Feeling despair

[Hybrocure]

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Have had the same experience fresh out in outpatient setting.
Anecdotally- the ones coming in asking for elective surgery have been huge red flags.

Nobody should ever want foot surgery. I exhaust conservative treatments first with all my patients before elective surgery. Those who come in wanting elective bunions usually bounce off to their next provider when I tell them I don’t operate unless it’s painful. And even if it is painful, half the time they’re wearing horrible shoes and the solution is “don’t wear that”.

 

[dtrack22]

Yep. Big income also comes with big hours if it means riding the pus bus to 10pm after clinic.

The other day I was doing elective cases and saw the usual hospital employed guy with amp booked for 1am on the OR board. No thanks.

if an employed doc is routinely doing cases after 10pm, there are a half dozen different ways to solve that problem. And it can be solved relatively easily almost regardless of facility. Hospital employed = late nights and weekend pus is a false equivalency

You,, DYK 343, retro, myself if I had enough infection volume. 100% rather do infection than elective all day long. As I said before, you're using your MSK rear foot principles, it's challenging it's rewarding. Despite what Feli says, it's not first year cases.

It also pays more, and guess what you don't need a fellowship for it.

My dream job at this point would be getting hired as a “Podiatric hospitalist.” Depending on the size of the facility (or number of facilities covered) maybe you do some wound care clinic, but otherwise you are salaried $400-500k to cover inpatient consults, round, and operate. Shift work. Nothing but pus. little or no follow up.

 

[Weirdy]

I’m in a hospital setting so most likely would feel different if I were doing private practice. High surgery volume in PP podiatry probably only makes sense if you are doing it in a surgery center you own shares in.

Most of the podiatry groups near me with 4-5+ DPMs are running all their surgeries out of the surgery center they have bought shares in.
To them that makes sense.
Little ol me- I lose money everytime I book someone at the nearby hospital. 2 hrs gone easily

 

[heybrother]

Most of the podiatry groups near me with 4-5+ DPMs are running all their surgeries out of the surgery center they have bought shares in.
To them that makes sense.
Little ol me- I lose money everytime I book someone at the nearby hospital. 2 hrs gone easily

Outpatient Surgery Codes with Increased Reimbursement When Performed at an Ambulatory Surgery Center | Blue Cross and Blue Shield of Texas

www.bcbstx.com

I don't know your state or your employment circumstances, but you should explore whether BCBS has this program in your state. The ASC incentive pay is substantial.

 

[Weirdy]

Outpatient Surgery Codes with Increased Reimbursement When Performed at an Ambulatory Surgery Center | Blue Cross and Blue Shield of Texas

www.bcbstx.com

I don't know your state or your employment circumstances, but you should explore whether BCBS has this program in your state. The ASC incentive pay is substantial.

Did not know this.
Thank you.

 

[heybrother]

Did not know this.
Thank you.

Make sure the site of service is appropriately chosen if you perform at the ASC because if you accidentally call the ASC an inpatient hospital you will be paid less.

 

[Aresnebula]

Nobody should ever want foot surgery. I exhaust conservative treatments first with all my patients before elective surgery. Those who come in wanting elective bunions usually bounce off to their next provider when I tell them I don’t operate unless it’s painful. And even if it is painful, half the time they’re wearing horrible shoes and the solution is “don’t wear that”.

Aren't you afraid of losing patient traffic in your practice if they start going to other providers?

 

[Hybrocure]

Aren't you afraid of losing patient traffic in your practice if they start going to other providers?

I have a pretty steady volume of patient traffic. Cosmetic bunions can kick rocks. Most of the time insurance wants to know they’ve failed conservative treatment before surgery anyways. And even when you operate on bunions in private practice the pay is hardly worth the time.

I see patients every day who regret bunion surgery from other podiatrists in town who got talked into it when it didn’t even bother them that much.

 

[Boba Foot]

I tell patients all the time if the bunion doesn't hurt, don't bother with it. A $400 Austin isn't worth dealing with animosity and pain complaints for months. Most patients appreciate the candidness as well. Many patients hire you as a professional advisor, not to be taken as a mark with unnecessary surgery.

