How Much is Surgery Worth to You?

[Adam Smasher]

In the jobs thread, we talk down the strictly nonoperative positions. Totally understandable, you undertake a long training path to learn a skill, so why wouldn't you want to use it? On the other hand, I believe every man has his price.

If you had 2 otherwise identical job offers, one with some surgery and one non-op, but the non-op job paid better, how much more money would you need to take the non-op job?

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[GreenHousePub]

I mean the scale you have is so low it is honestly laughable. Is the job market really that bad?

 

[Adam Smasher]

I mean the scale you have is so low it is honestly laughable. Is the job market really that bad?

So what's your number? 150? 200?

 

[MortonExtension]

Non op leads to less stress. Less call (if we’re talking not even doing amp and wash out cases) so it’s pretty ideal just in general. I’d just hate to limit myself early in my career and lose that skill. But 250k would be my number

 

[icebreaker32]

This is an appropriate question, but still the most podiatry thing ever. Podiatry is office heavy, but is now a surgical specialty. What other surgical specialty talks this way about jobs? None.....because podiatry.

There is a small niche for non surgical podiatrists at some ortho and large podiatry groups at hospitals which is quickly being replaced by PAs. Oh there is mobile podiatry also. The number of non surgical academic podiatrists is negligible. Most podiatrists at the VAs now do surgery and less purely non surgical are being hired.

As far as money you should make less not more by not doing surgery. Podiatry can admittedly sometimes be the exception here if not hospital employed or in private practice with a good insurance mix and some other source of revenue produced from surgical patients.

Podiatry will often voluntarily take call for free at hospitals and associate jobs can advertise it as a great perk that you will get your numbers for boards. Again what other surgical specialty does this? You know the answer....none.

Even a 4 year podiatry degree with no residency which no longer exists is too much training for toenails and some wounds when a PA can do it after 2 years.

We are so over saturated from a surgical, organizational job and competitive associate salary standpoint that I am tired of the arguments otherwise. There are some good jobs out there and surprisingly most end up doing well eventually, but definitely not all. We are likely the most saturated healthcare profession. Most healthcare professions live in entirely different universes as far as the job market.

 

[HardRoadPaved]

Simple and scalable surgery if you're in PP. I dont mind banging out 4-5 minor cases in a morning.

You have to figure out what you make on avg per hour in the office. If you're going to the OR for a half day for a calc ORIF to make $750, then you lose.

There are not enough organizational jobs paying based on RVUs.

 

[icebreaker32]

Simple and scalable surgery if you're in PP. I dont mind banging out 4-5 minor cases in a morning.

You have to figure out what you make on avg per hour in the office. If you're going to the OR for a half day for a calc ORIF to make $750, then you lose.

There are not enough organizational jobs paying based on RVUs.

Podiatry as a specialty has found ways to work around this.

If not busy enough for block time you add cases on the slowest day at the local hospital or surgery center.….often a Friday. Every other Friday or once a month etc. If you have no cases it becomes administrative or personal time and catch up time for staff.

Many podiatrists do cases as early as 6 AM at surgery centers as not to disrupt their office schedule and just do a case once or twice a week this way. You can start an hour late one day a week in the office if necessary and book cases on this day.

Most PP podiatrists do not have block time at hospital for pus cases. They are doing these cases after hours or sometimes 7 AM or over lunch and moving a couple of patients if necessary. If pus cases become a bit more common, but not extremely common you can have a couple days per week with an extra hour blocked off over lunch.

 

[Adam Smasher]

I think the fact of operating and gaining the reputation for being a surgeon can create positive spillovers, improve your referral mix, more nonop msk consultations, more cam walkers, more cash pts wanting custom foot orthotics ("shut up and take my money!"), possibly more Shockwaves if you do that.

If you're nonop, it all too often translates to being "the nice man who trims grandma's toenails and prescribes special creams" but as part of a group you theoretically could negotiate you're offloading the high productivity docs by doing the lobster work and enabling them to do more. In practice, this tactic wouldn't carry much weight, because our job market is too saturated, but from an egalitarian perspective, the nonop pod deserves a slice of the surgeon's pie

 

[icebreaker32]

I think the fact of operating and gaining the reputation for being a surgeon can create positive spillovers, improve your referral mix, more nonop msk consultations, more cam walkers, more cash pts wanting custom foot orthotics ("shut up and take my money!"), possibly more Shockwaves if you do that.

