DPMs and Surgery

[itswiggles]

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- So I have recently learned from numerous DPMs that some make a very good living without doing ANY surgery in their practice? So, does that mean they are just doing Routine Care in their private practices? Not that I disagree but it just seems very hard to believe that DPMs can make mucho dinero without doing surgery since they are "big ticket items". One even claimed a Pod was pulling in 400K with NO surgery? How is this possible?

 

[PADPM]

I've discussed this several times on this forum. Although most if not all of today's young DPM's have excellent surgical training, you can make an excellent living without performing surgery. However, I do believe it's imperative to have surgical training upon graduation.

Surgery can be a "big ticket" item, but there are other factors to consider;

1. When you are in surgery, you are away from your office not generating income at the office.

2. The surgical procedure may take one hour, two hours, 20 minutes, etc., but you must also consider your travel time to and from the hospital or surgical center.

3. In addition to your travel time, you must also consider pre-op prep time at the center/hospital, time in the recovery room with the patient or family, writing pre/post op orders, dictating notes, etc.

4. If performing your procedures in the hospital, there is ALWAYS the chance that the case will not go off on time and you will be delayed. Urgent/emergency cases take precedent over elective cases and your case may be "bumped" back, causing you to wait for an unspecified amount of time.

5. When considering all the "time" above, often you could have produced greater income IN your office treating patients.

6. Although some surgical procedures may initially be "big ticket" items, you must also remember (or learn) that surgical procedures also have what's called a global fee, usually encompassing a 30, 60 or 90 day period. Therefore, post operatively, you can not charge that patient for any services related to the surgery for that specified amount of time, other than x-rays. So when you break it down, your "big ticket" fee begins to not always be "so big" when you see the patient several times post operatively.

7. Surgical procedures also increase your medical liability which has the potential to increase your medical malpractice premiums if you are unfortunate enough to be involved with a lawsuit.

Surgery is a very rewarding part of my practice and something I enjoy both technically and academically. I utilize this choice when I believe it's indicated for my patient when other options have failed or when I feel it's the best interest of my patient.

However, you can earn an excellent living by providing other services to your patients, as long as it's not at the expense of your patient and denying surgical care. You must know when to refer surgical patients to a surgeon if you don't provide that service.

There are plenty of other ways to earn a good income in addition to "routine foot care". On a daily basis many offices perform physical therapy (our office does not), perform injections, take x-rays, provide diagnostic ultrasound services, perform vascular testing, make orthoses, Richie braces/Arizona Ankle braces, apply strappings, perform wound care services, specialize in "sports mediciine", etc.,etc. And most offices do all of the above or some of the above.

I do know of many DPM's who no longer perform surgery and make an excellent living. One of our partners who has excellent surgical training, is ABPS certified, etc., decided to stop performing surgery and let the "younger guys" in the practice take over, and he is still the top producer in our practice. My numbers aren't even close to his, despite all the surgery I perform.

 

[itswiggles]

- Once again padpm gives and excellent response... but I am still wondering how they have the option not to choose to do surgery. For instance you do a 3 year residency that is surgery based, so why would a student go through pod school and residency and then not do surgery??? Also, will most private practices or hospitals even take you if you elect not to do surgery? I thought that surgery was a big part of the DPM training, so to get a job after residency that is what you must do.
- Another way I looked at it was, if a DPM does not do surgery then he/she will lose more business to another DPM that does, because the patient won't have to get referred by the Pod that doesn't do surgery, i.e. don't waste time on an extra visit.
- I could be looking at this all wrong, but still curious to understand how this is possible. One DPM vaguely explained that it comes down to "Business sense" as to why one DPM that doesn't do surgery makes more than another who does, but failed to elaborate. I understand PADPM's explanation about being out of the office to do surgery, but is there anything else that explains "business sense"?

 

[itswiggles]

I do know of many DPM's who no longer perform surgery and make an excellent living. One of our partners who has excellent surgical training, is ABPS certified, etc., decided to stop performing surgery and let the "younger guys" in the practice take over, and he is still the top producer in our practice. My numbers aren't even close to his, despite all the surgery I perform.