 

[Hybrocure]

I tell patients all the time if the bunion doesn't hurt, don't bother with it. A $400 Austin isn't worth dealing with animosity and pain complaints for months. Most patients appreciate the candidness as well. Many patients hire you as a professional advisor, not to be taken as a mark with unnecessary surgery.

💯

 

[Feli]

+1 on elective surgery, esp forefoot, having mixed results (and elective/bunions was the biggest strength of my high-volume residency)

I sure don't shy away from it, but I definitely don't talk anyone into forefoot (or RRA) elective stuff either. Probably a third to half the elective I do is fixing eff ups of other area pods (non-unions, varus, recur HAV, cheilectomies that failed, whatever).

It's reasonably profitable for me as I'm fairly fast and good at it in OR (and do many more MPJ and Lapidus than Austins... they simply don't work long term). Even though I'm keeping 100% of surgery and the much highert associated e/m visits and DME and etc (also possible later HWR), it's not optimal. That's still not as profitable or problem-free as basic non-op warts, ingrowns, injects, dme, etc are... but you want to do it all in a smallish town imo.

Trauma and wound/amp surgery is inevitable, but even that stuff I don't go looking for anymore either (I will take it when ER sends, but I sure don't recruit it like I did first few years out of training).

...There is nothing wrong with sending most/all surgery out if you have DPMs nearby who you trust. A few send to me... others do unknowingly (pts come for revision or 2nd opin). I send the TAR candidates or big stuff I don't want to do at a small hospital to the metro. If you're far from most, you will probably have to do more stuff than if you're city/metro, though.

 

[DYK343]

My dream job at this point would be getting hired as a “Podiatric hospitalist.” Depending on the size of the facility (or number of facilities covered) maybe you do some wound care clinic, but otherwise you are salaried $400-500k to cover inpatient consults, round, and operate. Shift work. Nothing but pus. little or no follow up.

I still have clinic. But otherwise this bascially summarizes my job description. Its honestly quite nice.

 

[Hybrocure]

+1 on elective surgery, esp forefoot, having mixed results (and elective/bunions was the biggest strength of my high-volume residency)

I sure don't shy away from it, but I definitely don't talk anyone into forefoot (or RRA) elective stuff either. Probably a third to half the elective I do is fixing eff ups of other area pods (non-unions, varus, recur HAV, cheilectomies that failed, whatever).

It's reasonably profitable for me as I'm fairly fast and good at it in OR (and do many more MPJ and Lapidus than Austins... they simply don't work long term). Even though I'm keeping 100% of surgery and the much highert associated e/m visits and DME and etc (also possible later HWR), it's not optimal. That's still not as profitable or problem-free as basic non-op warts, ingrowns, injects, dme, etc are... but you want to do it all in a smallish town imo.

Trauma and wound/amp surgery is inevitable, but even that stuff I don't go looking for anymore either (I will take it when ER sends, but I sure don't recruit it like I did first few years out of training).

...There is nothing wrong with sending most/all surgery out if you have DPMs nearby who you trust. A few send to me... others do unknowingly (pts come for revision or 2nd opin). I send the TAR candidates or big stuff I don't want to do at a small hospital to the metro. If you're far from most, you will probably have to do more stuff than if you're city/metro, though.

Agree.

I am lucky to have good relationships with multiple people within like a 30 mile radius who only do TARs/trauma/charcot etc and turn away lobster work. I’ve gotten referrals from them for lobster stuff and I send them my big cases or revisions.

Insurances can make this difficult though. Hence why I have multiple people I refer to depending on that. Some take Medicaid others don’t, etc.

 

[Homo sapien]

I tell patients all the time if the bunion doesn't hurt, don't bother with it. A $400 Austin isn't worth dealing with animosity and pain complaints for months. Most patients appreciate the candidness as well. Many patients hire you as a professional advisor, not to be taken as a mark with unnecessary surgery.

I like this mentality