probably little/no surge pts from inpts/call for PP)
I'd say the clinic rate difference is mainly due to

1. more routine care visits in PP
2. less eager to do surgery in PP due to time suck, risk of malprac or bad reviews or hassle, and mainly better $ just seeing more office pts (while podiatrist working for hospital slants to sugery due to more $ versus clinic, surgery less risk for them as hospital pays malprac, and they're already at hospital).

The exception is the the guy(s) in a pod group that do the bigger surgery or get refers from other DPMs in the area. They will have a higher surgery percentage in office... although this DPM type is a bit of a dying breed now that every new grad thinks they do TARs and cavus foot recons (when a lot can barely do Lapidus or fibula Haglund right). They still definitely exist, though.

 

[air bud]

When you take call and inpt work, a much higher percentage of that is surgery.
Also keep in mind that a lot of hospital pods do nearly all I&D or amp as delay closure, so almost every amp or I&D becomes two cases (or more... for "grafts" and revisions and stuff).

It's just almost opposite day hospital pod to PP pod... hospial guy welcomes ER trauma and inpt or WCC wound care while PP usually avoids it (unless the need the scratch to start up or to compete in a satured area). Hospital guy doesn't mind the bad insurance or complications, but PP wants to steer around that to the greatest extent possible.


In PP, you're right that there is a lower rate of clinic pts that become surgery pts. (and probably little/no surge pts from inpts/call for PP)
I'd say the clinic rate difference is mainly due to

1. more routine care visits in PP
2. less eager to do surgery in PP due to time suck, risk of malprac or bad reviews or hassle, and mainly better $ just seeing more office pts (while podiatrist working for hospital slants to sugery due to more $ versus clinic, surgery less risk for them as hospital pays malprac, and they're already at hospital).

The exception is the the guy(s) in a pod group that do the bigger surgery or get refers from other DPMs in the area. They will have a higher surgery percentage in office... although this DPM type is a bit of a dying breed now that every new grad thinks they do TARs and cavus foot recons (when a lot can barely do Lapidus or fibula Haglund right). They still definitely exist, though.

this is all correct. Inpatient surgery makes sense for hospital pods. not for PP

Edit - inpatient work

 

[Bluecollarmed]

What was your time frame ramping up from
initial to the volume you are at now?

I'd say it took at good 8-9 months to get a consistent 12-17 people on a clinic day. You'd have days early on with 15 or so but some days were very slow. It gave me time as a new grad and new position to the hospital to create some work flows and protocols though which honestly was great. Some of those early months before ramping up elective cases were very dependent on trauma/infection for production. Hospital CFO said based on MGMA it takes 3 years to get to average production which was around 5800 wrvu if I remember correctly. I only did 4500 first year out with those early slow months. We'll see how consistent it stays but I have a relatively solid base that stays so I'll "never" be full production.

 

[GreenHousePub]

In PP I find it hard getting cases

Why would you want to anyways in that situation? None of this stuff pays well.

 

[Weirdy]

Why would you want to anyways in that situation? None of this stuff pays well.

All of mine have been out of necessity.
Fusion for symptomatic arthritis
Lot of toe amps

The groups near me are doing all kinds of stuff on all sorts of people.

 

[de Ribas]

When you take call and inpt work, a much higher percentage of that is surgery.

Yes, but I thought they said call was only like every 7-8wks. Idk, doesnt make sense to me. If you are hospital employed, I cant imagine seeing 20pts a day. Are they telling the hospital they won't see more than than 20 pts per day?

 

[air bud]

Yes, but I thought they said call was only like every 7-8wks. Idk, doesnt make sense to me. If you are hospital employed, I cant imagine seeing 20pts a day. Are they telling the hospital they won't see more than than 20 pts per day?

You are basically on "call" all the time like me if it's a small hospital and it's just you. Or 1:2 or 1: 3 if partners. But that time is built into your schedule.

Hospital work is easy when your office is across the parking lot and you round before or after clinic or between surgery.

I only see maybe 5 to 7 inpatients a month so it's not over whelming. As we have discussed...there isn't really anything to urgent except gas. You are not being called at night. Patient comes in 6pm through ER? Hospitaliat texts you at 7AM the next day. says hey this guy came in he is NPO. YMMV

And again, when you see all MSK and 12 plus are new....those are 30 min appts. Almost all those new patients are level 4s. Hard to do a good job, give patients attention they deserve and see more than 23-25.