^^^^^^^^^^^^^^^^

- For example PADPM, how is this possible?

 

[NatCh]

- So I have recently learned from numerous DPMs that some make a very good living without doing ANY surgery in their practice? So, does that mean they are just doing Routine Care in their private practices? Not that I disagree but it just seems very hard to believe that DPMs can make mucho dinero without doing surgery since they are "big ticket items". One even claimed a Pod was pulling in 400K with NO surgery? How is this possible?

It's true. Consider a hypothetical $1000 bunionectomy that takes a couple of hours away from the office versus two new patient ingrown toenail matricectomies at $500 each plus two plantar wart excisions at $200 each plus a couple of additional office visits ($70-$170) with x-rays ($75) in the same two hours.

Surgery provides glory (at least for awhile), but ingrown toenails are my favorite thing to do, both emotionally and financially. Whereas some medical issues never really get "cured" (e.g., anxiety, rheumatoid arthritis, etc.) and people are just varying degrees of being ill, ingrown toenails are a discrete problem that we can "cure" in under 30 minutes. The patient walks into your office in pain, walks out a little later with the problem solved.

 

[NatCh]

- Once again padpm gives and excellent response... but I am still wondering how they have the option not to choose to do surgery. For instance you do a 3 year residency that is surgery based, so why would a student go through pod school and residency and then not do surgery???

You pretty much have to become surgically trained at this point in the history of the profession, due to insurance and hospital requirements. Surgery attracts students to the schools and provides some glamour to what many people view as a nail-cutting profession. At some point after you've done a lot of cases though, surgery is less mysterious and exciting and becomes more just a regular part of work. Also, when you've survived through a few nasty surgical complications you become less scalpel-happy.

Also, will most private practices or hospitals even take you if you elect not to do surgery? I thought that surgery was a big part of the DPM training, so to get a job after residency that is what you must do.

To "get a job" yes, but when you're the boss you can practice however you want.

- Another way I looked at it was, if a DPM does not do surgery then he/she will lose more business to another DPM that does, because the patient won't have to get referred by the Pod that doesn't do surgery, i.e. don't waste time on an extra visit.

If that other DPM works for you, then you still benefit from the referral. Some guys are busy enough that they don't have to worry about losing a few patients here and there.

- I could be looking at this all wrong, but still curious to understand how this is possible. One DPM vaguely explained that it comes down to "Business sense" as to why one DPM that doesn't do surgery makes more than another who does, but failed to elaborate. I understand PADPM's explanation about being out of the office to do surgery, but is there anything else that explains "business sense"?

"Business sense" becomes more clear as you get into it.

 

[itswiggles]

- It's true. Consider a hypothetical $1000 bunionectomy that takes a couple of hours away from the office versus two new patient ingrown toenail matricectomies at $500 each plus two plantar wart excisions at $200 each plus a couple of additional office visits ($70-$170) with x-rays ($75) in the same two hours.

- Okay, so this explanation makes sense. I guess I can kind of understand how this is possible. I guess I was just more curious to know how this was possible. I didn't think that most Pods do surgery only or lots of surgery with no RC, however I was just surprised to hear that some Pod's do NO surgery.
- Also, do any of you current Pod students or DPMs in practice understand why Pods don't do surgery?
- Also, do you think it makes more business "Sense" to not do surgery in private practice i.e. make more money? Is the potential difference that big? Ex: Surgery (200k) no-surgery (400k)

 

[Podmeister]

- Also, do any of you current Pod students or DPMs in practice understand why Pods don't do surgery?
- Also, do you think it makes more business "Sense" to not do surgery in private practice i.e. make more money? Is the potential difference that big? Ex: Surgery (200k) no-surgery (400k)

Some pods are not surgically trained, some have lost hospital surgical privileges for not generating volume, and some voluntarily pass up surgery for other financial incentives.

The numbers quoted are exaggerated because income has more to do with the practice and less so on surgical versus non-surgical...as PADPM had earlier pointed out.