If you're nonop, it all too often translates to being "the nice man who trims grandma's toenails and prescribes special creams" but as part of a group you theoretically could negotiate you're offloading the high productivity docs by doing the lobster work and enabling them to do more. In practice, this tactic wouldn't carry much weight, because our job market is too saturated, but from an egalitarian perspective, the nonop pod deserves a slice of the surgeon's pie

This……for many reasons being strictly non operative means mainly toenails unless a niche situation.

 

[Feli]

I think the fact of operating and gaining the reputation for being a surgeon can create positive spillovers, improve your referral mix, more nonop msk consultations, more cam walkers, more cash pts wanting custom foot orthotics ("shut up and take my money!"), possibly more Shockwaves if you do that.

If you're nonop, it all too often translates to being "the nice man who trims grandma's toenails and prescribes special creams" but as part of a group you theoretically could negotiate you're offloading the high productivity docs by doing the lobster work and enabling them to do more. In practice, this tactic wouldn't carry much weight, because our job market is too saturated, but from an egalitarian perspective, the nonop pod deserves a slice of the surgeon's pie

Yep, surgery is just a part of what we do. I don' think it's negotiable - esp when all competition does at least some level of surgery these days.

Probably half of the patients in my office pool would have to be rereferred out now or very soon if I didn't do surgery (trauma, infection, pre and post-op). Another large fraction (arthrosis, deformity) would be limited in that I can only do callus care or inject or pads or whatever and not fix deformities that don't respond. That is just the needs of the community and the refers I cultivate.

In a surgical practice, you can offer everything... and that leads to a lot of new pts, DME, procedures (real, not just C&C "procedures"), etc.

Worse of all, I'd lose my referral sources if I didn't offer an easy place for them to send all foot and ankle stuff... and get good results.

"Big stuff doesn't pay much anyways ... you won't do much RRA after residency"

This gets debated or echoed all of the time on here (and in podiatry in general): "The big stuff doesn't pay," "surgery doesn't pay well," "you make more by not doing surgery," "you make most of your money in the office," etc. The numbers and the logic don't support this... at all...

forums.studentdoctor.net

 

[air bud]

For true non op jobs - no nails, I would say you are actually need to a good surgeon first and foremost. I know pleny of people with surgical training that would give up surgery for the right location and income. And then all you people not interested in surgery that didn't get good training and don't have any experience....good luck applying and competing vs these people.

goes back to Feli's point about always choose the best training. You can always take a step back, but a step forward is hard. Always give yourself the most options.

edit - to expand - take the classic saying if all you have is a hammer then everything looks like a nail. If you don't know how to do the surgeries because you never did them or were never exposed to them or never saw/experienced the complications, how can you properly evaluate someone and decide if they are a surgical candidate or not. You can't.

Good luck competing against me for this job.

 

[Adam Smasher]

Good luck competing against me for this job.

Could a PA compete against you for this job?

 

[Hybrocure]

In a PP non RVU setting I do not find it to be worth it. I still operate but I don’t just jump to surgery for everything. If a patient can find the right shoes to be comfortable wearing while having a bunion I’m not going to convince them they need to fix it like a lot of our predecessors did. Same with hammertoes, flat feet, etc. I generally operate after we exhaust conservative treatments, and if they still want surgery after I make them realistically aware of what to expect and the risks of the surgery.

There are many cases I don’t do (honestly most stuff proximal to the TMTJ these days) in which case I have good relationships with a few high volume ortho only type pods that I refer to. I am not afraid of my referral sources changing from me to them because these docs do not do routine care which I will happily do, and which is honestly what many PCPs want for their go-to podiatry referral source. I let my PCPs know they can send me everything and if anything is outside my wheelhouse I have close relationships with some of the best recon docs in town that I can refer them to.

There’s nothing worse than having a poor outcome (sometimes out of your control) on a patient that didn’t come to you wanting surgery but got talked into it. Unfortunately with everyone now graduating as a surgeon there are a lot of people operating who are either too proud to admit they shouldn’t be or are too oblivious to the fact that they aren’t a good surgeon. Couple this with massive student loans and low salaries from many jobs pushing these graduates to cut on everything and you create a dangerous surgical environment for patients.

