Elective and Non-Elective Cases

[heybrother]

The way it should be. ^^^

We don't take any formal call in my group, and we won't apply to be on staff or bring our elective to one hospital system that requires all staff DPMs all being on call schedule. They can have their FTE podiatrists do that evening and weekend work; we have plenty of other options in terms of places to do our cases or admissions. A few of the competing PP DPM groups take call to pick up new patients via ER and consults since they are trying to build, and that's their choice. I will do infrequent ER or floor consults at my location within a hospital, but they know there is no guarantee I will respond fast or respond at all since I might be on vaca, other location, or just not interested. I would rather just market and get good results to get patients and keep patients than chase patients wherever they may be.

As was said, if you're a DPM employed at the hospital with clinic at the hospital, it is a much different story... you're already there, and it is an expected part of your job. I have been in both situations, but to try to pick up a lot of inpatients and inpatient cases when you are PP - even if you have a clinic attached to the hospital - is almost never an efficient use of your time (assuming you have anything else productive to do).

In any business, you want clients or deals or buyers or whatever to come to you. You also want fewer clients or deals and more money per deal or client or whatever the business type dictates. As it applies to medicine, this is why you see any PP doc doing a lot of marketing and possibly some call, inpatient, etc in the early going. After they have enough patients, they close or mitigate their office locations with bad payer demographics or under-booked days, they avoid the hospital unless absolutely necessary (patients known to them), and they trim payers. They might narrow their scope. Some of them keep those locations and services and payers... and hire associates to do that work. Regardless, the goal is to increase per patient revenue and patients per day... to maximize per hour income (and max free time).

Agreed. A retired practitioner from my practice with literally zero idea how reimbursement worked wanted me to take call. I reminded him that we didn't take Medicaid and that the hospital semi-frequently called us trying to get someone to come down and cut patients nails on the floor. Pass.

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[DYK343]

I am really struggling with the idea that in the last 5 years you haven’t taken any time off since you don’t have an alternate and have inpatients at all times and respond to all consults from the ED and hospitalists. That sounds awful. How do you get CME if you can’t leave for any conferences? All online?

It is awful! Thats why I have said "its not impossible but difficult" and "My advice to OP is find a solution to this problem before it becomes a problem". I'm trying to give real world advice here because I'm living it. I get all the trauma, ER consults, open fractures, ride the pus buss, etc, etc. Its great because ive grown so much in 5 years. But it's also a drain.

Yes. That’s exactly what you do. Do you schedule clinic patients and elective surgery the week you are planning on going out of town? Of course not. This is no different.

Were talking about a non elective solo DPM practice in this thread. Not a traditional mostly outpatient private practice, ortho group, or hospital employed provider with someone else to call. If you want to take a 3 day weekend away now its ~7 days of no work. No inpatients. No income that week because you want to go to yellowstone with the family for 3 days. Could you imagine a general surgeon on a tuesday saying "welp, tough luck im at old faithful this weekend guess you better call someone else". Especially if there is no one else?

My whole point is you have to have someone else to call in a pinch in this setting. Its inevitable something will pop up.

A private practice with 2 inpatients every 4 months. No you probably dont need a 24/7 backup. An emergency practice only? Yes you need someone to answer that phone when you are gone.

 

[DYK343]

I have a question. So theoretically speaking, if I have a patient who walked into my office on Monday with gas whom I take to the OR for amp / I&D that Monday night, goes home but have complications on Wednesday and I happen to be off from call that night, am I obligated to see them when I am solo PP that night? Or like dtrack22 said, patient will have to be stabilized by whoever is call and I'll be notified of it the next day I'm back in office?

I'm trying to understand if our field is similar to what the PCP/Hospitalist model is like. But I'm getting confused between what DYK343 and dtrack22 is saying.

As you can see between Dtrack and my experiences it's multifactorial.

Well run hospital systems have providers on call at all times. The hospital my residency was at when you were on call you took ALL the cases in the hopsital. When you were on you were on. When you were off you were off. There was always an alternate surgeon and if you were not scheduled on call you saw no impatients.

Unfortunately my system is not run the same. I am expected to have followup with my patients both by the hospital but also by my MSG contract which explicitely states "provide management and followup care with MSG patients admitted to hospital".

If you did an I&D and you were the only person around when they came back in then you will almost certainly get a phone call from ED asking you to help out. Its whether or not you have someone else to pass the patient off to is the constructive arguing going on in this thread.

I have not been 100% truthful in that there are some community DPMs I can call and ask to cover for me but its a phone call with my tail between my legs.

When I signed my contract it was not something I really took into consideration. Next contract I sign it will be a very important consideration on my part. Live and learn.