 

[PADPM]

There have been many excellent points brought up in this thread. NatCh hit the nail right on the head. There are very few things we do in our practice that provide the patient with the quick relief and immediate satisfaction as when a patient enters with a severe ingrown toenail and we take care of that problem. Because no one can do it better than a DPM. And we look even better if the patient's PCP tried to "fix" the problem first, because they always botch the job and torture the patient making us look better!

Ironically, yesterday in our office I saw THREE new patients in a row who all came in with wicked paronychias. I basically had three rooms "running" almost simultaneously, and I entered one room, performed my H&P and had my assistant prep the patient. I entered the next room and did the same. I went back to room one and anesthetized the affected hallux and went to the third room to peform my H&P, then went to the 2nd room to anesthetize the hallux in that room. I then went back to room one to perform the avulsion/I & D (which literally takes 1-2 minutes) and I apply a portion of the dressing and my assistant finishes up. I go to the computer and print out RX's for each patient. I go to room 3 and anesthetize the hallux and go to room 2 and perform the procedure,etc., then back to room 3 and perform the procedure.

This all takes place in about 30-45 minutes. I've made 3 patients extremely happy and comfortable, and I've generated almost the same amount of money as I would if I performed a bunionectomy with osteotomy, without leaving my workspace (our office is set up very efficiently for each doctor that's working, which can be up to 3 docs at a time).

THAT'S how you can generate a nice income while also providing good care. You need a busy practice, good staff and you can't be lazy. I work a stressful schedule, but each patient gets good care. If I have a patient that needs extra time, he/she gets ALL the time needed. If I get backed up, we'll ask a patient if he/she will see another doctor in the office if he/she doesn't want to wait.

Our front desk knows that if a new patient is coming in for an ingrown nail, the patient only needs a short time slot, vs a patient coming in for a complicated problem. Once again, it's how well you train your staff. Believe me, it doesn't always work out as planned, but sometimes patients don't show for appointments and you get back on schedule!

Once again I DO believe doctors require surgical training. Whether or not they decide to perform surgery is a personal decision. Some docs simply don't have confidence, some don't enjoy surgery, some had a bad experience or two, etc.

Performing surgery in the real world is MUCH different than performing surgery as a resident when you walk into an OR, perform surgery on someone else's patient and don't really have to follow through. But when YOU have to "marry" the patient and answer to the patient and the family, it's not always fun or glamorous.

It can be stressful, and some docs simply can't handle the stress.

McDonalds makes a LOT of money, yet they don't sell any "high ticket" items. It's about volume and keeping people happy.

My partner who no longer performs surgery has a lot of loyal patients and sees a LOT of patients and produces a lot of money for the practice. He works very hard and bends over backwards for patients. He's the only member of our practice who leaves his personal cell phone number on our answering system for emergencies.

Our practice philosophy is really quite simple. We provide a full spectrum of services for patients, from routine palliative care to major reconstructive surgeries, and we are HAPPY to accommodate all patients with a smile. One service we don't provide are house calls. We refer house calls out to a local DPM who needs the business and appreciates our support.

Once again, although our office may not provide all the services below (such as physical therapy, since we believe PT should be provided by physical therapists), here is a list of non-surgical ways to bring money into your office;

orthoses
braces-Richie/Arizona ankles
wound care
sports medicine
physical therapy
diabetic therapeutic shoes
ESWT
laser therapy for onychomycosis (I'm not supporting or slamming this modality, it's an individual decision)
Keryflex for nails (ditto the above comment)
diagnostic ultrasound
PVD testing
Selling "products"
many others I've forgotten to list

 

[iwasjustinyou]

..

 

[PADPM]

That's an excellent question. It is a definite convenience and timesaver, however there are other issues that have to be taken into consideration.

Most of the time, I prefer to perform bunionectomies with osteotomies under local with sedation, and unless you have the equipment (extremely expensive) and anesthesia staff to support that, you obviously must use only local anesthetic if performing these procedures in your office.