I don’t see anything wrong with non op jobs. In fact I think there should be more that way we can accommodate more jobs for podiatrists who realize they could do better work in a non op situation. However - once you go into a non op environment it becomes very hard to be surgical again. You no longer have recent cases on the books should you wish to get hospital privileges, you likely will miss the window to gather cases for boards, and your skills will suffer substantially.

 

[air bud]

Could a PA compete against you for this job?

It depends on what role they want the non op pod to play. A non op pod with bad training no experience is probably worse than a PA but similar in many ways.

Non op for an Ortho job would be ideal. A MSG sounds like nails would slide in.

But you tell me I can do ingrowns all day, PF/neuroma injections, put on a boot on Achilles/PT/PB tendonitis, refer to PT when necessary....then when fail send to operative pod.....make 350k with bonuses and work 9 to 5 MF then yeah sign me up.

And again, surgical experience gives the patient a better choice. I don't do total ankles. When someone would come in and they were a candidate for total ankles, I did not feel it was appropriate for me to discuss total ankle versus fusion because I didn't have the experience doing them and didn't feel like I could truly have them make an informed consent. When someone came in and they were not a candidate for a total ankle then sure I felt it was appropriate for me to offer and do ankle fusions. I think that this is kind of a different take on that. I may not be able to do the actual surgery but I have done it and so I am able to truly give them informed consent and then refer them to somebody to do it.

 

[icebreaker32]

For true non op jobs - no nails, I would say you are actually need to a good surgeon first and foremost. I know pleny of people with surgical training that would give up surgery for the right location and income. And then all you people not interested in surgery that didn't get good training and don't have any experience....good luck applying and competing vs these people.

goes back to Feli's point about always choose the best training. You can always take a step back, but a step forward is hard. Always give yourself the most options.

edit - to expand - take the classic saying if all you have is a hammer then everything looks like a nail. If you don't know how to do the surgeries because you never did them or were never exposed to them or never saw/experienced the complications, how can you properly evaluate someone and decide if they are a surgical candidate or not. You can't.

Good luck competing against me for this job.

True good training and good experience helps but being too overqualified sometimes works against one also.

I have not gotten an organizational job before because I was overqualified and actually gotten a job because the other top candidate was overqualified (thought would eventually leave for another job).

In podiatry we are so saturated and try to one up each other on our CV. It is necessary to an extent, but we forget how the real world often works...is this candidate competent for the job, if so then their personality, references, networking and connections to the area (less likely to leave) often come into play if there are other applicants and in podiatry there always are. Sure ABFAS is often used as a filter for jobs but a long CV going on and on how great you are at TARs and your fellowship is not necessarily an advantage if the job will not involve that. They might assume you will just take the job and keep applying for other jobs that offer that.

The main problem is we are just too saturated. For most healthcare jobs right now a license and no major red flags regardless of any other factors equals a job if you want it and getting one in a particular are is not hard either.

 

[air bud]

True good training and good experience helps but being too overqualified sometimes works against one also.

I have not gotten an organizational job before because I was overqualified and actually gotten a job because the other top candidate was overqualified (thought would eventually leave for another job).

In podiatry we are so saturated and try to one up each other on our CV. It is necessary to an extent, but we forget how the real world often works...is this candidate competent for the job, if so then their personality, references, networking and connections to the area (less likely to leave) often come into play if there are other applicants and in podiatry there always are. Sure ABFAS is often used as a filter for jobs but a long CV going on how great you are at TARs and your fellowship is not necessarily an advantage if the job will not involve that. They might assume you will just take the job and keep applying for other jobs that offer that.

The main problem is we are just too saturated. For most healthcare jobs right now a license and no major red flags regardless of any other factors equals a job if you want it and getting one a particular are is not hard either.

Agree, and we all know over-saturation is only getting worse. You got to get that job and get it locked in and make sure that you don't ever lose it cuz because it's scary out there and is only getting scarier.

 

[Susitna]

In a surgical practice, you can offer everything... and that leads to a lot of new pts, DME, procedures (real, not just C&C "procedures"), etc.