Clipping nails...sure enjoy your 35 plus a day.

You can make 400k plus easily seeing 20 patients a day, 4 to 6 surgeries a week in a hospital setting.

Big urban centers? Or even medium city yeah it's not like this. Small community hospital like I am at and many other pods are at (more friendly Ortho....) this is what life is like.

 

[Dr.PatchAdams]

Yes, but I thought they said call was only like every 7-8wks. Idk, doesnt make sense to me. If you are hospital employed, I cant imagine seeing 20pts a day. Are they telling the hospital they won't see more than than 20 pts per day?

Imagine more than one hospital, double digit partners, and full scope MSK pathology and it will make more sense.

 

[eyeeye_captain]

So today’s DPM success story - I had 3 retinal detachments bumped for a toe/wound case. Guess I pay my debts for being allowed to hang out here

 

[air bud]

So today’s DPM success story - I had 3 retinal detachments bumped for a toe/wound case. Guess I pay my debts for being allowed to hang out here

Bro. Detaching a toe is more important than reattaching a retina. Eyeball? Seeing? Doc is my balance going to be ok missing a 4th toe? I haven't had zone 2 cardio in 30 years.

 

[Weirdy]

Bro. Detaching a toe is more important than reattaching a retina. Eyeball? Seeing? Doc is my balance going to be ok missing a 4th toe? I haven't had zone 2 cardio in 30 years.

"Will this nail ever grow back??"

 

[Bluecollarmed]

You are basically on "call" all the time like me if it's a small hospital and it's just you. Or 1:2 or 1: 3 if partners. But that time is built into your schedule.

Hospital work is easy when your office is across the parking lot and you round before or after clinic or between surgery.

I only see maybe 5 to 7 inpatients a month so it's not over whelming. As we have discussed...there isn't really anything to urgent except gas. You are not being called at night. Patient comes in 6pm through ER? Hospitaliat texts you at 7AM the next day. says hey this guy came in he is NPO. YMMV

And again, when you see all MSK and 12 plus are new....those are 30 min appts. Almost all those new patients are level 4s. Hard to do a good job, give patients attention they deserve and see more than 23-25.

Clipping nails...sure enjoy your 35 plus a day.

You can make 400k plus easily seeing 20 patients a day, 4 to 6 surgeries a week in a hospital setting.

Big urban centers? Or even medium city yeah it's not like this. Small community hospital like I am at and many other pods are at (more friendly Ortho....) this is what life is like.

This is essentially my setup as well. I've seen the revenue sheets for the hospital on less than 20 per day average and 5 cases per week. Hospitals are doing just fine and they cater to their docs because they understand most people (incorrectly for pods) don't want to work in rural or smaller cities. My only days over 20 pts have been post op days with ED fracture follow ups and nail avulsions thrown in.

 

[footpainhealer]

And again, when you see all MSK and 12 plus are new....those are 30 min appts. Almost all those new patients are level 4s. Hard to do a good job, give patients attention they deserve and see more than 23-25.

Now 15 per day in clinic is average.

The dichotomy of this vs other practices I have encountered that schedule (or that management schedules) 6 patients every 60 minutes regardless of if its nails, new patient Charcot, post-ops, new patient ED referral-achilles rupture, new peds MSK, or wound that's now infected etc...... is fascinating.
Especially the people with no PA/NP/residents/scribes that have 4-8 patients scheduled per hour.

I agree with Airbud. And I'm not sure how these places manage to not piss off patients constantly haha. Especially the private practices that do this. Just seems like a pathway to bad reviews and messed up notes cause you're bound to miss or forget things when you are going door to door with no time to document or talk to patients in-depth.

 

[Stormblest]

Hospital employed. I see 15-20 a day and it’s usually 5-10 new patients and I feel like I’m falling behind constantly. I only have one nurse helping me though. If I had another I maybe could increase to 25 a day. Can’t fathom doing 30+ unless it was heavily nail care. Also have inpatient work to consider which is usually 1-2 inpatients at most.