Many patients prefer some form of sedation to take the edge off. Additionally, I often use some hardware during a lot of my procedures, and purchasing and billing for that can become very laborious and expensive, ESPECIALLY if you are performing surgery in an OR "suite" in your office that isn't a certified surgical center.

A simple hammertoe repair is really a 10 minute procedure, but the office must be equipped to provide the correct sanitary conditions to perform bone surgery. As gruesome as it may sound, a toe amputation is a very simple and quick procedure that can be done in the office in minutes, though these patients often have many comorbidities that require medical monitoring, and performing the procedure in a hospital is often more prudent.

In my opinion, convenience simply takes second place to patient safety. I've never been comfortable with a room in an office dedicated to surgical procedures, unless that room is really a certified surgical suite with the necessary emergency equipment, etc., available.

I'm much more comfortable performing surgery in a hospital O.R. or surgical center, where there is a plethora of emergency equipment available and surgical equipment, etc., in the rare case that something goes wrong or I need some instrument, piece of hardware, bone graft, bone filler, etc., that I did not anticipate.

Although I was never a Boy Scout, for the sake of my patients, I do like to be prepared.

 

[NatCh]

I am glad some people brought up the surgery time issue.

Two of the podiatrists that I shadow have "surgical suites" in their office. I have seen hammertoe and bunion surgeries done in their office. In fact this tuesday I am going to watch one of the doctors perform a toe amputation in surgery (it should be interesting)

My question is, is it uncommon for podiatrists to have these surgical suites? Do most podiatrists have to leave their office to perform toe amputations, bunion surgeries and so on?

It seems like have a surgical area with in your office would cut reduce the time commitment of these procedures.

In the office I'll do flexor tenotomies and minor soft tissue but no bone surgery. In the past, before DPM's could get O.R. privileges, I think many did office bunion surgery. I don't know how many do it now, but I'm definitely uncomfortable with it (for all the reasons PADPM stated).

I used to work for someone who did bunions in the office out of convenience. His saw was wonky and the power would cut out pretty often. It was scary assisting him when the saw broke, and he'd be smacking it with the retractor in hopes of jarring it back to life. Sometimes he'd yell for the assistant to call one of the other practices in town to see if he could borrow the saw to finish the case. Meanwhile the numb but totally alert patient would be asking if everything was alright, methead sticking out. Screw that.

 

[NatCh]

Performing surgery in the real world is MUCH different than performing surgery as a resident when you walk into an OR, perform surgery on someone else's patient and don't really have to follow through. But when YOU have to "marry" the patient and answer to the patient and the family, it's not always fun or glamorous.

This part about "marrying the patient" is so true. Since I live in a small city, I can barely leave the house without running into at least one of my patients. They are cashiers at the stores where I shop, servers at restaurants where I eat, neighbors, friends, friends-of-friends, nurses at the hospital, teachers at my kids' school...you name it. The last thing I want to develop is a reputation as being someone who indiscriminately rushes patients off to surgery.

It's no fun seeing a patient limping around town, especially if he or she is post-surgical. Sometimes the foot "looks great on the table" (during surgery) but you see them three or four years later and that bunion has returned or that hammertoe is sticking up. It'll happen to you eventually and it'll leave you shaking your head.

 

[shenanigans327]

In the office I'll do flexor tenotomies and minor soft tissue but no bone surgery. In the past, before DPM's could get O.R. privileges, I think many did office bunion surgery. I don't know how many do it now, but I'm definitely uncomfortable with it (for all the reasons PADPM stated).

I used to work for someone who did bunions in the office out of convenience. His saw was wonky and the power would cut out pretty often. It was scary assisting him when the saw broke, and he'd be smacking it with the retractor in hopes of jarring it back to life. Sometimes he'd yell for the assistant to call one of the other practices in town to see if he could borrow the saw to finish the case. Meanwhile the numb but totally alert patient would be asking if everything was alright, methead sticking out. Screw that.

I have a sick sense of humor (8 years of EMS will do that to you), but I just got a mental picture of this and couldn't stop laughing😀

 

[NatCh]

I have a sick sense of humor (8 years of EMS will do that to you), but I just got a mental picture of this and couldn't stop laughing😀

It was so bad. I wanted no part of it.