100%, the key to a big referral practice.

 

[air bud]

100%, the key to a big referral practice.

Yeah but we're also talking about an MSG where they are always feeding you as opposed to not up private practice where you're fighting for scraps everyday

 

[PTPuser]

Over 330K because that's how much I spent chasing this scam.

 

[MoostashPod]

Over 330K because that's how much I spent chasing this scam.

That's is pretty close to mine at $348K. The podiatry scam is real and it's taking years to bring it down. I'm getting close to finishing mine. With the resumption of student loans burden coming up soon I wish the very best for recent and upcoming graduates.

 

[SouthPod7]

If I could make the same amount I do now by not doing surgery, I would stop cutting in a heartbeat. I like my job but surgery is probably where 90% of my stress and headaches come from. No more on-call riding the puss bus. No more patients complaining why their toe is still swollen 1 month after their hammer toe surgery. No more patients cutting off their cast and walking on their surgical foot. I didn't fully understand what my residency attendings said when they told me that operating on a patient was basically marrying them but now I see that it binds you to all of their decisions post-operatively which are frequently poor.

 

[DMEpod]

I only do surgery because those referrals come in and I feel like I would lose pt's if I started referring out all of the surgical consults. Money wise, clinic is 100x better. If I could figure out a good way to get rid of my surgical day and just do clinic I would do it in a heartbeat. Way less stress and more money in my pocket. Maybe some newly fellowship trained go getter will apply and I can dump the cases on them...

 

[heybrother]

We sometimes oversimplify things on the forum. There are surgeries that provide good value to the patient, are fun to perform, and are adequately reimbursed ... if the patient, the procedure, and the insurance are carefully selected. I can better tolerate more problematic procedures, payors, and problems if there are some of the above in the mix.

 

[DYK343]

The pus really adds up. At this point im all in on being a pus king.

Saddest thing Ill ever say: I couldnt give it up.

I didnt realize it until I got a break down of my outpatient vs inpatient wRVUs how much im generating.

At this point im more interested in pus than a bunion or fracture

Easy cases that pay well and lead to offloading surgeries in the future.

Especially good now that I&Ds and debridements have no global.

TAL takes me about 1 minute tops with a 30-45min TMA. Ill take that over a forefoot slam anyday.

Flexor tenotomy 60 seconds each x 5ish a week in my wound clinic? Yes please.

P longus release? 5 minutes

Elevating osteotomies 5 minutes

Keller arthroplasty 10 minutes

Lesser toe arthroplasty 5-10 minutes.

Best part is still get paid during global for the wound care.

I wouldnt give it up. Its a money machine.

 

[Hybrocure]

The pus really adds up. At this point im all in on being a pus king.

Saddest thing Ill ever say: I couldnt give it up.

I didnt realize it until I got a break down of my outpatient vs inpatient wRVUs how much im generating.

At this point im more interested in pus than a bunion or fracture

Easy cases that pay well and lead to offloading surgeries in the future.

Especially good now that I&Ds and debridements have no global.

TAL takes me about 1 minute tops with a 30-45min TMA. Ill take that over a forefoot slam anyday.

Flexor tenotomy 60 seconds each x 5ish a week in my wound clinic? Yes please.

P longus release? 5 minutes

Elevating osteotomies 5 minutes

Keller arthroplasty 10 minutes

Lesser toe arthroplasty 5-10 minutes.

Best part is still get paid during global for the wound care.

I wouldnt give it up. Its a money machine.

Very low risk too. What’s a patient going to do, sue you for not letting them die from sepsis?

Overnight call IMO is the largest barrier to it for many because that does take a toll on you over time. But pus cases are still my fav even though I don’t do call I agree with you completely

 

[DYK343]

Very low risk too. What’s a patient going to do, sue you for not letting them die from sepsis?

Overnight call IMO is the largest barrier to it for many because that does take a toll on you over time. But pus cases are still my fav even though I don’t do call I agree with you completely

yes the unpredictability of it is the biggest downside.

As we all have experienced, these patients fester for weeks then decide at 9PM on a friday its time to go to the hospital.
Never on a tusday at 10AM. Always late at night.
Having associates to share call helps too.