There was a PP guy I met at a conference who claimed he was seeing 50+ patients a day in clinic and he didn’t do any nails…

 

[Feli]

Hospital employed. I see 15-20 a day … I feel like I’m falling behind constantly.

VA or IHS?

...you will get more efficient with pts and with charting as you keep at it. Work on templates.
That is a half day patient load at most PPs for pod, MSG, ortho, etc.

My honest guess is you're just over-explaining things or doing full physical exam nearly every time... I got a lot better at that 5, 10, etc years out than I was early on. You really only need the full exam for DM new pts and some really tough ones that are hard to figure out. It's generally best to just be focused, efficient and mostly social convo... they are there for the problem fixed well and quick. Most don't care about the minutia from our books, boards; all that is mostly just noise to them. They already know you have a white coat and plaques on the wall. The [very few] patients who want to know more info or options will ask (and they get a tiiiny bit more... and a "meet me at the front for an info handout" to get them heading up to the desk for checkout 🙂 ).

...There was a PP guy I met at a conference who claimed he was seeing 50+ patients a day in clinic and he didn’t do any nails…

It's all a matter of how you're paid:
If it's PP on percentage (even if you're owner), you have to go quicker, do more... just to get paid. You learn how to.
If it's hospital with mostly salary, there is very little incentive to see any more than the minimum. It's often best to block/limit your schedule.

And for the guy you talked to, he didn't do many/any nails... MAs do it, and he just does the chart or pops in at the end to do a cursory exam (dentist style).

 

[Feli]

The dichotomy of this vs other practices I have encountered that schedule (or that management schedules) 6 patients every 60 minutes regardless of if its nails, new patient Charcot, post-ops, new patient ED referral-achilles rupture, new peds MSK, or wound that's now infected etc...... is fascinating....

That is pretty aggro, but it can be done with enough MA staffing and training. A lot of practices run that way.
Those ones also tend to get a lot of no-shows, bad reviews, turnover. It is a cluster when all scheduled pts show up.

There is a middle ground imo, but each office will run how it runs. That is why owner is so good: your % of collections goes WAY up, so you can see fewer and still make ends meet fairly well. I could add 10pts/day if I had another room and MA, but I dont' really want that many more notes, phone calls, Rx refills, tests to chase down, staff to manage, overall issues.

Most docs and offices will push it... esp if they are in the 30% non-owner role (and the office might push it onto them even if they don't want more volume). It is a cold bucket of water in the face when those pod supergroups take away the base for just the 35% or 30% or whatever. Associate is really lame because you get the double drag of low % AND no ability to controls the schedule, staffing, supplies, marketing, etc system. I sure don't miss it.

 

[Hybrocure]

Hospital employed. I see 15-20 a day and it’s usually 5-10 new patients and I feel like I’m falling behind constantly. I only have one nurse helping me though. If I had another I maybe could increase to 25 a day. Can’t fathom doing 30+ unless it was heavily nail care. Also have inpatient work to consider which is usually 1-2 inpatients at most.

There was a PP guy I met at a conference who claimed he was seeing 50+ patients a day in clinic and he didn’t do any nails…

Damn you have a nurse? I just have MAs

 

[de Ribas]

You are basically on "call" all the time like me if it's a small hospital and it's just you. Or 1:2 or 1: 3 if partners. But that time is built into your schedule.

Hospital work is easy when your office is across the parking lot and you round before or after clinic or between surgery.

I only see maybe 5 to 7 inpatients a month so it's not over whelming. As we have discussed...there isn't really anything to urgent except gas. You are not being called at night. Patient comes in 6pm through ER? Hospitaliat texts you at 7AM the next day. says hey this guy came in he is NPO. YMMV

And again, when you see all MSK and 12 plus are new....those are 30 min appts. Almost all those new patients are level 4s. Hard to do a good job, give patients attention they deserve and see more than 23-25.

Clipping nails...sure enjoy your 35 plus a day.

You can make 400k plus easily seeing 20 patients a day, 4 to 6 surgeries a week in a hospital setting.

Big urban centers? Or even medium city yeah it's not like this. Small community hospital like I am at and many other pods are at (more friendly Ortho....) this is what life is like.