 

[jonwill]

To me, it's more about being a complete physician/surgeon. Don't get me wrong, I want to maximize my income. But at the same time, I get referrals from other docs that can't do the things I can do. If I didn't do the trauma and reconstruction and just did the office stuff (that they are all capable of doing) I wouldn't get the referrals and would lose income that way. I had three patients with rearfoot/ankle trauma sent directly from the ER to me today alone. I have a calc fx coming in tomorrow.

I really enjoy the office and the procedures and it is very lucrative but I also really enjoy providing any and all foot & ankle care to my patients whether it be simple care or complex surgery.

 

[NatCh]

To me, it's more about being a complete physician/surgeon. Don't get me wrong, I want to maximize my income. But at the same time, I get referrals from other docs that can't do the things I can do. If I didn't do the trauma and reconstruction and just did the office stuff (that they are all capable of doing) I wouldn't get the referrals and would lose income that way. I had three patients with rearfoot/ankle trauma sent directly from the ER to me today alone. I have a calc fx coming in tomorrow.

I really enjoy the office and the procedures and it is very lucrative but I also really enjoy providing any and all foot & ankle care to my patients whether it be simple care or complex surgery.

I don't know if anyone can claim to be a complete physician/surgeon anymore. The closest thing might be a country doc GP who still does surgery. I get what you're saying though: be able to provide as many services as possible in the realm of our specialty.

 

[podpal]

Working is definitely about the $. Notice that the practitioners who NOW chose to do conservative care work graduated a long time ago. They are grandfathered IN to the insurance plans. This is spectacular! They will GET PAID because they are ALREADY PARTICIPATING. It is IMPERITIVE to do a surgical residency to get onto the insurance plans in today's climate. If I were to do the SAME INGROWN TOENAIL procedure I may get NOTHING since the insurance companies now REQUIRE BOARD CERTIFICATION to become participating.

SURGERY is the way to go. Imagine driving an hour to see a CC pt for nail care and getting NOTHING or like $25.00 VERSUS driving a short distance to an OR and getting at least $100 for a surgery!

IMO do NOT go the CC route. Unless you are board certified it simply will not pay!

 

[PADPM]

Working is definitely about the $. Notice that the practitioners who NOW chose to do conservative care work graduated a long time ago. They are grandfathered IN to the insurance plans. This is spectacular! They will GET PAID because they are ALREADY PARTICIPATING. It is IMPERITIVE to do a surgical residency to get onto the insurance plans in today's climate. If I were to do the SAME INGROWN TOENAIL procedure I may get NOTHING since the insurance companies now REQUIRE BOARD CERTIFICATION to become participating.

SURGERY is the way to go. Imagine driving an hour to see a CC pt for nail care and getting NOTHING or like $25.00 VERSUS driving a short distance to an OR and getting at least $100 for a surgery!

IMO do NOT go the CC route. Unless you are board certified it simply will not pay!

I'm sorry, but this post made no sense to me. We have a doctor that works part time for our practice (he/she also has his/her own practice) and does housecalls, nursing homes, etc., for our practice. This doctor is NOT board certified by any board and is on every insurance panel and gets paid the exact same amount as every doctor in our practice per procedure.

Not having surgical training or not being board certified may limit your ability to obtain hospital privileges, etc., but I can not see how it has any bearing on your ability to provide other podiatric services for your patients or to obtain fair reimbursements. Podpal, you state you have been in practice for many years, so now I REALLY don't understand why you haven't been able to get on insurance panels.

There is definitely something missing from the story.

Jonwill,

I hope you didn't miss my point. I would never discourage anyone from performing surgery or offering surgical options for patients. Surgery should be in your armamentarium when providing "complete" care.

Although I provide all servcies from palliative care to major reconstructive surgery, I was simply stating that performing surgery isn't always the "gold mine" that people believe for the reasons I've already mentioned.