1/2 of my elective surgical volume is diabetic foot rebalancing to prevent or heal an ulcer. So its not just active pus that I was talking about above. At least 1/2 of my "pus" volume is planned ahead of time.

- - -

Also being wRVU based makes a big difference in the pay. Fee for service does not pay as well in the diabetic surgical world (but pays much more for nail care than wRVU).

 

[Retrograde_Nail]

Best part is still get paid during global for the wound care.

I wouldnt give it up. Its a money machine.

The best part about being hospital employed. Cheat code unlocked.

 

[Shiyuan]

The pus really adds up. At this point im all in on being a pus king.

Saddest thing Ill ever say: I couldnt give it up.

I didnt realize it until I got a break down of my outpatient vs inpatient wRVUs how much im generating.

At this point im more interested in pus than a bunion or fracture

Easy cases that pay well and lead to offloading surgeries in the future.

Especially good now that I&Ds and debridements have no global.

TAL takes me about 1 minute tops with a 30-45min TMA. Ill take that over a forefoot slam anyday.

Flexor tenotomy 60 seconds each x 5ish a week in my wound clinic? Yes please.

P longus release? 5 minutes

Elevating osteotomies 5 minutes

Keller arthroplasty 10 minutes

Lesser toe arthroplasty 5-10 minutes.

Best part is still get paid during global for the wound care.

I wouldnt give it up. Its a money machine.

Do you PL release in-office? I was considering it.

Also... just because I am a bit naïve, why do pus bus surgeries make more as a employed hospital physician versus in private practice? Do you just get reimbursed more when you work for the hospital per RVU for the surgeries?

 

[Feli]

.... why do pus bus surgeries make more as a employed hospital physician versus in private practice? Do you just get reimbursed more when you work for the hospital per RVU for the surgeries?

Wound/infect pts have little to no insurance.

The hospital FTE docs get paid on wRVU. The patient could have no insurance, MCA, whatever... pay is same: wRVU rate.

In PP, you want many, many well-insured pts who come to you in a defined schedule from refer sources (PCPs and maybe ER or other).

Pus bus does none of those things PP thrives on... educated and therefore well-insured and well-employed ppl with reliable transportation don't (statistically) have very high rates of DM or related complications. If the higher edu/finance ppl are DM, it'll typically be well-controlled by Endo or IM with few or no complications due DM education and compliance. At the end of the day, diabetes (DM2) is a side effect of being out of shape and low education; those are facts proven many times over. Obesity and DM are a lot lower in educated populations; they maintain their weight better and just don't bomb the glucose receptors so hard with the candy and fast food. Therefore, not only do wound/amp ppl not help your PP goals of good payers and good schedule above, they do the reverse: they screwww your other private pt appt times, and they consume your lunches, evenings, weekends, etc to round and do the surgery (as PP docs seldom/never get paid for call).

Basically, in PP, you want to dump the wound/pus/amp pts onto hospital and their employed docs (who don't mind them since they get paid to take call and paid in wRVU) as much as possible. Most of them are their pts to begin with (as they have had wounds before and/or use ER as their PCP). Even the mediocre insured (MCR) pts with wound/amp stuff are very time and resource consuming for PP, and you typically want that office time filled with better stuff. The wounds clog the schedule, have complications (aka not taking care of themself) that require urgent attentions, and they pop up again and again despite good shoes/exam/etc prevent care. Most just go steadily downhill even if you do good good limb salvage; they just don't take care of themselves. This is why trying PP in low socio-econ area is such a headache and needs such high pt volume (and scammy grafts now not paid) to do ok. You get some high level E&M and inpt billing, but that's not usually the way to do it well in PP.

It's a PP worst nightmare to get called for a no-pay ER gas osteo that needs amp+admit+DPC which has Dr PP missing some office private pay ingrowns, warts, bunion, PF, etc in that same time. The hospital Dr FTE doesn't care about that situation... wRVU are wRVU. If the insurance mix of an area is bad, that's where it makes more sense to be hospital FTE (but that leaves a lot of job quality and $$ on the table in good payer mix area).