Well, I get all that. I was replying to a post saying that they work 4 days a week and seeing 20 pts a day in clinic and pumping 7 cases a week. No mention of inpatient load. If cases are coming from inpatient work like Feli mentioned, for example, then that is a whole other story. Inpatient work takes time no matter how close you are to the hospital. But if cases come from inpatient, I get that. But that's not what the post said.

Again, I understand hospital based practice very well. I was just simply replying to the unrealistic picture of working 4 days a week, seeing 20 pts and pumping 7 surgeries per week. There is more to that than that simple representation.

12 plus are new.

12 new pts per 20 pts a day? What happens to postops and follow ups? Someone else sees them? You guys paint unrealistic picture where hospital employed docs work 4 days a week seeing 20 pts a day of which 12 are new and you guys pump 7 cases per week.

 

[air bud]

Well, I get all that. I was replying to a post saying that they work 4 days a week and seeing 20 pts a day in clinic and pumping 7 cases a week. No mention of inpatient load. If cases are coming from inpatient work like Feli mentioned, for example, then that is a whole other story. Inpatient work takes time no matter how close you are to the hospital. But if cases come from inpatient, I get that. But that's not what the post said.

Again, I understand hospital based practice very well. I was just simply replying to the unrealistic picture of working 4 days a week, seeing 20 pts and pumping 7 surgeries per week. There is more to that than that simple representation.


12 new pts per 20 pts a day? What happens to postops and follow ups? Someone else sees them? You guys paint unrealistic picture where hospital employed docs work 4 days a week seeing 20 pts a day of which 12 are new and you guys pump 7 cases per week.

Yeah. Turn and burn. As you get further into practice you learn more who needs to follow up and who doesn't. You don't need that stress fracture to come back once they transition to a shoe. Tell them how to transition come back if you need to. That patient that comes in with PF and is 3/10. Inject OTC orthotics (walk hero) meloxicam and stretch.....cool you will be 100 eventually, here is how you prevent it coming back.... basically what you would say at the next appt.

You should be annoyed when a patient comes back and says all good bro thanks.

If you don't come back I assume you listened to me and got better.

I want room for new patients new pathology.

 

[Adam Smasher]

My secretary used to work in the ortho group where our local Fellowship Trained Foot and Ankle Surgeon™️works and she's got stories...apparently he would schedule 40-50 clinic pts a day. And you're goddamn right he doesn't do toenails.

 

[air bud]

My secretary used to work in the ortho group where our local Fellowship Trained Foot and Ankle Surgeon™️works and she's got stories...apparently he would schedule 40-50 clinic pts a day. And you're goddamn right he doesn't do toenails.

Oh nice there is a pod working in your local Ortho group? Must have gotten great training.

 

[Adam Smasher]

Oh nice there is a pod working in your local Ortho group? Must have gotten great training.

😏

 

[Bluecollarmed]

My secretary used to work in the ortho group where our local Fellowship Trained Foot and Ankle Surgeon™️works and she's got stories...apparently he would schedule 40-50 clinic pts a day. And you're goddamn right he doesn't do toenails.

I've heard of some crazy numbers per day from people. As a rural hospital pod I can't imagine just popping in and out of rooms that fast. Things move slower in rural so these people want you to be part of their day. I have plenty that come in who saw some previously whose trying to see 40 per day and the anger from patients is real when they feel rushed. I have a separate bonus based on community engagement (golfing for chamber events), and quality metrics like press-ganey scores. It's 10% of my base so me seeing a couple less patients and getting better scores because they get to tell me about their dog honestly works out to about the same value and I get to do less notes.

 

[air bud]

I've heard of some crazy numbers per day from people. As a rural hospital pod I can't imagine just popping in and out of rooms that fast. Things move slower in rural so these people want you to be part of their day. I have plenty that come in who saw some previously whose trying to see 40 per day and the anger from patients is real when they feel rushed. I have a separate bonus based on community engagement (golfing for chamber events), and quality metrics like press-ganey scores. It's 10% of my base so me seeing a couple less patients and getting better scores because they get to tell me about their dog honestly works out to about the same value and I get to do less notes.

Rural is different. Gotta enjoy it. Kids go to school together, you see people at the grocery store, you can't hide. Your name your reputation it's everything. Something happens, you're done You got to move. You don't just live in your same house and then drive to a different hospital in a different part of town and do stuff there.