Surgery has definitely been an important part of my practice for receiving referrals, making patients happy, keeping our practice comprehensive and helping to keep my sanity. I'd go crazy only doing "one" thing all the time....after all, isn't variety the spice of life?

 

[jonwill]

Jonwill,

I hope you didn't miss my point.

No, I got you. That's basically what I'm saying. I want to be able to present and be capable of performing any and all options for my patients. I really do enjoy variety. It makes the office a lot of fun.

 

[podpal]

I'm sorry, but this post made no sense to me. We have a doctor that works part time for our practice (he/she also has his/her own practice) and does housecalls, nursing homes, etc., for our practice. This doctor is NOT board certified by any board and is on every insurance panel and gets paid the exact same amount as every doctor in our practice per procedure.

Not having surgical training or not being board certified may limit your ability to obtain hospital privileges, etc., but I can not see how it has any bearing on your ability to provide other podiatric services for your patients or to obtain fair reimbursements. Podpal, you state you have been in practice for many years, so now I REALLY don't understand why you haven't been able to get on insurance panels.

There is definitely something missing from the story.

What's missing? I was in practice for a long time doing clinic work. I was paid a salary from the clinic. I made the change from clinic work to private practice, nursing homes and home visits. I never had a reason to apply for participation to insurance companies before this year. When I did I quickly learned that I would NOT be eligible for insurance participation due to:

1. lack of residency training
2. ineligibility for board certification
3. lack of board certification
4. unable to obtain staff privilages; I was informed that courtesy privilages do NOT count and I must have ACTIVE FULL privilages to be on the insurance plan

These new RULES are not made up by me, but by the insurance companies. These are the reasons I've been denied as participating by not 1, but nearly EVERY insurance company in my geographical location.

To obtain board certification one must have a surgical residency. To obtain hospital privilages one must have a surgical residency. To GET PAID, unless someone is grandfathered into a plan, one must have a surgical residency.

Don't kill the messenger. I'm reiterating what I recently learned from the insurance companies.

Surgical residency training is the way to go. It is what insurance companies in my location and probably in many other locations NOW DEMAND. I'm not making this up; they are the NEW RULES. I'm only trying to follow the rules so I too can earn a living.

 

[PADPM]

What's missing? I was in practice for a long time doing clinic work. I was paid a salary from the clinic. I made the change from clinic work to private practice, nursing homes and home visits. I never had a reason to apply for participation to insurance companies before this year. When I did I quickly learned that I would NOT be eligible for insurance participation due to:

1. lack of residency training
2. ineligibility for board certification
3. lack of board certification
4. unable to obtain staff privilages; I was informed that courtesy privilages do NOT count and I must have ACTIVE FULL privilages to be on the insurance plan

These new RULES are not made up by me, but by the insurance companies. These are the reasons I've been denied as participating by not 1, but nearly EVERY insurance company in my geographical location.

To obtain board certification one must have a surgical residency. To obtain hospital privilages one must have a surgical residency. To GET PAID, unless someone is grandfathered into a plan, one must have a surgical residency.

Don't kill the messenger. I'm reiterating what I recently learned from the insurance companies.

Surgical residency training is the way to go. It is what insurance companies in my location and probably in many other locations NOW DEMAND. I'm not making this up; they are the NEW RULES. I'm only trying to follow the rules so I too can earn a living.

I don't know where you practice, but it's a fact that there are still a significant number of the population who are covered by traditional Medicare, and I may be wrong, but I believe that Medicare does not require any of the above for you to participate.

If you participate with Medicare it will allow you to see a significant number of patients in the office, at facilities, in their homes, etc. It will also allow you to obtain a DME number and dispense diabetic therapeutic shoes when indicated, Richie braces, etc. If you already participate with Medicare, you've got to start looking harder for patients.....they are out there.

Additionally, you can start knocking on doors. Find out if there are any practices in your area that are busy and don't provide services that you may be willing to provide. As I stated already, we have a doctor who has his/her own practice, but we send this doctor housecalls (and the doctor bills these him/herself) and does some nursing home work for our practice, billed through our office.