...Personally, I'm in a small town and do it all (all foot/ankle path) since that's what the community needs and refer sources send all, but I definitely make more $/hr on elective derm/nail/ortho office than trauma surg ... and much more on that than on wound/amp stuff. Office payers are good. The trauma payers are variable. The wound/amp/pus is the worst payers, sickest pts, many no-pays, most likely to also pull no show or show late or last minute resched, not pay copays, ask for disability papers, show up in ER or office needing admit going into a weekend, etc. Between the low pay and the low challenge and the low compliance and poor outcomes, the wound/amp/pus is not my favorite (and 99% of MDs agree, hence podiatry's very existence in most areas/hospitals).
YMMV

 

[DYK343]

Wound/infect pts have little to no insurance.

The hospital FTE docs get paid on wRVU. The patient could have no insurance, MCA, whatever... pay is same: wRVU rate.

In PP, you want many, many well-insured pts who come to you in a defined schedule from refer sources (PCPs and maybe ER or other).

Pus bus does none of those things PP thrives on... educated and therefore well-insured and well-employed ppl with reliable transportation don't (statistically) have very high rates of DM or related complications. If the higher edu/finance ppl are DM, it'll typically be well-controlled by Endo or IM with few or no complications due DM education and compliance. At the end of the day, diabetes (DM2) is a side effect of being out of shape and low education; those are facts proven many times over. Obesity and DM are a lot lower in educated populations; they maintain their weight better and just don't bomb the glucose receptors so hard with the candy and fast food. Therefore, not only do wound/amp ppl not help your PP goals of good payers and good schedule above, they do the reverse: they screwww your other private pt appt times, and they consume your lunches, evenings, weekends, etc to round and do the surgery (as PP docs seldom/never get paid for call).

Basically, in PP, you want to dump the wound/pus/amp pts onto hospital and their employed docs (who don't mind them since they get paid to take call and paid in wRVU) as much as possible. Most of them are their pts to begin with (as they have had wounds before and/or use ER as their PCP). Even the mediocre insured (MCR) pts with wound/amp stuff are very time and resource consuming for PP, and you typically want that office time filled with better stuff. The wounds clog the schedule, have complications (aka not taking care of themself) that require urgent attentions, and they pop up again and again despite good shoes/exam/etc prevent care. Most just go steadily downhill even if you do good good limb salvage; they just don't take care of themselves. This is why trying PP in low socio-econ area is such a headache and needs such high pt volume (and scammy grafts now not paid) to do ok. You get some high level E&M and inpt billing, but that's not usually the way to do it well in PP.

It's a PP worst nightmare to get called for a no-pay ER gas osteo that needs amp+admit+DPC which has Dr PP missing some office private pay ingrowns, warts, bunion, PF, etc in that same time. The hospital Dr FTE doesn't care about that situation... wRVU are wRVU. If the insurance mix of an area is bad, that's where it makes more sense to be hospital FTE (but that leaves a lot of job quality and $$ on the table in good payer mix area).

...Personally, I'm in a small town and do it all (all foot/ankle path) since that's what the community needs and refer sources send all, but I definitely make more $/hr on elective derm/nail/ortho office than trauma surg ... and much more on that than on wound/amp stuff. Office payers are good. The trauma payers are variable. The wound/amp/pus is the worst payers, sickest pts, many no-pays, most likely to also pull no show or show late or last minute resched, not pay copays, ask for disability papers, show up in ER or office needing admit going into a weekend, etc. Between the low pay and the low challenge and the low compliance and poor outcomes, the wound/amp/pus is not my favorite (and 99% of MDs agree, hence podiatry's very existence in most areas/hospitals).
YMMV

This. I dont care what their insurance status is. I dont look because it doesnt matter.

It helps my office is in the hospital so when I get a consult its easy to see it quick then in 15 minutes be back in my clinic cranking through clinic patients.

I can easily get through a lunch hour I&D. They have food in the OR physician lounge so its not so bad.

I find, where I am at least, that patients with active wounds dont no show their follow ups. At least no more than 10%. Most make the appointments.

Also I get 100% wRVU for all procedures performed even if performed at the same time. No 50% cut for each successive procedure like fee for service surgeons get.

Got a STSG tomorrow morning. Then a TMA w TAL. Then a DPC. Nice pay day to not really have to use my brain. I have 14 patients scheduled in clinic. 6-7 to round on in the hospital. Home by 530PM (unless a bad gas case comes in....) for a stress free day.