 

[Feli]

... You should be annoyed when a patient comes back and says all good bro thanks. ...

Nah, that's $100 and a new-from-old EMR note... 3mins, no risk, no supplies.
Maybe $150 if they get more arch supports from the MA on the way out.
Might be $200 if their ingrown proc is healing well but needs a wound debride.
Maybe they refer spouse or kid or fam with good insurance also... maybe leave you 5 star review.
You want as many of those as possible. Cmon meow.

Can't have medicaid PER-3s clogging up those spots, sir. The real world is not some RVU fantasy land.

 

[deleted1218629]

Nah, that's $100 and a new-from-old EMR note... 3mins, no risk, no supplies.
Maybe $150 if they get more arch supports from the MA on the way out.
Might be $200 if their ingrown proc is healing well but needs a wound debride.
Maybe they refer spouse or kid or fam with good insurance also... maybe leave you 5 star review.
You want as many of those as possible. Cmon meow.

Can't have medicaid PER-3s clogging up those spots, sir. The real world is not some RVU fantasy land.

99212 in my area is $35-$45
99213 is $60-$75

probably with it at a 3, not worth it at a 2

 

[JAJE]

surgery is what it is. Make more money in clinic

I hear this often. Surgery is overlooked. Want to share my experience. I own shares in a surgery center, I was able to buy them because I bring cases to them. At the center, I operate one morning a week. If we are comparing physican fee reimbursement for clinic vs in the OR, then more money in clinic.

The benefits to surgery:
1. 0.5-1 day a week in the OR condenses my clinic schedule making my clinic time more productive (certainly some times of the year I have 1 full day a week)
2. Billing for DME/ crutches/ casts/ xrays etc. There is still a way to make some revenue despite a global.
3. Inserting DPM success story here... I know several DPM's in my area, including myself, who earn an annual dividend of $100,000 or more by providing a productive half day of surgery a week to the center
4. Surgery Center equity. This continues to grow with time and my shares are an asset I can sell when I slow down. Average equity ROI has been over 20% annually the last 5 years. Not to mention the distributions.
5. Time in the OR frees up time for my MA to catch up on admin duties, send patient reviews, etc
6. Being consistent surgically has allowed me to consult for hardware companies, teach labs etc. This time is worth $600-$1,200 an hour depending on what I do for them. Granted this time is limited but it augments the income.

In short, that half day of surgery a week is more financially valuable than any other time of my week.

These are the reasons many surgical speciaists have ownership in 2 facilities, becuase it makes great money.

 

[Feli]

99212 in my area is $35-$45
99213 is $60-$75

probably with it at a 3, not worth it at a 2

What is a 99212?
I think I saw one of those a year or two ago. 🙂

 

[deleted1218629]

What is a 99212?
I think I saw one of those a year or two ago. 🙂

fair criticism

 

[eyeeye_captain]

Bro. Detaching a toe is more important than reattaching a retina. Eyeball? Seeing? Doc is my balance going to be ok missing a 4th toe? I haven't had zone 2 cardio in 30 years.

Update: Said pod’s case took over an hour of operative time. They never removed their mask walking into PACU, so I’m unsure if I got mustached

 

[Weirdy]

Update: Said pod’s case took over an hour of operative time. They never removed their mask walking into PACU, so I’m unsure if I got mustached

Peak update right here.
Legit sorry on their behalf.

 

[Feli]

Update: Said pod’s case took over an hour of operative time. They never removed their mask walking into PACU, so I’m unsure if I got mustached

Welcome to podiatry, sir. Many of us do hour toe amps, multi-hour bunions, 4+ hours "reconstruction" on terrible candidates...

And we also have 3-5 page op reports and as many residents in the room as the local program has. Not uncommon.

 

[air bud]

I hear this often. Surgery is overlooked. Want to share my experience. I own shares in a surgery center, I was able to buy them because I bring cases to them. At the center, I operate one morning a week. If we are comparing physican fee reimbursement for clinic vs in the OR, then more money in clinic.