You may be able to get on the insurance companies through their office to provide services for THEM, to supplement your income. If you approach these practices with a positive attitude, and show them that YOU can increase THEIR revenue by providing services they may not be offering such as home visits, nursing home services, etc., it may peak their interest.

I assure you that you're not the only one in your situation. So you have two choices if you don't obtain a residency. You can complain about not having the ability to get on the companies, or you can pull up your boot straps and get creative when it comes to finding a way to put food on your table.

There are plenty of Medicare patients that need podiatric care. Obtain a DME number and start getting acquainted with some of your peers locally who may be your best resource.

 

[Podmeister]

These new RULES are not made up by me, but by the insurance companies. These are the reasons I've been denied as participating by not 1, but nearly EVERY insurance company in my geographical location.

May I ask where you practice?

Has managed care gobbled up the entire neighborhood?

Here in Los Angeles, home visits or nursing homes are 99% traditional Medicare.

BTW, you should always verify patients' eligibility and coverage before driving an hour to see them.

 

[Feli]

..."Business sense" becomes more clear as you get into it.

"Can you really explain to a fish what it's like to walk on land? One day on land is worth a thousand years of talking about it. And one day running a business has exactly the same kind of value."
-Buffett

 

[podpal]

I don't know where you practice, but it's a fact that there are still a significant number of the population who are covered by traditional Medicare, and I may be wrong, but I believe that Medicare does not require any of the above for you to participate.

If you participate with Medicare it will allow you to see a significant number of patients in the office, at facilities, in their homes, etc. It will also allow you to obtain a DME number and dispense diabetic therapeutic shoes when indicated, Richie braces, etc. If you already participate with Medicare, you've got to start looking harder for patients.....they are out there.

Additionally, you can start knocking on doors. Find out if there are any practices in your area that are busy and don't provide services that you may be willing to provide. As I stated already, we have a doctor who has his/her own practice, but we send this doctor housecalls (and the doctor bills these him/herself) and does some nursing home work for our practice, billed through our office.

You may be able to get on the insurance companies through their office to provide services for THEM, to supplement your income. If you approach these practices with a positive attitude, and show them that YOU can increase THEIR revenue by providing services they may not be offering such as home visits, nursing home services, etc., it may peak their interest.

I assure you that you're not the only one in your situation. So you have two choices if you don't obtain a residency. You can complain about not having the ability to get on the companies, or you can pull up your boot straps and get creative when it comes to finding a way to put food on your table.

There are plenty of Medicare patients that need podiatric care. Obtain a DME number and start getting acquainted with some of your peers locally who may be your best resource.

A substantial number of Medicare pts in my region have changed to outsourced medical plans. Yes, I am accepted onto Medicare, the only plan that actually does pay something.

I'm not complaining. I'm advising. It is IMPERITIVE that pod students realize that they MUST OBTAIN surgical residency training to be marketable in today's practice environment. This is why I've chosen to obtain residency training. I'm thrilled at the prospect of gaining knowledge in my chosen field; although I do feel bad for the patients that will be left to find someone to fill their podiatric concerns. I'm in an area of great need. If I am ultimately able to get employment in an office setting I will not have time to drive to tim buck too for a $25 pt encounter. I will not be able to afford to practice this way if I have MY OWN OFFICE!!! That's such an exhiliarating thought, to have my own office! Going into surgical practice is literally a dream come true for me. My bags are packed and I'm ready to go. YIPPEEE!!!!😉

 

[podpal]

May I ask where you practice?

Has managed care gobbled up the entire neighborhood?

Pretty much!

Here in Los Angeles, home visits or nursing homes are 99% traditional Medicare.

BTW, you should always verify patients' eligibility and coverage before driving an hour to see them.

Yes, I learned that the hard way. I now verify that they have MEDICARE ONLY before I travel. The nursing homes I have are less than 50% traditional medicare.

 

[NatCh]

"Can you really explain to a fish what it's like to walk on land? One day on land is worth a thousand years of talking about it. And one day running a business has exactly the same kind of value."
-Buffett

Nice.