I'm thinking the days of pilons, calcs, and rearfoot recons are over for me.

I'm on the pus bus.

- - -

I do not perform P longus releases in office. Always OR in sterile environment. I make my incision behind the fibula so I know exactly what tendon im cutting.

 

[Hybrocure]

This. I dont care what their insurance status is. I dont look because it doesnt matter.

It helps my office is in the hospital so when I get a consult its easy to see it quick then in 15 minutes be back in my clinic cranking through clinic patients.

I can easily get through a lunch hour I&D. They have food in the OR physician lounge so its not so bad.

I find, where I am at least, that patients with active wounds dont no show their follow ups. At least no more than 10%. Most make the appointments.

Also I get 100% wRVU for all procedures performed even if performed at the same time. No 50% cut for each successive procedure like fee for service surgeons get.

Got a STSG tomorrow morning. Then a TMA w TAL. Then a DPC. Nice pay day to not really have to use my brain. I have 14 patients scheduled in clinic. 6-7 to round on in the hospital. Home by 530PM (unless a bad gas case comes in....) for a stress free day.

I'm thinking the days of pilons, calcs, and rearfoot recons are over for me.

I'm on the pus bus.

- - -

I do not perform P longus releases in office. Always OR in sterile environment. I make my incision behind the fibula so I know exactly what tendon im cutting.

I mean you’re literally making the income of five podiatrists by riding the pus bus in addition to your clinic. It’s much, but it’s honest work

 

[Adam Smasher]

LOL, go into podiatry for the RRA, stay for the pus

 

[DMEpod]

You can make good money off the pus bus in PP as well. Billing these cases correctly can add up to more than TAR or big recon cases and they are typically easier and much faster. Most of these pts have an initial surgery to control the infection then end up with the TAL/TMA combo amongst other things. Hardest thing about it is the hours which is mentioned and you have to be able to dump them onto wound care centers once they inevitably break down or dehisce. I know that sounds bad but at the end of the day you gotta run a business and make a profit. Same as those vascular surgeons with OR suites in the office that get obvious PAD pt's with open wounds discharged so they can do the angio in those suites.

 

[NatCh]

No more on-call riding the puss bus.

Wait... what???

 

[Shiyuan]

Wait... what???

Wondering what happened to you 😁👍🏻

 

[HardRoadPaved]

LOL, go into podiatry for the RRA, stay for the pus

And do 4 years of school, 3-4 years of surgical training, a fellowship all to incise pus foot... Oh yea and the debt

 

[NatCh]

Wondering what happened to you 😁👍🏻

It took porn to bring me back.

 

[619]

You can make good money off the pus bus in PP as well. Billing these cases correctly can add up to more than TAR or big recon cases and they are typically easier and much faster. Most of these pts have an initial surgery to control the infection then end up with the TAL/TMA combo amongst other things.

True only if they have insurance as feli said above. However we in PP know that most of the patient in the pus bus do not have insurance. Only plan to be the driver in the pus bus if you are being paid by wRVU.

No new grad going into PP should plan his/her career on driving the pus bus. You will be very disappointed. Let the hospital employed folks drive the bus (they get paid very well for pus work). PP folks should focus on driving the clinic (DME/heel pain/warts/tendonitis/onycho-/callus/ingrown etc) bus.

To make it in podiatry, you have to know which bus to drive.

 

[air bud]

Pus bus, nail jail ....what else we got?

 

[Adam Smasher]

To make it in podiatry, you have to know which bus to drive.

I want to learn more about the puss bus

 

[DYK343]

True only if they have insurance as feli said above. However we in PP know that most of the patient in the pus bus do not have insurance. Only plan to be the driver in the pus bus if you are being paid by wRVU.

No new grad going into PP should plan his/her career on driving the pus bus. You will be very disappointed. Let the hospital employed folks drive the bus (they get paid very well for pus work). PP folks should focus on driving the clinic (DME/heel pain/warts/tendonitis/onycho-/callus/ingrown etc) bus.

To make it in podiatry, you have to know which bus to drive.

I make next to nothing to cut nails/calluses.