The benefits to surgery:
1. 0.5-1 day a week in the OR condenses my clinic schedule making my clinic time more productive (certainly some times of the year I have 1 full day a week)
2. Billing for DME/ crutches/ casts/ xrays etc. There is still a way to make some revenue despite a global.
3. Inserting DPM success story here... I know several DPM's in my area, including myself, who earn an annual dividend of $100,000 or more by providing a productive half day of surgery a week to the center
4. Surgery Center equity. This continues to grow with time and my shares are an asset I can sell when I slow down. Average equity ROI has been over 20% annually the last 5 years. Not to mention the distributions.
5. Time in the OR frees up time for my MA to catch up on admin duties, send patient reviews, etc
6. Being consistent surgically has allowed me to consult for hardware companies, teach labs etc. This time is worth $600-$1,200 an hour depending on what I do for them. Granted this time is limited but it augments the income.

In short, that half day of surgery a week is more financially valuable than any other time of my week.

These are the reasons many surgical speciaists have ownership in 2 facilities, becuase it makes great money.

This is awesome, we definitely don't get many people on here talking surgery center details... Do you think what's going on with your surgery center is going to continue or are they slowly chipping away at taking that away. Where I went to residency almost 80% plus of my surgeries which was a lot was in surgery centers and they were all killing it but it seemed like kind of a unique city for that and didn't think it was widespread across the country.

 

[Redsting]

Welcome to podiatry, sir. Many of us do hour toe amps, multi-hour bunions, 4+ hours "reconstruction" on terrible candidates...

And we also have 3-5 page op reports and as many residents in the room as the local program has. Not uncommon.

I was at a conference last year and someone from a big city was telling me how long different surgeries took (I’m rural) and said she also enjoys the easier surgeries like toe amps that take 45 minutes….
I tried to not look surprised and wondered if I was doing something wrong to be out in 8-12 minutes.

Since this is a success story thread, I’ll share mine.
I got really lucky. I think podiatry as a whole is terrible and my friends range from struggling to okay with a couple trying to do a lot of cash pay and products in their clinic. My goal is to save as much as quick as I can incase this goes away and I have to get a “normal” old job, then I don’t have to do it as long. My MD and DO friends here don’t have that stress cause they can get a job anywhere and do well no matter what.
I am don’t do any of the “big surgeries”. I get a couple the news one per year that need one and send it out. I do a couple surgeries a week. I have a day off a week. The hospital likes me. Since it is a smaller town I do run into patients all the time. Some teach my kids, some ring me up, are my neighbors, I coach their kids, I see them at the park, they bring cookies to my house at Christmas. It’s like a big extended family and I feel very lucky to have a great community. I spend time with them in the office. I’m not pushed to see more but I also make sure I see anyone that feels the need in. I make more money than I thought I would.

 

[Bluecollarmed]

Length of surgery is always a funny discussion because reps tell me all the time about orthos in the area taking 4-6 hrs for TTC nails, 3 hours just to prep the ankle for an ankle fusion etc. anesthesia will mention this as well with certain pods and orthos in the area. Idk about everyone else but I have existential dread set in on any case that approaches 2 hours and I'm still working

 

[Feli]

... Idk about everyone else but I have existential dread set in on any case that approaches 2 hours and I'm still working

Same. I think if the surgeon can't get it done in roughly that time, they are doing stuff that shouldn't be at that facility or they don't have enough skills/help... or both.

You should be able to get anything reasonable done in that ~2hrs of cut time or not much more (forefoot slam, flat foot, ORIF basically anything). If it's truly that big of a recon, then stage it or do it (or send it) somewhere with residents and higher volume of that type of case. I can do 90% of my cases without tourniquet, but it's just not safe to have anesthesia times running that long. They should be as short as possible; the patient is bleeding and being pumped with meds.

At my main facility, podiatry lost H&Ps a couple years ago because other DPMs were "clearing" ASA-3 pts (DM, older, obese, etc) and then taking 4hr+ or even 6hrs+ to do those "recon" cases. It was reckless, and the OR staff didn't love being there late for elective stuff. It affected me also, but I actually agree with it. I was only using the H&Ps option to occasionally get a ASA-1 or 2 young persons from ER with no PCP in quicker for trauma. I can totally understand why anesthesia and area PCPs were upset when they find out a 65yo DM or BMI 45 or some 75yo with CAD or apnea had 5 hours of anesthesia for an elective podiatry case that the PCP was never even told about pre-op. It's not good... not safe.