I make zero wRVU for dispensing DME

 

[619]

I make next to nothing to cut nails/calluses.

I make zero wRVU for dispensing DME

Hospital employed folks on wRVU will never know the sweet taste of dispensing DME. Meaning buy a CAM boot for 20 bucks, fit and dispense to patient and get reimbursed around $250 to $300. Same goes for night splint (purchase for $9.99 and reimburse around $150 to $200). AFO brace (L1971) is even more. Buy for about a 100 and get reimbursed around $700 give or take. Custom inserts also has a large profit margin. This is how PP survives.
I am not even going to get into grafts because apparently the gravy train for grafts is coming to an end soon.

 

[Adam Smasher]

Pus bus, nail jail ....what else we got?

"graft grift"

 

[DMEpod]

I make next to nothing to cut nails/calluses.

I make zero wRVU for dispensing DME

I make more off my CAM boot for post op than I do some of the actual surgeries. And that is why surgery is such bs.

As far as no insurance for the diabetics. I agree with Feli and 619 but I've found when I was taking call in the past about 80% were insured and that more than covered the hit I took on the un insured. Even the medicaid pts that I'm not contracted with paid well through their emergency coverage or whatever it's called. The pus bus money that I was seeing was good but it may just be location and volume based. I stopped call and doing those things because I value my time and personal life more than the revenue that made.

 

[NatCh]

I want to learn more about the puss bus

Nobody told me that it was even an option!

 

[air bud]

"graft grift"

Epic

 

[PTPuser]

Quoting our dear friend, mentor and fellow director of mine Dr. Pronation who's no longer with us, "Pus Patrol, Pus Camp, Pus Brigade."

I miss them.

 

[Scrantonicity]

You can make good money off the pus bus in PP as well. Billing these cases correctly can add up to more than TAR or big recon cases and they are typically easier and much faster. Most of these pts have an initial surgery to control the infection then end up with the TAL/TMA combo amongst other things. Hardest thing about it is the hours which is mentioned and you have to be able to dump them onto wound care centers once they inevitably break down or dehisce. I know that sounds bad but at the end of the day you gotta run a business and make a profit. Same as those vascular surgeons with OR suites in the office that get obvious PAD pt's with open wounds discharged so they can do the angio in those suites.

Man...in what universe? I did PP pus patrol for 10 years, and I only gathered treasures in heaven. Almost never got paid for it here on earth. Almost always indigent with no insurance. Or maybe they are in the process of applying for Medicaid so I can get paid my $50 or whatever it ended up being lol. People with good insurance tend to take better care of themselves, period. I'm sure I got paid for some, but man it's really just charity most of the time--which is OK, I mean someone has to do it, and I mostly did it gladly...but literally everyone else around you (the scrub techs, nurses, everyone helping with the case) is getting paid for it but you haha.

 

[GreenHousePub]

Man...in what universe? I did PP pus patrol for 10 years, and I only gathered treasures in heaven. Almost never got paid for it here on earth. Almost always indigent with no insurance. Or maybe they are in the process of applying for Medicaid so I can get paid my $50 or whatever it ended up being lol. People with good insurance tend to take better care of themselves, period. I'm sure I got paid for some, but man it's really just charity most of the time--which is OK, I mean someone has to do it, and I mostly did it gladly...but literally everyone else around you (the scrub techs, nurses, everyone helping with the case) is getting paid for it but you haha.

After staying late for a TMA one night that ended up being free, I quit ever doing it again.

 

[DYK343]

I make more off my CAM boot for post op than I do some of the actual surgeries. And that is why surgery is such bs.

As far as no insurance for the diabetics. I agree with Feli and 619 but I've found when I was taking call in the past about 80% were insured and that more than covered the hit I took on the un insured. Even the medicaid pts that I'm not contracted with paid well through their emergency coverage or whatever it's called. The pus bus money that I was seeing was good but it may just be location and volume based. I stopped call and doing those things because I value my time and personal life more than the revenue that made.

Commonly hospitals provide a stipend for consulting providers for uninsured/underinsured patients.
Typically pays medicare rates.
I had it at my last gig. Not sure how common it is for DPMs but it does exist.

I wouldnt take call for free. I wouldnt accept less than $800 a day to take call if I were private practice.