Most places I've ever worked - hospitals or ASCs, the OR staff think I'm "fast," but I'm pretty average... some of us are just sooooo slow in OR that they think podiatrist are all slow. It's crazy.

 

[dtrack22]

I own shares in a surgery center, I was able to buy them because I bring cases to them.

When did you buy in?

What is a 99212?

It’s the visit you described and claimed was worth $100…

 

[Sybly]

They should do podiatry like dentistry. Maybe a 1 year residency for basic **** and limited 3 year surgery spots for maybe 20 25%

Excellent idea! As podiatrist 40 years out!

 

[Sybly]

I clip nails and calluses 3-4 days a week 10 months of the year. 200K a year. No call, no surgery, no employees, no clinic, no office to rent, no patient complaints (yet), no ordering labs or x-rays, no diabetic shoes, no lotions and potions, no custom orthotics, no bosses or admin to deal with, and rarely write prescriptions. Vacation anytime, can change schedule anytime, nobody even knows if I take vacation. Wife stays at home with the kids. I am king lobster and if you have complaints you can find me at home because I don't work that much.

The drawback is if this work ever becomes unviable I'm screwed.

Doing that much nail and callous is fraught now with nasty audits

 

[air bud]

Now I can give some final numbers... I'm lucky. I've put in the work living in very rural locations in very rural hospitals... I've moved a lot sometimes because I was forced to sometimes because I chose to in the pursuit of something better... I'm now in a dream location. I'm the only surgical podiatrist in the community. I service about 70 to 90,000 people. Ortho does ankle fractures and that's it.

There's a non-surgical podiatrist in town who works at a different organization. I does a little bit at our wound care center, mostly just surgical consults. I do all inpatient admits. I'm able to send almost all of my infection post-ups there and rarely see them after operating on them. Great setup, great staff and other main guy there is awesome and is happy to see my post ops.

There was a recently retired podiatrist who was doing forefoot only in the community anything hindfoot used to travel about an hour to 2 hours away.

My job was advertised online, I had no relationship to the community other than it was a similar lifestyle to what I had previously lived and I was able to articulate my attraction and knowledge of that.

I did 9,000 RVs my first year -just got my final numbers today. They paid off the remaining amounts of my student loans. I literally doubled my income from my previous hospital job in one year. With bonuses, some call pay, I will probably average between 500 and 550 a year going forward.

I need to take more vacation. I'm not busy enough to need a nurse practitioner but it would be nice. Like a lot of these rural jobs, it's not overwhelming and there's not that much inpatient work. I've got great staffing, great relationship with administration they're very supportive they leave me alone because I do a good job and don't complain. I wouldn't have been able to ramp up this fast without previous experience . Life is good. But there's no way I'm finding another job like this... At least without a few years of trying.

And to be clear I spent two years trying to find this job. I interviewed for probably 5 to 8 in person interviews, turned some down, didn't get picked for others.

I probably had 20 legit hospital conversations over a 2-year period, but that's for a different day and has been chronicled in the past.

Life is good being a podiatrist that does MSK stuff, I enjoy going to work everyday. People appreciate me and value me and I love my job

I graduated And the top 10 of my class, I did a good residency lots of surgery. I don't do anything crazy a couple of IM nails a year I don't do X-Fix I don't do total ankles. You could say I do bread and butter hind foot and ankle surgery. Scope, fusions, ligament repair, chronic Achilles repair.


Tldr write your life in pencil not pen....things change.

Edit : I should also add, great relationship with Ortho, they're like yeah, you're the foot guy. As much as we complain on here there's plenty parts of the country where podiatry is respected, not dumped on, considered an equal medical specialty as all the other surgeons and doctors. But that's sure as hell not everywhere.

 

[Feli]

...the top 10 of my class, ...

But aren't there only like 14 or something each year in those little osteopathic + podiatry schools? 😀

You should have 125 per year like the old Ohio and NY did.

 

[Bluecollarmed]

But aren't there only like 14 or something each year in those little osteopathic + podiatry schools? 😀

You should have 125 per year like the old Ohio and NY did.

125 on day 1, 70 after part 1

 

[DarkPathMedicine]

125 on day 1, 70 after part 1

That sounds about right from a colleague I talked to. 70-90 after part 1.